Global Plan to Eliminate New HIV Infections

Global Plan to Eliminate New HIV Infections Abstract The study assessed the progress of 20 priority sub-Saharan African countries in the attainment of the targets outlined in the ‘Global Plan for the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive’. The 2012 progress reports of the countries were extracted from the UNAIDS online database. The global and Prong 1, 3, and 4 targets were analysed with respect to the May 2013 targets and milestones. The 2009 to 2012 and the 2005 to 2010 mid – point estimates were analysed respectively for global target 1 – Reduce number of new infections among children by 90% and global target 2- Reduce AIDS-related deaths during pregnancy or within 42 days of the end of pregnancy by 50%. Estimates were calculated using Spectrum version 4.6 and Wilcoxon ranked test was used for data analysis.Between 2009 and 2012, there was 38% total reduction in global target 1 while between2005 to 2012 there was 25% total reduction in global target 2 for the 20 priority countries. Ghana and South Africa recorded the most significant reduction for global target 1 with 72% and 63% respectively while Nigeria, Chad, Congo Democratic Republic and Lesotho recorded less than 20% reduction. Only Botswana and Ethiopia recorded over 50% reduction in global target 2. There has been significant progress however; the global milestones have not been attained. More effort is needed in Nigeria, Congo Democratic Republic and Angola and sustained momentum in other priority countries to achieve the Global Plan goals and milestones. HIV infection remains one of the major cause of death in children and their mothers in Sub Saharan African (SSA) countries [1,2,3]. Transmission of HIV infection from mothers to their unborn children and infants is mostly during pregnancy, labour and post – natally during breastfeeding period. [4,5]. There has been gradual reduction in new HIV infections among children of HIV infected mothers since the commencement of prevention of mother to child transmission programme (PMTCT) but as at 2009, a staggering 370,000 children were recorded to have became newly infected with HIV worldwide and an estimated 42,000 – 60,000 pregnant women also died due to HIV infection and its complications. [6,7].Over 90% of the countries responsible for this high burden of HIV infection and high mother to child transmission (MTCT) rates are located in SSA. India, which is located in Asia is another country which also contribute significantly to this burden. These countries account for the bu lk of the HIV infected women requiring antiretroviral therapy (ART) in order to prevent MTCT. They also account for over 90% of the paediatric HIV infected children who need ART [7].The case of MTCT presents a big disparity globally with high income countries recording almost zero new HIV infections among children and maternal and infant mortalities due to HIV infection. However; most of the low and middle countries especially those located in SSA record new infections because the number of women accessing HIV prevention and treatment services is considerably very low. The same situation applies to their children and this exposes them to new infections and death [7].The success recorded in reducing MTCT to almost zero and keeping their mothers alive is possible globally. However, this can only be a reality if all involved will ensure that all pregnant women living with HIV and their children have easy access to antiretroviral drugs and other necessary care as indicated during pregna ncy, delivery and breastfeeding. These measures will go a long way in preventing new infections among the children and take care of the health of the mothers as well. Provision and appropriate usage of ARVs as prophylaxis has been proven to reduce HIV MTCT to less than 5% [9]. Other measures that targets HIV infection prevention among women at increased risk of HIV and the unmet family planning needs of women living with HIV will contribute significantly to reduction for subsequent antiretroviral prophylaxis and treatment need [12].In May 2009, the Joint United Nations Programme on HIV/AIDS (UNAIDS) made a call for the virtual elimination of MTCT globally. This call was supported by many other multilateral and bilateral agencies, regional coordinating bodies, national governments and their HIV/AIDS control agencies . In furtherance of this noble course, the World Health Organisation (WHO) in 2010 published new guidelines which included the best available scientific and programmatic tools to accelerate the reduction of MTCT and achieve the virtual elimination of MTCT. These guidelines also included advice for safer infant feeding. [6,7] The call for the virtual elimination of new paediatric HIV infection led to the launching of an initiative known as â€Å"Global Plan Towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive † in July 2011 at the United Nations General Assembly High Level Meeting on AIDS. The Global Plan was developed through a consultative process by a Global Task Team convened by UNAIDS. The Global Task Team included experts and policy makers from 25 countries and 30 civil society organisations, private sector, networks of people living with HIV and international organisations. This plan was designed to provide the foundation for country-led movement towards the elimination of new HIV infections among children and keeping their mothers alive. The Global Plan covers all low- and middle-income countries, but with a particular focus on the 22 countries with the highest estimated numbers of pregnant women living with HIV. These countries are Angola, Botswana, Burundi, Cameroon, Chad, Cà ´te d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, India, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, South Africa, Swaziland, Uganda, United Republic of Tanzania, Zambia and Zimbabwe. These countries were selected based on the fact that they account for nearly 90% of pregnant women living with HIV in need of services. These countries also need exceptional efforts to achieve this