HIV in Haiti
With an estimated “2.2% of adults” noting an HIV-positive status in 2010, Haiti faces “the largest [HIV] epidemic in the Caribbean.” In 2020, 150,000 children and adults in Haiti lived with HIV. People older than the age of 15 made up 93% of this population. In addition, 20% of Haitians living with the disease are unaware that they are HIV-positive. To help reduce the prevalence of HIV in Haiti, several initiatives are currently underway, run by the Centers for Disease Control and Prevention (CDC), UNAIDS and the Elizabeth Glaser Pediatric AIDS Foundation.

CDC Initiatives

Since the CDC’s Division of Global HIV & TB opened its office in Haiti in 2002, the CDC has launched several initiatives to address the country’s HIV epidemic. The first aim is to strengthen health systems by training medical personnel, supporting staffing needs and strengthening the Haitian Ministry of Health’s governance. The CDC has also aided in the development of the iSanté national electronic medical record (EMR) software to better monitor and track HIV patient data. These innovative tools help inform evidence-based treatment for this disease. In 2018, iSanté, “along with two other EMR systems,” could monitor the data of “96% of HIV care and treatment sites.”

Another goal of the CDC office in Haiti helps improve laboratory resources. Through a collaboration with the National Public Health Laboratory and GHESKIO, a medical treatment, research and training center in Port-Au-Prince, Haiti, the CDC has helped develop and expand several HIV testing methods. In addition, the CDC assisted in developing “an external quality assurance program and a training curriculum” to support lab accreditation.

Community-led Monitoring

With support from UNAIDS, the Ministry of Public Health and Population and the U.S. government via the United States President’s Emergency Plan for AIDS Relief (PEPFAR), Haiti’s Civil Society Forum Observatory has initiated “community-led monitoring,” a program through which people living with HIV hold each other accountable throughout treatment. Community members are familiar with HIV patients from their community, and when patients do not follow through on treatments or follow-ups, community members know how to best communicate with them and encourage them to return. Community-led monitoring can provide valuable feedback on service delivery from a patient perspective, helping to improve on existing issues “to retain people in care.”

Community-led monitoring reveals the weaknesses of treatment plans for HIV in Haiti and brings corresponding solutions to light. For example, due to insight from community-led monitoring, the Civil Society Forum Observatory brings to light a need to increase the window of service hours and decrease patient wait times. It also recommends that stable HIV patients receive a six-month supply of antiretroviral medication. Through community-led monitoring and other resources, Haiti was able to allocate multiple months’ supplies of antiretroviral medicines to 88% of HIV patients during the COVID-19 pandemic.

Elizabeth Glaser Pediatric AIDS Foundation

The Elizabeth Glaser Pediatric AIDS Foundation strives to combat pediatric HIV worldwide through advocacy, research and initiatives for prevention and treatment. Although most HIV patients in Haiti are adults, 8,000 children younger than 15 lived with HIV in Haiti in 2020. Thus, addressing pediatric HIV in Haiti is an important health initiative.

Toward the latter part of 2020, the Foundation began its work in Haiti with the Delivering Technical Assistance Project. The project offers “cost-effective technical assistance (TA), capacity building and program implementation services” to HIV reduction programs. The technical assistance includes program management training, mentorship, consultations and workshops for health care workers.

These strategies, and many others throughout the country, are successfully helping lower HIV rates in Haiti. As organizations continue to implement HIV reduction plans, the severity of the HIV epidemic in Haiti may see a decline in the years to come.

– Aimée Eicher
Photo: Flickr

HIV/AIDS in Africa
The HIV/AIDS epidemic remains a significant public health problem in southern Africa. In the last decade, infections have drastically dropped while awareness of HIV status and availability of treatment has increased. This progress aligns with the UNAIDS 90-90-90 goal. Meeting this goal means that at least 90% of people with HIV are aware of their status, 90% are receiving antiretroviral drug treatments and 90% are virally suppressed. Viral suppression means that the virus will not negatively affect a person and that that person will not be able to transmit it to another person. Some of the most HIV-afflicted countries in Africa have met and even exceeded the 90-90-90 goals. Eswatini has the highest HIV prevalence in the world today at 26.8%. It has reached 95% in all categories and is on its way to reducing new infections.

HIV/AIDS and Conflicts

Despite recent progress, international aid has been focusing on HIV/AIDS less and less, especially as the COVID-19 pandemic has become a more imminent global threat. Sub-Saharan Africa still has the highest rates of HIV/AIDS in the world. It is also one of the most conflict-ridden regions in the world.

