30 research outputs found
Regulation on transportation of dangerous good by sea in Malaysia: whether it conforms to international standard / Muhammad Khairil Khalid
No full textThis study, "Regulation on Transportation of Dangerous Good by Sea in Malaysia: Whether it conforms to International Standard" is completed as a fulfilment of the course of Bachelor of Legal Studies (Hons). This study mainly conducted in Shah Alam and Kuala Lumpur to look into the regulations which govern the transportation of dangerous goods in Malaysia. There were.several methods used in order to find answers and to collect facts to answer the research questions and to meet the objectives of the study. Qualitative research which is library - based was conducted to gather information and relevant data for this study. The relevant data was gathered from various text books, journals, articles and internet. The researchers have also conducted several interviews with few respective people in gaining more information such as Dr. Irwin Ooi Ui Joo, Senior Research Fellow, Malaysia Institute for Transport (MITRANS) and last but not least, representatives from Maritime Institute of Malaysia (MIMA), Amy Aai Sheau Ye, Melda Marissa bt. Malek, and Elvia Cory Abu Hasan. These interviews were conducted to provide the researches with a clearer insight of the current situation of the research topic from the point of view of expertise. Apart from that, the researchers have also studied the regulation of transportation of dangerous goods in other countries for the purpose of comparison in the law from another point of view. Overall, it is found that there is not specific law which govern transportation dangerous goods by sea. However, practice on shipping of dangerous goods in Malaysia is guide by international guideline such as International Maritime Dangerous Goods Code (IMDG) Code
Demonstration of 80 Gbps NRZ-OOK electro-absorption modulation of InP-on-Si DFB laser diodes
No full textHigh-speed electro-absorption modulation of a heterogeneously integrated InP-on-Si DFB laser diode is used for the transmission of an 80 Gbps NRZ-OOK signal over 2 km of NZ-DSF link below the hard-decision forward-error-correction threshold. (C) 2019 The Author(s
Author Correction: Cucumber grafting on indigenous cucurbit landraces confers salt tolerance and improves fruit yield by enhancing morpho-physio-biochemical and ionic attributes
No full textBibliographic review of research publications on access to and use of medicines in low-income and middle-income countries in the Eastern Mediterranean Region: Identifying the research gaps
No full textObjectives: We assessed the situation of academic publications on access to and use of medicines (ATM) in low-income and middle-income countries (LMICs) of the Eastern Mediterranean Region (EMR). We aimed to inform priority setting for research on ATM in the region. Design: Bibliographic review of published studies. Setting: LMICs in EMR. Inclusion criteria: Publications on ATM issues originating from or focusing on EMR LMICs covering the period 2000-2011. Publications involving multinational studies were included if at least one eligible country had been included in the study. Information sources and data extraction: We conducted comprehensive searches of the PubMed, Social Science Citation Index and Science Citation Index. We used the WHO ATM framework for data extraction and synthesis. We analysed the data according to the ATM issues, health system levels, year of publication and the countries of origin or focus of the studies. Results: 151 articles met the inclusion criteria. Most articles (77percent) originated from LMICs in EMR, suggesting that the majority of evidence on ATM in the region is home-grown. Over 60percent of articles were from Iran, Pakistan, Jordan and Lebanon (in order of volume), while we found no studies assessing ATM in Somalia, Djibouti and South Sudan, all low-income countries. Most studies focused on the rational use of medicines, while affordability and financing received limited attention. There was a steady growth over time in the number of ATM publications in the region (r=0.87). Conclusions: There is a growing trend, over the years, of more studies from the region appearing in international journals. There is a need for further research on the financing and affordability aspects of ATM in the region. 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Metodología para el análisis del comportamiento y el desempeño de los estudiantes en un curso en línea
No full textAlthough many researchers have studied student performance prediction in online courses, they have primarily focused on courses with a linear structure, where students complete lessons and assessments sequentially. However, non-linear courses allow students to take lessons and assessments in any order, making performance prediction more challenging due to varying cumulative assessment percentages among students at any given time. This master's thesis aims to develop a data-driven method for early student performance prediction in non-linear courses.
