The Lancet Infectious Diseases, Volume 10, Issue 7, July 2010, Page 441
The Lancet Infectious Diseases
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Paul B Spiegel Heiko Hering, Eugene Paik and Marian Schilperoord
Conflict and Health 2010, 4:2
Background
Access to HIV and malaria control programmes for refugees and internally displaced persons (IDPs) is not only a human rights issue but a public health priority for affected populations and host populations. The primary source of funding for malaria and HIV programmes for many countries is the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). This article analyses the current HIV and malaria National Strategic Plans (NSPs) and Global Fund approved proposals from rounds 1-8 for countries in Africa hosting populations with refugees and/or IDPs to document their inclusion.
Methods
The review was limited to countries in Africa as they constitute the highest caseload of refugees and IDPs affected by HIV and malaria. Only countries with a refugee and/or IDP population of = 10,000 persons were included. NSPs were retrieved from primary and secondary sources while approved Global Fund proposals were obtained from the organisation's website. Refugee figures were obtained from the United Nations High Commissioner for Refugees' database and IDP figures from the Internal Displacement Monitoring Centre. The inclusion of refugees and IDPs was classified into three categories: 1) no reference; 2) referenced; and 3) referenced with specific activities.
Findings
A majority of countries did not mention IDPs (57%) compared with 48% for refugees in their HIV NSPs. For malaria, refugees were not included in 47% of NSPs compared with 44% for IDPs. A minority (21-29%) of HIV and malaria NSPs referenced and included activities for refugees and IDPs. There were more approved Global Fund proposals for HIV than malaria for countries with both refugees and IDPs, respectively. The majority of countries with =10,000 refugees and IDPs did not include these groups in their approved proposals (61%-83%) with malaria having a higher rate of exclusion than HIV.
Interpretation
Countries that have signed the 1951 refugee convention have an obligation to care for refugees and this includes provision of health care. IDPs are citizens of their own country but like refugees may also not be a priority for Governments' NSPs and funding proposals. Besides legal obligations, Governments have a public health imperative to include these groups in NSPs and funding proposals. Governments may wish to add a component for refugees that is additional to the needs for their own citizens. The inclusion of forcibly displaced persons in funding proposals may have positive direct effects for host populations as international and United Nations agencies often have strong logistical capabilities that could benefit both populations. For NSPs, strong and concerted advocacy at global, regional and country levels needs to occur to successfully ensure that affected populations are included in their plans.
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Rachel K Jewkes, Kristin Dunkle, Mzikazi Nduna, Nwabisa Shai
The Lancet, Volume 376, Issue 9734, 3 July 2010
Summary
Background
Cross-sectional studies have shown that intimate partner violence and gender inequity in relationships are associated with increased prevalence of HIV in women. Yet temporal sequence and causality have been questioned, and few HIV prevention programmes address these issues. We assessed whether intimate partner violence and relationship power inequity increase risk of incident HIV infection in South African women.
Methods
We did a longitudinal analysis of data from a previously published cluster-randomised controlled trial undertaken in the Eastern Cape province of South Africa in 2002—06. 1099 women aged 15—26 years who were HIV negative at baseline and had at least one additional HIV test over 2 years of follow-up were included in the analysis. Gender power equity and intimate partner violence were measured by a sexual relationship power scale and the WHO violence against women instrument, respectively. Incidence rate ratios (IRRs) of HIV acquisition at 2 years were derived from Poisson models, adjusted for study design and herpes simplex virus type 2 infection, and used to calculate population attributable fractions.
Findings
128 women acquired HIV during 2076 person-years of follow-up (incidence 6·2 per 100 person-years). 51 of 325 women with low relationship power equity at baseline acquired HIV (8·5 per 100 person-years) compared with 73 of 704 women with medium or high relationship power equity (5·5 per 100 person-years); adjusted multivariable Poisson model IRR 1·51, 95% CI 1·05—2·17, p=0·027. 45 of 253 women who reported more than one episode of intimate partner violence at baseline acquired HIV (9·6 per 100 person-years) compared with 83 of 846 who reported one or no episodes (5·2 per 100 person-years); adjusted multivariable Poisson model IRR 1·51, 1·04—2·21, p=0·032. The population attributable fractions were 13·9% (95% CI 2·0—22·2) for relationship power equity and 11·9% (1·4—19·3) for intimate partner violence.
Interpretation
Relationship power inequity and intimate partner violence increase risk of incident HIV infection in young South African women. Policy, interventions, and programmes for HIV prevention must address both of these risk factors and allocate appropriate resources.
Funding
National Institute of Mental Health and South African Medical Research Council.
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The Lancet, Volume 376, Issue 9734, Pages 4 - 6, 3 July 2010
Mark A Boyd, Chidi A Nwizu
Since the unprecedented UNGASS Declaration of Commitment on HIV/AIDS in 2001, 1 more than 4 million people globally have now received HIV care, including provision of combination antiretroviral therapy (cART). 2 This effort has strained health-resource capacity in many countries, and has led to occasional criticism that the effort is lopsided and removes resources from other pressing public health needs. 3 In response, and as part of a strategy to maintain the momentum of providing access to HIV care... [extract]
In the last few years, the scale of the HIV epidemic amongst men who have sex with men in Africa, Asia and Latin America has become clearer. There is now a body of data on HIV prevalence and on risk behaviours, but attention is now shifting to the inadequate amount of prevention work that is carried out with men who have sex with men in many countries.
In advance of the main AIDS 2010 conference in Vienna, activists and researchers gathered for Be Heard!, which turned out to be the largest pre-conference meeting organised by the Global Forum on MSM & HIV yet. The sessions covered a wide range of issues, especially human rights, but several workshop speakers highlighted how the internet has become central to their work with men who have sex with men.
For example, Yves Yomb from Alternatives-Cameroun explained how – in a context where homosexuality is penalised, blackmail and police harassment are common, the media are homophobic and funding for work with men who have sex with men is limited (MSM do not figure in Cameroon’s national strategic plan for HIV) – his organisation needed to be creative in finding ways to support men who have sex with men.