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.
]]>However, in many parts of Asia, people with different sexual identities including lesbians, gays, bisexuals, transgenders, and inter-sex people (LGBTS), face serious human rights violations due to their sexual orientation.
Many governments in the region are in a state of denial about same-sex relationships, and therefore lack the systematic research and facts required to effectively respond to the specific public health needs of LGBTS individuals.
LGBTS individuals have little to no access to public health services and information - a scenario which makes them highly vulnerable to HIV and STI infection. In addition, gender-based inequalities prevent many LGBTS people from being able to protect themselves. Millions of LGBTS people lack the social and economic power to insist on HIV prevention measures such as condoms, abstinence or mutual monogamy.
Due to political, socio-cultural, legal and religious systems that prohibit same-sex relationships, many who are LGBTS are unwilling to openly disclose their sexual orientations.
"The main issue facing LGBTS individuals in this region is discrimination due to their sexual preferences and orientation," said Aung Myo Min, the Asia Male Representative in the International Lesbian and Gay Association (ILGA).
"The discrimination of people who LGBTS occurs at many levels within the socio-economic, political and cultural systems in the society. Discrimination happens within the family and within the legal system," added Mr. Myo Min.
According to Mr. Myo Min, many governments in Asia maintain laws that violate the fundamental rights of LGBTS people. For example, in many parts of Asia, a person can be imprisoned for showing an affinity to same-sex relationships, he said.
"Same-sex relationships are perceived as unnatural within the cultural and religious systems, and that is what is reflected in the legal regimes of many of the countries in Asia," said Mr. Myo Min.
However, he highlighted that some countries, such as Thailand and Taiwan, had taken significant steps to improve the situation of sexual minorities but much more needed to be done to protect the rights of sexual minorities.
Even in model countries such as Thailand, LGBTS people cannot get health insurance because of discrimination thereby limiting their access to public health services. Also, healthcare workers stigmatize people involved in same-sex relationships.
Many LGBTS people live in fear of persecution and harassment in their communities, and they cannot seek legal protection because their rights are not recognized within the scope of the law.
"There is a culture of violence against LGBTS people in many parts of Asia which is condoned by the society, culture and legal processes," said Mr. Myo Min. "There is need for an anti-discrimination law that specifically protects the rights of people involved in same-sex relationships."
LGBTS are often afraid to reveal their sexual orientation because of the violence that confronts them in society. As a result, they cannot access information that can assist them to make responsible and informed about safer sexual activity.
"LGBTS individuals tend to be very secretive about their sexuality and hence do not go to access the relevant information which may be available," said Mr. Myo Min. "There have been efforts to reach out to LGBTS individuals with the appropriate information but where same sex relations are criminalized, it makes it difficult for non-governmental organizations to implement any reach-out programmes."
Decriminalization of same sex relationships and participation of sexual minorities in the design of programs is a key to halting the spread of HIV within that group.
"The heterosexual population may not be in a position to adequately understand the needs of people in same sex relationships, and that is why it is important for LGBTS people to be involved at a decision making level to ensure equal access to public health services," said Mr. Myo Min.
According to Mr. Myo Min, inaction will only increase the levels of HIV infection among LGBTS - a trend that is already apparent in many parts of Asia where men in same-sex relationships are disproportionately infected by HIV in comparison to other segments of the population.
]]>Increased investment in adolescent and reproductive health is a critical public health priority that can contribute to wider development goals, because it allows adolescents to become healthy, productive adults.
A recent study in four African countries revealed that although adolescents are highly aware of sexual and reproductive health issues, they lack the information and skills needed to protect themselves against HIV, unintended pregnancy and unwanted sex.
According to the Guttmacher Institute study, Protecting the Next Generation in sub-Saharan Africa: Learning From Adolescents to Prevent HIV and Unintended Pregnancy, only about half of 15-19 year olds across four Africa countries - Burkina Faso, Ghana, Malawi and Uganda - have received any sex education at school.
The report describes high rates of unintended pregnancy and unsafe abortion among adolescents in sub-Saharan Africa due to unmet sexual and reproductive health care needs. Adolescents make up 23 percent of sub-Saharan Africa’s population, and the report asserts that investing to meet their sexual and reproductive health needs is a “sensible long-term public health priority.”
“Preventing ill health and promoting healthy sexual behaviour gives young people the chance to have the healthy lives they deserve and the opportunity to grow into productive, contributing members of society,” states the report.
