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Olufadewa I, Adesina M, Damilola IA, Olalekan BY, Joshua AO, Oladele R, Nnatus J. Disability Inclusion in the National Strategic Plan for HIV/AIDS: A Review on the National Response of West African Countries. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2024; 36:415-424. [PMID: 39148918 PMCID: PMC11323867 DOI: 10.1080/19317611.2024.2349615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 08/17/2024]
Abstract
Objectives Persons with disabilities (PWD) often experience risks associated with HIV/AIDS including unmet needs and overlooked stigmatization. This could be attributed to certain misconceptions such as PWDs are asexual, and cannot enjoy sexual pleasure, among others. Therefore, this paper sought to investigate the extent of disability inclusion in recent National Strategic Plans (NSPs) for HIV/AIDS in West African countries. Methods This study was a policy review of NSPs in 13 African countries. Relevant indicators in the UN Convention on the Rights of Persons with Disabilities and the UNAIDS International Guidelines on HIV and Human Rights were used. Six indicators (identification of people living with disability (PLWD) as a key population, the inclusion of principles related to PWD within the NSPs on HIV/AIDS, protecting the rights of PWD, recognition of PWD as a vulnerable population at higher risk of HIV and in need of special protection, providing HIV-related support services for PWD and monitoring and evaluating the impact of HIV on PWD). Results Findings from this study revealed that only 30% of West African countries recognized disability as an issue of concern. Also, 38.5% of these countries recognize the vulnerability of people with disabilities to HIV. However, only a few (7.6%) provided support in the context of special needs, monitoring, and surveillance specifically for persons with disabilities. Conclusion Most of the West African NSPs are outdated and due for renewal. Therefore, it is necessary to integrate the needs of persons with disabilities within the context of HIV/AIDS in the NSPs. More importantly, support and services should also be prioritized among the vulnerable groups to optimize inclusion.
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Affiliation(s)
- Isaac Olufadewa
- Slum and Rural Health Initiative, Nigeria
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Miracle Adesina
- Slum and Rural Health Initiative, Nigeria
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Babatunde Yusuf Olalekan
- Slum and Rural Health Initiative, Nigeria
- Department of Pharmacy, University of Ilorin, Ilorin, Nigeria
| | | | - Ruth Oladele
- Slum and Rural Health Initiative, Nigeria
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joshua Nnatus
- Slum and Rural Health Initiative, Nigeria
- Lagos State Ministry of Health, Lagos, Nigeria
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Sharma A, Mwamba C, St Clair-Sullivan N, Chihota BV, Pry JM, Bolton-Moore C, Vinikoor MJ, Muula GK, Daultrey H, Gittelsohn J, Mulenga LB, Siyumbwa N, Wandeler G, Vera JH. The Social Construction of Aging Among a Clinic-Based Population and Their Healthcare Workers in Zambia. Int J Public Health 2024; 69:1606607. [PMID: 38711786 PMCID: PMC11070831 DOI: 10.3389/ijph.2024.1606607] [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] [Received: 09/09/2023] [Accepted: 04/01/2024] [Indexed: 05/08/2024] Open
Abstract
Objectives We sought to understand the social construction of aging in a clinic-based population, with and without HIV, to address gaps in care for older individuals living with HIV in Zambia. Methods Our exploratory qualitative study included 36 in-depth interviews with clinic clients and four focus group discussions with 36 professional and lay healthcare workers providing services to the clients. We identified themes based on social construction theory. Results At the individual level, aging was multidimensional, perceived both as an achievement in the HIV era and as a period of cognitive, physical, and economic decline. In social interactions, older individuals were often stereotyped and treated as helpless, poor, and "witches." Those living with HIV faced the additional stigma of being labeled as promiscuous. Some of the participants living without HIV refused to take daily medication for non-communicable diseases to avoid being mistaken for taking antiretroviral therapy for HIV. Older individuals wanted quality healthcare and family support to address the intersectional stigma of aging, poverty, and chronic illness. Conclusion Multifaceted interventions are required to combat age-related prejudice, intersectional stigma, and discriminatory practices, particularly for people living with HIV.
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Affiliation(s)
- Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Belinda V. Chihota
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Preclinical Medicine, Faculty of Medicine, Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jake M. Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Carolyn Bolton-Moore
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael J. Vinikoor
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Guy K. Muula
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Joel Gittelsohn
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | | | | | - Gilles Wandeler
- Brighton and Sussex Medical School, Brighton, United Kingdom
- Medical Faculty, Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Jaime H. Vera
- Brighton and Sussex Medical School, Brighton, United Kingdom
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Mbali M, Rucell J. African voices in global health: Knowledge, creativity, accountability. Glob Public Health 2022; 17:3993-4001. [PMID: 36417306 DOI: 10.1080/17441692.2022.2139853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In this article we offer an introduction to a special issue of Global Public Health on the theme of 'African Voices in Global Health: Knowledge, Creativity, Accountability'. This special issue explores Africans' self-understood roles - and voices - in global health (as both researchers and interlocutors in relation to various global health institutions/policies). We argue that the special issue's focus on African voices in global health is critical in view of the legacies of colonial medicine and public health for contemporary narratives, discourses, and practices. It is important to acknowledge that Africans continue to address the structural injustices facing them in relation to global health policies and practices on the continent. In the face of this they have demanded that donors, NGOs, governments, and intergovernmental organisations be politically, fiscally, and ethically accountable to the people they serve on the continent. As the special issue highlights, critical scholars of global health based in Africa are increasingly offering challenges to the frequent positioning of African patients and study-participants as either invisible, or disempowered, in understanding and shaping their own lived experiences of health in a transnational context.
