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Staybridge Suites Baltimore BWI Airport
Suite Hotel near BWI Airport
The art of convenience and comfort is carried out exquisitely at the Staybridge Suites Baltimore BWI Airport. Stay conveniently by the BWI airport and a short 15-minute ride from downtown Baltimore and the Inner Harbor. The hotel is located close to many major corporations such as Northrop Grumman, Verizon, BAE, Lockheed Martin, AeroTek, and Westinghouse. We offer a free shuttle to local corporations within a three-mile radius in addition to the airport. Settle into spacious, apartment-like suites with all of the conveniences of home, perfect for your extended-stay or short-term-stay needs. Our pet-friendly hotel features fully-equipped kitchens with a full-size fridge, microwave, stovetop and dishwasher, 37" flat screen cable TVs with HBO and free Wi-Fi. Start your day with a hot complimentary breakfast buffet in our great room inlcuding eggs, potatoes, waffles and breakfast meat. Then end the day with a well-deserved free beer or wine at our Evening Social gathering Tuesday through Thursday.
Check out Inner Harbor or other Boston area attractions such as the National Aquarium and Maryland Science Center. Get more from your stay with a 24-hour Business and Fitness Center, complimentary airport shuttle, free laundry facilities and outdoor pool. Get Comfortable at the Staybridge Suites Baltimore BWI Airport.
Quick Info
- Check In: 3:00 PM
- Check Out: 11:00 AM
- Minimum Check-In Age: 21
- Late Check Out Available
- Parking: Free
- Print Fact sheet
- Chat Online
Important Update
Hotel Highlights
- On-site Guest Self-Laundry Facilities
- Housekeeping Full Service
- Complimentary Breakfast Buffet
- Standard Wireless Internet service is free for all members
- On-Site Fitness Center Available
- Complimentary Shuttle Available
Guest Reviews
Overall Experience
Fumbled the Ball
July 23, 2015
Housekeeping was undependable. Staff left us in the lurch on several items, including dry cleaning that was never sent out. Smoking was allowed even though it is clearly signed and stated as such when one registers. Pool was well looked after even though it was a bit on the small side. Food service staff seemed to work hard. Could be a nice place if the staff were a bit more on the ball.
Excellent Stay
July 22, 2015
Excellent Stay as usual. Will be using again. blah ...............
Plesant Staff
July 14, 2015
The Staybridge was very close to the airport and was fast and easy to find. The staff was very friendly and happy to be of assistance. I would recommend this hotel and will be staying there again next time I'm in town.
Nice but noisy
July 12, 2015
The hotel is very nice. The staff is extremely friendly. I was working nights and the noise and odor of the remodel was to much. I'm still in town but didn't extend my stay because of the chemical odor of the wall paper remover and glue. It will be a great place once that is finished.


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To you and to me!
Shown is the booty from the swaps that I participated in during my first holiday season as a blogger. I have to admit, it was a treat to receive so many packages and cards in the mail! Thank you!
Image 1: Christmas card exchange organized by Emma.
Image 2: Ornament exchange organized by Micaela. My ornament is from Rhianne of For the Easily Distracted.
Image 3: Gift exchange organized by Carly. My gift is from Diana of Our.City.Lights.

subset: commoncrawl


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Share your air travel experiences in one of ten languages and win prizes!
Why closing gaps in the Tokyo Convention will be a deterrent to unruly passenger behavior.
The trusted source to prepare and document dangerous shipments in compliance with international regulations.
Improve baggage performance. From quick wins to strategical options, custom solutions for airlines, airports and ground handlers.
We're adding new IATA training centers, partner locations and distance learning options to bring our training closer to you.
A unique opportunity for airlines to discuss cost management, industry trends, and best practices.
Tony Tyler's address to the 1000 delegates from industry and media who gathered in Miami 7-9 June for IATA's 71st AGM
The objective of this workshop was to provide Latin American airlines with the latest project implementation information and guidance regarding the sunset of virtual Miscellaneous Charge Orders (vMCO) / virtual Multi-Purpose Documents (vMPD) by the end of the year.
From 1 January 2014, BSPs will no longer process vMCO and/or vMPD or any other miscellaneous documents other than Electronic Miscellaneous Documents (EMDs). To ensure a smooth transition, subject matter experts from the whole aviation distribution supply chain discussed the current progress and practical steps to support the implementation of EMD.
The workshop welcome positive feedback from delegates. Despite the current challenges, all participants reaffirmed their commitment to the implementation of EMD Standard. As some airlines are further advanced in implementation than others, more discussions regarding the time frame of EMD activation will be held in the near future.
These workshops are a valuable opportunity for the IATA e-Services team to provide guidance, discuss solutions, exchange best practices and deliver a transparent environment to engage directly with concerned airlines. As of the end of June, 89 airlines have implemented the EMD standard and 33 already issued EMDs through travel agents in 55 IATA BSP.
More information on e-services.
© International Air Transport Association (IATA) 2015. All rights reserved.


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Welcome to Wee Ones
Wee Ones is a seasonal,Children's consignment event taking place twice a year in Rincon, Georgia.
We specialize in gently loved~boutique, upscale, quality items for your children.
As a consignor you will EARN 70% and have the chance to SHOP FIRST at our consignor only Pre-SALE Event!
Event Dates:
Spring/Summer clothing, shoes, toys & more!
February 20th-28th
(details below)
Event Details:
Consignor Drop Off:
FRIDAY , FEB.20th~10am-7pm
SATURDAY, FEB. 21st~10am-7pm
SUNDAY, FEB. 22nd~By appointment ONLY....
(email if you need an appointment to drop off between
PRESALE event:
Tuesday, FEB. 24th ~PRE-SALE:
*Volunteer only Presale/ Preshop from 4pm-9pm
(limited spots, email me if you would like to volunteer ).
NEW volunteer details for this event (READ VOLUNTEER TAB)
*Consignors only Presale/Preshop 6pm-9pm
FEBRUARY 26th, 27th and 28th...
OPENING DAY:Thursday, FEB.26th-10am-7pm
& Friday, FEB. 27th- 10am-7pm
& Saturday, Sept. 28th- 10am-2pm (1/2 price select items this day)
Consignor Pick up:
Pick up your earnings Check & unsold items on Monday, March 2nd between 3pm-7pm.
SAME GREAT LOCATION~@ 1094 Goshen Road
In the GLOW Ministry Building OFF of GOSHEN Rd. NEXT TO GRACE Community Church, behind the soceer fields on Goshen Rd. by RR tracks- EASY TO FIND!!
***Thank you for GROWING with us~ this will be our 11th consignment event, thank you for your support as we begin our 6th year!! ***
We accept cash and credit cards. Min. purchase of $20 on cards. Thank you!


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HCM City travel firms club together
The HCM City Tourism Association has set up an organisation called the HCM City Travel Society to represent the interests of the 300 plus registered travel businesses in the city.
The new club's role includes improving the quality and diversity of package tours, formulating marketing strategies, planning advertising campaigns, training personnel for the hospitality industry, and forging closer links with foreign travel companies and industry bodies.
Category: Business


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UNICOI — A Thursday morning accident led to the arrest of a Unicoi man for the alleged manufacture of methamphetamine.
Clinton Cody Cooper, 25, 5109 Unicoi Drive, was charged with improper registration, leaving the scene of an accident, possession of drug paraphernalia and manufacture of methamphetamine.
Unicoi County Sheriff Mike Hensley said a single-vehicle accident was reported around 8:40 a.m. Thursday. Cooper, the owner of the vehicle, had struck a tree near the intersection of Unicoi Drive and Springbrook Road and had left the scene and his vehicle behind.
Deputies were sent to 5109 Unicoi Drive, the property being rented by Cooper, to conduct a welfare check. Hensley said investigators also previously had information that drug activity was taking place at the property.
"We've had this as a target," Hensley said. "It just went a little quicker than we thought. We had to step things up because of the accident. And we wanted to make sure he was OK. That was my main concern."
Police noticed trash containing precursors for meth scattered outside the residence, Hensley said. The door to the residence was open, and officers observed meth generators with attached hoses and other items associated with the "shake and bake" manufacture method inside the home. Hensley said there had also been a fire inside the residence, where the bottles used in the manufacture process were seen.
Based on Cooper being involved in an accident, coupled with what officers observed at the property, deputies had cause to enter the residence, Hensley said. Cooper was found hiding in the attic. Invesitgators also found drug paraphernalia components, including spoons and syringes, throughout the residence. An outbuilding behind the residence contained components of a meth lab.
Cooper was arrested around 10 a.m. Erwin police assisted at the scene, and the Tennessee Methamphetamine Task Force truck was called out.
Hensley said the property may have to be quarantined, but it would be up to the Tennessee Methamphetamine Task Force to make that determination. He also said the investigation was ongoing.
Cooper is scheduled to appear Friday in Unicoi County Sessions Court.


