Greater involvement of PLHA In NGO service delivery: Findings from a four-country study

At the conclusion of the Paris AIDS Summit in 1994, 42 governments issued a declaration supporting the greater involvement of people living with HIV/AIDS (PLHA) in policy formulation and service delivery. Despite growing recognition of its importance, there has been little research that examines PLHA involvement in the delivery of prevention, care, and support services in developing countries and its effects on PLHA, others affected by HIV/AIDS, and nongovernmental organizations (NGOs). To address this gap, the Horizons Program and the International HIV/AIDS Alliance conducted a study of PLHA involvement in NGOs in Burkina Faso, Ecuador, Maharashtra State, India, and Zambia between October 1998 and August 2001. As noted in this brief, the goal of the study was to identify the conditions that foster PLHA involvement and the strategies that organizations can use to achieve meaningful involvement of PLHA. Seventeen NGOs participated in the study, which focuses on HIV/AIDS prevention, care, and support. The NGOs chosen represent different types of organizations and a range of PLHA involvement

Ndola Demonstration Project: A midterm analysis of lessons learned

This report summarizes baseline and midterm findings of an intervention pilot study conducted by Horizons, LINKAGES, National Food and Nutrition Commission, District Health Management Team, Hope Humana, and the Zambia Integrated Health Program in Ndola District, Zambia. The aim of the research is to investigate how integrating services for the prevention of mother-to-child transmission (PMCT) of HIV into low-resource maternal and child health (MCH) and antenatal care (ANC) settings influences women’s ability to make and implement informed decisions about HIV. The intervention strengthened routine services and introduced HIV voluntary counseling and testing and PMCT counseling and services into the MCH/ANC setting. Exclusive breastfeeding was promoted for all mothers with infants below six months of age

Microfinance and households coping with HIV/AIDS in Zimbabwe: An exploratory study

The widespread prevalence of HIV/AIDS in sub-Saharan Africa adversely affects millions of households. In recent years, microfinance has been proposed as a strategy to help the households of microentrepreneurs respond to the negative economic impacts of HIV/AIDS. This attention to the potential role of microfinance builds upon earlier research that shows that microfinance institutions (MFIs) that charge commercial rates of interest and use sound business practices can become operationally self-sustainable and help improve the lives of the poor and vulnerable nonpoor. This type of MFI generally offers small loans, often combined with savings services. An MFI may also offer business management training, health and nutrition education, and other types of services. This brief presents findings from a study conducted in Zimbabwe that sought to better understand the relationship between a microfinance program, Zambuko Trust, and how microentrepreneurs’ households cope with the impact of HIV/AIDS. The study also examined how HIV/AIDS is affecting Zambuko’s operations and what MFIs can do to lessen the impact of HIV/AIDS on their clients and operations

Strengthening care and support services in the era of treatment: Symposium report

Sub-Saharan Africa has been devastated by the AIDS epidemic, with almost 26 million people infected in the region. As international attention continues to focus on sub-Saharan Africa as the region most affected by AIDS, hopeful signs have emerged, such as increased access to antiretroviral therapy (ART). Although the availability of ART has greatly increased in South Africa, care and support services continue to play a critical role in the lives of people infected and affected by HIV. In response to a growing call from program managers and researchers in South Africa to engage in a dialogue with policymakers and donors about strengthening care and support services, the Horizons Program organized a symposium in November 2005 in Johannesburg. The symposium was designed to review current research and field experiences to identify ways to strengthen care and support programs, and to link them with treatment services. It also aimed to identify research, program, and policy gaps and priorities. This symposium report focuses on key issues highlighted by participants, and includes research, policy, and program recommendations

Meeting the sexual health needs of men who have sex with men in Senegal

Research conducted in many countries has highlighted the vulnerability of men who have sex with men (MSM) to HIV and other STIs. Yet in Africa, they receive little attention in HIV/AIDS programming and service delivery because of widespread denial and stigmatization of homosexual behavior. In Senegal, a study conducted by researchers from the National AIDS Control Program, Cheikh Anta Diop University, and the Horizons Program has provided valuable information about the needs, behaviors, knowledge, and attitudes of MSM that has important implications for program managers and policymakers working to stem the spread of HIV/AIDS. The researchers used ethnographic and survey methods to elicit information from MSM 18 years of age or older from several neighborhoods in Dakar. As noted in this brief, the research team examined their own preconceived notions about sexuality, working through prejudices and taboos, and stressing the importance of maintaining the confidentiality of informants. All interviews were anonymous and informants were asked to provide oral informed consent. Informants received a small stipend to cover travel costs, information on STIs and HIV/AIDS, and a referral for a free medical consultation and treatment

