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Baldé T, Billaud A, Beadling CW, Kartoglu N, Anoko JN, Okeibunor JC. The WHO African Region Initiative on Engaging Civil Society Organizations in Responding to the COVID-19 Pandemic: Best Practices and Lessons Learned for a More Effective Engagement of Communities in Responding to Public Health Emergencies. Disaster Med Public Health Prep 2023; 17:e445. [PMID: 37551088 DOI: 10.1017/dmp.2023.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Engaging communities is a key factor in efficient response to public health emergencies (PHE). Previous and recent outbreaks have shown that civil society organizations (CSOs) can mobilize the communities to better prepare and respond to a PHE. Consequently, the World Health Organization (WHO) Regional Office for Africa (AFRO) implemented an initiative to partner with community leaders by engaging CSOs. The Civil Society Organization Initiative (CSO Initiative) aims to work directly with well-established community-based organizations to accelerate whole-of-society preparation and response. Twenty-three CSOs from 12 WHO African Region Member States have been supported financially and technically to implement effective community-based interventions to respond to the coronavirus disease (COVID-19) pandemic. After 1 year of implementation (2021), the successes, challenges, and recommendations for maximizing future engagements with CSOs are outlined. As the COVID-19 outbreak is again underlining, partnering with established CSOs to engage diverse social groups from various communities can help provide a timely and efficient response to a PHE.
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Affiliation(s)
- Thierno Baldé
- World Health Organization (WHO), Regional Office for Africa, Emergency Preparedness and Response Programme, COVID-19 Incident Management Support Team, Brazzaville, Congo
| | - Anthony Billaud
- World Health Organization (WHO), Regional Office for Africa, Emergency Preparedness and Response Programme, COVID-19 Incident Management Support Team, Brazzaville, Congo
| | - Charles W Beadling
- Military and Emergency Medicine, Uniformed Services, University of the Health Sciences, Bethesda, MD, USA
| | - Nellie Kartoglu
- WHO, Country Readiness Strengthening Department, Geneva, Switzerland
| | - Julienne Ngoundoung Anoko
- World Health Organization (WHO), Regional Office for Africa, Emergency Preparedness and Response Programme, COVID-19 Incident Management Support Team, Brazzaville, Congo
| | - Joseph Chukwudi Okeibunor
- World Health Organization (WHO), Regional Office for Africa, Emergency Preparedness and Response Programme, COVID-19 Incident Management Support Team, Brazzaville, Congo
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Caswell G, Dubula V, Baptiste S, Etya’ale H, Syarif O, Barr D. The continuing role of communities affected by HIV in sustained engagement in health and rights. J Int AIDS Soc 2021; 24 Suppl 3:e25724. [PMID: 34189840 PMCID: PMC8242979 DOI: 10.1002/jia2.25724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/27/2021] [Accepted: 04/14/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The meaningful involvement of persons affected by a disease is a unique aspect of the HIV response that places people living with (PLHIV) and those directly affected by HIV (peers) at the centre of the design, development and implementation of service delivery and research and policy making. The principle of greater involvement of PLHIV (GIPA) has and will increasingly ensure equitable access to services and engagement of marginalized groups in the HIV response, and to health services more broadly. This paper describes the history, current place in the HIV response and potential future role of PLHIV and communities in health responses. DISCUSSION Historically, the role of communities of PLHIV and peers in service delivery, research and drug development, advocacy, social and political accountability, resource mobilization and social and human rights protection is well documented. Their leadership and engagement have contributed directly to improved outcomes in access to HIV treatment, prevention, support and care services around the world. Their continued and expanded role is especially important for the future success of HIV responses in sub-Saharan Africa, where the HIV burden remains the greatest. The lessons learned from the leadership and involvement of communities of PLHIV and peers in the HIV response hold value beyond HIV responses. The models and approaches they have efficiently and effectively utilized have relevant applications in addressing shortfalls in health systems in the COVID-19 era, as well as broader, more integrated health challenges as countries move to develop and operationalize universal health coverage (UHC). However, neither HIV nor other health and development targets can be met if their contributions are not adequately recognized, valued and funded. CONCLUSIONS The past three decades have demonstrated that communities of PLHIV and their peers are instrumental in sustaining engagement and advocacy for health equity and financing for health and ensuring that the human rights of all people are recognized and upheld. Quality and effective integration of health systems and UHC can be more effectively designed, implemented and sustained with communities of PLHIV and peers at the centre.