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Audition CS6 Essential Training demonstrates all of the major features of Adobe Audition and prepares sound editors to start enhancing and correcting audio—whether it's music, dialogue, or other sound effects. Author and musician Garrick Chow begins by covering how to import, record, and manage media files, from extracting audio and importing video, to creating a new multitrack session from scratch. The course then dives deep into editing, repairing, and cleaning up audio files, using the Waveform and Multitrack Editors, and the Spectral Frequency Display. It also covers how to use built-in effects, how to mix both stereo and surround audio tracks, and how to work with video projects from Premiere Pro.
Among Audition's built-in effects, you'll find a category called Special, and these are special effects that can be used for any number of results, and you'll find that you can use them subtly or heavy-handed depending on what you're going for. I just want to show you a couple of examples here. I've opened up this file called Dynamic Guitar Chords, and it's just a simple looping pattern. (music playing) So this is an acoustic guitar, but maybe for my project, I need it to be an electric guitar.
Now ideally you would be able to go back and re-record the guitars playing an electric guitar. But if that's not a viable solution, you can use some of the Audition's effects to try and turn it into an electric guitar. In fact, if I go to Effects > Special, you'll see that there's actually a Guitar Suite here. Here I can select settings for Compression, Distortion, there's a filter and even an amp modeler. And there are some presets I can choose from to get started. Now the default setting is going to sound a little harsh, so adjust your headphones and speakers accordingly. But I'll go ahead and play this now.
(music playing) So that changed the sound pretty drastically. Depending on the preset you choose, you'll see that some of the modules are turned on or off. In this case, the Big And Dumb preset has turned everything on, but the Filter module which you can see, is still being bypassed. But you're free to use any of these presets as a starting point and then make your own adjustments from there. For example, this had a little bit too much distortion for my taste so I drag the Amount slider down under Distortion.
There's also a bunch of built-in amps. Maybe I'll switch this to Classic British Stack, and I'll play that. (music playing) This Mix slider lets me determine how much of these effects are applied to the file. (music playing) You can see I drag it down to 0. (music playing) I kind of like how it sits there. And once I'm satisfied with the sound, I can apply it, or I can even save my setting as a preset just like with the other effects we've seen.
I'm just going to cancel for now by clicking Close. And I also find an effect under Special called Distortion. Let me open a file with somebody talking here. I'm going to open up maya_intro_raw, and you remember it's just the intro to one of our Maya courses. (male speaker: Hi, I'm George Maestri, and welcome to character rigging in Maya.) All right! So I'm going to go to Effects > Special > Distortion, and here we have a Positive and Negative graph. Basically, the way this works is that anything you draw in the Positive graph by drawing nodes and dragging them around affects the top half of the waveform, basically anything above the center line.
Anything you draw in the Negative graph affects everything below the center line. And you might use an effect like this to simulate a blown-out speaker or a recording that was recorded way too loudly. (male speaker: In this course, we're gonna look at Maya's character rigging tools as well as how to use those tools to create your own rig. We're gonna start off with a basic introduction of rigging theory, and then we're--) I think it kind of sounds like a radio station that hasn't been quite properly tuned in. And of course, you have some presets you can choose from. I'm not going to select any of them here because most of them really increase the gain of the audio, and I don't even have to mess with the volume of your speakers or headphones anymore right now.
But feel free to check them out yourself. Let's look at one more. I'm going to go to Effects > Special > Vocal Enhancer, and this is a very simple filter. All it does is attempts to bring out the vocals more in your recording. You only have three choices here. You can select whether the voice is Male, Female, or you can specify that it's a Music and you want to try to enhance the vocals a bit more in a music recording. This can be a quick way to make a vocal pop a little bit more without having to get into the graphic equalizer. Just open this effect, choose one of the options.
It doesn't really matter whether you use these radio buttons or if you use the presets up here, they all do the same thing. And then see if it makes a difference to your recording. (male speaker: --dive into Maya's skeleton tools. We'll understand how to use the joint tool as well as how to create a skeleton for--) I think it actually does help his voice here. But if you don't hear much of a difference, you can always just close out of this, and you'll probably have to try some of the other tools like a graphic EQ. Okay, so that's a look at a couple of the special effects in Audition.
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We are currently installing new doors in the stairwell in Lauinger Library. During this time, visitors will not be able to use landings that are under construction, either to enter that floor or pass through en route to another. We encourage visitors to use the elevators, although the stairwell may still be used to access floors that are not under construction. Landings under construction should only be used in the case of an emergency.
Gilbert Stuart
United States; 1755-1828
Portrait of Archbishop John Carroll, c. 1804
oil on canvas; 29 x 24 inches
Gift of Judge Pacificus Ord, 1895
Hailed by his colleagues as the "father of American portraiture," Gilbert Stuart returned to the United States in 1792 after eighteen years abroad where he developed a style like that of Romney and Gainsborough. His famous likenesses of George Washington and Thomas Jefferson, reproduced on today's paper currency, cemented his reputation and he became the most highly sought after Federal era portraitist. This image of John Carroll seated in his library was commissioned by Robert Barry, an Irish gentleman at whose home in Baltimore the Archbishop was a frequent guest.
Portrait of Archbishop John Carroll was shown in the inaugural exhibit at the National Portrait Gallery in 1968.


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The Christian Assistance Bridge is a new service agency in Blythewood that provides emergency aid to individuals and families in need. The agency, a collaborative effort of local churches, individuals and support organizations, is located at 126 Blythewood Road.
The Christian Assistance Bridge provides hope and support to those in need and reches out to the poor by offering basic necessities and hand-up assistance. The faith-based organization represents Christian values, discipleship and service. It is located in the former site of a Cooperative Ministry satellite office on the property of Trinity UMC. In anticipation of the opening of the new agency, The Cooperative Ministry office ceased operation on June 17 after serving the Blythewood community for almost 10 years.
Hours: Monday and Thursday 9 a.m. – 1 p.m.


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No further action against Twitter storm PC
Posted: May 12, 2014|
A policeman who posted a tweet poking fun at people with mental health issues will not be sacked.
The tweet from the official @BristolUniCops account included a photograph of PC Nick Boyce with ice cream smeared on his uniform and the message: "Warning do not get close to people with mental health problems when they are eating ice cream."
PC Boyce will be spared any further punishment after apologising for causing offence while Chief Constable Nick Gargan has also apologised on behalf of Avon and Somerset police.
Mr Gargan tweeted: "No further action is going to be taken following the unwise mental health tweet from Monday. Advice given. Lesson learned. We move on."


