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In a particular way, the HIV pandemic exposes the prevailing gender relations and the definitions of male and female gender roles, both in intimate relationships and in the wider society. The HIV pandemic reveals the contradictions between women's legal rights and the persistence of women's cultural and sexual subordination. It reflects the impact of poverty, gender roles, culture and religion. Although HIV and AIDS cuts across class, South African rural black women's infection risk seems particularly high since they suffer notably from subordination and socio-economic hardships. Negotiating safer sex in marriage or intimate partnerships is very difficult for them in view of the traditional spaces in which they find themselves, where patriarchal structures are pervasive. Based on data obtained from a case study, this paper examines socio-cultural constraints to rural women's sexual agency in a patriarchal social order. These rules are based on a patriarchal code of respect, which is still pervasive in many aspects of the community under investigation. In terms of gender relations, the patriarchal code of respect is founded on an assumed 'naturalisation' of the two genders and the natural superiority of the male over the female. In terms of sexuality it is translated into male sex-right. The fear of HIV infection is omnipresent and results in unmarried women engaging in the negotiation of their wants and needs. Owing to the patriarchal code of respect, married women are perceived as having no choice in negotiating safer sex and are forced to put their lives at risk in contracting HIV. Unmarried women have greater although not endless choices in this regard. Although the study participants unexpectedly displayed a rather negative perception of other women, in order to strengthen women in their proximal environment the HIV epidemic may be seen as a vehicle for building solidarity among women in the community. [ABSTRACT FROM AUTHOR]

People living with HIV or AIDS (PLHIV) in sub-Saharan Africa sometimes have care-seeking behaviours that result in a suboptimal quality of life. This paper seeks to examine the role of stigma in the care-seeking behaviour of PLHIV. We hypothesise that stigma relates to the behaviour of PLHIV themselves and with societal reactions, including those of healthcare professionals. From a literature review, we identified the following as important correlates of care-seeking behavior: beliefs about pathways of HIV infection and people infected with HIV, social reactions, coping strategies, knowledge of HIV and AIDS, and self-efficacy in finding care and treatment in addition to coping with the disease. Poverty, gender, age, religion and policy were found to be moderating variables. The Precede-Proceed model was adapted to build an explanatory model of healthcare-seeking behaviour among PLHIV and particularly to explore the role of stigma in the non-utilisation of healthcare institutions. [ABSTRACT FROM AUTHOR]

If the practice of psychology is to be relevant to environmental realities and context sensitive then conscious consideration must be given to the psychology training programs. Training programmes should give due recognition to the historical, political, social, economic and cultural contexts of human behaviours so as to understand how these interacting contexts may contribute to placing people at risk for ill-health. The main aim of this article Is to present an analysis of African environmental realities to which training programs in psychology must respond. In view of the under-utilization of psychological services within healthcare systems in many parts of Africa, this article also provides some suggestions for the development of appropriate training and practice modalities that may be geared towards effective healthcare service delivery in Africa. [ABSTRACT FROM AUTHOR]

With the increasing prevalence of HIV infection and the high maternal mortality, orphans are a rapidly growing problem in Africa. However, few studies describe the social conditions of these children. Our study focuses on motherless children in urban and rural areas of Guinea-Bissau.A rural and an urban cohort of children (128 and 192, respectively) that had been followed by demographic surveillance since 1990 were identified and the relatives of these children interviewed. A control cohort of 808 individuals was also identified.Although orphan children remained disadvantaged, there were few differences between surviving motherless and control children in nutritional status, use of health care services, school attendance, quality of housing, and clothing. Motherless children moved more frequently and were more likely to live in small families, often with an older grandmother.The traditional extended family system appears to be capable of handling motherless children in a non-discriminatory fashion. However, the AIDS epidemic will continue to stress the extended family system and social services to the limit. [Copyright &y& Elsevier]

