Medicine and Health Commons^™

Caring For Caregivers: An Hiv/Aids Workplace Intervention For Hospital Staff In Zambia—Evaluation Results, Karusa Kiragu, Mutinta Nyumbu, Thabale J. Ngulube, Panganani Njobvu, Chilufya Mwaba, Arthur Kalimbwe, Spike Bradford

HIV and AIDS

The Horizons Program collaborated on a Caring for Caregivers initiative in Zambia whose objective was to develop and test a risk-reduction workplace program for hospital staff. This was motivated by the recognition that hospital workers are often overlooked in HIV programming, and yet many are infected or affected by HIV. It was also motivated by the fact that hospital staff are heterogeneous, with both clinical and non-clinical staff having varying levels of understanding regarding HIV transmission. Caring for Caregivers was a peer education program targeted at hospital staff and implemented in two hospitals in Zambia, with a combined staff of …

Repositioning Postnatal Care In A High Hiv Environment: Swaziland, Charlotte E. Warren, Rachel Shongwe, Allen Waligo, Mohammed Mahdi, Goldy Mazia, Indira Narayanan

HIV and AIDS

This Horizons report from the Swaziland Ministry of Health and Social Welfare discusses findings from an intervention which aimed to reposition postnatal care within the context of a high HIV prevalence environment. The objectives were to determine if changes to the sexual and reproductive health guidelines on postnatal care would result in the timely and quality provision of key components of essential maternal and newborn care in the postnatal period, increase utilization of postnatal care services among all postpartum women, and improve the care and follow up of HIV-positive postpartum women and their infants. The study confirms that the introduction …

Improving Hospital-Based Quality Of Care In Vietnam By Reducing Hiv-Related Stigma And Discrimination, Khuat Thi Hai Oanh, Kim Ashburn, Julie Pulerwitz, Jessica Ogden, Laura Nyblade

HIV and AIDS

To address HIV-related stigma and discrimination, and improve the quality of care in the healthcare setting in Vietnam, the Institute for Social and Development Studies, the International Center for Research on Women, and the Horizons Program conducted intervention research in four hospitals. The study team conceptualized two fundamental causes of HIV-related stigma: 1) fear of casual transmission; and 2) negative values/social judgments and associations between HIV and certain behaviors and groups, such as sex workers and injecting drug users. Both intervention strategies successfully reduced stigma and discrimination toward HIV-positive patients in these healthcare settings. The findings show that addressing stigma …

Assessment Of Risk Factors For Hiv Infection In Female Sex Workers And Men Who Have Sex With Men In Ciudad Del Este, Paraguay, Magda Chinaglia, Waimar Tun, Maeve Mello, Magdalena Insfran, Juan Diaz

HIV and AIDS

Research conducted by the Population Council/Brazil, supported by the USAID-funded Horizons Project, documents findings from a study in Paraguay among men who have sex with men and female sex workers to estimate HIV and syphilis prevalence; examine knowledge, attitudes, and risk behaviors related to HIV and STIs; and describe the contextual and behavioral factors influencing HIV and STI transmission. Findings provide guidance to the development of HIV and STI prevention and care interventions and further operations research to test strategies and interventions to reduce the spread of HIV and STIs in these groups.

School As A Workplace In Kenya: Evaluation Of The Teachers Matter Hiv/Aids Project, Karusa Kiragu, Caroline Mackenzie, Jennifer Weiss, Murungaru Kimani, Debbie Gachuhi

HIV and AIDS

The Horizons program of the Population Council embarked on an operations research initiative in Kenya to test the feasibility of implementing a teacher-centered workplace program based in schools. The study was conducted in partnership with the Ministry of Education, the Kenya Institute of Education, the Teachers Service Commission, and UNICEF. Called Teachers Matter, the project’s main audience was primary and secondary school teachers. The purpose of the research was to assess whether such a program would improve teachers’ HIV-related knowledge, attitudes, and behaviors; increase the proportion of teachers seeking voluntary testing and counseling; and enhance their ability to cope with …

Moving Forward: Tackling Stigma In A Tanzanian Community, Laura Nyblade, Kerry Macquarrie, Gideon Kwesigabo, Aparna Jain, Lusajo Kajula, Fausta Philip, William Henerico Tibesigwa, Jessie K. Mbwambo

HIV and AIDS

The International Center for Research on Women, the Muhimbili University College of the Health Sciences, the Population Council, and Family Health International conducted an evaluation of a community-based effort to reduce stigma surrounding HIV infections in a peri-urban community in Tanzania. Results presented a mixed, but hopeful, picture for a way forward in tackling stigma at the community level. Tackling stigma requires that the individuals tasked with doing this undergo personal change. Programs can start by focusing stigma-reduction efforts on a smaller, more manageable geographical area and adding specific anti-stigma components to their portfolio of activities. Engaging community opinion leaders …

