International Journal of Environmental Research and Public Health, 2021
Health risk communication plays a crucial role in preventing the spread of infectious disease out... more Health risk communication plays a crucial role in preventing the spread of infectious disease outbreaks such as the current coronavirus (SARS-CoV-2). Yet, migrants are far too often forgotten in health risk communication responses. We investigate the challenges and efforts made by migrants in Denmark-in the initial months of the pandemic-to access information about COVID-19. We draw on 18 semi-structured interviews conducted in May and June 2020. All interviews are thematically coded and analyzed. Our analysis reveals that many of the migrants faced several challenges, including accessing information in a language understandable to them and navigating constant streams of official news flows issuing instructions about which actions to take. However, we also note that the participating migrants found numerous creative ways to address some of these challenges, often aided by digital tools, helping them access crucial health and risk information. This paper highlights that migrants constitute an underserved group in times of crises. They are vulnerable to getting left behind in pandemic communication responses. However, we also identify key protective factors, social resources, and agentic capabilities, which help them cope with health and risk information deficits. National governments need to take heed of these findings to inform future pandemic responses.
Introduction: The HIV prevention cascade could be used in developing interventions to strengthen ... more Introduction: The HIV prevention cascade could be used in developing interventions to strengthen implementation of effica-cious HIV prevention methods, but its practical utility needs to be demonstrated. We propose a standardized approach to using the cascade to guide identification and evaluation of interventions and demonstrate its feasibility for this purpose through a project to develop interventions to improve HIV prevention methods use by adolescent girls and young women (AGYW) and potential male partners in east Zimbabwe. Discussion: We propose a six-step approach to using a published generic HIV prevention cascade formulation to develop interventions to increase motivation to use, access to and effective use of an HIV prevention method. These steps are as follows: (1) measure the HIV prevention cascade for the chosen population and method; (2) identify gaps in the cascade; (3) identify explanatory factors (barriers) contributing to observed gaps; (4) review literature to identify relevant theoretical frameworks and interventions; (5) tailor interventions to the local context; and (6) implement and evaluate the interventions using the cascade steps and explanatory factors as outcome indicators in the evaluation design. In the Zimbabwe example, steps 1-5 aided development of four interventions to overcome barriers to effective use of pre-exposure prophylaxis (PrEP) in AGYW (15-24 years) and voluntary medical male circumcision in male partners (15-29). For young men, prevention cascade analyses identified gaps in motivation and access as barriers to voluntary medical male circumcision uptake, so an intervention was designed including financial incentives and an education session. For AGYW, gaps in motivation (particularly lack of risk perception) and access were identified as barriers to PrEP uptake: an interactive counselling game was developed addressing these barriers. A text messaging intervention was developed to improve PrEP adherence among AGYW, addressing reasons underlying lack of effective PrEP use through improving the capacity ("skills") to take PrEP effectively. A community-led intervention (community conversations) was developed addressing community-level factors underlying gaps in motivation, access and effective use. These interventions are being evaluated currently using outcomes from the HIV prevention cascade (step 6). Conclusions: The prevention cascade can guide development and evaluation of interventions to strengthen implementation of HIV prevention methods by following the proposed process.
International Journal of Environmental Research and Public Health, 2021
Health risk communication plays a crucial role in preventing the spread of infectious disease out... more Health risk communication plays a crucial role in preventing the spread of infectious disease outbreaks such as the current coronavirus (SARS-CoV-2). Yet, migrants are far too often forgotten in health risk communication responses. We investigate the challenges and efforts made by migrants in Denmark-in the initial months of the pandemic-to access information about COVID-19. We draw on 18 semi-structured interviews conducted in May and June 2020. All interviews are thematically coded and analyzed. Our analysis reveals that many of the migrants faced several challenges, including accessing information in a language understandable to them and navigating constant streams of official news flows issuing instructions about which actions to take. However, we also note that the participating migrants found numerous creative ways to address some of these challenges, often aided by digital tools, helping them access crucial health and risk information. This paper highlights that migrants constitute an underserved group in times of crises. They are vulnerable to getting left behind in pandemic communication responses. However, we also identify key protective factors, social resources, and agentic capabilities, which help them cope with health and risk information deficits. National governments need to take heed of these findings to inform future pandemic responses.
