This study aimed to identify the conditions and strategies through which Community Health Assistants gained entry and acceptability into community health systems to provide sexual and reproductive health services services to youth in Nyimba district, Zambia. Community Health Assistants worked with a range of community actors, including other health workers, safe motherhood action groups, community health workers, neighborhood health committees, teachers, as well as political, traditional and religious leaders and took services to health facilities, schools, police stations, home settings, and community spaces. They used their health facility service delivery role to gain trust and entry into the community, and built relationships with other community level actors by holding regular joint meetings, and acting as brokers between the volunteer health workers and the Ministry of Health. They used their existing social networks to deliver sexual and reproductive health services to adolescents, and embedded this into general life skills at community level, the improving its acceptability. Support from community leaders also promoted their legitimacy. The acceptability of their services was limited by a taboo of discussing sexuality issues, a gender discriminatory environment, competition with other providers, and challenges in conducting household visits.
Equity and HIV/AIDS
This paper assessed the extent in East Africa to which policies reflect calls for HIV-NCD service integration, through document review. Integrated delivery of HIV and NCD care is recommended in high level health policies and treatment guidelines in four countries in the East African region; Kenya, Rwanda, Tanzania and Uganda, mostly relating to integrating NCD care into HIV programmes, in response both to increasing levels of NCDs and more person-centred services for people living with HIV. Other countries, however, have no reported plans for HIV and NCD care integration.
Malawi is one of the countries experiencing an unprecedented HIV/AIDS epidemic in an environment where malnutrition is rampant. In 2001 Malawi started providing ARVs to HIV patients. This ARV programme is now being scaled up to cover the whole country. Since underlying malnutrition is associated with adverse ART outcomes, the Malawi government commissioned a study to design a programme for integrating nutrition in the ARV scale up plan. This study used a Participatory qualitative research methodology. The study recommends that nutritional support should include therapeutic feeding, food supplements and take home ration and proposes a clear enrolment and discharge criteria.
This book examines the global governance of the AIDS epidemic, interrogating the role of this international system and global discourse on interventions. The geographical focus is Sub-Saharan Africa since the region has been at the forefront of these interventions. There is a need to understand the relationship between the international political environment and the impact of resulting policies on HIV and AIDS in the context of people's lives. There is a certain disjuncture between this governance structures and the way people experience the disease in their everyday lives. Although the structure allows people to emerge as policy relevant target groups and beneficiaries, the articulation of needs and design of policy interventions tends to reflect international priorities rather than people's thinking on the problem and the nature of the system does not allow interventions to be far reaching and sustainable.
We are disappointed and frankly outraged that gender equality and strengthening the women's machineries within the UN system are barely noted, and are not addressed as a central part of the reform agenda. Again we must ask how it can be that more than ten years after the commitment to gender parity at the Beijing Conference, the UN is still offering only token representation of women on critical committees, high level expert panels and in senior positions within the organization?
This paper examines some of the evidence linking structural factors to HIV risk; research gaps, including the pathways through which factors affect HIV vulnerability and interaction among factors; and explores the advantages of taking a “structurally informed” approach to HIV planning and implementation, namely the value of influencing clustered risk factors, the potential to influence multiple outcomes, and opportunities for co-financing. The authors argue that attention to structural forces that either heighten HIV vulnerability or create AIDS resiliency is an important but under-researched and under-programmed area of HIV prevention. There is long-standing evidence that demonstrates that a variety of social forces have both direct and indirect effects on HIV transmission, and undermine the effectiveness of proven biomedical prevention programmes. Intervening “upstream” yields multiple benefits: it allows programmes to potentially affect multiple risk factors at once (especially when they cluster), and it offers promise to influence a range of health and development outcomes through a single intervention. The authors argue that structural approaches to HIV prevention are an efficient and effective strategy in our current era of global fiscal austerity.
In this interview with Sheila Tlou, who took over as UNAIDS director for east and southern Africa in November 2010, Tlou notes that only two countries in east and southern Africa – Rwanda and Botswana – have achieved universal access to anti-retroviral treatment. In 2015, UNAIDS and other health governance bodies are expected to set more targets, according to Tlou. She believes that the region will reach Millennium Development Goal (MDG) 6 by 2015, namely to halt and reverse the spread of HIV. However, she emphasises that the region will not have reached its goals of zero new HIV infections, zero deaths and zero discrimination. She identifies the greatest barriers to achieving HIV and AIDS goals in the region as stigma and discrimination. Key populations have been criminalised, including men who have sex with men, sex workers, injecting drug users and transgender populations, despite statistics that indicate that, in Africa, 34% men who have sex with men also reported that they were married and 54% reported that they had had sex with both men and women in the past six months.
HIV status disclosure is a central strategy in HIV prevention and treatment but in high prevalence settings women test disproportionately and most often during pregnancy. This study reports intimate partner violence (IPV) following disclosure of HIV test results by pregnant women. The study demonstrated the interconnectedness of IPV, HIV status and its disclosure with IPV which was a common experience post disclosure of both an HIV positive and HIV negative result. The authors argue that health services must give attention to the gendered nature and consequences of HIV disclosure such as enskilling women on how to determine and respond to the risks associated with disclosure. Efforts to involve men in antenatal care must also be strengthened.
Since June of this year, the World Health Organization and the UNAIDS Secretariat have been coordinating a consultative process to develop guidance on provider-initiated HIV testing and counselling in health care settings. The latest draft of the guidance document in English is now available. An Executive Summary of the document is available in French, and will soon be available in Spanish. The full text of the document in these languages should be available on the same website by December 18. WHO are now seeking broad public comment on this document. If you wish to provide comments, please follow the instructions that appear on the website and send in your comments according to the following schedule:
o English comments by 5 January, 2007; and
o French and Spanish comments by 19 January, 2007.
Adolescents continue to be at high risk for HIV infection, with young men who have sex with men and youth with drug abuse and/or mental health problems at particularly high risk, according to this study. Multiple factors may interact to confer risk for these youth. Engaging vulnerable youth in HIV prevention research can present unique challenges in the areas of enrollment, retention, and trial adherence. Examples of successful engagement with vulnerable youth offer encouraging evidence for the feasibility of including these youth in clinical trials. Ethical challenges must be taken into consideration before embarking on biomedical HIV prevention studies with vulnerable youth, especially in the global context. Given the many individual and contextual factors that contribute to their high-risk status, the study urges that vulnerable youth populations be included in HIV prevention clinical research studies.