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Create email, print, and web publications (brochures, newsletters, and more!) with an Office 365 subscription to Publisher 2013.
Create your own brochures, newsletters, menus, postcards, and more, and prepare them to print, email, or post on the web, with Publisher 2013.
Get up to speed with Microsoft Publisher, the document-layout and publishing platform.
Take a look at suite-wide enhancements like cloud integration, Touch Mode, PDF editing, and Ribbon customization, as well as individual app improvements added to Office 2013.
Shows how to use Publisher 2010 to create professional publications for the web and for print.
Shows how to plan, format, edit, and print or distribute a project using Publisher 2007.
Covers working with publications, text, objects, tables, designs, and commercial printing.
"As a teacher, I respect the way that your tutorials are hands-on and interactive. They are quick and to-the-point, and the teachers you have chosen are patient and concise." —Joshua M.
more from our members »


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Donning a fishnet skirt over her barely-there bikini, Rihanna celebrates her 25th birthday with on-and-off beau Chris Brown during a loved-up stroll on the beach in Hawaii on Feb. 20, 2013.
Amber Rose is over all the Kardashian drama.
Maybe she's born with it. Maybe she just uses a lot of lotion.
If there is one lesson to be learned in 2015, it is the following: do not f*** with Nicki Minaj.


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RICHMOND, Va. (WTVR) – If you're excited about holiday shopping this year you might have to wait a little longer for all the decor in Nordstrom department stores.
The chain reminded its shoppers that it is the Nordstrom custom to finish up the Thanksgiving holiday before they make the move to Christmas themed decorations.
Some stores have a sign for shoppers saying that they won't be decking the halls until November 23rd.
This isn't the first year they've made this decision, the company says "we just like the idea of celebrating one holiday at a time."


