A Critical Analysis of the President's Emergency Plan for Aids Relief (PEPFAR) and Its Emphasis on Abstinence-Only Prevention

The President's Emergency Plan for AIDS Relief (PEPFAR) is the most recent in a series of policies aimed at promoting abstinence-only education over comprehensive sex education- those that combine information on abstinence, monogamy, and contraceptive use. United States policies promoting abstinence as the sole option for youth are as old as the AIDS pandemic itself- originating in 1981 with the Adolescent Family Life Act. PEPFAR represents the first exporting of abstinence-only education to developing nations besieged by HIV/AIDS. Numerous. evaluations have been conducted on the relative effectiveness of abstinence-only education and comprehensive sex education programs. These studies overwhelming illustrate the failure of abstinence-only programs to achieve their goals, while demonstrating the effectiveness of comprehensive sex education in delaying sex, reducing partners, and increasing contraceptive use. In support of this extensive evidence, several health organizations and associations - including the American Public Health Association, the Society for Adolescent Medicine, and the American Academy of Pediatricians - have generated policy statements supporting comprehensive sex education for youth. Despite the evidence, PEPFAR requires that two-thirds of funds available for prevention of the sexual transmission of HIV/AIDS be restricted to abstinence-only education interventions. PEPFAR and its supporters claim that abstinence-only education is an African solution to HIV/AIDS, citing Uganda's success in lowering its prevalence using what has come to be known as the ABC Model- Abstain, Be faithful, use Condoms. However, PEPFAR has significantly altered - some would say distorted - the Ugandan model. PEPFAR requires that donor recipients separate AB from C and remove information on contraception and condom use from their schools - in effect, transforming a model of comprehensive sex education for all into one that is essentially abstinence-only for youth. There has been an international outcry against PEPFAR and its feared impact on the HIV/AIDS pandemic. Meanwhile, Uganda - which receives more PEPFAR funds than any other country - reported in 2005 that the decline in the country's HIV prevalence rate has stagnated and even increased over the past three years, rising from 6.2 percent in 2002 to 7.1 percent in 2005 (UAC, 2005). Several U.S. policymakers have reexamined PEPFAR and legislation has been introduced in the House of Representatives to amend PEPFAR. It is critical that the PEPFAR's abstinence-only funding requirements be repealed, and that the ban on condom education for youth be lifted. On a larger scale, PEPFAR stands as a glaring example of ideology trumping evidence-based best practice. Clearly, we cannot assume that U.S. policymakers will support evidence-based best practices in IDV prevention. Therefore, health legislation with its potential for life or death consequences must be subject to review and approval by an independent panel of health experts.Master of Public Healt

Changes in public health preparedness services provided to local health departments by regional offices in North Carolina: a comparison of two cross-sectional studies

Background: In 2011, seven decentralized Public Health Regional Surveillance Teams (PHRSTs) were restructured into four centralized Public Health Preparedness and Response (PHP&R) regional offices to realign preparedness priorities and essential services with appropriate infrastructure; field-based staff was reduced, saving approximately $1 million. The objective of this study was to understand the impact that restructuring had on services provided to local health departments (LHDs) throughout North Carolina. Methods: A survey to document services that regional offices provide to LHDs in North Carolina was administered by the North Carolina Preparedness and Emergency Response Research Center in 2013. The results were compared to a similar survey from 2009, which identified services provided by regional teams prior to restructuring. Results: Of 69 types of assistance, 14 (20%) were received by 50% or more LHDs in 2012. Compared to 2009, there was a significant decrease in the proportion of LHDs receiving 67% (n = 47) of services. The size of the region served by regional offices was shown to inversely impact the proportion of LHDs receiving services for 25% of services. There was a slight significant decline in perceived quality of the services provided by regional teams in 2012 as comparison to 2009. Conclusions: Following a system-wide review of preparedness in North Carolina, the state’s regional teams were reorganized to refine their focus to planning, exercises, and training. Some services, most notably under the functions of epidemiology and surveillance and public health event response, are now provided by other state offices. However, the study results indicate that several services that are still under the domain of the regional offices were received by fewer LHDs in 2012 than 2009. This decrease may be due to the larger number of counties now served by the four regional offices

Changes in public health preparedness services provided to local health departments by regional offices in North Carolina: a comparison of two cross-sectional studies

