Older people living with HIV (PLWH) are at increased risks of co-morbidities and polypharmacy. However, little is known about factors affecting their needs and concerns about medicines. This systematic review aims to describe these and to identify interventions to improve medicine optimisation outcomes in older PLWH. Multiple databases and grey literature were searched from inception to February 2022 including MEDLINE, CINAHL, PsycInfo, PsychArticles, the Cochrane Database of Systematic Reviews and the Cochrane Controlled Register of Trials, Abstracts in Social Gerontology, and Academic Search Complete. Studies reporting interventions/issues affecting older PLWH (sample populations with mean/median age ≥ 50 years; any aspect of medicine optimisation, or concerns). Quality assessments were completed by means of critical appraisal checklists for each study design. Title and abstract screening was led by one reviewer and a sample reviewed independently by two reviewers. Full-paper reviews were completed by one author and a 20% sample was reviewed independently by two reviewers. Data were extracted by three independent reviewers using standardised data extraction forms and synthesised according to outcomes or interventions reported. Data were summarised to include key themes, outcomes or concerns, and summary of intervention. Seventy-nine (n = 79) studies met the eligibility criteria, most of which originated from the USA (n = 36). A few studies originated from Australia (n = 5), Canada (n = 5), Spain (n = 9), and the UK (n = 5). Ten studies originated from Sub-Saharan Africa (Kenya n = 1, South Africa n = 6, Tanzania n = 1, Uganda n = 1, Zimbabwe n = 1). The rest of the studies were from China (n = 1), France (n = 1), Germany (n = 1), Italy (n = 1), the Netherlands (n = 1), Pakistan (n = 1), Switzerland (n = 1), Saudi Arabia (n = 1) and Ukraine (n = 1). Publication dates ranged from 2002 to 2022. Sample sizes ranged from 10 to 15,602 across studies. The factors affecting older PLWH's experience of and issues with medicines were co-morbidities, health-related quality of life, polypharmacy, drug interactions, adverse drug reactions, adherence, medicine burden, treatment burden, stigma, social support, and patient-healthcare provider relationships. Nine interventions were identified to target older persons, five aimed at improving medication adherence, two to reduce drug interactions, and two for medicine self-management initiatives. Further in-depth research is needed to understand older PLWH's experiences of medicines and their priority issues. Adherence-focused interventions are predominant, but there is a scarcity of interventions aimed at improving medicine experiences for this population. Multi-faceted interventions are needed to achieve medicine optimisation outcomes for PLWH. This study is registered with PROSPERO registration number: CRD42020188448.

Alternatives to criminalization for the simple possession of illicit drugs are increasingly of interest to policy makers. But there is no existing theoretically based, empirically tested framework that can inform development and evaluation. This article presents a realist programme theory of such alternatives. It bases this on a realist review, which followed the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES). It describes the systematic process of searching the literature in English on nine relevant countries (Australia, Czech Republic, Denmark, Germany, Jamaica, Netherland, Portugal, the UK, the USA) for information on alternative measures in three categories: depenalization; diversion; and decriminalization. It shows how these measures – in theory and in practice – combine with pre-existing social conditions and institutional contexts to trigger mechanisms across three causal pathways (normative; criminal justice; and health and social services). It shows how some posited causal processes are more empirically supported than others. Alternative measures can reduce harms imposed by criminal justice processes without increasing drug use or related health and crime harms, but this depends on specific combinations of contexts, mechanisms and outcomes.

