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ETHICAL ISSUES IN HEALTH-RELATED research on politically oppressed migrant populations differ in significant ways from community health research in other contexts. The United Nations has set goals for such research. The health-related Millennium Development Goals (MDGs) were investigated in communities ("clusters") of migrants from Burma living in villages in the Sangkhlaburi District of Thailand, adjacent to the Thai-Burma border. Hunger was experienced regularly in 70% of the households, and 26% of children under 5 years were underweight. Malaria, tuberculosis, and HIV/AIDS were prevalent. Few households took part in family planning, and there were many large families and disabled children. The health of the migrant populations was compromised by poverty, social exclusion, and under- or unemployment. Stakeholders in discussion groups concurred with the authors that tuberculosis detection and treatment and food production activities were important issues to address in developing projects to improve migrant health. This case study illustrates how the MDGs can be operationally defined.
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PMID:Towards realizing the health-related millennium development goals for migrants from Burma in Thailand. 1975 34

Challenges for food and health security encompass food production and distribution, smallholder income generation, access to health care, harmful child care practices and epidemics (e.g. HIV), and tackling of the coexistence of undernutrition and caloric over-nutrition. The recently re-defined primary health care approach addresses the whole field of nutrition and health security. In general, Asia has more experience with technologies in various fields than Africa. But Africa has more experience in humanitarian approaches to emerging food and health crises. Objectives of the Asian-African collaboration need to be differentiated into one area where the public sector is developing and strengthened, and another area where the private sector can promote food and health security with its specific advantages and constraints. In the field of hunger and disease prevention, both sides can benefit from the exchange of knowledge and concepts. Whereas in the Western world drugs and technologies became major factors in health care and food production, the potential of Asia and Africa lies in optimizing the utilization of indigenous plants and protecting the biodiversity of the natural resources. As an example, the vegetable bitter gourd is presented: it can be grown almost everywhere and it exerts anti-obese and anti-diabetic effects. This is of extreme importance for those who do not have access to modern drug treatment for diabetes mellitus. Asian-African collaboration in food and health security provides a great opportunity as both sides can benefit from different experiences and opportunities in order to meet the challenges in food and health security.
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PMID:The value of Asian-Africa collaboration in food and health security. 1996 50

The eight Millennium Development Goals (MDGs) are the expressed commitment by world leaders to combat the most obvious forms of social inequality in the world: poverty, illiteracy and disease. The MDGs set health priorities and serve as markers of the most fundamental problems to solve: the maternal and child health high mortality, and the fight against major endemic diseases. Thus, health appears in three of the eight goals, and plays a decisive role in achieving the other MDGs such as the eradication of poverty and hunger, promotion of education and gender equality. While progress has been made in various domains and in numerous countries, enormous gaps and lack of funding remain. This is the case for infant mortality and HIV/AIDS, and even more so in the area of maternal mortality reduction especially in sub-Saharan Africa and Southeast Asia. The recent proliferation of forums and international partnerships for health have put at the forefront the targeted health-related MDG, increased financial resources for the benefit of poor countries but have made the architecture of global health even more fragmented and complex. Attempts to align on country priorities, needs and national health plans, and also to harmonize donors and partners' actions and funding according to the 2005 Paris Declaration principles, were difficult to actually materialize. The revitalization of primary health care and the strengthening of health systems are now back on the international and national health agenda.
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PMID:[A mid-term review of the Millennium Development Goals: where are we with the goals on health?]. 2018 87

Food insecurity has been linked to high-risk sexual behavior in sub-Saharan Africa, but there are limited data on these links among people living with HIV/AIDS, and on the mechanisms for how food insecurity predisposes individuals to risky sexual practices. We undertook a series of in-depth open-ended interviews with 41 individuals living with HIV/AIDS to understand the impact of food insecurity on sexual-risk behaviors. Participants were recruited from the Immune Suppression Clinic at the Mbarara University of Science and Technology in Mbarara, Uganda. Interviews were recorded, transcribed verbatim, translated, and coded following the strategy of grounded theory. Four major themes emerged from the interview data: the relationship between food insecurity and transactional sex for women; the impact of a husband's death from HIV on worsening food insecurity among women and children; the impact of food insecurity on control over condom use, and the relationship between food insecurity and staying in violent/abusive relationships. Food insecurity led to increased sexual vulnerability among women. Women were often compelled to engage in transactional sex or remain in violent or abusive relationships due to their reliance on men in their communities to provide food for themselves and their children. There is an urgent need to prioritize food security programs for women living with HIV/AIDS and address broader gender-based inequities that are propelling women to engage in risky sexual behaviors based on hunger. Such interventions will play an important role in improving the health and well-being of people living with HIV/AIDS, and preventing HIV transmission.
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PMID:Food insecurity and sexual risk in an HIV endemic community in Uganda. 2040 16

HIV/AIDS is concentrated among the inner-city poor and poverty may directly interfere with HIV treatment. This study examined food insufficiency in relation to HIV-related health and treatment. A sample of 344 men and women living with HIV/AIDS in Atlanta, Georgia completed measures of food security, health, and HIV disease progression and treatment. HIV treatment adherence was monitored using unannounced pill counts. Results showed that half of people living with HIV/AIDS in this study lacked sufficient food, and food insufficiency was associated with multiple indicators of poor health, including higher HIV viral loads, lower CD4 cell counts, and poorer treatment adherence. Adjusted analyses showed that food insufficiency predicted HIV treatment non-adherence over and above years of education, employment status, income, housing, depression, social support, and non-alcohol substance use. Hunger and food insecurity are prevalent among people living with HIV/AIDS, and food insufficiency is closely related to multiple HIV-related health indicators, particularly medication adherence. Interventions that provide consistent and sustained meals to people living with HIV/AIDS are urgently needed.
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PMID:Health and treatment implications of food insufficiency among people living with HIV/AIDS, Atlanta, Georgia. 2041 78