goal. The Global Plan also supports and reinforces the development of country-driven HIV national plans [7]. The Global Plan focuses on reaching pregnant women living with HIV and their children prior to pregnancy, through the time of pregnancy until stoppage of breastfeeding. The HIV prevention and treatment needs of mothers and children will be met within the existing comprehensive HIV care programmes.The implementation framework for the Global Plan is based on two global targets and broader four-pronged strategy. The strategy provides the foundation for national plans development and implementation. It encompasses ranges of HIV prevention and treatment indicators for mothers and their children, essential maternal, newborn and child health services and family planning, and as a crucial aspect of efforts to achieve Millennium Development Goals 4, 5 and 6 [10,11]. Global Target #1: Reduce the number of new HIV infections among children by 90% . Global Target #2: Reduce the number of AIDS-related maternal deaths by 50%. Prong 1: Prevention of HIV among women of reproductive age within services related to reproductive health such as antenatal care, postpartum and postnatal care and other health and HIV service delivery points. Target: Reduce HIV incidence in women 15-49 by 50%. Prong 2: Providing appropriate counselling and support, and contraceptives, to women living with HIV to meet their unmet needs for family planning and spacing of births, and to optimize health outcomes for these women and their children. Target: Reduce unmet need for family planning to zero (Millennium Development Goal). Prong 3: For pregnant women living with HIV, ensure HIV testing and counselling and access to the antiretroviral drugs needed to prevent HIV infection from being passed on to their babies during pregnancy, delivery and breastfeeding [9]. Target: Reduce mother-to-child transmission of HIV to 5%. 90% of mothers receive perinatal antiretroviral therapy or prophylaxis. 90% of breastfeeding infant-mother pairs receive antiretroviral therapy or prophylaxis. Prong 4: HIV care, treatment and support for women, children living with HIV and their families. Target : Provide 90% of pregnant women in need of antiretroviral therapy for their own health with life-long antiretroviral therapy. By the end of 2015, the estimated number of new HIV infections in children is expected to have been reduced by at least 85% in each of the 22 priority countries, the estimated number of HIV-associated pregnancy-related deaths reduced by 50% and all countries will have met the targets for elimination of new HIV infections among children and keeping their mothers alive. There is however need to measure the progress made by these countries and to address gaps and challenges identified. This study aimed to assess the progress made by twenty of the priority countries involved in the Global Plan in sub Saharan Africa. This is coming two years after the formal launching of the Global Plan with the countries making commitment towards the elimination of new HIV infections in children and keeping their mothers alive. This study looked at the progress made so far in meeting some of the targets and milestones set to be met by May 2013.We searched the UNAIDS online database of the 2012 progress reports submitted by the priority countries. The 2009 2012 mid – point estimates were analysed for 20 of the sub- Saharan African Global Plan priority countries. The estimates were calculated using Spectrum version 4.6. The Spectrum files were developed by country teams and compiled by UNAIDS in 2013. However, the estimates from AIDS related deaths during pregnancy or within 42 days of the end of pregnancy was from 2005 to 2010 [8].Only 20 of the Global Plan priority countries data were analysed due to non availability of country – specific data for Uganda and India. . In order assess the progress made, the global targets and Prong 1, 3, and 4 targets were quantitatively analysed with respect to the May 2013 targets and milestones. Some of the global and country targets and milestones assessed were : The estimated number of new HIV infections in children is reduced by 50% from 2010 levels in at least 10 high-burden countries. (Country target and milestone). The estimated number of new HIV infections in children is reduced by 50%. (Global target and milestone). The data was analysed using statistical package Stata version 12.1. Overall Targets Between 2009 and 2012, the number of new infections among children in the 20 Global Plan priority countries in sub-Saharan Africa countries with country-specific data was estimated to have reduced from 315570 to 197170. ( Wilcoxon ranked test ;P = 0.0001; Table 1 and 5). The total reduction in the estimated number of new HIV infections among children was 38% from 2009 levels in the high-burden countries.AIDS-related deaths during pregnancy or within 42 days of the end of pregnancy among the 20 Global Plan priority countries in sub-Saharan Africa countries with country-specific data reduced from 36000 in 2005 to 29030 in 2010.Prong 1 Target The new HIV infections among women 15–49 years old among the 20 Global Plan priority countries in sub-Saharan Africa countries with country-specific data reduced from 687900 in 2009 to 606000 in 2012 (Wilcoxon ranked test ;P = 0.0001; Table 2 and 5 ).Prong 3 Targets The final Mother to Child Transmission rate (%) among the 20 priority countries with country-specific data reduced from 27% in 2009 to 19% in 2012 (Wilcoxon ranked test ;P = 0.0001; Table 3 and 5 ). The percentage of women receiving antiretroviral medicines (excluding single-dose nevirapine) to prevent MTCT increased from 34% in 2009 to 63% in 2012 (Wilcoxon ranked test ;P = 0.0001; Table 3 and 5). The percentage of women or infants receiving antiretroviral medicines during breastfeeding to prevent MTCT increased from 11% in 2009 to 43% in 2012 (Wilcoxon ranked test ;P = 0.0001; Table 3 and 5).Prong 4 TargetsThe percentage of antiretroviral therapy coverage among children 0–14 years old increased appreciably from 22% to 35% in all the Global Plan