Public Health Commons^™

The Straight Talk Campaign In Uganda: Impact Of Mass Media Initiatives—Summary Report, Susan E. Adamchak, Karusa Kiragu, Cathy Watson, Medard Muhwezi, Tobey C. Nelson, Ann Akia-Fiedler, Richard Kibombo, Milka Juma

HIV and AIDS

This Horizons study in Uganda found that exposure by adolescents to Straight Talk, a mass media initiative focused on adolescent sexual and reproductive health (ASRH), was associated with greater ASRH knowledge, a greater likelihood of having been tested for HIV, and more communication with parents about ASRH issues.

Community-Based Approaches To Prevention Of Mother-To-Child Transmission Of Hiv: Findings From A Low-Income Community In Kenya, Susan Kaai, Carolyn Baek, Scott Geibel, Peter Omondi, Benson Ulo, Grace Muthumbi, Carol Nkatha, Naomi Rutenberg

HIV and AIDS

The Horizons program, in partnership with International Medical Corps and Steadman Research Services International, conducted an intervention study in Kibera, an urban slum in Nairobi, Kenya to determine what effect three different community-based activities had on utilization of key prevention of mother-to-child transmission (PMTCT) services. The interventions included moving services closer to the population via mobile clinics, as well as increasing psychosocial support through the use of traditional birth attendants and peer counselors as PMTCT promoters. Data from the study showed that there were positive trends during the study period in most of the PMTCT indicators, including knowledge of MTCT, …

Beacon Of Hope: Evaluation Of The Kenya Girl Guides Association Hiv/Aids Program For School Children, Karusa Kiragu, George Odingo, Milka Juma, Jane Mbugua, Magdalen Waweru, Wamuyu Mahinda, Beatrice Mwaniki, Charity Muturi, Simon Ochieng, Tobey C. Nelson, Ann P. Mccauley

HIV and AIDS

This Horizons report presents findings from an evaluation of the Kenya Girl Guides Participatory Peer Education Program for HIV and AIDS Prevention. The objective of the program was to train Girl Guide patrol leaders as peer educators, who in turn would communicate key information and concepts about such topics as HIV prevention, relationships, and self-esteem to other Girl Guides, and ultimately to their school peers. The results demonstrate that peer education conducted by Girl Guides is a feasible strategy for imparting HIV and AIDS education to school-going youth; however, such a program would need to be branded, strengthened, and appropriately …

Transcending Boundaries To Improve The Food Security Of Hiv-Affected Households In Rural Uganda: A Case Study, Katharine Coon, Jessica Ogden, John Odolon, Anthony Obudi-Owor, Charles Otim, James Byakigga, Peter Spebanja

HIV and AIDS

A case study conducted in Tororo, Uganda found that a partnership between TASO, an AIDS service NGO and agricultural extension, was successful in helping HIV-affected communities improve food security. This Horizons study reports that four participatory training workshops developed through the alliance resulted in improved management capacity and more collaborative organizational structures among the district partners. This in turn created the conditions for the AIDS community workers and other field partners to work more effectively together with farmers’ groups at the local level to identify and address constraints to food security.

Reaching Truckers In Brazil With Non-Stigmatizing And Effective Hiv/Sti Services, Magda Chinaglia, Sheri A. Lippman, Julie Pulerwitz, Maeve De Mello, Rick Homan, Juan Diaz

HIV and AIDS

Research with mobile populations has demonstrated that men in the mobile workforce tend to be exposed to greater HIV risk, and have higher sexually transmitted infection (STI) and HIV prevalence, than those in less mobile or non-mobile professions. At the request of the Brazilian Ministry of Health and with support from USAID/Brazil, the Population Council conducted an assessment in Brazilian border areas to determine which populations were most in need of HIV prevention activities. The research revealed the presence of an extremely mobile, international truck driver community with little to no access to HIV prevention, testing, and treatment services. The …

Day Of Dialogue—Insights And Evidence From Product Introduction: Lessons For Microbicides, Martha Brady, C. Elizabeth Mcgrory

HIV and AIDS

This report summarizes key issues and themes emerging from a Population Council Day of Dialogue held in March 2007. The Council convened this meeting of experts in the fields of product development, introduction, and social marketing; clinical trials; and reproductive health and HIV/AIDS in order to identify key features that can be used to guide efforts to introduce microbicides.

