Impact of Digital Health on the Management of Infectious Diseases: Lessons Learned during the COVID-19 Pandemic

IN A NUTSHELL
Author's note
This article examines the impact of digital health on the management of infectious diseases, focusing on lessons learned during the COVID-19 pandemic. It highlights the rapid expansion of telemedicine and virtual consultations, as well as the crucial role of contact tracing applications in containing the spread of the virus. Additionally, it analyzes the use of big data and predictive analytics to understand and predict the dynamics of the pandemic. Future challenges and opportunities in the implementation of digital health solutions, as well as the importance of public education and awareness, are discussed. In conclusion, the transformative role of digital health in the global response to infectious diseases is acknowledged, emphasizing the need to continue learning and adapting to address future health crises

By Nicolás Castillo

 Biochemical. Private Laboratory Santa Clara de Saguier Sanatorium, Santa Fe, Argentina 

 Impact of Digital Health on the Management of Infectious Diseases

Lessons Learned during the COVID-19 Pandemic

 

 

Introduction

The COVID-19 pandemic has underscored the critical importance of digital health in the management of infectious diseases. In this context, telemedicine, contact tracing applications, big data analysis, and public education have emerged as fundamental pillars in combating the virus spread and ensuring continuity of medical care. This article examines the impact of digital health during the pandemic, highlighting lessons learned and outlining future directions for the management of infectious diseases.

Development

During the COVID-19 pandemic, telemedicine and virtual consultations became essential tools to ensure continuous access to medical care. The expansion of telemedicine allowed patients to receive medical attention without exposing themselves to the risk of contagion in clinical settings. This mode of care has not only proven effective in providing primary care and patient follow-up but has also promoted greater convenience and accessibility for users.

In parallel, contact tracing applications played a crucial role in containing COVID-19 outbreaks. These tools utilized geolocation and Bluetooth technology to identify and notify individuals who were exposed to the virus, thereby facilitating a rapid and effective response to mitigate virus spread. However, their effectiveness was hampered by challenges related to data privacy and widespread adoption by the population.

Big data analysis emerged as a powerful tool to understand the pandemic’s dynamics and guide public health interventions. By integrating epidemiological, mobility, and socioeconomic data, researchers could identify transmission patterns and anticipate virus spread, thereby informing decision-making on health policies. However, the collection and management of large volumes of data posed ethical and legal challenges, highlighting the need for robust safeguards to protect individuals’ privacy.

Public Education and Awareness

Digital health also played a crucial role in public education and awareness about COVID-19. Through online platforms and social media, accurate and updated information on preventive measures, symptoms of the disease, and access to health services was disseminated. However, the proliferation of online information also led to the spread of misinformation and conspiracy theories, underscoring the importance of promoting digital literacy and ensuring access to reliable sources of information.

Discussion

The COVID-19 pandemic has accelerated the adoption of digital health in the management of infectious diseases but has also revealed significant challenges that must be addressed to maximize its effectiveness. The digital divide, data privacy, and online misinformation are just some of the areas that require ongoing attention to ensure an equitable and effective response to future public health crises. At the same time, the pandemic has generated unprecedented momentum for innovation in digital health, offering opportunities to improve accessibility, efficiency, and equity in medical care. 

Conclusion

In conclusion, the COVID-19 pandemic has transformed the landscape of infectious disease management, highlighting the critical role of digital health in this area. By learning from the lessons of the pandemic and addressing outstanding challenges, we can harness the potential of digital health to strengthen preparedness and response to future health threats. It is essential to continue innovating and collaborating in the development of digital solutions that enhance the health and well-being of populations worldwide.

References

[PMID: 33053287] – Smith, A. C., Thomas, E., Snoswell, C. L., Haydon, H., Mehrotra, A., Clemensen, J., & Caffery, L. J. (2020). Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). Journal of telemedicine and telecare, 26(5), 309-313.

[PMID: 32819220] – Hellewell, J., Abbott, S., Gimma, A., Bosse, N. I., Jarvis, C. I., Russell, T. W., … & Kucharski, A. J. (2020). Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts. The Lancet Global Health, 8(4), e488-e496.

[PMID: 33032487] – Ferretti, L., Wymant, C., Kendall, M., Zhao, L., Nurtay, A., Abeler-Dörner, L., … & Fraser, C. (2020). Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing. Science, 368(6491).

[PMID: 33046876] – Koonin, L. M., Hoots, B., Tsang, C. A., Leroy, Z., Farris, K., Jolly, B., … & Harris, A. M. (2020). Trends in the use of telehealth during the emergence of the COVID-19 pandemic—United States, January–March 2020. MMWR. Morbidity and Mortality Weekly Report, 69(43), 1595.

[PMID: 32354899] – Li, L., Xu, G., & Wang, H. (2020). Lessons from the experience in Wuhan to reduce risk of COVID-19 infection in patients undergoing long-term hemodialysis. Clinical Journal of the American Society of Nephrology, 15(5), 717-719.

[PMID: 33210924] – Joensen, L. E., Madsen, K. P., Holm, L., Nielsen, K. A., Rod, M. H., Petersen, A. A., … & Willaing, I. (2020). Diabetes and COVID-19: psychosocial consequences of the COVID-19 pandemic in people with diabetes in Denmark—what characterizes people with high levels of COVID-19-related worries? Diabet Med; 37(7): 1146-1154.

 

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Empowering Gray House Communities Towards Vaccination Efforts

IN A NUTSHELL
Author's note
This paper addresses the challenges faced in reaching Gray House children, residing in underserved areas such as urban slums and remote villages, during crucial vaccination campaigns. It discusses factors like vaccine hesitancy, logistical hurdles, and resistance to mandatory vaccination, proposing tailored communication strategies involving community engagement, influencer collaboration, and misinformation mitigation. Additionally, it emphasizes the significance of building trust, countering misinformation, and engaging diverse stakeholders to advance polio eradication efforts. The paper outlines strategies for effective communication, combating fake vaccination practices, and leveraging female influencers, providing a comprehensive framework for successful vaccination campaigns. It also presents a content framework, budget allocation strategy, and outreach plan, emphasizing adaptability and continuous improvement. Furthermore, the paper underscores the importance of evaluating campaign effectiveness and adjusting strategies accordingly to enhance vaccine uptake and accelerate progress towards polio eradication, promoting inclusivity, collaboration, and impact measurement

By Muhammad Noman

Healthcare System, CHIP Training and Consulting

Quetta, Balochistan Pakistan

Empowering Gray House Communities Towards Vaccination Efforts

 Navigating Fake Vaccination, Mobilizing Influencers, and Cultivating Trust

 

 

Introduction

In the pursuit of global health equity, Gray House children, residing in marginalized urban areas and remote villages, often face significant barriers to accessing vital healthcare services, including vaccinations against diseases like polio. Despite concerted efforts to eradicate polio, these children remain disproportionately affected due to socioeconomic factors and logistical challenges. Understanding the complex interplay of these factors is essential for designing targeted communication strategies to ensure that no child is left behind in the fight against polio. This paper explores the challenges faced in urban communities, the logistical hurdles of mobility, and the imperative for tailored communication strategies to effectively reach Gray House children. Additionally, it delves into the resistance to mandatory vaccination, the role of community leaders in dispelling misconceptions, and the necessity of countering fake vaccination practices. Through collaborative efforts and innovative communication approaches, stakeholders can move closer to the goal of polio eradication while safeguarding the health and well-being of vulnerable populations.

Understanding Gray House Children

Gray House children, residing in areas with limited healthcare access like urban slums and remote villages, are often overlooked in vaccination campaigns. Designing targeted communication strategies to reach them requires an understanding of the socioeconomic factors contributing to their invisibility.

Challenges in Urban Communities

Urban areas face a lack of awareness about polio vaccination importance, exacerbated by misinformation and rumours. This contributes to vaccine hesitancy, making it challenging to achieve high vaccination coverage.

Logistical Challenges of Mobility

The transient nature of urban populations poses logistical challenges for vaccination teams, resulting in missed opportunities for vaccination and gaps in coverage, especially among marginalized populations.

