We are continuing our new series, Media Day, where we spotlight individual medical institutions and infectious disease (ID) programs. Today, we spotlight UNC’s Institute for Global Health and Infectious Diseases (IGHID).
There are a number of concerning issues and barriers associated with PrEP access including insurance limitations, stigma, logistics, and awareness. It is this last issue, awareness, and limited educational opportunities that can make a significant difference in people accessing this form of HIV prevention, according to Sarah Rutstein, MD, PhD, assistant professor of medicine at School of Medicine at UNC in the Division of Infectious Diseases.
In her work overseas and in the US, Rutstein says one of the major differences is which sexes have been vulnerable to HIV in the US compared to Africa and specifically Malawi, a resource-depleted country.
“In the southeastern United States, we often think about men who have sex with men, and increasingly, now heterosexual women of African American descent. And historically in Malawi, the prime population that has been vulnerable to HIV has been adolescent girls and young women…To really make it clear, this is not about trying to single out one population based on whatever stereotypes or whatever sort of assumptions you’re making about who they’re having sex with.”
In Rutstein’s work, one of the biggest things she and colleagues have seen is that men do not engage in health care the way that women did.
“They’re [men] not coming in for antenatal care or family planning, or a lot of the other ways that we engage young women in Malawi in the health care system, and therefore, get an opportunity to educate them about PrEP and HIV prevention,” Rutstein said. “Men just don’t have that same access to health services. And we see the exact same thing here in the United States, where we’re looking at, how do we reach people who aren’t otherwise engaging in health services? And it turns out, [sexually transmitted infections] STI clinics, if you have an STI, you’re going to go in and you’re going to try and get it treated.”
In Malawi they integrated PrEP into one the largest urban STI clinics there. Taking that model, and applying it domestically, there were calls for applications from the National Institutes of Health to think about integrating PrEP into STI services in the US. And this seemed like an expansion of the work they had been doing in Malawi, according to Rutstein.
“I think it speaks to the unique opportunity to really take a lot of the lessons that we learned in low resource income settings like Malawi and apply them to other similarly very low resource settings here in the United States—where rural North Carolina certainly fits that bill,” Rutstein said.
While she notes that awareness and education are crucial, structural barriers are really the biggest access issues in the US today.
“It is this cost of the medication, the access to the blood tests that are needed to appropriately start,” Rustein said. “So, I think comfort with providers and actually prescribing and knowing, once I prescribe it, how are they actually going to get this medication? and how do I safely counsel them about the safety of staying on or safely coming off when they perceive themselves to no longer need it?”
In the next episode, Jonathan Parr, MD, MPH, details his work on a genomic sequencing project and how it is being used to monitor drug-resistant malaria.
As Israel escalates its attack on Gaza City, the UN moves to stop further violence and humanitarian violations by renewing UNIFIL’s mandate for the last time.
United Nations Secretary-General António Guterres at a press briefing on Israel’s plans to take over Gaza City. Credit: Jennifer Xin-Tsu Lin Levine/IPS
UNITED NATIONS, Aug 28 2025 (IPS) – Ahead of the Security Council meeting on the situation in the Middle East, United Nations Secretary-General António Guterres spoke to the press on the “unfolding tragedy that is Gaza,” calling Israel’s new plans to take over Gaza City with the military a “deadly escalation” and an “existential threat to the two-state solution.”
He warned that such a move could precipitate an unprecedented humanitarian catastrophe that imperiled any remaining prospects for negotiated peace.
The Secretary-General also reiterated his plea for an immediate ceasefire, emphasizing that capturing Gaza City would result in massive civilian casualties and widespread destruction—including severe impacts on the health sector already teetering on collapse.
At the daily press briefing, spokesperson for the Secretary-General Stéphane Dujarric reported on the displacement in Gaza since Israel’s most recent invasion, confirming the Secretary-General’s statements about refugees. UN experts report that the total number of people who have fled from north Gaza to south Gaza since August 14, when the Israeli invasion was announced, is 20,000.
The Secretary-General went on to address the most recent Israeli air strike on the Nasser Hospital in the southern Strip of Gaza, where at least 20 people were killed and 50 others were injured. Israel’s military defended the strike by asserting that it targeted a camera used by Hamas to surveil troop movements.
Dorothy Shea, United States ambassador to the United Nations, defended Israeli actions and urged condemnation of Hamas’ use of civilian facilities for military purposes. She also noted the Hamas members killed by the airstrike.
Prime Minister Benjamin Netanyahu issued a statement calling the strike a “tragic mishap” with no mention of a specific Hamas target. The Secretary-General called for an impartial investigation into these contrasting claims.
Although Netanyahu reaffirmed his respect for journalists on X, formerly known as Twitter, UNESCO reported at least 62 journalists and media workers killed in Palestine while working since October 2023. At least five journalists were killed in the Nasser air strike, according to World Health Organization Director Tedros Adhanom Gebreyesus.
At the Security Council meeting debating whether or not to renew the mandate for the United Nations Interim Force in Lebanon (UNIFIL), many representatives acknowledged Israel’s current military action and called UNIFIL’s work “vital” in maintaining borders, minimizing conflict and stabilizing tensions.
The representative for Algeria Amar Bendjama was critical of UNIFIL’s failures, but spoke in favor of the renewal. He said, “We must ask, has UNIFIL fulfilled its mandate? Clearly, the answer is no. Lebanese lines remain under Israeli occupation, and we regret that our proposal to include a clear reference to the 1949 general armistice agreement was not retained. Without ending Israel’s occupation of Arab lands, peace and stability in the region will remain elusive.”
UNIFIL was initially created in 1978 to oversee Israeli withdrawal from Lebanon. The mandate was adjusted and has played a significant role in maintaining Lebanese army control on the border between Lebanon and Israel rather than Hezbollah, a paramilitary organization, taking over. Critics, led by the United States, see the mandate as a waste of money that has helped Hezbollah consolidate power.
Dujarrac emphasized the necessity of all participating parties to respect UNIFIL’s mandate for it to successfully fulfill its promises.
The Council ultimately voted to renew UNIFIL’s mandate, with many members stressing that the mission continues to play an important role in preventing further escalation along the Israel-Lebanon border.
Guterres’s warnings on Gaza and the debate over UNIFIL underscored the overlapping crises in the region that face the Security Council.
