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Strengthening Sti Treatment And Hiv/Aids Prevention Services In Carletonville, South Africa, Lewis Ndhlovu, Catherine Searle, Johannes Van Dam

HIV and AIDS

Although knowledge about HIV/AIDS is widespread in South Africa, adult HIV prevalence is high, indicating high levels of risky sexual behavior. Understanding the gap between knowledge and behavior requires an examination of the social context in which the epidemic occurs. The Horizons Program conducted an intervention study in the Carletonville area to study the social determinants of the HIV epidemic and to assess the impact of a targeted program of HIV and STI prevention and service delivery. In 1998, the Mothusimpilo (“Working together for health”) Intervention Project (MIP) was launched to reduce community prevalence of HIV and other STIs and …

Combinando Estrategias Comunitarias Y Política Gubernamental Para Prevenir La Infección Del Vih En La República Dominicana, Deanna Kerrigan, Luis Moreno, Santo Rosario, Bayardo Gomez, Hector Jerez, Ellen Weiss, Johannes Van Dam, Eva Roca, Clare Barrington, Michael D. Sweat

HIV and AIDS

Programas efectivos para evitar nuevas infecciones del VIH entre trabajadoras sexuales y sus parejas, y por lo tanto la población en general, son componentes críticos de estrategias nacionales de prevención del VIH. Un estudio recientemente realizado por Horizons, en conjunto con dos organizaciones no-gubernamentales dominicanas y el Programa Nacional del Control de ITS y SIDA evaluó el impacto de dos modelos ambientales-estructurales en disminuir el riesgo de VIH en trabajadoras sexuales en la República Dominicana y comparó el costo-efectividad de los dos modelos. Los modelos, construidos sobre la base de años de experiencia adquirida a través de programas de educación …

Community Approaches And Government Policy Reduce Hiv Risk In The Dominican Republic, Deanna Kerrigan, Luis Moreno, Bayardo Gomez, Hector Jerez, Ellen Weiss, Johannes Van Dam, Eva Roca, Clare Barrington, Michael D. Sweat

HIV and AIDS

Effective programs that avert new HIV infections among sex workers and their partners, and hence the general population, are critical components of national HIV-prevention strategies. Prevention efforts have frequently relied on interventions that reach members of these vulnerable groups as individuals, such as condom promotion and STI management. Now, many researchers and program implementers are increasingly turning to “environmental-structural” interventions that address the physical, social, and political contexts in which individual behavior takes place. A recent Horizons study conducted jointly with two Dominican NGOs—Centro de Orientación e Investigación Integral and Centro de Promoción e Solidaridad Humana—and the National Program for …

Intervenciones Comunitarias Y Política Gubernamental Reducen El Riesgo Del Vih En La República Dominicana, Deanna Kerrigan, Luis Moreno, Bayardo Gomez, Hector Jerez, Ellen Weiss, Johannes Van Dam, Eva Roca, Clare Barrington, Michael D. Sweat

HIV and AIDS

Programas efectivos para evitar nuevas infecciones del VIH entre trabajadoras sexuales y sus parejas, y por lo tanto la población en general, son componentes críticos de estrategias nacionales de prevención del VIH. Generalmente los esfuerzos de prevención se han concentrado en intervenciones que alcanzan a los miembros de estos grupos vulnerables al nivel individual, tal como promoción de condones y manejo de ITS. Actualmente, muchos investigadores y gerentes de programas se encuentran dirigiéndose a intervenciones “ambientales-estructurales” que toman en cuenta los contextos físicos, sociales y políticos en que el comportamiento individual ocurre. Un estudio reciente realizado por Horizons, en conjunto …

The Role Of Incentives In Promoting Workplace Hiv/Aids Policies And Programs, Simon Baker, Srisuman Sartsara, Patchara Rumakom, Philip Guest, Katie D. Schenk, Anthony Pramualratana, Suparat Suksakulwat, Surachai Panakitsuwan, Sikarat Moonmeung

HIV and AIDS

This brief examines the role of incentives in encouraging companies in Thailand to adopt workplace policies and programs that address AIDS-related stigma and discrimination and respond to the needs of workers for information and services. The research was a collaboration between the Horizons Program, American International Assurance (AIA), the Thailand Business Coalition on AIDS (TBCA), and AusAID. After the initiative was launched (known as the AIDS-response Standard Organization), TBCA staff built relationships with company managers to explain and promote the advantages of joining. Companies agreeing to implement at least three HIV/AIDS workplace policies would receive a reduction of 5–10 percent …