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Affiliation(s)
| | - Vuyiseka Dubula
- Centre for Civil SocietyUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Solange Baptiste
- International Treatment Preparedness CoalitionJohannesburgSouth Africa
| | - Helen Etya’ale
- International Treatment Preparedness CoalitionJohannesburgSouth Africa
| | - Omar Syarif
- Global Network of People Living with HIVAmsterdamThe Netherlands
| | - David Barr
- The Fremont CenterNew YorkUnited States of America
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Akeju D, Nance N, Salas-Ortiz A, Fakunmoju A, Ezirim I, Oluwayinka AG, Godpower O, Bautista-Arredondo S. Management practices in community-based HIV prevention organizations in Nigeria. BMC Health Serv Res 2021; 21:489. [PMID: 34022857 PMCID: PMC8141130 DOI: 10.1186/s12913-021-06494-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 05/06/2021] [Indexed: 01/19/2023] Open
Abstract
Background Nigeria has one of the largest Human Immunodeficiency Virus (HIV) epidemics in the world. Addressing the epidemic of HIV in such a high-burden country has necessitated responses of a multidimensional nature. Historically, community-based organizations (CBOs) have played an essential role in targeting key populations (eg. men who have sex with men, sex workers) that are particularly burdened by HIV. CBOs are an essential part of the provision of health services in sub-Saharan Africa, but very little is known about the management practices of CBOs that provide HIV prevention interventions. Methods We interviewed 31 CBO staff members and other key stakeholders in January 2017 about management practices in CBOs. Management was conceptualized under the classical management process perspective; these four management phases—planning, organizing, leading, and evaluating—guided the interview process and code development. Data analysis was conducted thematically using Atlas.ti software. The protocol was approved by the ethics committees of the National Institute of Public Health of Mexico (INSP), the National Agency for the Control of AIDS in Nigeria (NACA), and the Nigerian Institute for Medical Research (NIMR). Results We found that CBOs implement variable management practices that can either hinder or facilitate the efficient provision of HIV prevention services. Long-standing CBOs had relatively strong organizational infrastructure and capacity that positively influenced service planning. In contrast, fledgling CBOs were deficient of organizational infrastructure and lacked program planning capacity. The delivery of HIV services can become more efficient if management practices are taken into account. Conclusions The delivery of HIV services by CBOs in Nigeria was largely influenced by inherent issues related to skills, organizational structure, talent retention, and sanction application. These, in turn, affected management practices such as planning, organizing, leading, and evaluating. This study shows that KP-led CBOs are evolving and have strong potentials and capacity for growth, and can become more efficient and effective if attention is paid to issues such as hierarchy, staff recruitment, and talent retention. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06494-1.
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Affiliation(s)
- David Akeju
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | | | - Andrea Salas-Ortiz
- National Institute of Public Health, Mexico and University of York, York, UK
| | | | - Idoteyin Ezirim
- National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | | | | | - Sergio Bautista-Arredondo
- Center for Health Systems Research, National Institute of Public Health, Universidad 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera C.P, 62100, Cuernavaca, Morelos, Mexico.
