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Regional Workshop on HIV and Drug Use
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1 AIDS Support and Technical Assistance Resources Regional Workshop on HIV and Drug Use HIV Prevention, Care and Treatment for People Who Inject Drugs: A review of evidence-based findings and best practices June 13-15, Nairobi, Kenya This document is made possible by the generous support of the US President s Emergency Plan for AIDS Relief (PEPFAR) and the US Agency for International Development (USAID) under contract No. GHH-I The contents are the responsibility of the AIDSTAR-Two Project and do not necessarily reflect the views of USAID or the US Government.
3 Table of Contents Acknowledgements. 4 Acronyms List. 5 I. Executive Summary. 6 II. Day One: Monday, June 13, 2011: Opening Ceremony. 8 Welcome. 8 Changes in USG policy to allow for strengthened HIV prevention and treatment for PWID: Setting the stage. 11 Session Summary: Current epidemiology of drug use and HIV among PWID. 12 Session Summary: Sexual HIV transmission among PWID and programmatic considerations for women who use drugs. 14 Session Summary: Monitoring and evaluation of programs for PWID. 17 Session Summary: Outreach. 19 Session Summary: HIV testing and counseling among PWID. 20 III. Day Two: Tuesday, June 14, Session Summary: Perspectives from the community. 22 Session Summary: Needle and syringe programs (NSPs). 23 Session Summary: Medication-Assisted Treatment as an HIV prevention tool. 25 Session Summary: Access to antiretroviral treatment. 27 Session Summary: Improving linkage and retention into care and other services. 28 Session Summary: Panel dialogue. 29. IV. Day Three: Wednesday, June 15, Session Summary: Enabling environment: support for program initiation and scale human rights approach to HIV prevention. 31 Session Summary: Building the evidence base for sustainable programs: implementation science. 32 Session Summary: Community Action on Harm Reduction. 33 Session Summary: Drug and substance use in Coastal Province, Kenya. 33 Session Summary: Cost-effectiveness of Medication-Assisted Therapy (MAT) in reducing HIV transmission among PWID. 35 V. Conclusion. 36 VI. References. 37 Page 3
4 Acknowledgements The President s Emergency Plan for AIDS Relief, and The Office of the Global AIDS Coordinator would like to thank members of the MARPs Technical Care and Support Host Country Organizing Committee: Katherine Perry, Mercy Muthui, Emma Mwamburi, and Reychad Abdool. The authors would also like to thank the country-level coordinators, meeting presenters and participants for their contributions to the regional workshop: Irene Benech, Beverly Cummings, and Marina Rifkin. The authors of this report would also like to thank the meeting note takers: Paula Ngarega, Veneranda Wangui Kamanu, Agnes Mukiri, and Rosebella Alinda. And we would like to thank Daniel Wolfe and Zoe Hudson from the Open Society Foundations for supporting the travel of many civil society organization staff members from Africa. Finally, we would like to thank Erin Rains from Management Sciences for Health for her great contributions in organizing and managing the meeting. Rich Needle Gillian Anderson Shimon Prohow Gaston Djomand Page 4
5 Acronyms List AIDSTAR ART CAHR CBO CDC COP CSO FBO FSW HBV HVC HIV/AIDS HTC IDU IEC KANCO KNASP III MARP MAT M&E MOH NASCOP NGO NSP OSIEA PEPFAR PMTCT RDS IBBSS SOP STI TB UNAIDS UNODC USAID USG WHO ZACP AIDS Support and Technical Assistance Resources Antiretroviral therapy Community Action on Harm Reduction Community based organization United States Centers for Disease Control and Prevention Country operational plans Civil society organization Faith-based organization Female sex worker Hepatitis B virus Hepatitis C virus Human immunodeficiency virus/acquired immune deficiency syndrome HIV testing and counseling Injecting drug user Information, education and communication Kenya AIDS NGOs Consortium Kenya National AIDS Strategic Plan III Most-at-risk population Medication-assisted treatment Monitoring and evaluation Ministry of Health National AIDS Control Program (Kenya) Nongovernmental organization Needle and syringe program Open Society Institute East Africa President s Emergency Plan for AIDS Relief Prevention of mother-to-child transmission Respondent Driven Sampling Integrated Biological and Behavioral Surveillance Survey Standard operating procedure Sexually transmitted infection Tuberculosis Joint United Nations Program on HIV/AIDS United Nations Office on Drugs and Crime United States Agency for International Development United States Government World Health Organization Zanzibar AIDS Control Program Page 5
6 I. Executive Summary The majority of new HIV diagnoses in Sub-Saharan Africa are attributable to sexual transmission, but the influence of drug use and of drug injecting is becoming increasingly evident in many countries. Although data on drug use in the region are limited, injecting drug use has been reported in the majority of the 47 sub-saharan countries and there are indications that HIV prevalence is high among people who inject drugs (PWID). Needle and syringe sharing is common, and extremely risky practices have been reported in Dar es Salaam and Zanzibar, Tanzania and in Mombasa and Nairobi, Kenya. The response to HIV among PWID in the context of large-scale heterosexually transmitted generalized epidemics in the region has until recently been limited. While other countries are planning to introduce needle and syringe programs (NSPs), Mauritius is the only country in sub-saharan Africa where these programs have been implemented. Medicationassisted treatment (MAT) one component of a comprehensive HIV prevention program has been implemented in Mauritius and Tanzania. Several other countries are considering the introduction of MAT into their HIV prevention portfolio. The regional workshop on HIV and drug use, HIV Prevention, Care and Treatment for People Who Inject Drugs: A Review of Evidence-Based Findings and Best Practices, took place June 13-15, 2011 in Nairobi, Kenya. It was convened as one of a series of three regional meetings to bring together government officials, civil society, multilateral agency representatives and US Government (USG) field staff from select countries in sub-saharan Africa and to share evidence-based practices, lessons learned, and the way forward for improving strategic planning for HIV prevention and care among PWID. Participating countries included Kenya, Tanzania, Nigeria, Seychelles, Mauritius, Madagascar, Mozambique, and South Africa. The meeting focused on advocating for and supporting the introduction of an evidencebased comprehensive HIV prevention for PWID in sub-saharan African countries. PEPFAR, WHO, UNODC, and UNAIDS support a comprehensive package of the following interventions for PWID: community based outreach; needle and syringe programs; medication-assisted treatment; HIV testing and counseling (HTC); HIV care and treatment; prevention and treatment of sexually transmitted infections (STIs); condom programs for PWID and their sex partners; targeted information, education and communication (IEC) campaigns for PWID and their sex partners; vaccination, diagnosis and treatment of viral hepatitis; and prevention, diagnosis and treatment of tuberculosis (TB). The rationale and supportive science for a comprehensive program are described in PEPFAR s Comprehensive HIV Prevention for People Who Inject Drugs Guidance. See documents/organization/ pdf. The objectives of the workshop included: Page 6
7 Provide up-to-date, evidence-based, critical information related to the prevention, care and treatment needs of PWID, including the 2010 PEPFAR guidance. Provide the opportunity to share country experiences regarding prevention, care, and treatment of PWID, including successes (and best practices), failures, and challenges; and to develop collaborative relationships among key stakeholders in neighboring countries. Provide knowledge and tools to enhance countries abilities to set targets, implement, and monitor and evaluate programmatic efforts targeting PWID. Facilitate exercises to allow country teams to work together to plan future programming for PWID, including preparation for PEPFAR FY 2012 Country Operational Plans (COP). Provide workshop participants with the opportunity to identify technical assistance needs and resources, including from US-based organizations and from the field (i.e., South-South technical assistance). This report summarizes the content of the workshop s sessions and attendee input. The report is organized by day and covers the opening remarks, daily session summaries, and concludes with a note regarding the importance of continuing efforts to enable a stronger response to the important needs of PWID. To obtain individual session presentations, contact Erin Rains who provided conference support, Page 7
