1) The document summarizes a report on the impact of HIV/AIDS in Swaziland, which has the highest HIV prevalence rate in the world at 42%.
2) The report used socioeconomic indicators to build a comprehensive picture of how HIV/AIDS has created a humanitarian crisis in Swaziland comparable to a conflict or natural disaster.
3) An evaluation found that the report raised awareness of the crisis and challenged international perceptions of Swaziland as a "middle income country" not requiring significant support for its HIV epidemic.
This document discusses the debate around AIDS exceptionalism. It argues that AIDS requires an exceptional response in some contexts but not others. Specifically:
- In countries with low HIV prevalence, AIDS should be normalized and treated as a public health issue, while still addressing the human rights and stigma faced by at-risk groups.
- In countries with mid-level prevalence, AIDS can also be normalized except where treatment depends on outside resources, as is the case in most African countries, due to sustainability challenges.
- Countries with high HIV prevalence over 10% still require an exceptional response, due to substantial morbidity, mortality, and challenges providing effective prevention and treatment programs. The impacts on demography, society and development are significant
Noncommunicable diseases (NCDs) account for 71% of the deaths worldwideΔρ. Γιώργος K. Κασάπης
NCDs are not selective; they affect men and women in all countries and all socioeconomic classes, albeit with notable regional differences that influence intervention strategies and outcomes. Further amplifying the crisis, the high prevalence and chronic nature of NCDs have a direct impact on economies; the total global burden estimated to reach US$47 trillion between 2010 and 2030. Upjohn, a Pfizer division, shares insights on the major causes, trends and methods of intervention against NCDs.
Evaluate the geographic impact of HIV/AIDS at the local, national and interna...Tom McLean
HIV/AIDS has had significant geographic impacts across local, national, and international scales in South Africa. At the local level, the disease has disproportionately affected the poor and black populations due to factors like poverty, lack of education, and sexual violence. Nationally, South Africa has seen its life expectancy drop dramatically and around 10% of its population is HIV positive, putting strain on healthcare resources. Internationally, HIV/AIDS has reduced life expectancy in many African countries and is now the fourth leading cause of death globally, with an estimated 36 million people infected worldwide mostly in developing areas.
The next pandemic? Non-communicable diseases in developing countries is an Economist Intelligence Unit report. It examines the growing burden of non-communicable diseases (NCDs) in low- and lower-middle-income countries, the drivers of this change, and possible solutions for how healthcare systems can bridge the resource gap to deliver appropriate NCD care for patients. The findings of this report are based on data analysis, desk research and five in-depth interviews with senior healthcare experts.
The right to health of non-nationals and displaced persons in the sustainable...Lyla Latif
Under the Millennium Development Goals (MDGs), United Nations (UN) Member States reported
progress on the targets toward their general citizenry. This focus repeatedly excluded marginalized ethnic and
linguistic minorities, including people of refugee backgrounds and other vulnerable non-nationals that resided
within a States’ borders. The Sustainable Development Goals (SDGs) aim to be truly transformative by being made
operational in all countries, and applied to all, nationals and non-nationals alike. Global migration and its diffuse
impact has intensified due to escalating conflicts and the growing violence in war-torn Syria, as well as in many
countries in Africa and in Central America. This massive migration and the thousands of refugees crossing borders
in search for safety led to the creation of two-tiered, ad hoc, refugee health care systems that have added to the
sidelining of non-nationals in MDG-reporting frameworks.
Cancer in sub saharan africa the need for new paradigms in public healthReinhard Hiller
Cancer is now the leading cause of death globally and rates are rising in sub-Saharan Africa due to lifestyle changes, increased life expectancy, and infectious disease exposures. While data often combines all cancers, the top four cancer deaths in men in sub-Saharan Africa are prostate, liver, Kaposi's sarcoma, and esophageal cancers, which have different risk factors and levels of treatability. Infectious diseases also contribute significantly to the cancer burden in sub-Saharan Africa. Despite the growing problem, only 5% of global cancer resources are allocated to lower income countries like those in sub-Saharan Africa.
This document discusses the debate around AIDS exceptionalism. It argues that AIDS requires an exceptional response in some contexts but not others. Specifically:
- In countries with low HIV prevalence, AIDS should be normalized and treated as a public health issue, while still addressing the human rights and stigma faced by at-risk groups.
- In countries with mid-level prevalence, AIDS can also be normalized except where treatment depends on outside resources, as is the case in most African countries, due to sustainability challenges.
- Countries with high HIV prevalence over 10% still require an exceptional response, due to substantial morbidity, mortality, and challenges providing effective prevention and treatment programs. The impacts on demography, society and development are significant
Noncommunicable diseases (NCDs) account for 71% of the deaths worldwideΔρ. Γιώργος K. Κασάπης
NCDs are not selective; they affect men and women in all countries and all socioeconomic classes, albeit with notable regional differences that influence intervention strategies and outcomes. Further amplifying the crisis, the high prevalence and chronic nature of NCDs have a direct impact on economies; the total global burden estimated to reach US$47 trillion between 2010 and 2030. Upjohn, a Pfizer division, shares insights on the major causes, trends and methods of intervention against NCDs.
Evaluate the geographic impact of HIV/AIDS at the local, national and interna...Tom McLean
HIV/AIDS has had significant geographic impacts across local, national, and international scales in South Africa. At the local level, the disease has disproportionately affected the poor and black populations due to factors like poverty, lack of education, and sexual violence. Nationally, South Africa has seen its life expectancy drop dramatically and around 10% of its population is HIV positive, putting strain on healthcare resources. Internationally, HIV/AIDS has reduced life expectancy in many African countries and is now the fourth leading cause of death globally, with an estimated 36 million people infected worldwide mostly in developing areas.
The next pandemic? Non-communicable diseases in developing countries is an Economist Intelligence Unit report. It examines the growing burden of non-communicable diseases (NCDs) in low- and lower-middle-income countries, the drivers of this change, and possible solutions for how healthcare systems can bridge the resource gap to deliver appropriate NCD care for patients. The findings of this report are based on data analysis, desk research and five in-depth interviews with senior healthcare experts.
The right to health of non-nationals and displaced persons in the sustainable...Lyla Latif
Under the Millennium Development Goals (MDGs), United Nations (UN) Member States reported
progress on the targets toward their general citizenry. This focus repeatedly excluded marginalized ethnic and
linguistic minorities, including people of refugee backgrounds and other vulnerable non-nationals that resided
within a States’ borders. The Sustainable Development Goals (SDGs) aim to be truly transformative by being made
operational in all countries, and applied to all, nationals and non-nationals alike. Global migration and its diffuse
impact has intensified due to escalating conflicts and the growing violence in war-torn Syria, as well as in many
countries in Africa and in Central America. This massive migration and the thousands of refugees crossing borders
in search for safety led to the creation of two-tiered, ad hoc, refugee health care systems that have added to the
sidelining of non-nationals in MDG-reporting frameworks.
Cancer in sub saharan africa the need for new paradigms in public healthReinhard Hiller
Cancer is now the leading cause of death globally and rates are rising in sub-Saharan Africa due to lifestyle changes, increased life expectancy, and infectious disease exposures. While data often combines all cancers, the top four cancer deaths in men in sub-Saharan Africa are prostate, liver, Kaposi's sarcoma, and esophageal cancers, which have different risk factors and levels of treatability. Infectious diseases also contribute significantly to the cancer burden in sub-Saharan Africa. Despite the growing problem, only 5% of global cancer resources are allocated to lower income countries like those in sub-Saharan Africa.
Social Challenges Facing Low Income Earning Women Living With HIV/AIDS: A Cas...paperpublications3
Abstract: Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has been in existence for more than twenty years and women account for nearly half the 40 million people living with HIV/AIDS. Women’s rate of new infection surpasses men’s because biological, cultural, and social economic conditions contribute to women’s greater vulnerability to HIV. The challenges that these low-income earning women living with HIV/AIDS face are social, economic, and psychological. When a woman is sick the family’s property, the children’s education, savings and food security are threatened because women provide the majority of labour and managerial services for their household. The purpose of the study was to establish the social challenges that face low-income earning women living with HIV/AIDS. A sample of 248 out of a population of 700 who were receiving Home Based Care within Nakuru Municipality was selected. The study was a survey where Questionnaire and interviews were used to collect data. The data was analyzed using descriptive statistics. The findings of the study revealed that low income women living with HIV/AIDS faced various social challenges such as shame, discrimination, and causing strain in the family among others. The disparities that existed among the singles and the married revealed that one’s marital status determined the extent to which one was ashamed, evoked negative changes in the behaviour of family members and experienced discrimination based on their HIV/AIDS status. The implications of the findings is that the public support for the low-income women living with HIV/AIDS is inadequate and mostly material, and emotional support is also crucial in the management and coping with HIV/AIDS.
Armed conflict in South Sudan since 2013 has led to widespread displacement, disruption of health services, and increased mortality. An estimated 4.5 million people have been displaced, both internally and as refugees in neighboring countries. A study estimated that between 2013-2018, nearly 400,000 excess deaths occurred in South Sudan's population due to the war, with around half being violent deaths and the rest indirectly from reduced access to healthcare and increased disease prevalence. The conflict has severely damaged South Sudan's health system and humanitarian response has been insufficient to address the health needs of the population.
The relationship between unemployment and poverty has been of interest to many a scholar with interest in development economics and social sciences. This paper is an addition to the empirical attempts to re-examine the relationship between unemployment rate and poverty incidence in Nigeria using secondary data sourced from relevant institutions to obtain major Social and Economic indicators spanning within 1980-2015. The study used Trend graph analysis, Correlation coefficient analysis and Granger causality tests in its analyses. As shown from the results, there is a positive-significant correlation between unemployment and poverty in Nigeria. More so, this was corroborated by the Trend graph analysis. It also established that unemployment granger causes poverty in Nigeria as suggests from the Granger causality tests. The economic implication of this result is that poverty is an increasing function of unemployment; and the Error Correction Mechanism (ECM) pointed that short run disequilibrium in the economy can be returned to equilibrium in the long run with a poor speed of adjustment of 6 %. In the light of these findings, this study recommends that efforts should be intensified in Nigeria towards implementation of unemployment reduction policies as this will significantly reduce poverty incidence.
