This study aimed to explore perceptions of Uganda-based key decision-makers about the past, present and optimal future roles of FBOs in HIV/AIDS work, including actions to promote or dissuade stigma and discrimination. Uganda's program continues to face challenges, including perceptions among the general population that HIV/AIDS is a cause for secrecy. By virtue of their networks and influence, respondents believe that FBOs are well-positioned to contribute to breaking the silence about HIV/AIDS which undermines prevention, care and treatment efforts.
Equity and HIV/AIDS
Examining the actions of faith-based organizations and their influence on HIV/AIDS-related stigma: A case study of Uganda
Otolok-Tanga E, Atuyambe L, Murphey CK, Ringheim KE and Woldehanna S: African Health Sciences 7(1): 55-60, 2007
Exceptional epidemics: AIDS still deserves a global response
Whiteside A and Smith J: Globalization and Health 5(15): 14 November 2009
There has been a renewed debate over whether AIDS deserves an exceptional response because of the amount of funding targeted to the disease and the belief that AIDS activists prioritise it above other health issues. The strongest detractors of exceptionalism claim that the AIDS response has undermined health systems in developing countries. This paper argues that AIDS should be normalised in countries with mid-level prevalence, except when life-long treatment is dependent on outside resources – as is the case with most African countries – because treatment dependency creates unique sustainability challenges. And AIDS must always require an exceptional response in countries with high prevalence (over 10%). In these settings there is substantial morbidity, filling hospitals and increasing care burdens, and increased mortality, which most visibly reduces life expectancy. The idea that exceptionalism is somehow wrong is an oversimplification. The AIDS response must be based on human rights principles, and it must aim to improve health and well-being of societies as a whole.
Expanding Access to Antiretroviral Therapy in Sub-Saharan Africa
January 2005, Vol 95, No. 1, American Journal of Public Health 18-2
"We describe a number of pitfalls that may occur with the push to rapidly expand access to antiretroviral therapy in sub-Saharan Africa. These include undesirable opportunity costs, the fragmentation of health systems, worsening health care inequities, and poor and unsustained treatment outcomes. On the other hand, AIDS "treatment activism" provides an opportunity to catalyze comprehensive health systems development and reduce health care inequities. However, these positive benefits will only happen if we explicitly set out to achieve them. We call for a greater commitment toward health activism that tackles the broader political and economic constraints to human and health systems development in Africa, as well as toward the resuscitation of inclusive and equitable public health systems."
Expanding access to HIV prevention
AIDS Research and Therapy 2006
The expanding HIV/AIDS epidemic represents one of the greatest threats to human health and international development today, and strengthening the global response is imperative. Despite recent progress in expanding access to HIV/AIDS treatment, the world continues to severely under-invest in efforts to fight HIV/AIDS, missing a tremendous opportunity to change the course of the epidemic by bringing proven treatment and prevention interventions to scale. Nowhere is the need for an expanded response more apparent – and the potential impact greater – than in efforts to prevent the spread of new infections.
Experiences in conducting multiple community-based HIV prevention trials among women in KwaZulu-Natal, South Africa
Ramjee G, Coumi N, Dladla-Qwabe N, Ganesh S, Gappoo S, Govinden R, Guddera V, Maharaj R, Moodley J, Morar N, Naidoo S, Palanee T: AIDS Research and Therapy 7(10), 23 April 2010
This paper conducted four phase III and one phase IIb trials of women-initiated HIV prevention options in KwaZulu-Natal between 2003 and 2009. A total of 7,046 women participated, with HIV prevalence between 25% and 45% and HIV incidence ranging from 4.5-9.1% per year. Community benefits from the trial included education on HIV prevention, treatment and care and provision of ancillary care (such as pap smears, reproductive health care and referral for chronic illnesses). Social benefits included training of home-based caregivers and sustainable ongoing HIV prevention education through peer educator programmes. Several challenges were encountered, including manipulation by participants of their eligibility criteria in order to enrol in the trial. Women attempted to co-enrol in multiple trials to benefit from financial reimbursements and individualised care. The trials became ethically challenging when participants refused to take up referrals for care due to stigma, denial of their HIV status and inadequate health infrastructure. Lack of disclosure of HIV status to partners and family members was particularly challenging. The researchers concluded that conducting these five trials in a period of six years provided them with invaluable insights into trial implementation, community participation, recruitment and retention, provision of care and dissemination of trial results.
