Understanding the linkages between informal and formal care for people living with HIV in sub-Saharan Africa.

In response to the human resource challenges facing African health systems, there is increasing involvement of informal care providers in HIV care. Through social and institutional interactions that occur in the delivery of HIV care, linkages between formal and informal systems of care often emerge. Based on a review of studies documenting the relationships between formal and informal HIV care in sub-Saharan Africa, we suggest that linkages can be conceptualised as either 'actor-oriented' or 'systems-oriented'. Studies adopting an actor-oriented focus examine hierarchical working relationships and communication practices among health systems actors, while studies focusing on systems-oriented linkages document the presence, absence or impact of formal inter-institutional partnership agreements. For linkages to be effective, the institutional frameworks within which linkages are formalised, as well as the ground-level interactions of those engaged in care, ought to be considered. However, to date, both actor- and system-oriented linkages appear to be poorly utilised by policy makers to improve HIV care. We suggest that linkages between formal and informal systems of care be considered across health systems, including governance, human resources, health information and service delivery in order to improve access to HIV services, enable knowledge transfer and strengthen health systems.

Living as an adolescent with HIV in Zambia -- lived experiences, sexual health and reproductive needs.

HIV services in developing countries are often ill-equipped to address the specific needs of HIV-positive adolescents. Studies suggest a lack of consistent, age-appropriate support regarding sexuality, relationships and transitioning to adulthood. The aims of this study were to explore and document the informational, psychosocial, sexual and reproductive health (SRH) needs of adolescents (aged 10-19 years) living with HIV in Zambia, and identify gaps between these needs and existing services. This paper reports a qualitative explorative study. Semi-structured interviews and focus group discussions were conducted with 111 HIV-positive adolescents and 59 key informants, including health care workers (n=38) and parents/guardians (n=21). Participants were selected via a purposive sampling method. Three sites - Lusaka, Kitwe and Kalomo - were selected to ensure a broad representation of service-delivery settings in Zambia. Data were entered into NVIVO (QSR International) software, and analysed inductively to extract key themes, gather results and draw conclusions. Findings confirm that social networks have significant impact on treatment adherence and assist adolescents in coming to terms with an HIV diagnosis. The trauma of diagnosis, however, is exacerbated if poorly managed. Nevertheless, many adolescents are determined not to let HIV change their lives. They want to know SRH and HIV information, but service providers do not often adequately meet these informational needs. Where available, tailored and participatory events around HIV and SRH are greatly appreciated. Services that are welcoming, empowering and provide tailored information are highly valued. Adolescents living with HIV require effective, targeted and sustainable HIV services to navigate safely through adolescence.

Only connect--the role of PLHIV group networks in increasing the effectiveness of Ugandan HIV services.

In recent years, Uganda has experienced rapid growth in networked groups of people living with HIV (PLHIV) who provide support, engage in advocacy, treatment and care and raise the profile of HIV in the public domain. This qualitative study focused the benefits of joining a networked group, relationships between groups, impact of networked groups on the community and shaping private and public experience living with HIV. Data were collected from two Ugandan districts, using semi-structured interviews, focus group discussions (FGDs), observation and reviews of group records and archives. Respondents (n=46) were adults living with HIV, and members of rural and urban PLHIV groups. Narratives from PLHIV (n=27) were gathered, and records from PLHIV group service-registers (n=20) reviewed. Key Informants (n=15) were purposively selected for interview, based on participation in PLHIV groups, utilisation of network services and their positions as key stakeholders. FGDs were held with network support agents (NSAs), members of PLHIV groups, and their leaders. Following qualitative analysis, findings suggest that for respondents, PLHIV networks enhance the impact and effectiveness of individual groups: the whole is greater than the sum of the parts. For groups, being part of a wider network allows for diversity of service delivery, and well-defined roles for individuals to participate in community support and sensitisation, with a reduction in the experience of stigma. We conclude that networking PLHIV groups is an effective strategy for improving the quality and reach of community-based HIV services. Governments should be encouraged to support networks and include them in policy-making at the national level. Local and regional groups should explore further ways to collaborate and expand support to PLHIV in Uganda.

Should public health be exempt from ethical regulations? Intricacies of research versus activity.

OBJECTIVE: To assess the role of ethical regulations in public health practice, and to review the need to exempt any public health activity from such ethical regulations. METHODS: Literature review of published papers regarding ethical regulations in public health practice. RESULTS: There is a current criticism of public health ethics as hindering rather than facilitating public health research. There is also an existing dilemma as to which Public health activities constitute research and are therefore subject to ethical regulations and which ones are exempt from such regulations. CONCLUSION: Exempting some public health activities from ethical regulation may occasion an inherent risk of subjective interpretation of the criteria guiding the distinction between Public health research and non-research. In order to avoid inadvertent breach of ethical regulations, ethical regulations should be applied to all public health activities whether formally classified as research or not.

Should Public Health be Exempt from Ethical Regulations? Intricacies of Research Versus Activity

Objective: To assess the role of ethical regulations in public health practice; and to review the need to exempt any public health activity from such ethical regulations. Methods: Literature review of published papers regarding ethical regulations in public health practice. Results: There is a current criticism of public health ethics as hindering rather than facilitating public health research. There is also an existing dilemma as to which Public health activities constitute research and are therefore subject to ethical regulations and which ones are exempt from such regulations. Conclusion: Exempting some public health activities from ethical regulation may occasion an inherent risk of subjective interpreta- tion of the criteria guiding the distinction between Public health research and non-research. In order to avoid inadvertent breach of ethical regulations; ethical regulations should be applied to all public health activities whether formally classified as research or not