priority countriesIn SSA,the percentage of pregnant women living with HIV receiving antiretroviral therapy for their own health increased from 23% in 2009 to 57% in 2012 (Wilcoxon ranked test ;P = 0.0001; Table 4 and 5). Two countries namely Ghana and South Africa have done tremendously well in achieving the highest reduction in the numbers of new HIV infections among children from 2009 to 2012 with 72% and 63% reduction respectively [8]. Others like Botswana, Malawi, Ethiopia, Zambia and Namibia had also achieved remarkable reduction with Zimbabwe, Kenya, Mozambique and Tanzania almost reaching the 50% reduction. Angola, Nigeria, Chad, Congo Democratic Republic and Lesotho are still lagging behind in the aspect of reduction of new infection in children. The case of Nigeria is really a concern considering the fact that she has the highest number and about one third of all new paediatric infection in sub Saharan Africa. Angola is also a case for concern, there has been increase in new infections rather than reduction since 2009. Furthermore , there has been reduction in the AIDS-related deaths during pregnancy or within 42 days of the end of pregnancy from 2005 to 2010, although with some exceptions like Mozambique and South Africa. There has been some reduction in new HIV infections among women 15–49 years old in the priority countries but with some exceptions such as Angola, Cameroun, Chad, Cote D’Ivoire, Mozambique, Namibia and Zimbabwe. There was reduction in the final Mother to Child Transmission rate with Botswana and South Africa leading the pack. These two countries have already reached the 5% target for the reduction in transmission rate [8]. More women are now able to access antiretroviral medicines and thereby reducing the risk of new HIV transmission to their children compared to 2009. Four countries had already surpassed the 90% target for the increase in percentage of women receiving antiretroviral medicines (excluding single-dose nevirapine) to prevent MTCT, however, Angola, Chad, Nigeria and Congo DR did poorly in this area of maternal antiretroviral coverage. The increase in the percentage of women or infants receiving antiretroviral medicines during breastfeeding to prevent MTCT among the priority countries is a commendable step because some of the countries do not have this programme in place as of 2009. There was a significant increase in antiretroviral therapy coverage for pregnant women living with HIV in the priority countries. Botwsana and Namibia had achieved above 90% antiretroviral therapy coverage for pregnant women living with HIV . These increased coverage levels of antiretroviral medicines is expected to translate into lower mother-to-child transmission rates. Over the years, there has been an increase in the number of children who are on antiretroviral therapy but this increase is still not the desired expectation with two third of eligible children been denied the needed medication in most of the priority countries. It is noteworthy that Botswana was already having above 95% paediatric antiretroviral coverage as at 2009. A major limitation of this study is the non availability of Uganda and India country – specific data . Another challenge was in measuring the progress of the initiative because most of the priority countries do not have a direct measurement of the number of new HIV infections among children [8].There has been a significant progress among most of the sub Saharan African priority countries in the bid to eliminate new HIV infections in children as seen by the reduction in the percentage of final mother to child transmission of HIV.The success story so far include reduced number of children newly acquiring HIV infection, improved and increased access to HIV treatment for eligible women and their children, increased coverage of antiretroviral medicines for pregnant women living with HIV to prevent mother-to-child transmission from and reduction in AIDS-related deaths during pregnancy or within 42 days of the end of pregnancy. However, only seven countries has been able to achieve the 50% reduction in estimated number of new HIV infections among children thereby falling short of the expected ten countries target by May 2012 [7]. Also the number of new HIV infections in the countries declined by only 38% against the target of 50%. More effort is needed in certain countries like Nigeria, Congo Democratic Republic and Angola and sustained momentum in other priority countries in order to achieve the Global Plan goals.

The Return: Midnight Chapter 15

Bonnie woke slowly, coming up from some dark place. Then she wished she hadn't. She was in some out-of-doors place – only buildings blocked the horizon where the sun hung forever. Around her were a lot of other girls, al approximately her own age. That was puzzling, first of al . If you took a random sampling of females off the street there would be little girls crying for their mothers, and there would be mother-aged women taking care of them. There might be a few older women. This place looked more like – – oh, God, it looked like one of those slave warehouse places that they had had to pass the last time they had come to the Dark Dimension. The ones that Elena had ordered them not to look at or listen to. But now Bonnie felt sure she was inside one herself, and there was no way not to look at the Stillfaces, at the terrified eyes, at the quivering mouths around her. She wanted to speak, to find the way – there would have to be a way, Elena would insist – to get out. But first she gathered al the Power at her command, wrapped it into a cry, and soundlessly screamed Damon! Damon! Help! I really need you! Al she heard in return was silence. Damon! It's Bonnie! I'm at a slave warehouse! Help! Suddenly she had a hunch, and lowered her psychic barriers. She was instantly crushed. Even here, at the edge of the city, the air was choked ful of long messages and short: cries of impatience, or camaraderie, of greeting, of solicitation. Longer, less impatient conversations about things, instructions, teasings, stories. She couldn't keep up with it. It turned into a menacing wave of psychic sound that was curled like a wave about to break over her head, to crush her into a mil ion pieces. And then, all of a sudden, the telepathic melee vanished. Bonnie was able to focus her eyes on a blond girl, a little older than her and about four inches taller. â€Å"I said, are you okay?