If You Build It, Will They Come? Kenya Healthy Start Pediatric Hiv Study: A Diagnostic Study Investigating Barriers To Hiv Treatment And Care Among Children, Karusa Kiragu, Katie D. Schenk, Julie Murugi, Avina Sarna

HIV and AIDS

In Kenya the proportion of eligible HIV-positive children receiving ART treatment is only 11 percent. This study explored and documented possible barriers in the community to accessing pediatric HIV testing and treatment, to guide the development of new interventions to encourage uptake. The study identified barriers such as cost, use of traditional healers, low knowledge of treatment options, attitudinal barriers, stigma, unique treatment issues, and dissatisfaction with available services. Additionally, healthcare workers missed opportunities to provide services and cited numerous service-side challenges. The study recommends prioritizing community awareness, mobile clinics, strengthening capacity of healthcare workers, supporting family-based HIV testing, and …

Sexual And Reproductive Health Needs Of Adolescents Perinatally Infected With Hiv In Uganda, Harriet Birungi, John Frank Mugisha, Juliana K. Nyombi, Francis Obare, Humphres Evelia, Hannington Nyinkavu

Reproductive Health

In Uganda, HIV/AIDS treatment, care and support programs are still organized around either adult or pediatric care and fail to adequately address the needs of adolescents, specifically perinatally-infected adolescents. This study, implemented jointly by the Population Council's Frontiers in Reproductive Health (FRONTIERS) program and the AIDS Support Organization (TASO), aimed to better understand the reproductive health and sexuality of this population group, and to identify anxieties or fears they have around entering social stages of adulthood. This study confirms that wide programmatic gaps exist in addressing the sexual and reproductive health needs of young people perinatally infected with HIV who …

Promovendo Normas E Comportamentos Eqüitativos De Gênero Entre Homens Jovens Estratégia De Prevenção Do Hiv/Aids, Julie Pulerwitz, Gary Barker, Marcio Segundo, Marcos Nascimento

HIV and AIDS

The Horizons program and the Promundo Institute studied the effectiveness of interventions in Brazil designed to change the attitudes of young men in relation to gender norms and reducing the risk of contracting HIV/STIs. One conclusion of the study was the recognition of the importance of engaging young people (men and women) in the issue of gender relations and the risks of HIV contamination. The results of the study indicate that addressing inequitable gender norms, particularly those that define masculinity, can be an important element of HIV prevention strategies. These findings suggest that group education interventions can successfully influence young …

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 …

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.

Continuum Of Care For Hiv-Positive Women Accessing Programs To Prevent Parent-To-Child Transmission: Findings From India, Vaishali Sharma Mahendra, Rupa Mudoi, Archana Oinam, Venkat Pakkela, Avina Sarna, Sucheta Panda, Ashok Rau, L. Birendrajit Singh, Naomi Rutenberg

HIV and AIDS

This study examined the efforts of PPTCT programs in different cities in India to offer women a continuum of care, and shows that the programs have both strengths and shortcomings. The government launched a national treatment program that offers antiretroviral therapy (ART) to HIV-positive women, children below 15 years of age, and men. However, since the start-up of the ART program there have been concerns about limited access to and utilization of these services by women and children. To address these shortcomings, the PPTCT programs studied should strengthen their referral systems to public and private treatment and family planning services, …

Key Findings From An Evaluation Of The Mothers2mothers Program In Kwazulu-Natal, South Africa, Carolyn Baek, Vuyiswa Mathambo, Sibongile Mkhize, Irwin Friedman, Louis Apicella, Naomi Rutenberg

HIV and AIDS

The Horizons program of Population Council, in collaboration with Health Systems Trust, completed the first evaluation of mothers2mothers (m2m) as part of its introduction in KwaZulu-Natal Province, South Africa. It is the first external evaluation that provides quantitative evidence about the role of the well-known m2m program in complementing services to prevent mother-to-child transmission of HIV (PMTCT). m2m is a peer support program that aims to provide education and psychosocial support to HIV-positive pregnant women and new mothers, help women access existing health care, and follow up with mothers and babies to ensure they receive appropriate medical care after delivery. …

Hiv-Positive Inmates Released From Nevada’S Prisons In 2001: Results From Matching Health Division And Corrections’ Databases, Paul G. Devereux, Kristen Clements-Nolle, Sharon Clodfelter, Jessey Bargmann-Losche, Miguel Feroro, Wei Yang

