Public Health Commons^™

Understanding Barriers To Community Participation In Hiv And Aids Services: Summary Report, Population Council, Health Systems Trust

HIV and AIDS

In 2003, South Africa announced its intention to roll out possibly the largest HIV and AIDS treatment program in the world. Much attention is currently focused on supply-side issues, particularly drug procurement and pricing. Far less attention has been paid to demand for and delivery of treatment, care, and support services. Further, although the role of the community and community organizations is articulated in government policy there has been little active engagement with NGOs on the development of these roles or on how to encourage community organizations to support and participate in the antiretroviral (ARV) rollout. This study collected data …

Reducing Stigma And Discrimination In Hospitals: Positive Findings From India, Vaishali Sharma Mahendra, Laelia Gilborn, Bitra George, Luke Samson, Rupa Mudoi, Sarita Jadav, Indrani Gupta, Shalini Bharat, Celine Daly

HIV and AIDS

People living with HIV (PLHIV) in India face stigma and discrimination in a variety of contexts. Stigma and discrimination against HIV-positive people is common in hospitals and acts as a barrier to seeking and receiving critical treatment and care services. Three New Delhi hospitals, SHARAN, and the Horizons Program collaborated on an operations research project to assess responses to hospital-based stigma and discrimination against PLHIV. A baseline survey to measure HIV/AIDS-related attitudes, knowledge, and practices was conducted in 2000 with a random sample of 884 health workers from four departments: medicine, STD and skin, obstetrics and gynecology, and surgery. Based …

Expanding Pediatric Access To Antiretroviral Therapy In South Africa, Desiree Michaels, Brian Eley, Lewis Ndhlovu, Naomi Rutenberg, Hena Khan

HIV and AIDS

In sub-Saharan Africa, AIDS has become one of the leading causes of death among children under the age of five years. Yet, despite increased availability of antiretroviral therapy (ART), children have been largely ignored or excluded from treatment initiatives. While efforts to get more children on treatment are increasing, important information is lacking to guide program and policy implementation. To address these gaps, the Horizons Program and the University of Cape Town conducted a rapid situational analysis in 2005 of pediatric HIV treatment sites in South Africa. In 2003, the South African government approved a plan for a national HIV …

Yaari Dosti: Young Men Redefine Masculinity, A Training Manual [Hindi], Horizons Program, Coro For Literacy, Mamta, Instituto Promundo

HIV and AIDS

This training manual, developed by the Population Council in collaboration with Instituto PROMUNDO, CORO for Literacy, MAMTA, and DAUD promotes gender equity and addresses masculinity as a strategy for the prevention of HIV. Adapted from the “Program H: Working with Young Men Series” developed in Brazil by Instituto PROMUNDO, it promotes the positive aspects of masculinity, encourages men’s participation in sexual and reproductive health, promotes respect for sexual diversity, and improves understanding of the body and sexuality. In this manual, HIV prevention is addressed within the larger framework of gender roles and relationships. Gender disparity, widely prevalent in Indian society …

Context And Dynamics Of Same-Sex Behavior Among Long-Distance Truckers In India: Findings From Qualitative Research, Vaishali Sharma Mahendra, Ravi K. Verma, Pertti J. Pelto, Sarat Chandra Pradhan, Vibha Singh, Asha Rao, Tarun Vij

HIV and AIDS

It is well established that truckers (drivers and helpers) have higher rates of nonmarital sex than any other occupational group. Because of this multipartner sexual activity, truckers form a key group of prevention efforts for HIV and sexually transmitted infections (STIs). Thus far, HIV/STI prevention interventions for truckers have been geared to providing risk-reduction information and services within a heterosexual context. Recent evidence suggests that a significant number of truckers engage in male-to-male (MSM) sexual activity that has implications for HIV/STI transmission. Therefore, information on the nature and extent of MSM activity among these populations is urgently needed for the …

Context And Dynamics Of Male-To-Male Sexual Behavior Of Truckers In India: Findings From A Multi-Site Qualitative Research Study, Ravi K. Verma, Vaishali Sharma Mahendra, Pertti J. Pelto, Sarat Chandra Pradhan, Vibha Singh

