Loren W. Galvao
University of Wisconsin Milwaukee, Center for Global Health Equity, Senior Scientist, Researcher (Global Health)
Dr. Galvao is a public health physician with thirty plus years of experience in global health programs and research, with a major focus on HIV prevention, maternal & reproductive health and family planning in less developed countries. She is a Senior Scientist, Global Health, at the University of Wisconsin-Milwaukee (UWM) Center for Global Health Equity (CGHE).
Before joining the UW system in 2003, she worked extensively in global health for over seventeen years, with experience in twenty countries in Africa, Asia, Latin America, and Europe. From 1995-2001 she was National Advisor for the Reproductive Health/HIV/AIDS Program at the Population Council-Brazil and worked at Save the Children-USA (1991-1995). She served as a consultant for several international and academic institutions, including the World Health Organization, EngenderHealth, Family Health International and others.
During the past decade she also devoted part of her time to programs in the United States, with a primary focus on population health and community-based research. Between 2005- 2015 she has been a Honorary Fellow, Population Health Sciences, at the University of Wisconsin (Madison) School of Medicine and Public Health.
Dr. Galvao’s major project is funded by the National Institute of Child Health and Human Development (NIH-NICHD). She is a Co-Investigator and the UWM’s CGHE site Principal Investigator on a study entitled “Pathways Linking Poverty, Food Insecurity, and HIV in Rural Malawi”; the project's short name is SAGE4Health. This 5-year study in rural Malawi examines the impact of a multi-level ecological intervention (economic development, sustainable agriculture training and food security) on HIV vulnerability, maternal health and other health outcomes.
Country Experience: Bangladesh, Bolivia, Brazil, Cambodia, Ethiopia, Guatemala, Honduras, Italy, Malawi, Mexico, Mozambique, Nigeria, South Africa, Switzerland, Thailand, and United States. Border regions of Brazil with Argentina, Bolivia, Paraguay and Uruguay.
Before joining the UW system in 2003, she worked extensively in global health for over seventeen years, with experience in twenty countries in Africa, Asia, Latin America, and Europe. From 1995-2001 she was National Advisor for the Reproductive Health/HIV/AIDS Program at the Population Council-Brazil and worked at Save the Children-USA (1991-1995). She served as a consultant for several international and academic institutions, including the World Health Organization, EngenderHealth, Family Health International and others.
During the past decade she also devoted part of her time to programs in the United States, with a primary focus on population health and community-based research. Between 2005- 2015 she has been a Honorary Fellow, Population Health Sciences, at the University of Wisconsin (Madison) School of Medicine and Public Health.
Dr. Galvao’s major project is funded by the National Institute of Child Health and Human Development (NIH-NICHD). She is a Co-Investigator and the UWM’s CGHE site Principal Investigator on a study entitled “Pathways Linking Poverty, Food Insecurity, and HIV in Rural Malawi”; the project's short name is SAGE4Health. This 5-year study in rural Malawi examines the impact of a multi-level ecological intervention (economic development, sustainable agriculture training and food security) on HIV vulnerability, maternal health and other health outcomes.
Country Experience: Bangladesh, Bolivia, Brazil, Cambodia, Ethiopia, Guatemala, Honduras, Italy, Malawi, Mexico, Mozambique, Nigeria, South Africa, Switzerland, Thailand, and United States. Border regions of Brazil with Argentina, Bolivia, Paraguay and Uruguay.
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We assessed two self-report outcomes: (1) new STI symptoms (reporting one of six STI symptoms at 18-month or 36-month follow-up), (2) new STI diagnosis (clinician-diagnosed with either one of six STIs at 18-month or 36-month follow-up) in intervention participants (N=600) and control participants (N=300). We used Chi-Square tests to analyze the categorical variables and logistic regressions to examine the intervention effect on new STI symptoms and diagnoses.