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Texas on the Potomac
Washington news with a Texas accent
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Jane Lute
TexMessage: Cybersecurity experts urge Congress for stronger public-private partnership
Posted by coreykane on Thursday, March 14 at 7:01am
TexMessage Thursday, March 14 Good morning, TexMessagers! Is Congress doing enough to keep our electronic infrastructure secure? TEXclusive A Department of Homeland Security deputy secretary and cybersecurity chiefs from companies like Houston's Centerpoint Energy told the House Homeland Security Committee that cyber attacks from foreign entities have escalated since 2006, and could jeopardize economy and […] [Read More]
Categories: Congress/Texas Delegation , Crime and punishment , Lamar Smith , Michael McCaul , Sheila Jackson Lee | More
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Integrating Gender into Programs for Most-At-Risk Populations
Gender inequity is a fundamental driver in the HIV epidemic, and integrating strategies to address gender inequity and change harmful gender norms is an increasingly important component of HIV programs. Integrating gender strategies into programs targeting most-at-risk populations (MARPs) which include men who have sex with men, transgender people, injecting drug users, and male, female and transgender sex workers, whether in mixed or concentrated epidemic countries is much less prevalent. The purpose of this Technical Brief is to provide program managers and planners with an overview of the recent research literature on gender-related constraints effecting MARPs, future program approaches, and gender-related challenges that should be considered in programs to reduce HIV risk among MARPs.
Download the Integrating Gender into Programs for Most-At-Risk Populations Technical Brief (PDF, 1.17 MB)
Текст на русском языке (Russian Translation)
Visit our Technical Brief Series page to see other recent publications.
Gender inequity(1) is a fundamental driver in the HIV epidemic, and integrating strategies to address gender inequity and change harmful gender norms is an increasingly important component of U.S. Government- supported HIV programs in countries with generalized epidemics. Much less prevalent are efforts to integrate gender strategies into programs targeting most-at-risk populations (MARPs), which include men who have sex with men (MSM), transgender (TG) people, injecting drug users (IDUs), and male, female, and TG sex workers, in both mixed or concentrated epidemic countries.(2) The purpose of this technical brief is to provide program managers and planners with an overview of the recent research literature on gender-related constraints affecting MARPs, promising program practices, future program approaches, and gender-related challenges that should be considered in programs to reduce HIV risk among MARPs.
While subpopulations of MARPs have unique HIV risk behaviors and vulnerabilities, there is growing evidence of overlapping risk behaviors. For example, some MSM and sex workers may inject drugs, some MSM and IDUs may be sex workers, and some MSM may buy sex from male or female sex workers (Berry et al. 2009). With this caveat in mind, this technical brief is organized by individual MARP subpopulations, because that is how most programs focus their work.
In many countries, the behaviors that increase HIV transmission risk among these populations are highly stigmatized, illegal, or both. Sixty-nine percent of countries with low-level or concentrated epidemics report having laws, regulations, or policies that pose barriers to use of HIV services for MARPs (World Health Organization [WHO]/Joint U.N. Programme on HIV/AIDS [UNAIDS] 2008). As a result, the size of MARPs is underestimated, as is the prevalence of HIV within different subpopulations (American Foundation for AIDS Research [amfAR] 2006). Despite stereotypes to the contrary, many MARPs are involved in longterm intimate relationships with partners who are overlooked by programs targeting MARPs. For example, a recent UNAIDS (2009) report about Asia showed that HIV transmission to women from their long-term male partners who inject drugs, who have sex with other men or with casual female partners, or who are clients of sex workers account for an increasing proportion of heterosexual transmission of HIV among women in the region.
Government responses to addressing the HIV epidemic among MARPs have been disturbingly slow and remain weak. In many countries, overall HIV prevention spending for MARPs is a small proportion of all prevention spending (WHO/UNAIDS 2008). Countries like Thailand, Cambodia, and Senegal, which successfully curbed rising HIV prevalence in the general population and among female sex workers, have only recently included IDUs, MSM, and male and TG sex workers in national epidemiological surveillance protocols (Beyrer 2007). Only slightly more than half of the countries with rising prevalence among MARPs have developed budgets that estimate the cost of antiretroviral therapy (ART) for those needing treatment (UNAIDS 2008). With rare exceptions, leadership for community-based programs targeting MARPs comes from civil society, not governments. Populations most at risk for HIV infection continue to remain invisible to, or ignored by, most policymakers, planners, and program implementers (Sawires et al. 2009).(3)
(2) In a mixed epidemic, HIV infections occur at almost equal rates among MARPs and the general population (Wilson 2006). In a concentrated epidemic, HIV prevalence is consistently over five percent in at least one defined MARP, but below one percent in pregnant women in urban areas (World Health Organization [WHO]/Joint U.N. Programme on HIV/AIDS [UNAIDS] 2009).
(3) Countries with generalized epidemics may also have a concentrated subepidemic among defined subpopulations. Programs for MARPs in generalized epidemics are rare, so for the purpose of this technical brief, only countries with concentrated epidemics will be described in detail. However, evidence suggests that MARPs living in countries with generalized epidemics, such as Tanzania and South Africa, experience similar stigma, discrimination, and human rights violations as do MARPs living in countries with concentrated epidemics.
Disclaimer: The author's views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.
Programs with Most-At-Risk Populations
Injecting Drug Users (IDUs)
UNAIDS (2008) estimates that 3 to 4 million IDUs are living with HIV. Globally, 10 percent of all HIV cases are related to injecting drug use, which drives the HIV epidemics in Eastern Europe, Southeast Asia, and the southern cone of Latin America, with prevalence among IDUs of more than 20 percent in some countries in these regions. Evidence suggests that injecting drug use occurs in Africa and the Middle East, but as in most countries in the world, few reliable data are available describing the size of these IDU populations. More extensive and rigorous monitoring must be undertaken to enable appropriate and effective responses to HIV among IDUs (Aceijas et al. 2004; Inchaurraga 2003; WHO 2008).
IDUs experience a wide variety of health issues, including high prevalence of hepatitis B and C, sexually transmitted infections (STIs), a variety of chronic and acute physical health concerns, and a lifetime prevalence of depressive symptoms more than twice that of the general population, which may translate into high-risk sexual behavior (Williams and Latkin 2005). Although sharing contaminated drug equipment is the primary mode of HIV transmission among IDUs, studies in the United States and elsewhere suggest that sexual transmission is also high in drug-using groups. Sex work is much more common among female IDUs, which increases their vulnerability to HIV infection significantly (Australian Agency for International Development [AusAID] 2008; Cleland et al. 2007; Kumar et al. 2008). Reducing the risky sexual behaviors of IDUs has proven to be more challenging than adopting safer needle practices (Semaan, Des Jarlais, and Malow 2006; Williams and Latkin 2005). Despite the growing evidence of the sexual transmission of HIV among IDUs and their regular same-sex or opposite-sex partners, there are few programs reaching out to sexual partners, who may also be injecting drugs or having unprotected sex, or both, with their IDU partners.
Gender Differences in HIV Risk between Male and Female Injecting Drug Users
Most data on gender differences in IDU risk behaviors come from studies conducted in the United States and Europe, and understanding of how well these differences generalize to low-resourced countries is limited (Cleland et al. 2007). What is clear from the available data is that addressing the different vulnerabilities is a critical concern (United Nations Office on Drugs and Crime [UNODC] 2004).
The STIGMA Foundation (SF), a nongovernmental organization (NGO) run by and for IDUs in Jakarta, Indonesia, has been proactive in its strategy to reach female IDUs. In 2009, after five years of implementing a peer outreach program and an NSP, SF had reached 3,000 IDUs, of which only 200 were women, not all of whom were accessing services. SF staff knew from their own experience that cultural norms restrict women more to the household and expect women to focus on the domestic roles of wife and mother. SF realized that there is a dearth of research in Indonesia on women IDUs. For example, there is little data about the constraints that affect women's access to NSP, methadone maintenance treatment, or drug rehabilitation services. Furthermore, there is no information in the national language, Bahasa Indonesia, for female IDUs on the effect of antiretroviral therapy (ART) on sexual and physical changes associated with treatment, or on the ability of female IDUs to pay the cost of ancillary ART services. SF has started a newsletter called "Angels" that is dedicated to issues of women IDUs. In addition, SF produces short leaflets on specific topics such as the impact of ART on women, arrest procedures, and "tips" for women facing gender-based violence (GBV).
Studies suggest that women's initiation into drug use intersects with wider social factors, including drug use in the family, peer group influence, and sexual relationships with male IDUs (Stocker 1998; Sarin and Selhore 2008). Studies from a number of countries indicate that in many instances, women are likely to have been initiated to drug use by their drug-using spouses or sexual partners, are more likely to share prefilled syringes and other equipment (Cleland et al. 2007), and are strongly influenced in their drug use behaviors by the sharing norms within women's social networks and sexual relationships (Cleland et al. 2007; Rieham et al. 2004). Programs focused on increasing female IDUs' access to HIV programs need to also empower female IDUs to negotiate equipment sharing norms and safer injection behaviors with their sexual partners and within their social networks.
Most female IDUs fulfill the cultural and gender roles of mother, sister, partner, and daughter (Andrade and Estrada 2003). Frequently, the financial and caring burden for male IDU partners, whether living with HIV or not, falls disproportionately on women and girls (AusAID 2008). Male drug users often prefer nondrug– using female partners, and women with drugusing partners often maintain traditional gender role expectations, acting as "caretakers" to their partner's drug use by attempting to limit drug use for both parties or by increasing their use to "match" that of their partner (UNODC 2004).
Gender norms influence men's injecting behavior and sexual risk behaviors as well. Studies in the United States have shown that male norms of dominance may inhibit men's willingness to insist on protected sex or safe injecting (Knight et al. 2002). Men are more likely than women to engage in injecting drug use with friends or with strangers in places like shooting galleries (Cruz et al. 2007; Davey-Rothwell and Latkin 2007). Among men, needle sharing often occurs during activities with other men, reinforcing masculine norms and making unsafe injecting a more accepted behavior. The willingness to share needles, despite the awareness of its potential risk of HIV transmission, can be perceived as fearlessness, generosity, loyalty, and solidarity toward peers (Choi, Cheung, and Chen 2006). Because gender norms vary in different contexts, in some settings men may inject first because women are expected to defer to men; in other settings, men inject after their partners because men are expected to take a greater risk (Jackson et al. 2003). In the United States, Eastern Europe, and Asia, men are more likely to have spent time in prison, where sharing of injection equipment is prevalent, and are much less likely to use health care services (Population Services International [PSI] and Salud CENSIDA 2008).
Lack of social support is a major barrier in the longterm rehabilitation of male and female IDUs; the provision of mental health services within treatment centers is an urgent need. A particular challenge for women users is the shortage of long-term residential services with sufficient space for women to keep their children with them; otherwise, women leave to return to their communities and families to care for their children. There is also a need for nonresidential day treatment programs to provide day care services for children of women in treatment. Services need to diversify from inpatient services only to include community-based detoxification services and femaleonly drop-in centers (Hankins 2007; UNODC 2004).
Programming Experience
Few countries in Eastern Europe, Latin America, and Asia are reaching significant numbers of IDUs with any community-based HIV prevention or care programs (Needle et al. 2005). Peer outreach and drop-incenter– based services have been successful—for male IDUs (Des Jarlais and Semaan 2005). Evidence from more than 40 published studies shows that when IDUs are reached by community-based outreach and provided with access to risk-reduction services, they report reducing HIV risk behaviors (Needle et al. 2005). Despite this evidence, the gap between the number of IDUs who want or could benefit from outreach services and the number of IDUs who actually receive them remains large. This is especially true for female IDUs. There is a need to raise levels of understanding among service providers, government agencies, and donor agencies in order to set priorities and strategize interventions for the growing number of IDUs who are women (Hankins 2007; Tran et al. 2005; UNODC 2004). Pregnant IDUs, who could be also infected with HIV, form an additional subgroup of female IDUs with specific unmet needs (UNODC 2004). Pregnant women who use drugs may face criminal charges for causing harm to their unborn children and thus avoid prevention and treatment programs.
Lessons learned from two programs in India highlight some of the specific kinds of support needed by female IDUs in almost all countries. The Sahara Centre for Residential Care & Rehabilitation (Sahara) and its sister organization, the Society for Service to Urban Poverty (SHARAN), based in New Delhi, India, work in drug rehabilitation with female drug users, including IDUs. Since 1995, SHARAN and Sahara have provided multilevel services to 3,700 women. More than 1,000 women have availed of its residential services, which include detoxification, medical care, literacy classes, vocational training, and job placement. Another 2,400 women have been offered drop-in center facilities, free lunches, referrals to medical and mental health care, legal aid, and shelter homes. While the program for women has not been evaluated separately, a 2005 evaluation of the effectiveness of SHARAN's program from 1999 to 2002 showed that, in addition to unconditional acceptance of the drug users by the service providers, substantial reduction in risk behavior and noticeable improvement in quality of life was reported by program users (Priya et al. 2005).