Equitable Access To Hiv Counseling And Testing For Youth In Developing Countries: A Review Of Current Practice, Ann P. Mccauley

HIV and AIDS

While many people get HIV-related counseling and testing, only those who receive pre- and post-test counseling, and test voluntarily, are participating in voluntary counseling and testing (VCT). The high rates of HIV infection among youth make it crucial to find programs to prevent infection. Because there is evidence that many adults benefit from VCT, there is increasing interest in extending these services to young people. VCT counseling helps adolescents evaluate their own behavior and its consequences. A negative test result offers the opportunity to recognize vulnerabilities and develop risk-reduction plans to adopt safe behaviors. Young people who test HIV-positive can …

Paving The Path: Preparing For Microbicide Introduction—Report Of A Qualitative Study In South Africa [Executive Summary], Julie Becker, Rasha Dabash, C. Elizabeth Mcgrory, Diane Cooper, Jane Harries, Margaret Hoffman, Jennifer Moodley, Phyllis Orner, Hillary J. Bracken

HIV and AIDS

With recently accelerated support for the development of microbicides to prevent HIV transmission and the urgency of the global AIDS epidemic, it is important to begin to identify strategies for introducing a microbicide once it is proven safe and effective and is approved for use. This executive summary presents results from a qualitative study that explored a range of issues likely to influence microbicide introduction at the community, health service, and policy levels. The study, which identified critical issues to be addressed in building support for microbicides and facilitating a smooth introduction, was conducted between September 2002 and September 2003 …

Paving The Path: Preparing For Microbicide Introduction—Report Of A Qualitative Study In South Africa, Julie Becker, Rasha Dabash, C. Elizabeth Mcgrory, Diane Cooper, Jane Harries, Margaret Hoffman, Jennifer Moodley, Phyllis Orner, Hillary J. Bracken

HIV and AIDS

With recently accelerated support for the development of microbicides to prevent HIV transmission and the urgency of the global AIDS epidemic, it is important to begin to identify strategies for introducing a microbicide once it is proven safe and effective and is approved for use. This report presents results from a qualitative study that explored a range of issues likely to influence microbicide introduction—positively or negatively—at three levels: community, health service, and policy. The study, which identified critical issues to be addressed in building support for microbicides and facilitating a smooth introduction, was conducted between September 2002 and September 2003 …

Involving Young People In The Care And Support Of People Living With Hiv/Aids In Zambia, Eka Esu-Williams, Katie D. Schenk, Joseph Motsepe, Scott Geibel, Anderson Zulu

HIV and AIDS

The Population Council, in collaboration with CARE International and Family Health Trust, conducted a study in Zambia to determine which care and support needs of people living with HIV and AIDS and their families could be met by trained youth, and to establish whether youth engaged in formalized care and support activities would increase their adoption of protective behaviors or reduce the stigma faced by members of AIDS-affected households. Discussions with caregivers and clients demonstrated that trained youth are able to meet a range of the needs of clients and orphans and vulnerable children, and that their efforts may be …

A Rapid Situation Analysis Of The Access To Care Project In Northern Thailand, Ratana Panpanich

HIV and AIDS

A rapid situation analysis (RSA) study, supported by the Horizons program, was undertaken to understand the strengths and weaknesses of the Thai government’s Access to Care (ATC) project in northern Thailand. The ultimate aim of the study was to make recommendations for action that will improve the quality of the antiretroviral (ARV) therapy that clients receive and to enhance their adherence to HAART. The RSA has shown high levels of support for the ATC project from health providers, HAART clients, their relatives, and even those who had dropped out of the program. However, the RSA has also shown that there …

Adherence To Antiretroviral Therapy In Adults: A Guide For Trainers, Horizons Program, International Centre For Reproductive Health, Mombasa Coast Province General Hospital

HIV and AIDS

Over the last five years, there has been a rapid change in treatment strategies for HIV infection. With the advent of newer antiretrovirals, treatment has moved from mono-therapy and bi-therapy to triple drug therapy or Highly Active Antiretroviral Therapy. One of the foremost concerns of ARV programs is the ability of people living with HIV/AIDS to maintain near perfect adherence over the long term. To achieve the goal of antiretroviral therapy (ART), undetectable levels of the virus in the blood, patients are required to maintain more than 90–95% adherence. Adherence is defined as a patient’s ability to follow a treatment …

Vulnerability And Intervention Opportunities: Research Findings On Youth And Hiv/Aids In South Africa, Population Council