Compared to the control group, the intervention group was less likely (OR=.51, 95% CI=.33-.79) to report having new STI symptoms at 36-month, controlling for symptoms presented at 18-month. This holds true for intervention men and women compared to control. Although not statistically significant, participants in the intervention group reported a higher percentage of newly diagnosed STIs at 36-month than the control. Among six STIs assessed, syphilis was the most commonly reported STI diagnosis (prevalence 2.3%-5.3%).
This combined structural intervention appears to have contributed to a decrease in newly presented STI symptoms. Coupled with the increase in new STI diagnoses, this could mean that the intervention contributed to an increase in STI testing and a decrease in undiagnosed STIs in the intervention group.
Can a Combined Structural Microfinance, Food Security and Gender Empowerment Intervention Impact STI Symptoms and Diagnoses in Rural Central Malawi?. Available from: https://www.researchgate.net/publication/266810310_Can_a_Combined_Structural_Microfinance_Food_Security_and_Gender_Empowerment_Intervention_Impact_STI_Symptoms_and_Diagnoses_in_Rural_Central_Malawi [accessed Jul 17, 2015].
Methods: We started with thematic analysis of end-of-program interviews and focus groups from a stratified purposive sample (N=90) to develop understanding of intervention impacts. To test intervention effects, we analyzed survey data measuring three outcomes (dietary diversity [proxy for nutrient adequacy], consumption of “groundnuts” [peanuts], and likelihood of reducing meals to cope with food shortages). We assessed outcomes at baseline, 18-month, and 36-month follow-ups for intervention participants (N=600) and controls (N=300) in Kasungu District Malawi during 2009 to 2012. Cross tabulation, Chi-Square tests, and Generalized Estimating Equations with repeated measures logistic regressions were used.
Results: Qualitative: Changes attributed to the intervention included: increased knowledge about nutritional food groups, new awareness of groundnuts as a protein source, and greater likelihood of eating a morning meal even in times of economic adversity.
Quantitative: Likelihood of consuming vitamin A-rich vegetables (p=.001), other vegetables (p=.009), and vitamin A-rich fruits (p< .001) was greater in intervention households compared to controls, and significantly increased at 18- and 36-month follow ups. Compared to baseline, consumption of groundnuts increased more in intervention households than controls at 36-months (OR=5.1, 95%CI=2.28-11.54). Intervention households were also less likely than controls to reduce amount and number of meals to cope with food shortages at 18-months (OR=0.27, 95%CI=0.11-0.67).
Conclusions: The CARE structural intervention seemed to contribute to improved dietary diversity and intake over time, providing evidence of food security important to HIV prevention and care. More emphasis on improving food security holds potential for decreasing HIV vulnerability. Future studies on reciprocal relationships among economic resilience, food security, and HIV prevention and care are warranted.
Methods: In a non-equivalent control group effectiveness study (SAGE4Health), we investigated effects of a combined structural microfinance, food security and gender empowerment intervention delivered by CARE Malawi on self-reported HIV stigma. HIV stigma was measured by the question "If a member of your household tested HIV positive, would you keep it a secret?" and assessed at baseline,18-month, and 36-month follow ups in intervention participants (N=600) and controls (N=300). Analysis was conducted using Generalized Estimating Equations (GEE) with repeated measures logistic regressions for whole sample and stratified by gender.
Results: Significant intervention effect (p< .001) on self-reported HIV/AIDS stigma was found. Compared to baseline, the likelihood of wanting to keep a family member''s positive HIV status a secret was significantly lower in the intervention group than in controls at 18-months (OR=0.56, 95% CI= 0.39 - 0.80) and 36-months (OR=0.52, 95% CI=0.35 - 0.76), respectively. When stratified by gender, the intervention decreased the likelihood of keeping a family member''s positive HIV status a secret was significantly lower for intervention males from baseline to 18-months (OR=0.22, 95% CI= 0.12 - 0.42) and 36-months (OR=0.29, 95% CI=0.14 - 0.62) compared to control males. No significant intervention effect was observed for females.
