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Analytic note: The HIV epidemic remains a major public health problem in the EU, though the number of HIV infections has ceased to increase. Heterosexually-transmitted HIV infection accounts for the second largest number of people with HIV in Europe. A considerable proportion of these HIV cases are among migrants, largely from sub-Saharan Africa. This article describes the epidemiology of HIV and AIDS among migrants in 27 European Union (EU) countries, plus Norway and Iceland from 1999 to 2006. The article indicates that migrants from sub-Saharan Africa represent a high proportion of HIV and AIDS in the EU. The main mode of transmission in this group is through heterosexual transmission. Its conclusion gives a base for our study.

Source excerpt: Migrant populations, largely Sub-Saharan Africans, represented a considerable and growing proportion of both AIDS cases and HIV infections reported in the 27 EU countries, Norway and Iceland during 1999–2006. The drop in AIDS cases observed in native populations is seen only in migrants from Western countries, while in migrants from other geographical origins increases are seen. The contribution of migrants to the AIDS and HIV epidemics is notably higher among female reports, in particular for women from SSA. Closely linked to the high burden of HIV infection in women from SSA is the high proportion of migrants from SSA among MTCH HIV reports. Although the largest proportion of migrants is, by far, among heterosexually acquired HIV and AIDS reports, a significant percentage of diagnoses in MSM are also migrants, largely from Western Europe and Latin-America and North-Africa and Middle East. A higher proportion of migrants developed TB as their initial ADC compared with natives; people from SSA and Eastern Europe had the highest prevalence of TB, closely followed by people from Southeast Asia.

Full Citation: Del, A. J., Likatavicius, G., Perez-Cachafeiro, S., Hernando, V., Gonzalez, C., Jarrin, I. et al. (2011) The epidemiology of HIV and AIDS reports in migrants in the 27 European Union countries, Norway and Iceland: 1999–2006. European Journal of Public Health 21(5), 620–626. https://doi.org/10.1093/eurpub/ckq150

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Analytic note: Healthcare providers are known to be a vital source of stigma and discrimination, which impacts the lives of persons living with HIV and AIDS. This study examines rates and drivers of stigma and discrimination among doctors, nurses and ward staff in different urban healthcare settings in high HIV prevalence states in India. It uses a cross-sectional research method. In correlation with previous studies in SSA and Jordan, the study finds high stigma and discrimination among doctors, nurses and other auxiliary medical staff towards people living with HIV and AIDS in India. This article reiterates that the high rates of stigma and discrimination among healthcare providers in these urban Indian healthcare settings appear to be driven primarily by negative feelings towards PLHIV, lack of experience, as well as misconceptions and fear of casual transmission. This article is very relevant with regards to the aim of our study, for it confirms the existent stigma and discrimination among health care providers in healthcare settings in resource-rich as well as resource-limited regions.

Source excerpt: Unfortunately, health professionals are often named as one of the most important sources of stigma for PLHIV. In sub-Saharan Africa, studies have documented discriminatory practices, including patient neglect, provision of differential treatment based on HIV status, denial of care, breach of confidentiality, isolation and verbal abuse by healthcare staff. High rates of refusal of care have also been reported among nurses in Jordan and stigma and discrimination have been documented in some healthcare settings in India also.

Full Citation: Ekstrand, M. L., Ramakrishna, J., Bharat, S. & Heylen, E. (2013) Prevalence and drivers of HIV stigma among health providers in urban India: implications for interventions. Journal of the International AIDS Society 16(3) (Supplement 2), 18717. doi: 10.7448/IAS.16.3.18717.

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Analytic note: AIDS-related stigma and discrimination remains a pervasive problem in health care institutions worldwide. Previous studies have demonstrated that AIDS-related stigma is a common phenomenon worldwide that occurs in a variety of contexts, including the family, community, workplace, and health care settings. This article discusses the effectiveness of a stigma-reduction intervention, with the goals of reducing discriminatory practices and improving quality of care for people living with HIV/AIDS in India. A mixed-method research is used and the study findings highlight issues peculiar to the health care sector in limited-resource settings. Strikingly, these findings mirrored in our study, done in a resource-rich context, confirm that HIV/AIDS-related stigma and discrimination in healthcare settings persist, despite progress made with various stigma-reduction interventions.

Source excerpt: The health care setting is a particularly conspicuous context for HIV/AIDS-related stigma and discrimination. In this context people living with HIV or AIDS (PLWHA) often discover their status, and it is where people living with HIV have the potential to gather information about how to care for themselves and prevent transmission to others, as well as get treatment and care. Because of stigma, there have been various reports of HIV positive people receiving inferior care or being denied care altogether (Ogden & Nyblade, 2005). For example, health care workers are influenced by the attitudes of the greater society, and prevailing negative attitudes can result in discrimination. In India, a country with an estimated HIV/AIDS. While AIDS-related stigma in health facilities has become better understood over the years, it is only recently that responses are moving beyond documenting negative experiences to implementing interventions. The findings reported on in this paper highlight that stigmatizing attitudes and discriminatory behaviors towards people living with HIV/AIDS are big challenges in hospitals in India, and that there are particular issues in this limited resource setting that are often not taken into account in global discussions about HIV-related stigma in the health care sector.

Full Citation: Mahendra, V. S., Gilborn, L., Bharat, S., Mudoi, R., Gupta, I., George, B. et al. (2007) Understanding and measuring AIDS-related stigma in health care settings: a developing country perspective. SAHARA Journal 4(2), 616–625. https://doi.org/10.1080/17290376.2007.9724883

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Analytic note: This article uses questionnaires to investigate the existence of discriminatory practices in the health sector that affect the health and well-being of people living with HIV/AIDS in Nigeria, the readiness of health workers and institutions to treat people living with HIV/AIDS and examine factors that may contribute to discriminatory practices. The author suggests that a majority of healthcare professionals are involve in discriminatory and stigmatizing attitudes and behaviors. Many of the healthcare professionals breach confidentiality and demonstrate unethical behavior. Though this study was conducted in Nigeria, it is relevant to the focus of our paper. The author recognizes the fact that a qualitative research is needed to understand the root causes of discrimination and stigmatization of people living with HIV/AIDS and what incites people, including healthcare professionals, to discriminate.

Source excerpt: The study suggests that a significant number of health-care professionals engage in discriminatory and unethical behavior. Some professionals reported giving confidential information to other people (family members and unrelated individuals) without the patient's consent. Despite these discriminatory attitudes, an optimistic finding is that most health-care professionals expressed an interest in additional information and suggested education and counselling as a way to address discriminatory behaviors by their colleagues.

Full Citation: Letamo, G. (2005) The discriminatory attitudes of health workers against people living with HIV. PLoS Medicine 2(8), e261. https://doi.org/10.1371/journal.pmed.0020261

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Analytic Note (Source 1): Stigma is still perceived as a major limiting factor in HIV/AIDS prevention and care. HIV/AIDS stigma and discrimination continue to influence people living with and affected by HIV disease as well as their health care providers, wherever they live. This review article discusses HIV/AIDS stigma, the impact of AIDS stigma and how healthcare providers can help to manage HIV/AIDS stigma in South Africa. In defining stigma, authors look into different definitions of stigma by various authors and make particular allusion to Goffman’s definition of stigma as ‘an attribute that is deeply discrediting within a particular social interaction’, as a ‘spoiled social identity’ and ‘a deviation from the attributes considered normal and acceptable by society. On the impact of AIDS stigma, the article gives an insight into the fear of, and the stigma associated with, HIV were significantly related to the HIV-affected person’s decision to not seek timely healthcare services. This article provided a base for our study.

Analytic Note (Source 2): According to the late Jonathan Mann, the former WHO Head of Global Program on AIDS recognized stigma, discrimination, blame, and denial as potentially the most difficult aspects of HIV/AIDS to address. This article summarizes the key contributions of the Horizons stigma research portfolio to describing the drivers of stigma, identifying effective interventions and approaches for reducing stigma in different settings, and improving methods for measuring stigma. Horizons developed and implemented a wide range of activities in collaboration with numerous local and international partners in Africa, Asia, and Latin America. This article is cited to corroborate the existence of stigma and discrimination in different settings including healthcare.

Analytic Note (Source 3): This article reflects on the progress over the last 30 years with respect to older and more emergent forms of education concerning HIV and AIDS. This education includes treatment education, HIV prevention education, and education to encourage positive and supportive community response. The article emphasizes on the careful analysis of different forms of HIV-related education, the consequences, effects and identifying specific effectivity of HIV-related education in order to achieve positive outcomes. The article also discusses new ways of seeing and understanding the need to support processes that “think” ahead of the epidemic. This article does not discuss HIV educational strategies that may reduce stigma and discrimination in healthcare settings in the globalized world. However, this article is relevant, though not the basis of our research, because it highlights the difficulty to provide HIV education to stigmatized and discriminated groups after more than 30 years since the start of the epidemic. Giving the negative social responses to HIV and AIDS, education is vital in contributing to a positive response. Individual and community empowerment are the necessary mechanisms by which social inclusion can be promoted.

Source Excerpt (Source 1): Other researchers have reported that health care personnel knew very little about the potential for HIV contamination in the workplace. In Kuwait, some family doctors knew less than they should have about HIV and looked upon AIDS patients negatively, even in the third decade of the AIDS pandemic. Similarly, AIDS stigma and discrimination continue to influence people living with and affected by HIV disease as well as their health care providers, particularly in southern Africa where the burden of AIDS is so significant. Stigma is perceived as a major limiting factor in primary and secondary HIV/AIDS prevention and care. Similar to the findings of Adebajo, Bamgbala and Oyediran (2003) in Nigeria, the results in Kuwait showed that nurses and laboratory technicians also had negative attitudes toward AIDS patients. Health care workers’ poor attitudes and inadequate care in these anecdotal reports could be related to stigma. This argument was reaffirmed in our study.

Source Excerpt (Source 2): Horizons and partners recognized from the outset that to improve the environment for people with HIV in health-care settings, it was important for management and health providers to acknowledge that stigma exists in their facilities. They found that a participatory approach that included ongoing sharing of data about levels and types of stigma in institutions helped build staff and management support for stigma-reduction activities

Source Excerpt (Source 3): “As we approach the 30th anniversary of the date on which AIDS was first identified, it is salutary to reflect on progress made in tackling the epidemic. This is especially so in relation to education and HIV, a field that is laden with possibilities but one that has in many ways eluded its potential. Despite these difficulties, education in a variety of forms holds the potential to arrest and turn back the three epidemics (Mann, 1987) to which HIV has given rise: (a) the epidemic of AIDS, which has caused untold harm through serious illness and death; (b) the epidemic of HIV, in many ways silent, unseen, and often unknown; and (c) the epidemic of fear, shame and denial that has led people living with HIV to be stigmatized, ostracized, discriminated against, and denied their human rights”.

Full Citation (Source 1): Holzemer, W. L. & Uys, L. R. (2004) Managing AIDS stigma. SAHARA Journal 1(3), 165–174. doi/pdf/10.1080/17290376.2004.9724839

Full Citation (Source 2): Pulerwitz, J., Michaelis, A., Weiss, E., Brown, L. & Mahendra, V. (2010) Reducing HIV-related stigma: lessons learned from Horizons research and programs. Public Health Reports 125(2), 272–281. doi: 10.1177/003335491012500218

Full Citation (Source 3): Aggleton, P., Yankah, E. & Crewe, M. (2011) Education and HIV/AIDS-30 years on. AIDS Education and Prevention 23(6), 495–507DOI: 10.1521/aeap.2011.23.6.495

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Analytic Note (Source 1): Most African cultures influence health and well-being.The authors use focus group discussions to explains migrant people’s understandings and experiences of healthcare services in the UK and in their home country. Access to, and use of, biomedical, alternative, and traditional sources of treatment were also discussed. The authors argue that patient-doctor relationships can be heavily influenced by the perceived legitimacy of different forms of medical knowledge, communication and treatments and by culturally influenced ideas regarding health, wellbeing and agency among African migrants. Our findings confirms the influence of culture on health.

Analytic Note (Source 2): The process and patterns of HIV disclosure differ in different settings. This article reviews literature that underscores the need for a careful review of the evidence on disclosure, an examination of individual motivations and experiences around disclosure, an assessment of the role of health workers, and a better understanding of the societal determinants and consequences of disclosure in diverse settings.

Analytic Note (Source 3): HIV status disclosure is vital to public health as a preventive measure to reduce and prevent HIV transmission and eventually enhance treatment.This article describes the role of health-care workers in Central and Nairobi provinces in Kenya in facilitating disclosure in the contexts of voluntary counselling and testing and provider-initiated testing and counselling and includes a discussion on how participants perceive and experience disclosure as a result. This article is relevant to our study because it focuses on disclosure, which was found to be a major concern in our study.

Source Excerpt (Source 1): This is of considerable significance in the case of HIV, since it affects a disproportionate number of black African migrants in relation to the white population of the UK, and requires adherence to carefully monitored and individualized anti-retroviral treatment regimens in order to help prevent the development of drug resistant strains and ultimately, death. At the same time, delays in getting affordable and consistent sources of ART to many parts of Africa have meant that historically, relatively few people from affected countries have been able to rely upon such forms of biomedicine and have been placed in situations in which it is arguably entirely rational to seek out alternative forms of treatments. Indeed, such treatments are often integral to African cosmologies which regard many types of ill health as having environmental or spiritual, rather than purely biomedical aetiologies, and many of which have been found to be effective in peoples’ own or shared experiences via the provision of physical and/or psychological relief.

Source Excerpt (Source 2): A main goal of this review was to assess the extent to which health facilities and health workers facilitated disclosure. We found that health worker facilitation of disclosure was limited by the potential for discrimination at health facilities, the limited counselling abilities of many health workers, and health workers’ own fears and concerns regarding HIV. The relatively high frequencies of health workers disclosing people's HIV status without their consent and the low levels of partner disclosure, particularly in less developed countries, testify to the difficult balance between encouraging disclosure and keeping HIV status confidential. Health workers on the front lines need support as they negotiate these complicated situations.

Source Excerpt (Source 3): The quote below from a Central Province woman demonstrates some of the problems that arise from obligatory disclosure: “First, I didn’t want people to know I am HIV positive. But what I really did not like was being told to disclose to someone before being started on ARVs. I was told I have to tell someone I am HIV positive. It was a painful decision, but I ended up telling my aunt ... she was very shocked. I went to her house and told her I wanted to see her on some private issue. We went to her bedroom and I told her I was tested HIV positive and they needed someone who knows about my status as a guarantor at the clinic before I am started on treatment. She was shocked and was quiet for some time. I told her that I was not going to disclose to her but the clinic required that I disclose to someone and go with the person to the clinic before I was started on ARVs. She still kept quiet, and then I asked her if she would agree to come with me to the clinic. She did not talk and I left. But a few minutes after arriving at my home, my aunt came to my house and told me she had accepted to come with me to the clinic”.

Full Citation (Source 1): Thomas, F., Aggleton, P. & Anderson, J. (2010) 'Experts', 'partners' and 'fools': exploring agency in HIV treatment seeking among African migrants in London. Social Science & Medicine 70(5), 736–743. https://doi.org/10.1016/j.socscimed.2009.10.063

Full Citation (Source 2): Obermeyer, C. M., Baijal, P. & Pegurri, E. (2011) Facilitating HIV disclosure across diverse settings: a review. American Journal of Public Health 101(6), 1011–1023. doi: 10.2105/AJPH.2010.300102

Full Citation (Source 3): Moyer, E., Igonya, E. K., Both, R., Cherutich, P. & Hardon, A. (2013) The duty to disclose in Kenyan health facilities: a qualitative investigation of HIV disclosure in everyday practice. SAHARA Journal 10 (Supplement 1), S60–S72. http://dx.doi.org/10.1080/02664763.2012.755339

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Analytic Note: It is evident in literature that healthcare workers perpetrate discrimination towards people living with HIV and AIDS. This paper uses questionnaires to examine the extent to which people living with HIV in London reported being discriminated against because of their infection. It also identifies factors associated with reporting HIV-related discrimination. This report asserts that discrimination by healthcare providers working with the National Health Services in London towards living with HIV persist. This article is relevant to our paper as it highlights the existence of HIV-related stigma and discrimination in healthcare settings.

Source Excerpt: In a diverse sample of people living with HIV surveyed in London in 2004 or 2005, nearly a third said they had been discriminated against because of their HIV infection. Of those who reported HIV-related discrimination, almost a half said this had involved a health care worker including dentists, general practitioners (ie primary care physicians) and hospital staff outside the HIV clinic. Overall, one-in-seven people living with HIV in our survey said they had been discriminated against by a health care worker because of their HIV status. While a number of studies in the USA and Australia have documented discrimination against HIV-infected people by health care staff.

Full Citation: Elford, J., Ibrahim, F., Bukutu, C. & Anderson, J. (2008) HIV-related discrimination reported by people living with HIV in London, UK. AIDS Behavior 12(2), 255–264. http://dx.doi.org/10.1007/s10461-007-9344-2

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Analytic Note: The cultural background and ethnicity of a person may engender prejudice and discrimination. Although HIV/AIDS as a disease can be considered a biomedical concept that is universally applicable, HIV/AIDS is always experienced in a particular socio-cultural context. The disease is experienced and interpreted differently by individuals within their particular cultural background. This article explores the cultural context of HIV positive women's perceptions of stigma in health care settings in Western Cape, South Africa using qualitative focus group discussions methods. Only the abstract of this article was consulted due to limited access to this article. Consistent with results of previous studies, and confirmed by the findings of our study, the abstract highlights the need to consider cultural context in delivering care to women living with HIV/AIDS in order to reduce HIV/AIDS-related stigma and discrimination in health care settings.

Source Excerpt: We explored the cultural context of HIV positive women's perceptions of stigma in health care settings in Western Cape, South Africa. We conducted seven focus groups with women living with HIV/AIDS in Gugulethu and Khayelitsha. We used deductive/inductive approaches to identify themes. Fifty-one women participated, with ages ranging from 18 to 47. Using the PEN-3 model as a guide, we detected these emergent themes: expectation of care (perceptions), care delivery protocols (enablers), and physical environment (nurturers). We recommend that the cultural context in which care is delivered to women living with HIV/AIDS be considered in efforts to reduce and eliminate HIV/AIDS-related stigma in health care settings

Full Citation: Okoror, T. A., Belue, R., Zungu, N., Adam, A. M. & Airhihenbuwa, C. O. (2014) HIV positive women's perceptions of stigma in health care settings in Western Cape, South Africa. Health Care Women International 35(1), 27–49. https://doi.org/10.1080/07399332.2012.736566

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Analytic Note: This is a qualitative study on the experiences of sub-Saharan African (SSA) migrant women living and aging with HIV/AIDS in Belgium. The author demonstrates that a majority of sub-Saharan African migrant women living with HIV/AIDS in Belgium refused to participate in this study because of fear of disclosing their HIV/AIDS status. Despite significant advances in treatment and care, HIV/AIDS remains life-threatening and life-changing, and new challenges continue to arise for HIV/AIDS women and SSA migrant women in particular throughout their lives. The high rate of refusal highlights the extent to which most HIV-infected women still want to keep their HIV positive status secret. Most of the women who refused to be interviewed informed the care providers that they did not want to discuss their illness out of the medical realm. However, some were willing to be interviewed if it was a European conducting the study. Most believed that by participating, their identities would be disclosed to members of the diaspora, and family and friends in their home countries. These reasons further depict the mistrust and confidentiality concerns present among the SSA communities.

Source Excerpt: Of the 116 patients invited to participate in the study 44 agreed to be interviewed and/or observed.

The main reasons why participants want to keep their HIV positive diagnosis secret are: fear of stigma and discrimination, shame, fear of disrupting relationships, rejection, violence and abandonment. Concerns about confidentiality and distrust of other SSA migrants living in Belgium as well as their compatriots in Africa was also evoked as fueling the determination to hide their HIV status.

Full Citation: Arrey, A.E. (2016): Experiences of sub-Saharan African Migrant Women Living and Aging with HIV in Belgium: an ethnographic study. VUBPRESS, Brussels University Press

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Analytic Note (Source 1): Qualitative research aims to address questions concerned with developing an understanding of the meaning and experience in human lives and social environment. Qualitative data are a source of grounded data with rich description and explanation of processes in identifiable local contexts. This book is relevant to our research as it addresses the need of qualitative researchers to share the explicit methods they use to collect, analyze and interpret data. Qualitative researchers need methods that are credible, dependable and replicable.

Analytic Note (Source 2): This is a book review on qualitative research methods. The book review offers an overview of what qualitative research is about. The author of this review is one of the authors of the book “In-depth Interviewing: Researching People” relevant in the use of in-depth interviewing employed in our larger study.

Source Excerpt (Source 1): Analytically, some points are notable. First, ethnographic methods tend toward the descriptive. The analysis task is to reach across multiple data sources (recordings, artifacts and dairies) and to condense them with somewhat less concern for the conceptual or theoretical meaning of these observations. Of course, in deciding what to leave in, what to highlight, what to report first and last, what to interconnect, and what main ideas are important, analytic choices are being made continuously. Social anthropologist are interested in the behavioral regularities in everyday situations language use, artifacts, rituals, relationships. These regularities are often expressed as “patterns” or “languages” or “rules”, and they are meant to provide the inferential keys to culture or society under study. As Van Maanen (1979) put it, the prime analytic task is to “uncover and explicate the ways in which people in particular (work) settings come to understand, account for, take action and otherwise manage their day to day situation.” This “uncovering” and “explicating” is typically based on successive observations and interviews, which are reviewed analytically to guide the next move in the field. (Page 20)

Source Excerpt (Source 2): In summary, this is a useful book for the beginner public health researcher who wants to learn about how to use qualitative research, be better informed about reading qualitative articles, or a better reviewer of qualitative grant applications. I also recommend it as a textbook for students studying research methods

Full Citation (Source 1): Miles, M. J. & Huberman, A. M. (1994) Qualitative Data Analysis: An Expanded Source Book, 2nd edition. Sage Publications, Thousand Oaks, CA.

Full Citation (Source 2): Minichiello, V. (2006) Book reviews: qualitative research methods. Australian and New Zealand Journal of Public Health 30(2), 190–196.

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Analytic Note (Source 1): In qualitative research, the researcher systematically watches people and events to find out about behaviors and interactions in natural settings. It epitomizes the idea of the researcher as the research instrument. It involves "going into the field"--describing and analyzing what has been seen. In health care settings this method has been insightful and illuminating, but it is not without pitfalls for an unprepared researcher. Our research used observational methods as one of the data collection methods. Observations were conducted allowing the researcher to interact socially with the participants in order to observe and understand them.

Analytic Note (Source 2): As qualitative methods are experiencing increasing popularity in consumer research, methods are being introduced from other disciplines, particularly anthropology and sociology. Ethnography has received attention as a promising consumer research method, although it has yet to achieve mainstream status within the discipline. The aim of this type of research is to see the world through the eyes of the members of the culture being examined. This paper discusses the compatibility of ethnography with the grounded theory method of theory induction as employed in sociology, anthropology and other disciplines. In examining stigma and discrimination, we looked into the culture (ethnography) of the study participants for a better understanding (grounded theory) of how stigma and discrimination is perceived by this group to generate patterns..

Source Excerpt (Source 1): The term "observational methods" seems to be a source of some confusion in medical research circles. Qualitative observational studies are very different from the category of observational studies (non-experimental research designs) used in epidemiology, nor are they like the clinical observation of a patient. Observational methods used in social science involve the systematic, detailed observation of behavior and talk: watching and recording what people do and say. Goffman neatly captured this distinct research method with his recommendation that, in order to learn about a social group, one should "submit oneself in the company of the members to the daily round of petty contingencies to which they are subject."' Thus, observational methods can involve asking questions and analyzing documents, but the primary focus on observation makes it distinct from a qualitative research interview (see the next paper in this series) or history taking during patient consultation. Another crucial point about qualitative observation is that it takes place in natural settings not experimental ones; hence, this type of work is often described as "naturalistic research."

Source Excerpt (Source 2): Ethnography can provide in-depth understandings of the ways in which consumers buy and use specific items, while also providing insights into consumption in general. The grounded theory method can generate substantive theories of behavior, thus supplying a means of extending or validating existing consumer behavior theories. It is suggested here that these two methods combined may produce a level of detail and interpretation that is unavailable from other methodologies. Further applications of the combination of ethnography and grounded theory, beyond the limited forays outlined here, are required to further explore the compatibility of these methods and to assess the potential of the combined approach.

Full Citation (Source 1): Mays, N. & Pope, C. (1995) Qualitative research: observational methods in health care settings. British Medical Journal 311(6998), 182–184. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2550229/pdf/bmj00601-0048.pdf

Full Citation (Source 2): Pettigrew, S. F. (2000) Ethnography and grounded theory: a happy marriage? Advances in Consumer Research 27, 256–260. http://acrwebsite.org/volumes/8400/volumes/v27/NA-27

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Analytic Note: In Belgium, HIV is concentrated among two main groups namely: predominately heterosexual Sub- Saharan African migrants and men having sex with men (MSM). Epidemiological surveillance of HIV infection and AIDS has been ongoing since 1985 and is based on the registration of new HIV diagnoses and new cases of AIDS by the Scientific Institute of Public Health. Since 2006, this surveillance is reinforced by collecting data from HIV infected patients in medical follow-up in Belgium: the Belgian HIV cohort. This report is important to our research because it provides the official 2015 epidemiological situation of HIV/AIDS among heterosexuals in Belgium.

Source Excerpt: La transmission par contact hétérosexuel est principalement rapportée par des personnes d’Afrique subsaharienne. Parmi les personnes hétérosexuelles diagnostiquées en 2015, 45 % (N=148) sont de nationalités africaines subsahariennes, 32 % (N=105) de nationalité belge, 14 % (N=47) de nationalités européennes et 9 % (N=30) d’autres nationalités. Les femmes représentaient en 2015, 74 % des diagnostics posés chez des hétérosexuels d’Afrique subsaharienne et 54 % chez des hétérosexuels de nationalité belge.

Source Excerpt Translation: Heterosexual contact transmission is mainly reported by people in sub-Saharan Africa. Of the heterosexual persons diagnosed in 2015, 45% (N = 148) are of sub-Saharan African nationality, 32% (N = 105) of Belgian nationality, 14% (N = 47) of European nationalities and 9% (N = 30) other nationalities. In 2015, women accounted for 74% of diagnoses among heterosexuals in sub-Saharan Africa and 54% among heterosexuals of Belgian nationality. (Google free translation).

Full Citation: Sasse, A., Van Beckhoven, D. & Verbrugge, R. (2015) Epidemiology of AIDS and HIV infection in Belgium. Scientific Institute of Public Health, Brussels, Belgium. URL: https://www.wiv-isp.be/pages/en-home.aspx accessed on 25-01-2016.

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Analytic Note: Globally, health disparities may result in experiences of discrimination, especially among vulnerable groups. This article examines through a cross-sectional study whether foreign-born persons are more likely to report discrimination in healthcare than U.S.-born persons in the same race/ethnic group, whether the immigration effect varies by race/ethnicity, and whether the immigration effect is "explained" by socio-demographic factors. This article highlights that migrants were more likely to report discrimination than U.S.-born persons adjusting for race/ethnicity. It concludes by proposing that immigration status should be included in studies of healthcare disparities because birth is a key determinant of discrimination experiences. Information in the abstract supplements information on discrimination in healthcare settings, the focus of our paper. The full paper is not accessible because of the copyright clause. However, the abstract gives an inside insight of the perception of discrimination in healthcare settings.

Source Excerpt: U.S. healthcare disparities may be in part the result of differential experiences of discrimination in health care. Previous research about discrimination has focused on race/ethnicity. Because immigrants are clustered in certain racial and ethnic groups, failure to consider immigration status could distort race/ethnicity effects. We examined whether foreign-born persons are more likely to report discrimination in healthcare than U.S.-born persons in the same race/ethnic group, whether the immigration effect varies by race/ethnicity, and whether the immigration effect is "explained" by sociodemographic factors. Seven percent of blacks and Latinos and 4% of Asians reported healthcare discrimination within the past 5 years. Immigrants were more likely to report discrimination than U.S.-born persons adjusting for race/ethnicity. For Asians, only the foreign-born were more likely than whites to report discrimination. For Latinos, increased perceptions of discrimination were attributable to sociodemographic factors for the U.S.-born but not for the foreign-born. Speaking a language other than English at home increased discrimination reports regardless of birthplace; private insurance was protective for the U.S.-born only. Immigration status should be included in studies of healthcare disparities because nativity is a key determinant of discrimination experiences for Asians and Latinos.

Full Citation: Lauderdale, D. S., Wen, M., Jacobs, E. A. & Kandula, N. R. (2006) Immigrant perceptions of discrimination in health care: the California Health Interview Survey 2003. Medical Care 44(10), 914–920. doi: 10.1097/01.mlr.0000220829.87073.f7

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Analytic Note (Source 1): The face of HIV in Western Europe is changing, as it mirrors the predominantly heterosexual pattern of the disease in sub-Saharan Africa (SSA). Sub-Saharan African migrants are disproportionately affected by HIV in Western Europe and wherever they live. This article discusses the barriers to HIV testing for black Africans living in the UK and the Netherlands. The authors identify access to testing and care, fear of death and disease and fear of stigma and discrimination in the community as cultural, social and structural barriers to testing for HIV. In addition, the lack of political will, restrictive immigration policies and the absence of African representation in decision-making processes as important factors preventing black Africans from testing. This study contributed in formulating the basis of our research.

Analytic Note (Source 2): Migration and HIV are often linked in literature. This report discusses monitoring migrant health, migrant-friendly health services, policy and legal frameworks on migrant health and partnerships, networks and multi-country frameworks. In the report, it addresses the HIV vulnerabilities of migrant population in western industrialized countries. This report is cited to support the relationship between HIV and migration.

Source Excerpt (Source 1): Across Western Europe, the face of the HIV epidemic is changing, reflecting patterns of disease in sub-Saharan Africa (SSA). Although the predominant mode of transmission within Western Europe is sex between men, countries have seen increases in new HIV diagnoses among heterosexuals originating from countries with generalized epidemics. In 2005 in the European Union (EU), nearly half (46%) of heterosexually acquired HIV infection was diagnosed among immigrants, primarily from SSA, and most infections were acquired outside the EU. Late diagnosis (diagnosis with an AIDS-defining illness or a CD4 count of <200 cells/μL) is common among migrants in Western Europe. The associated impact on individual morbidity and mortality means that migrant black Africans continue to be disproportionately affected. In this paper we discuss the barriers to HIV testing for sub-Saharan migrants, with particular emphasis on the experience in the UK and the Netherlands.

Source Excerpt (Source 2): Migrants from countries with generalised HIV epidemics who live in the EU are disproportionately affected by HIV. In 2010, 27 116 newly diagnosed cases of HIV infection were reported by 28 (of the 30 total) countries of the EU/EEA. In 2010 in the EU/EEA, the predominant mode of transmission for HIV infection was MSM (38 per cent of the reported cases), followed by heterosexual contact. In total, around 35 per cent of the new heterosexual HIV diagnoses in the EU were diagnosed in individuals originating from countries with generalised epidemics, primarily sub-Saharan Africa, ranging from very low levels in the eastern parts of the EU to approximately 60 per cent in Belgium, Sweden, and the United Kingdom. These percentages are most likely to be an underestimate of the true figures. Although migrants from countries with generalised HIV epidemics represent many of the HIV cases in the EU, more than 60 per cent of heterosexuals from generalised epidemic countries present at a stage in their illness when they are already in need of antiretroviral therapy, with a CD4 count of less than 350 copies/mL.