As displacement in Gaza mounts and humanitarian needs continue to fester, UNIFIL’s renewal has bought time rather than answers for a region caught between humanitarian crisis and unresolved conflict.
A patient being checked for BP at Mann PHC. Credit: Rina Mukherji/IPS
MANN, India, Aug 26 2025 (IPS) – Generally thought to be diseases of the wealthier classes, non-communicable diseases (NCDs) like hypertension and diabetes are on the rise among India’s underprivileged working classes in semi-urban and rural sprawls.
Take the case of Mohan Ahire. A middle-aged gardener in Pune, Mohan never realized that the heaviness in his head was a symptom of hypertension. Last summer, a mid-morning visit to the market saw him fall unconscious on return. Upon regaining consciousness, his wife and sons discovered the paralysis on the right side of his body, leading doctors to diagnose it as a stroke.
Bahinabai Gaekwad, a 56-year-old sweeper in Mann village, was at work when she suddenly collapsed and died. Doctors from the Primary Health Centre (PHC) next door found that she had been suffering from undiagnosed hypertension for a long time. The ailment ultimately led to a fatal cardiac arrest.
The worst problem is that most patients from underprivileged sections are not aware of their health condition.
Praful Mahato, a migrant laborer from Balasore in Odisha, who is currently employed in a dhaba (roadside eatery) in Mann, a fast-industrializing rural outpost of Pune city, had been suffering from heaviness and dizzy spells for some time. But he attributed his symptons to long hours at work and resulting fatigue. A chance visit to a medical camp confirmed high blood pressure and diabetes. Since the last four months, medication has controlled his blood pressure and brought down his sugar level.
Jagdish Mondol, in his 50s, did not realize he had hypertension and diabetes until he needed to undergo a hernia operation at a government hospital in Bhadrak, Odisha. This was despite blurred vision and difficulty in walking. Thankfully, the operation got him to wake up to his health condition. Regular medication has now improved his blood pressure and sugar level.
Fortunately, some patients may seek help on their own. Lalita Parshuram Jadhav, a 40-year-old migrant construction worker from Yavatmal, is one such. “Since the last two years, I have been experiencing pain in my legs; it became quite acute over the past year,” she tells IPS. A medical check-up confirmed hypertension and high sugar levels.
India’s Hypertension and Diabetes Epidemic
The cases cited above exemplify the rising burden of India’s non-communicable disease (NCD) of Hypertension and Diabetes. Ranked among the top ten NCDs responsible for untimely deaths worldwide, these two diseases are interlinked. This means those with hypertension are also vulnerable to developing prediabetes and diabetes.
According to the World Health Organization (WHO), an estimated 1.28 billion adults in the 30-79 age group suffer from hypertension, with two-thirds of them living in low- and middle-income countries. Yet, only 21 percent of those affected have their hypertension under control, while around 46 percent of these remain unaware of their condition and remain undiagnosed and untreated.
Diabetes, notably, can be of two varieties. Type 1 Diabetes is a congenital condition, while Type 2 diabetes is a lifestyle disease that develops later in life. South Asians, Pacific Islanders, and Native Americans have a significantly higher risk of developing the disorder.
The International Diabetes Federation (IDF) recorded a dramatic increase in the number of people affected by Type 2 Diabetes globally since the 1990s, and since 2000, the rise has been dramatic. In India, there are an estimated 77 million people above the age of 18 years suffering from diabetes (type 2), while nearly 25 million are prediabetic (at a higher risk of developing diabetes in the future). Yet, more than 50 percent of these are unaware of their diabetic status.
In India, the prevalence of Diabetes rose from 7.1 percent in 2009 to 8.9 percent in 2019. Meanwhile, 25.2 million adults are estimated to have Impaired Glucose Tolerance (IGT), a prediabetic condition that is estimated to increase to 35.7 million in the year 2045. It is also estimated that approximately 43.9 million people suffering from diabetes remain undiagnosed and untreated in India, posing a major public health risk.
It is a matter of concern that most deaths from these diseases occur in the 30- to 70-year-old age group, posing a major economic loss.
In Mann, doctors at primary health centers (PHCs) are battling this scourge, with hypertension affecting around 28 percent of the population and 12 percent being diabetic. The scenario is similar to that at Mullaheera, in rural Haryana, located just outside the national capital region of Delhi.
Dr. Sona Deshmukh, from the People-to-People Foundation, which is collaborating with the Government of India on its Viksit Bharat @2047 initiative and the in-charge for the Pranaa Project, tells me, “Diabetes is common among the older population, but hypertension is rising among the youth.”
Dangers Posed by Hypertension and Diabetes
The problem with both Hypertension and Diabetes is socio-cultural, with most people viewing these diseases as benign. Yet, ignoring them can lead to paralytic strokes and ultimately, death.
Characterized by headaches, blurred vision, nosebleeds, buzzing in the ears, and chest pain, uncontrolled and untreated hypertension can lead to—
chest pain (also termed angina);
heart attack, which occurs when the blood supply to the heart is blocked and heart muscle cells die from lack of oxygen.
heart failure, which occurs when the heart cannot pump enough blood and oxygen to other vital body organs; and
sudden death due to irregular heartbeat.
This is because excessive blood pressure can harden arteries, decreasing the flow of blood and oxygen to the heart. This elevated pressure and reduced blood flow can result in the complications listed above, besides bursting or blocking arteries that supply blood and oxygen to the brain, causing a stroke. It can also cause kidney damage, resulting in kidney failure.
In the case of Diabetes, the body is unable to either produce or use insulin effectively. While individuals with Type I diabetes have a congenital condition wherein the insulin-producing cells in the pancreas are attacked and destroyed, patients with Type II diabetes—which is a preventable lifestyle-related disease—either do not produce enough insulin or are unable to use insulin effectively for the body’s needs. Uncontrolled diabetes can lead to blindness and organ failures that affect the kidneys, heart, and nerves, ultimately leading to diabetic strokes and death.
Reasons Behind the Spurt
So, what are the reasons behind the spurt? Government Medical Officers Dr. Mayadevi Gujar and Dr. Vaishali Patil say, “The transition of many rural outposts into semi-urban industrialized zones has brought in lifestyle changes. Locals, who once partook of healthy home-cooked millets or cereals, now eat cheap, oily snacks from wayside kiosks cooked in reused palm oil. With more disposable income, workers lean towards sugary soft drinks and fast food, making them prone to diabetes. Addictions like tobacco and alcohol are on the rise. Tobacco-chewing remains common to both men and women in rural India.”
