Ryan White CARE Act Title I Funding Priorities and Unmet Service Needs in Baltimore, Maryland

The analysis presented in this paper explores the similarities and differences between the services selected as priorities for funding by the Baltimore Ryan White CARE Act Title I Planning Council during the first 2 years of the program in this metropolitan area, and services perceived by HIV/AIDS service providers and people living with HIV/AIDS to be unmet needs. The data used for these analyses were collected as part of a study to assess the implementation and impact of the CARE Act legislation in the Baltimore eligible metropolitan area( EMS ). This project includes three interrelated components: (a) a case study of the legislatively mandated Planning Council, (b) a survey of providers representing HIV/AIDS service organizations, and (c) a qualitative field study of the perceptions of people living with HIV/AIDS about the service delivery system. Taken together, the data from these three sources describe the similarities and differences among these three groups involved in HIV/AIDS care in Baltimore, in terms of their perceptions of services needed by people living with HIV / AIDS. The conclusions drawn from this study can be used to strengthen needs assessments in Title I-EMAs throughout the United States.     

Women With AIDS: Will It Change aids Service Organizations?

In the early 1980s, gay men formed AIDS service organizations (ASOs) in areas hardest hit by the disease, such as San Francisco and New York City, to provide assistance to infected members of their own communities. The Ryan White CARE Act of 1990 made funds available for community-based groups, such as ASOs, to provide support services to all people with HIV/AIDS. The epidemiology of AIDS has changed greatly in recent years, and increasing numbers of poor, minority women with children now contract HIV/AIDS. To determine if ASOs are in compliance with the CARE Act, this study surveyed 20 ASOs across the country and a number of their female clients to see if ASOs, some of which were started by gay men, have tailored their services for a growing minority, heterosexual population. The results indicate that a number of ASOs have been slow in responding to the diverse needs of women. Recommendations are offered to make the organizations more responsive.     

The Ryan White Act in Dallas

Virtually every locality affected by the AIDS epidemic has had to confront changes in the demographics of the disease, shifts in federal priorities, and medical advances in AIDS treatment. Creating a consistent federal policy has proven difficult because the epidemic manifests itself differently in virtually every locality it invades. As a result, some local caseloads increasingly are dominated by intravenous drug users and others by gay men. In recognition of this reality, the primary federal program to fund AIDS services relies on local decisionmakers to make allocation decisions for serving the needs of their caseload. Under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990, local Health Services Planning Councils were assigned the task of creating an effective continuum of care for persons with HIV I AIDS and were empowered with the task of allocating federal funds to accomplish that objective. In some cases creating and fostering an effective continuum of care proved to be an essentially noncontroversial managerial task, while in other localities political turmoil and rampant self-interest served as barriers to program effectiveness. This article explores the relationship between local political culture and the development of AIDS programs in Dallas County, Texas. Specifically, we compare the provision of AIDS services in Dallas before passage of the Ryan White Act in 1990, how these services were affected by the Ryan White program, and the experiences since the reauthorization of the Ryan White Act in 1996.     

Washington's Response to the AIDS Epidemic: The Ryan White CARE Act

Passage of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 followed a form familiar to students of policymaking in the American intergovernmental system: the provision of significant federal financing for policy initiatives located primarily at the state and local levels. The successes and failures of the Act, including its 1996 reauthorization, suggest both the strengths and the limitations of that design. This paper examines the structure of the Act as a vehicle for the federal government to fund AIDS service delivery at the state and local levels and the intergovernmental consequences of allocation policies associated with the Act. It concludes that perennial problems of equity and access cannot be resolved by the delegation of responsibility for significant policy or funding decisions to localities; rather, questions about the role of the federal government in overcoming intralocal and interlocal disparities remain to be addressed.     

After the Exception: HIV/AIDS Beyond Salvation and Scarcity

Abstract: Access to treatment for HIV/AIDS became a flashpoint for global justice struggles in the late 1990s. An expanding international response, premised to a significant extent on the idea of HIV/AIDS as an exceptional global problem, has since delivered treatment, care and prevention to growing numbers of people. HIV/AIDS exceptionalism, however, has increasingly been questioned, many aspects of the response have been critiqued and donor funding has started to decline. I argue that, having been framed as an exceptional humanitarian emergency, the question of HIV/AIDS as a global problem is increasingly located within a discourse of scarcity. Tracking the growing entanglement of global HIV/AIDS relief with neoliberal governmentality and the emergence of something I term therapeutic neoliberalism, I argue that the shift from a rationality of salvation to one of administration poses new challenges for global health activism. Questioning the discourse of scarcity remains essential to an alternative global health agenda.     

