The natural resource curse and the spread of HIV/AIDS, 1990–2008

Experts suggest that effective public action can prevent the spread of HIV/AIDS. Countries dependent on natural resource wealth, such as oil, are likely to suffer from governance failures and thereby suffer lower quality public health. Since the cost of fighting disease redistributes income away from rulers, resource wealth is likely to lead to neglect of public action aimed at stemming a deadly disease. We test this proposition in 137 countries from 1990 until 2008 using oil wealth as a proxy for endogenous policy choices on the prevalence of HIV/AIDS, a proxy outcome for ineffective policy and neglect of public action. We find that the ‘resource curse’ seems to affect the spread of HIV/AIDS, even though oil-rich countries ceteris paribus should have more financial resources for effective public action. The results are robust to a host of controls, alternative indicators, and fixed effects estimation.     

AIDS in Black and White: The Influence of Newspaper Coverage of HIV/AIDS on HIV/AIDS Testing Among African Americans and White Americans, 1993–2007

This study examined the effect of newspaper coverage of HIV/AIDS on HIV testing behavior in a U.S. population. HIV testing data were taken from the Center for Disease Control and Prevention's National Behavioral Risk Factor Surveillance System from 1993 to 2007 (N = 265,557). The authors content-analyzed news stories from 24 daily newspapers and 1 wire service during the same time period. The authors used distributed lagged regression models to estimate how well HIV/AIDS newspaper coverage predicted later HIV testing behavior. Increases in HIV/AIDS newspaper coverage were associated with declines in population-level HIV testing. Each additional 100 HIV/AIDS-related newspaper stories published each month was associated with a 1.7% decline in HIV testing levels in the subsequent month. This effect differed by race, with African Americans exhibiting greater declines in HIV testing subsequent to increased news coverage than did Whites. These results suggest that mainstream newspaper coverage of HIV/AIDS may have a particularly deleterious effect on African Americans, one of the groups most affected by the disease. The mechanisms driving the negative effect deserve further investigation to improve reporting on HIV/AIDS in the media.     

The 2015 long-term care reform in the Netherlands: Getting the financial incentives right?

In 2015 the system of long-term care (LTC) financing and provision in the Netherlands was profoundly reformed. The benefits covered by the former comprehensive public LTC insurance scheme were split up and allocated to three different financing regimes. The objectives of the reform were to improve the coordination between LTC, medical care and social care, and to reinforce incentives for an efficient provision of care by making risk-bearing health insurers and municipalities responsible for procurement. Unintentionally, the reform also created a number of major incentive problems, however, resulting from the way: (i) LTC benefits were split up across the three financing regimes; (ii) the various third party purchasers were compensated; and (iii) co-payments for the beneficiaries were designed. These incentive problems may result in cost shifting, lack of coordination between various LTC providers, inefficient use of LTC services and quality skimping. We discuss several options to get the financial incentives better aligned with the objectives of the reform.     

Preventing the high-risk sexual behavior of adolescents: focus on HIV/AIDS transmission, unintended pregnancy, or both?

Adolescents are at high risk for negative health outcomes associated with unprotected sexual intercourse including infection with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and unintended pregnancy. That unprotected sexual intercourse is the risk behavior common to both problems has not been fully capitalized on in prevention programs. Limited knowledge about the effects of type-of-outcome expectancy (i.e., disease vs. pregnancy) on the association between risk perceptions and precautionary or health-protective sexual behavior makes it difficult to determine what preventive approach would be most effective with adolescents. The literature suggests that pregnancy prevention is a greater concern for adolescents than disease prevention. This review focuses on the implications of these differential risk perceptions for HIV/AIDS prevention programs targeting adolescents.     

