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Differences between international recommendations on breastfeeding in the presence of HIV and the attitudes and counselling messages of health workers in Lilongwe, Malawi.
International Breastfeeding Journal. 2006 Mar 9; 1(1):2.To prevent postnatal transmission of HIV in settings where safe alternatives to breastfeeding are unavailable, the World Health Organization (WHO) recommends exclusive breastfeeding followed by early, rapid cessation of breastfeeding. Only limited data are available on the attitudes of health workers toward this recommendation and the impact of these attitudes on infant feeding counselling messages given to mothers. As part of the Breastfeeding, Antiretroviral, and Nutrition (BAN) clinical trial, we carried out an in-depth qualitative study of the attitudes, beliefs, and counselling messages of 19 health workers in Lilongwe, Malawi. Although none of the workers had received formal training, several reported having counseled HIV-positive mothers about infant feeding. Health workers with counselling experience believed that HIV-infected mothers should breastfeed exclusively, rather than infant formula feed, citing poverty as the primary reason. Because of high levels of malnutrition, all the workershad concerns about early cessation of breastfeeding. Important differences were observed between the WHO recommendations and the attitudes and practices of the health workers. Understanding these differences is important for designing effective interventions. (author's)
SAfAIDS News. 2000 Mar; 8(1):9-10.In March this year in New Delhi, India, Dr Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), launched the 2000 World AIDS Campaign. The 2000 Campaign aims to involve men more fully in the effort against AIDS and to bring about a new, much-needed, focus on men in national responses to the epidemic. (author's)
Strengthening the provision of adolescent-friendly health services to meet the health and development needs of adolescents in Africa. A consensus statement emanating from a regional consultation on strengthening the provision of adolescent-friendly health services to meet the health and development needs of adolescents in Africa, Harare, Zimbabwe, 17-21 October 2000.
Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 2001.  p. (WHO/FCH/CAH/01.16; AFR/ADH/01.3)Health ministers in the WHO African Region at the 45th regional Committee for Africa (1995) requested WHO to assist Member States in their efforts to address the health problems of adolescents in an integrated manner. In addition, the WHO reproductive-health strategy for the African Region includes a framework which provides for equitable access to quality health services through the establishment of youth-friendly services and counselling for all adolescents. There have been many initiatives, largely donor-driven, in many African countries to provide health services to adolescents. On the other hand, there is ample evidence that even when health services are available adolescents do not utilize them for various reasons, ranging from the organization of services; the attitude of health workers, and community acceptance of services for adolescents. (excerpt)
In: Resource material on HIV / AIDS in Vietnam, [compiled by] Care International in Vietnam. Hanoi, Viet Nam, CARE International in Vietnam, . 58-65.Although acquired immunodeficiency syndrome (AIDS) is relatively new to Viet Nam, socioeconomic realities such as increasing urbanization, demand for commercial sex, low condom use, injecting dug use, and expanded transportation movements presage a future epidemic unless immediate steps are taken. Viet Nam's National AIDS Committee, established in 1989, targets commercial sex workers, sexually transmitted disease clients, injecting drug users, youth, and blood donors. Problematic have been the government's designation of prostitution and drug addiction as "social evils" and the tendency to view AIDS as a foreign disease rather than one related to specific behaviors of the Vietnamese people. CARE Viet Nam has developed a model of the cycle of AIDS-related culture, values, attitudes, and behaviors. The values of paternalism must be replaced by empowerment-related values, including self-reliance, compassion, and honesty. The hegemonic views that women must be submissive and passively accept men's behavior and that it is men's nature to have sex with multiple partners can be modified through IEC. A televised soap opera serial being developed by CARE Viet Nam seeks to catalyze such change in AIDS-related attitudes and behaviors.
