Identifying and addressing the governance accountability problem

Successive global health crises – from HIV and AIDS to SARS and H5N1 to Ebola – highlight one of the most pressing challenges to global health security: the GAP – the governance accountability problem. Introduced in 2014 in the book entitled, HIV/AIDS and the South African state: The responsibility to respond, this article takes up Alan Whiteside’s challenges, in a book review in these pages, to offer a more comprehensive analysis of the GAP. The GAP [?ehovi?, A. B. (2014). HIV/AIDS and the South African state: The responsibility to respond. Ashgate Global Health.] posits that there is a disconnect between ad hoc, state and non-state interventions to respond to an epidemic crisis, and the ultimate guarantee for health (security), which remains legally vested with the state. The existence and expansion of such ad hoc solutions result in a negligence: a failure of re-ordering of health rights and responsibilities for health between such actors and the accountable state. The GAP aims to highlight this disjunction. This article first defines the GAP. Second, it asks two questions: First, what is the contribution of the GAP thesis to understanding the emerging health security landscape? Second, what can the GAP offer in terms of practical insight into viable solutions to the re-ordering of state/non-state-based responsibility and accountability for global health security?     

Developing country health systems and the governance of international HIV/AIDS funding

Donor country initiatives for the prevention and mitigation of HIV/AIDS are not a matter of simple burden sharing. Instead, they have brought in their wake many of the complexities and unforeseen effects that have long been associated with more general overseas development assistance. In the case of funding directed toward HIV/AIDS, these effects are by no means either secondary or easily calculable. It is widely acknowledged that there is no consensus framework on how these impacts may be defined, no framework/toolkit for the evaluation of impacts and no longitudinally significant data that could provide the substance for those evaluations. The subject of this study focuses not on the health outcomes of funding but on how donor-recipient relations could be better deliberated, negotiated and coordinated. We argue that effective leadership and governance of developing country health systems for HIV/AIDS work requires a reconfiguration of how donor-recipient relations are conceived and contracted, and for this purpose, we propose an adaptation of the Organisation for Economic Co-operation and Development Paris Declaration principles of aid effectiveness.     

Global governance and the broader determinants of health: A comparative case study of UNDP’s and WTO’s engagement with global health

This comparative case study investigated how two intergovernmental organisations without formal health mandates – the United Nations Development Programme (UNDP) and the World Trade Organization (WTO) – have engaged with global health issues. Triangulating insights from key institutional documents, ten semi-structured interviews with senior officials, and scholarly books tracing the history of both organisations, the study identified an evolving and broadened engagement with global health issues in UNDP and WTO. Within WTO, the dominant view was that enhancing international trade is instrumental to improving global health, although the need to resolve tensions between public health objectives and WTO agreements was recognised. For UNDP, interviewees reported that the agency gained prominence in global health for its response to HIV/AIDS in the 1990s and early 2000s. Learning from that experience, the agency has evolved and expanded its role in two respects: it has increasingly facilitated processes to provide global normative direction for global health issues such as HIV/AIDS and access to medicines, and it has expanded its focus beyond HIV/AIDS. Overall, the study findings suggest the need for seeking greater integration among international institutions, closing key global institutional gaps, and establishing a shared global institutional space for promoting action on the broader determinants of health.     

成本-效果分析在艾滋病预防干预措施经济学评价中的应用

成本-效果分析已经越来越多地用于卫生相关项目的评价，为卫生资源合理配置与利用提供决策依据。现介绍成本-效果分析方法在世界各国艾滋病预防干预资源分配中的应用，并讨论艾滋病干预成本-效果分析中存在的方法学问题，以期为我国进行艾滋病预防干预措施成本-效果分析提供借鉴。     

The impacts of AIDS movements on the policy responses to HIV/AIDS in Brazil and South Africa: A comparative analysis

Abstract

Brazil and South Africa were among the first countries profoundly impacted by the HIV/AIDS epidemic and had similar rates of HIV infection in the early 1990s. Today, Brazil has less than 1% adult HIV prevalence, implemented treatment and prevention programmes early in the epidemic, and now has exemplary HIV/AIDS programmes. South Africa, by contrast, has HIV prevalence of 18% and was, until recently, infamous for its delayed and inappropriate response to the HIV/AIDS epidemic. This article explores how differing relationships between AIDS movements and governments have impacted the evolving policy responses to the AIDS epidemic in both countries, including through AIDS programme finance, leadership and industrial policy related to production of generic medicines.     

