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The US President's Emergency Plan for AIDS Relief (PEPFAR) was originally designed as an emergency initiative, operating with considerable funds, immediate roll-out, fast scale-up, and top-down technocratic administration. In a more recent iteration, PEPFAR shifted its focus from an emergency response to more closely account for healthcare sustainability. This transition came on the heels of the 2008 financial crisis, which threatened to stall the ‘marvellous momentum’ of the 2000's boom in donor aid for global health overall. Now many programmes are having to do more with less as funding flattens or decreases. This paper examines how this transition took shape in Tanzania in 2011–2012, and the successes and challenges associated with it, using participant observation and interview data from 20 months of fieldwork in rural and urban healthcare settings. In particular, I discuss (1) efforts to increase sustainability and country ownership of HIV programmes in Tanzania, focusing on the shift from PEPFAR-funded American non-governmental organisations to Tanzanian partner organisations; (2) principal challenges stakeholders encountered during the transition, including fragmented systems of healthcare delivery and a weakened healthcare workforce; and (3) strategies informants identified to better integrate services in order to build a stronger, more equitable, and sustainable health system in Tanzania. [ABSTRACT FROM PUBLISHER]

This paper examines sociodemographic and HIV-related factors associated with moving post-HIV diagnosis for non-care- and care-related reasons (versus never moving post-HIV diagnosis). Distinctions are made between those who move for informal care only, formal care only, or informal and formal care. Data come from the nationally representative US HIV Cost and Services Utilization Study ( N =2,864). Overall, 31.8% moved at least once post-HIV diagnosis and 16.3% moved most recently for care. Among those who moved for care, 32.6% moved for informal care only, 26.8% for formal care only, and 40.6% moved for both. Post-HIV diagnosis moves for reasons unrelated to care were less likely among African Americans and older persons, and more likely among those with longer durations positive. Moves for care were less likely among African Americans, older persons, and persons with higher educational attainments, while they were more likely among those with an AIDS diagnosis and longer durations HIV-positive. Among those who moved for care, women and persons with higher incomes were less likely to move for formal or mixed care than informal care only. Given that moving for care may reflect disparities in access to care and unmet needs, additional analyses with more detailed data are warranted. [ABSTRACT FROM AUTHOR]

This paper reports on research designed to assess access to care by Latino immigrant populations in the New York area. A qualitative approach and methods were employed, involving focus groups with PLWAs (persons living with AIDS) and affected men and women from Mexico, the Dominican Republic and Central America to explore the perceptions, beliefs, experiences and knowledge of HIV care issues. A total of 57 men and women participated, ranging in age from 19-61. Results included detailed information on cultural meanings of HIV/AIDS; experience of stigma and rejection; gendered health-seeking behaviour; testing issues; and satisfaction with services. Data support the conclusion that to be effective in reaching and providing services to these immigrant groups, it is crucial to understand the environment from which they come and the impact of immigration. Poverty, repressive governments, lack of education/literacy, ethnicity, class, colour-based stigma and cultural norms are crucial factors in determining their attitudes, motivations, decisions and behaviour. AIDS agencies were seen to play a crucial role in connecting PLWAs to services and resources. The key elements for the provision of services to this population appear to be those that build on cultural norms and network human and institutional resources. [ABSTRACT FROM AUTHOR]

This paper examines the relationship of client satisfaction and staff empathy at five pediatric NW/AIDS outpatient clinics in Brooklyn, New York. Client satisfaction is a topic of great interest in health care. It is associated with a variety of health outcomes and has economic, psychological and social benefits. It refers to the extent to which provision of services and interactions with providers gratify client's needs and desires for treatment. Staff empathy may be an important component of client satisfaction. One hundred fifty-eight clients, caretakers or parents, of infected children were interviewed in this investigation. Two staff empathy items were significantly related to client satisfaction even after adjusting for program organization characteristics for e.g., scheduling of appointment times. Staff empathy may influence program utilization, treatment compliance and adherence to life-sustaining medication regimens for NW-infected individuals and is, important to assess in today's managed care environment. This study has implications for staff development and training at HIV/AIDS programs and in other health care settings.

This paper explores the obstacles and opportunities experienced by a diverse group of persons living with HIV and AIDS in accessing medical and social services. A social networks approach is used to analyse data from 56 in-depth interviews conducted with persons living with HIV and AIDS in Orange County, California. From this analysis, the service pathways by White/Caucasian gay men, Latina/Hispanic women who speak only Spanish, and injecting drug users of diverse ethnicities are used to illustrate the influence of race/ethnicity, gender, and sexual orientation on service access. Implications for service provision and future research are discussed. [ABSTRACT FROM AUTHOR]