In this study, the impact of a government policy change, comprising the provision of rapid diagnostic tests (RDTs) and advice to restrict anti-malarial treatment to RDT-positive individuals, was assessed by describing diagnostic behaviour and treatment decision-making in febrile outpatients <10 years of age in three hospitals in the Kagera and Mwanza Region in northern Tanzania. The researchers found that, prior to policy change, there was no evident association between the actual level of transmission intensity and drug-prescribing behaviour. After policy change, there was a substantial decrease in anti-malarial prescription and an increase in prescription of antibiotics. The proportion of parasite-negative individuals who received anti-malarials decreased from 89.1% to 38.7% in Biharamulo and from 76.9% to 10% in Rubya after policy change. This study shows that an official policy change, where RDTs were provided and healthcare providers were advised to adhere to RDT results in prescribing drugs can be followed by more rational drug-prescribing behaviour. The current findings are promising for improving treatment policy in Tanzanian hospitals.
Values, Policies and Rights
The UNAIDS Reference Group on HIV and Human Rights has called on UN Member States to reaffirm the focus on human rights that has driven thirty years of progress in the global HIV response. This statement sets out five non-negotiables for Member States as they negotiate the outcome document for the High-Level Meeting between now and June 8. It states that the outcome document should reaffirm the emphasis on a human rights approach that mutually obliges rich and poor nations to fulfil the human right to health and that respects, protects and fulfils the human rights of people living with, affected by and vulnerable to HIV and AIDS, as well as reaffirm Member States’ shared responsibility to realise the human right to health by setting clear targets for funding the HIV response. Governments should also commit to utilising, to the fullest extent possible, flexibilities under the TRIPS agreement to lower the price of essential medicines, as well as remove laws, policies, practices, stigma and discrimination that block effective responses to AIDS. They should reaffirm the centrality of people living with HIV to the response as well as their human rights to non-discrimination, treatment as prevention, and meaningful participation.
A controversial United States-based project that pays drug users and alcoholics to undergo sterilisation or long-term contraception, is alleged in this article to be setting its sights on women living with HIV in South Africa. The Founder of Project Prevention is reported to have confirmed that they were making plans to offer similar services to women living with HIV in South Africa as well as drug users, in co-operation with local non-governmental organisations. However a government official in the Maternal, Child and Women’s Health in the Department of Health is reported to have said they would approach the Human Rights Commission if the project started operating in South Africa, and that doctors found involved in such medical interventions could be reported to the Health Professions Council of South Africa.
A Ugandan health lobby group, the Centre for Health Human Rights and Development, has petitioned the Constitutional Court over the alarming number of maternal deaths in government health facilities - currently, Uganda has one of the highest maternal mortality rates in the world. The group is arguing that government neglect is responsible, manifested in the ‘careless manner’ in which government hospital staff handle expectant mothers before, during and after birth. They are hoping the Constitutional Court will declare that it is a violation of the right to health when health workers and government fail to take required essential care during pre- and post-natal stages. The petitioners also want financial compensation from government for the affected families.
In this study, the authors set out to determine whether countries with high gender empowerment have a higher female-to-male smoking prevalence ratio. They explored the relationship between the United Nations Development Programme’s gender empowerment measure (GEM) and the female-to-male smoking prevalence ratio (calculated from the World Health Organisation’s 2008 Global Tobacco Control Report). Because a country’s progression through the various stages of the tobacco epidemic and its gender smoking ratio are thought to be influenced by its level of development, they explored this correlation as well, with economic development defined in terms of gross national income (GNI) per capita and income inequality (Gini coefficient). In their findings, the authors note that gender smoking ratio was significantly and positively correlated with the GEM. In addition, the GEM was the strongest predictor of the gender smoking ratio after controlling for GNI per capita and for Gini coefficient. Whether progress towards gender empowerment can take place without a corresponding increase in smoking among women remains to be seen, the authors conclude. They argue for stronger tobacco control measures in countries where women are being increasingly empowered.
In this paper, the authors examine the growing convergence between human rights and development thinking, particularly with regard to social and economic rights. They ask how the dialogue between human rights and development can contribute to furthering progress on the Millennium Development Goals (MDGs). They argue that developing countries need to secure relatively good rates of economic growth to make progress, but may be hampered by the fact that they remain far behind the developed world in terms of technology. Given a good enabling environment, most developing economies would be able to raise productivity fairly rapidly by absorbing existing knowledge from abroad, rather than inventing it for themselves. The rapid growth of South-South trade and investment flows among developing countries would be another supportive factor, but the authors caution that economic growth alone will not guarantee reaching MDG outcomes: governments need to ensure that the economic benefits of growth are equitably distributed.