Introduction: The HIV prevention cascade could be used in developing interventions to strengthen ... more Introduction: The HIV prevention cascade could be used in developing interventions to strengthen implementation of effica-cious HIV prevention methods, but its practical utility needs to be demonstrated. We propose a standardized approach to using the cascade to guide identification and evaluation of interventions and demonstrate its feasibility for this purpose through a project to develop interventions to improve HIV prevention methods use by adolescent girls and young women (AGYW) and potential male partners in east Zimbabwe. Discussion: We propose a six-step approach to using a published generic HIV prevention cascade formulation to develop interventions to increase motivation to use, access to and effective use of an HIV prevention method. These steps are as follows: (1) measure the HIV prevention cascade for the chosen population and method; (2) identify gaps in the cascade; (3) identify explanatory factors (barriers) contributing to observed gaps; (4) review literature to identify relevant theoretical frameworks and interventions; (5) tailor interventions to the local context; and (6) implement and evaluate the interventions using the cascade steps and explanatory factors as outcome indicators in the evaluation design. In the Zimbabwe example, steps 1-5 aided development of four interventions to overcome barriers to effective use of pre-exposure prophylaxis (PrEP) in AGYW (15-24 years) and voluntary medical male circumcision in male partners (15-29). For young men, prevention cascade analyses identified gaps in motivation and access as barriers to voluntary medical male circumcision uptake, so an intervention was designed including financial incentives and an education session. For AGYW, gaps in motivation (particularly lack of risk perception) and access were identified as barriers to PrEP uptake: an interactive counselling game was developed addressing these barriers. A text messaging intervention was developed to improve PrEP adherence among AGYW, addressing reasons underlying lack of effective PrEP use through improving the capacity ("skills") to take PrEP effectively. A community-led intervention (community conversations) was developed addressing community-level factors underlying gaps in motivation, access and effective use. These interventions are being evaluated currently using outcomes from the HIV prevention cascade (step 6). Conclusions: The prevention cascade can guide development and evaluation of interventions to strengthen implementation of HIV prevention methods by following the proposed process.
Introduction: Recent years have witnessed a rapid expansion of efficacious biomedical HIV prevent... more Introduction: Recent years have witnessed a rapid expansion of efficacious biomedical HIV prevention technologies. Promising as they may be, they are largely delivered through standard, clinic-based models, often in isolation from structural and beha-vioural interventions. This contributes to varied, and often poor, uptake and adherence. There is a critical need to develop analytical tools that can advance our understandings and responses to the combination of interventions that affect engagement with HIV prevention technologies. This commentary makes a call for practice-based combination HIV prevention analysis and action, and presents a tool to facilitate this challenging but crucial endeavour. Discussion: Models and frameworks for combination HIV prevention already exist, but the process of identifying precisely what multi-level factors that need to be considered as part of a combination of HIV interventions for particular populations and settings is unclear. Drawing on contemporary social practice theory, this paper develops a "table of questioning" to help interrogate the chain and combination of multi-level factors that shape engagement with HIV prevention technologies. The tool also supports an examination of other shared social practices, which at different levels, and in different ways, affect engagement with HIV prevention technologies. It facilitates an analysis of the range of factors and social practices that need to be synchronized in order to establish engagement with HIV prevention technologies as a possible and desirable thing to do. Such analysis can help uncover local hitherto unidentified issues and provide a platform for novel synergistic approaches for action that are not otherwise obvious. The tool is discussed in relation to PrEP among adolescent girls and young women in sub-Saharan Africa. Conclusions: By treating engagement with HIV prevention technologies as a social practice and site of analysis and public health action, HIV prevention service planners and evaluators can identify and respond to the combination of factors and social practices that interact to form the context that supports or prohibits engagement with HIV prevention technologies for particular populations.
Major changes in UNAIDS international policy and treatment guidelines from 2010 to 11 still need ... more Major changes in UNAIDS international policy and treatment guidelines from 2010 to 11 still need to be correspondingly translated into policy and practice at national and local in-country levels. This special issue has drawn on social determinants of health (SDH) perspective to investigate how better to provide HIV and health services to affected children and youth. The articles featured here give examples of how a SDH perspective not only supports flexible and coordinated in-country service provision, but also fits well with UNAIDS' broader policy goals for the eradication of HIV and AIDS through the “Getting to Zero” policy campaign. We call for the widespread adoption of a SDH-based framework for policy, programming, and funding at all levels, to advance the UNAIDS policy goals of increased HIV service usage and decreased HIV rates in children and youth, as well as in all populations globally.