†the girl was repeating – obviously she'd been saying it for a while. â€Å"Yes,†Bonnie said automatically. No! Bonnie thought. â€Å"You might want to get ready to move. They've sounded the first dinnertime whistle, but you looked so out of it, I waited for the second one.† What am I supposed to say? Thank you seemed safest. â€Å"Thanks,†Bonnie said. Then her mouth said all on its own, â€Å"Where am I?† The blond girl looked surprised. â€Å"The depot for runaway slaves, of course.† Well, that was that. â€Å"But I didn't run away,†she protested. â€Å"I was going right back after I got a sugarplum.† â€Å"I don't know about that. I was trying to run away, but they finally caught me.†The girl slammed one fist into an open hand. â€Å"I knew I shouldn't have trusted that litter carrier. Carried me right to the authorities and me blind and without a clue.† â€Å"You mean you had the litter curtains down – ?†Bonnie was asking, when a shril whistle interrupted her. The blond girl took hold of her arm and began dragging her away from the fence. â€Å"That's the second service dinnertime whistle – we don't want to miss that, because after that they shut us up for the night. I'm Eren. Who're you?† â€Å"Bonnie.† Eren snorted and grinned. â€Å"All right by me.† Bonnie allowed herself to be led up a dirty stairway and into a dirty cafeteria. The blond girl, who seemed to regard herself as Bonnie's keeper, handed her a tray, and pushed her along. Bonnie didn't get any choice in what she was to have, not even to veto the noodles that were squirming slightly, but she did manage to snatch an extra bread rol in the end. Damon! Nobody was tel ing her not to send a message, so she kept on doing it. If she was going to be punished, she thought defiantly, she was going to be punished for trying to get out of here. Damon, I'm in a slave warehouse! Help me! Blond Eren grabbed a spork, so Bonnie did too. There were no knives. There were thin napkins, which relieved Bonnie, because that was where the Squirmy Noodles were going to end up. Without Eren, Bonnie would never have found a place at the tables, which were crammed with young girls eating. â€Å"Shove over, shove over,†Eren kept saying, until there was room for Bonnie and her. Dinner was a test of Bonnie's courage – and also of how loud she could scream. â€Å"Why are you doing all this for me?†she shouted into Eren's ear, when a lul in the deafening conversation gave her a chance. â€Å"Oh, Well, you being a redhead and all – it put me in mind of Aliana's message, you know. To the reall Bonny.†She pronounced it oddly, sort of swall owing the y, but at least it wasn't Bonna. â€Å"Which of them? Which message, I mean?†Bonnie screamed. Eren gave her an are you kidding look. â€Å"Help when you can, shelter when you have room, guide when you know where to go,†she said in a sort of impatient chant, then looked chagrined and added, â€Å"And be patient with the slow.†She attacked her food with an air of having said everything there was to say. Oh, boy, Bonnie thought. Somebody had really taken the balland run with it. Elena had never said any of those things. Yeah, but – but maybe she'd lived them, Bonnie thought, a tingling breaking out all over her body. And maybe somebody had seen her and made up the words. For instance, that crazy-looking guy she'd given her ring or bracelet or something to. She'd given her earrings away to people with signs, too. Signs that said: POETRY FOR FOOD. The rest of dinner was a matter of picking up food with the spork and not looking at it, crunching it once, and then deciding whether to spit into her Still-writhing napkin, or to try to swallow without tasting. Afterward the girls were marched into another building, this one fil ed with pal ets, smal er and not so comfortable-looking as Bonnie's at the inn. She was now horrified at herself for leaving that room. There she had had safety, she had had food that she could actual y eat, she had had entertainment – even the Dustbins were clothed in a golden glow of remembrance now – and she had had the chance of Damon finding her. Here she had nothing. But Eren seemed to have some mesmeric influence on the girls around, or else they al were Aliana-ites too, because when she shouted â€Å"Where's a pal et? I've got a new girl in my bedroom. Think she's gonna sleep on the bare floor?†And eventual y, a dusty pal et was passed hand over hand into Eren's â€Å"bedroom† – a group of pal ets al spread with the heads together in the middle. In exchange, Eren handed over the wriggling napkin Bonnie had given her. â€Å"Share and share alike,†she said firmly, and Bonnie wondered if she thought Aliana had said that, too. A whistle shril ed. â€Å"Ten minutes until lights-out,†a hoarse voice shouted. â€Å"Every girl not on her pal et in ten minutes wil be punished. Tomorrow section C goes up.† â€Å"All right! We're going to be bloody deaf before we're sold,†Eren muttered. â€Å"Before we're sold?†Bonnie repeated stupidly, even though she had known what would happen from the first moment she had recognized this as a warehouse for slaves. Eren turned and spat. â€Å"Yeah,†she said. â€Å"So you can have one more breakdown and then that's it. Only two per customer, and by tomorrow you may wish you'd saved one up.† â€Å"I wasn't going to have a breakdown,†Bonnie said, with al the courage at her command. â€Å"I was going to ask how we're going to be sold. Is it at one of those horrible public places, where you have to stand in front of a crowd in just a shift?† â€Å"Yeah, that's what most of us wil be doing,†a young girl, who had been crying quietly through dinner and the pal et-arranging time, spoke up in a soft voice. â€Å"But the ones they pick out as special items wil have to wait. They'l give us a bath and special clothes, but it's al just so we look more presentable for the clients. So the clients can inspect us more closely.