AIDS Activism in Pakistan: Diminishing Funds,Evasive State

This article draws on a year of ethnographic fieldwork in the HIV/AIDS sector of Pakistan at the moment of rolling back a World Bank‐financed programme. Classified by UN agencies as at ‘high risk’ of a generalized HIV epidemic, Pakistan has an epidemiology driven by injecting drug use, and a Penal Code and Islamist legislation which criminalize non‐therapeutic drug use and extra‐marital sex. In recent years, a sharp increase in the numbers of registered HIV‐positive people has necessitated a shift from HIV prevention among ‘high risk groups’ to the provision of care to those living with HIV/AIDS. The rolling back of external funding, which was further compounded by the effects of devolution on the Ministry of Health, created challenges for AIDS activism in Pakistan, as reflected in the everyday lives — and deaths — of the patient‐activists and their community‐based organizations. This article recounts the story of one such aspiring AIDS activist caught in multiple dilemmas emanating from these macro‐processes. This story throws light on the limitations of the complex agency of actors in development, and shows how the shifting loci of power from the state to non‐state entities in the global neoliberal order impacts the provision of vital services like HIV prevention and AIDS control.     

Navigating the AIDS industry: being poor and positive in Tanzania

This article shows how poor people living with HIV/AIDS in Tanzania navigate a myriad of actors, agencies and organizations to obtain the aid they need to survive. It focuses on community-based organizations which establish networks of care through which people obtain care, treatment and financial support. A case study of a roadside town in Tanzania illustrates that these community-based networks of care — essential to the survival of many — are partly the product of the AIDS industry, which encourages the establishment of community-based organizations and voluntary service delivery rather than more formalized systems of care. Community-based organizations, however, are so poorly supported that they often deploy self-destructive strategies. The need to strategically navigate the AIDS industry creates tension and even conflict among HIV-positive activists, the people they represent and the wider community, which undermines rather than strengthens community-based interventions. Whilst the AIDS industry promises inclusion of HIV-positive people in the response to HIV/AIDS, it succeeds only partially, with the result that it may potentially do more harm than good.     

Privileging prevention,gendering responsibility: an analysis of the Ghanaian campaign against HIV/AIDS

This article focuses on the discourses around HIV/AIDS in the national Ghanaian ‘Stop AIDS Love Life!’ public health campaign, within non-governmental HIV/AIDS publications, and the Ghanaian national print media. I have used critical discourse analysis to interpret and deconstruct a range of these social texts collected between June and September of 2001 and 2003 in and around Greater Accra, Ghana. I argue, firstly, that these discourses are shaped by an international politics of funding for HIV/AIDS that privileges prevention through behaviour change over treatment action under the premise that prevention is a more cost-effective option for the Global South. I critique this stance, highlighting the emerging possibilities for integrated prevention–treatment efforts in resource-poor settings such as Ghana. Secondly, I argue that the discourses around HIV/AIDS presented in prevention campaign materials powerfully construct normative and gendered subjectivities with assigned roles and responsibilities. The fight against HIV/AIDS is constructed as a national project in which an idealized, and often very young, female citizen is positioned as educator, volunteer, carer and protector of herself and society. This discursive coding of responsibility places the many burdens of HIV upon some of the most vulnerable in society, ignoring the structural constraints of gender, generational and economic inequality. I conclude my paper by arguing that efforts to reduce transmission rates, stigma, and the burden of care for those living with HIV/AIDS in Ghana must integrate both preventative efforts and treatment action. Where prevention campaigns are utilized I suggest that these must recognize the limitations of behaviour change initiatives that primarily target women and acknowledge the gendered constraints faced by those very subjects identified as responsible for the protection and education of the nation.     

Assessing the relationship between physician availability and viral load suppression in British Columbia

In 2014, the Joint United Nations Programme on HIV/AIDS set the target of dramatically reducing the burden of HIV through expansion of access to timely HIV treatment. In order to achieve this target, it is necessary to expand access to care along the HIV cascade of care. This study examines the relationship between viral suppression and the availability of physicians providing HIV treatment in British Columbia, Canada. Data from the Drug Treatment Program of the British Columbia Centre for Excellence in HIV/AIDS was analyzed. The floating catchment method was used to assess physician availability and multivariable logistic regression was used to implement a confounder selection technique to independently assess the relationship between physician availability and viral load suppression. Individuals with more than 25 physicians within a one‐hour catchment were more likely to reside in urban areas and almost twice as likely to have a suppressed viral load (adjusted odds ratio: 1.97; 95% CI 1.50 – 2.58). This study highlights the impact of physicians’ availability on viral load levels. Mapping technology was used to identify the locations in which patients were most impacted by the lack of physicians.     