HIV/AIDS has a history of destabilizing political and social institutions in countries and leaving them vulnerable to violent conflict. The International Crisis Group estimated that one in seven civil servants, including government employees, teachers and the armed forces in South Africa were HIV-positive in 1998.

How Does HIV/AIDS Affect Civil Servants in Africa?

  1. The disease affects the productivity of the military and its ability to respond to armed conflicts. In 2003, the Zimbabwe Human Development Report estimated that the Zimbabwe Defense Forces had an HIV prevalence rate of 55%. With such a high rate of illness, the military has high training and recruitment costs, as soldiers get sick and are unable to work. In addition to this, HIV can transmit through sexual contact. It disproportionately affects younger populations which typically make up the bulk of the armed forces.
  2. The HIV/AIDS epidemic breaks down political institutions by limiting their capacity to govern. According to former president Robert Mugabe in 2001, AIDS had a significant presence in his cabinet, killing three of his cabinet ministers in the span of a few years and infecting many more. The disease wipes out workers essential to the function of a state, like policymakers, police officers and judicial employees.
  3. HIV/AIDS threatens the quality and accessibility of education. A UNICEF report found that more than 30% of educators in Malawi were HIV positive. If children cannot receive a quality primary education, they are less likely to receive secondary education and start professional careers. Instead, crime may open up opportunities for security that education could not provide. With increased antiretroviral use and awareness of the disease, HIV rates and deaths among educators have likely dropped along with overall rates in the last decade.

Civil Servants

The impact of HIV/AIDS on civil servants in Africa has been immense. The disease affects vulnerable populations such as gay men, sex workers and young women disproportionately. However, it has also affected those who work as civil servants. Civil servants are integral to the functioning of governments. Without them, countries are vulnerable to conflict and violence. Furthermore, HIV/AIDS prolongs conflict in countries already experiencing it.

While there are many other causes of violent conflict, the breakdown of political and social institutions fueled by HIV/AIDS only exacerbates conflict. War can also be a vector for the further spread of the disease. According to UNHCR, both consensual and non-consensual sexual encounters happen more often during the conflict. Rape has been a weapon of war in conflicts in Rwanda, the Democratic Republic of Congo (DRC) and Liberia in recent years and has likely contributed to the spread of HIV.

Solutions

Combating HIV and AIDS is a very important step in stabilizing economic, political and social structures across Africa. USAID programs like PEPFAR have had a significant role in combating HIV and AIDS. PEPFAR has invested nearly $100 billion in the global AIDS response in various ways. Most notably, it has provided 18.96 million people with much-needed antiretroviral treatment.

PEPFAR also aids in prevention care. For example, it has supported more than 27 million voluntary medical male circumcisions as well as testing services for 63.4 million people. In 2012, there was a government campaign in Zimbabwe to promote circumcision, in which at least 10 members of parliament participated.

These campaigns and USAID programs have had tangible results. In 2013, a study by the South African National Defense Forces showed an 8.5% HIV prevalence rate among its soldiers, much lower than the 19% prevalence in the general population. Given the successes in decreasing HIV/AIDS infections across Africa, perhaps economic, political and social stability is to follow.

– Emma Tkacz
Photo: Flickr

HIV/AIDS in UkraineUkraine has one of the highest rates of HIV/AIDS in the world, with an estimated 260,000 people living with the disease. Odessa, the third-most populous city in Ukraine, has “the highest concentration of HIV/AIDS of anywhere in Europe.” Poverty exacerbates HIV/AIDS in Ukraine and links to injected drug use, threats to government funding, lack of access to antiretroviral treatment and social discrimination.

Poverty and HIV/AIDS in Ukraine

In 2019, Ukraine and Moldova stood as the two most impoverished countries in Europe. The poverty rate in Ukraine increased during the COVID-19 pandemic, from 42.4% in 2020 to 50% as of February 2021. There is a strong connection between poverty and the spread of diseases; disease could be both a cause and a result of poverty.

HIV/AIDS causes conditions of poverty when working adults become ill and can no longer support their families. The disease becomes a result of poverty when the conditions of poverty put people at greater risk of contracting it. As an example, women and girls who live in poverty are more vulnerable to sexual exploitation. They are more likely to resort to working in the sex trade, which could put them at high risk of contracting HIV.