Additionally, with climate change affecting agricultural incomes in rural India, the younger generation is stressed with employment issues. These make a potent recipe for hypertension and diabetes.
Dr. Sundeep Salvi, a noted specialist in cardiovascular diseases, who heads the Pulmocare Research and Education (PURE) Foundation and has chaired the respiratory group for the Global Burden of Disease Study, adds, “Unlike in the past, people eat and sleep late, watch late-night television, drink endless cups of tea and coffee, and work late hours. Skipping meals is common, with little time for exercise. Sleep deprivation is a fallout of this. Stress and inadequate sleep are a deadly combination, feeding hypertension and diabetes.”
Salvi calls for hydration and good nutrition to stave off hypertension and diabetes. “Excess tea and coffee are harmful. Caffeine-present in tea and coffee-is a diuretic; it prevents hydration. A dehydrated constitution results in hypertension and diabetes, which, in turn, cause heart disease, stroke, kidney diseases, and eventually, death.”
He also views air pollution as a major risk.
“By air pollution, I am referring to both indoor and outdoor pollution. In rural areas, the burning of crop waste causes outdoor pollution. But indoor pollution in rural homes and urban slums is 5–10 times greater than outdoor pollution. High levels of particulate matter contribute to 20 percent of the global burden of diabetes, as well as hypertension.
Diabetologist and Director of the Diabetes Unit at Pune’s KEM Hospital Prof. Chittaranjan Yajnik, who has been working on this issue for over two decades, has an interesting take on the matter based on his findings.
Yajnik sees a direct correlation between vulnerability to diabetes and poor intrauterine growth.
“Poor intrauterine growth reflects in poor organ growth, especially of the infra-diaphragmatic organs (liver, pancreas, kidneys, and legs), reducing their capacity to perform adequately in later years. Such individuals, when faced with overnutrition and calories later in life, end up with prediabetes and diabetes.”
Yajnik’s research found that two-thirds of prediabetic girls and a third of the prediabetic boys were underweight at birth.
“These findings are suggestive of a ‘dual teratogenesis’ concept, which envisages a combination of undernutrition and overnutrition over a life course due to rapid socio-economic and nutritional transition…” This means intrauterine programming of diabetes needs to be supported in growth-retarded babies since metabolic abnormalities develop very early in life.
Yajnik certainly has a point, since anemia in expectant mothers and low birthweight babies is a major problem all over India. The National Family Health Surveys conducted over the years by the Government have shown a persistently high prevalence of fetal growth restriction in Indian babies. This phenomenon is linked to low birth weight in newborns, which is as high as 18.24 percent, according to the latest data.
The Solution
Recently, the Ministry of Health and Family Welfare (MOHFW) of the Government of India has implemented several schemes nationwide at the primary health level, starting with nutrition, medical care, and immunization for pregnant mothers while ensuring institutional delivery. Offspring are also extended comprehensive help for the 4 D’s (defects at birth, diseases, deficiencies, and developmental delays), immunization, supplementary nutrition, and WASH interventions. These continue through adolescence to prepare a healthy population for reproductive age.
Meanwhile, weekly wellness sessions have been introduced all over India. Deshmukh adds, “Regular screenings for hypertension and diabetes are done every few months for early detection and follow-up. Counselling sessions encourage people to adopt healthier lifestyles, while Yoga is being popularized through events like the International Yoga Day.”
These initiatives, one hopes, will arrest the epidemic.
Dr. Alvaro Bermejo, Director General of the International Planned Parenthood Federation (IPPF) addresses the Let’s Discuss the Future of Africa Together seminar that took place last week (August 21) on the sidelines of TICAD9 in Yokohama City, Japan. Credit: APDA
YOKOHAMA CITY, Japan & JOHANNESBURG, South Africa, Aug 25 2025 (IPS) – As funding for sexual and reproductive health rights was on a “cliff edge,” parliamentarians now needed to play a “visionary” leadership role because “financing strong, resilient health systems for all their people rests with governments,” said Dr. Alvaro Bermejo, Director General of the International Planned Parenthood Federation (IPPF).
He was speaking at the Let’s Discuss the Future of Africa Together seminar that took place last week (August 21) on the sidelines of TICAD9 in Yokohama City, Japan.
The session was organized by the Asian Population and Development Association (APDA), in collaboration with the Forum of Arab Parliamentarians for Population and Development (FAPPD) and the African Parliamentary Forum on Population and Development (FPA).
“Africa’s health faces a serious challenge: According to WHO’s latest analysis, health aid is projected to decline by up to 40% this year compared to just two years ago. This is not a gradual shift—it is a cliff edge,” Bermejo said. “You know as well as I do that lifesaving medicines are sitting in warehouses, health workers are losing jobs, clinics are closing, and millions are missing care.”
While this reality was outrageous, it needed to be adapted to.
“And in this crisis lies an opportunity—an opportunity to shake off the yoke of aid dependency and embrace a new era of sovereignty, self-reliance, and solidarity,” with a clear mission to protect the health and lives of women and vulnerable populations through delivering high-quality sexual and reproductive health services.
Parliamentarians engaged in debates during a policy dialogue seminar organized by the Asian Population and Development Association (APDA), in collaboration with the Forum of Arab Parliamentarians for Population and Development (FAPPD) and the African Parliamentary Forum on Population and Development (FPA). Credit: APDA
This seminar and another in the series, Policy Dialogue on the Africa-Japan Partnership for Population and Development, were both supported by the UN Population Fund (UNFPA) Arab States Regional Office (ASRO), the Japan Trust Fund (JTF) and IPPF.
During the discussions, a wide range of topics about population dynamics in Africa and Africa-Japan cooperation were discussed.
In his opening remarks, Ichiro Aisawa, a member of the House of Representatives of Japan, told the seminar it was necessary to take joint action across borders and generations.
“Youth holds the key to unlocking Africa’s future. By 2050, it is predicted that approximately 70 percent of Africa’s population will be under the age of 30. As African countries enter a demographic dividend period, the role played by parliamentarians in each country will be extremely important.
