Improving LGBT Health Education in South Africa: Addressing the Gap

I first became interested in the topic of lesbian, gay, bisexual, and transgender (LGBT) health care and health education while working as a country lead for the Presidential Emergency Plan for AIDS Relief (PEPFAR). During my time there I had the opportunity to travel to South Africa and understand their community and health care system a bit better, with an emphasis on their HIV/AIDS epidemic. This post focuses on the LGBT history in South Africa, recent developments, addressing that there is a gap between homophobia and non-judgmental care, and the importance of health care workers understanding LGBT health education.

More and more countries around the world are opening their arms to welcome and embrace LGBT pride. South Africa has one of the world’s more progressive constitutions which legally protects LGBT people from discrimination, although current research indicates that they continue to face discrimination and homophobia in many different facets of life. The most recent milestone occurred in 2006 when the country passed a law to recognize same-sex marriages. Nevertheless, LGBT South Africans particularly those outside of the major cities, continue to face some challenges including conservative attitudes, violence, and high rates of disease. As the country continues to grow there seems to be an increase in LGBT representation (with approximately 4,900,000 people identifying as LGBT) whether it is through activism, tourism, the media and society or support from religious groups. So, what about LGBT health education? Continue reading “Improving LGBT Health Education in South Africa: Addressing the Gap”

Advertisements

Growth and challenges of health research in the WHO Africa Region: new analysis in the BMJ

This was cross-posted to my own blog.


I have always been devoted to the principle of evidence-based policy and decision making in public health, but I have taken a keen interest in the finer points of research and methodology since taking my current position as an epidemiologist (and contemplating the pursuit of a doctorate more seriously). Earlier this month, I spotted an article from BMJ examining the output of health research in the WHO Africa region from 2000 to 2014 (h/t to Dr. Ron LaPorte, professor of epidemiology at the WHO Collaborating Center at the University of Pittsburgh and co-founder of the Supercourse project). The article, entitled “Increasing the value of health research in the WHO African Region beyond 2015,” is a bibliometric analysis of the health research publications from the WHO Africa region indexed on PubMed; it analyzes the influence of various factors, including GDP, population, and health spending on the number and growth of published papers by country over the time period. The abstract reads:

Objective To assess the profile and determinants of health research productivity in Africa since the onset of the new millennium.

Design Bibliometric analysis.

Data collection and synthesis In November 2014, we searched PubMed for articles published between 2000 and 2014 from the WHO African Region, and obtained country-level indicators from World Bank data. We used Poisson regression to examine time trends in research publications and negative binomial regression to explore determinants of research publications.

Results We identified 107 662 publications, with a median of 727 per country (range 25–31 757). Three countries (South Africa, Nigeria and Kenya) contributed 52% of the publications. The number of publications increased from 3623 in 2000 to 12 709 in 2014 (relative growth 251%). Similarly, the per cent share of worldwide research publications per year increased from 0.7% in 2000 to 1.3% in 2014. The trend analysis was also significant to confirm a continuous increase in health research publications from Africa, with productivity increasing by 10.3% per year (95% CIs +10.1% to +10.5%). The only independent predictor of publication outputs was national gross domestic product. For every one log US$ billion increase in gross domestic product, research publications rose by 105%: incidence rate ratio (IRR=2.05, 95% CI 1.39 to 3.04). The association of private health expenditure with publications was only marginally significant (IRR=1.86, 95% CI 1.00 to 3.47).

Conclusions There has been a significant improvement in health research in the WHO African Region since 2000, with some individual countries already having strong research profiles. Countries of the region should implement the WHO Strategy on Research for Health: reinforcing the research culture (organisation); focusing research on key health challenges (priorities); strengthening national health research systems (capacity); encouraging good research practice (standards); and consolidating linkages between health research and action (translation).

In the discussion, there is some fascinating commentary on the challenges facing researchers in the research and the barriers to publication, as well as to making those publications available to other researchers in the field. Some of them are familiar and strike me as a common symptom of the complicated relationship between politics and (especially evidence-based) policy making:

Although there is clearly a need for improving the performance of health researchers on the continent, African health decision makers should use the available research evidence to guide policy, strengthen practice and maximise the use of resources in order to improve the welfare of their citizens. However, there appears to be a failure to apply available research evidence to improve the health of populations on the continent. This unfortunate situation may be related to the lack of sharing of research evidence for translation into policy and practice, a non-alignment of research conducted in African countries to national research policies and/or the non-existence of national health research policies with clearly defined priorities.

However, others are somewhat unique to Africa. Not of them are economic (though funding plays a major role), and the paper goes so far as to describe some of the challenges as “intractable”:

The difficulties in research, publication, editorial bias and information access facing Africa are profound and seem almost intractable. Another difficulty facing African researchers is dissemination of findings to other parts of the world. Most of the information published in African journals is largely not included in major databases. Access to technological tools, information access and other equipment and supplies to ease research work is not always possible.