The West Africa-America Chamber of Commerce & Industries presents: Sub sahara...David Lary
The West Africa-America Chamber of Commerce & Industries presents: Sub sahara africa economic impact of tropical and infectious diseases by Dr. Oluwole Kukoyi
Utilization of reproductive health services in ghanaAlexander Decker
The document analyzes factors affecting utilization of reproductive health services in Ghana based on a survey of 200 individuals. The results of a probit analysis show that being married and having a higher income positively influence utilization of services, while higher prices negatively affect utilization. Policy should target the unmarried and poor by providing subsidies to increase utilization and enhance reproductive health outcomes.
The document discusses the history and current state of the AIDS epidemic in Africa. It begins by tracing HIV back to chimpanzees in Cameroon in the 1930s and its spread to humans. By the 1980s, AIDS cases rose sharply across Eastern Africa due to factors like labor migration. Treatment was not widely available until the 1990s. Currently, South Africa has the most HIV cases but prevalence has declined by a third over the past decade due to treatment programs. However, the number of people needing treatment is expected to exceed resources by 2020 without increased prevention and sustainable treatment options. More work is still needed to curb the epidemic.
A REVIEW OF THE AGENCIES OF THE CONTROL MEASURES OF HIV/AIDS IN NAGALANDpaperpublications3
This document reviews the agencies involved in controlling the HIV/AIDS epidemic in Nagaland, a state in northeast India. It discusses how religious organizations, governmental and non-governmental organizations, schools, police, hospitals, and individuals all play roles in prevention, care, and treatment efforts. The HIV/AIDS problem has become multidimensional, affecting health, social, economic, and cultural aspects of society. While agencies have adopted various strategies, more opportunities are needed for people living with HIV/AIDS. Religious organizations in particular can provide support through awareness programs, counseling, health camps, and prayer. They have begun establishing cells focused on HIV/AIDS issues.
This document summarizes poverty trends in South Asia. It finds that poverty is widespread and disproportionately affects rural populations, who often work in agriculture and lack access to resources, education, health services and infrastructure. While poverty has declined in some countries according to government estimates, these figures are disputed, and poverty remains a significant problem. Poverty is often concentrated in particular areas or among specific ethnic groups. Eradicating poverty requires concerted efforts across governments and communities.
The document discusses the impact of the HIV/AIDS epidemic in Kenya. It provides statistics on the number of people living with HIV/AIDS, deaths from AIDS, and new infections in Kenya and worldwide. It then describes the significant demographic, educational, agricultural, health, industrial, social and economic impacts of the epidemic in Kenya, including increased orphan rates, declines in life expectancy, increased burden on the healthcare system, and loss of skilled workers. It notes the government of Kenya has declared AIDS a national disaster and established policies and institutions to accelerate the national response.
Title - What is going on HIV and AIDS in 2013 and beyond
Presented at the HIV Capacity Summit. view program here - http://www.hivcapacityforum.org/index.php?sid=12
This document provides information on HIV/AIDS statistics in Kenya and Africa, the disproportionate impact of HIV/AIDS on women and girls, challenges in accessing healthcare in Kenya including shortages of healthcare workers and facilities, and prior mHealth trials in Kenya that faced challenges with scale and sustainability. It discusses the potential for mHealth solutions in Kenya that utilize international partnerships and collaboration across industries and sectors to develop culturally appropriate, autonomous solutions for increasing access to care, education and social support through mobile technologies and services.
Geographic Factors Affecting HIV/AIDS in South Africa (Prevention vs. Treatme...Tom McLean
The document examines the geographic factors responsible for the spread of HIV/AIDS in South Africa. It discusses trends in HIV prevalence over time as well as patterns across regions. Socio-cultural factors like apartheid, stigma, and gender inequality increased women's vulnerability and reduced access to services. Politically, former President Mbeki downplayed the epidemic. Economically, prevention was prioritized over treatment due to costs. Overall, the document analyzes how geography, socio-cultural issues, politics, and economics contributed to HIV/AIDS in South Africa with prevention emphasized more than treatment.
The document discusses how sustainable livelihood approaches can help address the HIV/AIDS epidemic by taking a holistic view of its impact. It recognizes that HIV/AIDS affects many aspects of people's lives beyond just health, impacting finances, social support, education, and various livelihood assets. A livelihoods lens allows for joined-up thinking across sectors to understand how people adapt their livelihoods in response. Local responses have often been more effective than global strategies, and livelihood approaches can help share learning to support such responses.
The document discusses the importance of health to business and the economy. It notes that a nation's health indicators reflect the state of its wealth and economy. Poor health leads to a less productive workforce and economic drain. The document then provides an overview of Nigeria's poor health indices and underfunding of the health sector compared to global standards. It also discusses the social determinants of health issues in Nigeria like poverty, cultural beliefs, and brain drain of health professionals.
Rwanda has made tremendous progress in rebuilding its health system and improving health outcomes after the 1994 genocide devastated the country. National policies focused on equity, social cohesion, and community-based care. As a result, premature mortality has fallen and life expectancy has doubled. Key factors in Rwanda's success include community health insurance, performance-based financing, partnerships between the government and development organizations, and prioritizing decentralized and integrated health services.
Domestic accidents in a rural community of bangladesh a cross sectional study...Alexander Decker
This study assessed the prevalence and characteristics of domestic accidents in a rural community in Bangladesh. A survey of 297 households with 1171 family members found that 171 domestic accidents occurred over one year, a prevalence of 146.02 per 1000 people. Most victims were male (52.6%) aged 19-64 years. The most common types of accidents were falls (50.9%), cuts (22.2%), and burns (11.7%). Most accidents occurred in courtyards (49.7%) while victims were doing household chores or playing. The results suggest domestic accidents impose a significant health burden in rural Bangladesh and prevention through safety education could help reduce accidents.
Poverty implicates a condition where people are unable to afford the minimal standards of food, clothing, healthcare, education, and also not capable to continue traditions that are important to them. Poverty reduction strategies now receive high attention across the world because of the negative impact on the individual and national prosperity. The average poverty rate of about 68.40 percent is a clear indication that a majority of Nigerian citizens sleep below the poverty line despite the presence of poverty reduction programmes. The exploratory research method was deployed for the study in an attempt to explore the impact of NEEDS as a poverty reduction strategy in Nigeria. Through statistical analysis, it was found that NEEDS has not made significant positive impact on poverty reduction in Nigeria.
This document provides an overview of global health by defining key terms, outlining major players and organizations, and summarizing the history and evolution of the field from 1945 to the present day. It describes how global health has shifted from a focus on infectious disease control to addressing social determinants of health and health issues that transcend national borders. Major milestones discussed include the founding of the UN and WHO, the Alma-Ata Declaration, structural adjustment policies, the Millennium Declaration and MDGs, debt relief campaigns, and the establishment of the Global Fund. The summary highlights the ongoing tension between disease-specific and comprehensive primary healthcare approaches.
This document summarizes the history and current understanding of the AIDS epidemic. It discusses how AIDS has become one of the most studied diseases and our understanding of its medical and social drivers has deepened over time. However, the impacts are still unfolding over generations and varying significantly between places. While early models predicted severe economic impacts, some hard-hit countries have maintained growth. Understanding the social impacts remains challenging given the epidemic is only 25 years old.
What strategy for optimal health in poorest developing countriesAlexander Decker
This article analyzes strategies for achieving optimal health in developing countries with high rates of HIV/AIDS. It uses an economic model to study how international goals of zero new HIV infections, zero deaths from AIDS, and zero discrimination in healthcare access can be achieved. The model finds that HIV vaccines may be effective before individuals reach the "seropositivity" threshold, and medical care may slow death rates after individuals pass the HIV threshold but before reaching the AIDS threshold. However, once the AIDS threshold is passed, existing tools are no longer effective at fighting the virus. Overall eradication requires public education to change behaviors and cooperation between governments, international organizations, and low-cost drug companies on prevention and treatment.
Swaziland has the highest HIV prevalence in the world, with prevalence among pregnant women rising from 3.9% in 1992 to 42.6% in 2004. Every sector of Swazi society is struggling to cope with the impacts of the epidemic, which include rising mortality, mass orphaning, and declines in agricultural production. The situation has been exacerbated by gender inequality, drought, insufficient financial resources, and a lack of accountable domestic governance and ill-suited policies from international organizations. Without greater support from the Swazi government and international donors, community-led interventions may be undermined.
Social Challenges Facing Low Income Earning Women Living With HIV/AIDS: A Cas...paperpublications3
Abstract: Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has been in existence for more than twenty years and women account for nearly half the 40 million people living with HIV/AIDS. Women’s rate of new infection surpasses men’s because biological, cultural, and social economic conditions contribute to women’s greater vulnerability to HIV. The challenges that these low-income earning women living with HIV/AIDS face are social, economic, and psychological. When a woman is sick the family’s property, the children’s education, savings and food security are threatened because women provide the majority of labour and managerial services for their household. The purpose of the study was to establish the social challenges that face low-income earning women living with HIV/AIDS. A sample of 248 out of a population of 700 who were receiving Home Based Care within Nakuru Municipality was selected. The study was a survey where Questionnaire and interviews were used to collect data. The data was analyzed using descriptive statistics. The findings of the study revealed that low income women living with HIV/AIDS faced various social challenges such as shame, discrimination, and causing strain in the family among others. The disparities that existed among the singles and the married revealed that one’s marital status determined the extent to which one was ashamed, evoked negative changes in the behaviour of family members and experienced discrimination based on their HIV/AIDS status. The implications of the findings is that the public support for the low-income women living with HIV/AIDS is inadequate and mostly material, and emotional support is also crucial in the management and coping with HIV/AIDS.
Armed conflict in South Sudan since 2013 has led to widespread displacement, disruption of health services, and increased mortality. An estimated 4.5 million people have been displaced, both internally and as refugees in neighboring countries. A study estimated that between 2013-2018, nearly 400,000 excess deaths occurred in South Sudan's population due to the war, with around half being violent deaths and the rest indirectly from reduced access to healthcare and increased disease prevalence. The conflict has severely damaged South Sudan's health system and humanitarian response has been insufficient to address the health needs of the population.
The relationship between unemployment and poverty has been of interest to many a scholar with interest in development economics and social sciences. This paper is an addition to the empirical attempts to re-examine the relationship between unemployment rate and poverty incidence in Nigeria using secondary data sourced from relevant institutions to obtain major Social and Economic indicators spanning within 1980-2015. The study used Trend graph analysis, Correlation coefficient analysis and Granger causality tests in its analyses. As shown from the results, there is a positive-significant correlation between unemployment and poverty in Nigeria. More so, this was corroborated by the Trend graph analysis. It also established that unemployment granger causes poverty in Nigeria as suggests from the Granger causality tests. The economic implication of this result is that poverty is an increasing function of unemployment; and the Error Correction Mechanism (ECM) pointed that short run disequilibrium in the economy can be returned to equilibrium in the long run with a poor speed of adjustment of 6 %. In the light of these findings, this study recommends that efforts should be intensified in Nigeria towards implementation of unemployment reduction policies as this will significantly reduce poverty incidence.