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Hegarty B, Nanwani S, Praptoraharjo I. Understanding the challenges faced in community-based outreach programs aimed at men who have sex with men in urban Indonesia. Sex Health 2020; 17:352-358. [PMID: 32753101 DOI: 10.1071/sh20065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/05/2020] [Indexed: 11/23/2022]
Abstract
Background Community-based outreach programs play an important role in the provision of HIV testing, treatment and health care for men who have sex with men (MSM) in Indonesia. However, qualitative studies of community-based HIV programs have mostly focused on clients rather than on outreach workers (OW). The experiences of MSM peer OW provide insights into how to extend and improve community involvement in HIV programs in Indonesia. METHODS This is a qualitative study based on focus group discussions, which brought together MSM OW (n = 14) and healthcare workers (n = 12). This approach facilitated documentation of the challenges associated with community-based outreach programs in Indonesia through a participatory focus group discussion between OW and healthcare workers. RESULTS Findings are reported in relation to challenges experienced in the context of community outreach, and solutions to the challenges faced by OW. It was found that awareness of a shared commitment to delivering HIV programs can facilitate good relationships between OW and healthcare workers. CONCLUSION Future efforts should consider the role of OW within broader relationships, especially with healthcare workers, when developing community-based responses to HIV testing and treatment. Documenting the role of OW can help contribute to an understanding of ways to adapt HIV programs to reduce barriers to access both for those identified as MSM and others who are ambiguously placed in relation to the programmatic use of such categories.
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Affiliation(s)
- Benjamin Hegarty
- Faculty of Arts, School of Social and Political Sciences, John Medley Building, The University of Melbourne, Parkville, Melbourne, Vic. 3010, Australia; and Corresponding author.
| | - Sandeep Nanwani
- Yayasan Kebaya, Daerah Istimewa Yogyakarta, JT III Jl. Gowongan Lor No.148, Gowongan, Kec. Jetis, 55233, Indonesia
| | - Ignatius Praptoraharjo
- Atma Jaya University, HIV/AIDS Research Center Jakarta, Jl. Jend. Sudirman No.51, RT.5/RW.4, Karet Semanggi, Kecamatan Setiabudi, 12930, Indonesia
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Chang J, Agliata J, Guarinieri M. COVID-19 - Enacting a 'new normal' for people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102832. [PMID: 32654930 PMCID: PMC7332951 DOI: 10.1016/j.drugpo.2020.102832] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/25/2020] [Accepted: 06/28/2020] [Indexed: 12/22/2022]
Abstract
The COVID-19 crisis has magnified existing social, economic and political inequities. People who use drugs are particularly vulnerable due to criminalisation and stigma and often experience underlying health conditions, higher rates of poverty, unemployment and homelessness, as well as a lack of access to vital resources – putting them at greater risk of infection. On the other hand, COVID-19 presents an opportunity to confront the mistakes of the past and re-negotiate a new social contract. The International Network of People who use Drugs (INPUD) believe that this crisis must be an occasion to rethink the function of punishment, to reform the system and to work towards ending the war on drugs. This commentary presents a set of recommendations to UN agencies, governments, donor agencies, academics, researchers and civil society, challenging these actors to work alongside people who use drugs to enact a new reality based on solidarity and cooperation, protection of health, restoration of rights and dignity and most importantly to mobilise to win the peace.
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Affiliation(s)
- Judy Chang
- International Network of People who use Drugs, London, UK.