Nevada Journal of Public Health

It is estimated that about one quarter of all HIV-infected individuals in the United States are released from a correctional facility each year. To better understand the needs of inmates with HIV exiting the prison system, a partnership with the Nevada State Health Division (NSHD), the Nevada Department of Corrections (DOC), and the University of Nevada, Reno School of Public Health was formed to examine this population using information contained in existing databases. An analysis of DOC data matched with the data from the HIV/AIDS Reporting System (HARS) maintained by the NSHD identified 2,802 HIV-negative inmates (2,451 males and 350 …

Does Verbal Communication Impairment Affect Quality Of Life In Amyotrophic Lateral Sclerosis Patients?, Jason Michael Duff

PCOM Psychology Dissertations

The purpose of this study was to examine the self-perceived QOL in ALS patients. Literature will be presented on the incidence, prevalence, prognosis, diagnosis and management of ALS, QOL studies for ALS, the role of the multidisciplinary team, the impairments and dysfunction that ALS patients experience, communication issues, and the development of ALS specific instruments to measure QOL. The "bulbar dysfunction" that ALS patients experience in salivation management, speech, and swallowing were examined in detail. The objectives of this research study were to investigate the following hypotheses: 1. QOL will differ among ALS patients with varying levels of speech, swallowing, …

Reducing Aids-Related Stigma And Discrimination In Indian Hospitals, 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/AIDS in India, as elsewhere, face stigma and discrimination in a variety of contexts. Research in India has shown that stigma and discrimination against HIV-positive people and those perceived to be infected are common in hospitals and act as barriers to seeking and receiving critical treatment and care services. Recognizing the need to move beyond documentation of the problem, three New Delhi hospitals; SHARAN, an Indian NGO; and the Horizons program, with support from the National AIDS Control Organisation (NACO), carried out an operations research project to develop and test responses to hospital-based stigma and discrimination against …

Promoting More Gender-Equitable Norms And Behaviors Among Young Men As An Hiv/Aids Prevention Strategy, Julie Pulerwitz, Gary Barker, Marcio Segundo, Marcos Nascimento

HIV and AIDS

The Population Council and the Promundo Institute studied the effectiveness of interventions in Brazil designed to change the attitudes of young men in relation to gender norms and reducing the risk of contracting HIV/STIs. One conclusion of the study was the recognition of the importance of engaging young people (men and women) in the issue of gender relations and the risks of HIV contamination. The results of the study indicate that addressing inequitable gender norms, particularly those that define masculinity, can be an important element of HIV prevention strategies. These findings suggest that group education interventions can successfully influence young …

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

HIV and AIDS

The Horizons Program and FHI/IMPACT developed a collaborative research study to explore how adults and youth in Kenya define and perceive the ABC (abstinence/being faithful/consistent condom use) terms and behaviors. Additional objectives of the study were to identify attitudes and norms around the ABC behaviors that influence perceptions of them, and the role of important actors in transmitting messages about them. Findings highlight potential challenges in promoting each of the ABC behaviors, as well as some positive elements that can be built upon when developing programs. HIV prevention programs that incorporate ABC messages—both in Kenya and elsewhere—should consider a number …

Examining Adherence And Sexual Behavior Among Patients On Antiretroviral Therapy In India, Avina Sarna, Indrani Gupta, Sanjay Pujari, A.K. Sengar, Rajiv Garg, Ellen Weiss

HIV and AIDS

With increased availability of ART, HIV-positive individuals are living healthier lives and continuing or resuming sexual activity. However, optimism related to ART’s success in slowing disease progression, reducing viral load, and improving health status may lead to more risky sexual practices and a possible increase in transmission of infections. To determining the sexual behavior of HIV-positive persons on ART, the Horizons program, in collaboration with research partners in Delhi and Pune, conducted a study to assess current levels of adherence to ART among a sample of people living with HIV/AIDS, identify the factors that influence their adherence to treatment, and …

Orphans And Vulnerable Youth In Bulawayo, Zimbabwe: An Exploratory Study Of Psychosocial Well-Being And Psychosocial Support, Laelia Gilborn, Louis Apicella, Jonathan Brakarsh, Linda Dube, Kyle Jemison, Mark Kluckow, Tricia Smith, Leslie M. Snider

HIV and AIDS

This Population Council Horizons report presents findings from an exploratory study by the Regional Psychosocial Support Initiative and Catholic Relief Services’ Support to Replicable, Innovative Village/Community-level Efforts Program of vulnerable youth living in and around Bulawayo, Zimbabwe. It describes their demographic characteristics, exposure to stress and trauma, and psychosocial well-being. The report also highlights the relationships between psychosocial well-being outcomes and exposure to stress and trauma, and the differences in psychosocial well-being between males and females, orphaned and nonorphaned youth, and younger and older adolescents. The report concludes with program and research implications.

