Conflict has long been assumed to contribute significantly to the spread of HIV infection. However, new research is casting doubt on this assumption. Studies from Africa suggest that conflict does not necessarily predispose to HIV transmission and indeed, there is evidence to suggest that recovery in the ‘post-conflict’ state is potentially dangerous from the standpoint of HIV transmission. There has also been concern that high rates of HIV infection among many of the militaries of sub-Saharan Africa poses a threat to regional security. However, data is lacking on this. These issues are of vital importance for HIV programming and health sector development in conflict and ‘post-conflict’ societies and will constitute formidable challenges to the international community. Further research is required to better inform the discussion of HIV, conflict and security in sub-Saharan Africa.
Equity and HIV/AIDS
The HIV status of surgeons, in the context of the informed consent obtained from their patients, is a contentious matter. We surveyed the views of practising surgeons in South Africa regarding aspects of HIV and its impact on surgeons. A cross-sectional survey was conducted with surgeons who were members of the Association of Surgeons of South Africa to find out their attitudes to the preceding issues. The salient findings included the view that a patient-centred approach requiring HIV status disclosure to patients would be discriminatory to surgeons and provide no clear benefit to patients, and that HIV-positive surgeons should determine their own scope of practice. Patient-centred approaches and restrictive policies do not accord with clinicians’ sentiments. In the absence of comparable local or international data, this study provides clinicians' views with implications for the development of locally relevant policies and guidelines.
Ugandan HIV activists have expressed concern over a recommendation by parliament's budget committee that the allocation for antiretroviral (ARV) drugs be cut. The national budget for 2008/09 allocated 76 billion shillings (US$38 million) to purchasing ARVs, the first such allocation in the country's history, but the house standing committee recommended that the amount be cut to 40 billion shillings in the 2009/2010 budget. ‘We recognise that HIV is a serious disease but it is not the only disease affecting Ugandans,’ said Rose Akol Okullo, chair of the committee. ‘Cancer and diseases afflicting women need equal attention if we are to meet the Millennium Development Goal on health. More than 300,000 HIV-positive people in Uganda need ARVs. AIDS activists argue that the committee's recommendation will allow the government to shirk its responsibility to provide drugs to them.
This article presents the first known systematic review of the research literature on carers of AIDS-orphaned children. Twenty-nine studies of caregivers of AIDS-orphaned children were identified and assessed, mostly in the developing world. Most studies included identifying the individuals who were providing care, assessing the capacity of the extended family to care for AIDS orphans and exploring the process of care placement. Few examined the caregiving experience in any depth, including the challenges of caring for orphans or the effects of caring for these children on the caregivers' health and wellbeing. The article concludes with suggestions for future research to guide policy and programming efforts.
This study has investigated human immunodeficiency virus (HIV) knowledge, attitudes and sexual at-risk behaviours of youths from disadvantaged communities of Dar es Salaam, Tanzania. Participants were 800 youths aged 12-15 years from poorer communities. Participants showed low levels of HIV knowledge, little experience with condom use and low intention to use condoms. Contrary to expectations, there were no significant differences between those in-school and those out-of-school. Gender differences were apparent, in that girls scored consistently lower than boys on all variables. HIV and AIDS education within the schools of Tanzania needs to be re-evaluated and better educational strategies developed.
Nearly 500 delegates from all over the world met at the Rio de Janeiro Global Forum to discuss how men can help improve gender equality, prevent domestic and sexual violence, and improve maternal and reproductive health for themselves and their partners. Gender roles play a major role because they can determine the extent of our vulnerability to the HIV infection. Research in nine Latin American countries found that young men, aged 10 to 24, were far more concerned with achieving and preserving their masculinity than with their health. Another study found that expectations about male behaviour may result in early sexual initiation and more sexual partners, less intimacy in relationships and reluctance to use condoms.
Anecdotal evidence that entrenched cultural beliefs among Swazis actively encourage the spread of HIV/AIDS has been confirmed by a joint government and UN report. The study, called 'The State of the Swaziland Population', echoes warnings by local NGOs that 'AIDS cannot be stopped unless there is a change in people's sexual behaviour.' 'Swazis are very traditional people, and their sexual behaviour is inbred and totally against safe sexual practices, like condom use and monogamous relationships, that limit the spread of HIV,' noted an HIV testing counsellor in Manzini, the country's main commercial city. The report, based on focus groups and surveys, found that maintaining a centuries-old cultural belief in procreation to increase the population size, was having devastating consequences in the age of AIDS.
This article examines the dynamic role of law as a tool, and potential barrier, to public health interventions designed to ameliorate the negative impacts of HIV and AIDS globally. Laws may empower public health authorities, reinforce the human rights of persons living with HIV or AIDS and protect them from social risks, stigma and other harms by respecting privacy and prohibiting unwarranted discrimination. However, laws can also create legal barriers by penalising HIV+ people through criminal sanctions or other policies. As a result, it is recommended globally that laws should facilitate the prevention and treatment of HIV/AIDS consistent with scientific and public health practices and with a human rights framework.
A shortage of free female condoms in public hospitals in Kenya's Coast Province is compromising the ability of women to protect themselves from unwanted pregnancy and sexually transmitted infections. Female condoms are available in private hospitals and pharmacies in the province, but at a cost of up to US$5 – five times the cost of a male condom – they are too expensive for most women, especially in a time of famine, where every penny goes towards food. Sex workers are among those affected most by the shortage. Some have reported that that the female condom was a key part of their business. If customers refuse to wear a condom, sex workers at least have the option of wearing a female condom to protect themselves against sexually transmitted diseases like HIV.
The layering of HIV-related stigma with stigmas associated with gender, race, and class poses a methodological challenge to those seeking to understand and, thereby, to minimise its negative effects. In this meta-study of 32 reports of studies of stigma conducted with HIV-positive women, the researchers found that gender was hardly addressed despite the all-female composition of samples. Neither sexual orientation nor social class received much notice. Race was the dominant category addressed, most notably in reports featuring women in only one race/ethnic group. The relative absence of attention to these categories as cultural performances suggests the recurring assumption that sample inclusiveness automatically implies the inclusion of gender, race, and class, which is itself a cultural performance.