Tailored Communication Strategies

Engaging community leaders and utilizing mobile health clinics can facilitate dialogue and improve access to vaccination services in urban areas. Tailored communication strategies are crucial to ensuring that no child is left behind in the fight against polio.

Resistance to Mandatory Vaccination

Administrative pressure to administer polio doses sometimes leads to resistance among families in cities. Improved communication and trust-building efforts are necessary to address this reluctance and encourage participation in vaccination campaigns.

Engaging Community Leaders

Engaging with community leaders, religious figures, and influencers is vital to dispel misconceptions and build confidence in vaccination campaigns, ultimately encouraging families to participate willingly in immunization efforts.

Communication Challenges

Various obstacles hinder efforts to reach Gray House children and tackle fake vaccination concerns. These obstacles encompass language barriers, low literacy rates, and distrust in healthcare authorities, compounded by misinformation disseminated through social media and community networks. Cultural and religious beliefs also contribute to vaccine hesitancy, adding layers of complexity to communication endeavours.

Customized Communication Strategies

Effective engagement with Gray House children and the mitigation of fake vaccination concerns necessitate customized communication strategies. These strategies should address language barriers by utilizing multilingual materials and interpreters. Moreover, initiatives to enhance health literacy within communities, particularly in urban slums and remote areas, are imperative.

Building Trust and Countering Misinformation

Establishing trust in healthcare authorities through transparent and respectful communication is paramount. Simultaneously, countering misinformation with accurate and credible information is essential. Engaging religious leaders and community influencers to advocate for vaccination from a culturally sensitive perspective can help address underlying cultural and religious beliefs.

Moving Towards Polio Eradication

By addressing these communication challenges head-on, stakeholders can bolster vaccination uptake and advance toward the ultimate goal of polio eradication. Efforts to bridge communication gaps and foster trust within marginalized communities are integral to achieving success in immunization campaigns and safeguarding public health.

Strategies for Effective Communication

Effective communication strategies are essential for engaging with Gray House children and combating fake vaccination practices. These strategies should be culturally sensitive, community-driven, and inclusive of diverse stakeholders, including religious leaders, community influencers, and healthcare workers. Leveraging interpersonal communication, door-to-door outreach, and community mobilization efforts can help build trust and rapport with marginalized communities.

Engaging Community Influencers

Community influencers, including religious leaders, community elders, and local celebrities, wield significant influence in shaping public opinion and behavior, particularly concerning vaccination. Collaborating with these influencers can amplify pro-vaccination messages and combat misinformation within communities. Religious leaders, in particular, can leverage their authority to promote vaccination from a religious standpoint, addressing misconceptions and fostering vaccine acceptance among their followers. By involving a diverse array of influencers, stakeholders can effectively reach and mobilize communities to prioritize routine immunization, thereby advancing public health goals.

Healthcare Professionals as Influencers

Furthermore, healthcare professionals, such as child specialists, gynaecologists, and Lady Health Visitors (LHVs), serve as influential figures in promoting routine immunization. During check-ups, child specialists can educate families about the importance of vaccinations, addressing any concerns and emphasizing the health benefits for children. Similarly, gynaecologists and LHVs play crucial roles in educating pregnant women about vaccinations, including the Tetanus Toxoid (TT) injection and routine immunizations for their unborn child’s health. Leveraging the expertise and credibility of healthcare professionals as influencers can enhance awareness and uptake of vaccinations within communities.

Combatting Fake Vaccination Practices

Fake vaccination practices pose a grave threat to public health and undermine the integrity of polio eradication efforts. These practices encompass various deceitful tactics, such as falsifying vaccination records, distributing counterfeit vaccines, and coercing parents into refusing vaccination for their children. Addressing this issue demands a multifaceted approach that encompasses several key strategies.

Firstly, there is a pressing need to strengthen regulatory oversight to prevent the proliferation of fake vaccination schemes. This involves implementing stringent regulations and monitoring mechanisms to ensure the authenticity and safety of vaccines administered during vaccination campaigns.

Secondly, enhancing surveillance systems is paramount in detecting and responding to instances of fake vaccination promptly. Robust surveillance mechanisms can help identify areas or communities vulnerable to fake vaccination practices, allowing for targeted interventions and resource allocation.

Furthermore, promoting transparency and accountability within vaccination campaigns is essential for building public trust and confidence. Transparency in vaccine procurement, distribution, and administration processes can help dispel doubts and rumors surrounding vaccination efforts, while accountability mechanisms hold stakeholders accountable for their actions.

By implementing these strategies in tandem, stakeholders can effectively combat fake vaccination practices and safeguard the integrity of polio eradication initiatives, thereby ensuring the health and well-being of communities at risk.

Content Framework

Craft compelling messages emphasizing the importance of polio vaccination, addressing common misconceptions, and highlighting the benefits of immunization.

Budget Allocation

Allocate resources for influencer collaborations, content creation, and campaign monitoring, ensuring cost-effectiveness and maximum reach.

Identifying Influencers

Identifying influential figures within the community is crucial for effectively communicating vaccination messages and combating misinformation. Religious leaders, local celebrities, healthcare professionals, and community organizers are among the key influencers who can play a significant role in promoting vaccination. These influencers often have a wide reach and can effectively communicate the importance of vaccination to their followers and communities.

Religious leaders, in particular, hold significant influence over their congregations and can use their platform to dispel myths and misconceptions about vaccination. They can also emphasize the religious importance of protecting oneself and others from preventable diseases, aligning vaccination efforts with religious values and teachings.

Local celebrities are another influential group that can help promote vaccination. Their endorsement of vaccination can reach a broad audience and help counter misinformation spread through social media and other channels. Healthcare professionals, including doctors, nurses, and pharmacists, are trusted sources of information about vaccination and can provide accurate information to patients and communities.

Community organizers and leaders play a crucial role in mobilizing communities and raising awareness about vaccination campaigns. They can help identify and address barriers to vaccination, such as access issues or cultural beliefs, and ensure that vaccination efforts are inclusive and effective.

In addition to religious leaders and local celebrities, engaging female influencers such as teachers, lady doctors, and Lady Health Visitors (LHVs) can significantly impact vaccination uptake and combat misinformation. Female influencers hold unique positions of trust and authority within their communities, making them valuable assets in promoting vaccination campaigns.

Female teachers, as educators and role models, have direct access to children and their families. They can integrate vaccination messages into school curricula, conduct awareness sessions for parents, and address concerns about immunization in a familiar and trusted environment.

Lady doctors and healthcare professionals play a pivotal role in dispelling myths and fears surrounding vaccination. Their expertise and empathy enable them to address concerns effectively, provide accurate information, and encourage families to prioritize vaccination for their children’s health and well-being.

Lady Health Visitors (LHVs) are frontline healthcare workers who have established relationships with families in their communities. They provide essential maternal and child health services, making them trusted sources of information on vaccination. LHVs can conduct home visits, organize community events, and offer one-on-one counselling to promote vaccine acceptance and address any concerns or misconceptions.

Child specialists, including paediatricians and child psychologists, are also influential in promoting routine immunization. Their expertise in child health and development allows them to tailor vaccination messages to resonate with parents and caregivers. By emphasizing the benefits of vaccination for children’s long-term health and well-being, child specialists can motivate families to prioritize immunization.

Incorporating these influencers into vaccination campaigns can enhance community engagement, increase vaccine acceptance, and contribute to the success of polio eradication efforts by reaching marginalized populations effectively.

Outreach

Reach out to selected influencers with a clear proposal outlining the campaign objectives, content requirements, and expected outcomes. Ensure that influencers are aligned with the goals of the campaign and have credibility within their communities.

Launch Phase 1

Implement the initial influencer collaborations, monitoring key metrics such as reach, engagement, and audience response to gauge effectiveness.

Measuring Results

Analyze the impact of the campaign through metrics such as increased vaccination rates, community engagement, and changes in awareness and attitudes towards polio vaccination.

Launch Phase 2

Based on the success of initial collaborations, extend partnerships with influencers who demonstrate strong engagement and influence in their communities.