†She shuddered. â€Å"You're frightening the new girl, Mouse,†Eren scolded. â€Å"We cal her Mouse, because she's always so scared,†she told Bonnie. Bonnie silently screamed, Damon! Damon was decked out in his new captain of the guard suit. It was nice, being black on black, with lighter black piping (even Damon recognized the necessity of contrast). It had a cloak. And he was a ful vampire again, as powerful and prestigious as even he could have imagined. For a moment he simply luxuriated in the feeling of a job well done. Then he flexed his vampire muscles more strongly, urging Jessalyn, who was upstairs, into deeper sleep, while he sent tendrils of Power al over the Dark Dimension, sampling what was going on in different districts. Jessalyn†¦now there was a dilemma. Damon had the feeling that he should leave her a note or something, but he wasn't quite sure what to say. What could he tel her? That he was gone? She would see that for herself. That he was sorry? Well, obviously he wasn't so sorry that he'd chosen not to go. That he had duties elsewhere? Wait. That might actual y work. He could tel her that he needed to check up on her territory and that if he were to stay here in the castle he doubted he'd ever get anything done. He could tel her he'd be back†¦soon. Soonish. Soonishly. Damon pressed his tongue against a canine and felt the prompt rewarding sharpness and length. He real y wanted to try out those legendary Black Ops vs. vampires programs. He wanted to hunt, period. Of course, there was so much Black Magic wine about the place that when he stopped a male servant and asked for some, the servant had brought a magnum. Damon had been having flutes every now and then, but what he real y wanted was to go hunting. And not to hunt a slave and certainly not an animal, and it hardly seemed fair to wander the streets on the chance that there was a noblewoman to get to know better. It was at that moment that he remembered Bonnie. In a matter of three more minutes he had everything he needed to do wrapped up, including the annual delivery of dozens of roses to the princess in his name. Jessalyn had given him a very liberal al owance, and already advanced for the first month. In a matter of five minutes he was flying, though that was very bad manners on the street, and doubly so in a market district. In a matter of fifteen minutes he had his hands around the landlady's neck, the one whom he had paid very well to make sure that exactly what had happened never happened. In sixteen minutes, the landlady was grimly offering him the life of her young and not very intel igent slave as recompense. He was Stillwearing his captain of guard suit. He could have the boy to kil , to torture, whatever†¦he could have the money back†¦ â€Å"I don't want your filthy slave,†he snarled. â€Å"I want my own back! She's worth†¦Ã¢â‚¬ Here he came to a stop, trying to calculate how many ordinary girls Bonnie was worth. A hundred? A thousand? â€Å"She is worth infinitely more – â€Å"he began, when the landlady surprised him by interrupting. â€Å"Why'd you leave her in a dump like this, then?†she said. â€Å"Oh, yes, I know what my own lodgings are like. If she was so damn precious, why'd you leave her here?† Why had he left her in this place? Damon couldn't think now. He'd been panicked, half out of his mind – that was what being human had done to him. He'd been thinking only about himself, while little Bonnie – fragile Bonnie, his little redbird – had been shut up in this filthy place. He didn't want to keep thinking about it. It made him feel searing hot and icy cold at once. He demanded that a search be made of al the neighborhood buildings. Someone had to have seen something. Bonnie had been awakened too early and parted from Eren and Mouse. She immediately had an urge to lose control, to have a breakdown at once. She was shivering al over. Damon! Help me! Then she saw a girl who couldn't seem to get up off her pal et and saw a woman with arms like a man's go over with a white ash rod to administer punishment. And then something seemed to go blank in Bonnie's mind. Elena or Meredith might have tried to stop the woman, or even this huge machine they were caught in, but Bonnie couldn't. The only thing she could do was try not to have a breakdown. She had a song stuck in her head, not even a song she liked, but it repeated endlessly over and over as the slaves around her were dehumanized, broken into mechanical, but clean, mindless bodies. She was being scrubbed mercilessly by two muscular women whose whole life doubtless consisted of scrubbing grimy street girls into pink cleanliness – at least for a night. But final y her protests led the women to actual y look at her – with her fair, almost translucent skin scrubbed raw – and concentrate instead on washing her hair, which felt as if it were being pul ed out at the roots. Final y, though, she was done and was given an adequate towel with which to dry off. Next, in what she was realizing was a giant assembly line, were kinder plump women who stripped off the towel and proceeded to put her on a couch and massage her with oil. Just when she was starting to feel better she was hustled up to have the oil removed, except that which had soaked into her skin. Women then appeared who measured her, cal ing out the numbers as they did, and by the time Bonnie had tramped to the wardrobe station, three dresses were waiting for her on a bar. There was a black one, a green one, and a gray one. I'l get the green for sure because of my hair, Bonnie thought blankly, but after she had tried al three on, a woman took the green and gray away, leaving Bonnie in a little black bubble dress, strapless, with a glittery touch of white material at the neck. Next was a giant sanitary room, where her dress was careful y covered with a white paper robe that kept ripping. She was led to a chair with a hair dryer and the rudiments of makeup, which a white-shirted woman used to put too much on Bonnie's face. Then the hair dryer was swung over her head, and