We created a feature extractor and evaluated three types of features: engagement, behavior, and performance. The data comes from Moodle courses designed to prepare high school students for a public university entrance exam. Our method achieved early predictions at 20% of cumulative weight assessment with an F1-score of 0.73 for binary classification and an R² of 0.40 for regression. We also conducted a feature importance analysis, showing that performance and behavior features are the most significant predictors, with engagement features, such as time spent on educational resources, also contributing significantly.
In addition to predicting student performance, we performed a clustering analysis and identified four patterns that consistently appear across various cumulative weight assessments. These patterns significantly impact performance and can help educators provide better feedback and more personalized attention to students' needs.Aunque muchos investigadores han estudiado la predicción del rendimiento de los estudiantes en cursos en línea, se han centrado principalmente en cursos con una estructura lineal, en los que los estudiantes completan las lecciones y las evaluaciones de forma secuencial. Sin embargo, los cursos no lineales permiten a los estudiantes realizar las lecciones y evaluaciones en cualquier orden, lo que hace que la predicción del rendimiento sea más difícil debido a la variación de los porcentajes de evaluación acumulada entre los estudiantes en un momento dado. Esta tesis de máster tiene como objetivo desarrollar un método basado en datos para la predicción temprana del rendimiento de los estudiantes en cursos no lineales.
Creamos un extractor de características y evaluamos tres tipos de características: compromiso, comportamiento y rendimiento. Los datos proceden de cursos de Moodle diseñados para preparar a estudiantes de secundaria para un examen de acceso a una universidad pública. Nuestro método logró predicciones tempranas al 20% de la evaluación del peso acumulado con una puntuación F1 de 0.73 para la clasificación binaria y un R² de 0.40 para la regresión. También llevamos a cabo un análisis de la importancia de las características, mostrando que las características de rendimiento y comportamiento son los predictores más significativos, con características de compromiso, como el tiempo dedicado a los recursos educativos, que también contribuyen significativamente.
Además de predecir el rendimiento de los alumnos, realizamos un análisis de agrupación e identificamos cuatro patrones que aparecen de forma consistente en varias evaluaciones de peso acumulativo. Estos patrones influyen significativamente en el rendimiento y pueden ayudar a los educadores a proporcionar mejores comentarios y una atención más personalizada a los estudiantes.ModelamientoCOL0044448MaestríaMagíster en Ingeniería de Telecomunicacione
Characterising acute and chronic care needs: insights from the Global Burden of Disease Study 2019
No full textChronic care manages long-term, progressive conditions, while acute care addresses short-term conditions. Chronic conditions increasingly strain health systems, which are often unprepared for these demands. This study examines the burden of conditions requiring acute versus chronic care, including sequelae. Conditions and sequelae from the Global Burden of Diseases Study 2019 were classified into acute or chronic care categories. Data were analysed by age, sex, and socio-demographic index, presenting total numbers and contributions to burden metrics such as Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLD), and Years of Life Lost (YLL). Approximately 68% of DALYs were attributed to chronic care, while 27% were due to acute care. Chronic care needs increased with age, representing 86% of YLDs and 71% of YLLs, and accounting for 93% of YLDs from sequelae. These findings highlight that chronic care needs far exceed acute care needs globally, necessitating health systems to adapt accordingly.
© 2025. The Author(s)
Author Correction: Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017
No full textConfession without Borders: 1st Wave Feminism against Woman’s Right Disproportion in AtiqRahimi’sThe Patience Stone
No full textConfession without Borders: 1st Wave Feminism against Woman’s Right Disproportion in AtiqRahimi’sThe Patience Stone
TitikHariPangestu
English Literature
Faculty of Languages and Arts
State University of Surabaya
[email protected]
Diana Budi Darma, SS. M.Pd.