Aisawa said it was necessary to listen to the voices of the community in addressing issues related to youth empowerment, gender equality, and sexual and reproductive health (SRH).
Parliamentarians should take “concrete action through legislation and policies; it is essential to harnessing the potential of young people, directly linking them to social and economic growth, and creating a society in which no one is left behind.”
Yoko Kamikawa, Chairperson of Japan Parliamentarians for Population (JPFP), addresses a seminar for African and Asian parliamentarians on the sidelines of the TICAD9 in Yokohama City, Japan. Credit: APDA
During the discussions, representatives from Africa gave examples of how Japan had supported their health initiatives, especially important in a climate of decreasing aid.
Maneno Zumura, an MP from Uganda, said what compounded the issues in her country and in Africa was “the changes in climate. The unpredicted climate has affected agricultural activities by 40 percent, especially in drought-prone areas of the country.” This had resulted in nearly a quarter (24 percent) of children experiencing malnutrition.
However, she noted that Japan had made considerable contributions to education and health.
“As we assess Uganda’s development and Japan’s impact, it’s clear that sustainable progress thrives on global solidarity and local governance. Key achievements include a 62 percent rise in women’s incomes through cooperatives, a 50 percent drop in maternal mortality in refugee settlements, and supporting the road infrastructure and education, illustrating how policy-driven interventions can break cycles of poverty and inequality.”
There were several specific projects she alluded to, including education experts from Japan who contributed to an improvement of the quality of primary education in districts of Wakiso, Mbale, and Arua through the Quality Improvement in Primary Education Project (2021-2023). They also trained 1,500 teachers in participatory teaching methods.
“The Government of Japan supported the vulnerable communities like refugees and host communities by strengthening the social services like health in refugee camps like Rhino Camp,” Zumura continued, including construction of a health center with antenatal facilities serving over 300,000 people in camps of Bidibidi and Rhino Camp. They also trained 200 health workers in the management of childhood illnesses and maternal health care.
Mwene Luhamba, MP, Zambia, said his country was looking forward to partnering with Japan in expanding One-Stop Reproductive Health Services, enhancing parliamentary engagement, and investing in youth programs.
Bermejo said part of the solution to the development issues is to confront constraints.
“Some countries in Africa do need global solidarity, but what Africa needs from the world, more than anything else, is fair terms. We must also confront the structural constraints. Debt service burdens are crowding out social investments. Let us seize this moment, not just to repair but to transform,” he said. “Sexual and reproductive health services save lives. They empower individuals, promote dignity, and drive national development.”
In her closing remarks, Yoko Kamikawa, Chairperson of Japan Parliamentarians for Population (JPFP), said that it was through dialogue across borders and sectors that “we build consensus, strengthen legal frameworks, and ensure that national strategies reflect the voices of all people and empower them—especially women and youth.”
The global response to HIV, which has spanned several decades,1,2 is currently at an inflection point. By 2023, the number of individuals receiving life-saving antiretroviral therapy had reached nearly 31 million, while the number of those living with HIV who were not receiving such therapy stood at 9.3 million. This public health success has led to a significant reduction in the number of AIDS-related deaths, which have now reached their lowest level since the peak in 2004.1
In the Democratic Republic of Congo, the epidemic is considered generalized (with a low prevalence of 1.2%, a seroprevalence rate of 1.6% in women aged 15 to 49 years and 0.6% in men of the same age), with epidemic foci in mining communities (Haut-Katanga and Lualaba) and urban centers of Kinshasa.3
The international community’s commitment to the Sustainable Development Goals (SDGs) has led to significant progress in the fight against HIV, with the eradication of HIV as a public health threat being considered a realistic possibility by 2030. However, the accession to power of the new US administration has led to a setback in these efforts, jeopardising the progression of HIV as a public health threat.4,5 However, the continued provision of “life-saving humanitarian assistance” has been facilitated by UNAIDS, which has obtained an exemption, thus ensuring the continuation or resumption of essential medicines and medical services, including HIV treatment, as well as the necessary supplies for this assistance. Furthermore, UNAIDS has committed to the continuation of its efforts in favour of other essential components of the PEPFAR (Emergency Programme of Health and HIV Prevention Services, Care and Support for Orphans and Vulnerable Children) initiatives.4
In this context of uncertainty, it becomes imperative to explore ways to improve the psychosocial and economic support provided to these Children people in a country facing aggression from armed groups. HIV/AIDS is now considered a chronic disease, causing not only physical health complications.6
This situation also affects Children people living with HIV, and is accompanied by a large number of children entering adolescence and adulthood with a chronic infectious disease, thanks in particular to psychosocial and economic support services.7
However, existing research reveals a lack of psychosocial and economic support for children and young people living with HIV (CPLHIV). Existing research shows that young people living with HIV do not receive sufficient psychosocial and economic support7–11. A review demonstrated that treatment adherence, disclosure of HIV status, gender-related issues and lack of support networks are problems faced by CPLHIV across the world.
In the DRC, particularly in Lubumbashi, health and community professionals play a key role in providing holistic care and treatment for people living with HIV, especially young people. As front-line workers, they have a comprehensive understanding of the challenges faced by children living with HIV and how these challenges are perceived and experienced, including those not expressed by the children themselves. This perception of the psychosocial and economic challenges faced by children living with HIV can therefore inform the design of viable policies and programmes.12–17 Our study also includes community members, such as adolescent and adult peer educators, providing a broader view of the situation.18
This study therefore aims to determine the challenges requiring psychosocial and economic support faced by Children living with HIV, to describe the interventions in place and to explore the experience of professionals providing psychosocial support to Children people living with HIV in Lubumbashi, in the current context of uncertainty.
Methods
Study Framework
Katuba health zone (Figure 1),19 in the city of Lubumbashi, capital of the Haut-Katanga province in the Democratic Republic of Congo. It involved eight structures in this zone: the KATUBA General Reference Hospital, the BUKAMA Reference Health Center, the POLY BARAKA, the CDTI Health Center, the AVE MARIA Health Center, the MASAIDIANO Health Center, the LWIZI Health Center and the MANE CACHEE Health Center (Table 1). All these health care establishments (ESS) were targeted because they have an HIV/AIDS care service.
