Suchergebnisse

Cover -- Half Title -- Title -- Copyright -- Contents -- List of Tables -- Acknowledgments -- Introduction -- Notes, -- 1 The Intriguing Epidemiology of AIDS in Africa -- STDs and HIV Infection -- Impacting STD Incidence -- STDs: The Domain of Traditional African Medicine -- Notes -- 2 Issues in the Development of Collaborative Programs -- African Healers -- Indigenous Knowledge Systems -- The Policy Background of Collaborative Programs -- The Emergence and Reemergence of Collaborative Programs -- Constraints to Collaborative Programs -- An Outline of the Continuing Policy Debate -- Should Healers Be Salaried by African Governments? -- The Question of Medicinal Plants -- Notes -- 3 Preliminary Research in Swaziland -- Background -- A National Survey and Census of Healers -- Illness and Treatment in a Pluralistic Setting -- Swaziland's First Collaborative Program -- Indigenous STDs in Swaziland -- Summary of Findings and Prospects for Referrals of STD Cases -- Case History of Gcunsula -- A Framework for Analysis -- Use of Antibiotics and Other Recent Trends -- Note on AIDS and Condoms -- Swazi Attitudes Toward Contraceptives -- The Traditional Healers Organization and Condoms -- Notes -- 4 STDs and AIDS in Liberia -- Background to Study -- Research Methods -- Sexually Transmitted Diseases -- AIDS -- Prevention of STDs and AIDS -- Sexual Behavior -- Discussion of Liberian Findings -- Condom Promotion and Its Problems -- Spermicides -- Addressing Risky Behavior -- STD Therapies and Therapy-Seeking Behavior -- Liberia in the Future -- Notes -- 5 STDs and AIDS in Mozambique -- Background on Mozambique -- The Genesis of a Policy and a Program -- The Issue of Village Health Workers -- National Policy and Pilot Project in Manica Province -- Profiles of Locally Recognized STDs -- Discussion and Analysis of Findings -- AIDS -- Note on Sorcery.

Voluntary medical male circumcision (VMMC) has been rapidly accepted by global HIV policy and donor institutions as a highly valuable HIV prevention strategy given its cost-effectiveness, limited interactions with a health facility, and projected long-lasting benefits. Many southern African countries have incorporated VMMC into their national HIV prevention strategies. However, intensive VMMC promotion programs have met with limited success to date and many HIV researchers have voiced concerns. This commentary discusses reasons behind the less-than-desired public demand and suggests how inclusion of the traditional sector – traditional leaders, healers, and circumcisers – with their local knowledge, cultural expertise and social capital, particularly in the realm of social meanings ascribed to male circumcision, may improve the uptake of this HIV prevention strategy. We offer Lesotho and Swaziland as case studies of the integration of universal VMMC policies; these are countries with a shared HIV burden, yet contrasting contemporary socio-cultural practices of male circumcision. The similar hesitant responses expressed by these two countries towards VMMC remind us that the incorporation of any new or revised and revitalized public health strategy must be considered within unique historical, political, economic, and socio-cultural contexts.

1. An anthropological approach to AIDS prevention -- 2. Sex, culture and disease -- 3. How the global AIDS response went wrong -- 4. Refocusing HIV prevention on primary prevention -- 5. Primary prevention in concentrated epidemics -- 6. Facts and myths about HIV prevention in generalized epidemics -- 7. Primary behavior change and HIV decline -- 8. HIV prevention and structural factors -- 9. Gender, marriage and HIV -- 10. An endogenous response to AIDS.

The global diversity of HIV epidemics can be explained in part by types and patterns of sexual partnerships. We offer a typology of sexual partnerships that corresponds to varying levels of HIV‐transmission risk to help guide thinking about appropriate behavioral interventions, particularly in the epidemics of sub‐Saharan Africa. Declines in HIV prevalence have been associated with reductions in numbers of sex partners, whereas many other prevention strategies have not been demonstrated to reduce HIV transmission at a population level. We suggest a reorientation of current prevention efforts, based on the epidemiology of sexually transmitted HIV epidemics and trends in sexual behavior change. Concurrent sexual partnerships are likely to play a large role in transmission dynamics in the generalized epidemics of East and Southern Africa, and should be addressed through improved behavior‐change interventions.

There has been considerable interest in understanding what may have led to Uganda's dramatic decline in HIV prevalence, one of the world's earliest and most compelling AIDS prevention successes. Survey and other data suggest that a decline in multi-partner sexual behavior is the behavioral change most likely associated with HIV decline. It appears that behavior change programs, particularly involving extensive promotion of "zero grazing" (faithfulness and partner reduction), largely developed by the Ugandan government and local NGOs including faith-based, women's, people-living-with-AIDS and other community-based groups, contributed to the early declines in casual/multiple sexual partnerships and HIV incidence and, along with other factors including condom use, to the subsequent sharp decline in HIV prevalence. Yet the debate over "what happened in Uganda" continues, often involving divisive abstinence-versus-condoms rhetoric, which appears more related to the culture wars in the USA than to African social reality.

Uganda has long been considered an AIDS success story, although in recent years declines in prevalence and incidence appear to have stalled or even reversed. During the early stages of Uganda's AIDS prevention program, health messages emphasized behavior change, especially fidelity. Ugandans were made to fear AIDS and feel personally at risk of dying from a new, poorly understood disease. In this research, six focus group discussions with 64 participants in peri‐urban and rural areas outside Kampala suggest that HIV prevention messages have shifted in the direction of risk reduction: condoms, testing, and drugs. Ugandans now seem less afraid of becoming infected with HIV, at least in part because antiretroviral therapy is available, and this diminished fear may be having a disinhibiting effect on sexual behavior. Participants believe that HIV rates are on the rise, that more individuals are engaged in multiple and concurrent sexual partnerships, and that sexual behavior is less restrained than a generation ago. These findings suggest that AIDS‐prevention programs in Uganda would benefit from refocusing on the content that yielded success previously—sexual behavior change strategies.