English Department
Faculty of Languages and Arts
State University of Surabaya
[email protected]
Abstrak
Penelitianinimemfokuskanpadaketidakseimbanganatashak-hakperempuan di Afghanistan denganmenggunakantindakantokohutamadalam novel inisebagaisumberdalamtesisini. Ktidakseimbanganhakmunculsebagaiakibatdaridominasisatusisikesisi lain. Masalahpertamadalamtesisiniberbicaratentangdominasilaki-laki. Yang keduamengungkapkanpengakuanperempuansebagaicerminandarifeminismegelombangpertama. Dalammenjawabpertanyaanpertama, penelitianinididukungolehteoripatriarki, sertadidukungolehbukuNawal El – Saadawi, dimanabukuiniberfokuspadadominasilaki-laki di wilayahArab. Permasalahankeduaakandijawabdenganmenggunakanteoridarifeminism, yang mengkhususkanpada feminismgelombangpertama. Analisisiniakanmenunjukkanbahwaketidakseimbanganperempuandisebabkanolehadanyawarisan agama danbudayasecaraturuntemurundalamkomunitasini. Setelahmenggambarkandoominasikaumpria, selanjutnyatesisiniakanmenggambarkanbagaimanaperempuan di wilayahinimenghadapiketidakseimbanganini. Tesisiniakanmengemukakan,sistemPatriarki yangdinilaisebagaipenyebabmunculnyaketidakseimbangantersebut,.Ketidakseimbanganinimemberikantekananbesartercermindalampengakuanistri, yang padaakhirnyamemberinyakekuatanuntukmelawanterhadapketidakseimbanganini.
Kata kunci: Patriarki ,FeminismeGelombangPertama
Abstract
This study focuses on depicting Afghan women’s rights disproportion by using main character’s act inside this novel. Right disproportion appears as a result of the domination of one sides to the other. The first problem talks about the domination of men’s. The second reveal the women’s confession represent first wave feminism. In answering first question, this research is supported by patriarchy theory, and supported by Nawal-El-Saadawi’s book which focus on men’s domination in this region. The second statement of problem will be answered by using a theory from the first wave feminism. The analysis reveals the disproportion of women right caused by hereditary thought of their religion and cultural and also how women in this region face this disproportion. Patriarchal believes is use as a cause of the disproportion. Furthermore, this disproportion which cause a huge pressure analyzing by wife’s confession finally give her a power to fight back against this disproportion.
Keywords: Patriarchy, First Wave Feminism
INTRODUCTION
Offending to women in the society, especially to traditional system, it must dribble a fact of disproportion of women within it. This fact finally grounds the responder of it, especially to whom it may concern with cultural study to talk to. Besides that, this phenomenon also creates an unforgettable experience to author to write it down in utterance of beautiful work, especially novel that brings conflicts in detail. According to Rene Wellek and Austin Warren say that literary work is the representation of the author toward social life and society (Wellek & Warren, 1949: 90). According those quotation, literary can be affected by society because the author is part of the society. His idea can come from his or her society. The author combining his experience with some fiction than use this as the main source of literary works. In other word, between literary work and society or social life is tightly related each other. By using particular literary work, a researcher can identify a social condition in a particular area.
Empirically, women are seen as the weakness subject. They are only put in in the second position in this life. Their duties only focus on domestic area such as bearing a child, cook for the household, and clean the house. Functionally, in war era women are only used for king and warrior sex satisfaction. They do not have any important role struggling for the war. Women’s involvement in the war seen as a problem. They are seen as the weakness creature that will cause difficulties and also seen as a stupid creature who does not understand about war strategy. So, in this era, they were only used as the object for the warrior’s sexual desire.
Institutionally women are consider as the womb of baby child before it is born to the world. Unfortunately after their birth, the right of their naming is totally in their father hands. For example, in Chines system of family name, the structural of their kids name is come from their father family name. From those explanation, it can be conclude that women only seen from their function rather than their role.