Bonnie, with a stolen tissue, took off as much makeup as she dared. She didn't want to look good, didn't want to be sold. When she finished she had silvery eyelids, a touch of blush, and velvety rose-red lipstick that wouldn't wipe off. After that she just sat and finger-combed her hair until it was dry, which the ancient machine announced with a ping. The next station was a bit like the day after Thanksgiving at a big shoe store. The stronger or more determined girls managed to wrench shoes away from their weaker sisters and jammed them on one foot, only to start the process again the next minute. Bonnie was lucky. She saw a tiny black shoe that had a faintly silvery bow coming down the ramp and kept her eye on it while it passed from girl to girl until someone dropped it and then she swooped in and tried it on. She didn't know what she would have done if it hadn't fit. But it did fit, and she went to the next station to get its mate. As she sat waiting, other girls were trying on perfume. Bonnie saw two entire bottles go down the bodices of girls and wondered if they meant to sel them or try to poison themselves with them. There were also flowers. Bonnie was already dizzy with perfume and had decided not to wear any, but a tal woman bel owed over her head and a garland of freesia was pinned to frame her curls, without anyone asking her permission. The last station was the hardest to bear. She had on no jewelry and would have worn only one bracelet with the dress. But she was given two: slim unbreakable plastic bracelets, each with a number on it – her identity from now on, she was told. Slave bracelets. She had now been washed, packaged, and stamped, so that she could be conveniently sold. Damon! she cried voicelessly, but something had died inside her, and she knew now that her cal s would not be answered. â€Å"She was picked up as a runaway slave and confiscated,†the sweetshop man told Damon impatiently. â€Å"And that's al I know.† Damon was left with a feeling he didn't often have. Sickening terror. He was real y beginning to believe that this time he had cut it too fine; that he would be too late to save his redbird. That any of several dreadful scenarios might have played out before he got to her. He couldn't stand to visualize them in detail. What he would do if he didn't find her in time†¦ He reached out and without the slightest effort gripped the sweetshop man around the throat, lifting him off the floor. â€Å"We need to have a little chat,†he said, turning the ful force of his menacing dark eyes on the bulging ones of his prey. â€Å"About just how she got confiscated. Don't struggle. If you haven't hurt the girl, you've got nothing to fear. If you have†¦Ã¢â‚¬  He pul ed the terrified man completely across the counter and said very softly, â€Å"If you have, then, by al means struggle. It won't make any difference in the end – if you know what I mean?† The girls were put into the largest carriages Bonnie had yet seen in the Dark Dimension, three slim girls to a seat and two sets of seats in a carriage. She got a nasty jolt, though, when instead of going forward like a carriage, the whole thing was lifted straight up by sweaty male slaves straining at poles. It was a giant litter and Bonnie immediately snatched off her freesia garland and buried her nose in it. It had the added function of hiding her tears. â€Å"Do you have any idea of how many homes and dancing rooms and hal s and theaters there are where girls are being sold tonight?†The golden-haired Guardian looked at him sardonical y. â€Å"If I knew that,†Damon said with a cold and ominous smile, â€Å"I wouldn't be here asking you.† The Guardian shrugged. â€Å"Our job is real y only to try to keep the peace here – and you can see how well we succeed. It's a matter of too few of us; we're insanely understaffed. But I can give you a list of the venues where girls are being sold. Still, as I said, I doubt you'l be able to find your runaway before morning. And by the way, we'l have an eye on you, because of your little query. If your runaway wasn't a slave, she's Imperial property – no humans are free here. If she was, and you freed her, as reported by the baker across the street – â€Å" â€Å"Sweet-sel er.† â€Å"Whatever. Then he had a right to use a stun gun when she ran. Better for her, real y, than being Imperial property; they tend to char, if you get my drift. That level's a long way down.† â€Å"But if she was a slave – my slave†¦Ã¢â‚¬  â€Å"Then you can have her. But there's a certain mandatory punishment set before you can have her. We want to discourage this kind of thing.† Damon looked at her with eyes that made her shrink and look away, abruptly losing her authority. â€Å"Why?†he demanded. â€Å"I thought you claimed to be from the other Court. You know. The Celestial one?† â€Å"We want to discourage runaways because there've been so many since some girl named Alianna came around,†the Guardian said, her frightened pulse visible in her temple. â€Å"And then they get caught and have even more reason to try it again†¦and it wears out the girl, eventual y.† There was no one in the Great Hal when Bonnie and the others were hustled off the giant litter and into the building. â€Å"It's a new one, so it's not on the lists,†Mouse said, unexpectedly at her shoulder. â€Å"Not that many people wil know about it, so it doesn't fil up til late, when the music gets loud.† Mouse seemed to be clinging to her for comfort. That was fine, but Bonnie needed some comfort of her own. The next minute she saw Eren and, dragging Mouse behind her, headed for the blond girl. Eren was standing with her back against the wal . â€Å"Well, we can stand around like wal flowers,†she said, as a few men came in, â€Å"or we can look like we're having the best time of any of them right here by ourselves. Who knows a story?† â€Å"Oh, I do,†Bonnie said absently, thinking of the star bal with its Five Hundred Stories for Young Ones. Instantly there was a clamor. â€Å"Tel it!†Ã¢â‚¬ Yes, please tel !† Bonnie tried to think of the fairy tales that she had experienced. Of course. The one about the kitsune treasure.

