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THE NEED FOR COMMUNITY BASED RESEARCH AGAINST HIV/AIDS

THE NEED FOR COMMUNITY BASED RESEARCH AGAINST HIV/AIDS. David Zakus, BSc, MES, MSc, PhD Director, Centre for International Health Associate Professor, Department of Public Health Sciences and Department of Health Policy, Management and Evaluation Faculty of Medicine, University of Toronto

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THE NEED FOR COMMUNITY BASED RESEARCH AGAINST HIV/AIDS

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  1. THE NEED FOR COMMUNITY BASED RESEARCH AGAINST HIV/AIDS David Zakus, BSc, MES, MSc, PhD Director, Centre for International Health Associate Professor, Department of Public Health Sciences and Department of Health Policy, Management and Evaluation Faculty of Medicine, University of Toronto University of Toronto – McGill University Joint Satellite Symposium “Canada’s National and Global HIV Research: Where Have We Been, Where Are We Going and How Do We Get There?” International AIDS Conference Toronto, August 14, 2006

  2. OVERVIEW • Based on experience as lead evaluator of major African HIV/AIDS program in 2005-06: Southern Africa AIDS Trust. • Community based responses to HIV/AIDS in southern Africa. • Identification of major research needs.

  3. Southern Africa AIDS Trust (SAT) • SAT operates in five African countries and is now headquartered in Johannesburg (moving from Harare in late 2005 after about 15 years there). • SAT partners with local community based organizations to help them develop good: vision, mission, planning, financial management, reporting, governance. • SAT is unique in providing dependable program/organizational funding (i.e. administration, salaries) as opposed to “project” or “activity” funding – in addition to operational support. • SAT is often the initial “donor”, helps build capacity, CBOs/NGOs able to diversity funding sources.

  4. BUILDING HIV COMMUNITY COMPETENCY SAT capacity building is a package: • skills building workshops; • mentoring visits; • exchange visits; • annual country and other meetings; • publications; • data bases; • other informal support.

  5. Malawi -Context • 14.2 % of adult population HIV+ • 23,000 on ARTs (14% of need) • 150,000 of ART need is unmet

  6. MozambiqueContext • 12.2% of adult population HIV+. • Highest prevalence in the Beira Corridor – but nearing same level in the south. • 13,000 on ARTs (6% of need). • Unmet need 204,000.

  7. Zambia -Context • 16.5% of adult population is HIV+ • 33,000 on ARTs (18% of need) • Unmet ART need is 153,000

  8. Tanzania -Context • 8.8% of adult population HIV+ • 9,500 on ARTs (3 % of need) • Unmet ART need is 307,000

  9. Zimbabwe -Context • 24.6% of adult population is HIV+ • 15,000 on ARTs (9,000 public ARV) • 340,000 of ART need is unmet

  10. Current Players • Ususal institutions (multi/bi-lateral, public/private) • Hundreds/Thousands of new COMMUNITY BASED ORGANIZATIONS who are involved the battle, in scale up operations, their number is increasing every day… • BUT, they need assistance in really understanding the problems and their responses…especially at the community (and household) level.

  11. CURRENT CBRESEARCH ISSUES • Current burning topics in SAT include: 1) Treatment Literacy; 2) Orphans and Vulnerable Groups; 3) Children Living with HIV; 4) Stigma. • Organization of CBOs: Staffing and HR Development; Organization Culture; Management and Leadership; Strategic Partering and Networking; Monitoring and Evaluation…(thru Operations Research). • Gender: GENDER MAINSTREAMING

  12. CB Research Challenges (cont’d) • Care for the sick and dying (home-based and institutional…but community based) • Integration of traditional healers, including birth attendants. • New Treatment related issues: treatment adherence, drug supply, storage and resistance, post ARV care (side effects), regular check-up/follow up of those on treatment, rehabilitation of PLWAs back into the workforce … revival of community participation.

  13. CB Research Challenges (cont’d) • Giving voice to PLWHA. • Responding to unemployment, lack of food, housing, and clean water, etc… • Communications: How to effectively communicate messages and influence behaviour change. • Scaling up…meeting the increased need for services and HIV programs as more people present for testing, test positive and need care and other services.

  14. CONCLUSIONS • Huge need for community based research; research as capacity building. • Great opportunity for ‘researchers’ and trained staff to make significant contributions. • Imperative to have multidisciplinary research and research teams, community level training, and participatory methodologies.

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