Table 1 List of ESS
Figure 1 Health map of the city of Lubumbashi, DRC, subdivided into health zone and Katuba health zone surrounded by a red frame.
Study Design
The present study adopted a descriptive case study approach,20 employing a phenomenological qualitative method, in order to ascertain the psychosocial and economic support care provided to persons living with HIV (PLHIV).21,22 In order to achieve the objectives of the study, the views of providers and community workers (case managers and peer educators) were canvassed. The research took place over an eight-month period, from June 1, 2024 to February 8, 2025, with data collection between July 1 and August 1, 2024.
Sampling
The study covered all staff working in the field of CPLHIV care in health facilities in the Katuba Health Zone. The study population was organized into three hierarchical levels: the focal points of each health facility, then the peer educators and the case managers. In order to ensure optimal representativeness of the study population, targeted (or purposive) sampling was methodically applied for the recruitment of participants. They have been grouped according to the department in which they work: Appui Psychosocial (APS) and Orphelin et Enfants Vulnerables (OVC)., in order to ensure the homogeneity of the sample; without distinction of sex (mixture of men and women).
Inclusion Criteria
We included in the study only those who had at least six months of direct experience with CPLHIV (Table 2). All participants were over 18 years old. According to the DRC Constitution, as amended, a child is any person under the age of 18.23
Table 2 Study Participants
Recruitment of Study Participants
Before the start of each in-depth, face-to-face, semi-structured interview with providers and peer educators, or each non-directive focus group session with case managers, participants were contacted and given an information sheet and an informed consent form. Due to the locations of the participants and the configuration of their workplaces, semi-structured interviews were conducted with all participants, while focus groups were conducted with case managers only. Participants who consented to participate in the study were instructed to not limit themselves to the list of questions and to iterate until information saturation was reached.
The in-depth, semi-structured interviews lasted between 45 and 60 minutes, while the focus groups lasted between 75 and 90 minutes. All interviews were conducted in French, although the participants spoke Swahili. We moderated the sessions and took notes. Our mission was to obtain consent for participation in the study, explain the theme and how the focus groups would be conducted, initiate and encourage discussion, and ensure that participants’ comments were not misinterpreted.
Instruments
The tools used were the interview guide, the Focus Group Guide in French and the Android phone recorder application for recording sounds on themes such as: Challenges that require psychosocial and economic support faced by Children people living with HIV/AIDS, psychosocial and economic interventions, the experience of community caregivers providing psychosocial support to Children people living with HIV/AIDS, psychosocial and economic support and collaboration within the team. These interview guides were developed by reviewing existing literature12,13 and the socio-ecological model14,15 which aims to explore psychosocial and economic support systems among CPLHIV and recognizes that health experiences and outcomes are often influenced by factors intrinsic and extrinsic to the individual.16–18
Data Analysis
The audio recordings were listened to several times before being faithfully transcribed into Microsoft Word and translated (three authors) into French for the Swahili interventions. Before analyzing the data in ATLAS.ti (version 12), the transcripts were imported into the software for content analysis to identify emerging themes associated with the APSC in Lubumbashi.
Reliability
To ensure scientific rigor, we employed criteria of credibility, dependability, transferability, and confirmability19. The audio files were audited several times before being carefully transcribed into Microsoft Word and translated into French by three authors for the Swahili interventions. The supervisory team received the audio recordings, transcriptions, and coding, as well as the themes, to conduct a cross-analysis to ensure the credibility of the results. The lead author (CKD) reviewed the results with other members of the research team (MMM and LNM) as well as his supervisor (CKM). This was made possible through the triangular analysis conducted by the first and fourth authors (CKD and BKP).
Ethical Considerations
This study was conducted in accordance with the Declaration of Helsinki (1964). Participants gave written informed consent prior to taking part, including consent for the publication of anonymised responses and direct quotes. Authorisation for the research was provided by the faculty. This was for reasons of confidentiality and anonymity. Appropriate data management was ensured in three stages: First, recordings, transcripts and field notes were deleted from the original devices. Second, they were saved in password-protected files on a computer and external hard drive. Finally, they were anonymised. The study obtained research certificate No. 0050/2024 from the Faculty of Medicine at the University of Lubumbashi.
Results
Participant Characteristics
Table 3 presents the sociodemographic characteristics of the respondents. The largest groups were full-time nurses, followed by case managers (28.57%) with an average experience of 15.5 ± 11.43 years (4–34) years. The respondents included were women (57%) and 43% men, with an average age of 44.21 ± 9.40 years.
