Developing and implementing global gender policy to reduce HIV and AIDS in low- and middle-income countries: policy makers' perspectives

Gender inequalities have been recognised as central to the HIV epidemic for many years. In response; a range of gender policies have been developed in attempts to mitigate the impact and transform gender relations. However; the effects of these policies have been less than successful. In March 2010 the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched the Agenda for accelerated country level action on women; girls; gender equality and HIV (the Agenda); an operational plan on how to integrate women; girls and gender equality into the HIV response. This paper explores the perspectives of those involved in developing and implementing the Agenda to understand its strengths and limitations. In-depth one-on-one interviews were conducted with 16 individuals involved in the development and implementation of the Agenda. The data were analysed using thematic network analysis. Facilitators of the Agenda centred on the Agenda's ability to create political space for women and girls within the global HIV/AIDS response and the collaborative process of developing the Agenda. Barriers to the implementation and development of the Agenda include the limited financial and non-financial resources; the top-down nature of the Agenda's development and implementation and a lack of political will from within UNAIDS to implement it. We suggest that the Agenda achieved many goals; but its effect was constrained by a wide range of factors

Representations of HIV/AIDS Management in South African Newspapers

In South Africa; numerous strong policy statements emphasise the importance of involving communities in HIV/AIDS management; yet in practice such involvement tends to be tokenistic and minimal. Social representations in the public sphere constitute the symbolic dimension within which responses to HIV and AIDS are conceptualised and transformed into action. Through an analysis of newspaper articles; we explore the dominant representations of HIV/AIDS management circulating in the South African public sphere and examine how community engagement is depicted. We highlight the way media representations reflect narrow understandings of HIV and AIDS as a predominantly medical problem; while depicting HIV/AIDS management as a top-down activity dominated by prominent individuals; such as national leaders; health professionals and philanthropists; thus marginalising the role played by communities; who are often depicted as passive recipients of interventions by active outsiders. These representations fail to reflect the key role played by members of grassroots communities in responding to the HIV epidemic. Such representations provide flawed conceptual tools for shaping responses to the epidemic; given that HIV-related programmes are unlikely to have optimal outcomes unless they resonate with the perceived needs and interests of their target communities; as we contend that effective HIV/AIDS management is best achieved through active participation by communities in HIV/AIDS management strategies. We discuss the implications of a more 'civic-minded journalism

Hearing community voices: grassroots perceptions of an intervention to support health volunteers in South Africa

With the scarcity of African health professionals; volunteers are earmarked for an increased role in HIV/AIDS management; with a growing number of projects relying on grassroots community members to provide home nursing care to those with AIDS - as part of the wider task-shifting agenda. Yet little is known about how best to facilitate such involvement. This paper reports on community perceptions of a 3-year project which sought to train and support volunteer health workers in a rural community in South Africa. Given the growing emphasis on involving community voices in project research; we conducted 17 discussions with 34 community members; including those involved and uninvolved in project activities - at the end of this 3-year period. These discussions aimed to elicit local people's perceptions of the project; its strengths and its weaknesses. Community members perceived the project to have made various forms of positive progress in empowering volunteers to run a more effective home nursing service. However; discussions suggested that it was unlikely that these efforts would be sustainable in the long term; due to lack of support for volunteers both within and outside of the community. We conclude that those seeking to increase the role and capacity of community volunteers in AIDS care need to make substantial efforts to ensure that appropriate support structures are in place. Chief among these are: sustainable stipends for volunteers; commitment from community leaders and volunteer team leaders to democratic ideals of project management; and substantial support from external agencies in the health; welfare and NGO sectors

Cotrimoxazole for childhood febrile illness in malaria-endemic regions

The efficacy of co-trimaxozole for the treatment of Plasmodium falciparum parasitaemia in children younger than 5 years of age was evaluated in Malawi. 46 children with P falciparum parasitaemia; 37 percent of whom also met clinical criteria for acute respiratory tract infection; were treated with 20 mg/kg co-trimaxozole twice daily for five days. Parasitaemia (mean clearance time 2.7 days) and syptoms were rapidly abolished and improvement was maintained during the follow-up 14 days. Co-trimaxozole may be an effecitve single treatment for febrile illness in young children in areas where malaria is endemic; resources are few; and diagnosis must rely on clinical findings alone

In vivo efficacy of chloroquine treatment for Plasmodium falciparum in Malawian children under five years of age

In 1984 the government of Malawi instituted a program to reduce malaria mortality and morbidity in children less than 5 years of age as a part of the Combatting Childhood Communicable Diseases (CCCD) program. To define the appropriate malaria therapy regimen; investigators used a quality assurance design in a simplified 7-day in vivo drug response study with follow-up observations on day 2 (D2) ; D3; and D7 after the initial day of the study (D0). The efficacy of oral chloroquine was assessed in 224 children who were enrolled at 6 sites; 2 in each of the 3 administrative regions of Malawi. Parasitological failure; defined as failure of parasitemia to decrease by 75 percent of the value by D3 or presence of any detectable parasitemia on D7; ranged from 41 percent -65 percent following administration of chloroquine 25 mg (base)/kg. However; only 8 percent of children who were parasitemic on D7 were febrile or judged to be ill. Considering these therapeutic results and the higher cost and limited availability of alternative therapies; chloroquine 25 mg/kg therapy was adopted as the primary therapy for malaria