In the absence of proper interventions to equip adolescents with appropriate sexual and reproductive health education, the lives of young men and women continue to be cut short by preventable diseases.
Due to widespread silence surrounding sexual matters, many adolescents make uninformed decisions about sexual choices. Data from the four-country study shows that many adolescents do not use contraceptives, have experienced unwanted sex, have multiple or much older partners and lack adequate knowledge about avoiding sexually-transmitted infections (STIs) and pregnancy.
“More than 90% of 15-19 year olds have heard of HIV, yet fewer than 40% of adolescents in this age group can both correctly identify ways of preventing transmission of HIV and reject common misconceptions about HIV transmission,” says the report. “The proportion who know of STIs other than HIV is low in Burkina Faso and Ghana (31-56%), but much higher in Malawi and Uganda (71-82%)”.
According to the report, young people in the region urgently need gender-related as well as reproductive health education. It is not enough to teach adolescents only the theory and moral aspects of sex - they also need life skills to deal with practical situations.
Denying that young people engage in sexual activity is a recipe for disaster and the report argues that comprehensive sex education is effective in improving knowledge and reducing sexual risk behaviors - but that it does not increase sexual behaviour, as many falsey believe.
The study recommends that school curricula should provide comprehensive, accurate sexual and reproductive health information and should not be exclusively focused on the 'abstinence-until-marriage' approach, because evidence shows that the latter does not lead to protective behaviours. Furthermore, teachers need to have adequate training in sex education so that they can provide sex education. More importantly, sex education must be targeted at younger adolescents in order to reach people before their sexual debut.
The health care system must also be designed in a way that meets the sexual and reproductive health needs of adolescents. Youth-friendly corners were young people can receive STI testing and treatment need to be integrated into the health care system. Equally important is the need to ensure that adolescents have access to a range of contraceptive methods, especially the male condom.
Mobilizing local communities is critical to get support for interventions to address sex education gaps. In sub-Saharan Africa the media, and in particular radio, can be a powerful way to spread sexual health messages that are tailor-made to meet the diverse needs of adolescents.
Adolescents need to be provided with a multi-dimensional set of tools that help them to delay sexual debut if possible, resist pressure to engage in unwanted sex, and to practice safer sex, says the report.
]]>Many of the kids, dressed in filthy rags, are regarded as a menace to society due to their anti-social behaviour. Near the traffic lights a big poster warns members of the public not to give money or food to the children, euphemistically referred to as ‘street kids’.
According to the poster, giving money or food only causes the children to remain on the street. Put in other words, the social menace that many of the nouveau rich in this leafy and suburban area fear will continue to grow.
Many of the so-called street kids are part of a generation of children in Zambia that is growing up without parental care, support or guidance. The children are vulnerable to exploitation, abuse and disease.
The United Nations Children’s Fund (UNICEF) estimates that there are approximately1,250,000 orphans in Zambia – that is, one in every four Zambian children – with about 50% under nine years of age.
Orphans are defined as children who have lost one or both parents.The extended family network, a traditional safety net for orphaned children, is breaking apart due to the enormity of the HIV crisis throughout the country.
Additionally, the huge number of orphaned children is overwhelming national health, social welfare and education systems in Zambia, as in many parts of sub-Saharan Africa.
Most of the children face a bleak future, without parents to care for them and little, if any, assistance offered by the government.
The children are often traumatized by the death of parents, stigmatized through association with HIV and often thrown into desperate poverty by the loss of bread-winners. They live under enormous pressure and suffer depression and other psychological problems.
Young girls, in particular, are the first to be denied educational opportunities in favour of boys, and are forced into early marriages with older men, which puts them at higher risk of HIV infection.
Children, both girls and boys, turn to the streets in search of a better life but the reality that confronts them can only be described as grim. Street life creates extreme vulnerability to violence, exploitative and hazardous labour, sexwork and trafficking.
In fact, internal trafficking of children has become rampant in Zambia. Sadly, there is little to no awareness of this social malaise.
Nothing short of a Herculean effort is required to help the growing legion of orphans in Zambia to lead normal lives. A holistic approach which includes provisions for nutrition, health and cognitive development, and educational and psychosocial support is required to effectively respond to the orphan crisis in the country.
Addressing these basic needs at an early age would give orphaned children a
healthy start and more hopeful future.
Strengthening family systems and community care mechanisms is fundamental to this holistic approach because putting children into institutional homes can have a devastating effect ontheir self worth and identity.
Furthermore, there needs to be a concerted effort to keep
children in school because it is one recognized shelter that can help the children to discover their own potential.