HIV and AIDS

It is well established that truckers (drivers and helpers) have higher rates of nonmarital sex than any other occupational group. Because of this multipartner sexual activity, truckers form a key group for HIV/STI prevention efforts. Thus far, HIV/STI prevention interventions for truckers have been geared to providing risk-reduction information and services within a heterosexual context. Recent evidence suggests that a large number of truckers engage in male-to-male (MSM) sexual activity that has serious implications for HIV/STI transmission. Therefore, information on the nature and extent of MSM activity among these populations is urgently needed for the design and implementation of comprehensive …

Facts About Adolescents From The Demographic And Health Survey—Statistical Tables For Program Planning: Nigeria 2003, Population Council

Poverty, Gender, and Youth

The Population Council initiated its work on adolescents in the mid-1990s. At that time, those advocating greater attention to adolescent issues were concerned about adolescent fertility—particularly outside of marriage—and adolescent “risk-taking” behavior. As an international scientific organization with its mandate centered around the needs of developing countries, the Council sought a more nuanced and context-specific understanding of the problems confronting adolescents in the developing world. In working with colleagues inside and outside the Council, it became clear that information on adolescents, and the way data are organized, were limiting the ability to understand the diversity of their experiences or to …

A Case-Control Study Of Farming And Prostate Cancer In African-American And Caucasian Men, Tamra E. Meyer, Ann L. Coker, Maureen Sanderson, Elaine Symanski

CRVAW Faculty Journal Articles

Objective: To determine the risk of prostate cancer associated with farming by duration, recency and specific activities among African-Americans and Caucasians.

Methods: This population-based case–control study had information on farming-related activities for 405 incident prostate cancer cases and 392 controls matched for age, race and region in South Carolina, USA, from 1999 to 2001. Cases with histologically confirmed, primary invasive prostate cancer who were aged between 65 and 79 years were ascertained through the South Carolina Central Cancer Registry. Appropriately matched controls were identified from the Health Care Financing Administration Medicare Beneficiary File. Data were collected using computer-assisted telephone interviewing, …

Cervical Cancer Survival By Socioeconomic Status, Race/Ethnicity, And Place Of Residence In Texas, 1995–2001, Katherine S. Eggleston, Ann L. Coker, Melanie Williams, Guillermo Tortolero-Luna, Jeanne B. Martin, Susan R. Tortolero

CRVAW Faculty Journal Articles

Objective: The current study explored whether socioeconomic status (SES), race/ethnicity, and rural residence may be linked to poorer cervical cancer survival by stage at diagnosis.

Methods: Data from 7,237 cervical cancer cases reported to the Texas Cancer Registry from 1995–2001 were used to address the association by stage at diagnosis and cause of death. Zip code-level census data were used to classify residence and to develop a composite variable for SES. Multilevel Cox proportional hazards modeling was used to estimate hazard ratios

(HR) and 95% confidence intervals (CI).

Results: Late stage at diagnosis was a strong predictor …

Exploring Current Practices In Pediatric Arv Rollout And Integration With Early Childhood Programs In South Africa: A Rapid Situation Analysis, Desiree Michaels, Brian Eley, Lewis Ndhlovu, Naomi Rutenberg

HIV and AIDS

This Horizons program report describes the status of pediatric HIV treatment in selected sites in South Africa, identifies gaps in service delivery, and proposes recommendations for strengthening services and expanding children’s access to treatment. The study provides much needed information on critical issues of pediatric HIV care, especially regarding health service and contextual issues surrounding the expansion of access to treatment for HIV-infected children, and key factors that facilitate sustainability of treatment by young children. The aims of the study were to identify successful program strategies in pediatric HIV treatment in South Africa and to determine priority knowledge gaps to …

Abcs For Hiv Prevention In Kenya: Messages, Beliefs, And Barriers, Julie Pulerwitz, Tiffany Lillie, Louis Apicella, Ann P. Mccauley, Tobey C. Nelson, Simon Ochieng, Peter Mwarogo, Karusa Kiragu, Edward Kunyanga

HIV and AIDS

A great deal of attention has been focused recently on promoting the “ABCs” of HIV prevention— abstinence or delaying sex, being faithful to one sexual partner or reducing the number of sexual partners, and consistently using condoms during sex. Yet even as programs that focus on the ABCs to prevent sexual HIV transmission are rolled out, questions remain about how well different groups in varied cultural contexts understand the terms, as well as how best to address challenges to adopting the ABC behaviors. The Horizons Program and FHI/IMPACT developed a collaborative research study in 2004 to explore how adults and …

