Medicine and Health Commons^™

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 …

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 …

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 …

Current Research And Good Practice In Hiv And Aids Treatment Education, Avina Sarna, Ellen Weiss

HIV and AIDS

This report was prepared by UNESCO and WHO for presentation at the HIV and AIDS Treatment Education Technical Consultation in Paris, November 22–23, 2005. There is a growing realization among program managers and donors that merely providing antiretroviral therapy (ART) and training health providers is not sufficient and that unless efforts are made to engage communities and individuals to improve their knowledge and understanding of HIV, AIDS, and ART, programs will not meet the targets set by these initiatives and will fall short of contributing to the goal of attaining universal access to treatment. This report describes current research and …

Engaging Advocates From Concept To Results: Summary Report Of The Advocates' Consultation On Hiv Prevention Trials: Carraguard And Voice Studies, Johannesburg, South Africa, 18-19 October 2007, Microbicide Trials Network, Population Council

HIV and AIDS

Advocate consultations are increasingly becoming the rule, not the exception in the HIV-prevention research field. As an increasing number of Phase III trials enter the field, research groups are seeking new ways to collaborate with advocates and maximize civil society input and engagement. The Advocates’ Consultation for HIV Prevention Trials: Carraguard and VOICE Studies provided leaders from African NGOs a unique opportunity to learn about the clinical trial process from beginning to end, and to collectively identify ways to influence how scientific research is formulated. Participants represented a wide range of advocacy groups from Southern African countries, including those working …

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, …

Developing Regional Operations Research Training Capacity In South Asia, M.E. Khan, James R. Foreit, Sohini Roychowdhury, F. Ram, Chander Shekhar

Reproductive Health

This project’s overall objective was to create a self-sustaining regional operations research (OR) training and research center for South Asia at the International Institute of Population Sciences (IIPS), in Mumbai, India. The goal was to institutionalize operations research (OR) in IIPS by building the teaching and research capabilities of the faculty and research team. Capacity building was accomplished through a training of trainers that included an OR workshop in Nepal, two four-day OR workshops for program managers, one ten-day OR workshop for researchers, and a four-day scientific-writing course for researchers and program managers to provide guidelines for preparing research articles …

Situation Analysis Of The Sexual And Reproductive Health And Hiv Risks And Prevention Needs Of Older Orphaned And Vulnerable Children In Nyanza Province, Kenya, Milka Juma, Ian Askew, Alan Ferguson

Reproductive Health

The increasing number of children in Kenya who are orphaned or made vulnerable (OVC) from HIV/AIDS and other factors calls for a holistic understanding of their situation so that effective programs to address their needs can be designed. This is especially important for those areas hardest hit by the HIV/AIDS pandemic, such as Nyanza Province. Little is known about the vulnerabilities of older orphans to risky sexual behavior, and whether they are more vulnerable than nonorphans. The Department of Children’s Services has initiated a cash transfer program to households taking care of OVC. The main objective is to provide a …

Disparities In Health And Well-Being Among Latinos In Washington Heights/Inwood, 2000–2005, Ana Motta-Moss

Center for Latin American, Caribbean, and Latino Studies

Introduction: This report analyzes how well the residents of Washington Heights/Inwood (WH/IN) have fared on selected health indicators set forth by the NYC Department of Health and Mental Hygene between 2000 and 2005.

Methods: Data on Latinos and other racial/ethnic groups were obtained from the U.S. Census Bureau American Community Survey, reorganized for public use by the Minnesota Population Center, University of Minnesota, IPUMSusa. Cases in the dataset were weighted and analyzed to produce population estimates.

Results: Immigrant families in particular face a multitude of health concerns, as well as specific barriers to accessing health care services. The socioeconomic and …

The Hiv/Aids Prevention Project For Vulnerable Youth In Northern Nigeria: Community Advocates Training Manual, Population Council, Adolescent Health And Information Projects, Federation Of Muslim Women's Associations In Nigeria, Islamic Education Trust

HIV and AIDS

This Community Advocates training manual contains a curriculum developed by the Population Council, Nigeria, under the HIV Prevention Project for Vulnerable Youth in Northern Nigeria funded by USAID/Nigeria. The curriculum was developed as a tool for training community advocates in conducting advocacy activities on the issues of early marriage, HIV/AIDS, and reproductive health. The curriculum aims to improve knowledge and strengthen the skills of community representatives from the northern region of Nigeria so they can openly discuss sensitive issues relating to HIV/AIDS, reproductive health, and marriage. Designed to be adapted or implemented as written, the curriculum is based on the …