Social Media, Though Relatively New,Is A Growing Part Of

Social media, though relatively new, is a growing part of everyday life. The question one must ask is: what impact does this form of communication have on global politics? Whereas social media is not always a reliable source, it serves to engage the global population in a casual manner, weaving politics into the fabric of everyday life. Social media influences not only the mundane, daily political ongoings from country to country but also political movements and revolutions. However, one must remain wary, as that this form of media is heavily biased, which can present issues for a less informed audience. Social media presents a new method of communication in which the modern citizen may participate in informal political debate,†¦show more content†¦While these types of political monologues may still take place on social media, they are not the only kind of discussion and, generally, leave room for debate between parties. With these everyday discussions surrounding politics comes influence from the general public social media provides a space to â€Å"enable a more efficient information exchange and a more egalitarian structure of communication between politicians and citizens†, rather than relying exclusively on formal methods of communication. New technological advancements, particularly in social media, have virtually severed the gap between politicians and the public, resulting in a changing political rhetoric from what was previously considered the norm. Much of a politician’s campaign and publicity now takes place online through likes, tweets, and reposts. In this fashion, Israel held their general elections in March of 2015, which the right-wing party won. Throughout the electoral campaign â€Å"right-wing politicians exhibited higher levels of activity† on social media platforms compared to the centre or left-wing parties. While left-wing supporters were highly active on line, it was not through the support of their preferred candidates. What was most commonly shared by those against the right-wing party were â€Å"posts, videos, and images attacking the incumbent right-wing Prime Minister Benjamin Netanyahu, who eventually won†. Despite being vehemently against Netanyahu and showing this through users’ onlineShow MoreRelatedThe Political Power Of Social Media1171 Words   |  5 Pagesthe concept of communication has been an integral part of society in order to express and spread ideas. However, through technological advancements and the prevalence of social media, communication has become faster and easier than before, allowing for greater involvement in activities globally. This has allowed for social media to become a method of political action because of its accessibility and speed. With the advancing processes of social media as a political force, there have been argumentsRead MoreSociety And Its Social Media1216 Words   |  5 Pagesand its Social Media Social Networking, a pinnacle of what keeps the world entertained as we know today. The economy is rapidly changing in the developing world. Now our days we see teens spending an excessive amount of time socializing through social medias such as Facebook, Twitter, Instagram, and much more. The media has a direct influence on the formation of basic skills of human interaction, which some experts can argue that social medias are having a significant part in our growing societyRead MoreSocial Media And The Misuse Of Information1641 Words   |  7 PagesSocial Media and the Misuse of Information Social media refers to the publication and dissemination of media content such as text, images and videos, through online social communications via easily reached and scalable publishing platforms such as websites, social networking sites and blogs and media aggregators. The social media was conceptualized as just a medium of interaction and virtual home to transfer or extend relationships but today social media has become a platform used to encourage misinformationRead MoreTechnological Convergence1577 Words   |  7 Pagesdefined as the interlinking of computing and other information technologies, media content, and communication networks that have arisen as a result of the evolution and popularization of the internet as well as the activities, products and services that have emerged in the digital media space. Convergence is loosely defined as the occurrence of two or more things coming together to eventually meet and or in which old and new intersects or builds upon. Although fo r the consumer convergence simply meansRead MoreEssay on How Does Facebook and Twitter Affect Social Interaction1257 Words   |  6 Pagesinstant. These technological advancements have made it easier to send a message to family and friends, create new links in a social network, and express one’s opinion about anything under the sun. With the growing popularity of the internet and social media websites, people have utilized these as new channels to express their thoughts on different political issues. Formally, social media is defined by Merriam-Webster as â€Å"forms of electronic communication through which users create online communitiesRead MoreRole Of Social Engineering Tricks On Employees Essay1448 Words   |  6 PagesThe threats, this relatively small company, will face. Since recently becoming a major player in the robotic industry, and having a break through development, that is considered a significant advancement to the industry, are considerable. The company must now consider a number of possibilities that previously may not have be an issue for them. The company will now have to consider the competition and foreign companies/countries that would utilize threats of social engineering tricks on employeesRead MoreMarketing Analysis : Digital Marketing1520 Words   |  7 Pagestechnology, marketing h as taken a bold new perspective that rivals its former self in terms of reach, effectiveness, and general appeal. Industry pundits have acclaimed new age marketing techniques as thoroughly sufficient and one through which economies stands to benefit substantially should they be employed. One such emerging offshoot is digital marketing. Digital marketing is the promotion of products, brand or services in one or more forms of electronic media. It is a departure from traditionalRead MoreEssay on Ageism: A Constant Disregard in Society1714 Words   |  7 Pagesdiscrimination such as racism, or sexism, because ageing is an inevitable part of life, and therefore everyone will be discriminated against in time. In present-day society, old age is commonly feared, and often times evaded altogether. Dying grey hairs and procedures such as Botox injections or face lifts are becoming more customary methods in which people attempt to mask their growing age from their peers. (Sachs) The media is a major reason in which people do not embrace their old age, becauseRead MoreThe Effects Of Pornographic Websites On Young Children1363 Words   |  6 PagesThe internet is one of the biggest innovations of the 21st century. It is a library full of information that would be difficult to find before its creation, as well as a hub for communication with chat rooms and social media sites. For those interested in the news, fashion, or trivia, a simple search becomes a goldmine of their interests. Unfortunately, the same is also true for sexual content. Because of the internet’s accessibility, minors can find themselves exposed to inappropriate material,Read MoreAnalysis Of Alexander Mann Solutions Inno vative Strategy1089 Words   |  5 PagesIntroduction Innovation can be defined as the introduction of a new product, process or market by an organization. According to Pearce Robinson (2011), organizations are innovative when they succeed in turning ideas into revenues. However, Petkovska (2015), states that it takes more than ideas to be innovative, firms have to invest in their time, resources as well as technology in order to bring the ideas into fruition. Firms must decide which type of innovation to focus on as there are several