| | - Jake Agliata
- International Network of People who use Drugs, London, UK
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Dzimiri CT, Dzimiri P, Batisai K. Fighting against HIV and AIDS within a resource constrained rural setting: a case study of the Ruvheneko Programme in Chirumhanzu, Zimbabwe. SAHARA J 2019; 16:25-34. [PMID: 30991895 PMCID: PMC6493291 DOI: 10.1080/17290376.2019.1605537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Since reports of the first incidence of the HIV virus in Zimbabwe in 1985, the epidemic has negatively impacted on every facet of human security. Rural areas, by virtue of being the periphery and constrained in terms of resources and health care provision, bear the brunt of the epidemic. In light of the above background, this paper examined how the establishment of Ruvheneko Programme by the people of Chirumhanzu helped in mitigating on the impact of HIV and AIDS in the rural sphere. The paper analyses how the community of Chirumhanzu successfully engaged each other to the extent of coming up with such a vibrant programme. This is raised against the backdrop of failure usually associated with HIV and AIDS engagement projects. The study made use of field interviews and focus group discussions as data collection instruments. Participants were purposively selected on the basis of their knowledge and participation in the establishment and activities of Ruvheneko Programme. Selected were 5 St Theresa’s Hospital Staff, 10 Roman Catholic Church members of which, 5 were from the St Anna’s woman prayer group and 5 men from St Joseph’s men prayer group, 1 village head and 2 elders from the same nearby village constituted key informants. Complementing the use of interviews and focus group discussions was the analysis of secondary data sources on HIV and AIDS in Zimbabwe as well as the Ruvheneko Programme. To understand the collective role of various sectors of the community in establishing Ruvheneko Programme, the paper derives insights from the perspective of social capital theory and its notion of commonality to strengthen communities. Findings from the study show that, unlike other HIV and AIDS programmes that are exported from the urban to the rural areas, Ruvheneko Programme demonstrates a grassroots-level response to HIV and AIDS. Again, social cohesion fostered by aspects such as religiosity, cultural ethos of Ubuntu, and a consultative approach played a key role in unifying people towards fighting HIV and AIDS in Rural Chirumhanzu.
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Affiliation(s)
| | - Patrick Dzimiri
- b Department of Development Studies , University of Venda , Thohoyandou , South Africa
| | - Kezia Batisai
- a Department of Sociology , University of Johannesburg , Johannesburg , South Africa
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Walsh A, Matthews A, Manda-Taylor L, Brugha R, Mwale D, Phiri T, Byrne E. The role of the traditional leader in implementing maternal, newborn and child health policy in Malawi. Health Policy Plan 2018; 33:879-887. [PMID: 30084938 DOI: 10.1093/heapol/czy059] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2018] [Indexed: 01/12/2023] Open
Abstract
Traditional leaders play a prominent role at the community level in Malawi, yet limited research has been undertaken on their role in relation to policy implementation. This article seeks to analyse the role of traditional leaders in implementing national maternal, newborn and child health (MNCH) policy and programmes at the community level. We consider whether the role of the chief embodies a top-down (utilitarian) or bottom-up (empowerment) approach to MNCH policy implementation. Primary data were collected in 2014/15, through 85 in-depth interviews and 20 focus group discussions in two districts in Malawi. We discovered that traditional leaders play a pivotal role in supporting MNCH service utilization, through mobilization for MNCH campaigns, and encouraging women to give birth at the health facility rather than at home or in the community setting. Women and their families responded to bylaws to deliver in the facility out of respect for the traditional leader, which is ingrained in Malawian culture. Fines were imposed on women for delivering at home, in the form of goats, chickens and money. Fear and coercion were often used by traditional leaders to ensure that women delivered at the health facility. Chiefs who failed to enforce these bylaws were also fined. Although the role of the traditional leader was often positive and encouraging in relation to MNCH service utilization, this was sometimes carried out in a coercive manner. Results show evidence of a utilitarian top-down model of policy implementation, where the goal of health service utilization justified the means, through encouragement, fear, punishment or coercion. Although the bottom-up approach would be associated with a more empowerment approach, it is unlikely that this would have been successful in Malawi, given the hierarchical nature of society. Further research on policy implementation in the context of community participation is needed.