Institutional commitment and HIV/AIDS: Lessons from the first 3 years of the Lesotho–Boston University Collaboration

Abstract

In mid-2003, Boston University made a decade long institutional commitment to collaborate with the Government of Lesotho as it grappled with the human resource implications of the HIV/AIDS epidemic. The collaboration is a work in progress. We explore the rationale for the University's commitment, detail the development of the relationship between the Government and the University, review the principles that guide the collaboration, report on the activities, results, and challenges to date, and conclude with a look toward the future. We stress the importance of six principles: trust, mutual respect, shared interests, a long time horizon, sustainability, and a country-driven agenda. Although technical or programme content is important, long-term results of value are difficult to achieve if these principles are not honoured.     

Emotional Development and Nutritional Status of HIV/AIDS Orphaned Children Aged 6–12 Years Old in Thailand

Objective To explore the emotional development and nutritional status of HIV/AIDS orphans by their infection status. Methods A community-based cross-sectional survey was conducted during January and December 2005 in four provinces and Bangkok Metropolis where the prevalence of HIV/AIDS among pregnant women was high. The study population consisted of 388 HIV/AIDS orphans who were maternal or paternal or double orphans aged 6–12 years old. The orphans’ main caregivers gave informed consent to the project and assessed the emotional development of their orphaned children. The children were measured for weight, height, and emotional development by standard instruments. They were divided into three groups regarding their HIV/AIDS infection status reported by their caregivers: infected, non-infected, and unknown. The χ² test was used to determine the association between nutritional status and infection status. Results Regarding HIV/AIDS infected children, 19.1% were infected, 57.5% were not infected, and 23.4% were unknown. The main caregivers of all types of orphans were grandparents. Only 13.7% of infected orphans lived with their mothers. Most caregivers were females and more than 40 years old. Infected orphans had mean scores of overall emotional development and for each domain less than other groups. The mean scores of self-control and quick recovery were significantly different between infected and non-infected groups (P-value < 0.05). Nearly 50% of infected orphans were rather short and approximately 42% were under weight and light. The findings revealed a significant association between height for age, weight for age and infection status of orphans at a P-value of <0.001. Conclusions Orphanhood itself is a vulnerable status and HIV/AIDS infected orphans are most vulnerable. Acceptable and friendly services for orphans and their families are crucial. The services should continue and protect stigmatization.     

Does Autonomy Require Freedom? The Importance of Options in International HIV/AIDS Research

This paper analyses the way in which being in possession of an adequate range of options is an essential component of autonomy. I discuss the way in which the conceptualisation of options in terms of basic rights might assist this argument, and apply these ideas to HIV/AIDS clinical research in the developing world. Finally, I suggest that mechanisms should be put in place through which vulnerable research participants can express their views about the relationship between the research in which they are involved, and needs of a worthwhile life.     

The fight against sexually transmitted diseases in Ivory Coast: what strategies can we use in the face of HIV/AIDS?

In the AIDS era, sexually transmitted diseases (STDs) have become a major health problem in developing countries, particularly in Africa. Delays in the diagnosis and treatment of such infections may result in complications, many of which primarily affect women. Epidemiological studies in Abidjan have shown that more than 10% of the pregnant women attending antenatal clinics present STDs potentially serious for their own health or that of their infants (gonorrhea, chlamydia infection, genital ulcers or active syphilis). There is evidence that STDs increase the transmission of HIV and that improving the syndromic management of STDs reduces the incidence of HIV infection. This provides a strong argument in favor of controlling STDs in areas of high HIV prevalence. In Ivory Coast, as in other African countries, a STD control program has been integrated into the AIDS control program since 1992, as recommended by the World Health Organization. During the first six years of the STD program, considerable progress was made in some areas, but not without difficulty. Simple syndrome-based decision trees have been adopted for the management of STDs in primary health care. Clinical studies have shown these therapeutic algorithms to be effective. At the same time, effective and affordable drugs for treating STDs were added to the list of essential drugs in Ivory Coast, after an international invitation to tender. The entire staff of the public health sector in Abidjan has been trained in syndromic STD management. Training is now being extended to other parts of Ivory Coast, including the private health sector and, in particular, private nurses. The surveillance of syndromic STDs, mainly genital ulcers in both sexes and urethral discharge in men, facilitates monitoring and evaluation of the STD program, following health care activities and adapting orders for drugs for treating STDs to real needs. In the near future, some parts of the STD program will be strengthened, particularly the management of sexual partners of STD patients and reduction of the cost of STD treatment for pregnant women.     

