Critical issues arising from litigating HIV/AIDS discrimination in Nigeria

The evolution of HIV/AIDS policy and legal frameworks in Nigeria has happened in distinct phases. The first period between 1986 when the first AIDS cases were reported and 1996 was uneventful and generally characterized by a distinct lack of appreciation of the spread and impact of the disease. During the following decade, notable achievements included the institutionalization of multisectoral responses at all levels of government and the introduction of national and sub-national policies and programmes. Comparable breakthroughs have been slow to occur in the legal environment despite evidence of widespread HIV/AIDS discrimination. This article analyses the legal mechanisms for addressing HIV/AIDS discrimination in Nigeria and argues that even with the emergence of HIV/AIDS-specific anti-discrimination legislation, the protection for persons living with or affected by HIV/AIDS is far from being secured.

HIV/AIDS Politics and Policy in Sub-Saharan Africa

Sub-Saharan Africa has the world largest proportion of adults and children living with AIDS. To mitigate the multiple consequences of the epidemic, novel forms of governance arose as international organizations usurped the roles traditionally played by states; new funding streams emerged that led to asymmetries in biomedical resource allocation; and diverse partnerships among international agencies, nation-states, and local and international nongovernmental organizations emerged. Global health actors attempted to define AIDS policy and programming as an apolitical biomedical intervention. However, political dynamics were evident in the negotiations between international donors and African state bureaucracies in setting AIDS policy agendas and the contestations between African and international social movements and global health agencies over AIDS treatment drug prices and access to treatment interventions across the continent. During the first two decades of the African AIDS epidemic (1980–2005) the dominant approach to AIDS disease mitigation was the focus on AIDS prevention, and across sub-Saharan Africa standardized prevention interventions were introduced. These interventions were founded upon limited evidence and ultimately these programs failed to stem rates of new HIV infections. Social movements comprising coalitions of local and international activists and scientists brought extensive pressure on global health institutions and nation-states to reform their approach to AIDS and introduce antiretroviral therapy. Yet the path toward universal provision of antiretroviral treatment has been slow and politically contentious. By the second decade of the 21st century, antiretroviral therapy interventions together with AIDS prevention became the dominant policy approach. The introduction of these initiatives led to a significant decline in AIDS-related mortality and slowed rates of transmission. However, health disparities in treatment access remain, highlighting ongoing shortcomings in the political strategies of global health agencies and the public health bureaucracies of African states.

Applying the health belief model to identify predictors of self-perceived risk of HIV infection among undergraduates in mainland China

Objective This cross-sectional study aimed to identify predictors of self- perceived risk of HIV infection among undergraduates in mainland China, based on the health belief model.Methods A self-administered questionnaire survey method was used to collect information from 10665 eligible undergraduates across the whole country (except for Tibet). Multivariate Logistic regression analysis was chosen to explore the predictors of self-perceived risk of HIV infection.Results Approximately half (48.2%) of the undergraduates perceived themselves to be at risk of contracting HIV, yet only 8.9% reported to engage in risky sexual behaviors. After controlling for potential confounders, males [adjusted odd ratio (AOR)=0.72, 95% confidence interval (CI)=0.66-0.77], those residing in urban areas (AOR=0.86, 95% CI= 0.79-0.93), having higher levels of condom use self-efficacy (AOR=0.64, 95% CI=0.58-0.69) and knowing the national AIDS policy (AOR=0.68, 95% CI=0.62-0.74) were less likely to perceive themselves to be at risk of acquiring HIV. Conversely, freshmen (AOR=1.27, 95% CI=1.16-1.38), non-heterosexuals (AOR=1.57, 95% CI=1.39-1.77), and those who had expressed less stigma towards people living with HIV (PLHIV) (AOR=1.25, 95% CI=1.15-1.35) and had the intention of utilizing voluntary counseling and testing (VCT) services (AOR=1.29, 95% CI=1.16-1.43) perceived themselves to be at increased risk for HIV infection.Conclusions Undergraduates tended to overestimate their own risk of acquiring HIV infection. In order to help undergraduates accurately assess their risk of being infected with HIV and effectively avoid risk, a comprehensive intervention measure should be taken to target females, non-heterosexuals, freshmen and those residing in rural areas, raise their awareness of the national AIDS policy, relieve their stigma against PLHIV, improve their condom use self-efficacy and provide VCT services in college campus.