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Affiliation(s)
- Aisling Walsh
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Beaux Lane House, Lower Mercer Street, Dublin, Ireland
| | - Anne Matthews
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | | | - Ruairi Brugha
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Beaux Lane House, Lower Mercer Street, Dublin, Ireland
| | - Daniel Mwale
- College of Medicine, University of Malawi, Malawi
| | - Tamara Phiri
- Department of Nursing and Midwifery, Mzuzu University, Malawi
| | - Elaine Byrne
- Institute of Leadership, Royal College of Surgeons in Ireland, Dublin, Ireland
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Kagotho N, Bunger A, Wagner K. "They make money off of us": a phenomenological analysis of consumer perceptions of corruption in Kenya's HIV response system. BMC Health Serv Res 2016; 16:468. [PMID: 27595765 PMCID: PMC5011864 DOI: 10.1186/s12913-016-1721-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/26/2016] [Indexed: 11/23/2022] Open
Abstract
Background Problems with misallocation and redirection of critical resources and benefits intended for PLHIV are not uncommon in Kenya. This study explores corruption in Kenya’s HIV response system and the implications for health outcomes from the perspective of people living with HIV (PLHIV). Although they might not be directly responsible for health care fund management, PLHIV and their advocacy efforts have been central to the development of HIV system response and they have a vested interest in ensuring proper governance. Methods This phenomenological study was conducted in 2012 in Kiambu County in Kenya. The study was designed to capture the experiences of a select group of individuals living with HIV and AIDS and subsequent effects on intergenerational wealth transmission. Four focus groups were conducted with self-convened HIV/AIDS peer support groups. Findings related to corruption emerged unexpectedly, albeit consistently, across all four focus groups. To validate core themes within the data, including corruption, two coders independently reviewed and coded the data. Results Participants described incidences of resource misallocation, theft, and denial of services across three thematic levels namely at the interpersonal, provider, and institutional levels. Participants described the negative influence of corruption on their health and financial well-being, and propose: (1) strengthening legal protections for assets belonging to PLHIV, (2) direct representation of PLHIV within service agencies, (3) and addressing information asymmetries to inject transparency into the response system. Conclusion Our findings add to the growing literature that identifies advocacy among individuals and families impacted by HIV and AIDS to be a useful tool in drawing attention to harmful practices in the HIV response infrastructure; consistent with this movement, communities in Kenya demand greater control over programmatic interventions both at the national and local levels.
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Affiliation(s)
- Njeri Kagotho
- Ohio State University College of Social Work, 325-E Stillman Hall, 1947 College Road, Columbus, OH, 43210, USA.
| | - Alicia Bunger
- Ohio State University College of Social Work, 325-E Stillman Hall, 1947 College Road, Columbus, OH, 43210, USA
| | - Kristen Wagner
- University of Missouri St. Louis, 121 Bellerive Hall, One University Boulevard, St. Louis, MO, 63121, USA
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HIV epidemics among transgender populations: the importance of a trans-inclusive response. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.3.21259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Silva-Santisteban A, Eng S, de la Iglesia G, Falistocco C, Mazin R. HIV prevention among transgender women in Latin America: implementation, gaps and challenges. J Int AIDS Soc 2016; 19:20799. [PMID: 27431470 PMCID: PMC4949309 DOI: 10.7448/ias.19.3.20799] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/21/2016] [Accepted: 04/26/2016] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Transgender women are the population most vulnerable to HIV in Latin America, with prevalence between 18 and 38%. Although the region has improved antiretroviral coverage, there is an urgent need to strengthen HIV prevention for key populations to meet regional targets set by governments. We conducted an assessment on the state of HIV prevention among transgender women in Latin America. METHODS We conducted a desk review of Global AIDS Response Progress Reports, national strategic plans, technical reports and peer-reviewed articles from 17 Latin American countries published through January 2015. The review was preceded by 12 semi-structured interviews with UNAIDS and Pan American Health Organization officers and a discussion group with transgender women regional leaders, to guide the identification of documents. We assessed access to, implementation and coverage of programmes; legal frameworks; community participation; inclusion of new strategies; and alignment with international recommendations. RESULTS AND DISCUSSION Overall, prevention activities in the region focus on condom distribution, diagnosis of sexually transmitted infections and peer education, mostly delivered at health facilities, with limited community involvement. Argentina and Uruguay have implemented structural interventions to address social inclusion. Argentina, Brazil and Mexico have adopted early initiation of antiretroviral therapy and treatment as prevention strategies. The other countries do not have substantial tailored interventions and consider the trans population a sub-population of men who have sex with men in data collection and programme implementation. Limited coverage of services, discrimination and a deep-seated mistrust of the health system among transgender women are the main barriers to accessing HIV prevention services. Promising interventions include health services adapted to transgender women in Mexico; LGBT-friendly clinics in Argentina that incorporate community and health workers in mixed teams; task-shifting to community-based organizations; mobile HIV testing; and gender identity laws. CONCLUSIONS Transgender women in Latin America continue to have limited access to HIV prevention services, which presents a bottleneck for reaching prevention goals and incorporating new prevention interventions. Prevention programmes should be rights-based; offer tailored, holistic interventions; and involve transgender women in their design and implementation.