HIV/AIDS in Ukraine’s Women and Girls

UNAIDS estimates that out of all people with HIV/AIDS in Ukraine, 120,000 are women older than 15 and 2,900 are children aged 14 or younger. Gender inequality, poverty and violence against women and girls are significant factors in the spread of HIV. Women and girls who live in fear of violence may be reluctant to advocate for safe sex, receive testing or seek treatment for HIV and other diseases.

Gender inequality inhibits women’s access to resources for sexual and reproductive health. In rural Ukraine, where the poverty rate is highest, 36% of women do not participate in community or family decision-making. Only 46% of these women are competent with a computer or the internet. Furthermore, almost 48% do not have access to medical services.

The Lack of Access to Antiretrovirals

As Sky News reported, access to antiretrovirals is a major problem for many people living with HIV/AIDS in Ukraine. Although a law stipulates that antiretroviral therapy should be free to all citizens, limited national resources have resulted in restricted access.

Antiretrovirals are crucial for preventing the spread of HIV to children. The use of antiretrovirals during pregnancy and administered to an infant for four to six weeks after birth can result in a transmission rate of 1% or less. According to U.N. Women, the majority of women living with HIV/AIDS in Ukraine fell between 18 and 45 years old. Out of these women, 39% discovered that they were HIV-positive during pregnancy.

Social Discrimination Against People Living With HIV/AIDS

According to the World Health Organization (WHO), discrimination against people who use drugs and people living with HIV presents a serious challenge to identifying those who need treatment. Harsh drug laws, fear of HIV/AIDS and systematic police abuse undermine efforts to provide HIV information and services such as testing and safe needle exchanges. In addition, the law requires drug treatment centers in Ukraine to register drug users and share the information with law enforcement. This protocol keeps people who use drugs from seeking medical help, which subsequently prevents them from testing and receiving treatment for HIV/AIDS.

The War in Donbas

The war in Donbas has made it difficult for people to receive treatment in a region that previously had one of the highest rates of HIV/AIDS in the country and was home to nearly one-quarter of all antiretroviral recipients. When the war began in March 2014, it displaced 1.7 million people. To compound this, unsafe sex has resulted in an increase of HIV/AIDS within the military. Combined with ongoing military conflict and a shortage of antiretrovirals, Ukraine is experiencing a crisis: the government has failed to keep up with infection rates.

Solutions

In July 2021, Ukraine received a grant of $35.8 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria. According to the Ukrainian government, the nation would use the funds to purchase personal protective equipment (PPE), reduce risks associated with COVID-19 and strengthen the health care system.

Ukraine is collaborating with the Centers for Disease Control and Prevention (CDC), USAID and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The country wants to implement prevention campaigns, increase access to antiretroviral treatment and target key risk groups, such as people who inject drugs, sex workers and men who have sex with men.

On September 1, 2021, President Biden announced that the United States would provide more than $45 million in additional assistance for Ukraine. The aid would help people facing the impacts of the COVID-19 pandemic and the war in Donbas. The U.S. is working with USAID-supported programs to provide supplies for Ukrainian health care centers, training for health care workers and psychosocial support for the most vulnerable populations.

– Jenny Rice
Photo: Flickr

Low Health Literacy in Developing Countries
While developing countries often face pressing issues such as inadequate health care, a less obvious but equally threatening problem is low health literacy rates. In comparison to developed nations, health literacy rates in developing nations are significantly low. However, if society as a whole works to educate and empower individuals to make better choices regarding their health, low health literacy, also known as the “silent killer,” will see a drastic reduction. Here is some information about low health literacy in developing countries.

Defining Health Literacy

The World Health Organization (WHO) defines health literacy as an individual’s ability to adequately comprehend health information and to implement this knowledge into their everyday life in order to “maintain or improve quality of life.” An individual with lower health literacy is more likely to make questionable health choices and is less likely to take preventative action against manageable diseases.

Limited health literacy also correlates with unhealthy lifestyle choices, increased hospitalization rates and higher mortality rates. These impacts make it clear to understand how inadequate health literacy serves as a “silent killer,” especially within developing nations where these rates are prominently low.

The Situation in Developing Countries

Low health literacy rates link to inadequate education systems and health systems because these structures hold the responsibility of relaying health information to the general public. Thus, nations that lack these proper systems are more likely to have insufficient health education levels.

A survey of adult citizens in Isfahan, Iran, indicates that almost 80% of respondents did not have sufficient health literacy. Most of the respondents with inadequate health literacy were females with “low financial status” and limited education. This data suggests that an overwhelming number of individuals in developing nations lack satisfactory health education, particularly women. The reason for this is likely issues of gender equality — women lack access to education, essential services and employment opportunities. Furthermore, poverty disproportionately impacts women all over the world.