HIV and AIDS

The Nelson Mandela Children’s Fund (NMCF) seeks comprehensive local solutions to address the negative effects of HIV/AIDS on children, adolescents, households, and communities. To this end, NMCF initiated the Goelama Project, which uses a community mobilization strategy to catalyze action by local organizations and government bodies to prevent HIV infection and mitigate the socioeconomic impacts of the disease, particularly as they affect orphans and vulnerable children (OVC). This brief highlights key findings from an assessment of reproductive and sexual health knowledge and behaviors among nearly 5,000 youth from eight districts in three provinces in South Africa where the Goelama Project …

Attracting Youth To Voluntary Counseling And Testing Services In Uganda, Ann P. Mccauley, Milka Juma, Edward Kirumira, Nelson Kakande, Scott Geibel, C. Hitimana-Lukanika, Daniel Lukenge, Edith Mukisa

HIV and AIDS

Little is known about the use of voluntary counseling and testing (VCT) by youth, a group that comprises more than half of those newly infected with HIV. An exploratory study conducted in Nairobi, Kenya, and Kampala and Masaka in Uganda revealed that young people want information, confidentiality, low-cost HIV testing, and friendly, professional counseling. Two facilities in Kampala, the AIDS Information Center (AIC) and Naguru Teenage Information and Health Center (NTIHC), implemented new youth-oriented strategies to increase VCT utilization and satisfaction with services among young people. In 2001, AIC established a youth corner behind the regular adult clinic with a …

Transitions To Adulthood In The Context Of Aids In South Africa: The Impact Of Exposure To Life Skills Education On Adolescent Knowledge, Skills, And Behavior, The Transitions To Adulthood Study Team

HIV and AIDS

This study is a collaborative research project of the University of Natal-Durban, the Horizons program, and Tulane University. One objective of the study was to contribute to understanding the effectiveness of life skills education in changing behavior in South Africa. The findings indicate substantial short-to-medium-term effects of exposure to life skills education on certain areas of sexual and reproductive health-related knowledge, confidence to use condoms, and condom use behavior. Further research is needed to assess whether the observed effects are transitory or long-term in nature, whether the observed behavioral changes have an impact on HIV infection rates among youth, and …

Using Incentives To Encourage Aids Programs And Policies In The Workplace: A Study Of Feasibility And Impact In Thailand, Simon Baker, Srisuman Sartsara, Patchara Rumakom, Philip Guest, Katie D. Schenk, Anthony Pramualratana, Suparat Suksakulwat, Surachai Panakitsuwan, Sikarat Moonmeung

HIV and AIDS

A recently completed Horizons study in Thailand examined the question of how to encourage the private sector to become actively involved in developing and improving workplace HIV/AIDS programs. The study found that the AIDS-response Standard Organization (ASO) initiative mobilized a moderate proportion of different types of companies to develop and improve HIV/AIDS workplace policies and programs. The data also reveal that companies that were eligible for the insurance discount made the greatest improvements. Thus a financial incentive combined with efforts to tap into managers’ willingness to respond to the epidemic can be important motivators for certain companies to improve their …

Challenges Faced By Households In Caring For Orphans And Vulnerable Children, Population Council

HIV and AIDS

South Africa has seen a rapid increase in HIV prevalence among the general population over the past ten years, from less than 1 percent in 1990 to 20 percent in 2001. As the HIV/AIDS epidemic increases, so do the number of orphans and vulnerable children (OVC). In 2002, an estimated five million people were living with HIV/AIDS. Because of the average 10-year period between infection and death, even if HIV prevalence declined rapidly, South Africa would still experience an increasing orphan burden for many years to come. By 2010, 16 percent of all children in South Africa will be orphans …

The Implications Of Early Marriage For Hiv/Aids Policy, Judith Bruce, Shelley Clark

Poverty, Gender, and Youth

This brief is based on a background paper prepared for the WHO/UNFPA/Population Council Technical Consultation on Married Adolescents, held in Geneva, Switzerland, December 9–12, 2003. The final paper is entitled “Including married adolescents in adolescent reproductive health and HIV/AIDS policy.” The consultation brought together experts from the United Nations, donors, and nongovernmental agencies to consider the evidence regarding married adolescent girls’ reproductive health, vulnerability to HIV infection, social and economic disadvantage, and rights. The relationships to major policy initiatives—including safe motherhood, HIV, adolescent sexual and reproductive health, and reproductive rights—were explored, and emerging findings from the still relatively rare programs …

Including Married Adolescents In Adolescent Reproductive Health And Hiv/Aids Policy, Judith Bruce, Shelley Clark