Social capital and AIDS competent communities: evidence from eastern Zimbabwe, 2011
Youth in Zimbabwe are at a high risk of being AIDS-infected, AIDS-affected, or orphaned. Stigma a... more Youth in Zimbabwe are at a high risk of being AIDS-infected, AIDS-affected, or orphaned. Stigma and negative representations of orphans and vulnerable children (OVC) inhibit community efforts to provide optimal support to HIV-positive children and children caring for HIV-positive family members; it is particularly detrimental to their health and wellbeing when compounded with other sources of struggles and hardship. Our work recognizes children's perspectives, agency, and unique coping strategies and seeks to ...
Contents: Technical report 2: Church responses to HIV in Zimbabwe: To what extent are the Anglica... more Contents: Technical report 2: Church responses to HIV in Zimbabwe: To what extent are the Anglican, Apostolic and Catholic churches supportive of HIV care, treatment and prevention? Technical report 3: In what way do formal community groups impact HIV-related behaviours? The role of social capital in building HIV competence in rural Zimbabwe. Technical report 4: In what ways do community groups support optimal access and adherence to antiretroviral treatment in Zimbabwe? Technical report 5: Grassroots ...
Reporting on local experiences of a community-led cash transfer programme in Manicaland Province,... more Reporting on local experiences of a community-led cash transfer programme in Manicaland Province, Zimbabwe, this qualitative study reports on a thematic network analysis of the perspectives of 58 adults and 4 children (age 14-15) who participated in 35 structured individual interviews (av. 40 min.) and three focus group discussions (av. 94 min.)(see Table below). Interviews were conducted in Shona, translated and transcribed into English. Transcripts were subjected to thematic analysis and coding to generate concepts.
Page 1. Unearthing Environmental Citizens: Exploring the Representations and Agency of Ethiopian ... more Page 1. Unearthing Environmental Citizens: Exploring the Representations and Agency of Ethiopian Students in Addis Ababa Eleanor Campbell (1) Morten Skovdal (1) Catherine Campbell (1) (1) Institute of Social Psychology, London School of Economics 1 Page 2. Abstract ...
Children living in households affected by HIV face numerous challenges as they take on significan... more Children living in households affected by HIV face numerous challenges as they take on significant household-sustaining and caregiving roles, often in conditions of poverty. To respond to their hardships, we must identify and understand the support systems they are already part of. For this reason, and to emphasise the agentic capabilities of children, this article explores how vulnerable children cope with hardship through peer social capital. The study draws on the perspectives of 48 HIV-affected and caregiving children who through PhotoVoice and draw-and-write exercises produced 184 photographs and 56 drawings, each accompanied with a written reflection. The themes emerging from the essays reveal that schools provide children with a useful platform to establish and draw on a mix of friendship structures. The children were found to strategically establish formalised friendship groups that have the explicit purpose of members supporting each other during times of hardship. The children also formed more natural friendship groups based on mutual attraction, with the implicit expectation that they will help each other out during times of hardship. In practice, the study found that children help each other through sharing (e.g. schools material and food) as well as through practical support (e.g. with domestic duties, securing food, and income-generation) - thus demonstrating that children are able to both accumulate and benefit from 'peer social capital.' The study concludes that a key coping strategy of HIV-affected and caregiving children is to mobilise and participate in friendship groups which are characterised by sharing and reciprocity of support. Development responses to support children affected by the HIV epidemic need to take heed of children's ability to draw on peer social capital.
Background: The 2014-2016 West Africa Ebola Virus Disease (EVD) outbreak was an unprecedented pub... more Background: The 2014-2016 West Africa Ebola Virus Disease (EVD) outbreak was an unprecedented public health event, and in addition to claiming over 11,000 lives, it resulted in the deaths of more healthcare workers than any outbreak in recent history. While a cadre of willing and able health workers is essential for an effective epidemic response, health workforce capacity in times of crisis may be significantly impacted by how risks are perceived by health staff. This study aimed to explore how risk perceptions influenced healthcare workers' willingness to respond during this outbreak.