Within a harm reduction framework and the recognition that women need and want safe spaces of their own, Ladies' Night, a U.S.-based program in San Francisco, California, is being implemented for highly marginalized homeless IDUs and TG women who experience violence and other physical and sexual trauma. This program is offered at the Mission Neighborhood Resource Center, a community space for homeless and marginally housed men and women. Ladies' Night, offered one evening a week, provides a safe space for women to escape violence, chaotic drug use, discrimination, family, and health concerns. Women can participate in diverse activities that respond to their needs: art activities, games, health education discussions on topics ranging from safer sex to overdose prevention, health services, and HIV testing. Women are not required to abstain from substance use, attend a support group, or meet with a case manager in order to gain access to services. By feeling valued in a environment that offers safety, social support, and empowerment, women report feeling less stigma and establishing trusting and respectful relationships between participants and providers. For women in the program who have experienced significant trauma, a sense of safety is essential to healing and engaging in change (Magee and Huriaux 2008).
In 2008, the International Harm Reduction Development Program of the Open Society Institute, with the support of the Canadian International Development Agency, funded six gender-sensitive IDU programs in different regions of Ukraine, including Kyiv, Dnipropetrovsk, Poltava, Nikopol, and Mykolayiv. These programs have provided more than 4,500 women drug users, the majority of them mothers, with services that included a needle and syringe exchange program (NSP), access to substitution treatment, sexual and reproductive health care, assistance during pregnancy, and legal aid. The program takes a holistic approach, working with women as individuals and with their families, as well as at the structural level, to strengthen connections and coordination among the many medical and social services needed to reduce the barriers the women and their families face as they attempted to negotiate the social services system. Health care providers working for the programs or at referral clinics and hospitals receive training on the needs of women who use drugs, human rights, violence and discrimination against women, and substitution treatment in order to reduce stigma and discrimination (S&D) against women drug users and build their capacity to provide sensitive and appropriate care. Programs include a community sensitization component as well as to foster tolerance and understanding about drug abuse in the general public (Pinkham and Shapoval 2010).
Programs with Most-At-Risk Populations
Men Who Have Sex with Men (MSM)
MSM(4) are embedded within social and cultural contexts that equate masculinity with risk taking, dominance, and sexual conquest, behaviors that negatively influence risk reduction and health-seeking behaviors (Peacock et al. 2009). In a 2009 study of HIV risk behavior by Latino MSM in New York City, researchers note the perception that condom use with sexual partners outside of a primary relationship is a sign of weakness and suggest that machismo may be influencing both unprotected insertive anal sex and excessive consumption of alcohol at bars and clubs (Flores et al. 2009; Peralta and Ross 2009). While the authors do not suggest interventions that would change male norms among MSM, addressing harmful gender norms in the design of HIV prevention, treatment, or care and support programs targeting MSM is an important but underutilized strategy.
New HIV infections among MSM remain a key driver of the HIV epidemic in many countries. In low- and middle-income countries, data on MSM and HIV are sparse and of poor quality (Pan American Health Organization [PAHO] 2008; WHO 2008). In many African countries experiencing generalized epidemics, most MSM remain hidden due to the harassment and stigma driven by cultural, religious, and political unwillingness to acknowledge that same-sex behavior occurs within African societies (Smith et al. 2009), which makes outreach to this population difficult. Globally, MSM are 19 times more likely to be infected with HIV than the general population (amfAR 2008). UNAIDS estimates that fewer than 1 in 20 MSM had access to appropriate HIV infection prevention and care services in 2005 (Beyrer et al. 2005; WHO/Europe 2008). Individual-level risks for HIV infection among MSM— such as unprotected anal intercourse; a high number of sexual partners; use of alcohol, injection-, and non-injection drugs that reduce inhibition; and having STIs—are similar in high- and low-income countries (Beyrer 2007; Ramachandran 2008). Factors that may interact to increase HIV risk—such as substance use and abuse, violence, and mental health problems experienced by many MSM—are rarely addressed in programs targeting MSM.
Terms like homosexual and heterosexual do not adequately categorize the dynamic nature of sexual expression over time or within cultures (Duch et al. 2009; Silenzio 2003). In India, for example, male-to-male sex is practiced without any admission or recognition of identity, which is based on caste, class, and religious affiliation (International Center for Research on Women [ICRW] 2002). A study in Russia and Hungary found that 97 percent of the men in the sample reported same-sex activity in the past year: 75 percent of Hungarian participants, but only 34 percent of the Russian sample identified themselves as exclusively homosexual (Amirkhanian et al. 2009). In a study of urban Mexican men, 42 percent who identified as MSM reported having sex with women (Strathdee and Magis-Rodriguez 2008). In Vietnam, like other countries in the region, there are many subgroups of MSM: selfidentified gay, bisexual, TG, or heterosexual. In countries as diverse as Thailand and Guatemala, homosexual behavior does not necessarily lead to an "MSM identity" or a transgression of gender norms (International HIV/ AIDS Alliance [IHAA] 2007a). Social stigma attached to homosexual activity may prevent some men from disclosing their sexual orientation, leading them to deny their own risk or to assume that their risk for HIV is significantly lower than heterosexually identified men who have sex with women (Saewyc et al. 2006). Male sex workers and their male clients are another group of individuals who are missed by HIV prevention programs that target MSM (amfAR 2006); male sex workers who are also IDUs are missed by programs targeting MSM and IDUs.
Gender-based Violence
The focus of research and programs to reduce GBV has, with rare exception, been on women and girls. Yet GBV against MSM is widespread and may begin early in life as child sexual abuse (CSA) or be experienced later in life as punishment for deviating from gender sexual norms (ICRW 2002). As noted by Peralta and Ross (2009, p. 95):
There are more studies on specific groups of women than there are about men…Defining women as victims of IPV [intimate partner violence] and men as perpetrators obscures the variability in violence and contributes to the perpetuation of stereotypes and myths… Generating data founded on gender and sexual diversity allows for richer understanding of IPV both within and between social groups.
Many studies have documented the high levels of CSA experienced by MSM and the association between CSA and risky sexual behavior (Brennan et al. 2007; Jay et al. 2001). A growing literature is exploring the syndemic of GBV directed against MSM and negative health outcomes, including HIV infection, poorer mental health, barriers to medical care, and substance abuse (Human Rights Watch 2004; PAHO 2008; Rodríguez- Madera and Toro-Alfonso 2005; Stall 2007; Stall et al. 2003). Recent studies report that 68 percent of young MSM reported ever experiencing threats or violence from either family or partners, and 25 percent reported threats or violence by both family and partners. Recent unprotected anal sex and drug use were significantly associated with a history of threats or violence by both family and partners, or with a history of sexual victimization (amfAR 2006; Bennet and Messeri 2007; Koblin et al. 2006; Saewyc et al. 2006). Although most of these studies were conducted in the United States, given the violence experienced by MSM in higher-resourced countries (Bingswanger 2005), the association between violence, HIV risk behavior, and poor health outcomes among MSM may also be applicable in lower-resourced settings (Bingswanger 2005; PAHO 2008).
The relationship between GBV and access to HIV programs by MSM is largely unexplored. The literature on S&D, of which GBV is an extreme manifestation, focuses mostly on MSM (and other most-at-risk groups) who are already living with HIV. Yet it also provides some evidence that S&D has been a barrier to the uptake of HIV testing and counseling services by MSM, as well as to the effectiveness of prevention and care services (Genberg et al. 2009).
Sisters was founded in 2005 "by TG, for TG" to provide solidarity, support, and HIV prevention and care services to TG women. Sisters conducts outreach and peer education with TG sex workers in Pattaya, a major sex-tourism resort town. Sisters has established a drop-in center, carries out peer education on the beach and at go-go bars, does behavior change communication, distributes condoms and lubricants, and provides on-site counseling for HIV testing. Sisters provides referrals to STI and ART services. Sisters also has a home-based care program that sends Sisters staff or volunteers to visit TGs with HIV to provide adherence and psychosocial support.
Male-to-female TGs constitute a unique subpopulation underserved by HIV programs and are often subject to pervasive S&D not only from the heterosexual majority but from other MARPs as well. TGs have multiple HIV risk behaviors: unprotected anal sex, sex work (in which many but not all TGs engage), and femaleidentity gender norms. Many TGs may have difficulty negotiating condom use with their intimate partners or, if they are sex workers, with their clients. Because TGs reproduce traditional gender roles (which construct women as subservient to male partners) to strengthen their gender identity, they may feel constrained about initiating discussions about condom use or safer sex practices with clients or about condom use and HIV testing with intimate partners (Rodríguez-Madera and Toro-Alfonso 2005). Understanding how TGs construct gender must be addressed in all programs for TGs. As Rodríguez-Madera and Toro-Alfonso (2005, p. 12) note:
[TG] participants in this study reported that they protect themselves more with "tricks" and casual partners than they do with their primary partner, as a result of their "feminine" gender socialization. Women often base their partnership on the values of truth, love, and trust. According to these values, many "biological women" adhere to the philosophy that if you trust your partner, you do not have to protect yourself. The same may be true for TG[s] and this issue is of vital importance in developing HIV prevention programs for TG[s].
Some data suggest that men who have sexual relationships with TGs are more likely to identify as a TG's partner rather than view themselves as MSM. In contrast, TGs are more likely to see themselves as part of a cohesive community and therefore might be more easily targeted in prevention programs (Bockting et al. 2005). HIV prevention programs targeting TGs should focus on developing the same self-respect and condom negotiation skills training provided to non-TG sex workers and women who do not identify as sex workers but who are involved in relationships that include transactional sex. Although the evidence for promising programmatic approaches using couplesbased HIV prevention and sexual health education is still weak, these strategies may offer promising approaches for reducing risk for transmission among TGs and their sexual partners. However, further research is necessary to understand how existing approaches to HIV counseling for couples must be adapted to incorporate gender and relationship dynamics between male partners of TGs (El-Bassel et al. 2003; Farquhar et al. 2004).
Programming Experience
There are far too few programs targeting MSM or TGs. Programs addressing how gender norms increase HIV risk and providing life skills training for MSM and TGs to address GBV, HIV prevention information, and violence are virtually non-existent.
HIV prevention programs have overwhelmingly focused on reducing sexual risk behavior. In the multisystemic context of structural violence, S&D, and social exclusion, HIV prevention programs that address individuallevel factors would be more effective if they included strategies to influence the social, economic, political, legal, and health system factors that drive risk behavior (Stall 2007).
An example of one effort to generate data on GBV against MSM is the U.S. Agency for International Development's Health Policy Initiative Project, which collaborated with NGOs in Thailand and Mexico to pilot test a screening tool for health care providers to assess the experience of GBV among MSM. Experience from this pilot demonstrated that addressing GBV among MSM in a health services setting requires addressing the capacity of health systems to integrate gender equity and reduce S&D (Egremy, Betron, and Eckman 2009). The tool was piloted at three sites in Mexico in 2009, and a training manual is available for health care providers.
A growing amount of literature shows that the most promising practices for reducing S&D—a combination of the empowerment of MARPs and participatory education at the community level, which encourages people to reflect on their own attitudes and actions— seems especially effective for catalyzing individual change around stigma (Kidd and Clay 2003). Several programs and tools have been developed to reduce S&D among health care providers against people living with HIV, although these tools often fail to include sections on gender, working with MARPs in general, or with MSM and TGs in particular.
Examples of programs to reduce homophobia include mass media campaigns conducted between 2002 and 2005 in Colombia, Argentina, Mexico, and Brazil. The campaigns moved away from individual behavior messaging approaches and instead raised issues of how political, cultural, and socioeconomic factors increase vulnerability to the virus. The campaigns promoted dialogue and debate on homophobia in the public arena, attempting to change social norms, public policy, and even culture. Process evaluation and impact evaluation, however, were extremely limited due to lack of standardized implementation strategies and of robust indicators to measure change in attitudes. One conclusion of the campaign implementers was that while mass media can be an important tool in reducing homophobia, "Real, sustainable change can only be achieved through a combination of prevention approaches. In that sense, it is best not to evaluate the impact of individual interventions, but rather the impact of a combination of interventions of which the campaigns…are only a component" (PAHO 2008, p. 39).
Programs with Most-At-Risk Populations