The government must protect the children of Zambia with improved institutional, legal and social conditions, hopefully bringing an end the need to ‘protect’ motorists from ‘street kids’ attraffic lights.
]]>PLWHAs should be able to seek and receive information related to sex and sexuality that allows them to pursue a satisfying, safe and pleasurable sexual life.
Lessons and medical advances from three decades of responding to the HIV and AIDS epidemic show that it is possible for PLWHA to have a sexual life. However, popular opinion assumes that an HIV infection equals the dearth of sexual engagement.
Nothing could be further from the truth.
The wide availability of antiretroviral therapy coupled with appropriate family planning systems expand the sexual reproductive health choices available to PLWHA.
According to WHO, family planning implies the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility.
Family planning is literally at the center of sexual reproductive health interventions that can significantly reduce the rate of HIV, sexually transmitted infections (STIs) and unwanted pregnancies.
Unfortunately, family planning is more often than not overlooked in HIV interventions.
"Family planning can help ease the burden of HIV and limit new occurrences of HIV infection by decreasing unintended and unwanted pregnancies in HIV positive women, thereby preventing the transmission of HIV from mother to child," states a new report by the Access, Quality and Use in Reproductive Health (ACQUIRE) Project.
According to the report, family planning is often overlooked as a preventive measure because the healthcare system primarily focuses on offering "curative care or responding to the medical social needs of HIV positive women and couples."
"Society has often presumed that people living with HIV should not have sex or bear children," argues the report titled "Integrating Family Planning with Antiretroviral Therapy Services in Uganda." "However, now that HIV is becoming controllable due to the increased access to antiretroviral therapy (ART), an increasing number of PLWHA are living longer and fuller lives and planning families."
The report states that a holistic approach to client care is required to ensure that PLWHAs have access to appropriate messaging, information, counseling and services that can assist them to live healthy, sexually fulfilling, normal lives.
Integrating services, not only helps the client, but clearly has programmatic and cost benefits because multiple services are provided during one visit or at one facility.
"Integration is an approach that uses a client visit as an opportunity to address other health and social need," say the report. "This tactic combines services at one site and/or enhances linkages between health service delivery points."
It is imperative that programmatic interventions for people living with HIV must incorporate messages about healthy sexuality, including the reproduction choices that are available.
Sexuality counseling can significantly change perceptions as well as assist PLWHA to make responsible choices that can enable them to fulfill their sexual needs and feelings.
But, more importantly, cross-sectoral collaboration and coordination between reproductive health services can exponentially increase the sexual wellbeing of PLWHA. With access to an integrated package of treatment, counseling, information and access to the appropriate family planning tools, there's no doubt that PLWHA can develop meaningful and fruitful sexual relationships and lives.
]]>Unsafe abortions are the second leading cause of death for women, after tuberculosis. Though abortion is illegal in Ethiopia, studies indicate that abortion is widespread and generally performed by untrained persons.
According to Planned Parenthood, Ethiopia has among the highest fertility and maternal death rates in the world. Approximately 1 out of every 7 women die from pregnancy- or abortion-related complications.
Given such shocking statistics, the recent announcement by the Ethiopia's Ministry of Health to provide family planning services to 8.5 million women across the country during the next Ethiopian year is highly laudable. If fully implemented, the plan will definitely have a positive ripple effect across the Ethiopian society.
Political will is a key ingredient to improve the reproductive health status of women, particularly in countries where long-held traditions and customs put women at high risk.
"Traditionally, women in Ethiopia have been consigned to strict societal roles, based on cooking, raising children, and a muted voice in decisions affecting them," says the World Bank.
"Most women have accepted tradition without question, subjecting themselves and their daughters to genital mutilation, early marriage, milk tooth extraction, and domestic abuse."
With increased government efforts to expand family planning services, more women will be reached, in the process saving lives and giving women and their families greater hope. But with political will there must be a willingness to also improve the health infrastructure and distribution systems.
Although family planning tools are available in Ethiopia, access to them has been a major hindrance for the majority of the women. Planned Parenthood states that only 13% of Ethiopian women - and only 4% in rural areas - use modern contraception. This is despite the fact that studies show that approximately 60% of the women in the country approve family planning.
Undoubtedly, improved access to family planning and other reproductive health services in the country could significantly combat the incidence of maternal mortality and improve the state of women. Comprehensive, high-quality sexual reproductive services can help to prevent the unnecessary deaths of women in the country.
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 Ethiopia.
