This book provides an overview of the current epidemiology of the HIV epidemic among young people in Eastern and Southern Africa (ESA) and examines the efforts to confront and reduce the high level ...of new HIV infections amongst young people. Taking a multi-dimensional approach to prevention, the contributors discuss the many challenges facing these efforts, in view of the slow progress in curbing the incidence of HIV amongst young people, focusing particularly on the structural and social drivers of HIV. Through an examination of these issues, chapters in this book provide valuable insights on how to mitigate HIV risk among young people and what can be regarded as the catalysts to mounting credible policy and programmatic responses required to achieve epidemic control in the region. The contributors draw on examples from a range of primary and secondary data sources to illustrate promising practices and challenges in HIV prevention, demonstrating links between conceptual approaches to prevention and lessons learnt from implementation projects in the region. Bringing together social scientists and public health experts who are actively engaged in finding effective solutions, the book discusses ‘which interventions works’, ‘why they work’, and the limitations and gaps in our knowledge to curb the pandemic amongst young people. As such it is an important read for researchers focusing on HIV/AIDS and public health.
Female sex workers bear a disproportionate burden of HIV and other poor sexual and reproductive health (SRH) outcomes which has led to the tailoring of SRH interventions to mitigate risk. ...Understanding of the SRH vulnerabilities of young women who sell sex (YWSS) (16–24 years) in Southern Africa is under-represented in research which may result in a mismatch in current SRH interventions and service design.
This paper is based on a sub-analysis of a qualitative study investigating the SRH of young women who sell sex (16–24 years) in Zimbabwe. We explored the differences in dynamics of SRH vulnerability amongst YWSS within the 16–24 year age band.
In-depth interviews (IDIs) were conducted amongst key informants (n = 4), health care providers (n = 5), and peer educators (n = 16). Amongst YWSS, we conducted IDIs (n = 42) and focus group discussions (n = 30). Transcripts were inductively coded for emergent themes and categories.
Age and life stage determinants led to key differences in SRH vulnerabilities between younger (16–19 years) and older YWSS (20–24 years). These determinants emerged in the following ways: 1) distancing of younger participants from a “sex worker” identity leading to difficulties in identification and limiting intervention reach, 2) inexperience in dealing with clients and immature cognitive development leading to greater exposure to risk, and 3) the subordinate social position and exploitation of young participants within sex worker hierarchies or networks and lack of protective networks.
We highlight the presence of a diverse group of vulnerable young women who may be missed by sex worker programme responses. In future intervention planning, there is need to consider the age-related needs and vulnerabilities within a spectrum of young women involved in a wide range of transactional relationships to ensure that services reach those most vulnerable to poor SRH outcomes.
•Young women who sell sex have unique sexual and reproductive health needs.•Elusive identities within the economies of sex pose a challenge to related interventions.•Substance use as a coping mechanism amongst young women who sell sex.•Subordinate social status of young women who sell sex in sex worker hierarchies.•Younger and older sex workers differ in characteristics and vulnerability.
In June, 2016, the UN General Assembly made a political commitment to end AIDS by 2030,1 endorsing the fast-track approach of the UNAIDS.2 This political declaration is unflinching in its ...characterisation of AIDS as "a paramount health, development, human rights and social challenge", and is detailed about the structural, programmatic, and normative challenges facing the global response to the HIV epidemic.1 But as Michel Sidibé, Executive Director of UNAIDS, asserted at the 21st International AIDS Conference held in Durban, South Africa, in July, 2016, "If we are serious about ending AIDS, it is high time to make funding sustainable and predictable".3 Worldwide financing for HIV and AIDS has been substantial, reaching about US$19·2 billion in 2015, with funding by affected governments accounting for 57% of all investments.4 However, political and fiscal momentum is faltering and international funding is expected to flatline in the next 5 years.4 Donor intentions are changing and there are political pressures generated by non-AIDS priorities.
The drive for universal health coverage (UHC) now has a great deal of normative impetus, and in combination with the inauguration of the sustainable development goals, has come to be regarded as a ...means of ensuring the financial basis for the struggle against HIV and AIDS. The argument of this paper is that such thinking is a case of 'the right thing at the wrong time': it seriously underestimates the scale of the work against HIV and AIDS, and the speed with which we need to undertake it, if we are to consolidate the gains we have made to date, let alone reduce it to manageable proportions. The looming 'fiscal crunch' makes the challenges all the more daunting; even in the best circumstances, the time required to establish UHCs capable of providing both essential health services and a very rapid scale-up of the fight against HIV and AIDS is insufficient when set against the urgency of ensuring that AIDS does not eventuate as a global health catastrophe.