Taking Action

There are several ways to improve health literacy rates, and therefore, improve global health. It is crucial to educate the population on their health and to empower them to effectively manage their well-being. Several interventions have proven effective. In South Africa, providing individuals with informative yet easy-to-read pamphlets that include graphics is improving health education in the country. Meanwhile, in China, findings determined that “periodic training of health educators is essential for improving health knowledge” among the general public.

Media is yet another way to improve health education. In Uganda, “more than one in three used the internet to search for health information.” In Iran, secondary school students cited television as their most helpful source of information on HIV/AIDS. In Israel, “a model of Media Health Literacy (MHL)” showed potential in improving health literacy among younger citizens.

Across Asia, the Asian Health Literacy Association (AHLA) works to understand and improve health literacy rates. This organization aims to raise awareness of this issue “among researchers, officials, healthcare organizations as well as experts in health and education, corporations and media” in order to formulate effective interventions to improve these rates in Asia. AHLA sees this as an essential  part of improving the quality of healthcare “and reducing health disparities between communities, groups and nations.” Ultimately, the AHLA aims to improve global health, starting with Asia.

Moving Forward

Increasing health literacy rates in developing countries is an effective way to improve global health and eliminate inequalities. Through education programs, improved communication and dedicated organizations,  these rates can improve. By educating individuals on matters of health, people all over the world can live an improved quality of life.

– River Simpson
Photo: Flickr

Myanmar's Healthcare System Post Coup

On February 1, 2021, Myanmar’s military seized control of the country in a coup. Following a series of raids, several democratically-elected government officials were arrested, including the president, Aung San Suu Kyi. Since the coup, many protesters have taken to the streets, resulting in more than 100 deaths on March 27 alone. Even before the coup, Myanmar’s healthcare system was in shambles. However, NGOs and other groups believe that the coup, as well as the COVID-19 pandemic, will exacerbate conditions in the country. The situation is compounded by the return of 100,000 migrant workers to Myanmar in March 2021.

Effect on COVID-19 and Immunizations

Healthcare workers were among some of the first to join the pro-democracy movements. However, this has led to shortages of staff, significantly impacting healthcare service delivery. According to The New Humanitarian, “Soldiers have also occupied major public hospitals and attacked healthcare workers, including emergency responders trying to help injured protesters.” With limited healthcare services available, some doctors are volunteering their time and community groups are stepping in to bridge the gap in healthcare. “The public health system has practically collapsed,” said Andrew Kirkwood, the senior U.N. official in Myanmar, during a briefing in March 2021.

Additionally, the coup has stalled routine vaccinations for children. Due to healthcare workers joining the movement, as well as continued fighting in the remote regions, many refugees and citizens are unable to get their children vaccinated. By July 2021, close to one million children were unable to receive their vaccinations since the coup began.

Due to the fragility of Myanmar’s healthcare system, COVID-19 testing and treatment also came to halt, producing uncertainty regarding Myanmar’s vaccination rollout amid the coup. The coup and the counter-protests induced outbreaks, worsening COVID-19 and causing shutdowns. With the economic strain as well as the risk of the virus, Myanmar’s impoverished families are struggling. Fortunately, in July 2021, the U.N. Country Team in Myanmar stepped in to scale up “the provision of critical health services and COVID-19 vaccination efforts.” The U.N. Country Team is also working to increase testing rates and accelerate the COVID-19 vaccination rollout while tackling the oxygen shortage.

Effect on HIV/AIDS

The coup also led to the shut down of HIV treatment programs and testing, putting many lives at risk. Before the coup and the COVID-19 pandemic, Myanmar implemented several programs to tackle HIV/AIDs in impoverished areas. With the ongoing conflict, it has become harder to access anti-retroviral drugs and there are concerns of shortages due to disrupted supply chains.

ICAP, a global public health NGO, with funding from the U.S. President’s Emergency Plan for AIDS Relief  (PEPFAR), is “collaborating with the community-based organization Myanmar Positive Group (MPG) to build its capacity to deliver HIV care services.” During the COVID-19 pandemic, ICAP provided “virtual conferencing software for community self-help groups” to host virtual support meetings as these services are crucial to controlling HIV in Myanmar. ICAP also provided training on using virtual software and conducting tele-counseling. During the coup, these established tools will ensure these services continue.

