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The variability and predictors of quality of AIDS care services in Brazil

NEMES, Maria Ines Battistella; MELCHIOR, Regina; BASSO, Caritas Relva; CASTANHEIRA, Elen Rose Lodeiro; ALVES, Maria Teresa Seabra Soares de Britto e; CONWAY, Shaun
Fonte: BIOMED CENTRAL LTD Publicador: BIOMED CENTRAL LTD
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
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Background: Since establishing universal free access to antiretroviral therapy in 1996, the Brazilian Health System has increased the number of centers providing HIV/AIDS outpatient care from 33 to 540. There had been no formal monitoring of the quality of these services until a survey of 336 AIDS health centers across 7 Brazilian states was undertaken in 2002. Managers of the services were asked to assess their clinics according to parameters of service inputs and service delivery processes. This report analyzes the survey results and identifies predictors of the overall quality of service delivery. Methods: The survey involved completion of a multiple-choice questionnaire comprising 107 parameters of service inputs and processes of delivering care, with responses assessed according to their likely impact on service quality using a 3-point scale. K-means clustering was used to group these services according to their scored responses. Logistic regression analysis was performed to identify predictors of high service quality. Results: The questionnaire was completed by 95.8% (322) of the managers of the sites surveyed. Most sites scored about 50% of the benchmark expectation. K-means clustering analysis identified four quality levels within which services could be grouped: 76 services (24%) were classed as level 1 (best)...

"Convivendo com a diferença: o impacto da sorodiscordância na vida afetivo-sexual de portadores do HIV/AIDS" ; Living with the Difference: the impact of serodiscordance on the affective and sexual life of HIV/aids patients.

Reis, Renata Karina
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 01/07/2004 PT
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Com o advento da terapia antiretroviral houve um aumento significativo na sobrevida e qualidade de vida dos portadores do HIV/aids. Esta nova realidade traz novas possibilidades de conviver com a aids, sendo a sorodiscordância uma delas. Este estudo teve como finalidade descrever e analisar o impacto da sorodiscordância na vida afetivo-sexual de portadores do HIV/aids que convivem com parceria heterossexual com status sorológico discordante. Como referencial teórico utilizou-se o conceito da vulnerabilidade. O local de estudo foi o ambulatório especializado no atendimento do HIV/aids do Hospital das Clínicas da Faculdade de Medicina da Ribeirão Preto-SP. Os dados foram coletados através de entrevista individual gravada e organizados e analisados com base na Análise de Prosa de André (1983). A partir dos dados emergiram nove temas: A percepção da invulnerabilidade, A descoberta da soropositividade ao HIV, Via de Infecção, Revelação do diagnóstico para o parceiro, A sexualidade, Vulnerabilidade da parceria sexual, Uso do preservativo, Saúde Sexual e Reprodutiva, A convivência. Os casais sorodiscordantes enfrentam inúmeros desafios após a descoberta de soropositividade em um dos parceiros, precisando desenvolver estratégias para o manejo de dificuldades para a vivência da sexualidade...

Significando as formas de infecção e a relação com a gestão do cuidado a pessoa com HIV/Aids

Kirchner, Angela Regina
Fonte: Universidade Federal de Santa Catarina Publicador: Universidade Federal de Santa Catarina
Tipo: Dissertação de Mestrado Formato: 154 p.| il., grafs.
POR
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Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem, Florianópolis, 2014.; Pesquisa que objetivou compreender os significados atribuídos pelos profissionais de saúde à forma de infecção pelo HIV e a relação deles com a gestão do cuidado oferecido a pessoas que vivem com HIV/aids. Trata-se de estudo de natureza qualitativa, guiada pelo método da Teoria Fundamentada em Dados, realizado em hospital de referência em infectologia no Estado de Santa Catarina. A coleta de dados foi realizada por meio de entrevista em profundidade, sendo o primeiro grupo amostral composto por um representante de cada categoria profissional atuante na instituição com, no mínimo, dois anos de assistência direta a pessoas com HIV/aids. O segundo grupo amostral foi formado por gestores e um terceiro grupo foi constituído para validação do modelo teórico construído. Fundamentados nos dados, emergiram resultados cujo fenômeno central é: indicando como significativa a forma com que a pessoa adquiriu o HIV e a aids na gestão do cuidado. Esse fenômeno está envolvido nas categorias paradigmáticas de: a) condição causal - Entendendo aids como fenômeno político...