Baseline Household Survey: Jhelum District, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by the United States Agency for International Development (USAID). PAIMAN is committed to assisting the Government of Pakistan in implementing the full spectrum of interventions necessary to address maternal and neonatal health issues. USAID has provided a grant to implement PAIMAN in ten districts of Pakistan’s four provinces. The goal of the project is to reduce maternal, newborn, and child mortality. The project calls for a multipronged and integrated strategic approach combining individual health care with public health and community-based interventions. To ensure that success is properly …

Baseline Survey: Summary Report Of District Sukkur, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

This summary report presents some of the key findings of a 2005 baseline household survey in Sukkur district, one of the ten districts in Pakistan that are the focus of the PAIMAN project. The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by the United States Agency for International Development. The project is committed to assisting the Government of Pakistan in implementing the full spectrum of interventions necessary to address maternal and neonatal health (MNH) issues. PAIMAN district survey results are presented individually for each of the ten districts. PAIMAN developed a monitoring and evaluation plan …

Baseline Household Survey: Jaffarabad District, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by the United States Agency for International Development (USAID). PAIMAN is committed to assisting the Government of Pakistan in implementing the full spectrum of interventions necessary to address maternal and neonatal health issues. USAID has provided a grant to implement PAIMAN in ten districts of Pakistan’s four provinces. The goal of the project is to reduce maternal, newborn, and child mortality. The project calls for a multipronged and integrated strategic approach combining individual health care with public health and community-based interventions. To ensure that success is properly …

Promoting Gender Equity Among Young Brazilian Men As An Hiv Prevention Strategy, Julie Pulerwitz, Gary Barker, Marcio Segundo, Marcos Nascimento

HIV and AIDS

There is growing evidence that social norms that promote unequal gender roles increase young men and women’s risk of HIV/STIs and partner violence. Thus, changing gender norms is increasingly recognized as an important strategy to prevent the spread of HIV infection. Few interventions to promote gender-equitable norms and behaviors among young men have been systematically implemented or evaluated, and little is known about how best to measure changes in gender norms and their effect on HIV/STI protective and risk behaviors. To address these gaps, the Horizons Program and Instituto Promundo examined the effectiveness of interventions designed to improve young men’s …

Understanding The Hiv/Sti Prevention Needs Of Men Who Have Sex With Men In Kenya, Washington Onyango-Ouma, Harriet Birungi, Scott Geibel

HIV and AIDS

Understanding the sexual behaviors of populations who are vulnerable to HIV is an important component in the battle against AIDS. Yet policymakers in developing countries, particularly in Africa, have often overlooked men who have sex with men (MSM) as a vulnerable group because of stigmatization of homosexual behavior and denial of the existence of MSM and the role they may play in HIV transmission. A growing body of literature not only documents the presence of this population in Africa but also the importance of reaching them with information and services to prevent HIV and other sexually transmitted infections (STIs). In …

Pregnancy-Related School Dropout And Prior School Performance In South Africa, Monica J. Grant, Kelly Hallman

Poverty, Gender, and Youth

Using data collected in 2001 in KwaZulu-Natal, South Africa, this working paper examines the factors associated with schoolgirl pregnancy, as well as the likelihood of school dropout and subsequent re-enrollment among pregnant schoolgirls. This analysis triangulates data collected from birth histories, education histories, and data concerning pregnancy to strengthen the identification of young women who became pregnant while enrolled in school and to define discrete periods of school interruption prior to first pregnancy. Given the increasing levels of female school participation in sub-Saharan Africa, our findings suggest that future studies will benefit from exploring the causal relationships between prior school …

Baseline Survey: Summary Report Of District Khanewal, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

This summary report presents some of the key findings of a 2005 baseline household survey in Khanewal district, one of the ten districts in Pakistan that are the focus of the PAIMAN project. The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by the United States Agency for International Development. The project is committed to assisting the Government of Pakistan in implementing the full spectrum of interventions necessary to address maternal and neonatal health (MNH) issues. PAIMAN district survey results are presented individually for each of the ten districts. PAIMAN developed a monitoring and evaluation plan …

