A theater troupe performing plays about men who have sex with men. A group of injecting drug users in Bangladesh drawing attention to their plight with red mannequins. And a beauty pageant in Nepal –with only transgendered contestants.
In South Asia, a number of different initiatives are now under way in attempting to reduce stigma around HIV/AIDS. At a panel last week at the Global Health Council annual conference, representatives from the World Bank and the International Center for Research on Women presented results from their joint project called the South Asia Regional Development Marketplace Partnership (SARDM).
The project, which began in 2008, provided grants for South Asian advocacy groups to begin distinctive stigma-reduction programs in their respective countries. The presenters explained that although HIV prevalence in South Asia is low overall, HIV is still on the rise among vulnerable and often marginalized groups, such as sex workers and their clients; injection drugs users (IDUs) and their partners; and men having sex with men (MSM). Stigma and other barriers impede efforts to reach those most in need of prevention, care, and treatment services.
Each project included people from marginalized groups in planning and implementation, and encouraged them to artistically convey anti-stigma and discrimination messages. In doing so, they gave them a voice in communities where stigma and discrimination usually keep them silent.
Mariam Claeson, the regional coordinator for the World Bank South Asia AIDS Team, explained that over 1000 groups submitted applications to the program when it was announced. Submissions came from Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka. Out of the 1000, 26 were chosen from six countries to pilot their innovative interventions over a 12- to 18-month period. They awarded grants totaling $1.04 million; an average grant was $40,000. In all, the 26 groups reached more than 96,264 people, and trained 4,905 people. The projects generated 504 news articles, and developed 426 projects, such as training curricula, information, documentaries, and plays.
- Traditional theatre in India: A group called Lotus Integrated AIDS Awareness Sangam, which reaches out to men who have sex with men, had members develop a play about their struggles in life. They performed it 75 times in one year in rural villages of Tamil Nadu. Participants reported a significant decrease in stigma and discrimination, and 147 “hidden” MSM identified themselves to Lotus and sought services.
- Making mannequins in Bangladesh: JOBS Trust, a group which seeks to rehabilitate injection drug users through economic development, employed injection drug users to make specially designed, red mannequins which are displayed in clothing stores. These mannequins are adorned with signs which highlight the plight of marginalized groups victimized by stigma and discrimination.
- Beauty pageants in Nepal: The Federation of Sexual and Gender Minorities Nepal held a beauty pageant featuring transgendered contestants as a way to empower its members and raise awareness about stigma. As government officials attended the pageant and voiced their support, implementers hoped that such an event would aid in reducing discrimination.
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For decades, global health experts, policymakers, and others have been debating the merits of disease-specific initiatives versus broader efforts to strengthen health systems. It’s the old the vertical vs. horizontal argument.
No one has settled that debate. But maybe we should stop asking that particular question. Or at least start asking some new ones.
“It’s not a helpful way to frame the issues,” Peter Berman, a lead economist on the health, nutrition and population team at the World Bank said today at a brown bag lunch exploring what TB and AIDS programs can contribute to health system strengthening in Africa.
He said all health initiatives, whether focused on one disease or on something broader, are aimed at improving results, i.e. health outcomes. So it’s not productive to engage in a debate that pits one approach against another. Instead, Berman suggested, we need to start asking more “why” questions. Why is the quality of a country’s TB program so poor? Why are the primary care clinics in another resource-poor country crumbling?
“We need to think more about the casual analysis,” he said. If we don’t ask the why questions, he said, we’re at risk of introducing “technical solutions” that improve things in the short term, but that fail to make enduring fundamental change.
Berman’s remarks came near the end of the World Bank session, which featured two experts from Family Health International. (more…)
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In Swahili, it means “explosive.’’ In Tanzania, a group is using an evil character called Fataki in a mass-media campaign to slap a new ugly name to sugar daddies, older men who prey on girls and young woman for sex. The aim is to empower family and friends of young women to help them avoid the Fatakis, who by definition have multiple sex partners and are a high risk of transmitting HIV.
“ We created a bad character – this Fataki – and the meaning of explosion also means he damages or kills. It’s the behavior of old men chasing young girls and possibility transmitting the HIV virus to them,’’ said Deo Ng’wananasabi of the Johns Hopkins University Center for Communications Programs. “We also wanted some humor with it because that helps people remember the message.’’ (more…)
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Stefano Bertozzi speaks Thursday in the plenary session at the 2009 HIV/AIDS Implementers' Meeting in Windhoek, Namibia
While many people at the 2009 HIV/AIDS Implementers’ Meeting have expressed concern about the global economic crisis hurting AIDS and health budgets, Stefano Bertozzi turned the focus back on AIDS programs today, which he said had too much “wasteful spending’’ and needed to be better run.
Bertozzi, executive director of the Center for Evaluation Research and Surveys at Mexico’s National Institute of Public Health, paraphrased a saying often used by his old boss, Julio Frenk, as his own “take-home message’’: “We need more money for AIDS, but we also need less AIDS for the money. For the last 27 or so years, we’ve paid much more attention to getting more money for AIDS, and we’ve paid much less attention to getting less AIDS for the money.’’ (more…)
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AIDS experts are anxiously awaiting word from the White House about the selection of a new Global AIDS Coordinator. Last we heard, Dr. Eric Goosby was supposed to be tapped for the position today.
But there’s nothing official yet from the White House or the State Department. Meanwhile, swine flu is (justifiably) getting loads of press and public attention. Perhaps the White House decided to delay on Goosby until the swine flu furor passes?
Whatever the case, we hope any news about Goosby and global AIDS doesn’t get completely eclipsed. It comes amid increasing fears about the Obama administration’s commitment to global AIDS, with fresh reports emerging about White House plans to flatline PEPFAR.
That would be particularly devastating in this climate, where developing countries across the globe are increasingly unable to maintain their HIV/AIDS programs. The World Bank recently put out a report warning that the global economic downturn could cause widespread drug shortages and interrupted treatment for HIV/AIDS patients. The report says that already, 8 countries are facing shortages of antiretroviral drugs or experiencing other HIV/AIDS treatment disruptions. A total of 22 countries—from the Caribbean to Africa—expect to face such problems in the coming year.
This is a recipe for drug-resistance, the makings of a global health catastrophe.
Click here to read a Financial Times story on the report or below for the full World Bank report. You should find it under the “research” heading–it’s called “Averting A Human Crisis…”
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