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Affiliation(s)
- Alfonso Silva-Santisteban
- Center for Interdisciplinary Research on Sexuality, AIDS and Society, Cayetano Heredia University, Lima, Peru;
| | - Shirley Eng
- Regional Support Team for Latin America, UNAIDS, Panama City, Panama
| | - Gabriela de la Iglesia
- Horizontal Cooperation Technical Group for Latin America and the Caribbean, Buenos Aires, Argentina
| | - Carlos Falistocco
- Horizontal Cooperation Technical Group for Latin America and the Caribbean, Buenos Aires, Argentina
| | - Rafael Mazin
- HIV and Sexually Transmitted Infections, Pan American Health Organization, Washington, DC, USA
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Time for full inclusion of community actions in the response to AIDS. J Int AIDS Soc 2016; 19:20712. [PMID: 27083149 PMCID: PMC4833769 DOI: 10.7448/ias.19.1.20712] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 02/02/2016] [Accepted: 03/15/2016] [Indexed: 01/09/2023] Open
Abstract
Introduction Community action, including activism, advocacy and service delivery, has been crucially important in the global response to AIDS from the beginning of the epidemic and remains one of its defining features. This indispensable contribution has been increasingly acknowledged in strategic planning documents from UNAIDS, the Global Fund to fight AIDS, Tuberculosis and Malaria, the World Bank, the World Health Organization and other organizations. A growing body of literature demonstrates that community-based services can have measurable impact, serve populations that are not accessing public health services and reach people at scale. Discussion Recognition of the powerful potential role of community has not translated into full incorporation of community responses in programme planning or financing, and communities are still not fully understood as true assets within overall systems for health. The diverse community contributions remain seriously underappreciated and under-resourced in national responses. Conclusions It is time for a paradigm shift in how we think about, plan and finance community-based responses to HIV in order to achieve improved impact and move toward ending the epidemic. We must utilize the unique strengths of communities in creating resilient and sustainable systems for health. There are several priorities for immediate attention, including agreement on the need to nurture truly comprehensive systems for health that include public, private and community activities; re-examination of donor and national funding processes to ensure community is strategically included; improvement of data systems to capture the full spectrum of health services; and improved accountability frameworks for overall health systems. Health planning and financing approaches run by governments and donors should institutionalize consideration of how public, community and private health services can strategically contribute to meeting service needs and accomplishing public health targets.