8 II. Day One: Monday, June 13, 2011: Opening Ceremony The first day of the workshop consisted of an introduction to the meeting, the epidemiology of injecting drug use with a focus on sub-saharan Africa and an introduction to the key interventions to combat HIV amongst PWID. Welcome Dr. Willis Akwhale, Head Department of Disease Prevention and Control Ministry of Public Health and Sanitation, Kenya Distinguished Guests, Ladies and Gentlemen, Colleagues, It gives me pleasure to address this consultation for two particular reasons: first, because it is the first international consultation on the specific issue of reducing harm related to injecting drug use, including prevention of HIV transmission. It is also special because it comes at a time when Kenya is creating momentum to lead to more comprehensive efforts to reduce and eliminate drug use altogether and accelerate HIV prevention efforts. I see in this room a dedicated group of individuals who share a common goal of making HIV prevention, treatment and care for drug users a reality. Congratulations to all the organizations involved in this initiative. The most recent estimates from the United Nations show that that there are around 16 million injecting drug users worldwide. Of the 33.3 million people living with HIV globally, an estimated three million are people who inject drugs. People who inject drugs account for 30% of HIV infections outside of sub-saharan Africa, and up to 80% of infections in Eastern Europe and Central Asia. In much of the world, the HIV epidemic among drug users is long-standing. But in some places it is newly emerging. In East Africa, HIV transmission due to drug use is rising. There are concerns that rising numbers of injecting drug users will propel a new wave of infections and undo recent gains we have made in curbing sexual transmission of HIV. According to some of the statistics available in Kenya injecting drug users contribute up to about 4% of new infections and the latest integrated bio behavioral studies show that HIV prevalence is about 20% among PWID, which is four times more than the national average of 6.3%. There is however a big discrepancy between those injecting drug users who share needles and those that never share needles; with a prevalence of 33% and 6% respectively. Because of this reality, Kenya has developed comprehensive HIV strategies for injecting drug users and we are in the process of scaling up access to core services that are critical to stopping the spread of HIV among this group. During this meeting, my technical staff will be sharing with you the details of our programs including support from the Global Fund Page 8
9 under round 10 for starting pilot programs for needle and syringe programs among other components in service delivery for injecting drug users. The 2001 UNGASS Declaration of Commitment and the 2006 Political Declaration on HIV/ AIDS established time-bound targets to be met and reported on by countries worldwide. The commitments aimed to address the needs of people who inject drugs, their families and the communities in which they live through an urgent, coordinated and sustained response. These commitments remain unfulfilled. People who inject drugs are increasing as a percentage of global HIV infections with devastating consequences for individuals and communities. The mobilization of an intensified, much more urgent and comprehensive response to HIV for people who inject drugs requires strong global leadership, concrete national policies and adequate funds to implement and scale up evidence-based services. The targets and commitments set in the 2006 Political Declaration must be met to address the needs of, and to fulfill the human rights of people who inject drugs living with, and at risk for HIV acquisition. Universal Access and barriers to access among drug users PEPFAR s First Annual Report (2003) stated that, Emergency Plan funds will not support needle or syringe exchange. However, in July 2010, PEPFAR reissued guidance for HIV prevention for injecting drug users. The new guidance actively encourages a comprehensive HIV prevention package for PWID including needle and syringe programs and other harm reduction strategies previously disallowed under PEPFAR. According to the revised guidance, needle exchange and syringe programs do not increase the numbers of persons who begin to inject drugs or increase the frequency of drug use and studies have shown that NSPs result in marked decreases in drug-related risk behavior. This updated PEPFAR guidance recommends giving priority to interventions reaching people who inject drugs in all countries that report injecting drug use and it provides practical guidance on a comprehensive package of interventions for prevention of HIV related to injecting drug use. A comprehensive package therefore means providing a full range of treatment options and relevant services. These include opioid substitution treatment, needle and syringe programs, peer education and outreach, voluntary HIV testing and counseling, prevention of sexually transmitted infections, primary health care and anti retroviral therapy. However, the current coverage of these services is appallingly low. It is shocking that according to UNAIDS the global average is fewer than 2 clean needles per month per injecting drug user, that under 13% of drug users are in opioid substitution treatment and that only 4% of injecting drug users living with HIV are on HIV treatment. Page 9
10 Ladies and gentlemen, it is clear that today we have the means needed to make a real difference tackling HIV related to injecting drug use. We have high-level commitment to address the epidemic; we have the science, meaning that we know what works and we have the resources to scale up interventions. It s time to take action but to do so we must consider some of the obstacles we must tackle to get there. I wish to highlight a few examples. One of the main barriers for access to prevention, treatment and care services by people who inject drugs continues to be the stigma and discrimination associated both with HIV and injecting drug use. The prejudice encountered by people living with HIV is well documented. But people who use drugs also report stigma and discrimination, and being an HIV-positive drug user brings with it a double-stigma that makes it all the more difficult to access relevant services. We also know that in several countries drug users and positive people s networks are still not allowed to organize themselves and that drug users and their networks are excluded from decisions that affect them. This needs to change. The stigma and discrimination associated with drug use and HIV need to go, communities and governments need to embrace the reality of what works in curbing the epidemic. But the one, overarching bottleneck noted across most sub-saharan countries is how current legislation and policies hamper implementation of comprehensive programs for prevention of HIV among injecting drug users. There is an urgent need to harmonize drug policies with HIV policies. Criminalization of drug users hampers access to treatment and prevention services. Let us use this consultation as a platform from which to call on all those who are involved in the response to HIV to move toward concerted action on the following agenda: To review and revise laws that criminalize drug use To tackle the stigma associated with drug use and HIV To ensure comprehensive coverage of PWID with prevention, treatment and care interventions To involve networks of drug users and community based organizations in delivery of prevention, treatment, care and support services To maximize financial and technical resources for prevention, treatment and care programs for injecting drug users And finally to promote and facilitate organizations of people who use drugs. Page 10