The Good News

Several NGOs stepped up to help Myanmar. The Myanmar Red Cross is intensifying its efforts for humanitarian assistance and healthcare. The organization reported in June 2021 that nearly 236,000 people require assistance as COVID-19 shutdowns and the coup exacerbate poverty. About 2,000 Red Cross healthcare volunteers provided frontline assistance to those injured during the protests and others in need of healthcare services. The organization also provided ambulance services.

The EU also stepped in to assist with a donation of “€9 million in emergency humanitarian aid” in April 2021. The funding will go toward “emergency health support, protection, food security and multi-sector emergency assistance” in Myanmar.

With organizations taking a stand to help Myanmar’s most vulnerable people during the coup, citizens will receive the aid they need while the country awaits the end of the widespread violence and instability.

– Lalitha Shanmugasundaram
Photo: Wikimedia Commons

HIV/AIDS in Israel
With the marvels of medical technology, medical professionals can now cure most infections and diseases with a combination of treatments and pharmaceutical drugs. However, it is challenging for them to treat some viruses still. Amongst the stubborn viruses that still elude the medical communities’ ability is the HIV/AIDS virus, a diagnosis that for too many means the end of living a normal life. The effects of HIV/AIDS in Israel have been profound and COVID-19 may worsen the situation.

The Effects of HIV/AIDS in Israel

Following the first case of AIDS in the 1980s, the world bore witness to an epidemic that swept the globe in an unprecedented manner. From 1981 to 2010, Israel reported nearly 10,000 cases, with around 7,000 of them still ongoing in the country. People living with HIV/AIDS in Israel fall into some of the most vulnerable groups in society. This includes injecting drug users and immigrants. Israeli immigrants, often from countries like Sudan, China and Eritrea, often face obstacles receiving treatment for AIDS. While testing is free, the pathway to HIV/AIDs drugs remains expensive and out of reach for many. This creates a socioeconomic divide on who has access to treatment and who does not. According to a report by the Israeli Task Force, many immigrants are unaware of their access to free testing.

COVID-19 Compounding Consequences

Since the beginning, nation-states have strived to mitigate the effects of the HIV/AIDS virus on their populations. Communities most at risk often face marginalization and are disproportionately at risk of poverty. The COVID-19 pandemic has halted services to help these groups. This has caused many to fall into poverty. The Health Ministry of Israel worries that poverty and food and housing insecurity will rise due to the COVID-19 pandemic.

In addition, the Health Ministry of Israel is collaborating with other government sectors to create and strengthen initiatives to fight HIV/AIDS. For example, needle exchange programs, homeless shelters and meals all function as efforts to combat the effects of HIV/AIDS in Israel. Health officials in these programs are now essential as the government prepares for a rise in cases.

The Good News

As a result, Israel is taking steps in the right direction to fight HIV/AIDS. Within society, a conservative outlook on sex and the religious practice of circumcision keep the numbers relatively low. In addition regional cooperation inside of Israel with IGOs like the UN and WHO have made workshops and collaboration with Israeli NGOs and the Jerusalem AIDS Project. Israeli researchers are some of the world’s foremost pioneers and drivers of HIV/AIDS vaccine research and in 2019 introduced a ‘mosaic’ vaccine that identifies and responds to more variant strains of the HIV virus. Though HIV/AIDS is still a prevalent issue, Israel is making great strides in combating the virus.

– Alex Pinamang
Photo: Flickr

HIV/AIDS in JordanForearms of Change Center to Enable Community (FOCCEC) is an NGO based in Amman, Jordan, working to help people with HIV/AIDS in Jordan. Through collaborative efforts with several Jordanian health service providers and partners, FOCCEC provides HIV-positive people with access to treatment and care resources. Through a variety of services, FOCCEC aims to support an often underserved and stigmatized community.

HIV/AIDS in Jordan and the MENA Region

With an HIV prevalence rate of 0.1%, the Middle East and North Africa (MENA) region has the fewest HIV cases per capita in the world. In Jordan specifically, this rate is less than 0.1% and the new case count is fairly low. Between the beginning of 2020 and February 2021, Jordan reported 21 new HIV cases. HIV cases do not occur evenly among populations in the MENA region. Sex workers and people who use injectable drugs are at an elevated risk of contracting HIV. However, the total case numbers are low compared to other regions.