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Estimated age and gender profile of individuals missed by a home-based HIV testing and counselling campaign in a Botswana community. J Int AIDS Soc 2015; 18:19918. [PMID: 26028155 PMCID: PMC4450241 DOI: 10.7448/ias.18.1.19918] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/23/2015] [Accepted: 05/06/2015] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION It would be useful to understand which populations are not reached by home-based HIV-1 testing and counselling (HTC) to improve strategies aimed at linking these individuals to care and reducing rates of onward HIV transmission. METHODS We present the results of a baseline home-based HTC (HBHTC) campaign aimed at counselling and testing residents aged 16 to 64 for HIV in the north-eastern sector of Mochudi, a community in Botswana with about 44,000 inhabitants. Collected data were compared with population references for Botswana, the United Nations (UN) estimates based on the National Census data and the Botswana AIDS Impact Survey IV (BAIS-IV). Analyzed data and references were stratified by age and gender. RESULTS A total of 6238 age-eligible residents were tested for HIV-1; 1247 (20.0%; 95% CI 19.0 to 21.0%) were found to be HIV positive (23.7% of women vs. 13.4% of men). HIV-1 prevalence peaked at 44% in 35- to 39-year-old women and 32% in 40- to 44-year-old men. A lower HIV prevalence rate, 10.9% (95% CI 9.5 to 12.5%), was found among individuals tested for the first time. A significant gender gap was evident in all analyzed subsets. The existing HIV transmission network was analyzed by combining phylogenetic mapping and household structure. Between 62.4 and 71.8% of all HIV-positive individuals had detectable virus. When compared with the UN and BAIS-IV estimates, the proportion of men missed by the testing campaign (48.5%; 95% CI 47.0 to 50.0%) was significantly higher than the proportion of missed women (14.2%; 95% CI 13.2 to 15.3%; p<0.0001). The estimated proportion of missed men peaked at about 60% in the age group 30 to 39 years old. The proportions of missed women were substantially smaller, at approximately 28% within the age groups 30 to 34 and 45 to 49 years old. CONCLUSIONS The HBHTC campaign seems to be an efficient tool for reaching individuals who have never been tested previously in southern African communities. However, about half of men from 16 to 64 years old were not reached by the HBHTC, including about 60% of men between 30 and 40 years old. Alternative HTC strategies should be developed to bring these men to care, which will contribute to reduction of HIV incidence in communities.
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Treloar C, Jackson C, Gray R, Newland J, Wilson H, Saunders V, Johnson P, Brener L. Care and treatment of hepatitis C among Aboriginal people in New South Wales, Australia: implications for the implementation of new treatments. ETHNICITY & HEALTH 2015; 21:39-57. [PMID: 25665723 DOI: 10.1080/13557858.2015.1004870] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Despite Aboriginal Australians being over-represented in populations of people living with hepatitis C (HCV), there is a dearth of research to guide policy and programme development in the area of care and treatment, particularly relating to new HCV treatments. METHOD In-depth interviews were conducted with 39 people identifying as Aboriginal Australians and living with HCV in New South Wales. RESULTS Participants' experiences were characterised by a lack of detailed or appropriate information provided at diagnosis, high levels of stigma associated with HCV and low overall knowledge of HCV as reported for themselves and their communities. Despite poor diagnosis experiences, participants had undertaken changes to their lifestyle, especially in relation to alcohol use, in order to promote liver health. Concerns about treatment side effects and efficacy impacted participants' decisions to undertake treatment. Eleven participants had undertaken HCV treatment in a variety of care models with a peer worker and in prison. CONCLUSIONS The similarities between concerns and experiences of Aboriginal people and other populations living with HCV do not suggest that services and strategies to engage these populations should also be the same. These results suggest that further engagement of the primary care sector in HCV care is important as well as increasing Aboriginal community knowledge of HCV. A variety of service models should be available to meet individuals' preferences, including those offered within Aboriginal community controlled health services emphasising holistic notions of health, and supported by information and communication programmes using principles of health literacy relevant to Aboriginal people.