The West Africa-America Chamber of Commerce & Industries presents: Sub sahara...David Lary
The West Africa-America Chamber of Commerce & Industries presents: Sub sahara africa economic impact of tropical and infectious diseases by Dr. Oluwole Kukoyi
Utilization of reproductive health services in ghanaAlexander Decker
The document analyzes factors affecting utilization of reproductive health services in Ghana based on a survey of 200 individuals. The results of a probit analysis show that being married and having a higher income positively influence utilization of services, while higher prices negatively affect utilization. Policy should target the unmarried and poor by providing subsidies to increase utilization and enhance reproductive health outcomes.
The document discusses the history and current state of the AIDS epidemic in Africa. It begins by tracing HIV back to chimpanzees in Cameroon in the 1930s and its spread to humans. By the 1980s, AIDS cases rose sharply across Eastern Africa due to factors like labor migration. Treatment was not widely available until the 1990s. Currently, South Africa has the most HIV cases but prevalence has declined by a third over the past decade due to treatment programs. However, the number of people needing treatment is expected to exceed resources by 2020 without increased prevention and sustainable treatment options. More work is still needed to curb the epidemic.
A REVIEW OF THE AGENCIES OF THE CONTROL MEASURES OF HIV/AIDS IN NAGALANDpaperpublications3
This document reviews the agencies involved in controlling the HIV/AIDS epidemic in Nagaland, a state in northeast India. It discusses how religious organizations, governmental and non-governmental organizations, schools, police, hospitals, and individuals all play roles in prevention, care, and treatment efforts. The HIV/AIDS problem has become multidimensional, affecting health, social, economic, and cultural aspects of society. While agencies have adopted various strategies, more opportunities are needed for people living with HIV/AIDS. Religious organizations in particular can provide support through awareness programs, counseling, health camps, and prayer. They have begun establishing cells focused on HIV/AIDS issues.
This document summarizes poverty trends in South Asia. It finds that poverty is widespread and disproportionately affects rural populations, who often work in agriculture and lack access to resources, education, health services and infrastructure. While poverty has declined in some countries according to government estimates, these figures are disputed, and poverty remains a significant problem. Poverty is often concentrated in particular areas or among specific ethnic groups. Eradicating poverty requires concerted efforts across governments and communities.
The document discusses the impact of the HIV/AIDS epidemic in Kenya. It provides statistics on the number of people living with HIV/AIDS, deaths from AIDS, and new infections in Kenya and worldwide. It then describes the significant demographic, educational, agricultural, health, industrial, social and economic impacts of the epidemic in Kenya, including increased orphan rates, declines in life expectancy, increased burden on the healthcare system, and loss of skilled workers. It notes the government of Kenya has declared AIDS a national disaster and established policies and institutions to accelerate the national response.
Title - What is going on HIV and AIDS in 2013 and beyond
Presented at the HIV Capacity Summit. view program here - http://www.hivcapacityforum.org/index.php?sid=12
This document provides information on HIV/AIDS statistics in Kenya and Africa, the disproportionate impact of HIV/AIDS on women and girls, challenges in accessing healthcare in Kenya including shortages of healthcare workers and facilities, and prior mHealth trials in Kenya that faced challenges with scale and sustainability. It discusses the potential for mHealth solutions in Kenya that utilize international partnerships and collaboration across industries and sectors to develop culturally appropriate, autonomous solutions for increasing access to care, education and social support through mobile technologies and services.
Geographic Factors Affecting HIV/AIDS in South Africa (Prevention vs. Treatme...Tom McLean
The document examines the geographic factors responsible for the spread of HIV/AIDS in South Africa. It discusses trends in HIV prevalence over time as well as patterns across regions. Socio-cultural factors like apartheid, stigma, and gender inequality increased women's vulnerability and reduced access to services. Politically, former President Mbeki downplayed the epidemic. Economically, prevention was prioritized over treatment due to costs. Overall, the document analyzes how geography, socio-cultural issues, politics, and economics contributed to HIV/AIDS in South Africa with prevention emphasized more than treatment.
The document discusses how sustainable livelihood approaches can help address the HIV/AIDS epidemic by taking a holistic view of its impact. It recognizes that HIV/AIDS affects many aspects of people's lives beyond just health, impacting finances, social support, education, and various livelihood assets. A livelihoods lens allows for joined-up thinking across sectors to understand how people adapt their livelihoods in response. Local responses have often been more effective than global strategies, and livelihood approaches can help share learning to support such responses.
The document discusses the importance of health to business and the economy. It notes that a nation's health indicators reflect the state of its wealth and economy. Poor health leads to a less productive workforce and economic drain. The document then provides an overview of Nigeria's poor health indices and underfunding of the health sector compared to global standards. It also discusses the social determinants of health issues in Nigeria like poverty, cultural beliefs, and brain drain of health professionals.
Rwanda has made tremendous progress in rebuilding its health system and improving health outcomes after the 1994 genocide devastated the country. National policies focused on equity, social cohesion, and community-based care. As a result, premature mortality has fallen and life expectancy has doubled. Key factors in Rwanda's success include community health insurance, performance-based financing, partnerships between the government and development organizations, and prioritizing decentralized and integrated health services.
Domestic accidents in a rural community of bangladesh a cross sectional study...Alexander Decker
This study assessed the prevalence and characteristics of domestic accidents in a rural community in Bangladesh. A survey of 297 households with 1171 family members found that 171 domestic accidents occurred over one year, a prevalence of 146.02 per 1000 people. Most victims were male (52.6%) aged 19-64 years. The most common types of accidents were falls (50.9%), cuts (22.2%), and burns (11.7%). Most accidents occurred in courtyards (49.7%) while victims were doing household chores or playing. The results suggest domestic accidents impose a significant health burden in rural Bangladesh and prevention through safety education could help reduce accidents.
Poverty implicates a condition where people are unable to afford the minimal standards of food, clothing, healthcare, education, and also not capable to continue traditions that are important to them. Poverty reduction strategies now receive high attention across the world because of the negative impact on the individual and national prosperity. The average poverty rate of about 68.40 percent is a clear indication that a majority of Nigerian citizens sleep below the poverty line despite the presence of poverty reduction programmes. The exploratory research method was deployed for the study in an attempt to explore the impact of NEEDS as a poverty reduction strategy in Nigeria. Through statistical analysis, it was found that NEEDS has not made significant positive impact on poverty reduction in Nigeria.
This document provides an overview of global health by defining key terms, outlining major players and organizations, and summarizing the history and evolution of the field from 1945 to the present day. It describes how global health has shifted from a focus on infectious disease control to addressing social determinants of health and health issues that transcend national borders. Major milestones discussed include the founding of the UN and WHO, the Alma-Ata Declaration, structural adjustment policies, the Millennium Declaration and MDGs, debt relief campaigns, and the establishment of the Global Fund. The summary highlights the ongoing tension between disease-specific and comprehensive primary healthcare approaches.
This document summarizes the history and current understanding of the AIDS epidemic. It discusses how AIDS has become one of the most studied diseases and our understanding of its medical and social drivers has deepened over time. However, the impacts are still unfolding over generations and varying significantly between places. While early models predicted severe economic impacts, some hard-hit countries have maintained growth. Understanding the social impacts remains challenging given the epidemic is only 25 years old.
What strategy for optimal health in poorest developing countriesAlexander Decker
This article analyzes strategies for achieving optimal health in developing countries with high rates of HIV/AIDS. It uses an economic model to study how international goals of zero new HIV infections, zero deaths from AIDS, and zero discrimination in healthcare access can be achieved. The model finds that HIV vaccines may be effective before individuals reach the "seropositivity" threshold, and medical care may slow death rates after individuals pass the HIV threshold but before reaching the AIDS threshold. However, once the AIDS threshold is passed, existing tools are no longer effective at fighting the virus. Overall eradication requires public education to change behaviors and cooperation between governments, international organizations, and low-cost drug companies on prevention and treatment.
Swaziland has the highest HIV prevalence in the world, with prevalence among pregnant women rising from 3.9% in 1992 to 42.6% in 2004. Every sector of Swazi society is struggling to cope with the impacts of the epidemic, which include rising mortality, mass orphaning, and declines in agricultural production. The situation has been exacerbated by gender inequality, drought, insufficient financial resources, and a lack of accountable domestic governance and ill-suited policies from international organizations. Without greater support from the Swazi government and international donors, community-led interventions may be undermined.
Attitude of the youth towards voluntary counselling and testing (vct) of hiv ...Alexander Decker
This document summarizes a study on the attitudes of youth in Accra, Ghana toward voluntary counseling and testing (VCT) for HIV/AIDS. The study found that while knowledge of HIV/AIDS was high, awareness and use of VCT services was low. Most respondents were unaware that VCT services existed or where they could access them. Of those aware of VCT, very few had utilized the services themselves. Fear of knowing their HIV status appeared to be a major barrier preventing youth from seeking VCT. The study concluded that efforts must be made to increase awareness and use of VCT, especially among youth, through expanded information and education campaigns.
Swaziland has the highest HIV/AIDS prevalence rate in the world at 26.1% of adults. As a result, life expectancy has dropped to only 31.88 years and there are over 70,000 orphaned children. The spread of HIV/AIDS in Swaziland is largely driven by polygamy and cultural stigma surrounding HIV status, which prevents many from getting tested or disclosing their status. The government has tried to address the epidemic through prevention programs, testing initiatives, and behavior change campaigns, but Swaziland remains the worst affected country.
The document summarizes the findings of a baseline survey on access to HIV/AIDS services and social protection in 5 Sub-Saharan African countries. The survey found that 48% of households headed by older people had orphans and 24% had someone with a disability. Only 30% of older people had accurate HIV information. While countries had free medical policies, limited resources inhibited access. It recommends policies to strengthen multi-sectoral social protection approaches, increase agriculture support for older households to improve food security, and advocacy policies to promote social protection as a right.
The document discusses HIV/AIDS awareness and prevention practices among male adolescents and young adults in Cavite, Philippines. It notes that adolescents lack access to essential HIV facts and testing services. Most young people believe they are immune to HIV, and few are able to correctly answer basic questions about transmission and prevention. Growing threats of HIV infection among youth highlight the need for improved awareness initiatives targeting this vulnerable population.
