Gynecological morbidity is defined as "any condition, disease or dysfunction of the reproductive system that is not related to pregnancy, abortion or childbirth but may be related to sexual behavior." The study states that such gynecological conditions are frequent in women infected with Human Immunodeficiency Virus (HIV).
Cameroon is one of the sub-Saharan African countries with a high prevalence of HIV; 6.8% of women of reproductive age are HIV infected.
The study was aimed at comparing the prevalence of gynecological conditions among HIV infected and non-infected pregnant women.
Over two thousand pregnant women were screened for HIV, lower genital tract infections and lower genital tract neoplasia at booking antenatal visit.
About 10% of the women were found to be HIV positive. In addition, all lower genital tract infections except candidiasis were more prevalent among HIV positive compared to HIV negative women.
Both pregnancy and HIV predispose women to certain gynecological conditions because of modification of the immune system, states the study.
The study cites the Center for Disease Control and Prevention (CDC) classification system for HIV infection includes several gynecological conditions such as persistent, frequent or poorly responsive episodes of vaginal candidiasis, moderate or severe cervical intraepithelial neoplasia (CIN) and pelvic inflammatory disease (PID), chronic herpes simplex virus ulcers and invasive cervical cancer.
According to the study, titled "Gynaecological morbidity among HIV positive pregnant women in Cameroon," only HIV and syphilis are screened during antenatal care in Cameroon, despite the fact that HIV is known to be associated with other sexually transmitted infections.
There is a clear disconnect between practice and evidenced-based information which shows the infections that affect women during pregnancy. In itself, that disconnect between scientific evidence and actual practice is a trend common to many HIV and AIDS programs.
Scientific information about HIV and AIDS is still very much ignored in programs as implementers are mainly engrossed in work related to the social manifestation of the epidemic. But, in order to achieve progress against AIDS, there is need for program implementers to incorporate evidence-based recommendations into their programs.
The study, which compared the prevalence of gynecological morbidity among pregnant women according to their HIV serostatus identified during antenatal care, found sexually transmitted infections (STIs) and pre-invasive cervical lesions to be more prevalent among HIV infected pregnant women compared to their non-infected counterparts.
Previous studies have reported that sexually transmitted infections producing ulcerative lesions such as syphilis, chancroid and genital herpes simplex virus (HSV) are associated with a higher rate of HIV transmission. In addition, non-ulcerative STIs are also associated with a three- to five-fold increase in the risk of HIV acquisition.
According to the study, routine screening and treatment of STIs during antenatal care in Cameroon and other countries with similar social profiles needs to be conducted on a regular basis. For pregnant, antenatal care also offers an excellent entry point to encourage women to consider getting on AIDS treatment.
]]>Religions play a fundamental role in defining the attitude of society and governments to matters of reproduction and sexuality. The influence of religion in individual decision-making on sex-related issues is beyond doubt, even among self-declared anti-religion activists.
Yet there is so much more that could come out of a comfortable co-existence between sex and religion, and this interconnection is usually sacrificed at the altar of both conservative views or self-justified sexuality.
Suffice it to say that around the world there are many religious organizations that are already engaged in work to improve the lives of women; that work oftentimes touches on sexual and reproductive health and rights. Unfortunately, religious and secular organizations have largely failed to forge links that than can advance the cause of sexual and reproductive health and rights, opting instead to regard each other as enemies. Sexuality and reproduction are at the core of religion's attitude toward women, and in many parts of the world, improving the status of women needs to work at the nexus of religion and reproductive health and rights.
To achieve this requires the religious
and secular groups and individuals working in concert to ensure that
men and women can have satisfying and constructive sexual lifestyles.
In its purest essence, religion -
whether Christian, Muslim or Hindu - seeks to promote justice, dignity
and compassion. These core values can be harnessed in the effort to
advance sexual and reproductive health and rights.
In fact, the religious sector can play
a significant role to challenge patriarchal systems that legitimate
violence, abuse, and exploitation of men by women. Oftentimes, the religious sector
turns a blind face when atrocities are committed against sexual minorities
and women in the name of religious doctrine. Conversely, secular organizations and
individuals will often employ blame tactics and adversarial attitudes
towards the religious sector, grabbing media headlines in the process,
but without making headway to change the status quo.
When the secular and religious sector
can collaborate and interconnect on commonly held values, much more
progress will be made in promoting sexual rights.
In Africa, for example, where HIV and AIDS are widespread, religious organizations find themselves having to deal with the disease and they are often forced to deal with human sexuality. Instead of helping matters, the religious have been found wanting in dealing with human sexuality due to a stiff-necked moralistic approach to sex and sexuality. Much of stigma and discrimination against people living with HIV in Africa has its roots in the religious sector.
The faith based sector can certainly serve its adherents better by incorporating evidence-based information in a sensitive manner that advances the cause of social justice and human dignity.
Overall, there is need for more collaborative work at the intersection of religion and sexual and reproductive health for the betterment of our societies. ]]>
According to the latest issue of Population
Reports, titled "Vasectomy: Reaching
Out to New Users,"
published by the Johns Hopkins Bloomberg School of Public Health,
vasectomy is simpler and more cost effective than female sterilization
and offers men a way to share responsibility for family planning.
"The most entrenched and powerful rumors concern manhood, masculinity, and sexual performance. Many men confuse vasectomy with castration and fear, incorrectly, that vasectomy will make them impotent," says the report. But in fact, "Castration involves removal of the testicles. In contrast, vasectomy leaves the testicles intact, and they continue to produce male hormones."
The procedure which typically takes from 15-30 minutes and usually causes few complications and no change in sexual function is one of the most reliable forms of contraception. Though it does not offer protection against sexually transmitted infections or HIV, for couples it is a way for men to be directly involved in family planning. Family planning has been largely seen as the responsibility of women but vasectomies allow men to play a part.
The report states that the largest number of vasectomized men are in China, where almost 7% of women in relationships -- or more than 17 million couples -- rely on vasectomy for birth control.
Although the process of vasectomy does not usually pose any medical risks, the uptake of this contraceptive method is very low in many developing countries.