服务行业女性从业人员性病、艾滋病认知调查

目的了解深圳市某娱乐场所从业人员的人口学状况、行为特征及对HIV／AIDS相关知识的知晓程度。方法利用随机抽样方法，对深圳市某社区13家娱乐场所的245名女性从业人员进行性病、艾滋病知识的宣传教育；教育前后进行现场调查。结果首次性生活年龄最小13岁、最大25岁，中位数19岁；曾自愿接受HIV抗体检测占9．2％；经常使用安全套的仅占13．6％；教育前：HIV／AIDS相关知识知晓率2．0％（5／245）；HIV/AIDS经性传播相关知识知晓率22．0％（54／245）；教育后：HIV/AIDS相关知识知晓率16．7％（41／245）；HIV／AIDS经性传播相关知识知晓率35．5％（81／245）。结论娱乐场所从业人员对性病、艾滋病相关知识的了解和安全性行为的认知度低。有必要加强教育，以减少该人群性病和艾滋病的发生。遏制性病、艾滋病由高危人群向一般人群的蔓延。     

Disciplined appetites: Reimagining food and nutrition programs for people living with HIV and AIDS

Aims

Medical nutrition therapy is recommended for people living with HIV/AIDS to improve health and wellness; however, there is a lack of food and nutrition programs for people living with HIV/AIDS in Nova Scotia, Canada. The aim of this study was to explore the beliefs, values, and experiences of people living with HIV/AIDS in relation to food and nutrition programs.

Methods

A critical social theory lens with two disciplinary contexts: critical health geography and critical dietetics guided this research. Semi-structured interviews were conducted with 12 people living with HIV/AIDS and analysed for themes.

Results

The three main themes were identified: (1) intersections of social determinants of health, wellness, and food security; (2) discursive shaping of food and nutrition in relation to HIV; and (3) the dynamic nature of HIV care.

Conclusions

Participants offered recommendations on how food and nutrition programs might be reimagined to be more accessible, inclusive, and effective for people living with HIV/AIDS.     

Students and their parental attitudes toward the education of children affected by HIV/AIDS: a cross‐sectional study in AIDS prevalent rural areas,China

Objective : To investigate the prevalence and determinants of student and parental attitudes toward the education of children affected by HIV/AIDS in areas of rural China where AIDS is prevalent. Methods : A cross‐sectional study of a random sample of students (n=732) and their parents (n=732) conducted in April 2010, using a questionnaire and in‐depth interview. Results : Twenty‐six per cent of students and 29% of parents had a ‘good’ attitude toward the education of children affected by HIV/AIDS. Following adjustment for sociodemographic characteristics, students’ attitudes were significantly associated with knowledge of HIV/AIDS non‐transmission (adjusted odds ratio [aOR]= 3.13) and their parents’ attitudes (aOR= 2.38), but not with knowledge of HIV/AIDS transmission, prevention or their parents’ knowledge. Parents’ attitudes were significantly associated with knowledge of HIV/AIDS non‐transmission (aOR= 2.12) and their children's attitudes (aOR= 2.52), but not with knowledge of HIV/AIDS transmission, prevention or their children's knowledge. Conclusion : Stigma and discrimination undermine the right to education of HIV/AIDS‐affected children in rural China. Improving non‐transmission knowledge may improve caring attitudes. Implications : HIV/AIDS public health educational campaigns highlighting non‐transmission and extending family education, combined with school education, may help to enhance an environment of non‐discrimination and safeguard public support programs for the right to education of children affected by HIV/AIDS.     

Economic sanctions and child HIV

Approximately 1.8 million children under age 15 were living with HIV. This study is the first to empirically examine the impact of sanctions on children's new HIV infection and AIDS‐related death rates. Using sanction and HIV/AIDS data that are available for 71 developing countries from 1990 to 2012, this study reveals that sanctions increase children's new HIV infection and their AIDS‐related death rates. This study increases understanding about the consequences of sanctions, especially their effect on a marginalized population and is in line with previous literature. The significant impacts of sanctions on children's HIV/AIDS suggest that the leader in a country targeted by sanctions needs to consider extending programs to respond to children's HIV/AIDS both during sanctioning and after it is lifted.     

The social meanings of death from HIV/AIDS: An African interpretative view

Death from HIV/AIDS is increasingly common in Kenya. However, the ways in which people diagnosed with HIV/AIDS and society more generally make sense of this kind of death has been little investigated. By analysing accounts from a sample of fourteen heterosexual people diagnosed HIV positive and presented for treatment in four specialized clinics in Nairobi, and other accounts elicited from members of the clergy and lay persons, this paper examines how people make sense of death from HIV/AIDS. To be infected by HIV equates to death, and because AIDS acts as a metaphor for moral and physical contamination, HIV infection confers on the individual a spoilt image and identity. This image and identity is projected into life beyond physical death, and is reinforced, popularized and legitimized by Christian and African religious schema in such a way that death from HIV/AIDS is now constructed and experienced as 'permanent'. This kind of death has implications for the way in which people living with HIV/AIDS seek treatment and manage an HIV seropositive status. It is also relevant to an understanding of the ways in which funerals and burials for people dying of HIV/AIDS are now being organized in Kenya.