Sex Workers
During the first wave of the HIV epidemic, female sex workers were among the groups identified at high risk for HIV infection; almost three decades later, sex workers remain a highly vulnerable population. While countries such as Cambodia can report impressive decreases in HIV prevalence among brothel-based sex workers—43 percent in 1998 to 13 percent in 2006 (National Center for HIV/AIDS, Dermatology and STD [NCHADS] 2007a)—prevalence is still unacceptably high. Sex workers are a diverse population; one review conducted in India found at least nine categories of sex workers (Buzdugan, Halli, and Cowan 2009), but program interventions are not always diverse enough to reach all groups. Male sex workers have been relatively absent from the research, and HIV prevention or sexual health programs that target sex workers rarely include interventions for male or TG sex workers, a significant omission that urgently needs addressing.
The context of sex work introduces myriad harms, including forced unprotected sex, exploitation, infections and physical injury, suicide attempts, coercion, criminalization, and alcohol and drug abuse. A longitudinal study conducted in Vancouver, Canada, found that over an 18-month follow-up period, 49 percent of sex workers experienced physical violence, 30 percent experienced client-perpetrated violence, and 25 percent had been raped. These forms of violence are all too common around the world, and researchers concluded that structural inequities of poverty, criminalization, and gender inequality drive both GBV and HIV infection risk (Shannon et al. 2008).
High rates of needle and syringe sharing and use of non-injecting drugs have been more recently identified as a risk behavior among sex workers. Drug and alcohol use is used as a coping strategy to reduce the physical and psychological stress of sex work, which in turn contributes to the vulnerability of sex workers by decreasing their ability to engage in safe sex (Panchanadeswaran et al. 2008; Shahmanesh et al. 2009). Entry into sex work may be motivated by the need to support drug abuse or addiction. The epidemics of methamphetamine use among sex workers and young women in Thailand, Cambodia, Mexico, and elsewhere suggest a growing association between sex work and drug use (Thomson et al. 2009).
Sex Worker Clients
Much more work needs to be done with clients of sex workers to understand how to influence male norms at the individual and group levels that drive paid sex. There is growing research literature on the influence of globalization and modernization on the sexual practices of wealthy urban businessmen and government officials in China (Uretsky 2008), and sex worker clients in Vietnam (Family Health International [FHI] 2006) and in Cambodia (PSI and FHI 2007). This literature highlights how group eating and drinking and group visits to sex workers is used to "strengthen social networks that are founded on culturally prescribed masculine customs of sharing" (Uretsky 2008, p. 809) or to demonstrate to friends or coworkers they are "real men" (FHI 2006; PSI and FHI 2007). Results from a recent qualitative study conducted among 48 urban men by PSI in Cambodia suggest that many men viewed strong group pressure as a barrier to opt out of transactional sex (Dianna et al. 2008). By frequenting entertainment establishments, men demonstrate commitment to their social group and reap rewards in terms of self-esteem, belonging, and pleasure.
Programming Experience
The early response to the epidemic was to encourage condom use with every client, but the limited ability of some sex workers to negotiate condom use with clients led to new strategies that focused on knowledge of HIV and condom negotiation skills, and such structural determinants of condom use as the implementation of 100 percent condom use programs (CUPs), which shifted some of the onus for use of condoms to brothel owners. CUPs are credited with driving a significant decrease in HIV prevalence in such countries as Cambodia (NCHADS 2007b) and Thailand (Rojanapithayakorn and Hanenberg 1996), and with increasing consistent condom use among sex workers in the Dominican Republic (Kerrigan et al. 2003) and Guatemala (Sabido et al. 2009). In India, the Sonagachi program in Kolkata and the Sangram in Sangli define HIV as an occupational health problem and empower sex workers through multifaceted, multilevel interventions at the community level (reducing S&D, increasing access to government entitlements, and engaging in high-level advocacy with community stakeholders), group level (building trust between sex workers to change social relationships and collective action to protest exploitation or violence), and individual level (improving skills and competencies related to negotiating condom use). Project components such as empowerment, selfefficacy training, and peer outreach support appear to be replicable across settings within India and worldwide (Jana et al. 2004). However, most of these interventions were conducted with female sex workers in brothels. Far fewer success stories are available on reducing risk among "indirect" entertainment venues, street-based sex workers, or male or TG sex workers.
There are significant economic variations among sex workers, and while they are not always poor, they are one of the most socially marginalized groups. Given that economic problems and debts play a role for many in the initiation and continuation of sex work, microfinance/microcredit programs that offer sex workers alternative income options are an underutilized prevention strategy. Recognizing that sex workers are unlikely to be able to get conventional microcredit, the World Bank project in Bangladesh, Financial Services for the Poorest Project (2003–2007), finds models of sustainable interventions for the poorest groups through the use of microcredit and other financial services and included sex workers as a target group. A research project for sex workers in Chennai, India, that provided microenterprise training to produce and market canvas bags reduced the women's sexual risk by reducing the number of clients they had and enhancing their economic well-being. The project has resulted in a sustainable foundation that markets sex workers' products around the world (Sherman et al. 2010). Another project in Kenya, the Strengthening STD/AIDS Control Project, provided small loans (average of $133) to program participants, which included sex workers. After one year, 17 percent of sex workers had left sex work, and for those who remained in sex work, the average number of clients declined by two-thirds, STI incidence fell by 50 percent, and average income from sex work decreased by 50 percent as it was supplemented by income from their microenterprises (Hanck, West, and Tsui 2007).
Sex workers have long been active agents in addressing the violence and stigma they face. A report by the IHAA (2007b), while not specifically reporting on gender strategies to reduce HIV risk, notes that sex workers and HIV projects have collaborated to develop strategies for reducing GBV. These campaigns have countered violence and stigma by:
- Challenging the blame for HIV directed toward sex workers. Sex workers have conducted many campaigns providing information or arranging discus sions with clients and community leaders, nationally, or even at the international level, as with the International Day of No Violence against Sex Workers.
- Promoting dialogue between sex workers and religious leaders in Mali to change perceptions of sex workers, which religious leaders then disseminate to the wider community.
- Helping sex workers in Kyrgyzstan and Madagascar develop relationships with and contribute to training for journalists to make reporting about sex work more balanced.
- Enabling sex worker organizations to participate in media events to challenge perceptions that sex workers accept violence as a condition of their work.
Future Programming Directions
HIV programs working with MARPs should conduct gender analysis of their current prevention, treatment, and care and support programs to identify how and where gender strategies that reduce inequity—and HIV risk—can be integrated into all programs targeting MSM, TG, sex workers, and IDUs. Specific activities include the following.
Increasing gender equity in HIV programs and services:
- Recognizing that men's and women's needs differ is the first step to finding ways of tailoring responses to those needs. Engaging and involving MSM, TGs, female IDUs, and male and female sex workers in program design, implementation, and evaluation not only improves program outcomes but also enhances self-esteem and helps reduce stigma by demonstrating the value of the contribution of women's and TG's lived experience (Pinkham and Malinowska-Sempruch 2007).
- Implementation of gender-responsive services requires that all program staff undergo ongoing, not one-off, gender-sensitization training on the concerns and needs of each MARP.
- Services must become more gender responsive by scheduling flexible hours, implementing drop-in and mobile services and having services available in the evening and on weekends, setting minimal rules for use of services, providing child care, and creating women-, TG-, or men-only spaces or hours.
- Financial, procurement, and distribution barriers to wide distribution of female condoms and lubricant must be addressed to enable MSM and male, TG, and female sex workers to exercise more control over HIV prevention with partners unwilling to use a male condom.
Reducing violence and coercion:
- Programs should screen for a history of CSA and GBV and develop strategies and services to address the mental health needs of MARPs.
- Programs working with MARPs should incorporate violence reduction, mitigation, and social support into all their programs. Conflict resolution programs within the communities should also be developed to mitigate violence between individual IDUs, sex workers, TGs, and MSM.
Increasing MARPs' legal protections:
- Policy change and advocacy for more evidence-based approaches to prevention, care and support, and treatment programs for MARPs are urgently needed. Countries should enact legislation that decriminalizes same-sex consensual sexual relationships and possession of condoms and injecting equipment.
- Advocacy for policy changes that provide voluntary, evidence-based rehabilitation services rather than incarceration for sex workers and IDUs is urgently needed.
- Facilitating partnerships between police and national security agencies and HIV prevention initiatives for MARPs to reach agreement on mutually acceptable harm reduction strategies is critical for creating environments conducive to risk reduction (Rhodes et al. 2006).
Increasing MARPs' access to income and productive resources:
- Programs working with sex workers should link with and provide referrals for adult education programs.
- Programs working with sex workers should provide access to microfinance and income generation that link credit or incentive systems with skills building, literacy, and vocational training in work that provides a comparable or near comparable wage to sex work.
Addressing gender norms and behaviors:
- Prevention programs should highlight sexual relationships as a salient context for injection risk behavior and emphasize the avoidance of syringe sharing and other risk behaviors with intimate partners.
- Working with boyfriends and pimps and using a team approach to outreach may enable more women and TGs to do peer outreach work.
- Programs for intimate partners and families of MARPs should be conducted in tandem with interventions for MARPs.
- Much more work needs to be done with men to change norms about commercial and transactional sex.
- To target sex worker clients, mass media campaigns alone are not sufficient to change norms that are influenced by the group or structured within work or political contexts. Programs need to work along a continuum, from mass media to men in the communities, with male peer groups, and in workplaces where men are employed.
Gender norms and risk behaviors vary between and within cultures based on class, ethnic and minority affiliation, and economic status. What the literature makes clear is that far too little is known about the sexual dynamics, normative expectations, and gender scripts that influence risk behaviors among at-risk populations and their sexual partners (Andrade and Estrada 2003).
The good news is that studies conducted in resourcerich and resource-constrained settings have shown that MARPs are able to change their risk behaviors to avoid becoming infected with HIV or, if they are living with HIV, infecting their sexual partners (Colon et al. 2009; Des Jarlais and Semaan 2005). Because risk reduction behavior is influenced less by individuallevel determinants than by social- and contextuallevel factors—which are amenable to change over periods of years or decades—future programs for and with MARPs must engage government, the legal system, civil society organizations, and MARP advocacy organizations in a long-term, multipronged strategy to influence gendered social norms and societal barriers.
- The international community lacks the tools and resources to address the epidemics emerging in countries experiencing concentrated epidemics. There is a particular need to recognize and address the specific characteristics of HIV transmission in intersecting sexual and needle sharing networks of IDUs, sex workers and their partners and clients, and MSM (AIDS Projects Management Group 2005).
- There is a lack of international and national leadership and advocacy on behalf of MARPs. Donor and government support for long-term advocacy efforts remains weak, as does funding to build the capacity of local community-based organizations to lead advocacy efforts.
- Governments continue to respond insufficiently to the HIV epidemic among MARPs. Few governments and donors have made a priority of prevention, care, and treatment programs for MARPs.
- There are few prevention programs designed to reach and work with female IDUs in safe and appropriate ways. Engaging female IDUs to do peer outreach programs may be more difficult due to gender constraints: Visiting parks, shooting galleries, dark streets and corners, or going into a contact's home may be dangerous for women. Women may be less able to engage as peer outreach workers because they have less autonomy, either due to domestic responsibilities, stigma, and fear of revealing their drug using status, or because of control by boyfriends or pimps (Birgin 2009).
- There is too little research on gender and HIV vulnerability in resource-constrained countries. Because most of the research on gender, vulnerability, and HIV has been conducted in resource-rich settings, it is important to conduct research in different national and cultural settings to develop interventions appropriate to MARPs in lowresource countries.
- Female condoms (and lubricant) are missing from the mix of prevention interventions available to MARPs. In 2009, PEPFAR distributed 25 billion male condoms and 2.5 million female condoms. Sex workers, MSM, and TGs do not have access to a proven prevention product whose use they can control.
Bill & Melinda Gates Foundation AVAHAN Project
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AIDSTAR-One would like to thank members of the PEPFAR Gender Technical Working Group for their thoughtful review of this document.
Recommended Citation
Spratt, Kai. 2010. Technical Brief: Integrating Gender into Programs with Most-at-Risk Populations. Arlington, VA: USAID's AIDS Support and Technical Assistance Resources, AIDSTAR-One, Task Order 1.


