Suchergebnisse

This article presents the integration of traditional data collection methods for the evaluation of an HIV-prevention programme for Vietnamese sex workers in Cambodia with a participatory approach to project implementation. Local instability and powerlessness posed serious challenges to maintaining our commitment to the principles of participation and ensuring rigorous research. The project consequently focused on negotiating these challenges and adapting the study. Although our efforts did not fully harness the empowering potential of participation and raised a series of contradictions in our design, we gained a rich understanding of the complex community dynamics in this marginalized population. Our experience highlights the need for careful consideration of what participation can feasibly hope to achieve in severely constrained settings, but suggests it can contribute to critical knowledge for the development of appropriate interventions.

Contribution to a special issue on sexuality, human rights and health. In recent years, the international sex trade has received increasing media coverage and policy attention, particularly in regard to associated migration and the growing role played by organized criminal networks. Yet failure to recognize the complex dynamics behind why women enter the sex industry and how it is subsequently organized can lead to "anti-trafficking" measures that actually harm the communities they aim to serve. Presents a case study of migrant Vietnamese sex workers in Cambodia which demonstrates how local interpretations of protection from trafficking and debt bondage can contribute to abuses of sex workers' human rights and exacerbate their vulnerability to HIV and other adverse sexual health outcomes. (Quotes from original text)

Cambodia received international attention in the early 1990s when it emerged from civil war with the highest HIV rate in Asia, in which up to 60% of sex workers were infected. A massive influx of financial, human, and material resources ensued, and debates over "best practices" for HIV prevention were played out. Over time, the politics of AIDS shifted, mirroring changes in the politics of the largest player in global health, the United States. This sparked acrimonious polarization within international health policy, with direct implications for the lives of sex workers. This article traces those debates over sex work and HIV, highlighting the example of one brothel district in Cambodia where Medecins Sans Frontieres provided services to over 300 migrant Vietnamese sex workers. Using literature and program documentation from the time, this article highlights how countries such as Cambodia can become vulnerable to manipulation and used to serve wider political agendas. © Taylor & Francis Group, LLC.

BACKGROUND: International migration has become a global political priority, with growing concern about the scale of human trafficking, hazardous work conditions, and resulting psychological and physical morbidity among migrants. Ethiopia remains a significant "source" country for female domestic workers to the Middle East and Gulf States, despite widespread reports of exploitation and abuse. Prior to introduction of a "safe migration" intervention, we conducted formative research to elicit lessons learned by women who had worked as domestic workers abroad. The aim of the study was to identify realistic measures future migrants could take to protect themselves, based on the collective insights and experience of returnees. METHODS: We conducted a qualitative assessment among returnee domestic labour migrants in Amhara Region, Ethiopia, an area considered a "hotspot" for outmigration. We conducted in-depth interviews and focus group discussions with a total of 35 female returnees, exploring risk and protective factors experienced by Ethiopian women during domestic work abroad. We used thematic content analysis to identify practical messages that could improve prospective migrants' preparedness. RESULTS: Returnees described the knowledge and skills they acquired prior to departure and during migration, and shared advice they would give to prospective migrants in their community. Facilitators of positive migration included conforming to cultural and behavioural expectations, learning basic Arabic, using household appliances, and ensuring safety in employers' homes. Respondents also associated confidence and assertiveness with better treatment and respect, and emphasized the importance of access to external communication (e.g. a mobile phone, local sim card, and contact details) for help in an emergency. Following their own challenging or even traumatic experiences, returnees were keen to support resilience among the next wave of migrants. CONCLUSIONS: There is little evidence on practices that foster safer migration, yet attention to human trafficking has led to an increase in pre-migration interventions. These require robust evidence about local risk and protective factors. Our findings identify knowledge, skills, attributes and resources found useful by returnee domestic workers in Amhara region, and have been used to inform a community-based programme aiming to foster better decision-making and preparation, with potential to offer insights for safer migration elsewhere.

IntroductionChildren living with HIV rely on adult caregivers for access to HIV testing and care, including clinical monitoring and adherence to treatment. Yet, many caregivers confront barriers to ensuring children's care, including fear of disclosure of the child's or the parents' HIV status, competing family demands, fluctuating care arrangements and broader structural factors such as entrenched poverty or alternative beliefs about HIV's aetiology and treatment. Thus, many children are "falling through the gaps" because their access to testing and care is mediated by guardians who appear unable or unwilling to facilitate it. These children are likely to suffer treatment failure or death due to their caregivers' recalcitrance.DiscussionThis Commentary presents three cases from paediatric HIV services in Zimbabwe that highlight the complexities facing health care providers in providing HIV testing and care to children, and discusses the implications as a child's rights issue requiring both legal and programmatic responses. The cases provide examples of how disagreements between family members about appropriate care, conflicts between a child and caregiver and religious objections to medical treatment interrupt children's engagement with HIV services. In all three cases, no social or legal mechanisms were in place for health staff to intervene and prevent "loss to follow up."ConclusionsWe suggest that conceptualizing this as a child's rights issue may be a useful way to raise the debate and move towards improved treatment access. Our cases reflect policy failure to facilitate access to children's HIV testing and treatment, and are likely to be similar across international settings. We propose sharing experiences and encouraging dialogue between health practitioners and global advocates for children's right to health to raise awareness that children are the bearers of rights even if they lack legal capacity, and that the failure of either the state or their caregiver to facilitate access to care is in fact a rights violation.