Eating Disorder Essay - 2080 Words

Eating disorders are prominent within younger children mostly involving problems that arise in childhood and adolescence. Many times eating disorders could be less prevalent, but throughout today’s era eating disorders have increased significantly; the most common eating disorder, anorexia nervosa has increased three times over the past forty years (Bà ¤ck, 2011). Moreover, overweight and obesity within children and adults has increased significantly over the past twenty years (Bà ¤ck, 2011). These dramatic statistics are influenced from parent-child interactions. The relationship the parent has with their children reflects back to the child’s emotional stability. If the child has body dissatisfaction, has a low self-esteem, or is crying out†¦show more content†¦Eating disorders in young children are more apparent because of the role of attachment with their mother and father. The role of attachment within a parent-child relationship can be very important to the child’s health and especially habits. According to Zachrisson Skarderud, it has been apparent that the quality of enmeshed relationships has detrimental effects on mental health problems. The attachment styles related to parental styles, such as secure attachment, which is like the authoritative parenting style, the child knows they are safe within this context, nurtured and supported. Whereas, insecure attachment, which is, like the permissive parenting style, the child is very unhappy and their parents are not involved in their lives. According to Bowlby, secure attachment is when the parent successfully fulfills the needs of the child. Although, insecure attachment has a negative effect on the child because the parent is enable to fulfill the child’s needs. Out of all the different parenting styles and attachment styles, Schore suggests that secure attachment is the most beneficial parenting style for the child because the child develops a healthy well-balanced life. With that said, Wilfley and colleagues (1997) suggests that, insecure attachment can relate to children having low self esteem, which can result to binge eating or weight gain in order to feel comfort and cope with their emotions. Throughout previous research, insecureShow MoreRelatedEating Disorders : Eating Disorder1205 Words   |  5 PagesEating Disorders in Today’s World Eating disorders are alive and well in today’s world and they are a major problem. An eating disorder can look like a few different things, ranging from a severe reduction of food intake to over eating to feelings of negativity towards your body shape or weight (Lehigh University). While some disorders can only be found in specific age groups, races, etc., eating disorders can be found amongst all and it does not necessarily have to be pointed towards food (LehighRead MoreEating Disorders : An Eating Disorder1184 Words   |  5 Pagesas an eating disorder. Weir (2016) goes on to explain the origins behind eating disorders in individuals. This topic is important because, in the United States, many women and men suffer from a clinically significant eating disorder at some point in their life. It is important to know the influences that cause an individual to experience an eating disorder. Genetically, or environmentally, or both genetically and environmentally. Anorexia ner vosa, bulimia nervosa, and binge eating disorder are eatingRead MoreEating Disorders And Eating Disorder1573 Words   |  7 Pagesaffects people called an â€Å"eating disorder.† Why did you choose this topic? I chose this topic because it is a very prevalent issue in our society today, and a close friend of mine is suffering from an eating disorder. What question(s) did you want to answer or what was your hypothesis regarding this topic? As mammals, there is no chance of escaping the need to consume food in everyday life. However, when it comes to food there can be a major concern of eating too much or eating too little. Doing eitherRead MoreEating Disorders And Eating Disorder1104 Words   |  5 PagesEating disorder is a serious problem happens in both men and women. Eating disorder is a sort of disease in which a person is having a strange routine of eating like consuming a huge amount of food each time they eat. This can incorporate not eating enough nourishment or indulging. Eating disorder influence many people around the world. The larger part of peoples who are dealing with this issue are ladies. A person with eating disorder issue may focus nonsensically on their weight and shape. EatingRead MoreEating Disorders And Eating Disorder1410 Words   |  6 Pagesâ€Å"An eating disorder is about anxiety and control and healing from trauma and food and weight are just the tools of destruction† (Floyd, Mim ms, Yelding, 2008). An eating disorder is defined as a severe disturbance in eating behavior. An eating disorder, as defined by our text book for class, is psychological disturbances that lead to certain physiological changes and serious health complications. The three most common and most easily identifiable forms of eating disorders include anorexia nervosaRead MoreEating Disorders : Eating Disorder966 Words   |  4 PagesEating Disorders Many people, both women and men of all ages, suffer from the psychological disorder, eating. Up to thirty million people in the world suffer from some kind of an eating disorder. There a two types of eating disorders, anorexia and bulimia, and have several methods of treatment. What is an eating disorder, and what do they cause? Eating disorders are maladaptive and very serious interruptions in eating. They can come in the form of overeating, or not eating enough, they are oftenRead MoreEating Disorders And Eating Disorder1496 Words   |  6 PagesAn eating disorder is an illness that causes serious disturbances to your everyday diet, such as eating extremely small amounts of food or severely overeating. A person with an eating disorder may have started out just eating smaller or larger amount of food, but as some point, the urge to eat less or more has gotten out of control. Severe distress or concern about body weight or shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and a binge-eatingRead MoreEating Disorders : Eating Disorder1031 Words   |  5 Pagesâ€Å"The eating disorder is a very jealous and abusive partner. It requires a lot of devotion in the extent that you have to devote yoursel f to tending to the anorexia. There s not a lot of time left over for adult life,† was stated by Dr. Doug Bunnell, a specialist in eating disorders. Eating disorders effect a variety of people. Age, race, and gender aren’t role playing keys in eating disorders. Not everyone gets an eating disorder, but if they do then, it will more than likely destroy their livesRead MoreEating Disorders : An Eating Disorder1906 Words   |  8 Pagesobtain their body goal, thus causing an eating disorder. An eating disorder is a psychological condition that is characterized by abnormal or disturbed eating habits. There are three types of eating disorders; which are Anorexia Nervosa, Bulimia Nervosa, and Binge Eating.These disorders affect all aspects of a person’s life, including their psychological, emotional, and physical health. There are many factors that contribute to individuals developing eating disorders including: genetics, family pressuresRead MoreEating Disorders : Ea ting Disorder1235 Words   |  5 PagesEating Disorders Eating disorders are a very serious psychological condition that affects your mind so that you are more focused on your food and weight than you are on everything else. The most known and most commonly diagnosed eating disorders are anorexia, bulimia, and binge eating disorder; however, these are not the only eating disorders. Eating disorders cause psychical and psychological problems, which at their worst can even become life threating. Statistics show that more women are affected