Full Citation (Source 1): Fakoya, I., Reynolds, R., Caswell, G. and Shiripinda, I. (2008), Barriers to HIV testing for migrant black Africans in Western Europe. HIV Medicine, 9: 23–25. doi:10.1111/j.1468-1293.2008.00587.x

Full Citation (Source 2): ECDC (2012) Responses to HIV and Migration in Western Industrialized Countries: Current Challenges, Promising Practices, Future Directions. European Centre for Disease Control, Stockholm. URL: http://www.ecdc.europa.eu/en/publications/publications/hiv-migration-meeting-report.pdf accessed on 11-02-2013.

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Analytic Note: For some reasons migrants, especially from resource-limited regions, have increased vulnerability to infectious diseases and face multiple barriers to healthcare. The article explores the views of new migrants around barriers, accessibility, and acceptability of screening for HIV, tuberculosis, hepatitis B, and hepatitis C in the UK, a resource-rich setting similar to the setting (Belgium) in our study. Similar to our study, this paper confirms the vulnerability of migrants, especially from sub-Saharan Africa to infectious diseases including HIV and AIDS. Moreover, barriers that discourage uptake of screening include disease-related stigma present in their own communities and services being perceived as non-migrant friendly are also present in our study. Most migrants are likely to be disproportionately affected by these barriers, with implications for health status, as reiterated in our study.

Source Excerpt: In the past decade the UK in particular has received a sizeable and increasing number of new migrants, which has had important implications for public health services. Infectious diseases are believed to be the key health issue for new migrants from high-prevalence countries, with asylum seekers and refugees considered to be particularly affected. Migrants bear the largest burden of infectious disease in the UK; approximately 70% of newly diagnosed UK tuberculosis (TB) and 60% of new HIV cases are in migrants, with comparable trends expected for hepatitis B and C. London now has the highest tuberculosis rate among all capital cities in western Europe. Numerous factors contribute to the vulnerability of new migrants to infectious diseases, with migrants - and ethnic minorities more broadly - known to face barriers to healthcare, which may result in delays to screening and diagnosis. Tackling infectious diseases may raise specific issues, including stigma and fear of discrimination. New migrants may be particularly affected in terms of their ability to access and benefit from screening programmes for infectious disease as they attempt to navigate a new health system.

Full Citation: Seedat, F., Hargreaves, S. & Friedland, J. S. (2014) Engaging new migrants in infectious disease screening: a qualitative semi-structured interview study of UK migrant community health-care leads. PLoS One 9(10), e108261. https://doi.org/10.1371/journal.pone.0108261

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Analytic Note: Literature documents poor relationship between drug users and therapeutic staff. This article examines consumer projects introduced in three Australian drug treatment services. The title of the article ‘We are people too’ depicts the vulnerability of this group of persons, similar to the group (migrant women with HIV/AIDS) in our study.

Source Excerpt: For service users, the opportunity to have ‘a voice’ began to disrupt the routine objectification or dehumanization that consistently, if unintentionally, characterize the treatment experience. Having a voice, it seemed, was synonymous with being human, with having ones’ ‘humanness’ recognized. We contend that not only did the introduction of consumer participation appear to empower service users and enhance the therapeutic alliance, it may have also improved service quality and health outcomes.

Full Citation: Rance, J., & Treloar, C. (2014) ‘We are people too’: consumer participation and the potential transformation of therapeutic relations within drug treatment. International Journal of Drug Policy https://doi.org/10.1016/j.drugpo.2014.05.002

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Analytic Note: Men having sex with men (MSM) is a vulnerable group, especially when these persons are HIV- positive. This review article assesses MSM comfort in accessing health services and willingness to participate in HIV prevention research in Kisumu, Kenya-an area of high HIV prevalence. This study uses mixed-methods comprising of interviews and surveys. It is relevant to our study which also studied a vulnerable group of migrant women with HIV/AIDS.

Source Excerpt: The only factor in our analysis associated with these men was a report of feeling people were staring at them. In a similar vein, the main barrier to participating in HIV research was having their personal information made available to others in the community. Receiving education that could help prevent HIV infection was the main motivator to taking part in an HIV research study. That a large proportion of MSM in Kisumu had some discomfort (62.7%) when seeking services at a public hospital agrees with reports of MSM from other areas of Africa. Among MSM in South Africa, all reported witnessing or experiencing homophobia from health care workers. Among MSM in Malawi, Namibia, and Botswana, there was an association between fear of health care services and ever having experienced discrimination. Homophobia and provider stigma were noted as barriers to obtaining condoms, lubricants, HIV testing, and HIV treatment in a global MSM health and rights study.

Full Citation: Okall, D. O., Ondenge, K., Nyambura, M., Otieno, F. O., Hardnett, F., Turner, K. et al. (2014) Men who have sex with men in Kisumu, Kenya: comfort in accessing health services and willingness to participate in HIV prevention studies. Journal of Homosexuality 61(12), 1712–1726. doi: 10.1080/00918369.2014.951261

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Analytic Note (Source 1): All women are at risk of acquiring HIV but black women have higher rates of HIV. The authors discuss the effect of gender-sensitive and culturally relevant HIV prevention film messages using behavioural interventions on HIV prevention behaviour changes among women resident in Boston. Contrarily to our study, the authors avoided asking if participants were HIV positive. The authors focused on HIV prevention interventions. A similarity with our study is the unwillingness to participate in HIV research for fear of disclosure, stigma and breach of confidentiality.

Analytic Note (Source 2): Most HIV persons perceive participating in HIV research as confirming HIV positive status. This qualitative study expands current knowledge of stigma and discrimination related to participation in HIV vaccine research in sub-Saharan Africa. It explores the perception of stigma and discrimination as a barrier to participation in HIV vaccine research in Kenya. This paper is relevant to our study because many women with HIV who were invited to participate in our study refused participation on grounds that their HIV status will be disclosed. Fear of the negative effects of HIV positive status hampers participation in HIV research.

Analytic Note (Source 3): This toolkit discusses and illustrates that to disclose HIV positive status is an obligation under the Canadian criminal law since 1990s. This article reveals that since 2012, people living with HIV in Canada have a legal duty to disclose their HIV status before having sex.

Source Excerpt (Source 1): The participants were not asked if they were living with HIV, because stigma related to disclosure has often decreased willingness to participate in studies such as this, and the focus of this study was on primary prevention.

Data Source (Source 1): DeMarco_2009

Source Excerpt (Source 2): Four prominent stigma-related barriers to participation emerged among all respondent groups, across both centers: (1) volunteers are often assumed by family and community members to be HIV positive because of their participation in vaccine research; (2) HIV-related stigma is perceived as pervasive and damaging in the communities where volunteers live, thus they fear consequent stigma if people believe them to be HIV positive; (3) potential volunteers fear being tested for HIV, a prerequisite for participation, because of possible disclosure of HIV status in communities with high perceived HIV-related stigma; and (4) volunteers must carefully manage information about their participation because of misperceptions and assumptions about vaccine research volunteers. HIV-related stigma and discrimination influence people's decisions to join HIV-vaccine related research.

Data Source (Source 2): Nyblade_2011

Source Excerpt (Source 3): This guide is useful for lawyers, advocates, researchers and persons living with HIV and AIDS. Criminalization of HIV non-disclosure also exist in Belgium as in many other European countries, making this toolkit important to our paper.

Full Citation (Source 1): DeMarco, R. F., Kendricks, M., Dolmo, Y., Looby, S. E. & Rinne, K. (2009) The effect of prevention messages and self-efficacy skill building with inner-city women at risk for HIV infection. Journal of the Association of Nurses in AIDS Care 20(4), 283–292.. DOI: 10.1016/j.jana.2009.02.007

Full Citation (Source 2): Nyblade, L., Singh, S., Ashburn, K., Brady, L. & Olenja, J. (2011) ‘Once I begin to participate, people will run away from me’: understanding stigma as a barrier to HIV vaccine research participation in Kenya. Vaccine 29(48), 8924–-8928. DOI: 10.1016/j.vaccine.2011.09.067

Full Citation (Source 3): Canadian HIV/AIDS Legal Network, (2014) Criminal Law and HIV Non-Disclosure in Canada. URL: www.aidslaw.ca/criminallaw accessed on 24-04-2015.

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Analytic Note: Positive HIV diagnosis has not impeded the desire of women and men living with HIV to have children. This article describes the experiences of conceiving and having children following an HIV diagnosis of women and men living with HIV in Iringa, Tanzania. Despite the existing stigma and discrimination, this study like in previous studies, and our study, supports the fact that childbearing desires of women and men living with HIV/AIDS are shaped by personal, social and institutional factors.

Source excerpt: The lived experience of having children after an HIV diagnosis is situated within this sociocultural and institutional context, where parenthood often defines one’s sense of self and one’s social position. Because of the stigma associated with being HIV-positive, weighing biomedical and social risks can be particularly challenging for those women and men who have children following an HIV diagnosis. The social risk of being ostracized for not having children or for not reaching a socially desirable family size may override any real or perceived biomedical risks

Full Citation: Saleem, H. T., Surkan, P. J., Kerrigan, D. & Kennedy, C. E. (2015) Childbearing experiences following an HIV diagnosis in Iringa, Tanzania. Qualitative Health Research https://doi.org/10.1177/1049732315605273

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Analytic Note (Source 1): Stigma and discrimination in healthcare remains a pervasive problem. This review paper argues that stigma has a far more insidious influence, going well beyond the individual and potentially impacting on all sectors of society. As in our study, this article underlines how stigma undermines a person's identity and capacity to cope with the disease at an individual level.

Analytic Note (Source 2): The study examines internalized AIDS stigmas among people living with HIV/AIDS in Cape Town, South Africa. It demonstrates that discrimination experiences are common and internalized AIDS stigmas were prevalent among people living with HIV/AIDS. Our article confirms the persistence of social stigmas and discrimination and internalized stigma.

Analytic Note (Source 3): HIV/AIDS has evolved but stigma and discrimination persists. This article measures the frequency of discrimination and assesses its correlates among people living with HIV in France. The survey uses data from a national representative survey, the ANRS-Vespa2 study, conducted in France in 2011 among 3022 male and female HIV-positive patients followed at hospitals. The most striking finding relates to women from sub-Saharan Africa reporting the highest levels of discrimination, whereas heterosexual non-African men reporting the lowest. In this study, HIV-related stigma and gender intertwine. We cited this article because it demonstrates that people living with HIV are exposed to stigma not only because of their HIV-positive status but also because they are blacks or belong to a minority population in France, as is the case in Belgium and most European Union countries.

Source Excerpt (Source 1): Discrimination has significant impacts on diagnosis and treatment. For the individual it can delay diagnosis and therefore also delay entry into treatment and adoption of a healthy lifestyle. There is no motivation to be tested, as the person sees no benefit when the diagnosis of HV is seen as equivalent to death, and they are likely to experience discrimination.

Source Excerpt (Source 2): Discrimination experiences were common and internalized AIDS stigmas were prevalent among people living with HIV/AIDS in Cape Town.

Source Excerpt (Source 3): Since the advent of AIDS, discrimination has remained at the core of the experience of people living with HIV (PLHIV). PLHIV who belong to minority groups are exposed to discrimination not only on the grounds of their HIV infection but also because of rejecting attitudes towards drug users, homosexuals and black people.

Full Citation (Source 1): Skinner, D. & Mfecane, S. (2004) Stigma, discrimination and the implications for people living with HIV/AIDS in South Africa. SAHARA Journal 1(3), 157–164. DOI: 10.1080/17290376.2004.9724838

Full Citation (Source 2): Simbayi, L. C., Kalichman, S., Strebel, A., Cloete, A., Henda, N. & Mqeketo, A. (2007) Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. Social Science & Medicine 64(9), 1823–1831. DOI:10.1016/j.socscimed.2007.01.006

Full Citation (Source 3): Marsicano, E., Dray-Spira, R., Lert, F., Aubriere, C., Spire, B. & Hamelin, C. (2014) Multiple discriminations experienced by people living with HIV in France: results from the ANRS-Vespa2 study. AIDS Care 26 (Supplement 1), S97–S106. DOI: 10.1080/09540121.2014.907385

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Analytic Note (Source 1): This article discusses HIV prevention programs as HIV is now a preventable disease. With intervention programs that focus on identifying and targeting high risk groups, based on evidence of knowing the HIV epidemic, new HIV transmission can be prevented. This article was selected because it depicts HIV as a preventable disease through efficient and sustainable prevention intervention programs that include a combination of behavioural as well as biomedical intervention programs. It was not selected for any specific intervention program but to support the fact that HIV is a preventable disease since it emerged more than 30 years ago.

Analytic Note (Source 2): This study discusses gender-sensitive and culturally relevant HIV prevention film messages combined with self-efficacy and skill building exercises on self-reported safe sex behaviours, intentions, attitudes, and self-advocacy over time. The findings show that, HIV is preventable through a combination of interventions. Despite the short duration of the intervention, participants self-reported significantly more use of safe sex behaviours and being prepared for sexual intimacy after the intervention. The article is relevant to our study because the preventive messages it purports could be encouraged among women at risk of HIV.

Analytic Note (Source 3): This article discusses early AIDS epidemiology and surveillance, AIDS as a metaphor for emerging infections and a new global health, the globalization of science, research and practice, response and the future of AIDS. This article is relevant because it supports our claim that HIV is a preventable disease.

Analytic Note (Source 4): This article upholds that though HIV is a preventable disease, but the challenging social environment makes prevention difficult.

Source Excerpt (Source 1): Millions of people would not be newly infected each year if that were not the case. Our challenge now is to start doing more prevention, better. We must also ensure that the situation improves each year as researchers develop more effective interventions, programme evaluators learn about what works best, where, and for whom, and managers learn how to deliver services more efficiently. Although we still hope that a magic bullet will one day be discovered, we must now start designing and implementing prevention programmes that can succeed without one.

Source Excerpt (Source 2): The purpose of this study was to examine the effect of gender-sensitive and culturally relevant HIV prevention film messages combined with self-efficacy and skill building exercises on self-reported safe sex behaviours, intentions, attitudes, and self-advocacy over time. A sample of 131 women of mixed ethnicity from inner-city Boston who were living in transitional housing participated in a 4-week pre/post measurement design. Results showed that, despite the short duration of the intervention, participants self-reported significantly more use of safe sex behaviours and being prepared for sexual intimacy after the intervention. The study validated use of an approach originally intended for African American women with other women at risk for HIV.

Source Excerpt (Source 3): Although the end of the epidemic is not yet in sight and many challenges remain, the response has been remarkable and global health has changed for the better.

Source Excerpt (Source 4): Evidence from the study showed that prevailing HIV prevention paradigms reinforce the difficulties faced by young women in their sexual lives. This research adds to calls for alternative and wider approaches to HIV prevention, underpinned by gender empowerment.

Full Citation (Source 1): Bertozzi, S. M., Laga, M., Bautista-Arredondo, S. & Coutinho, A. (2008) Making HIV prevention programmes work. The Lancet 372(9641), 831–844. DOI:10.1016/S0140-6736(08)60889-2

Full Citation (Source 2): DeMarco, R. F., Kendricks, M., Dolmo, Y., Looby, S. E. & Rinne, K. (2009) The effect of prevention messages and self-efficacy skill building with inner-city women at risk for HIV infection. Journal of the Association of Nurses in AIDS Care 20(4), 283–292.. DOI: 10.1016/j.jana.2009.02.007

Full Citation (Source 3): De Cock, K. M., Jaffe, H. W., & Curran, J. W. (2011). Reflections on 30 Years of AIDS. Emerging Infectious Diseases, 17(6), 1044–1048. http://doi.org/10.3201/eid1706.100184

Full Citation (Source 4): Conn, C. (2013) Young African women must have empowering and receptive social environments for HIV prevention. AIDS Care 25(3), 273–280. https://doi.org/10.1080/09540121.2012.712659

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Analytic Note: This article is about shouldering stigma emanating from health problems. This article discusses burn-out syndrome in rich healthcare systems and brain-drain in poor countries.The author posits that the burden of disease can be reduced by appropriate treatment and other measures but that it is not reduced by transferring responsibility to the persons who are suffering from a disease to the responsibility of someone else. This article is relevant as a citation in our study to demonstrate how the consequences of health problems are often left to the individual to shoulder as in the case of HIV/AIDS-related stigma and discrimination.

Source Excerpt: The introduction of the idea of self-reliance goes against this arrangement and places the responsibility after individual. Should individuals fail to look after themselves the responsibility falls on society as a whole, i.e. to the government that is supposed to represents it. For many, particularly the healthy and the strong in the country previously relying on interdependence the principle of self-reliance is attractive because it liberates them from the myriad of obligations that interdependency implies. Thus, they accept the notion and promote it. The problem resides in the fact that governments in countries in which the members of the population until now coped by relying on one another usually do not have the resources and perhaps not even the intention to help its citizens deal with their problems. Another sin of many administrators and

Full Citation: Sartorius, N. (2009) Illnesses of the health system. Psychiatria Danubina 21(4), 444–445.

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Analytic Note: This article discusses cultural beliefs surrounding mental illness, and how experiences of stigma impact relationship with family and help-seeking behaviours among black and minority communities in the UK. This qualitative study asserts that stigma is communicated by the medical staff, community members or through the family. Although the focus of this article is on mental illness, its reference is pertinent because HIV/AIDS-related stigma and discrimination can also affects the mental health of an individual. Moreover, some HIV/AIDS persons may suffer from a mental disorder such as anxiety, depression and chronic stress at one point in their HIV/AIDS trajectory. Additionally, some of our study participants experienced one or more mental disorders.

Source Excerpt: Participants identified inequalities in diagnosis, particularly psychosis, and treatment. These experiences echo previous research particularly relating to higher rates of diagnoses of psychosis among black and minority ethnic groups as well as compulsory admission (Boast & Chesterman, 1995; Davies et al 1996; Dunn & Fahy 1990; McGovern & Cope 1991; Singh et al 1998. This finding that external stigma compromises the trust of ethnic minorities demonstrates how experiences of stigma impact on help-seeking behaviours and treatment. Ultimately, stigma from authorities or medical services can lead to the underutilisation of the medical system by ethnic minorities (Burgess et al 2008; Gary 2005).

Full Citation: Shefer, G., Rose, D., Nellums, L., Thornicroft, G., Henderson, C. & Evans-Lacko, S. (2013) 'Our community is the worst': the influence of cultural beliefs on stigma, relationships with family and help-seeking in three ethnic communities in London. International Journal of Social Psychiatry 59(6), 535–544. DOI: 10.1177/0020764012443759

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Analytic note: This article assesses the experience of stigma and discrimination on the psychological and health behaviour of people living with HIV/AIDS in Arba Minch, Ethiopia. It suggests that stigma and discrimination has an implication on care and support behaviour among people living with HIV/AIDS in a resource-limited area. Although conducted in a resource-limited area, this paper is relevant to our research because it reports on the progress made in alleviating stigma and discrimination among individual and the community. Notwithstanding the changes from an overt to a more concealed type, the problem remains pertinent in the lives of people living with HIV/AIDS in resource-limited as well as resource-rich regions. The looming concealed nature of present day stigma and discrimination not only affects the psychological wellbeing but also physical health, whereby individuals refuse to disclose their status, seek timely medical treatment and increase the possibility of non-adherence to antiretroviral therapy.

Source excerpt: Fear of being identified as having HIV or AIDS may discourage a person from getting tested, from accessing medical services and medications, and from disclosing their HIV status to family and friends. This might be mainly due to the fact that higher perceived susceptibility and perceived severity to stigma and discrimination leads to decreased motivation, which in turn results in reduced performance and productivity

Full Citation: Alemu, T., Biadgilign, S., Deribe, K., & Escudero, H. R. (2013). Experience of stigma and discrimination and the implications for healthcare seeking behavior among people living with HIV/AIDS in resource-limited setting. Sahara J, 10(1), 1–7. http://doi.org/10.1080/17290376.2013.806645

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Analytic Note: Ebola has recently been included in the list of diseases with stigmatizing and discriminatory attitudes and behaviors tied to it. This article reviews literature that discusses the similarities and differences between HIV/AIDS and Ebola virus disease in the community as well as in healthcare settings. The authors also discuss how lessons learnt from HIV/AIDS-related stigma can be applied to Ebola disease and ensuing stigma. The article highlights similar stigmatizing attitudes and behaviors directed towards persons with HIV/AIDS and Ebola, and the life-threatening nature of both diseases. In both cases, stigma and discrimination is propagated by misinformation and myths on mode of transmission and affected persons. They differ in the mortality. Ebola has a shorter life span than HIV/AIDS. In addition, Ebola patients don’t suffer from potential criminal persecution in case of Ebola transmission due to non-disclosure. This article is relevant to our research because it confirms stigma as a disruptive factor in the quality of life of persons with HIV/AIDS and Ebola survivors.

Source Excerpt: Stigmatizing attitudes and behaviours, including patient blaming and neglect, refusal/denial of care, and irrational and inappropriate fear of contagion directed toward impacted populations have not only devastated familial, social, and economic relationships and infrastructures but they have also interfered and created colossal barriers to access, prevention, and treatment . More specifically, HIV/AIDS-related stigma has led to avoidance of healthcare, reduced adherence to antiretroviral medications, increased HIV symptomatology, and emergence of mental health pathologies including depression. Stigma in the context of EVD is equally disconcerting as it also originates from structural inadequacies, including poverty, lack of education, and political conflict. These factors combined with cultural practices subsequently influence attitudes, beliefs, and behaviors with respect to disease transmission. During the 2000 and 2001 EVD epidemics in Uganda for example, harassment, rejection, and abandonment of individuals with EVD were common occurrences. Those in contact with EVD patients were also victimized with some being prevented from returning to their homes and communities, and their properties destroyed. Children were also not spared. There are reports of children orphaned by EVD who remain sero-negative but have not been taken up for care by families and communities out of fear of contagion.

Full Citation: Davtyan, M., Brown, B., & Folayan, M. O. (2014). Addressing Ebola-related Stigma: Lessons Learned from HIV/AIDS. Global Health Action, 7, 10.3402/gha.v7.26058. http://doi.org/10.3402/gha.v7.26058

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Analytic Note: Stigma has been perceived as accompanying certain diseases for which society associates behavioral norms to these disease. Stigma is an obstacle to the positive development of physical as well as mental health. This article reviews and describes anti-stigma activities in 14 European countries (including Belgium) regardless of language used to publish the article or if the article had been previously published. This article indicates that there is a lack of adequate support against stigma and discrimination of mental illness. The anti-stigma and discrimination activities in these countries are not part of long-term programs to fight mental health stigma and discrimination. This article is useful because it highlights the fact that mental illness remains a stigmatized disease despite treatment of the disease, just like HIV. The paper is relevant because some HIV/AIDS patients may suffer from a mental illness as a result of their HIV infection.

Source Excerpt: Stigma of a disease often indicates that the persons who suffer from that disease are dangerous, likely to infect or otherwise harm others, that they are incurable, and that they are of little or no value to society. The discovery of a treatment that cures the disease changes such perceptions and signals that it is worth investing in treatment because it will return the sick individuals to useful roles in society. It also signals that persons affected by the disease have not become valueless because they have the illness.

Full Citation: Beldie, A., den Boer, J. A., Brain, C., Constant, E., Figueira, M. L., Filipcic, I. et al. (2012) Fighting stigma of mental illness in midsize European countries. Social Psychiatry and Psychiatric Epidemiology 47 (Supplement 1), 1–38. https://doi.org/10.1007/s00127-012-0491-z

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Analytic Note: This article highlights the existence of stigma among persons living with type 2 diabetes, especially as it can sometimes be considered a disease of lifestyle, just like HIV. The authors conducted a qualitative study consisting of interviews and informed on a literature review with the aim of exploring the social experiences of Australian adults living with type 2 Diabetes, with a particular (but concealed) focus on the perception and experience of diabetes-related stigma. Thematic analysis using an inductive approach was used to analyse data. The study finds evidence of feelings or experiences of stigma among a majority of study participants and concludes that type two diabetes is a stigmatizing disease. This confirms the perception of stigma of life-style chronic diseases including HIV.

Source Excerpt: A total of 21 (84%) participants indicated that they believed T2DM was stigmatized, or reported evidence of stigmatization. Specific themes about the experience of stigma were feeling blamed by others for causing their own condition, being subject to negative stereotyping, being discriminated against or having restricted opportunities in life. Other themes focused on sources of stigma, which included the media, healthcare professionals, friends, family and colleagues. Themes relating to the consequences of this stigma were also evident, including participants’ unwillingness to disclose their condition to others and psychological distress. Participants believed that people with type 1 diabetes do not experience similar stigmatization. “I think the stigma is that it's a lifestyle disease. That somehow you've been lazy and you've allowed this to happen to yourself. I think to me that must come through very strongly, that's the judgment that I think that is made. (#19; woman, 54 years)”

Full Citation: Browne, J. L., Ventura, A., Mosely, K. & Speight, J. (2013) 'I call it the blame and shame disease': a qualitative study about perceptions of social stigma surrounding type 2 diabetes. BMJ Open 3(11), 1–10. BMJ Open 2013;3:e003384. doi: 10.1136/bmjopen-2013-003384

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Analytic Note: There has always been an undeniable relationship between stigma and discrimination and health. This article reviews the development of international research on the relationship between discrimination and health. This author identifies from reviewed articles some key findings that might guide practical and programmatic responses to human suffering and health challenges caused by stigma and discrimination. We used this article to confirm the interconnection between stigma, discrimination and health

Source Excerpt: In examining stigma and the HIV issue, we gave even greater emphasis to the emergence and evolution of stigma in specific contexts of culture and power. For this reason, stigma is not a free-floating social phenomenon; the historically determined nexus between cultural formulations and systems of power and domination is crucial. We argued that the period in which a stigma appears and the form it takes are always influenced by historical circumstances. Understanding this historical context and its consequences for affected individuals and communities can help us develop better approaches for combating this phenomenon and reducing its effects. This framework focuses on how stigma is used by individuals, communities and the state to produce and reproduce structures of social inequality. It also pushes us to examine the political economy of stigmatization and its links to social exclusion and how historically constructed forms of stigma are strategically deployed to produce and reproduce social inequalities.

Full Citation: Parker, R. (2012). Stigma, prejudice and discrimination in global public health. Cadernos de Saúde Pública, 28(1), 164-169. https://dx.doi.org/10.1590/S0102-311X2012000100017

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Analytic Note: Stigma and discrimination are social processes, characterized by cross-cultural diversity and complexity. This article offers a new framework, from that of Goffman, by which to understand HIV and AIDS-related stigma and its effects. It highlights the manner in which stigma feeds upon, strengthens and reproduces existing inequalities of class, race, gender and sexuality. This article forms a solid basis of our research.

Source Excerpt: This sociological emphasis on the structural dimensions of discrimination is particularly useful in helping us think more sensibly about HIV and AIDS-related stigmatization and discrimination. To move beyond the limitations of current thinking in this area, we need to reframe our understandings of stigmatization and discrimination to conceptualize them as social processes that can only be understood in relation to broader notions of power and domination. In our view, stigma plays a key role in producing and reproducing relations of power and control. It causes some groups to be devalued and others to feel that they are superior in some way. Ultimately, therefore, stigma is linked to the workings of social inequality and to properly understand issues of stigmatization and discrimination, whether in relation to HIV and AIDS or any other issue, requires us to think more broadly about how some individuals and groups come to be socially excluded, and about the forces that create and reinforce exclusion in different settings.

Full Citation: Parker, R. & Aggleton, P. (2003) HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Social Science & Medicine 57(1), 13–24. https://doi.org/10.1016/S0277-9536(02)00304-0

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Analytic Note: Stigma and discrimination severely hampers the fight against the spread of HIV. This review article identifies stigma-reduction strategies and interventions in the field of HIV/AIDS, mental illness, leprosy, TB and epilepsy. Due to copyright restrictions, only the abstract of the article was read. However, in the abstract the authors briefly argue for a patient-centered approach in order to empower affected persons and develop interventions to reduce stigma and discrimination at other levels.

Source Excerpt: In many health conditions, people are severely affected by health-related stigma and discrimination. A literature review was conducted to identify stigma-reduction strategies and interventions in the field of HIV/AIDS, mental illness, leprosy, TB and epilepsy. The review identified several levels at which interventions and strategies are being implemented. These are the intrapersonal, interpersonal, organizational/institutional, community and governmental/structural level. Although a lot of work has been carried out on stigma and stigma reduction, far less work has been done on assessing the effectiveness of stigma-reduction strategies. The effective strategies identified mainly concentrated on the individual and the community level. In order to reduce health-related stigma and discrimination significantly, single-level and single-target group approaches are not enough. What is required is a patient-centred approach, which starts with interventions targeting the intrapersonal level, to empower affected persons to assist in the development and implementation of stigma-reduction programmes at other levels.

Full Citation: Heijnders, M. & Van Der Meij, S. (2006) The fight against stigma: an overview of stigma-reduction strategies and interventions. Psychology, Health & Medicine 11(3), 353–363. https://doi.org/10.1080/13548500600595327

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Analytic Note (Source 1): The article discusses the inclusion of stigma and discrimination reduction programs as a critical component in achieving an AIDS-free generation. The authors review articles on current evidence on approaches to reducing stigma and discrimination in the healthcare setting, the general public, people living with HIV and key populations. This article reflects the progress made towards reducing stigma and discrimination in healthcare settings since the outbreak of the epidemic more than 30 years ago and stresses the fact that multilevel interventions are needed in order to effectively incorporate stigma and discrimination reduction into national AIDS plans. This article is relevant to our study because it confirms that HIV-related stigma and discrimination is persistent in the general public as well as in healthcare settings more than 30 years after the emergence of the HIV pandemic.

Analytic Note (Source 2): The authors introduce the global action to reduce HIV stigma and discrimination and discuss current approaches for reducing stigma and discrimination in the healthcare settings, among the general public and among people living with HIV/AIDS and key populations. This paper is important for the advances that it highlights as well as the gaps it identifies in creating an enabling environments for HIV prevention, care and treatment strategies.

Source Excerpt (Source 1): The persistence of HIV-related stigma and discrimination is evident in research and programmatic data alike, despite treatment advances that have turned HIV into a chronic, manageable condition. Thirty years into the HIV pandemic, stigma and discrimination continue to impede individuals and communities from accessing and benefiting from effective prevention and treatment strategies. There is mounting evidence that HIV-related stigma and discrimination are barriers to HIV testing, sero-status disclosure, retention in care and uptake of and adherence to antiretroviral therapy (ART). There is also evidence of the associations between HIV-related stigma and racism, poverty and heterosexism, although the complexities of these associations and interactions are only beginning to be unravelled via research. In many settings, the stigma associated with HIV is fuelled by laws and policies that keep key populations at risk of HIV infection and PLHIV at the margins of society, despite evidence of the negative public health impact of criminalization.

Source Excerpt (Source 2): HIV-related stigma and discrimination continues to endanger people living with the virus, and it still prevents millions of people from coming forward for testing and for prevention and treatment services. Some 50–60% of people living with HIV are unaware of their status. Many others choose to hide it. Communities most affected by the epidemic – sex workers, people who use drugs, men who have sex with men and transgender people –remain highly stigmatized. These individuals and their families are often unable to exercise their right to health, non-discrimination and freedom from violence.

Full Citation (Source 1): Grossman, C. I. & Stangl, A. L. (2013) Editorial: global action to reduce HIV stigma and discrimination. Journal of the International AIDS Society 16(3) (Supplement 2), 18881. doi: 10.7448/IAS.16.3.18881

Full Citation (Source 2): Sidibe, M. & Goosby, E. P. (2013) Foreword: global action to reduce HIV stigma and discrimination. Journal of the International AIDS Society 16(3) (Supplement 2), 18893. doi: 10.7448/IAS.16.3.18893

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Analytic Note (Source 1): Living with HIV places huge demands on physical, mental and psychological resources. Many HIV-infected women are young and mothers. Many others become mothers and have to continue mothering despite their HIV infection. Most face the dual challenge of being a mother and a patient. This descriptive qualitative article discusses HIV-infected women in their dual role of mothers and patients. Stigma emerges as one of the main findings of the study. Stigma is still very present in 2016 (year of our study) as it was in 1997 when the article referred to was written.