Addressing Gupt Rog: Narrative Prevention Counselling For Sti/Hiv Prevention—A Guide To Ayush And Allopathic Practitioners, Bonnie K. Nastasi, Niranjan Saggurti, Stephen L. Schensul, Ravi K. Verma, Meena Gandhi

HIV and AIDS

Although India has over 600,000 registered AYUSH practitioners who are engaged in homeopathic, Ayurvedic, and Unani systems of medicine, they have not been integrated into the country’s national health system. While practitioners of these systems of medicine treat all illnesses, they have a special niche in providing services to address men’s sexual health concerns (Gupt Rog). A project on Research and Intervention in Sexual Health: Theory to Action was undertaken by the International Institute for Population Sciences/Mumbai, the Population Council/New Delhi, and partners, in three slum communities in Mumbai, from 2001–07. The objective was to control the spread of sexually …

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. …

Our Stories: Women Speak Out Against Hiv And Aids—An Interactive Communication Package For Rural Low-Literate Women, Vijaya Nidadavolu, Moumita Saha, Vijaya Usha Rani

HIV and AIDS

The National AIDS Control Organisation (NACO) estimates that there are over 5.1 million people living with HIV and AIDS in India. Among new infections reported in 2006, 88 percent were reported in the reproductive age group (15–49 years). The virus is spreading rapidly among women, including married and monogamous women, and adolescent girls. Existing literature shows that women's vulnerability is compounded due to their gendered disadvantage in information access, literacy, and decision-making. This disadvantage is particularly acute in the case of married women in rural India. NACO has indicated the need to develop audience-appropriate strategies for communicating HIV-related information. To …

Reducing The Social Exclusion Of Girls, Kelly Hallman, Eva Roca

Poverty, Gender, and Youth

Across the globe, girls are systematically excluded from participation in social, economic, and political life. The absence of girls in these arenas has implications not only for the young women themselves but also for society as a whole, exacerbating poverty and perpetuating disparities in health, education, and economic achievement. Internationally, this marginalization makes it difficult or impossible for some countries to achieve society-wide goals, such as the Millennium Development Goals identified by the United Nations as benchmarks to reduce poverty. For a number of years, the Population Council has been studying the causes and effects of girls’ social exclusion in …

Emergency Contraception, Female Condoms And Iuds In Kenya's Public Sector: Findings From A National Diagnostic Assessment, Jill Keesbury, Benter Owino, Spike Bradford

Reproductive Health

In 2005, the Kenya Ministry of Health, Department of Reproductive Health (DRH), began an initiative to strengthen the provision of emergency contraception (EC) in the public sector. As a first step, 700,000 units of the dedicated EC product Postinor 2 were procured by UNFPA for use in government facilities and select providers were trained on its administration. In 2006, the DRH requested assistance from ECafrique, the African Forum on Emergency Contraception, to expand access to the product. This report documents the results of a diagnostic assessment conducted at the outset of this initiative. It examines the provision and utilization of …

Kenya: Multisectoral Engagement Increases Support For Adolescent Reproductive Health, Frontiers In Reproductive Health

Reproductive Health

In 1999, FRONTIERS launched the Kenya Adolescent Reproductive Health Project (KARHP), testing a multisectoral approach to improving young people’s reproductive health knowledge and behavior at community, school, and health-facility levels in two pilot districts in the Western Province. The intervention involved three key government ministries—Education, Science and Technology, Health, and Gender, Sports, Culture, and Social Services—with input from community leaders, parents, and youth. Positive findings from the study convinced the three ministries and USAID to institutionalize and scale up selected elements from the pilot project. In 2003, FRONTIERS and PATH began providing technical assistance aimed at mainstreaming and expanding cost-effective …

Evaluation Of Berhane Hewan: A Pilot Program To Promote Education And Delay Marriage In Rural Ethiopia, Annabel Erulkar, Eunice N. Muthengi

Poverty, Gender, and Youth

The Berhane Hewan Program pilot-tested in rural Ethiopia from 2004–06 was developed to sensitize community members to the dangers of child marriage, prevent early marriage among unmarried adolescents, and provide support for girls who are already married. The program included social mobilization of girls aged 10–19 into groups led by female mentors; support to stay in school or convening of groups outside of school including nonformal education and livelihoods skills; and community-wide conversations on early marriage and reproductive health issues affecting girls. Economic incentives were provided to families who did not marry off their daughters during the project period. Population-based …