CYCLES OF POVERTY, FOOD INSECURITY, AND PSYCHOSOCIAL STRESS AMONG AIDS CARE VOLUNTEERS IN URBAN ETHIOPIA

Maes, Kenneth; Shifferaw, Selamawit
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
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With the rollout of AIDS therapies, volunteer AIDS care has been promoted across Africa under the assumption that volunteerism is economically imperative in settings of health professional and resource scarcity. As low-income volunteers have become a major part of HIV/AIDS prevention and treatment workforces, it is imperative to question how poverty impacts their well-being. This chapter presents epidemiologic data collected during the 2008 food crisis from a sample of 110 AIDS care volunteers in Addis Ababa, Ethiopia, as well as narratives offered by HIV-positive volunteers, highlighting a widely overlooked way in which food insecurity and mental distress impact efforts to treat AIDS in sub-Saharan Africa. Food insecurity and elevated common mental disorder (CMD) symptom loads were common and tightly linked among the volunteers in the sample. Volunteers who were HIV-positive (17 percent) fared slightly worse in terms of food insecurity and psychosocial well-being. However, positive HIV serostatus was not associated with CMD in multivariate analyses accounting for food insecurity. Narratives illustrate how being HIV-positive shaped experiences of psychosocial stress, which involved unemployment and lack of prospects for marital relationships or strife within them. Our focus demonstrates the potential for mixing ethnographic and epidemiological methods to inform policy questions regarding poverty-reduction through compensation for volunteers’ valuable labor...

Medicaid Policies for AIDS-Related Hospital Care

Buchanan, Robert J.; Kircher, Fred G.
Fonte: CENTERS for MEDICARE & MEDICAID SERVICES Publicador: CENTERS for MEDICARE & MEDICAID SERVICES
Tipo: Artigo de Revista Científica
Publicado em //1994 EN
Relevância na Pesquisa
46.23%
With hospital services comprising an important part of care related to acquired immunodeficiency syndrome (AIDS), and all Medicaid programs becoming major payers of these services, Medicaid policies affect the care that Medicaid recipients with AIDS receive. Many States pay hospitals on the basis of prospective payments that do not vary with patient diagnosis. In contrast, Medicaid programs using diagnosis-related group (DRG) payment methods adjust payments to reflect the greater cost of AIDS care. At least 12 Medicaid programs limited the number of paid inpatient hospital days during 1992; Medicaid recipients with AIDS could easily exceed such limits.

Enhancing Patient Adherence: Promoting Engagement via Positive Patient-Provider Relationships in HIV/AIDS Care

Farrell, Leah; Ingersoll, Karen; Ceperich, Sherry Dyche
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
Relevância na Pesquisa
46.25%
The face of HIV/AIDS has shifted. Traditionally disenfranchised groups including African Americans and those known to be current or past substance-users are disproportionately infected and affected by the domestic HIV/AIDS epidemic. While caring for all people living with HIV/AIDS (PLWHA) is a public health priority, there are vast disparities in HIV/AIDS care and outcomes linked to treatment engagement and medication adherence. Historically, providers and researchers have focused heavily on seeking effective interventions to promote medication adherence among patients engaged in care. After having modest success when concentrating solely on outcomes pertaining to medication adherence (i.e., medication taking), the definition of adherence is broadening. Adherence to medications is now thought to occur along a continuum of engagement in care with regard to chronic illnesses such as HIV/AIDS. Patient-provider communication styles that are consistent with a motivational interviewing (MI) style are useful in enhancing active engagement in care, with potential to promote better medication adherence. Positive patient-provider relationships may be conduits for positive changes in vulnerable patients’ lives. Positive changes in individual patients’ lives culminate to reduce disparities in health status between PLWHA on a population level.

