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Public opinion as leadership disincentive: exploring a governance dilemma in the AIDS response in Africa.
Contemporary Politics. 2012 Jun; 18(2):174-185.There is increasing emphasis in global declaration on the need to get politics right in the response to AIDS, particularly in terms of strengthening accountable leadership. However, in the worst affected countries in sub-Saharan Africa, such governance prescriptions introduce political concerns that are not well understood. In a context of the neo-patrimonial governance that characterises African democracies, the paper analyses data from the Afrobarometer on public opinions on AIDS in 20 countries to identify and explore the governance dilemma that leaders face when they are expected to show strong leadership on an issue that is low on the public political agenda. By identifying country-level correlates and individual-level determinants of the strong opinion on AIDS that is held by a minority, the paper suggests how public opinion for an effective response can be mobilised in ways that are politically sustainable.
Are country reputations for good and bad leadership on AIDS deserved? An exploratory quantitative analysis.
Journal of Public Health. 2008 Dec; 30(4):398-406.Some countries (e.g. Brazil) have good reputations on AIDS policy, whereas others, (notably South Africa) have been criticized for inadequate leadership. Cross-country regression analysis reveals that these 'poster children' for AIDS leadership have indeed performed better or worse than expected given their economic and institutional constraints and the demographic and health challenges facing them. Regressions were run on HAART coverage (number on highly active antiretroviral therapy as percentage of total need) and MTCTP coverage (pregnant HIV+ women accessing mother-to-child-transmission prevention services as percentage of total need). Brazil, Cambodia, Thailand and Uganda (all of whom have established reputations for good leadership on AIDS performed consistently better than expected-as did Burkina-Faso, Suriname, Paraguay Costa Rica, Mali and Namibia. South Africa, which has the worst reputation for AIDS leadership, performed significantly below expectations-as did Uruguay and Trinidad and Tobago. The paper thus confirms much of the conventional wisdom on AIDS leadership at country level and suggests new areas for research.
Indian Journal of Medical Ethics. 2009 Jan-Mar; 6(1):5-6.This editorial examines the issue of male circumcision (MC) in India and discusses doctor's challenges' with the question,"Doesn't the public have the right to know that male circumcision protects against HIV?" It describes the reluctance of the Government of India to disclose this information due to the controversy that may erupt between conservative Hindus and the Muslims in the country in which male circumcision is a marker of religious identity.
Global Public Health. 2008; 3(S2):39-57.This study is aimed at examining how subsequent Peruvian governments, since 1990, have addressed reproductive rights, HIV/AIDS prevention and treatment, and sexual diversity rights, as well as the drastic policy shifts and its many contradictions. Abortion and contraception consistently generated the deepest public controversies and debates, which made progress in reproductive rights difficult. HIV/AIDS was often portrayed as having the potential to affect everyone, which allowed advocates and activists to achieve some success in advancing HIV/AIDS-related rights. Sexual diversity rights, perceived as a demand made by "others", were generally trivialised and disdained by politicians, officials, and the general population. Positive changes occurred as long as the issue was given a low political and institutional profile. The analysis of policy-making and programme implementation in these three areas reveals that: (1) Weaknesses in national institutional frameworks concerning reproductive health made it possible for governments to adopt two very different (even contradictory) approaches to the issue within the past 15 years; (2) Policies were presented as rights-based in order to garner political legitimacy when, in fact, they evidenced a clear disregard for the rights of individual citizens; and (3) By favouring low-profile "public health" discourses, and marginalising "the sexual" in official policies related to sexuality, advocacy groups sometimes created opportunities for legal changes but failed to challenge conservative powers opposing the recognition of sexual and reproductive rights and the full citizenship of women and sexual minorities. (author's)
Nairobi, Kenya, Program for Appropriate Technology in Health [PATH], Scouting for Solutions, 2006 Oct.  p. (USAID Cooperative Agreement No. GPO-A-00-05-00009-00)Scouting for Solutions is a five-year project that aims to prevent the spread of HIV and AIDS by promoting health sexual behavior amongst Scouts in Kenya and Uganda, including the promotion of abstinence until marriage, fidelity in marriage, and monogamous relationships. The project, funded by the US Agency for International Development, is being implemented by the US-based nongovernmental organization PATH, in conjunction with national Scouts associations in Kenya and Uganda. By 2009, the project with reach as estimated 325,000 girls and boys aged 12-15 years with intensive and repeated HIV prevention strategies and health promotion activities. (excerpt)
Comprehensive sex education: strong public support and persuasive evidence of impact, but little funding.