While HIV impacts few people living in Jordan, those who are HIV-positive often experience stigma and lack access to proper medical treatment. A survey of Jordanian women found that more than 70% would not want to purchase vegetables from someone with HIV. Instead of receiving medical care, solitary confinement is common among incarcerated individuals with HIV/AIDS in Jordan who are not Jordanian nationals.

Non-citizens may be less likely to seek treatment because of legal concerns. Jordanian healthcare providers are required to report the HIV status of patients to the Jordanian government. The Jordanian government typically deports non-nationals who test positive for HIV. Jordan’s deportation policies impact asylum seekers needing HIV treatment. In early 2020, an HIV-positive Iraqi refugee did not seek treatment because he feared deportation.

FOCCEC Supports HIV-Positive People

FOCCEC works to help people with HIV access testing services and assists in navigating the treatment process. The organization travels outside of Amman to regions of Jordan such as Irbid, Mafraq and Zarqa to increase people’s access to HIV testing services.

Following individuals’ diagnoses, FOCCEC provides treatment and counseling services. It also helps patients with other sexually transmitted diseases. FOCCEC strives to ensure that refugees and non-Jordanians can access HIV treatment services. It also offers monetary support for patients with financial barriers to treatment as a way of making healthcare accessible and affordable.

Preventing HIV Transmission in Jordan

Historically, most cases of HIV/AIDS transmission occurred in other countries. However, local transmission is increasing, particularly among people 20-24 years old. New HIV/AIDS cases are also common in people aged between 30-39, representing 25% of new HIV/AIDS cases in Jordan.

FOCCEC implements programs to improve HIV awareness in Jordan, an initiative that could help reduce local transmission rates. A survey of young adults in Jordan concluded that only 25% of respondents knew that condoms help prevent HIV transmission, suggesting that young Jordanians could benefit from better education on HIV transmission and protection.

FOCCEC is a change-driven organization working to create a world where vulnerable communities in Jordan can access the resources needed to meet their medical and social needs. Through its efforts, the prevalence of HIV/AIDS in Jordan can reduce even further.

Caroline Kuntzman
Photo: Flickr

Economic and Educational Disparity
As economic vulnerability is an important risk factor for HIV, economic empowerment projects are becoming an increasingly common measure for HIV prevention and mitigation. Stakeholders are primarily concerned with the effects of HIV/AIDS on women and girls. However, concerted efforts have begun to improve their living conditions by finding sustainable ways to remove economic and educational disparity and improve their economic status.

Connections between economic and educational disparity and HIV status remain complicated. Few studies have linked involvement in economic empowerment methods and HIV outcomes for young women. Therefore, the exploration of effective interventions must go beyond the healthcare sector to further address the linkage between HIV risks and economic and social factors.

Furthermore, strong stigmatization of the disease persists in sub-Saharan Africa in addition to poor awareness of HIV transmission and preventive initiatives. This increases the need to improve HIV-related knowledge in the region for future prevention strategies. Thus far, initiatives to improve HIV-related awareness in sub-Saharan Africa have included a broad range of information-dissemination methods, including the use of means that can easily reach the vulnerable populations, such as mass media or community-based social cohesion methods.

The significant social determinants of HIV require more comprehensive educational interventions. These interventions became designed in light of social- and gender-inequity-based theories. These include social norms theory, the social constructivist theory of gender and the theory of gender and power. Furthermore, approaches focused on behavior theories have undergone wide use in interventions aimed at improving HIV-related knowledge, as experts have found that HIV-education interventions, when combined with behavioral change components, correlate with a higher probability of eventual implementation of preventive behaviors.

The Current Landscape

Implementation issues in HIV-education interventions became neglected. The sub-Saharan region of Africa suffers from a lack of HIV education because this region has the highest rates of education exclusion and the highest out-of-school rates for all age groups in the world. A disproportionate number of young children attend school for a short while and quickly drop out. Around 20% of children from 6 to 11 years old are out of school in addition to 34% of children between 12 and 14 years old. According to UIS, 60% of teenagers from 15 to 17 years old remain unenrolled in school.

These statistics show that HIV-education interventions do not always have wide distribution. This results in few youths receiving education from these programs. Thus, how to deliver effective HIV/AIDS education in sub-Saharan Africa is worth discussing.

Current trends in sub-Saharan Africa indicate that digital education is getting traction even though technological barriers persist. Many perceive digital education as not only a better form of learning but also as a cost-effective way to broaden educational opportunities. The rapidly growing population is exploding with demands for education. Countries are increasingly embracing digital tools to increase access to education and improve educational and social equity.