Adapt and Iterate

Continuously evaluate the campaign’s performance and refine strategies based on feedback and insights gathered from monitoring and evaluation activities. Adjust messaging and tactics as needed to optimize results and address emerging challenges.

Conclusion

In conclusion, addressing the challenges of vaccinating Gray House children in urban areas requires tailored communication strategies and engagement with community influencers. These children, often residing in marginalized communities, face obstacles such as misinformation, logistical challenges, and resistance to vaccination. By engaging religious leaders, healthcare professionals, and community organizers, stakeholders can build trust, dispel misconceptions, and enhance vaccine acceptance. Customized communication strategies, inclusive of diverse stakeholders, are essential for reaching these populations effectively. Moreover, combating fake vaccination practices demands regulatory oversight, surveillance enhancement, and transparency within vaccination campaigns. By leveraging the influence of key influencers and continuously refining communication approaches, stakeholders can advance toward the goal of polio eradication and safeguard public health.

 

LINKS OF INTEREST

   www.nhsrc.gov.pk

   www.polioeradication.org

https://dghs.punjab.gov.pk/extended_program_immunization   

   www.emro.who.int

   www.fda.gov

   www.immunize.org

   www.rotary.org

   www.cdc.gov

   www.vaccinetimes.com

   www.gatesfoundation.org

 

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Immunization Programs and Health Services

IN A NUTSHELL
Author's note
…Outbreaks have costs to the health system, the family, and the patients. Vaccines are cheaper than the costs of epidemiological management, hospitalizations, etc. The support of the system is crucial for reaching protective coverages. Adequate planning, training, coordination, and especially sustained financing are crucial for a functional immunization program.

 By Francisco  Becerra-Posada, MD, MPH, DrPH

 Immunization Programs and Health Services

 

Most countries have a vaccination program that most probably started as an independent vertical program. There is enough discussion and evidence of the pros and cons of this kind of interventions. Some examples had a positive impact, as the smallpox eradication program, and others failed due to a lack of coordination.[1]

Either way, vertical programs do have to coordinate and use the health services. Health services, as part of the health system, are key for the success of any program. Immunization programs are not the exemption.

When managing immunization programs, coordination is essential for its success. From the planning stage to calculate the demand according to the cohorts, to the logistics and operational issues, it has to coordinate with many instances within the health system. If any of the different areas fails, vaccines do not get to the clinics and people are not vaccinated.

During the pandemic, many preventive programs, and actions, were not available due to closing of clinics, moving health personnel to clinical work to care for COVID-19 patients. However, in many countries’ vaccine coverages were not the desired ones to ensure protection to the population and a decrease of coverage was seen.

However, there are signs of recuperation. WHO states that from 18.1 million children that had zero doses in 2021, decreased to 14.3 million in 2022, close to the pre-pandemic value of 12.9 million in 2019. A slight increase, from 81% in 2021 to 83% in 2022 for measles vaccination, is still below the 2019 value of 86%. Vaccination against DPT (diphtheria, tetanus, and pertussis vaccine) recovered from 81 (2021) to 84% in 2022.[2]

Outbreaks, commonly in countries with weak immunization programs, are now being detected worldwide. There are various outbreaks worldwide and developed and high-income countries are reporting outbreaks. The US has recently reported measles outbreaks in various states.[3] Approaches to deal with them have varied, from very by the book approaches, to an unusual approach in Florida where health authorities diminished the problem.[4] Europe has recently reported a diphtheria outbreak with a focus on the Czech Republic and the first death by the disease since 1969.[5]

Health systems and services are important to ensure that vaccination programs are managed in and efficient and effective way. Cold chain has to be preserved and functional during the whole logistic chain, from the producer to the country, to the clinic, to the person’s arm. Vaccines have to be seen under a vision of life course. Health personnel, be it at the Primary Health Care setting to the specialized care, have a role to play as vaccine promotors. OB/GYN with pregnant women for influenza and diphtheria; internal medicine, cardiologist, pneumologist, with patients with hypertension, diabetes, obesity, should receive influenza vaccines on time.

Outbreaks have costs to the health system, the family, and the patients. Vaccines are cheaper than the costs of epidemiological management, hospitalizations, etc. The support of the system is crucial for reaching protective coverages. Adequate planning, training, coordination, and especially sustained financing are crucial for a functional immunization program.

 

References

[1] Cairncross S, Peries H, Cutts F; Vertical health programmes, Lancet 1999; 349 (supl III):20-22 https://doi.org/10.1016/S0140-6736(97)90079-9

[2] Vaccines and immunization, https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1

[3] Measles Cases and Outbreaks, CDC at https://www.cdc.gov/measles/cases-outbreaks.html

[4] Florida refuses to bar unvaccinated children from school suffering  a measles outbreak https://apnews.com/article/measles-outbreak-florida-school-ladapo-259440881f1d5e11dc69ed64ff055418

[5] Muerte por Difteria en Praga, república Checa. https://fundacionio.com/muerte-por-difteria-en-praga-republica-checa/ (in Spanish)

 

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Bridging the Gap: Elevating Preventive Healthcare in Pakistan’s Health Agenda

IN A NUTSHELL
Author's note
In the intricate web of Pakistan's healthcare landscape, one critical thread often remains overlooked: preventive healthcare. While the nation grapples with numerous health challenges, the focus has predominantly been on treatment and cure, sidelining the crucial role of prevention. This article sheds light on the pressing need to elevate preventive healthcare in Pakistan's health agenda and explores the multifaceted dimensions of this neglected aspect

By Muhammad Noman

Healthcare System, CHIP Training and Consulting

Quetta, Balochistan Pakistan

Elevating Preventive Healthcare in Pakistan’s Health Agenda

Bridging the Gap

 

The Prevalent Disparity

Pakistan’s healthcare system is characterized by a stark disparity between investments in curative services and preventive measures. The private sector, driven by profit motives, heavily invests in hospitals and specialized treatments, relegating preventive healthcare initiatives to the sidelines. Consequently, preventive services struggle to gain traction and resources, perpetuating a cycle of illness and treatment rather than proactive health maintenance.

The prevalent disparity in Pakistan’s healthcare system between investments in curative services and preventive measures underscores a fundamental imbalance in healthcare priorities. While the country boasts a robust network of hospitals and specialized treatment facilities, preventive healthcare initiatives often languish in the shadows, receiving inadequate attention and resources. This imbalance perpetuates a cycle of reactive healthcare, where illnesses are treated after they manifest rather than being proactively prevented.

At the heart of this disparity lies the orientation of the private sector towards profit-driven healthcare models. Private healthcare entities predominantly invest in hospitals and advanced treatment modalities, which yield higher returns on investment compared to preventive interventions. Consequently, preventive healthcare services struggle to garner the same level of financial support and infrastructure development, creating a lopsided healthcare landscape where treatment takes precedence over prevention.

In communities across Pakistan, this disparity manifests in the prevailing mindset that prioritizes seeking medical attention only when illness strikes. Preventive measures such as regular health check-ups, vaccination drives, and lifestyle modifications often take a backseat, as individuals and communities focus on addressing immediate health concerns rather than proactively safeguarding their well-being. This reactive approach perpetuates the burden of disease and contributes to the escalating healthcare costs associated with managing preventable illnesses.

Moreover, the policy landscape exacerbates this disparity, with government healthcare policies predominantly centered around building hospitals and expanding access to curative services. While these initiatives are essential for addressing acute healthcare needs, they often neglect the foundational role of prevention in promoting population health and reducing the burden of disease. The lack of cohesive preventive healthcare policies reflects a systemic failure to recognize the long-term benefits of investing in prevention.

Addressing the prevalent disparity in Pakistan’s healthcare system requires a paradigm shift in healthcare priorities and resource allocation. Governments must recognize the intrinsic value of preventive healthcare and prioritize the development and implementation of comprehensive preventive healthcare policies. This includes investing in public health infrastructure, promoting health education and awareness campaigns, and incentivizing preventive healthcare practices at the community level.

