Issues and Challenges of HIV/AIDS Prevention and Treatment Programme in Nepal

This paper explores some of the key issues and challenges of government HIV/AIDS prevention and treatment programme in Nepal. Providing HIV/AIDS prevention and treatment services in Nepal is associated with a number of issues and challenges which are shaped mostly on cultural and managerial issues from grass root to policy level. Numerous efforts have been done and going on by Nepal government and non-government organization but still HIV prevention and treatment service is not able to reach all the most at risk populations because cultural issues and managerial issues are obstructing the services. The existing socio-cultural frameworks of Nepal do not provide an environment for any safe disclosure for person who is HIV infected. Thus, there is an urgent need to address those issues and challenges and strengthen the whole spectrums of health systems through collaborative approach to achieve the millennium development goals. It will be the purpose of this paper to contribute to the policy makers by exploring the pertinent issues and challenges in the HIV/AIDS programme

HIV/AIDS, Security and Conflict: New Realities, New Responses

Ten years after the HIV/AIDS epidemic itself was identified as a threat to international peace and security, findings from the three-year AIDS, Security and Conflict Initiative (ASCI)(1) present evidence of the mutually reinforcing dynamics linking HIV/AIDS, conflict and security

Alternatives to prohibition illicit drugs: how we can stop killing and criminalising young Australians

This report follows from a Roundtable discussion held in July 2012 to consider new approaches to public policy about illicit drugs in Australia. An earlier Australia21 report launched in April 2012 had concluded that attempts to control drug use through the criminal justice system have clearly failed. They have also caused the needless and damaging criminalisation of too many young people, often with adverse life-changing consequences, including premature death from overdose

Tipping the Balance: Why Legal Services Are Essential to Health Care for Drug Users in Ukraine

Examines the need to integrate legal support for drug users with harm reduction programs to effectively stem the spread of HIV/AIDS. Discusses approaches, legal problems, and recommendations for government policy and for nongovernmental organizations

Children talk about living with problem drug and alcohol use.

‘She knew not to go near me in the morning ’til I had my foil, then ‘mummy would play’. In the mornings the sickness was the worst … I’d just be telling her to get away. Once I had the gear [drugs] into me I’d be the best mother on the earth.’ These words were spoken by a mother of a four-year-old girl interviewed as part of a research study in Ireland published last year. It is quoted in a new EMCDDA thematic paper on European children’s experiences and perceptions of drug and alcohol issues, published to mark International Children’s Day on 1 June.1 The purpose of the paper is to enhance drug policies and interventions for children and young people by highlighting children’s and young people’s perspectives and their needs. Comprising quotations selected from research studies and governmental and non-governmental reports in 14 EU countries, including Ireland, the thematic paper gives voice to four main issues: o living with harmful parental drinking or drug taking (neglect, violence, abuse, stigma or shame), o being separated from parents and looked after by relatives, foster carers or institutions, o experiences and perceptions of alcohol and drug consumption, and o experiences and perceptions of interventions to address alcohol and drug consumption. The authors consulted three Irish sources2 and used quotations from them to highlight issues associated with living with parents engaging in harmful substance use, and children’s and young people’s own experience of substance use. For example, an Irish child care worker is quoted on the effect of living with a parent engaging in harmful substance use: ‘They become adults very young; they’re like the carer to their parent. They actually know, you can see it in them, that they know when their parent isn’t well … it seems to be a constant worry.’ Looking back, a young Irish woman who had been abused by a member of her extended family during her childhood recalled her teenage years: ‘I turned 15 that January, I just went wild then you know after that like. I did have problems at home … Like when I was growing up, that would have been the start of it, but then I just used to go wild you know with the problems and the issues that I did have, I’d end up going drinking and taking drugs, you know, and not having any, no self-respect or anything for myself.’ In concluding the report, the authors make several observations: o given the complexity and diversity of children’s experiences, correspondingly flexible and holistic interventions need to be developed; o more qualitative drug and alcohol research is needed if Europe is to understand the real needs of children and young people and to implement fully the United Nations Convention on the Rights of the Child (UNCRC); o large numbers of parents with alcohol problems may generate more problems overall for children in the EU than the smaller number of children affected by parents with illicit drug problems; o the quotations highlight children’s extreme vulnerability, and yet also their desire and capacity to ‘cope’ with difficulties and to make rational judgements about their own situation based on objective information and personal experience; o while quality care and other drug and alcohol interventions are needed to grant children in the EU their right to ‘harmonious development and protection from harmful influences’, abuse, neglect and exploitation, the root cause for many children facing both drug and alcohol problems are poverty and social exclusion. 1. Olszewski D, Burkhart G and Bo A (2010) Children’s voices: experiences and perceptions of European children on drug and alcohol issues. Thematic paper. Luxembourg: The Publications Office of the European Union. Available at www.emcdda.europa.eu 2. The three Irish research studies used in the EMCDDA thematic paper were Bates T, Illback RJ, Scanlan F and Carroll L (2009) Somewhere to turn to, someone to talk to. Dublin: Headstrong – The National Centre for Youth Mental Health; Mayock P (2000) Choosers or losers: influences on young people’s choices about drugs in inner-city Dublin. Dublin: Children’s Research Centre, TCD; Mayock P and Carr N (2008) Not just homelessness … A study of ‘out of home’ young people in Cork city. Dublin: Children’s Research Centre, TCD. These three research reports are available at www.drugsandalcohol.i