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Affiliation(s)
- Carla Treloar
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Clair Jackson
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Rebecca Gray
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Jamee Newland
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Hannah Wilson
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Veronica Saunders
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Priscilla Johnson
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Loren Brener
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
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14
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Lippman SA, Treves-Kagan S, Gilvydis JM, Naidoo E, Khumalo-Sakutukwa G, Darbes L, Raphela E, Ntswane L, Barnhart S. Informing comprehensive HIV prevention: a situational analysis of the HIV prevention and care context, North West Province South Africa. PLoS One 2014; 9:e102904. [PMID: 25028976 PMCID: PMC4100930 DOI: 10.1371/journal.pone.0102904] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 06/25/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Building a successful combination prevention program requires understanding the community's local epidemiological profile, the social community norms that shape vulnerability to HIV and access to care, and the available community resources. We carried out a situational analysis in order to shape a comprehensive HIV prevention program that address local barriers to care at multiple contextual levels in the North West Province of South Africa. METHOD The situational analysis was conducted in two sub-districts in 2012 and guided by an adaptation of WHO's Strategic Approach, a predominantly qualitative method, including observation of service delivery points and in-depth interviews and focus groups with local leaders, providers, and community members, in order to recommend context-specific HIV prevention strategies. Analysis began during fieldwork with nightly discussions of findings and continued with coding original textual data from the fieldwork notebooks and a select number of recorded interviews. RESULTS We conducted over 200 individual and group interviews and gleaned four principal social barriers to HIV prevention and care, including: HIV fatalism, traditional gender norms, HIV-related stigma, and challenges with communication around HIV, all of which fuel the HIV epidemic. At the different levels of response needed to stem the epidemic, we found evidence of national policies and programs that are mitigating the social risk factors but little community-based responses that address social risk factors to HIV. CONCLUSIONS Understanding social and structural barriers to care helped shape our comprehensive HIV prevention program, which address the four 'themes' identified into each component of the program. Activities are underway to engage communities, offer community-based testing in high transmission areas, community stigma reduction, and a positive health, dignity and prevention program for stigma reduction and improve communication skills. The situational analysis process successfully shaped key programmatic decisions and cultivated a deeper collaboration with local stakeholders to support program implementation.
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Affiliation(s)
- Sheri A. Lippman
- University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States of America
| | - Sarah Treves-Kagan
- University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States of America
| | - Jennifer M. Gilvydis
- University of Washington, International Training and Education Center for Health (ITECH) – South Africa, Pretoria, South Africa
| | - Evasen Naidoo
- University of Washington, International Training and Education Center for Health (ITECH) – South Africa, Pretoria, South Africa
| | - Gertrude Khumalo-Sakutukwa
- University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States of America
| | - Lynae Darbes
- University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States of America
| | - Elsie Raphela
- University of Washington, International Training and Education Center for Health (ITECH) – South Africa, Pretoria, South Africa
| | - Lebogang Ntswane
- University of Washington, International Training and Education Center for Health (ITECH) – South Africa, Pretoria, South Africa
| | - Scott Barnhart
- University of Washington, International Training and Education Center for Health, Seattle, Washington, United States of America
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15
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Robertson L, Mushati P, Skovdal M, Eaton JW, Makoni JC, Crea T, Mavise G, Dumba L, Schumacher C, Sherr L, Nyamukapa C, Gregson S. Involving Communities in the Targeting of Cash Transfer Programs for Vulnerable Children: Opportunities and Challenges. WORLD DEVELOPMENT 2014; 54:325-337. [PMID: 24748713 PMCID: PMC3990423 DOI: 10.1016/j.worlddev.2013.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/12/2013] [Indexed: 06/02/2023]
Abstract
We used baseline data, collected in July-September 2009, from a randomized controlled trial of a cash transfer program for vulnerable children in eastern Zimbabwe to investigate the effectiveness, coverage, and efficiency of census- and community-based targeting methods for reaching vulnerable children. Focus group discussions and in-depth interviews with beneficiaries and other stakeholders were used to explore community perspectives on targeting. Community members reported that their participation improved ownership and reduced conflict and jealousy. However, all the methods failed to target a large proportion of vulnerable children and there was poor agreement between the community- and census-based methods.
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Affiliation(s)
| | | | | | | | | | - Tom Crea
- Boston College, Chestnut Hill, USA
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