A comprehensive programme addressing HIV/AIDS and gender based violence

A survey was administered to 304 respondents participating from three areas near Welkom, South Africa. Face-toface interviews were conducted with women from randomly selected households to evaluate the impact of a service provision programme targeting women living with HIV/AIDS and gender based violence. Gender based violence (GBV) awareness and knowledge was high. Respondents had high perceived levels of risk. They reported making various behavioural changes to avoid GBV. The respondents were aware of their legal rights pertaining to GBV. HIV/AIDS knowledge levels and attitudes were acceptable. Behavioural changes included condom use, abstinence and being faithful to one partner. Disclosure of HIV was lower than disclosure of GBV.Awareness and knowledge of female condoms were high, yet usage low. Participants reported that they would be able to introduce condoms to a relationship and negotiate usage with relative ease. Perceived levels of GBV and HIV were high, and stigma levels towards the affected women were also relatively high. The awareness and knowledge levels of GBV and HIV of older respondents were lower than younger respondents. The key findings of this study support the notion of using a holistic approach, targeting more than one issue. There is lower stigma levels associated with combined conditions, which might allow easier access to vulnerable groups. Coordination and collaboration of services are however needed to enable this benefit.     

Development and implementation of an HIV/AIDS case management outcomes assessment programme

The Case Management Section of the New York State Department of Health AIDS Institute coordinates the provision of case management services for people living with HIV/AIDS throughout the state. The Community Follow-Up Program (CFP), providing intensive case management for HIV-positive individuals and their families, operates under the auspices of the Case Management Section. This article focuses on a public/private outcomes assessment partnership, sponsored by the Case Management Section, and developed in conjunction with a team of CFP programme managers from across the state. The process used to develop outcome indicators and measures is described; challenges encountered along the way are detailed; and suggestions for other public/private partnerships are outlined. Results from two years of outcomes data collection are also presented. The article concludes that the inclusion of providers in the identification and measurement of desired outcomes can help overcome provider resistance to outcomes assessment and can help ensure that outcomes data are used to improve programme performance.     

Use and neglect of best-practice HIV/AIDS programme guides by South African companies

Numerous guidelines set out best-practice policies for HIV/AIDS interventions in the workplace. This study analysed 14 recognised codes and guidelines to gain an understanding of the theoretical consensus regarding the key components of best-practice workplace HIV/AIDS interventions. Nine key components of best practice were drawn from the analysis; interviews aimed to verify these components by determining the extent to which HIV/AIDS practitioners in South Africa share a similar understanding of best practice. Participants in a research questionnaire and semi-structured interviews included managers responsible for company HIV/AIDS programmes, HIV/AIDS experts, consultants, and disease management service providers. There was a high level of agreement between the practitioners who were interviewed and the codes and guidelines that were analysed concerning what best practice entails. However, reported usage of the recognised codes and guidelines to inform workplace HIV/AIDS interventions was low. Although large companies in South Africa may recognise certain interventions as examples of best practice, it appears that these are not being readily implemented. This appears to be partly because the cost-benefit of a recommended intervention is not immediately apparent or conclusive, and also because the concept of best practice with respect to workplace HIV/AIDS interventions is not yet fully accepted.     

HIV/AIDS and TB: contextual issues and policy choice in programme relationships

Tuberculosis (TB) and HIV/AIDS affect each other closely. Given the rapid spread of the HIV-driven TB epidemic worldwide, the case for establishing some form of relationship between control activities for HIV/AIDS and TB is clear. However, the question 'how' has not been resolved satisfactorily. TB and HIV/AIDS programmes have traditionally maintained their own management, supervision, funding flows and specialist boundaries. This article explores opportunities and challenges for collaboration between the two, through drawing on the expertise in organization and management, policy analysis and disease control of both TB and HIV/AIDS. Based on an extensive literature review, the article investigates how contextual issues affect the design of a collaboration; what the organizational options are; and what impact a collaboration would have. A universal model for organizational change is unlikely and changes may present as both solutions and contradictions. Careful planning and consultation are required before implementing the changes, in order to avoid jeopardizing the function and effectiveness of both disease control programmes and the health service system.     

Kompetenznetz HIV/AIDS

Thanks to a nationwide network of specialized, clinic-associated outpatient facilities and competent registered physicians, the quality of care for HIV-infected patients in Germany is high. Although basic HIV research is also well advanced in several centers, in contrast Germany's clinical HIV research is barely discemable on an international level. This deficit is primarily due to a lack of clinical studies involving patients from across the country and the fact that no national patient cohort system exists which could provide a basis for such clinical studies. The competence network HIV/AIDS aims to overcome this shortcoming by serving as a comprehensive, nationwide research alliance. The established patient cohort is linked to 13 projects. The infrastructure required for communications and data exchange will be based on a telematics platform. There will also be various service facilities established within the network, creating an organizational structure to promote the horizontal exchange of information between centers, as well as establish the vertical exchange of knowledge between physicians, patients, public health policy makers, and the general public.     

Kompetenznetz HIV/AIDS

Germany's clinical HIV research efforts are underrepresented on an international level. This deficit is primarily due to a lack of clinical studies involving patients from across the country and the fact that no national patient cohort system exists in Germany which could provide a basis for such clinical studies. The competence network HIV/AIDS is filling this shortcoming by serving as a comprehensive, nationwide research alliance. The establishment of a patient cohort is linked to 20 projects. The success of this new structure is becoming visible.     

