http://www.globalizationandhealth.com The latest research articles published by Globalization and Health 2010-03-02T00:00:00Z This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ Background: A coordinated response to HIV/AIDS remains one of the 'grand challenges' facing policymakers today. Global health initiatives (GHIs) have the potential both to facilitate and exacerbate coordination at the national and subnational level. Evidence of the effects of GHIs on coordination is beginning to emerge but has hitherto been limited to single-country studies and broad-brush reviews. To date, no study has provided a focused synthesis of the effects of GHIs on national and subnational health systems across multiple countries. To address this deficit, we review primary data from seven country studies on the effects of three GHIs on coordination of HIV/AIDS programmes: the Global Fund to Fight AIDS, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief (PEPFAR), and the World Bank's HIV/AIDS programmes including the Multi-country AIDS Programme (MAP). Methods: In-depth interviews were conducted at national and subnational levels (179 and 218 respectively) in seven countries in Europe, Asia, Africa and South America, between 2006 and 2008. Studies explored the development and functioning of national and subnational HIV coordination structures, and the extent to which coordination efforts around HIV/AIDS are aligned with and strengthen country health systems. Results: Positive effects of GHIs included the creation of opportunities for multisectoral participation, greater political commitment and increased transparency among most partners. However, the quality of participation was often limited, and some GHIs bypassed coordination mechanisms, especially at the subnational level, weakening their effectiveness. Conclusions: The paper identifies residual national and subnational obstacles to effective coordination and optimal use of funds by focal GHIs, which these GHIs, other donors and country partners need to collectively address. http://www.globalizationandhealth.com/content/6/1/3 Neil Spicer Julia Aleshkina Regien Biesma Ruairi Brugha Carlos Caceres Baltazar Chilundo Ketevan Chkhatarashvili Andrew Harmer Pierre Miege Gulgun Murzalieva Phillimon Ndubani Natia Rukhadze Tetyana Semigina Aisling Walsh Gill Walt Xiulan Zhang Globalization and Health 2010, 6:3 2010-03-02T00:00:00Z doi:10.1186/1744-8603-6-3 Globalization and Health 1744-8603 6 3 2010-03-02T00:00:00Z XML Sickle Cell Disorder is a global health problem with psychosocial implications. Nigeria has the largest population of people with sickle cell disorder, with about 150,000 births annually. This study explored the psychosocial impact of sickle cell disorder in 408 adolescents and adults attending three hospitals in Lagos, Nigeria. A questionnaire was designed for the study, with some of commonly described areas of psychosocial impact including general public perceptions and attitudes, education, employment, and healthcare issues, and emotional responses.The majority of participants thought that society in general had a negative image of SCD, and reported negative perceptions and attitudes. Some issues in education, employment, and healthcare were expressed, however these were in the minority of cases. The results also showed that depressive feelings were experienced in almost half the study population, even though feelings of anxiety or self-hate were uncommon. Clinical implications of these findings are considered. http://www.globalizationandhealth.com/content/6/1/2 Kofi Anie Feyijimi Egunjobi Olu Akinyanju Globalization and Health 2010, 6:2 2010-02-20T00:00:00Z doi:10.1186/1744-8603-6-2 Globalization and Health 1744-8603 6 2 2010-02-20T00:00:00Z XML Background: Sex work is receiving increased attention in southern Africa. In the context of South Africa's intense preparation for hosting the 2010 FIFA World Cup, anxiety over HIV transmission in the context of sex work has sparked debate on the most appropriate legal response to this industry.DiscussionDrawing on existing literature, the authors highlight the increased vulnerability of sex workers in the context of the HIV pandemic in southern Africa. They argue that laws that criminalise sex work not only compound sex workers' individual risk for HIV, but also compromise broader public health goals. International sporting events are thought to increase demand for paid sex and, particularly in countries with hyper-endemic HIV such as South Africa, likely to foster increased HIV transmission through unprotected sex.SummaryThe 2010 FIFA World Cup presents a strategic opportunity for South Africa to respond to the challenges that the sex industry poses in a strategic and rights-based manner. Public health goals and growing evidence on HIV prevention suggest that sex work is best approached in a context where it is decriminalised and where sex workers are empowered. In short, the authors argue for a moratorium on the enforcement of laws that persecute and victimise sex workers during the World Cup period. http://www.globalizationandhealth.com/content/6/1/1 Marlise Richter Matthew Chersich Fiona Scorgie Stanley Luchters