Suchergebnisse

Aus US-amerikanischer Sicht

In the same way that the Samoa Government's decision to suspend the national immunisation program from July 2018 to April 2019 following two vaccine-associated paediatric deaths (later found to be due to medical negligence) [1,2] led to a sharp decline in measles-containing vaccine (MCV) coverage among infants in 2018 (first- and second-dose MCV coverage of just 40% and 28%, respectively) [1,3] and laid the foundation on which the current measles crisis was able to develop, health authorities should be concerned that the redirection of health resources to respond to the crisis may – if not managed carefully – have negative impacts on other priority health programs.In the background of the measles epidemic, the Samoa population faces a non-communicable disease (NCD) tsunami with an estimated 71.2% of the burden of disease, including approximately 880 deaths annually, attributable to cardiovascular diseases, diabetes, cancers and other NCDs [4]. The drawing of clinical and public health resources away from services that aim to treat and reduce the impact of these diseases, even in the short term, runs the risk of stalling the good work that has been done and – inadvertently – resulting in greater associated deaths and disabilities.The Samoa government faces many challenges in responding to both the acute infectious and underlying chronic epidemics the population faces. When monitoring and evaluating the impact of the measles outbreak on population health the indirect and opportunity costs associated with the response should be realised and accounted for.

Purpose - Injecting drug use is a global concern, with an estimated 16 million people who inject drugs (PWIDs) in over 148 countries. A number of Asian countries detain PWIDs for compulsory treatment. The paper aims to discuss this issue. Design/methodology/approach - The authors reviewed the literature on compulsory drug treatment in seven Asian countries. Findings - The authors identified 1,269 closed settings which held over 600,000 drug users in eight countries. The average detainee was aged from 20 to 30 years and was predominantlymale. HIV risk behaviour continued in detention in some countries. In most countries treatment comprised physical labour,military drills. Methadone maintenance treatment and antiretroviral therapy were rarely available. No data were located to show detention in a closed setting treated drug dependency. Issues of concern were; no due legal process for the detention of drug users, lack of evidence-based drug treatment, lack of HIV prevention and treatment, abusive conditions, forced labour and exercise, arbitrary exit procedures and very high relapse rates. Research limitations/implications - The review of compulsory treatment of drug users failed to find any evaluation of effective drug treatment for detainees. Instead serious breaches in human rights conditions were evident. Prominent international organisations have called for the compulsory treatment of drug users to cease. Practical implications - Many countries are spending vast amounts of funding on ineffective treatments for drug users. Social implications - Funding should be directed to community-based drug treatments that have been shown to work. Originality/value - This is the largest review of compulsory treatment of drug users to date.

In his conceptualisation of pastoral power, Michel Foucault argues that modern healthcare practices derive a specific power technique from pastors of the early Christian church. As experts in a position of authority, pastors practise the care of others through implicitly guiding them towards thoughts and actions that effect self-care, and towards a predefined realm of acceptable conduct, thus having a regulatory effect. This qualitative study of healthcare workers from two Christian faith-based organisations in Papua New Guinea examines the pastoral rationalities of HIV prevention practices which draw together globally circulated modern medical knowledge and Christian teachings in sexual morality for implicit social regulation. Community-based HIV awareness education, voluntary counselling and testing services, mobile outreach, and economic empowerment programs are standardised by promoting behavioural choice and individual responsibility for health. Through pastoral rationalities of care, healthcare practices become part of the social production of negative differences, and condemn those who become ill due to perceived immorality. This emphasis assumes that all individuals are equal in their ability to make behavioural choices, and downplays social inequality and structural drivers of HIV risk that are outside individual control. Given healthcare workers' recognition of the structural drivers of HIV, yet the lack of language and practical strategies to address these issues, political commitment is needed to enhance structural competency among HIV prevention programs and healthcare workers.

Introduction: Leadership is a key factor in the success of HIV prevention and treatment. Positive HIV-related outcomes are also affected by funding levels for HIV, health sector resources, disease burden and the socio-economic environment. Leadership on HIV as well as these other factors are affected by the quality of political governance of the country, which may be an overarching factor that influences the making of effective responses to the HIV epidemic. Aim : The aim of the study was to investigate the association between quality of political governance, on one hand, and coverage of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT), on the other, in low- to middle-income countries. Methods: This investigation was carried out through a global review, online data sourcing and statistical analyses. We collected data on health burden and resources, the socio-economic environment, HIV prevalence, ART and PMTCT coverage and indicators of political governance. Outcome variables were coverage of ART (from 2004) and PMTCT (from 2007) to 2009 as a percentage of persons needing it. Potential predictors of treatment coverage were fitted with a baseline multilevel model for univariable and multivariable analyses. Results: Countries with higher levels of political voice and accountability, more political stability and better control of corruption have higher levels of ART coverage but not PMTCT coverage. Control of corruption (in standard deviation units) had a strong association with ART (AOR = 1.82, p = 0.002) and PMTCT (AOR = 1.97, p = 0.01) coverage. Indicators of economic development were not significant when control of corruption was included in the multivariable regression model. Many countries in all income groups had high ART but not PMTCT coverage (e.g. Mexico, Brazil and Romania in the upper-middle-income group; Papua New Guinea and Philippines in the lower-middle-income group; and Cambodia, Laos and Comoros in the low-income group). Very few low-income countries (notably, Haiti and Kenya) had high PMTCT coverage. Conclusions: Our research found a significant relationship between quality of political governance and treatment coverage. Measures and policies for improving the quality of political governance should be considered as a part of HIV programme implementation to more effectively improve the welfare of people living with HIV, particularly mothers living with HIV and their babies. © 2014 Man WYN et al; licensee International AIDS Society.