Technical assistance for health in non-conflict fragile states: challenges and opportunities.

The paper examines how best technical assistance (TA) for health might be implemented in post-conflict fragile states. It does so in the light of current development trends such as harmonization and alignment and moves towards aid instruments that favour country-led approaches. A number of key issues are addressed. The first of these considers which core principles for ethical TA might apply in post-conflict fragile states; the second reviews thematic challenges, such as the need to balance 'good enough governance' with effective attention to equity, rights and working with local health capacity. A third area for discussion is how best to plan for, and implement, long-term health TA inputs in often volatile and insecure environments, while a fourth topic is the engagement of civil society in rebuilding health systems and service delivery post-conflict. Attention to gender issues in post-conflict fragile states, including the importance of acknowledging and acting upon women's roles in peacekeeping and maintenance, the necessity to apply and sustain more gender equitable approaches to health in such contexts and how TA might facilitate such participation, represents the fifth issue for debate.

Ectodermal dysplasia. A seven-year case report.

This case report describes the manifestations of ectodermal dysplasia and tracks the seven-year management of a male ED patient. It demonstrates the benefits of early intervention, describes restorative and orthodontic treatment rendered, and a range of future treatment options available when early intervention is employed.

Does conflict increase vulnerability to HIV infection? Issues for a research agenda.

Much action has been taken in the last ten years to prevent and mitigate HIV infection in times of conflict, yet two fundamental questions remain unanswered: Does conflict always and everywhere increase vulnerability to HIV infection, and are women and girls always disproportionately affected? This paper considers the ways in which conflict, gender inequality and HIV prevalence and infection rates may or may not be connected; its intention is to map key areas for a research agenda addressing issues of HIV/AIDS, gender and conflict. Consideration is also given to how HIV prevention and mitigation activities in times of conflict, transition, and the post-conflict reconstruction and development phase might best serve vulnerable populations. In the worst instance, failure to achieve some consensus on the best way forward might contribute to reduced attention by the international community and donors to civilian populations' vulnerability to HIV infection during times of conflict.

HIV/AIDS and community conflict in Nigeria: implications and challenges.

This paper discusses how HIV/AIDS prevention, treatment and mitigation activities and funding for such work can lead to community conflict. The central role of communities in combating HIV/AIDS is widely agreed, with the contributions of social capital networks and civil society seen as pivotal; a rights-based approach to HIV/AIDS activities is considered essential. Yet experiences from a UK Department for International Development funded project in Nigeria suggest that greater critical attention must be given to the impacts and effects of HIV/AIDS on communities, and the ways in which conflict can develop, emerge and be sustained, resulting in severe breakdown of social cohesion and reduction or cessation of HIV/AIDS activities. It is argued here that conflict can be fuelled by the different priorities and perceptions of community members and groups vis-à-vis those of development organisations, and by the impact of funds on often desperately poor communities. Case studies analyse the development of the conflict, failed attempts at resolution, and two post-conflict project interventions whose design and implementation were informed by its experiences and outcome. The paper concludes by considering the potential input of participatory approaches, community psychology and change management in the development and implementation of HIV/AIDS interventions specifically so as to reduce potential for conflict. Its intention is to contribute to the debate on how best to implement genuinely community-based and managed HIV/AIDS interventions.

Silent survivors of sexual violence in conflict and the implications for HIV mitigation: experiences from Eritrea.

This paper considers the impacts of sexual violence perpetrated while the Eritrean town of Senafe was occupied by the Ethiopian military in 2000, during the second Ethiopia-Eritrea war. It discusses the aftermath for the survivors, all women and girls belonging to the Saho ethnic group, and the responses of other groups in the Saho community. An attempt is made to understand the reasons for the failure of one intervention that sought to provide support to these survivors of sexual violence. The potential repercussions of community denial of the sexual violence are addressed. These include lack of access by survivors to information on HIV, testing and care; refusal to face up to the possible infection of survivors, their husbands and unborn children, and to the psychological, social and economic impacts of HIV/AIDS.

Vulnerability to malaria, tuberculosis, and HIV/AIDS infection and disease. Part II: Determinants operating at environmental and institutional level.

This review summarises a wide range of evidence about environmental and institutional factors that influence vulnerability to malaria, tuberculosis, and HIV infection. By combining this information with that obtained on factors operating at individual, household, and community level, we have identified potential common strategies for improving resilience to all three diseases simultaneously. These strategies depend on collaborations with non-health sectors and include progress in rapid access to funds, provision of education about disease transmission and management, reduction of the burden on carers (predominantly women), and improvement in the quality of health services.

Vulnerability to malaria, tuberculosis, and HIV/AIDS infection and disease. Part 1: determinants operating at individual and household level.

A high burden of malaria, tuberculosis, and HIV infection contributes to national and individual poverty. We have reviewed a broad range of evidence detailing factors at individual, household, and community levels that influence vulnerability to malaria, tuberculosis, and HIV infection and used this evidence to identify strategies that could improve resilience to these diseases. This first part of the review explores the concept of vulnerability to infectious diseases and examines how age, sex, and genetics can influence the biological response to malaria, tuberculosis, and HIV infection. We highlight factors that influence processes such as poverty, livelihoods, gender discrepancies, and knowledge acquisition and provide examples of how approaches to altering these processes may have a simultaneous effect on all three diseases.