Analytic Note (Source 2): The sexuality of women with chronic diseases is often impacted by diseases like cancer, diabetes, mental disorder or HIV. This article illuminates sexuality as an important health issue for women living with a chronic illness and also offers ways to facilitate sexuality issues for this women. The paper reveals the construction of sexuality articulated by women living with chronic illness with regards to concerns on changes in their bodies, meeting the needs of others and communicating sexuality. It is relevant to support our claim that women wherever they may be found still perform their roles as mothers and caregivers despite having HIV/AIDS or other chronic illnesses.

Analytic Note (Source 3): Presently, there are about 37 million people worldwide living with HIV/AIDS and about half are women. This book is about women living with HIV/AIDS. It provides a background understanding about women living with HIV/AIDS. It discusses salient issues concerning women who are mothers and the essence of having children as well as infant feeding practices. A gender lens perspective is also introduced as all chapters in the volume are argued to be situated within this approach. The book details information on the experiences of women with HIV/AIDS which is relevant to our paper.

Source Excerpt (Source 1): More than 60,000 women in the US have been diagnosed with AIDS, and millions of women worldwide are infected with HIV. Most of these women will die at an early age, leaving their children motherless. During their HIV illness, these women confront the challenge of being both patient and family caregiver. The authors conducted semi-structured interviews with 8 HIV-positive women (aged 23–47 yrs), focusing on primary life concerns in their lives. Significant factors emerging from the interviews included the impact of stigma associated with HIV/AIDS, disbelief of the diagnosis, the lack of a guardian for their children, the paucity of women's support groups, and barriers associated with seeking services. All women exhibited evidence of clinical depression. A model for multidisciplinary intervention is proposed that focuses on women's needs within their family systems.

Source Excerpt (Source 2): Whilst we acknowledge that sexuality has multiple meanings, in this paper we describe the way in which women themselves have constructed and articulated their sexuality. We found that sexuality incorporated women's desires, appearance, sexual feelings and expression and imposed on aspects of their lives that they had not needed to acknowledge before illness intruded. Three concerns are discussed; the changing body, meeting the needs of others and communicating sexuality. This paper reveals that issues of sexuality are an important health concern for women who live with long-term illness and should be acknowledged in sensitive and responsive health practices. The paper concludes that it is important for nurses to provide women opportunity for open and genuine communications about sexuality. In this way, a foundation of acceptance for the whole person is established which provides women permission to ask questions and seek assistance with sexuality issues.

Source Excerpt (Source 3): There are about 34 million people worldwide living with HIV/AIDS. Half are women. There has been a dramatic global increase in the rates of women living with HIV/AIDS. Among young women, especially in developing countries, infection rates are rapidly increasing. Many of these women are also mothers with young infants. When a woman is labelled as having HIV, she is treated with suspicion and her morality is being questioned. Previous research has suggested that women living with HIV/AIDS can be affected by delay in diagnosis, inferior access to health care services, internalized stigma and a poor utilization of health services. This makes it extremely difficult for women to take care of their own health needs. Women are also reluctant to disclose their HIV-positive status as they fear this may result in physical feelings of shame, social ostracism, violence, or expulsion from home. Women living with HIV/AIDS who are also mothers carry a particularly heavy burden of being HIV-infected. This unique book attempts to put together results from empirical research and focuses on issues relevant to women, motherhood and living with HIV/AIDS which have occurred to individual women in different parts of the globe. The book comprises chapters written by researchers who carry out their projects in different parts of the world, and each chapter contains empirical information based on real life situations. This can be used as evidence for health care providers to implement socially and culturally appropriate services to assist individuals and groups who are living with HIV/AIDS in many societies. The book is of interest to scholars and students in the domains of anthropology, sociology, social work, nursing, public health & medicine and health professionals who have a specific interest in issues concerning women who are mothers and living with HIV/AIDS from cross-cultural perspective. (Book summary on back cover page)

Full Citation (Source 1): Hackl, K. L., Somlai, A. M., Kelly, J. A. & Kalichman, S. C. (1997) Women living with HIV/AIDS: the dual challenge of being a patient and caregiver. Health & Social Work 22(1), 53–62. https://doi.org/10.1093/hsw/22.1.53

Full Citation (Source 2): Kralik, D., Koch, T. & Telford, K. (2001) Constructions of sexuality for midlife women living with chronic illness. Journal of Advances Nursing 35(2), 180–187. doi:10.1046/j.1365-2648.2001.01835.x

Full Citation (Source 3): Liamputtong, P. (2013) Women, Motherhood and Living with HIV/AIDS: A Cross-Cultural Perspective. Springer, Bundoora, Australia, doi:10.1007/978-94-007-5887-2.

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Analytic note: Presenting late for HIV treatment and care maybe harmful to the individual, the community and healthcare system. Some persons with HIV/AIDS report that they are afraid to go to the clinic because someone might recognize them and associate them with HIV/AIDS. As part of a lager study, this article confirms that denial and the fear of stigma and discrimination may encourage late health-seeking behaviours among women and (men) with HIV/AIDS.

Source excerpt: “I refused the diagnosis and refused to go to the hospital for treatment for more than six years because to me going to the hospital meant I was HIV positive and would meet someone at the clinic who would identify me as HIV positive and spread the news. I had to run away from people and did not want to be treated. I continued having unprotected sex with my partner who is HIV negative and had two healthy children. I decided to start treatment when the doctor insisted that my life and that of my third baby was at stake if I continued refusing treatment”. (Interviewee 32, mother of 4 children)

Full Citation: Arrey, A. E, Bilsen, J. Lacor, P. Deschepper, R. “People don’t know I’m HIV positive” Self-Stigma among sub-Saharan African migrant women with HIV/AIDS in Belgium. Global Advanced Research Journal of Medicine and Medical Sciences (GARJMMS) March 2015 Vol. 4(3), pp. 121-131. http://garj.org/garjmms/index.htm

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Analytic note: This paper is part of a larger study on sub-Saharan African migrant women with HIV/AIDS in Belgium. In the paper, HIV care providers show concern for the persistent HIV-related stigma and discrimination in healthcare settings.

Source excerpt: “Some African women have been infected here in Belgium…so there is still a big problem…the stigma, the fear, not being tested; I think there are missed opportunities as well at the general practitioners’ (GPs’) or surgery or anywhere. Because it [HIV] is not talked about, people are still scared even in the hospitals. In the fertility clinic here, we have to do information session in a couple of months because the nurses and the operating theatre staff are still scared of using the same measures for HIV people as for non-HIV people. That means there is information problem everywhere…There is still stigma in the healthcare settings, so that tells a lot in the non-healthcare”. (Interview with HIV treating physician)

Full Citation: Arrey, A. E, Bilsen, J. Lacor, P. Deschepper, R. “We listen to them”: a qualitative study of HIV provider-patient relationship in the management of care. British Journal of Education, Society & Behavioural Science, 12(4): 1-10, 2016. DOI : 10.9734/BJESBS/2016/20582

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Analytic note: Public perceptions of HIV and HIV/AIDS patients after more than thirty years drives stigma and internalized stigma. This article is part of a larger study on the experiences of sub-Saharan African migrant women with HIIV/AIDS in Belgium. The findings highlight stigma and discrimination in the general public and within the African diaspora in particular, where culture plays a significant role in health and illness. Source excerpt: “Africans have their way of looking at illnesses. Some don’t understand people who are ill [HIV positive]. I think it’s an African way of thinking. When you are ill and pale, they say ‘that one is sick’ -meaning having HIV/AIDS. For example in my country, a woman who is HIV positive is taken to be a prostitute or promiscuous. But you can have HIV without being a prostitute. I was married with children and thought HIV was for others. I did not go out to look for HIV”. (Interviewee 18, mother of 2 children)

Full Citation: Arrey, A. E, Bilsen, J. Lacor, P. Deschepper, R. “People don’t know I’m HIV positive” Self-Stigma among sub-Saharan African migrant women with HIV/AIDS in Belgium. Global Advanced Research Journal of Medicine and Medical Sciences (GARJMMS) March 2015 Vol. 4(3), pp. 121-131.

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Analytic note: This paper is part of a larger qualitative study that examined the experiences of sub-Saharan African migrant women living and aging with HIV/AIDS in Belgium. The notion that HIV transmission as the sole responsibility of an individual may discourage discussing about HIV, increase HIV transmission risk and propagate stigma.

Source excerpt: “It is shame because HIV is contracted through sex and sex is a taboo for some Africans. There is no other reason. If I tell him/her, she/he will spread it everywhere. We have not yet reached that stage of removing the shame of being HIV infected. It is shame and shame kills.” (Participant 2, first interview)

Full Citation: Arrey, A. E, Bilsen, J. Lacor, P. Deschepper, R. “It’s my secret”: Fear of disclosure among sub-Saharan African Migrant Women Living with HIV/AIDS in Belgium. PLOS One. 2015 Mar 17; 10(3). DOI:10.1371/journal.pone.0119653

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Analytic note: There is empirical evidence that stigma, discrimination and fear may contribute to increase in HIV transmission and people with HIV/AIDS suffer from stigma and discrimination. Through a national survey conducted among a large sample of HIV-infected outpatients attending French hospitals (VESPA/ANRS 2003) this article analyses the relationship between PLWHAS' experience of discrimination by their social environment and their sexual risk behaviours. This article documents that although people with HIV/AIDS have less occasions to feel discriminated, the relationship between perceived discrimination and unsafe sex was especially strong among heterosexual transmission group. This study is a quantitative study, thus different from our qualitative study but the similarity lies in the fact that both studies are conducted in resource-rich settings. Our study did confirm the perception of stigma and discrimination among people living with HIV/AIDS.

Source excerpt: Indeed, both the results of the VESPA study and French epidemiological data seriously question the hypothesis that HIV-stigma has no effect or could even reduce the infection spread within the general population. Heterosexual transmission has become the major contributor to the HIV epidemics in France: migrants originating from sub-Saharan Africa accounted for 27% of HIV new diagnoses in France in 2004; whereas the majority of these infections has been acquired in their country of origin before they moved to France, there is some evidence that an increasing number of HIV infections among migrants now occur after they arrived in France moreover, the proportion of new HIV diagnoses among French individuals infected through heterosexual contacts (17% of the total number of cases in 2004) has increased in recent years, particularly in women, and French HIV-positive heterosexual men living in a couple with children have been found to be at high risk for late testing. The VESPA study clearly confirms a significant relationship between discrimination and high risk behaviours in this heterosexual group that has become the main vector of HIV transmission in France and who is the more likely of sexual mixing with the general population.

Full Citation: Peretti-Watel, P., Spire, B., Obadia, Y. & Moatti, J. P. (2007) Discrimination against HIV-infected people and the spread of HIV: some evidence from France. PLoS One 2(5), e411. doi: 10.1371/journal.pone.0000411

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Analytic note: There is reported satisfaction with the positive change of behaviour of most sub-Saharan African women in relation to health-seeking behaviour. Patients are now diagnosed earlier than had been the case and good patient-provider rapport helps improve the quality of health of the patients as this paper indicates.

Source excerpt: I don’t have the statistics but I have also the impression that sub-Saharan African population patients are diagnosed earlier. In the past we have what we call ‘later presenters’ and now it has become really rare. It means that people are tested earlier, whether it is here or in Africa. We have patients who are coming from Africa and if they are positive, they are already on treatment. I think it is a good sign. That was not the case 10 years ago. (HIV treating physician)

Full Citation: Arrey, A. E, Bilsen, J. Lacor, P. Deschepper, R. “We listen to them”: a qualitative study of HIV provider-patient relationship in the management of care. British Journal of Education, Society & Behavioural Science, 12(4): 1-10, 2016

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Analytic note: This article discusses the epidemiologic data of AIDS cases in Belgium from 1979 to 1983. The majority of AIDS cases in Belgium were diagnosed among African migrants living or had travelled to Belgium for medical care. This study involved 40 Africans and most of them were diagnosed with HIV and AIDS. This article is used in our paper to confirm the general view (without much scientific evidence) that HIV and AIDS may still be regarded as an African disease even among clinicians.

Source excerpt: We report here the epidemiologic data of AIDS cases in Belgium during the years from 1979 to November 1983. The vast majority of AIDS cases diagnosed in Belgium were in African patients who lived in Belgium or who travelled to Belgium for medical care.

Full Citation: Clumeck, N., Sonnet, J., Taelman, H., Cran, S., Henrivaux, P. and Desmyter, J. (1984), Acquired Immune Deficiency Syndrome in Belgium and its Relation to Central Africa. Annals of the New York Academy of Sciences, 437: 264–269. doi:10.1111/j.1749-6632.1984.tb37144.x

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Analytic note: Sub-Saharan Africans (SSA) with HIV and AIDS are the second largest group, after men having sex with men, receiving medical treatment and care in the UK and in most European Union countries. This study describes reasons for delays in seeking care among black Africans in London. It also explores treatment issues including when to start treatment, treatment side effects and treatment uncertainty. The study insinuates cultural beliefs and health experience among SSA as contributing to treatment concerns and general mistrust of medical personnel. The paper also highlights the fear of stigma and discrimination as a major barrier to HIV treatment and care, which is reiterated in our study. Strikingly, despite medical advancement in HIV treatment with antiretroviral therapy since 1999, stigma and discrimination still persist. However, the concern of mistrust differs in that it was mainly with regards to non-HIV treating personnel.

Source excerpt: Black Africans are the second largest group of HIV/AIDS service users in London, UK. They are distinguished from other patient groups by their delay in access to services and appear to have a lower uptake of antiretroviral therapies. This study explores the treatment issues concerning black Africans which may affect their uptake of therapies. Issues raised included questions about if and when to start treatment, fears of side-effects both short and long term, awareness of the current uncertainties surrounding combination therapies and concerns about how to achieve compliance. The social circumstances of HIV positive black Africans living in London together with differences in cultural beliefs and experience of health care in the UK give rise to particular treatment concerns. These concerns include the fear of being experimented upon, lack of confidence in drugs tested only on Caucasians, distrust of the medical profession and fears of discrimination. Efforts to encourage the uptake of antiretroviral therapies by black Africans in Britain must take into account the particular experiences, fears and concerns of this patient group.

Full Citation: Erwin, J. & Peters, B. (1999) Treatment issues for HIV+ Africans in London. Social Science & Medicine 49(11), 1519–1528. https://doi.org/10.1016/S0277-9536(99)00220-8

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Analytic note: The patterns of migration in Belgium as well as in Europe are complex, diverse and driven by various factors including economic imbalances, health, colonial ties and the quest for better lives. The process of migration may create certain vulnerabilities like access to healthcare, employment, economic, education, housing and legal status. Labour migrants are considered a vulnerable population for HIV infection. This multi-region review investigates possible associations between labour migration and HIV risk among migrants. A striking finding is that the ability of migrant workers, especially those with HIV/AIDS to access quality healthcare maybe limited due to stigma and discrimination as confirmed in our paper.

Source excerpt: Limited access to health care for labor migrants made it difficult or impossible to get clinical or preventative care, including HIV/AIDS care. Without legal status, Tajik migrants in Russia were not able to access public health care institutions. Private clinics that provided services charged very high rates for screening and treatment of STIs. While the majority (66 %) of migrant women working in Hong Kong had medical insurance as a condition of their employment, they reported that their ability to access quality health care was limited due to discrimination.

Full Citation: Weine, S. M. & Kashuba, A. B. (2012) Labor migration and HIV risk: a systematic review of the literature. AIDS Behavior 16(6), 1605–1621. doi: 10.1007/s10461-012-0183-4

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Analytic note: HIV has evolved from a life-threatening disease to a chronic disease with the introduction of the highly active anti-retroviral therapy. In a cross-sectional study, the article assesses the epidemiological, clinical and therapeutic features of HIV infection in patients coming from outside of the EU, compared with those in Italian and EU HIV-infected subjects. This article is relevant to our paper as both papers deal with migrants from out of the European Union and having HIV/AIDS.

Source excerpt: Our cross-sectional observational survey, although based on a limited patient sample, has revealed an appreciable percentage (slightly over 4%) of the HIV positive 988 patients followed at our reference centre for at least 9 months, come from outside of the EU: over 50% of cases from central Africa, followed by Eastern Europe (but surprisingly not from Albania), Northern Africa, and South America, with a large prevalence of HIV-1 infection acquired through heterosexual or perinatal transmission. A significantly higher prevalence of females (46±3%) was found among immigrants, compared with that observed overall in our cohort of HIV-infected individuals. The shorter duration of known HIV infection among foreigners is clearly related to the recent immigration and the frequent, late recognition of HIV disease: however, the arrival in our country allowed the diagnosis of a probable prior infection acquired in the country of origin in the majority of cases (73±2%).

Full Citation: Manfredi, R., Calza, L. & Chiodo, F. (2001) HIV disease among immigrants coming to Italy from outside of the European Union: a case-control study of epidemiological and clinical features. Epidemiology & Infection 127(3), 527–533. DOI: 10.1017} S0950268801006227

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Analytic note: This study examines items designed to validate HIV-related stigma and discrimination among healthcare providers in a resource-poor region in Ethiopia. This cross-sectional validation study demonstrates the high degree of stigma and discrimination in healthcare settings using valid and reliable HIV-related stigma scale. This article is cited because it makes reference to the existing stigma and discrimination towards persons with HIV in healthcare settings, the focus of our paper.

Source excerpt: Service providers in health care institutions are expected to provide social and psychological support to persons living with HIV (PLHIV) in order to help them cope with stress and to reduce the stigma directed against PLHIV. However, HIV/AIDS-related SAD has been extensively documented among health care providers. There have been many reports from health care settings of HIV testing without consent, breaches of confidentiality, labelling, gossip, verbal harassment, differential treatment, and even denial of treatment. People who feel stigmatized by health care providers face problems accessing HIV testing and optimal health care services. The fear of stigma impedes prevention efforts, including discussions of safer sex and the prevention of mother-to-child transmission.

Full Citation: Feyissa, G. T., Abebe, L., Girma, E., & Woldie, M. (2012). Validation of an HIV-related stigma scale among health care providers in a resource-poor Ethiopian setting. Journal of Multidisciplinary Healthcare, 5, 97–113. http://doi.org/10.2147/JMDH.S29789

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Analytic note: This study discusses the nature and extent of discriminatory practices and attitudes in the health sector and indicates possible contributing factors and intervention strategies. This article is cited to support the persistent of stigma and discrimination since the beginning of the epidemic more than 30 years ago.

Source excerpt: People living with AIDS (PLWA) may also face discrimination from those employed in the health-care sector. Discriminatory or unethical behavior by health-care professionals against PLWA, as documented in other countries, may create an atmosphere that interferes with effective prevention and treatment by discouraging individuals from being tested or seeking information on how to protect themselves and others from HIV/AIDS.

Full Citation: Reis, C., Heisler, M., Amowitz, L. L., Moreland, R. S., Mafeni, J. O., Anyamele, C. et al. (2005) Discriminatory attitudes and practices by health workers toward patients with HIV/AIDS in Nigeria. PLoS Medicine 2(8), e246. DOI: 10.1371/journal.pmed.0020246

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Analytic note: This study explores, within an Irish context, HIV-positive patients' experiences of hospitalization and particularly their experiences of nursing care, and to a lesser extent, with each other. Data from this qualitative study was analyzed using thematic analysis. Our article supports the findings of this study and previous study findings pertaining to the judgmental attitudes of nurses towards people with HIV/AIDS, especially regarding the means by which the patient contracted the disease and the extent to which nurses' believed this to be self-inflicted.

Source excerpt: Although segregated units may ensure that patients do not have to confront 'normals' (that is, other patients without the disease), they are unlikely to overcome fissures between different groups of patients, most notable gay people and drug users. Indeed, without being burdened by concerns with presenting themselves to 'normals', tension between these two groups may in fact intensify. Moreover, unless nurses working in segregated units can overcome prejudice towards some people with HIV/AIDS, most notably drug users, degrees of stigma and differentials in the quality of care are likely to result.

Full Citation: Surlis, S. & Hyde, A. (2001) HIV-positive patients' experiences of stigma during hospitalization. Journal of the Association of Nurses in AIDS Care 12(6), 68–77. DOI: 10.1016/S1055-3290(06)60185-4

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Analytic Note (Source 1): This paper reports findings from a study funded by the National Board for Nursing, Midwifery and Health Visiting for Scotland to test selected nursing and midwifery clinical competence assessment tools for reliability and validity. Because of copyright provisions, only the abstract of this paper is available for reading. This limits any candid evaluation of the article. However, this finding supports previous research, and confirms the validity of the different data collection methods used in our study.

Analytic Note (Source 2): Validity and quality have been an issue in qualitative research. This article questions the widely-held assumption of a single, more or less unified paradigm of ‘qualitative research’ whose methodologies share certain epistemological and ontological characteristics, and explores the implications of this position for judgements about the quality of research studies. This article is cited to support the fact that qualitative studies should be evaluated according to the merits of each study and not on some prescribed conceptualization of qualitative research.

Analytic Note (Source 3): The aim of this article is to outline rigour, or the integrity in which a study is conducted, and ensure the credibility of findings in relation to qualitative research. It discusses reliability, validity and generalizability typically associated with quantitative research and alternative terminology in comparison to their application to qualitative research. In our study, several methodological strategies (multiple data collection methods, sampling methods, engaging other researchers and data triangulation) were used to ensure credibility.

Source Excerpt (Source 1): A clear finding from this study is that no single method is appropriate for assessing clinical competence. A multi-method UK-wide strategy for clinical competence assessment for nursing and midwifery is needed if we are to be sure that assessment reveals whether or not students have achieved the complex repertoire of knowledge, skills and attitudes required for competent practice.

Source Excerpt (Source 2): The search for a generic framework for assessing the quality of qualitative research should be abandoned in favour of individual judgements of individual studies. Hope and Waterman (2003) call for a reconceptualization of validity in qualitative research in the search for the most appropriate set of criteria. Perhaps it would be more fruitful to reconceptualize qualitative (and quantitative) research. Rather than search for an overarching set of criteria by which to judge the validity of qualitative research, we should perhaps acknowledge that there is a multiplicity of (so-called) qualitative paradigms, each requiring very different approaches to validity. Or, put another way, there is no qualitative paradigm at all, so that each research methodology (and perhaps each individual study) must be appraised on its own merits.

Source Excerpt (Source 3): In the broadest context these terms are applicable, with validity referring to the integrity and application of the methods undertaken and the precision in which the findings accurately reflect the data, while reliability describes consistency within the employed analytical procedures.

Full Citation (Source 1): Norman, I. J., Watson, R., Murrells, T., Calman, L. & Redfern, S. (2002) The validity and reliability of methods to assess the competence to practise of pre-registration nursing and midwifery students. International Journal of Nursing Studies 39(2), 133–145. DOI: http://dx.doi.org/10.1016/S0020-7489(01)00028-1

Full Citation (Source 2): Rolfe, G. (2006) Validity, trustworthiness and rigour: quality and the idea of qualitative research. Journal of Advanced Nursing 53(3), 304–310. DOI: 10.1111/j.1365-2648.2006.03727.x

Full Citation (Source 3): Noble, H. & Smith, J. (2015) Issues of validity and reliability in qualitative research. Evidence Based Nursing 18(2), 34–35. DOI: 10.1136/eb-2015-102054

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Analytic Note: The media plays a role in shaping public perception of HIV, stigma and discrimination. From the onset of the HIV pandemic, most media have propagated HIV as an African disease and have encouraged the linkage of migration to HIV disease, thereby increasing the existing stigma and discrimination against migrants in the UK and many other European countries. This author reviews a report that highlights the role of both the UK media and African communities in the UK to combat stigma around HIV and AIDS. The author explains that the UK media primarily focuses on HIV as an African disease but does little to challenge myths about African migrants or the underlying factors that lead to Africans being especially vulnerable to HIV. Although this article was written in 2007, it is relevant to our research because it confirms the community linkage of migration to HIV and AIDS and the exacerbation of stigma and discrimination of migrants with HIV by mainstream media.

Source Excerpt: A new report launched last week highlights the role of both the UK media and African communities in the UK to combat stigma around HIV and AIDS. The report, Start the Press – from the African HIV Policy Network (AHPN) and Panos London – found that the UK media primarily focuses on HIV as an African disease but does little to challenge myths about African migrants or the underlying factors that lead to Africans being especially vulnerable to HIV. It suggests that journalists and African community advocates should be engaging more with each other. Last year, a study found that although African people account for the greatest number of new HIV diagnoses in the UK, many Africans are failing to come forward for testing or to access health services due to stigma and discrimination. Although this stigma and discrimination can come from within vulnerable communities themselves, it can also be exacerbated by mainstream and ethnic press coverage.

Full Citation: Bernard, E. J. (2007) UK Report Highlights Role of Media and African Communities to Combat HIV-Related Stigma. The African HIV Policy Network (AHPN) and Panos, London. https://www.aidsmap.com/UK-report-highlights-role-of-media-and-African-communities-to-combat-HIV-related-stigma/page/1428871/ (published 14 /11/2007)

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Analytic Note: Globally, HIV-related stigma clearly permeates migrants and minority communities. The fear of stigmatization and the degree to which stigmatization is experienced is reportedly greater among black people living with HIV/AIDS than white people living with HIV/AIDS. This book discusses lived experiences of HIV-positive migrants and ethnic minority background living Netherlands. The book highlights the medical, legal as well as the socio-economic challenges faced by these people. This study inspired the larger study on the experiences of sub-Saharan African migrant women living and aging with HIV/AIDS in Belgium, of which our article is part.

Source Excerpt: This book presents the stories of 15 HIV-positive people from migrant and ethnic minority backgrounds living in the Netherlands. Attention is drawn to the problems and challenges faced by these people and to the assistance they need. It deals with the medical aspects of HIV, but more importantly, it unveils their socio-economic context and highlights the legal aspects related to living with HIV. Additionally, attention is paid to the intimate lives and sexual health of migrants with HIV.

Full Citation: Shiripinda, I. & Eerdewijk, A. H. J. M. V. (2008) Facing HIV in The Netherlands: Lived Experiences of Migrants Living with HIV. Pharos, Utrecht. URL: http://hdl.handle.net/2066/73172.

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Analytic Note: HIV transmission and exposure is criminalized in some countries. This article comments on a previous article published by Bennett, Draper, and Frith (2000) on the criminalization of HIV transmission that saw a successful prosecution for the sexual transmission of a disease. This article provides background information on the Kelly case and also explores the possibilities for prosecution under English law in relation to HIV transmission. Although criminalization is not the focus of our study, however, it shows that criminalization of HIV transmission remains in discussion in different criminal justice systems.

Source Excerpt: In 2000, Bennett, Draper, and Frith published a paper in this journal considering the question of whether an HIV-positive individual could be said to have a moral duty to inform sexual partners of their HIV-positive status, and whether this moral duty should be reinforced by the criminal law. Since that paper appeared, an important legal development has taken place. In February 2001, at the High Court in Glasgow, Stephen Kelly became the first ever person to be convicted in the UK of transmitting HIV—and, indeed, the first person to be successfully prosecuted for the sexual transmission of disease for over a century.

Full Citation: Chalmers, J. (2002). The criminalisation of HIV transmission. Journal of Medical Ethics, 28(3), 160–163. http://doi.org/10.1136/jme.28.3.160

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Analytic Note: The authors provides a brief summary of the knowledge and practices concerning HIV amongst the Ethiopian and Eritrean immigrant community living in the West Midlands of the UK. The flow of migrants from high human immunodeficiency virus (HIV) prevalence regions such as sub-Saharan Africa to western countries is changing the profile of HIV infection in host countries, with immigrants from these countries accounting for the majority of heterosexually acquired HIV infection. Using in-depth qualitative methods, the study investigates the HIV "risk environment" of this immigrant community. The study finds that the group had little knowledge or understanding of the HIV epidemic in the UK and this resulted in serious misconceptions which led to risky sexual practice. The full article could not be accessed because of copyright. However, this study is relevant to our study because it highlights the fact that the pattern of HIV prevalence mirrors the prevalence of migrant population in the UK, similar to the HIV prevalence among sub-Saharan African migrants in Belgium who account for 3/4 of the heterosexual population of HIV persons.

Source Excerpt: The flow of migrants from high human immunodeficiency virus (HIV) prevalence regions such as sub-Saharan Africa to western countries is changing the profile of HIV infection in host countries, with immigrants from these countries accounting for the majority of heterosexually acquired HIV infection. Few studies have been conducted on the sexual culture and practices of different migrant African communities living in western countries including the UK. Significant gaps therefore exist in our knowledge of the HIV/AIDS prevention needs of culturally diverse communities, particularly those from sub-Saharan Africa living in the UK. Based on empirical research undertaken in 2007, this article explores the knowledge and practices concerning HIV amongst the Ethiopian and Eritrean immigrant community living in the West Midlands of the UK. Using in-depth qualitative methods, the study investigated the HIV "risk environment" of this immigrant community.

Full Citation: Barrett, H. R. & Mulugeta, B. (2010) Human Immunodeficiency Virus (HIV) and migrant ‘risk environments’: the case of the Ethiopian and Eritrean immigrant community in the West Midlands of the UK. Psychology, Health & Medicine 15(3), 357–369. DOI:10.1080/13548501003653192

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Analytic Note: The authors provides a brief summary of the knowledge and practices concerning HIV amongst the Ethiopian and Eritrean immigrant community living in the West Midlands of the UK. The flow of migrants from high human immunodeficiency virus (HIV) prevalence regions such as sub-Saharan Africa to western countries is changing the profile of HIV infection in host countries, with immigrants from these countries accounting for the majority of heterosexually acquired HIV infection. Using in-depth qualitative methods, the study investigates the HIV "risk environment" of this immigrant community. The study finds that the group had little knowledge or understanding of the HIV epidemic in the UK and this resulted in serious misconceptions which led to risky sexual practice. The full article could not be accessed because of copyright. However, this study is relevant to our study because it highlights the fact that the pattern of HIV prevalence mirrors the prevalence of migrant population in the UK, similar to the HIV prevalence among sub-Saharan African migrants in Belgium who account for 3/4 of the heterosexual population of HIV persons.

Source Excerpt: The flow of migrants from high human immunodeficiency virus (HIV) prevalence regions such as sub-Saharan Africa to western countries is changing the profile of HIV infection in host countries, with immigrants from these countries accounting for the majority of heterosexually acquired HIV infection. Few studies have been conducted on the sexual culture and practices of different migrant African communities living in western countries including the UK. Significant gaps therefore exist in our knowledge of the HIV/AIDS prevention needs of culturally diverse communities, particularly those from sub-Saharan Africa living in the UK. Based on empirical research undertaken in 2007, this article explores the knowledge and practices concerning HIV amongst the Ethiopian and Eritrean immigrant community living in the West Midlands of the UK. Using in-depth qualitative methods, the study investigated the HIV "risk environment" of this immigrant community.

Full Citation: Barrett, H. R. & Mulugeta, B. (2010) Human Immunodeficiency Virus (HIV) and migrant ‘risk environments’: the case of the Ethiopian and Eritrean immigrant community in the West Midlands of the UK. Psychology, Health & Medicine 15(3), 357–369. DOI:10.1080/13548501003653192

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Analytic Note (Source 1): Stigma and discrimination has public health implications worldwide. This essay discusses five interrelated components of stigma namely labelling, stereotyping, grouping, discrimination and loss of status and self-esteem and the exercise of power. It also discusses direct, structural, and insidious (labelling) as major forms of discrimination. This essay is vital as it forms a base for our research, whereby stigma and discrimination is experienced by women living with HIV/AIDS.

