Global Society's Response to HIV/AIDS: Botswana's Experience

Approximately 37% of Botswana's population was HIV-positive in 2005. This study examines Botswana's experience of the HIV/AIDS threat in order to assess the strengths and weaknesses of the response by global society. Botswana is particularly useful in evaluating the pandemic threat and national and global responses since it is considered a sub-Saharan leader in establishing a national infrastructure of HIV/AIDS governance—one closely coordinated with global society's infrastructure and culture of HIV/AIDS governance. This paper argues that a polyarchic notion of governance and authority has relevance to the sphere of HIV/AIDS governance and this is evident in Botswana's experience. This study analyses the key features of the global response to the pandemic. It then explains and evaluates Botswana's administrative, financial and operational responses to the pandemic. The paper concludes by identifying critical policy challenges for the further development of effective global–national HIV/AIDS governance.     

Managing and controlling HIV/AIDS talk among Ghanaians living with HIV/AIDS

Abstract

This study explored the meanings people attribute to talking about living with HIV/AIDS. Framed by interpersonal and health communication scholarship based on disclosure and the meanings of talk about illness, people living with HIV/AIDS are asked to describe how and why they discussed their health condition with others. Interviews (focus group and one-on-one) were conducted with 120 people living with HIV/AIDS. A grounded theory analysis of the interviews revealed how communication about HIV/AIDS may be particularly meaningful because it is something people feel they can control during what is already a highly stressful and turbulent time. However, attempts to manage communication are challenged by constraints imposed by others, such as unfavourable and unpredictable reactions to disclosure, which ultimately place limits on how people living with HIV/AIDS control information about them.     

Evaluating HIV/AIDS education programmes in Ugandan secondary schools

Although not part of the national curriculum until 2004, HIV/AIDS education has been taught for some time in Ugandan secondary schools through a variety of extracurricular means, including the media, youth groups, drama, music, and Parent–Teacher Associations. This article identifies and evaluates the integration of HIV/AIDS information into the national curriculum in Ugandan secondary schools between 2002 and 2004, based on the viewpoints of administrators, teachers, and students from 76 schools. While most schools did not include HIV/AIDS as part of the formal national curriculum at this time, the information was disseminated through a range of alternative means. The authors identify the most effective of these, discuss the perceived reactions of various stakeholders regarding HIV/AIDS being taught in secondary schools, and make recommendations for curricular reform.     

HIV/AIDS and governance along the corridors of conflict in West Africa

West Africa demonstrates a sub-regional pattern of violence and political instability that has engulfed Côte d'Ivoire, Liberia, Sierra Leone and Guinea, and now extends out from these states through corridors of violent conflict throughout the region; both physical and figurative. This article makes two arguments. That HIV/AIDS has developed a complex inter-relationship with violent conflict in the West African sub-region; and that the presence of HIV/AIDS in West Africa in zones of violent conflict is not given the recognition needed by the international policy community. The neglect of West Africa in the Pan-African response to HIV/AIDS, and the intractability of the region's Complex Political Emergencies, is creating an emerging phenomenon of Complex Human Emergency in the region. An acknowledged gap exists in social analyses of HIV/AIDS between policy speculations and the actual evidence base that these are built upon. Instead of speculative theorizing, this article presents seven key questions that need to be asked about HIV/AIDS and conflict in West Africa, in order to begin the process of serious policy research on the issue.     

Stemming the HIV/AIDS epidemic in South Africa: Are our HIV/AIDS campaigns failing us?

Abstract

Media-based campaigns are critical tools in changing the behaviours that are fuelling the HIV/AIDS epidemic in South Africa. However, given the absence of an effective behaviour-change response in the face of the epidemic, many have come to doubt the efficacy of these campaigns. Campaign designers who profess to using best-practice principles in designing HIV/AIDS campaigns also report that although some of these campaigns book changes in beliefs and attitudes, they seldom have a significant effect on the behaviours that are fuelling the epidemic.

