Who Governs Public Health? Donor Retreat and the Shifting Spheres of Influence in Southern African HIV/AIDS Policy Making

For the last decade, discussions about who governs policy on prevention and treatment of HIV/AIDS have revolved around  the  controversial  relationship  between Western  donors and  the  power  they  have  over  their  recipient governments. While these debates were once politically germane, recent trends show a decline of donor funding, as well as an increase of financial  ownership of the epidemic within Southern Africa. Commensurate with this shifting financial influence, some well‐governed, wealthy  African  states  are  beginning  to  deviate  from  global  M&E  (monitoring  and  evaluation)  indicators.  These  policy movements, away  from global M&E indicators, also  correlate with increases in HIV  prevalence, which  signals  the  need  for  further investigation into policy efficacy.  

Donor Agendas, Community Priorities and the Democracy of International HIV/AIDS Funding

Each year, donors channel $7.6 billion into HIV programming in affected countries. With this funding often comes significant control over interventions at country level, though there is considerable skepticism about the value of donor-driven strategies. Locally conceived approaches are believed to be more effective, but it is not always clear that donors are responding accurately or appropriately to the priorities of communities. Concept notes submitted to the Global Fund to Fight AIDS, Tuberculosis and Malaria by eight African countries were systematically measured to determine their responsiveness to community priorities. National Civil Society Priorities Charters were used as a measure of community-identified needs. Malawi’s concept note was by far the most responsive to civil society priorities and Zambia’s was the least. The concept notes were the most responsive to civil society priorities on key populations’ issues, and the least responsible on priorities related to voluntary medical male circumcision. Statistically significant relationships were found between the responsiveness of Global Fund concept notes and Afrobarometer indicators on democracy, participation and civic engagement. There was also a significant relationship found between the voice and accountability rankings from the World Governance Indicators. This makes a compelling case to show that a context of democracy is linked to civil society’s ability to influence HIV/AIDS funding decisions at national level. Understanding the factors which hinder or enable community-led program development is critical for a more effective HIV response

Lesbian, gay, bisexual, transgender and intersex human rights in Southern Africa: A contemporary literature review

Individuals engaging in same-sex acts, individuals identifying as lesbian, gay, bisexual, transgender, and/ or intersex (LGBTI), and individuals who do not conform to heteronormative ideals of gender and sexuality experience structural, institutional and individual discrimination and exclusion across the world. This is no different in Southern African countries. While LGBTI individuals are heterogeneous and face very specific challenges based on their sexual orientation, gender identity, race, class, ethnicity and other factors, they share experiences of structural, institutional and individual discrimination and marginalisation based on their sexual orientation and gender identity (SOGI). In most Southern African countries, same-sex activity remains criminalised, which further marginalises LGBTI individuals, and acts as an additional barrier to accessing public services and realising full civil and political rights. This contemporary literature review focuses on the state of LGBTI human rights in 10 Southern African countries: Angola, Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. The purpose of this review is to contribute towards a strong evidence base and scientific foundation for informed programming in the region

Who governs public health? : the spheres of influence in southern AFrican HIV/AIDS policy making.

Includes abstract. Includes bibliographical references

Effectiveness of the Sista2Sista programme in improving HIV and other sexual and reproductive health outcomes among vulnerable adolescent girls and young women in Zimbabwe

Background: In Zimbabwe, adolescent girls and young women (AGYW) experience high rates of HIV and other sexual and reproductive health challenges. In 2013, the Zimbabwe Ministry of Health and Child Care partnered with the United Nations Population Fund to implement the Sista2Sista programme, a structured peer group intervention aimed at improving health outcomes among vulnerable in- and out-of-school AGYW.Methods: Programme data was analysed for 91 612 AGYW aged 10–24 years old who participated in Sista2Sista from 2013 to 2019. Logistic regression was used to determine odds ratios (OR) and evaluate programme exposure as a factor in a set of defined variables.Results: 58 471 AGYW (63.82%) graduated from the Sista2Sista programme by completing at least 30 of 40 exercises. Graduates were more likely to take an HIV test (2.78 OR 95% CI 2.52–3.10), less likely to get married (0.63 OR 95% CI 0.55–0.73) and less likely to drop out of  school (0.60 OR 95% CI 0.53–0.69). At higher thresholds of programme completion, additional positive outcomes were observed. Participants who completed all 40 exercises were more likely to return to school (1.41 OR 95% CI 1.18–1.69), more likely to use  contraception (1.38 OR 95% CI 1.21–1.56), more likely to report sexual abuse (1.76 OR 95% CI 1.17–2.66), and less likely to become pregnant as adolescents (0.41 OR 95% CI 0.24–0.72). Individual counselling improved the likelihood of programme graduation.Conclusions: The Sista2Sista programme had a positive effect on HIV and other sexual health outcomes among vulnerable AGYW in Zimbabwe. Strategies to improve graduation rates should be explored