The US President's Emergency Plan for AIDS Relief (PEPFAR) is funding thousands of community-based organisations, international NGOs and government services in high HIV prevalence countries to persuade young people to abstain from sex until marriage (Abstinence, Behaviour Change, Youth--ABY). This paper describes how this strategy is being implemented in Zambia, and community responses to it. It is derived from published information and observations and discussions in the Eastern Province in 2005-2006. A few NGOs have challenged the strategy, but many took the funds and are paying large numbers of peer educators to promote abstinence only. Messages are rife that condoms have holes or don't work sufficiently well to make them worth using. Condom promotion materials have been replaced. Service providers refuse to give condoms to young people. Young people who had attended sexuality and life skills programmes that gave them accurate information are rejecting inaccurate messages and demanding condoms. Without this education, however, inaccurate messages will spread quickly. It is not possible to promote condoms only for high risk people without stigmatising both the people and condoms, and it also jeopardises promoting condom use for contraception. Everything possible must be done to reduce negative messages about condoms. Everyone involved in HIV/AIDS needs to reflect on their own work in relation to this new climate and ensure that all prevention options are widely available, correct information is given and condoms are available for everyone who needs them.
Objective: To evaluate the effects of a transformative training programme on children aged 5–14 years affected by HIV and their caregivers. Method: A formative process was used to draft, pilot and finalise training materials in Tanzania. We ran workshops with children living with HIV, their caregivers and some siblings in four communities. We assessed changes in knowledge, attitudes and well-being, and compared the health of child participants living with HIV with that of a control group of children living with HIV. Results: Although we intentionally excluded ‘disclosure’ of HIV sero-status to children as an indicator, the proportion who knew their sero-status increased from 27% to 93%. Assessment of clinical data before and after the workshops showed a statistically significant increase ( p-value of <.01) in the CD4 count among the child participants living with HIV ( n = 85, mean CD4 change + 317; from 530 to 847) compared with the control group ( n = 91, mean CD4 change + 133; from 557 to 690). The mean weight gain was 3.51 kg for child participants and 1.33 kg for controls. Other benefits included improved relationships and reduced violence against the children, greater confidence, more willingness to use HIV services and better networks of support. Conclusion: The Stepping Stones with Children programme can achieve multiple outcomes, including disclosure and better adherence to treatment, to reduce the impact of the adverse childhood experience of being affected by HIV. It is possible and acceptable to include children aged five and over in learning about HIV, sexual health and skills to improve their resilience.
Summary This article outlines some of the ways in which women are particularly vulnerable to risk in relation to their sexuality, and suggests how primary health care programme could begin to address the impact of sexuality on health in a holistic and gender specific way. The article discusses the cultural and economic determinants of sexual expression and explores how these influence people's options for practising safer sex. Personal values around sexuality have a particularly profound influence on programme design and implementation. The first steps in any programme would be an exploration of how sexuality relates to health in different groups, followed by training which enables staff to address this area comfortably without imposing their own values. A genuinely participatory programme would acknowledge sexual diversity and respond to a range of needs. It would aim to empower people to make their own informed decisions, explore their values and practise skills. Often a development approach will be needed which involves activities outside the normal remit of the health sector. Integrating sexuality into PHC in this could have far‐reaching consequences. At the very least, it would highlight the way in which existing power relations between men and women, generations and people with different sexual orientations have severely detrimental effects on the health of the whole community. Resumé La sexualité — l'aspect négligé de la santé des femmes Les auteurs passent en revue certains des éléments qui rendent les femmes particulièrement vulnérables au risque et qui ont trait à leur sexualité, et suggèrent différentes approches holistiques et spécifiques aux femmes que peuvent adopter les programmes de soins de santé primaires dans un premier temps. Les déterminants culturels et économiques de l'expression sexuelle sont examinés ainsi que leur influence sur le choix des individus d'avoir des rapports protégés. Les valeurs personnelles sur la sexualité ont une profonde influence sur l'élaboration et la mise en oeuvre des programmes. La première démarche dans tout programme devrait être d'explorer la relation entre sexualité et santé, dans les différents groupes, approche qui serait suivie d'une formation pour permettre aux personnels d'aborder ce domaine débarrassé de tout préjugé et sans imposer leurs propres valeurs. Un programme vraiment participatif ne manquerait pas de reconnaitre la diversité sur le plan sexuel et de répondre à toute une gamme de besoins. Ce programme chercherait à offrir aux individus les moyens de décider en toute connaissance de cause, d'explorer leurs propres valeurs, et de faire valoir leurs compétences. Il sera souvent demandé de mettre en oeuvre des activités qui dépassent le cadre usuel de la santé. Intégrer la sexualité dans les soins de santé peut avoir des conséquences de longue portée. Tout au moins cette démarche soulignerait la manière dont les rapports de force entre hommes et femmes, entre générations et individus d'orientations sexuelles diverses ont des effets néfastes sur la s...
In recent years there have been an increasing number of attempts to survey the distribution of psychiatric morbidity, or to estimate the need for psychiatric treatment, in the general population. Various methods of defining or diagnosing psychiatric illnesses have been used (Blum, 3; Scott, 20). These methods include interviews by psychiatrists (Lin, 17; Essen-Müller, 13; Hagnell, 14); the judgment of family physicians (11; Kessel, 16; Shapiro and Fink, 21); the use of self-administered symptom check lists (White et al., 23); and structured interviews by non-psychiatrists relating to symptom occurrence, attitudes, personality scales, etc. This paper outlines an attempt to determine some of the relationships between the results of a symptom-questionnaire; the diagnoses recorded by physicians; and the physicians' request for psychiatric consultation.
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