This situation raises a number of general questions with regard to South African HIV/AIDS campaigns: How effective are media-based campaigns in general in changing health-related behaviours? Are South African HIV/AIDS campaigns successful or not? If not, why not, what could be done to optimise their efficacy? What aspects of South African HIV/AIDS campaigns contribute to their efficacy and could be up-scaled in future campaigns?

This article provides a critical analysis of the processes followed in the design of the Living Positively Campaign and of the design features of the messaging of the booklet Living positively with HIV and AIDS. This analysis clearly indicates that despite claims by campaign designers of adherence to best-practice heuristics, very few of them are implemented in the design of HIV/AIDS campaigns.     

Communication,choice and freedom with reference to risk in aspects of communication on HIV/AIDS

Abstract

Where analysis concludes that a context is characterised by high risk, as in thecase given HIV/AIDS in South Africa, individual choice and freedom are often negated, for instance, by social scientists when they resort to the statistical logic of large numbers. Ironically, given that knowledge and rationality are arguably related, the choice and freedom of the individual deemed not to have knowledge about a given issue, is questioned and soon negated. By focusing on the black people in South africa, as a key example, it is argued that such analyses and solutions deny the existential possibilities of the people. The aim of this article is to affirm an individual's possibilities. The situation of the individual who communicates is recalled to argue against approaches that variously seek to blame the individual.

In the time of HIV/AIDS, ideas such as those of Søren Kiekegaard should be engaged to advance understanding of the limitations and possibilities of the individual who communicates. In the trasition from understanding to acting on information on HIV/AIDS, the individual has the freedom to choose. This is humbling for communication scientists and practioners who seek to prevent the further spread of HIV/AIDS.     

Probiotics in Tanzania: a multi-partner development project

This article critically examines an HIV/AIDS development and research project in Mwanza, Tanzania. A group of women produce a type of probiotic yoghurt that has provided evidence of lowering the incidence of HIV infection. The yoghurt is consumed by the women, their family members, and local citizens living with HIV/AIDS; surplus is sold within the community. While the project's multi-partner, multi-disciplinary composition allows for varied expertise and insights, it also requires open and collaborative dialogue. This article discusses the project's challenges, positive outcomes, and some of the socio-cultural issues that need to be addressed if it expands in size and/or scope.     

A participatory approach to community-based HIV / AIDS awareness

This paper examines a participatory approach to community-based HIV/AIDS awareness campaigns in South Africa. The SARAR methodology, developed by Lyra Srinivasan, Ron Sawyer, and Jake Pfohl, was adapted specifically to the water supply and environmental sanitation sector through the PROWWESS and Participatory Hygiene and Sanitation Transformation (PHAST) initiative. The SARAR methodology of participatory learning is based on the innate ability of the people to address and resolve their own problems. The application of this methodology in HIV/AIDS awareness was explored through a training session held in KwaZulu/Natal, South Africa. The course seeks to demonstrate how participatory methods could intensify mass media campaigns. A summary of this approach, together with the outcome of the workshop, was presented. This paper concludes that participatory methodologies, such as modified versions of SARAR and PHAST, could open up discussions on HIV/AIDS. It could also assist in developing and strengthening existing household-coping strategies, and emphasize alternative ways for health care professionals to play a supportive, proactive, and constructive role at the community level.     

湄公河流域诸国的艾滋病问题及其对我国边疆地区的影响

近年来,境外湄公河流域几个东南亚国家的艾滋病问题已经引起越来越多的人的关注,而且这个问题对我国西南边疆多民族地区,特别是同属一个“大湄公河次区域”的中国云南省的边疆少数民族地区的经济的发展和社会的稳定都造成了越来越大的负面影响。本文对境外湄公河流域诸国艾滋病问题的由来和发展及其对我国西南边疆多民族地区产生的影响及我国目前的一些对策进行了初步的分析和评介。     

Using art and everyday objects to fight HIV/AIDS in Uganda

This paper argues for the importance of enabling dialogue between women and men about taboo subjects of sex and sexuality in HIV/AIDS prevention. It reports the findings of a project that sought to use art (specifically sculpture) for creating dialogue between women and men in rural Uganda. It then provides suggestions for HIV/AIDS practitioners on how to use everyday objects to stimulate similar discussion about sex and disease prevention between women and men. We argue for the utility of art and everyday objects where literacy rates are low, or where modes of communication and information-sharing are predominantly orate.     