The document discusses sustaining progress against AIDS in Asia and the Pacific. While new HIV infections declined by 30% between 2001-2009, progress has since stalled. Most infections occur among key populations like sex workers, clients, men who have sex with men, transgender people and people who inject drugs. Countries that have prioritized these groups have seen lower infection rates. Treatment access has increased nine-fold since 2005, reducing AIDS deaths by 27%, but only 1 in 3 people with HIV are on treatment. More work is needed to reach key populations for testing and treatment and sustain funding to end the epidemic.
Today we stand at a vital threshold. Within our grasp is the opportunity to end 30 years of suffering and death due to HIV/AIDS. Individuals and communities around the world have been mobilized toward prevention, and existing treatment can prolong life for many years. While we celebrate these successes, we reject any modicum of complacency. Now is the time to double down and finish the job. The world is fighting AIDS today just as it had previously fought to eliminate smallpox. For centuries, smallpox was a feared scourge that killed nearly half of those infected and maimed those that survived. A worldwide campaign to end the disease began in earnest in the late 1960s and by 1980 smallpox was officially eradicated.
Planet Aid anticipates the day when AIDS, too, will be stopped. To this end, we have been helping mobilize communities around the globe to increase HIV/AIDS prevention and care. With this special issue of the Planet Aid Post, we focus on the battle ahead. We also extend a warm welcome to those joining us on the forefront of this work,
This document discusses a study on the "fearonomic effects" of the Ebola outbreak in Nigeria on the private sector. The study used interviews and a survey to examine the direct and indirect economic impacts of the outbreak. Key findings include:
- Misinformation and fear-induced behavior during the outbreak led to health service outages, reduced healthcare usage, and changes in consumption patterns.
- While certain sectors like health, aviation, and hospitality were more directly affected, no business was immune to the impacts of fear about Ebola.
- Even sectors expected to benefit, like pharmaceuticals, suffered due to demand shocks and changed consumption behaviors.
- Outbreaks can trigger short-term economic impacts through
Knowledge and Prevalence of HIV/Aids among Suya Vendors in Kafanchan of Jema’...IIJSRJournal
This study was carried out on knowledge and prevalence of hiv/aids among suya vendors in kafanchan of jema’a local government area of kaduna state. To achieve this objective, the researcher developed and administered a questionnaire on eighty respondents. The likert scale statistical and graphical method was used in testing the null hypothesis. From the study, It was observed that The society or public authority do not educate Suya Vendors about Hiv/Aids. Economic status and educational background among Suya Vendors do not determine their knowledge of Hiv/Aids. It was also discovered that parents, religious leaders or government responsible for Hiv/Aids among Suya Vendors. It was observed that that All Suya Vendors are not knowledgeable about their Hiv Status. It was also observed that Suya Vendors negligent in knowing their status. that Suya Vendors do not tell their sexual partners about their Hiv Status. That Suya Vendors have multiple sexual partners. Both the state and federal government should take on joint projects to combat AIDS at the border areas. Projects including training, counselling, public meeting and rallies may be undertaken for awareness-building to this effect. The government should set up blood testing centre across that will be easily accessible, so that the people at Kafanchan municipal areas can get free access to HIV/AIDS testing. Educational Programmes about safe sex should be provided to the illiterate mass. Radio, TV programmes, visual aids and multimedia on AIDS should be produced to augment their awareness level.
HIV/AIDS is a global issue that disproportionately affects developing countries and vulnerable groups. By 2000, over 34 million people worldwide were living with HIV/AIDS, with 95% residing in developing nations. Responses have included prevention education programs, working to increase access to low-cost treatment, and addressing underlying social and economic factors that increase risk. One such program is the National Highway One Project in Vietnam, which aims to reduce transmission along major transport routes through community outreach and encouraging behavior change.
This document provides an overview of how microfinance services can help address the economic impacts of HIV/AIDS. It discusses how HIV/AIDS affects households economically, forcing them to utilize coping strategies like taking children out of school, selling assets, or taking on debt. Microfinance can help strengthen households' ability to manage risks and losses by helping them generate income, build savings, and avoid selling productive assets. While microfinance should not explicitly target HIV-positive individuals, targeting areas with high HIV prevalence can help the families and communities impacted. The document argues microfinance has a comparative advantage over other interventions in mitigating HIV/AIDS' economic effects through increasing income, providing secure savings, and reducing vulnerability.
This interactive webinar is part of the world tour series designed by the World Health Organization's Patients for Patient Safety (PFPS) Global Network and hosted by Patients for Patient Safety Canada, the patient-led program of the Canadian Patient Safety Institute, a WHO Collaborating Centre on Patient Safety and Patient Engagement.
Achievements and Implications of HIV Prevention of Mother-toChild Transmissio...QUESTJOURNAL
This intervention provided HIV prevention services to women of reproductive age in Plateau State, Nigeria. A total of 9,258 women were reached, exceeding the target of 7,460. Structural interventions included 85 community dialogues and 17 income generation activities. Behavioral interventions included distributing 87,028 condoms and providing HIV education to 5,079 peers. Biomedical interventions saw 5,606 women receive counseling, testing and results, with 44 (0.8%) testing positive for HIV. While the intervention helped reduce HIV burden, future programs need to improve coverage and extend services to more local government areas.
AIDSTAR-One Case Study: Rwanda's Mixed EpidemicsAIDSTAROne
Rwanda had secured full funding for its national HIV program through PEPFAR and the Global Fund. This allowed Rwanda to undertake a comprehensive HIV prevention, care, treatment, and impact mitigation program for the first time. Rwanda used new data sources to revise its national HIV strategy and refocus prevention priorities on behaviors driving new infections. The strategy targeted most-at-risk populations like female sex workers and their clients, as well as the general population. This represented a shift away from traditional programming toward an evidence-based, ambitious strategy responsive to Rwanda's mixed epidemic. While still early, Rwanda's strategic planning approach and data-driven refocusing of prevention efforts provides lessons for other countries with similar epidemics.
Sustaining the HIV and AIDS Response in the Countries of the OECS: Regional I...HFG Project
In 2014, the six countries of the Organization of Eastern Caribbean States (OECS) of Antigua and Barbuda, Dominica, Grenada, St. Kitts and Nevis, St. Lucia and St. Vincent and the Grenadines developed HIV and AIDS Investment Case Briefs, with the support of USAID’s Health Finance and Governance (HFG) and Strengthening Health Outcomes through the Private Sector (SHOPS) projects. This document provides a summary of the findings of these briefs, which includes an analysis of the costs of HIV and AIDS programs that respond to the disease in the six countries, the resources that are available, the funding gaps, and the potential impact of different levels of investment in programming on the progression of the disease in the region.
How Africa turned AIDS around By Michel Sidibé Celebrating 50 Years of Africa...Dr Lendy Spires
Michel Sidibé Executive Director UNAIDS At the May 2013 African Union Summit celebrating the 50 years of African unity, a new commission will be launched to explore HIV and global health in the post-2015 debate. “The UNAIDS and Lancet commission: from AIDS to sustainable health” will be co-chaired by Malawi President Joyce Banda, African Union Commission Chairperson Nkosazana Dlamini Zuma and London School of Hygiene and Tropical Medicine Director Peter Piot.
The pace of progress is quickening in Africa. Nowhere have we seen this more clearly than in the AIDS response. Fewer people are dying from AIDS. The number of HIV infections is coming down, with young Africans leading the prevention revolution. There is true hope that in a matter of years, Africa will reach an AIDS-free generation. It has taken a massive shift in how we work together. It has required leaders to show immense courage, passion and action from all sectors. It has taken a united Africa. I am not saying it has been easy— but it has happened. We have a shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.
And today there is an African Union endorsement of a new Roadmap to accelerate progress in HIV, Tuberculosis and Malaria—through shared responsibility and global solidarity. Given the extraordinary history of the AIDS response in Africa—in terms of both galvanizing political support and mobilizing resources and communities—the Roadmap sees AIDS as a pathfinder for tuberculosis, malaria and other diseases affecting the continent that require African-sourced solutions. Leadership, it turns out, was that elusive magic bullet. It is the “disruptive innovation” that has irrevocably changed the course of AIDS and now can do even more. As we look to our future goals, I am confident that African leadership can be UNAIDS | Special report with vision and action we can change the world
This document is a special report from UNAIDS highlighting progress and challenges in the AIDS epidemic in Africa. It features statistics and facts about the status of the AIDS epidemic in different African countries, profiles of individuals living with HIV, and articles on various topics related to the AIDS response in Africa, including innovations, the role of the private sector, using sports to raise awareness, and challenges and successes in preventing mother-to-child transmission of HIV.
Since the emergency of COVID-19 pandemics, many countries have been encountered a multitude of challenges. People have been facing health related and other social consequences throughout the world. It is too early to know the aggravated impact of COVID-19 on people living in resource-limited setting, like east Africa countries. In these countries, besides direct public health impact, the COVID-19 pandemic has provoked social stigma and discriminatory behaviors against people of certain ethnic backgrounds as well as anyone perceived to have been in contact with the virus. Social stigma can negatively affect those with the disease, as well as their caregivers, family, friends and communities.COVID-19 pandemics have also been provoked great impacts on daily social consumptions such as food and other food supplements. In addition, COVID-19 pandemic were overshadowed endemics diseases such as malaria, TB and HIV related care and antenatal care services as well as other non-communicable diseases prevention and control. Social stigma coupled with other consequences could result in more severe health problems, can undermine social cohesion and prompt possible social isolation of groups, which might contribute to a situation where the virus is more, not less, likely to spread and difficulties controlling a disease outbreak. Therefore, how we communicate about COVID-19 is critical in supporting people to take effective action to help combat the disease and to avoid fuelling fear and stigma. An environment needs to be created in which the disease and its impact can be discussed and addressed openly, honestly and effectively. This is a message for government, media and local organizations working on the COVID-19 infections.
Similar to The impact of hiv and aids research a case study from swaziland (20)
This study investigated individual and psychosocial factors associated with high educator-learner interactions around HIV/AIDS and sexuality in South Africa. Younger educators and those in lower job categories interacted with learners on these issues more frequently than older colleagues. Favorable interactions were associated with good HIV/AIDS knowledge, personal experience with HIV/AIDS, and low stigmatizing attitudes. However, educators reported a lack of HIV/AIDS training support from the Department of Education. Younger educators also reported higher sexual risk behavior than older educators, undermining their credibility as educators. The findings highlight the need for formal HIV/AIDS training for educators to equip them to provide education and skills to learners.