Reaching Truckers In Brazil With Non-Stigmatizing And Effective Hiv/Sti Services, Magda Chinaglia, Sheri A. Lippman, Julie Pulerwitz, Maeve De Mello, Rick Homan, Juan Diaz

HIV and AIDS

A study conducted by the Population Council in 2001 found that truckers crossing Brazil’s southern border had easy access to commercial sex and extremely limited access to health services, condoms, HIV testing and counseling, and HIV/STI prevention messages. In response, the Population Council’s Horizons Program conducted an intervention study from 2002 to 2005. The study examined the feasibility, acceptability, and impact of providing a range of health services to truckers at a health post inside a customs station, where truckers wait anywhere from one day to a week for documents and cargo to clear customs. As noted in this brief, …

Preparedness Of Kenyan Health Workers To Deliver Hiv/Aids Services, National Aids And Std Control Programme, Ministry Of Health Kenya, Centers For Disease Control And Prevention, Horizons Program

HIV and AIDS

Most Kenyan adults do not know their HIV status. Patients who present to a health facility can learn their status as part of a diagnostic assessment, enabling health-care personnel to provide a more accurate clinical evaluation and accelerate access to comprehensive care. This is particularly relevant in Kenya because up to 60 percent of all medical ward hospital beds are occupied by HIV-infected patients. Therefore provider-initiated HIV testing and counseling, which includes diagnostic testing and counseling (DTC), provides an opportunity to interrupt the cycle of HIV transmission to patients’ partners and children. In 2004, the Kenya Ministry of Health launched …

Impact Of Antiretroviral Therapy On Household Economics: Findings From Mombasa, Kenya, Rick Homan, Desai Jaikishan, Paul Munyao, Avina Sarna, Scott Geibel

HIV and AIDS

While the clinical impact of receiving antiretroviral therapy (ART) on individuals living with HIV is well documented, less is known about how the receipt of ART affects household economics. This analysis examined the direct and indirect effects of receiving ART on household economics. A direct effect is reduced spending on health services as a result of the improved health status of the household member on ART. The potential indirect effects include increased labor-force participation by the household member on ART, a change in how other household members spend their time (working or in school), and a shift in composition of …

Sexual Risk Behaviors Of Hiv-Positive Persons Receiving Art In Mombasa, Kenya: Longitudinal Study Findings, Stanley Luchters, Avina Sarna, Scott Geibel, Matthew F. Chersich, Paul Munyao, Susan Kaai, Kishorchandra N. Mandaliya, Naomi Rutenberg, Marleen Temmerman

HIV and AIDS

As a result of the success of antiretroviral therapy (ART) in dramatically decreasing morbidity and mortality due to HIV, many HIV-infected individuals are now living longer, healthier, and more sexually active lives. However, unprotected sex by people living with HIV is an area of concern because of the risk of transmission to sero-discordant partners and reinfection with new, drug-resistant viral strains. There is evidence to suggest that some sero-positive individuals continue to engage in unprotected sex that places others at risk for infection and places themselves at risk for contracting secondary infections. To learn more about the impact of ART …

Changes In Stigma Among A Cohort Of People On Antiretroviral Therapy: Findings From Mombasa, Kenya, Susan Kaai, Avina Sarna, Stanley Luchters, Scott Geibel, Paul Munyao, Kishorchandra N. Mandaliya, Khadija Shikely, Marleen Temmerman, Naomi Rutenberg