11 If we can take these concrete steps, we can make universal access a reality and stop the emerging threat of HIV and injecting drug use. It s now my pleasure to officially open this meeting and wish you the best in your deliberations. Changes in USG policy to allow for strengthened HIV prevention and treatment for PWID: Setting the stage Dr. Richard Needle, Senior Public Health Advisor, Office of the US Global AIDS Coordinator In the summer of 2010, PEPFAR issued new guidance to enable US-funded programs to effectively react to HIV prevention among PWID and to demonstrate leadership in the fight against HIV. Addressing the HIV epidemic among vulnerable populations in sub- Saharan Africa requires political leadership and commitment together with multi-sectoral coordination supporting implementation of comprehensive prevention, treatment and care programs; a strong public health rights-based approach; reliance on evidence based findings to inform policy and program. Strategies must be implemented to address HIV among PWID and inclusion of drug addiction treatment in HIV treatment for HIV positive PWID. PEPFAR plans to increase access, expand coverage and reduce the burden of HIV on PWID in PEPFAR-supported countries. There is therefore a need for responsive programming. PEPFAR is taking initiative to strengthen civil society efforts to fight HIV. An implementation science research agenda is critical to improve the uptake of services, by translating research findings into routine best practice. There are approximately 16 million IDUs worldwide, with an estimated 3 million living with HIV. The emerging twin epidemics of injecting drug use and HIV infection among PWID has posed challenges in sub-saharan Africa because there is a high and expanding HIV burden among PWID and barriers persist limiting the scope and quality of core interventions for PWID. PEPFAR supports a comprehensive package of interventions for prevention and treatment for PWID with three core prevention interventions specific to HIV prevention among IDUs, including community-based outreach, needle and syringe programs (NSP), and medicationassisted treatment (MAT). The challenge for PEPFAR supported countries is to move from the guidance document to strategy and process, through planning to implementation based on experiences. From the PEPFAR perspective it is hoped that this meeting will: Stimulate increased FY12 COP requests for PWID programs, monitoring and evaluation, and surveillance Facilitate the adoption of a standardized indicator package Page 11
12 Contribute to the cumulative evidence-base Strengthen civil society Foster country-to-country networking and sharing of experiences and best practices Session Summary: Current epidemiology of drug use and HIV among PWID Speakers: Dr. Reychad Abdool, UNODC Senior Regional HIV and AIDS Advisor; Dr. Farhat Khalid, Strategic Information Coordinator, Zanzibar AIDS Control Program, MoH; Scott Geibel, Population Council HIV and AIDS Program; Dr. Amita Pathack, National AIDS Coordinator, National AIDS Secretariat, Mauritius; David Makapela, UNODC Regional HIV and AIDS Advisor, Southern Africa. Overviews of epidemiological data from Tanzania, Zanzibar, Kenya, Mauritius, and the southern Africa region were presented during this session. UNODC presented an overall regional overview: Drivers of the HIV epidemic vary across countries with concentrated PWID epidemics in Mauritius and Zanzibar to more mixed and generalized epidemics in Kenya, mainland Tanzania and southern Africa. In the absence of PWID-specific prevention programs and with high rates of needle sharing present, it is probable that there will be a continuing high prevalence of HIV and co-infection of hepatitis B virus (HBV) and hepatitis C virus. PWID programming varies by country, from Kenya which is in the planning stages of comprehensive PWID programs that will include needle and syringe programs and medically assisted therapy; to Dar es Salaam which is piloting MAT; to established programming in Mauritius where MAT and NSP pilots are moving to scale in the coming months. Heroin is the most widely injected drug across the countries, except in Mauritius, where 80% of PWID currently inject buprenorphine. See Table 1 for epidemiology, programs and policies presented during the workshop. Note that not all countries represented at the meeting are in listed in the table. Page 12
13 Table 1. HIV Epidemiology and PWID programs National HIV prevalence HIV prevalence among PWID PWID size estimation Risk behavior Kenya Tanzania Coast Nairobi Zanzibar Mainland Mauritius Mozambique South Africa 6.3% 0.60% 5.7% ~1% 0.2% 10.9% 31% 19% 16% 42% 75% Not known Not known Not known 3,000-10, ~20, % are needlesharing, taking drugs from a common reservoir, using ready-made solution without boiling, and not exchanging a used for a new syringe in the past month 61.4% of HIV+ lent a needle to person in past month HIV prevalence among persons who share needles (31%) and those who never shared (5%) 54% are needle sharing 9% flash blood practice (males) Multiple partners in past month (33%) Sold sex (16.5%) 31% needle sharing 16.6% flash blood practice (females) Multiple partners in past month (51%) Sold sex (33%; 85% female) 80% of PWID inject buprenorphine, 19.4 % heroin 30.5% FSWs inject 58% never use condoms with paid partners 77% always clean needle/ syringe in past 3 months Group injection consumption is high Renting of needles Scarce needle supplies 30% don t see importance of clean needles 47% lack access to services Needle and syringe programs Medically Assisted Therapy Other programs or policies Provincial Commissioner has begun open community forums for discourse, instructed police to refer to services instead of arrest Yes NASCOP is developing comprehensive HIV prevention for PWID/ PWUD, including provision of NSPs and MAT Planned to begin Fall 2011 ZACP has begun training its HTC counselors to deliver PWID specific preand post- test HIV counseling Yes, 189 people enrolled MoH is reviewing initial data from MAT rollout and considering adding additional MAT sites to reach better coverage Yes, 2,000 people enrolled MoH has included harm reduction HIV prevention language in its 2006 HIV national plan Page 13
14 Session Summary: Sexual HIV transmission among PWID and programmatic considerations for women who use drugs Speakers: Dr. Timothy Mah, Senior HIV Prevention Advisor, USAID Office of HIV/AIDS; Marina Rifkin, Public Health Prevention Specialist, CDC South Africa; Rebecca Tolson, Deputy Director of the International Harm Reduction Development Program, Open Society Foundations. Practical moderation also provided by Mercy Muthui, Technical Advisor, HIV Prevention, CDC Kenya. As epidemics mature, changes in the percentage of new infections attributable to drug using practices and sexual transmission are likely to occur. This has been demonstrated in countries such as the United States, Russia, Ukraine, India and China. This typically is a shift in transmission from drug use to sexual transmission. Modeling and cohort studies have shown that among PWID, sexual transmission is rapidly becoming a key source of new infections in Russia and the United States. 1, 2, 3 The impact of different patterns of sexual mixing between groups with different levels of sexual activity and between injecting drug users, non-injecting drug users and persons who do not use drugs, has important programmatic implications. High risk injection practices often co-occur with high-risk sexual practices. One example was provided during a presentation from a two-phase rapid assessment (I-RARE) in Durban, Cape Town and Pretoria South Africa conducted in 2005 and See Slide 1, on the following page, for I-RARE participants categorized by risk behavior. A convenient sample of sex workers and men who have sex with men showed that among long-term heroin injectors, drug use and sex were often two separate activities. Others reported foregoing sex due to a loss of sexual arousal, mentioning the use of stimulant-type drugs such as crystal meth-amphetamine and ecstasy to increase sexual desire. More often than not, when drug use and sex are mixed, the ordering is drug use first, and then sexual contact as noted in Slide 2. 1 Grassly, N. C et al. (2003). Modelling emerging HIV epidemics: the role of injecting drug use and sexual transmission it the Russian Federation, China and India. International Journal of Drug Policy 14, Strathdee, S. A. et al. (2001). Sex differences in risk factors for HIV seroconversion among injection drug users-a 10-year perspective. Archives of Internal Medicine 161, Kral, A. H. et al. (2001). Sexual transmission of HIV-1 among injection drug users in San Francisco, USA: risk-factor analysis. Lancet 357, Parry et al. (2008). Rapid assessment of drug-related HIV risk among men who have sex with men in three South African cities. Drug and Alcohol Dependence 95, Page 14
