This document discusses reinvigorating condoms as an HIV prevention tool. It summarizes that condoms are effective at preventing HIV transmission but there are still barriers to their use. Condoms play a key role in HIV prevention strategies alongside other interventions. However, risk compensation behaviors, structural barriers like criminalization of homosexuality, and lack of messaging around dual protection can reduce condom uptake and consistent use. The document calls for addressing these challenges and rigorously evaluating condom programming elements to improve access and effectiveness in different epidemic settings.
Earning Their Way to Healthier Lives: Women First in MozambiqueAIDSTAROne
A complex matrix of factors, such as low literacy, early sexual initiation, and limited economic opportunities, increases the vulnerability of women to HIV infection in Mozambique. The Women First program addresses the role that poverty and lack of access to health information play in the spread of HIV through legal rights and income-generating activities.
This case study covers one of the 31 programs from the Africa Gender Compendium, an AIDSTAR-One gender and HIV integration resource. A series of five Africa Gender Compendium case studies is accompanied by a findings report, which describes lessons learned, gaps, and common experiences across the programs.
Download this and other gender & HIV resources: http://j.mp/zyjmG7
AIDSTAR-One Findings Report: Analysis of Services to Address Gender-based Vio...AIDSTAROne
Because gender-based violence (GBV) is widely recognized as both a cause and a consequence of HIV infection, the President's Emergency Plan for AIDS Relief (PEPFAR) has identified reducing GBV as one of its five high-priority gender strategies. As part of this effort, AIDSTAR-One conducted case studies in three countries where GBV services were available: Swaziland, Vietnam, and Ecuador. The case studies and this accompanying findings report aim to identify and share promising programmatic approaches and disseminate key elements of success for replication and scale-up.
www.aidstar-one.com/focus_areas/gender/resources/reports/gbv_series_findings_report
AIDSTAR-One Outreach to Most-at-Risk Populations through SIDC in LebanonAIDSTAROne
Successful outreach to most-at-risk populations (MARPs) recognizes the sociocultural context and particularly the gendered norms in which MARPs live. This case study (one of nine in a series) documents how outreach workers in Lebanon raise awareness about how gender norms can increase HIV risk; deliver basic information on HIV, hepatitis, and other STIs; offer counseling to support positive behavior change, and distribute free condoms, syringes, and lubricants.
www.aidstar-one.com/focus_areas/gender/resources/case_study_series/sidc_lebanon
Condoms as a harm reduction approach in prisonsErin Bortel
Keeping High-Impact Prevention at the forefront of our attention will guide administrators and policy-makers implementing harm reduction strategies in incarcerated settings to End AIDS in NYS by 2020.
This fact sheet shows the strength of the existing evidence that demonstrates the impact health communication has on other HIV prevention strategies like partner reduction and discouraging cross-generational sex.
Earning Their Way to Healthier Lives: Women First in MozambiqueAIDSTAROne
A complex matrix of factors, such as low literacy, early sexual initiation, and limited economic opportunities, increases the vulnerability of women to HIV infection in Mozambique. The Women First program addresses the role that poverty and lack of access to health information play in the spread of HIV through legal rights and income-generating activities.
This case study covers one of the 31 programs from the Africa Gender Compendium, an AIDSTAR-One gender and HIV integration resource. A series of five Africa Gender Compendium case studies is accompanied by a findings report, which describes lessons learned, gaps, and common experiences across the programs.
Download this and other gender & HIV resources: http://j.mp/zyjmG7
AIDSTAR-One Findings Report: Analysis of Services to Address Gender-based Vio...AIDSTAROne
Because gender-based violence (GBV) is widely recognized as both a cause and a consequence of HIV infection, the President's Emergency Plan for AIDS Relief (PEPFAR) has identified reducing GBV as one of its five high-priority gender strategies. As part of this effort, AIDSTAR-One conducted case studies in three countries where GBV services were available: Swaziland, Vietnam, and Ecuador. The case studies and this accompanying findings report aim to identify and share promising programmatic approaches and disseminate key elements of success for replication and scale-up.
www.aidstar-one.com/focus_areas/gender/resources/reports/gbv_series_findings_report
AIDSTAR-One Outreach to Most-at-Risk Populations through SIDC in LebanonAIDSTAROne
Successful outreach to most-at-risk populations (MARPs) recognizes the sociocultural context and particularly the gendered norms in which MARPs live. This case study (one of nine in a series) documents how outreach workers in Lebanon raise awareness about how gender norms can increase HIV risk; deliver basic information on HIV, hepatitis, and other STIs; offer counseling to support positive behavior change, and distribute free condoms, syringes, and lubricants.
www.aidstar-one.com/focus_areas/gender/resources/case_study_series/sidc_lebanon
Condoms as a harm reduction approach in prisonsErin Bortel
Keeping High-Impact Prevention at the forefront of our attention will guide administrators and policy-makers implementing harm reduction strategies in incarcerated settings to End AIDS in NYS by 2020.
This fact sheet shows the strength of the existing evidence that demonstrates the impact health communication has on other HIV prevention strategies like partner reduction and discouraging cross-generational sex.