Archives of Pediatrics and Adolescent Medicine. 2006 Nov; 160(11):1182-1184.The article by Bleakley et al strong evidence that a very large majority of adults in this country supports comprehensive sex education programs that teach about abstinence and also other methods of preventing pregnancy and sexually transmitted disease, whereas only a minority of adults supports the teaching of only abstinence. These results build on numerous somewhat similar surveys that have been conducted for decades demonstrating such support. Indeed, as long ago as 1943, the Gallup Poll found that 68% of adults approved of sex education in schools. By 1985, that support had increased to 85%. Furthermore, for decades these polls have demonstrated that adults want the instruction to include both abstinence and condoms and other methods of contraception. Notably, this support is not limited to only certain parts of the country; similar polls in more conservative southern states, such as North Carolina, South Carolina, and Texas, have demonstrated strong support for programs that encourage abstinence but also encourage the use of condoms and other contraceptives among those who do have sex. (excerpt)
Adapting the popular opinion leader intervention for Latino young migrant men who have sex with men.
AIDS Education and Prevention. 2006; 18 Suppl A:137-148.Young Latino migrant men who have sex with men are at high risk for HIV infection. The Popular Opinion Leader intervention, shown to be effective with White gay men, was adapted by the Farm worker Justice Fund, Inc., for this Latino migrant population. This project, called the Young Latino Promotores, was implemented over a 2-year period by community-based organizations in Vista, California, and McAllen, Texas, with capacity building assistance from the Farm worker Justice Fund, Inc. We report on challenges, preliminary findings, and lessons learned from adapting this intervention. (author's)
Connections. 2006 Jan;  p.Public opinion surveys in Russia indicate that a majority of Russians believe more attention should be given to HIV/AIDS and that the media can be an effective vehicle for promoting greater awareness of the issue, according to a July 2005 survey released by Transatlantic Partners Against AIDS (TPAA). The survey, which polled a nationally representative sample of Russian adults aged 18 to 50, also indicates that 84 percent of respondents believe that the number of Russians living with AIDS has increased during the past five years, 70 percent believe that AIDS is not receiving enough public attention, and 78 percent view mass media as an instrumental component in the fight against AIDS. This survey is reflective of official AIDS statistics, which estimate that 800,000 to 1.5 million Russians may be living with HIV/AIDS, according to TPAA. The organization also reports that AIDS has been particularly devastating to younger generations, with men and women under the age of 30 accounting for 80 percent of all registered cases of HIV. This finding is critical because it raises serious health concerns for the future of an already declining Russian population. (excerpt)
Clinical Medicine. 2005 Jan-Feb; 5(1):62-68.Infectious diseases with high mortality, disability and creating public anxiety are not new, but despite this our initial responses to HIV/AIDS have been primitive and slow. Since the start of the epidemic over 60 million people throughout the world have been infected, with the main focus of the epidemic currently in Sub-Saharan Africa. However, there is every indication that the epidemic will move more towards South-East Asia, with increasing numbers in India and China. Infection with HIV has a profound effect on individuals and their families, and can also lead to destabilisation of societies through its effects on the economy, institutions and security. Considerable emphasis has been placed recently on the widespread use of anti-retroviral therapy. This is a worthwhile initiative but is only part of a balanced array of approaches, which requires building a political consensus, social economic interventions and modifying the biology. Strong political leadership is still required, with an approach that recognises that the socioeconomic drivers of this epidemic. (author's)