The report states that worldwide fewer
than 3% of women ages 15 to 49 who are married or in partnerships rely on a
partner's vasectomy for contraception. In sub-Saharan Africa, less than
one-tenth of 1% of women in union rely on a partner's vasectomy for
contraception. Even in developed countries overall the uptake of vasectomy
is very low with less than 5% of women relying on vasectomy.
Due to traditional and cultural beliefs about male virility, many men shun vasectomy. The fear that vasectomy will cause impotence makes many men turn away from opting for vasectomy as a family planning method.
Also, in many parts of the developing world very few men have heard about the contraceptive method. But many men want to know that they are able to impregnate a woman whenever they choose to -- thereby lessening the procedure's appeal.
To promote vasectomy requires the mammoth task of dispelling the myths surrounding the contraceptive, in particular, reassuring men that their sexuality will not be effective after the procedure. It is critical to communicate the fact that a vasectomy will not affect a man's sex drive, as the procedure does not affect the production of male hormones.
Another key message is that vasectomy is
not an option for all men; it is only appropriate for men who no longer want to bear children. Following a vasectomy a man will continue
to enjoy sex, and produce the same amount of fluid when he ejaculates --
but the fluid will not contain sperm that can impregnate a woman.
The report recommends that mass media and interpersonal communication directed to clients can dispel myths and rumors, disseminate accurate information about the procedure, tell men where the method is offered, and prompt men to discuss vasectomy with family and friends.
Vasectomy also needs to be promoted throughout health care systems, and all clinic staff should receive general training to help them better understand vasectomy, and ultimately feel comfortable with male clients. ]]>More often than not, communities are only involved in AIDS programs as target groups which reduces the impact of interventions. As a result, millions of dollars invested into AIDS every year go to waste and nothing changes at community level.
During a monthly NGO Forum held in Chiang Mai, Thailand, titled "Community Based HIV and AIDS Responses: Care and Treatment and Research," NGO participants agreed that an HIV and AIDS response which is not grounded in the community remains abstract and fails to address the real needs of people infected or affected by the epidemic.
Three Approaches to Community Involvement
"The community is key to our work, we aim to make the community aware and involved in HIV and AIDS efforts," said Nipha Chompoopah of the RaksThai Foundation.
She added that a good response to the AIDS epidemic relied on community participation at all levels, and that in Thailand there was a traceable evolution of the community's involvement in HIV and AIDS research programs.
"Our work began with encouraging people living with HIV to open up about their status, and when that happened sexual behaviours came into question," said Chompoopah. "With sexual behaviors, we needed to face up to gender-related issues, sexual diversity and sexual reproductive health as well as looking at sexuality from the social perspective."
As a direct result of community based research, her organization began implementing home based care interventions to get the community to be involved in the care of people living with HIV.
"Lessons learned inform our project that prevention work cannot be carried out separately from work on sexual behavior. We learned that to work effectively on prevention, issues such as sexuality, safe sex, unwanted pregnancy, reproductive health, sexual health, sexual diversity, gender, promotion of equality and social dimension of sex cannot be avoided," she said.
According to Chompoopah, the research conducted by the RaksThai Foundation is not merely confined to clinical study and relies on participation from community to bring about solutions. Chompoopah said ongoing research that her organization is conducting is focused on the role of alcohol, HIV and domestic violence.
The hypothesis is that excessive alcohol consumption influences the spread of HIV and many women are treated with violence as a result of unequal status between men and women and the patriarchal structure in society.
Prasert Dechaboon, coordinator of the Protestant Network, which is part of the Religious Network for HIV/AIDS in Thailand, said that since its inception in 2004, one of the most important strategies of his organization is to apply religious teachings to HIV and AIDS responses.
"Based of the attitudes of conservatives, religious teaching perpetuates a dichotomy of good and bad, right and wrong, even though, essentially, all religions hold it most important to develop inner strength," said Dechaboon.
Dechaboon said that sustainable care in the community is made possible by raising awareness to make local people feel that HIV and AIDS is a common problem that can be resolved with greater inner power.
The primary objective of the work by religions organizations is to mobilize the community to help in the care of PLHAs and affected people as well as to enable PLHAs and their families and community members to have access to health services. In addition, support has been provided for orphans and vulnerable children and their families.
Spiritual approaches underpin the work and religious teachings are applied to promote the "volunteer spirit" among local villagers, said Dechaboon.
According to Dechaboon, lessons from working with the community inform the work of religious organizations, particularly regarding communication which eventually leads to action planning at the local level - highly essential within the community.
"The focus should be on promoting self-esteem, self-care, strengthening and empowerment of organizations, promoting participation, and a sense of ownership among local people. All of these will contribute to a supportive environment for promoting care in community by relying on resources from temples, mosques and churches," he added.
Suwalai Chalermphanmethakul of the Program for HIV Prevention and Treatment (PHPT) said that her work focuses on designing and implementing research on the treatment.
She said that one of PHPT's major achievements was the use of ARV drug (AZT) to reduce mother to child infection.
"In a full scale clinical research, a lot of people have to be recruited as participants, thus communication with community is very necessary," she said. "Participants are informed of the pros and cons of getting involved. Getting participants to know the real issues and coming to terms with them is essential for carrying out the work."
The research implementation largely relies on help from the "Community Advisory Board (CAB)" which makes possible the most effective follow up on the ARV treatment. The community must be informed during the process to recruit participants including information about HIV/AIDS research projects.
The CAB is composed of representatives from the PLHAs, affected people, NGOs, local state agencies and Buddhist monks. The CAB plays an important role to promote the clinical research within the community.
"Local people are given information about the project and are encouraged to have more understanding about HIV/AIDS and to have better access to prevention and care," said Suwalai.
A major achievement of PHPT is the provision of HIV testing and ARV treatment for children as young as 2-4 months. As a result of early detection of HIV, children can have access to early treatment.
Apart from carrying out research, PHPT also provides training to educate PLHAs on reproductive health, prevention of viral exchange, drug adherence, training for caretakers on ARV treatment and educating youth as well as disseminating information about research results of the research through radio.
Effective AIDS programs need the community to be engaged. In the absence of effective community participation, there will be limited real impact of HIV and AIDS programs.
]]>The study states that young men are likely to engage in high-risk sexual behavior because that is the way men are expected to behave, with the majority believing that their identity is defined by their sexual prowess.
On the other hand, young women have
multiple sexual partners as a way to escape poverty.