Harm reduction Project 25: Meeting of the Minds JOComm
Started in 2011, Project 25 aims to solve the many difficulties associated not just with chronic homelessness, but especially those who are frequent users of public systems such as local hospitals and law enforcement. In its first year alone, Project 25 demonstrated the following results and these trends have continued into subsequent years. First year results include:
• 56 percent decline in number of hospitalizations
• 58 percent decrease in days spent in the hospital
• 62 percent drop in ambulance rides
• 66 percent reduction in emergency room visits
• 63 percent cut in costs
Public Health Association of South Africa (PHASA) poster presentation of the "Theoretical underpinnings of promotion campaigns for
medical male circumcision HIV prevention interventions in sub-Saharan Africa"
The Texas Department of Insurance can lower the costs for chronic disease healthcare by partnering with local public health agency chronic disease programs
CORE Group Fall Meeting 2010. A framework on generating attention for global health issues: case study of maternal survival. - Jeremy Shiffman, American University
Gender,HIV/AIDs Transmission: Socio Economic And Socio Cultural Impact in Tan...Sandeep Singh
The research was done in Tanzania and presented at Banaras Hindu University International Conference who also published Complete article in "EDUCATION FOR THE NEW MILLENNIUM" by Nutan Publication Chapter 6 ISBN: 978 81 927002 1 2
This presentation provides an overview of the role that policy advocacy has played in activating greater visibility for the female condom and increased procurement in the developing world. It highlights the important role that third-party partnerships play in mobilizing evidence of need and demand for health products in the developing world. The presentation identifies policy advocacy and social marketing as essential complements to a comprehensive marketing and promotion strategy.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Harm reduction Project 25: Meeting of the Minds JOComm
Started in 2011, Project 25 aims to solve the many difficulties associated not just with chronic homelessness, but especially those who are frequent users of public systems such as local hospitals and law enforcement. In its first year alone, Project 25 demonstrated the following results and these trends have continued into subsequent years. First year results include:
• 56 percent decline in number of hospitalizations
• 58 percent decrease in days spent in the hospital
• 62 percent drop in ambulance rides
• 66 percent reduction in emergency room visits
• 63 percent cut in costs
Public Health Association of South Africa (PHASA) poster presentation of the "Theoretical underpinnings of promotion campaigns for
medical male circumcision HIV prevention interventions in sub-Saharan Africa"
The Texas Department of Insurance can lower the costs for chronic disease healthcare by partnering with local public health agency chronic disease programs
CORE Group Fall Meeting 2010. A framework on generating attention for global health issues: case study of maternal survival. - Jeremy Shiffman, American University
Gender,HIV/AIDs Transmission: Socio Economic And Socio Cultural Impact in Tan...Sandeep Singh
The research was done in Tanzania and presented at Banaras Hindu University International Conference who also published Complete article in "EDUCATION FOR THE NEW MILLENNIUM" by Nutan Publication Chapter 6 ISBN: 978 81 927002 1 2
This presentation provides an overview of the role that policy advocacy has played in activating greater visibility for the female condom and increased procurement in the developing world. It highlights the important role that third-party partnerships play in mobilizing evidence of need and demand for health products in the developing world. The presentation identifies policy advocacy and social marketing as essential complements to a comprehensive marketing and promotion strategy.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Clinical Case Presentation SummarySummary of Primary and Secon.docxmccormicknadine86
Clinical Case Presentation Summary
Summary of Primary and Secondary Syphilis
In 2017, a total of 30,644 cases of primary and secondary syphilis were reported in the United States, yielding a rate of 9.5 cases per 100,000 population (CDC, 2018). According to the CDC (2018), this rate signifies a 10.5% increase compared with 2016 (8.6 cases per 100,000 population). Syphilis has a high prevalence among certain racial/ethnic groups, as well as in other groups, such as adolescents, sex workers, men who have sex with men (MSM), and sexually abused women (Hollier, 2018). Syphilis is transmitted through direct contact with an ulcerative lesion, or chancre which appears during the primary stage (most infectious) of syphilis (Hollier, 2018). Patients with this infection may seek medical treatment for signs and/or symptoms of primary syphilis (chancre/ulcer), or secondary syphilis (diffuse rash on palms and soles) (Hollier, 2018). On the other hand, patients may be completely asymptomatic and only diagnosed on routine screening.
Yonglin suggested to me one prevention strategy from the CDC called the “Talk, Test, Treat” method that has been suggested by the CDC is the “Talk, Test, Treat” method. Talking involves discussing sexual health history, testing involves screening for syphilis. The CDC recommends screening all sexually active men who have sex with men at least once a year, and more frequently if they are at-risk for infection. Pregnant women should be tested at their first prenatal visit, and at-risk women should be rescreened in their third trimester and again at delivery to prevent congenital syphilis. Lastly, patients need to be treated with benzathine penicillin G who test positive for syphilis.
Evidence-Based Action Plan #1
Implementing a mobile health unit (MHU) or van that offers community-based screening services for at-risk populations, such as female sex workers, men who have sex with men (MSM), and IV drug users could assist with reducing the transmission of primary and secondary syphilis. An MHU can be used as part of a community education, screening, and counselling program to serve urban and rural communities (Khanna & Narula, 2016). The MHU would have to be clearly identified as a free syphilis testing unit in order to make it more appealing to interested individuals who may approach. The health care providers working the mobile unit would be required to obtain a focused health history and patient contact information in order to provide screening results and the necessary follow-up instructions for any positive test results. Studies have shown that MHUs have been very helpful in detecting new cases of syphilis and beneficial to the at-risk population (Lipsitz et al., 2014). Also, MHUs may even increase patient compliance with the follow-up serologic testing that is required after being treated for syphilis, which may be a barrier for patients of low income or who lack transportation. This evidence-based intervention could be ...
THEORETICAL CONCEPT The Health Belief Model (HBM) is by far the mo.docxchristalgrieg
THEORETICAL CONCEPT The Health Belief Model (HBM) is by far the most commonly used theory in health education and health promotion (Glanz, Rimer, & Viswanath, 2008; National Cancer Institute [NCI], 2005). The underlying concept of the HBM is that health behavior is determined by personal beliefs or perceptions about a disease and the strategies available to decrease its occurrence (Hochbaum, 1958). Personal perception is influenced by the whole range of intrapersonal factors affecting health behavior, including, but not limited to: knowledge, attitudes, beliefs, experiences, skills, culture, and religion.
THEORETICAL CONSTRUCTS
The following four perceptions serve as the main constructs of the model: perceived seriousness, perceived susceptibility, perceived benefits, and perceived barriers. Each of these perceptions, individually or in combination, can be used to explain health behavior. More recently, other constructs have been added to the HBM; thus, the model has been expanded to include cues to action, motivating factors, and self-efficacy. PERCEIVED SERIOUSNESS The construct of perceived seriousness speaks to an individual’s belief about the seriousness or severity of a disease. While the perception of seriousness is often based on medical information or knowledge, it may also come from beliefs a person has about the consequences an illness might have on him or her personally. For example, most of us perceive seasonal flu as a relatively minor ailment. We get it, stay home a few days, and get better. However, if you have asthma, contracting the flu could land you in the hospital. In this case, your perception of the flu might be that it is a serious disease. Or, if you are self-employed, having the flu might mean a week or more of lost wages. Again, this would influence your perception of the seriousness of this illness. Perception of seriousness can also be colored by past experience with the illness. No doubt, most people would consider skin cancer a serious disease. However, the perception of serious might be diminished in someone who had a cancerous lesion removed and recovered without much more than a sore area and a Band-Aid for a few days.