Background: Human trafficking has been recognized both by the international community and many individual states around the world as a serious violation of human rights. Trafficking is associated with extreme violence and a range of physical, mental, and sexual health consequences. Despite the extreme nature of the harm caused by human trafficking, harm is not a concept that is integrated in the definition of trafficking or in policies to address the health of trafficked people. This paper examines the United Kingdom's response to human trafficking as a case study to explore national policy responses to the health needs of trafficked people and assess the willingness of UK authorities to implement international and regional law in securing trafficked people's health rights. Methods: Between 2007 and 2010, data on the development of the UK response to trafficking were obtained through 46 interviews with key trafficking policy stakeholders and health care providers, participant observation at 41 policy-relevant events, and document collection. Framework analysis was used to analyze the data. Results: International and regional instruments specifically protect the health rights of trafficked people. Yet, UK engagement with trafficked people's health rights has been limited to granting, under certain circumstances, free access to health care services. Changes to trafficked people's entitlements to free health care occurred following the ratification of the Council of Europe Convention on Action against Trafficking in Human Beings, but had limited impact on trafficked people's access to medical care. Conclusions: International and regional instruments that provide specific or mandated instruction about states' health care obligations can be effective in furthering the health rights of vulnerable migrant groups. The UK government has demonstrated limited appetite for exceeding its minimum obligations to provide for the health of trafficked people, however, and key principles for promoting the health rights of trafficked people are yet to be fulfilled. Adapted from the source document.

Background: Human trafficking has been recognized both by the international community and many individual states around the world as a serious violation of human rights. Trafficking is associated with extreme violence and a range of physical, mental, and sexual health consequences. Despite the extreme nature of the harm caused by human trafficking, harm is not a concept that is integrated in the definition of trafficking or in policies to address the health of trafficked people. This paper examines the United Kingdom's response to human trafficking as a case study to explore national policy responses to the health needs of trafficked people and assess the willingness of UK authorities to implement international and regional law in securing trafficked people's health rights. Methods: Between 2007 and 2010, data on the development of the UK response to trafficking were obtained through 46 interviews with key trafficking policy stakeholders and health care providers, participant observation at 41 policy-relevant events, and document collection. Framework analysis was used to analyze the data. Results: International and regional instruments specifically protect the health rights of trafficked people. Yet, UK engagement with trafficked people's health rights has been limited to granting, under certain circumstances, free access to health care services. Changes to trafficked people's entitlements to free health care occurred following the ratification of the Council of Europe Convention on Action against Trafficking in Human Beings, but had limited impact on trafficked people's access to medical care. Conclusions: International and regional instruments that provide specific or mandated instruction about states' health care obligations can be effective in furthering the health rights of vulnerable migrant groups. The UK government has demonstrated limited appetite for exceeding its minimum obligations to provide for the health of trafficked people, however, and key principles for promoting the health rights of trafficked people are yet to be fulfilled. Adapted from the source document.

BACKGROUND: Human trafficking has been recognized both by the international community and many individual states around the world as a serious violation of human rights. Trafficking is associated with extreme violence and a range of physical, mental, and sexual health consequences. Despite the extreme nature of the harm caused by human trafficking, harm is not a concept that is integrated in the definition of trafficking or in policies to address the health of trafficked people. This paper examines the United Kingdom's response to human trafficking as a case study to explore national policy responses to the health needs of trafficked people and assess the willingness of UK authorities to implement international and regional law in securing trafficked people's health rights. METHODS: Between 2007 and 2010, data on the development of the UK response to trafficking were obtained through 46 interviews with key trafficking policy stakeholders and health care providers, participant observation at 41 policy-relevant events, and document collection. Framework analysis was used to analyze the data. RESULTS: International and regional instruments specifically protect the health rights of trafficked people. Yet, UK engagement with trafficked people's health rights has been limited to granting, under certain circumstances, free access to health care services. Changes to trafficked people's entitlements to free health care occurred following the ratification of the Council of Europe Convention on Action Against Trafficking in Human Beings, but had limited impact on trafficked people's access to medical care. CONCLUSIONS: International and regional instruments that provide specific or mandated instruction about states' health care obligations can be effective in furthering the health rights of vulnerable migrant groups. The UK government has demonstrated limited appetite for exceeding its minimum obligations to provide for the health of trafficked people, however, and key principles for promoting the health rights of trafficked people are yet to be fulfilled.