To improve health and economy of the world population, the United Nations has set up eight international goals, known as Millennium Development Goals (MDGs), that 192 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015. The goals include: (1) eradicating extreme poverty and hunger; (2) achieving universal primary education; (3) promoting gender equality; (4) reducing child mortality; (5) improving maternal health; (6) combating HIV/AIDS, malaria and other diseases; (7) ensuring environmental sustainability; and (8) developing a global partnership for development. Having been in the midway from the 2015 deadline, the UN Secretary-General urges countries to engage constructively to review progress towards the MDGs. This paper aims to evaluate advances in public health, with special reference to gender inequalities in health, health sector reform, global burden of disease, neglected tropical diseases, vaccination, antibiotic use, sanitation and safe water, nutrition, tobacco and alcohol use, indicators of health, and disease prevention in Latin America and the Caribbean region (LAC). The paper also identifies areas of deficits for the achievement of MDGs in LAC.
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PMID:Latin America and the Caribbean: assessment of the advances in public health for the achievement of the Millennium Development Goals. 2062 22

Despite combination antiretroviral therapy (ART), HIV infected people have higher mortality than non-infected. Lower socioeconomic status (SES) predicts higher mortality in many chronic illnesses but data in people with HIV is limited. We evaluated 878 HIV infected individuals followed from 1995 to 2005. Cox proportional hazards for all-cause mortality were estimated for SES measures and other factors. Mixed effects analyses examined how SES impacts factors predicting death. The 200 who died were older, had lower CD4 counts, and higher viral loads (VL). Age, transmission category, education, albumin, CD4 counts, VL, hunger, and poverty predicted death in univariate analyses; age, CD4 counts, albumin, VL, and poverty in the multivariable model. Mixed models showed associations between (1) CD4 counts with education and hunger; (2) albumin with education, homelessness, and poverty; and (3) VL with education and hunger. SES contributes to mortality in HIV infected persons directly and indirectly, and should be a target of health policy in this population.
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PMID:Poverty, hunger, education, and residential status impact survival in HIV. 2063 79

The number of people on antiretroviral treatment in Mozambique has increased by over 1,500 percent since it first became free and publicly available in 2004. The rising count of "lives saved" seems to portray a success story of high-tech treatment being provided in one of the poorest contexts in the world, as people with AIDS experience dramatic recoveries and live longer. The "scale-up" has had significant social effects, however, as it unfolds in a region with a complicated history and persistent problems related to poverty. Hunger is the principal complaint of people on antiretroviral treatment. The inability of current interventions to adequately address this issue leads to intense competition among people living with HIV/AIDS for the scarce resources available, undermining social solidarity and the potential for further community action around HIV/AIDS issues. Discourses of hunger serve as a critique of these shortcomings, and of the wider political economy underlying the HIV/AIDS epidemic.
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PMID:"All I eat is ARVs": the paradox of AIDS treatment interventions in central Mozambique. 2094 41

Despite growing numbers of people living with HIV (PLWH), the landscape of related services is shrinking. This study investigated health and social service needs of men (N = 489) and women (N = 165) living with HIV in Atlanta, GA. Participants completed confidential measures asking about the health and social services they needed and accessed. Results showed an array of health and social service needs among PLWH; failure to access services was prevalent. Hunger was among the most common basic needs, reported by greater than 60% of men and women. For men, unmet service needs were associated with fewer years since testing positive for HIV, higher CD4+ T cell values, experiencing more stressors and depression, and greater quantity of alcohol use. For women, failure to access services was associated with experiencing depression and not receiving HIV medications. Providing basic services to PLWH remains a public health priority and a moral imperative.
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PMID:Falling through the cracks: unmet health service needs among people living with HIV in Atlanta, Georgia. 2149 10

Food insufficiency is associated with medication non-adherence among people living with HIV/AIDS. The current study examines the relationship between hunger and medication adherence in a US urban and peri-urban sample of people living with HIV/AIDS. Men (N=133) and women (N=46) living with HIV/AIDS were recruited using snowball sampling and small media in Atlanta, Georgia. Participants completed computerized behavioral interviews that included measures of demographics, food insufficiency, social support, depression, and substance use, and provided blood specimens to determine HIV viral load. Participants also completed monthly unannounced pill counts to prospectively monitor medication adherence over 8 months. Results indicated that 45% of participants were less than 85% adherent to their medications and that food insufficiency was related to non-adherence; nearly half of non-adherent participants reported recent hunger. Geocoding of participant residences showed that 40% lived more than 5 miles from the city center. Multivariable logistic regression controlling for demographics and common factors associated with adherence showed that the interaction between distance from downtown and experiencing hunger significantly predicted non-adherence over and above all other factors. Medication adherence interventions should address access to food, particularly for people living outside of urban centers.
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PMID:Food insufficiency and medication adherence among people living with HIV/AIDS in urban and peri-urban settings. 2160 19


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