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2 results

  • Chapter 7 - Listening to Women

  • Sara L.M. Davis, Graduate Institute of International and Development Studies, Geneva
  • Book:
    The Uncounted
    Published online:
    18 May 2020
    Print publication:
    11 June 2020, pp 173-197

  • Summary

    Global health donors, under pressure to demonstrate progress in order to persuade US and UK government representatives to continue funding for the global HIV response, have intensified efforts to get more people at risk of HIV to test and know their status in high-prevalence regions, such as East and Southern Africa. PEPFAR, the US bilateral HIV financing program, has mastered doing this by using granular data to set priorities and manage funding. Women living with HIV in Kenya have raised concerns about the donor-driven practice of assisted partner notification services (aPNS), an approach in which those who test positive for HIV are required to share the contacts of their sexual partners with health workers, in order to inform those partners that they are at risk and should test for HIV. This chapter examines the delicate problem of eliciting disclosure of intimate partner violence safely and ethically, and how this is neglected in the academic studies on which the World Health Organizations based its recommendations. It shows that lack of evidence of domestic violence was used as evidence of lack of such violence, in order to promote donor-driven efforts to test more people for HIV.

  • PEPFAR support of alcohol–HIV prevention activities in Namibia and Botswana: a framework for investigation, implementation and evaluation

  • M. Glenshaw, N. Deluca, R. Adams, C. Parry, K. Fritz, V. Du Preez, K. Voetsch, P. Lekone, P. Seth, P. Bachanas, M. Grillo, T. F. Kresina, B. Pick, C. Ryan, N. Bock
  • Journal:
    Global Mental Health / Volume 3 / 2016
    Published online by Cambridge University Press:
    26 January 2016, e2
    • Article
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  • Background

    The association between harmful use of alcohol and HIV infection is well documented. To address this dual epidemic, the US President's Emergency Plan for AIDS Relief (PEPFAR) developed and implemented a multi-pronged approach primarily in Namibia and Botswana. We present the approach and preliminary results of the public health investigative and programmatic activities designed, initiated and supported by PEPFAR to combat the harmful use of alcohol and its association as a driver of HIV morbidity and mortality from 2008 to 2013.

    Approach

    PEPFAR supported comprehensive alcohol programming using a matrix model approach that combined the socio-ecological framework and the Alcohol Misuse Prevention and Intervention Continuum. This structure enabled seven component objectives: (1) to quantify harmful use of alcohol through rapid assessments; (2) to develop and evaluate alcohol-based interventions; (3) to promote screening programs and alcohol abuse resource services; (4) to support stakeholder networks; (5) to support policy interventions and (6) structural interventions; and (7) to institutionalize universal prevention messages.

    Discussion

    Targeted PEPFAR support for alcohol activities resulted in several projects to address harmful alcohol use and HIV. Components are graphically conceptualized within the matrix model, demonstrating the intersections between primary, secondary and tertiary prevention activities and individual, interpersonal, community, and societal factors. Key initiative successes included leveraging alcohol harm prevention activities that enabled projects to be piloted in healthcare settings, schools, communities, and alcohol outlets. Primary challenges included the complexity of multi-sectorial programming, varying degrees of political will, and difficulties monitoring outcomes over the short duration of the program.