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Pandemic: My Country Is O n I ts Knees

Pandemic: My Country Is O n I ts Knees. Ellen Chan Rebecca Finch Courtney Kappes Gretchen Landgraf April 20, 2011. Key Concepts. The HIV & AIDS epidemic is devastating Africa – Brain Drain – The emigration of skilled professionals from one country to another

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Pandemic: My Country Is O n I ts Knees

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  1. Pandemic:My Country Is On Its Knees Ellen Chan Rebecca Finch Courtney Kappes Gretchen Landgraf April 20, 2011

  2. Key Concepts • The HIV & AIDS epidemic is devastating Africa – • Brain Drain – • The emigration of skilled professionals from one country to another • Change in Family Structure – • Grandmothers taking care of grandchildren • “child-headed households” • Lack of ACCESS and an excess of STIGMA • Death and “passing” – • During 2009 – 1.3 million people died in Africa from AIDS • Hunger and Malnutrition – • The HIV & AIDS epidemic is compounded by Africa’s severe lack of food and malnutrition

  3. Epidemiology Triangle • Most African countries lack all components of a model for wellness: • Appraisal of health risk by clinicians • Funding for widespread behavior and therapeutic interventions • Adequate public health and social services

  4. Current AIDS Related Statistics About 16.6 million children were orphaned from AIDS in 2009 http://www.avert.org/aids-orphans.htm http://www.avert.org/africa-hiv-aids-statistics.htm

  5. Health Care Systems Org & Delivery • Nominal Public Policy • When CD4 count drops below 200, a person requires treatment of antiretroviral drugs • Health Care Delivery • Overcrowded University Teaching Hospitals, Hospitals, Clinics, Hospices • Many primarily supported by international NGOs • “Home Based Care” • Promising practices • Prevention of Mother-to-Child Transmission (PMTCT) & PMTCT-PLUS program

  6. International Coordination http://www.mercycorps.org/topics/hivaids/15550 • Consortium of American foundations led by Rockefeller Foundation directed by Columbia School of Public Health • Initiated PMTCT-Plus at number of facilities across Africa • Doctors without Borders (Medecins Sans Frontieres) • 1100 in treatment 2500 on list for future treatment programs • UN World Food Programme • Held workshop about HIV prevention to truck drivers • Mercy Corp • Peer Education and Youth Empowerment Programs

  7. Community Support • Catholic AIDS Action • People Living With AIDS • Community based organization for commercial sex workers • Encourages safe sex and provides condoms • Residential School for Orphan Girls • Recovery, acclimatization, academe Results: No stigma! Universal availability of free treatment and HIV counseling, Empowerment, & Self-confidence

  8. Financing International Funding • Private International NGOs • Rockefeller Group, Mercy Corp, Columbia University • Advocated by International Celebrities Local Income Generating Projects • Miniature Papier-Mache Coffin Fabrication • Community Grown Cabbage Patches • Profits go towards purchasing coffins $$$

  9. Challenges or Erected Barriers? Africa’s circumstances result in treating care as market justice, but the poverty of the population forms a permanent barrier to access under this approach Results in maldistribution of access to this resource, as with nutrition/food Cultural inhibitors: widespread socio-economic disparity between leaders and populations Ostracism and banishment by those not infected Children and grandmothers raising families – a missing generation

  10. Recommendations and Solutions • Education • HIV prevention by condom adoption • Empowerment and rebuilding of self-esteem • Treatment • Simple medication with big differences • Universal availability of treatment and counseling • Eradicating Stigma • Elimination of prejudice and intolerance

  11. Other Recommendations Bossert, T. J., and Ono, T. (2010). Finding affordable health workforce targets in low-income nations. Health Affairs, 29:7, 1376-1382. http://hbswk.hbs.edu/item/3395.html http://www.nytimes.com/2006/08/06/world/africa/06aids.html • Set country-specific, reasonable targets by achievable percentage of GDP to health • Supply-side approach instead of one-size-fits-all • Focus on resources available and build infrastructure • Medical delivery capability • “Cheap” solutions can make huge differences • Education on higher HIV infection rates among older men • Mechanisms to drive discussions on condom adoption • “Cabbages and Condoms” restaurants in Thailand

  12. Discussion How can governments and NGOs sustainably support community based solutions to social and economic disparities with respect to the AIDS epidemic? How can small scale successes be expanded regionally? Who should be responsible for the necessary infrastructure and implementation of larger scale ventures?

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