HIV and AIDS

Stigma has been a reality in the lives of people living with HIV (PLHIV) since the inception of the AIDS epidemic, and it can have profound implications for health, psychosocial well-being, and utilization of health services. In the industrialized world, the availability of antiretroviral therapy (ART) and a subsequent change in perception of AIDS as a chronic manageable disease has coincided with a decrease in stigma and discrimination directed toward PLHIV. However, little is known in developing countries about whether perceptions and experiences of stigma among PLHIV have changed following increased access to ART. The Horizons Program and the International …

Promoting Adherence Through A Directly Administered Antiretroviral Therapy Strategy In Mombasa, Kenya, Avina Sarna, Stanley Luchters, Scott Geibel, Matthew F. Chersich, Paul Munyao, Rick Homan, Susan Kaai, Kishorchandra N. Mandaliya, Marleen Temmerman, Naomi Rutenberg

HIV and AIDS

A principal concern of antiretroviral therapy (ART) programs is the ability of clients to maintain a high level of adherence to medication. Based on formative research conducted with HIV-infected clients and health workers in Mombasa, Kenya, and lessons learned from directly observed therapy strategies to encourage adherence to treatment for tuberculosis, a directly administered antiretroviral therapy (DAART) strategy to promote adherence to ART was developed. This study examines whether the intervention was more effective in fostering adherence to ART than standard follow-up among people living with HIV in Mombasa. Researchers from the Horizons Program and the International Centre for Reproductive …

Support By Migrants To Their Elderly Parents In Rural Cambodia And Thailand: A Comparative Study, Zachary Zimmer, Kim Korinek, John Knodel, Napaporn Chayovan

Poverty, Gender, and Youth

Internal migration in Southeast Asia raises questions about strains upon traditional systems of support for older adults. While remittances to parents’ households play a role in rural household economies, uncertainty remains regarding whether and under what circumstances children interact with their elderly parents. This paper focuses on the adult children of older persons living in rural Cambodia and Thailand and examines the determinants of personal visits, monetary remittances, and more general forms of household support. Analyses consider ways in which geographically distant children support parents, the extent to which characteristics of parents, children, and households enhance or detract from these …

Implementing Sti/Hiv Prevention And Care Interventions For Men Who Have Sex With Men In Senegal, Amadou Moreau, Placide Tapsoba, Abdoulaye Ly, Cheikh Ibrahima Niang, Abdou Khoudia Diop

HIV and AIDS

Exploratory research conducted by the Horizons Program in 2002 revealed that men who have sex with men (MSM) in Dakar, Senegal, are particularly vulnerable to sexually transmitted infections (STIs) and HIV. Further, the stigma and discrimination suffered by many MSM result in the concealment of sexual behaviors from health-care providers, making it difficult to receive appropriate services. Finally, there is a lack of HIV-prevention campaigns geared to this group. Key stakeholders in Dakar developed and implemented an intervention to meet the STI/HIV prevention needs of MSM and address prevailing stigma that effectively serves as a barrier to care. The intervention …

Psychosocial Benefits Of A Mentoring Program For Youth-Headed Households In Rwanda, Lisanne Brown, Janet C. Rice, Neil W. Boris, Tonya R. Thurman, Leslie M. Snider, Joseph Ntaganira, Laetitia N. Nyirazinyoye, Edward Kalisa, Emmanuel Nshizirungu

HIV and AIDS

In Rwanda, the combined effects of the 1994 genocide and the AIDS pandemic have devastated the lives of children and families. More than 300,000 young people have been “left behind,” not only by parents and other caregivers who have died, but also by extended families and communities who stigmatize and fail to support them. The phenomenon of youth-headed households in the region is a relatively recent development. Despite the long history of fostering in sub-Saharan Africa, family and community safety nets are overstretched. Youth-headed households may be a legitimate coping strategy; however, children living in youth-headed households are less likely …