Books reviewed in this article:Chris Beyrer, War in the Blood: Sex, Politics and AIDS in Southeast AsiaCaroline H. Bledsoe et al. (eds.), Critical Perspectives on Schooling and Fertility in the Developing WorldDonald J. Hernandez and Evan Charney (eds)., From Generation to Generation: The Health and Well‐Being of Children in Immigrant FamiliesNana Poku and David T. Graham (eds.), Redefining Security: Population Movements and National SecurityJyoti Shankar Singh, Creating a New Consensus on PopulationJael Silliman and Ynestra King (eds.), Dangerous Intersections: Feminist Perspectives on Population, Environment, and Development; A Project of the Committee on Women, Population, and the EnvironmentMichael S. Teitelbaum and Jay Winter, A Question of Numbers: High Migration, Low Fertility, and the Politics of National IdentityUnited Nations Department of Economic and Social Affairs, Population Division, World Population Monitoring 1997Anthony Young, Land Resources: Now and for the Future

IntroductionChildren living with HIV experience particular challenges in accessing HIV care. Children usually rely on adult caregivers for access to care, including timely diagnosis, initiation of treatment and sustained engagement with HIV services. The aim of this study was to inform the design of a community‐based intervention to support caregivers of HIV‐positive children to increase children's retention in care as part of a programme introducing decentralized HIV care in primary health facilities.MethodsUsing an existing conceptual framework, we conducted formative research to identify key local contextual factors affecting children's linkages to HIV care in Harare, Zimbabwe. We conducted semi‐structured interviews with 15 primary caregivers of HIV‐positive children aged 6–15 years enrolled at a hospital clinic for at least six months, followed by interviews with nine key informants from five community‐based organizations providing adherence support or related services.ResultsWe identified a range of facilitators and barriers that caregivers experience. Distance to the hospital, cost of transportation, fear of disclosing HIV status to the child or others, unstable family structure and institutional factors such as drug stock‐outs, healthcare worker absenteeism and unsympathetic school environments proved the most salient limiting factors. Facilitators included openness within the family, availability of practical assistance and psychosocial support from community members.ConclusionsThe proposed decentralization of HIV care will mitigate concerns about distance and transport costs but is likely to be insufficient to ensure children's sustained retention. Following this study, we developed a package of structured home visits by voluntary lay workers to proactively address other determinants such as disclosure within families, access to available services and support through caregivers' social networks. A randomized controlled trial is underway to assess impact on children's retention in care over two years.

BackgroundIndividuals diagnosed with HIV in developing countries are not always successfully linked to onward treatment services, resulting in missed opportunities for timely initiation of antiretroviral therapy, or prophylaxis for opportunistic infections. In collaboration with local stakeholders, we designed and assessed a referral system to link persons diagnosed at a voluntary counselling and testing (VCT) clinic in a rural district in northern Tanzania with a government‐run HIV treatment clinic in a nearby city.MethodsTwo‐part referral forms, with unique matching numbers on each side were implemented to facilitate access to the HIV clinic, and were subsequently reconciled to monitor the proportion of diagnosed clients who registered for these services, stratified by sex and referral period. Delays between referral and registration at the HIV clinic were calculated, and lists of non‐attendees were generated to facilitate tracing among those who had given prior consent for follow up.Transportation allowances and a "community escort" from a local home‐based care organization were introduced for patients attending the HIV clinic, with supportive counselling services provided by the VCT counsellors and home‐based care volunteers. Focus group discussions and in‐depth interviews were conducted with health care workers and patients to assess the acceptability of the referral procedures.ResultsReferral uptake at the HIV clinic averaged 72% among men and 66% among women during the first three years of the national antiretroviral therapy (ART) programme, and gradually increased following the introduction of the transportation allowances and community escorts, but declined following a national VCT campaign. Most patients reported that the referral system facilitated their arrival at the HIV clinic, but expressed a desire for HIV treatment services to be in closer proximity to their homes. The referral forms proved to be an efficient and accepted method for assessing the effectiveness of the VCT clinic as an entry point for ART.ConclusionThe referral system reduced delays in seeking care, and enabled the monitoring of access to HIV treatment among diagnosed persons. Similar systems to monitor referral uptake and linkages between HIV services could be readily implemented in other settings.