Women do not have their own in making important decision, to give their opinions, especially deliver about their feeling. They cannot live with their own will. Their man is the center of their live. They have to fulfill what their man need. This Traditional gender role cast men as rational, strong, protective, and decisive. They cast women as emotional (irrational), weak, nurturing, and submissive (Lois Tyson, 2006: 84). Men is the leader of their women, they have total control in decide how the women behave and act. However, in fact this traditional gender role still occur in this modern era, especially in Middle East country such as Afghanistan. This country known as an Islamic country which is uses Koran as their main laws, and guidance of their live. In Koran. Islam had been stated that "Men are the protectors and maintainers of women, because God has made one of them to excel the other, and because they spend from their means. Therefore the righteous women are devoutly obedient and guard in the husband's absence what God orders them to guard. It is also said that men are little bit higher than women and they are oblised to protect and save the women.
Patriarchy has become an inevitable issue of the growth of Afghanistan as a Muslim country. Especially during the Taliban leadership, which began in 1996 till 2001. Taliban as a part of Arabian world has different perception in apply Islamic laws. The Taliban's version of Islam appears too many Muslims to be a new-born faith developed, canonized, and interpreted by Taliban scholars with the reclusive supreme leader, Mohammed Omar at the helm giving his stamp of approval for implementation.
Afghan women were forced to wear the burqa at all times in public which is quite different with burqa from Arabian women. Afghan women cover all of parts their body including their face except their eyes area. Taliban see face of a woman is a source of corruption for men who are not related to them. In a systematic segregation sometimes referred to as gender apartheid, women were not allowed to work, they were not allowed to be educated after the age of eight, and until then were permitted only to study the Qur'an. Women were beaten for showing a bit of ankle or wearing noisy shoes. They could not speak in public or to men who were not relatives. They were beaten, even killed, for minor violations of these rules. But all of that oppression does not make women in Afghanistan hate Taliban men.
Marrying Taliban warrior seen as one of the pride in their life. It cause the Taliban warrior seen as the hero in Afghanistan. They were struggling for their freedom from the western shackles, even in fact their coming give another suffering for women in Afghanistan. Marry them can increase the assessed value and the social status of a family. They will be considered as a family of heroes who fought for his country. So, it is pride for any Afghanistan women to married a Taliban warrior even they know what kind of consequence that they will face. Finally, it sharpen to a problem about the relation of them, Islam, Taliban, Patriarchy, and women in the world, especially to the facts reflected in Atiq Rahimi’s The Patience Stone.
Generally, religion have a patriarchal view of the relationship between the genders. The relation between Adam and Eve how many religion view woman. As Al-Hibri writes, God was declared male, and man was declared to be created in His likeness. Eve became the symbol of temptation and sin. The woman was consequently judged as a less likely candidate for salvation and an everlasting life in heaven than man. (Al-Hibri, 1981:176). Islam inherited the old image of Eve and of women that depict them as the close followers and instrument of Satan, the body of women being his abode (Saadawi, 2001:274). So, it is important to envelop them in veils and flowing robes (Saadawi, 2001:275).
As the living carrier of the danger of sexuality and its infinite social destructive forces, women have to be controlled. Since Islam regards women as an active sexual power, it is important to restrict women’s sexual power over men. The result is isolating women and men in different worlds.
In talking about women’s oppression, feminism thought as the appropriate philosophy in investigate this phenomenon. Feminism is an awareness of women’s oppression and exploitation in society. This theory is struggling to achieve dignity, rights, and freedom for women to control their lives and bodies within home and outside. According to its movement, this philosophy were divided into three waves, first wave, second and third wave.
First wave is concern about equality, second wave concern about the commitment of diversity, and third wave concern in diversity in specific normative. And according to the problem which is appear in the explanation above, the first wave movement of feminism, is appropriate movement that will be used to answer this question.
Originally it focus on the promotion of equal contract and property rights for women and the opposition to chattel marriage and ownership of married women (and their children) by their husbands. This movement begin with Mary Wollstonecraft’s Vindication of the Rights of Woman (1792). Wollstonecraft’s was the first to issue an outspoken rallying cry to middle-class women, especially mothers, as major influences on society (Gamble, 2001:15). Her emphasis was on the need to make women rational, till women are more rationally educated.