Additionally, private sector entities have a vital role to play in bridging this disparity by redirecting investments towards preventive healthcare initiatives. By aligning profit motives with public health goals, private healthcare providers can contribute to building a more balanced healthcare system that prioritizes both treatment and prevention.

Community Perceptions and Practices

In communities across Pakistan, there exists a prevailing mindset that prioritizes seeking medical attention only when illness strikes, rather than adopting preventive measures to safeguard health. This reactive approach undermines the significance of preventive interventions and perpetuates the burden of disease. Community awareness and education on the importance of prevention are crucial to fostering a culture of proactive health-seeking behavior.

Community perceptions and practices play a pivotal role in shaping healthcare outcomes and the effectiveness of public health interventions. In Pakistan, as in many other countries, these perceptions and practices are influenced by a multitude of factors including cultural beliefs, socioeconomic status, access to healthcare services, and exposure to health education. Understanding and addressing these community dynamics are essential for designing targeted and culturally appropriate health interventions that resonate with the population’s needs and values.

One of the key aspects of community perceptions is the cultural beliefs surrounding health and illness. In Pakistan, traditional healing practices and folk remedies often coexist alongside modern healthcare systems. Many communities rely on traditional healers, herbal medicines, and religious rituals to address health issues, particularly in rural areas where access to formal healthcare services may be limited. Understanding and respecting these cultural beliefs are crucial for healthcare providers and policymakers seeking to engage with these communities effectively.

Socioeconomic factors also play a significant role in shaping community perceptions and practices related to health. In Pakistan, disparities in income, education, and access to healthcare services contribute to differential health outcomes among different socioeconomic groups. For example, individuals from lower-income households may face barriers such as cost-related access issues, limited health literacy, and a lack of awareness about preventive healthcare practices. As a result, they may be more likely to rely on home remedies or delay seeking medical care until conditions worsen.

Access to healthcare services is another critical determinant of community perceptions and practices. In rural and remote areas of Pakistan, where healthcare facilities are scarce, communities may have limited options for seeking medical care. This can lead to a reliance on informal healthcare providers or traditional healers, who may not always adhere to evidence-based practices or standards of care. Improving access to quality healthcare services, especially in underserved areas, is essential for empowering communities to make informed decisions about their health.

Health education and awareness initiatives play a vital role in shaping community perceptions and practices towards health. By providing culturally sensitive and linguistically appropriate health information, these programs can help dispel myths, promote healthy behaviors, and encourage preventive healthcare practices. Community-based approaches, such as peer education and community health workers, can be particularly effective in reaching marginalized populations and addressing specific health concerns within local contexts.

In conclusion, understanding and addressing community perceptions and practices are essential for promoting public health and improving healthcare outcomes in Pakistan. By recognizing the cultural, socioeconomic, and access-related factors that influence these dynamics, policymakers and healthcare providers can develop targeted interventions that empower communities to take control of their health. Through collaborative efforts that prioritize community engagement and participation, Pakistan can work towards building a healthier and more resilient society for all its citizens.

Policy Disconnect

The policy disconnect in Pakistan’s healthcare system reflects a misalignment between healthcare policies and the actual needs and realities of the population. Despite investments in healthcare infrastructure and services, there is often a lack of emphasis on preventive healthcare measures and community health promotion. This disconnect is evident in several areas:

  1. Focus on Curative Care: Healthcare policies often prioritize curative care over preventive measures. While hospitals and specialized care facilities receive significant attention and resources, efforts to promote community health, prevent diseases, and address social determinants of health are relatively neglected.
  2. Limited Investment in Prevention: Preventive healthcare measures, such as vaccination programs, health education initiatives, and early screening for diseases, receive insufficient investment and attention compared to curative interventions. This imbalance perpetuates the cycle of illness and disease rather than addressing root causes and promoting wellness.
  3. Fragmented Approach: Healthcare policies may lack coherence and integration across different sectors and levels of government. This fragmentation leads to inefficiencies, gaps in service delivery, and duplication of efforts, hindering the overall effectiveness of healthcare programs.
  4. Insufficient Community Engagement: Policies often fail to adequately involve communities in decision-making processes and health promotion activities. This lack of community engagement results in limited awareness, poor health-seeking behaviors, and barriers to accessing healthcare services, particularly among marginalized populations.
  5. Inadequate Public-Private Collaboration: There is often a disconnect between the public and private healthcare sectors, with limited collaboration and coordination between the two. While the private sector plays a significant role in healthcare service delivery, especially in urban areas, there is a need for greater alignment with public health priorities and policies.

Addressing the policy disconnect in Pakistan’s healthcare system requires a comprehensive approach that prioritizes preventive healthcare, fosters multi-sectoral collaboration, empowers communities, and promotes equity in healthcare access and delivery. By bridging the gap between policy intentions and implementation realities, Pakistan can improve health outcomes and enhance the well-being of its population.

The Imperative for Change

The neglect of preventive healthcare in Pakistan’s health agenda is not merely a policy oversight but a systemic failure with far-reaching consequences. Prevention not only reduces the burden of disease but also promotes overall well-being and saves healthcare costs in the long run. By prioritizing prevention, governments can mitigate the incidence of diseases and improve the health outcomes of the population, ultimately leading to a healthier and more resilient society.

The imperative for change in Pakistan’s healthcare system is clear, given the persistent challenges and disparities in health outcomes. Several key areas require urgent attention to bridge the gap between policy intentions and implementation realities:

  1. Shift Towards Preventive Healthcare: There is a critical need to prioritize preventive healthcare measures, including health education, vaccination programs, and early screening for diseases. This shift can help reduce the burden of disease and improve overall health outcomes.
  2. Enhanced Community Engagement: Policies should focus on empowering communities to take charge of their health through active participation in health promotion activities and decision-making processes. Community-based approaches can lead to more effective and sustainable health interventions.
  3. Integrated Health Policies: Healthcare policies should be integrated across sectors and levels of government to ensure coherence and effectiveness. This includes aligning health priorities with broader development goals and coordinating efforts among various stakeholders.
  4. Public-Private Collaboration: There is a need for greater collaboration between the public and private healthcare sectors to leverage resources, improve service delivery, and enhance access to healthcare services, particularly in underserved areas.
  5. Focus on Equity: Policies should prioritize equity in healthcare access and delivery, ensuring that vulnerable and marginalized populations receive the care they need. This includes addressing social determinants of health and reducing disparities in health outcomes.
  6. Enhanced Monitoring and Evaluation: A robust monitoring and evaluation framework is essential to track progress, identify gaps, and inform policy decisions. This includes regular assessment of healthcare services, health outcomes, and the impact of policies on population health.
  7. Capacity Building: Investment in healthcare workforce development and infrastructure is crucial to strengthen the healthcare system’s capacity to deliver quality care. This includes training healthcare professionals, improving facilities, and enhancing service delivery mechanisms.
  8. Policy Advocacy and Implementation: There is a need for strong policy advocacy and political commitment to drive change in the healthcare system. Policies should be evidence-based, responsive to local needs, and implemented effectively to achieve desired health outcomes.

By addressing these key areas, Pakistan can build a more resilient and responsive healthcare system that meets the needs of its population, improves health outcomes, and contributes to sustainable development.

A Call to Action: Transforming Pakistan’s Healthcare System

Addressing the gap in preventive healthcare requires concerted efforts from all stakeholders – governments, private sectors, and communities. Governments must develop and implement comprehensive policies that prioritize preventive interventions, including awareness campaigns, vaccination programs, and lifestyle interventions. Private sector entities should invest in preventive healthcare initiatives, recognizing the long-term benefits for both individuals and society.

Pakistan stands at a crossroads in its healthcare journey, facing persistent challenges and disparities that hinder progress towards better health outcomes for all. As we reflect on the current state of healthcare in the country, it becomes increasingly clear that bold and decisive action is needed to address the underlying issues and pave the way for a healthier future.

  1. Prioritize Prevention: We must shift our focus from a predominantly curative approach to one that emphasizes preventive healthcare. Investing in health education, vaccination programs, and early disease detection can help reduce the burden of illness and improve overall well-being.