Supporting Volunteer Mentors: Insights From A Mentorship Program For Youth-Headed Households In Rwanda, Lisanne Brown, Tonya R. Thurman, Edward Kalisa, Janet C. Rice, Jean De Dieu Bizimana, Neil W. Boris, Leslie M. Snider, Joseph Ntaganira

HIV and AIDS

In 2004, World Vision Rwanda (WVR), in collaboration with Tulane University and the Rwanda School of Public Health, implemented a program to provide support through regular visits by an adult mentor to youth living without adult care. After completion of baseline quantitative and qualitative research, WVR implemented the program in two areas of a province in southwestern Rwanda. Over an 18-month period, 156 trained adult mentors visited and supported 441 youth-headed households. The mentor training covered key aspects of child development and skills for addressing key psychosocial issues that were identified through the baseline research. Specifically, the training addressed how …

Intergenerational Communication On Sexuality And Hiv/Aids: Exploring Feasibility Of Building Effective Youth-Adult Partnerships To Reduce Young People's Hiv Vulnerabilities, Vaishali Sharma Mahendra, Sarat Chandra Pradhan, Saraswati Swain, Aradhana Nanda, Sanjit Patnayak, Sucheta Panda, Rajendra Prasad

HIV and AIDS

In India, over one-third of all reported AIDS cases occur among people aged 15–24 years. Young people need competencies to navigate daily-life situations and engage in productive activities, and the relationships they form with adults and peers are the source of support and guidance critical to the development of their competencies. The peer-based approach is integral to sexual health and HIV-prevention programs for youth. However, in some settings, program and policy directions have been hampered by adult beliefs of what young people should be permitted to know. Recent projects show that working on changing the norms and beliefs of adults …

Patterns And Implications Of Male Migration For Hiv Prevention Strategies In Andhra Pradesh, Ravi K. Verma, Niranjan Saggurti, Madhumita Das, Saumya Ramarao, Anrudh K. Jain

HIV and AIDS

HIV is widespread in Andhra Pradesh, with high HIV prevalence among pregnant women receiving antenatal care and patients receiving treatment for sexually transmitted infections. High HIV prevalence among women indicates that the infection, rather than being restricted to groups at high risk, is present in the general population. Districts with high HIV prevalence are also destinations for large numbers of male migrants. Migration may be a major contributor to the spread of HIV in the state, however empirical evidence is limited. Furthermore, evidence is required to maximize the impact of programmatic inputs intended to contain the spread of the epidemic. …

Identifying Areas For Linkages Between Hiv And Srh For Vulnerable Populations: An Exploratory Study To Assess Female Sex Workers' Sexual And Reproductive Health Needs, Vaishali Sharma Mahendra, Sushma Mehrotra, B. Srikanthi, Sucheta Panda, Avina Sarna, A.K. Jayasree, Rajendra Prasad, Naomi Rutenberg

HIV and AIDS

Sexual and reproductive ill-health and HIV/AIDS share root causes, including poverty, gender inequality, and social marginalization of the most vulnerable populations. This has prompted the international community to call for policy and program approaches to strengthen the linkages between SRH and HIV/AIDS programs. However, most integration efforts have given priority to family planning, maternal and child health, and STI treatment and to addressing the needs of married women from the general population. Female sex workers have been targeted for HIV prevention efforts but little attention has been given to SRH-related care. To bring sex workers into the focus for SRH-HIV …

Exploring The Barriers To Accessing Care And Treatment For Hiv-Infected Children In India: A Diagnostic Study, Avina Sarna, Jaleel Ahmad, Glory Alexander, Vaishali Sharma Mahendra, Ashok Rau, Arjun Singh, Naomi Rutenberg

HIV and AIDS

Each year 27 million births take place in India. A conservative estimate of HIV prevalence of 1 percent among antenatal women translates to about 80,000 HIV-infected children being born annually. The latest figures from the National AIDS Control Organisation show that there are about 5,600 documented HIV-positive children (0–14 years), but a very small number are receiving antiretroviral therapy. The Population Council and partners conducted a qualitative study in three high-prevalence states of India to explore the facilitators and barriers to accessing care for HIV-positive children and assessed the current level of adherence to ART among children receiving treatment. A …

A Theory And Definition Of Public Health Law, Lawrence O. Gostin

Journal of Health Care Law and Policy

No abstract provided.