Furthermore, this thesis will become a great analysis when it is known that the object of this thesis, AtiqRahimi’s The Patience Stone, is the winner of prestigious Goncourt Prize in France, and is a deceptively simple book written in a spare, poetic style. It is rich read, part allegory, part of tale of retribution, part an exploration of honour, love sex, marriage, and war. It is without doubt an important and courageous book. This voice is in giving voice to those who, as the fable goes, suffer the most and cry out the least (Khaled Hosseini, The Patience Stone’s Preface).
The Patient Stone is a France novel which is translated in English version. Set almost entirely in one room - the bedroom of the husband and just about the only character who talks is the wife. The woman open up her feeling and thought to the men in her society, confronting the taboo of female oppression and sexuality. Her voice can describe the darkness in her live, her painful and her sorrow for being as a women. Her monologue definitely drive out the reader to think as the woman side, without eliminating the other character in this novel.
Besides The Patience StoneAtiqRahimi also wrote some canon novel and won some prestigious appreciation. The first novel is Earth and Ashes, written in Persian and become an instant best seller in Europe and South America. A movie based on this book, directed by Rahimi, was awarded the Prix du Regard versl'Avenir at the 2004 Cannes Film Festival. The film was featured in 50 festivals, winning a total of 25 awards including the one at Cannes and a Golden Dhow award for best feature film at the Zanzibar International Film Festival. And the others work is A thousand Rooms of Dream and Fear.
Working on disproportion of women right for study is always an interesting and courageous idea. Through the confession of “Wife” character in this novel, this study can reveal that there is a rebellion and courageous, and how this character survive from the disproportion in Taliban era. Wife already thought since she was young that man is leader for woman, so she must obey him. Rather than fight back against her husband, she choose to use her silence as a form of rebellion. By using this character, it is can be seen that there is a rebellion inside of hereditary understanding regarding woman and man positioned. With discussing this topic, there is a description about what happened in this country especially about the inequality and also how far the disproportion of the women right still exist in this country.
RESEARCH METHOD
As has been stated in the description above, literature is a reflection of a society portray and the combination of the author fiction. Literary work is meaningful. Hence, it delivers many meanings and interpretations that can be caught by the reader as an interpreter. In other word, to find the accounted result, it needs a method that is based on the problems to avoid the blurry result. This study take novel from Atiq Rahimi The Patience Stone as the main source, and using some quotation inside it as the data. The type of this research is qualitative research because it produces descriptive data. The problem in this study is concerning about man’s domination and woman’s inequality treatment that will be analyzed by using patriarchy and first wave feminism from several feminists.
WOMAN IN ISLAM
Islam already stated that man is a leader for woman so they obliged to educate, protect and maintain the woman. God had been created man little bit more than the woman. It can be seen by the existence of their muscle. This gift, make man as the stronger one so they are seen as the appropriate one to be a leader while woman is the follower. So, woman must follow and obey their husband. According to Saadawi’s book, Islam inherited the old image of Eve and of women that depict them as the close followers and instrument of Satan, the body of women being his abode (Saadawi, 2001:274). So, it is important to envelop them in veils and flowing robes (Saadawi, 2001:275). In other word, this society position woman as the guilty one dealing with their body and sexuality. That is why, woman in Islam, especially in Patriarchy country must get married, so they need man to control their temptation.
Islam makes marriage as the only institution where sex between men and women can be done in a way that is more moral (Saadawi, 2001:280). Sex is done outside this institution directly transformed into an act of sin and evil, even masturbation was not permitted. Based on Ibnu Abbas’ (friend of Prophet Muhammad) statement “and married a slave is better than masturbation and fornication (zina)”. Therefore an unmarried men divided into three sins, first married a slave, then masturbation the foremost is fornication (zina). In other words, marriage is an established system for sex where one part uses to avoid slander (fitnah) and the other side used it as the legalization for reproduction as much as they want, and off course get good agreement to acquire pleasure within the bounds of Islam (Saadawi, 2001:281).
