Evolve case study answers hiv and tb

PLWHIV reported their everyday lives, their livelihoods, and their work to be severely affected by flooding and its consequences for houses, fields, livestock, assets, income, and increased expenditure. HBC, Ohangwena region. I don't feel well during flooding.


My body is going down and weakening during flooding. Immune resistance … gets less when you are HIV positive. So you need to eat good and enough food. Red Cross, Ohangwena region. There are definitely more diseases, many people get sick with malaria, cholera, diarrhoea and flu. The church is also affected … and those people … won't be able to come to the church. Pastor, Ohangwena constituency. When people are in camps, there is no privacy ….

People are scared to take it [their medication] because they don't want to be seen. Pastor, Endola constituency. The destruction of infrastructure presents a huge barrier for the delivery of prevention, treatment, care and support services.

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Some of the PLWHIV are unable to reach health facilities or outreach points and remain without sufficient assistance or services until the waters recede. Crossing the water is dangerous, so you sometimes don't want to do that. When it is flood, it is difficult for someone, who falls sick, to go to the hospital. Sometimes even the clinics are flooded and do not operate.


Nurse, Eenhana district. Access to antiretroviral ARV treatment is disrupted, causing more defaulters during a flood. Many PLWHIV miss the dates for collecting their medication because of the flood water and the widespread inaccessibility of health services and facilities. One woman had to cross a very deep stream … to go to the health facility ….

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  7. Her ARV finished and she didn't want to threaten her health. So she risked her life to get her treatment. Some have defaulted their services for fear of water. PHC Supervisor, Engela district. It doesn't help for someone who needs ARV if he or she is not counselled. If there is no counselling, there is also no way to check if people take their medication. HBC, Ohangwena constituency. Logistically, you cannot reach everybody, even the limited services you want to provide the people with.

    It is difficult. In the process of flooding our other activities get affected. Our staff are really stressed to the limit. They are overworked and the quality of services is poor …. And at the end of the day the quality of health care diminishes. CMO, Ohangwena region.

    The floods affect our existing plans. You get 3 to 4 months where we are completely losing focus. We all concentrate on the floods and we forget about our main plans, our main monitoring and evaluation exercise, which includes even the HIV and AIDS monitoring and evaluation. Challenges for HIV service providers during flooding are: poor communication and poor dissemination of information between local, regional, and national levels; the administrative procedures the stakeholders have to follow; too little involvement of the affected population; and aid sometimes being poorly targeted CMO, Ohangwena region.

    The risk of HIV transmission increases during flooding because of behavioural changes and environmental circumstances. PLWHIV may use fewer preventive measures because of decreased social control and a temporary acceptance of higher risks. Information on HIV and family planning is limited and condoms in particular are not accessible to many people, who therefore practice unsafe sex. When people are flooded in the community, condom distribution is not possible anymore, putting people at a higher risk of communicating HIV, as well as sexually transmitted diseases. Another factor which affects the risk of HIV transmission is the increase in physical and sexual violence during flooding, which is linked to high consumption of alcohol, limited control, and diminished safety and security.

    Crimes increase during floods; even sexual violence happened. People are getting infected with HIV during flooding because they are raped. The environment is not conducive, there are no lights in the relocation camps and people have to walk long distances. We have difficulties to protect the people …. We need to protect the houses, the relocation sites, … it is nearly impossible. Finally, malnutrition and disease weaken the immune systems and therefore increase the likeliness of virus transmission.

    When there is just no food, they have weaker bodies. They represent the interlinkages between HIV and flooding, lead to an improved understanding of this complex issue, and provide the basis for disaster preparedness. The Namibian government has a national disaster plan in case of floods. In each region, a permanent Regional Disaster Risk Management Committee is responsible for coordinating all the disaster-related activities and stakeholders in the region.

    It is spearheaded by the regional council, and all line ministries and NGOs are members of the committee. Each sector and line ministry further has their own plan; they do not rely solely on the structure at the regional level CMO, Ohangwena region. When a disaster occurs, the regional council calls all stakeholders together, they have emergency meetings and are then given responsibilities and an action plan Representative of the NRC. All of the sudden when we are facing emergencies, we start working nicely and we meet so regularly and we exchange our information.

    These are positive impacts that we can get from the flood. PLWHIV's behaviour becomes more risky, and their vulnerability increases even more, leaving them with an exhausted capacity to cope. HIV in emergencies: case study: Northern Kenya. Table 2 Overview of empirical data aggregation and analysis. PLWHIV need a good nutritious diet and have higher energy requirements than the non-infected to lead a healthy life. Therefore, flood-related crop failure and food insecurity leading to malnutrition hit them hard.

    HIV is more virulent in malnourished people, and HIV-induced immune impairment and the higher risk of subsequent infection can worsen their nutritional status further 14 Samuels F , Harvey P , Bergmann T. HIV in emergency situations. Synthesis report. Water SA.

    Evolve case study answers hiv and tb

    Global health impacts of floods: epidemiologic evidence. Epidemiol Rev. The interaction between HIV and malaria in Africa. Curr Infect Dis Rep. Climate change and AIDS: a joint working paper. If they lose their family members, social networks, and community institutions due to flooding, PLWHIV's vulnerability is strained further. The importance of churches and pastors in dissemination of HIV-related information in the Ohangwena region needs to be emphasised, as it was mentioned by all research participants.

    HIV transmission can increase as a result of people not seeking health care. Towards an understanding of sexual risk behavior in people living with HIV: a review of social, psychological, and medical findings. It was reported by the majority of the women interviewed in Ohangwena that the loss of goods and of their homes as well as relocation due to flooding, resulted in an additional burden for the affected population.

    This is in line with Few 21 Few R. Health and climatic hazards: framing social research on vulnerability, response and adaptation. Global Environ Change. Mental health in emergencies: mental and social aspects of health of populations exposed to extreme stressors. Guidelines on mental health and psychosocial support in emergency settings. PLWHIV face insecure access to basic health services due to inaccessibility and the destruction of infrastructure.

    All the women interviewed and some experts and participants in the focus group discussions reported that access to HIV services had been severely hit in recent years, as flooding disrupted services and supplies in the region. No figures on the adherence to HIV services were available and no official data could be provided by the Regional Health Directorate. The representatives working on HIV and health service provision reported the general health sector to be severely affected by flooding. This leads to a lower priority of HIV compared to the immediate health threats and other needs such as food aid, shelter, and safe water.

    Simon 24 Simon S. Guidelines for HIV interventions in emergency settings.

    TB/HIV Case Presentations