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Issues: Along the Thai-Burma border, undocumented workers - about two-thirds of all Burmese working in Thailand have limited access to services. Many migrants, particularly women, have little knowledge of HIV. Lack of awareness, combined with the ongoing exposure of male migrant workers to female sex workers in Thailand, created an urgent need to make HIV counseling and testing services available. Fewer than 30% of those screened for HIV return for their HIV test result. Common reasons for this include population mobility, lack of affordability of confirmatory testing, and up to a three-week delay in return of confirmed test results. Description: Mao Tao clinic is staffed primarily by trained volunteers, lay counselors and trained lay laboratory technicians. The clinic links counseling and testing with reproductive health care and education programs aimed at disease prevention, to more than 58, 000 Burmese migrants yearly. Twenty counselors were trained to provide counseling and thirteen lay laboratory technicians were trained to provide serial rapid serological testing for HIV. External Quality Assurance EQA ; for the rapid testing program is provided by a community partner. Lessons learned: Since the inception of the program, uptake of VCT at the clinic has improved. In 2005, the clinic delivered counseling and testing services to 800 clients 60 % from the STI clinic ; , 15-20% of whom were HIV-positive. A partnership forged between the lay staffed VCT clinic and a local government hospital program to prevent mother-to-child transmission of HIV provided counseling to 2, 123 pregnant women, and voluntary HIV testing to 1, 590 women of whom 3.2 % were HIV-positive. Return rates for HIV results rose significantly from 30 to 90% after the introduction of the rapid testing algorithm. Recommendations: Well trained and supervised lay staff should be used to support rapid HIV testing in resource-poor settings.
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The African HIV Policy Network AHPN ; is an alliance of African communitybased organisations and their supporters working for fair policies for people living with HIV AIDS in the UK. The AHPN is the only African organisation in the UK whose work is dedicated to policy, advocacy and representation at national level. Its major focus is on HIV and the sexual health of Africans in the UK. AHPN's work focuses on mobilising and strengthening communities so that they can respond to HIV AIDS themselves. The AHPN is an initiative of people, forums, organisations and communities working towards a shared vision by supporting effective community responses to HIV AIDS. AHPN believes that effective advocacy must be inclusive of the voice of those most vulnerable to HIV. Given the level of stigma that exists within African communities and in the wider social and political context advocacy can mean exposing yourself as HIV positive and or a migrant. The conclusion for many Africans living with and or affected by HIV is that participation in informing policy and advocacy activities can mean exposing oneself to being discriminated against. As such the AHPN's capability to effectively advocate on their behalf is critical. AHPN's Changing Perspectives campaign seeks to encourage faith organisations, the media, HIV positive people and government to tackle HIV-related stigma and discrimination. In support of the campaign David Lammy, MP for Tottenham, publicly took an HIV test at St. Ann's Hospital to highlight the importance of testing. Rhon Reynolds, AHPN Senior Policy Officer and Deputy CEO, commented, "Fear continues to drive the HIV epidemic underground, particularly in African and other BME communities. It is our hope that David Lammy's decision to take an HIV test will encourage others to follow suit getting tested is a key strategy to reducing infection rates. I grateful for the courage David Lammy has displayed in tackling this issue head-on with the community." The National African HIV Prevention NAHIP ; programme, funded by the Department of Health, is managed by the AHPN. Working with community based organisations the NAHIP programme has developed the "Beyond Condoms" campaign. The campaign seeks to encourage debates within.
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This year, about 192, 000 American women will be diagnosed with invasive breast cancer, making it second only to skin cancer as the most common cancer in women. Over 40, 000 women die from breast cancer each year. Efforts to reduce mortality rates show that early detection of breast cancer is effective. M-CARE's clinical practice guidelines recommend routine screening for breast cancer every year, either with mammography alone or with mammography and clinical breast examination for women ages 50-69. Recommendations for screening highrisk women ages 40-49 and healthy women age 70 and older may be made based on risk factors, comorbidities, life expectancy, and patient preference. The HEDIS "Breast Cancer Screening" measure assesses the percentage of women ages 50 to 69 who received at least one mammogram during a two year period. Random samples of HMO, Medicaid, and Medicare women were drawn and medical records were reviewed for those members who did not have claims records for a mammogram in 1999 or 2000. HMO In 2000, 82.3 percent of HMO women had received at least one mammogram during 1999 or 2000. This rate places M-CARE in the top ten percent of managed care plans nationwide p 0.05 ; , which reflects very positively on M-CARE practitioners' commitment to providing appropriate breast cancer screening. In 1998, the previous time this was assessed, the rate for HMO women was at 81.5 percent. Medicare For women in the Medicare population, breast cancer screening rates were 89.7 percent in 1998, 81.1 percent in 1999, and 79.2 percent in 2000 reflect a downward trend not statistically significant ; . The rates are also not significantly different from the HMO rates. Medicaid The Medicaid population, in contrast, does show lower rates of mammography. In 2000, the rate was 52.3 percent, which was statistically significantly lower than the previous time this was measured, 65.0 percent in 1998 p 0.05 ; . The Medicaid rates were also statistically significantly lower than both HMO and Medicare p 0.001 ; . Medicaid women do not receive mammography screening as often as HMO and Medicare women. To encourage breast cancer screening, M-CARE annually mails mammography reminder postcards to HMO, POS, Medicaid, and Medicare female members who are in need of a mammogram. These postcards remind women of the importance of mammograms and encourage women to schedule their mammogram. In an attempt to improve screening rates, members are allowed to self-refer to their primary care physician, gynecologist or M-CARE-approved mammography center. Referrals are not necessary, but a doctor's order is required. Further, eligible Medicaid members are offered free transportation to and from a scheduled mammogram. Future breast cancer screening interventions will target all members, with a special emphasis on the Medicaid and Medicare populations.
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