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 …

Suicide Trends And Prevention In Nevada, Matt Wray

Social Health of Nevada Reports

Suicide has been around for as long as human society and it continues to challenge our collective wisdom. Consider this data provided by the National Institute of Medicine:

• Each year about one million people commit suicide worldwide.
• Every year some 30,000 Americans end their lives by suicide, and approximately 650,000 people receive emergency treatment after attempting suicide.
• Every 41 seconds someone in the U.S. attempts suicide; every 16.7 minutes, someone completes suicide; and every day over 85 people die by suicide.
• Suicide is the eighth leading cause of death in the U.S. and the third leading cause of death among …

Problem Gambling And Treatment In Nevada, Bo Bernhard

Social Health of Nevada Reports

For many years, it was moral experts, rather than medical and academic ones, who told us who gambled “too much.” Speaking from pulpits rather than podiums, church leaders informed us that gambling was uniquely subversive of the American way of life, for its something-for-nothing promise threatened to undermine the popular ethic of honest toil and gradual accumulation of goods. Samuel Hopkins, in an 1835 sermon on “The Evils of Gambling,” captured this sensibility: “Let the gambler know that he is watched, and marked; and that . . . he is loathed. Let the man who dares to furnish a resort …

Diseases Prevalence And Behavioral Choices In Nevada, Mary Guinan, Chad L. Cross, Lawrence Sands

Social Health of Nevada Reports

Determining the health of a state population is a complex task. It involves knowing at least the prevalence of various diseases and conditions as well as the leading causes of death and disability compared to a national mean or median. The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Since health is affected by numerous social, economic, environmental, and cultural factors, these factors must also be considered when examining the health status of a population. All attempts to rank states in health are limited …

Health Care Access And Insurance Availability In Nevada, Charles B. Moseley, Michelle Sotero

Social Health of Nevada Reports

According to the Institute of Medicine (IOM),

• Approximately 18,000 Americans die prematurely every year, solely because they lack health insurance coverage (Institute of Medicine, 2004).
• The IOM estimates that the aggregate cost of increased morbidity and mortality due to un-insurance in the U.S. is between $65 billion and $130 billion per year.
• Costs to the health care system can be measured conservatively in terms of the value of uncompensated care provided to the uninsured, estimated at almost $35 billion in 2001, of which $24 billion was provided by hospitals.

Access to medical care is not a constitutional right in the …

Hiv/Aids And Condom Usage: Factors That Contribute To African American Women's Vulnerability To Hiv Infection, Monica P. Washington

Sociology & Criminal Justice Theses & Dissertations

HIV/AIDS poses an enormous health threat to African Americans, specifically African American women. According to the Center for Disease Control "1 in 160 African American women are believed to be infected with HIV (Center for Disease Control 1999:1). In 2000, although African American women only represented 12% of the female population, they accounted for 64% of HIV cases reported among women (The White House 2000; National Institute of Allergy and Infectious Diseases 2004).

This study examined HIV/AIDS and African American women and attempted to answer the question: Why are African American women not consistently using condoms to protect themselves against …

Reducing The Transmission Of Hiv And Sexually Transmitted Infections In A Mining Community: Findings From The Carletonville Mothusimpilo Intervention Project: 1998 To 2001, Lewis Ndhlovu, Catherine Searle, Johannes Van Dam, Yodwa Mzaidume, Bareng Rasego, Solly Moema

HIV and AIDS

The Horizons program, in collaboration with the Center for Scientific and Industrial Research, the South African Institute for Medical Research, and the London School of Economics, conducted an intervention study in the mining town of Carletonville, South Africa to examine the social determinants of the HIV epidemic, and to assess the impact of a targeted program of HIV and STI prevention and service delivery. The project did not reduce STI prevalence or HIV prevalence, as changing sexual behavior is far more complex than educating individuals about HIV. The report recommends interventions to support behavioral change education, STI treatment, the role …

Programming For Hiv Prevention In South African Schools: A Report On Program Implementation, Priscilla Reddy, Shegs James, Ann P. Mccauley

HIV and AIDS

An evaluation study conducted in KwaZulu Natal, South Africa, provides important insights into whether learners who participated in a fact-based, interactive course had more knowledge about HIV risks, prevention, and care practices; more positive attitudes toward prevention practices and people living with HIV and AIDS; and a higher prevalence of reported safe behaviors than comparable learners who did not participate in the course. Results show that the Life Skills Grade 9 Curriculum had a positive impact of students’ knowledge of HIV/AIDS, attitudes about abstinence, and intention to use condoms. There was, however, no evidence of increased adoption of such protective …