"Among young women in the study,
the practice of multiple sexual partnerships seemed fairly widespread
and it typically involved powerful socio-economic ties, making it difficult
for individuals to change their own behavior," states the study.
According to UNAIDS, an estimated 16.5 percent (1,200,000) of people aged 15-49 in Zambia are living with HIV, of which 57 percent are women with the main mode of HIV transmission being heterosexual intercourse.
To make matter worse, UNAIDS reports
that in Zambia there is also pressure on women to demonstrate their
fertility, so they do not use condoms and a cultural trend for inter-generational
relationships also puts girls at risk: statistics show that HIV prevalence
peaks in men between the ages of 29 and 34; in women it is 15 - 24.
Among young people ages 15-24, the estimated number of young women living
with HIV in Zambia is more than twice that of young men.
In Zambia, like many countries in sub-Saharan
Africa, epidemiological evidence shows that multiple sexual partnerships
are contributing considerably to HIV transmission.
In light of this, there is need for increased emphasis on fidelity and partner reduction in the prevention of HIV transmission. However, a combination of cultural and economic factors push young people into potentially risky sexual engagement with multiple partners.
According to the study, although young
people were aware of the risk associated with having multiple sexual
partnerships, they described several barriers to translating knowledge about safer sex
into health-promoting safer-sex behaviours.
"For many young men, having many partners was a way of demonstrating their virility and manliness," states the study. "It was seen as more acceptable for men than women to have multiple sexual partners."
The study adds that a traditional culture that associates masculinity with having multiple sexual partners does exist among youth in Zambia.
"When respondents spoke about young men having multiple sexual partnerships in order to 'prove a point,' it is evident that in essence the point they were trying to 'prove' was that they could live up to the cultural expectations of masculinity in Zambia," says the report.
Notions of masculinity have long been singled out as a stumbling block to safe sexual practices between men and women.
The study recommends challenging the traditional notions of masculinity that put both men and women at risk of exposure to HIV.
Respondents also cited polygamy, which is widely practiced in some parts of Zambia, as a factor which drives multiple sexual relationships for young people socialized in a polygamous environment.
Effective responses to HIV and AIDS in Zambia, like many countries in sub-Saharan Africa, need to continuously figure out how to tackle often-sensitive cultural issues that facilitate HIV transmission.
Among young men, existent concepts
of masculinity need to be redefined so that the definition of manhood
is not simply confined to sexual prowess or number or sexual encounters.
The study further recommends that young women need to be offered more opportunities to escape poverty because this will reduce the need to resort to multiple partners as a means of survival.
"While the majority of the young
people were well aware that having multiple sexual partnerships increased
their chance of contracting HIV, it is vital that youth be made aware
of the sexual networks that are created as a result of this multiple
partnering - and how the chance of becoming infected can depend on
one's position within the networks," states the study.
Harvey's murder was blamed on stigma and discrimination against gays, and led to a huge outcry within the AIDS community.
The witch hunt against homosexuals in the country is regarded as a factor contributing to the spread of HIV, the virus that causes AIDS.
According UNAIDS, the national HIV infection rate in Jamaica is 1.5 percent among an estimated 2,700,000 people, and AIDS is the leading cause of death among 15- to 44-year-olds. Predominant modes of HIV transmission include multiple sex partners, history of sexually transmitted infections, drug use, and unprotected sex among men who have sex with men.
It is estimated that 33 percent of gay men in Kingston, Jamaica's capital city, are HIV positive, but many of them opt to stay underground, away from public health services due to fear of stigma and discrimination.
"The fear drives gay men underground," said Anthony Hron of the Jamaican Network of Seropositives (JNPlus) in an interview with POZ magazine, an HIV and AIDS publication.
In Jamaica, as in many parts of the
world, HIV and AIDS create a specter of fear, hopelessness, and persecution,
which in turn, leads to stigma and discrimination. Paradoxically, the
categorization of social groups perceived to be at risk of HIV infection
fuels discrimination yet creates a false sense of protection. In Jamaica,
gay men are heavily vilified in popular musical lyrics.
In many parts of the world, the social stigma towards marginalized groups, such as sex workers, drug users, women, men who have sex with men, and migrants acts as a barrier to HIV testing or accessing health services.
Like gay men in Jamaica, many people are unwilling to get an HIV test due to fear of stigma and discrimination. Statistics show that of the 25,000 HIV infected people in Jamaica, approximately two thirds don't know their status.
According to Brendan Bain, director of the Caribbean HIV/AIDS Regional Training Network, heterosexual men in Jamaica are also reluctant to come forward because it may be assumed they are gay.
It is freedom from fear and discrimination that will finally empower individuals and communities to act, to mobilize their resources, and to respond collectively and positively to the AIDS epidemic, says UNAIDS.
Across the globe, the image of HIV
and AIDS ingrained in the popular consciousness is not founded on bio-medical
facts that the disease is manageable with anteritroviral drugs.
Instead, social and mental constructions based on myth, misinformation, fear and ignorance fuel HIV stigma, and inevitably influence discriminatory action against people with the disease or perceived to be at risk. Equally true is the fact that stigma is founded on some real life experiences of the disease, especially in places like Jamaica where ante-retroviral treatment does not reach many people.
Being HIV positive is seen as a sign of promiscuity, immorality or divine punishment and in such a context naturally carries shame with it. Religious and traditional beliefs, as well as legislation that perpetuates discrimination, is often the root of such social attitudes.
In spite of the bio-medical and social work that has been done to fight HIV, stigma and discrimination remain like two towers blocking progress to effectively respond to the AIDS epidemic.
In places where AIDS is the leading cause of death, people inevitably associate the disease with death. Many people turn their fear into disdain and discrimination of anything associated with HIV and AIDS, including people living with the disease.
In many parts of sub-Saharan Africa, for example, where public health services are dilapidated and access to treatment is non-existent, people's experiential knowledge of HIV and AIDS often consists of seeing loved ones dying painfully of the disease.
This undoubtedly influences the common attitudes of fear and discriminatory behavior unlike in the developed countries where availability of AIDS drugs has resulted in people with HIV leading normal lives.