[Unpublished] 1990 Mar 6. vi, 71 p.Men may impede broader use of family planning methods by women in many countries. Efforts have therefore been made to reach men separately in order to promote greater acceptance and use of male or female contraceptive methods. Typically, programs may encourage men to allow partners to use contraception; persuade men to adopt a more active, communicative role in decision making on contraceptive use; and/or promote the use of male methods. This paper presents findings from male involvement program initiatives in 60 developing countries since 1980. Male involvement programs are clearly needed, and condom use should be encouraged for protection against both pregnancy and HIV infection. Given their relatively low cost per couple-year of protection, social marketing programs should be encouraged to promote condom sales. Employment-based programs, despite relatively high start-up costs, have also generated large increases in condom use. Both condom and vasectomy use have been increased through mass media campaigns, yet more campaigns should address AIDS. Clinic services and facilities should be made more attractive to men, and new print materials are warranted. Community-based distribution programs have been found to be great sources of information and supplies, especially in rural areas, and male adolescents are especially in favor of telephone hotlines. Little information exits on the effectiveness and costs of programs targeting organized groups. Further, youth-oriented programs generally reach their intended audiences, but are relatively expensive for the amount of contraceptive protection provided. Finally, a positive image must be promoted for the condom through coordinated media presentations, user and worker doubts of efficacy must be eliminated, and regular condom supplies ensured. Recommendations are included for policy, research, public education, the World Health Organization, national AIDS prevention programs, and family planning agencies.
FAR EASTERN ECONOMIC REVIEW. 1992 Feb 20; 29-30.AIDS and HIV infection are in the early stages in Indonesia. 21 AIDS cases have been reported, and 30 persons have tested HIV-seropositive. Given the relatively low number of cases, and the presumed slow spread of HIV in the population, the government may yet be able to react in timely fashion to thwart epidemic spread. A rigorous education campaign and early detection of infected individuals are elements central to such intervention. The World Health Organization set a 1992 budget of US$500,000 for AIDS efforts in Indonesia. Research is young, awareness is minimal, and the campaign has barely commenced. AIDS cases have emerged in Jakarta, Surabaya, Bandung, and Denpasar. It is especially in cities that the government is concerned over checking the spread of AIDS. In these populations, many engage in extramarital sex, visible transvestite communities exist, and commercial sex districts thrive. Low condom use among sex workers, and relatively high rates of untreated STDs prevail in the general population. From March, blood donated in 15 cities, including these 4, will be compulsorily screened for HIV. Socially, moral and religious attitudes must be recognized and accommodated in mounting an effective AIDS prevention and education campaign in Indonesia. While religious sensibilities may be offended by the discussion of sex and sexual practices, such discussion is necessary and must be supported by the well-organized religious groups in this overwhelmingly Muslim country. Hopefully, Indonesia will bring to bear against AIDS the same cultural pragmatism exhibited to effect population control in the 1970s and 1980s.
INTERNATIONAL JOURNAL OF HEALTH SERVICES. 1991; 21(3):505-10.This article asks the reader to carefully consider the personal implications of AIDS were either he or close friends and relatives afflicted with the syndrome. We are urged to acknowledge the limited capabilities of personal and social response to the epidemic, and recognize the associated degree of social inequity and knowledge deficiency which exists. Summaries of 3 articles are discussed as highly integrated in their common call for global solidarity in the fight against HIV infections and AIDS. Pros and cons of Cuba's evolving response to AIDS are considered, paying attention to the country's recent abandonment of health policy which isolated those infected with HIV, in favor of renewed social integration of these individuals. Brazil's inadequate, untimely, and erred response to AIDS is then strongly criticized in the 2nd article summary. Finally, the 3rd article by Dr. Jonathan Mann, former head of the World Health Organization's Global program on AIDS, on AIDS prevention in the 1990s is discussed. Covering behavioral change and the critical role of political factors in AIDS prevention, Mann asserts the need to apply current concepts and strategies, while developing new ones, and to reassess values and concepts guiding work in the field. AIDS and its associated crises threaten the survival of humanity. It is not just a disease to be solved by information, but is intimately linked to issues of sexuality, health, and human behavior which are in turn shaped by social, political, economic, and cultural factors. Strong, concerted political resolve is essential in developing, implementing, and sustaining an action agenda against AIDS set by people with AIDS and those at risk of infection. Vision, resources, and leadership are called for in this war closely linked to the struggle for worldwide social justice.