Globalising dynamics have had wide-ranging and pervasive impacts on nearly every form of human relatedness, which now include the bases upon which states calculate and express their political ...responsibilities. As the 'reach' of practical and normative pressures extends and their demands intensify, the compass of state responsibility is becoming a key pressure point for facing the challenges and mediating the tensions of our globalised and still globalising world. This theme is examined from a global health perspective. The general disposition of states toward their acknowledged political responsibilities is unlikely to change, but the combination of legal, normative, political and practical dynamics impinging on them have already begun to register, as both states and the international system adjust to a politics that now have global dimensions.
Background
Persistent symptoms of SARS‐CoV‐2 are prevalent weeks to months following the infection. To date, it is difficult to disentangle the direct from the indirect effects of SARS‐CoV‐2, ...including lockdown, social, and economic factors.
Objective
The study aims to characterize the prevalence of symptoms, functional capacity, and quality of life at 12 months in outpatient symptomatic individuals tested positive for SARS‐CoV‐2 compared to individuals tested negative.
Methods
From 23 April to 27 July 2021, outpatient symptomatic individuals tested for SARS‐CoV‐2 at the Geneva University Hospitals were followed up 12 months after their test date.
Results
At 12 months, out of the 1447 participants (mean age 45.2 years, 61.2% women), 33.4% reported residual mild to moderate symptoms following SARS‐CoV‐2 infection compared to 6.5% in the control group. Symptoms included fatigue (16% vs. 3.1%), dyspnea (8.9% vs. 1.1%), headache (9.8% vs. 1.7%), insomnia (8.9% vs. 2.7%), and difficulty concentrating (7.4% vs. 2.5%). When compared to the control group, 30.5% of SARS‐CoV‐2 positive individuals reported functional impairment at 12 months versus 6.6%. SARS‐CoV‐2 infection was associated with the persistence of symptoms (adjusted odds ratio aOR 4.1; 2.60–6.83) and functional impairment (aOR 3.54; 2.16–5.80) overall, and in subgroups of women, men, individuals younger than 40 years, those between 40–59 years, and in individuals with no past medical or psychiatric history.
Conclusion
SARS‐CoV‐2 infection leads to persistent symptoms over several months, including in young healthy individuals, in addition to the pandemic effects, and potentially more than other common respiratory infections. Symptoms impact functional capacity up to 12 months post infection.
There is no viable substitute for re-energizing, funding and supporting culturally attuned, locally staffed HIV advocacy and prevention programmes, especially in resource poor settings. The evidence ...that such interventions are effective remains compelling; and although the cost implications are not negligible, the medium to long-term outcomes must be regarded not as complementary, but as integral, to biomedical interventions. The success of the anti-retroviral drugs upscale has enabled a noticeable improvement in AIDS related morbidity and mortality in the recent years; yet the underlying dynamics of the epidemic remains undetermined by the rate at which new infections are taking place in relation to the number of AIDS deaths. While the rate of new HIV infections is stabilising in some of the hardest hit countries, it remains far too high and the future cost of maintaining an ever-expanding pool of people reliant on daily drugs for survival is unsustainable. Countries must exercise caution in continuing to focus on treatment as a 'quick fix' to end AIDS as a public health concern. HIV is a socially culturally induced crisis and, as such, a variety of measures are needed simultaneously to appeal to different people, groups and circumstances.
The Sustainable Development Goals (SDGs) and the Agenda 2063 chart a new development pathway for Africa. 'Leaving no one behind', or full social inclusion, is central to this effort. What will this ...mean for lesbian, gay, bisexual, transgender, or intersex (LGBTI) people in Africa who are among the most socially excluded members of the population? This article explores this through a discussion framed by the concept of social inclusion and the commitments regarding it that appear in the SDGs and the Agenda 2063. Although LGBTI inclusion across Africa is not explicit in either document, there are nevertheless important opportunities for linking continental LGBTI advocacy to the sustainable development enterprise.
Five years from the end of the 15-year span of the Millennium Development Goals (MDGs) it is already plain that progress has been patchy and that the larger goals will not be met. The scale and ...profile of the MDGs will make them subject to eventual success or failure judgments and 'lessons learned' analyses, but the evidence of the past decade and current trajectories are sufficient to reveal our conceptual and operational shortcomings and the kinds of reorientation needed to ensure that the last five years of the MDGs will exhibit positive momentum rather than winding-down inertia. Such reorientations would include prioritising actors over systems; disaggregated targets over global benchmarks; qualitative aspects of complex forms of human relatedness over technical 'solutions'; and the painstaking work of developing country enablement over quick outcome indicators, not least for the purpose of sustainability. Thinking and planning beyond 2015 must be made integral to the last five years of the MDGs, for normative as well as practical reasons.
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