Dracunculiasis (Guinea worm disease) is caused by Dracunculus medinensis, a parasitic worm. Approximately 1 year after a person acquires infection from contaminated drinking water, the worm will emerge through the skin, usually on the lower limb. Pain and secondary bacterial infection can cause temporary or permanent disability that disrupts work and schooling. In 1986, the World Health Assembly called for dracunculiasis elimination. The global Guinea Worm Eradication Program, supported by The Carter Center, World Health Organization (WHO), UNICEF, CDC, and other partners, began assisting ministries of health of countries in which dracunculiasis is endemic in meeting this goal. At that time, an estimated 3.5 million cases occurred each year in 20 countries in Africa and Asia. This report updates published (3-5) and unpublished surveillance data reported by ministries of health and describes progress toward dracunculiasis eradication. A total of 148 cases were reported in 2013 from five countries (in order of prevalence: South Sudan, Chad, Mali, Ethiopia, and Sudan) compared with 542 cases in 2012 from four countries (South Sudan, Chad, Mali, and Ethiopia). The disease remains endemic in four countries in 2014 (South Sudan, Chad, Mali, and Ethiopia), but the overall incidence is falling faster in 2013 compared with 2012 (by 73%) and continues to fall faster in the first 6 months of 2014 (by 71%) compared with the same period in 2013. Failures in surveillance and containment, lack of clean drinking water, insecurity in Mali and parts of South Sudan, and an unusual epidemiologic pattern in Chad are the main remaining challenges to dracunculiasis eradication.

Dracunculiasis (Guinea worm disease) is caused by Dracunculus medinensis, a parasitic worm. Approximately 1 year after infection from contaminated drinking water, the worm emerges through the skin of the infected person, usually on the lower limb. Pain and secondary bacterial infection can cause temporary or permanent disability that disrupts work and schooling. In 1986, the World Health Assembly (WHA) called for dracunculiasis elimination, and the global Guinea Worm Eradication Program, supported by The Carter Center, World Health Organization (WHO), United Nations Children's Fund (UNICEF), CDC, and other partners, began assisting ministries of health of dracunculiasis-endemic countries in meeting this goal. At that time, an estimated 3.5 million cases occurred each year in 20 countries in Africa and Asia. This report updates published and unpublished surveillance data reported by ministries of health and describes progress toward dracunculiasis eradication. A total of 542 cases were reported in 2012, compared with 1,058 in 2011. The disease remains endemic in four countries in 2013, but the overall rate of reduction in cases has accelerated compared with the first 6 months of 2012. In the month of January 2013, no cases were reported worldwide for the first time since the eradication program began in 1986. Failures in surveillance and containment, lack of clean drinking water, insecurity in Mali and parts of South Sudan, and an unusual epidemiologic pattern in Chad are the main remaining challenges to dracunculiasis eradication.

Dracunculiasis (Guinea worm disease) is caused by Dracunculus medinensis, a parasitic worm. Approximately 1 year after initial infection from contaminated drinking water, the worm emerges through the skin of the infected person, usually on the lower limb. Pain and secondary bacterial wound infection can cause temporary or permanent disability that disrupts work and schooling for the entire family. In 1986, the World Health Assembly (WHA) called for dracunculiasis elimination and the Guinea Worm Eradication Program, supported by The Carter Center, World Health Organization (WHO), United Nations Children's Fund (UNICEF), CDC, and other partners, was coalesced to assist ministries of health of endemic countries in meeting this goal. At that time, an estimated 3.5 million cases occurred annually in 20 countries in Africa and Asia. This report updates published and previously unpublished surveillance data reported by ministries of health and describes progress toward global dracunculiasis eradication. In 2011, a total of 1,058 cases were reported. As of 2012, dracunculiasis remained endemic in only four countries. Through June 2012, worldwide reductions in reported cases continued, compared with the first 6 months of 2011. Failures in surveillance and containment, lack of clean drinking water, and insecurity in Mali and parts of South Sudan continue to challenge dracunculiasis eradication efforts.