Health service utilization among widows living with HIV/AIDS: an interview survey in Manipur, India

Widows living with HIV/AIDS (WLHA) are a vulnerable and often overlooked group. The North Eastern Indian state of Manipur, which has one of the highest concentrations of HIV/AIDS cases in India, is not an exception. This paper aims to describe the pattern of and factors contributing to the use of health services by WLHA in Manipur. Structured face-to-face interviews were conducted among 510 respondents. Only 49% of the respondents were aware of available health facilities. The place of residence (67.8%) and appointment at a convenient time (70.8%) were the main factors affecting the use of health services. To improve access to health services, it is imperative that the services of trained health providers are made easily available. Policy makers and organizations working on HIV/AIDs should work together to remove the barriers to the use of health services, making them user friendly for vulnerable groups such as WLHA.     

Corporate wealth or public health? WTO/TRIPS flexibilities and access to HIV/AIDS antiretroviral drugs by developing countries

Between 1994 and 2003, the TRIPS (Trade-Related Aspects of Intellectual Property Rights) Agreement of the WTO was refined to allow for flexibilities in the use of compulsory licences to import and export ‘generic’ varieties of pharmaceutical products, including ARV drugs for the treatment of HIV/AIDS. After summarising this process, and assessing its implications in practice for developing countries, this article briefly places the current regime in a longer-term context of the institutional protection of patents in Britain and Europe dating from the nineteenth century. It traces how that pattern, which benefits major patent holders, continues to be present in TRIPS. The article goes on to demonstrate the continuity of corporate influence over the state, as expressed in the ‘TRIPS-plus’ conditions, which are appearing in bilateral free-trade agreements between the USA and either individual developing countries or regional groupings. This array of what amount to institutional obstacles to the sustained availability of cheap drugs presents serious problems for future operations of the supply chain for many imported medicines and, in the case of HIV/AIDS, has negative implications for the long-term clinical effectiveness of the most widely used drugs.     

Achieving behaviour change: Three generations of HIV/AIDS programming and jargon in Thailand

NGOs have played an important role worldwide in the fight to prevent the spread of HIV/AIDS through achieving behaviour change. NGOs have often been at the forefront of innovative changes, influencing government and international programming activities. This paper identifies and analyses the evolution of the HIV/AIDS programmes of one NGO in Thailand over a period of ten years. Three generations of programming are identified both through distinct approaches to this area of work and through the changing jargon used to describe the people the programmes are aimed at.     

Conflict and gender: the implications of the Burundian conflict on HIV/AIDS risks

Sexual and gender-based violence in many conflict and post-conflict contexts are creating vulnerabilities to HIV. The paper is based on research conducted in Burundi in 2007–2008.The country experienced long-term civil war from the early 1990s until recently and has been the locus of post-conflict disarmament, demobilisation and reintegration programmes, providing a coherent and focused study. The research finds that the relationship between conflict and HIV/AIDS is a function of pre-existing gender relations that also regulate sexual life and determine critical female vulnerabilities. When put under stress by armed conflict, these vulnerabilities become amplified, creating conditions for the increased spread of HIV. Analysis of how gender relations and vulnerabilities change according to the specific social and economic circumstances generated by military mobilisation, organisation and deployment, in relation to civilian displacement and insecurity, in a range of distinct circumstances, provides a framework for understanding HIV vulnerabilities during and after the conflict.     