Experiences of orphan care in Amach, Uganda: Assessing policy implications
Oleke C, Blystad A, Rekdal OB, Moland KM: SAHARA Journal 4 (1): 532-543, 2007
This paper presents findings from a study on the experiences of orphan care among Langi people of Amach sub-county in Lira District, northern Uganda, and discusses their policy implications.The findings revealed that the Langi people have an inherently problematic orphan concept, which contribute toward discriminatory attitudes and practices against orphans.The clan based decision-making to care for orphans, the category of kin a particular orphan ends up living with, the sex and age of the orphan, as well as the cessation of the ‘widow-inheritance' custom emerged as prominent factors which impact on orphan care.Thus there is the need to draw upon such local knowledge in policy making and intervention planning for orphans.
Exploring equity and inclusion in the responses to AIDS
Loewenson R: AIDS Care 19 (S1): 2-11, 2007
The HIV and AIDS epidemic feeds on, and worsens, unacceptable situations of poverty, gender inequity, social insecurity, limited access to healthcare and education, war, debt and macroeconomic and social instability. This paper introduces a series of eight papers from a programme of work reported in this supplement of AIDS Care with an analysis of background evidence of community responses to HIV and AIDS. It explores how interventions from state institutions and non-governmental organizations (NGOs) support and interact with these household, family and community responses. Through review of literature, this background paper sets out the questions that the studies reported in this supplement have, in various settings, sought to explore more deeply.
Exploring the impacts of HIV/AIDS on patient and carer well-being in the Caprivi Region, Namibia
Thomas, F: Social Science & Medicine, 63(12), 3174-3187, 2006
It is generally assumed that caring is a substantial burden upon households afflicted by HIV/AIDS. However, as a ‘private’ household responsibility, little is known about the experiences of either those who provide the care, or those receiving care, despite the fact that the process may extend over several years and may have a greater impact upon the livelihood security and well-being of the household than the actual death of the ill person. Drawing upon data collected through solicited diaries, this paper explores how illness and the daily and long-term duties of caring amongst a sample of households in the Caprivi Region of Namibia impacts upon the physical and psychological well-being of ill people and their carers.
Exposing misclassified HIV/AIDS deaths in South Africa
Birnbaum JK, Murray CJL and Lozano R: Bulletin of the World Health Organisation 89(4): 278-285, April 2011
The objective of this paper was to quantify the deaths from human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) that are misattributed to other causes in South Africa’s death registration data and to adjust for this bias. Differences between global and South African relative death rates were used to identify the causes to which deaths from HIV and AIDS were misattributed in South Africa and quantify the HIV and AIDS deaths misattributed to each. These deaths were then reattributed to AIDS. In South Africa, deaths from HIV and AIDS are often misclassified as being caused by 14 other conditions. Whereas in 1996–2006 deaths attributed to HIV and AIDS accounted for 2.0–2.5% of all registered deaths in South Africa, the analysis shows that the true cause-specific mortality fraction rose from 19% to 48% over that period. More than 90% of HIV and AIDS deaths were found to have been misattributed to other causes during 1996–2006. In conclusion, adjusting for cause of death misclassification, a simple procedure that can be carried out in any country, can improve death registration data and provide empirical estimates of HIV and AIDS deaths that may be useful in assessing estimates from demographic models.
Extending antiretroviral therapy to resource-poor settings: implications for drug resistance
The emergence of drug resistance in human immunodeficiency virus type 1 (HIV-1) may limit the clinical benefits of antiretroviral therapy. There is no objective evidence that the risk of drug resistance is greater in resource-limited settings than in the developed world. Treatment programmes will be most successful at preventing the spread of drug resistance if they provide healthcare infrastructures to maximize the effectiveness of antiretroviral therapy through the use of potent and convenient combination regimens that achieve durable suppression of HIV-1 replication.