7 results on '"Nunn, A"'
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2. Descentralização, AIDS e redução de danos: a implementação de políticas públicas no Rio de Janeiro, Brasil Decentralization, AIDS, and harm reduction: the implementation of public policies in Rio de Janeiro, Brazil
- Author
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Elize Massard da Fonseca, Amy Nunn, Paulo Borges Souza-Junior, Francisco Inácio Bastos, and José Mendes Ribeiro
- Subjects
Descentralização ,Políticas Públicas de Saúde ,Redução de Danos ,Abuso de Drogas ,HIV ,Decentralization ,Health Public Policy ,Harm Reduction ,Drug Abuse ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
O artigo avalia como a descentralização dos recursos e ações do Programa Nacional de DST e AIDS influenciou as transferências de recursos para os programas de prevenção ao HIV/AIDS entre usuários de drogas injetáveis no Rio de Janeiro, Brasil (1999-2006). Foram avaliados os efeitos da política de descentralização sobre as transferências de recursos para os Programas de Redução de Danos (PRD) no Rio de Janeiro. A descentralização das transferências para os PRD no Rio de Janeiro se efetivou em 2006, com a virtual supressão do financiamento federal direto, obrigando estes programas a buscarem fontes alternativas de financiamento. Constata-se uma fragilidade dos PRD no Estado, agravada pela redução recente do volume de recursos. Dos 22 programas, existentes em 2002, o Estado passou a contar, em 2006, com apenas dois programas, financiados pelo Estado e por um município. A descontinuidade dessas ações pode vir a favorecer a reemergência da epidemia de AIDS nesta população, o que reclama um processo de descentralização mais gradual e melhor pactuado dessas iniciativas.This paper assesses how decentralization of resources and initiatives by the Brazilian National SDT/AIDS Program has impacted the transfer of funds for programs to prevent HIV/AIDS among injecting drug users in Rio de Janeiro, Brazil (1999-2006). The effects of the decentralization policy on Rio de Janeiro's Syringe Exchange Programs (SEPs) are assessed in detail. Decentralization effectively took place in Rio de Janeiro in 2006, with the virtual elimination of any direct transfer from the Federal government. The elimination of direct transfers forced SEPs to seek alternative funding sources. The structure of local SEPs appears to be weak and has been further undermined by current funding constraints. Of 22 SEPs operating in 2002, only two are still operational in 2006, basically funded by the State Health Secretariat and one municipal government. The current discontinuity of SEP operations may favor the resurgence of AIDS in the IDU population. A more uniform, regulated decentralization process is thus needed.
- Published
- 2007
- Full Text
- View/download PDF
3. Barriers to HIV testing, linkage to care, and treatment adherence: a cross-sectional study from a large urban center of Brazil
- Author
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Sarah MacCarthy, Michael Hoffmann, Amy Nunn, Luís Augusto Vasconcelos da Silva, and Ines Dourado
- Subjects
AIDS ,HIV ,continuity of patient care ,diagnosis ,patient compliance ,Brazil ,Medicine ,Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
ABSTRACT Objective Early, continued engagement with the HIV treatment continuum can help achieve viral suppression, though few studies have explored how risk factors for delays differ across the continuum. The objective of this study was to identify predictors of delayed diagnosis, delayed linkage to care, and nonadherence to treatment in the city of Salvador, Bahia, Brazil. Methods Data were collected during 2010 in a cross-sectional study with a sample (n = 1 970) of HIV-infected individuals enrolled in care. Multiple logistic regression analyses identified sociodemographic variables, behaviors, and measures of health service quality that were associated with delayed diagnosis, delayed linkage to care, and treatment nonadherence. Results For delayed diagnosis, male gender (adjusted odds ratio (AOR), 3.02; 95% confidence interval (CI), 2.0–4.6); age 45 years and older (AOR, 1.67; 95% CI, 1.1–2.5); and provider-initiated testing (AOR, 3.00; 95% CI, 2.1–4.4) increased odds, while drug use (AOR, 0.29; 95% CI, 0.2–0.5) and receiving results in a private space (AOR, 0.37; 95% CI, 0.2–0.8) decreased odds. For delayed linkage to care, unemployment (AOR, 1.42; 95% CI, 1.07–1.9) and difficulty understanding or speaking with a health care worker (AOR, 1.61; 95% CI, 1.2–2.1) increased odds, while posttest counseling (AOR, 0.49; 95% CI, 0.3–0.7) decreased odds. For nonadherence, experiencing verbal or physical discrimination related to HIV (AOR, 1.94; 95% CI, 1.3–3.0) and feeling mistreated or not properly attended to at HIV care (AOR, 1.60; 95% CI, 1.0–2.5) increased odds, while posttest counseling (AOR, 0.34; 95% CI, 0.2–0.6) decreased odds. Conclusions More attention is needed on how policies, programs, and research can provide tailored support across the treatment continuum.
