Table 1 Summary of main themes, subject themes, and supporting evidence
From: Chronic political instability and HIV/AIDS response in Guinea-Bissau: a qualitative study
| Main theme | Subject themes | Supporting evidence |
|---|---|---|
| Constantly starting over |
Frequent rotation and turn-over of staff working in the HIV/AIDS response Lack of handover |
“Start over and begin again.” “Reinvent the wheel”, “we never learn.” |
| Effects of instability rippling from central level throughout the health pyramid |
Changes at central level leading to changes in regional health directors Effects on people living with HIV/AIDS Outward emigration of health personnel, including HIV/AIDS specialists and care providers |
“The farther you go from Bissau… you don’t have this political instability problem.” “The butterfly effect, it starts from the top and when flapping the wings it drags all that [down].” |
| Vulnerable populations becoming more vulnerable |
Breakdown of the Guinean family Extreme vulnerability of girls and women to HIV infection Social and economic conditions favouring spread of HIV |
“Any political crisis… means that those who are vulnerable become much more vulnerable.” “At this period it was quite obvious that who provides for the family was the young girls.” |
| Coping mechanisms |
Community-led response to HIV/AIDS was early and has filled gaps Decentralized approaches Technical staff who keep working despite challenges |
“That was how [the NGO] practically emerged as a pioneer in filling the gaps left by the Ministry in the national response.” “If you want to promote changes in Guinea-Bissau, the best level to invest on is at local level where you can force changes at upstream level.” |