To address these shortcomings, a 'super setting approach' is recommended, in which a Health Promoting School could improve the girls' individual and group needs, and a community setting which would address the broader socio-economic, cultural and environmental conditions. This would enable creating a supportive environment for the girls to manage their periods. To successfully utilize the approach, all stakeholders (parents, teachers, children, governments and communities) should cooperate to generate context-specific solutions for creating safe menstrual care, and better and dignified conditions for adolescent girls. Therefore, this calls for comprehensive, strident advocacy for policy changes at national level, and mediation and involvement at community level.

Partnerships between local governments, health districts and non-governmental and community-based organiza-tions are an increasingly important part of health promotion practice, as well as other policy and programme areas. Two inherent tensions in partnership working have been widely described. First, partnerships are generally set up as 'top down' initiatives, which advocate a 'bottom up' approach, with the inevitable power imbalances that this implies. Secondly, the gains made by partnerships tend to be limited compared with the claims made for them. Despite these tensions, individuals and organizations continue to devote considerable effort to making partnerships 'work'. This paper describes a study, which explored the implications of these apparent contradictions of power imbalance and potential disillusionment within partnerships. The study explored partnership working between community and statutory organizations within two very different Healthy Cities initiatives, one in the UK and the other in South Africa. This paper focuses on why the partners contributed continued effort and energy into maintaining the partnerships, despite their awareness of the constraints. Findings suggest that partners dealt with the tensions first by assuming a discrete identity as an 'entity of boundary people' that operates at the interface between the statutory sector authorities and the communities in question; and secondly, by reducing their activities to specific 'boundary' issues that do not threaten the main agenda of the authorities.

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Objective. To determine the prevalence of occult HIV infection in patients who decline routine HIV testing in an urban emergency department. Design, Setting, and Patients. Discarded blood samples were obtained from patients who had declined routine ED HIV testing. After insuring that the samples came from patients not known to be HIV positive, they were deidentified, and rapid HIV testing was preformed using 5 μL of whole blood. Main Outcome Measures. The prevalence of occult HIV infection in those who declined testing compared with prevalence in those who accepted testing. Results. 600 consecutive samples of patients who declined routine HIV screening were screened for HIV. Twelve (2%) were reactive. Over the same period of time, 4845 patients accepted routine HIV testing. Of these, 35 (0.7%) were reactive. The difference in the prevalence of HIV infection between those who declined and those who accepted testing was significant (P = .001). The relative risk of undetected HIV infection in the group that declined testing was 2.74 times higher (95% CI 1.44–5.18) compared with those accepted testing. Conclusion. The rate of occult HIV infection is nearly three-times higher in those who decline routine ED HIV testing compared with those who accept such testing. Interventions are urgently needed to decrease the opt-out rate in routine ED HIV testing settings.

Topical application of MI-S on skin lesions was also not effective, but cutaneously infected mice treated orally with MI-S had significantly reduced disease scores (P < 0.05) after day 9, suggesting that healing was accelerated. Vaginal administration of MI-S 20 min before viral challenge reduced the mean disease scores on days 5 to 9 (P < 0.05), viral titers on day 1 (P < 0.05), and mortality (P < 0.0001) in comparison to the control groups (untreated and vehicle treated). These results show that MI-S may be useful as an oral agent to reduce the severity of HSV cutaneous and mucosal lesions and, more importantly, as a microbicide to block sexual transmission of HSV-2 genital infections.