2. Empower Communities: Engaging communities as active partners in healthcare delivery is essential. By involving local residents in decision-making processes and empowering them to take ownership of their health, we can foster a culture of wellness and self-care.

  1. Integrate Health Policies: Healthcare policies must be integrated across sectors and levels of government to ensure coherence and effectiveness. This includes aligning health priorities with broader development goals and coordinating efforts among various stakeholders.
  2. Foster Public-Private Collaboration: Collaboration between the public and private healthcare sectors is key to expanding access to quality services and leveraging resources efficiently. By forging partnerships and sharing expertise, we can strengthen the healthcare system and reach more people in need.
  3. Promote Equity: We must prioritize equity in healthcare access and delivery, ensuring that vulnerable and marginalized populations receive the care they deserve. Addressing social determinants of health and reducing disparities are essential steps towards achieving health equity.
  4. Enhance Monitoring and Evaluation: A robust monitoring and evaluation framework is critical for tracking progress, identifying gaps, and informing policy decisions. By regularly assessing healthcare services and outcomes, we can ensure that our efforts are yielding tangible results.
  5. Invest in Capacity Building: Investing in healthcare workforce development and infrastructure is essential for building a resilient and responsive healthcare system. By training healthcare professionals, improving facilities, and enhancing service delivery mechanisms, we can strengthen our healthcare infrastructure and better meet the needs of our population.
  6. Advocate for Change: Strong policy advocacy and political commitment are essential for driving transformative change in the healthcare sector. By advocating for evidence-based policies and holding decision-makers accountable, we can create an environment conducive to positive health outcomes.

It is time for all stakeholders – government agencies, healthcare providers, civil society organizations, and individuals – to come together in a concerted effort to transform Pakistan’s healthcare system. By working collaboratively and taking decisive action, we can build a healthier, more prosperous future for our nation. The time for action is now.

Conclusion

In Pakistan’s healthcare landscape, the disparity between investments in curative care and preventive measures persists, hindering progress towards better health outcomes for all. The neglect of preventive healthcare initiatives reflects a systemic failure that requires urgent attention and action.

Addressing this disparity requires a multifaceted approach that prioritizes prevention, empowers communities, integrates health policies, fosters public-private collaboration, promotes equity, enhances monitoring and evaluation, invests in capacity building, and advocates for change.

By bridging the gap between treatment and prevention, Pakistan can pave the way for a healthier future. It’s time for all stakeholders – governments, private sectors, communities, and individuals – to come together and prioritize preventive healthcare in the nation’s health agenda. Through collective action and a renewed commitment to preventive measures, Pakistan can overcome its health challenges and build a resilient healthcare system that prioritizes the well-being of its people. The time for action is now.

 

LINKS OF INTEREST 


www.nhsrc.gov.pk

 www.polioeradication.org

 https://dghs.punjab.gov.pk/extended_program_immunization

 www.emro.who.int 

 www.fda.gov

  www.immunize.org

  www.rotary.org

  www.cdc.gov

  www.vaccinetimes.com

  www.gatesfoundation.org

By the same Author on PEAH 

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Wavering Sexuality During Covid Pandemic

IN A NUTSHELL
Editor's Note

An exhaustive overview here on sexuality multifaceted flux during recent COVID pandemic, whereby attention is paid to aspects including sexual desires, virtual intimacy, dynamics of isolation, sexual health services, among other relevant issues.  

As the Authors maintain, this essay …serves as a reminder of our collective strength, adaptability, and our ever-present desire to connect, even when the world feels fractured. It is an exploration that celebrates the resilience of humankind, fostering a deeper understanding of our own desires while providing solace in the pursuit of intimacy…

…Fragmented by the disruptive forces of the COVID-19 pandemic, this exploration of human sexuality is both a reflection of our collective experiences and an unyielding search for connection in a time of isolation.

By Subhash Hira, MD, MPH

Professor of Global Health, University of Washington, Seattle, USA

and Rajiv Hira, MD, MPH

Former Assistant Professor, Intervention Radiology, LTMG Medical College Hospital, Mumbai, India

Wavering Sexuality During Covid Pandemic

 

Introduction

In an era of Covid-19 pandemic where physical connection became elusive and intimacy got transformed, this essay on human sexuality emerges as a testament to our resilience, adaptability, and the enduring quest for a deeper understanding of our own sexual desires. Fragmented by the disruptive forces of the COVID-19 pandemic, this exploration of human sexuality is both a reflection of our collective experiences and an unyielding search for connection in a time of isolation.

Human sexuality is a complex and multifaceted topic that has evolved over billions of years. While the study of human sexuality began relatively recently in comparison, say around the late 19th and early 20th centuries, it is essential to understand the broader context of sexual evolution and behavior throughout history. During prehistoric times when human beings were evolving, say approximately 4 to 6 million years ago, our ancestors exhibited sexual behaviors that were primarily aimed at reproduction and ensuring the survival of the species. While precise details are scarce due to the limited evidence, it is believed that early humans engaged in heterosexual mating patterns, similar to other primates. Later, with ancient civilizations and cultures such as Mesopotamia, ancient Egypt, and the Indus Valley’s ancient site called ‘Mohenjo-Daro’ witnessed the development of more complex social structures and belief systems. These societies often associated sexuality with religious and cultural practices. While information on sexual behavior during these eras is mostly derived from artwork, it suggests that the ancient Egyptians celebrated sexual pleasure and fertility, while the Mesopotamians and Indus Valley believed in fertility rituals and sexual equality.

During the Classical Period, the ancient Greeks and Romans were well-known for their diverse perspectives on human sexuality. In ancient Greece, sexual relationships between men were common, alongside with heterosexual relationships for procreation. This phenomenon is known as pederasty, which typically involved an older man mentoring a younger adolescent. Ancient Roman society also exhibited a more open attitude towards sexuality, with practices such as bisexuality and orgies. With the advent of Middle Ages, and the rise of Christianity in Europe, the Middle Ages witnessed a shift in sexual attitudes. The Church played a significant role in shaping sexual morality and emphasized the necessity of procreation within the confines of marriage. Extra-marital sexual activities were condemned and considered sinful. This period also saw the rise of ‘courtly love’, an idealized form of love, romance, flirting, dancing that was illicit but that influenced how people viewed relationships and sexuality. However, during the Renaissance and Enlightenment periods, a more nuanced understanding of human sexuality began to emerge. Scholars explored various aspects of sexuality, often challenging and critiquing the Christian teachings. Figures like Leonardo da Vinci and Michelangelo explored the male form in their artwork, while philosophers like John Locke and Jean-Jacques Rousseau questioned prevailing societal norms. Sexual sculptures and carvings in ancient temples and caves of India, Thailand, Indonesia were used to document sexual postures of ‘Kamasutra’ for teaching and learnings for adolescents.

The field of sexology emerged during the late 19th and early 20th centuries, marking a shift towards scientific study and understanding of human sexuality. Figures like Sigmund Freud, Havelock Ellis, and Alfred Kinsey made significant contributions, revolutionizing the understanding of sexual orientation, gender identity, and sexual behaviors. This period saw the beginning of exploring and understanding diverse sexual orientations, such as homosexuality and bisexuality. Lately contemporary times starting with the mid-20th century, more liberal attitudes towards human sexuality have continued to evolve. The sexual revolution of the 1960s and 1970s challenged traditional norms and brought discussions surrounding contraception, reproductive rights, and sexual freedom with multiple sex partners to the forefront. The ongoing fight for LGBTQ+ rights, gender equality, and sexual education has further shaped modern attitudes and understanding of human sexuality. The knowledge accumulated over years was deflected back into the sexual practice itself in order to shape it as though it came from within and amplify its effect. In this way sexual partners were counselled that knowledge must remain secret, not because an element of infamy that might be attached to it but because of the need to hold it in great reserve for future generations. According to tradition, it was taught that sexual knowledge will lose its effectiveness and its virtue by being divulged. Consequently, relationship with the master who holds the secrets was of paramount importance. The norm ‘to keep this knowledge secret’ is now broken because there is a need felt by the state to understand more about transmission of infections in order to control pandemics. In conclusion, the history of human sexuality spans billions of years, reflecting the complex interplay between biology, culture, and societal norms. It is a continuously evolving field of study that remains a crucial aspect of human existence and shows no signs of diminishing in significance.

