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Barriers to implementing WHO's exclusive breastfeeding policy for women living with HIV in sub-Saharan Africa: an exploration of ideas, interests and institutions.
International Journal of Health Planning and Management. 2013 Jul-Sep; 28(3):257-68.The vertical transmission of HIV occurs when an HIV-positive woman passes the virus to her baby during pregnancy, delivery or breastfeeding. The World Health Organization's (WHO) Guidelines on HIV and infant feeding 2010 recommends exclusive breastfeeding for HIV-positive mothers in resource-limited settings. Although evidence shows that following this strategy will dramatically reduce vertical transmission of HIV, full implementation of the WHO Guidelines has been severely limited in sub-Saharan Africa. This paper provides an analysis of the role of ideas, interests and institutions in establishing barriers to the effective implementation of these guidelines by reviewing efforts to implement prevention of vertical transmission programs in various sub-Saharan countries. Findings suggest that WHO Guidelines on preventing vertical transmission of HIV through exclusive breastfeeding in resource-limited settings are not being translated into action by governments and front-line workers because of a variety of structural and ideological barriers. Identifying and understanding the role played by ideas, interests and institutions is essential to overcoming barriers to guideline implementation. Copyright (c) 2012 John Wiley & Sons, Ltd.
How evidence based are public health policies for prevention of mother to child transmission of HIV?
BMJ. 2013; 346:f3763.Add to my documents.
New York, New York, UNICEF, 2005. 25 p.The world must take urgent account of the specific impact of AIDS on children, or there will be no chance of meeting Millennium Development Goals (MDG) 6 - to halt and begin to reverse the spread of the disease by 2015. Failure to meet the goal on HIV/AIDS will adversely affect the world's chances of progress on the other MDGs. The disease continues to frustrate efforts to reduce extreme poverty and hunger, to provide universal primary education, and to reduce child mortality and improve maternal health. World leaders, from both industrialized and developing countries, have repeatedly made commitments to step up their efforts to fight the spread of HIV/AIDS. They are beginning to increase the political leadership and the resources needed to fight the disease. Significant progress is being made in charting the past and future course of the pandemic, in providing free antiretroviral treatment to those who need it, and in expanding the coverage of prevention services. But children are still missing out. (excerpt)
Global AIDSLink. 2004 Aug-Sep; (87):16-17.The importance of addressing HIV/AIDS from a stronger sexual and reproductive health and rights perspective has over the past few months been gaining increased global momentum and recognition. Earlier this year, the All Party Parliamentary Group on Population, Development and Reproductive Health in the UK commenced their hearings into the very question of integration: its successes, failures and contextual realities. The Glion Call to Action (see page 8)— released in June — specifically addressed the integration aspects involved in PMTCT programs and policies. And in May, UNFPA hosted a series of technical meetings that aimed to explore some of the broader technicalities of integration. This advocacy document was launched in July at the Bangkok XV International AIDS Conference. Clearly, the question of when, where and how to integrate HIV/AIDS with reproductive health has been plaguing programmers and policy makers, donors and service providers. Answering these questions with meaningful action is not only long overdue but — in the age of increased awareness, and treatment access increasingly becoming a reality — it is unarguably the most unexplored terrain of our international response. For it is only with the concerted effort and coordinated involvement of the sexual and reproductive health community that the lofty Millennium Development Goals; the UN General Assembly's Special Session on HIV/AIDS Commitments; the '3 by 5' targets; and even new modalities of reducing HIV/AIDS-related stigma, will be achieved. The mainstreaming of HIV/AIDS is perhaps not only an untapped avenue, but it also has the potential to awake the full potential of a by-and-large under used resource. Getting there, however, would involve a change in mind-set of all the role players involved. A 'business as usual' approach that does not move beyond rhetoric will have damning consequences. The exceptionality of HIV/AIDS as a largely sexually transmitted infection requires an exceptional response — especially from sexual and reproductive health providers. (excerpt)
BMJ. British Medical Journal. 2004 Apr 24; 328(7446): p..The Chinese government is to offer free HIV tests and treatments to those who cannot afford to pay. The policy includes free antiretroviral drugs, testing, prevention of mother to child transmission, and schooling of orphans. Joel Rehnstrom, country coordinator of UNAIDS China, said he was “very encouraged by the commitment of central government in China to provide free testing and treatment.” He added, however, that there would no doubt be setbacks: “I believe it will be an enormous challenge to provide free testing and treatment across China. My sense is that every country in the world should probably have woken up earlier to HIV/AIDS. China is no exception.” UNAIDS (the Joint United Nations Programme on HIV/AIDS) has been involved with the scheme, including the development of guidelines for testing, voluntary counselling, and antiretroviral treatment. According to the state controlled Chinese media, the central government will fund the scheme in areas with a high prevalence of HIV—for example, Yunnan and Sichuan in the south west. Areas not covered by central government will be funded by local governments. (excerpt)