PERCEIVED SUSCEPTIBILITY
Personal risk or susceptibility is one of the more powerful perceptions in prompting people to adopt healthier behaviors. The greater the perceived risk, the greater the likelihood of engaging in behaviors to decrease the risk. This is what prompts men who have sex with men to be vaccinated against hepatitis B (de Wit, Vet, Schutten, & van Steenbergen, 2005) and to use condoms in an effort to decrease susceptibility to HIV infection (Belcher, Sternberg, Wolotski, Halkitis, & Hoff, 2005). Perceived susceptibility motivates people to be vaccinated for influenza (Chen, Fox, Cantrell, Stockdale, & Kagawa-Singer, 2007) to use sunscreen to prevent skin cancer, and to floss their teeth to prevent gum disease and tooth loss (Figure 4– 1). It is only logical that when peop ...
Technical brief decision making for condom use and hiv testing among fisherf...Jane Alaii
A research brief assessing motivators and decision-making factors among fisherfolk who take up condom use and HIV testing services in a selected hot spot in Uganda.
Using Everett Rogers' Diffusion of Innovations Theory an intervention for automatic STI screening for adolescents is applied to primary care settings in Baltimore, Maryland.
PAGE 24The perceptions of health workers on the effecti.docxalfred4lewis58146
PAGE
24
The perceptions of health workers on the effectiveness of HIV Prevention Programmes for MSM in Jamaica
May 2013
Abstract
The Jamaican Ministry of Health (MOH) has framed a policy and strategy that allows for sexual health promotion and HIV prevention programmes to be conducted for men who have sex with men (MSM), despite an enforced legal framework which makes it illegal to participate in anal sex. The population of Jamaica’s MSM accounts for the highest HIV prevalence rate on the island. While the National HIV/ STI Programme conducts a government-run programme, a significant portion of the work is conducted by local and internationally funded non-government organizations (NGO). This study seeks to explore the efficiency of these HIV/AIDS prevention programmes from the experiences and perspectives of the health care workers involved in their implementation. It will utilize qualitative research methodology of a descriptive cross-sectional design. The procedure will involve the use of interviews. These will be conducted with health workers in MSM programmes from NGOs and the Jamaica National HIV/STI Programme. It is expected that the results may indicate a view of success with many programmes, with limitations being attributed to the societal and legal framework within which they work. It may also show disparities between government and locally ran programmes conducted by NGOs. The results of this study will be shared and made available to public libraries, the government of Jamaica and other stakeholders working to alleviate the impact of HIV and AIDS in Jamaica and the world. *
Keywords: HIV/AIDS, health promotion and HIV prevention, men who have sex with men (MSM), Jamaica, sexual health, gay men, other MSM and transgender individuals (GMT).Table of Contents
Page #
Abstract
Introduction
Methodology
Discussion
Conclusion
Reflection
References
Appendix Consent
Appendix Draft Interview
Glossary
Privacy Statement
1. Introduction
This study explores the effectiveness of the HIV and AIDS response within the target population of MSM in Jamaica. It investigates, the views and perspectives of the health workers who carry out or implement these programmes.
Thanks to science, the ability to treat and care for persons living with HIV (PLHIV) and AIDS has grown exponentially. Individuals are defying their prognoses and are living with HIV and AIDS for record number of years than they did when the virus was first discovered. Gay, bisexual, transgendered and other men who have sex with men but may not identify as gay, are disproportionately affected by sexually transmitted infections like HIV (MOH, 2011a). For the purpose of this research the term MSM will be defined and utilized as the public health terminology to capture the target audience of all males who have sex with males.
For the purpose of this research.
Choose an organization according to the following· Current empl.docxmccormicknadine86
Choose an organization according to the following:
· Current employer
· Most recent or former employer
· Place of business that you have patronized or have been familiar with over a long period of time.
· Avoid choosing an organization that is so large that historical data would be difficult to apply. Firms in the Russell 2000® index may fit well, whereas firms in the Dow 30 Industrial index probably do not.
· The organization can be a start-up that you or a significant other may create in the future. For a start-up, focus on an entrepreneurial idea that is of substantive interest, so this project leaves you with a product you may leverage in the future.
Write a 1,000-word (maximum word count) paper in which you address the following:
· Identify the major components of the strategic management process.
· Discuss how these components work together to create value for the organization.
· Evaluate the company's mission statement, vision statement, motivation strategy, innovation strategy, and people strategy. If the organization does not have one or more of these, how does that affect the organization and its people?
· Explain the role of ethics and corporate social responsibility in strategic planning. How does this direct their strategy? How does the organization's vision and mission align with your own values and vision? If you are currently working for the organization, how does your role influence this and vice versa?
Format your paper according to APA guidelines.
Using the information below Create a 3-4 -slide PowerPoint presentation. Include speaker notes and citations for each slide, and create a slide at the end for References.
Immunization is important to infants as it prevents them from diseases which would be expensive to treat. The benefit of immunization and prevention of infectious diseases among mothers and infants cost-effective healthcare intervention and contribute significantly in reduction of mortality and morbidity in the country (Walls et al. 2018). Immunization also helps the mother to spend less on possible diseases that could affect their children. Prevention of infectious diseases is important to both the victim and other people who might be close to them, including the caregivers. In the maternal and infant population, immunization and infectious diseases continue to be a topic of debate. Averagely, immunization and prevention of infectious diseases has improved. In the United States the rate of immunization has gone up across all races, income groups and ethnicities. Similarities among the races where this special population are located narrowed down.
More so, prevention of diseases is less costly compared to the case where everyone is infected and needs medication. Despite the decreasing disparity, due to vaccination programs such as vaccination for infants, mother and infants from poor families, non-white have low immunization rates than those who were well off and white. Similarly, there are cost ba ...
