Surgical Care and Health Systems.

BACKGROUND: While surgical care impacts a wide variety of diseases and conditions with non-operative and operative services, both preventive and curative, there has been little discussion concerning how surgery might be integrated within the health system of a low and middle-income country (LMIC), nor how strengthening surgical services may improve health systems and population health. METHODS: We reviewed reports from several meetings of the working group on health systems strengthening of the Global Initiative for Emergency and Essential Surgical Care, and also performed a review of the literature including the search terms "surgery," "health system," "developing country," "health systems strengthening," "health information system," "financing," "governance," and "integration." RESULTS: The literature search revealed no reports which focused on the integration of surgical services within a health system or as a component of health system strengthening. A conceptual model of how surgical care might be integrated within a health system is proposed, based on the discussions of our working group, combined with sources from the medical literature, and utilizing the World Health Organization's conceptual model of a health system. CONCLUSIONS: Strengthening the delivery of surgical services in LMICs will require inputs at multiple levels within a health system, and this effort will require the coalescence of committed individuals and organizations, supported by civil society.

Belief in a just world, generalised self-efficacy and stigma may contribute to unsafe sexual intentions via a reduced perception of vulnerability to HIV/AIDS amongst young people in Ghana.

Complacency about one's HIV risk status may reduce the intention to practise safe sex. It was hypothesised that belief in a just world and stigmatising attitudes may contribute to complacency and thereby have a negative impact on safe sex intention. A sample of 238 young people in Ghana, ranging in age from 14 to 22, completed the Generalised Self-Efficacy Scale and the Belief in a Just World Scales for Self and Other, together with self-report measures of stigmatising attitudes, perceived vulnerability to HIV/AIDS and intentions to practise safe sex. Mediation analysis supported the hypothesis that stigma and just world beliefs may have a negative impact on safe sex intention that is mediated by a reduced perception of vulnerability. It was also found that generalised self-efficacy beliefs had a similar mediated impact. Each of the three factors had a mediated impact that was relatively independent of the other two factors. In addition, stigma had a negative direct (unmediated) effect on safe sex intention (i.e., more stigma was associated with reduced safe sex intention); but generalised self-efficacy beliefs had a positive direct effect (i.e., greater belief was associated with increased safe sex intention). The study replicates some previous research about stigma, and provides new evidence about the role of just world and generalised self-efficacy beliefs. Implications for public health programmes are discussed.

Do stigma, blame and stereotyping contribute to unsafe sexual behaviour? A test of claims about the spread of HIV/AIDS arising from social representation theory and the AIDS risk reduction model.

In the context of social representation theory and the AIDS risk reduction model, it has been claimed that stigmatizing, blaming and stereotyping attitudes make people feel less at risk of contracting HIV/AIDS, and that this, in turn, results in them taking fewer precautions in their sexual behaviour. Previous research has failed to provide convincing evidence to support these claims. The present study provided a test of the claims that addressed some of the methodological issues identified in the earlier research. A sample of 460 young people from Ghana, ranging in age from 15 to 28 years (mean=18), completed a questionnaire that measured the relevant constructs. The results supported the claims in relation to stigmatizing and intended sexual risk behaviour, but not stigmatizing and actual sexual risk behaviour. Although the latter two were correlated, this was not mediated by reduced perceptions of vulnerability. Claims in relation to blaming and stereotyping were not supported. Contrary to expectation, specific blaming and stereotyping attitudes that constructed HIV/AIDS as a sexual disease were associated with safer intended sexual behaviour, and this relationship was mediated by feeling at greater risk.