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    Lipid levels, insulin resistance and cardiovascular risk over 96 weeks of antiretroviral therapy: a randomised controlled trial comparing low-dose stavudine and tenofovir
    (BioMed Central, 2018-12) Vos, Alinda G.; Chersich, Matthew F.; Klipstein‑Grobusch, Kerstin; Zuithof, Peter; Moorhouse, Michelle A.; Lalla‑Edward, Samanta T.; Kambugu, Andrew; Kumarasamy, N.; Grobbee, Diederick E.; Barth, Roos E.; Venter, Willem D.
    Background: HIV infection and antiretroviral treatment are associated with changes in lipid levels, insulin resistance and risk of cardiovascular disease (CVD). We investigated these changes in the first 96 weeks of treatment with lowdose stavudine or tenofovir regimens. Methods: This is a secondary analysis of a double blind, randomised controlled trial performed in South-Africa, Uganda and India comparing low-dose stavudine (20 mg twice daily) with tenofovir in combination with efavirenz and lamivudine in antiretroviral-naïve adults (n = 1067) (Clinicaltrials.gov, NCT02670772). Over 96 weeks, data were collected on fasting lipids, glucose and insulin. Insulin resistance was assessed with the HOMA-IR index and 10-year CVD risk with the Framingham risk score (FRS). A generalized linear mixed model was used to estimate trends over time. Results: Participants were on average 35.3 years old, 57.6% female and 91.8% Black African. All lipid levels increased following treatment initiation, with the sharpest increase in the first 24 weeks of treatment. The increase in all lipid subcomponents over 96 weeks was higher among those in the stavudine than the tenofovir group. Insulin resistance increased steadily with no difference detected between study groups. FRS rose from 1.90% (1.84–1.98%) at baseline to 2.06 (1.98–2.15%) at week 96 for the total group, with no difference between treatment arms (p = 0.144). Lipid changes were more marked in Indian than African participants. Conclusion: Lipid levels increased in both groups, with low-dose stavudine resulting in a worse lipid profile compared to tenofovir. Insulin resistance increased, with no difference between regimens. CVD risk increased over time and tended to increase more in the group on stavudine. The low CVD risk across both arms argues against routine lipid and glucose monitoring in the absence of other CVD risk factors. In high risk patients, monitoring may only be appropriate at least a year after treatment initiation.
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    Using a cascade approach to assess condom uptake in female sex workers in India: a review of the Avahan data
    (BioMed Central, 2018-07) Weiner, Renay; Fineberg, Micah; Dube, Bridget; Goswami, Prabuddhagopal; Mathew, Shajan; Dallabetta, Gina; Johnson, Saul
    Background: The Avahan India AIDS Initiative was implemented to provide HIV prevention services to key populations including female sex workers (FSWs) who carry the burden of India’s concentrated HIV epidemic. Established in 2003 and handed over to the Indian government in 2009, the Initiative included peer-led outreach education, condom promotion and distribution and STI treatment. This study aimed to determine if HIV prevention cascades could be generated using routine monitoring and evaluation data from the Avahan program and to assess their value in identifying and responding to program gaps for FSWs. Methods: Two data sources were used namely the Integrated Behavioural and Biological Assessment reports and the Centralized Management Information System dataset. Indicators selected for the cascades were: FSWs at risk, belief that HIV can be prevented, condom access and consistent condom use with an occasional partner. Six districts were selected and stratified by HIV prevalence at baseline and two cascades were generated per district reflecting changes over time. Results: Consistent condom use with occasional partners in this population increased in all six districts during program implementation, with statistically significant increases in four of the six. No patterns in the cascades were detected according to HIV prevalence either at baseline (2005) or at follow-up (2009). Cascades were able to identify key programmatic bottlenecks at baseline that could assist with focusing program efforts and direct resources at district levels. In some districts the belief that HIV could not be prevented contributed to inconsistent condom use, while in others, low levels of condom access were a more important barrier to consistent condom use. Conclusion: This HIV prevention cascade analysis among FSWs in India suggests that cascades could assist in identifying program gaps, focus intervention efforts and monitor their effect. However, cascades cannot replace a detailed understanding of the multiple factors at individual, community and structural levels that lead to consistent condom use in this key population. Careful indicator selection coupled with innovative data collection methods will be required. Pilot projects are proposed to formally evaluate the value of HIV prevention cascades at district level.
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    With and against Platformisation: Men in care professions and the gendered dynamics of the future of work(ers).
    (Southern Centre for Inequality Studies (SCIS), 2022-11-15) Komarraju, Sai Amulya
    While several studies examine platformisation and the future of work from a gendered perspective, much of the media coverage and academic scholarship on the platform economy is divided in terms of their focus – (migrant) men involved in the supposedly “masculine” and visible work of construction, driving, and delivery, and the invisible care work performed by women workers and the challenges involved in both. Undoubtedly, the over-representation of women in different kinds of care work prompts such research. However, in India, both men and women from marginalised castes and classes have historically performed care work, such as domestic work and salon work. Based on patchwork ethnography and interviews with male workers in two feminised care professions (cleaning and salon work), this working paper first makes a case for feminisation of platform work beyond the mere presence of women, and then proceeds to explore the material contexts within which male workers enter (platformised and not-platformised) feminised care work, their views on platformisation, their resistance to and co-optation of platform work, and, related to these, the strategies they use to affirm their masculinity.
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    Unexceptional neoliberalism: enterprise and informality in the gig economy of India
    (Southern Centre for Inequality Studies (SCIS), 2022-11-15) Nair, Gayatri; Divyadarshi, Jennifer
    This paper examines the conditions of work in the platform economy across India, which has witnessed a significant expansion in the number of gig workers joining platform enterprises. The precarity underscoring work in the gig economy is now widely acknowledged, but what does this entail for workers in India and the global South who have typically been a part of the informal economy? The paper explores whether the absence of labour regulation and social security in gig work marks it as an extension of informal work. Based on interviews with gig workers and rooted in their experiences of work that remains unregulated, we consider whether gig work is an instance of “unexceptional neoliberalism” as it extends informality to new sectors. The paper unpacks the impact of the neoliberal state’s agenda of promoting enterprise on gig workers who are now subject to algorithmic controls of platforms, alongside “traditional” constraints of caste, class and gender, even as they are considered by the State and digital platforms to be autonomous entrepreneurial subjects.