Poverty, Gender, and Youth

The majority of sexually active girls aged 15–19 in developing countries are married, and married adolescent girls tend to have higher rates of HIV infection than their sexually active, unmarried peers. Married adolescent girls represent a sizable fraction of adolescents at risk and experience some of the highest rates of HIV prevalence of any group. Nonetheless, married adolescents have been marginal in adolescent HIV/AIDS policies and programs and have not been the central subjects for programs aimed at adult married women. This paper offers a partial explanation for why married adolescents have so often been overlooked, the reasons why marriage …

Les Implications Du Mariage Précoce Pour Les Politiques De Vih/Sida, Judith Bruce, Shelley Clark

Poverty, Gender, and Youth

Ce dossier est basé sur un document contextuel préparé pour la Consultation Technique OMS/ FNUAP/Population Council sur les Adolescentes Mariées, tenue à Genève en Suisse du 09 au 12 Décembre 2003 (le document final intitulé "Inclure les adolescentes mariées dans les politiques de santé reproductive des adolescents et de VIH/SIDA"). La Consultation a réuni des experts provenant des Nations Unies, des bailleurs de fonds et des agences non gouvernementales pour examiner les faits concernant la santé reproductive des adolescentes mariées, leur vulnérabilité face à l’infection du VIH, leurs inégalités sociales et économiques ainsi que leurs droits. Les rapports avec des …

Testing The Effectiveness Of Integrating Community-Based Approaches For Encouraging Abandonment Of Female Genital Cutting Into Care's Reproductive Health Programs In Ethiopia And Kenya, Jane Chege, Ian Askew, Susan Igras, Jacinta Muteshi-Strachan

Reproductive Health

CARE International, with technical support from the Frontiers in Reproductive Health Program completed a study in Ethiopia and Kenya designed to test the effectiveness of education activities using behavior change communication (BCC) approaches and advocacy activities by religious and other key leaders to abandon female genital cutting (FGC). In Ethiopia, the increased knowledge of harmful FGC effects and human rights issues translated to a positive attitude in support of FGC abandonment and an intention not to cut their daughters in the future. In Kenya, the analysis indicated mixed results in attitude and intended behavior change.

Chronic Pain: The Extra Burden On Canadian Women, Marta Meana, Robert Cho, Marie Desmeules

Psychology Faculty Research

Health Issue: Chronic pain is a major health problem associated with significant costs to both afflicted individuals and society as a whole. These costs seem to be disproportionately borne by women, who generally have higher prevalence rates for chronic pain than do men.

Key findings: Data obtained from 125,574 respondents to the Canadian Community Health Survey (2000–2001) indicated that 18% of Canadian women suffered from chronic pain, compared to 14% of men. This gender discrepancy, however, seemed to be linked primarily to differences in age, income, and education between adult men and women in this large sample. Age, income, depression …

Next-Of-Kin Perceptions Of Physician Responsiveness To Symptoms Of Hospitalized Patients Near Death, Joel C. Cantor, Jan Blustein, Matthew J. Carlson, David A. Gould

Sociology Faculty Publications and Presentations

Many different medical providers visit critically ill patients during a hospitalization, and patients and family members may not feel any physician is truly in charge of care. This study explores whether perceiving that a physician was clearly in charge is associated with reports by surviving next of kin about the responsiveness of physicians to symptoms in hospitalized patients near the end of life. We conducted telephone interviews with surviving next of kin of adult patients (n = 1107) who died in one of five New York City teaching hospitals between April 1998 and June 1999 after a minimum 3-day inpatient …

Introduction Of A Waterless Alcohol-Based Hand Rub In A Long-Term Care Facility, Lona Mody, Mcneil A. Shelly, Rongjun Sun, Bradley Suzanne, Carol A. Kauffman

Sociology & Criminology Faculty Publications

OBJECTIVE:

To examine the impact of introduction of an alcohol-based hand rub on hand hygiene knowledge and compliance and hand colonization of healthcare workers (HCWs) in a long-term-care facility (LTCF).

METHODS:

Two floors of an LTCF participated. Ward A used the hand rub as an adjunct to soap and water; ward B was the control. HCWs' hands were cultured using the bag-broth technique for Staphylococcus aureus, gram-negative bacilli (GNB), Candida, and vancomycin-resistant enterococci (VRE). HCWs completed a questionnaire at baseline and after an educational intervention and introduction of rub.