Female Genital Mutilation In Kenya: Evidence Links Health Workers To Fgm, Population Council, Gtz

Reproductive Health

Female genital mutilation (FGM) is a traditional practice that affects women and girls in several African countries. It is practiced in a variety of ways, classified by WHO into four broad types all found in Kenya. In some communities it is associated with passage into maturity; in others, it is considered a symbol of ethnic identity, a religious obligation, or a necessary prerequisite for marriage, either through symbolizing attainment of womanhood or as a means of preserving and demonstrating virginity. FGM is considered a harmful traditional practice because it may be associated with a variety of short- and long-term health …

Safe Motherhood Applied Research And Training (Smart) Report 1: Project Overview, Gul Rashida, Peter C. Miller

Reproductive Health

Maternal mortality in Pakistan is believed to be quite high, at about 350–500 maternal deaths per 100,000 live births. Reducing maternal mortality is one of the major objectives of the Government of Pakistan. Interventions required to address maternal mortality include safe motherhood, which means a woman’s ability to have a safe and healthy pregnancy and delivery. The Safe Motherhood Applied Research and Training (SMART) project was an operations research project designed to develop and test interventions to reduce maternal and neonatal mortality in a predominantly rural district of Pakistan. The vast majority of maternal deaths are attributed to delays in …

Comment Mener Un Exercice De Couverture : Outil D'Évaluation Rapide De Programmes Et Services, Carey Meyers, Solene Lardoux

Poverty, Gender, and Youth

Un exercice de couverture (EC) est un instrument d’évaluation simple, économique et rapide pouvant servir à profiler les personnes touchées par un prestataire donné, un groupe de prestataires ou des organisations partageant une clientèle commune dans une zone géographique particulière. Cet instrument a été mis au point pour assister les programmes de jeunesse, mais il peut également être utilisé par d’autres bénéficiaires ayant des services offerts en établissement ou en antenne. L’EC collecte les données relatives à différentes caractéristiques, y compris le sexe, la scolarisation, l’habitat, l’activité rémunératrice et l’état matrimonial des personnes bénéficiant d’un programme ou d’un service. Il …

Como Conduzir Um Exercício De Cobertura: Uma Ferramenta Para A Avaliação Rápida De Programas E Serviços, Carey Meyers, Solene Lardoux

Poverty, Gender, and Youth

Um exercício de cobertura (EC) é uma ferramenta de avaliação rápida, simples e de baixo custo que pode ser utilizado para se obter o perfil das pessoas atingidas por um determinado serviço ou grupo de prestadores de serviços1ou organizações com uma clientela comum atuando numa área geográfica definida. Esta ferramenta foi desenvolvida com o intuito de auxiliar programas de atendimento à juventude, mas a mesma também pode ser utilizada com outros beneficiários. Pode ser empregada para um gama de serviços, tanto os realizados numa clínica ou ambulatório bem como na comunidade. Um EC coleta dados sobre uma variedade de características, …

Cómo Realizar Un Ejercicio De Cobertura: Una Herramienta De Evaluación Rápida Para Programas Y Servicios, Carey Meyers, Solene Lardoux

Poverty, Gender, and Youth

Un ejercicio de cobertura (EC) es una herramienta de evaluación sencilla, rápida y de bajo costo que puede emplearse para perfilar quién está siendo alcanzado por un determinado servicio o grupo de proveedores de servicios u organizaciones con una clientela común que operan dentro de un área geográfica particular. Esta herramienta fue desarrollada para ayudar a los programas que ofrecen servicios a jóvenes; pero puede emplearse igualmente para otros beneficiarios. Se le puede utilizar en una gama de servicios, desde las que operan en instalaciones hasta las de alcance comunitario. Un EC recaba información sobre características diversas—que incluyen género, escolaridad, …

Berhane Hewan ('Light For Eve'): A Program To Support Married And Unmarried Adolescent Girls In Rural Amhara Region, Ethiopia, Population Council

Poverty, Gender, and Youth

Berhane Hewan (meaning “Light for Eve” in Amharic) is a program in rural Amhara region designed to assist unmarried girls by imparting the knowledge, skills, and resources they need to avoid child marriage as well as give support to adolescent girls who are already married. With support from UNFPA, DFID, and the Turner Foundation, the program is implemented by the Ministry of Youth and Sport and the Regional Youth Bureaus, with technical assistance from the Population Council. The program promotes functional literacy, life skills, livelihoods skills, and reproductive health education. In developing the project, the Regional Youth Bureau staff felt …