15 Slide 1. I-RARE participants categorized by risk behavior. Slide 2. Context of drug use among I-RARE respondents Page 15
16 The co-occurrence of both risk practices and even timed use of substances (concurrent, pre, post) in relation to unprotected sex is of particular importance and should be considered when developing prevention programs that adequately address the intersection of high risk behavior. Second on the Needle I was always home and he would go buy it himself until he got busted. Even now I rarely inject myself. Whoever is near me injects me. Right now it s my boyfriend. Female injecting drug user from Ukraine Too often the discussion of injecting drug use is centered on male PWID and programmatic responses. Female PWID face unique risks for HIV acquisition and transmission. Studies show that women often inject last in a group and are more likely to need help injecting; two circumstances that can increase their exposure to HIV. Women are also much more likely than men to have sex partners who also use drugs, compounding their risk exposure to HIV, HCV and HBV. In addition to heighted risk for women, female PWID are often commonly neglected for quality care and prevention services. Pregnant women with a history of drug use are significantly less likely to receive prenatal care, including timely HIV tests and, when necessary, ARVs for PMTCT. Women face stigma and discrimination for multiple reasons: gender, drug use, and HIV status. Parenting rights are commonly withheld, with coerced abortion and adoptions. High rates of sexual exchange for money or drugs are found among female PWID, and more often than not female PWID experience high rates of physical and sexual violence. Some studies have shown women to have a greater propensity to engage in flashblood, a practice in which a person who has recently injected heroin uses her syringe to withdraw blood from her vein and directly inject her blood into another person, as a weak proxy for injecting heroin. Often described as an act of altruistic behavior, people risk their own health thinking that small trace of heroin in their blood will prevent another from getting sick with withdrawal. Conventional harm reduction programs are generally designed around male clientele with virtually no specially trained staff and facilities to accommodate female drug users. As became evident in country presentations on their harm reduction programs (during later workshop sessions), enrollment numbers from Mauritius and Tanzania showed very few female injectors were being reached by their country s NSP and MAT programs. This gender imbalance must be addressed. During this session, some best practices were offered to help countries move forward in meeting the unique hardships that female PWID face: Integrate sexual and reproductive health services into PWID-specific programs Design programs and entry points that are low-threshold (easily accessible) Page 16
17 Include gender-specific information, provide counseling and support as well as case management to improve follow-up Pregnant and parenting opiate users should be prioritized for making substitution treatment accessible Safe spaces that promote motherhood and family preservation projects (e.g., adding daycare to drug treatment services, provision of diapers or pediatric care, access to washing machines) should be considered as options for attracting female PWID to services Female-oriented PWID sites should also provide a full range of in-house medical and opioid treatment options, including NSP, condoms and MAT Additional gender-responsive services suggested included providing legal aid and assistance with regaining lost passports, housing or child custody, and empowerment projects Session Summary: Monitoring and evaluation of programs for PWID Speakers: Annette Verster, Technical Officer at WHO HIV Department; Dr. Patrick Muriithi, National AIDS Control Council. Achieving universal access to HIV prevention and treatment for all those who need it, as declared at the G8 Summit in 2005, requires target setting and monitoring. Such goal setting requires a consensus on terminology, priority interventions, coverage levels to achieve defined timelines, and decision-making on how to measure progress within and between countries. First published in 2009, technical experts have participated in various review forums to develop a WHO, UNODC, UNAIDS Technical Guide to set targets for universal access to HIV prevention, treatment and care for injecting drug users. Since its publication, this technical guide has been endorsed by high-level political bodies including the Economic and Social Council, UN Commission on Narcotic Drugs, the UN high level meeting on HIV/AIDS 2011, and the UNAIDS Program Coordinating Board. Currently, the indicators and targets are under revision in an effort to further fine tune them. Revised indicators have been piloted in multiple settings with varying epidemiologic profiles, with an expected revision to the Technical Guide to be published late 2011 to Examples of issues when defining targets include: How to define the population drug user or injection drug user? Current drug use or life-time ever drug use? The measuring process is challenging largely because countries are at different stages of establishing a comprehensive response. Additionally countries need to formalize such a system so that it is ongoing and not sporadic or for one-time use. Recognizing that many countries do Page 17
18 not implement the entire package of PWID HIV services, the technical guide recommends at least four of the interventions be monitored as a minimum requirement: needle and syringe programs, medically assisted therapy, HIV testing and counseling, and HIV care and treatment. Such indicators measure availability, coverage, quality, and impact, with suggested indicators listed in the Technical Guide. See Slide 3 for sample indicators for measuring NSPs. Countries may want to consider the following next steps if planned use of the target setting guide: Assess the situation in their country (know your epidemic) Define priority interventions on the basis of the recommended package of nine key interventions Set targets for each intervention against timelines Monitor progress of the defined indicators and use Slide 3. WHO-suggested indicators for NSPs data to improve program quality, coverage, accessibility and impact Dr. Patrick Muriithi from Kenya s National AIDS Control Council described Kenya s national HIV/AIDS Monitoring and Evaluation (M&E) framework, which outlines 55 national indicators to track progress over the lifetime of KNASP III and includes two indicators to track progress of programs for people who inject drugs: 1. Annual number of new HIV infections among PWID 2. Percentage of injecting drug users who reported using sterile injecting equipment the last time of injection Dr. Muriithi listed data sources that will help to measure these indicators are integrated bio-behavioral surveillance surveys (performed every two to three years among most-atrisk populations) and routine service delivery data (facility and community based). Kenya is working to resolve challenges such as a lack of predictable schedule of surveillance studies among PWID and the general absence of clearly defined standard services for PWID. Page 18