Public Health And Constitutional Law: Recognizing The Relationship, Wendy E. Parmet

Journal of Health Care Law and Policy

No abstract provided.

Beyond Compensation: Using Torts To Promote Public Health, Elizabeth A. Weeks

Journal of Health Care Law and Policy

No abstract provided.

"Public-Private" Health Law: Multiple Directions In Public Health, Nan D. Hunter

Journal of Health Care Law and Policy

No abstract provided.

Medicine And Public Health: Crossing Legal Boundaries, Wendy K. Mariner

Journal of Health Care Law and Policy

No abstract provided.

R.J. Reynolds Tobacco Co. V. Shewry: Has The Tobacco Industry Met Its Match?, Lauren Rachel Bregman

Journal of Health Care Law and Policy

No abstract provided.

The Human Papillomavirus Vaccine: Should It Be Mandatory Or Voluntary?, Carrie A. Roll

Journal of Health Care Law and Policy

No abstract provided.

Village Health Workers Improve Child Health: The Jamkhed, India Experience, A. Crandall, J. S. Job, P. N. Singh, S. R. Arole, R. S. R. Arole

International Journal of Global Health and Health Disparities

OBJECTIVE: To assess the effect of the three-decade old Comprehensive Rural Health Project (CRHP) on morbidity, mortality, immunization rates, and health care utilization among children under 5 years of age in Jamkhed, Central India. METHODS: We conducted a cross-sectional survey of a stratified, cluster sample of 879 children (under-fives) in 15 Jamkhed villages served by CRHP. CRHP has a three-tiered primary health care model that comprises a tertiary care facility, a mobile health program supporting 30 subcenters, and community-based health workers.

FINDINGS: We found a prevalence of diarrhea [6.4%, 95% CI: 4.0%-8.8%], measles [2.3%, 95% CI: 0%-5.6%], tuberculosis [0.3%, 95% …

Injecting Drug Users In India: Understanding Sexual Behaviours And Sexual Networks To Design Effective Behaviour Change Strategies, Avina Sarna, Waimar Tun, Aruna Bhattacharya, Vaishali Sharma Mahendra, Neville Selhore, Arjun Singh, Louis Apicella

HIV and AIDS

The practice of injecting drug use has been spreading to different parts of India since the early 1980s and is associated with an increase in HIV prevalence rates. Injecting drug users (IDUs) engage in both risky injection and sexual practices that increase the risk for HIV transmission. While risky injection practices are well understood, there is limited understanding of IDUs’ sexual behaviors and social networks. The Population Council conducted a cross-sectional study to explore patterns of risky sexual behaviors, sexual network characteristics, and drivers of high-risk behaviors of IDUs in Delhi and Imphal. The contrasting settings were selected to allow …

The Status Of Childhood Lead Poisoning And Prevention In Nevada, Usa, Anne Rothweiler, Elena E. Cabb, Shawn Gerstenberger

Environmental & Global Health Faculty Research

One of the first steps in addressing the problem of childhood lead poisoning is to identify the possible sources of exposure in specific communities and target high-risk populations with appropriate interventions. Due to several factors, such as lack of funding and lack of blood lead reporting, little information exists regarding the occurrence of childhood lead poisoning and the prevalence of potential exposure sources in the state of Nevada. Following the recent establishment of a Nevada-based Lead Poisoning Program, we compiled the most current information available on Nevadans, and use this knowledge to suggest future research objectives and outreach activities for …