Menlo Park, California, Henry J. Kaiser Family Foundation, 2001. 22 p.Latinos, who now comprise the largest and fastest growing ethnic minority in the United States, continue to be disproportionately affected by HIV/AIDS. Although they represent approximately 14% of the U.S. population, Latinos accounted for 19% of new AIDS cases reported in 2000. The AIDS case rate (per 100,000) among Latino adults (30.4) was almost four times that for whites (7.9), and AIDS is now the fourth leading cause of death for Latinos between the ages of 25 and 44. The epidemic’s effect on different subgroups of Latinos is also striking. For example, the AIDS case rate among adult Latinas is 13.8 per 100,000, more than six times the rate for white women (2.2). And although Latino youth represent approximately 14% of U.S. teenagers, they accounted for 20% of new AIDS cases reported among those ages 13–19 in 2000. In addition, in a recent study of young men who have sex with men (MSM), HIV prevalence (the proportion of people living with HIV in a population) for young Latinos was 6.9, compared to 3.3 for whites. Finally, there is growing evidence that the HIV/AIDS epidemic is increasingly concentrated in low-income communities in which people of color are often disproportionately represented. Such communities generally are faced with multiple other health and social issues and limited resources with which to respond to the epidemic. (excerpt)
Menlo Park, California, Henry J. Kaiser Family Foundation, 2001. 60 p.On June 5, 1981, the U.S. Centers for Disease Control and Prevention (CDC) issued its first warning about a relatively rare form of pneumonia among a small group of young gay men in Los Angeles, which was later determined to be AIDS-related. Since that time, more than 750,000 cases of AIDS have been reported in the U.S. and almost half a million Americans have died of the disease. Of the more than 36 million individuals worldwide estimated to be living with HIV/AIDS, approximately 95% live in the developing world – a full 70% in sub-Saharan Africa alone. During this twenty-year period, there has been a great deal of progress in the fight against AIDS. New infections in the U.S. have declined dramatically, and there are signs that new infections in sub-Saharan Africa may be stabilizing. The more widespread use of antiretroviral drugs has also contributed to fewer new AIDS cases and AIDS-related deaths. Despite this progress, critical challenges remain. The AIDS epidemic is becoming increasingly complex. Proven prevention programs are not reaching everyone in need. More people are living with HIV/AIDS than ever before, and significant disparities exist across age and race. For example, while African Americans and Latinos represent 12% and 13% of the U.S. population, they represent 47% and 19% of reported cases, respectively. An estimated half of all new infections in the U.S. are among those under the age of 25. In addition, the high cost of HIV care presents significant barriers to access for people with HIV/AIDS in the United States, many of whom are not in regular care, and treatment is not available to the vast majority of those living with HIV/AIDS in the developing world. And though progress is steady, we are still years away from developing an effective vaccine. (excerpt)
Talking points for Bill Gates, UN Media Leaders Summit on HIV / AIDS, January 15, 2004. 8-10 minute remarks.
[Unpublished] 2004. 4 p.The media have played a crucial role in highlighting the most important issues of our time—civil rights, apartheid, political oppression. Yet HIV/AIDS may be the greatest challenge of all. You have played a remarkable role already. In fact, the media had a great influence on my own commitment to fight diseases in the developing world. Early on, when my wife, Melinda, and I were thinking about our philanthropy and how we could have the greatest impact with our resources, my father sent me a clip from a newspaper about preventable deaths in poor countries. I remember reading a chart that listed the world’s deadliest diseases. One disease I had never even heard of— rotavirus—was killing literally half a million kids each year. I thought: That can’t be true, that’s got to be a typo. If a single disease was killing that many kids, we would have heard about it—it’d be front-page news. But it isn’t. As Melinda and I have become more engaged in global health issues over the past decade, one thing has become clear: not enough is being done about the millions of preventable deaths each year from diseases like AIDS or malaria. In part, that’s because people aren’t aware of what is happening. We don’t see these issues covered enough in newspapers, radio and television. (excerpt)
Kaiser Family Foundation Survey of Americans on HIV / AIDS. Part Three – Experiences and opinions by race / ethnicity and age. Summary and chartpack.