19 Session Summary: Outreach Speakers: Karina Rapposelli, Behavioral Scientist, Centers for Disease Control and Prevention (CDC); Tinga Kalafa, Outreach Field Supervisor, Kenya Network for IDUs Trust (KNIT); Dr. Amita Pathack, National AIDS Coordinator, National AIDS Secretariat, Mauritius. When working with hidden populations, access to services is largely dependent on the outreach that facilitates the delivery of such services. Outreach is a systematic approach to delivering services to people who inject drugs in their natural environments. In general, two components comprise outreach: (1) making contact, and (2) type of encounter (which generally includes screening, assessment of need, engagement, service delivery and followup). Outreach workers must be trusted and viewed as sources of information and services by the target community. Outreach is typically delivered by peers, but doesn t have to be. In Medley et al. (2008) peer outreach is significantly associated with increased levels of HIV knowledge (OR 1.82), reduced STI prevalence (OR.70), increased condom use (OR 1.61), and increased condom use with both casual (OR 1.65) and regular partners (OR 1.58). 5 Some best practices in outreach include formalization of peer educators, selection of peers who represent different groups within the target community, inclusion of quality standards (hiring, training, retention mechanisms, supervision, program implementation, M&E). Looking at specific country examples, PWID-targeted outreach services in Kenya vary by location and are generally more sophisticated along the coastal region where heroin consumption is believed to be greater. PWID outreach services along Kenya s coast include HTC drop-in center, HTC and STI referral, case-management, peer support groups, drug rehabilitation referral and other wrap-around service referrals. Slide 4. Mobile van offering needle and syringe services in Mauritius In Mauritius, PWID-targeted outreach services began in 1989 and have a high degree of political buy-in and support. This was formalized with a comprehensive outreach program, which was endorsed in the National Strategic Framework for HIV and AIDS, Due in large part to vocal advocacy from civil society, NGOs and the Ministry of Health (MoH) have a strong working relationship delivering information, education and communication (IEC) and peer awareness and education, HIV, STI and Hepatitis B and C testing, 5 Medley A. et al (2009). Effectiveness of peer education interventions for HIV prevention in developing countries: a systematic review and meta-analysis. AIDS Education and Prevention, 21(3) Page 19
20 condom promotion and distribution, modeled safe injection practices (NSPs began in 2006), and other service referrals (such as MAT). A peer driven intervention (PDI) model was developed as an alternative to traditional peer outreach, to have enhanced involvement of peer leaders within the community. This model was bolstered also by the successful inclusion of peers during RDS IBBSS s performed in Slide 4 depicts Mauritius government-operated mobile van offering needle and syringe services. Session Summary: HIV testing and counseling among PWID Speakers: Charlene A. Brown, MD, MPH, Senior Technical Advisor, HIV Testing and Counseling, USAID; Gillian Anderson, MPH Public Health Analyst, CDC; Irene Benech, MD HIV Prevention Chief, CDC Tanzania. Because of the hidden nature of PWID, multiple approaches and delivery settings for HTC should be considered depending on assessment of the community being reached. Types of HTC can include provider initiated testing and counseling at PWID clinical service points (e.g. at NSP or MAT sites), home-based, mobile outreach, drop-in center, voluntary counseling and testing (VCT) stand alone sites and others. HIV testing and counseling should be accompanied by a package of HIV-related prevention, treatment, care and support services, although not all services need necessarily be available in the same location in which the HIV test is performed, but every effort should be made to co-locate services and strengthen linkages to referrals made (e.g. referral documentation, peer escorts, case manager to monitor referrals, etc.). Rapid HIV testing with same-day results and non-venous puncture specimen collection is recommended for all most at-risk populations. VCT should include a standard intake risk assessment and PWID-specific pre and post-test counseling. The Centers for Disease Control and Prevention in collaboration with WHO have developed and piloted a one-week most-at-risk population (MARP) HIV testing and counseling training curriculum for healthcare providers and lay counselors to become proficient in targeted HIV testing and counseling to PWID populations. Developed in 2008, the training has been piloted in two epidemiologically diverse locations (Antigua and Zanzibar) with an expected third pilot in South East Asia. Once revisions are finalized, the curriculum will be made available with technical assistance support. The next panelist discussed current HTC services being provided in mainland and Zanzibar Tanzania. Zanzibar provides static and mobile HTC outreach services in conjunction with STI and TB screening and peer escort referrals for wraparound services and for those needing HIV care and treatment. As seen in slide 5, gender imbalances remain with HIV testing. In Dar es Salaam, HIV testing and counseling for PWID is provided through caravans Page 20
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text:
Everyone and their mother is congregating down on the end of the East Concourse, enjoying the views of pencil-planes and jumbo-jets.
Those familiar with T6 will remember that it wasn't exactly window central. Thankfully T5 IS! This place is filled with soaring floor-to-ceiling windows — great for checking out the activity out on the ramp and admiring our perty planes.

subset: commoncrawl


text:
I talked to Sam Bradford, who agrees with Adrian Peterson.
If u finna name drop, make sure it's not something named Auston English. Whatever that is.
I do love English tho, for that cheap shot on McCoy that wasn't called.
Current and former players are going to be all over place with opinions just like people on this board. Basically what it boils down to IMO is expectations. People who have higher expectations (winning a bowl game and being in the MNC picture) get embarrassed more quickly. Those of you whose expectations are a little lower (10+ wins is a good season) are not embarrassed as easily.
I ask those of you who think that the OP is a DA what would it take for you to think that OU is laughing stock of college football? Where ever that line is there will be people who think you're a DA for thinking that because there is always someone with lower expectations then your own.
Are there any former players who could come in and teach these "kids" how to tackle? You know just basic football.
Why not let the qb call his own plays, he couldn't have done any worse than the OC or the dummies on the sidelines. Wouldn't have to call as many timeouts....maybe...
Note to former players, if any of you guys have any stroke to help the football program would you please do so. thanks............
The most embarassing thing for me, as a fan and a loong time supporter of the program (financially and otherwise), is the quit I saw in our team -- players AND coaches. After the three 3 and outs to start the 2nd half, you could just see everyone deflate and from that point on, the outcome of the game was not in doubt. Worst display I have seen since 55-19...
I'm to the point I can't say anything nice about the OU program so why say anything at all? Doesn't matter if I want bob gone. Doesn't matter if I think he's past his prime. I think it does more harm griping about it then not.
Lot of fair weather fans
You ought to know "Palm Beach"
OU coaches must be great evaluators of undervalued in state talent.
We seem to win more now... But the errors are the same crap we were all so relieved to be rid of in 1999 when we could line up correctly..... Get plays off.... The wins in 99 were icing on the cake.
another thing ... did YOU think we were on a downward slump before the florida game or before the lsu game. like right before the game, did you actually say to yourself damn ... this team is going nowhere.
Last edited by DirtySouth_Sooner; January 6th, 2013 at 01:14 AM.
Teams that are on the upswing or better than OU
OSU (yes I said it)Uhh, what?UG
Wait, what?Baylor
Based on what?OSU (yes I said it)
Are you familiar with irony?Outside of FSU who has OU beat worth a damn in a bowl game? Iowa? UConn? Washington? Ark? All very avg. or below avg teams at the time.
Teams that are on the upswing or better than OU
OSU (yes I said it)
In the end we really coudn't come up with a consensus so they all were in agreement that we might want to talk to some younger alums......
So tomorrow night we are going to conjure up Viv Nemacek, Jack Baer, Iron Mike Massad, Norval Locke and we are going to see if we can get Art and Bill Pansze
Last edited by Yuck Fu; January 6th, 2013 at 05:41 AM.
I agree with many of the opinions here. I happen to know from a former safety how Bob questioned their heart after losing to Boise and compared their heart to the 2000 team. In his thick head it's never the coaches. Where I differ from original post is the "laughing stock" comment.
Until these coaches recruit some guys that can play D line again we are going to keep having this conversation every year.