Narrative review: Is it rational to pursue Zero Suicides among patients in he...Jan Mokkenstorm
Suicide prevention is a major health care responsibility in need of new perspectives. This study reviews Zero Suicide, an emerging approach to suicide prevention that embraces the aspirational goal of zero suicides among patients treated in health care systems or organizations. Zero Suicide is gaining international
momentum while at the same time evoking objections and concerns. Fundamental to Zero Suicide is a multilevel system view on suicide prevention, with three core elements: a direct approach to suicidal behaviors; continual improvement of the quality and safety of care processes; and an organizational commitment to the aspirational goal of zero suicides. The rationale and evidence
for these components are clarified and discussed against the backdrop of concerns and objections that focus on possible undesired consequences of the pursuit of zero suicide, in particular for clinicians and for those who are bereaved by suicide. It is concluded that it is rational to pursue zero suicides as
an aspirational goal, provided the journey toward zero suicides is undertaken in a systemic and sustained manner, in a way that professionals feel supported, empowered, and protected against blame and inappropriate guilt.
Fourteen years ago I was asked to prepare the following document. After it was completed, the contractor asked me to re-do it because they had made a mistake in the age they wanted covered. [They seemed to believe the information was too sensitive politically] and buried the report. I'm submitting it here now to learn what the LinkedIn audience thinks. Is it time to update it?
QUIZ 2 Questions1. What are the primary advantages of diversity.docxcatheryncouper
QUIZ 2 Questions:
1. What are the primary advantages of diversity in the workforce? Be specific with a summary of each one.
2. Explain the three (3) main reasons for conducting performance appraisals.
3. What are the key difference between BARS and the Graphic Rating Scale?
4. What is the difference between a right and a privilege? Give an example of the difference within an organization?
5. Provide a summary of the components of the Wagner Act/National Management Labor Relations ACT, the year it was passed and who it benefitted?
6. Provide a summary of the components of Taft-Hartley Act (Labor Management Relations Act), the year it was passed and who it benefitted?
7. What are the five (5) required steps to set up a representation election, such as an organization like a union?
8. What is the difference between a lockout and a strike?
9. What is the difference between defined benefits and defined contributions?
10. What are the four types of compensation along with a brief summary of each?
Running Head: CANCER TREATMENT IN CHILDREN 1
CANCER TREATMENT IN CHILDREN
11
How to Treat Cancer in Children
Name
Institution
Introduction.
Cancer is an epidemic that is wiping out the world’s population at a very high rate; it is worrying to the society because cancer is now a problem that faces children most of the time. This is unlike in the previous years when cancer was associated with old age and older people. The number of children with these horrible disease has acutely risen (Situ, 2015).As (Evan,44) puts it cancer is a dangerous disease because of the fact that treatment of cancer only takes place when the patient takes precaution before getting worse. Doctors say that early detection of cancer helps the victims in dealing with the situation better unlike if it is detected at a later stage.
According to Evan (44) Cancer is a dangerous disease owing to the fact that its treatment only occurs when the affected takes precaution before the situations worsens. It is for these same reasons that physician’s advice that one should conduct frequent health checkups to take care of any possibility of developing cancer. Children who are affected especially those below the age of fifteen are usually subjected to clinical trials. To illustrate further, the treatment takes place in phases, older and newer methods of treatment are compared to see which one gives better results. Through this analysis, great care needs to be observed to elude giving wrong treatment to the children. In addition due to the delicate nature of treating children it is advised that treatment should take place in a cancer center where the children will be monitored and taken care of well. To add on at the cancer center guardian and parents will be taught on how to best handle their children. Cancer treatment process has clinical and scientific methodologies. There ...
AIDSTAR-One Case Study: Targeted Outreach Program BurmaAIDSTAROne
The Targeted Outreach Project (TOP) provides HIV prevention services, as well as social, civic, and educational programs, for sex workers and men who have sex with men in Burma. TOP's community-driven and evidence-based strategies have contributed to its success and scale up across the country. Furthermore, epidemiological data suggest that TOP has contributed to declining HIV incidence in Burma. http://www.aidstar-one.com/focus_areas/prevention/resources/case_study_series/top_burma
AIDSTAR-One Co-trimoxazole Pilot Assessment ReportAIDSTAROne
AIDSTAR-One developed and piloted provider and patient educational tools to increase appropriate prescription and use of co-trimoxazole for eligible people living with HIV. Before and after the pilot, AIDSTAR-One conducted a mixed-methods assessment to analyze the effectiveness and acceptability of the co-trimoxazole tools. This report recommends adoption and scale-up of the tools in Uganda and other countries.
AIDSTAR-One Issue Paper: The Debilitating Cycle of HIV, Food Insecurity, and ...AIDSTAROne
This document aims to facilitate an understanding of the bi-directional relationship between HIV and food and nutrition security. It illuminates the causes of HIV-related food and nutrition insecurity, and points to a list of programmatic interventions and resources to consider for addressing each cause in detail. http://j.mp/U1L0iV
AIDSTAR-One conducted a 3-year demonstration project in Namibia to reduce heavy drinking and risky sexual behavior among bar patrons in a low-income neighborhood on the outskirts of Namibia's capital, Windhoek. This report describes how the intervention was implemented, monitored, and evaluated, and reports the final assessment results. It also offers key recommendations for future research and programming. http://aidstarone.com/focus_areas/prevention/resources/reports/alcohol_namibia_intervention_report
AIDSTAR-One Faith-Based Organizations and HIV Prevention with MARPs in MexicoAIDSTAROne
The influence of religious groups in parts of Latin America positions them to target most-at-risk populations (MARPs) who may have been overlooked by traditional HIV prevention outreach. In Mexico, La Iglesia de la Reconciliación, VIHas de Vida, and El Mesón de la Misericordia are challenging assumptions about faith-based organizations (FBOs) and the role they can play in HIV prevention. These three FBOs integrate spirituality and a holistic vision of health into their activities, sharing information on HIV and providing other HIV-related services in Mexico City and Guadalajara.
www.aidstar-one.com/focus_areas/prevention/resources/case_study_series/fbos_and_hiv_prevention_with_marps_in_mexico
AIDSTAR-One HIV Treatment Guidelines in Guyana - The Fast Track to Diagnosis ...AIDSTAROne
This case study details Guyana's process for revision of their national HIV treatment guidelines, based on WHO's 2010 revised recommendations . While many countries are still working to revise their national guidelines in response to WHO's latest guidance, the National AIDS Programme in Guyana has been implementing elements of WHO's 2010 recommendations since 2006.