Menlo Park, California, Henry J. Kaiser Family Foundation, 2004 Aug.  p.The Kaiser Family Foundation Survey of Americans on HIV/AIDS was designed and analyzed by researchers at the Kaiser Family Foundation. Fieldwork was conducted by telephone by Princeton Survey Research Associates between March 15 and May 11, 2004, among a nationally representative random sample of 2,902 respondents 18 years of age and older. The survey included an oversample of African American and Latino respondents (a total of 800 African American and 439 Latino respondents were interviewed). Results for all groups have been weighted to reflect their actual distribution in the nation. The margin of sampling error for the survey is plus or minus 2 percentage points. For results based on White respondents the margin of sampling error is plus or minus 3 percentage points; for African Americans it is plus or minus 4 percentage points; and for Latinos it is plus or minus 6 percentage points. For results based on subsets of respondents the margin of error is higher. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll. This is the third of three phases in which the full survey and in-depth analysis has been released. The first release (Part One, June 2004) focused on findings related to Americans’ views of the global HIV/AIDS epidemic. The second release (Part Two, June 2004) focused on Americans’ views and experiences with HIV testing. This release (Part Three) represents a more in-depth report on Americans’ views and experiences with HIV, with a focus on differences between and among key subgroups of the population. (excerpt)
Kaiser Family Foundation Survey of Americans on HIV / AIDS. Part One -- Global HIV / AIDS. Summary and chartpack.
Menlo Park, California, Henry J. Kaiser Family Foundation, 2004 Jun.  p.The broad foreign policy context within which Americans view the global HIV epidemic hasn’t changed much in the past few years. Most Americans think the U.S. currently spends too much on foreign aid in general, and a strong majority believes the U.S. should address problems at home first rather than spending more money on the global HIV/AIDS epidemic. In discussing Americans’ views of the global HIV/AIDS epidemic, and what they think about the role of the U.S. in helping solve this global problem, it’s important to set the context with their views on foreign aid in general. More than six in ten adults (62%) think the U.S. currently spends too much on foreign aid, while about one in five (18%) say it spends about the right amount, and one in ten (10%) say the U.S. spends too little on foreign aid (Chart 1). Responses to this question have been similar since 2000. When asked about the largest areas of spending by the federal government, half the public (49%) incorrectly identifies foreign aid as one of the two largest areas of federal spending (Chart 1). Half the public (53%) agrees with the statement that the U.S. is a global leader and has a responsibility to spend more money to fight HIV/AIDS in developing countries. However, when forced to choose, three in ten (30%) say they agree more strongly with this statement, while, perhaps not surprisingly, six in ten (62%) say they agree more with the statement that the U.S. should address problems at home first rather than spending more money to fight HIV/AIDS in developing countries (Chart 2). (excerpt)
Lancet. 2005 Mar 26; 365:1119-1121.As the HIV/AIDS pandemic rages globally into a third decade, one of our best hopes for reversing the pandemic is the development, evaluation, and dissemination of safe and effective preventive HIV vaccines. An important challenge on this arduous journey is the recruitment of volunteers for trials of such vaccines. Edward Mills and colleagues’ recent article is an important milestone in this Herculean battle. They provide a comprehensive systematic review of existing studies on barriers to participation in HIV vaccine trials. They identify several key barriers to participation in HIV vaccine trials: safety concerns, mistrust of clinical research, and fear of social discrimination. They recommend that vaccine trialists use these findings to anticipate and mitigate barriers to trial participation. (excerpt)
Lancet. 2005 Mar 26; 365:1127-1128.20 million condoms will soon be airlifted into Uganda, after an emergency order issued by the government in early March, with funding from international donors. The new supplies will help to ease a crisis that has gripped the country for more than 5 months, ever since doubts were raised about the quality of “Engabu” brand condoms, which are free and account for 80% of the condoms distributed in Uganda each year. NGOs and donor groups have welcomed the airlift as a long-awaited step towards resolving the country-wide condom shortage. After immediate supplies are restored, however, Ugandan health agencies will face further challenges, including what to do with at least 20 million Engabu condoms that have been quarantined, re-establishing long-term supplies into the country, and how to restore public faith in condoms. The latter task may be complicated by disagreements about various components of the Ugandan prevention policy—”ABC” or abstinence, being faithful, and using condoms—says Ugandan MP Elioda Tumwesige, who chairs the parliamentary committee on HIV/AIDS. “This has come at a time of debate over what we should emphasise more. It could not have come at a worse time for condom promotion.” (excerpt)
