This study investigates the effects of a brief training programme on the communication skills of doctors in ambulatory care settings in Trinidad and Tobago. Evaluation of doctor performance is based on analysis of audiotapes of doctors with their patients during routine clinic visits and on patient satisfaction ratings. A pre-test/post-test quasi-experimental study design was used to evaluate the effects of exposure to the training programme. Doctors were assigned to groups based on voluntary participation in the programme. Audiotapes of the 15 participating doctors (nine trained and six control) with 75 patients at baseline and 71 patients at the post-training assessment were used in this analysis. The audiotapes were content-coded using the Roter Interaction Analysis System (RIAS). Doctors trained in communication skills used significantly more target skills post-training than their untrained colleagues. Trained doctors used more facilitations in their visits and more open-ended questions than other doctors. There was also a trend towards more emotional talk, and more close-ended questions. Patients of trained doctors talked more overall, gave more information to their doctors and tended to use more positive talk compared to other patients. Trained doctors were judged as sounding more interested and friendly, while patients of trained doctors were judged as sounding more dominant, responsive and friendly than patients of untrained doctors. Consistent with these communication differences, patient satisfaction tended to be higher in visits of trained doctors.

Gender inequality and gender norms are key social drivers of the HIV epidemic through their influences on sexual relationships, behavior, and risk taking. However, few empirical studies have measured the influence of gender norms on HIV sexual-risk behaviors and HIV testing among men in sub-Saharan Africa. We analyzed cross-sectional, survey data from 399 sexually active men (ages 18-39) in Democratic Republic of the Congo to examine the relationship between the men's support for inequitable gender norms and their HIV-risk behaviors. Logistic regression analyses revealed that moderate and strong levels of support for inequitable gender norms were significantly associated with never having been tested for HIV (AOR = 2.92, p < .05 and AOR = 3.41, p < .01, for moderate and strong support, respectively). Our findings indicate that changing the prevailing gender norms should be prioritized in HIV-prevention efforts that aim to increase counseling and testing for men.

Cutaneous leishmaniasis is a parasitic infection which is especially endemic in the southern parts of Europe, in several regions of Africa, and in South and Central America. Whether treatment is necessary or not depends on the virulence of the germ, the infection's localization, and the host's immunological reaction. Because of the high rate of recidivation and the large number of undesirable side-effects of systemic chemotherapy of localized cutaneous leishmaniasis, several methods of local therapy have been tested. This case report demonstrates one of several approaches to the local treatment of this disease. Despite progress in this field, cutaneous leishmaniasis will continue to be a considerable medical and sociopolitical problem, because successful treatments in under-developed countries must be highly efficient, cost little, be easy to administer, and have a low rate of undesirable side-effects.