Analytic Note (Source 2): HIV-related stigma and discrimination goes beyond borders and culture. This study discusses factors that are associated with the level of empathy among healthcare service providers in China. The authors hypothesize that providers’ empathy levels would be associated with a lower level of avoidance attitudes to PLWHA at work. However, the study finds empathy, as well as stigma and discrimination among healthcare providers towards people living with HIV/AIDS in China, similar to what we found in our study.

Source Excerpt (Source 1): Stigma processes have a dramatic and probably under recognized effect on the distribution of life chances such as employment opportunities, housing, and access to medical care. We believe that under recognition occurs because attempts to measure the impact of stigma have generally restricted analysis to one circumstance (e.g., AIDS, obesity, race, or mental illness) and examined only one outcome (e.g., earnings, self- esteem, housing, or social interactions). If all stigmatized conditions were considered together and all outcomes examined we believe that stigma would be shown to have an enormous impact on people’s lives. To exemplify one part of this point we analyzed nationally representative data from the USA, in which multiple stigmatizing factors were taken into consideration in relation to self-esteem, and found that stigma could explain a full 20% of the variance beyond the effects of age, sex, and years of education.

Source Excerpt (Source 2): HIV-related stigma is prevalent worldwide and greatly undermines public health efforts to combat the epidemic. Perceived stigma is associated with stress, depression, and lower perceived quality of life among people living with HIV/AIDS (PLWHA). More directly, health service providers’ stigmatizing attitudes and avoidance behaviours toward PLWHA discourage people from seeking HIV testing and counselling, participating in prevention programs, accessing HIV treatment, and adhering to antiretroviral therapies. To start to address HIV-related stigma in health care settings, researchers have made efforts to understand its multiple origins. Factors contributing to stigmatizing and discriminatory responses among service providers include a lack of appropriate knowledge and training; the perception that HIV/AIDS is incurable; insufficient institutional support and perceived societal discrimination against HIV; lack of knowledge and supply of universal precautions and post exposure prophylaxis and legislative or policy gaps including health controls, quarantine, compulsory internment, and/or segregation in hospital etc.

Full Citation (Source 1): Link, B. G. & Phelan, J. C. (2006) Stigma and its public health implications. Lancet 367(9509), 528–529. DOI:10.1016/S0140-6736(06)68184-1

Full Citation (Source 2): Lin, C., Li, L., Wan, D., Wu, Z. & Yan, Z. (2012) Empathy and avoidance in treating patients living with HIV/AIDS (PLWHA) among service providers in China. AIDS Care 24(11), 1341–1348. doi: 10.1080/09540121.2011.648602

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Analytic Note: Physical, mental and economic burdens are encountered albeit the stigma and discrimination suffered by people infected or affected by HIV/AIDS. Children are most often infected and affected by HIV/AIDS stigma and discrimination. This cross-sectional study focuses on caregivers’ perceptions of stigma and discrimination related to HIV/AIDS affecting themselves and their children in central Haiti. This article is relevant to our study because it supports the fact that HIV/AIDS-related stigma and discrimination is persistent in different context.

Source Excerpt: Haiti is the most impoverished country in the western hemisphere and also has one of the highest prevalence estimates of HIV outside of sub-Saharan Africa (2.2%) (UNAIDS, 2008). In addition to the significant physical and economic burden of HIV disease, those who are HIV-infected in resource-poor settings may also face a significant degree of discrimination (Liechty & Bangsberg, 2003). In rural Haiti, being affected by HIV/AIDS can result in ostracism, blaming the victim for the disease, withholding of food, social isolation, and denial of human dignity (Fitzgerald & Simon, 2001)

Full Citation: Surkan, P. J., Mukherjee, J. S., Williams, D. R., Eustache, E., Louis, E., Jean-Paul, T. et al. (2010) Perceived discrimination and stigma toward children affected by HIV/AIDS and their HIV-positive caregivers in central Haiti. AIDS Care 22(7), 803–815. doi: 10.1080/09540120903443392

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Analytic Note: Stigmatization and discrimination are social processes, often characterized by cross-cultural diversity and complexity. This article offers a new framework by which to understand HIV and AIDS-related stigma and its effects. It highlights the manner in which stigma feeds upon, strengthens and reproduces existing inequalities of class, race, gender and sexuality. This article forms a solid basis of our research.

Source Excerpt: This sociological emphasis on the structural dimensions of discrimination is particularly useful in helping us think more sensibly about HIV and AIDS-related stigmatization and discrimination. To move beyond the limitations of current thinking in this area, we need to reframe our understandings of stigmatization and discrimination to conceptualize them as social processes that can only be understood in relation to broader notions of power and domination. In our view, stigma plays a key role in producing and reproducing relations of power and control. It causes some groups to be devalued and others to feel that they are superior in some way. Ultimately, therefore, stigma is linked to the workings of social inequality and to properly understand issues of stigmatization and discrimination, whether in relation to HIV and AIDS or any other issue, requires us to think more broadly about how some individuals and groups come to be socially excluded, and about the forces that create and reinforce exclusion in different settings.

Full Citation: Parker, R. & Aggleton, P. (2003) HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Social Science & Medicine 57(1), 13–24. https://doi.org/10.1016/S0277-9536(02)00304-0

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Analytic Note: This article upholds that though HIV is a preventable disease, but the challenging social environment makes prevention difficult.

Source Excerpt: Evidence from the study showed that prevailing HIV prevention paradigms reinforce the difficulties faced by young women in their sexual lives. This research adds to calls for alternative and wider approaches to HIV prevention, underpinned by gender empowerment.

Full Citation: Conn, C. (2013) Young African women must have empowering and receptive social environments for HIV prevention. AIDS Care 25(3), 273–280. https://doi.org/10.1080/09540121.2012.712659

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Analytic Note: Tuberculosis like HIV is a major public health problem and carries with it as much stigma as HIV. This literature review explores stigma and the impact of having tuberculosis or having a family member with tuberculosis. The review identifies fear, shame and isolation as the main themes emerging from the reviewed articles. This review highlights how tuberculosis stigma can have a negative impact on the individual and family and may result in discrimination similar to what is experienced by people living with HIV/AIDS, as correlated in our study.

Source Excerpt: The two major obstacles to the success of TB control are delays by people in seeking treatment and treatment being stopping prematurely. One of the suggested reasons why people delay in seeking treatment is related to the stigma associated with having this disease. Stigma caused by TB is difficult to define because it is such an abstract concept. Stigma is considered to be a social process that gives a mark or attribute to individuals and is characterised by exclusion, rejection, blame or devaluation of that individual. Goffman (1963) described stigma as a social disgrace that results from a transformation of the body, blemish of the character or membership of a despised group and that it disqualifies the bearer from full social acceptance.

Full Citation: Juniarti, N. & Evans, D. (2011) A qualitative review: the stigma of tuberculosis. Journal of Clinical Nursing 20(13–14), 1961–1970. doi: 10.1111/j.1365-2702.2010.03516.x

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Analytic Note: This article examines the level of perceived stigma and the risk factors contributing to it among leprosy affected person attending the green Pastures Hospital in Pokhara municipality in Western Nepal. The article is based on a cross-sectional study including questionnaires and focus group discussions. It describes illiteracy, perceived economic inadequacy, change of occupation due to leprosy, lack of knowledge, perception of leprosy as a severe disease and difficult to treat as factors associated with the high stigma. The authors further discuss the different types of stigma associated with leprosy such as: experienced or enacted, and perceived stigma, resulting to the loss of self-esteem and dignity, and commonly referred to as self-stigma or internalized stigma. The article gives a clear idea of the current understanding of perceived stigma in Western India and other regions of India, consistent with studies in Bangladesh and the Netherlands. Notwithstanding the fact that only perceived stigma was evident, this article is useful to our research on HIV stigma as it outlines the causes, forms and consequences of stigma among people suffering from a highly stigmatized disease like leprosy. The attitudes to conceal leprosy and lowered self-esteem are similar to the attitudes of concealment of HIV disease in our study. Most people living with HIV live with the fear of being stigmatized and discriminated against, similar to the fear when suffering from Leprosy.

Source Excerpt: “Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. Besides clinical sequel followed usually after infection, the consequences of stigma associated with leprosy outweigh the burden of physical afflictions. The article describes three kinds of stigma associated with leprosy. Experienced or enacted stigma refers to the real discrimination or acts experienced by leprosy affected persons while perceived stigma refers to the development of fear within an affected person where the fear may arise out of potential discrimination from family members, friends or society”.

Full Citation: Adhikari B, Kaehler N, Chapman RS, Raut S, Roche P (2014) Factors Affecting Perceived Stigma in Leprosy Affected Persons in Western Nepal. PLoS Negl Trop Dis8(6): e2940. https://doi.org/10.1371/journal.pntd.0002940

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Analytic Note: People who are obese do experience stigma and discrimination in various context. This article gives an in‐depth picture of both lived experience of obesity and the impact of socio‐cultural factors on people living with obesity. Additionally, this article describes an increasing culture of ‘blame’ against people living with obesity perpetuated by media and public health messages. This article has no direct link with HIV-related stigma and discrimination, the focus of our paper, but it is relevant in the similarities in the experiences of illness-related stigma and discrimination mentioned in our paper.

Source Excerpt: Participants believed that medical professionals – in particular GPs – were vitally important in helping people with obesity. However, most stated that this help had to be given in conjunction with long‐term weight loss support from nutritionists or dieticians and exercise consultants, and emotional support from psychologists or counsellors. The lack of affordable interventions meant that for most individuals this combination was not a realistic option. Participants stated that they wanted to be treated as ‘individuals’ rather than be prescribed a blanket remedy for their obesity. Many stated that they were frustrated that they were constantly told what to do about their obesity but not given support to implement diet/exercise regimes.

Full Citation: Thomas, S. L., Hyde, J., Karunaratne, A., Herbert, D. & Komesaroff, P. A. (2008) Being 'fat' in today's world: a qualitative study of the lived experiences of people with obesity in Australia. Health Expectations 11(4), 321–330. doi: 10.1111/j.1369-7625.2008.00490.x

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Analytic Note: People who are obsessed do experience stigma and discrimination in various context. This article gives an in‐depth picture of both lived experience of obesity and the impact of socio‐cultural factors on people living with obesity. Additionally, this article describes an increasing culture of ‘blame’ against people living with obesity perpetuated by media and public health messages. This article has no direct link with HIV-related stigma and discrimination, the focus of our paper, but it is relevant in the similarities in the experiences of illness-related stigma and discrimination mentioned in our paper.

Source Excerpt: Participants believed that medical professionals – in particular GPs – were vitally important in helping people with obesity. However, most stated that this help had to be given in conjunction with long‐term weight loss support from nutritionists or dieticians and exercise consultants, and emotional support from psychologists or counsellors. The lack of affordable interventions meant that for most individuals this combination was not a realistic option. Participants stated that they wanted to be treated as ‘individuals’ rather than be prescribed a blanket remedy for their obesity. Many stated that they were frustrated that they were constantly told what to do about their obesity but not given support to implement diet/exercise regimes.

Full Citation: Thomas, S. L., Hyde, J., Karunaratne, A., Herbert, D. & Komesaroff, P. A. (2008) Being 'fat' in today's world: a qualitative study of the lived experiences of people with obesity in Australia. Health Expectations 11(4), 321–330. doi: 10.1111/j.1369-7625.2008.00490.x

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Analytic Note: Stigma concept is literally applied to many circumstances and illnesses. This review article provides a critique of the different stigma concepts, nature, sources and consequences inspired by Goffman’s essay on “Notes on the management of Spoiled Identity”. The review looks into the variations and challenges in the definition of stigma concepts. After reviewing various concepts of stigma, the authors define stigma as the co-occurrence of its components–labeling, stereotyping, separation, status loss, and discrimination–and further indicate that for stigmatization to occur, power must be exercised. This work was cited because our article is focused in stigma and it is important to know the evolution of the conceptualization of stigma in social sciences.

Source Excerpt: Social science research on stigma has grown dramatically over the past two decades, particularly in social psychology, where researchers have elucidated the ways in which people construct cognitive categories and link those categories to stereotyped beliefs. In the midst of this growth, the stigma concept has been criticized as being too vaguely defined and individually focused. In response to these criticisms, we define stigma as the co-occurrence of its components–labelling, stereotyping, separation, status loss, and discrimination–and further indicate that for stigmatization to occur, power must be exercised. The stigma concept we construct has implications for understanding several core issues in stigma research, ranging from the definition of the concept to the reasons stigma sometimes represents a very persistent predicament in the lives of persons affected by it. Finally, because there are so many stigmatized circumstances and because stigmatizing processes can affect multiple domains of people's lives, stigmatization probably has a dramatic bearing on the distribution of life chances in such areas as earnings, housing, criminal involvement, health, and life itself. It follows that social scientists who are interested in understanding the distribution of such life chances should also be interested in stigma.

Full Citation: Link, B. G. & Phelan, J. C. (2001) Conceptualizing Stigma. Annual Review of Sociology 27(1), 363–385. http://dx.doi.org/10.1146/annurev.soc.27.1.363

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Analytic Note: Stigma is an illuminating excursion into the situation of persons who are unable to conform to standards that society calls normal. In this book, the author makes the aspect of stigma prominent and analyses a stigmatized person’s feelings about himself and his/her relationship to his/her social environment. This book demonstrates that stigma can occur in different forms, the most common deal with culture, gender, race, illness and disease. Once the stereotype is secured, society form expectations of the labelled groups and the stigmatized individuals must strive to their uncertain social identities. Goffman further explores the different strategies stigmatized individuals use to deal with being discredited or discreditable. The author gives an explanation of the process of stigma which spoils normal identity because of the deeply discreditable attribute. This book sets the foundation for our study.

Source Excerpt: "The term stigma, then, will be used to refer to an attribute that is deeply discrediting, but it should be seen that a language of relationships, not attributes, is really needed. An attribute that stigmatizes one type of possessor can confirm the usualness of another, and therefore is neither creditable nor discreditable as a thing in itself. For example, some jobs in America cause holders without the expected college education to conceal this fact; other jobs, however, can lead the few of their holders who have a higher education to keep this a secret, lest they be marked as failures and outsiders. Similarly, a middle class boy may feel no compunction in being seen going to the library; a professional criminal, however, writes:

'I can remember before now on more than one occasion, for instance, going into a public library near where I was living, and looking over my shoulder a couple of times before I actually went in just to make sure no one who knew me was standing about and seeing me do it.' (1)

Full Citation: Goffman, E. (1963) Stigma: Notes on the Management of Spoiled Identity. Simon & Schuster Inc., New York.

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Analytic Note: Stigma is pervasive and a fundamental cause of health and social inequalities. This article discusses the persistence of inequality because of certain characteristics of the fundamental causes. It examines how fundamental social cause influences multiple disease outcomes through multiple risk factors among a substantial number of people. It also indicates that fundamental social cause involves access to resources such as knowledge, money, power, prestige, and beneficial social connections. This article was useful in our research as we described the causes of stigma in healthcare settings. Our findings confirmed the existing HIV stigma.

Source Excerpt: Bodies of research pertaining to specific stigmatized statuses have typically developed in separate domains and have focused on single outcomes at 1 level of analysis, thereby obscuring the full significance of stigma as a fundamental driver of population health. Here we provide illustrative evidence on the health consequences of stigma and present a conceptual framework describing the psychological and structural pathways through which stigma influences health. Because of its pervasiveness, its disruption of multiple life domains (e.g., resources, social relationships, and coping behaviors), and its corrosive impact on the health of populations, stigma should be considered alongside the other major organizing concepts for research on social determinants of population health.

Full Citation: Hatzenbuehler, M. L., Phelan, J. C. & Link, B. G. (2013) Stigma as a fundamental cause of population health inequalities. American Journal of Public Health 103(5), 813–821. doi: 10.2105/AJPH.2012.301069

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Analytic note: I collected the data on California ethnic fractionalization from annual reports released by the California Department of Corrections and Rehabilitation.

Full Citation: California Department of Corrections and Rehabilitation. 2012. Prison Census Data. Data Analysis Unit.

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Analytic note: This seems to be true, based on resident's observations. However, there is no strong, quantitative evidence to establish this relationship. Given the way in which prisoners describe the market, it seems reasonable that prices would reflect quality.

Full Citation: Stringham, E. 2015. Private Governance: Creating Order in Economic and Social Life. New York: Oxford University Press.

Tiebout, C. M. 1956. “A Pure Theory of Local Expenditures.” The Journal of Political Economy, 416–24.

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Analytic note: The claim that officials provide little to no governance is surprising, and one that I initially met with skepticism. However, the number of confirming accounts, from a wide range of source (cited here, but also a large literature), provide confidence in the claim. More generally, as one observes the shockingly low quality of official governance in many Latin American prisons, the case in Bolivia becomes less unusual and more plausible.

Full Citations: Baltimore, B., A. Bastien van der Meer, M. Brennan, M. Burton, M. Castillo, L. Cavise, A. Davis, J. Friedman-Rudovsky, A. Mendoza, D. Oliveira, J. Somberg,V. Spinazola, K. Staskawicz, L. Stern, and L. Tockman, et al. 2007. Report of Delegation to Bolivia. New York: National Lawyers Guild.

Organization of American States. 2007. Access to Justice and Social Inclusion: The Road Towards Strengthening Democracy in Bolivia. Washington, DC: Inter-American Commission on Human Rights.

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Analytic note: While it is difficult to establish a precise causal relationship between these factors, there is a substantial amount of supportive evidence. The authors cited have a deep knowledge of crime and prisons in Brazil. They provide credible information about the existence and operation of the gang's adjudication procedures and credible data on prison violence. Of course, there may be endogeneity problems or confounding variables, but given the rich qualitative evidence available, the causal relationship seems highly likely.

Full Citations: Denyer Willis, G. 2015. The Killing Consensus: Police, Organized Crime, and the Regulation of Life and Death in Urban Brazil. Berkeley: University of California Press.

Dias,C. N., and F. Salla. 2013. “Organized Crime in Brazilian Prisons: The Example of the PCC.” International Journal of Criminology and Sociology 2: 397–408.

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Analytic note: This quote is representative of other accounts, and I used it because the author was in the best place possible to make this assessment. He worked in the prison for a long period in a context that would allow for informal and open conversations with prisoners and observations of their activity.

Full Citation: Varella, D. 1999. Lockdown: Inside Brazil’s Most Dangerous Prison. London: Simon & Schuster.

</a> <br> This is an Annotation for Transparent Inquiry project, published by the Qualitative Data Repository.

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<font>The Data Overview discusses project context, data generation and analysis, and logic of annotation.</font>

<br> Please cite as:

Skarbek, David. 2018. "Data for: Covenants without the sword? Comparing prison self-governance globally". Qualitative Data Repository. https://doi.org/10.5064/F6AGINR7

Learn more about ATI here.

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Analytic Note: This quote is from an interview conducted by the author. The respondent did not consent to an audio recording so notes were taken by hand. This specific quote caught my attention and I put it in quotation marks in my original notes, which I have cut and pasted below. Detailed information about the semi-structured interviews on which this article relies can be found in Section 1 of the online appendix.

Source Excerpt: --the authorities were much worse than criminals: “who cares about criminals—all the inspectors can close you in a matter of seconds; this is itself a kind of mafia system”

Full Citation: Author interview, Firm 25, 3 June 2009

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Analytic Note: This quote is from an interview conducted by the author. The respondent did not consent to an audio recording so notes were taken by hand. I immediately recognized the usefulness of this quote and bolded it when I typed up my notes the evening after the interview. Below is an excerpt from my original notes. Detailed information about the semi-structured interviews on which this article relies can be found in Section 1 of the online appendix.

Source Excerpt: great quote from gen director: “We don’t send in guys with guns because we don’t want guys with guns coming to see us.”

Full Citation: Author interview, Firm 10, 14 March 2009

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Analytic Note: This quote is from an interview conducted by the author. The majority of the interview was recorded but the respondent began talking before I could request permission to turn on my recorder. Because he was touching on interesting subjects, I did not want to cut him off. I was taking notes by hand and immediately circled this quote for potential use in publications. Additional information about the semi-structured interviews on which this article relies can be found in Section 1 of the online appendix. The passage below is verbatim from the notes I typed up on the evening of the interview (including the bolding and the note to myself).

Source Excerpt: says firms are definitely more willing to turn to courts against the government: “15-20 years ago, my main problem was not winning, but convincing businesspeople that it is worth going to court.” [note: he said this before I started the recording]

Full Citation: Author interview, Lawyer 21, 5 November 2009

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Analytic Note: To support the claim that the population of lawyers has more than doubled during the time period in question, I cite my earlier study Gans-Morse (2012, pp. 274-5), which in turn cites two sources. The first is Table 4 on p. 385 in Hendley (2006), which provides data for 1996-2004. The second is a publication of the Federal Chamber of the Lawyers of the Russian Federation, which provides data for 2009. The relevant excerpts are provided below.

Source Excerpt: One indicator of the expanding role of law in the Russian business world is the growing population of lawyers. The legal community in Russia is divided among advokaty and yuristy. Only the former are required to take a bar exam and pay bar membership dues. Therefore, only the exact number of advokaty is known, even though they represent the minority of all lawyers. Among advokaty, there has been a dramatic increase, from 26,300 in 1996 to 63,740 in 2010, a 140 percent change, even though during this period the overall population of Russia was declining.12 (Gans-Morse 2012, pp. 274-5)

From footnote 12 of Gans-Morse (2012, p. 275): Biannual data from 1996–2004 on the number of registered advokaty can be found in Hendley (2006, p. 385). For more recent data, see the report produced by the Federal Chamber of Lawyers of the Russian Federation (in Russian, Federal’naya palata advokatov Rossiyskoy Federatsii) (Informatsionnaya spravka, 2010, p. 32).

Source Excerpt (Supplementary Source 2): По состоянию на 31 декабря 2009 г. в региональных реестрах субъектов Российской Федерации зарегистрированы сведения о 63 740 адвокатах, имеющих действующий статус.

Source Excerpt Translation (Supplementary Source 2): As of December 31, 2009, according to the regional registers of the subjects of the Russian Federation, 63,740 lawyers [advokaty] with active status were registered.

Data Sources: https://data.qdr.syr.edu/file.xhtml?fileId=2652

https://data.qdr.syr.edu/file.xhtml?fileId=2649

Full Citation: Gans-Morse, Jordan. 2012. “Threats to Property Rights in Russia: From Private Coercion to State Aggression.” Post-Soviet Affairs 28 (3): 263–95.

Full Citation (Supplementary Source 1): Hendley, Kathryn, “Assessing the Rule of Law in Russia,” Cardozo Journal of International and Comparative Law, 14, 2:347–391, Fall 2006. (see Table on p. 385)

Full Citation (Supplementary Source 2): Federal Chamber of Lawyers of the RF, “Informatsionnaya spravka o sostoyanii advokatury i advokatskoy deyatel’nosti v 2009 (Report on the state of the bar and the legal profession’s activity in 2009),” Vestnik federal’noy palaty advokatov Rossiyskoy Federatsii, 28, 2:32–53, 2010

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Analytic Note: The claim that less than 15 percent of industrial firms had a shareholder with a majority stake in 1995 is from Table 1 (bottom row, first column) on p. 7 of Dolgopyatova (2005). The claim that approximately three-fourths of such firms had a majority shareholder by the mid-2000s is from the passage on p. 85 of Dolgopyatova (2010) presented below. Additional sources and discussion of ownership consolidation can be found on pp. 129-131 of Gans-Morse, Property Rights in Post-Soviet Russia: Violence, Corruption, and Demand for Law, Cambridge University Press, 2017. To be sure, comparison of surveys from different sources and different time periods requires caution, as there are differences in sample size and composition across studies. These figures should therefore be considered rough approximations, the central point being that existing sources overwhelmingly point to a significant trend of ownership concentration in privatized firms in Russia form the late 1990s through the mid-2000s. One final note is also warranted: Dolgopyatova (2010) discusses how between 2005 and 2009 some of these trends toward ownership concentration began to reverse course. While noteworthy, the changes she identifies are relatively small. Moreover, they presumably occurred after dominant owners had acquired control of a firm and put in place procedures that made them more confident in their ability to sell blocks of ownership to minority shareholders without facing the threats and conflicts that were common in the 1990s.

Source Excerpt: Первый раунд продемонстрировал, что в 2005 г. высокий уровень был характерен для 3/4 хозяйственных обществ, всего 8% составили предприятия со средним уровнем концентрации и 16% – с низким. (Dolgopyatova 2010, 85)

Source Excerpt Translation: The first round [of survey monitoring] demonstrated that in 2005 a high level [of concentrated ownership] was characteristics for ¾ of enterprises. Only 8% of enterprises had a medium level of concentration and 16% had a level. (Dolgopyatova 2010, 85)

Note: In the preceding paragraph on p. 85 Dolgopyatova (2010) explains that a high level of concentration is when a single owner or consolidated group of owners control 50% of shares; a medium level is when a single owner or group controls 25-50% of shares; and a low level is when the largest owner controls less than 25%.

Data Sources:

https://data.qdr.syr.edu/file.xhtml?fileId=2647

https://data.qdr.syr.edu/file.xhtml?fileId=2648

Full Citation (Source 1): Dolgopyatova, Tatiana. 2005. “Evolution of Corporate Control Models in Russian Companies: New Trends and Factors.” Higher School of Economics Working Paper.

Full Citation (Source 2): Dolgopyatova, Tatiana. 2010. “Kontsentratsiya Sobstvennosti v Rossiiskoi Promyshlennosti: Evolyutsionnye Izmeneniya na Mikrourovne [Concentration of Ownership in Russian Industry: Evolutionary Change on the Micro-level].” Dzhurnal Novoi Ekonomicheskoi Assotsiatsii (8): 80–100.

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Analytic Note: There are two claims here: a specific one about the sources of the private security sector’s income and a broader one about the evolution of private security in Russia. The latter is the more important one with respect to the arguments developed in the article. These claims are based on several sources. First, they are based on my interview notes with Ivanchenko, the head of an association of private security companies (this interview was not recorded, but the respondent agreed to the use of his name). The respondent indicated that the private security market had annual revenues at the time of approximately 7 billion USD, of which about 5.5 billion USD (or 78.5%) was from basic physical security and the rest from information security and the sale of security technology. In other work, I have also cited Khodorych (2002) in support of this point about revenues in the private security sector (see p. 52 of Jordan Gans-Morse, Property Rights in Post-Soviet Russia: Violence, Corruption, and Demand for Law, Cambridge University Press, 2017). An excerpt from Khodorych (2002) is included below. But more important than the specific figures is the larger point that the role of private security in Russia had evolved by the mid-to-late 2000s, if not earlier, and came to resemble the types of private security that are common in the West. As I discuss in Property Rights in Post-Soviet Russia (p. 52), “Today, the Russian acronym for private security agencies introduced above – ChOP – narrowly refers to security guards.” A footnote to this point (footnote 11 of Chapter 3) then expands: “This statement was corroborated without exception in interviews with businesspeople and security specialists. In a typical response regarding the functions of ChOPs, one small businessperson in Moscow explained: ‘ChOPs? Those are just the guys that stand outside and guard the door’ (Firm 1, interview, 2009).”

Source Excerpt (Supplementary Source): По разным оценкам (опрошено восемь руководителей крупных охранно-детективных объединений), собственно охрана приносит до 70% доходов рынка. Остальное добирается информационно-аналитическими и юридическими услугами, продажей спецоборудования и аксессуаров. (Khodorych, 2002)

Source Excerpt Translation (Supplementary Source): According to various assessments (eight directors of large security-detective associations were surveyed), [physical] security itself brings as much as 70% of the market’s income. The rest is obtained from information-analytical and legal services and from the sale of specialized equipment and accessories. (Khodorych, 2002)

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2655

Full Citation: Author interview with Aleksandr Ivanchenko, Director of Russian Security Industry Association on June 8, 2009.

Full Citation (Supplementary Source): Khodorych, Aleksey, “Posledniy dovod zashchity (The defense’s last argument),” Den’gi, April 17, 2002

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Analytic Note: The claim that in 1993 there were approximately 5,000 private security agencies is based on Table 3 on p. 138 of the Volkov (2002). Volkov’s data in the table are for 1992 through 1999. I initially sought to update this table using the same sources as Volkov, a series of trade journals from the private security sector, but these journals were defunct. I therefore collected a variety of sources from the Russian press and the Russian Ministry of Internal Affairs, which are cited in Gans-Morse (2012) on p. 267 (footnote 5). The estimate of 30,000 by the late 2000s is from these sources. Below are excerpts from the two most relevant sources.

Source Excerpt (Supplementary Source 1): На рынке частной охраны насчитывается около 29 тыс. юридических лиц…. (Borodkin, 2008)

Source Excerpt Translation (Supplementary Source 1): There are around 29 thousand legal entities in the private security market….(Borodkin, 2008)

Source Excerpt (Supplementary Source 2): На 1 января 2009 г. в ОВД состоит на учете 29,8 тыс. охранно-сыскных структур….(MVD, 2009)

Source Excerpt Translation (Supplementary Source 2): As of January 1, 2009, there are 29.8 thousand security-detective companies registered with the organs of internal affairs…. (MVD, 2009)

Data Sources:<br> https://data.qdr.syr.edu/file.xhtml?fileId=2664 https://data.qdr.syr.edu/file.xhtml?fileId=2645 https://data.qdr.syr.edu/file.xhtml?fileId=2801

Full Citation (Source 1): Volkov, Vadim. 2002. Violent Entrepreneurs: The Use of Force in the making of Russian Capitalism. Ithaca, NY: Cornell University Press

Full Citation (Source 2): Gans-Morse, Jordan. 2012. “Threats to Property Rights in Russia: From Private Coercion to State Aggression.” Post-Soviet Affairs 28 (3): 263–95.

Full Citation (Supplementary Source 1): Borodkin, Aleksey, “Razoruzhennaya okhrana (Disarmed guards),” Den’gi, November 24, 2008.

Full Citation (Supplementary Source 2): Press release from the Ministry of Internal Affairs (MVD) from 4.02.2009

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Source Excerpt: Все начинается с индивидуального уровня. Движение к легалицации требует принятия личных решений владельцев и высших менеджеров бизнеса, которые готовы в этом случае взять на себе неизбежные дополнительные издержки. Однако индивидуальных решений в таком деле явно не достаточно. Ни у кого из российских участников рынка нет достаточных сил, чтобы легализоваться в одиночку, не обращая внимания на то, что делают конкуренты. Это означает, что представители ведущих компаний должны договориться между собой о новых правилах игры.

Здесь возникают вполне понятные объективные и субъективные трудности. Кто-то лично не ладит друг с другом (говорят: «так сложилось»). Но главное – многие являются прямыми конкурентами. И о полной откровенности и открытости в вопросах явно коммерческого характера говорить не приходиться. Впрочем, как правило, речь идет уже не об открытом недоверии (которое в значительной степени преодолено), а скорее, о несколько осторожном отношении бизнесменов друг к другу. Установлению более доверительных отношений на интересующем нас рынке электробытовой и компьютерной техники способствует особая ситуация, когда корпус руководителей максимально однороден по составу – по возрасту, уровню и профилю образования. Это, несомненно, облегчает контакты. Вдобавок, руководители знают друг друга, следят за деятельностью «соседей» в течение многих лет и, следовательно, имеют представление о том, чего можно ожидать от них, а на что лучше не рассчитывать. (Radaev 2002, 48)

Source Excerpt Translation: It all begins at the individual level. The movement toward legalization requires personal decisions by owners and top managers of the business, who are ready in this case to take the inevitable additional expenses on themselves. However, individual decisions in this matter clearly are not enough. None of the Russian partcipants in this market have enough strength to legalize by themselves without paying attention to what their competitors are doing. This means that representatives of leading companies must come to agreement among themselves about new rules of the game.