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2001 Feb. 42 p. (UNAIDS Best Practice Collection Key Material; UNAIDS/01.05E)This handbook aims to equip scientists especially with ideas, skills, and knowledge on how to relate to the media and thereby reach both the general public and some specific groups. The handbook is not a communication strategy and does not address all aspects of communication and audiences that must be included in effective communication about vaccine trials. Many vaccine development and vaccine trials in humans have to be carried out with the expressed support and cooperation of national governments. Such cooperation usually manifests itself through regulations and monitoring by organizations such as the Food and Drug Administration (FDA) in the USA or equivalent national institutions. Consequently, there is a necessary collaboration between government and medicine (science) in the interests of public health. Ordinarily, that would be a good thing. But, ironically, in many countries, this is a collaboration between two 'institutions' whose popularity and public confidence have dwindled over the years, and their support for HIV vaccine trials does not readily translate into public confidence in those trials. (excerpt)
Washington, D.C., USAID, Bureau for Global Health, 2003 Oct. (7)  p. (Success Stories -- HIV / AIDS)NEARLY 4 MILLION PEOPLE IN INDIA are infected with HIV—the second highest figure in the world. Staggering misconceptions about how HIV is transmitted and a reluctance to publicly discuss the disease fuel its spread. But an innovative and aggressive HIV/AIDS education and awareness campaign implemented in 12 major port communities across India is helping to dispel widespread myths surrounding HIV/AIDS and to open channels of communication, enabling those who are at high risk for infection to learn how to steer clear of the disease. The campaign—implemented by Population Services International, with support from the U.S. Agency for International Development—features several components. In Mumbai, it revolves around Balbir Pasha, a fictional character the target audience of young, urban men can relate to, learn from, and empathize with. Balbir is portrayed in a series of identifiable, real-life sexual situations in which he runs the risk of contracting HIV. Scenarios concern the use of alcohol and “forgetting” to use a condom, the mistaken belief that having a regular partner (even a prostitute or casual partner) means one is safe from HIV/AIDS infection, and the misconception that if one’s partner looks healthy, he or she must be free of HIV/AIDS. (excerpt)
Alliance News. 2001 Dec; (12): p..Increasing attention is being paid to the role of stigma as a major contributory factor in the global HIV/AIDS pandemic. Stigma associated with HIV/AIDS is especially powerful and pervasive because the disease is usually closely associated with such fundamental issues as life and death, sex and sexuality, and morality. (excerpt)
AIDS and Society. 1991 Jan-Feb; 2(2):4.In fact, an integrated policy has not occurred for one basic reason: in the United States, public policy follows public opinion, and public opinion is driven at least in part by media exposure. The issue of AIDS has been seen as a domestic tragedy that has beset homosexuals and I.V. drug users. Only as AIDS has begun to affect new-born children, adolescents and heterosexuals, and only as the cost of AIDS has exploded, has broad concern crystalized. Even so, international AIDS is removed from the consciousness of most Americans. It can be argued that only when television coverage of third world suffering children and sick and dying mothers reaches the living rooms of America will an integrated strategy emerge. (excerpt)
[Geneva, Switzerland], WHO, Global Programme on AIDS, Social and Behavioral Research Unit, .  p. (WHO File: Data on Social Issues; Report No. 2)The Social and Behavioural Research Unit has prepared its second international inventory of Knowledge, Attitude, Behaviour, and Practices surveys. The report reviews 80 projects drawing upon both published and unpublished materials dealing with 7 major study groups: adolescents and young people, the general public, health care workers, homosexual/bisexual men, drug injectors, prostitutes, and other groups. For each of these the inventory classifies the project concerned by selected key features such as when and where it was undertaken, sampling strategy used, and methodology and conclusions. (excerpt)
BMJ. British Medical Journal. 2002 Jan 26; 324:226-9.This article discusses barriers to HIV vaccine research and the strategies developed to overcome them. Prior to the initiation of HIV vaccine trial in Uganda, the researchers created initiatives to help them overcome the potential scientific, sociobehavioral, ethical and logistical barriers. Despite the elaborate preparation for the Ugandan trial, researchers experienced various barriers, namely: public misconceptions and media misinformation; use of concerns about Ugandans serving as guinea pigs by public figures for political gains; ethical concerns about the consent process, possible coercion of volunteers, reimbursement, and volunteer's confidentiality; public issue on the safety of trial participants; and apprehension among the public due to disagreements between scientists. Hence, successful initiation of trials of HIV vaccines requires support from politicians, media and the general public, involvement of scientists in the planning and implementation, involvement of stakeholders in scientific, social, legal, and ethical discussions, and use of regulatory control and approval process for research protocols.
