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ANTC61-LEC 11.docx

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Laura Sikstrom

 research question-what you want to find out o a good one has to be what you can answer in the paper e.g. not "why is the world unfair?"  thesis statement Question: Why are children half as likely to access free HIV treatment than adults?  treatment for HIV is free globally, but children are still half as likely to get treatment than adults  research hypotheses o therapy management is shaped by the political economy (Foley);  rural area in Malawi, all farmers (cash crop farmers)...growing tobacco  this draws thousands of migrants, they come without extended family, without social support o 2. the parents were more concerned that if they passed away, they wouldn't have the social network to continue to treat the child Global HIV Prevalence  survival strategies o transactional strategies (giving sex for food etc) o mobility Treatment Denial  denied treatment, thinking that people would not adhere to treatment regimens (if they don't take it at the same time everyday for the rest of their lives, it develops treatment resistance) 1996-2004 Global Activist Movement  global protests against patents on ART  pilot projects-trying to prove that Africans can take HIV medicines (research has shown that Africans have higher adherence than Western countries)  Global fund o Product Red (sell red things) o funded by Bill and Melinda Gates o made up of philanthropists, governments, companies etc. 2004 Global "ART Scale Up"  FREE universal access: The Global Fund 11.4 bn  Malawi-has the lowest retention rates in the world after 5 years (nearly 50% of the people that started treatment are no longer alive) o poor food security, poor country etc. (treatment works better if you are well nourished) Critics of GPPPs  Unintended consequences o increase social conflict (because come home and give food to family or else will look greedy) o corporations show off as good corporate citizens, which allows them to keep prices high here (global pricing strategy-allows them to make higher profit)..."the joy of giving in public" o plumpy nut (fortified peanut butter)...very effective for treating malnutrition  being rolled out on a national level, not very cheap though (0.25 cents a day), but kids need it 3-4 times a day, which means that it is about $3, why can't they just give them the money?  once you give the plumpy nut, how do you know that they will eat it? They may just give it to their family members  Ulterior political and economic motives o tax write offs (by doing charitable things) o captive market for pharmaceuticaliztion of disease (motives for profit)  limits autonomy of nation governments to develop locally relevant solutions o standardized programs (same program implemented everywhere) size fits all o health care workers have never been consulted  reifies global health inequalities o performance based funding  certain countries perform better than others (because they have more money than others), this perpetuates inequality  rewards "donor darlings"...those who do better and show results  drive for profit in private sector conflicts with health goals GPPPs and an Average clinic  standardized global treatment models (the local clinic has no say as to how it is run, what is done etc.)  rely on lower tier health care workers o Malawi has very few doctors o train workers for 6 weeks on how to fill in charts  very little monitoring and support o patients are not weighed, their side effect is not tracked o no support if patients are having problems  cannibalization of health services o give HIV programs, at the expense of other programs (while HIV programs increase, vaccination has decreased)  older, generic ART medicines (1st and 2nd lines) o not getting top of the line, cutting edge drugs o gov't can only afford to give drugs that have known side effects  people may not die from HIV, but dying from hu
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