Advancing the Right to Health: The Vital Role of Law

Effective laws and an enabling legal environment are essential to a healthy society. Most public health challenges – from infectious and non-communicable diseases to injuries, from mental illness to universal health coverage – have a legal component. At global, national and local levels, law is a powerful tool for advancing the right to health. This tool is, however, often underutilized. This report aims to raise awareness about the role that public health laws can play in advancing the right to health and in creating the conditions for all people to live healthy lives. The report provides guidance about issues and requirements to be addressed during the process of developing or reforming public health laws, with case studies drawn from countries around the world to illustrate effective practices and critical features of effective public health legislation. Advancing the right to health: the vital role of law is the result of a collaboration between the World Health Organisation, the International Development Law Organisation (IDLO), the O’Neill Institute for National and Global Health Law, Washington D.C., USA, and Sydney Law School, University of Sydney. The Project Directors were: Professor Lawrence O. Gostin, Linda D. and Timothy J. O’Neill Professor of Global Health Law and University Professor, Georgetown University; Faculty Director, O’Neill Institute for National and Global Health Law, Georgetown University; Mr David Patterson, Senior Legal Expert – Health; Department of Research & Learning, International Development Law Organization; Professor Roger Magnusson, Professor of Health Law & Governance, Sydney Law School, University of Sydney; Mr Oscar Cabrera, Executive Director, O’Neill Institute for National and Global Health Law, Georgetown University Law Center; Ms Helena Nygren-Krug (2011–2013), Senior Advisor, Human Rights & Law, UNAIDS. The content and structure of the report reflect the consensus reached at the second of two international consultations in public health law that preceded the preparation of the report, hosted by WHO and IDLO in Cairo, Egypt, 26-28 April 2010. Part 1 introduces the human right to health and its role in guiding and evaluating law reform efforts, including efforts to achieve the goal of universal health coverage. Part 2 discusses the process of public health law reform. The law reform process refers to the practical steps involved in advancing the political goal of law reform, and the kinds of issues and obstacles that may be encountered along the way. Part 2 identifies some of the actors who may initiate or lead the public health law reform process, discusses principles of good governance during that process, and ways of building a consensus around the need for public health law reform. Part 3 turns from the process of reforming public health laws to the substance or content of those laws. It identifies a number of core areas of public health practice where regulation is essential in order to ensure that governments (at different levels) discharge their basic public health functions. Traditionally, these core areas of public health practice have included: the provision of clean water and sanitation, monitoring and surveillance of public health threats, the management of communicable diseases, and emergency powers. Building on these core public health functions, Part 3 goes on to consider a range of other public health priorities where law has a critical role to play. These priorities include tobacco control, access to essential medicines, the migration of health care workers, nutrition, maternal, reproductive and child health, and the role of law in advancing universal access to quality health services for all members of the population. The report includes many examples that illustrate the ways in which different countries have used law to protect the health of their populations in ways that are consistent with their human rights obligations. Countries vary widely in terms of their constitutional structure, size, history and political culture. For these reasons, the examples given are not intended to be prescriptive, but to provide useful comparisons for countries involved in the process of legislative review

Recognizing the influence of social determinants on HIV risk behaviors and the need for structural interventions to prevent HIV in women

The design and implementation of structural interventions may provide for simultaneous and longitudinal responses to prevention needs in multiple contexts as defined by social determinants, thus varied opportunities exist to respond to the HIV prevention needs of women. According to the CDC, in 2010, the rate of new HIV infections among black women was 20 times that of white women, and the rate among Hispanic/Latino women was 4 times the rate of white women. Additionally, 86% of HIV infections in women were attributed to heterosexual contact and 14% to injection drug use (CDC, 2012). These numbers are reflected outside the US with 49% of those infected by HIV being women with a predominant source of infection being related to heterosexual transmission (WHO, 2008). In sub-Saharan Africa, of those living with HIV, 60% are women. Attention to the influential context of social determinants of health provides unique opportunities for innovative prevention practice in HIV/AIDS prevention for women. In this paper, social determinants of health as an influential, behavioral concept is defined both in terms of women’s health and their sexual behavior decision making, along with examples of potential structural interventions that not only address the social determinants of their HIV risks but also reflect the contextual complexity of their life experiences. An earlier study (Abdul-Qader and Collins, 2011) solicited statements from a sample of experts in HIV prevention and areas of public health to identify potential structural interventions that would be feasible and impactful regarding HIV prevention - the DHAP Structural Interventions Mapping project. Data was elicited from these stakeholders most likely to be designing and guiding interventions to determine their perspectives on feasible and impactful structural intervention to address sexual behavior in women. The current paper is based on secondary analysis of 20 of these potential structural interventions generally and specifically applicable to women and their HIV prevention needs. Qualitative analysis resulted in three overall themes of economic interventions, response to violence against women and integrated health service delivery strategies that address key health-belief and socio-cultural issues. The themes are reflected and substantiated in current research literature, and provide a foundation for the next steps regarding research, policy planning and program implementation for developing evidence-based structural interventions focused on preventing HIV in women