Thus, in Jamaica, like in many parts highly affected by the epidemic, people prefer to live without knowing their HIV status. Stigma and discrimination therefore conceal HIV, and facilitate the transmission of the virus within the population. ]]>In many parts of the continent, public health systems are ill-equipped to deal with postpartum depression, which affects a significant number of women after giving birth. The situation is made worse by the absence of psychiatrists or clinical psychologists trained to help women cope with the condition.
According to researchers, postpartum depression (also called post-natal depression) affects as many as one in five women, particularly during the first year of motherhood. Less than 2 in 1,000 women are also at risk of developing postpartum psychosis.
The condition causes mothers to feel exhausted and emotionally empty and can potentially destroy the bonding between a mother and her newborn baby.
"Women seem to be particularly vulnerable to depression during their reproductive years: rates of the disorder are highest in females between the ages of 25 and 45. New data indicate that the incidence of depression in females rises, albeit modestly, after giving birth," reports the Scientific America journal.
According to the journal, dramatic hormonal fluctuations that occur after delivery may contribute to postpartum depression in susceptible women, but causes of the disorder are not fully understood.
"A longer term consequence of not diagnosing and treating postpartum depression is the effects it can have on the family, including the parental relationship and the development of the child. Children of depressed women have been found to have attachment problems, higher rates of behavioural problems and lower vocabulary skills," states a report titled Postpartum Depression: A Literature Review.
For some new moms, the situation can be so severe it can lead to cases of infanticide and suicide.
However, among African women, few if any studies have been conducted to better understand the condition, and the way that women cope in the absence of appropriate public health services.
It is possible to surmise from existing data from other parts of the world the general experience of African women following childbirth.
A study by the University of Iowa revealed that low-income women are much more likely to suffer from postpartum depression than wealthier women.
The research revealed that women who are poor already have a lot of stress, ranging from poor living conditions to concerns about paying the bills. The birth of an infant can represent additional financial and emotional stress, and depression negatively impacts the woman's ability to cope with these already difficult circumstances, according to the study.
The study which focused on a sample of 4,332 new mothers from four Iowa counties showed that compared to white or Latino mothers, African-American mothers are more likely to experience depression after having a baby.
Furthermore, the study revealed that African-American women tend to have weaker support networks, a major predictor of postpartum depression.
Like African-American women, African women that give birth are also affected by low incomes and live in stressful contexts which increases the likelihood of the onset of depression.
While there is clearly a need for more research into the coping methods of African women, simple screening methods can be utilized to identify women that are at risk of postnatal depression. Nurses in public health settings need to be provided with training so that they are able to detect and assist new mothers from post-partum depression. The use of a simple tool, the Edinburgh Postpartum Depression Scale, translated into local language, can assist nurses, family members and new moms to detect depressive symptoms.
If anything, public educational and awareness raising programs or simple pamphlets and posters describing the condition need to be displayed in ante-natal clinics so that women are mentally prepared to deal with the problem.
As research shows, social support networks can also play a key role in helping women deal with postnatal depression.
Overall, it is essential for national government throughout the world to guarantee that new moms have access to clinical and maternal services that can help to avert the emotional upheavals associated with giving birth.
]]>In order to make communication effective, there is a need to fully and rigorously understand the audiences, including contextual factors (political, cultural, economic, gender etc.) that determine the health choices people make.
The underlying factor is that communication does not occur within a vacuum, and thus it is essential to be aware of elements that may deter effective communication in the design, distribution and measurement of AIDS or TB messages.
Communication that saves people's lives, improves health and enhances well being is about ideas, creativity, research, knowledge and money. Given the fact that resources are finite, strategic communication needs to consciously build upon existent social capital to ensure sustainability of processes.
Strategic communication can help to shape context and build relationships that enhance the achievement of objectives to respond effectively to AIDS and TB.
To be effective, strategic communicators must understand attitudes and cultures, respect the importance of ideas, adopt advanced information technologies, and employ sophisticated communication skills and strategies. To be persuasive, they must be credible.
More importantly, strategic communication for better health appreciates what works scientifically combined with flexibility to adapt it to specific cultural contexts.
As already stated, it should go beyond simply addressing individual behaviour to structural and institutional realities that are largely responsible for driving diseases and epidemics. In many ways, public policies tend to be responsible for social and health inequalities and cannot be ignored in the communication process.
Therefore, an effective communication strategy puts people and structural realities at its heart in the design, development, implementation and evaluation of messages.
In essence, strategic communication for better health needs to be informed by a process that identifies behaviours and attitudes, identifies policy priorities, and embarks on a process to influence a broad section of society through appropriate themes and messages.
In that respect, communication is not an end goal, but rather a means to influence dialogue and engagement through relevant mediums.
Laboring over which medium to choose when targeting a specific audience is a critical component in the communication for health process. In many ways, the medium defines the message in as much as does the target audience. A chosen medium has its limitations, and key messages and themes have to be aligned to the limitations of the medium to ensure effective message delivery. Obviously, the research-based needs of a target audience determine what delivery mechanisms to utilize.
It is important to know at the outset what goal seeks to be achieved with the particular choice of a medium so that the measurements of success or failure are specified.
Events, activities, messages, and materials must be designed with your objectives, audiences, partnerships and resources clearly in place. Building a communication strategy is about directing and focusing evidence-based messages and themes according to clearly defined pathways to achieve intended objectives.
The process of strategically positioning communication needs to ensure the participation of intended beneficiaries in the designing of messages, no matter what the level of focus.
Strategic communications shifts away from communicating to, and instead focuses on communicating with target groups in order to establish solutions., with emphasis being on how to build a relationship that allows for communication to take place so that appropriate action is taken. In that sense it is a significant shift from the magic bullet theory of communication which treats audiences as inactive recipients of messages.
Fact-based communication research is necessary for demonstrating and validating the need for resources required to increase the impact of communication. It is also essential that message platform for key initiatives are identified through the research process.
New media offers a significant opportunity to unify organizational health communications in order to achieve that inner coherence which is often times based on the vision, mission, goals and values of the organization.
New media offer an opportunity to encourage conversation and promote collaboration in creating appropriate messages. It is essential to integrate social media into the communication infrastructure and tap into its potential to create dialogue and reach a wide audience. New media make it cheaper, easier and faster to communicate and collaborate, and is an essential element to public health communications.