The HIV care cascade: models, measures and moving forward

MacCarthy, Sarah; Hoffmann, Michael; Ferguson, Laura; Nunn, Amy; Irvin, Risha; Bangsberg, David; Gruskin, Sofia; Dourado, Ines
Fonte: International AIDS Society Publicador: International AIDS Society
Tipo: Artigo de Revista Científica
EN_US
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56.09%
Introduction: This article seeks to identify where delays occur along the adult HIV care cascade (“the cascade”), to improve understanding of what constitutes “delay” at each stage of the cascade and how this can be measured across a range of settings and to inform service delivery efforts. Current metrics are reviewed, measures informed by global guidelines are suggested and areas for further clarification are underscored. Discussion Questions remain on how best to evaluate late entry into each stage of the cascade. The delayed uptake of HIV testing may be more consistently measured once rapid CD4 testing is administered at the time of HIV testing. For late enrolment, preliminary research has begun to determine how different time intervals for linking to HIV care affect individual health. Regarding treatment, since 2013, the World Health Organization (WHO) and UNAIDS recommend treatment initiation when CD4 <500 cells/mm3; these guidelines provide a useful albeit evolving threshold to define late treatment initiation. Finally, WHO guidelines for high-, low- and middle-income countries also could be used to standardize measures for achieving viral suppression. Conclusions: There is no “one size fits all” model as the provision of services may differ based on a range of factors. Nonetheless...

Exploring the Links between HIV/AIDS, Social Capital, and Development

David, Antonio C.; Li, Carmen A.
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
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This paper attempts to quantify the impact of the HIV/AIDS epidemic on social capital with cross-country data. Using data from the World Values Survey, the authors estimate reduced-form regressions of the main determinants of social capital controlling for HIV prevalence, institutional quality, social distance, and economic indicators. The results obtained indicate that HIV prevalence affects social capital negatively. The empirical estimates suggest that a one standard deviation increase in HIV prevalence will lead to a decline of at least 1 percent in trust, controlling for other determinants of social capital. Moving from a country with a relatively low level of HIV prevalence, such as Estonia, to a country with a relatively high level, such as Uganda, there is a more than 11 percent point decline in social capital. These results are robust in a number of dimensions and highlight the empirical importance of an additional mechanism through which HIV/AIDS hinders the development process.

Evidence-based Implementation Efficiency Analysis of the HIV/AIDS National Response in Colombia

Moreno, Antonio; Álvarez-Rosete, Arturo; Luque Nuñez, Ricardo; del Carmen Moreno Chavez, Teresa; Rodriguez-García, Rosalía; Montenegro, Fernando; Moreno, Luis Ángel; Suarez Lissi, Alejandra; Magne Concardo, Pedro; Gaillard, Michel Eric
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
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46.39%
This study on the implementation efficiency of the HIV/AIDS national response in Colombia seeks to examine how it has been implemented -- whether it has been done according to the available evidence about the epidemic and as the response was originally planned. The study approaches three specific dimensions of implementation efficiency: (i) programmatic; (ii) budgetary; and (iii) service delivery. The study uses a range of research techniques, including: (i) documentary analysis of key policies, official publications and reports; (ii) semi-structured interviews with representatives of the central government and territorial entities, international and community-based organizations, insurers, care providers, etc.; and (iii) case-study analysis to visualize the ways in which people are cared for in practice. The available data suggest that the HIV/AIDS response is succeeding in keeping the prevalence low and the epidemic concentrated. In recent years, the level of health coverage has increased and the quality of care services has improved. The identified problems in service delivery (mostly related to coverage and access) are linked to system fragmentation and integration...