Asylum seekers to Europe may come from war-torn countries where health systems have broken down, ... more Asylum seekers to Europe may come from war-torn countries where health systems have broken down, and there is evidence that asylum-seeking children have low coverage of childhood vaccinations, as well as uptake of immunisations in host countries. Such gaps in immunisation have important implications for effective national vaccination programmes. How we approach vaccination in children and adults entering Western Europe, where as a group they face barriers to health services and screening, is a growing debate; however, there are limited data on the vaccination status of these hard-to-reach communities, and robust evidence is needed to inform immunisation strategies. The aim of this study was to explore the vaccination status and needs of asylum-seeking children and adolescents in Denmark. Study design: We conducted a retrospective data analysis of anonymised patient records for asylum-seeking children and adolescents extracted from the Danish Red Cross database. Methods: We retrospectively searched the Danish Red Cross database for children and adolescents (aged 3 monthse17 years) with active asylum applications in Denmark as of October 28, 2015. Data were extracted for demographic characteristics, vaccination status and vaccinations needed by asylum-seeking children presenting to Red Cross asylum centres for routine statutory health screening. Results: We explored the vaccination status and needs of 2126 asylum-seeking children and adolescents. About 64% of the study population were male and 36% were female. Eight nationalities were represented, where 33% of the total of children and adolescents were not immunised in accordance with Danish national guidelines, while 7% were considered partly vaccinated, and 60% were considered adequately vaccinated. Afghan (57% not vaccinated/unknown) and Eritrean (54% not vaccinated/unknown) children were the least likely to be vaccinated of all nationalities represented, as were boys (37% not vaccinated/
Background: Partnerships are core to global public health responses. The HIV field embraces partn... more Background: Partnerships are core to global public health responses. The HIV field embraces partnership working, with growing attention given to the benefits of involving community groups in the HIV response. However, little has been done to unpack the social psychological foundation of partnership working between well-resourced organisations and community groups, and how community representations of partnerships and power asymmetries shape the formation of partnerships for global health. We draw on a psychosocial theory of partnerships to examine community group members' understanding of self and other as they position themselves for partnerships with non-governmental organisations. Methods: This mixed qualitative methods study was conducted in the Matobo district of Matabeleland South province in Zimbabwe. The study draws on the perspectives of 90 community group members (29 men and 61 women) who participated in a total of 19 individual in-depth interviews and 9 focus group discussions (n = 71). The participants represented an array of different community groups and different levels of experience of working with NGOs. Verbatim transcripts were imported into Atlas.Ti for thematic indexing and analysis.
In the context of HIV, there is considerable debate about the role of schools and teachers as pot... more In the context of HIV, there is considerable debate about the role of schools and teachers as potential sources of care and support for vulnerable children. This qualitative research examines 'care' as experienced and practiced by pupils and teachers in rural Western Kenya. In primary and secondary schools, interviews were conducted with 18 teachers and 57 orphaned and vulnerable pupils, alongside Photovoice. Drawing on thematic analysis and an 'ethic of care' theoretical perspective, we unpack the informal caring practices of teachers within resource-constrained settings. The research provides glimpses of schools as spaces of care, participation and support for orphaned and vulnerable pupils. Recognising and providing institutional support for the development of an ethic of care in schools may help to tackle the considerable educational barriers facing girls and boys who are orphaned and vulnerable and move 'care' closer towards the centre of educational policy and practice in the global South.
This study examines whether children in rural Zimbabwe have differing representations of their HI... more This study examines whether children in rural Zimbabwe have differing representations of their HIV/ AIDS-affected peers based on the gender of those peers. A group of 128 children (58 boys, 70 girls) aged 10–14 participated in a draw-and-write exercise, in which they were asked to tell the story of either an HIV/AIDS-affected girl child, or an HIV/AIDS-affected boy child. Stories were inductively thematically coded, and then a post hoc statistical analysis was conducted to see if there were differences in the themes that emerged in stories about girls versus stories about boys. The results showed that boys were more often depicted as materially deprived, without adult and teacher support, and heavily burdened with household duties. Further research is needed to determine whether the perceptions of the children in this study point to a series of overlooked challenges facing HIV/AIDS-affected boys, or to a culture of gender inequality facing HIV/AIDS- affected girls – which pays more attention to male suffering than to female suffering.
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