I hope this will influence the wider debate on the future of aid and health spending in Africa. The call for a shift in funding and emphasis from technologically-focused solutions to health-systems strengthening and sustainability has gained momentum, and research and academic exchange is a crucial part of the latter.

US Partnership with Africa: Economic Growth and Global Development – Rajiv Shah (CGDev Video)

This is another (fairly long) video from the Center for Global Development featuring a high-profile speaker, USAID Director Rajiv Shah. This hour-long dialogue between Shah and Nancy Birdsall, CGDev president, focused on President Obama’s recent trip to Africa and covers a wide range of topics. Obviously, it can be difficult to get government officials – especially high-level ones – to deviate from the official line and get out of bureaucratic-speak, but Birdsall does try to push him a little bit, I think. They also take audience questions during the second half of the video. The first video, of the entire dialogue, is about an hour long; the following videos are clips of the interview focusing on specific topics.



The Center for Global Development was pleased to host USAID Administrator Rajiv Shah for a discussion of the US partnership with Africa. Shah was just back from accompanying President Obama in Senegal, South Africa, and Tanzania, where the president outlined a vision for US-Africa relations that puts a premium on economic opportunity, democracy, and African-led approaches to development.

At the event, Shah discussed the administration’s new commitments and USAID’s role in doubling electric power in Africa, working with young African leaders, boosting food security and global health, and attracting trade and investment to the continent.


Short Clip: Trade and the Africa Growth and Opportunity Act (AGOA)

Short Clip: Update on Feed the Future

Short Clip: Energy as Constraint to Economic Growth

Short Clip: USAID and the Future of Development

Short Clip: Prospects for Food Aid Reform

China’s Development Finance to Africa: A Media-Based Approach to Data Collection

As China is taking an increasingly active role on the world stage, its foreign assistance and development programs in other countries in increasing. However, unlike most Western nations, China does not publish this information. This report is particularly interesting because it tries to get an idea of China’s development financing over the last decade through media reports (press releases and newspaper articles).



How big is China’s aid to Africa? Does it complement or undermine the efforts of traditional donors? China releases little information and outside estimates of the size and nature of Chinese aid vary widely. In an effort to overcome this problem, AidData, based at the College of William and Mary in Virginia, has compiled a database of thousands of media reports on Chinese-backed projects in Africa from 2000-2011. The database includes information on 1,673 projects in 51 African countries, and $75 billion in commitments of official finance.

Global Health News Last Week

October 10 was World Mental Health Day.
October 15 was Global Handwashing Day.

POLITICS AND POLICY

  • The U.S. Army has proposed major cuts to its work on HIV, especially in the vaccine field. Leaders of the Infectious Diseases Society of America and other biomedical research organizations oppose the cuts.
  • The WHO plans to recommend tighter nutritional standards in food aid for young children, a move activists say is necessary to improve donations from countries such as the United States.
  • The US Department of Defense is funding platforms that will completely rethink how malaria drugs are developed.
  • Former Bush Administration official Andrew Natsios argues the case for foreign aid: “Singling out foreign aid for disproportionate cuts—which is exactly what has happened—is a serious mistake the United States as a world leader will pay for in the future.”
  • A survey of 507 Americans at the end of September sought to capture what, exactly, Americans know about the foreign aid budget. Particpiants were asked four questions about their impressions of foreign aid and opinions on why it is important to American interests.  Go here to read the full fact sheet that also includes more details about the study’s methods and see below to review the results in more detail.
  • The World Health Organization’s chief on Monday urged governments to unite against “big tobacco”, as she accused the industry of dirty tricks, bullying and immorality in its quest to keep people smoking.

PROGRAMS

  • Berk Ozler examines some recent reports about the challenges surrounding male circumcision. In the World Bank Development Impact blog, he offers two suggestions for how to improve the programs.
  • A partnership between Pampers and UNICEF to deliver neonatal tetanus vaccines is on track to eliminate the disease by 2015.
  • A $258 million initiative sponsored by the Bill & Melinda Gates Foundation aimed at preventing AIDS in India appears to have paid off overall, researchers say, resulting in more than 100,000 fewer new HIV infections over five years. Many aren’t quite ready to judge this project, Avahan, a success, however. The project failed in three of the six Indian states where it was tested.
  • Are the Millennium Villages an intervention that can reach scale? Supporters say yes and detractors are skeptical. Madeline Bunting covers the debate in the Guardian Development.
  • A report on the MGDS by United Nations Development Program, the UN Economic Commission for Africa, the African Development Bank and the African Union Commission says that social protection programs can have a wide positive impact.

RESEARCH

DISEASES AND DISASTERS