The ability of new information tools to alter the way we communicate needs to be tapped into but as with any component of the health communication process the focus must be on people and not just the technology.
Overall, a strategic communication process needs to be planned, directed, coordinated, funded, measured and conducted in ways that promote the wellbeing of individual in a manner that aligns with organizational values and goals.
]]>For pregnant women living in areas with high TB infection rates, there are increased chances of transmission of TB to a child before, during delivery or after birth.
The disease, especially if associated with HIV, also accounts for a high incidence of maternal and infant mortality.
Unfortunately, there is little to no attention to women's vulnerability in the current discussion and media blitz of a resurgent TB internationally, and in particular, sub-Saharan Africa.
In sub-Saharan Africa, TB is threatening to unravel public health developments gains around increased HIV awareness yet the solutions are not easy, particularly where they concern the well-being of women.
There is need for huge financial, human, research and technological investments to fight the problem, but such investments will work only if they radically put women's health needs at the core.
More importantly is the need to align TB services and sexual reproductive health services, so that men and women know about the implications of the disease to their sexual lives and households.
In sub-Saharan Africa, however, there are pervasive systemic factors driving TB and drug resistance which cannot be ignored in the search of an effective solution to the problem.
A myriad of social and economic factors, as well as weaknesses in the health care system, inadequate laboratories combined with high HIV infection rates are fuelling the resurgence of the TB in the region. Food insecurity, poor sanitation and overcrowding also contribute to the easy spread of the disease.
According to WHO, although Africa has only 11% of the world's population, it accounts for more than a quarter of the global TB burden with an estimated 2.4 million TB cases and 540,000 TB deaths annually.
Governments in the region are grappling with inadequate infrastructure and the increasing threat of drug-resistant strains and co-infection with HIV.
HIV infection increases the likelihood of active TB more than 50-fold. An estimated one-third of the 24.5 million people living with HIV (PLHIV) in sub-Saharan Africa also have TB.
For women in the region, the prospect of a growing TB epidemic is harrowing, but discussion about the disease rarely sheds light nor seeks to address women's specific needs.
Given the high rates of HIV infection among women in the region - the majority of people living with HIV in sub-Saharan Africa (61% or 13,1 million) are women - it is clear that they are the largest group at threat to develop active TB, and more likely drug resistance.
Even with the availability of TB drugs women's socio-economic status and gender roles including child-bearing and caring puts them at high risk of both HIV and TB infection.
For many women in the region, the costs required to access health care centers for TB treatment are usually out of reach due to poverty and undermined socio-economic positions.
The social stigma associated with a TB diagnosis and its association with HIV forces both men and women to delay going to get tested for the disease. In some cases, when men in marital relationships test positive for TB, they are likely to withhold the information, thereby increasing the likelihood to spread the disease to both their partner and children.
Moreover, women in the region are largely responsible for the upkeep of the family, including looking after children, which may also affect consistent uptake of TB drugs. When a woman is infected with TB, the likelihood of spreading the disease to young children is very high.
An additional concern for women is that the uptake of TB drugs interferes with contraceptive use, pregnancy, and fertility.
According to researchers, Rimfampicin, a key component of TB treatment can reduce the effectiveness of oral contraceptive pills and possibly other hormonal methods, such as implants, injectables and emergency contraception.
TB in pregnant women not only increases the rate of maternal mortality, but is also a major factor contributing to the risk of mother-to-child transmission of the disease.
A study conducted in South Africa revealed mother-to child-transmission of TB in 15% of infants born to a study cohort of pregnant women in which 77% were HIV-infected. Maternal HIV/TB coinfection also increases the risk of mother-to child transmission of HIV.
Screening and treatment for TB in pregnant women at antenatal clinics must therefore be a major public health priority in the region. Information about TB needs to be an integral component of sexual reproductive health services.
To be precise, women infected with TB need to be empowered so that they can take control of their own care and lives.
]]>In order to stem the flow of monthly periods, the women and girls use anything from rags, tree leaves, old clothes, toilet paper, newspapers, cotton wool, cloths or literally anything that can do the job. Most girls from poor, rural communities do not use anything at all.
Menstruation is perhaps one of the most regular individual female experiences, but in sub-Saharan Africa, the experience impacts general society negatively due to the absence of products required by women and girls to cope with menstrual flow.
To state it bluntly, menstruation has become like a curse not only to the women and girls but to society in general on the continent. Because menstruation is largely a private act, the social damage is hidden and never makes the news headlines. Also, there are cultural and social attitudes that render discussion of menstruation almost impossible.
Affordable and hygienic sanitary protection is not available to many women and girls in Africa, and governments have done very little to address this reproductive health issue which has serious public health consequences.
In sub-Saharan Africa, millions of girls, in particular, that reach the age of puberty are highly disempowered due to the lack of access to sanitary wear. Many of the girls from poor families cannot afford to buy sanitary pads.
Hence they resort to the use of unhygienic rags and cloths which puts them at the risk of infections. Some of the girls engage in transactional sex so that they can raise the money required to buy sanitary pads, putting themselves at the risk of HIV and STI infection.
Alternatively, young girls are forced to skip school during the time they experience monthly periods to avoid both the cost of pads or use of cloths.
"Less-privileged girls and women who represent substantial percentage in our contemporary Africa will continue to suffer resulting to school absenteeism and also compromising their right to health care," says Fredrick W. Njuguna, Program Director of Familia Human Care Trust in Kenya.
A girl absent from school due to menstruation for four days in 28 days (a month) loses 13 learning days, equivalent to two weeks of learning, in every school term.
It is estimated that within the four years of high school the same girl loses 156 learning days equivalent to almost 24 weeks out of 144 weeks of learning in high school.
Consequently, a girl child potentially becomes a "school drop out" while she is still attending school. In addition, the girl child has to deal with emotional and psychological tension associated with the menstrual process.
To make matters worse, according to Familia Human Care Trust, many schools in underprivileged areas lack sufficient sanitation facilities which are vital not only during a girl's period but at all times generally such as water, adequate toilet facilities and appropriate dumping facilities for sanitary wear.
As a result, menstruating girls opt to stay at home due to lack of facilities to help them manage their periods than go to school.