www.aidstar-one.com/focus_areas/treatment/resources/case_study/guyana_treatment_guidelines
AIDSTAR-One Implementation of WHO's 2008 Pediatric HIV Treatment GuidelinesAIDSTAROne
In April 2008, the WHO Technical Reference Group for Pediatric HIV/ART and Care released a series of nine updated recommendations for diagnostic testing, initiation of treatment, and appropriate treatment regimens for HIV-exposed and infected infants. This technical brief outlines practical implementation considerations for program planners and policymakers working to incorporate these recommendations into their local efforts.
http://www.aidstar-one.com/implementation_whos_2008_pediatric_hiv_treatment_guidelines
AIDSTAR-One Protecting Children Affected by HIV Against Abuse, Exploitation, ...AIDSTAROne
This document is intended to explore strategies to protect children orphaned or made vulnerable by HIV (OVC) from abuse, exploitation, violence, and neglect. The report draws from lessons learned by OVC program managers, designers, and policy developers—particularly those associated with the President’s Emergency Plan for AIDS Relief (PEPFAR).
http://www.aidstar-one.com/focus_areas/OVC/reports/protecting_children_affected_by_HIV
AIDSTAR-One Increasing Access to Prevention of Mother-to-Child Transmission S...AIDSTAROne
This technical report discusses the many services needed throughout the prevention of mother-to-child transmission (PMTCT) and infant care services continuum and identifies potential barriers to service coverage, access, and utilization. AIDSTAR-One provides examples of evidence-based and emerging practices to mitigate these barriers.
www.aidstar-one.com/focus_areas/pmtct/resources/report/increasing_access_to_pmtct_services
AIDSTAR-One Prevention of Alcohol-Related HIV Risk BehaviorsAIDSTAROne
A growing body of research suggests that alcohol consumption is associated with the sexual behaviors that put people at risk for HIV. In developing countries battling severe HIV epidemics, addressing harmful drinking in conjunction with interventions to reduce sexual risk behavior may reduce HIV transmission more quickly than conventional HIV prevention interventions alone. Developed for program planners and implementers, this technical brief reviews the evidence on new and innovative programs in this emerging area. The brief catalogs what is known about the relationship between harmful alcohol use and HIV sexual risk behavior and offers a critical analysis of interventions to address the issue.
www.aidstar-one.com/focus_areas/prevention/resources/technical_briefs/prevention_alcohol_related_risk_behavior
AIDSTAR-One Meeting the Psychosocial Needs of Children Living with HIV in AfricaAIDSTAROne
An abbreviated version of the Equipping Parents and Health Providers to Address the Psychological and Social Challenges of Caring for Children Living with HIV in Africa report, this technical brief documents promising practices in critical services related to the psychological and social wellbeing of perinatally-infected children in Africa. These promising practices include the identification, testing, and counseling of children so that they are linked to appropriate care as early as possible, as well as on-going support to help children and their families manage disclosure, stigma, grief and bereavement processes.
www.aidstar-one.com/focus_areas/care_and_support/resources/technical_briefs/foundation_future
AIDSTAR-One NuLife—Food and Nutrition Interventions for UgandaAIDSTAROne
This technical report examines a nutritional assessment, counseling, and support (NACS) program in Uganda that uses a quality improvement approach to services.
www.aidstar-one.com/focus_areas/care_and_support/resources/report/nulife_food_and_nutrition_interventions_uganda
AIDSTAR-One PRASIT: Using Strategic Behavioral Communication to Change Gender...AIDSTAROne
Programs focused on promoting gender equity and combating detrimental gender norms play a key role in HIV prevention. This case study (one of nine in a series) documents how the PRASIT program in Cambodia targets entertainment workers, their mainly middle class and male clients, and males who have sex with males using strategic behavior communication. Although the programs vary in their approaches, strategies employed by PRASIT have focused on community outreach, mass media campaigns, and peer education.
www.aidstar-one.com/focus_areas/gender/resources/case_study_series/prasit_cambodia
AIDSTAR-One STIGMA Foundation in IndonesiaAIDSTAROne
Integrating strategies to address gender inequity and change harmful gender norms is an increasingly important component of HIV programs. However, gender integration among programs targeting most-at-risk populations (MARPs) is much less prevalent. In Indonesia, the STIGMA Foundation uses a peer outreach model to help men and women who inject drugs live safer, healthier, more productive lives through community organizing, advocacy, and networking.
www.aidstar-one.com/focus_areas/gender/resources/case_study_series/STIGMA_foundation
Prompted by a growing knowledge of the complexity of HIV transmission, many countries are reassessing the nature of their HIV epidemics. "Mixed" epidemics, or concurrent epidemics experienced by both the general population and members of most-at-risk populations (MARPs), are of growing importance in HIV programming. Nigeria, a country with a range of regional and local epidemics, is now attempting to incorporate programming for MARPs into the national HIV response. This case study documents the country's analysis of its epidemics and the efforts of the Nigerian government to adjust their national strategic plan according to the results of the analysis.
www.aidstar-one.com/focus_areas/prevention/resources/case_study_series/nigeria_mixed_epidemics
AIDSTAR-One Caring for Children Living with HIV in AfricaAIDSTAROne
This report, Equipping Parents and Health Providers to Address the Psychological and Social Challenges of Caring for Children Living with HIV in Africa, provides information to better understand the psychological and social challenges faced in Africa by perinatally-infected children (aged 0-12 years), their parents/caregivers, and their health providers. It explores factors that contribute to the ability of children living with HIV to cope and thrive, and identifies the tools and approaches being used to help parents/caregivers and health providers provide psychosocial support (PSS) to these children. The report elaborates on the themes discussed in the Meeting the Psychosocial Needs of Children Living with HIV in Africa technical brief.