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Pack Baseball Hosts Charlotte Tuesday at 3 p.m.
Feb. 18, 2013
After two cancellations last weekend, the Wolfpack will take on Charlotte this Tuesday at 3 p.m. Game time subject to change based on weather conditions.
Any updates to Tuesday's schedule will be posted here and on Twitter via @NCStateBaseball. Admission to Tuesday's game will be FREE.


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Jambu Cali Marble PatentSKU: #7993451
Product Information
- Shine brightly all season long in the exceptional style of the Cali Marble Patent from Jambu™.
- Beautiful marbled patent leather.
- Vintage leather at toe.
- Synthetic overlays offer a bit of stretch for an easier on and off.
- Memory foam footbed supplies light underfoot comfort.
- Non-marking, partially recycled outsole is made of compressed rubber and provides reliable traction and lasting wear.
- Imported.
- Measurements:
- Heel Height: 2 3⁄4 in
- Weight: 13 oz
- Product measurements were taken using size 9, width B - Medium. Please note that measurements may vary by size.


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With this skirt, I used 3 yards of fabric and added a contrasting color to the hem and waistband.
Step 1: Materials
Fabric: See diagram to determine amount of fabric needed. When in doubt, 3 yds will make most things!
Hook & eye for waistband
Sewing Machine
(honestly, I quit trying to use the ruler after about 15 minutes and just made the pleating up as I went along.)
Step 2: Cut & Sew Panels
Now it's time to cut them and sew them together to create one long panel that we'll pleat up.
Sew together the pieces at the side seams along the selvage edges, and press the seams open.
Step 3: Make the Pleats
I tried out a bunch of different methods (including marking them all with a ruler and chalk) and then decided just to eyeball it. Really, when you have a lot of pleats on your skirt, especially if it's a busy fabric, people won't notice the precision of your pleats.
I ended up settling with 1" knife pleats. See the first diagram to show you how they should look. Each fold is 1" deep and none of them overlap. Rather the top fabric comes to the place where the bottom of the fold stops. It's easier to understand once you get your hands on it. And again, there are no hard set rules here! Do what you like.
Iron and pin your pleats in place.
Sew along the top of the pleats to hold them in place. You're almost done!
Thank you so much for this tutorial! It was super easy to understand and very simple to make. I had never sewn much more than hems on a machine before I tried this because I like sewing by hand, but this helped give me a confidence boost when it comes to using a machine, and I was very pleased with the two I made. Awesome! (you'll have to excuse my face in the first picture, I'm not a fan of taking mirror selfies)
Hi! The tutorial looks pretty easy, i had to translate some words because i didnt understand well what i had to do, but nothing more than that. There's one thing i dont understand and i couldn't get it: in steps 1 and 2 i dont understand the panels thing. I get that you need like, 3 yds of fabric for starters?? and in the graphic it has the rectangle like divided in 3, are those supposed to be the panels?? and then in step 2 you have to sew them together, i dont understand from which part and how (i honestly couldn't understand the pictures, particularly the one with the white line in the middle). what are the measurements of the panels be?? like length x waist and then sew them on the 'lenght side'?? sorry i have so many questions; hope you understand what i mean :)
This tutorial looks doable for me this beginner :)
However, I do not understand the measurement part. Please help me :)
This tutorial looks doable for me this beginner :)
However, I do not understand the measurement part. Please help me :)
I made a pleated skirt using your tutorial! Yay! Prefect for my Halloween costume!
I've uploaded a picture :)
Love your tutorials, pleated maxi skirt is next on my list! I'm only 5 ft. tall so I MUST make my own, lol! xoxo- Katie
I've been looking for something to do with my old fabric (well, fabric that I decided I needed to have and never used!)
I'll try and post a picture when I'm done :)