Table 3 Sociodemographic Characteristics of Respondents
Themes Emergent
Data from eight (8) interviews and one (1) focus group were summarized into three (3) themes which emerged as: Challenges that require psychosocial and economic support faced by Children People Living with HIV/AIDS (i), Psychosocial and Economic Interventions among CPLHIV (ii) and Experience of Community Caregivers Providing Psychosocial Support to CPLHIV (iii). These themes are developed in the following lines (Table 4):
Table 4 Overview of the Main Themes and Their Sub-Themes Relating to Challenges and Interventions in Psychosocial and Economic Support for Children People Living with HIV/AIDS Among Health and Community Workers in the Katuba Health Zone in Lubumbashi, DRC
Theme 1: Challenges That Require Psychosocial and Economic Support Faced by Children People Living with HIV/AIDS
Situation of Children People Living with HIV
Participants shared their experiences of the current challenges faced by Children people living with HIV, which included the burden of treatment and daily adherence to treatment, stigma, and discrimination. Participants also stated that some Children people, in the absence of visible symptoms, struggle to recognize the need for their treatment, which compromises their treatment adherence, and Children people living with HIV experience ridicule, isolation, and discriminatory attitudes from those around them, including those in their families and schools. Participants stated:
[…] Their problem is first of all the effect of taking the medication every day and for an indefinite period. They think that they are not useful to society, that they cannot have children, that they cannot work in life and that they cannot get married, so there are a lot of problems like that […] KAT004
[…] The big problem with these children is adherence to treatment. Physically they don’t feel sick. Their appearance says they’re not sick and they themselves say they’re not sick. So it’s difficult for these children to adhere to treatment and the other problem is that they are mostly orphans so they are mistreated and rejected at times. […] KAT002
The testimonies collected from participants highlight other psychosocial and relational challenges, including the impact of HIV on schooling and socio-professional integration, financial difficulties and access to care, increased vulnerability to abuse and violence, lack of information and fear of disclosure. One participant said:
[…] Children people living with HIV/AIDS, regardless of their age, face multiple and complex challenges. Academic problems: The disease can lead to frequent absences, difficulty concentrating, and decreased academic performance. Relationship difficulties: Children people may have difficulty forming friendships and intimate relationships, due to fear of rejection or transmission of the virus. Uncertainty about the future: The future may seem uncertain, which can generate anxiety and depression. Financial difficulties: Families of Children people living with HIV/AIDS may face financial difficulties related to treatment costs, which can limit access to quality care and essential resources. […] KAT006
Prevention and Psychosocial Support Intervention for Children People Living with HIV/AIDS
Prevention and psychosocial support intervention are a priority, declared all participants, for several reasons justifying this priority: Impact on overall health, prevention of transmission, improvement of life expectancy and reduction of inequalities in all health establishments integrating HIV/AIDS care services. According to them, if these Children people are well prepared, mentally, they will protect themselves and protect others, so it is really a priority. A focal point stated:
[…] If it is an absolute priority, because we must disclose HIV status to Children people and this will allow Children people to know themselves and know how to behave, not to have sex in a disorderly manner, because that could contribute to increasing the number of HIV infections. So, it is also an economic priority, because these Children people living with HIV must be educated and we must prepare them for future life […] KAT002
Awareness of the Psychosocial and Economic Problems of Children People Living with HIV
Participants’ testimonies divide psychosocial and economic problems into two categories: those living with HIV who are aware of the problem and those who are not. This varies depending on their age, social environment, and level of information. Others minimize or deny them. Two focal points summarize this sentiment:
[…] Yes, but well! It depends on the age group. A Children person over 10 is more aware than a Children person under 10. Yes, they consider it an important problem, because they want to know if they will need to get married one day and work like everyone else […] KAT003
[…] Indeed, yes, they are aware because we teach them and they are taught for that. Yes, they consider it as a problem, already the effect of taking the treatment every day while other children their age do not take it and the effect that they live mostly in foster families or in orphanages. Yes, they consider it as a major problem […] KAT006
Questions from Children People Living with HIV
All participants stated that all Children people living with HIV/AIDS face psychosocial and economic challenges. One participant said:
[…] Yes, Children people living with HIV regularly ask questions about psychosocial and economic issues. These questions often concern the future: ‘Will I be able to have a normal life?’ Relationships: ‘Will I be able to find love?’ Work: ‘Will I be able to find a job?’ Education: ‘Will I be able to continue my education?’ […] KAT007
Regarding economic concerns alone, participants stated that community members are more familiar with this concept, and they stated that Children people living with HIV/AIDS require economic support. The most urgent need is access to vocational training. Many of our Children people do not have a diploma and struggle to find employment.
Case Manager 3_FG:
[…] The most urgent need is access to vocational training. Many of our Children people do not have a diploma and have difficulty finding a job. […]
Theme 2: Psychosocial and Economic Interventions for Children People Living with HIV/AIDS
Advice and Management of Children People Living with HIV
Participants stated that the management and counseling of Children people living with HIV/AIDS is done in collaboration with psychosocial workers, other providers do it alone to avoid falls and some entrust this task to social workers, who are there for this situation.
[…] We provide individual and group counseling: Mental health professionals provide a safe space for Children people to express their emotions, concerns, and challenges. Peer support groups: Children people can connect with other Children people living with HIV and share their experiences. Socio-educational activities: Workshops are organized to develop Children people’s social, emotional, and career skills […] KAT006
Children people living with HIV also receive several types of psychosocial support:
[…] We offer active listening, personalized advice, group activities (sharing experiences, self-esteem building workshops) and individualized support. These interventions are effective because they allow Children people to feel supported, develop coping strategies and strengthen their resilience […].CASE MANAGER_3_FG_BKM
Assessment of Psychosocial Risk in Children People Living with HIV
Psychosocial risk assessments for Children people living with providers are conducted by psychosocial workers (case managers and peer educators) and other care providers conduct them alone.
[…] We leave this task to the agents of a non-governmental organization (case manager, peer educators), these social agents have assessment protocols and this allows them to see if they can strengthen psychosocial support […] KAT004
[…] We have a framework, questionnaires that help us to talk with them and to get to the bottom of the problem […] KAT003
Economic Risk Assessment Among Children People Living with HIV
The economic risk assessment is carried out by case managers who are psychosocial agents.
[…] This assessment is done by social workers. For example, there are Children people who have financial difficulties in their family and who need to go to school, they go on site to assess the vulnerability of the family, these agents will judge if the Children people can benefit from the transfer cache. […] KAT003
Effectiveness and Efficiency of Current Psychosocial and Economic Support Assessment and Intervention Services
Current services provided to Children people living with HIV appear efficient and effective for most participants and ineffective for some.
[…] These interventions are effective because they allow Children people to feel supported, develop coping strategies and strengthen their resilience […]. ALL CASE MANAGERS_FG_BKM
[…] It’s not really effective, because the budget we had planned beforehand is not the one we are using today, it’s not working as it should because there are patients who have not received anything until today and we are still waiting, however, the psychosocial support seems to be working […] KAT006
Theme 3: Experience of Community Caregivers Providing Psychosocial Support to Children People Living with HIV
Constraints in Psychosocial and Economic Support Services
Regarding constraints from a psychosocial and economic perspective, the participants’ interview accounts reveal two sides: those who encounter them and those who do not. Among those service providers who encounter obstacles.