小型图书馆的发展问题探讨

阐述了小型图书馆在藏书管理、服务模式、人员编制、经费投入等方面的现状,根据其优势和面临的困境,提出相应对策.在加强科学管理,完善基础建设,注重人才培养等之外,还要拓展服务空间.随着数字化、网络化进程的发展,图书、情报、档案一体化是小型图书馆发展的必然趋势.而各种文献信息的数字化是一体化的前提和关键.在一体化的基础上,以单位科研项目、研究人员为本,对文献信息进行深层次开发,提供高效、创新的知识服务,是提升小型图书馆服务功能的重点.     

Supporting women's empowerment in Djibouti

This article reports on the work carried out by the UN Population Fund (UNFPA) in the small island of Djibouti, Africa. The republic's population has been plagued with problems of high levels of unemployment, poverty, malnutrition, an almost non-existent family reproductive health care service, 100% prevalence rate of female genital mutilation and low literacy rate, especially for women. In addition, refugees from Ethiopia and Eritrea have settled in the country increasing the risks of sexually transmitted diseases (STDs), HIV/AIDS, prostitution, and other social ills. In 1983, UNFPA started funding family planning and later reproductive health projects aimed at assuring access to services for a majority of Djiboutan women. The first country population program of assistance was started in 1992. This would help the government with health care for its population and to conduct a population census. In addition, the Fund has paid for training of doctors, midwives, and traditional birth assistants in the country and for rehabilitating maternity clinics and information centers. Moreover, it has supported agencies concerned with educating people on STDs, HIV/AIDS, safe motherhood and reproductive health for men and women, and other important issues.     

HIV/AIDS financing: a case for improving the quality and quantity of aid

There is no doubt that increasing amounts of funding are needed to provide a full package of HIV/AIDS prevention, treatment and mitigation interventions to Africa. However, even the existing funding flows are posing considerable challenges at a national level. In the quest for rapid results, donors have too often chosen to alleviate the lack of local capacity by bringing in foreign technical assistance or building parallel systems for delivering commodities such as drugs that may not be sustainable over the long term once external assistance stops. Even when such interventions may be relevant, they do not address the biggest challenge, namely how to build up the capacity and the systems needed for large-scale implementation of the AIDS response. This article argues that to attain the needed efficacy in HIV/AIDS mitigation programmes, further sustainable increase in external financing is certainly required (particularly for treatment programmes), but even more important is the need to implement them.     

"Indirect Regulation" of Environmental Hazards Through the Provision of Information to The Public

Title III of the Superfund Amendments and Reauthorization Act of 1986 seeks to reduce the risks of chemical accidents through a strategy of indirect regulation that relies on providing the public with information about chemical hazards. For this strategy to be effective, citizens must aggressively utilize the information provided to monitor industrial practices and press for risk reduction. Since prior research suggests it is very difficult to evoke the degree of citizen action that would be required to make a strategy of indirect regulation successful, and since the federal legislation provided no funds for implementation, there is a question of whether the structures set up by Title III are sufficient to achieve its objectives. This article reports the results of anational study that examined selected aspects of the implementation of Title III in an effort to assess the likely outcome of its attempt at indirect regulation. Our focus is on the degree to which the Title III-mandated Local Emergency Planning Committees are pursuing policies that are likely to get the necessary information to citizens and foster community debate on hazardous materials issues.     

Funding Faction or Buying Silence? Grants,Contracts, and Interest Group Lobbying Behavior

During the past decade, numerous congressional bills and amendments have attempted to curtail lobbying by nonprofit organizations that receive federal grants. These policy efforts grow out of an assumption that federal funds are encouraging advocacy at levels that are excessive and encourage additional government spending. Using survey data on more than 700 organizations based in Washington, DC, this article tests this assumption. The data show that for the most part, organizations receiving federal grants and contracts lobby no more frequently than similar organizations that do not receive such benefits. The exception is contacting federal agencies, which charitable organizations receiving federal funds do slightly more often than similar organizations without such funds. A multivariate analysis assesses federal funding together with other variables theorized to affect lobbying—federal tax status, resource levels, and the nature of the lobbying issue—confirming that while these other variables affect lobbying levels, federal funding does not.     

PROPERTY LEFT BEHIND: AN UNINTENDED CONSEQUENCE OF A NO CHILD LEFT BEHIND “FAILING” SCHOOL DESIGNATION

Under the No Child Left Behind Act (NCLB), schools receiving Title I funding that fail to meet adequate academic performance targets for two consecutive years are deemed “failing.” This broadly defined, but often misunderstood designation has exerted a negative and unintended effect on low‐income neighborhoods—the same neighborhoods NCLB was originally intended to help. Specifically, we find that “failing” designations significantly decrease home prices. This property value response is observed even after controlling for a myriad of traditional test score measures and school‐level student demographics. Additional analyses suggest that this home price effect is largely due to strong perceptions of poor school quality or social stigma surrounding a “failing” designation.     