www.aidstar-one.com/focus_areas/care_and_support/resources/report/clhiv_pss_needs_africa
AIDSTAR-One Sex Work and Life with Dignity: Sex Work, HIV, and Human Rights P...AIDSTAROne
In Peru, where cultural norms emphasize women's subordination and the importance of masculinity, programs with a focus on gender—particularly those involving sex workers—are often underfunded and underrepresented. This case study (one of nine in a series) describes how three organizations focused on sex workers and transgendered and transsexual people have joined together to advance the rights of sex workers. The Sex Work, HIV, and Human Rights Program uses a democratic and participatory approach in order to raise awareness of human rights and advocate for sex workers' rights on both national and local levels.
www.aidstar-one.com/focus_areas/gender/resources/case_study_series/life_with_dignity_peru
AIDSTAR-One Different Needs But Equal Rights: Giving Voice to Transgender Com...AIDSTAROne
Although transgender individuals are a highly vulnerable segment of El Salvador's population, the national political climate has only recently begun to support HIV programming that is tailored to their needs. Additionally, limited access to medical services and legal protection and considerable societal stigma and discrimination means that organizations working with transgender individuals must meet a variety of complex and varied needs. This case study, one of 9 in a series, describes the challenges and successes of the Solidarity Association to Promote Human Development (ASPIDH), an NGO that promotes transgender rights via sensitization, education, and advocacy activities.
www.aidstar-one.com/focus_areas/gender/resources/case_study_series/aspidh_salvador
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. AIDSTAR-One SpOTlIghT On pREVEnTIOn
Reinvigorating Condoms as an hIV prevention Tool
Krishna Jafa and Steven Chapman
The world is enticingly close to realizing the
vision of an AIDS-free generation. More HIV-
infected individuals are accessing treatment
earlier in the course of their disease, and
elimination of vertical (mother-to-child)
transmission—while still a challenge—is
closer to becoming a reality (Ciaranello et
al. 2012). However, this vision cannot be
achieved through treatment alone. HIV
will only slow down when new infections,
currently at two for every one person put on
treatment, diminish dramatically (Joint United
Nations Programme on HIV/AIDS 2010). This
means improved access to, and utilization of,
combination prevention—a mix of evidence-
based HIV prevention interventions including
condoms.
In this editorial, we summarize the evidence on
condoms for HIV prevention, discuss barriers and
opportunities regarding supply, and propose ways to
reinvigorate the use of condoms as an HIV prevention
tool. This reinvigoration is needed now more than ever,
given the vital role of condoms in both primary HIV
prevention and in interventions to promote positive
health, prevention, and dignity for people living with
HIV.
Condoms Work, and Many People Use Them
Condoms are an effective barrier method for
preventing HIV, other sexually transmitted infections
(STIs), and unintended pregnancy, and are used in
hundreds of millions of sex acts each year (Davis
and Weller 1999; Pinkerton and Abramson 1997;
Weller and Davis-Beaty 2002). They play a key role
in sustaining the benefits of other high-impact HIV
prevention interventions such as male circumcision
and prevention of mother-to-child transmission. Thus,
condoms are a vital component of a comprehensive
HIV prevention strategy.
Condom promotion is generally considered a cost-
effective HIV prevention intervention as measured
by the cost per disability-adjusted life year (DALY)
averted. The DALY is a composite metric that
combines years lived with disability and years lost to
premature death, and one DALY averted represents
one year of healthy life. While cost effectiveness ratios
are context-specific and there isn’t universal agreement
on thresholds of cost effectiveness, a cost per DALY
averted ratio of under U.S.$50 is generally considered
cost-effective. The cost per DALY averted for male
condoms ranges from U.S.$19 to $205, and this
range indicates condom programs vary in design and
implementation (Jamison et al. 2006).
Condom promotion can be controversial. Earlier in
the course of the epidemic, there were concerns that
condoms were being promoted in ways that ignored
structural barriers and religious sensitivities, failed
to include communities, and potentially increased
promiscuity (Pfeiffer 2004). Were these concerns
overstated? Perhaps. We now know that condoms
The views in this editorial do not necessarily reflect those of USAID or the U.S. Government.
1 September 2012
2. 2
SPoTlIGHT oN PREVENTIoN • REINVIGoRATING CoNDoMS AS AN HIV PREVENTIoN Tool
have been essential to achieving significant prevention
gains in both generalized and concentrated HIV
epidemics. For example, a recent modeling paper
suggests that HIV incidence in South Africa among
15 to 49 year olds declined by as much as 23 to 37
percent from 2000 to 2008—and that much of this
decline can be attributed to increased condom use
(Johnson et al. 2012). Similarly, in Zimbabwe, reduction
of multiple and concurrent partnerships, high condom
use in non-regular partnerships, and improved
consistency of condom use among women with their
casual partners are thought to have contributed
to a fall in HIV prevalence from 29.3 percent in
1997 to 15.6 percent in 2007 (Gregson et al. 2010).
Thailand’s program requiring 100 percent condom
use during commercial sex had similar results from
1991 to 1995 among young Thai men—condom use
at last commercial sex increased from 61 percent to
92.5 percent, and HIV prevalence fell from between
10.4 and 12.5 percent to 6.7 percent (Nelson et al.
1996). Similar successes are noted in other countries
(Population Services International 2006; Population
Services International 2009; Riedner et al. 2006; World
Health Organization [WHO] 2000).
But Not Everyone Wants to Use—or Is Able
to Use—Condoms
Despite proven effectiveness, there are still several
challenges to condom use. Moving forward, programs
must address these barriers and incorporate (and test)
potential solutions as part of any prevention strategy.
Risky Behavior
Even the most ardent condom promoter will admit
that it is difficult to promote condoms among couples
in established sexual relationships, one or both of
whom may also have other sex partners. This is true
regardless of whether societal and cultural norms
condone multiple and concurrent sexual partnerships
(Halperin et al. 2011; Shelton 2006). Moreover, condom
use is self-reported and survey respondents may
therefore adjust their answers according to what seems
more socially desirable (Aho et al. 2010). Condom
promotion without efforts to reduce the number of
partners is only half a solution.
Two behavioral models of risk-taking provide insights
into why people use condoms less often, or stop using
condoms altogether, even when they are aware that
continued use protects against HIV and other STIs.