- Child and adolescent marriage is common in many developing countries, with over 30% of girls married by age 18.
- Married adolescent girls have little power to negotiate safe sex and are often in unions with much older husbands, increasing their risk of HIV.
- Data from 29 countries show that the majority (over 80% in most) of sexually active adolescent girls who had unprotected sex recently were married.
- HIV prevalence tends to be higher among married adolescent girls than sexually active unmarried adolescents in some settings, highlighting marriage is not always protective against HIV risk for adolescent girls.
Young women in South Africa are disproportionately affected by HIV/AIDS, with infection rates four times higher than young men. Researchers conducted a study examining how poverty, orphanhood, and social isolation relate to risky sexual behaviors. They developed a pilot intervention program to enhance life options for at-risk youth through safe social spaces, financial literacy training, and HIV/AIDS education. Preliminary findings show the intervention was associated with improved knowledge, attitudes, and behaviors regarding self-esteem, finances, and HIV prevention among participants.
1. The document summarizes a case study of an HIV/AIDS impact assessment conducted on a South African contract cleaning company with 500 employees.
2. Key findings include that 31% of employees tested were HIV positive, with the highest levels of infection among women aged 35-40.
3. The estimated average cost to the company for each newly infected employee is 9,007 Rand, which is 63.2% of the average annual salary. However, the overall financial cost of HIV/AIDS to the company is projected to decrease over time from 1999 to 2015.
The document discusses challenges in linking health research to policy in Ghana. It describes how the Research and Development Division of the Ghana Health Service used a collaborative approach to build consensus on research priorities related to orphans and vulnerable children affected by HIV/AIDS. Through stakeholder consultations, gaps in understanding this issue were identified and a research study was undertaken to assess the situation of HIV-affected children. The study informed policy by providing evidence on how to best support these children within their communities rather than institutions.
This document discusses how the conceptualization of HIV as a "long-wave event" needs to be revisited given increased access to antiretroviral therapy (ART). Originally, HIV was seen as involving three curves: an HIV curve, an AIDS curve, and a societal impact curve. However, widespread ART has shifted HIV from a terminal illness to a chronic condition for many. This prompts reconsidering disability as a new form of the second curve, representing transition from HIV infection to HIV-related disability for those on long-term ART. At a population level, experiences of disability are expected to become common for people living with HIV in coming decades, with implications for health and social services.
The document summarizes a project in KwaZulu Natal, South Africa that aims to build assets and reduce vulnerability among youth. It describes the socioeconomic challenges in the region like poverty, unemployment, and HIV. The project uses participatory learning with boys and girls to prepare them for opportunities and risks. Students are randomized into groups receiving different combinations of HIV education, social support, and financial capability training. Evaluations assess changes in knowledge, behaviors, and economic outcomes through surveys, interviews, and diaries. Preliminary findings show improvements in areas like budgeting skills, savings, and social networks.
The document summarizes a study that assessed the impact of a 2007 report titled "Reviewing 'Emergencies' for Swaziland." The report analyzed socioeconomic data to portray the HIV/AIDS epidemic in Swaziland as a humanitarian crisis and call for an emergency response. To evaluate the report's influence, researchers conducted interviews and distributed questionnaires. They found the report initially raised awareness and shifted perceptions of the crisis. In the long-term, it influenced policy by contributing to changes in funding and emergency classifications. While attribution is difficult, the assessment demonstrated research can provide insights into maximizing future impact.
This study investigated the psychosocial and behavioral correlates of attitudes towards antiretroviral therapy (ART) in South African mineworkers. 806 mineworkers at a large South African mine participated. Despite high HIV testing rates and generally favorable attitudes towards ART, temporary employees and contractors were found to be more vulnerable in terms of HIV risk, testing behaviors, and knowledge/attitudes about ART. Employees with more positive ART attitudes had greater ART knowledge and more positive views of the mine's HIV/AIDS treatment program. The findings are discussed in relation to the mine's low ART uptake rates and recommendations are provided.
The document discusses challenges in linking health research to policy in Ghana. It describes how the Research and Development Division of the Ghana Health Service used a collaborative approach to build consensus on research priorities related to orphans and vulnerable children affected by HIV/AIDS. Through stakeholder consultations, gaps in understanding this issue were identified and a research study was undertaken to assess the situation of HIV-affected children. The study informed policy by providing evidence on how to best support these children within their communities rather than institutions. The experience highlights the value of engaging multiple stakeholders to ensure research meets social needs and informs policymaking across sectors.
This document discusses how organizations can act as "boundary organizations" to promote evidence-based policymaking. It uses the Regional Network on AIDS, Livelihoods and Food Security (RENEWAL) as a case study. RENEWAL aims to enhance understanding of the links between HIV/AIDS and food security in Africa. It builds networks between researchers and policymakers to identify policy-relevant research topics and facilitate communication. The document analyzes RENEWAL's experiences networking with South African government officials to encourage use of research evidence in policy. It draws lessons on effective strategies for engaging policymakers and getting research into policy and practice.
The document discusses the African Women's Protocol and its potential role in supporting women's reproductive rights and progress toward achieving the Millennium Development Goals in Africa. Key points:
1) The protocol provides a strong framework for women's reproductive rights in Africa, going beyond other treaties in promoting these rights.
2) However, only 29 of 52 African countries have ratified it so far, and barriers remain to implementing its provisions in national laws and policies.
3) If fully implemented and integrated into legislation, the protocol could help create an enabling environment for women's reproductive rights and support progress on MDGs 3, 5, and 6 relating to gender equality, maternal health, and HIV/AIDS.
- Explicit insurance does not offer a panacea for HIV/AIDS service coverage on its own. Where insurance systems already exist, they can be expanded to include HIV/AIDS services.
- Introducing social health insurance is complicated and will take time to cover all people. The process should not be rushed and existing mechanisms should continue in the meantime. Some people will remain inadequately covered and should not be forgotten.
- Political commitment is indispensable for including HIV services in any coverage mechanism. A political-economy analysis will be useful. Financial feasibility is also key, and external funding may be needed initially before being replaced by government funds over time. Not all people will be able to contribute to insurance schemes
This document provides an overview of mental health promotion initiatives for children and youth in contexts of poverty in South Africa. It discusses:
1) Critical risk influences on early childhood development like poor nutrition, maternal depression, and lack of early childhood services in South Africa and evidence that mental health promotion programs can help mediate these risks.
2) Examples of mental health promotion programs in South Africa that have shown benefits for early childhood development, including a home visitation program and programs to reduce alcohol use in pregnancy.
3) Risk influences on middle childhood development in South Africa and how mental health promotion programs may help mediate risks like poor family environments and schooling.
This document summarizes a study that examined how gender and socioeconomic status interact with peer norms and attitudes to influence sexual risk behaviors among youth in a poor, urban community in South Africa. The study uses a social cognitive approach to measure attitudes, beliefs, intentions, and perceived control related to sexual behavior. It reviews literature on factors that influence HIV risk for South African youth, including socioeconomic status, gender-based violence, and psychosocial factors like peer norms. The findings of this study provide insight into how interventions can address the complex ways gender interacts with these other issues to impact youth sexual health outcomes.
This document discusses the history of AIDS exceptionalism over the past 30 years. It begins by providing background on the global HIV/AIDS epidemic, noting its widespread demographic, economic, and political impacts. It then describes how AIDS exceptionalism originated as a response to the initially frightening nature of the virus and its disproportionate effect on certain groups. More recently, AIDS exceptionalism referred to the unprecedented global response and resources dedicated to addressing the epidemic through organizations like UNAIDS. However, there has also been criticism of AIDS exceptionalism and claims that it receives too much funding compared to other health issues. The document aims to situate this debate in historical context by examining the shifting meaning of exceptionalism over time.
This document summarizes a mixed methods study conducted in KwaZulu-Natal, South Africa to design and evaluate an intervention program aimed at improving the health, economic, and social capabilities of adolescents at high risk for HIV/AIDS, teenage pregnancy, and other issues. The intervention incorporated life skills education into the school day and was evaluated using longitudinal surveys, focus groups, and interviews with participants, guardians, and facilitators. The mixed methods approach allowed for iterative improvement of the program and instruments as well as triangulation across data sources. Preliminary results were promising and the Department of Education was interested in scaling up the program.
The document summarizes a program called Siyakha Nentsha in KwaZulu-Natal, South Africa that aims to build capabilities among adolescents threatened by HIV/AIDS. It describes the socioeconomic challenges in the region like poverty, unemployment, early pregnancy and school leaving. Research found these factors associated with higher HIV risk behaviors. The program provides evidence-based, multi-session curriculum on HIV prevention, resource management, and future planning to empower participants. Preliminary feedback suggests it improves attitudes, knowledge, aspirations, and agency. The goal is to scale it up through the Department of Education.
This document summarizes findings from a pilot program in South Africa that aimed to address social and economic factors influencing HIV risk among youth. Formative research found that youth living in poverty, lacking social connections, being orphaned, or not enrolled in school were more vulnerable. The pilot program provided weekly sessions for groups of 10-20 youth to reduce social isolation, increase financial literacy, and teach about sexuality/STIs/HIV. Emerging findings showed participants had larger increases than comparisons in discussing contraception, HIV/AIDS, and gender-based violence, and greater improvements in savings behaviors. Participants reported the program was an "eye-opener" and helped them understand health issues not covered in school. Next steps include a full evaluation and
The Siyakha Nentsha program in KwaZulu-Natal, South Africa aims to improve the capabilities and well-being of adolescents at high risk for HIV, teenage pregnancy, school dropout, and more. The program was developed using formative research that identified structural factors associated with adolescent HIV risk behaviors such as poverty and lack of social connections. It provides knowledge and skills for pregnancy and HIV prevention, economic empowerment, and social support. Evaluations found that participants had increased discussion of sensitive topics, financial literacy, condom use confidence, and ability to open a bank account compared to non-participants. The program is being considered for scale-up in partnership with the Department of Education.