I wasnt a long snapper, or former player, so my opinion is going to be like most the other "experts" on the board. But, the way I see it, Bob is too loyal, and has tried to hire with in the program and it has cost us big time. JH was not ready to take the play calling over...and he has proven that. I am not ready to kick Mike Stoops out yet, until I see what players HE can bring in. BUT, this could be his down fall, BV could bring the talent in and maybe it took both of them together to have the right recipe for a good defense? IDK. In the end, we dont have the talent anymore, and the reason for that can be pushed in many directions. We lose the big games that are on national TV, Recruits love a winner...look at the players going to ND now. I am not going to question Bob Stoops on how much "fire he has in his belly", but I do know the product he is putting on the field is not good. It starts with recuiting which we are behind, then it comes with coaching, and I think JH is way over his head. Defense I get so pissed off watching them. There are 2 players that play on that defense that I GUARANTEE would not start on TU's team. And I am not saying we are the laughing stock of college football, but I for one was completely embarrassed, and it seems to be a pattern as of late. Look at the teams that are heading up and the ones that are heading down. UT better make coaching changes as well...they are on a decline. Bama was bad years ago, but Saban came in and embraced the traditions and here we go. Same as Kelly at ND...tradition and then good coaching and here we go. Oregon I just think they are flashy because of their facilities and Phil Knight, they will prolly have good teams, but I just look at them the same...again my opinion. Long of short, I am very interested to see if thing happens after this loss. If Bob comes in and says golly gee we got beat, lets go back to work..and no changes, I am going to be amazed because EVERYONE sees the faults, and the changes that need to come, and he will once again let his loyalty stand in the way of the program.
fefferson said mini knew how to handle balls better than most anyone else.
Originally Posted by Soonerlife
EVERYONE? Hyperbole much..Link?the_edge;1024716]Find a post where you actually talk about football. It's not hyperbole if it's true.
Texas A&M - 1997, 1998, 2010, 2012 Big 12 Champs*
Texas A&M - 1997, 1998, 2010, 2012 Big 12 Champs*
I don't expect us to be perfect. I don't expect to be undefeated every year. I know shit happens. I expect just like they used to demand out of us...play smart, fundamental football, and never quit. Play with pride, and do your best. This team looks like it gave up, and we've seen that happen too many times lately. It's baffling to me. They've told me that kids are just different these days versus 15 years ago. I don't know how it's really THAT different, but it seems to be. I just remember the "No Excuses" mantra when they first came. We lived by that at the time. Now? It just seems like there's always one. Maybe they still preach that. I hope so.
I should just probably shut up and keep on cheering my beloved Sooners on.
There is a middle here boys (and Mcrib)...there needs to be changes...I think most would agree. There might be a laundry list of them, honestly I just see the top issues and that is talent, and our OC (again my opinion). No need to go ****ing full retard ( or BoomerMagic) and talk about how this once was the best program in the nation like Bob has not had it there before and it was all Bud and Barry...Bob brought this ****ing program back...sure Gibbs did pretty good, but not by most of your standards. I am on board, I agree as I posted early, Bob is too damn loyal and needs to admit he has made some back choices....


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May 2009 by Peter H. Spectre
WE ALL HAVE HAD a meal that was so special, so extraordinarily good, that it sticks in the mind as the best we ever had. The principal cause of that impression could be anything or a combination of things-the breaking of a long fast, the taste of the food or its presentation or the person we shared it with, even the decor of the dining room-but we remember.
My most memorable meal came about 25 years ago at a banquet sponsored by a town-gown club at Bowdoin College in Brunswick. At each club gathering one of the members gave a lecture on an assigned topic; the menu for the meal, an elaborate affair, related to the subject of the lecture, in this case one with a nautical theme. I had been invited to attend because I had provided advice to the lecturer. The meal-a feast, really-centered on bouillabaisse, a seafood stew that was so artfully prepared that the memory of its aroma, its texture, its taste, is as powerful now as it was the day after I ate it.
At the Pentagöet Inn they treat you as a guest, not a customer
Eileen said that I exaggerate. No stew could be that good. ("How much did you have to drink?" she wanted to know.) After all, bouillabaisse is nothing more than bits and pieces of fish and shellfish in a broth, with French bread on the side to provide a little body. She made her point long before the evening late last summer when we dined at the Pentagoet Inn in Castine.
I say dined, not ate, because while the inn has a decidedly relaxed atmosphere, it is civilized in a way that, say, Moody's Diner in Waldoboro is not. They treat you as a guest, not a customer.
The Pentagoet Inn specializes in seafood, and the choice the night we were there was proof of that. The specials were red snapper and linguini with lobster; the regular menu included Pacific salmon and lobster bouillabaisse.
I know what you're thinking. This boy, given the above yarn, had to have had the latter. Now he's going to tell us that it can't hold a candle to Bowdoin's recipe. But no, he didn't and he won't.
I had the Pacific salmon, and it was as good as any I have ever had. It was a civilized piece of wild fish-firm, with a robust but not overwhelming flavor-nothing like the too-mild farm-raised salmon we usually get in Maine. There was only a hint of garlic in the sauce used in its preparation.
It was the matter of garlic that steered me away from the bouillabaisse and toward the salmon. Too much garlic doesn't agree with Inc. For too many chefs, garlic in spades seems to be a central ingredient of bouillabaisse. ~ -"You want garlic?"' I envision them snarling "We'll give you garlic!" It's almost like a punishment.) Why take a chance?
Eileen had the bouillabaisse. I don't know if she had a Bowdoinian experience, but after she gave me a taste, I did. Yes, there was garlic, but it was used judiciously. It was one flavor among many other equals, not an overpowering dominant that would turn the various seafood flavors in the stew-especially the lobster-into a monotone. It was a stew, yes, but all the components were identifiable and complementary. This was world class, and (sob) I hadn't ordered it. ("There's always another time...." Eileen said.)
The rest of the meal was as grand. The salad was a work of art, a mixture of texture and color that included haricot verts, beefsteak tomatoes, goat cheese, and arugula, accented with just the right amount of vinaigrette-not too much, not too little; the bread, studded with olives, was delicious.
And the dessert: pecan tart with maple ice cream. Profiterole filled with hazelnut gelato, topped with chocolate sauce.
And the ambience: Two dining rooms decorated in a comfortable New England take on Victorian style, with a pub-style bar decorated with old photographs, prints, paintings, and posters of everything from ships in the tropics to portraits of Mohandas Ghandi and Fidel Castro.
Generally I'm no big fan of the modern bed-and-breakfast. Too over-the-top cutesy for my taste: frills and fussiness with an almost mythological pretentiousness that makes me want to flee on first sight. While the Pentagoet Inn itself, not the restaurant, flirts with that condition-there are rooms upstairs and in a separate cottage, and a garden in the back-it is less of a caricature and more of a simple, restful place to settle into for a longish vacation or a shortish getaway.


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Why are poor people so angry at rich people??
Question: "Why are poor people so angry at rich people??" Answer: Christina Binkley's new article in the Wall Street Journal… "In the never-ending race to create the world's most impractical fashion trend, a new entrant is hitting the streets: the all-white designer sneaker. Pristine white sneakers are showing


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Germany's Ruhr Region Turns from Coal to European Capital of Culture
In this photo, the painting 'Roulin' by Vincent van Gogh is displayed behind the sculpture 'The Age of Bronze' by Auguste Rodin in the exhibition 'The Most Beautiful Museum in the World' in the Folkwang Museum in Essen, western Germany. The exhibition aims at reconstructing, for the first time, the Museum Folkwangs original collection and comprises around 350 art works in total: paintings and sculptures from the modern period. AP Photo/Jens Meyer.
By: Kirsten Grieshaber, Associated Press Writer
The Emscher river in western Germany's
The Ruhr
region was one of the country's most polluted for decades, so bad that parents spooked children with warnings they could die if they fell into the poisonous stew of sewage and chemical waste.
Today, a much-cleaner Emscher is the backdrop to more than 20 new art installations the latest European effort to transform blighted industrial areas into cultural destinations for tourists and to breathe new life into the region.