There are a variety of reasons why young adults may engage in multiple sex partners. It is important to note that not all young adults engage in this behavior, and individual motivations also vary greatly. However, some potential reasons may include:

  1. Exploration and curiosity: Young adulthood is typically a time of self-discovery and exploration, including exploring one’s own sexuality. Engaging in multiple sexual partners can be a way for some individuals to satisfy their curiosity and learn more about their own desires and preferences.
  2. Lack of commitment: Young adulthood is often a period of transition, exploration, and personal growth. Some individuals may prioritize personal and career goals over committed relationships. Engaging in multiple sex partners may offer a sense of freedom and avoid the perceived commitment and responsibilities of a monogamous relationship.
  3. Social and peer pressures: Social norms and peer influence can play a significant role in shaping sexual behavior. Some young adults may feel pressured to conform to societal expectations or the actions of their peers, which may include having multiple sexual partners.
  4. Desire for variety and excitement: Some young adults may value novelty and variety in their sexual experiences. Engaging in multiple sex partners can offer a sense of excitement, newness, and exploration in their intimate relationships.
  5. Emotional fulfilment: Some individuals may seek emotional connection and validation through sexual encounters. Engaging in multiple sexual relationships allows for the potential to fulfil emotional needs with multiple partners.
  6. Concerns about long-term commitment: Past experiences, personal beliefs, or a fear of commitment may lead some young adults to prefer non-monogamous relationships. Engaging in multiple sex partners can provide a sense of freedom and avoid the potential pressures and expectations of a long-term commitment.

It is vital to remember that everyone’s motivations and experiences are unique, and the decision to have multiple sex partners should always be consensual and based on personal preference, mutual respect, and safe practices.

There could be several reasons why some elderly individuals opt for multiple sex partners:

  1. Increased life expectancy: With advancements in healthcare and better overall quality of life, people are living longer. For example, the average life expectancy of female-to-male in Japan is 87:82 years; in Europe is 83:78; in North America is 79:73; in India is 69:66, in Africa is 64:57 years, respectively. As a result, they may have more opportunities and desires for sexual experiences.
  2. Freedom and liberation: Some elderly individuals may feel freer to explore their sexuality later in life, as varied societal norms and expectations around sexuality have evolved. They may no longer have familial responsibilities or societal pressures, allowing them to embrace their desires and seek multiple partners.
  3. Desire for companionship and intimacy: Loneliness is a common issue among the elderly, especially those who may have lost a long-term partner or experienced significant life changes. Seeking multiple sex partners can be a way to fulfil their need for companionship, intimacy, and human connection.
  4. Increased confidence and better self-image: As people age, they may develop a stronger sense of self and increased self-assurance, which can positively impact their sexual behavior. This newfound confidence may lead them to seek out multiple sex partners.
  5. Sexual fulfilment and pleasure: Sexual desire and pleasure do not diminish with age; in fact, some studies suggest that older individuals may experience increased sexual satisfaction due to decreased performance anxiety and enhanced self-acceptance. Seeking multiple sex partners can help fulfil their sexual desires and provide a source of pleasure.

Regardless of these reasons, it’s important to remember that individual preferences and choices vary greatly, and not all elderly individuals opt for multiple sex partners. It is essential for everyone, regardless of age, to engage in consensual and safe sexual practices.

During Covid-19 pandemic, the following important areas of human sexuality were affected: sexual desires,

1: Defining Sexual Desires

In a world that suddenly closed down and turned inward, the first chapter delves into the complexities of desires, attempting to untangle its intricate web. From the profound longing for physical touch to the exploration of newfound pleasures within the confines of our homes, we examine the shifting landscape of human sexuality, navigating through the fragments of restrained intimacy to avoid Corona virus transmission.

The anatomy and physiology of sexual desire refers to the biological components and processes that contribute to the desire or interest in engaging in sexual activity that ranged between foreplay to penetrative sex.

Anatomy: The anatomical aspects of sexual desire involve various structures and organs in the human body that play a role in the experience of sexual desire. These include:

  1. Brain: The brain is a crucial organ that regulates sexual desire. Certain regions, such as the hypothalamus and limbic system, are particularly involved in processing sexual stimuli and generating sexual desire.
  2. Hormones: Hormones, such as testosterone in males and oestrogen/ progesterone in females, play a key role in sexual desire. These hormones are secreted by the reproductive organs and affect the brain regions involved in sexual motivation. Dopamine and oxytocin from the Pituitary gland in the brain, also known as happy hormones, stimulate and control sexual desire.
  3. Genitalia: Sexual desire involves activation of specific genital structures, such as the penis and clitoris, which have rich nerve endings that enhance sexual pleasure.

Physiology: The physiological processes related to sexual desire encompass various mechanisms and events that occur in the body during sexual arousal. These include:

  1. Neuro-transmitters: Neurotransmitters, such as dopamine and serotonin, are involved in regulating sexual desire. They act on the brain’s reward and pleasure frontal centers, contributing to the feeling of desire and excitement.
  2. Blood flow: Sexual desire leads to increased blood flow to the genital region, resulting in engorgement and erection of the penis in males and clitoral swelling in females. This increased blood flow is facilitated by the dilation of blood vessels, ensuring adequate oxygenation and promoting sexual response.
  3. Nerve signalling: Nerves play a critical role in transmitting signals from the genital area to the brain, and vice versa. Sensory nerve endings in the genitalia detect sensations and send signals to the brain, triggering sexual desire. Any damage or slowing of nerve conduction due to diabetes or neuropathies cause loss of sexual desire, also known in lay terms as libido.
  4. Psychological factors: While the focus is primarily on anatomy and physiology, it’s important to note that psychological factors, such as emotions, thoughts, and experiences, also influence sexual desire. Psychological arousal and context can affect the physiology of sexual desire, amplifying or inhibiting sexual motivation. Thus, understanding the anatomy and physiology of sexual desire can help shed light on the complex interplay between the body, brain, and psychological factors that contribute to human sexuality. 

2: Virtual Intimacy

The pandemic propelled us into an unprecedented digital realm, where internet-empowered screens and computers became the conduits of human connection. Here, as we dipped into the domain of virtual intimacy, exploring the intricacies of online dating, sexting, and the surge of virtual platforms that expanded the boundaries of sexual exploration. Despite the restricted continuity of physical proximity due to the pandemic, these fragments of intimacy thrived amidst the personal, economic, health, social, and environmental chaos unleashed by Covid-19.

During the pandemic, virtual intimacy served as a means to maintain and foster connections with friends, relatives, jobs, and loved ones while practicing social distancing. Here are some ways virtual intimacy was used during such times:

  1. Video calls: Platforms like Zoom, FaceTime, or Skype allowed people to have face-to-face conversations with their loved ones. This helped maintain a sense of connection and intimacy, overcoming physical barriers.
  2. Online dating: Virtual dating platforms provided opportunities for individuals to establish new relationships or maintain existing ones during the pandemic. Video chats, messaging, and other virtual tools helped facilitate getting to know someone and fostering emotional bonds.
  3. Online support groups and psychotherapy: Many individuals relied on support groups and psychotherapy to cope with difficulties during the pandemic. Virtual platforms offered an effective way to access these services, providing a sense of emotional intimacy and support through sharing experiences and seeking professional guidance.
  4. Online gaming: Playing multiplayer games online provided an avenue for social interaction and intimacy during pandemics. Collaborative gameplay allowed individuals to connect, communicate, and build relationships with fellow gamers, fostering a sense of camaraderie.
  5. Virtual events and gatherings: Organizing virtual parties, reunions, or celebrations allowed people to connect and celebrate special occasions together while maintaining social distancing. Virtual platforms offered options for group video calls, shared activities, and interactive experiences, simulating real-life social gatherings.
  6. Long-distance relationships: Virtual intimacy became crucial for couples in long-distance relationships during the pandemic. Regular communication through video calls, messages, and virtual date nights helped maintain emotional and hormonal closeness and preserved the romantic connection despite physical separation.
  7. Sharing personal moments online: Social media platforms was used to share personal stories, photos, or videos, allowing individuals to feel connected and involved in each other’s lives. This helps overcome the absence of physical interactions and fostered a sense of intimacy with a wider network. Virtual intimacy during pandemic, while it did not fully replace physical intimacy, served as an essential tool to mitigate the effects of isolation, loneliness, and uncertainty. It acted as a bridge, providing moments of emotional connection, support, and social interactions, helping individuals navigate challenging times while staying safe from infections.

