Intricate links : displacement, ethno-political conflict, and claim-making to land in Burundi

This paper explores claim-making to land in Burundi, where civil war and multiple waves of displacement and return have resulted in complex disputes over land. Zooming in on two different regions, the paper shows that, as people articulate their claims and defend their interests in land disputes, they strategically draw on a diversity of arguments, related to legal categories, notions of belonging and citizenship, social categories derived from (land) policy, but also victimhood, security concerns, and political loyalty. Post-peace agreement land policies play an important role in this, as they instrumentalise war-based categories of identity and victimhood, privileging certain groups of displaced people for political purposes. As we show in two case studies, claim-making tactics follow shifting political discourses and policy changes, as people seek to secure the support of (powerful) allies. A perspective on processes of making claims to land allows us to explore the entanglements between multiple waves of displacement, policy implementation and the instrumentalisation of identities in conflict-affected settings.ASC – Publicaties niet-programma gebonde

Individual and healthcare supply-related barriers to treatment initiation in HIV-positive patients enrolled in the Cameroonian antiretroviral treatment access programme

International audienceIncreasing demand for antiretroviral treatment (ART) together with a reduction in international funding during the last decade may jeopardize access to ART. Using data from a cross-sectional survey conducted in 2014 in 19 HIV services in the Centre and Littoral regions in Cameroon, we investigated the role of healthcare supply-related factors in time to ART initiation in HIV-positive patients eligible for ART at HIV diagnosis. HIV service profiles were built using cluster analysis. Factors associated with time to ART initiation were identified using a multilevel Cox model. The study population included 847 HIV-positive patients (women 72%, median age: 39 years). Median (interquartile range) time to ART initiation was 1.6 (0.5-4.3) months. Four HIV service profiles were identified: (1) small services with a limited staff practising partial task-shifting (n = 4); (2) experienced and well-equipped services practising task-shifting and involving HIV community-based organizations (n = 5); (3) small services with limited resources and activities (n = 6); (4) small services providing a large range of activities using task-shifting and involving HIV community-based organizations (n = 4). The multivariable model showed that HIV-positive patients over 39 years old [hazard ratio: 1.26 (95% confidence interval) (1.09-1.45), P = 0.002], those with disease symptoms [1.21 (1.04-1.41), P = 0.015] and those with hepatitis B co-infection [2.31 (1.15-4.66), P = 0.019] were all more likely to initiate ART early. However, patients in the first profile were less likely to initiate ART early [0.80 (0.65-0.99), P = 0.049] than those in the second profile, as were patients in the third profile [association only significant at the 10% level; 0.86 (0.72-1.02), P = 0.090]. Our findings provide a better understanding of the role played by healthcare supply-related factors in ART initiation. In HIV services with limited capacity, task-shifting and support from community-based organizations may improve treatment access. Additional funding is required to relieve healthcare supply-related barriers and achieve the goal of universal ART access