Decentralisation of Brazil’s HIV/AIDS programme: intended and unintended consequences

ABSTRACT

Brazil’s response to the HIV/AIDS epidemic was characterised by an innovative alliance of governmental and non-governmental actors inspired by a strong progressive tradition in public health. Brazil eventually moved to decentralise HIV/AIDS programmes to its states and cities, a policy endorsed and supported financially by the World Bank as consistent with the mix of public and private elements central to the country’s HIV/AIDS strategy. However, decentralisation has not provided the results anticipated. Through interviews with key informants, government officials and patient advocates as well as observation of treatment sites, we outline how the shift of administration and resources to state and municipal bodies operated in practice. The Bank promoted decentralisation as an uncontroversial technical matter, and its programmatic guidelines implied that the nonprofit sector would be strengthened by it. However, instead of bringing HIV/AIDS policy closer to the grassroots, decentralisation has undermined the country’s early work and opened the door to a rejuvenated epidemic by empowering unsympathetic local elites, marginalising the human rights focus, and removing federal oversight. Its experience holds crucial lessons for developing countries facing similar conditions.     

The burden of invasive meningococcal disease in the Netherlands, 2011–2020

IntroductionRepresentative information on disease course and outcome of invasive meningococcal disease (IMD) is important because of the shift in meningococcal epidemiology that recently occurred in the Netherlands. With this study, we update earlier research on the burden of IMD in the Netherlands.Material and methodsWe performed a retrospective study using Dutch surveillance data on IMD from July 2011 to May 2020. Clinical information was collected from hospital records. The effect of age, serogroup, and clinical manifestation on disease course and outcome was assessed in multivariable logistic regression analyses. Grouping of infecting isolates was performed by Ouchterlony gel diffusion or by PCR.ResultsClinical information was collected for 278 IMD cases of which the majority had IMD-B (55%), followed by IMD-W (27%), IMD-Y (13%), and IMD-C (5%). Most patients presented with meningitis (32%) or sepsis (30%). Hospitalisation for ≥ 10 days was most frequent among 24–64 year olds (67%). ICU admission was highest among 24–64 year olds (60%), and in case of sepsis (70%), or sepsis plus meningitis (61%). Sequelae at discharge was lower for patients with mild meningococcaemia compared to patients with sepsis plus meningitis (OR: 0.19, 95% CI: 0.07–0.51). The overall case fatality rate was 7%, and was highest for IMD-Y (14%) and IMD-W (13%) patients.ConclusionsIMD remains a disease with high morbidity and mortality. Sepsis (with or without meningitis) is associated with a more severe disease course and outcome compared to other clinical manifestations. The high disease burden can be partly prevented by meningococcal vaccination.     

The epidemiology of self-defense gun use: Evidence from the National Crime Victimization Surveys 2007–2011

ObjectivesTo describe the epidemiology of self-defense gun use (SDGU) and the relative effectiveness of SDGU in preventing injury and property loss.MethodsData come from the National Crime Victimization Survey for 2007–2011, focusing on personal contact crimes. For property loss, we examined incidents where the intent was to steal property. Multivariate analyses controlled for age, gender of offender and victim, if offender had a gun, urbanicity, and thirteen types of self-protective action.ResultsOf over 14,000 incidents in which the victim was present, 127 (0.9%) involved a SDGU. SDGU was more common among males, in rural areas, away from home, against male offenders and against offenders with a gun. After any protective action, 4.2% of victims were injured; after SDGU, 4.1% of victims were injured. In property crimes, 55.9% of victims who took protective action lost property, 38.5 of SDGU victims lost property, and 34.9% of victims who used a weapon other than a gun lost property.ConclusionsCompared to other protective actions, the National Crime Victimization Surveys provide little evidence that SDGU is uniquely beneficial in reducing the likelihood of injury or property loss.