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Affiliation(s)
- Mandisa Mbali
- Department of Historical Studies, University of Cape Town, Cape Town, South Africa
| | - Jessica Rucell
- Department of Sociology, University of Cape Town, Cape Town, South Africa
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Denardo D, Mojola SA, Schatz E, Gómez-Olivé FX. Antiretroviral therapy and aging as resources for managing and resisting HIV-related stigma in rural South Africa. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100148. [PMID: 36687383 PMCID: PMC9851406 DOI: 10.1016/j.ssmqr.2022.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The widespread roll-out of antiretroviral therapy (ART) in Africa has contributed to a large population of adults aging with HIV. However, little is known about how HIV-related stigma interacts with aging in the ART era. This study uses in-depth interviews with middle-aged and older South Africans living with HIV to explore stigma-related experiences and response strategies. Participants describe a persistence of stigma which requires the deployment of a range of common and age-based stigma management and resistance strategies. We find that participants minimize their exposure to stigma through selective disclosure of their HIV status; neutralize HIV-related stigma through comparisons to chronic illnesses common among older adults, and deflect stigma through asserting an ART-adherent identity and othering younger non-adherent adults. Overall, our study highlights the roles of ART and aging as resources for managing and resisting HIV-related stigma.
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Affiliation(s)
- Danielle Denardo
- Social and Behavioral Sciences, Soka University of America, Aliso Viejo, CA, USA
| | - Sanyu A. Mojola
- Department of Sociology, School of Public and International Affairs, Office of Population Research, Princeton University, Princeton, NJ, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa
| | - Enid Schatz
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa
- Department of Public Health and Department of Women’s & Gender Studies, University of Missouri, Columbia, MO, USA
| | - F. Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa
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Mojola SA, Angotti N, Schatz E, Houle B. "A NOWADAYS DISEASE": HIV/AIDS AND SOCIAL CHANGE IN A RURAL SOUTH AFRICAN COMMUNITY. AJS; AMERICAN JOURNAL OF SOCIOLOGY 2021; 127:950-1000. [PMID: 35967824 PMCID: PMC9365075 DOI: 10.1086/718234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Why do some people adapt successfully to change while others do not? We examine this question in the context of a severe HIV/AIDS epidemic in South Africa, where adapting (or not) to social change has borne life and death consequences. Applying an age-period-cohort lens to the analysis of qualitative life history interviews among middle-aged and older adults, we consider the role of the life course and gendered sexuality in informing Africans' strategies of action, or inaction, and in differentially driving and stalling change in each cohort in response to the HIV/AIDS epidemic. Our study illuminates the unique challenges of adapting to social change that result from dynamic interactions among aging, prevailing social structures, and a cohort's socio-historical orientation to a new period.
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Affiliation(s)
- Sanyu A Mojola
- Princeton University and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Angotti
- American University and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Enid Schatz
- University of Missouri Columbia and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Brian Houle
- The Australian National University and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Schatz E, Knight L, Belli RF, Mojola SA. Assessing the feasibility of a life history calendar to measure HIV risk and health in older South Africans. PLoS One 2020; 15:e0226024. [PMID: 31940307 PMCID: PMC6961824 DOI: 10.1371/journal.pone.0226024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/19/2019] [Indexed: 11/18/2022] Open
Abstract
Life history calendars capture patterns of behavior over time, uncovering transitions and trajectories. Despite the growing numbers of older persons living with HIV in southern Africa, little is known about how HIV testing and risk unfold in this population. Operationalizing a life course approach with the use of an innovative Testing and Risk History Calendar [TRHC], we collected pilot data on older South Africans' risk and HIV testing. We found older persons were able to provide (1) reference points to facilitate recall over a 10-year period, (2) specifics about HIV tests during that decade, and (3) details that contextualize the testing data, such as living arrangements, relationships, and health status. Interviewer debriefing sessions after each interview captured information on context and links across domains. On a larger scale, the TRHC has potential to reveal pathways between sexual behavior, HIV testing and risk perception, and health at older ages.
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Affiliation(s)
- Enid Schatz
- Department of Public Health, University of Missouri, Columbia, Missouri, United States of America
- MRC/Wits Rural Health and Health Transitions Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia Knight
- School of Public Health, University of the Western Cape, Belville, South Africa
| | - Robert F. Belli
- Department of Psychology, University of Nebraska, Lincoln, Nebraska, United States of America
| | - Sanyu A. Mojola
- Department of Sociology, Princeton University, Princeton, New Jersey, United States of America
- Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey, United States of America
- Office of Population Research, Princeton University, Princeton, New Jersey, United States of America
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