Based on the Al-Ghazali an Arabian philosopher statement in Nawal’s book, besides for reproduction, the purpose marital is immunity against demons, break the sharp tip of the desire, distance from danger of lust, keep our eye from what who supposed not to be seen, protect male sexual organ, as well as follow the advice our prophet (Saadawi, 2001:276). But this institution is still different for men and women, especially dealing with their rights and obligations not only inside in their house hold but also in their society. In their household activities, wife only concern about their domestic business. Their main job only raising their children, cleaning their house and satisfying their husband in bed. They do not allowed to care about what happened outside their area. Marriage makes men’s heart free from household and clean their house, so they can concern to their job, religion and science in other word, they can concern in developing themselves. Al-Ghazali states in Saadawi’s book “In fact, your wife let you to work on the final day and she concern about your house and relieve your lust” (Saadawi, 2001:284). Therefore, a man is seen not able to devote themself in science development and religion unless they have a wife that can handle their household.
ARABIC SOCIETY
Arabic culture is male centered. Males dominate most cultural, political and social institutions. This has a direct impact on the cultural status of women in both Arabic and Islamic countries. While Islam emphasizes the equality of men and women, Arabic culture minimizes it. A Jewish Arab in Morocco or a Christian Arab in Syria adheres to the same system and thus would have the same views on the role and status of women. The socially-rooted conceptualizations of differences in women’s and men’s sexualities and their biological nature are so frequently evoked to the extent that they become part and parcel of the individual and collective consciousness. In this regard, the “natural role” of women is one of the most deeply rooted interventions at the conscious and unconscious levels. Consequently, women’s fulfillment of their “natural role” associated with the reproductive process becomes compulsory and coercive. In the end, this leads to women’s lives becoming regulated through the sharia, constitutions, laws, and predominant social norms, in ways that far exceed what applies to men.
In Arab societies, women’s status is mainly defined by their roles as mothers and wives. Their main job only concern about raising children, cleaning their house and also serve their husband (Saadawi, 2001:285). Different from the husband's position as head of the family, they are taking control over their families, so that the actual duty as a husband in this culture region is to control and supervise the family and finally it position woman in second position after their husband.
Women could not make decisions based on their own beliefs, and had little control over their marriages. Society create that the noble obligation for a wife to completely obedient to their husband, they cannot be different, no asking a question or refused their orders, (Saadawi, 2001:286). In other words, there is no independent decision for women. Their freedom is limited or moreover it is deleted because the ideal women in this society is a woman who can follow her husband without complaining about anything. Essentially. So, it can be conclude women were slaves to men and made no decisions on anything, whether it be something that directly impacted them or not.
LOVE AND SEX IN ARABIC SOCIETY
The strong influence of the cultural background of the Arab and Islamic values which strongly stuck in Arabic life makes this nation see love and sex as something taboo and full of mystery. In this region, woman take crucial part in this ritual. As the legacy from cultural background and also religion values the Arabic seen women without exception as cause of fitnah (fornication). Arab woman adorned with temptation and fitnah. Where in this sense they become part of the spirit of Islam, which force women into sexual temptation in the community who bring libel. In this case is related to a conspiracy libel, resistance, which interfere with any order that has been built by the gods. So, they are very closely related to sex and sin (Saadawi, 2001:273).
Men on the other hand, though had great sex appetite, not accused of sin unless driven by temptation and seduction of women. The power of the male sex being a part of the soul of the Arabs and its soul is connected with virility (Saadawi, 2001:294). Thus, man is ordered to marry in order to defeat the evil and the woman temptation. Despite the desire of sex are owned by both parties, but in fact women in this region bear all the restraints.
Man sexuality is connected with virility different with women sexuality which their sex connected with sins and devil. So, it will be ashamed if men in this region have a problem in their sexuality that is impotent and the only one who can know this, is woman. But the solution taken upon of these problem were quite surprisingly.
As quoted in Saadawi’s book “Virgins were not permitted to know far about sex, while a widow who already have experience from her previous marriage definitely can recognize this weakness. That is why they give “Lower” for their label” (Saadawi, 2001:295). These restraints were taken up in order to protect men from women so they cannot drop them.