Guidance Note on Health Care Worker Safety from HIV and Other Blood Borne Infections

Gold, Julian; Tomkins, Maggy; Melling, Phillip; Bates, Nicholas
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
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46.3%
The safety of heath care workers (HCWs) who take care of people with HIV/AIDS and other infectious diseases is of paramount importance. Occupational transmission of blood borne infections is not regarded as a common problem in developed country settings, but this is not the case in resource poor countries where the incidence and impact of such exposures is under-reported and is now becoming appreciated as an important risk factor for HCWs. It is generally assumed that protection from occupational exposures requires expensive equipment which is not reasonable for resource poor healthcare services. However, appropriately designed education and training, in combination with relatively low-cost technologies have the potential for both reducing injuries and increasing the confidence of Healthcare workers in providing essential care for their patients.

HIV/AIDS in the Caribbean : Issues and Options

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
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46.37%
Intensified efforts are needed in the Caribbean region if inroads are to be made against the AIDS epidemic. Although many Caribbean governments have initiated a limited response to HIV/AIDS, much remains to be done to bring proven interventions quickly up to nationwide scale. Moreover there is growing recognition that HIV/AIDS is not just a serious health issue in developing countries, but a major developmental catastrophe that threatens to dismantle the social and economic achievements of the past half century. The challenge for Caribbean countries is to learn from the dramatic experiences of some African countries and act decisively now to prevent the progressive extension of the epidemic to the general population. This report provides an overview of the challenges and opportunities in addressing the problem of HIV/AIDS in the Caribbean. It presents a snapshot of the HIV/AIDS epidemic in the region, offers examples of ways in which Caribbean countries and regional bodies have responded to the epidemic, discusses alternative actions for addressing the crisis...

HIV/AIDS in Latin American Countries : The Challenges Ahead

Garcia Abreu, Anabela; Noguer, Isabel; Cowgill, Karen
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
EN_US
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46.31%
HIV/AIDS in Latin America falls within the framework of a low endemic setting. In the majority of the countries, the epidemic is still concentrated in high-risk populations: men who have sex with men (MSM), injecting drug users (IDUs), commercial sex workers (CSWs), prisoners, and people with sexually transmitted infections (STIs). The exceptions are Honduras and southeastern Brazil, where the epidemic has reached the general population. Heterosexual sex is the primary mode of transmission in Central America, with sex between men predominating in South America, and injecting drug use playing a significant role in the Southern Cone. Survey respondents also identified other populations with increased vulnerability in which interventions would be crucial-young people and women. Although the number of men living with AIDS outweighs the number of women in all countries, the gender gap is closing, and in some countries, the effect of AIDS on rural communities is increasing rapidly. In low endemic settings, the main priority is the highest risk groups...

AIDS morbidity and the role of the family in patient care in Uganda

Ntozi, James P. M
Fonte: Health Transition Centre, National Centre for Epidemiology and Population Health, The Australian National University Publicador: Health Transition Centre, National Centre for Epidemiology and Population Health, The Australian National University
Tipo: Artigo de Revista Científica Formato: 77315 bytes; application/pdf
EN_AU
Relevância na Pesquisa
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Extended families and clans in African societies have extensive systems of treatment and patient management which can be used with AIDS sufferers. This paper used data from a baseline survey of six districts to study patient care in Uganda. The levels of AIDS illness are high, and highest in the sexually active age groups of 20-49 years. Of the nuclear family, parents, siblings, spouses and children are the dominant AIDS patients’ primary carers in that order. Other relatives in the extended family also contribute much primary care. The contribution of neighbours and friends to primary caring and of other relatives as secondary carers is small. This is perhaps because of the financial burden of caring for the patients. However, there are indications that households and families are coping with the effects of the disease.; no

HIV/AIDS epidemic in the State of Amazonas: characteristics and trends from 2001 to 2012