The risk compensation model suggests that when an
effective prevention or treatment intervention (or one
perceived to be effective) is available, an individual’s
perception of transmission risk may be reduced,
which in turn can lead to increased risk-taking (Eisele
et al. 2009; Kelly et al. 1998; Tun et al. 2004). For
example, men who become circumcised—and who
are thus partially protected from HIV acquisition—may
incorrectly perceive themselves to be at no risk for HIV,
and thus may choose to discontinue condom use or to
have more sex partners. The behavioral disinhibition
model suggests that when an effective intervention
such as antiretroviral treatment is available, an individual
may be less likely to exercise self-restraint and more
likely to focus on the pleasure of unprotected sex—and
not use a condom (Blower, Gershengorn, and Grant
2000; Law et al. 2001; Wilson et al. 2008). Substance
use is thought to further increase such risk-taking
because of its own disinhibiting effect.
Both models of risk-taking help to explain the rationale
for stopping or reducing condom use among men who
are medically circumcised (Agot et al. 2007; Bailey et
al. 2007; Gray et al. 2007), alcohol or substance users
with their partners (Fritz 2011), men who have sex with
men (MSM) (Grulich 2000; Hogg et al. 2001; Sampaio
et al. 2002), and discordant couples (Allen et al. 2003;
Coldiron et al. 2008; Eaton and van Der Straten
2009). There is mixed evidence of consistent condom
use in some of these populations. Furthermore, the
concept of partial protection that is conferred by
HIV prevention interventions such as medical male
circumcision, and the attendant need to continue using
condoms consistently, is difficult to convey.
3. 3
spotlight on Prevention • Reinvigorating Condoms as an HIV Prevention Tool
Understanding the underlying reasons for risk-taking
better, and designing interventions based on that
understanding, becomes even more important with
the U.S. Food and Drug Administration’s recent
approval of pre-exposure prophylaxis (U.S. Food and
Drug Administration 2012). Messages may need to
address several types of barriers—such as a risk-based
calculation that condom use is not as necessary, or
arousal-based barriers to condom use.
Structural Barriers
It is essential to consider, and address where possible,
structural factors that may contribute to increased risk-
taking. These barriers—including stigma, criminalization,
and other legislative and social barriers—can impede
condom use in important ways. For example, even
though we know that unprotected receptive anal sex is
the most efficient route for transmitting HIV, condom
promotion among MSM and transgendered people
is patchy or absent in a number of countries (Ayala
n.d.; Baggaley, White, and Boily 2010). A recent report
shows that limited or absent condom promotion
results from criminalization of same-sex behaviors,
homophobia, and discrimination against this vulnerable
population (Beyrer 2010; Global Commission on
HIV and The Law 2012). When condoms, lubricants,
and educational materials promoting condom use
are used as evidence of crime, it becomes difficult to
reach MSM—and other at-risk populations such as
sex workers—with these much-needed interventions.
Sadly, such criminalization continues despite growing
evidence that robust coverage of HIV interventions for
MSM has positive epidemiologic effects and is cost-
effective (Beyrer et al. 2011).
Dual Protection and Dual Use
Another prevention option that needs to be better
understood is the use of condoms for dual protection
(against STIs and pregnancy), as well as dual use
of condoms plus one other modern contraceptive
method to prevent unintended pregnancy and HIV
transmission or re-infection (Pazol, Kramer, and
Hogue 2010; Prata, Sreenivas, and Bellows 2008).
There is no globally accepted indicator for measuring
use of dual protection, and Demographic and Health
Surveys only report on the primary family planning
method used. These are missed opportunities to
understand the impact of family planning and HIV
integration programs—with potential negative impacts
on reduction of both heterosexual and vertical
transmission (Wilcher and Cates n.d.).
These and other challenges demand fresh thinking
about how to address impediments to equitable access,
as well as rigorous evaluation of which elements of
condom programming work—and, equally importantly,
don’t work—in both concentrated and generalized
epidemics (Hearst and Chen 2004).
The Supply Side: Who Procures and
Distributes Condoms?
Next, we discuss who buys and distributes condoms
for HIV prevention, quality considerations, and key
challenges in condom commodity procurement
planning and forecasting.
Donor Contributions
Condoms are listed on the WHO’s Model List of
Essential Medicines (2011). Male condoms are very
affordable (U.S.$0.02–0.04 per unit) and are widely
distributed. In 2010, procurement of male condoms
by bilateral and multilateral donors for public sector
distribution and social marketing exceeded 2 billion
for the first time and reflected a 22 percent increase
over 2009 (Reproductive Health Supplies Coalition
n.d.). The five leading agencies that purchased male
and female condoms in 2010 were the U.S. Agency
for International Development (USAID; 37 percent),
the UN Population Fund (UNFPA; 22 percent), the
Global Fund to Fight AIDS, Tuberculosis and Malaria
(9 percent), Kreditanstalt Für Wiederaufbau (KfW; 2
percent), and the UK Department for International
4. 4
spotlight on Prevention • Reinvigorating Condoms as an HIV Prevention Tool
Development (2 percent). Sub-Saharan African
countries are the major recipients of donated condoms.
Country Contributions
Unfortunately, very few governments in the countries
worst hit by the epidemic procure sizeable quantities
of condoms. By 2015, an estimated 13 billion condoms
will be required globally for HIV prevention, and an
additional 5 billion for family planning (Reproductive
Health Supplies Coalition 2009). While larger middle-
income countries such as Brazil, China, India, and
South Africa have begun, and will probably continue,
to include condoms in their own country budgets,
donors—and ministries of health with available
resources—will still need to help lower-income
countries purchase an estimated 2.4 billion condoms
for HIV prevention, and 2 billion condoms for family
planning in 2015. This signifies a 120 percent increase
over current donor procurement levels (Reproductive
Health Supplies Coalition 2009). Additional resources
would be needed for shipping, distribution, and
promotion. While the volume of condoms needed
seems large, the funding needed to support condom
commodity security in the highest-need countries is a
fairly modest $88 million (assuming a unit cost per male
condom of $0.02)—less than 1.5 percent of total HIV
funding disbursements made by donor governments
in 2010 (Kates et al. 2011). Separate calculations are
needed to estimate the funding needed for lubricants.
