Evaluation of a Depression Intervention in People With HIV and/or TB in Eswatini Primary Care Facilities: Implications for Southern Africa.

INTRODUCTION: Depression associated with chronic illnesses is common in Southern Africa, yet there are major treatment gaps. This study assesses the feasibility and acceptability of the Healthy Activity Program intervention for depression among people with HIV and/or TB. The intervention involves training nonspecialist nurses in depression, including identification, counseling based on behavioral activation theory, and structured referral. METHODS: This is a mixed methods evaluation of a pilot counseling service integrated within routine HIV and TB care from 2018 to 2019. Participants included people living with HIV and/or patients with TB in rural Eswatini. RESULTS: A total of 324 people living with HIV and/or TB were screened for depression, with 19% (62/324) screening positive. The median number of sessions attended was 3 (interquartile range: 1-5), with 16/60 (26%) attending the minimum 5 sessions. Qualitative results indicated acceptability, but there were concerns about feasibility. CONCLUSIONS: The Healthy Activity Program is a promising option to manage the treatment gap for depression in people with HIV and/or TB. However, task-shifting to nonspecialist health care professionals without increasing staff capacity is a barrier to implementation. Realistic and pragmatic assessments of capacity and workforce are essential.

Evidence or stereotype? Health inequalities and representations of sex workers in health publications in England.

The health of sex workers is considerably influenced by their position in society and by the marginalisation and stigmatisation they face worldwide. They are frequently criminalised and labelled as deviant, disordered or 'vulnerable': stereotypes that simplify and misrepresent their realities. Sex work policies create social and structural barriers, creating dangerous work environments and exacerbating significant health inequalities. Health organisations and their policies play an important role in highlighting inequalities and guiding health systems in reducing them. In this article, we use a document analysis design to analyse how and when sex workers are depicted in policies and publications by English national health organisations: National Health Service (NHS) England, Public Health England and the National Institute for Health and Care Excellence, along with the UK Department of Health. We find that sex workers are largely absent in these documents and, when present, are depicted not using evidence, but simplistically with moralistic undertones. The dichotomous constructions found in these texts: vulnerable yet also criminal 'prostitute' reflect wider political and social constructions of sex working women. This not only obscures their realities but also homogenises, blames and stigmatises, ultimately doing the opposite of what these organisations purport to do: it damages their health and well-being.