According to World Bank Education, the learning crisis, which resulted from learning poverty, started long before the COVID-19 pandemic. With the spread of COVID-19, 1.6 billion children and youth are out of school. Thus, it has become more and more urgent to prepare students in low-resource areas for digital learning. This is so they have an opportunity to gain healthcare knowledge, especially the knowledge of COVID-19 treatment and HIV prevention.

Educational Radio Programmes

Educational radio programming can be an excellent tool to keep children from disadvantaged areas engaged in HIV-knowledge acquisition. It enables disadvantaged populations to access the information they need to achieve sustainable development. Many of these radio programs aim to improve regional development. Community radio platforms became promoted to encourage local development. Many villages have limited access to information about education and nutrition. Radio programs allow them to study and improve their living conditions.

UNESCO, which set up multi-collaborations with low-resource countries, stated that these countries rely heavily on the radio (93%) and “the use of radio and television broadcasts as distance learning solutions is a powerful way to bridge the digital divide in the education sector and reach the most marginalized learners.” Previous research and studies have focused on how the radio programs have developed in recent years, but these studies have neglected the application of radio and have rarely directly studied how people use the radio, and specifically how radio platforms can be effective educational tools.

Many countries in sub-Saharan Africa seek to develop into emerging nations by 2035 and are setting policies and goals. For example, in Cameroon, the government has prioritized Information Communication Technologies (ICT) development in the economic, culture and education domains in all state sectors, with a specific focus on ICT in the education domain. It encouraged programs consisting of agriculture, health and rural and urban development content for a mass audience. Many see radio programming as a way for Cameroon to achieve overall development.

Educational Equity and Digital Learning

Still, a portion of the population in the rural areas – for example, 42% of the population of Cameroon – cannot receive national radio services. Young adolescents in these rural areas are still in a more disadvantaged position than those in urban districts because they are unable to receive important information.

Therefore, policymakers ought to develop a short- or long-term digital learning arrangement and evaluate their systems’ capability to support a digital learning paradigm that incorporates a mixture of technologies and delivery mechanisms. It is also critical for policymakers to collaborate with outside stakeholders such as EdTech companies, local broadcast centers and private radio stations to ensure the accelerated growth of the designated digital learning modality. Dispersing economic and educational disparity should always be the priority among all planning efforts.

Aining Liang
Photo: Flickr

Children in Pakistan
Pakistan is a mostly Muslim country between Afghanistan and India in South Asia. The country gained independence in 1947 and the government operates as a parliamentary democracy. In recent years, the country has adopted Sunni Islam’s essence, with Northern Pakistan facilitating a sanctuary for various Islamic extremist groups. The life expectancy in the country averages 67 years. In 2015, an Asian Development Bank report determined that 24.3% of Pakistanis live below the poverty line and UNAIDS claimed that 190,000 Pakistani are HIV positive. The organization also stated that the number of deaths from HIV cases has increased by 385% since 2010, with only 12% of patients receiving treatment. Unfortunately, the number of children in Pakistan with HIV has been significant.

Recent HIV Outbreak

Between April and July 2019, medical professionals diagnosed 735 children in Pakistan with HIV. The World Health Organization (WHO) has labeled the epidemic as a Grade Two Emergency. This implies a moderate approach to combating the problem since, according to WHO, Pakistan is one of the lowest spending countries when it comes to funding for health. Pakistan utilizes only 3% of its GDP for healthcare, whereas its neighbor, Afghanistan, allots 10%. Per person, Pakistan spends less than $45 on annual healthcare.

With the COVID-19 pandemic, many essential health issues have received neglect. In September 2020, Lancet Global Health constructed an investigation around how the pandemic has affected other health crises. In its findings, reports determined that deaths for HIV have increased by 10% since the beginning of the pandemic. The medical system has been under stress due to the pandemic, leading to a decrease in medical support for HIV. During this time, a local reporter named Gulbahar Shaikh, who had been covering a story in Ratodero around this time, decided to have his children tested to be safe. He was reportedly stunned when his daughter, Rida, came back positive for HIV.

Solutions

In November 2019, cases of HIV-positive children in Pakistan started to emerge in Ratodero, a city just north of Larkana. In fact, reports stated that 1,132 children had HIV in Ratodero. As soon as possible, the local government sent experts to respond. During their investigations, it came to light that many of the patients did not have infected parents, which set off a red flag to officials. They later found that many of the infected children saw a doctor named Muzaffar Ghanghro. He was a cheap, in-town physician working primarily with children. Finding this, officials made Ghanghro obtain a test for HIV too. Even when his results came back positive for HIV, he denied the results.