Here arises fully understandable objective and subjective difficulties. Someone doesn't get along with someone. But importantly – many of them are direct competitors. And we shouldn't even speak of full openness and sincerity in commercial matters. However, as a rule, the issue isn't even about outright distrust (which to a significant degree can be overcome), but more likely about the somewhat cautious attitude of businesspeople toward each other. In the electronics and computer market in which we are interested the establishment of more trusting relationships is faciliated by a unique situation in that the main body of directors is maximally similar in composition – similar age, level, and educational profile. This, undoubtedly, makes contact easier. Additionally, directors [of firms] know each other, they have followed the activities of their ‘neighbors’ for many years and, accordingly, they have a good conception of what to expect from them, and what is better to not count on. (Radaev 2002, 48)

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2802

Full Citation: Radaev, Vadim. 2002. Institutsionalnaya Dinamika Rynkov i Formirovanie Novych Konseptsii Kontrolya [Institutional Market Dynamics and the Formation of New Concepts of Control]. Higher School of Economics working paper.

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Source Excerpt: Принудительные методы с использованием силовых и государственных контролирующих структур уже не считаются наиболее эффективными. Так, привлечение «правильных пацанов» (криминальных группировок) – дело, опасное, и дорогое. А организация заказных проверок со стороны государственных структур – дело, конечно, более надежное, но также является «палкой о двух концах». Любые грубые силовые действия означают начало «войны». А открытой «войны» ведущие игроки уже, как правило, не хотят.

Source Excerpt Translation: Forceful methods using violence or government regulatory structures already are not considered to be the most effective. For instance, involving ``the boys’’ (criminal gangs) is a dangerous and expensive matter. And organizing contract inspections by government agencies is of course more reliable, but this also is a double-edge sword. Any rough use of force signifies the beginning of a “war.” And an open “war” is something that the leading players [in the market] already, as a rule, do not want.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2802

Full Citation: Radaev, Vadim. 2002. Institutsionalnaya Dinamika Rynkov i Formirovanie Novych Konseptsii Kontrolya [Institutional Market Dynamics and the Formation of New Concepts of Control]. Higher School of Economics working paper.

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Source Excerpt: Нельзя легализоваться в одиночку, нужно, чтобы легализовалось вся остальная часть рынка, а может быть, даже весь рынок. Потому что если 90% работают легально, а 10% -- нелегально, мы просто ничего сделать не можем. Все в конце концов будут перебегать (туда, где 10%), и все.

Source Excerpt Translation: It’s not possible to legalize one’s business by oneself. It’s necessary that the rest of the market, and maybe even the whole market, is legalized. Be- cause if 90 percent work legally, and 10 percent illegally, then we can’t do anything. Everyone [i.e., consumers] will eventually run to the 10 percent.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2802

Full Citation: Radaev, Vadim. 2002. Institutsionalnaya Dinamika Rynkov i Formirovanie Novych Konseptsii Kontrolya [Institutional Market Dynamics and the Formation of New Concepts of Control]. Higher School of Economics working paper.

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Source Excerpt: При этом на практике на микроуровне сосуществуют различные модели корпоративного управления. Они тесно связаны с разными структурами собственности и контроля в компаниях и оказывают существенное влияние на мотивацию собственников и менеджеров предприятий, которая стала ощутимо меняться в России в последние 2-3 года. В целом возникают основания говорить о возможном переходе в поведении инсайдеров от модели систематического вывода активов к созданию условий для развития подконтрольного бизнеса. (Yakovlev et al. 2004, p. 144)

Source Excerpt Translation: In practice different models of corporate governance coexist on the micro-level. They are closely related to different structures of ownership and control in the company and have a substantive effect on the motivations of enterprise owners and managers, which visibly have been changing in Russia over the last 2-3 years. Overall, there are now grounds to say that a possible transition in the behavior of insiders from the model of systematic asset stripping to the creation of conditions for the development of a business already under their control. (Yakovlev et al. 2004, p. 144)

Source Excerpt: Анализ интервью показывает, что консолидация собственности сопровождается удлинением горизонта планирования и ростом инвестиционной активности. (Yakovlev et al. 2004, p. 149)

Source Excerpt Translation: Analysis of the interviews shows that consolidation of ownership is accompanied by the lengthening of time horizons for planning and the growth of investment activity. (Yakovlev et al. 2004, p. 149)

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2668

Full Citation: Yakovlev, Andrei, Victoria Golovanova, Tatiana G. Dolgopyatova, Boris Kuznetsov, and Yuri Simachev. 2004. Spros na Pravo v Sfere Korporativnogo Upravleniya [Demand for Law in the Sphere of Corporate Governance]. Moscow: Higher School of Economics.

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Analytic Note: The claims about the number of privatized firms are based on row 6 (for small enterprises) and row 10 (for medium and large enterprises) in Table 1 of the appendix for Blasi et al. (1997) on p. 189. By 1995, 105,111 small enterprises and 17,937 medium and large enterprises had been privatized.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2644

Full Citation: Blasi, Joseph R., Maya Kroumova, and Douglas Kruse. 1997. Kremlin Capitalism: Privatizing the Russian Economy. Ithaca, NY: Cornell University Press

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Analytic Note: The claim about Peruvian apparel firms' motivations for emerging from the informal sector is based on the top panel of Box 22 on p. 46 of Bruce et al. (2007).

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2646

Full Citation: Bruce, John W., Omar Garcia-Bolivar, Michael Roth, Anna Knox, and Jon Schmid. 2007. Land and Business Formalization for Legal Empowerment of the Poor. Strategic Overview Paper, USAID. Ithaca, NY

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Analytic Note: In Gans-Morse (2012, pp. 284-286) examples beyond Khodorkovsky are provided. On the claim about copycat behavior, I cite an interview I conducted with Yana Yakovleva, the founder of a business association created to aid entrepreneurs who had been attacked by state agencies (see the source excerpt below). I additionally show in Table 3 on p. 286 of Gans-Morse (2012) that economic crimes increased in the immediate aftermath of the Khodorkovsky affair (see the source excerpt above). Meanwhile, the claim of 110,000 businesspeople being incarcerated is based on a New York Times article. This exact figure should be treated with caution. In the article, the exact source of the statistic is not made clear, but at the time of the article’s publication this was a figure being circulated by various Russian business associations, representatives of which are cited by Kramer (2013). While my confidence in this exact figure is circumscribed, the larger point about increases in economic crimes being used as a tool of repression by state agencies – and about the overall prevalence of this tactic – is well supported by the data in Table 3 of Gans-Morse (2012) and the accompanying discussion.

Source Excerpt (Source 1): In the words of Yana Yakovleva, the founder of Biznes Solidarnost’, an association dedicated to aiding entrepreneurs who have been wrongly imprisoned, after 2003 every official was looking for his “own little Yukos” (Yakovleva, 2009). (Gans-Morse 2012, p. 285)

Source Excerpt (Source 1): As can be seen in Table 3, after 2003, the initial year of the Khodorkovskiy affair, there was a notable increase in the number of economic crimes uncovered by Ministry of Internal Affairs investigators: Between 2003 and 2004, fraud-related cases, which since the late 1990s had remained relatively constant, increased nearly 15 percent. The number of money-laundering cases nearly doubled and then continued to skyrocket as the decade proceeded. (Gans-Morse 2012, pp. 285-286)

Data Sources: https://data.qdr.syr.edu/file.xhtml?fileId=2651

https://data.qdr.syr.edu/file.xhtml?fileId=2656

Full Citation (Source 1): Gans-Morse, Jordan. 2012. “Threats to Property Rights in Russia: From Private Coercion to State Aggression.” Post-Soviet Affairs 28 (3): 263–95.

Full Citation (Source 2): Kramer, Andrew, “Russia’s Stimulus Plan: Open the Gulag Gates,” The New York Times (August 8, 2013)

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Analytic Note: The claim about the spike in interfirm cases between 2008 and 2009, and lack of a similar spike between 1997 and 1998, is based on the rows titled По спорам, возникающим из гражданских правоотношений (Cases arising from civil law disputes) on p. 1 and p. 4. As can be seen on p. 1, the change between 1997 and 1998 was just 8.3% (from 280,583 to 286,296). By contrast, as can be seen on p. 4, the change between 2008 and 2009 was 76% (from 457,218 to 804, 820).

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2663

Full Citation: Vysshyi Arbitrazhnyi Sud (VAS). 2011. Osnovnye Pokazateli Raboty Arbitrazhniykh Sudov RF [Basic Indicators of the Work of the Commercial Courts of the RF]. Vysshyi arbitrazhnyi sud [Supreme Arbitrazh Court] in Moscow.

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Analytic Note: In earlier versions of the article and other related studies, I cited a number of studies to support the claim that multiple surveys document firms’ extensive use of legal institutions (see p. 59 in Gans-Morse, Property Rights in Post-Soviet Russia: Violence, Corruption, and Demand for Law, Cambridge University Press, 2017). During the review process I removed some citations to reduce word count. I am here providing one of these sources, INDEM (2009), because it provides the most direct support for the specific claim that about one-third of small and two-thirds of large firms have used the courts. Table 2.1 on p. 12 of this summary of the INDEM survey results shows that of all firms in the sample, around 33% had at some point used the courts. Of small firms, this figure was 27%; of medium, 35%; and of large, 64%.

Meanwhile, Hendley et al. (2000), whose sample consists of relatively larger industrial firms, show in Table 5 on p. 636 that 61% of firms in their sample had used the commercial courts to address a problem with a customer. Yakovlev et al. 2004 (pp. 69-72) find that just over 60% of firms in their overall sample had been to court, including approximately 90% of large firms (more than 500 employees), 55% of medium firms (100-500 employees), and just under 40% of small firms (less than 100 employees) (see especially Table 2.10 (Рис. 2.10) on p. 71). It should be noted that the sample in the Yakovlev et al. 2004 study consists of joint-stock companies, which face more legal regulations and may be more likely to use courts than other firms.

Data Sources: https://data.qdr.syr.edu/file.xhtml?fileId=2653

https://data.qdr.syr.edu/file.xhtml?fileId=2668

https://data.qdr.syr.edu/file.xhtml?fileId=2654

Note: I am providing the full document for Yakovlev et al. (2004) because it is available for free on the Higher School of Economics website: https://id.hse.ru/data/2012/05/04/1263461146/4.pdf

Full Citation (Source 1): Hendley, Kathryn, Peter Murrell, and Randi Ryterman. 2000. “Law, Relationships and Private Enforcement: Transactional Strategies of Russian Enterprises.” Europe-Asia Studies 52 (4): 627–56.

Full Citation, (Source 2): Yakovlev, Andrei, Victoria Golovanova, Tatiana G. Dolgopyatova, Boris Kuznetsov, and Yuri Simachev. 2004. Spros na Pravo v Sfere Korporativnogo Upravleniya [Demand for Law in the Sphere of Corporate Governance]. Moscow: Higher School of Economics.

Full Citation (Supplementary Source): INDEM Fund. 2009. “Sudebnaya vlast i predprinimateli: rezultaty sotsiologicheskogo analiza” [The judicial branch and entrepreneurs: Results of sociological analysis] (Note: in other studies I have cited this same survey material from a related source, Rimskii (2009).)

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Source Excerpt: К концу 90-х большинство платежеспособных предпринимателей «добровольно» оказывало поддержку правоохранительных органам. Можно сказать, что страна была разделена на зоны «милицейской ответственности».

Source Excerpt Translation: By the end of the 1990s, the majority of entrepreneurs capable of making money were ‘voluntarily’ providing support to the law enforcement authorities. It could be said that the country had been divided into zones of ‘police patronage’

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2662

Full Citation: Sborov, Afanasiy, “Oborotni v pogonakh (Werewolves in epaulets),” Vlast’, July 21, 2003.

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Analytic Note: The claim that over 40 percent of respondents in the Frye and Zhuravskaya (2000) survey reported recent contact with criminal groups is based on the first row of Table 3 on p. 488.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2650

Full Citation: Frye, Timothy, and Ekaterina Zhuravskaya. 2000. “Rackets, Regulation, and the Rule of Law.” Journal of Law, Economics, and Organization 16 (2): 478–502.

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Analytic Note: The claim that approximately two out of five respondents in the Radaev (1999) survey experienced violence or threats of coercion is based on the second row of Table 1 on p. 37.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2660

Full Citation: Radaev, Vadim. 1999. “The Role of Violence in Russian Business Relations.” Problems of Economic Transition 41 (12): 34–61.

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Analytic Note: This quote is from an interview conducted by the author. The interview was recorded and transcribed. Detailed information about the semi-structured interviews on which this article relies can be found in Section 1 of the online appendix.

Source Excerpt: Но как человек, который в душе законо-послушен, а большинство людей предпочтут жить по законам, чем против закона – большинство, то мы – Я всегда чувствовал дискомфорт от этого и сейчас, когда постепенно ужесточается и контроль и законы и наказание и все прочее, и – с одной стороны, а сдругой стороны себестоимость – как следствие этого стоимость вот этих вот серых схем, возрастла на столько, что уже стала экономически в общем-то, не то чтобы выгоднее, но не так обидно работать вбелую, впрямую, что мы когда вот это появилась такая возможность, мы стали это делать. Мы перешли большей частью на белые схемы.

Source Excerpt Translation: As a person with a law-abiding soul, and the majoriy of people prefer to live by the laws, rather than against the law – I always felt uncomfortable [with illicit schemes] –When gradually regulations and laws and punishment and all the rest became stricter and – well, from the one side, and the prime cost from the other – as a result the costs of these “gray” schemes grew, maybe not so much that it became economically profitable, but at least not so harmful to work legally, when such an opportunity arose, we started to do this. We switched a large part [of our business] to legal schemes

Full Citation: Author interview, Firm 21, 3 April 2009

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Analytic Note: This quote is from an interview conducted by the author. The interview was recorded and transcribed. Detailed information about the semi-structured interviews on which this article relies can be found in Section 1 of the online appendix.

Source Excerpt: Есть другие положительные, дело в том, я вообще сторонник жить по законам и платить налоги, и делать более белый бизнес, чем так сказать многие другие привыкли. Собственно говоря, мы начинали как люди технари, которые вот даже 10 лет [?] до этого, мы начинали с того, что мы пытались жить по законам. И когда мы занимались импортом товаров, мы пытались платить все налоги, и все так сказать...Но в результате, себестоимость наших товаров оказывалась выше, чем этот же товар, наших конкурентов, продавали на улице – имея уже прибыль. Потому что цвел так называемый черный импорт, серый импорт, челноки и прочее, на этом делали собственно говоря основной капитал. Вот. Тогда чтобы выжить, мы вынуждены были перейти на эти схемы.

Source Excerpt Translation: There are other positives. The fact is, I am in general an adherent to living by the law, paying taxes, doing business more legally than, so to say, many others are used to doing. Strictly speaking, we started out as technicians, who even ten years before this started by trying to live according to the laws. And when [we started] we imported goods, and we tried to pay all taxes. . . . But as a result, the cost of our goods turned out to be higher than of those goods our competitors were selling on the street – and making a profit. [This was] because the so-called “black” imports, “grey” imports, shuttle traders and so on were flourishing, and on this they made their capital stock. So there you go. In order to survive, we were forced to also switch to these schemes.

Full Citation: Author interview, Firm 21, 3 April 2009

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Analytic Note: This quote is from an interview conducted by the author. The interview was recorded and transcribed. Detailed information about the semi-structured interviews on which this article relies can be found in Section 1 of the online appendix.

Source Excerpt:

Respondent: -- Ну я считаю, что, мне почему в америке понравилось, то есть что мне в америке понравилось, это равенство всех перед законом, ну я думаю что конечно есть там единицы, да, ну это до того единицы, которые могут себе позволить как-бы да, быть выше какого-то закона. Пускай не всех да, ну я знаю что допустим тех же губернаторов могут оштрафовать, наказать, так ведь? То есть, мне вот это вот в России не нравится, что у нас есть все-равно -- то есть они и раньше были, но и как-бы, с каждым годом их становится меньше, те кто стоит выше закона. А в Америке, то есть я увидел, что действительно, все как-бы соблюдают. А у нас один --

Interviewer: Не всегда как ты говоришь, но это исключение, не--

Respondent: -- а у нас как-бы еще не дошло до этого, поэтому я считаю, пускай они не популярные, допустим там не будут, да, законы, но если эта вся система начинает работать, то есть во всех сферах, и по работе и просто в жизни, на улице, да там, и на дорогах с ГАИ допустим, поэтому --

Interviewer: То есть впринципе, ты как бизнесмен, ты говоришь, что если эти, если все не соблюдали, а если все были равные перед законом, ты был бы за. Это просто когда ты стараешься соблюдать, и из-за этого у другого человека, который не соблюдает, не имеет, ну у него преимущество, да?

Respondent: -- у него да, преимущество. Да. И он как-бы быстрее допустим, выбивается вперед или так далее.

Source Excerpt Translation:

Respondent: Well, I think that what I liked in America is the equality of everyone under the law. Well, I think there of course are rare cases that can permit themselves to be above some law. But let's say, not all, yes? I know that, let's say, governors can be fined or punished, is it not so? That is, what I don't like in Russia is that here, both now and before, although it's getting less and less with each year, there are those who are above the law. But in America, I saw that truly everyone, it seems, follows the law. We have here one –

Interviewer: Well, it's not always as you say, there are exceptions –

Respondent: – but for us it hasn't even come to that. Therefore, I think that even though laws are not popular, let's suppose that they won't exist, but if the whole system starts to work, that is in all spheres, both in the workplace and simply in life, on the street, and on the roads with the traffice police, let's suppose, then therefore –

Interviewer: That is, in principle, you as a businessman, you are saying that if everyone follows the law, and if everyone were equal under the law, you would be for this. It is simply that when you try to follow the law, the because of this a different person, who doesn't follow the law, doesn't have, well, does have an advantage? Respondent: – Yes, he has an advantage. He gets ahead more quickly.

Full Citation: Author interview, Firm 52, 18 September 2009 [Note: the firm number on this citation in the article is a typo – it should read Firm 52; interviews with Firms 51 and 52 were conducted on the same day so the date is correct]

<br>

Analytic Note: This quote is from an interview conducted by the author. The interview was recorded and transcribed. Detailed information about the semi-structured interviews on which this article relies can be found in Section 1 of the online appendix.

Source Excerpt: Больше стало хозяйственных споров между юридическими лицами. То есть компании все же перешли, то есть переходят на белую систему налогооблажения, соответственно они обращаются, они заключают сделки, гражданско-правовые, и находят защиту своих сделок именно в судах. Раньше все решалось именно руко-пожатием. Раньше договор смысла не было подписывать, потому что все-равно в суде бы никто ниче не выиграл бы. И не исполнял. Сейчас же нет.

Source Excerpt Translation: There are [now] more commercial disputes between legal entities. That is, companies have switched, well, are switching, to a “white” [i.e., legal] tax regime system. Accordingly, they turn to law firms, conclude civil contracts, and find protection for their contracts in the courts. Previously, everything was decided with a handshake. Previously, there was no point in signing a contract, because nevertheless no one was going to win anything in court, or enforce a court decision. Now it’s not like this.

Full Citation: Author interview, Lawyer 20, 28 October 2009 [Note: the date in the article is a typo – it should read 2009]

<br>

Analytic Note: This quote is from an interview conducted by the author. The interview was recorded and transcribed. Detailed information about the semi-structured interviews on which this article relies can be found in Section 1 of the online appendix.

Source Excerpt: Поэтому вот, они вынуждены быть белыми, они просто вынуждены быть белыми, да, потому что, потом когда они хватаются нечистых бухгалтеров на руку, они объясняют, парень, я плачу, налоги поэтому, они требуют потом как-бы [inaudible] потом в суд пойдем спокойно, и они не боятся идти в суд, потому что как-бы у них бухгалтерия чиста.

Source Excerpt Translation: Therefore, well, they have to operate legally, they are simply forced to operate legally, because when they catch a dishonest accountant in the act of stealing, they explain: Listen fellow, I pay my taxes….so let's calmly go to court. And they will not be afraid to go to court because they know that their books are clean.

Full Citation: Author interview, Firm 15, 26 March 2009

<br>

Analytic Note: This quote is from an interview conducted by the author. The respondent did not consent to an audio recording so notes were taken by hand. Detailed information about the semi-structured interviews on which this article relies can be found in Section 1 of the online appendix.

Full Citation: Author interview, Lawyer 8, 6 February 2009

<br>

Source Excerpt (Source 1): The capacity to implement judicial decisions in economic disputes is a critical element of a functional legal system in a market economy. Although enforcing judgments is a time-consuming process in many legal systems, the shortcomings outlined in the Russian system certainly constitute a serious problem. When I first began investigating the relative non-use of courts in Russia, I assumed that the lack of proper incentives was the key roadblock. Over the past decade, as the incentives have been redesigned through a series of reforms, I have grown increasingly skeptical of the power of this explanation. Over the years, I have talked with enterprise managers about their choice of legal versus extra-legal solutions to problems. Their choices have varied, but rarely do managers cite problems with collection as a reason for bypassing courts. (Hendley 1997, p. 242).

Source Excerpt (Source 2): When I asked managers at the case-study enterprises why they persisted in using these courts, they were consistently taken aback by the question. In all instances, it was clear that it had never occurred to them to abandon the courts because they were not perfect. The survey data confirm that enterprise lawyers regard the difficulties with implementing judgments as serious obstacle to using the arbitrazh courts, but that this feeling does not materially affect their willingness to use these courts. (Hendley 2001, p. 39)

Full Citation (Source 1): Hendley, Kathryn. 1997. “Legal Development in Post-Soviet Russia.” Post-Soviet Affairs 13 (3): 228–51.

Full Citation (Source 2): Hendley, Kathryn. 2001. “Beyond the Tip of the Iceberg: Business Disputes in Russia.” In Assessing the Value of Law in Transition Economies, ed. Peter Murrell. Ann Arbor, MI: University of Michigan Press, pp. 20–55.

<br>

Analytic Note: This quote is from an interview conducted by the author. The interview was recorded and transcribed. Detailed information about the semi-structured interviews on which this article relies can be found in Section 1 of the online appendix.

Source Excerpt:

Interviewer: Ну мне говорят что часто здесь, ну когда я задавал вопрос ну Российским юристам, а почему так тяжело иностранцам иногда бывает, они говорят ну потому что нужны связи здесь чтобы выиграть, тем более без связей будет очень тяжело с исполнением решений, и --

Respondent: -- нууу, не совсем так, нет. Связи скорее нужны, если дело громкое, политическое, если крупные, если противник процессуальный, это крупная компания, а по таким средним делам это не обязательно. Это скорее преувеличение все-таки.

Interviewer: И это даже не значит, потому что когда сначала, когда я начал проводить исследования, я слышал вот это связи, я думал что они именно ну имели в виду деньги, а потом мне объяснили, что нет, нет об этом не говорим, просто значит что я просто общаюсь с ними, и я знаю что...

Respondent: -- это правда, это правда, но это скорее верно в отношении таких, крупных дел. В большинстве...большинство же дел рассматривается по незначительным делам, и там это не обязательно.

Source Excerpt Translation:

Interviewer: I been told that here, well, when I ask Russian lawyers the question of why it's so hard for foreigners [to win in court], they say that this is because connections are needed in order to win, and moreover without connections it will be very hard to enforce a decision, and –

Respondent: Well, no, things aren't really quite that way. Connectinos are probably needed if the case is high-profile, big or political, or if the opponent is a large company. But for middle-sized cases they are not necesary. And probably this is an exaggeration in any case.

Interviewer: And does this also not mean – because when at first, when I was beginning to conduct research, I heard about connections, and I thought that people specifically meant money, and then they explained to me that no, we are not talking about that, it simply means that I socialize with them, and I know that –

Respondent: -- this is true, this is true, but it's probably true with respect to big cases. In the majority – the majority of cases are rather small, and there this [i.e., connections] is not necessary.

Full Citation: Author interview, Lawyer 6, 6 March 2009

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Source Excerpt: The legal system, as it has evolved over the past decade, is best conceptualized as a dual system under which mundane cases are handled in accordance with the prevailing law, but cases that attract the attention of those in power can be manipulated to serve their interests. To put it more simply, justice is possible and even probable, but it is not assured. This lack of predictability is unfortunate, but it does not make Russia unique. (Hendley, 2006, p. 351)

Full Citation: Hendley, Kathryn, “Assessing the Rule of Law in Russia,” Cardozo Journal of International and Comparative Law, 14, 2:347–391, Fall 2006.

<br>

Analytic Note: This quote is from an interview conducted by the author. The interview was recorded and transcribed. Detailed information about the semi-structured interviews on which this article relies can be found in Section 1 of the online appendix.

Source Excerpt:

Respondent: То есть народ сейчас более или менее цивилизованно стал решать вопросы в суде --

Interviewer: Значит они обращаются намного больше в суды?

Respondent: -- сейчас вообще, да. Сейчас в коридор суда зайти не возможно, вакансии судей как-бы это. То есть сейчас не протолкнешься, конвеер целый. То есть как-бы, если будет, ну побывайте в это, просто посмотрите, что твориться как-бы столпотворение….

Source Excerpt Translation:

Respondent: That is to say, people more or less have come to resolve disputes in a civilized way, by going to court --

Interviewer: Meaning that they go to court more often?

Respondent: Now, in general, yes. To move through the corridors of a courthouse is now impossible. That is, now you can’t even push your way through, the conveyor is full. Well, go there, simply take a look at what type the stampede being created….

Full Citation: Author interview, Lawyer 22, 30 September 2009

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Analytic Note: This quote is from an interview conducted by the author. The interview was recorded and transcribed. Detailed information about the semi-structured interviews on which this article relies can be found in Section 1 of the online appendix.

Source Excerpt: Security Firm: И как ни странно на тот период, ну что значит странно, на тот период можно было заметить, что криминал подходит на второй, третий план.

Author: И это уже в 95м, 96м?

Security Firm: да, да, он все больше и больше. Это уже наличие такого криминала дерзкого, классического криминала становилось настолько меньше, что он становился просто экзотикой, если появлялось от нашего клиента что приехали просто какие-то бандиты там, как с улицы и хотят его рэкетировать, но это для нас был некоторым праздником, это вот она ностальгия старая, ну откуда они взялись бедные и так далее....

Source Excerpt Translation: Security Firm: And however strange it may seem, during this time period it was possible to see that the criminal world was fading into the background.

Author: And this was already in 1995 or 1996?

Security Firm: Yes, yes, just more and more. Wild, classical criminal groups were disappearing to such an extent that they were becoming simply something exotic. If a client came to us and said that some thugs from the street had tried to extort him, well, this was for us something exciting. [It gave us a] sort of nostalgia for the old days. Well, from where did these poor things appear from? And so on….

Full Citation: Author interview, Security Firm 5, 18 September 2009

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Analytic Note: The additional quotes below, taken from the video transcript (at https://collateralmurder.wikileaks.org/en/transcript.html ) are further, but not exhaustive, examples:

04:31 Oh, yeah, look at those dead bastards.

04:36 Nice.

10:11 Oh yeah, look at that. Right through the windshield!

10:14 Ha ha!

18:29 I think they just drove over a body.

18:31 Hey hey!

18:32 Yeah!

<br>

Source Excerpt: Transcript extract at 7:38: "I saw an RPG next to one of the men and an AK47."

Full Citation: 'WikiLeaks' Collateral Murder: U.S. Soldier Ethan McCord's Eyewitness Story', embedded at: https://collateralmurder.wikileaks.org/

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Source Excerpt: 'However, when I did come up on the scene, there was an RPG as well as AK-47s there…. You just don’t walk around with an RPG in Iraq, especially three blocks away from a firefight…. Personally, I believe the first attack on the group standing by the wall was appropriate, was warranted by the rules of engagement. They did have weapons there.'

Full Citation: Zetter, ‘U.S. soldier on 2007 Apache attack’.

<br>

Source Excerpt: Julian Assange, a WikiLeaks editor, acknowledged to Fox News in an interview Tuesday evening that "it's likely some of the individuals seen in the video were carrying weapons."

Assange said his suspicions about the weapons were so strong that a draft version of the video they produced made specific reference to the AK-47s and RPGs. Ultimately, Assange said, WikiLeaks became "unsure" about the weapons. He claimed the RPG could have been a camera tripod, so editors decided not to point it out.

"Based upon visual evidence I suspect there probably were AKs and an RPG, but I'm not sure that means anything," Assange said. Nearly every Iraqi household has a rifle or an AK. Those guys could have just been protecting their area."'

Full Citation: Fox News, ‘Military raises questions about leaked Iraq shooting video’.

<br>

Source Excerpt: Ethan McCord: 'I don't think that [the] big picture is whether or not [the Iraqis who were killed] had weapons. I think that the bigger picture is what are we doing there?'

Full Citation: Zetter, 'US soldier on 2007 attack':

<br>

Source Excerpt: Transcript extract at 7:15 and 12:08 - "My son was born May 31st 2007 and I was yet to see him. And I had a daughter who was barely older than this girl".

Full Citation: 'WikiLeaks' Collateral Murder: U.S. Soldier Ethan McCord's Eyewitness Story', embedded at: https://collateralmurder.wikileaks.org/

<br>

Source Excerpt: "During the mid-February 2010 time frame the 2nd Brigade Combat Team, 10th Mountain Division targeting analysts, then Specialist Jihrleah W. Showman discussed a video that Ms. Showman had found on the T-drive. The video depicted several individuals being engaged by an aerial weapons team. At first I did not consider the video very special, as I have viewed countless other war porn type videos depicting combat. However, the recording of audio comments by the aerial weapons team crew and the second engagement in the video of an unarmed bongo truck troubled me. As Showman and a few other analysts and officers in the T-SCIF commented on the video and debated whether the crew violated the rules of engagement or ROE in the second engagement, I shied away from this debate, instead conducting some research on the event. I wanted to learn what happened and whether there was any background to the events of the day that the event occurred, 12 July 2007."

Full Citation: The Guardian, ‘Bradley Manning’s personal statement to court martial: Full text’, The Guardian (1 March 2013), available at: http://www.guardian.co.uk/world/2013/mar/01/bradley-manning-wikileaks-statement-full-text .

<br>

Analytic Note: The statistical analysis was conducted in a series of stages. Our descriptive analysis suggested that glottal replacement represented a vigorous change in progress but that many of the factors also appeared to interact with age. The initial model revealed a significant interaction between age and linguistic environment. However, the interpretation and presentation of the full model was slightly cumbersome where each permutation of age and linguistic context are compared within the same group; this resulted in 15 different categories (see file: Age and linguistic context interaction.JPG). In order to avoid this, we ran three separate models as this enabled a more direct comparison of the ordering of the linguistic constraints across the age groups.

Data Sources:

https://data.qdr.syr.edu/file.xhtml?fileId=2513

<br>

Analytic Note: Once the interviews were transcribed, the transcriber .trs transcription files are used to search, auditorily analyse, and mark-up each speakers tokens. As glottal-replacement contexts are frequently occurring, only a section of the transcript is needed to generate enough tokens for statistical analysis. Therefore, in order to minimise Observers Paradox effects, analyses would start 10 minutes into the interview. File Donald_ATI_markup.trs provides an extract of an annotated .trs file and the accompanying sound file to illustrate the process. The mark-up notation used was [t-1] for the standard, alveolar realisation and [t-2] for the non-standard, glottal realisation of the underlying /t/.