More from ABBA RPC (Addressing the Balance of Burden in HIV/AIDS) (20)
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economy there were few hard data to back this up. The emergency thresholds, health, social indicators, orphans,
people of Swaziland knew that they were attending coping mechanisms, economic growth and investment
more funerals, agricultural production was declining, and agriculture. These were tracked over time. For
and the economy was in difficulty. However, no one had advocacy purposes Swazi data was compared with that
collected data across all sectors and looked at the effects of Zambia and Malawi, poorer countries with lower pre-
on the country as a whole. valence. The report painted a bleak picture showing that
In early 2007 the terms of reference for a study to Swaziland is experiencing a humanitarian crisis compar-
assess the impact of the AIDS epidemic across the able to countries besieged by conflict or struggling in
nation were drawn up. The ideas were developed pri- the wake of a severe natural disaster. AIDS has been a
marily by Dr Derek Von Wissell, Head of the National slow-onset disaster, leading to a long-term catastrophe,
Emergency Response Council on HIV/AIDS in Swazi- but requiring an urgent response.
land (NERCHA) and Professor Alan Whiteside, Director The report spoke to two audiences. For Swazi’s it con-
of the Health Economics and HIV/AIDS Research Divi- firmed that AIDS was indeed having a devastating effect
sion (HEARD) at the University of KwaZulu-Natal. The on their nation. The same message was aimed at the inter-
research was partly funded by HEARD and led by Amy national community. However it also urged the latter to
Whalley, a former Overseas Development Institute Fel- re-examine the HIV and AIDS epidemic. It sought to
low who had worked with NERCHA and the Ministry of broaden the traditional consensus on what constitutes an
Health and guided by Whiteside and staff at NERCHA. emergency to include ‘long-wave emergencies’. Effective
Whalley’s task was to gather and analyse information on interventions require both an immediate emergency
what was going on across the nation using available response but also have to build capacity for long-term pro-
data sets; to compare Swaziland’s situation with other grammes [5]. In the course of the research the country’s
countries and thus build advocacy material for use classification emerged as an important issue. As a lower-
inside the country and with the international commu- middle income country Swaziland is not eligible for inter-
nity. The write up was primarily by Whalley with major national development assistance (IDA) grants from the
input by Whiteside. In October 2007 the report, World Bank, and concessional-lending [6]. The report
‘Reviewing ‘Emergencies’ for Swaziland: Shifting the challenged the use of GDP per capita as an indicator to set
Paradigm in a New Era’, (here after called ‘Reviewing the status of a country and its access to support in the face
Emergencies’) was published [5], distributed and disse- of a generalised AIDS epidemic. It noted the global per-
minated. In June 2008 the impact of the work was eval- ception of ‘middle-income countries’ is that they need less
uated and is the subject of the article. support and are somehow ‘less deserving’. (Figure 1)
Reviewing Emergencies Report
Reviewing Emergencies used key socio-economic indica- Methods
tors from many sources to build a holistic and multidi- Assessing the impact: The research to policy interface
mensional picture of impact of HIV/AIDS in Swaziland. Much of SRH and HIV and AIDS research, particularly
Information was obtained on demographic changes, in the development arena, aims to influence policy, it is
Figure 1: Reviewing ‘Emergencies’ for Swaziland: Shifting the Paradigm in
a New Era
“Traditional humanitarian thinking focuses on the short term, and is often aimed at
returning affected populations to ‘normality’. HIV/AIDS in Swaziland has been
characterized by a slow onset of impacts [falling economic growth, increasing poverty,
mortality and morbidity, and associated changes in the demographic structure of
society] that have failed to command an emergency response. With insufficient
resource allocation and a lack of capacity, slow onset events can become emergencies...
The case of Swaziland emphasizes that emergencies can be long term, complex,
widespread events that evolve over years.” [7].
Figure 1 Reviewing ‘Emergencies’ for Swaziland: Shifting the Paradigm in a New Era
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“research committed to improvement” [7]. Policy makers This article was developed from the assessment
are increasingly concerned to make policy choices assisted by a presentation given at the meeting of DFID
underpinned by rigorous research. The research-to-pol- funded Research Programme Consortia on ‘Strengthen-
icy interface is a fast growing area of study, particularly ing the research to policy and practice interface: Explor-
in the SRH and HIV and AIDS research communities. ing strategies used by research organisations working on
The purposes are two fold: accountability of a research Sexual and Reproductive Health and HIV and AIDS’
organisation, demonstrating achievement and value for held in Liverpool in May 2009; and through peer review.
money for funders; and as a learning exercise, develop- In an ideal world an impact assessment should be
ing a better understanding of the research impact pro- designed from the outset; this ultimately makes the pro-
cess in order to enhance future impact [8]. HEARD is cess of collecting information to track impact easier.
an applied research organisation aiming to mobilise evi- This was not done due to lack of staff and time and is
dence for interventions in health and HIV in the region acknowledged as a limitation. The lesson learnt is to
[9]. Only by identifying where change has transpired as plan dissemination and the evaluation of activities at the
a result of its research, where it has not, and the reasons beginning of a project, and budget for this.
for this, can it deliver effective research. Forward-tracking and attribution
Impact assessment is an underdeveloped field of Two broad categories exist for impact assessments; for-
study, in part due to the complex and dynamic nature ward-tracking, from research to outcome, and back-
of research impacts and the consequent difficulty in wards-tracking, from decisions taken to potential
measuring them. Sumner, Perkins and Lindstrom research influence. Our impact assessment wanted to
(2008, unpublished) identify a number of significant track from publication to outcome. However, forward-
problems when attempting to track the impact of tracking approaches can have serious limitations [12].
research: difficulty in determining conceptual influence They are often linear in approach, neglecting the com-
(on opinion, attitudes and thinking); identifying plexity of the processes at work and the significance of
research users, timing of assessment; attributing impact context. The policy environment is influenced by socio-
in the context of other drivers; and using qualitative cultural, political and economic factors and these must
and subjective data [10]. Notwithstanding such issues, be acknowledged in order to understand why an impact
if real understanding of research-to-policy interface is took place. Taking this into account, the assessment
to be achieved, an assessment must also explain why attempts to put identified ‘impacts’ into a relevant
impacts took place, going beyond just identifying them. context.
Difficult as it may be, there are good reasons for The assessment cannot claim to fully understand the
attempting to evaluate the impact of policy research influence of other ‘drivers’ on outcomes. Policy research
[11]. The assessment considered here offers an exam- is only one of many sources of information used in deci-
ple of this work, in the context of a complex and sion making or to form opinion. To conceptualise the
multi-player environment. counterfactual, and isolate the impacts of Reviewing
Methodology and issues Emergencies alone, would be both resource intensive
It seemed that the Reviewing Emergencies report had and difficult to determine. As a consequence, the impact
been effective in influencing policymakers. We believed assessment could not claim outright attribution of policy
the report had had an impact for Swaziland both con- impacts. It instead recognises impacts as contributions
ceptually, on the way people think about HIV, AIDS to change, where the evidence supported such claims.
and emergency responses and instrumentally, influen- This difficult methodological issue of attributing out-
cing behaviour and policy. In mid 2008, the decision comes can result in a ‘shying away’ from impact assess-
was taken to carry out an assessment of the impact of ments [10]. However, with a pragmatic approach to
the report to determine the validity of this claim and understanding impact, based on evidence and informed
understand what ‘worked’ and what ‘didn’t’. Fiona opinion, and understanding that impacts will rarely be
Henry, who was awarded a fellowship by the University attributed solely to an individual publication or pro-
of Edinburgh to work with HEARD, was tasked with gramme, an impact assessment can still be of value.
leading the assessment. Conceptualising ‘impact’: A temporal approach
The specific objectives were to: ‘Impact’ is used interchangeably with terms such as
• Document the creation and dissemination of the ‘influence’, ‘outcomes’, ‘use’ and ‘uptake’, and a number
report; of definitions exist in the literature [10]. In the assess-
• Identify and explain its impact; ment of the Reviewing Emergencies impact is defined
• Identify any barriers and/or limitations to its impact; temporally, referring to ‘initial impact’, ‘long-term
• Draw lessons for maximising the impact of future impact’ and ‘potential impact’. This is important. Firstly,
research. initial impact refers to the ‘sticky messages’ of the
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report: what strikes the reader instantly about the report The methods consisted first of a literature review, to
and its findings and the key messages that they come develop understanding of the background and terms of
away with. Identifying those findings, statements or reference for the study. Relevant policy documents, arti-
graphs that resonated with the reader would provide cles, op-eds and minutes of key meetings were reviewed.
powerful tools for communicating messages of future A questionnaire with questions relating to influence to
research. Secondly, impact was assumed to have a date, potential influence and barriers to influence across
longer-term element, influencing thinking and decision sectors was distributed to 50 individuals, in the five sec-
making. This constituted the main body of the assess- tors. Questions asked the respondents to rank how
ment. ‘Long-term impacts’ are those conceptual and influential they thought the report had been in different
instrumental impacts that change understanding and areas, from ‘no influence’ to a ‘very large influence’
attitudes or contribute to a change in policy or beha- (including a ‘don’t know’ option). They were then asked
viour. As the assessment took place about a year after to give examples or describe why they believed this level
the launch of Reviewing Emergencies, ‘potential impact’ of influence had been achieved.
considered the possibility of impact in the future. With Detailed interviews were conducted with five key peo-
continued advocacy, and changes to the policy environ- ple who had significant involvement in the creation and
ment, potential impact outlines the ‘capability’ of the dissemination of the report. Twenty questionnaires were
report’s findings. It highlights areas in which to focus returned; unfortunately, given time restraints, a follow-
advocacy efforts in the future. up of the original questionnaire to increase response
Research users rates was not possible. In analysing feedback from ques-
Policy research can be used for multiple, often unfore- tionnaires, the percentage of answers for each ranking
seen, purposes [11]. Tracking a research contribution, were calculated. Similar details or examples from both
especially one that seeks conceptual change, is difficult. respondents and interviewees were grouped together to
Taking a pragmatic approach, a good place to begin is find trends in opinion.
identifying likely users of research. The impact assess- We recognised a positive bias could exist. Firstly, the
ment chose five sectors for analysis to try to encompass writing of the assessment assumed an impact had
key actors. They were: donors; government; civil society occurred. To mitigate this problem, a ‘no influence’
and non-governmental organisations; academia and the option was included in the questionnaire. Secondly, the
media. Identifying them helped to structure the analysis respondents that worked on creating the report, or
and understand the different ‘uptake’ of the research. those in close partnership with the writers, may give
The categories were purposefully broad in recognition optimistic estimates of the report’s impact to validate
of the broad array of policy players, and to enable flex- their own work. For this reason, weight was given to
ibility in analysis; crossing national boundaries and disci- opinion that was reinforced with explicit examples, and
plines. Lessons from Swaziland, we believed, would be to those highlighting barriers, limitations or negative
applicable elsewhere in the region, especially in Lesotho, impacts of the report.