For orphaned girls, the prospect of coping with bodily changes can be a significant challenge because they have no one to turn to for information or advice. In addition, due to the use of improper methods to contain their menstrual flow, young girls may develop bodily odors that will lead to social exclusion within peer groups thereby impacting negatively on the young girl's confidence.
The need for affordable sanitary wear for women and girls in Africa is indeed a major public health issue that governments need to prioritize in their planning.
On the other hand, there is need for social innovation around this issue because the need for sanitary wear among girls and women will forever be there, at least in the long term future.
The bottom line is that no girl child must be disadvantaged by the natural process of menstruation, and governments, civil society organizations and other players need to work together to ensure that the appropriate services are made available.
As it is, menstruation has becomes the undeclared basis for the social exclusion of young girls. Sanitary protection is an urgent need among women and girls and needs to be made affordable so that poor and marginalized groups can have access.
Global alliances between women in the rich and poor worlds can be a key solution to the problem of access to sanitary wear. But governments also need to recognize that ensuring women and girl's access to sanitary wear has positive public health implications.
Access to affordable sanitary care is human right but one that is never discussed in our male dominated world. Whatever the case, the fact remains: every woman should be able to have access to the right products which can enable them to happily experience menstruation.
No woman should be cursed do disempowerment by the natural act of monthly periods.
]]>This post is part of our online salon: A New Agenda for Girls' and Women's Health and Rights, co-hosted with UN Dispatch.
The pending US legislation to reauthorize the President's Emergency Plan for AIDS Relief (PEPFAR) needs to be informed by the fact that increasing targets and money alone will not significantly help in responding to AIDS.
After more that 25 years of a global fight against AIDS with little progress made, it is important to re-define the values and principles that will guide us to achieve the ideal of combating a disease that has brought much suffering to many individuals, families and communities around the world.
In my view, the principle of equity and equality must remain the two key defining elements of local, national and global responses to the AIDS epidemic.
First, all human groups, in spite of sexual identity or orientation, must have an un-restricted, user friendly access to appropriate sexual reproductive health services.
Second, public health responses cannot be implemented in isolation from the contextual realities. It is therefore critical to take into account historical, traditional, cultural, and economic factors that have marginalized certain groups in society when putting together policies and finances to guide interventions.
Money tied with restrictions that exclude many groups and limit access to services will only serve to extend the lifeline of the epidemic.
In order to make real progress, there has to be a paradigm shift in our perception of sex and sexuality in the context of HIV. Underlying that should be a commitment to principles and ideals of making real progress in the global fight against AIDS.
Global health responses should work to ensure that the weaknesses, needs and concerns that put marginalized groups at risk are reflected in policies and programs.
In that vein, while US' financial investment on efforts to fight the AIDS epidemic has indeed positively impacted many communities, households and individuals in sub-Saharan Africa, much more could be done. If only US's new President could see in his or her mind the suffering of many women, girls and youth denied services in places where funding is targeted and do something about it.
The main problem with the US financial package is that it is not hitched to the ideals that will help individuals, communities and nations to fight the epidemic. Certainly, some progress will be recorded in monitoring and evaluation reports that will end up on cozy shelves but the human damage will be far much more, and difficult to comprehend.
As I see it, the ideological trumping of proven public health strategies that reflects the past and current thinking around PEPFAR is a result of the major challenge which is at the heart of HIV: sex and sexuality.
In order to save lives and truly make an impact, US policy must engage in a process of self-introspection with the aim of removing culture or religious specific notions of sex and sexual engagement.
But honestly, all it takes is to appreciate evidence-based, ground realities, and ensure that they are reflected in public health policies, funding and practices.
Perhaps the major shortfall of US's "strings-attached" foreign public health assistance to an effective HIV response is that it does not project the holistic approaches required to help affected and infected communities fight the epidemic.
There is nothing inherently wrong with promoting "abstinence-only" earmarks; the problem comes when that is the sole method regarded above all the others. Abstinence only strategies must be part and parcel of other proven initiatives to fight AIDS, such as condom use, and access to services for all groups.
Maintaining uncompromising positions on sex and sexuality only means that millions of people will not be reached by services, and intended outcomes of financial investment will remain a pipedream.
It is highly unfortunate that in the design of policies, politicians and government leaders fail to listen to ground realities from researchers, implementers and scientists working with affected communities, and instead only cater to the interests of minority constituencies that are far flung from the ground reality.
In that vein, by ignoring evidence-based research, and promoting morality over reason, the US government is wittingly committing genocide against millions of marginalized people, particularly women, girls, youth and children.
The real losers of US' straight jacketed overseas public health funding are the weak, voiceless, and highly marginalized groups in already disenfranchised communities.
A more progressive approach must ensure that all women have access to medical treatment, including access to drugs that can prevent sexually transmitted infections, condoms, psychosocial and legal support and access to abortion services to terminate forced and unwanted pregnancies.
In communities where PEPFAR is supposed to have an impact, particularly in sub-Saharan Africa, women have a very small voice in deciding sex and sexuality matters. Many are forced to sex work due to lack of economic opportunities.
Denying these women access to services is indeed tantamount to committing genocide, and it's not due to ignorance but a failure to understand the new thinking required to combat AIDS.
]]>The Caribbean region is the second worst HIV/AIDS affected regions in the world, after sub Saharan Africa. Poverty, gender inequalities and a high degree of HIV-related stigma have caused a festering of the epidemic in the region.
Human mobility throughout the Caribbean, between the region and other geographic areas including migration and tourism which brings more than 20 million visitors each year has also been singled out as a major driver of the epidemic.
According to UNAIDS, AIDS remains one of the leading causes of death among people aged 25 to 44 years in the region, and the adult HIV prevalence is estimated at 2.3%.
The main mode of HIV transmission in this region is unprotected heterosexual intercourse; unprotected sex between sex workers and clients is a key factor in the spread of HIV, reports UNAIDS.
UNAIDS estimates that 330,000 HIV-positive people live in the Caribbean, about 22,000 of whom are children, with 51 percent of people living with HIV, the virus that causes AIDS, being women.
Against this background, there is massive human interaction between the US and the Caribbean, with many Americans attracted to visit the idyllic, sandy and sunny spots in the region.
Statistics from the U.S. Department of Commerce show that 14 percent of the 27,351,000 US travelers in 2004 went to the Caribbean.