Data Sources:

https://data.qdr.syr.edu/file.xhtml?fileId=2517

https://data.qdr.syr.edu/file.xhtml?fileId=2521

<br>

Analytic Note: This is an unclassified telegram of 7 January 1972 from Terence Garvey, the High Commissioner to India at the Embassy in Delhi to the FCO in London, from folder 15/751 of the Prime Minister’s Archives held at the National Archives at Kew, UK. The telegram reports on a meeting between Abdus Samad, the Bangla Desh Foreign Minister, with Indian Prime Minister Indira Gandhi, and Indian Defence Minister Jagjivan Ram, on 6 January 1972. This excerpt shows that the Indian government at least wanted to make it appear as if it was looking to withdraw troops “as soon as possible” but that the representative of the new Bangladesh government requested presence and involvement in Bangladesh by the Indian army. The thrust of the alternative explanation here is that Mujib’s administration asked the Indian troops to leave in order that they would not be subject to the influence of the Indian government. This request by Samad is evidence in the opposite direction to this alternative explanation.

Source Excerpt: During his talks with Jagjivan Ram, Samad reportedly exchanged ideas on long range co-operation on defence to safeguard mutual security. While Jagjivan Ram conveyed India's desire to recall Indian forces from Bangla Desh as soon as possible, Samad said that ''certain essential tasks still remain to be performed'' by Indian Army. In response to Samad's request, Jagjivan Ram offered full assistance in training of officers and men of Bangla Desh forces.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2560

Full Citation: Terence Garvey, the High Commissioner to India at the Embassy in Delhi to the FCO in London, an unclassified telegram, 7 January 1972 . Folder 15/751 of the Prime Minister's Archives held at the National Archives at Kew, UK.

<br>

Analytic Note: This is a confidential telegram from Cyril S Pickard, High Commissioner to Nigeria, to the FCO in London, from folder 37/1024 of the FCO Archives held at the National Archives at Kew, UK. The excerpt describes a meeting that Pickard had with Mr. Yolah, Acting Deputy Permanent Secretary of the Nigerian Ministry of External Affairs, concerning the recognition of Bangladesh. In the excerpt, Yolah explains that the Nigerian government was waiting until after the actual withdrawal of Indian troops to recognize Bangladesh. .

Source Excerpt: Yolah said that Nigeria did not dispute that the usual criteria were fulfilled but felt obliged for their own part to apply rather special criteria. They accepted at face value the assurances that the Indian Army would be withdrawn, but would be even more reassured when they saw this actually happening. They had seen the display of popular support for Sheikh Mujib but knew from experience how displays of popular feeling could be manipulated. Having paid a high price to put down their own secession they could not appear too ready to recognise a secessionist state. Nigeria would therefore want to move slowly and be well to rear in recognising Bangladesh.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2537

Full Citation: Cyril S Pickard, High Commissioner to Nigeria, to the FCO in London, a confidential telegram. Folder 37/1024 of the FCO Archives held at the National Archives at Kew, UK.

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Analytic Note: This is a confidential letter of 3 February 1972 from John C A Roper, UK Ambassador to Luxembourg, to Iain J M Sutherland, Head of the FCO South Asian Department, from folder 37/1024 of the FCO Archives held at the National Archives at Kew, UK. In this letter, Roper reports on his discussions with Western European countries regarding the UK’s declaration of recognition of Bangladesh on the 4th of February. Despite earlier statements by Italian diplomats that withdrawal of troops or even an explicit timetable for withdrawal was not essential to their decision, this thinking had been undergoing changes before 3 February. This excerpt shows that a decision had been made to “put off” recognition “until there was some withdrawal or engagement to withdraw Indian troops”.

Source Excerpt: The revised Italian proposal said to have been watered down at Moro's insistence, was for a declaration of intent nuance to take account of the special position of West Pakistan; to say that the existence of Bangladesh must also be taken into account; to suggest the early possible establishment of contact between Islamabad and Dacca; but not to put "au premier plan" the possibility of the recognition of Bangladesh, which the Italians proposed to put off until there was some withdrawal or engagement to withdraw Indian troops and until contact had been resumed between Islamabad and Dacca.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2536

Full Citation: John C A Roper, UK Ambassador to Luxembourg, to Iain J M Sutherland, Head of the FCO South Asian Department, a confidential letter, 3 February 1972. Folder 37/1024 of the FCO Archives held at the National Archives at Kew, UK.

<br>

Analytic Note: This is an unclassified, no distribution, telegram of 24 January 1972, from Terence Garvey, UK High Commissioner to India at the Embassy in Delhi to the FCO in London, from folder 37/1020 of the FCO Archives held at the National Archives at Kew, UK. This excerpt shows just one instance of various times that the Indian government released public statements indicating that they would be responsive to Mujib’s desires regarding the presence of Indian troops.

Source Excerpt: Indian Press today reports discussions held in Dacca on 22 January between D.P. Dhar (Chairman Policy Planning Committee in Indian MEA and Mrs. Gandhi's Special Envoy to Bangladesh) and Shaikh Mujib. Discussions are said to have covered timing of Indian troop withdrawal; procedure for trial of some senior civilians of Yahya regime and West Pakistan army officers; Bangladesh's short and long term requirements of food and supplies; resettlement of refugees; Bangladesh internal situation particularly following Shaikh Mujib's call for arms surrender. Indian side reiterated that its troops would be pulled out the moment Shaikh Mujib so wished. Meanwhile Indian army functions would have to be clearly worked out to avoid unnecessary involvement in local situation. At no stage did Shaikh Mujib suggest immediate withdrawal.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2535

Full Citation: Terence Garvey, UK High Commissioner to India at the Embassy in Delhi to the FCO in London, an unclassified, no distribution, telegram, 24 January 1972. Folder 37/1020 of the FCO Archives held at the National Archives at Kew, UK.

<br>

Analytic Note: This is an extract from a meeting of the UK Cabinet held on 27 January 1972, from folder 37/1025 of the FCO Archives held at the National Archives at Kew, UK. This excerpt shows both that the justification given for recognition was in terms of “normal criteria for recognition” but that this required an additional qualification. The only concrete description of what counted was that “the Indian Army had begun to leave; and those elements which remained did so at the request of …Mujib”. This indicates that the presence of Indian troops is being explained away, that there is something wrong with the troop presence and that the current situation is being designated a legitimate exception to the general rule, or the “normal criteria”.

Source Excerpt: The Foreign and Commonwealth Secretary said that the Government of Bangla Desh now fulfilled practically all of our normal criteria for recognition. In particular, the Indian Army had begun to leave; and those elements which remained did so at the request of the Prime Minister of Bangla Desh, Sheikh Mujibur Rahman.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2534

Full Citation: Extract from a meeting of the UK Cabinet, 27 January 1972. Folder 37/1025 of the FCO Archives held at the National Archives at Kew, UK.

<br>

Analytic Note: This is a confidential memorandum summarizing a call on 5 January 1972 by the Vietnamese Ambassador on Sir Stanley Tomlinson, Deputy Under Secretary in the UK Foreign Office, from folder 37/1019 of the FCO Archives held at the National Archives at Kew, UK. This excerpt shows that the British government was presenting, as the only barrier to recognition, that “the maintenance of order depended on the presence of the Indian Army”.

Source Excerpt: Mr Chan then asked "unofficially" whether Britain intended to recognise Bangladesh. Sir S Tomlinson replied that unless there was a major change in the situation, which he did not foresee, this was a matter of time, but how much time it was difficult to say. It was in our own interests to recognise as soon as possible, but it would not be feasible while the maintenance of order depended on the presence of the Indian Army.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2533

Full Citation: Vietnamese Ambassador on Sir Stanley Tomlinson, Deputy Under Secretary in the UK Foreign Office Memorandum, memorandum call summary, 5 January 1972. Folder 37/1019 of the FCO Archives held at the National Archives at Kew, UK.

<br>

Analytic Note: This is a memorandum written on 31 December 1971 to the head of the South Asian Department in the UK Foreign and Commonwealth Office, Stanley Tomlinson, by Timothy Daunt, the Personal Secretary to the Permanent Under Secretary of State, from folder 37/902 of the FCO Archives held at the National Archives at Kew, UK. This telegram shows that the UK was putting forward, as the primary if not only issue relevant to recognition, “the presence of large numbers of Indian troops in East Bengal”.

Source Excerpt: When the German Ambassador called this afternoon on the Permanent Under-Secretary, he asked about the likely timing of our recognition of Bangladesh. The PUS said that we were moving slowly and cautiously, taking the line that our normal criteria applied and that the presence of large numbers of Indian troops in East Bengal complicated the situation at the present time. Herr van Hase said that recognition was a matter of great interest to his Government; there was of course a danger of Indian recognition of the DDR if they took a false step. He would be grateful if his Embassy could be kept up to date over British thinking and likely moves by HMG on recognition.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2532

Full Citation: Stanley Tomlinson, by Timothy Daunt, the Personal Secretary to the Permanent Under Secretary of State, memorandum to the head of the South Asian Department in the UK Foreign and Commonwealth Office, 31 December 1971. Folder 37/902 of the FCO Archives held at the National Archives at Kew, UK.

<br>

Analytic Note: This is a confidential telegram sent on 29 January 1972 by UK Foreign Minister Alec Douglas-Home to the UK Embassy in Islamabad, Pakistan, (and various other embassies) relaying a private reply from UK Prime Minister Edward Heath to a message from Pakistan President Zulfikar Ali Bhutto, from folder 15/751 of the Prime Minister’s Archives held at the National Archives at Kew, UK. The language used here is representative of the kind of language used by the UK in justifying the decision to recognize. For example, in a 21 January telegram, Douglas-Home told a variety of embassies that “The Government has effective control over the territory and has popular support. Mujib and the Awami League are the elected representatives of the people in the East. He has agreed with Mrs Gandhi that the Indian Army will be withdrawn on his request. In the meantime, Indian forces are in Bangladesh with the agreement of the local government.”

Source Excerpt: I ought to tell you, however, the position we have now reached in our consideration of the matter. In our view the criteria for recognition of a new state have now been fulfilled. Shaikh Majib [sic] had made clear in his public speeches that Bangladesh is an independent sovereign country and that this is a point on which his government is not open to compromise. We accept this as the reality of the situation. His government is in control of the country: the Indian forces are there at his behest and the Indian government has undertaken to withdraw them at his request.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2559

Full Citation: Alec Douglas-Home, UK Foreign Minister to the UK Embassy in Islamabad, Pakistan, confidential telegram sent by Douglas-Home relaying a private reply from UK Prime Minister Edward Heath to a message from Pakistan President Zulfikar Ali Bhutto, 29 January 1972. Folder 15/751 of the Prime Minister’s Archives held at the National Archives at Kew, UK.

<br>

Analytic Note: This is a telegram of 22 December 1971 from John Killick, UK Ambassador the USSR, to the FCO in London, from folder 37/902 of the Foreign and Commonwealth Office's Archives at Kew, UK. It describes Killick’s judgments concerning Soviet reasoning over recognition of Bangladesh based on reading of official statements, press reports, and discussions with other missions to the USSR, e.g. India’s. Killick judges that Soviet Premier Leonid Brezhnev’s public position is interpretable in terms of withdrawal of Indian troops, possibly but not necessarily actual withdrawal. Killick raises the issue of a “Hallstein doctrine”, which was the policy of West Germany to not have diplomatic relations with any country that recognized East Germany. In fact, after Pakistan President Zulfikar Ali Bhutto broke off diplomatic relations with Bulgaria and Poland, the USSR did delay recognition for a couple of weeks.

Source Excerpt: Brezhnev's public position is that a political settlement should be reached quote without interference of any kind from outside forces unquote. This seems likely to inhibit recognition at least while Indian forces are so dominant and perhaps until they are withdrawn. Indian minister's remarks to Dobbs suggest that Indians themselves accept this. ... Against all this Soviet Government recognise Bangladesh as a national liberation movement and will want the credit of being among the first major countries, if not the first, to grant official recognition to the new state. If it looked as if other states might recognise and if Islamabad made it clear that no kind of Hallstein doctrine would apply then inhibitions mentioned above might fall by the way.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2555

Full Citation: John Killick, UK Ambassador the USSR, telegram from Killick to the FCO in London, 22 December 1971. Folder 37/902, Foreign and Commonwealth Office's Archives at Kew, UK.

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Analytic Note: This is a secret telegram of 13 January from Alec Douglas-Home, UK Foreign Secretary, to a variety of UK embassies, from folder 37/1020 of the Foreign and Commonwealth Office's Archives at Kew, UK. The telegram describes Douglas-Home's reasoning and strategy regarding the recognition of Bangladesh. The excerpt shows that Douglas-Home is stating that the two criteria for recognition are control of territory and self-determination. He also refers to "The fact that the Indian army is still in the East" but says that this "is not necessarily conclusive". This is interpretable as meaning that the Indian army presence is a potential problem, a conclusive, i.e. serving to prove a case, decisive, convincing, problem. However, he then presents a reason that the presence is in fact not a problem. This reason is that Mujib and Gandhi have agreed to withdraw the troops and that “the important thing is that they are there with the consent and at the will of the indigenous government”.

Source Excerpt: On the criteria for recognition, Sheikh Mujib's Government evidently has the support of the people and reports indicate that the country is under reasonable control. The fact that the Indian army is still in the East is not necessarily conclusive. Sheikh Mujib told us that he would arrange for its withdrawal in due time and he has since confirmed that Mrs Gandhi has agreed to this. The important thing is that they are there with the consent and by the will of the indigenous government.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2553

Full Citation: Alec Douglas-Home, UK Foreign Secretary, secret telegram from Douglas-Home to a variety of UK embassies, 13 January 1972. Folder 37/1020, Foreign and Commonwealth Office's Archives, Kew, UK.

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Analytic Note: This is a letter of 10 January 1972 from Stephen Olver, UK High Commissioner to Sierra Leone, to John Wilson of the West Africa Department at the FCO in London, from folder 37/1025 of the Foreign and Commonwealth Archives at Kew, UK. The letter describes a meeting Olver had with Solomon Pratt, Minister of External Affairs in Sierra Leone, on recognition of Bangladesh. The excerpt provides evidence that Sierra Leone explicitly conditioned its recognition solely on the actual withdrawal of Indian troops.

Source Excerpt: Pratt said that this had in fact been discussed yesterday again by Cabinet. They are in no great hurry to recognise and will in any case do nothing until all Indian troops have withdrawn. They would like to recognise as part of a group and to this end he sounded out Arikpo during the recent OAU meeting at Addis. Pratt suggested that Nigeriam with its experience of the Biafran War and as the largest West Africa country, would be in a good position to lead a further group of recognisers, and had said that Sierra Leone would join such a group.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2554

Full Citation: Stephen Olver, UK High Commissioner to Sierra Leone, letter from Olver to John Wilson of the West Africa Department at the FCO in London, 10 January 1972. Folder 37/1025, Foreign and Commonwealth Office's Archives, Kew, UK.

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Analytic Note: This is part of the transcript from an interview with Senegal President Leopold Sedar Senghor with Agence France Presse from folder 37/1020 of the Foreign and Commonwealth Office's Archives at Kew, UK. The document is undated but is included in between Notes for Prime Minister’s Question Time on 20 January 1972 and a telegram of 27 January 1972 in a folder whose contents when dated are in chronological order.

The interview covers President Senghor’s views on a variety of issues related to world affairs and in particular recognition, including Israel and the Occupied Territories, the admission of the People’s Republic of China to the UN, the status of Norodom Sihanouk, exiled Head of State of Cambodia, and Bangladesh. Senghor expresses the position (in regards to Cambodia) that occupying the territory of a country is a crucial condition for recognition, and specifically says “the soldiers, by calling in foreign troops, demonstrated that they did not have the support of the people”. In relation to Bangladesh specifically he says that Mujib needs “proof of his authority over East Pakistan”. This is interpretable as meaning that withdrawal of Indian troops is a crucial condition for Senghor to recognize Bangladesh.

Source Excerpt: Religion is becoming less and less of a factor in national unification. More important are ethnology, language, and culture and from these points of view the two Pakistans are different. Senegalese recognition of Bangla Desh will depend on the declarations and actions of Sheikh Mukibur Rahman and proof of his authority over East Pakistan. He has already proved that he is elected by the people and is in their confidence. This is an essential point.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2556

Full Citation: Senegal President Leopold Sedar Senghor with Agence France Presse, part of interview transcript. Folder 37/1020 of the Foreign and Commonwealth Office's Archives at Kew, UK.

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Analytic Note: This is a telegram of 28 January 1972 from John Curle, UK Ambassador to the Philippines, to the FCO in London from folder 37/1023 of the Foreign and Commonwealth Office's Archives at Kew, UK. It summarizes a conversation between Curle and Philippine Under-Secretary of Foreign Affairs Jose D. Ingles about the recognition of Bangladesh. The excerpt shows that the only issue raised was the continued presence of Indian troops.

Source Excerpt: Ingles said that Department proposed to leave timing of recognition to council. Continued presence of Indian troops was a factor. Other Asian countries quote did not seem to be in a hurry unquote.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2551

Full Citation: John Curle, UK Ambassador to the Philippines, a telegram from Curle to the FCO in London, 28 January 1972. Folder 37/1023 of the Foreign and Commonwealth Office's Archives at Kew, UK.

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Analytic Note: This is a telegram of 14 February 1972 from John Curle, UK Ambassador to the Philippines, to the FCO in London from folder 37/1024 of the Foreign and Commonwealth Office's Archives at Kew, UK. It describes a foreign policy council meeting of 12 February 1972 in which it was decided that the Philippines would defer action on the question of recognition of Bangladesh. This excerpt shows that the reason for deferment was that recognition (of Bangladesh as a seceded state) might stimulate demands for secession domestically.

Source Excerpt: Deferment was at request of Muslim leaders who have sought delay in recognition quote at least until end quote departure of Indian troops from the territory stop They fear recognition would adversely affect unrest in Mindanao and may stimulate international help for secessionist movement stop.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2552

Full Citation: John Curle, UK Ambassador to the Philippines, telegram to the FCO in London, 14 February 1972. Folder 37/1024, Foreign and Commonwealth Office's Archives, Kew, UK.

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Analytic Note: This is a telegram of 26 January 1972 from John Johnston, UK High Commissioner to Malaysia, to the FCO in London from folder 37/1023 of the Foreign and Commonwealth Office's Archives at Kew, UK. The extract shows the reasoning presented by Tan Sri Zaiton Ibrahim Ahmad, the Malaysian Secretary-General of the Ministry of Foreign Affairs, about recognition of Bangladesh. He mentions the issue of control of territory and also the "part Indian played in dismemberment of a Muslim nation", which is interpretable as being concerned about India's use of force, i.e. aggression, although particular as it relates to the issue of interference in the internal affairs of another, particularly Muslim, state. Johnston then "argued" with these reasons, presenting the arguments provided by Alec Douglas-Home (UK Foreign Secretary). Zaiton then raised as the only remaining barrier to recognition that there had not been "even a token reduction in the large Indian forces ... or any positive statement about their withdrawal by the Indian government". I coded this as statement rather than actual withdrawal as it seems as if a statement would have been sufficient. In fact, Malaysia recognized on 25 February 1972, after the 8 February statement but before the full withdrawal on 13 March.

Source Excerpt: Zaiton [SG, MFA] reaffirmed Malaysian acceptance of inevitability of recognition but argued that Malaysia's interest lay in moving cautiously for following reasons:

1. There was no internal pressure. Not a single question had been asked about recognition during current sitting of parliament.
2. Malaysian interest was almost wholly in West Pakistan. Previous break in diplomatic relations with Pakistan during confrontation had caused much dismay and a second break must be avoided.
3. No Muslim country had yet recognised, nor were any among the countries we were approaching about collective recognition on 4 February
4. The Malays had resented part India had played in dismemberment of a Muslim nation and were not yet convinced that Mujibur Rahman was in total control of Bangla Desh. I argued this on lines of your telno 145 to Islamabad but Zaiton insisted that position was difficult for countries like Malaysia in absence of any move by Mujibur to make even a token reduction in the large Indian forces in Bangla Desh, or any positive statement about their withdrawal by the Indian Government.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2550

Full Citation: John Johnston, UK High Commissioner to Malaysia, telegram to the FCO in London, 26 January 1972. Folder 37/1023, Foreign and Commonwealth Office's Archives, Kew, UK.

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Analytic Note: This is an extract from the Hansard (parliamentary record) of Malawi from 29 February 1972, included along with an unsigned letter of 14 March 1972 from the Chancery of the British High Commission to Malawi to the Central and Southern Africa Department of the FCO in London from folder 37/1025 of the Foreign and Commonwealth Office's Archives at Kew, UK. This excerpt shows the reasoning presented publicly by the President of Malawi when he announced Malawi’s recognition of Bangladesh. He raises issues of control of territory and the acceptance or acquiescence of authority by the people, which is interpretable as being concerned with self-determination. He also presents the “question of the presence of the Indian army on the soil of the new state” and it seems from the context that this is a potential problem for recognition. He follows the question with “But” and then says that the army will be withdrawn. This implies that the publicly declared intention to withdraw troops (from the joint statement by Gandhi and Mujib) removes this potential objection to recognition.

Source Excerpt: There are certain conditions which any new Government or new State must satisfy before it can seek or expect recognition by other States. These conditions are: i) The Government seeking recognition, whether of existing State or of a new State, must be in full effective control over the country under its authority or jurisdiction. ii) The people of the country concerned, must accept the new Government or acquiesce in its authority. iii) The Government seeking recognition must create and maintain conditions of law and order, peace and calm over the country in question.... There is also the question of the presence of the Indian Army on the soil of the new State. But again it is understood that the Indian Army is being withdrawn in March. It is said on the 25th or the 28th.... This being the case, there is no obstacle to our recognition of the new State. Therefore, we recognise the new State of Bangladesh as or from today.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2549

Full Citation: Extract from the Hansard (parliamentary record) of Malawi, 29 February 1972 and unsigned letter of 14 March 1972 from the Chancery of the British High Commission to Malawi to the Central and Southern Africa Department of the FCO in London. Folder 37/1025 of the Foreign and Commonwealth Office's Archives at Kew, UK.

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Analytic Note: This is a memorandum of 4 February 1972 from K. Michael Wilford, Assistant Under-Secretary for Asia/Far East in the FCO in London, to the South Asian Department of the FCO from folder 37/1024 of the Foreign and Commonwealth Office's Archives at Kew, UK. In this memo he describes a meeting with Mr Takahashi, Minister at the Japanese Embassy in London about the recognition of Bangladesh. The excerpt shows that the only issue raised by the Japanese representative was “whether the continued presence of Indian forces in Bangladesh was or was not a hindrance to recognition”. While this is not strong evidence that the Japanese would not have recognized if troops had not been withdrawn, this does show that it was the only issue raised, and also that the implications of the troop presence were fluid and up-for-grabs in the sense of being a subject for argumentation.

Source Excerpt: Mr Takahashi went on to tell me that talks about modalities of relations between Bangladesh and Japan would probably be conducted by their Consul General, who was still in Dacca, or, he added as an afterthought, in Tokyo. The remainder of our conversation consisted of a discussion about whether the continued presence of Indian forces in Bangladesh was or was not a hindrance to recognition. I gave him our line.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2548

Full Citation: K. Michael Wilford, Assistant Under-Secretary for Asia/Far East in the FCO in London, a memorandum from Wilford to the South Asian Department of the FCO, 4 February 1972. Folder 37/1024 of the Foreign and Commonwealth Office's Archives at Kew, UK.

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Analytic Note: This is a telegram of 24 January 1972 from John Peck, UK Ambassador to Ireland, to the FCO in London from folder 37/1020 of the Foreign and Commonwealth Office's Archives at Kew, UK. The excerpt reveals that the Irish government said that the only potential barrier to recognition, apart from wanting to act at the same time as other countries, was “the continuing presence of the Indian army in East Pakistan”. This is not strong evidence that the Irish would not have recognized had the Indian army not withdrawn, but it does show that it was the only concern they raised and that the withdrawal of Indian troops would have removed this sole source of potential concern.

Source Excerpt: An official in the DFA, to whom we spoke on the lines of your paras 2 and 3, said, that, although the Irish government were somewhat concerned at the continuing presence of the Indian army in East Pakistan, they agreed that recognition was virtually a matter of timing. They hoped to concert action with a majority of the ten and Dr. Hillery, the Minister, had intended to sound out views in Brussels last weekend: the department did not yet know the results of his contacts. The official was interested in the possibility of wide commonwealth recognition at the same time and asked to be given news of our soundings.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2547

Full Citation: John Peck, UK Ambassador to Ireland, telegram to the FCO in London, 24 January 1972. Folder 37/1020 of the Foreign and Commonwealth Office's Archives at Kew, UK.

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Analytic Note: This is a telegram of 26 February 1972 from Myles P. Preston, Counsellor of the UK Embassy to Indonesia, to the FCO in London, from folder 37/1025 of the Foreign and Commonwealth Office's Archives at Kew, UK. This excerpt shows that Adam Malik, Foreign Minister of Indonesia, appealed to the joint statement by Gandhi and Mujib as a justification for recognizing. This is a particularly clear example of making recognition conditional on withdrawal, or in this case, on a statement by the two countries.

Source Excerpt: Foreign Minister Adam Malik has announced that Indonesia has decided to recognise Bangla Desh as from 25 February. … After the return of Sheikh Mujibur Rahman to Dacca and the joint statement of Mujibur Rahman and Mrs Gandhi on the withdrawal of Indian Troops, the Indonesian Government now sees no obstacle to the recognition of Bangla Desh.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2545

Full Citation: Myles P. Preston, Counsellor of the UK Embassy to Indonesia, telegram, 26 February 1972. Folder 37/1025 of the Foreign and Commonwealth Office's Archives at Kew, UK.

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Source Excerpt:

1. I spoke today as instructed to Director General of Political Affairs at Department of Foreign Affairs. Despite indications you have had from Indonesian Embassy in London it now seems unlikely that Indonesians will be prepared to recognise Bangladesh at as early a date as you have in mind.
2. Although the Indonesians regard the Bangladesh situation as a genuine nationalist movement their main difficult is the recent role of the Indian army and its continuing presence. Indonesia's own past history and the possibility of external intervention in the future in the affairs countries in this area the Indonesians are reluctant to appear to condone too speedily the Indian intervention. Furthermore they seem to have some doubts about the effectiveness of the control of the territory by the government if the Indian troops were withdrawn. Nevertheless, they would wish to see some signs of withdrawal of troops before they recognise (as Malik has said publicly).

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2546

Analytic Note: This is a telegram of 25 January 1972 from Myles P. Preston, Counsellor of the UK Embassy to Indonesia, to the FCO in London, from folder 37/1020 of the Foreign and Commonwealth Office's Archives at Kew, UK. The excerpt summarizes a conversation between Preston and the Indonesian Director General of Political Affairs at the Department of Foreign Affairs concerning recognition of Bangladesh. It shows that the reasons given by Indonesian diplomats were related to control of territory and also to condoning external intervention. I interpreted this concern about condoning external intervention as being about the use of military force, i.e. aggression, rather than about control because control was mentioned separately.

Full Citation: Myles P. Preston, Counsellor of the UK Embassy to Indonesia, telegram, 25 January 1972. Folder 37/1020 of the Foreign and Commonwealth Office's Archives at Kew, UK.

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Analytic Note: This is a telegram of 4 February 1972 from Myles P. Preston, Counsellor of the UK Embassy to Indonesia, to the FCO in London, from folder 37/1024 of the Foreign and Commonwealth Office's Archives at Kew, UK. This excerpt shows that Adam Malik, Foreign Minister of Indonesia, used withdrawal of Indian troops as one of two conditions for recognition.

Source Excerpt: Malik said that Indonesia is "in principle" already in a position to recognise Bangladesh if two conditions are fulfilled: First, that Pakistan and Bangladesh should reach an "understanding" and second, that Indian troops should be withdrawn from Bangladesh. He said that these conditions had been sent to Indonesian consulate in Dacca and to the parties concerned.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2544

Full Citation: Myles P. Preston, Counsellor of the UK Embassy to Indonesia, a telegram from Preston to the FCO in London, 4 February 1972. Folder 37/1024 of the Foreign and Commonwealth Office's Archives at Kew, UK.

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Analytic Note: This is a telegram of 25 January 1972 from Robert Edmonds, UK High Commissioner to Cyprus, to the FCO in London, from folder 37/1020 of the Foreign and Commonwealth Office's Archives at Kew, UK. The excerpt summarizes a conversation with George Pelaghias, Acting Director-General of the Cyprus Ministry of Foreign Affairs, in which he justified why Cyprus was recognizing Bangladesh. He refers to the self-determination of the Bangladesh people, and the fact that the Mujib administration had effective control. He also refers to the fact that Indian forces were in Bangladesh with the agreement of Mujib’s government. This can easily be interpreted to imply that there is an awareness that the presence of Indian forces is a potential problem and that Mujib had agreed to the troop presence is a way to dismiss or undercut that criticism.

Source Excerpt: Pelaghias said the Cyprus Government's view is that the state of Bangladesh exists as a fact; that Mujib and the Awami League are fully representative of their people, and the Government has effective control; and that the Indian forces are in Bangladesh with the agreement of Mujib's Government.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2542

Full Citation: Robert Edmonds, UK High Commissioner to Cyprus, a telegram from Edmonds to the FCO in London, 25 January 1972. Folder 37/1020 of the Foreign and Commonwealth Office's Archives at Kew, UK.

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Analytic Note: This is a telegram of 28 January 1972 from Peter A. Wilde, UK Deputy High Commissioner to Ceylon, to the FCO in London, from folder 37/1023 of the Foreign and Commonwealth Office's Archives at Kew, UK. This excerpt summarizes a conversation between Gunasingham, the director of the Ceylonese Asia section of the Department of External Affairs, and the UK Head of Chancery in the UK Embassy to Ceylon. This is evidence that a key decision maker explicitly used India’s aggression as a reason not to recognize, or to delay recognition of, Bangladesh. The fact that this information was given at a party and not as an official line could mean that this was more genuine feelings revealed in an unguarded moment. This adds to other evidence (i.e. omahoney_archivefco2_1972) showing that others in the ministry felt that whether Indian Prime Minister Indira Gandhi had agreed to withdraw troops on Mujib’s request was relevant to a recognition decision.

Source Excerpt:

1. Head of Chancery spoke to Gunasingham, Director (Asia) IM M D E A ...
2. Gunasingham told head of Chancery at a party last night that Ceylon will take its time over recognition quote even if it is the last country to do so unquote. This was because the Ceylonese felt strongly about India's breach of principle of non-interference in another country's internal affairs and her use of force. Today, Gunasingham was at pains to explain that what he said last night should not be taken as the official view of the government of Ceylon.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2541

Full Citation: Peter A. Wilde, UK Deputy High Commissioner to Ceylon, a telegram from Wilde to the FCO in London, 28 January 1972. Folder 37/1023 of the Foreign and Commonwealth Office's Archives at Kew, UK.

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Analytic Note: This is a confidential telegram of 14 January 1972 from Peter Hayman, UK High Commissioner to Canada, to the FCO in London, from folder 37/1020 of the Foreign and Commonwealth Office's Archives at Kew, UK. In this telegram, Hayman describes a conversation with Thomas Wainman-Wood, Director of the South Asia Division of the Canadian Department of External Affairs. This excerpt provides evidence of early Canadian thinking on recognition, in particular that Indian withdrawal of troops was the only relevant barrier to recognition, on the basis of normal criteria and law and order, and that the Foreign Minister had publicly linked that to the issue of control of territory and “independence” so possibly also self-determination as well.