Oliveira,Romina do Socorro Marques de; Benzaken,Adele Schwartz; Saraceni,Valeria; Sabidó,Meritxell
Fonte: Sociedade Brasileira de Medicina Tropical - SBMT Publicador: Sociedade Brasileira de Medicina Tropical - SBMT
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2015 EN
Relevância na Pesquisa
46.27%
A scoping review was conducted to describe the epidemiological characteristics of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in the State of Amazonas, Brazil, from 2001 to 2012, and temporary patterns were estimated from surveillance data. The results suggest that in its third decade, the Amazon HIV/AIDS epidemic is far from being stabilized and displays rising AIDS incidence and mortality rates and late diagnoses. The data suggest that AIDS cases are hitting mostly young adults and have recently shifted toward men, both homosexual and heterosexual. AIDS cases among the indigenous people have remained stable and low. However, the epidemic has disseminated to the interior of the state, which adds difficulties to its control, given the geographical isolation, logistical barriers, and culturally and ethnically diverse population. Antiretroviral (ARV) therapy has been decentralized, but peripheral ARV services are still insufficient and too distant from people who need them. Recently, the expansion of point-of-care (POC) rapid HIV testing has been contributing to overcoming logistical barriers. Other new POC devices, such as the PIMA CD4 analyzer, will bring the laboratory to the patient. AIDS uniquely coexists with other tropical infections...

Analyzing Community Responses to HIV and AIDS : Operational Framework and Typology

Rodriguez-García, Rosalía; Bonnel, Réne; N'Jie, N'Della; Olivier, Jill; Pascual, F. Brian; Wodon, Quentin
Fonte: Banco Mundial Publicador: Banco Mundial
Tipo: Publications & Research :: Policy Research Working Paper
ENGLISH
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This paper presents a framework for analyzing the community response to HIV and AIDS. On the basis of a review of the literature, six criteria are proposed for characterizing such community responses: (1) the types of organizations and structures implementing the response, (2) the types of activities or services implemented and the beneficiaries of these, (3) the actors involved in and driving community responses, (4) the contextual factors that influence community responses, (5) the extent of community involvement in the response, and (6) the extent to which community responses involve wider partnerships and collaboration.

China : AIDS Expenditure Tracking in Guangxi Zhuang Autonomous Region

China Health Economics Institute; World Bank
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Economic & Sector Work :: Other Social Protection Study; Economic & Sector Work
ENGLISH; EN_US
Relevância na Pesquisa
46.37%
The Chinese government's spending on HIV/AIDS has increased dramatically in recent years. However, it only accounts for a part of the total resources dedicated to HIV/AIDS. The fragmented nature of HIV/AIDS financing makes it difficult to register the flows of funds in a holistic and useful manner. More importantly, there are questions over the extent to which increased resources for HIV/AIDS have been allocated and utilized in an equitable and effective manner in order to achieve the intended outcomes specified in the Second Five Year Action Plan for HIV/AIDS Prevention and Control (2005-2010). This study was designed to gain a better understanding of possible impediments to an effective local HIV/AIDS response. It mainly focused on: (a) assessing different aspects of HIV/AIDS financing such as sources of financing, HIV/AIDS related services and their providers being financed, and beneficiaries; (b) estimating households out of pocket spending on HIV/AIDS; and (c) identifying bottlenecks preventing the effective and equitable utilization of existing HIV/AIDS resources.

HIV/AIDS Education in Health Professionals Training in the Philippines

Tawasil, John R.; Salvador, Vincent DG; Juban, Noel R.; Chan, Michael B.
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Other Health Study; Economic & Sector Work
ENGLISH; EN_US
Relevância na Pesquisa
46.29%
It is recognized by both private and public sectors that an adequate education plays an important part in stemming the spread of HIV. While the topic of sex education among primary and secondary schools remains a contentious issue for a predominantly Catholic country like the Philippines, teaching health professionals about HIV/AIDS is a vital part of the subject of infectious diseases. At present, there is a need to evaluate the current curriculum of health professionals in terms of the adequacy of the teaching about HIV/AIDS. This study was undertaken to review the present state of HIV/AIDS education in undergraduate health professionals' curriculum and to assess the response of local tertiary private hospitals to the emerging threat of HIV/AIDS. It analyzes the current situation of HIV/AIDS lectures and discussions in public tertiary education academic curricula of health professionals in the Philippines. It determines the perceptions of different stakeholders as to the sufficiency of the current level of lectures and discussions on HIV/AIDS. It describes the private hospital sector response to the HIV/AIDS problem. This study was divided into two parts. The first part dealt with the first and second objectives...