While bringing much needed revenue to the region, the impact of tourism has seen a rise in sex work, with poor women and men aged between 18 to 44 selling their bodies as a means of survival throughout the Caribbean.
Many American tourists both male and female perceive the Caribbean region as sexually exotic and free-going. So it's common that when Americans visit the Caribbean, many end up engaging in sexual activity, in a high HIV risk environment.
According to Avert, an international AIDS charity, the Caribbean's thriving sex industry, which serves both local clients and many tourists, features prominently in the AIDS epidemics of certain countries, such as the Dominican Republic and Jamaica.
Americans, particularly tourists to the Caribbean region, should therefore be concerned that they can easily contract HIV if they do not utilize protective measures. It is imperative for Americans who engage in sexual unionships in the region to be concerned about the consistent use of protection to avoid HIV and STI infection.
Given the high rates of American visitors to the region, it is conceivable that the epidemic can rebound in the US, if they do not apply protective measures during sexual contact.
More importantly, if the AIDS problem in the Caribbean continues to grow unabated, there is no doubt that it will spiral into the US. The non-availability of AIDS drugs and treatment in the region may force Caribbean people to illegally migrate to the US where the treatment options are many.
In fact, migration between the islands and to the United States is prevalent in the Caribbean region and plays a key factor in the spread of the disease. In that sense, Americans need to be seriously concerned because they are vulnerable to both HIV and secondary diseases such as TB that immigrants may bring with them.
Having said that, the decimation of entire populations within the Caribbean can destabilize many of the countries, thereby posing a security risk right in front of the US's doorstep.
Americans also have a responsibility to ensure that the tools and methodologies that have worked in their country can be exported to the Caribbean region, albeit, in a culturally sensitive manner.
"The epidemic's full extent is obscured by fear, denial, limited treatment and a lack of public health resources," the New York Times reported on the impact of HIV/AIDS in the region, "What is certain, however, is that a social and economic catastrophe is imperiling many countries as infections steadily climb and AIDS spreads in the general population."
For the ordinary American traveler, this could potentially mean that traveling to the sunny and sandy beaches of the Caribbean may be rendered impossible.
It is incumbent upon the Americans to intensify calls for non-judgmental, humanitarian efforts targeted at the region. The Global Gag Rule which restricts funding for family planning reinstated in 2001 by President George Bush has been a major factor blamed for the restriction of women's access to contraceptives in the region.
The U.S. President's Emergency Plan for AIDS Relief, precludes anyone who does not condemn sex work from getting the money, thereby dampening efforts to fight the epidemic among the most affected women and girls of the region. Evidence already shows that restricting access to contraceptives and promoting abstinence only approaches does not work.
Therefore Americans must demand that the US government show leadership through revoking the Global Gag rule which only serves to worsen the situation of already marginalized women in the Caribbean region and other poorer parts of the world.
And, for purely humanitarian reasons, Americans should be concerned about the suffering of fellow human beings infected or affected by HIV/AIDS in the Caribbean region.
US citizens should alleviate the suffering of these people, unconditionally and without any ulterior motive through provision of material support for purchasing medicine and supplies.
Humanitarian aid can go a long way to save lives and support orphaned children in the region, thereby averting full-scale destabilization of the region due to the epidemic.
]]>According to the UN, although abortion is commonly practiced throughout most of the world and has been practiced since long before the beginning of recorded history, it is a subject that arouses passion and controversy.
In Zimbabwe, as in many sub-Saharan African countries, abortion, except in cases of rape, incest, fetal impairment, or to preserve a woman's health, is illegal - and if caught, women face jail terms. As a result, many women resort to clandestine, unsafe and life-threatening abortion methods.
Backyard abortions are so rife in Zimbabwe in spite of the laws that prohibit the practice, putting the life of women, particularly young women, at risk. UNICEF estimates that 70,000 illegal abortions take place in the country every year. In sub-Saharan Africa, 70% of women who end up in hospital after an unsafe abortion are under 20.
Marie Stopes International reports that the risk of death from unsafe abortion is higher in Africa than any other region: nearly half of global maternal deaths related to abortion occur in the region.
"Unsafe abortion has the highest impact in developing countries whose citizens lack widespread access to high-quality medical care," the group reports.
Given the high rates of HIV infection among women in the region - the majority of people living with HIV in sub-Saharan Africa (61% or 13,1 million) are women - governments will have to adopt progressive pro-adoption policies.
In the absence of Prevention of Parent to Child Transmission (PPTCT) methods, there will likely be an increased demand for abortion services. And, thus, there is need to set up abortion clinics and ensure access to safe abortions.
"Women living with HIV seek abortion care for the same myriad reasons as all other women. Additionally, the same factors that make some women vulnerable to HIV also often increase their need for access to safe abortion services," says Barbara Crane, Ipas executive vice president for technical leadership and advocacy.
Having said that, young women - in particular - left with little choice, face immense pressure to terminate unwanted pregnancies. Traditional and cultural norms highly stigmatize and discriminate against children born out of wedlock further putting pressure on young women who fall pregnant before marriage to opt for abortion - either conducted by untrained persons or self-inflicted.
Abortions are usually conducted in unregulated and unsanitary conditions and with methods that kill the young women or render them infertile for the rest of their lives. To put it bluntly, clandestine abortions are a leading cause of maternal mortality in the country.
According to a UNICEF report, illegal, self-inflicted abortion methods are thought to include the consumption of detergents, strong tea, alcohol mixes and malaria tablets; other methods include the use of knitting needles, sharpened reeds and hangers.
The termination of the pregnancy is permitted in circumstances where a pregnancy endangers the life of a woman or where there is a serious risk that if the child to be born would suffer from a physical or mental defect of such a nature as to be severely handicapped.
In addition, the termination of pregnancy is permitted if the fetus is conceived as a result of unlawful "intercourse," defined as rape, incest or intercourse with a mentally handicapped woman.
Given the high rates of maternal mortality attributed to unsafe abortions in the country, there is need for treating abortion as an issue of health and welfare as opposed to one of crime and punishment in order to save women's lives.
The fact is that even though abortion is criminalized, young women affected by high levels of poverty and the social undesirability of children born out of wedlock, resort to abortion as a way to manage their lives and livelihoods.