Source Excerpt: Canadians agree that recognition is inevitable and desirable and they too would prefer to recognise with other like-minded governments. But they believe timing to be premature in relation to normal criteria for recognition as long as law and order is manifestly dependent on presence of Indian troops. Before release of Mujib they had had in mind recognition in three to six months time on assumption that by then there would be a significant Indian withdrawal. Release of Mujib has brought their timescale forward but they are still thinking of weeks rather than days.<br> ...It is also relevant that Mr Mitchell Sharp in a television interview on January 11 (which admittedly has passed largely unremarked here) has done a long way towards committing himself to withdrawal of Indian troops as a precondition of recognition (text by bag).<br> Relevant extract, which Wainman-Wood drew to our attention reads as follows: "For the establishment of the fact of an independent govt I think that the presence of foreign troops is sort of a reflection upon the independence. Its one thing if you have foreign troops in because you are trying to protect yourself from outside aggression: thats one state of affairs and to have foreign troops on your soil under these conditions may not/not be a reflection on your own independence. If you have foreign troops in, however, for the purpose of enforcing local law and order then I think questions can be raised. So that the presence of Indian troops in Bangla Desh at the present time is one of the factors that must be taken into account."

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2540

Full Citation: Peter Hayman, UK High Commissioner to Canada, a confidential telegram from Hayman to the FCO in London, 14 January 1972. Folder 37/1020 of the Foreign and Commonwealth Office's Archives at Kew, UK.

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Analytic Note: This is a telegram of 26 January 1972 from Michael Hadow, UK Ambassador to the FCO in London, from folder 37/1020 of the FCO Archives held at the National Archives at Kew, UK. The excerpt describes a conversation Hadow had with Jose Maria Ruda, an under-secretary at the Argentine foreign ministry, in which Ruda gives his analysis of the barriers to recognition. This is evidence that a key player in the Argentine decision-making apparatus not only saw the Indian troop presence as a “legal difficulty” but also thought that actual withdrawal should be the criterion.

Source Excerpt: He telephoned this morning and said that Argentina would clearly have to recognise, but the question of timing was difficult for them as they had been active in the security council "in a rather pro-Pakistan way". Furthermore as far as he was concerned whatever statements might have been made the actual presence of Indian troops in Bangladesh presented a legal difficulty. These were his own views and he had not been able to consult his minister, who was in Ecuador, but this was the submission he would be making.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2539

Full Citation: Michael Hadow, UK Ambassador to the FCO in London, a telegram from 26 January 1972. Folder 37/1020 of the FCO Archives held at the National Archives at Kew, UK.

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Analytic Note: This is a transcript of a press conference given by Canadian Minister of Foreign Affairs Mitchell Sharp on 31 January 1972, from folder 37/1024 of the FCO Archives held at the National Archives at Kew, UK. This excerpt shows that at least one Canadian decision-maker held that the extent of control over the territory was a crucial factor in the recognition decision. He also mentions that this “will continue to be a factor in decisions of many countries”.

Source Excerpt: Question: Is it true you are waiting for Brit to follow suit [in recognizing Bangladesh] sir? Answer: No/no, we have been making up our own mind in this question...We are looking at the question that is concerning everyone, namely, is the govt that has been formed in Bangladesh really in authority and what is the effect of the presence of Indian troops.... As I say the presence of Indian troops is a cause of a good deal of concern because if there was any idea that the new govt was being kept in office by the Indian troops, then one would question the authority of that govt….I am sure it will continue to be a factor in decisions of many countries.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2531

Full Citation: Mitchell Sharp, Canadian Minister of Foreign Affairs, transcript of a press conference, 31 January 1972. Folder 37/1024 of the FCO Archives held at the National Archives at Kew, UK.

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Analytic Note: This is a confidential telegram from UK High Commissioner to Australia Morrice James to the Foreign and Commonwealth Office (and others) of 1 February, from folder 37/1023 of the FCO Archives held at the National Archives at Kew, UK. This excerpt shows that Australia’s formal statement of recognition was linked directly to the issue of self-determination, i.e. the extent to which Mujib had the support of the population, and also to the withdrawal of Indian troops. The structure of the statement implies that the fact that Indian forces would be withdrawn is a counterargument. The excerpt also shows that the Australian government is relying on a statement by the Bangladesh government, who have ‘made it clear’, that Indian troops would be withdrawn, not the actual withdrawal of troops.

Source Excerpt: The Foreign Minister, Mr. Nigel Bowen, announced today that Australia had recognised the government led by Sheikh Mujibur Rahman as the government of the new state of Bangladesh. Mr Bowen said there was no doubt of the breadth and depth of the support which Sheikh Mujib's Government enjoyed among the people of Bangladesh. The new government had established administrative control throughout most of the country and had made it clear that all Indian forces would be withdrawn as soon as law and order had been completely restored.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2530

Full Citation: Morrice James, UK High Commissioner to Australia, confidential telegram from James to the Foreign and Commonwealth Office (and others), 1 February 1972. Folder 37/1023 of the FCO Archives held at the National Archives at Kew, UK.

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Analytic Note: This is a confidential telegram from UK Ambassador to Mexico Sir Peter Hope to the Foreign and Commonwealth Office of 26 January, 1972, from folder 37/1020 of the FCO Archives held at the National Archives at Kew, UK. This excerpt shows that the Mexican Foreign Minister, Emilio Oscar Rabasa, gave as a reason for the Mexican President’s decision not to recognize Bangladesh, that they did not want to condone territorial aggrandizement as a result of war until Indian troops had been withdrawn. The telegram also indicates that this reason and another reason, i.e. that Mujib’s assumption of several cabinet portfolios cast doubt on the fact that his government had been elected by the people, were the only two reasons cited by the Mexican government.

Source Excerpt: Rabasa said that, since the Mexicans, like many Latin Americans, refuse to condone territorial aggrandizement as a result of war, they would prefer to wait on the withdrawal of Indian troops as the sign of true independence.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2529

Full Citation: Sir Peter Hope, UK Ambassador to Mexico, a confidential telegram from Hope to the Foreign and Commonwealth Office, 26 January 1972. Folder 37/1020 of the FCO Archives held at the National Archives at Kew, UK.

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Analytic Note: This is a confidential telegram from UK High Commissioner to Ceylon Sir Angus Mackintosh to the Foreign and Commonwealth Office (and others) of 25 January, from folder 37/1020 of the FCO Archives held at the National Archives at Kew, UK. This excerpt shows that officials in the Ceylon External Affairs Ministry “seem impressed” by the point made by Pakistan President Zulfikar Ali Bhutto on the presence of Indian troops in Bangladesh as a barrier to recognition.

Source Excerpt: Official thinking in the Ministry is that, while Bangladesh is a fact and the question of recognition is only one of timing, Ceylon cannot as yet concede this in public. Officials seem impressed by President Bhutto's plea to time for further talks with Sheikh Mujib and by the Pakistan point on the presence of Indian troops in Bangladesh. ... In the meantime he has asked if we could let him know ... (b) Whether Mujib has stated publicly that Mrs. Gandhi has agreed to withdraw Indian forces on his request:

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2528

Full Citation: Sir Angus Mackintosh, UK High Commissioner to Ceylon, a confidential telegram from Mackintosh to the Foreign and Commonwealth Office (and others) , 25 January 1972. Folder 37/1020 of the FCO Archives held at the National Archives at Kew, UK.

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Analytic Note: This is a confidential telegram from UK Ambassador to Turkey Sir Roderick Sarell to the Foreign and Commonwealth Office (and others) of 25 January, from folder 37/1020 of the FCO Archives held at the National Archives at Kew, UK. This excerpt shows that the Turkish Foreign Minister both cited the presence of Indian troops as a barrier to recognition and also indicates that this linkage was not immediately apparent and was dependent upon it being made.

Source Excerpt: I spoke as instructed to the Secretary-General of the Ministry of Foreign Affairs and later to the Foreign Minister after lunch today. 2. They had both had a long meeting with Bhutto the previous evening…The Turks had clearly been impressed by Bhutto's argument that the continued presence of the Indian Army in Bangladesh was incompatible with Mujibur Rahman's claim to effective control, which might he maintained crumble within a week or two of the Army's evacuation.<br> ... Bayulken [Turkish Foreign Minister] also made a good deal of play with Bhutto's arguments about the continued presence of Indian troops.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2527

Full Citation: Sir Roderick Sarell, UK Ambassador to Turkey, a confidential telegram from Sarell to the Foreign and Commonwealth Office (and others) , 25 January 1972. Folder 37/1020 of the FCO Archives held at the National Archives at Kew, UK.

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Analytic Note:This is an extract from briefing notes for the Prime Minister Edward Heath for a meeting between him and Sheikh Mujibur Rahman at 18.30 hours, Saturday, 8 January, from folder 15/751 of the Prime Minister’s Archives held at the National Archives at Kew, UK. This extract shows both that the Prime Minister was advised to explicitly link recognition and the presence of the Indian Army in Bangladesh and also that Mujib likely was aware of this linkage due to an informal meeting with his representative 2 days before the meeting with the Prime Minister.

Source Excerpt: Mujib will press for early recognition by HMG. The British Government accepts the fact of Bangladesh. However, given the continuing role of the Indian Army our criteria for recognition are not yet satisfied. We must also look to our relations with the Government in Islamabad. So far only the Governments of India and Bhuttan [sic] have accorded recognition and we will wish to act with others. However, we do not wish to delay too long and in the meantime the Bangladesh Government should exercise patience in their interest as well as ours. These points have already been made by the Foreign and Commonwealth Secretary at an informal discreet meeting on 6 January with Mr Justice Choudhury, the Bangladesh representative in London who has since left for Dacca.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2558

Full Citation: Edward Heath, British Prime Minister (1970-1974), extract from briefing notes for the Prime Minister Edward Heath for a meeting between him and Sheikh Mujibur Rahman at 18.30 hours, 8 January 1972. Folder 15/751, of the Prime Minister’s Archives held at the National Archives at Kew, UK.

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Analytic Note: This is an extract from a Note of a Meeting at 10 Downing Street on Saturday 8 January 1972 at 6.30pm, marked “Secret”, from folder 15/751 of the Prime Minister’s Archives held at the National Archives at Kew, UK. The Note includes a paraphrased summary of a wide-ranging discussion between Prime Minister Edward Heath, Sheikh Mujib-ur-Rahman and others, which includes Mujib revealing his desire for recognition. This extract shows that the Prime Minister explicitly mentioned the role of the Indian Army in Bengal in keeping law and order, linked this with world opinion, and asked Sheikh Mujib what his plans for the future of the Indian Army were.

Source Excerpt: The Prime Minister said that it had been remarkable that law and order had been kept to such a degree in Bengal. He was most impressed: the more so in the way in which trouble in persecuting collaborators with the West Pakistanis had been kept down. He was sure that continuing on this course would win support from world opinion. The Indian Army had been very well disciplined in its work in Bengal. He asked, however, about Skeikh Mujib's plans for the future of the Indian Army. Sheikh Mujib said that he would speak to Mrs. Gandhi about this when he met her in Delhi. The Indian Army would have to withdraw. After he arrived in Dacca he would officially ask for withdrawal and say that he wished to work out a phased plan for this with Mrs. Gandhi.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2557

Full Citation: Edward Heath, British Prime Minister (1970-1974), extract from a Note of a Meeting at 10 Downing Street, 8 January 1972. Folder 15/751, from the Prime Minister’s Archives held at the National Archives at Kew, UK.

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Analytical note: The list, attached to this volume, on the history of military stations comprises a total of 63 short historical accounts of the respective stations in German East-Africa until 1911. Nigmann states himself in the introduction to this volume (p. IV), that the list is not comprehensive. The list nonetheless provides very helpful accounts of rationales driving the establishment of colonial stations. We have extracted information on station type, the year of establishment or status change (e.g. from auxiliary station to main station) as well as the original (German) note on the main objective of the establishment of the station.

Data Sources: https://data.qdr.syr.edu/file.xhtml?fileId=2608

https://data.qdr.syr.edu/file.xhtml?fileId=2609

Full Citation: Nigmann, Ernst. 1911. Geschichte der kaiserlichen Schutztruppe für Deutsch-Ostafrika [History of the Colonial Protection Force in German East-Africa]. Hamburg: E. S. Mittler und Sohn.

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Analytical note: We have extracted information on the year of the event, the location description as well as a short description of the military encounter. We have used the location description to locate the event as precisely as possible. The resulting dataset contains original information in German as extracted from Nigmann’s accounts.

Data Source: https://data.qdr.syr.edu/file.xhtml?fileId=2610

Full Citation: Nigmann, Ernst. 1911. Geschichte der kaiserlichen Schutztruppe für Deutsch-Ostafrika [History of the Colonial Protection Force in German East-Africa]. Hamburg: E. S. Mittler und Sohn.

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Analytical note: Data on the location of cotton plantations and rubber forests stems from the "Economic Atlas of the German Colonies" (Wirtschaftsatlas der deutschen Kolonien) prepared by the “Colonial Economic Committee" (Kolonialwirtschaftliches Kommittee) in 1906. The map number 7 of the atlas "Economic and Commerce Map of German East-Africa" (Wirtschaftsund Verkehrskarte von Deutsch-Ostafrika; 1:5.000.000) displays the location of the production sites of all main agricultural goods in the colony. We geo-referenced the map using all 43 visible markings of the coordinate grid and created two separate vector layers pinpointing the location of all rubber (89) and all cotton (102) producing sites displayed on the map.

Full Citation: "Economic Atlas of the German Colonies," (Wirtschaftsatlas der deutschen Kolonien), 1906, prepared by the “Colonial Economic Committee" (Kolonialwirtschaftliches Kommittee).

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Analytical note: Martin Schlunk, the author of this survey, was a German mission inspector, stationed in Hamburg. The main aim of this inquiry was to gather comprehensive information on mission schools in 1911 and subsequently analyze the German mission's schooling system throughout the colonies. As part of this exercise, he collated comprehensive lists of mission stations, including information on their location. We have used this information to geolocate the primary missionary stations in the colony.

Full Citation: Schlunk, Martin, 1914. Die Schulen für Eingeborene in den deutschen Schutzgebieten [The Schools for Natives in the German Protected Areas]. Hamburg: L. Friederichsen & Co.

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Analytical Note: Martin Gensichen, the director of the Berlin Missionary Society (Berliner Missionsgesellschaft), describes the progress made by Protestant missionaries in building a connected network of missionary stations from the Njassa-lakes in southern German East-afrika to coastal hub Dar Es Salaam. He highlights the necessity for internal cohesion, so as to prevent Catholic missionaries from interfering with Protestant ambitions. The quote indicates that this was a, if not the, major concern for mission placement, as he refers to it ahead of vital requirements for successful missionary stations.

Source excerpt: Man wird es nicht für ein Fehlgreifen halten, wenn das Komitee und unsere Brüder diese Gedanken, den Katholiken das Quellgebiet in friedlichem Wettstreit abzugraben, nicht aus den Augen lassen – ebenso wenig aber auch den andere Gesichtspunkt, daß für die Stationen immer volkreiche Gegenden ausgesucht warden, bei denen die übrigen Bedingung: möglichst gesunde Lage, Nähe von Wasser, Holz und Lehmerde zum Ziegelstreichen zutreffen (Gensichen, p. 14-15).

Source translation: One would not consider it a mistake, if the committee and the brothers would keep their eyes on reclaiming the source region from the Catholics through peaceful competition – but at the same time not to neglect other factors, namely to choose densely populated areas with good health conditions, proximity to water, and building material as locations for new stations” (Gensichen, p. 14-15).

Full Citation: Gensichen, Martin. 1902. Die Jüngsten Afrikanischen Missionsgebiete Der Missionsgesellschaft Berlin I, Maschonaland Und Deutsch-Ostafrika in Vergleichung Miteinander [A Comparison of Missionary Society Berlin I.’s New African Mission Territories in Maschonaland and German East-Africa]. Berlin: Buchhandlung der Berliner Evangelischen Missionsgesellschaften.

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Analytical note: Information on the location and length of main roads and traditional caravan routes stem from two colonial maps. The edited volume “The German Colonial Empire" (Das Deutsche Kolonialreich - Eine Länderkunde der deutschen Schutzgebiete) published by Hans Meyer in 1909/1910 is one of the most detailed historical descriptions of economic, natural and social conditions of the German colonies. We geo-referenced the “Transportation and Administration Map of German East-Africa" (Verkehrs- und Verwaltungskarte von Deutsch-Ostafrika; 1:2.000.000) included in the book with 37 visible markings of the coordinate grid displayed on the map. Finally, we created a line layer representing all main roads and summed the road length per grid cell. We proceeded in a similar way for the caravan routes with a map prepared in 1892 (1:5.000.000), geo-referenced with 153 markings. The map has been published in the monograph “History of the Arab Uprising in East-Africa" (Geschichte des Araberaufstands in Ost-Afrika. Seine Entstehung, seine Niederwerfung und seine Folgen) by Rochus Schmidt (1892).

Full Citation: Hans Meyer, 1909/1910, “The German Colonial Empire" (Das Deutsche Kolonialreich - Eine Länderkunde der deutschen Schutzgebiete), edited volume.

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Analytical note: Rough estimates of the African population density are based on two maps taken from the "German Colonial Lexicon" (Deutsches Koloniallexikon) published in 1920 by the former governor of German East-Africa Heinrich Schnee; the maps themselves are not dated. We have georeferenced the map on the population density (1:15.000.000) using landmarks as the maps does not contain coordinate grids. The map displays rough polygons of four density levels (1-5; 5-10; 10-50; more than 50 people per square kilometer). While the map does not provide a reliable source for accurate numerical estimates of the actual population density it can be used to roughly indicate areas of relatively higher or lower density. We have attributed ascending numbers for the 4 density-levels to each grid according to spatial overlaps of grid centroids and aforementioned polygons.

Full Citation: Heinrich Schnee, former governor of German East-Africa, German Colonial Atlas (Deutsches Kolonial-Lexikon; Schnee), 1920.

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Analytical note: The map on Tsetse Fly presence (1:5.000.000) is provided in the Bericht uber die Schlafkrankheit in Deutsch-Ostafrika [Report on the sleeping sickness in Deutsch-Ostafrika] prepared by the colonial army's principal physician Dr. Emil Steudel in 1909. We have geo-referenced the map using 26 markings of the coordinate grid. A total of 1357 individual points on the map represent the Tsetse Fly density. We have digitized these points and calculated counts per grid cell.

Full Citation: Emil Steudel, Colonial Army Principal Physician. 1909. Bericht uber die Schlafkrankheit in Deutsch-Ostafrika [Report on the sleeping sickness in Deutsch-Ostafrika]. Tsetse Fly Map.

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Analytical note: After the uprising of 1905-1907 the German forces felt the need to reduce their prior lack of military and strategic knowledge concerning the diverse characteristics of the colony. Thus, they undertook expeditions and evaluated past battle experiences as well as the local knowledge of their officers and brought them together in the Militärisches Orientierungsheft für Deutsch-Ostafrika [Military Orientation Book for German East-Africa], which also included an 8-sheet military road map, in which strategic places and travel (times) where demarcated. The goal was to have a systematic and transferrable guide for all troops to use, even in districts formerly unknown to them.

Full Citation: Militärisches Orientierungsheft für Deutsch-Ostafrika. [Military Orientation Book for German East-Africa]. 1911. Daressalam: Deutsch-Ostafrikanische Rundschau.

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Source excerpt: "Der erste, der ein Stück Land verlangte und erhielt, ein festes Haus darauf baute, einen Soldaten oder Polizisten, eindrucksvoll bewaffnet, zur Bewachung des Hauses und zur Ausführung seiner Entscheidungen zurückließ, dreist den umstehenden Menschen befahl, die Anordnungen des Soldaten zu befolgen, denn sie seien Ausdruck des Willens des großmächtigen Herrschers in einer fernen Hauptstadt, einfältige, furchtsame oder gerissene Leute fand, die glaubten, diesem Befehl nachkommen zu sollen, und der, nachdem er das alles getan hatte, sich zur fernen Hauptstadt auf und davon machte, nicht ohne nachdrücklich zu betonen, daß er eines nicht fernen Tages zurückkommen werde, ist der wahre Begründer des Staates. Der Staat beginnt mit der Station.“ (p. 58)

Source translation: The first one who demanded and received a piece of land, built a solid house on it, left a soldier or policeman, impressively armed, to guard the house and to carry out his decisions, boldly ordered the bystanders to obey the orders of the soldier, for they were expressions of the will of the great ruler in a distant capital, who found simple-minded, timid, or sharp people, who believed they were to follow this order, and who, having done all this, set off to the distant capital, not without emphasizing that he will come back in a time not long from now, is the true founder of the state. The state begins with the station." (p.58)

Full Citation: Trotha 1994, 58 ‘Der Staat beginnt mit der Station’ in the original (authors’ translation).

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Analytical note: This book was written by Ernst Nigmann, at the time Major at the staff of the 2nd Nassau pioneer battalion of the German Military and formerly a major in the German colonial force. It records the history of the German colonial forces and its military actions in German East-Africa and contains a detailed list of all violent encounters of the military between 1889 and 1910 as well as on the establishment of German stations across the colony. The book represents the most comprehensive account of the internal organization and activities of the German military forces in the colony.

Full Citation: Nigmann, Ernst. 1911. Geschichte der kaiserlichen schutztruppe für Deutsch-Ostafrika. E. S. Mittler und Sohn.

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Analytical note: The atlas has been compiled by the colonial department of the German foreign ministry between 1901 and 1915. It represented the most detailed and extensive collection of colonial maps available. To date, it is considered the most accurate collection of high-resolution maps of German colonial territories. The atlas consists of nine over-sized map sheets (1:1.000.000). We geo-referenced the maps using a total of 129 markings of the coordinate grid.

Full Citation: Schnee, Heinrich. 1920. Deutsches Kolonial-lexikon [German Colonial Lexicon]. Leipzig: Quelle & Meyer.

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Analytical Note: These yearly reports were one of the main tools of accountability for the German Colonial Office. The Governor of German East Africa had an obligation to provide reliable information on various aspects of colonial life to the Colonial Office, which in turn aggregated reports from all colonies. The statistical annexes contain information on the size of the colonial bureaucracy, tax revenue, expenditures, information on settlers and economic activity.

Full Citation: Jahresbericht über die Entwicklung der deutschen Schutzgebiete in Afrika und der Südsee [Yearly report on the development of German colonies in Africa and the South Seas]. For the years 1890-1914. Berlin: Mittler.

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Analytical note: Numbers provided here stem from colonial yearbooks described below. They reflect numbers provided in other sources such as Pesek, Michael (2005). Koloniale Herrschaft in Deutsch-Ostafrika: Expeditionen, Militär und Verwaltung seit 1880 [Colonial Rule in German East-Africa: Expeditions, Military, and Administration since 1880]. Frankfurt a.M.: Campus.

Source excerpt: Dem kolonialen Staat fehlte es an Kolonisierenden. 1888 hatte die DOAG 56 Vertreter an der Küste. Mit der 'Wissmann-Truppe' kamen 32 Offiziere sowie 56 Unteroffizieren ach Ostafrika. Im Jahre 1900 waren 997 männliche deutsche Kolonisierende in Ostafrika, davon 415 Offiziere und Kolonialbeamte.

Source translation: The colonial state lacked colonizers. In 1888 the DOAG [German East-Africa Society] had 56 representatives on the coast. With the 'Wissmann force' came 32 officers and 56 NCOs to East Africa. In 1900 there were 997 male German colonizers in East Africa, including 415 officers and colonial officials.

Full Citation: Pesek, Michael. 2005. Koloniale Herrschaft in Deutsch-Ostafrika: Expeditionen, Militär und Verwaltungseit 1880 [Colonial Rule in German East-Africa: Expeditions, Military, and Administration since 1880]. Frankfurt a.M.: Campus Verlag GmbH.

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Analytical note: In this article Killingray analyzes how law and order could be maintained by the British colonizers on the African continent. He highlights that across different colonies British administrators were driven by the aim of maximizing territorial control when internally organizing colonial states.

Source excerpt: The deployment of police and military in a colony reflected internal security considerations. Military headquarters, for example those at Kaduna, Kumase and Khartoum, stood in strategic centres at the heart of newly conquered territories, the forts and barracks intended to overawe recently rebellious Mahdists and Asantes. Certain railway lines also had a strategic military function; the line to Kumase, opened in 1903 shortly after the suppression of the Asante rebellion, was equipped with an armoured train and stores of timber and sandbags ready for improvized defences at strategic stations. Certain roads also had a stategic purpose, early mapping and construction being undertaken by military surveyors and engineers“ (p. 433).

Full Citation: Killingray, David. 1986. The Maintenance of Law and Order in British Colonial Africa. African Affairs 85 (340):411–37.

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Source excerpt: The signatory Powers of the present Act recognize the obligation to assure, in the territories occupied by them, upon the coasts of the African Continent, the existence of an authority sufficient to cause acquired rights to be respected and, the case occurring, the liberty of commerce and of transit in the conditions upon which it may be stipulated.

Full Citation: General Act of the Conference of Berlin Concerning the Congo. Signed at Berlin, February 26, 1885. Printed in: The American Journal of International Law 3 (1):7-25.

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Source Excerpt: “Discussions at the time of an organ offer Consent should be reaffirmed when the potential recipient is admitted for a transplant. In those cases where the risks exceed those that are accepted within current guidelines (for example where the donor has a primary intra-cranial cancer or a recent history of malignancy such that there is a possibility of tumour transmission), this should be discussed with the potential recipient when the organ is offered and the discussion and outcome documented in the patient records.”

Analytic note: This excerpt is again from the updated guidance, as the previous policy is no longer available. It clearly states that consent should be reaffirmed at the time of organ offer.

Full Citation: NHS Blood and Transplant. Guidelines for consent for solid organ transplantation in adults; available at: http://www.nhsbt.nhs.uk/download/guidelines_for_consent.pdf (last accessed 1 Apr 2014).

Link broken. Permanent link to alternate resource https://perma.cc/7WMN-EZAN created 2 Feb. 2018

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Source Excerpt: “Before the patient is placed on the National Transplant Waiting List, the potential recipient should be given information about the process of donation and be told specifically about: i) the screening process, including the information requested and investigations done by the Specialist Nurses in Organ Donation (SNODs), prior to offering organs; ii) the information about the donor that may be shared with the recipient before or after transplantation; iii) the categories and types of donors and organs (as relevant to the individual); iv) the risks associated with all organs and those that may derive from the varying characteristics of the donor (such as lifestyle, cause of death), from the organ itself and from the logistics of the transplant; v) the benefits of transplantation; vi) the short and long-term risks and implications of transplantation.”

Analytic note: The document originally cited has now been updated by NHS Blood and Transplant. The excerpt above is from the updated guidance, but does not differ significantly from the previous document. The document describes exactly what patients should be told prior to being placed on a transplant waiting list, including nuanced information regarding risk.

Full Citation: NHS Blood and Transplant. Guidelines for consent for solid organ transplantation in adults; available at: http://www.nhsbt.nhs.uk/download/guidelines_for_consent.pdf (last accessed 1 Apr 2014).

Link broken. Permanent link to alternate resource https://perma.cc/7WMN-EZAN created 2 Feb. 2018

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Source Excerpt: “The data indicate that many patients have poor comprehension and recall of risk information. The fuzzy trace theory predicts that it may be completely unrealistic to even expect patients to recall accurate risk information. While clinicians typically report risk information as percentages or relative risks, the evidence suggests that people may code information qualitatively. Decision making has been shown to be subject to bias as a result of heuristics. More recent evidence indicates that much of the information that people are presented with may not even be used in the decision making process.”

Analytic note: The cited article provides are review of other research that has found patient understanding of risk to be limited, particularly for those patients who face substantial treatment risks.

Full Citation: Lloyd AJ. The extent of patients’ understanding of the risks of treatments. Quality in Health Care 2001;10(1 Suppl):14–18.

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Source Excerpt: “Nevertheless, these challenges must be overcome as involvement of patients in setting goals is fundamental to the concept of patient centredness. Clarifying patients' objectives is not a substitute for the GMC's guidance on good consent practice. Rather, it provides the ideal reference point for tailoring treatment and information to individual patients' needs. Conversely, if patients' objectives are not established, offers of treatment with even full disclosure of risks, benefits, and alternatives, may yet fail to be patient centred if made in ignorance of what a compliant patient truly wants.”

Analytic Note: The cited article supports the empirical claim that patient-centred care is considered important in the UK. It discusses the need to ensure that consent is patient-centred and highlights the importance of doing this to comply with relevant UK guidelines.

Full Citation: Bridson J. Making consent patient centred. British Medical Journal 2003;327:1159.

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Source Excerpt:

I: Right, okay. Erm, so, do you think that it’s reasonable for adults to be expected to bear some of the cost?

IV: I think, I think so, yes. I think that, erm, you know, we can’t promise any adult now a good quality organ, and split livers, along with other types of, what we classify as marginal [yeah] donors, are really what we are now expecting to offer adults [yeah]. It’s not very common that we can actually give them a perfect organ [yeah]. So I think, er, a split liver is probably not much different in some ways to some of the other marginal livers that we have to end up using [yeah], either because of donor comorbidity, fatty liver [yeah], or other, erm, issues which render them marginal - non- heart-beating donors, for example [yeah].

So, I, I think it’s increasingly becoming recognised that, you know, a split liver, erm, is – the data would suggest that split livers do probably do worse [yeah], in terms of graft survival [yeah], but that they are probably in the same ballpark as better marginal livers [yeah] that we’re using. So, I, I, I think that, explaining that to the adult population, they would understand, particularly with knowing the benefits for children [yeah], that this is reasonable if it’s done in a controlled way; that we’re selective about which organs are split [yeah], and that we reduce the, er, time taken to get the liver to the centre, which is one of the issues [yeah] at the moment, about where it’s split. And, occasionally, the right lobe can travel to more than one centre before it gets to its final destination [right], which can prolong the ischemic time which can then [yeah] lead to complications.

Analytic note: This source supports the descriptive claim that staff participants thought that split livers are not the worst livers available for transplantation. This participant discusses marginal organs,, and places split livers in the same ballpark as better marginal livers.

Full Citation: Moorlock et al., interview with LS13 (LS= Liver staff).

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Source Excerpt:

I: so children benefit from splitting livers. But adults actually don’t benefit generally, they tend to do slightly worse. Do you think that’s erm … what do you think about that trade off?

IV: Well I suppose I’d have to … I look at it from, as a human being, and as a human being that my, and also professionally having, having a job all my life, or most of my life to do with improving a lot of children. [Yeah.] It was … also as a human being I think ‘well then I was just over 60/61’. [yeah] You know, I’m married, got children of my own.[yeah]grandchildren. You know? [Yeah]I thought ‘well as a human being I’ve done my bit but there’s a child here that needs it that’s had virtually no life at all’.[Yeah]. And so, no it was … that was the one … I felt that from my point, personal point of view, very positive that I’d shared a liver. So sort of… err I found that very fulfilling that we, we’ve somehow got this other human, that I don’t know, but we’re sharing something which … that somebody else had to die to give us. That is almost … it forms the circle.

Analytic note: This source supports the descriptive claim that some participants felt positive about receiving a split liver, and appeared to consider it partly their decision. This participant states that they felt positive about sharing their liver, and interestingly, that they had done their bit. This was an interesting perspective because adult patients do not get a choice about whether the liver that they receive is split or not – they either accept an offered split liver or wait for another offer.

Full Citation: Moorlock et al., interview with LP5 (LP= Liver patient).

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Source Excerpt:

I: so do you think that it’s erm reasonable to give priority to children?

IV:What you’re trying to do when you prioritise younger patients is to erm give them the opportunity to have a life. I think on those grounds it’s reasonable to erm prioritise, but where does that sliding scale stop, because I would argue that patients in their 20s probably should have priority over patients in their 60. So I’m not sure that my argument holds purely for children. Erm, to be erm consistent maybe someone in their 40s or 30s should have priority over someone in their 50s?

Analytic note: This quotation supports the claim that some participants felt that younger people in general should receive priority over older people. This view was stated in many of the interviews, and appeared partly to be because participants struggled to think of a reason why priority should be cut-off at age 18.

Full Citation: Moorlock et al., interview with LS29 (LS= Liver staff).