The officials found Ghanghro fully responsible for the increase in outbreaks within children in Ratodero, and police arrested him. He spent about two months in jail but the pediatrician has not received any charges.

In 2019, $6.3 million went into funding investigations for children in Pakistan with HIV, resulting in the shutting down of 300 medical facilities in Ratodero. However, unlicensed private clinics still function on “nearly every block,” and several facilities do not even have a place for physicians to wash their hands.

Save the Children

In 2020, UNAIDS and the United Nations HIV program reported that 2.8 million individuals under 20 were living with HIV. Additionally, over 50% of those individuals were under 10 years old.

An organization fighting for the betterment of children named Save the Children works in Pakistan. Together with the National Health Emergency Preparedness and Response Network, the organization provides reputable health facility managers to implement more humane health responses. The Mothers, Newborn and Child Health Program (MNCH) is an integral part of what Save the Children offers for healthcare. The program provides improved services from households to hospitals to moms and their children. The program’s focus is on the already existing primary healthcare facilities within areas of poverty in Pakistan. The program ensures a healthier emergency and medical experience for children in Pakistan.

Save the Children also has an initiative explicitly targeting individuals with HIV/AIDS. The project consists of providing more support to the physicians practicing in Pakistan. This program provides care to People Living with HIV (PLHIV) through Community and Home-Based Care services. The service actively raises awareness on transmission causes along with referring cases to further investigations. Together with the other efforts, Pakistan hopes to change the trend of rising HIV numbers.

– Libby Keefe
Photo: Flickr

Progress Against HIV/AIDS in ThailandIn the last decade, Thailand has made significant efforts to reduce HIV/AIDS transmission and deaths, resulting in a dramatic decrease in one of the world’s most stigmatized diseases and an effective model for other countries to follow.

HIV — first identified in 1981 — is a viral infection that attacks the human immune system and spreads through bodily fluids. If left untreated, it can cause AIDS, a condition with which most people only survive a few years. There is no cure for HIV/AIDS, but there are treatments such as antiretroviral therapy that can keep the infection from progressing to AIDS.

HIV/AIDS in Thailand

The first case of HIV/AIDS in Thailand was in 1985, and the country continues to have one of the highest rates of the disease in Asia and the Pacific. An estimated 470,000 people are living with HIV/AIDS in Thailand, and 14,000 AIDS-related deaths occurred in the country in 2019.

Like in other countries, the Thai populations most at risk for HIV/AIDS are those living in poverty or otherwise on the margins of society. These circumstances can reduce access to healthcare and testing, which is made worse by the heavy stigmatization of the disease.

Progress in Thailand

However, the Thai government has made substantial progress against the virus after making it one of the country’s prioritized health initiatives. In 2006, Thailand incorporated HIV services into its universal healthcare system, and now testing and treatment are free for anyone who might need them.

Awareness campaigns have also had a large impact on the state of HIV/AIDS in Thailand. The government has partnered with civil society groups to increase public knowledge both about the disease and preventative measures. Another important aspect of these partnerships has been specific efforts to reduce the stigma associated with HIV/AIDS.

Since 2010, the rate of new infections in Thailand has dropped 65%, and AIDS-related deaths have fallen 44%. These improvements have directly resulted from the efforts to increase awareness and improve access to healthcare and testing. Of the Thai population living with HIV, 80% are on antiretroviral treatment, and 78% have suppressed viral loads preventing the infection from progressing to AIDS.

Thailand is also the first country that has nearly eliminated mother-to-child transmission of HIV/AIDS. Now, less than 2% of children test positive for HIV after being exposed. This has significantly reduced the number of children who are infected and need antiretroviral care.

Future Goals

With all of this progress, the government is in a strong position to continue reducing the prevalence of HIV/AIDS in Thailand. The country still has not met UNAIDS’ 90-90-90 targets where 90% of those HIV positive are aware of their status, 90% are on antiretroviral treatment and 90% have suppressed viral loads. However, Thailand’s efforts remain an important international model of effective policy against HIV/AIDS.

Through its focus on decreasing the number of new infections and improving access to antiretroviral treatment, the prevalence of HIV/AIDS in Thailand has decreased. Along with its prioritization of spreading information and awareness about the disease and its transmission, Thailand has created an effective method for tackling HIV/AIDS.

– Nicole Ronchetti
Photo: Flickr