According to analysts, abortion laws which are traceable to colonial regimes in sub-Saharan Africa need to be reformed in order to safeguard the rights of women.
However, removing women's criminal liability for abortion is only but one part of the solution. There is need for widespread educational campaigns about contraceptive methods that are available to women. Access to the methods must be made as easy as possible to women who may face social condemnation for using contraceptives within their communities.
Also, evidence in countries such as Nepal shows that provision of comprehensive care and support and approving clinics where women can have an abortion safely can significantly reduce the number of women that die due to pregnancy-related causes.
All in all, a liberalized law in Zimbabwe can help to avert the high rates of injury and death among women associated with unsafe abortion.
]]>Amidst the welter of irrational behaviors prompted by the disease, new information and communication technologies can play a key role of bringing the disease out of the shadows, and get people talking in an open and informed way.
Access to vital, life saving information on AIDS is indeed increasingly becoming a significant human right in the wake of the devastation caused by disease. It is important, therefore, to establish innovative and creative ways to reach audiences and provide them with crucial awareness and knowledge about HIV. It is often said that education is the vaccine against HIV.
New information tools provide alternative channels of communication that can help to foster discussion about HIV and AIDS. Such channels encourage open and frank discussions about the disease, its causes and how to prevent it. Information and communication lie at the heart of HIV and AIDS programs that can address usually private and sensitive matters such as sex, sexuality, trust and death.
And new media technologies can assume a central role in this respect because of their ability to reach large groups of people individually, quickly and effectively. The new media can also tackle the taboos surrounding the epidemic, particularly among young people who represent the future, and who are key to any successful fight against the epidemic.
But behind the new media technologies, people are required who have the integrity, passion, knowledge and a willingness to tell and share the day-to-day stories of people living with HIV.
Independent, local knowledge and information is critical to alter attitudes and policies that fester HIV and AIDS. The people who are directly affected by the disease are in a better place to tell their stories. The production of such information has a potential to influence a better response.
Citizens therefore can play an essential in bringing stories of people living with HIV and AIDS to the general public, at local and international levels.
Citizen journalism, also known as "participatory journalism," is the act of citizens "playing an active role in the process of collecting, reporting, analysing and disseminating news and information.
Citizen journalism allows correspondents located in different parts of the world, bring local and national views of those dealing and living with the epidemic on a daily basis.
New media technologies can be used to provide free news and information, containing the latest research data, analysis, information, events and briefings and reports from around the world on the epidemic.
In fact, a new wave of the Internet is promoting better and freer ways for people to tell their stories.
New Internet developments have become all about the people, about joining the conversations, about opening up to the rest of the world or just to whatever your area of expertise may be, and share it with everyone.
Citizen journalists knowledge can get information out there, share what they know in whatever the social media, i.e. blogs, wikis, social bookmarks, tagging, podcasts, web syndication, etc. etc. and engage in the conversations with everyone else. Never before has been such an opportunity to share and publish what you know without any further user intervention other than your own.
If new media's unparalleled ability to communicate with millions of people around the world is fully harnessed, more people than ever will be able to receive vital, life-saving information on AIDS.
]]>If anything, the newly revised estimates - rather than being a cause célèbre - clearly show that there's still much work to do in the fight against the AIDS epidemic.
Already, UNAIDS has attracted a maelstrom of criticisms and accusations for bloating figures in the past years in order to attract financial and political support for the AIDS cause.
According to UNAIDS, the number of new infections fell from 40 million estimated last year to 33.2 million.
"The downward revision is largely due to improved methodology, an increase in sentinel surveillance sites and population-based household surveys, and changes in key epidemiological assumptions used to calculate the estimates," stated an editorial in The Lancet.
"Revised figures for India account for much of the decrease, followed by several sub-Saharan African countries, including Nigeria, Mozambique, Zimbabwe, Kenya, and Angola."
Whatever the case, the report clearly indicates that far too many people are dying everyday, making it imperative to strengthen efforts to fight the epidemic.
In 2007 alone, over 5700 people died each day from AIDS-related and 6800 people are still being infected with HIV daily, about 1200 of whom are children under 15 and about 2900 are women 15 years and older.
Young people are particularly affected by HIV and AIDS - about 40% of the 2.5 million new infections each year occur in people aged 15 to 24.1
"Resources for information services, health care, medicines, and support services still fall far short of need, stigma and discrimination are rampant, and gender inequality, violence, and poverty deny access for people to accurate information, prevention, testing, counselling and treatment. While these conditions still exist, HIV will continue to spread," said the Global Steering Committee (GSC) of the World AIDS Campaign in response to the new data.
As a matter of fact, in HIV and AIDS work, numbers alone cannot completely paint a picture of the devastation that the epidemic has caused in its wake.
Behind the figures are individuals, families, and whole communities that are bearing the brunt of the epidemic. Many of these people exist at the margins of society, amidst shocking levels of poverty and lack of access to basic services such as water, sanitation, health and education.
The Lancet correctly notes that focusing on numbers alone is missing the point. Only history will reveal the true toll of the epidemic, including the tremendous levels of human suffering.
"The global trends described in this report are equally important. In the future it is likely that there will be two different kinds of epidemics-a generalised one centred in sub-Saharan Africa and a concentrated one in specific high-risk groups worldwide. Responding to these different epidemics correctly will be key," states the publication.
Put simply, UNAIDS' global HIV/AIDS estimates 2007 reveal that it's a fallacy to say that AIDS is and sub-Saharan epidemic only.
A cursory analysis shows that with certain pockets of society in USA such as gay men and black women to injecting drug users in Eastern Europe, HIV infection is on the rise.
Any let-up to the momentum that has been created in the past three decades of fighting HIV will only see an exponential rise of the disease. More anything else, the new AIDS data must be seen as a call to vigilance.
"In a battle with a disease that has had too few signs of hope, this report signals some good news. Being more certain of the numbers should help policymakers, civil society, and governments to plan, mobilise resources, and implement activities more effectively to overcome HIV," says The Lancet.
"These new figures should also strengthen commitment and action in the face of a pandemic that can be defeated."
With the tools available to fight HIV and AIDS at our disposal, no one deserves to get infected or die. The good work that has been done in the past to face up to the epidemic must be expanded and replicated, and more effort must be made to reach the marginalized populations across the world.
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