[…] Yes, there are constraints, the number of providers is not sufficient, so coverage on the ground seems a little difficult and also the financial subsidy is not sufficient […] KAT003
[…] Here at home, there are no constraints since we started in 2016, in any case, there are no constraints […] KAT008
Recommendations for Improving Psychosocial and Economic Support Services for Children People Living with HIV
All participants made recommendations and challenges to overcome to contribute to better psycho-social and economic support for Children people living with HIV. The strengthening of human and material resources appears first as a first recommendation with the following challenges: the shortage of care providers, the increased need for community workers (case managers and peer educators) and strengthening the training of health professionals. One participant said:
[…] Increase the number of healthcare providers (doctors, nurses, case managers and peer educators) because they are insufficient. For good psychological support, we need a lot of peer educators and a lot of case managers. We also need to increase a lot of efforts because this will allow for good monitoring of Children people living with HIV. For economic support, we only need to increase the budget and then we can improve a lot of things […] KAT004
The second recommendation from the participants concerns increased funding and economic support for JVHIV, better partner funding to ensure business continuity and financial involvement from the government. One participant said:
[…] We must continue to support them. There is also the bad faith of our leaders because the country does not lack the means if we only have to wait for the partners to act; it will not be enough so we ask that the government can help us with funding so that all Children people living with HIV can be cared for, because if the partner left you can imagine what would happen next? […].KAT002
The third recommendation made by the participants was prevention and awareness activities with several challenges. One participant said:
[…] Strengthening prevention: By focusing on primary and secondary prevention, including strengthening sex education and facilitating access to condoms. Combating stigma: By organizing awareness campaigns and involving communities […]. KAT001
The fourth and final recommendation from the interviews was to improve Access to Care and Psychosocial Support, with challenges such as geographical and financial access to care and increased support for families of Children people living with HIV.
[…] Improving access to care: By facilitating geographical and financial access to care, and by strengthening the quality of services offered. Supporting families: By providing psychosocial support to families and involving them in the care of their children. By working together, we can improve the quality of life of Children people living with HIV and empower them to achieve their goals. […] KAT001
Discussion
The present study explores the psychosocial and economic support for CPLHIV as perceived by health workers and community workers in the Katuba health zone. The study identifies the main findings as follows: It is evident that children encounter a multitude of distinctive challenges that exert a detrimental influence on their physical, mental, emotional and social health. The early identification and management of psychosocial and economic issues appear to be pivotal in enhancing their overall well-being. While the efficacy of current psychosocial and economic interventions is acknowledged, there is a consensus that their effectiveness could be enhanced. The recommendations made by the service providers surveyed underscore the necessity to fortify the support system in its entirety, encompassing both human resources and organisational arrangements.
CPLHIV face a multitude of specific challenges that influence their physical, mental, emotional and social health. These challenges vary depending on the social environment, population, culture and the broader socio-economic and political context.24 As reported by the participants in our study who reported as challenges the burden of treatment, daily therapeutic adherence, stigma and discrimination, including social and academic rejection. Other participants also mentioned various situations that CPLHIV may face, such as the effect of HIV on education and professional integration, economic problems and access to care, increased susceptibility to abuse and violence, information deficit and fear of exposure24–28. The results of this study are consistent with those of several research studies that have highlighted issues such as personal stigma, isolation and adjustment problems. These issues can significantly impact people’s ability to adhere to antiretroviral therapy, their independence, and their ability to establish and maintain healthy social relationships24–27. For example, it has been reported that some people, in the absence of visible symptoms, struggle to recognize the need for treatment, which compromises their treatment adherence. Some CPLHIV avoid social interactions and do not seek the necessary social support, believing that they do not deserve respect or attention. This dynamic can lead to a state of hopelessness and a constant fear of rejection, without the social support they desperately need.24–27
The findings of this study, supported by,29 highlight the critical importance of comprehensive psychosocial and economic interventions to provide CPLHIV with more tailored coping strategies and support systems in light of the challenges identified. Psychosocial support is an essential component of holistic care for these CPLHIV. Indeed, it has been shown that this support enables Children people to cope with the emotional, social and economic challenges related to their diagnosis, to improve their self-esteem and to develop life skills.
However, in low-resource settings, health systems often face challenges in supporting populations in managing these multifaceted challenges. These difficulties are exacerbated by various factors compounded by the suspension of PEPFAR assistance, including limited government attention, armed conflict in the case of the DRC, population displacement, and political instability.30,31
Regarding psychosocial and economic interventions for CPLHIV, stakeholders highlighted that support and guidance, as well as assessment of psychosocial and economic risks for these individuals, are primarily carried out in collaboration with community members. Psychosocial and economic interventions can be effectively deployed to improve adherence to antiretroviral therapy among HIV-positive adolescents and Children adults in resource-limited settings,32–34 as demonstrated by several studies, including ours. These findings are consistent with several studies that have demonstrated increased retention and adherence to antiretroviral therapy (ART) among adolescents and Children people following the application of a psychosocial method.9,32,34–42
Early identification and intervention of psychosocial and economic problems are crucial. The data collected reveal a variety of circumstances associated with the challenges encountered in implementing psychosocial and economic support services for people living with HIV. On the one hand, various participants reported problems related to insufficient human and financial resources. On the other hand, others reported not encountering any major obstacles.
Research has shown that initiatives aimed at strengthening support networks, improving the training of health professionals and promoting community actions can have a decisive influence on improving the quality of life of people living with HIV and their caregivers.43–45
Strasser et al46 argue that evidence-based psychosocial and economic support services for CPLHIV are currently underdeveloped and underfunded. They state that this situation needs to be addressed and improved, as some participants attested. The sudden interruption of current development assistance or future reduction of PEPFAR funding may negate efforts made so far towards the elimination of HIV/AIDS as a health problem36. The goal of ending the AIDS pandemic by 2030 is within reach, urgent action is needed from world leaders20, particularly in sub-Saharan Africa, which concentrated more than 90% of the funding and was home to two-thirds of all people living with HIV.37,38
Strength and Limits
The primary strength of this study lies in the diversity of the participants, encompassing various genders, age ranges, and roles, thereby facilitating an in-depth exploration of the realities experienced by CPLHIV. Notwithstanding, this study is not without its limitations. Primarily, the research design, employing a case study approach guided by a phenomenological method, renders the findings inherently bound to the context of the Katuba health zone. It is acknowledged that each health zone possesses its own unique characteristics, which serve to distinguish it from other health zones. Consequently, it is posited that the results of this research may only be applicable to other zones that exhibit similar contexts. Secondly, the study of the challenges faced by young people can only be better understood through the application of socio-ecological approaches, which emphasise the interaction between the different levels (individual, family, community, institutional).47 This study did not achieve this.
Future research endeavours could concentrate on the challenges confronted by CPLVHIV. This could be achieved by investigating the perspectives of family members, young people themselves, community workers and healthcare staff.
