a) In the Republic of New World (RNW), reported HIV cases have increased by about 30% over the past several years. This in itself is viewed by many area experts as an undercount, because the surveillance system in RNW is limited and depends on voluntary reporting from the network of district and rural hospitals as well as those in urban settings.
b) The primary mode of transmission is heterosexual, in â€œconcentric circlesâ€ out from the commercial sex trade to clients and then to their partners/spouses and sometimes children.
c) This transmission pattern is complicated by a number of key social factors. RNW is still largely a rural country that has undergone a rapid period of urban and industrial growth over the past fifteen years. The overall poverty rate is extremely high, and there has been a significant migration from rural to urban areas in search of work, which is not always available, leading to the expansion of shantytowns and slum areas. Agricultural development in some rural areas has also forced small farmers out of business with no alternate sources of income. As a result of these patterns, one common source of income has been for daughters to be pushed (by families) into the sex trade â€“ sometimes in the elusive hope of finding a wealthy patron.
d) Along with this overall situation, the network of health services is far below capacity, and basic health services of any kind â€“ much less anti-retroviral therapy for AIDS â€“ is simply not available for vast numbers of people.
e) Further complicating this picture is the stigma that is attached to people who have AIDS. Not only does this hinder treatment, but it leads many people to conclude (as heard in rapid assessment focus groups) that they are better off not getting HIV tested, not knowing, and â€“ if they do know or suspect their HIV status â€“ not letting anyone, even their partner, know.
f) Condom distribution programs have been instituted on a limited scale, primarily by international aid agencies. The central government has been preoccupied with economic development and has until recently been reluctant to address the HIV/AIDS crisis for fear of scaring off foreign investment. However, even the existing condom distribution/education efforts have met with limited success.
g) Male sex trade clients have reported that they often just deny that they are at risk, or rationalize that they patronize â€œbetter girls,â€ or â€œbetter establishmentsâ€ where the women are younger (viewed as less likely to be infected) and â€œclean.â€ In focus groups, men who are clients also question their alternatives, since they are often working as migrant labor and are far from home, and far from the social institutions through which they would otherwise meet a â€œproper partner.â€ In addition, having a â€œside relationshipâ€ was viewed as a common situation for men in any case.
h) You are working with a core task force of RNW health professionals and government representatives to design a prevention strategy to slow the tide of HIV infection. The RNW government wants a three-year plan to start.
5. Again, recognizing that you have three years, and you need data from your initial plan to help develop the second three year plan, what could you do (BRIEFLY!) to evaluate the intervention you proposed in Question 3 (include process, impact, outcome)?
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