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Source Excerpt:

I: Right. Now, I think you’ve mentioned a couple of times now, the idea of giving, well, placing the interests of children, erm, first [hmm]. Erm, why do you think that’s justifiable?

IV: I mean that’s a good question. I think it’s just a, sort of, a, a general feeling that you want to see children survive [yeah], and, you know, having a child myself, I think you, sort of, sense that, I mean, someone who is starting out on life, who want to give them the best chance [yeah], whereas someone who’s already lived part of their life [yeah], you know. It’s, it’s a tricky area, and often we ask to ourselves whether we’re justified in transplanting. And there’s a whole ethical issue about what age do you [yeah], should you transplant adults up to [yeah], and should there be an age limit, and we tend to do it on a biological basis.

Erm, but, for example, a 20-year old who needs to have a re-transplant, versus a 66-year old first transplant, you know [yeah], should there be a benefit for the younger patient? At the moment there isn’t. They are all treated the same [yeah], but because we have our separate adult list, we don’t, sort of, look at the children’s list and say, ‘All the kids should have preference to the adults,’ [yeah] but my feeling is that the children should [yeah] have the benefit, particularly as we can, seemingly, offer them transplantation without too much detriment to the adults. Because I mean the split, the numbers of split livers are quite small [yeah], and the proportion of splits, compared with all the donors that adults are getting is, sort of, well under 5% would be my [yeah] reckoning [yeah]. Erm, but, er, er, it’s difficult for me to, sort of, put into words why I think children should get preference.

Analytic note: This source supports the descriptive claim that some staff felt that the low number of livers being split meant that the costs to adults relative to benefits to children were low. The participant specifically references the low numbers of split livers, and the limited detriment to adult

Full Citation: Moorlock et al., interview with LS13 (LS= Liver staff).

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Source Excerpt:

I: But it benefits children. So do you think that’s a fair reason to do it?

IV: I do.

I: Right, okay.

IV: I really do.

I: And do you feel strongly about that?

IV: Very strongly. Because I have grandchildren and if it were me and it was a choice between me having a transplant and them, it would be them. Everyday. I think children are the priority. Definitely.

I: Yeah and would you feel that if it was just your grandchildren or if it was any child?

IV: Any one, any child. Any child. I think where it's difficult, I mean I'm 60 when I had my transplant. And I knew there was a chance I was going to die. But I felt that at 60 well at least I'd had 60 good years of life. And for me, if it meant a split liver and it not working well, so be it, a child's life might well have been saved. To me that’s a priority. And that wouldn't just be my children or my grandchildren, it would be anybody's. Yes. Definitely.

I: So you generally think it's okay for children to receive priority.

IV: I do, I absolutely do, yes.

I: And you'd have been happy to take the split liver if it meant that a child could also receive a transplant?

IV: Absolutely, yes. I mean I feel that children on the waiting list should be the priority anyway. That’s always been my feeling. Where I think I may - I start to worry is it's okay for me to say that I'm 60, plus, and there are people much younger than me on the waiting list, but they're not children. And maybe it's more significant for them to have a whole liver and not a split one. But that’s where I start to doubt my myself.

Analytic note: This participant highlighted that they were in their 60s, and that they thought that they had had a 60 good years of life. The participant explicitly stated that a child’s life is a priority.

Information on participants’ ages was not formally recorded for this study, so the claim that many were middle/old-aged is based upon my own reflections on the interviews.

Full Citation: Moorlock et al., interview with LP7 (LP= Liver patient).

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Source Excerpt:

I: But it’s unacceptable, it would be deemed as unacceptable to everybody concerned and to society, if a child died because they didn’t have a liver in time [yes], erm, because that would be felt, you know, we treat children differently [yes], in all the sorts of aspect in society, don’t we?

I: We do.

IV: And, erm, well the way we treat them in the hospital is different [yeah], and therefore, erm, that carries on to the way we, er, – consider them for the waiting list for a liver transplant [yeah]. So it would be completely unacceptable to have a, a percentage of children - obviously, there will be children who die on the waiting list [yeah], that’s inevitable - but if it runs, er, above a very, very, very low level, that would be deemed unacceptable [yeah]. And the, er, only way to ensure that you don’t have, er, that sort of death rate on the waiting list [yeah], is to keep the waiting times for all the children as low as possible [yeah]. And that means, you know, they have access to all the paediatric organs, and they have access to all the, er, healthy adult organs which can be split. Now, the splitting criteria are relatively strict [yeah], erm, so it, you know, it’s not in any way, in any, any way close to the majority of, erm, adult livers that [yeah] are available. It is only a, er, actually, a relatively small [yeah] percentage, but you’re not gonna change that [right, okay], without profoundly changing the way people regard children.

I: And – but, as an individual, do you think it’s right that children are, maybe prioritised isn’t the right word, but given, their interests are given extra attention?

IV: Well, they are prioritised. Why, why is prioritised not the right word? They are prioritised [yeah]. They are completely prioritised.

I: Yeah, and are you happy with that?

IV: If it was my child I would want them prioritised even more wouldn’t I [yes], so therefore I have to be, because...

I: What if it was you who needed a transplant?

IV: Yes, but, er, you – the, the – our attitude in society, erm, is that children are, have the whole of their life in front of them, they are special and, you know, erm, where you draw the line [yeah] is difficult. Erm, but there is no doubt that, you know, it would be difficult to justify not transplanting a 10-year old child, erm, with a right lobe, er, a left lateral segment, to avoid a 60-year old having a slightly increased risk of complications.

Analytic note: This source supports the descriptive claim that one staff participant stated that the public would find it unacceptable for there to be higher levels of paediatric waiting list mortality. The participant went into some detail on this, suggesting that the public would not tolerate anything other than very low paediatric waiting list mortality. This participant therefore stated that prioritisation of paediatric recipients was well-aligned with what society more generally would want.

Full Citation: Moorlock et al., interview with LS15 (LS= Liver staff).

<br>

Source excerpt:

I: Yeah. So splitting livers is something that can be done to turn one very good liver into two livers basically. And normally that’s done so that one adult can receive a transplant and one child can also receive a transplant, erm so in some ways it creates two livers from one liver. [yeah] Erm but unfortunately for the adult recipient they tend to not do quite as well as if they had been given a whole liver. Erm were you aware of that?

IV: Yeah. I was aware of that.

I: Yeah so would you have been willing to accept a split liver [yeah] if they had offered you one?

IV: Definitely, yeah.

I: And that’s even considering the additional risks involved? [yeah] Okay and erm - so why would that be?

IV: Erm because I think it's - I'm 55 now, I was 53, and erm children, they haven't lived have they? [no] And I would much rather a child's life was saved [yeah] I mean I've got seven grandchildren, [yeah] and if push come to shove I'd rather children be saved.

I: Yeah so I mean to what extent would you think that children's lives should almost take priority over adult's lives? Would you - would you have been happy for your - the liver that you were given, to have been given to a child instead of you, even if it meant you waiting longer?

IV: Yes, yes, I would have, yes.

I: Right. And erm is that again just been children haven't lived?

IV: Erm well yeah, I think it's important you know children are the future aren't they? [yeah] You know. Having lost a grandchild as well.

Analytic note: This view was articulated by several patient participants, and is illustrated by this quotation. The phrase ‘children, they haven’t lived have they?’, particularly given the previous reference to age, was interpreted as meaning ‘children have lived a less life than adults’, in a numerical sense. It could also perhaps be characterised in a qualitative sense suggesting that children have just experienced less than adults, but the use within argumentation would be similar.

Full Citation: Moorlock et al., interview with LP4 (LP= Liver patient).

<br>

Source Excerpt:

I: Right, so, a nice general warm up question, erm, what do you take the ethical issues to be regarding split liver transplantation?

IV: Erm, well I think the issues are around the fact that there are children, obviously, who benefit from the process. But there may be some disservice to the adults [yeah], because of the slightly inferior right lobe graft that you get [yeah] as opposed to a whole donor, but I think in essence it is the, sort of, right thing to be doing [yeah], because the paediatric waiting list benefits from this.

I: Yeah. Do you think that simply because it’s benefiting children, or would you think the same if it was, erm, benefiting other adults, as well?

IV: There are different ways to split livers and you can split a liver in such a way that you could give half of the liver to each adult [yeah], small adults, but the liver would have to be split slightly differently, and there’s a degree of expertise that’s needed for that [yeah]. Erm, again, I think that, in this era of organ shortage, anything that could be done to maximise reasonable quality organs [yeah] is of benefit.

Analytic note: This extended quotation illustrates the qualification articulated by many members of transplant that it is important to maximise reasonable quality organs. There was, of course, a range of views on what ‘reasonable’ entails.

Full Citation: Moorlock et al., interview with LS13 (LS= Liver staff).

<br>

Source Excerpt:

I: And would you want them to explain any sort of like specific risks associated with a specific liver that you’re offered? So say that you got a phone call and they, they said “we’ve got a liver for you, we can tell you the precise risks about it, erm over and above erm other livers and more general risks”. Erm would you want to know about them?

IV: Erm.

I: And would it influence your decision on whether to accept it?

IV: I’d want to know but whether it would have an influence or not would … I doubt it. [Right]Erm I’d just be interested to know what the risks were so that at least I was aware of them. [Yeah]. Erm if the risks … no, I still don’t think they’d give me a risk … a liver which would be too high a risk because it’s a major operation and I don’t think they’re going to do an operation with something that’s too high a risk for them to be a success.

Analytic note: This quotation is used to support the descriptive claim that patient participants trusted their doctors to not offer them a liver that was too risky. In this case the participant did want to know about any additional risks involved, but they did not think that the risks would influence their decision.

Full Citation: Moorlock et al., interview with LP24 (LP= Liver patient).

<br>

Source Excerpt:

I: Erm so some people have suggested that splitting livers is actually placing children ahead of adults and prioritising them. So it’s taking a good quality liver away from an adult giving a good quality liver to a child and then giving the remaining part of the liver to an adult which isn’t quite as good.

IV: Hmm.

I: Erm what do you think about that?

IV: Well I think everybody deserves a chance and I think if erm err two people could have even a slightly better err life. [yeah] then that, to me, I, I would accept that. [yeah] You know, you’re giving two people chances instead of one. [Yeah] If they don’t work it’s sods law isn’t it? [Yeah]. Erm but I think everybody, as many people as possible deserves a chance.

I: Right, okay.

IV: I mean I think I, I was in a very fortunate position that I had a full liver. [Yeah] And that I may not have had such a fantastic recovery time as I feel I have. [Yeah] erm because I feel now like I did 20 years ago [right] erm before I was diagnosed with liver disease. [yeah] but I’m fortunate that I did go that length of time before becoming really poorly.

Analytic note: This quotation is used to support the descriptive claim that some participants appeared to value quantity of transplants over quality. The quotation highlights this participant’s view that it is important to provide people with a chance to receive a transplant, and that it’s just bad luck if increasing the number of chances to benefit people results in a failed transplant.

Full Citation: Moorlock et al., interview with LP23 (LP= Liver patient).

<br>

Source Excerpt:

I: Yeah. So another question would be would you have been willing to turn down an offer of a lower quality liver?

IV: Don’t think I would have thought about it like that. [Right] I don’t think I would have thought about it because erm if you’re in such a desperate situation that you need a new liver [Yeah] I think whether it’s a high quality one or not, it’s a second chance. [Yeah] And I think you’ve got to take a second chance. [yeah] You know. You know you’re not going to live forever with a liver disease because there’s nothing … not a lot they can do to prolong it. So I, I would, personally, accept erm, you know, a grade down from a grade A.

Analytic note: This quotation illustrates the idea that a liver transplant offers a second chance at life, and that one should take a second chance if offered.

Full Citation: Moorlock et al., interview with LP5 (LP= Liver patient).

<br>

Source Excerpt:

I: So what did you understand, erm, about the risks associated with split livers?

IV: If I remember correctly,,the way it was explained to me was that if I had the lesser liver, which I was destined for, it’s a little bit longer to get it kick-started into action, but, you know, people have successfully undergone that surgery. I think I thought that having a new liver, erm even if it took a while to get going, was erm going to erm help me.

Analytic note: This quotation supports the descriptive claim that patients had a simplified and overly-general understanding of risks associated with transplantation. Although delayed graft function can be a risk associated with marginal livers, there are many other risks involved, some of which are much more serious. By focusing on the idea that these livers have worked for other people, and that it would – even after a delay – kickstart into action, this participant was understood to have not fully appreciated the complex risks involved.

Full Citation: Moorlock et al., interview with LP26 (LP= Liver patient).

<br>

Source Excerpt:

I: Yeah, yeah. So how much information do you think patients should actually be given if they don’t understand it?

IV: If they understand the nuances? I was generally taught that if you have a got a risk of something being greater than one in a thousand then you should give full information to the patient. [yeah] And so I think the answer is you should explain as much as possible erm and have the opportunity to answer questions, then if they don’t fully appreciate it what - but are happy to sign the consent now, I don’t think there's anything further you can do.

I: Right, okay. So it's a case of giving them as much information so they can understand [yeah] and do the best you can do?

IV: Absolutely. Yeah.

I: So some people might say that actually, if the patients don’t really know what they're letting themselves in for, erm and it's not valid consent, does that worry you?

IV: I think that’s a fair point and I can see the point of view you made with that and I think if it's clear that the patient isn't - doesn't understand things then I don’t think you can assume it's valid consent. [yeah] I think you have to see [yeah] some degree of understanding from the patient or some statement to say well, doctor, I don’t mind, I trust you or something along those lines [yeah] to be valid when they sign the consent form.

Analytic note: This quotation was used to support the descriptive claim that some members of staff felt that there are limits to what staff can achieve in terms of enhancing patient understanding, but that they should do their best.

Full Citation: Moorlock et al., interview with LS2 (LS= Liver staff).

<br>

Source Excerpt:

IV: Well, what is consent? [Yeah] What is consent? I’m asking you a question.

I: Well, I guess it’s, generally speaking, erm, granting permission to go ahead with something, but informed consent will be saying that you understand the risks and the potential benefits associated with it.

IV: Yeah, but, er, informed consent is a myth [yeah] in most cases...

I: Right, okay.

IV: ...erm, and we will go some way towards trying to, er, ensure that they have informed consent, the patient, but a lot of them don’t read it or take it in [right]. And we certainly don’t give them proper informed consent, every minute detail [no], the figures and everything [yeah], because that would almost certainly result in people not doing operations which you know are actually very safe and that, actually, their overall general health would be less good [yeah] because they wouldn’t have had the treatment that they, that would have given them great benefit [yeah]. So I think informed consent is an extremely difficult [yeah] concept, and is, it’s something that’s easily trotted out [yeah], as, oh, you know, ‘We really must have informed consent,’ but what it actually means in practice is a very different thing.

Analytic note: This quotation, in full, provides evidence for the descriptive claim that some staff had concerns about the implications of providing too much information. It highlights how a member of staff considered giving too much information to potentially be contrary to the best interests of their patients. The quotation arose in a discussion relating to informed consent, and I interpreted this data as expressing doubts about the informedness of consent, but also the value of informed consent. This participant appeared to have little confidence in patients making ‘good’ decisions on the basis of complex information.

Full Citation: Moorlock et al., interview with LS17 (LS= Liver staff).

<br>

Source Excerpt: “This effect on pediatric transplantation has been demonstrated at UCLA. Since implementation of a policy to split every suitable liver, we have decreased the waiting list for children younger than 1 year from 128 days to 24 days; for children older than 1 year, the waiting time has decreased from 192 days to 30 days. Further, use of split livers will benefit the small blood group 0 recipient, the perennial laggard on the transplant waiting list.”

Analytic note: This source uses statistics from the United States rather than the UK, but it is broadly acknowledged that liver splitting has had the same impact in the UK.

Full Citation: Busuttil R, Goss JA. Split liver transplantation. Annals of Surgery 1999;229(3):313–21.

<br>

Analytic note: This source was a report on split liver transplantation presented to the Liver Advisory Group in the UK. The report is no longer available.

Full Citation: NHS Blood and Transplant Liver Advisory Group. Liver splitting activity report; available at: http://www.odt.nhs.uk/pdf/advisory_group_papers/LAG/Liver_splitting_activity_report_may2013.pdf (last accessed 29 May 2014).

Link broken. No suitable alternative available at time of data curation, 2 Feb. 2018

<br>

Analytic note: This source provides figures for the number of people who have been removed from liver transplant waiting lists. There is again an additional layer of complexity here, because some patients are removed because they become too ill, whereas others are removed because their liver has recovered to the extent that they no longer require a transplant.

Full Citation: NHS Blood and Transplant. Liver transplant activity report; available at: http://www.organdonation.nhs.uk/statistics/transplant_activity_report/current_activity_reports/ukt/liver_activity.pdf (last accessed 1 Apr 2014).

Link broken. Permanent link to alternate resource https://perma.cc/RKL9-FTNT created 2 Feb. 2018

<br>

Analytic note: This source provides organ donation statistics for the UK, and demonstrates the shortage of organs for transplantation by highlighting the number of people waiting for liver transplants. This may not, in itself, accurately reflect the full extent of need for a transplant. Some patients are not eligible to be placed on the waiting list (due to inability to complete a period of alcoholic abstinence, for instance).

Full Citation: NHS Blood and Transplant. Latest statistics; available at: http://www.organdonation.nhs.uk/statistics/downloads/weekly_stats.pdf (last accessed 1 Apr 2014).

Link broken. Permanent link to alternate resource https://perma.cc/U74D-VHEJ created 2 Feb. 2018

<br>

Full citation: Records of the German Ministry for Colonial Affairs, R1001/812, minutes f the sixth meeting of the government council, May 18-19, Daresssalam.

Source excerpt: Vorschlag Feilkes zur Änderung der Bezirksgrenzen im Süden der Kolonie; Bezirk Rufiyi zwischen Kilwa und Daressalam aufteilen und im Hinterland einen neuen Bezirk gründen um „erneuten unliebsamen Ueberraschungen“ vorbeugen zu können (139) „intensivere Ausübung der Reigerungsgewalt“ im Hinterland von Kilwa und Lindi sei notwendig in Form eines neuen Bezirksamtes (140) besonders wegen des Umfanges, den der Aufstand dort angenommen habe (142)

Source translation: Proposition by Feilke to redraw the district boundaries in the south of the colony; dividing district of Rufiyi in between Kilwa and Daressalam and establish a new district in order to be able to prevent “renewed unpleasant surprises” (139), “intense exercise of governmental power” in the hinterland of Kilwa and Lindi is necessary in the form of a new station (140) in particular due to the magnitude of the insurgency in this area.

<br>

Source excerpt: Wohl sind, wie dies in einer großen und kaum halb zivilisierten Kolonie begreiflicherweise noch von Zeit zu Zeit zu geschehen pflegt, auch im Jahre 1905 Befürchtungen wegen Unruhen unter den Eingeborenen gelegentlich aufgetaucht und zur Kenntnis der Behörden gelangt. Sie fußten aber niemals auf Tatsachen und deuteten überdies auf Negerstämme am Kilimandscharo oder auf den Stamm der Wanjamwesi, also gerade solcher Völkerschaften, die sich am Aufstande nicht beteiligt haben. In den später aufständischen Bezirken hat jedenfalls niemand unsere Position für gefährdet angesehen, geschweige denn, daß von irgendeiner Seite eine solche Einmütigkeit unter den Volksstämmen für möglich gehalten worden wäre, wie sie bald in die Erscheinung treten sollte (42).

Source translation: It is true that, as is understandable in a large and barely semi-civilized colony, from time to time, also in 1905, fears of unrest among the natives have occasionally cropped up and come to the knowledge of the authorities. But they were never based on facts and pointed moreover to Negro tribes at Mount Kilimanjaro or to the tribe of the Nyamwezi, in other words precisely those peoples who did not participate in the uprising. In any case, no one in the later insurgent districts regarded our position as endangered, let alone that from any one side such an unanimity would have been considered possible among the tribes as it was soon to appear (42).

<br>

Source excerpt: Es wurde bereits angedeutet, daß der Sparsamkeitsdrang des Mutterlandes den Gouverneur von Deutsch-Ostafrika vor eine in gewissen Fällen unlösbare Aufgabe stellt. Diese Aufgabe bestand im Jahre 1905 in kurzen Worten darin, eine Million Quadratkilometer Landes mit beträchtlichen darin investierten europäischen Werten gegen die völlig unberechenbaren Launen von sieben Millionen halbwilden Negern mit 1701 farbigen Soldaten und 659 farbigen Polizisten zu sichern, mit Mannschaften, die noch dazu in der Mehrzahl den eingeborenen Stämmen entnommen waren, gegen die sie gegebenenfalls zu kämpfen hatten.

Source translation: It has already been suggested that the thriftiness of the Motherland requires the Governor of German East Africa to be faced with an, in certain cases, impossible task. In a nutshell, this task in 1905 was to secure a million square kilometers of land, with considerable European value invested, against the utterly unpredictable whims of seven million black Negroes, with 1701 colored soldiers and 659 colored policemen, working with, what were in most cases, individuals taken from the native tribes, against whom they had to fight if necessary.

<br>

Source excerpt: Die gegen Wahehe angelegte M.S. Ulanga (s. daselbst) wurde 1895 aus Gesundheitsrücksichten nach Perondo verlegt. 1896 schob Prince diese in das Land Uhebe selbst vor (s. Iringa). Stationschefs: v. Stocki. – Prince. (164) Zur Erschließung des Wahehereiches 1896 durch Hauptmann Prince nahe der alten Sultansresidenz Ruirenga angelegt der dorthin die bisherige M.S. Perondo vorschob.

Source translation: The M.S. Ulanga, constructed against the Wahehe (see above) was relocated to Perondo in 1895 for health reasons. In 1896, Prince pushed the station into the land of Uhebe himself (see Iringa). Station chiefs: v. Stocki. - Prince. (164) Created in 1896 by Captain Prince near the old residence of the Sultan Ruirenga with the aim of controlling the Wahehe empire, has relocated the previous M.S. Perondo there.

<br>

Full citation: Records of the German Ministry for Colonial Affairs, R1001/215, decree to all stations, Dar-es-Salâm, June 28, 1899.

Source excerpt: das Bezirksamt wird „[m]it Rücksicht auf die äußerst ungünstigen gesundheitlichen Verhältnisse in Mikindani“ nach Lindi verlegt, beide Bezirke werden unter dem neuen Namen „Lindi“ vereinigt

Source translation: The station will “considering the extremely unfavorable health conditions in Mikindani” be relocated to Lindi, the two districts will be joined under the new name of “Lindi”.

<br> Full citation: Records of the German Ministry for Colonial Affairs, R1001/1026, Communication of von Götzen to Stübel, Dar-es-Salâm, December 1, 1903.

Source excerpt: Grundsätzlich verweist Götzen darauf, dass (anderweitig durchaus sinnvolle) Truppenvermehrungen bzw. -verminderungen an bestimmten Orten (Mpapua mit Kondoa-Irangi und Kilimatinde mit Mkalama (Issansu)) wegen potentiell hoher Kosten für Gebäudeerrichtung nicht durchgeführt würden (116)

Source translation: Generally, Götzen elaborated that (in principle sensible) increases or decreases of troop sizes at certain locations (Mpapua with Kondoa-Irangi and Kilimatinde with Mkalama (Issansu)) will not be implemented, due to potentially high construction costs (31)

<br>

Full citation: Records of the German Ministry for Colonial Affairs, R1001/1026, Communication of von Schele to von Caprivi, Daressalam, October 22, 1893.

Source excerpt: Drittens muß zum Schutz der großen Karawanen-Straße für die aus Mangel an Mitteln seiner Zeit aufgegebene Station Unjangwira, zwischen Mpapua und Tabora, nothwendiger Weise wieder ein Ersatz geschaffen werden. (31)

Source translation: Third, to protect the great caravan route, the station of Unjangwira, in between Mpapua and Tabora, that has formally been abandoned for budgetary reasons, necessarily needs to be replaced. (31)

<br> Full citation: Götzen, Gustav A. 1909. Deutsch-Ostafrika im Aufstand 1905/06 [German East-Africa at Insurrection 1905/06]. Berlin: Reimer.

Analytical note: This book has been written by former German East-African governor Gustav A. Götzen. Drawing on his own experiences in the colony he focuses on the background and direct aftermath of the so-called Maji Maji-insurgency from 1905 and 1907. This excerpt is taken from Götzen's accounts on the administration of the colony, entitled „The natives and the German position of power“.

Source excerpt: Mit dem Vorschieben von Truppenabteilungen und der Errichtung von Standlagern kamen allmählich die umwohnenden Völkerschaften, zunächst die mit Waffengewalt unterworfenen, dann die schutzsuchenden, unter deutsche Einwirkung […]. Aus den erwähnten vorgeschobenen Standlagern der Schutztruppe gingen Verwaltungszentren hervor.

Source translation: With the advancement of troop divisions and the establishment of camps, the surrounding peoples, first those subjected to armed force, then those seeking protection, gradually came under German influence […]. Administrative centers emerged from the troop camps.

<br> Analytical note: The orientation book contains several conflicting narratives of ethnic groups depending on which stations prepared the respective reports. We illustrate these accounts with the example of the Wazeguha that have been described by district administrations in Morogoro and Tanga.

Source excerpt: 1.) Bezirk Morogoro: Kampfart: Kriegerisch, kamen als Eroberer ins Land unter dem Vorfahren Kingo's, der ihr Oberhaupt ist. Verhalten gegen die deutsche Herrschaft, Einfluss der Verwaltung, Stammesorganisation: Kultiviert, nicht leicht zu behandeln, haben ständig Verbindung mit Uzeguha. Mehrere einflussreiche Große [...]“ (p. XI 4- XI 5). 2.) Bezirk Tanga: Kampfart: Früher viele Kämpfe untereinander zwecks Sklaven- und Viehraub. Wurden von den Masai wiederholt geschlagen und beraubt. Nicht kriegerisch. Verhalten gegen die deutsche Herrschaft, Einfluss der Verwaltung, Stammesorganisation: Fügen sich der deutschen Herrschaft. Einfluss der Verwaltung überall bemerkbar. [...]“ (p. IXX 4 – IXX 5).

Source translation: 1.) District of Morogoro: Combat Style: Warlike, came as conquerors into the land under the ancestor of Kingo, who is their chief. Behavior against German rule, influence of administration, tribal organization: Cultivated, not easy to handle, have constant contact with Uzeguha. Several influential leaders [...] "(p.XI 4- XI 5). 2.) District of Tanga Combat Style: used to fight against each other for the purpose of slaving and cattle robbery. Were repeatedly beaten and robbed by the Masai. Not warlike. Behavior against German rule, influence of the administration, tribal organization: Comply with German rule. Influence of administration everywhere noticeable. [...] "(pp. IXX 4 - IXX 5).

<br> This is an Annotation for Transparent Inquiry project, published by the Qualitative Data Repository. Please cite as:

Pierskalla, Jan; De Juan, Alexander. 2018. "Data for: The territorial expansion of the colonial state: Evidence from German East Africa 1890–1909." Qualitative Data Repository. [DOI forthcoming]

These annotations to the supplementary material accompany the main article and annotations here.

Additional documentation can be found on QDR.

Learn more about ATI here.

<br>

See annotation #1

<br>

Analytic Note: This is rendered on the 'Transcript' page of the WikiLeaks site: https://collateralmurder.wikileaks.org/en/transcript.html

<br>

Analytic Note: This is a still taken from the video by the author.

<br>

Analytic Note: This is a still taken from the video by the author.

<br> Full Citation: Reforma. (2005, October 14). Persiste riesgo en Neza. Click to access full source. <br> Full Citation: Universal. (2002a, May 16). Inundan aguas negras varias viviendas de Neza. Click to access full source.

<br> Full Citation: Universal. (2002b, May 19). Inservible el cárcamo Villada en Neza. Click to access full source. <br> Full Citation: Universal. (2003, July 11). Muerte y enfermedad por aguas negras. Click to access full source. <br> Full Citation: Universal. (2006b, April 24). Lluvia deja 100 casas inundadas en Neza. Click to access full source.

<br> Full Citation: World Bank. (2005). Mexico infrastructure public expenditure review (IPER). Washington DC: World Bank, p. 27.

<br> Full Citation: DOF. (1980). Diario Oficial de la Federación. Estados Unidos Mexicanos (November 5). Click to access full source. <br> Full Citation: SAHOP. (1981). Entrega de los sistemas de agua potable y alcantarillado a los gobiernos de los estados, fortalecimiento del federalismo. Secretaría de Asentamientos Humanos y Obras Públicas (February 5).

Click to access full source.

<br> Full Citation: Reforma. (1998f, March 20). Gritan, bloquean. . .y se van—Cierran 2 mil personas el Palacio Municipal, Periférico y Gustavo Baz; no logran nada. Click to access full source.

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Full Citation: Reforma. (1998h, April 15). Disuelve Policía protesta-Retiran a seis manifestaciones de la alcaldía; asegura Durán que se actuó conforme a la ley. Click to access full source.

Analytic Note: These sources report on an instance of massive protest against cost recovery policies in Naucalpan in March and April of 1998. 32 different social organization blocked the entrance to city hall during the week of March 20, with demands beginning with lowering water tariffs but then spreading to other demands, such as the high cost of property taxes, police corruption, the mayor's arrogance, among others. They created a movement called the Frente (Frente de Convergencia Politicio y Social), or Front. City hall representatives responded that they thought that the Frente had political (or partisan) objectives rather than real social concerns. The Frente protested, marched and eventually staged a sit in. Later in April, the same movement was said to be associated with the PRI and PRD opposition parties, and staged a second sit in, calling for the mayor's resignation. Police came to disband the protestors and arrest several operatives associated with the PRI and PRD. They were charged with defacing municipal property and discharged.

<br> Full Citation: Jornada. (1997, January 13). Neza: 33 años de olvido y corrupción. Click to access full source.

<br> Full Citation: Sol de Toluca. (2008a, April 19). Le recuerdan al alcalde cumplir sus compromisos. Click to access full source.

Analytic Note: This newspaper article confirms what was reported through interview data, that the mayor fell behind in completing public works project during his administration. This point is also corroborated in Milenio 2009d and Sol de Toluca 2009, sources cited (and provided) elsewhere in this study.

Excerpt: Al senialar que ayer se cumplieron 20 meses de la actual administracion municipal de Toluca, y han quedado pendiente de ejecucion diversos acuerdo aprobados por el cabildo, el tercer sindico Tomas Ruiz Perez solicito al alcalde Juan Rodolfo Sanchez Gomez no solo girar instrucciones, sino cuidar y hacer realidad su pronta y eficaz ejecucion, en beneficio de la poblacion.

Translation: As of yesterday the [current] municipal administration of Toluca has been in office for 20 months, and has left a diverse number of public works uncompleted that have been approved by city hall. The city council person Tomas Ruiz Perez demands that the mayor Juan Rodolfo Sanchez Gomez not only give out order but also keep his promises and undertake execution of works to benefit the people.

<br> Full Citation: World Bank. (1976). Water supply and sewage: Sector study, Mexico (No. Report no. 1278-ME). Washington, DC: World Bank, p. 25.

<br> This is an Annotation for Transparent Inquiry project, published by the Qualitative Data Repository. Please cite as:

Herrera, Veronica. (2015) Data for: "Does Commercialization Undermine the Benefits of Decentralization for Local Services Provision? Evidence from Mexico’s Urban Water and Sanitation Sector." 2013. World Development, 56 (1):16-31. Active Citation Compilation, QDR:10050. Syracuse, NY: Qualitative Data Repository [distributor]. http://doi.org/10.5064/F6F769GQ

Additional documentation can be found on QDR.

Learn more about ATI here.

<br> Full Citation: World Bank. (2005). Mexico infrastructure public expenditure review (IPER). Washington DC: World Bank, p. 30. Click to access full source.