Fewer And Better-Educated Children: Expanded Choices In Schooling And Fertility In Rural Pakistan, Zeba Sathar, Cynthia B. Lloyd, Minhaj Ul Haque, Mumraiz Khan, Monica J. Grant

Poverty, Gender, and Youth

This report presents the results of a longitudinal study of changing educational opportunities in rural Punjab and N.W.F.P. from 1997 to 2004. The purpose of the study was to answer two major research questions: what were the effects of changes in schooling opportunities in the community over the past six years on enrollment and attainment, and what were the effects on family planning and fertility behavior? This study builds on an earlier study undertaken in 1997. As noted in this report, the study is innovative in several ways: (1) it is longitudinal; (2) it combines consideration of three dimensions of …

'She Knew Only When The Garland Was Put Around Her Neck': Findings From An Exploratory Study On Early Marriage In Rajasthan, Population Council

Poverty, Gender, and Youth

In India, despite several policy and program efforts, early marriage persists with considerable variation between and within states. Unraveling the complex drivers of early marriage in particular contexts requires careful site-specific diagnostic research. Whether and how these downward pressures on age at marriage are ameliorated by India's national and state efforts to foster later marriage is not well understood. As noted in this brief, research is required at the community level to understand the extent of actual implementation of various policies and programs intended to prevent early marriage and the extent to which such efforts have found acceptability among parents …

Meeting The Health And Social Needs Of Married Girls In India: The First Time Parents Project's Implementation And Reach, Population Council

Poverty, Gender, and Youth

India has one of the largest populations of married adolescent girls in the world. Despite the high prevalence of early marriage and the distinct and predictable risks these girls and young women face, little is known about the lives of married young women, and little has been done to support them. In response, the Population Council, in partnership with Child in Need Institute and Deepak Charitable Trust, initiated the First-Time Parents project. This project developed and tested an integrated package of health and social interventions that would improve married young women's reproductive and sexual health knowledge and practices, and expand …

Spending, Saving And Borrowing: Perceptions And Experiences Of Girls In Gujarat, Population Council

Poverty, Gender, and Youth

Microfinance and savings programs that offer user-friendly and flexible savings schemes for women are increasingly being implemented in India, but such programs have been limited to adults. Although a number of programs have been implemented that aim to empower adolescent girls and young women, these have largely focused on enhancing life skills and awareness. The potential among young females to enhance control over resources through savings and use of other financial products in formal and informal banking institutions has rarely been addressed, either in research or through programs. As stated in this brief, the Council and the Self Employed Women's …

Marriage And Motherhood: An Exploratory Study Of The Social And Reproductive Health Status Of Married Young Women In Gujarat And West Bengal, F. Ram, Ranjana Sinha, S.K. Mohanty, Arup Das, Aruna Lakhani, Nicole Haberland, K.G. Santhya

Poverty, Gender, and Youth

In India, sexual activity and childbearing among young women take place overwhelmingly within the context of marriage. Despite the high prevalence of early marriage, little is known about the lives of married young women, and few interventions have focused on supporting this group. In response, the Population Council, in partnership with Child In Need Institute in Kolkata (West Bengal) and Deepak Charitable Trust in Vadodara (Gujarat), initiated the First-Time Parents project aimed at developing and testing an integrated package of health and social interventions that would improve married young women’s reproductive and sexual health knowledge and practices, and expand their …

Formation Of Partnerships Among Young Women And Men In Pune District, Maharashtra, Mallika Alexander, Laila Garda, Savita Kanade, Shireen J. Jejeebhoy, Bela Ganatra

Poverty, Gender, and Youth

Young people in India face traditional age- and sex-stratified norms that espouse gender double standards. Premarital partnerships are taboo and anecdotal evidence suggests that in many settings in India, the hint of a romantic relationship or even social interaction between young girls and boys is sufficient to damage a family's reputation and/or result in accelerated arranged marriage, particularly for the girl. While there is a prevailing perception at the community level that in these circumstances, premarital partnerships are rare, there is a small body of literature that suggests that such partnerships are indeed formed and sexual relations experienced, among, typically, …