Women must keep their virginity by their own self. A woman who lost her virginity before marriage will be confuse and fear of family rejection both from family or society, but men who come save her will be seen as a hero and respectful (Me
Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017
No full textA double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4 (62.3 (55.1–70.8) million) to 6.4 (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5 in over half of LMICs by 2025. Prevalence of overweight increased from 5.2 (30 (22.8–38.5) million) in 2000 to 6.0 (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic. © 2020, The Author(s)
Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015 : the Global Burden of Disease Study 2015.
No full textBACKGROUND: Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. METHODS: For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. FINDINGS: Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1-3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5-2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6-40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7-1·9 million) in 2005, to 1·2 million deaths (1·1-1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections. INTERPRETATION: Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030.Funding: We thank the countless individuals who have contributed to the Global Burden of Disease (GBD) Study 2015 in various capacities. We specifically thank Jeffrey Eaton and John Stover. HW and CJLM received funding for this study from the Bill & Melinda Gates Foundation; the National Institute of Mental Health, National Institutes of Health (NIH; R01MH110163); and the National Institute on Aging, NIH (P30AG047845). LJAR acknowledges the support of Qatar National Research Fund (NPRP 04-924-3-251) who provided the main funding for generating the data provided to the GBD-Institute for Health Metrics and Evaluation effort. BPAQ acknowledges institutional support from PRONABEC (National Program of Scholarship and Educational Loan), provided by the Peruvian government. DB is supported by the Bill & Melinda Gates Foundation (grant number OPP1068048). JDN was supported in his contribution to this work by a Fellowship from Fundacao para a Ciencia e a Tecnologia, Portugal (SFRH/BPD/92934/2013). KD is supported by a Wellcome Trust Fellowship in Public Health and Tropical Medicine (grant number 099876). TF received financial support from the Swiss National Science Foundation (SNSF; project number P300P3-154634). AG acknowledges funding from Sistema Nacional de Investigadores de Panama-SNI. PJ is supported by Wellcome Trust-DBT India Alliance Clinical and Public Health Intermediate Fellowship. MK receives research support from the Academy of Finland, the Swedish Research Council, Alzheimerfonden, Alzheimer's Research & Prevention Foundation, Center for Innovative Medicine (CIMED) at Karolinska Institutet South Campus, AXA Research Fund, Wallenberg Clinical Scholars Award from the Knut och Alice Wallenbergs Foundation, and the Sheika Salama Bint Hamdan Al Nahyan Foundation. AK's work was supported by the Miguel Servet contract financed by the CP13/00150 and PI15/00862 projects, integrated into the National R&D&I and funded by the ISCIII (General Branch Evaluation and Promotion of Health Research), and the European Regional Development Fund (ERDF-FEDER). SML is funded by a National Institute for Health Research (NIHR) Clinician Scientist Fellowship (grant number NIHR/CS/010/014). HJL reports grants from the NIHR, EU Innovative Medicines Initiative, Centre for Strategic & International Studies, and WHO. WM is Program analyst, Population and Development, in the Peru Country Office of the United Nations Population Fund, which does not necessarily endorse this study. For UOM, funding from the German National Cohort Consortium (O1ER1511D) is gratefully acknowledged. KR reports grants from NIHR Oxford Biomedical Research Centre, NIHR Career Development Fellowship, and Oxford Martin School during the conduct of the study. GR acknowledges that work related to this paper has been done on the behalf of the GBD Genitourinary Disease Expert Group supported by the International Society of Nephrology (ISN). ISS reports grants from FAPESP (Brazilian public agency). RSS receives institutional support from Universidad de Ciencias Aplicadas y Ambientales, UDCA, Bogota Colombia. SS receives postdoctoral funding from the Fonds de la recherche en sante du Quebec (FRSQ), including its renewal. RTS was supported in part by grant number PROMETEOII/2015/021 from Generalitat Valenciana and the national grant PI14/00894 from ISCIII-FEDER. PY acknowledges support from Strategic Public Policy Research (HKU7003-SPPR-12).</p