RESULTS:

Hand hygiene practices, knowledge, and opinions did not change after …

Expanding Self-Direction In Services For The Aged And People With Disabilities, Ruth A. Burgess

Theses, Dissertations and Capstones

Medicaid-funded long-term care services are traditionally delivered in nursing homes. States may apply for waivers which allow them to provide home and community based services with Medicaid funds. Because these services are by definition an alternative to nursing home care, waiver services are generally based upon a medical model which emphasizes medical deficits and tends to restrict consumers’ movements to inside the home. Recent developments such as the Olmstead Decision and federal New Freedom Initiatives have caused states to recognize that consumers desire and have a legal right to be part of a community rather than institutionalized or homebound. These …

Reproductive Health Services In Kwazulu Natal, South Africa: A Situation Analysis Study Focusing On Hiv/Aids Services, Lewis Ndhlovu, Catherine Searle, Robert A. Miller, Andrew A. Fisher, Ester Snyman, Nancy L. Sloan

HIV and AIDS

This Horizons report examines the readiness of reproductive health services in South Africa, which are primarily geared to women, to deliver HIV and AIDS treatment, care, and prevention services. The goal of the study was to obtain information from a representative sample of provincial health care facilities offering reproductive health services in KwaZulu Natal to meet the growing demand for HIV/AIDS-related services. Ninety-eight hospitals, community health centers, and clinics participated in the situation analysis that identified gaps in service delivery and determined priorities for service integration. Results of the study were presented to a large audience of Department of Health, …

Empowering Communities To Respond To Hiv/Aids: Ndola Demonstration Project On Maternal And Child Health: Operations Research Final Report, Hope Humana, Linkages, National Food And Nutrition Commission, Ndola District Health Management Team, Horizons Program, Zambia Integrated Health Project

HIV and AIDS

A pre–post intervention study conducted in Zambia by Horizons and local NGOs and governmental organizations demonstrated that HIV voluntary counseling and testing (VCT) and infant feeding counseling (IFC) to mothers attending maternal and child health (MCH) clinics are vital components of any mother-to-child transmission (MTCT) reduction strategy, whether or not antiretrovirals (ARVs) are available. These interventions enable mothers to make informed and healthy decisions. Data from the Ndola Demonstration Project yielded encouraging results from efforts to improve the capacity of mothers to make informed decisions about their own health and the health of their infant. The interventions succeeded in raising …

Microfinance And Households Coping With Hiv/Aids In Zimbabwe: An Exploratory Study, Carolyn Barnes, Erica Keogh, Nontokozo Nemarundwe, Loveness Nyikahadzoi, Ellen Weiss

HIV and AIDS

This study, conducted in Zimbabwe, sought to better understand the relationship between a microfinance program, Zambuko Trust, and how microentrepreneurs’ households cope with the impact of HIV/AIDS. The study examined how HIV/AIDS is affecting Zambuko’s operations and what microfinance institutions (MFIs) can do to lessen the impact of HIV/AIDS on their clients and operations. The findings indicate several small yet important ways that MFI programs help microentrepreneurs and their families respond to these impacts through access to credit and business management training. Participation in a microfinance program led to income smoothing and better financial management, which can help households mitigate …

Evaluating Operations Research Utilization: Guidelines For Assessing Process And Impact, M. Celeste Marin, Jane T. Bertrand

Reproductive Health

The Population Council has been providing technical assistance and conducting Operations Research (OR) studies in family planning and reproductive health for over two decades. These studies are designed to identify problems and test strategies to resolve those problems, providing program managers, administrators, and policymakers with the information they need to improve service-delivery systems. The ultimate goal is that strategies tested through OR will be adopted, leading to changes in policy or operational procedures at institutional, national, or international levels. These changes are what we refer to as impact. The purpose of the new approach to evaluation described in this Evaluation …

A Comparison Of Human Energy Fields Among Children, Youth, Adults, & Dahn Masters, Geoffrey K. Leigh, Karen A. Polonko, Catherine D. Leigh

Sociology & Criminal Justice Faculty Publications

While concepts and investigations of human energy fields have been developed for centuries, there has been little systematic work comparing the fields of children, adolescents, and adults. In addition, general fields have had little comparison between average adults and those participating in an intense practice that may affect the field. Using the GDV machine, this research compared small groups of children, adolescents, average adults, and Dahn Hak Masters on measures of 20 basic aspects of the human energy fields, including the seven chakras. Differences were found in seven of the 13 field parameters as well as all seven measures of …

Update - September 2002, Loma Linda University Center For Christian Bioethics

Update

In this issue:

-- Just Put Me to Sleep . . . PLEASE!: Ethical Issues in Palliative and "Terminal" Sedation
-- Terminal Sedation: A Jewish Perspective
-- Terminal Sedation: A Catholic Perspective
-- Announcing the Center for Christian Bioethics Nation Conference in 2003: "Promise and Peril of the New Genetics"
-- Center news . . .