The persuasive effect of Tsotsitaal in HIV/AIDS material

ABSTRACT

According to Statistics South Africa (2002) HIV infections were the leading cause of death for females between 15 and 39 years of age for the period 1997 to 2001. The South African Department of Health (2003) estimates that 3.1 million women (15–49 years) in South Africa are HIV-infected. The Human Sciences Research Council (HSRC) (2002) claimed that in the 15- to 24-year age group, 12 per cent of the women and 6.1 per cent of the males are HIV-infected. The high incidence of HIV/AIDS has resulted in a number of campaigns that seek to promote safe sex. According to the results that have been published, young people are seen as a high-risk group. However, of the campaigns that seek to address the issue of HIV/AIDS, the loveLife project is the only campaign aimed exclusively at young people. loveLife makes extensive use of the printed media in their campaigns. They claim to speak in a language with which young people will identify. Very little research into the effectiveness of the language use in these campaigns has been undertaken. Saal (2003) examined the effect of teenager slang as used by loveLife among learners in the Western Cape. This research is an extension of the research conducted by Saal (2003), looking in particular at the effect of Tsotsitaal among learners in the Eersterust area. Tsotsitaal is widely used in Eersterust, Gauteng Province, and its persuasive effect in HIV/AIDS material will be examined. Two brochures (written in Standard Afrikaans and Tsotsitaal) were tested in terms of their effect on source–receiver–similarity, source attraction and credibility (source expertise and trustworthiness) as well as persuasiveness. The findings of the study suggested, somewhat surprisingly, that speakers of Standard Afrikaans are rated more favourably than Tsotsitaal speakers in terms of source–receiver–similarity and credibility. The participants also viewed the brochure in Standard Afrikaans as significantly more persuasive than the Tsotsitaal brochure.     

Funding development in Rwanda: the survivors' perspective

Why has the humanitarian world already forgotten the people of Rwanda? And why do the survivors of the Rwandan genocide continue to be sidelined, particularly those women who were raped and deliberately infected with HIV/AIDS in a campaign of systematic sexual violence? The focus of humanitarian organisations shifted from Rwanda after 1994, and these women – most of whom have to maintain their households alone – are needlessly dying because they have no access to treatment. Humanitarian and development efforts will not achieve lasting benefits without better coordination and the ability to act on lessons learned.     

Churches,mosques, and condoms: understanding successful HIV and AIDS interventions by faith-based organisations

There are an estimated 33 million people living with the Human Immunodeficiency Virus (HIV) worldwide. While national education campaigns have been successful in providing a broad platform of awareness of HIV and AIDS, within some countries faith-based organisations (FBOs) have assumed an important role in educating and supporting local communities to reduce HIV transmission. This article conceptualises the successful characteristics of a Christian organisation in West Papua and a Muslim organisation in Thailand. The ability of both these FBOs to engage successfully with their communities on issues of sexual practice provides important lessons for other FBOs seeking to reduce HIV transmission.     

Strengthening public health supply chains in Ethiopia: PEPFAR-supported expansion of access and availability

When the US President's Emergency Plan for AIDS Relief (PEPFAR)-supported Supply Chain Management System (SCMS) programme began working in Ethiopia in 2006, the estimated population of people living with HIV exceeded one million, while only 24,000 were on treatment and only 50 treatment sites were in operation. SCMS and other key partners entered into this context to support the Ethiopian government in significantly strengthening the public health supply chain system, with the aim of increasing the availability and accessibility of pharmaceutical products. The country now has 1,047 treatment sites and is nearing complete treatment coverage. This article discusses how priorities were set among many competing challenges from 2006 until 2014, and how the four-step strategy of build, operate, transfer, and optimise has resulted in a successful partnership.     

Mitigating the impact of HIV and AIDS on rural livelihoods in Southern Africa

A variety of interventions to mitigate the increasing impact of the HIV and AIDS epidemic on smallholder agricultural production and food security are currently implemented in sub-Saharan Africa. However, documentation and dissemination of such interventions is limited and patchy. Building on emerging experiences from the field, this article seeks to move beyond charting the impacts of HIV and AIDS on rural livelihoods to review existing mitigation policies and programmes, identify the challenges to mitigation, and provide suggestions for future mitigation strategies and policy priorities. The experiences cited in the article are mainly drawn from the hardest-hit regions in Southern and Eastern Africa, but they provide useful lessons for AIDS-affected rural communities in other contexts. The main conclusion is that, as current initiatives are to a large extent ad hoc and localised, there is a need for documentation, dissemination, and scaling up of existing interventions, as well as greater coherence and co-ordination in policies and programmes to extend their reach and make the most of limited resources.