Rapid health impact appraisal of eviction versus a housing project in a colony-dwelling Roma community

BACKGROUND: During implementation of a community development project involving a severely disadvantaged Roma community, the community was threatened with eviction. Two scenarios, eviction with placement on the waiting list for social housing versus a replacement housing development, were identified and specified. A health impact assessment (HIA) was carried out to inform subsequent negotiations. AIMS: To assess the health effects of eviction in comparison with that of a housing project for a Roma community; to make recommendations on short-term and long-term benefits of the two scenarios in order to inform the local government; and to develop a demonstration HIA that can act as a model for other disadvantaged Roma populations. METHOD: A prospective assessment, based on a broad model of health, was carried out to assess health effects of a housing project compared with eviction. By design, it ensured full involvement of members of the community, local decision makers and relevant stakeholders. RESULTS AND CONCLUSION: This HIA identified numerous positive and some probable negative health effects of a housing project. Despite the uncertainty around some of its predicted effects, the overall health benefit of a housing project clearly outweighed that of eviction. Although the immediate financial advantages of eviction for the municipal government are clear, this example provides further evidence to support the adoption of a statutory requirement to assess both economic and health outcomes. It also provides an example that other Roma communities can emulate.     

Routine offer of antenatal HIV testing ("opt-out" approach) to prevent mother-to-child transmission of HIV in urban Zimbabwe

OBJECTIVE: To assess the impact of routine antenatal HIV testing for preventing mother-to-child transmission of HIV (PMTCT) in urban Zimbabwe. METHODS: Community counsellors were trained in routine HIV testing policy using a specific training module from June 2005 through November 2005. Key outcomes during the first 6 months of routine testing were compared with the prior 6-month "opt-in" period, and clients were interviewed. FINDINGS: Of the 4551 women presenting for antenatal care during the first 6 months of routine HIV testing, 4547 (99.9%) were tested for HIV compared with 3058 (65%) of 4700 women during the last 6 months of the opt-in testing (P < 0.001), with a corresponding increase in the numbers of HIV-infected women identified antenatally (926 compared with 513, P < 0.001). During routine testing, more HIV-infected women collected results compared to the opt-in testing (908 compared with 487, P < 0.001) resulting in a significant increase in deliveries by HIV-infected women (256 compared with 186, P = 0.001); more mother/infant pairs received antiretroviral prophylaxis (n = 256) compared to the opt-in testing (n = 185); and more mother/infant pairs followed up at clinics (105 compared with 49, P = 0.002). Women were satisfied with counselling services and most (89%) stated that offering routine testing is helpful. HIV-infected women reported low levels of spousal abuse and other adverse social consequences. CONCLUSION: Routine antenatal HIV testing should be implemented at all sites in Zimbabwe to maximize the public health impact of PMTCT.