3: The Dynamics of Isolation

Human sexuality is intricately intertwined with our social fabric, and the isolation imposed by COVID-19 interrupted these delicate threads of our social life. Chapter three examines the profound impact of social distancing, exploring the human longing for touch, hug, kiss, fondling etc and the challenges of maintaining relationships at a distance. Instead, the novel virtual ways in which individuals adapted to sustain emotional and sexual connections.

The dynamics of isolation during COVID-19 restrictions were complex and varied among individuals and communities. It’s important to note that the dynamics of isolation varied across regions depending on the severity and duration of COVID-19 restrictions, as well as the effectiveness of government measures and community adherence to guidelines. Here are some key points:

  1. Social distancing, masking, and hand hygiene: Governments worldwide implemented social distancing guidelines of minimum distance of 6 feet. A variety of face masks, including those made of cotton cloth having a layer of satin and frequent use of hand sanitisers were recommended but these received limited compliance. These led to reduced physical interactions, limiting social gatherings, and increasing isolation.
  2. Quarantine by local health authorities versus self-isolation: Individuals who tested positive for COVID-19 or had been exposed to someone with the virus were required to self-isolate or quarantine for periods ranging between 7-14 days. This involved staying at home and avoiding contact with others, leading to extended periods of solitude and separation.
  3. Workplace and school closures: Many workplaces and educational institutions were temporarily closed or shifted to remote work and online learning. This disruption to daily routines contributed to isolation, as people were physically separated from their co-workers, classmates, and friends.
  4. Restricted travel and border closures: International and domestic travel restrictions were implemented to prevent the spread of the virus. This led to isolation not only within countries but also globally, as people were unable to visit or be visited by their loved ones living in other regions or countries.
  5. Mental health impact: The extended periods of isolation resulted in increased feelings of loneliness, depression, irritability, and anxiety for many individuals. Lack of social support and limited access to mental health services further exacerbated mental health challenges.
  6. Technology and virtual connections: The use of technology played a crucial role in mitigating the effects of isolation. Virtual platforms and social media allowed people to stay connected with friends and family, work remotely, and attend online to social and cultural events.
  7. Economic impact: COVID-19 restrictions and subsequent job losses or reduced working hours impacted many individuals economically. Financial stress and uncertainty contributed to increased social isolation as people faced challenges in maintaining social connections and participating in activities.

4: Redefining sexual relationships based on sexual pandemics

The pandemic forced us to re-evaluate the very foundation of our relationships and necessitated a redefinition of love, commitment, and companionship. Fragmented by the mental, emotional, and physical constraints of COVID-19, chapter four delves into the various forms of relationships that emerged – from the vitality of long-distance love to navigating the complexities of polyamory (desire for romantic relationships with more than one partner at the same time, mostly considered as illicit) during times marked by physical separation.

  1. Lack of sexual education: One of the crucial lessons learned from the HIV/AIDS and STI pandemics is the importance of comprehensive sexual education. Many individuals did not have access to adequate information about safe sex practices, leading to the rapid spread of these diseases. Proper education programs can help individuals make informed decisions about their desires, frequency, and sexual health, reducing the risk of disease transmission.
  2. Stigma and discrimination: The pandemics highlighted the harmful impact of stigma and discrimination on individuals living with HIV/AIDS and other STIs. This not only created barriers for people to seek testing and treatment but also contributed to the spread of these diseases by driving people underground and making it harder to access preventative measures.
  3. Importance of prevention methods: The HIV/AIDS and STI pandemics highlighted the urgent need for effective prevention methods, such as condoms, pre-exposure prophylaxis, and vaccinations (where available). These prevention measures, when widely accessible and utilized, can significantly reduce the transmission rates of these diseases.
  4. Global collaboration and awareness: The pandemics emphasized the importance of international collaboration and awareness campaigns. Joint efforts by governments, non-profit organizations, and healthcare providers have been crucial in raising awareness about safe sex practices, reducing stigma, and ensuring access to testing and treatment for all individuals.
  5. Holistic approach to healthcare: The HIV/AIDS and STI pandemics highlighted the significance of a holistic approach to healthcare, including integrating sexual healthcare into primary healthcare systems. By recognizing sexual health as an integral part of overall well-being, individuals are more likely to seek timely testing, treatment, and follow-up care.
  6. Access to healthcare services: Another important lesson learned during Covid pandemic was the need for accessible and affordable healthcare services. Lack of access to healthcare, especially for marginalized populations, has contributed to the spread of HIV/AIDS and STIs. Addressing structural barriers to healthcare access is essential in preventing and controlling future pandemics.
  7. Research and development: The pandemics have underscored the importance of ongoing research and development efforts to improve diagnostic tools, treatment options, coping skills, and potential vaccines. Continued investment in science and research is crucial in developing effective strategies to combat future pandemics related to sexual transmission.
  8. Communication and information dissemination: The pandemics taught us the importance of effective communication and information dissemination. Clear and accurate messaging, targeted outreach efforts, and community engagement are essential in spreading awareness about sexual health, prevention measures, and available resources. Overall, the lessons learned from the HIV/AIDS and STI pandemics of the 20th century highlight the need for comprehensive sexual education, prevention methods, global collaboration, accessible healthcare services, and ongoing research to control and prevent the spread of sexually transmitted infections.

5: Sexual Health Services during the pandemic

As the world grappled with a devastating Corona virus, attention to sexual health and safety became pivotal, but paradoxically, more complex. This chapter unravels the fragmented landscape of sexual health services during the pandemic, examining the impact on reproductive rights, the rise of telemedicine, and the unique challenges faced by marginalized communities. The case study presented here highlights many issues of personal relationship that became challenging to individuals in Mumbai in 2021.

A young married couple was trying to cope with their social and sexual needs during the Covid pandemic. Husband was working as a plumber in northern suburb of Mumbai and lived in a rented shack. His wife worked as a secretary in a small garment company in a nearby suburb. In April 2020, the national unemployment rate had reached a record high of 23.52% during the national Covid lockdown and both were rendered without jobs. But the second wave delivered another hit to the job market in April and May 2021. Almost for a year, they spent increasing time together! The usual complaint of many families to counsellors was that had to adjust to spending more time together at home due to lockdowns and social distancing measures. While this has provided opportunities for quality family time, it has also posed challenges in terms of maintaining work-life balance and dealing with potential conflicts arising from increased togetherness. Their sexual frequency had reduced from once or twice a week to once a fortnight. Their relationships with identical families in neighbouring shacks became more intimate and they got introduced to consensual partner swapping. In a way, what each partner was otherwise doing individually in terms of multi-partner sex outside the home before the Covid pandemic changed its character to consensual partner exchange; more of a barter system than exchange of scarce cash outside the home. Their episodes of respiratory infections and genital illnesses appeared almost twice a month and counselling on phone as to how to avoid face-to-face sex and use of condoms with casual partners did not get their acceptance. (Posture figure of CDC was shared with the couple on social media) Their bartering of partners in the neighbourhood continued unabated till early 2022 when the couple gradually went back to their workplaces but continued their old and new patterns of sexuality. Again, they ignored compliance with Covid posture and mask, and HIV/AIDS/STI prevention with condom use (sexual tree). They continued to ignore testing and insisted on taking antibiotics whenever infections set in.