All over the region, around 1,000 former industrial structures have been turned into cultural venues, among them Dortmunder U, a former brewery that has become a gallery, and Zeche Nordstern, a former coal mine that was turned into office space and a museum for model railroads.
There are more than 100 theaters and dozens of concerts and musical festivals taking place every year in the Ruhr region, one of Europe's most densely populated areas, making it also one of the culturally most happening places.
As testament to the success of the program, the entire Ruhr region, with its 5.3 million inhabitants and 53 cities, was chosen by the European Union this year as a European Capital of Culture 2010 the first time the distinction went to an area rather than a single city.
More than just creative installations, many Ruhr 2010 cultural ventures combine cutting-edge art with long-term reconstruction efforts that seek to revitalize an area that has been on the decline since the 1970s.
"In addition to the financial support we get as European Capital of Culture, the European Union is spending euro4.4 billion on cleaning up the Emscher during the next 15 years that makes it the biggest renaturation project of the world," Emscher art curator Florian Matzner told The Associated Press during a recent visit there, explaining the long term goals for the revival of the Ruhr.
Once the motor of Germany's industrialization and prosperity, the Ruhr became notorious for high unemployment, heavy pollution and hopelessness, when the mines closed and young people started to move away looking for a brighter future elsewhere.
However, in recent years, cities and even local grassroot initiatives have started turning abandoned industry buildings into monuments or new homes for museums, theaters and office space for creative businesses.
Other regions in Europe have undergone similar transformations, like Liverpool in northern Britain, which boomed in the 50s and 60s, mining coal, manufacturing cement and milling flour, but went to seed from the 70s as traditional manufacturing industries declined. It became an umemployment black spot and home to numerous riots and miners' strikes.
Today Liverpool has lavished billions of pounds in regeneration projects, most of its docks and ports have been converted into bars and shops, and it sells itself as a major city of culture based on its associations with The Beatles and its museums.
In Spain, the northern city port of Bilbao the driving motor behind Spain's most industrialized area began a $1 billion plus refurbishment in the 1990s to halt the serious decline suffered by the city's shipyards and steelworks of the previous decade.
Its crowning glory was the titanium-sheathed $140 million Guggenheim museum in the city center where warehouses had stood before. The museum draws some 1 million visitors a year and has turned Bilbao into one of Spain's' leading tourist destinations, something unimaginable a decade earlier.
In France, the Louvre Museum turned for its latest expansion to an abandoned coal mining site in the depressed northern town of Lens that was pummeled by the two world wars.
The museum, set to open in 2012, is part of a strategy to spread art beyond the traditional bastions of culture in Paris to new audiences in the provinces.
For decades, workers risked their lives in Lens' coal mines, and then the mines closed the last one in 1986 plunging the area into hardship. Lens' unemployment rate is about 14 percent, well above the national level of 9.5 percent.
In the Ruhr region, one of the most famous landmarks is Zeche Zollverein in Essen, a United Nations World Heritage Memorial known for the 180-feet-tall (55-meter) towers that stand outside its disused coal mines. The former coal mine and coking plant now house several museums, contemporary dance and performance shows and, in 2012, will open a university campus for hundreds of design students.
"Zeche Zollverein shows that culture is not only a luxury good for rich people, but also creates new jobs for all levels of societies," said Fritz Pleitgen, who is in charge of Ruhr 2010, the company that organizes the European Capital of Culture events and oversees a budget of about euro70 million.
Almost 7,000 people used to work in the mine until it closed in 1986. They all lost their jobs, but the mine's transformation into a cultural venture has created almost 4,000 new jobs at Zollverein and attracted creative companies like filmmakers, fashion designers and advertisers on the 100-hectare (250-acre) compound, he said.
Another highlight is a wooden, bridge-like structure by the Dutch artists' group Observatorium, which stands about 200 yards (meters) away from the Emscher on a barren field covered with left-over black coal dust, nettles and birch trees.
Visitors who fully want to embrace the art, can even rent a room on the bridge for euro75 ($92) a night including dinner and breakfast according to the organizers the unusual hotel is already sold out for most of the summer.
It remains to be seen if the cultural renaissance of post-industrial European regions also brings new opportunities to those who suffered the most from the end of industrialization blue collar workers and immigrants or whether they will be left out from the revival, especially in today's times of financial crisis.
Elli Vogel-Gdanitz, who runs a newspaper stand in downtown Essen, enjoys the current artsy feel of her hometown. As part of a Capital of Culture project she is not only selling the usual chocolate bars, liquor and potato chips, but also small design items by local artists like pillow cases made out of old coal mining towels or silver pins in the shape of the Ruhr river.
Vogel-Gdanitz, 54, said that she has visitors coming from all over Germany and abroad to check out her "design kiosk" and that profit was up.
"All of the old industry is gone, so now they're trying to invest in tourism and culture, which is a great idea," Vogel-Gdanitz said. "But the big question is what will happen next year, when we no longer enjoy the spotlight of the European Capital of Culture."
Associated Press writers Sylvia Hui in London, Ciaran Giles in Madrid, Spain and Angela Doland in Paris contributed to this report.
The Ruhr
Fritz Pleitgen
Today's News
June 30, 2010
Lost Ambroise Vollard Art Collection Sells for 3.5 Million Pounds at Sotheby's in Paris
Rudolf Leopold, Austrian Art Collector, Dies Today at 85
Exhibition Examines Artistic Practice and Current Events
Marilyn Manson and David Lynch Open Exhibition at Kunsthalle in Vienna
Highly Anticipated King Tutankhamun Exhibition Makes its Denver Debut
Ringo Starr's Gold Drum to Go on View at Met Museum
Ray Harryhausen Pledges Collection of Life's Work to National Media Museum
Schirn Kunsthalle Presents a 360-Degree Multi-Projection by Peter Kogler
Colonial Painting Found in Palacio de Bellas Artes Restored
Pobeda Gallery Presents Work from the Last 10 Years of Alexandra Catiere's Career
At the 25th Biennale, the New Generation of Art Dealers will Be in the Spotlight
Germany's Ruhr Region Turns from Coal to European Capital of Culture
Secret Portrait of Artist's Confiscated Children to Sell at Bonhams
Unique Unpublished Bawden Book Depicting Kew Gardens Acquired for Bedford
MoMA Installs Dinh Q. Le's The Farmers and the Helicopters as Part of Its Project Series
Stedelijk Museum Amsterdam Announces New Work by Lawrence Weiner
First Solo Museum Exhibition of the Work of Brian Donnelly, a.k.a. KAWS Opens at the Aldrich Contemporary Art Museum
Gaddafi's Artist Son Shows Off Paintings in Moscow
UCSB's University Art Museum Appoints Bruce Robertson as Acting Director
Most Popular Last Seven Days
The Morgan explores the Medieval world's fascinating approach to the passage of time
Experts discover hidden ancient Maya structures in Guatemala
Egyptian archaeologists unveil tomb of Old Kingdom priestess Hetpet
The Speed Art Museum and Italian Ministry reach loan agreement on ancient calyx-krater
Major exhibition features artistic masterpieces from the glorious Church of the Gesù
From Beowulf to Chaucer, the British Library makes 1,000 years of rich literary history freely available online
Truck damages Peru's ancient Nazca lines
Trish Duebber is new Coordinator of Youth Programs at Boca Raton Museum Art School
Exhibition examines the way art, like language, was used to articulate a rhetoric of exclusion
The Dallas Museum of Art announces gift of three major European works
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It has been revealed that the West End cast of Close To You: Bacharach Reimagined are in the studio recording a cast album.