Marleen Temmerman Richard Steen Globalization and Health 2010, 6:1 2010-02-11T00:00:00Z doi:10.1186/1744-8603-6-1 Globalization and Health 1744-8603 6 1 2010-02-11T00:00:00Z XML Background: Access to medicines in developing countries continues to be a significant problem due to lack of insurance and lack of affordability. Chronic Myeloid Leukemia (CML), a rare disease, can be treated effectively, but the pharmaceutical treatment available (imatinib) is costly and unaffordable by most patients. GIPAP, is a programme set up between a manufacturer and an NGO to provide free treatment to eligible CML patients in 80 countries worldwide.ObjectivesTo discuss the socio-economic and demographic characteristics of patients participating in GIPAP; to research the impact GIPAP is having on health outcomes (survival) of assistance-eligible CML patients; and to discuss the determinants of such outcomes and whether there are any variations according to socio-economic, demographic, or geographical criteria. Methods: Data for 13,568 patients across 15 countries, available quarterly, were analysed over the 2005-2007 period. Ordered Probit panel data analysis was used to analyze the determinants of a patient's progress in terms of participation in the programme. Four waves of patients entering quarterly in 2005 were used to evaluate patient survival over the sample period. Results: All patients in the sample are eligible to receive treatment provided they report to a facility quarterly. 62.3% of patients were male and 37.7% female. The majority (84.4%) entered during the chronic phase of the disease and their average age was 38.4 years. Having controlled for age, location and occupation, the analysis showed that patients were significantly much more likely to move towards a better health state after receiving treatment irrespective of their disease stage at the point of entry to the program (OR = 30.5, α = 1%); and that the larger the gap between diagnosis and approval for participation in the program, the more likely it is that patients' condition deteriorates (OR = 0.995, α = 1%), due to absence of treatment. Regressions to account for the effect of large countries (India, China, Pakistan) did not show any important differences when compared to the remaining countries in the sample. Survival analysis shows that at least 66 percent of all patients that entered the program in 2005 were alive and active by the end of 2007. Conclusions: GIPAP has a significant positive effect on patient access to important medicines for a life threatening condition such as CML. It impacts both the progress and phase of the disease and leads to a high survival rate. Overall, it sets a good example for access to treatment in developing countries, where such programmes can substitute or complement local efforts to provide care to eligible patients. http://www.globalizationandhealth.com/content/5/1/19 Panos Kanavos Sotiris Vandoros Pat Garcia-Gonzalez Globalization and Health 2009, 5:19 2009-12-31T00:00:00Z doi:10.1186/1744-8603-5-19 Globalization and Health 1744-8603 5 19 2009-12-31T00:00:00Z XML The burden of smoking-related diseases in Jordan is increasingly evident. During 2006, chronic, noncommunicable diseases (NCDs) accounted for more than 50% of all deaths in Jordan. With this evidence in hand, we highlight the prevalence of smoking in Jordan among youth and adults and briefly review legislation that governs tobacco control in Jordan. The prevalence of smoking in Jordan remains unacceptably high with smoking and use of tobacco prevalences ranging from 15% to 30% among students aged 13-15 years and a current smoking prevalence near 50% among men. Opportunities exist to further reduce smoking among both youth and adults; however, combating tobacco use in Jordan will require partnerships and long-term commitments between both private and public institutions as well as within local communities. http://www.globalizationandhealth.com/content/5/1/18 Adel Belbeisi Mohannad Al Nsour Anwar Batieha David Brown Henry Walke Globalization and Health 2009, 5:18 2009-12-01T00:00:00Z doi:10.1186/1744-8603-5-18 Globalization and Health 1744-8603 5 18 2009-12-01T00:00:00Z XML Worldwide, far more people migrate within than across borders, and although internal migrants do not risk a loss of citizenship, they frequently confront significant social, financial and health consequences, as well as a loss of rights. The recent global financial crisis has exacerbated the vulnerability internal migrants face in realizing their rights to health care generally and to antiretroviral therapy in particular. For example, in countries such as China and Russia, internal migrants who lack official residence status are often ineligible to receive public health services and may be increasingly unable to afford private care. In India, internal migrants face substantial logistical, cultural and linguistic barriers to HIV prevention and care, and have difficulty accessing treatment when returning to poorly served rural areas. Resulting interruptions in HIV services may lead to a wide range of negative consequences, including: individual vulnerability to infection and risk of death; an