HIV/AIDS epidemiology

In this paper, Charles Todd comments that the report of Evan Wood and colleagues illustrates the dangers of taking a narrow medical view of the HIV/AIDS epidemic in Africa. It runs the risk of reversing the growing realization that the HIV/AIDS epidemic in southern Africa is a broad, social, cultural, political, and economic issue rather than a purely medical one. Todd raises the point that Wood and colleagues did not model the costs associated with the voluntary testing and counseling that should accompany a prophylaxis program. To this effect, a more helpful approach on meeting basic health needs and eradicating poverty would be to compare the impact of such levels of expenditure. It is also emphasized that the title of the paper of Wood and colleagues is misleading, implying that the focus of the modeling was sub-Saharan Africa as a whole, when it was in fact South Africa alone. Accordingly, the gross domestic product of South Africa per person is higher than that of nearly all other sub-Saharan African countries, and health expenditure is 10-20 times greater.     

Behavioural change in injecting drug users: evaluation of an HIV/AIDS education programme

The results obtained from the training and follow-up of 189 IDUs who participated in a programme consisting of an audiovisual presentation, pre-/post-testing and individual counselling are presented. Syringe sharing decreased from 35% at initial contact to 12% after 6 months. Sexual behaviour proved more resistant to change. However, condom use in at-risk situations increased from 49% to 70%. IDUs under continuous methadone treatment were less likely to engage high risk drug injecting practices than the other IDUs. Results indicate that an educational programme addressed toward risk reduction may determine relevant behavioural change among IDUs.     

HIV/AIDS patient satisfaction with a food assistance programme in Sofala province,Mozambique

Food insecurity is one of the main factors affecting access and adherence to antiretroviral treatment (ART) in middle- and low-income countries. To mitigate this problem, food assistance interventions are being integrated in ART programmes. As evidence of effectiveness of these interventions has been mixed, evaluating their implementation is important. We measured the satisfaction of HIV/AIDS patients with a food assistance programme in Sofala province in Mozambique. This was an observational study that used a combination of qualitative and quantitative methods. HIV/AIDS patients receiving food assistance took part in focus group discussions (FDGs) and completed a semi-structured questionnaire about their opinions about the programme. Data were analysed using content and factor analysis, percentages of the maximum attainable scores (PMAS) and regression. Patients were satisfied with food assistance and rated it well above 60% of PMAS. Four factors were identified as underlying factors of satisfaction with food assistance. From these factors, patients were satisfied with 2, product availability and the distribution process, and rated these above 60%. They were dissatisfied with the other 2, quantity of products and the enrolment period, and rated these below 60%. From the four factors, only the distribution process was significantly associated with satisfaction with food assistance (p = 0.001). Satisfaction and the helpfulness of food assistance in adherence to ART, as perceived by patients, were significantly associated (p < 0.001). Patients were satisfied with food assistance. Programme managers should focus on the distribution process, quantity of products and enrolment period to further improve satisfaction of patients receiving food assistance.     

Financing of HIV/AIDS programme scale-up in low-income and middle-income countries, 2009-31

As the global HIV/AIDS pandemic nears the end of its third decade, the challenges of efficient mobilisation of funds and management of resources are increasingly prominent. The aids2031 project modelled long-term funding needs for HIV/AIDS in developing countries with a range of scenarios and substantial variation in costs: ranging from US$397 to $722 billion globally between 2009 and 2031, depending on policy choices adopted by governments and donors. We examine what these figures mean for individual developing countries, and estimate the proportion of HIV/AIDS funding that they and donors will provide. Scenarios for expanded HIV/AIDS prevention, treatment, and mitigation were analysed for 15 representative countries. We suggest that countries will move in increasingly divergent directions over the next 20 years; middle-income countries with a low burden of HIV/AIDS will gradually be able to take on the modest costs of their HIV/AIDS response, whereas low-income countries with a high burden of disease will remain reliant upon external support for their rapidly expanding costs. A small but important group of middle-income countries with a high prevalence of HIV/AIDS (eg, South Africa) form a third category, in which rapid scale-up in the short term, matched by outside funds, could be phased down within 10 years assuming strategic investments are made for prevention and efficiency gains are made in treatment.     

Rural HIV/AIDS Services

Abstract

An exploratory study to investigate the needs of those living with HIV disease to determine related service challenges was conducted in 1997 and replicated in 1999. This study utilized qualitative and quantitative measures, surveyed both individuals who are living with HIV disease and HIV/AIDS service providers in predominately rural counties of a midwest -ern state with a low incidence of HIV infection. Respondents' perceptions were solicited regarding existing services in the areas of: (1) awareness; (2) satisfaction; and (3) gaps and barriers. Findings indicate: (1) the critical role AIDS service organizations have in rural service delivery; (2) service awareness is much stronger among those living with HIV disease than HIV/AIDS service providers; (3) satisfaction with available services is growing; and (4) there is a widening gap between important needs and available services.     

HIV/AIDS in adolescence

Adolescents are among the fastest growing populations of HIV-infected persons. Their access to adequate health care is complicated by their age, their financial resources, medical consent laws, and the societal demands placed on them. Also, little research has been done to determine the most effective treatment approach for HIV-positive adolescents. HIV disease progression in young people is described, along with the barriers to care. How to approach treatment options for HIV-positive adolescents is examined. A list of organizations that deal with adolescent treatment and prevention is provided. Contact information is also provided.