The female condom: Dynamics of use in urban Zimbabwe

In July 1997, Population Services International (PSI), at the request of the Zimbabwe National AIDS Coordination Programme, launched a social marketing program for the female condom in Zimbabwe. The campaign\u27s intended audience was women in long-term relationships. To avoid the stigma associated with condoms and the prevention of sexually transmitted infections, PSI marketed the female condom as a family planning product under the brand name Care™. Approximately one year after the start of the female condom social marketing campaign, the Horizons Program and PSI conducted a descriptive, cross-sectional study of female condom users, male condom users, and nonusers of either barrier method. At the time of the study, the female condom was being marketed in urban Zimbabwe through radio, TV, and print media, and sold through selected sales outlets, including pharmacies, large supermarkets, and convenience stores at a subsidized price. As stated in this brief, the goal of this research was to increase understanding of the patterns and dynamics of female condom use to inform policymakers and program planners involved in decisions about promotion and distribution of the female condom in Zimbabwe

Acceptability of the female condom after a social marketing campaign in Campinas, Brazil

The female condom is a relatively new product that is intended to serve the dual role of protecting against unwanted pregnancy and sexually transmitted infections (STIs). Recent research has found moderate to high levels of initial trial and acceptance of the female condom among women. However, information is lacking about its continued use, particularly among women at high risk of HIV and other STIs. The female condom was registered in Brazil in January 1997 and since then has been available commercially through DKT, a social marketing organization. In addition to socially marketed female condoms, the Brazilian Ministry of Health has also given female condoms to public health clinics and community organizations to distribute free as part of activities targeted to vulnerable groups of women. This brief summarizes the findings from a study that examined the role of the female condom as a method of protection against HIV/STIs among female sex workers in Campinas, Brazil, who received increased access to the product and information about it through an educational and social marketing intervention

Cost of care and support services for PLHA: Implications for the financial sustainability of nongovernmental organizations

As HIV/AIDS prevalence increases, providers of care and support services will face greater demand for their services. The ability of nongovernmental organizations (NGOs) to help meet this increased demand will be influenced in part by their ability to control the cost of their services while generating sufficient revenue to meet expenses. The Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE) in Chennai, India, was one of the earliest providers of integrated care and support services in South India and currently serves clients from the four South Indian states. This brief highlights the key findings of a study that investigated the cost of People Living with HIV/AIDS (PLHA) services offered by YRG CARE. This research is part of a larger study conducted by YRG CARE and Horizons that examines the scale-up of care and support services in South India

Estimating the cost and effectiveness of different STI management strategies for sex workers in Madagascar

In Madagascar, the prevalence of sexually transmitted infections (STIs) is a serious public health problem, particularly among sex workers. A Horizons study conducted in 2000 found approximately two-thirds of female sex workers had an STI, although few were infected with HIV. Since the link between STIs and transmission of HIV has been well established, affordable strategies to manage STIs among sex workers need to be developed. Study investigators also assessed STI management practices in health facilities in two urban areas of Madagascar. Health practitioners were using a syndromic approach, which may be appropriate for managing certain STIs in the general population but is less appropriate for sex workers who may have multiple, often asymptomatic infections. Diagnosing STIs with laboratory tests would make medical visits prohibitively expensive. Researchers developed a risk profile for various STIs based on characteristics of women that present with each STI, such as age, number of partners, symptoms. The investigators hypothesized that a risk assessment tool using these profiles would result in more appropriate and effective STI treatment for sex workers. This summary presents a cost-effectiveness analysis of different strategies to manage STIs among sex workers in Madagascar

HIV and partner violence: Implications for HIV voluntary counseling and testing

An important component of HIV voluntary counseling and testing (VCT) programs is encouraging clients to inform partners of their serostatus, yet many clients do not do so. Studies have found that a serious barrier to disclosure for women is fear of a violent reaction by male partners and that HIV-infected women are at increased risk for partner violence. Building on previous research, this study explored the links between HIV infection, serostatus disclosure, and partner violence among women attending the Muhimbili Health Information Center (MHIC), a VCT clinic in Dar es Salaam, Tanzania. As noted in this summary, the study first collected qualitative data from women, men, and couples (n=67) who were MHIC clients. In the second phase, researchers enrolled 340 women after pre-test counseling and prior to collection of test results, and 245 women were interviewed three months after enrollment and testing. Nearly a third of the sample were HIV-positive, almost half were married, and 50 percent were between the ages of 18 and 29 and had less than seven years of education. The study followed WHO ethical and safety protocols for conducting research on violence against women