Quality Considerations
Also on the supply side, condom quality is an essential
consideration. Most donors and implementing agencies
procure condoms from manufacturers whose factories
are pre-qualified by WHO. However, from time to
time, reports of poor condom quality—often difficult
to substantiate—do surface, and these can rapidly
undermine condom promotion programs. There are
other quality-related issues too. While there were
26 pre-qualified male condom factories owned by 21
different manufacturers in 2011 (UNFPA 2012; WHO,
UNFPA, and Family Health International 2010), there
are only two WHO pre-qualified female condom
manufacturers at the time of writing. Also, while there
is clear guidance from WHO on male latex condom
specifications and procurement (WHO, UNFPA, and
Family Health International 2010), there is no globally
agreed protocol for ongoing quality control from the
point of manufacture to the end user.
Another issue is that male condoms are often
paired with lubricant for distribution to certain key
populations (MSM and transgendered people, and
sometimes sex workers). The absence of globally
accepted manufacturing specifications for lubricant, and
of evidence to strongly support lubricant use for HIV
prevention, is of concern. In vitro studies suggest that
hyperosmolar lubricant may increase the risk of HIV
transmission by causing damage to colonic and rectal
surface epithelial cells (Begay et al. 2011; Fuchs et al.
2007).
Challenges in Quantifying How Many Condoms are
Needed
In a number of settings, capacity to undertake accurate
forecasting and procurement planning is limited. It is
thus currently a challenge to precisely quantify how
many condoms are needed, and where. Even basic
current information on the quantities of condoms
procured by country governments, or distributed by
private sector players, is either difficult or prohibitively
expensive to obtain. This limits the ability to define
the size, value, and capacity of the total condom
market to meet current need to prevent HIV/STIs
and unintended pregnancy. Broader participation by
more agencies, country governments, and commercial
players in providing data to the Reproductive Health
Supplies Coalition’s RHInterchange will help make such
information more widely available.
Additionally, at the country level and often at the donor
level, condom requirements are typically calculated
separately for HIV prevention and family planning,
which can lead to losses in procurement efficiency.
USAID’s Central Contraceptive Procurement Project
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spotlight on Prevention • Reinvigorating Condoms as an HIV Prevention Tool
seeks to resolve this coordination problem by providing
guidance on condom procurement for both purposes
(Family Planning Logistics Management 2000).
As condom promotion programs strive for
sustainability, it is important to consider the total
market for condoms, including public-sector (free),
subsidized, and commercial distribution. Programs
should also monitor use in key populations, equity
of condom access, and levels of subsidy needed to
maintain high levels of consistent condom use among
the highest-risk populations. Finally, they should seek to
increase levels of use among non-users or inconsistent
users who are at higher risk for HIV (Chapman et al.
2012).
Call to Action to Reinvigorate Condom
Promotion
We propose a call to action to reinvigorate the
promotion of condoms as an HIV prevention tool.
We believe that if programs follow the steps outlined
below, condom promotion will be more effective and
cost-effective, and ultimately will achieve a higher health
impact:
• Consider and address behavioral disinhibition
and risk compensation when designing condom
promotion and combination prevention programs.
• Combine condom promotion with initiatives to
address the structural factors associated with risky
sexual behaviors, such as stigma, discrimination, and
criminalization of certain key populations.
• Develop a globally accepted indicator and a body
of evidence on dual use of condoms with other
modern family planning methods.
• Disseminate to policymakers evidence on the impact
of making HIV prevention interventions, including
condoms and lubricants, freely accessible to MSM.
• Address the evidence gap for lubricants in the
context of HIV transmission.
• Build consensus on protocols for condom quality
control at the country level to address quality
concerns among consumers.
• Advocate with country governments for the
inclusion of condom procurement within their health
budgets, while reaffirming donor commitments to
countries most in need.
• Strengthen capacity at the national and global levels
to coordinate condom procurement for both HIV
and family planning, and at national levels to improve
procurement planning to prevent stockouts and
shortages.
• Invite and involve private-sector players to join
rums such as the
, so that comprehensive supply information
becomes available.
• Develop country-level condom commodity
security strategies that consider the total market
for condoms, and not just the public and social
marketing sectors.
fo Reproductive Health Supplies
Coalition
Condoms are an effective, affordable, and vital part of
a comprehensive and combined response to the HIV
epidemic. Condom use can, and must, be included
among the critical strategies for achieving the vision of
an AIDS-free generation. g
About the Authors
Krishna Jafa is Director of Sexual & Reproductive
Health & Tuberculosis at PSI. She is a physician
and epidemiologist with experience in the design,
management, and monitoring and evaluation of public
health programs and research in Asia, Africa, and the
United States. Areas of technical expertise include: family
planning; sexual and reproductive health and rights; HIV
prevention and diagnosis; commodity security; quality
improvement of clinical services; correctional health;
post-conflict humanitarian response; and epidemic
response. Dr. Jafa has successfully led efforts to improve
6. 6
spotlight on Prevention • Reinvigorating Condoms as an HIV Prevention Tool
social marketing and social franchising programs for
sex workers, MSM, inmates, people who inject drugs,
and other vulnerable populations. She contributed to
the U.S. Centers for Disease Control and Prevention’s
(CDC’s) landmark 2005 recommendation to permit
condom distribution in U.S. prisons and jails. Dr. Jafa
obtained her medical degree from Rajasthan University,
India and her MPH from Harvard University; she is an
alumna of CDC’s Epidemic Intelligence Service.
Steven Chapman became Chief Technical Officer at
PSI in 2008 and leads PSI’s efforts to improve the
effectiveness, cost-effectiveness, and equity of its
interventions. Steven manages PSI’s Technical Services
team which consists of more than 50 specialists in five
departments: malaria and child survival; HIV, tuberculosis
and reproductive health; research and metrics; social
marketing; and learning and performance. He also heads
PSI’s strategic initiative on innovation, which aims to
increase the proportion of DALYs averted by PSI from
new interventions, and consists of an innovation fund,
cross departmental innovation teams, capacity building
efforts, and pilot projects.
Acknowledgments
This publication was made possible through the
support of the U.S. President’s Emergency Plan for
AIDS Relief (PEPFAR) through the U.S. Agency for
International Development under contract number
GHH-I-00-07-00059-00, AIDS Support and Technical
Assistance Resources (AIDSTAR-One) Project, Sector I,
Task Order 1.
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