In 1986, the World Health Assembly (WHA) called for the elimination of dracunculiasis (Guinea worm disease), a parasitic infection in humans caused by Dracunculus medinensis. At the time, an estimated 3.5 million cases were occurring annually in 20 countries in Africa and Asia, and 120 million persons were at risk for the disease. Because of slow mobilization in countries with endemic disease, the 1991 WHA goal to eradicate dracunculiasis globally by 1995 was not achieved. In 2004, WHA established a new target date of 2009 for global eradication; despite considerable progress, that target date also was not met. This report updates both published and previously unpublished data and updates progress toward global eradication of dracunculiasis since January 2009. At the end of December 2009, dracunculiasis remained endemic in four countries (Ethiopia, Ghana, Mali, and Sudan). The number of indigenous cases of dracunculiasis worldwide had decreased 31%, from 4,613 in 2008 to 3,185 in 2009. Of the 766 cases that occurred during January--June 2010, a total of 745 (97%) were reported from 380 villages in Sudan. Ghana, Ethiopia, and Mali each are close to interrupting transmission, as indicated by the small and declining number of cases. The current target is to complete eradication in all four countries as quickly as possible. Insecurity (e.g., sporadic violence or civil unrest) in areas of Sudan and Mali where dracunculiasis is endemic poses the greatest threat to the success of the global dracunculiasis eradication program.

The increasing prevalence of non-communicable diseases (NCDs) in low- and middle-income countries is a big challenge to the governments, which are still struggling with a myriad of communicable diseases (e.g. malaria, tuberculosis and HIV/AIDS). There are common risk factors for the four major NCDs in Africa (cancer, diabetes, cardiovascular disease [CVD] and chronic respiratory infections), which are: obesity; lack of physical activity (PA); tobacco consumption; and inappropriate use of alcohol. Furthermore, NCDs are determined by individual and societal level factors, and the general socio-economic, cultural and environmental conditions (e.g. agriculture and food production, education, working and living conditions, transport, housing and unemployment) which can be addressed by use of health promotion. Thus, in order to address the multiple factors comprehensively, there is need for multi-pronged approaches that bring together multiple disciplines, sectors and partners focused on addressing NCDs in an effective, efficient and sustainable manner.

Objective: The Convention on the Rights of the Child (CRC) is generally viewed from an ethical perspective, specifically for its influence and impact on our ethos and the place of children in society. A recent ground-breaking report prepared by The African Child Policy Forum (ACPF) shows conceptually and empirically how the CRC can be used as a tool for planning national action and for monitoring government performance and compliance. This paper reports on the methodology followed, the philosophical and legal foundations, the results of the application and the policy lessons., Method: This work is based on a methodology, the Child-Friendliness Index (CFI), developed by ACPF to analyse and monitor the performance of all 52 African governments. The index is inspired by the CRC's three core principles-Protection, Provision and Participation-and based on over forty policy and child-outcome indicators., Results: The methodology was applied to organise data, assess performance and score and rank all 52 African governments at a point in time and over time. On this basis, the study identifies which governments are child-friendly and which ones are not and why, and what it is that poorly performing governments can do to comply with their international obligations., Conclusions: Two important conclusions emerge from this exercise. The first is the beauty and power of simplicity. Much analysis of government obligations is hampered by the tedious task of having to scan voluminous information and bulky reports. But this CRC-inspired and CRC-based methodology provides a simple but powerful, transparent and objective framework for policy analysis and comparison. Secondly, the African experience confirms that three things matter on the policy front: politics that put children at the centre of public policy; Laws that protect them; and Budgets that provide for their basic needs and full development., Practical Implications: ACPF's work provides an approach that governments, advocacy groups and treaty bodies can use to monitor government compliance, to identify areas for progress and to formulate effective pro-children policies. The approach is important and relevant for other regions of the world as it is for Africa., (Copyright (c) 2009 Elsevier Ltd. All rights reserved.)

Twenty-five years after the description of the first cases of AIDS, the HIV pandemic remains a major public health problem. Although often described as a single epidemic, there are many distinct epidemiological situations. Individual-level risks are at the center of this evolution and influenced by social, economic and political contexts. The overall situation in Europe and the Americas seems stable in recent years. However, the generalized epidemics in sub-Saharan Africa continue to spread and new hidden epidemic foci involving specific risk populations are emerging throughout the rest of the world. A multidimensional approach, tailored to the particular socio-cultural context, is essential to control these complex and diversified epidemics.