4. Descentralização, AIDS e redução de danos: a implementação de políticas públicas no Rio de Janeiro, Brasil
- Author
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Fonseca, Elize Massard da, Nunn, Amy, Souza-Junior, Paulo Borges, Bastos, Francisco Inácio, and Ribeiro, José Mendes
- Subjects
Drug Abuse ,Redução de Danos ,Harm Reduction ,Health Public Policy ,Decentralization ,HIV ,Descentralização ,Políticas Públicas de Saúde ,Abuso de Drogas - Abstract
O artigo avalia como a descentralização dos recursos e ações do Programa Nacional de DST e AIDS influenciou as transferências de recursos para os programas de prevenção ao HIV/AIDS entre usuários de drogas injetáveis no Rio de Janeiro, Brasil (1999-2006). Foram avaliados os efeitos da política de descentralização sobre as transferências de recursos para os Programas de Redução de Danos (PRD) no Rio de Janeiro. A descentralização das transferências para os PRD no Rio de Janeiro se efetivou em 2006, com a virtual supressão do financiamento federal direto, obrigando estes programas a buscarem fontes alternativas de financiamento. Constata-se uma fragilidade dos PRD no Estado, agravada pela redução recente do volume de recursos. Dos 22 programas, existentes em 2002, o Estado passou a contar, em 2006, com apenas dois programas, financiados pelo Estado e por um município. A descontinuidade dessas ações pode vir a favorecer a reemergência da epidemia de AIDS nesta população, o que reclama um processo de descentralização mais gradual e melhor pactuado dessas iniciativas. This paper assesses how decentralization of resources and initiatives by the Brazilian National SDT/AIDS Program has impacted the transfer of funds for programs to prevent HIV/AIDS among injecting drug users in Rio de Janeiro, Brazil (1999-2006). The effects of the decentralization policy on Rio de Janeiro's Syringe Exchange Programs (SEPs) are assessed in detail. Decentralization effectively took place in Rio de Janeiro in 2006, with the virtual elimination of any direct transfer from the Federal government. The elimination of direct transfers forced SEPs to seek alternative funding sources. The structure of local SEPs appears to be weak and has been further undermined by current funding constraints. Of 22 SEPs operating in 2002, only two are still operational in 2006, basically funded by the State Health Secretariat and one municipal government. The current discontinuity of SEP operations may favor the resurgence of AIDS in the IDU population. A more uniform, regulated decentralization process is thus needed.
- Published
- 2007
5. Mind the gap: implementation challenges break the link between HIV/AIDS research and practice
- Author
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Sarah MacCarthy, Sari Reisner, Michael Hoffmann, Amaya Perez-Brumer, Alfonso Silva-Santisteban, Amy Nunn, Leonardo Bastos, Mauricio Teixeira Leite de Vasconcellos, Ligia Kerr, Francisco Inácio Bastos, and Inês Dourado
- Subjects
VIH ,Síndrome de Inmunodeficiencia Adquirida ,Muestreo ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract: Sampling strategies such as respondent-driven sampling (RDS) and time-location sampling (TLS) offer unique opportunities to access key populations such as men who have sex with men (MSM) and transgender women. Limited work has assessed implementation challenges of these methods. Overcoming implementation challenges can improve research quality and increase uptake of HIV services among key populations. Drawing from studies using RDS in Brazil and TLS in Peru, we summarize challenges encountered in the field and potential strategies to address them. In Brazil, study site selection, cash incentives, and seed selection challenged RDS implementation with MSM. In Peru, expansive geography, safety concerns, and time required for study participation complicated TLS implementation with MSM and transgender women. Formative research, meaningful participation of key populations across stages of research, and transparency in study design are needed to link HIV/AIDS research and practice. Addressing implementation challenges can close gaps in accessing services among those most burdened by the epidemic.
- Full Text
- View/download PDF
6. Descentralização, AIDS e redução de danos: a implementação de políticas públicas no Rio de Janeiro, Brasil.
- Author
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da Fonseca, Elize Massard, Nunn, Amy, Souza-Junior, Paulo Borges, Bastos, Francisco Inácio, and Ribeiro, José Mendes
- Abstract
Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2007
- Full Text
- View/download PDF
7. [Decentralization, AIDS, and harm reduction: the implementation of public policies in Rio de Janeiro, Brazil].
- Author
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Fonseca EM, Nunn A, Souza-Junior PB, Bastos FI, and Ribeiro JM
- Subjects
- Acquired Immunodeficiency Syndrome economics, Acquired Immunodeficiency Syndrome prevention & control, Brazil, Delivery of Health Care standards, Financing, Government, HIV Infections economics, Health Care Rationing standards, Health Care Reform, Health Plan Implementation, Humans, Needle-Exchange Programs economics, Needle-Exchange Programs standards, Policy Making, Substance Abuse, Intravenous prevention & control, HIV Infections prevention & control, Harm Reduction, Health Care Rationing economics, National Health Programs standards, Program Evaluation, Public Policy
- Abstract
This paper assesses how decentralization of resources and initiatives by the Brazilian National SDT/AIDS Program has impacted the transfer of funds for programs to prevent HIV/AIDS among injecting drug users in Rio de Janeiro, Brazil (1999-2006). The effects of the decentralization policy on Rio de Janeiro's Syringe Exchange Programs (SEPs) are assessed in detail. Decentralization effectively took place in Rio de Janeiro in 2006, with the virtual elimination of any direct transfer from the Federal government. The elimination of direct transfers forced SEPs to seek alternative funding sources. The structure of local SEPs appears to be weak and has been further undermined by current funding constraints. Of 22 SEPs operating in 2002, only two are still operational in 2006, basically funded by the State Health Secretariat and one municipal government. The current discontinuity of SEP operations may favor the resurgence of AIDS in the IDU population. A more uniform, regulated decentralization process is thus needed.
- Published
- 2007
- Full Text
- View/download PDF
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