Conclusion
This research highlights a series of challenges faced by children living with HIV that have a deleterious influence on their overall well-being. It highlights the need for early identification and management of these challenges, in order to significantly improve the quality of life of the individuals concerned. Although current interventions are considered effective, there is a consensus that their effectiveness could be improved. This could be achieved by strengthening the support system through recommendations from service providers, particularly in terms of human resources and organisation. As part of our recommendations for future interventions or the adjustment of existing interventions, we advocate the strengthening of human and material resources in order to meet the following challenges: the shortage of healthcare providers; the increased needs of community members and their training; increased funding, in particular the financial involvement of the national government; focusing on more prevention and awareness-raising activities; improving access to care and support for the families of children living with HIV. These strategies should be implemented to reduce the psychological and economic distress of children living with HIV. To achieve this, the various stakeholders should be involved with a view to “eliminating HIV/AIDS by 2030”. Further research could be carried out in all the health zones of the city of Lubumbashi, using qualitative or mixed methodologies as part of a socio-ecological approach.
Abbreviation
CPLHIV, Children people living with HIV/AIDS.
Data Sharing Statement
The original contributions to this study are presented in the article, and the transcripts and other supporting material for this manuscript are available from the corresponding authors and publishers.
Disclosure
No competing interests have been declared by the authors.
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Eloy Alfaro de Alba (with gavel), Permanent Representative of Panama to the United Nations and President of the Security Council for the Month of August, chairs the Security Council meeting on the situation in the Middle East. Credit: UN Photo/Evan Schneider
UNITED NATIONS, Aug 21 2025 (IPS) – Human rights groups have expressed alarm over the surge in unprecedented executions in Saudi Arabia in 2025. Humanitarian experts have underscored the Saudi Arabian monarchy’s use of the death penalty to silence peaceful dissent among civilians and impose justice for minor offenses, with little to no due process.
On August 11, Human Rights Watch (HRW) raised the alarm on the rise in executions of civilians and foreign nationals in Saudi Arabia. Their new report highlighted the June 14 execution of journalist Turki al-Jasser, who worked to expose corruption and human rights violations linked to the Saudi monarchy.
Following al-Jasser’s execution, Saudi Arabia’s Interior Ministry issued a statement in which it accused al-Jasser of committing “terrorist crimes” and “destabilizing the security of society and the stability of the state”. This follows the 2024 execution of Abdullah al-Shamri, a Saudi political analyst, after appearing as a political commentator on broadcast news for prominent media organizations.
“The June 2025 execution of Saudi journalist Turki al-Jasser, after seven years of arbitrary imprisonment on fabricated charges over his online publications, is a chilling testament to the kingdom’s zero tolerance to peaceful dissent and criticism, and a grim reminder of the peril journalists face in Saudi Arabia,” said Sylvia Mbataru, a researcher of civic space at CIVICUS Global Alliance.
HRW reports that Saudi authorities are pursuing the death penalty against Islamic scholar Salman al-Odah and religious reformist activist Hassan Farhan al-Maliki on vague charges related to the peaceful and public expression of their beliefs.
“Behind closed doors, Saudi Arabia is executing peaceful activists and journalists following politicized trials,” said Abdullah Alaoudh, senior director of countering authoritarianism at the Middle East Democracy Center. “These state-sanctioned killings are an assault on basic human rights and dignity that the world cannot afford to ignore.”
Figures from HRW show that as of August 5, Saudi authorities had carried out over 241 executions in 2025. including 22 alone on the week of August 4. Amnesty International reports that 2024 set a new record for annual executions in Saudi Arabia, documenting at least 345. The human rights organization Reprieve projects that if executions are carried out at the same rate, 2025 could exceed all prior records.
“Saudi authorities have weaponized the country’s justice system to carry out a terrifying number of executions in 2025,” said Joey Shea, researcher for Saudi Arabia and the United Arab Emirates at Human Rights Watch. “The surge in executions is just the latest evidence of the brutally autocratic rule of Crown Prince Mohammed bin Salman.”
Estimates from Reprieve show that roughly 162 of this year’s recorded executions were for minor drug-related offenses, with over half involving foreign nationals. HRW reports that none of these executions followed due process, making it highly unlikely that any of those executed received a fair trial.
“Saudi Arabia’s relentless and ruthless use of the death penalty after grossly unfair trials not only demonstrates a chilling disregard for human life; its application for drug-related offenses is also an egregious violation of international law and standards,” said Kristine Beckerle, Amnesty International’s Deputy Regional Director for the Middle East and North Africa.
“We are witnessing a truly horrifying trend, with foreign nationals being put to death at a startling rate for crimes that should never carry the death penalty. This report exposes the dark and deadly reality behind the progressive image that the authorities attempt to project globally.”
Earlier this year, Amnesty International, the European Saudi Organization for Human Rights, and Justice Project Pakistan documented the cases of 25 foreign nations who were on death row or have been executed in Saudi Arabia for drug-related offenses. The investigation found that the majority of individuals on death row were not afforded their fundamental human rights, such as access to a legal representative, interpretation services, and consular support. Additionally, Amnesty International reported that in many of these cases, individuals from disadvantaged socio-economic backgrounds faced heightened risks of discrimination in legal proceedings.
Furthermore, it was reported that at least four of these cases involved the use of torture and ill treatment in detention facilities to extract confessions from individuals charged with drug-related crimes. For many of these individuals, their families were not informed of the status of their convictions and were only notified of an execution the day prior. In all cases of execution, Amnesty International reported that the bodies of executed individuals were withheld by Saudi authorities.
The recent surge in executions has drawn immense criticism from human rights groups for violating international humanitarian law. Although Saudi Arabia has not acceded to the International Covenant on Civil and Political Rights (ICCPR), a multilateral treaty adopted by the UN that promoted an inherent right to life and due process, it has ratified the Arab Charter on Human Rights, which obligates that Saudi Arabian security forces are only to use the death penalty for the “most serious crimes”.
Mandeep Tiwana, the Secretary-General of CIVICUS Global Alliance, informed IPS that the current civic space conditions in Saudi Arabia are listed as “closed”, indicating that civilians hold little to no power and are bereft of the ability to represent themselves in governmental affairs and peacefully dissent. “This means that those who criticize the authorities or engage in protests of any kind or seek to form associations that demand transformational change can face severe forms of persecution including imprisonment for long periods, physical abuse and even death.”