Namibia and Botswana as these are all defined as lower-
middle-income countries; have similar prevalence levels; Results and discussion
and are members (with South Africa) of the Southern Key findings
African Customs Union. It was also important as Minis- In the assessment the three elements (initial, long-term,
tries of Health are often weak and in many African and potential) of impact were discussed for each of the
countries donor policies have a disproportionate influ- five sectors, providing a specific and detailed account of
ence on health. ‘impact’ [13]. See Figure 2 for an overview of these find-
Data and measurement ings. The focus is not on the impacts, but on the find-
‘Measuring’ impact posed some difficulty. Changes to ings which helped to explain them. It is these lessons
thinking and decisions are particularly hard to quantify. that are key to creating effective HIV and AIDS research
For this reason a qualitative approach was used, asking in future.
how and why people believed the report had altered The significance of communication
their approach to the Swazi epidemic, and what impact The questionnaire asked, “What is the single most strik-
they believed the report had. Anecdotal evidence and ing aspect of the report (e.g. a graph, a statistic, a state-
substantive examples were key to supporting such ment)?” The graphs were singled out by respondents.
beliefs in the absence of quantitative evidence. Impact Where they were not specifically cited, the concepts
was ultimately considered against the aims of the report: they conveyed were seen as important. One respondent
determining what was achieved as intended, what was answered, “A combination of statistics, graphical illustra-
not achieved, and any unintended impacts. tions and words are used effectively to convey the
5. Whiteside and Henry Health Research Policy and Systems 2011, 9(Suppl 1):S9 Page 5 of 10
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Figure 2: A Summary of ‘Impacts’ from ‘Assessing the Impact of ‘Reviewing
‘Emergencies’ for Swaziland: Shifting the Paradigm in a New Era’
“The paper has had the greatest impact to date on the donor community, as intended.
An increased awareness of the gloomy outlook for Swaziland if nothing changes has
been achieved, at least in part, amongst some key donors. This is exemplified by the
World Bank fact finding mission to Swaziland following the presentation of the report’s
findings, the resulting Interim Strategy Note (ISN), and the discussion of Swaziland’s
plight at key high level meetings…
Influencing the framework within which countries are assessed by income level has
proved difficult. Despite the socio economic indicators in Swaziland that tell a very
different story to its low middle income status, there has been little sign of change to
this measure from the international community. The World Bank has recognised that
the status masks severe poverty and inequality. However, it is not yet clear if this will
result in a real change to the current system…
Donors, academics and NGOs, such as The Red Cross, have all engaged with the debate
on ‘emergencies’ partially as a result of the paper [in their 2008 ‘World Disasters Report’
they claim that one reason global, regional and national responses have, for the most
part, been only fitfully successful is that HIV is rarely referred to as an emergency (The
Red Cross 2008: 61)]. Further advocacy and research will be necessary to continue this
debate, and to see a shift in the current paradigm of thinking on what constitutes an
‘emergency.’” [18].
Figure 2 A Summary of ‘Impacts’ from ‘Assessing the Impact of ‘Reviewing ‘Emergencies’ for Swaziland: Shifting the Paradigm in a
New Era’
message”, illustrating the clear use of these tools in the equivalent burden there would be nearly 11.5 million
original report. British citizens infected. When presenting these data, it
The demographic implications of the HIV and AIDS would be tailored to the audience – for example talking
epidemic on the Swazi population had a significant in Sweden the presenter said ‘Swaziland’s prevalence
impact on the readers. In particular respondents cited would be equivalent to 1.75 million Swedes being
‘Figure 8: Swaziland Population Pyramids’, in Whiteside infected’.
and Whalley 2007 (shown below) and the concept that a It is unsurprising that such dramatic predictions of the
permanent alteration of the structure of Swazi society effects of the epidemic on the structure of the popula-
has occurred. (Figure 3) [14] tion would strike the reader. It demonstrates the neces-
The application of Swaziland’s HIV prevalence rate to sity of clearly reiterating and educating about the long-
western countries, in Table 2 (page 8) of the report term consequences of the epidemic. Shortly after the
‘stuck’ with some. This table shows if the UK had the publication of Reviewing Emergencies the government
Figure 3: Swaziland Population Pyramids 2000, 2025 and 2050
1. US Census Bureau International Database 2007. [www.census.gov/ipc/www/idb/]
Figure 3 Swaziland Population Pyramids 2000, 2025 and 2050
6. Whiteside and Henry Health Research Policy and Systems 2011, 9(Suppl 1):S9 Page 6 of 10
http://www.biomedcentral.com/1478-4505/9/S1/S9
released preliminary data from the national 2007 census academics and businesses. Informally, according to Von
showing a decline in the population - 17, 489 fewer Wissell, many others have discussed the report, includ-
Swazis than in 1997 [15]. The serendipitous release of ing numerous missions, delegations and envoys. The
this data helped give Reviewing Emergencies report was made accessible online by HEARD [5] and
momentum. NERCHA as well as UNAIDS [16], Relief Web [17],
Successful dissemination was crucial, but wide disse- Food, Agriculture and Natural Resources Policy Analysis
mination is not the same as wide impact, and it cannot Network [18] and Aidsportal. (Table 1)
be assumed that the former naturally or inevitably leads HEARD and NERCHA co-ordinated their efforts in
to the latter [8]. The communication and advocacy communicating the findings. The delivery of the mes-
efforts surrounding a message help facilitate impact and sage itself was particularly significant. It had a coherence
are important to understanding where, how and why achieved by using the same slide set – presenters were
impact was achieved. ‘singing from the same song sheet.’ However, presenta-
The report was presented and formally discussed at a tions were tailored to the audiences; Von Wissell pre-
consultation in July 2007. It was available in print from sented to Swazi audiences in SiSwati; in Scandinavia the
October 2007, and a core set of power point slides was importance of donors was stressed.
developed and presented to a range of organisations An example of the impact achieved by this dissemina-
inside and beyond Swaziland. The audiences included tion process was exemplified by the visit of representa-
civil servants, politicians, the donor community, NGOs, tives of the World Bank. In November 2007, the Human
Table 1 The Dissemination of “Reviewing ‘Emergencies’ for Swaziland”, July 2007 to April 2008
Presentation of ‘Reviewing ‘Emergencies’ for Swaziland’
Month Government Donors NGOs Institutes of Education Business
Jul - Drafts circulated for comment to UNAIDS and US Government among others. In August some of the content exposed to NERCHA
Sep AGM which is attended by many local stakeholders and donors
2007
Oct SIDA Reference Group, Lusaka
2007
World Bank, including Vice
President of the World Bank
Nov Cabinet and OCHA/RIASCO, Johannesburg
2007 Principle
Secretaries in
Swaziland
Dec Parliamentary HIV/AIDS and Development. A
2007 Portfolio Case Study from Swaziland AIID
Committees for Workshop, Amsterdam
PM’s Office and
Health
Swaziland
Partnership Forum
on HIV/AIDS
Feb NERCHA Council AIDS and Development: The Church Forum, Swaziland
2008 case of Swaziland’ Rockefeller
Brothers Foundation, Cape
Town
Mar The Donor Forum, The AIDS, Development The AIDS, Development Royal Swazi
2008 Swaziland Emergency, Conundrum: A Case Emergency, Conundrum: A Case Sugar Company
Study of Swaziland’ Medicine Study of Swaziland’ Institute of and surrounding
Sans Frontiers, Brussels Tropical Medicine, Antwerp companies
Apr April ‘AIDS impact on economic ‘Rethinking Emergencies: ‘Rethinking Emergencies: Federation of
2008 and other development Swaziland a Case Study’, Swaziland a Case Study’, Harvard Employers and
indicators: the case of Population Council Seminar School of Public Health Seminar, Chamber of
Swaziland’ UNAIDS Meeting New York Cambridge MA USA Commerce
Executive Director of the ‘Rethinking Emergencies: ‘Rethinking Emergencies:
Global Fund and delegation Swaziland a Case Study’ IFPRI, Swaziland a Case Study’ South
Washington African Reading Group, New York
Law School, New York
Presentations in bold were conducted by Dr. Derek Von Wissell, Director of NERCHA, and those in italics by Professor Alan Whiteside of HEARD.
7. Whiteside and Henry Health Research Policy and Systems 2011, 9(Suppl 1):S9 Page 7 of 10
http://www.biomedcentral.com/1478-4505/9/S1/S9
Development Vice President and Country Director from with whom HEARD and NERCHA had established
the World Bank visited Swaziland to assess first-hand links. As one respondent commented, “The wide net-
the country’s situation in human development and HIV work of individuals, organisations and donors with
and AIDS. They met with key government officials whom HEARD and NERCHA are affiliated were key to
including the Minister of Finance, and Von Wissell. It its wide reception”. The effectiveness of historic rela-
was here that Von Wissell presented Reviewing Emer- tionships such as these, built on both individual and
gencies. One World Bank official described the effect of institutional credibility cannot be underestimated. For
this by saying, “It was NERCHA’s presentation that example Whiteside had served on a UN Commission
brought home the gravity of the HIV/AIDS situation in with the Deputy President of the World Bank, and is a
Swaziland”, and subsequently the World Bank sent a Governor of a school in Swaziland; Von Wissell held
mission to Swaziland to explore next steps for the Bank. the position of Minister of Trade and Industry and Min-
The presentation of the report’s findings was critical to ister of Health in previous governments. The message
this decision. was delivered by people driven to see change and who
Engagement, timing and credibility could speak with authority. Both NERCHA and HEARD
The work built on a long-term engagement of Whiteside are known as being responsive to need and based on
and HEARD with Swaziland. This historical background principled operations. In addition, the involvement of
is particularly important to both locate the research and NERCHA - a Swazi based and Swazi run body - created
the response to it. The timeline below shows the pro- an ‘ownership’ of the research and a further credibility
gression of HIV/AIDS in Swaziland through significant to its message.
events and statistics, simultaneous to key examples of Terminology
research conducted on the epidemic by HEARD and The specific terminology used in research can both help
associates. As the timeline shows, Reviewing Emergen- and hinder the impact of a message. In Reviewing Emer-
cies built on three major reports in 1994, 2003 and gencies the term and concept of a ‘long-wave emergency’
2006, which illustrated there was something going ser- was particularly significant. A media respondent explained
iously wrong. Its message was credible - based on a his- the term ‘emergency’ acted as a “hook”, giving journalists
tory of research and evidence. It used good and an attention-grabbing story, substantiated by genuine and
informative scientific indicators to build a body of evi- shocking statistics. Titles such as ‘‘Swaziland: Declare
dence difficult to refute. Furthermore, it was it was writ- HIV/AIDS a “humanitarian emergency”’ [20] and “When
ten at a critical time in Swaziland: with unusual levels of is HIV/AIDS a disaster?” [21] exemplify how the term
death; increasing numbers of orphans; and tuberculosis renewed interest in the epidemic in Swaziland.