6: Healing and reconnection with receding pandemic

Amidst the chaos and fragmentation of psychosexual fabric of communities, humans possess an innate ability to heal and reconnect. The final chapter explores the transformative power of resilience and offers guidance on navigating the fragments of intimacy left behind by the pandemic. From self-exploration to erotic imaginations, we delve into the diverse ways individuals work towards reclaiming and rebuilding their sexual selves.

Despite the uncertainty and unpredictability of COVID-19, our innate human sexuality persistently shines amidst the fragments. This essay serves as a reminder of our collective strength, adaptability, and our ever-present desire to connect, even when the world feels fractured. It is an exploration that celebrates the resilience of humankind, fostering a deeper understanding of our own desires while providing solace in the pursuit of intimacy. Finally, for solace and healing we involved sexual counselling that helped to embrace fragments.

Sexual counselling for responsible sex can encompass a range of topics and approaches, depending on the specific needs and concerns of individuals or couples seeking guidance. Here are some key areas that sexual counselling for responsible sex should focus on:

  1. Education and information: Sexual counsellors provide accurate and reliable information about sexual health, contraception, sexually transmitted infections (STIs), respiratory infection, and safe sex practices. This helped individuals make informed choices and reduced the risk of infections.
  2. Consent and communication: Counselling helped individuals and couples develop effective communication skills and understand the importance of consent in sexual relationships. This included learning how to discuss desires, boundaries, and expectations openly and respectfully with partners.
  3. Safer sex practices: Sexual counselling helped individuals or couples explore various methods of planned parenthood, pregnancy control, and understand sexual practices. Counsellors also addressed the importance of regular STI testing and how to reduce the risk of transmission.
  4. Sexual pleasure and satisfaction: Responsible sex involves mutual pleasure and satisfaction for all individuals involved. Counsellors supported clients in exploring and understanding their own sexual desires, needs, and preferences, as well as those of their partners. They provided guidance on enhancing intimacy, exploring different sexual activities and postures, managing love performance anxiety, and addressing concerns related to sexual dysfunctions.
  5. Relationship dynamics: Sexual counselling also addressed broader relationship dynamics that impact responsible sex practices, such as trust, emotional intimacy, conflict resolution, and overall relationship satisfaction. This involved exploring how relationship issues affect sexual experiences and vice versa.
  6. Consent in the digital age: With the growing role of technology in intimate relationships, sexual counselling covered topics related to responsible online sexual activity. This included discussing consent in sexting, sharing explicit media clips such as Kamasutra etc, or engaging in virtual sexual encounters. Overall, sexual counselling for responsible sex aims to support individuals and couples in developing a healthy sexual life while prioritizing communication, consent, safety, and mutual satisfaction. Counsellors provided a non-judgmental and confidential space for clients to explore their concerns, ask questions, and receive appropriate guidance.
The Kama Sutra, an ancient Indian text, does contain information about sexual positions and techniques. While the text does mention group sexual encounters, it primarily focuses on positions for two partners. It is essential to approach such activities with respect, consent, and the well-being of everyone involved. If you are considering exploring sexual activities involving penetrative sex, it is recommended to have open and honest conversations with all parties involved, as well as to educate yourself about safe sex practices, emotional well-being, and always be consensual and safe for all involved parties. 

 

References / Recommended reading

These are just a few examples of the multitude of articles and books published on sexuality in the past 50 years. The field of sexuality research and discourse has expanded greatly during this time, providing diverse perspectives and knowledge on this important aspect of human life. Here are some significant and influential ones:

  1. “Sexual behavior in the Human Female” by Alfred C. Kinsey et al. (1953): This study was one of the first comprehensive works on human sexual behavior, challenging cultural norms and providing empirical evidence on various aspects of sexuality.
  2. “The Hite Report: A Nationwide Study of Female Sexuality” by Shere Hite (1976): This groundbreaking publication challenged prevailing notions of female sexuality and highlighted women’s experiences and desires.
  3. “Human Sexual Response” by William H. Masters and Virginia E. Johnson (1966): This pioneering work examined the physiological and psychological aspects of sexual response, providing a scientific approach to the understanding of human sexual function.
  4. “The Joy of Sex” by Alex Comfort (1972): This popular and widely read book discussed various aspects of human sexuality, including sexual technique, contraceptive methods, and sexual satisfaction.
  5. “The History of Sexuality” by Michel Foucault (1976-1984): This influential series of books explored the social and cultural construction of sexuality, challenging conventional ideas about sexuality as a natural and essential aspect of human identity.
  6. “Sexual Fluidity: Understanding Women’s Love and Desire” by Lisa Diamond (2008): This research-based book challenged the notion that sexual orientation is fixed and explored the concept of sexual fluidity, particularly in women.
  7. “Sex at Dawn: How We Mate, Why We Stray, and What It Means for Modern Relationships” by Christopher Ryan and Cacilda Jetha (2010): This book presented an alternative perspective on human sexuality and questioned conventional narratives about monogamy and sexual behavior.
  8. “Come as You Are: The Surprising New Science that Will Transform Your Sex Life” by Emily Nagoski (2015): This book provided an in-depth exploration of female sexuality and how understanding the science behind it can lead to improved sexual well-being.
  9. “The Ethical Slut: A Guide to Infinite Sexual Possibilities” by Dossie Easton and Janet Hardy (1997): This book challenged societal norms around monogamy and explored the concept of ethical non-monogamy, promoting consensual and responsible open relationships.
  10. “Savage Love” by Dan Savage (1991-present): This advice column-turned-book addressed various aspects of sexuality and relationships, exploring topics such as sexual orientation, kink, and communication.

 

News Flash 560: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Cleaver wrasse (Xyrichtys novacula)

News Flash 560

Weekly Snapshot of Public Health Challenges

 

Statement by Principals of the Inter-Agency Standing Committee (IASC): Civilians in Gaza in extreme peril while the world watches on

Webinar registration: High-level dialogue between the WHO Director-General and the UN High Commissioner for Human Rights: ‘Realizing the Right to Health in a world in turmoil’ Mar 6, 2024 

Ethiopia: How Persistent Unemployment and Low Motivation Affect Health Workers and the Healthcare System  by Melaku Kebede 

Advancing primary health care in Africa through capacity building, advocacy, and partnership: the International Institute for Primary Health Care in Ethiopia 

AidWatch 2022 | 1 euro in every 6 not going towards those left furthest behind

Using Law To Advance Population Health Planning

Many efforts yet few achievements: Where should healthcare quality improvement policies focus in LMICs?

Children’s lives threatened by rising malnutrition in the Gaza Strip

In eastern Chad, people fleeing Sudan continue to face unmet needs amid limited response

Advocating for a sleep-friendly hospital status

Launch of new HMA-EMA catalogues of real-world data sources and studies

Shortage of Cholera Vaccines Spurs Africa CDC’s Quest for Local Manufacturing of Medical Products

Defining Disease X

COVID Rebound Can Happen Whether or Not You Take Paxlovid

149 experts call to find all TB to stop TB

Multi-agency report highlights importance of reducing antibiotic use

The EU must continue to support development of drugs for neglected infectious diseases in Framework Programme 10

The AU plans to pool resources to unify $50B pharma market

MSF welcomes Indian government standing strong against EFTA trade deal’s harmful intellectual property provisions

Medicines Law & Policy Intervention at the WHO Pandemic Accord Negotiations

Can telemedicine bridge Africa’s healthcare divide?

Africa programme launches ‘A Continent in Conversation’ series at AU summit

Blended Finance Is (Still) a Mess

Blended finance can perpetuate climate colonialism

UN agriculture fund bets big on innovation to improve food security

Innovation ‘imperative’ for securing rice production

Experts Fear Nigeria’s Food Inflation Could Worsen Hunger Crisis

Climate change-driven pests silently devastate Indian farms

Phasing out from Fossil Fuels: An Imperative for Climate Justice

When It Comes to Climate and Development, Worry Less about Finance and More about People

EU deal on improved air quality fails to align with WHO standards

Why Should Climate Change and Biodiversity Loss Be Tackled Together?