This paper examines parental control and monitoring and the implications of this on young people's sexual decision making in a rural setting in North-Western Tanzania. Data collection involved 17 focus group discussions and 46 in-depth interviews conducted with young people aged 14-24 years and parents/carers of young people within this age-group. The researchers found that parents were motivated to control and monitor their children's behaviour for reasons such as social respectability and protecting them from unwanted pregnancies and sexually transmitted diseases. Children from single-parent families reported that they received less control and researchers noted that a father's presence in the family seemed important in controlling the activities of young people, while a mother's did not appear to. Girls received more supervision compared to boys. Despite parents making efforts to control and monitor their young people's sexual behaviour, the researchers conclude that parents are faced with major challenges, such as too little time available to spend with their children, which make it difficult for them to monitor them effectively. The researchers argue that there is a need for interventions, such as parenting skills-building, that might enable parents to improve their relationships with their children and help guide their sexual behaviour.
The primary objective of this study was to explore risk factors for sexual violence in childhood in a nationally representative sample of females aged 13 to 24 years in Swaziland. During a household survey respondents were asked to report any experiences of sexual violence before the age of 18 years. A total of 1,244 respondents were included in the study. Using the survey data, the researchers then analysed the association between childhood sexual violence and several potential demographic and social risk factors. They found that, compared with respondents who had been close to their biological mothers as children, those who had not been close to her had higher odds of having experienced sexual violence, likewise with those who had had no relationship with her at all. In addition, greater odds of childhood sexual violence were noted among respondents who were not attending school at the time of the survey, who were emotionally abused as children, and who knew of another child who had been sexually assaulted or was having sex with a teacher. Childhood sexual violence was positively associated with the number of people the respondent had lived with at any one time. Inadequate supervision or guidance and an unstable environment put girls at risk of sexual violence, the authors conclude, calling for greater educational opportunities and improved mother-daughter relationships.
A HIV-positive South African man has won a case of discrimination and unfair dismissal against his former employers in the Labour Court, and he says he hopes the ruling will encourage other HIV-positive people who are being discriminated against by their employers to come forward. The court ruling stated that he was unfairly dismissed by his employer because of his HIV status. The man was dismissed two years ago immediately after his former employer discovered that he was HIV-positive. Human rights organisation Section 27 has hailed the ruling, saying it sends a clear message that HIV-positive people cannot be discriminated against. According to Section 27, people with HIV should come forward and seek the protection of the law because if they go to court and their case is clear, they will win in court and the employer will be forced to pay compensation or legal costs. Advocates identified two major barriers to seeking legal redress in cases of discrimination against HIV-positive people – most people are not aware of their rights, and lawyers are inaccessible because the cost of their services is beyond the means of ordinary South Africans. Without proper legal services, they warn, it’s unlikely that claims will succeed.
Despite a growing body of research into risk factors for intimate partner violence (IPV), methodological differences limit the extent to which comparisons can be made between studies. The authors of this study used data from ten countries (including Namibia and Tanzania) from the World Health Organisation’s Multi-country Study on Women's Health and Domestic Violence to identify factors that are consistently associated with abuse across sites. Standardised population-based household surveys were conducted between 2000 and 2003, with one woman aged 15-49 years randomly selected from each sampled household. Those who had ever had a male partner were asked about their experiences of physically and sexually violent acts. The researchers found that, despite wide variations in the prevalence of IPV, many factors affected risk similarly across sites. Secondary education, high socio-economic status and formal marriage offered protection, while the risk of IPV increased with alcohol abuse, cohabitation, young age, attitudes supportive of wife beating, having outside sexual partners, experiencing childhood abuse, growing up with domestic violence, and experiencing or perpetrating other forms of violence in adulthood. The strength of the association was greatest when both the woman and her partner had the risk factor. The authors conclude that current IPV prevention programmes should pay greater attention to transforming gender norms and attitudes, addressing childhood abuse and reducing harmful drinking. Development initiatives to improve access to education for girls and boys may also have an important role in violence prevention.