Algorithms for Purchasing AIDS Vaccines

Bishai, David; Lin, Maria K.; Kiyonga, C.W.B.
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Policy Research Working Paper; Publications & Research
ENGLISH; EN_US
Relevância na Pesquisa
46.39%
The authors delineate two different algorithms for the purchase of AIDS vaccines, to show how differences in policy objectives can greatly affect projections of the number of courses of vaccine that will be needed. They consider a hypothetical vaccine costing ten dollars to produce, and offering sixty percent, seventy five percent, and ninety percent reductions in the risk of HIV for ten years. For each of the world's ten major geographic divisions, they sue published estimates of the risk of AIDS, the value of medical costs averted, and the value of potential productivity losses. Under the "health sector" algorithm - in which purchases are made to minimize the impact of AIDS/HIV on government health spending - 766 million courses of vaccine would be purchased. Under the "societal" algorithm - in which purchases are made to minimize the impact of AIDS/HIV on health spending and GDP - more than 3.7 billion courses of vaccine would be purchased. Under an "equity" model - allocating vaccines to everyone in the world at high risk...

Improving HIV/AIDS services through palliative care: An HRSA perspective

O'Neill, Joseph F.; Marconi, Katherine; Surapruik, Ann; Blum, Nancy
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
Publicado em /06/2000 EN
Relevância na Pesquisa
46.31%
There has been a dramatic shift of the human immunodeficiency virus/acquired immunodeficiency syndrom (HIV/AIDS) epidemic into poor, marginalized, and minority communities in the US. At the same time, the availability of new highly active antiretroviral treatments has made it possible for a large number of individuals to live for a much longer time with their disease. A net result is that the US is faced with an increasing number of people who are living with HIV/AIDS and are dependent on publicly supported health care services. In this paper, we review the palliative care efforts of the federal agency, the Health Resources and Services Administration (HRSA), responsible for providing Ryan White CARE Act HIV/AIDS care to medically underserved populations. In addition to supporting traditional hospice care, HRSA's HIV/AIDS Bureau has begun a series of initiatives that apply a broader concept of palliative care to its HIV programs in hospital-and community-based settings. Our interest is not to substitute palliation for access to new HIV therapies, such as highly active antiretroviral treatments, but to ensure that our health delivery systems attend to the alleviation of symptoms and suffering along with the provision of antiretroviral and other necessary treatments. HRSA's HIV/AIDS Bureau is organizing a broader provision of palliative care for its clients and actively contributing to improving care for the disenfrachised internationally.

(Re)placing health and health care: mapping the competing discourses and practices of traditional and modern Thai medicine

Del Casino, Vincent
Fonte: Pergamon-Elsevier Ltd Publicador: Pergamon-Elsevier Ltd
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
46.26%
In the wake of the AIDS crisis, 'traditional' Thai medicine has received new attention as a means by which people living with HIV and AIDS (PLWHA) can receive some level of care. The revitalization of Thai medicine, however, is complicated by the competing organizational politics and social dynamics that regulate discourses and practices of health and health care in Thailand. This paper examines how Thai medicine is being (re)placed in the context of competing health-care systems and practices. Specifically, this analysis focuses on the complex interrelationships between 'traditional,' holistic medicine and 'modern,' allopathic medicine in a Thai context; and investigates the role of 'Thai medicine' (phaet phaen thai) and 'village medicine' (phaet pheun baan) as part of governmental and non-governmental efforts to provide health care to PLWHA in Chiang Mai, Thailand. The provisioning of such health care, however, takes place within the context of a struggle over 'local knowledge' and 'global change' and the ways in which places are organized in relation to the available treatment regimens for HIV/AIDS care. What this paper suggests is that the meanings of health and health care are inextricably linked to the complex, contested nature of social relations as they flow in...