"The gag rule restricts the simplest ways to improve the status of women: funding birth control supplies so they can avoid unintended pregnancies and care for children they already have," said Dian Harrison, President and CEO of Planned Parenthood Golden Gate.
In an October 2007 report, Population Action International also points out the Global Gag rule, abstinence only education, and the anti-prostitution pledge as harmful policies that undermine women's access to information and healthcare in countries such as Ethiopia.
Fortunately Ethiopia has seen the light and will implement initiatives that will benefit its women. In order to increase the uptake, Ethiopia's Ministry of Health plans to create accessible, affordable and comprehensive coverage of family planning services for women.
More importantly, 600 health professionals will be trained to train nurses currently working at health facilities specifically carry out family planning for women. If the expanded access to family planning services in Ethiopia is to improve the status of women, it must be culturally appropriate, with particular attention to marginalized communities across the country.
In addition, the Ethiopian government needs to adequately finance the process both in the short and long term so that access to the family planning services is neither compromised nor cut mid-way. There must be a commitment to make access to services that improve the status of women as much a part of national life as breathing air.
Having said that, mechanisms must be put in place to monitor both the costs and the quality of services provided.
Indeed, the Ethiopian government can become a model for many countries around the world if it follows through on the plan to improve women's lives.
However, the US must show leadership by revoking the Global Gag rule which only serves to worsen the situation of already marginalized women in poorer parts of the world. According to Planned Parenthood, the resulting lack of U.S. funds has restricted the contraceptive supply, which means that abortion is also very common.
For any society to live up to its potential, its women need to have access to comprehensive information and healthcare that can help them to make responsible choices.
More than anything else, the Ethiopia government needs to implement policies that promote the liberation of women from traditional, economic, legal and cultural fetters.
"Female education and empowerment are critical determinants of fertility, and providing girls with access to education is likely to reduce the fertility rate," states Kristen P. Patterson in a paper titled Integrating Population, Health, and Environment in Ethiopia.
]]>Political advocacy targeted at governments of the most AIDS-affected countries is a key but missing factor in the overall response to the epidemic.
In the absence of strong and credible political efforts to raise the profile of AIDS, governments, at best, continue to maintain or adopt policies that are counterproductive, and at worst, pay lip service to an effective response to the epidemic.
Evidence shows that in countries (e.g., Thailand, South Africa, Brazil, USA) where AIDS civil society organizations have been politically motivated to confront their governments, there has been greater and positive response to the epidemic.
In many countries with critical AIDS situations, bad governance characterized by a lack of political will, unaccountability, neglect, nepotism, corruption, incompetence, moribund health systems and insufficient health workforce continue to fuel the epidemic.
Because of a combination of lack of political skills to engage governments, "professionalization" of AIDS work or funding constraints, civil society organizations in these contexts have tended to stay clear of political advocacy.
As a result, there has been little to no impact on the epidemic, as government resource allocation does not reflect the myriad needs of the AIDS affected communities.
Ensuring an equitable distribution of resources, particularly for those most in need demands more than rhetorical commitments. It requires governments and civil society to work together to create the social and political will for translating a vision of access to AIDS services into lived experience of peoples' day-to-day lives.
AIDS political advocacy can create accountability and increase political will, limit neglect and nepotism, and possibly even force the replacement of corrupt or incompetent officials.
However, given the historical lack of resources and, in many cases, only recent moves toward democratic civic participation, the advocacy capacity of HIV infected and affected populations must be strengthened and supported.
Ensuring that advocacy is firmly grounded in accurate information regarding local priorities, opportunities, and challenges in AIDS affected countries is essential for ensuring that the needs and experiences of everyone, specifically, poor and marginalized populations, are comprehensively met and with full respect to their human rights and dignity.
In countries where there are few people with the cultural assets needed for advocacy work, and where the personal risk associated with AIDS political advocacy is significant, the only way to attract and retain advocacy workers for periods of time consistent with campaign success is to provide them appropriate compensation, training and working conditions and a travel and communications budget.
The development of partnerships is essential to building a groundswell of support to maintain AIDS high on the political agenda. No single organization can effectively fight AIDS alone or in isolation from the context and actors that make up the global AIDS advocacy movement.
Aligning issues, movements and agendas requires deliberate steps, planning, and dedicated time and resources to ensure synergy and mutual gain. In addition, it demands a culture of trust and accountability among advocacy partners, including the belief that there is enough work and resources for everyone, and that competition and lack of coordination reflect a major inefficiency and waste of precious, needed resources.
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