Conclusions: Our findings indicate that this combined structural intervention may have contributed to decreased stigma toward PLHIV in men. Further investigation may uncover contextual or gender role factors affecting HIV/AIDS stigma in women. While this analysis of stigma was limited to one item, and might have been strengthened by measuring multidimensional aspects of stigma, it suggests the potential for HIV/AIDS stigma reduction in structural interventions.
Methods: In the context of the SAGE4HEALTH study, a quasi-experimental evaluation of a structural CARE-Malawi intervention, we conducted baseline (n=1000; year 2009), and endline (n=1000; year 2012) cross-sectional randomized household surveys in six traditional authorities within Kasungu District. Cross tabulations and chi-square tests were used.
Results: Overall, awareness about effects of MC was low, particularly for females (94.5% at baseline had never heard about effects of MC; 87.7% at endline). Among those aware of effects of MC, males were significantly more likely to think of MC as a protective factor against HIV at baseline (p< 0.05) and endline (p< 0.05) (males: 46.5% baseline, 77.9% endline; females: 19.4% baseline, 47.9% endline). Males were significantly more likely to think of MC as a protective factor against STIs at endline (p=0.039) (males: 19.8% baseline, 44.1% endline; females 27.8% baseline, 25.6% endline). For both genders, the perception "MC makes one cleaner" increased, although the difference was only significant at endline (males: 10.5%, females 23.4%; p=0.21). At baseline, males (37.2%) were more likely than females (16.7%) to think MC “causes one to lose his culture/tradition” (p=0.025); the gender difference weakened at endline (males: 20.4%; females: 23.3%).
Conclusions: Although awareness about the effects of MC remained low, there is a trend toward increased awareness from 2009 to 2012. Negative attitudes regarding MC were uncommon. More gender differences in attitudes became significantly different in 2012. MC as a protective factor against HIV was the most stated attitude, potentially related to district-wide MC efforts preceding endline data collection. Understanding nuanced attitudes on MC in this region could better inform MC promotion strategies.
Methods: The evaluation was a mixed-methods, quasi-experimental, non-equivalent control group effectiveness study. To develop understanding of intervention impact, we started with thematic analysis of end-of-program qualitative interviews and focus groups (N=90). To confirm intervention effects we analyzed prospective survey data (2009-2012) measuring two outcomes (economic crises due to unpredictable events, and emergency livelihood strategies in intervention households (N=600) and controls (N=300). We used cross tabulation, Chi-Square tests, and Generalized Estimating Equations with repeated measures logistic regressions.
Results: Qualitative: Intervention participants described how successful growing seasons using sustainable FFS methods, and timely emergency loans and cumulative savings from VSL enhanced their capacity to cope with sudden adversity (e.g., illness, drought, crop failure), and decreased the need to engage in “ganyu” (agricultural piecework), a practice perceived as oppressive, health-threatening, and economically ruinous. Quantitative: Compared to baseline, economic crises due to illness/hospitalization decreased more in intervention than control households at 18-months (OR=.44, 95%CI=.31-.62) and 36-months (OR=.34, 95%CI=.23-.50). Likewise, intervention households reported decreased economic crises due to environmental disaster at 18-months (OR=.27, 95%CI=.10-.79) and 36-months (OR=.22, 95%CI=.08-.56). Both adults (OR=.39, 95%CI=.24-.62) and children (OR=.50, 95%CI=.28-.90) in intervention households had decreased odds of doing ganyu from baseline to 18-months. Similar decreases were observed at 36-months.
Conclusions: As a result of combined structural intervention, households were better able to: absorb shocks without falling further into poverty, and respond to emergencies without resorting to ganyu, a livelihood strategy participants called “harvesting hunger” wherein they worked others'' fields while neglecting their own. Improving household resilience to shocks holds promise for reducing vulnerability to HIV and other hazards.