undermining of state efforts to curb the HIV epidemic and provide universal access to treatment; and the emergence of drug-resistant disease strains. International human rights law guarantees individuals lawfully within a territory the right to free movement within the borders of that state. This guarantee, combined with the right to the highest attainable standard of health set out in international human rights treaties, and the fundamental principle of non-discrimination, creates a duty on states to provide a core minimum of health care services to internal migrants on a non-discriminatory basis. Targeted HIV prevention programs and the elimination of restrictive residence-based eligibility criteria for access to health services are necessary to ensure that internal migrants are able to realize their equal rights to HIV prevention and treatment. http://www.globalizationandhealth.com/content/5/1/17 Katherine Wiltenburg Todrys Joseph Amon Globalization and Health 2009, 5:17 2009-11-19T00:00:00Z doi:10.1186/1744-8603-5-17 Globalization and Health 1744-8603 5 17 2009-11-19T00:00:00Z XML Sub-Saharan Africa carries a massive dual burden of HIV and alcohol disease, and these pandemics are inextricably linked. Physiological and behavioural research indicates that alcohol independently affects decision-making concerning sex, and skills for negotiating condoms and their correct use. More than 20 studies in Africa have reported higher occurrence of HIV among people with problem drinking; a finding strongly consistent across studies and similar among women and men. Conflation of HIV and alcohol disease in these setting is not surprising given patterns of heavy-episodic drinking and that drinking contexts are often coterminous with opportunities for sexual encounters. HIV and alcohol also share common ground with sexual violence. Both perpetrators and victims of sexual violence have a high likelihood of having drunk alcohol prior to the incident, as with most forms of violence and injury in sub-Saharan Africa. Reducing alcohol harms necessitates multi-level interventions and should be considered a key component of structural interventions to alleviate the burden of HIV and sexual violence. Brief interventions for people with problem drinking (an important component of primary health care), must incorporate specific discussion of links between alcohol and unsafe sex, and consequences thereof. Interventions to reduce alcohol harm among HIV-infected persons are also an important element in positive-prevention initiatives. Most importantly, implementation of known effective interventions could alleviate a large portion of the alcohol-attributable burden of disease, including its effects on unsafe sex, unintended pregnancy and HIV transmission. http://www.globalizationandhealth.com/content/5/1/16 Matthew Chersich Helen Rees Fiona Scorgie Greg Martin Globalization and Health 2009, 5:16 2009-11-17T00:00:00Z doi:10.1186/1744-8603-5-16 Globalization and Health 1744-8603 5 16 2009-11-17T00:00:00Z XML There has been a renewed debate over whether AIDS deserves an exceptional response. We argue that as AIDS is having differentiated impacts depending on the scale of the epidemic, and population groups impacted, and so responses must be tailored accordingly. AIDS is exceptional, but not everywhere. Exceptionalism developed as a Western reaction to a once poorly understood epidemic, but remains relevant in the current multi-dimensional global response. The attack on AIDS exceptionalism has arisen because of the amount of funding targeted to the disease and the belief that AIDS activists prioritize it above other health issues. The strongest detractors of exceptionalism claim that the AIDS response has undermined health systems in developing countries.We agree that in countries with low prevalence, AIDS should be normalised and treated as a public health issue--but responses must forcefully address human rights and tackle the stigma and discrimination faced by marginalized groups. Similarly, AIDS should be normalized in countries with mid-level prevalence, except when life-long treatment is dependent on outside resources--as is the case with most African countries--because treatment dependency creates unique sustainability challenges. AIDS always requires an exceptional response in countries with high prevalence (over 10 percent). In these settings there is substantial morbidity, filling hospitals and increasing care burdens; and increased mortality, which most visibly reduces life expectancy. The idea that exceptionalism is somehow wrong is an oversimplification. The AIDS response can not be mounted in isolation; it is part of the development agenda. It must be based on human rights principles, and it must aim to improve health and well-being of societies as a whole. http://www.globalizationandhealth.com/content/5/1/15 Alan Whiteside Julia Smith Globalization and Health 2009, 5:15 2009-11-14T00:00:00Z doi:10.1186/1744-8603-5-15 Globalization and Health 1744-8603 5 15 2009-11-14T00:00:00Z XML Background: Pharmaceuticals are an integral component of health care systems worldwide, thus, regulatory weaknesses in governance of the pharmaceutical