Abstract: Background: In 2011, seven decentralized Public Health Regional Surveillance Teams (PHRSTs) were restructured into four centralized Public Health Preparedness and Response (PHP&R) regional offices to realign preparedness priorities and essential services with appropriate infrastructure; field-based staff was reduced, saving approximately $1 million. The objective of this study was to understand the impact that restructuring had on services provided to local health departments (LHDs) throughout North Carolina. Methods: A survey to document services that regional offices provide to LHDs in North Carolina was administered by the North Carolina Preparedness and Emergency Response Research Center in 2013. The results were compared to a similar survey from 2009, which identified services provided by regional teams prior to restructuring. Results: Of 69 types of assistance, 14 (20%) were received by 50% or more LHDs in 2012. Compared to 2009, there was a significant decrease in the proportion of LHDs receiving 67% (n = 47) of services. The size of the region served by regional offices was shown to inversely impact the proportion of LHDs receiving services for 25% of services. There was a slight significant decline in perceived quality of the services provided by regional teams in 2012 as comparison to 2009. Conclusions: Following a system-wide review of preparedness in North Carolina, the state’s regional teams were reorganized to refine their focus to planning, exercises, and training. Some services, most notably under the functions of epidemiology and surveillance and public health event response, are now provided by other state offices. However, the study results indicate that several services that are still under the domain of the regional offices were received by fewer LHDs in 2012 than 2009. This decrease may be due to the larger number of counties now served by the four regional offices

Linking public health agencies and hospitals for improved emergency preparedness: North Carolina's public health epidemiologist program

<p>Abstract</p> <p>Background</p> <p>In 2003, 11 public health epidemiologists were placed in North Carolina's largest hospitals to enhance communication between public health agencies and healthcare systems for improved emergency preparedness. We describe the specific services public health epidemiologists provide to local health departments, the North Carolina Division of Public Health, and the hospitals in which they are based, and assess the value of these services to stakeholders.</p> <p>Methods</p> <p>We surveyed and/or interviewed public health epidemiologists, communicable disease nurses based at local health departments, North Carolina Division of Public Health staff, and public health epidemiologists' hospital supervisors to 1) elicit the services provided by public health epidemiologists in daily practice and during emergencies and 2) examine the value of these services. Interviews were transcribed and imported into ATLAS.ti for coding and analysis. Descriptive analyses were performed on quantitative survey data.</p> <p>Results</p> <p>Public health epidemiologists conduct syndromic surveillance of community-acquired infections and potential bioterrorism events, assist local health departments and the North Carolina Division of Public Health with public health investigations, educate clinicians on diseases of public health importance, and enhance communication between hospitals and public health agencies. Stakeholders place on a high value on the unique services provided by public health epidemiologists.</p> <p>Conclusions</p> <p>Public health epidemiologists effectively link public health agencies and hospitals to enhance syndromic surveillance, communicable disease management, and public health emergency preparedness and response. This comprehensive description of the program and its value to stakeholders, both in routine daily practice and in responding to a major public health emergency, can inform other states that may wish to establish a similar program as part of their larger public health emergency preparedness and response system.</p

10 Guiding Principles of a Comprehensive Internet-Based Public Health Preparedness Training and Education Program

Distance learning is an effective strategy to address the many barriers to continuing education faced by the public health workforce. With the proliferation of online learning programs focused on public health, there is a need to develop and adopt a common set of principles and practices for distance learning. In this article, we discuss the 10 principles that guide the development, design, and delivery of the various training modules and courses offered by the North Carolina Center for Public Health Preparedness (NCCPHP). These principles are the result of 10 years of experience in Internet-based public health preparedness educational programming. In this article, we focus on three representative components of NCCPHP's overall training and education program to illustrate how the principles are implemented and help others in the field plan and develop similar programs

Escaping poverty and becoming poor in 36 villages of Central and Western Uganda

Twenty-four per cent of households in 36 village communities of Central and Western Uganda have escaped from poverty over the past 25 years, but another 15 per cent have simultaneously fallen into poverty. A roughly equal number of households escaped from poverty in the first period (ten to 25 years ago) as in the second period (the last ten years) examined here. However, almost twice as many households fell into poverty during the second period as in the first period. Progress in poverty reduction has slowed down as a result. Multiple causes are associated with descent into poverty and these causes vary significantly between villages in the two different regions. For nearly two-thirds of all households in both regions, however, ill health and health-related costs were a principal reason for descent into poverty. Escaping poverty is also associated with diverse causes, which vary across the two regions. Compared to increases in urban employment, however, land-related reasons have been more important for escaping poverty in both regions.