This paper reviews the nexus between poverty and HIV/AIDS in Africa using a sustainable livelihood framework. Much of the literature on HIV and AIDS has generated an almost universal consensus that the AIDS epidemic is having an immense impact on the economies of hard-hit countries, hurting not only individuals, families and firms, but also significantly slowing economic growth and worsening poverty. International evidence has concentrated on the pathways through which HIV/AIDS undermines livelihoods and raises vulnerability to future collapse of livelihoods. Yet, little attention has been paid to the role that social relations and livelihood strategies can play in bringing about risky social interaction that raises the chance of contracting HIV. Using the sustainable livelihood and social relation approaches, this article demonstrates that although AIDS is not simply a disease of the poor, determinants of the epidemic go far beyond individual volition and that some dimensions of being poor increase risk and vulnerability to HIV.

Launched in 1988, the Bamako Initiative was considered as a policy aimed at revitalizing the primary health care strategy while strengthening equity in access to health care. A decade later, two research initiatives conducted in Mali and Uganda, and later in Burkina Faso, concluded that a) this policy did very little to improve or increase access to health care among the most deprived and excluded vulnerable population groups, b) this policy only served to marginalize certain population groups already disenfranchised due to the emphasis on financial sustainability and viability of health care organisations, and c) the exemption mechanisms for alleviating the burden of payment and financial barriers for the poorest represent a technically feasible solution, while one not socially advocated. The current state of affairs requires that in order to give impetus to the principles of equity and the initial goals of the Bamako Initiative, African states should implement incentives, NGOs should consider planning as a tool for social change and donors need to ensure investments which are centred upon and prioritize principles of equity.

Youth-related violence is a frequent topic of press reports and editorial comment. The most disturbing aspects of the phenomenon are the younger and younger age of delinquents and the greater and greater availability of firearms. While the advocates of an American-style approach of absolute repression clash with those of the educative approach to change aggressive attitudes and young people benefit from their "minor" status, the compelling reality is that all preventive programs have failed flatly. This purpose of this study was twofold. The first aim was to highlight the important contribution of tradition and custom to channeling youthful behavior in African society today and yesterday through signification and transmission of law in familial, social, educative and juridical practices. The second goal was to identify and define the psycho-relational elements that can be considered as factors promoting violent and self-destructive tendencies in minors of African origin tempted by migration in a society in which social representations inhibit parents and prevent them from conveying the limits of the law in their children.

The purpose of this report was to show how special features of the African home environment affect child development. Special emphasis was placed on the traditional social structure and the roles of various players. The different stages of development are described in relation to the major social events in African families and communities. Psychomotor development in African children presents several particularities in relation to children in the industrialized world but differences tend to decrease as a result of ongoing social upheaval. Modernization or globalization has had a profound effect on family organization and child care. These changes must be taken into account by officials in charge of child-psychiatry services. Preventive initiatives should taken into account and, insofar as possible, preserve traditional familial resources.

The impact of the human immunodeficiency virus (HIV) epidemic in sub-Saharan Africa on future mortality rates of infants, children, and mothers, life expectancy, and economic growth is profound. Vertical transmission of HIV, transmission from mother to child, is a major factor in the increasing rates of HIV infection in sub-Saharan Africa. Vertical transmission of HIV occurs in utero, intrapartum during labor and delivery, and postpartum during breast-feeding. Because of the large numbers of HIV-infected mothers in developing countries, the majority trials regarding prevention of vertical transmission of HIV have been conducted in sub-Saharan Africa. Thus, sub-Saharan Africa has become a human laboratory, which demonstrates both the successes and failures of preventative methods to reduce vertical transmission of HIV. This review summarizes the body of research dedicated to understanding the pathophysiology of vertical transmission of HIV and pharmacology of inhibition of vertical transmission of HIV. While many debate the ethics of conducting trials in developing countries where effective prevention modalities have been slow to be implemented for economic, social and political reasons, studies continue and researchers continue to discover therapies and preventative methods, which may reduce the future devastation of HIV both in sub-Saharan Africa and throughout the world.