system negatively impact health outcomes especially in developing countries 1 . Nigeria is one of a number of countries whose pharmaceutical system has been impacted by corruption and has struggled to curtail the production and trafficking of substandard drugs. In 2001, the National Agency for Food and Drug Administration and Control (NAFDAC) underwent an organizational restructuring resulting in reforms to reduce counterfeit drugs and better regulate pharmaceuticals 2 . Despite these changes, there is still room for improvement. This study assessed the perceived level of transparency and potential vulnerability to corruption that exists in four essential areas of Nigeria's pharmaceutical sector: registration, procurement, inspection (divided into inspection of ports and of establishments), and distribution. Methods: Standardized questionnaires were adapted from the World Health Organization assessment tool and used in semi-structured interviews with key stakeholders in the public and private pharmaceutical system. The responses to the questions were tallied and converted to scores on a numerical scale where lower scores suggested greater vulnerability to corruption and higher scores suggested lower vulnerability. Results: The overall score for Nigeria's pharmaceutical system was 7.4 out of 10, indicating a system that is marginally vulnerable to corruption. The weakest links were the areas of drug registration and inspection of ports. Analysis of the qualitative results revealed that the perceived level of corruption did not always match the qualitative evidence. Conclusion: Despite the many reported reforms instituted by NAFDAC, the study findings suggest that facets of the pharmaceutical system in Nigeria remain fairly vulnerable to corruption. The most glaring deficiency seems to be the absence of conflict of interest guidelines which, if present and consistently administered, limit the promulgation of corrupt practices. Other major contributing factors are the inconsistency in documentation of procedures, lack of public availability of such documentation, and inadequacies in monitoring and evaluation. What is most critical from this study is the identification of areas that still remain permeable to corruption and, perhaps, where more appropriate checks and balances are needed from the Nigerian government and the international community. http://www.globalizationandhealth.com/content/5/1/14 Habibat Garuba Jillian Kohler Anna Huisman Globalization and Health 2009, 5:14 2009-10-29T00:00:00Z doi:10.1186/1744-8603-5-14 Globalization and Health 1744-8603 5 14 2009-10-29T00:00:00Z XML Background: The Global Movement for Mental Health has brought renewed attention to the neglect of people with mental illness within health policy worldwide. The maltreatment of the mentally ill in many low-income countries is widely reported within psychiatric hospitals, informal healing centres, and family homes. International agencies have called for the development of legislation and policy to address these abuses. However such initiatives exemplify a top-down approach to promoting human rights which historically has had limited impact at the level of those living with mental illness and their families. Methods: This research forms part of a longitudinal anthropological study of people with severe mental illness in rural Ghana. Visits were made to over 40 households with a family member with mental illness, as well as churches, shrines, hospitals and clinics. Ethnographic methods included observation, conversation, semi-structured interviews and focus group discussions with people with mental illness, carers, healers, health workers and community members. Results: Chaining and beating of the mentally ill was found to be commonplace in homes and treatment centres in the communities studied, as well as with-holding of food ('fasting'). However responses to mental illness were embedded within spiritual and moral perspectives and such treatment provoked little sanction at the local level. Families struggled to provide care for severely mentally ill relatives with very little support from formal health services. Psychiatric services were difficult to access, particularly in rural communities, and also seen to have limitations in their effectiveness. Traditional and faith healers remained highly popular despite the routine maltreatment of the mentally ill in their facilities. Conclusion: Efforts to promote the human rights of those with mental illness must engage with the experiences of mental illness within communities affected in order to grasp how these may underpin the use of practices such as mechanical restraint. Interventions which operate at the local level with those living with mental illness within rural communities, as well as family members and healers, may have greater potential to effect change in the treatment of the mentally ill than legislation or investment in services alone. http://www.globalizationandhealth.com/content/5/1/13 Ursula Read Edward Adiibokah Solomon Nyame Globalization and Health 2009, 5:13 2009-10-14T00:00:00Z doi:10.1186/1744-8603-5-13 Globalization and Health 1744-8603 5 13 2009-10-14T00:00:00Z XML