An international public health crisis: can global institutions respond effectively to HIV/AIDS?

The United Nations Millennium Project (2005 UN Millennium Project , 2005 . Combating AIDS in the developing world ( London : Taskforce on HIV/AIDS, Malaria, TB, and Access to Essential Medicines: Working Group on HIV/AIDS, Earthscan ). [Google Scholar]) describes the HIV/AIDS epidemic as a ‘global catastrophe, threatening social and economic stability in the most affected areas, while spreading relentlessly into new regions’. Multilateral institutions under the leadership of the Joint United Nations Program on HIV/AIDS and World Health Organization have been charged with coordinating the worldwide response. Yet with attention and funding diverted between bilateral, regional and multilateral aid providers, and little discernible success in containing the global epidemic to date, it remains an open question whether traditional global institutions are able to effectively combat HIV/AIDS. It is argued that bilateral relationships are still heavily relied upon at present as traditional multilateral arrangements struggle for resources and political attention. The critical questions discussed here are whether global institutions should, can and will respond effectively to the HIV/AIDS crisis. This analysis finds that the most readily organised and deployed global response will likely involve an alliance of public and private agencies that can escape some of the domestic, political and organisational constraints inherent in existing HIV/AIDS funding arrangements. Ultimately, newer hybrid arrangements that have emerged recently, like the Global Fund to Fight AIDS, Tuberculosis and Malaria, may offer a more enduring global regime to control the HIV/AIDS epidemic. The corollary is that UN agencies alone in their traditional form, hampered by multilateral practicalities, will be less effective.     

Women endangered,says world population report

This report highlights key points from the UN Population Fund's "State of World Population 1997," which focused on women's right to choose in matters relating to reproductive health. The report documents global progress toward achieving reproductive rights for women and recommends more funding for reproductive health care and family planning and increased efforts to promote gender equality and individual rights. International agreements protect: the right to reproductive and sexual health throughout the life cycle; voluntary choice in marriage and childbearing and the means to determine when to have children; equality and equity in all spheres for men and women; and freedom from sexual violence and coercion. When these rights are denied, the result is maternal mortality (a death every minute). There is a lack of access to contraceptive services that affect 350 million women. Unsafe abortions are performed on 20 million women, of whom 70,000 die. There is a lack of access to sex education and services for teenagers that results in HIV infections and sexually transmitted diseases (STDs). 1.5 million die from HIV/AIDS related causes, and another 1 million die from reproductive tract infections and STDs. Teenagers represent about 50% of the 333 million new cases of HIV and STDs that occur each year. Female genital mutilation is performed on 120 million girls and women, and 2 million are at risk each year. 2 million girls aged 5-15 years enter the commercial sex trade each year. The report documents the suffering from anemia and malnutrition and complications from pregnancy.     

Wealth alone does not buy health: Political capacity,democracy, and the spread of AIDS

Although there have been have numerous studies on AIDS documenting its mortality, its epidemiological features, and its relationship to poverty and development, few studies have systematically analyzed how political factors and policies may help curtail the spread of AIDS. In this paper I consider how a variety of domestic factors influence HIV infection rates across countries. I argue that states with higher state capacity are better able to reduce the spread of the HIV/AIDS epidemic. Moreover, I argue that while strong autocracies can implement efficient policies with fewer constraints, democracies tend to be more responsive to the needs of the population and can be more efficient in curtailing the spread of HIV/AIDS. I empirically evaluate the hypotheses using a cross-sectional time-series sample of 117 countries. The empirical results indicate that greater state capacity indeed appears to help curtail HIV/AIDS infection rates.     

Abbott’s ‘budget crisis’, CALD women’s loss? Service providers explore the impact of funding cuts

Women have been disproportionately affected by funding cuts to services following the 2008 global financial crisis. Using a feminist intersectional analysis of austerity measures applied to family violence (FV) services in Victoria, Australia, including 11 service provider interviews, we find that: the Australian government drew on global narratives of austerity in constructing a ‘budget crisis’, with subsequent cuts to funds addressing FV; budget cuts negatively impacted services’ abilities to address the needs of culturally and linguistically diverse (CALD) women; there is a lack of qualified interpreters and multilingual services, and; there are missed opportunities to engage and support young CALD people in FV services. Policy recommendations to support FV services and their abilities to help CALD women and young people are provided.