Problems arise when attempting to compare caries data collected in both Africa and the People's Republic of China. These difficulties are not only the result of differences in the criteria used for the diagnosis of caries but are also due to the diversity of cultural and social conditions existing within each of the geographical areas. However, interpreted with caution, the data seem to suggest that caries experience among children is still fairly stable and at a low level, in contrast to the predictions of a decade ago. When comparing data from adult and elderly cohorts, however, caries is seen to be a widespread disease with continuing slow progression throughout life.

World Bank/International Monetary Fund Structural Adjustment Programs (SAPs) have been introduced in over 40 countries of Africa. This article outlines their economic policy measures and the experience of the countries that have introduced them, in terms of nutrition, health status, and health services. The evidence indicates that SAPs have been associated with increasing food insecurity and undernutrition, rising ill-health, and decreasing access to health care in the two-thirds or more of the population of African countries that already lives below poverty levels. SAPs have also affected health policy, with loss of a proactive health policy framework, a widening gap between the affected communities and policy makers, and the replacement of the underlying principle of equity in and social responsibility for health care by a policy in which health is marketed commodity and access to health care becomes an individual responsibility. The author argues that there is a deep contradiction between SAPs and policies aimed at building the health of the population. Those in the health sector need to contribute to the development and advocacy of economic policies in which growth is based on human resource development, and to the development of a civic environment in Africa that can ensure the implementation of such policies.

This article analyzes the widely held assumption in academia and the mainstream press that capitalism has proven superior to socialism in responding to human needs. The author surveys the health conditions of the world's populations, continent by continent, and shows that, contrary to dominant ideology, socialism and socialist forces have been, for the most part, better able to improve health conditions than have capitalism and capitalist forces. In the underdeveloped world, socialist forces and regimes have, more frequently than not, improved health and social indicators better than capitalist forces and regimes, and in the developed world, countries with strong socialist forces have been better able to improve health conditions than those countries lacking or with weak socialist forces. The socialist experience has, of course, also included negative developments that have negated important components of the socialist project. Still, the evidence presented in this article shows that the historical experience of socialism has not been one of failure. To the contrary: it has been, for the most part, more successful than capitalism in improving the health conditions of the world's populations.

As the AIDS epidemic in Africa assumes major proportions, the need to understand the social context in which heterosexual transmission occurs takes on urgent importance. In this article we explore how the intersection of traditional culture with the colonial legacy and present-day political economy has influenced family structure and sexual relations, and particularly the social position of women. Drawing on Zimbabwe's historical experience, we show how land expropriation, rural impoverishment, and the forcible introduction of male migrant labor fostered new patterns of sexual relations, characterized by multiple partners. Traditional patriarchal values reinterpreted in European law resulted in further subjugation of women as even limited rights to ownership were withdrawn. For many women, sexual relations with men, either within marriage (for the majority) or outside, become inextricably linked to economic and social survival. In this setting, all sexually transmitted diseases became rampant, including genital ulcer, which facilitates transmission of the human immunodeficiency virus (HIV). Intervention programs to halt the spread of AIDS need to take into the account the epidemic's historical roots and social nature. For example, efforts to reduce risk of HIV transmission should seek to expand women's limited options, both technically (e.g., by providing alternatives to condoms) and socially (e.g., by promoting employment).

The study compares attempted suicide data among young women of two ethnic groups resident in native West Indian and immigrant Birmingham environments. Although African rates were higher than East Indian ones, the three-fold increase in the immigrant population was unrelated to ethnic origin. This was also true regarding clinical data, patients using psychotropic tablets and giving similar reasons for attempting suicide. Formal psychiatric diagnoses were, however, less frequently made in Birmingham where patients preferred analgesic tablets to the domestic agents used instead by the West Indian population. The aetiological significant of sociocultural factors is discussed.

There are special population groupings in Africa which constitute a social periphery of great magnitude. The groups include women and children, the urban and rural poor, and a youthful labour force that is relatively uneducated. The critical issues they face include ever-increasing food shortage, decreasing employment opportunities and political instability which further reduces the effectiveness of government. While solutions are not easy to find, they require urgent critical assessment by policy makers and planners.