Following its UK premiere at the Menier Chocolate Factory, Close To You transferred to the Criterion Theatre in October where it is currently booking until Valentine's Day on 14th February 2016. Featuring new arrangements of Burt Bacharach's songbook, Close To You broke box office records at the Criterion with the biggest advance in the venue's history.
Kyle Riabko, who co-created the show with David Lane Seltzer, leads the cast. Direction is by Steven Hoggett. The cast also includes: Daniel Bailen, Greg Coulson, Anastacia McCleskey, Stephanie McKeon, Renato Paris and James Williams.
Writing on Instagram last week, Riabko said: "Very excited to announce that the @closetoyouldn and I are headed to the studio tmrw to start recording the album of the show!"
Further information, including a release date, is yet to be announced.
Further information, including a release date, is yet to be announced.
We had a great first day in the studio laying down tracks from the show! Watch this space everyone... 🎤🎤🎤 pic.twitter.com/U8TwOETD7D
— Close To You (@CloseToYouLDN) November 20, 2015
Follow @West_End_Frame


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Perfect for social media campaigns and blogs. Web photos (up to .5 MP). 1 Seat.
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beige, mountain, rocks, brown, light brown, stone, rock
portal peak taken in glacier peak wilderness at sunset with the clouds coming home for a moisture recharge over the snow fields. this wilderness area is just the most beautiful I have seen. the light was incredible the way it lit up the small tundra plants and the small summit cairn. just under 7000 feet, portal peak is a great place to feed cordura packs and wool hats to marmots.


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Well, yes, you are missing 2 things
1) FormatDecimal is a function that outputs a string, I used it to format the string in the text box. Just omit it.
2) Sprite('dist') / 20 will be a relative number [0, 1] If the blur shader you're using accepts a strength value in that range, then everything's ok. Else you need to transform the value just like in the first cap, I uploaded here, but for the value range the blur shader expects.
You are close to a result. Step by step we will get it right.


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Gregory Denbeaux: Flying high with model planes
Published 1:00 am, Sunday, July 18, 2010
Name: Gregory Denbeaux
Age: 39
Hometown: Guilderland
Current Job: Assistant professor of nanoengineering, University at Albany's College of Nanoscale Science and Engineering
Outside interest: Flying model airplanes. Although Denbeaux is building a new microscope as one of his projects at the NanoCollege, he also loves to build radio-controlled model airplanes. He says that one day he was walking past a hobby shop when one of the planes caught his eye. He crashed his first one, and has been hooked ever since, saying it satisfies his desire to learn new things and take on new challenges. Using his understanding of technology and mechanics, Denbeaux has taken the hobby to another level. Not only does he build his own planes, but he also outfits them with a video camera, and he likes to fly his planes using a special pair of goggles that allow him to see and record where his plane is flying. That came in handy one time when his plane crashed. He showed the video to someone who lived nearby, and with his help was able to locate where the plane had fallen and retrieve it. Denbeaux has taught model-plane flying to middle-school students, and he is considering starting a club for NanoCollege undergrads.
Quote: "I have lots of parts, there are lots of crashes, I've learned from my mistakes."


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Kiosks now being installed in certain H-E-B stores will allow customers to pay their utility bills, cell phone and cable bills in cash.
And H-E-B isn't the only one. Exxon Mobil Tiger Marts also are installing the kiosks at 27 locations.
The stores' partner in the venture is TIO Networks Corp. of Canada, which says that customers can choose from a Spanish or English menu, make the payment, and e-mail a receipt to themselves if they wish.
A customer will make a payment by feeding the cash directly into a terminal. TIO's system uses an Internet link to ensure the payment is posted in a timely way. Some of the kiosks will accept debit cards.


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Douglas Maicon is back in the Roma squad, but Kevin Strootman and Daniele De Rossi are still out against Chievo.
The Giallorossi travel to the Stadio Bentegodi in Verona for the Serie A fixture on Saturday at 19.45 GMT. Click here for a match preview.
De Rossi continues to sit out his three-match ban, while Strootman's season is over following knee ligament surgery.
Federico Balzaretti is also a long-term absentee, but Maicon returns to the fold.
Roma squad for Chievo: Bastos, Benatia, Castan, De Sanctis, Destro, Dodo, Florenzi, Gervinho, Jedvaj, Ljajic, Lobont, Maicon, Mazzitelli, Nainggolan, Pjanic, Ricci, Romagnoli, Skorupski, Taddei, Toloi, Torosidis, Totti
See the latest Serie A predictions and betting tips with Eurotips.co.uk


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Ask a Law Question, Get an Answer ASAP!
Did the funds accumulate after the death of your husband or prior to his death?
Prior to his death, the funds went into his current account
As soon as my Husband passed away I notified them and all transactions stopped
Hi, I will take a look into this and revert back to you shortly.
Thank you
Will This take long or can I log out and come back later
You have not answered my Question
I had to step away from my desk for a few hours. Do you still require an answer?
yes Please
I will rate you again when I get an answer


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Painted on the altar wall of the Sistine Chapel, 28 years after Michelangelo completed the glorious and hopeful ceiling, The Last Judgment is full of stark images depicting the End of Days. James Connor uses the famous fresco as the lens by which to view the end of the Renaissance, arguing that Michelangelo's imagery and composition reflect the religious and political upheavals of the time.
Combining his flair for storytelling with incisive historical analysis, Connor demonstrates how the Counter-Reformation arose from the ashes of Renaissance Italy, and how that sea change altered the course of Western history.
About James A. ConnorSee more books from this Author
Michelangelo did not want to create the Last Judgment (1537–1541), yet, argues Connor (Pascal's Wager ), it was his clearest expression of the "terror at the bottom of his psyche," a terror stemming largely from the conflict between his probable homosexual desires and his religious faith.May 11 2009 | Read Full Review of The Last Judgment: Michelange...
An aggregated and normalized score based on 5 user ratings from iDreamBooks & iTunes


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|Three medals at China Wine & Spirits Awards
|Friday, 14 March 2014
2014, Mar 14 - This year's spring awards season has started with some good news for us: We have been awarded 3 medals at the China Wine & Spirits Awards Best Value:
Gold medal for our Chianti Classico DOCG "Riserva del Conte"
After the four medals for our new Chianti Classicos at the Cathay Pacific Hong Kong International Wine & Spirit Competition in autumn 2013, this judgement from China is another great feedback from Asian wine connoisseurs. We are particularly happy since we started producing these wines with a special focus on the Asian market.
The China Wine & Spirits Award (CWSA) is the biggest and most prestigious wine and spirits competition in China. The wines are blind tasted by 100 judges that are importers, distributors and sommeliers and the top buyers of the Chinese market. Its "Best Value" edition takes place in Feburary/March each year and recognizes wines with best quality-price level.