emerging as a major killer, the grim predictions of pre- Conversely however, concerns over the term ‘emer-
vious publications were no longer speculative, but reality gency’ were discussed at length at the Low-Middle-
[5]. (Figure 4) Income Countries meeting hosted by HEARD in Febru-
The timeline illustrates the progression of HIV/AIDS ary 2008. One respondent explained, “There is some
from Stage 1 to Stage 5 in less than 20 years using the reluctance on the part of donors/NGOs/civil society/
concept idea of ‘Stages of the HIV/AIDS epidemic’ government to call HIV/AIDS an ‘emergency’ because
developed by Barnett and Whiteside (2002) [19]. As one there seems to be fear that terming it so will result in
interviewee reflected, “While, in many ways, Swaziland’s short-term funding for a long-term problem. The sus-
response has been admirable and unique, it is clear that tainability of the HIV/AIDS effort is seen as under
the HIV prevention programmes have not worked thus threat with short-term language.” This meeting con-
far, and more importantly, that the social and economic cluded there was a need to marry the urgency of the cri-
implications of the epidemic have not been adequately sis with a long-wave understanding of the future impact
thought through.” Reviewing Emergencies tried to of HIV/AIDS on the country, and that ‘emergencies’
explain the significance of the latter, hence filling a cru- may not be the best term to represent this [22]. A key
cial gap in the research arena. message of the report is the long-wave nature of HIV
Significantly, the report was disseminated into a recep- and its impacts should be included in a new kind of
tive network of researchers, policymakers and associates thinking on emergencies. This debate will continue.
Figure 4: HIV and AIDS in Swaziland and Key HEARD (or associated) Research
1986-2008
Figure 4 HIV and AIDS in Swaziland and Key HEARD (or associated) Research 1986-2008
8. Whiteside and Henry Health Research Policy and Systems 2011, 9(Suppl 1):S9 Page 8 of 10
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Barriers and tensions A number of significant international barriers threa-
Our assessment identified five key limitations: the role tened the impact of the report and indeed the issue of
of government was not addressed; using Malawi and HIV/AIDS throughout Sub-Saharan Africa. Firstly, the
Zambia as comparator countries had mixed results; economic and political weight of Swaziland in the inter-
issues around timing; the status of AIDS (and Swazi- national sphere is small. One frustrated interviewee
land) on the international agenda; and finally the calls described that “Swaziland is just not on the list”, as it is
for radical change may not be achievable. considered as insignificant by larger countries. Secondly,
The report did not deal with the role of the Swazi HIV as a humanitarian emergency must compete for
Government in the epidemic. This is significant since it funding with other important humanitarian issues, such
is ultimately government who guides and executed HIV as famine and natural disasters. One respondent
strategy in the country. The Government, along with described a ‘shift’ in global priorities to issues such as
the King, have faced criticism for their response to the climate change, terrorism and the rising price of food.
epidemic [23]. One respondent reminded us, the crisis Donors have finite resources and HIV and AIDS must
“cannot be fixed with more funding alone.” Another dis- compete with other issues. HIV and AIDS was the glo-
cussed the structural difficulties in addressing the crisis, bal health issue receiving the most attention and fund-
including the ‘vertical’ response, exemplified by a sepa- ing but this will change, already a gap exists between
rate AIDS response council (NERCHA) which, it was pledges and funding [3].
claimed, failed to join up a national response. Finally, the report called for a change within the fra-
The historic and legal relationship between HEARD, mework that international organisations use to identify
NERCHA and the Swazi Government restrained the countries’ level of development - that of income classifi-
report’s ability to criticise. Prescribing how Swaziland cation. It further calls for a shift in the paradigm of
should respond to the crisis was never the intention of thinking on emergencies. “Effectively what this report
the paper. Whiteside argued that attempting to change says is that it can’t be business as usual”. Changing
the behaviour of the Swazi Government was beyond the entrenched ways of thinking is a major task [24].
scope of what a researcher from outside of the country
should attempt: “That is for the people of Swaziland to Conclusions
do.” Working with the government in a ‘strategic alli- ‘Reviewing ‘Emergencies’ for Swaziland’ argued that
ance’, rather than against is more productive. Strategi- socio-economic indicators show that the Swazi popula-
cally limiting the scope of what, and whom, research tion is experiencing a humanitarian crisis comparable to
tries to influence can be a wise decision when trying to countries besieged by conflict or struggling in the wake
achieve impact within a complex policy arena. of a severe natural disaster. In the short-term, the report
The report made comparisons between Swaziland and aimed to focus attention on Swaziland and what AIDS
Zambia and Malawi, in order to demonstrate the scale was doing to the country. It contributed to raising the
of the emergency facing Swaziland. Despite the compari- profile of the plight of the Swazi people amongst donors
son having the desired effect of emphasising the scale of and policy makers, described by one interviewee as a
the Swazi’s crisis - some respondents referenced these “catalyst for re-engagement”. In the medium-term, the
comparative graphs as a striking and influential tool - it report aimed to influence debate on the classification of
also had unintended consequences. Zambia and Malawi low-middle income countries. This has proved more dif-
are both countries that, like Swaziland, compete for the ficult. In the long-term, the report has seen some suc-
attention of donors and development aid. By focusing all cess in opening the debate on HIV/AIDS as a ‘long-
attention on Swaziland, the report appeared to belittle wave emergency’. Likening HIV/AIDS to a large scale
the issues faced by both Malawians and Zambians. humanitarian disaster helped fuel a debate on the need
‘Time’ is no doubt a barrier to the impact of the for urgency combined with long-term responses to the
report, since research is usually most influential when epidemic. Donors, academics and NGOs have all
first published. The challenge to HEARD and NERCHA engaged with the debate, but further advocacy and
was to continue the momentum behind the report. One research is necessary to continue this, and see a shift in
respondent warned that the report “may lack academic the current paradigm of thinking on what constitutes an
credibility if it is not followed up by further research ‘emergency.’
that is able to collect primary data.” The report aimed Developing a better understanding of the relationship
for both an immediate awareness of Swaziland’s epi- between research and policy impact is vital to advancing
demic, and a longer-term discussion on emergencies the influence of SRH and HIV and AIDS research.
and low-middle income classifications. It is the latter of Tracking the impact of research, using one or many
these in particular that needs to be worked at or risk a case studies, can help facilitate this learning. Crucial to
‘fizzling out’ as time marches on. this process is to not simply identify impacts, but to
9. Whiteside and Henry Health Research Policy and Systems 2011, 9(Suppl 1):S9 Page 9 of 10
http://www.biomedcentral.com/1478-4505/9/S1/S9
seek understanding of how and why they came about. a logical path. The sense of frustration and the need to
Of particular use for developing effective research in the provide evidence led to this innovative work. It is our
future is identifying where intended impact has not belief that it achieved many of its goals and spurred an
been achieved and why. The assessment of the impact international dialogue around the issues. The evaluation
of Reviewing Emergencies attempted to do exactly this. taught us additional lessons, which can be applied to help
Drawing from the assessment, the following lessons maximise the impact of research in the future.
may help inform future SRH and HIV/AIDS research.
Communication is critical. The original work - collect-
Acknowledgements and funding
ing existing data to tell one clear story - is a striking This work was supported by the DFID Research Partner’s Consortium (ABBA)
way to demonstrate the reach and scale of disease and the donors of the Joint Funding Arrangement. The generous support of
impact; the demographic implications of AIDS power- the staff of NERCHA is acknowledged. The responsibility for the contents
and interpretation of the data remains with the authors.
fully communicated the severity of the epidemic; a tar- This article has been published as part of Health Research Policy and Systems
geted, tailored and cohesive dissemination effort helped Volume 9 Supplement 1, 2011: Strengthening the research to policy and
facilitate the impact of research; sustained advocacy practice interface: exploring strategies used by research organisations
working on sexual and reproductive health and HIV/AIDS. The full contents
which is vital in keeping momentum for a message, of the supplement are available online at http://www.health-policy-systems.
should be reflected in planning and resources; further com/supplements/9/S1.
publications validating and extending a message are a
Author details
good way to do this; and terminology can help or hinder 1
Director and Professor, Health Economics and HIV/AIDS Research Division
the impact of a message. University of KwaZulu-Natal, Durban. 2Visiting Fellow, Health Economics and
Context and timing may be beyond the control of HIV/AIDS Research Division University of KwaZulu Natal, Durban.
researchers but can significantly influence the uptake of Authors’ contributions
research. These include world events, developments AW conceptualised the paper, and was co-author to the original study
within the policy arena, and specifically within the topic entitled ‘Reviewing ‘Emergencies’ for Swaziland’ (2007). AW also edited the
manuscript. FH drafted the manuscript, with input from AW. FH was the
area. If these conditions align in the favour of the author of the study ‘Assessing the Impact of ‘Reviewing ‘Emergencies’ for
research the impact may be much greater, therefore Swaziland: Shifting the Paradigm in a New Era’ (2008). Both authors read
awareness of this, and careful timing of publications and and approved the final manuscript.
advocacy efforts could maximise impact. Authors information
The credibility of both evidence and researcher play AW is Director of the health economics and HIV/AIDS Research Division
an important role in the use of research. Historical (HEARD) at the University of KwaZulu-Natal. He has an MA from the School
of Development Studies at the University of KwaZulu-Natal and a D Econ
integrity of the evidence and an established researcher from the University of Natal.
(or institution) can foster confidence in the use of FH has an MSc Development Management at the Department of
research and increase the likelihood of it being used to International Development from the London School of Economics and MA
Economics and Politics from Edinburgh University. She was a visiting fellow
inform policy. Established relationships and networks to HEARD in 2008.
between individuals and institutions can guarantee an
audience and encourage a dialogue on the findings. Competing interests
This article critically reflects on a research project in which the authors have
‘Ownership’ of research, by the people it affects, is a been involved.
powerful way to ensure both credibility and drive behind
the message. Published: 16 June 2011
The impact assessment taught further lessons on how
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doi:10.1186/1478-4505-9-S1-S9
Cite this article as: Whiteside and Henry: The impact of HIV and AIDS
research: a case study from Swaziland. Health Research Policy and Systems
2011 9(Suppl 1):S9.
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