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SUMTER - A 7-year-old Thomas Sumter Academy student was recently honored by the Sumter Fire Department for saving her parents from a house fire in September.
Olivia Diller, who woke her parents up in the middle of the night when their house caught fire, received the Sumter Fire Department's Bravery and Valor Award, which the department started in March to highlight and promote young students who successfully practice fire safety. This was the second time the department has presented the award, the first going to a Cherryvale Elementary School student who saved his mother and baby sister when his house caught fire.
"She has done a great job for her community, and she has done a great job for her parents," said Johnnie Rose, battalion chief for the Sumter Fire Department.
Speaking in front of Olivia's classmates at the Thomas Sumter auditorium, Rose said that 57 deaths in South Carolina in 2013 were caused by fires, but that Olivia's heroism kept the total from reaching 60.
"I am so very proud of her, and it makes you feel so good to know that the kids are learning," Rose said. "If the kids take this information in and learn from it, they let their parents know because they go home and say stuff like 'Mom and Dad, I learned about fire prevention,' and the parents should listen to their kids."
Thomas Sumter Headmaster Debbie Nix also spoke to the students to praise Olivia and to teach them about real bravery.
"Actors and musicians are not heroes," Nix said to the students in the auditorium. "A hero can be anyone, even a little girl with a beautiful smile and pretty blonde hair."
Olivia's parents, Joel and Elizabeth, couldn't be more proud of their daughter, nor more grateful for what the school and the fire department have done for her, they said.
"It's phenomenal how the school and the community have come together to recognize her," Joel Diller said. "I thank God every day that my little angel woke us up."
Both of Olivia's parents remember everything that occurred the night of the fire at their Camden home. Olivia woke up about 4:30 a.m. to the sounds of crumbling and cracking outside her bedroom window, so she opened the blinds to see that the back porch deck was on fire. She rushed into her parents' bedroom to calmly tell her parents.
"By the time we jumped out of bed and went into the kitchen, the back deck was already spreading and moving, and it was so huge," said Elizabeth Diller. "Once we saw it, we immediately grabbed our dog and ran out to the front yard."
Within two minutes, the fire had begun to engulf the entire house. So extensively damaged was the house that to this day, the cause of the fire has never been determined.
After living in a rental house for two weeks after the fire, the family eventually found more comforting shelter with Elizabeth's stepmother, whose husband passed away a few days before the fire.
Recovery has not been easy for the family, but the people around them - from friends at their church to their home contractor - have made it easier.
"Looking back, you never forget the heat, and you never forget the smell," Elizabeth Diller said. "For whatever reason it happened, every day since then has been one blessing after another."
Even after the fire, Olivia continued to be brave for her family while enduring the loss they suffered in September.
"For the first two months, she would sleep by our window to make sure if we were all right," Joel said. "There are times where she would be so overwhelmed by the attention that she would want some time for herself or just find a change in atmosphere."
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JULIEN Classic Collection Undermount Apron Sink with Single Bowl, 16 Gauge Stainless Steel, 36"W x 18-1/4"D x 8"H
Our Price: $1532.30
List Price: $2189.00, You Save: 30%, No Sales Tax, Except CT
Product Reviews
This JULIEN Classic Collection Undermount Apron Sink with Single Bowl is handcrafted from a single sheet of 16 gauge stainless steel having 18/10 chrome/nickel content and a no. 4 brushed finish. Featuring bowl bottom grooves, rear 3 1/2" drain placement and sound deadening pads, the overall dimensions of the sink are 36" left-to-right and 18 1/4" front-to-back.
(W = side to side) (D = front to back) (H = top to bottom)
Overall Sink: 36"W x 18-1/4"D x 8"H
Inside Bowl: 33"W x 16"D x 8"H
Cabinet Size: 36"
Ship Method: