Abstract
Guinea-Bissau suffers from political instability and an unusually high HIV/AIDS burden compared to other countries in the West Africa region. We conducted a systematic review on the HIV/AIDS epidemic in Guinea-Bissau during the Millennium Development Goals (MDGs) period (2000–2015), which dovetailed with a period of chronic political instability in the country’s history. We searched published works on the HIV/AIDS epidemic in Guinea-Bissau for references to chronic political instability. Six databases and the grey literature were searched, informed by expert opinion and manual research through reference tracing. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The search yielded 122 articles about HIV/AIDS in Guinea-Bissau during the MDG years. Biomedical, clinical, or epidemiological research predominated public health research production on HIV/AIDS in Guinea-Bissau in this period. Six articles addressing themes related to chronic political instability, including how political instability has affected the HIV/AIDS disease response, were identified. The results suggest the importance of considering a broader political epidemiology that accounts for socio-political aspects such as governance, human rights, and community responses into which any national HIV/AIDS response is integrated.
Highlights
Significant progress has been achieved in the global fight against HIV/AIDS in the last twenty years [1]
A recent comparative survey of 137 countries established a correlation between countries with lower levels of peace and higher corruption levels and countries with lower antiretroviral therapy (ART) coverage (p < 0.001), suggesting “that there may be a threshold of conflict and corruption levels, below which ART coverage is compromised” [6]
From 2010 to 2017, there was generally an increase in the number of articles published about HIV/AIDS in Guinea-Bissau compared to the period of 2000–2009
Summary
Significant progress has been achieved in the global fight against HIV/AIDS in the last twenty years [1]. Despite these results, which have led to HIV/AIDS becoming a chronically manageable illness over time (distinct from its “framing as a human emergency” [2]), the disease as a social pathology continues to influence, and is influenced by a country’s larger social, economic, and political context. The case of Guinea-Bissau, a small country in West Africa, provides an opportunity to assess how political instability may have affected its unique HIV/AIDS epidemic. While HIV/AIDS remains, to varying degrees, a public health threat in the neighboring countries of The Gambia, Senegal and Guinea, the data on HIV incidence and prevalence suggest that Guinea-Bissau has been significantly more affected than neighboring countries. During the same period (2000–2015), the neighboring countries of Senegal, The Gambia, and Guinea all remained relatively stable or experienced more isolated periods of political instability or uncertainty
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