BMJ. British Medical Journal. 1999 Mar 20; 318(7186):757.Against a background of scams to treat HIV/AIDS, the government's erratic approach to the epidemic, and an increasingly cynical but desperate public, a team from the Medical University of South Africa recently announced Inactivan as an anabolic steroid which stops HIV from replicating in white blood cells. The development of the drug was announced in a well-publicized press conference after a 5-day trial on humans. However, few people in South Africa are ready to accept the team's findings since it comes shortly after 2 poorly-qualified scientists claimed to have found a cure for AIDS in 1998. Their drug, Virodene, was actually a toxic industrial solvent. South Africa's minister of health, Dr. Nkosazana Dlamini-Zuma, tarnished her reputation by associating herself with the drug, which had not been through any of the usual research protocols, peer review, or drug regulatory mechanisms.
Women's preferences for vaginal antimicrobial contraceptives IV. Attributes of a formulation that would protect from STD / AIDS.
CONTRACEPTION. 1998 Oct; 58(4):251-5.Market research conducted in Campinas, Sao Paulo State, Brazil, in 1996-97 investigated the attributes that potential users considered acceptable and unacceptable in a vaginal antimicrobial contraceptive. 635 women from two age groups (adolescent and adult) and two socioeconomic groups (low and middle/high) were enrolled. 99% of respondents indicated a preference for a vaginal formulation that provided dual protection against unwanted pregnancy and sexually transmitted diseases (STDs), including HIV. Overall, 40% of women stated they would use a dual protective method even if it was messy. Acceptance of messiness was lowest (35%) among adolescent respondents. Irritation, itching, swelling, or burning were unacceptable side effects to the vast majority of women. 96% would use a vaginal method if it could only be inserted with an applicator, but this rate dropped to 75% if the method required manual insertion. 55% would use the method if it appeared on their partner's penis. Overall, 50% would accept a method that required refrigeration during very warm days--but rates were higher among adult women and those of low socioeconomic status. There was a clear preference for a formulation that was transparent or had a very light color. About 45% of women were willing to pay up to US$5 for each application of the product, while another third said they would pay $1. Socioeconomic status did not exert an effect on price considerations, confirming the importance to all women of protection against both pregnancy and STDs.
Women's preferences for vaginal antimicrobial contraceptives II. Preferred characteristics according to women's age and socioeconomic status.
CONTRACEPTION. 1998 Oct; 58(4):239-44.Efforts to prevent the transmission of HIV and other sexually transmitted diseases (STDs) have focused on woman-controlled vaginal methods. To identify the characteristics women prefer in a new vaginal contraceptive method and thereby guide product development, a descriptive study of 635 women from Campinas, Sao Paulo State, Brazil, was conducted in 1996-97. A total of 310 women were 15-19 years of age and 325 were 20-45 years old. The two age groups were further divided so that half the women were of low socioeconomic status and half were of middle or high status. Most women in the 4 subgroups (73.5-82.8%) selected the vaginal cream over a suppository for the preferred form of an ideal vaginal formulation. A clear or white-colored product with no taste or odor was preferred. Almost all women wanted the method to protect against STDs as well as pregnancy. More than 80% of women in all 4 subgroups preferred to use an applicator to insert the formulation before coitus. More than half the women wanted a method with a duration of effectiveness of 8 hours to eliminate the need for reapplication. Preferences did not differ significantly according to the respondent's age or socioeconomic status.