Background: Increasing international attention is being given to alternative measures to criminalization for the possession of illicit drug. Such schemes are heterogeneous and a clear conceptual framework for their discussion and analysis is lacking. Aim: To present a conceptually informed, empirically based taxonomy for the classification of alternative measures to decriminalization for the possession of drugs. Methods: The research uses qualitative comparative analysis (QCA) of existing alternative measures. It proceeds from analysis of existing distinctions between and classifications of alternative measures. It uses data from a realist review of alternative measures in nine countries (Australia, Czech Republic, Denmark, Germany, Jamaica, Netherland, Portugal, UK and USA) to derive three dimensions of comparison (whether they: are de jure or de facto; involve diversion to an educative, therapeutic of social service; involve the use of civil/administrative sanctions). A QCA truth table using data from twenty-six schemes in the nine countries is used to identify types in the taxonomy. The types are grouped - using pragmatic reduction informed by Boolean minimization across a smaller number of classes in order to create a two-level taxonomy. Results: The resulting taxonomy contains six types of alternative measures: depenalization; de facto diversion; de jure diversion; decriminalization with diversion and civil sanctions, decriminalization with civil sanctions; and decriminalization with no sanctions. The six types fall into three classes: depenalization; diversion; and decriminalization. It is possible to classify emerging alternatives into this new taxonomy. Conclusion: Conceptually informed empirical observation of cases enables the construction of a two-level taxonomy of alternative measures to criminalization for the simple possession of drugs. This may facilitate clearer and better-informed discussion of alternatives to criminalization for drug possession.

This paper looks at the ways that people living with HIV in the Gambia, as members of HIV support groups, engaged with the programmes available to them in this context. People living with HIV engage with the global in a variety of ways. Following Ong and Collier this paper analyses the way in which people in this context experience and negotiate with the "global assemblage" around international HIV work. This can be observed in everyday practice in the formation of networks and partnerships linking people and their activities into international structures. Using qualitative methods and a grounded theoretical approach, the research followed events around HIV treatment in the Gambia 2006–2007. Looking at the support societies and their members' struggles to gain some material support, findings show how support group members negotiated and expressed agency within the available structures. They make use of accepted frames of international action which bypass the state, presenting an internationally linked "biological citizenship" which brings associated opportunities to access resources. Through the intervention of the president and his "cure" programme, this case also illustrates that people's commitment to the value structures implicit in these funding streams may not be as strong as might be assumed. In these circumstances two alternate treatment programmes, linked to very different values, were on offer, both backed up by the powerful machinery of either the state or international funding. The negotiation by people living with HIV of these avenues through which to acquire benefits and so support and health, calls into question assumptions of a "buy in" to global ideas and values without further scrutiny of the ways in which such assemblages function in different contexts.

In early 2007 the President of a small African country announced his 'cure' for AIDS based on herbal, Islamic, and traditional medicine, resulting in the enrolment of several hundred people testing HIV-positive. This unleashed an ongoing yet remarkably silent controversy around AIDS treatment. The emergence of the presidential treatment can be understood in the political and scientific context of recent global AIDS funding and programming, and longstanding tensions between 'foreign' and local concerns with biomedicine and research. Framed in terms of appeals to tradition, ethnicity, religion, nation, and pan-Africanism, the President's programme appears diametrically opposed to mainstream scientific discourses. Yet in promoting and garnering support for his claims, this President has successfully co-opted and harnessed key elements of biomedical AIDS treatment discourse: in claims to identity as a doctor, and in deploying CD4 and viral load counts and personal testimonies as evidence of treatment efficacy. Uncertainty over how to interpret such evidence amongst vulnerable people living with HIV has encouraged many to volunteer. Such politics of science, along with the threatening political and security practices of this particular state, help explain why to date there has been so little overt criticism of the President's programme either within the country or internationally.

Making sense of an HIV-positive diagnosis is often a struggle. Across Africa this is mediated by a new globalism in public health; the last decade has seen an array of new international initiatives and funding mechanisms. These dimensions of governance exemplify, in the health sector, an intensified move away from forms of authority based on the pre-eminence of nation states in global arenas, towards an array of new arrangements including global public-private-philanthropic partnerships. This Gambian case study unpicks the picture of an emergent 'therapeutic citizenship' (Nguyen 2005) in this context – of condom demonstrations and public disclosures – looking to the strands of authority and governance linked to an epistemic structure initiated by the Global Fund, but that works through a complex web of other organisations and agencies. This suggests that in Gambia in the period up to the end of 2006, the focus of this paper, a localglobal axis which constructed HIV related problems, solutions and related notions of identity and political affiliation had come into being. For people living with HIV in the Gambia, making claims based on their status in this field has been problematic, and their ability to shape proactively what goes on and assert their felt needs often rather limited.