HIV/AIDS Policy-Making in Iran: A Stakeholder Analysis

Introduction: HIV/AIDS phenomenon is one of the most serious public health challenges which includes wide range of epidemiological, social, economic and political dimensions. Therefore, its effective control requires involvement of different stakeholders. The present study aims to identify and analyze HIV/AIDS stakeholders in Iran.Methods: This qualitative stakeholder analysis was conducted in 2018 nationwide both retrospectively and prospectively. Identification and analysis of stakeholders was carried out by the review of related literature and policy documents and official websites, as well as holding semi-structured interviews with policy makers and other key informants. Purposive sampling was utilized and followed by snowball sampling until data saturation. Data were analyzed using framework analysis. Also, qualitative data analysis software MAXQDA (Version 11) and Policy Maker software (version 4) were applied.Findings: A total of 44 stakeholders were identified and categorized into 23 active and 21 inactive stakeholders. Despite the great importance of educating and informing pubic about HIV/AIDS, the Ministry of Education and Islamic Republic of Iran Broadcasting organization (IRIB), have moderate participation in this regard. Supreme Council of Health and Non-governmental organizations (NGOs) have low participation. The Ministry of Health and Medical Education (MoHME), State Welfare Organization of Iran, Iranian Blood Transfusion Organization, the State Prisons and Security and Corrective Measures Organization are interested in HIV/AIDS policymaking. The MoHME, as main body responsible for stewardship of the HIV/AIDS in Iran, does not have enough authority in handling the issue due to the low funding, institutional and structural deficits and insufficient human resources.Conclusion: The process of HIV/AIDS policy making is fragmented in Iran and despite multiple active and passive stakeholders in this field, there is no integrated system to involve all stakeholders in the process of AIDS policy-making. Therefore, given the importance of the issue, an upstream entity is needed in order to coordinate and mobilize all stakeholders associated with managing and controlling HIV/AIDS.

Empowered Criminals

“Empowered Criminals” compares the mobilization of sex workers and MSM and gay groups around two separate legal campaigns: the campaign to decriminalize adult consensual same-sex sex (Section 377 activism) and the campaign to stop new amendments to ITPA. Through advocacy and sustained campaigning, sex worker and MSM/kothi groups were able to not only mobilize against these laws but also use their roles in the HIV/AIDS prevention programs to argue that these laws undermined the state’s health mandate. Through protests and lobbying, they were able to gain the crucial support of HIV/AIDS groups as well as the federal Ministry of Health (which is primarily responsible for implementing HIV/AIDS policy). Furthermore, sex workers successfully stalled ITPA amendments in 2007, and LGBTKQHI groups had brief success with the reform of Section 377 in 2009. I argue that despite these successes, sex workers and LGBTKQHI groups still remained “empowered criminals.” They were empowered to make claims on the state based on their shared responsibility in preventing HIV/AIDS, and yet they were still classified as criminals because the laws that criminalize sex acts remain intact.

Case Study: A Wellness Workplace Policy and HIV/AIDS Policy for Zambia’s Ministry of Tourism and Arts

The Ministry of Tourism and Arts (2018) identified an overall goal of utilizing Zambia’s natural and cultural resources as a tourism driver to increase economic growth for the country. However, the industry has experienced problems with attrition, productivity, and high mortality rates of wildlife police officers (WPOs) which negatively affects the ability to protect the wildlife and natural resources that drive the tourism industry. A systematic review of the evidence was conducted in support of the Ministry of Tourism and Arts (MOTA) to identify the key components of a workplace wellness and HIV/AIDS program to reduce the attrition and mortality of the WPOs. The findings from the review indicate the essential components of a wellness workplace and HIV/AIDS policy can be bucketed into four categories: (a) program design; (b) program growth; (c) disease management and prevention; and (d) program evaluation. Findings also indicate that wellness programs have a positive correlation with absenteeism, job satisfaction, job performance/productivity, employee turnover, and return on investment (ROI). However, management involvement and support to resource a program and reduce the stigma associated with it are necessary for its success. This case study presents evidence-based recommendations to assist the MOTA with the development and implementation of an effective Wellness Workplace Policy focusing on HIV/AIDS, other communicable and noncommunicable diseases, addiction, and mental health support. Recommendations included the formation of a workplace wellness committee, development and communication of the wellness program, engagement through employee forums, increased training for leadership, and the involvement of stakeholders as program advisors.