SCIENCE. 1991 Oct 25; 254:511-2.The 1st Director of the World Health Organization's (WHO) Global Program on AIDS (GPA) abruptly resigned March, 1990. Jonathan Mann led the GPA in an innovative, aggressive, and comparatively non-bureaucratic style since its inception in 1986, building a staff of nearly 200 under an eventual 1990 budget of $90 million. Mann's non-conformist style and ever-growing budget, however, ran counter to the bureaucratic forces in WHO, causing him to leave for a position at Harvard University. A 12-year WHO veteran, Michael H. Merson succeeded Mann, and has since managed the GPA in a more conventional, bureaucratic manner. Senior staff have resigned, and the budget will drop to only $75 million for 1992. Staff replacements are used to the bureaucratic structure and demands of WHO, but lack experience in the field of AIDS. This paper discusses the markedly different management styles and approaches of Merson and Mann, with concern voiced over the future of the GPA. Critics are uncertain of GPA's present direction, and whether or not it is a necessary, positive change in the fight against the AIDS pandemic. As AIDS appears with less frequency and centrality i the world's media, the GPA is needed now even more than just a few years ago to inform the world of the dangers of AIDS. Merson is expected to promote relatively simple treatment options for AIDS, with some emphasis upon technological fixes like the condom. With cuts to the behavioral research budget, however, it is almost certain that inadequate steps will be taken to effect behavioral change for the prevention and control of HIV infection.
HEALTH FOR THE MILLIONS. 1991 Aug; 17(4):20-3.Until recently, the only sustained AIDS activity in India has been alarmist media attention complemented by occasional messages calling for comfort and dignity. Public perception of the AIDS epidemic in India has been effectively shaped by mass media. Press reports have, however, bolstered awareness of the problem among literate elements of urban populations. In the absence of sustained guidance in the campaign against AIDS, responsibility has fallen to voluntary health activists who have become catalysts for community awareness and participation. This voluntary initiative, in effect, seems to be the only immediate avenue for constructive public action, and signals the gradual development of an AIDS network in India. Proceedings from a seminar in Ahmedabad are discussed, and include plans for an information and education program targeting sex workers, health and communication programs for 150 commercial blood donors and their agents, surveillance and awareness programs for safer blood and blood products, and dialogue with the business community and trade unions. Despite the lack of coordination among volunteers and activists, every major city in India now has an AIDS group. A controversial bill on AIDS has ben circulating through government ministries and committees since mid-1989, a national AIDS committee exists with the Secretary of Health as its director, and a 3-year medium-term national plan exists for the reduction of AIDS and HIV infection and morbidity. UNICEF programs target mothers and children for AIDS awareness, and blood testing facilities are expected to be expanded. The article considers the present chaos effectively productive in forcing the Indian population to face up to previously taboo issued of sexuality, sex education, and sexually transmitted disease.
AIDS WATCH. 1989; (8):8.The Chilean Red Cross Society and the family planning association--APROFA, International Planned Parenthood Federation's affiliate, are joining forces to help prevent the spread of the acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection. APROFA established a working group to study the knowledge, attitudes, and sexual behavior of students at the National Training Institute, INACAP. 7000 students were sampled in 11 Chilean cities. The study found that 36% of the females, and 77% of males were sexually active before the age of 20. Nearly 1/2 of the women and 1/5 of the men did not know that condoms could protect them against sexually transmitted diseases (STDs) and pregnancy. APROFA designed a program to increase students knowledge of AIDS, reduce promiscuity and increase knowledge of and use of condoms. In October, 1988 an educational package distributed, consisting of a training manual, slides, educational booklets, a poster, and a video of 3 films. It has proved so successful that APROFA has adapted it for community groups, educational institutions, and its youth program. APROFA/Red Cross nurses and Red Cross volunteers have participated in workshops and training with the package. The Red Cross has organized AIDS-related activities in Chile since 1986, including education campaigns, information for blood donors, and a telephone hotline to provide AIDS counseling. Goals are to target more poor areas and groups outside of society's mainstream in the next year for sex education and information on STDs.