These guidelines contain essential information on prevention of mother-to-child transmission, as well as counselling, support and testing, and preventing paediatric HIV infection. Clinical features of HIV-positive children are provided. Care guidelines are given on HIV-positive children on anti-retroviral therapy (ART). Nutritional support is also covered, providing indicators for assessing the nutritional status of children and requirements for nutritional support, including nutrition interventions in situations where children have not been adequately nourished. Treatment guidelines for concomitant tuberculosis are also given, along with responses to adverse advents, like side-effects from ART, and guidelines for treatment of a range of typical secondary infections, like respiratory infections, thrush and gastro-enteritis.
Values, Policies and Rights
Rwanda's national condom awareness campaign has failed to include messages designed for people with disabilities, despite their risk of HIV being the same as the rest of the population. Many disabled people are sexually active and may take part in unprotected sex, according to Jacques Sindayigaya, coordinator of the HIV programme for the non-governmental organisation, Handicap International. A three-month government campaign, which mainly used radio and television spots as well as billboards and more than 200,000 posters to spread information on condoms, ended in February 2010. According to government sources, it was successful in raising awareness. However, this article points to the need for such campaigns to also target the specific needs and situations of those with disability.
More than 450,000 people have signed an online petition urging Uganda's parliament to drop a bill that would impose the death sentence when a positive person has sex with someone of the same sex who is disabled or under the age of 18. On 1 March, the petition was presented to the speaker of Uganda's Parliament, Hon Edward Ssekandi, by the country’s AIDS activists, including founder of the national non-governmental organisation, The AIDS Support Organization, Noerine Kaleeba, and Canon Gideon Byamugisha, the first religious leader to publicly declare that he was living with HIV. Responding to the petition, Hon Ssekandi said it could not be withdrawn at this stage, not even by the MP who tabled it; but he assured the activists that their concerns would be passed on to the legislature. The legislature would debate passing the bill, amending it or not passing it. Homosexuality is illegal in Uganda, but the new law would impose more stringent punishments for homosexual activity, while compelling people in authority with knowledge of such activity to report it or face criminal charges.
Indoor residual spraying (IRS) and insecticide-treated nets (ITNs), two principal malaria control strategies, are similar in cost and efficacy. This study aimed to describe recent policy development regarding their use in Mozambique, South Africa and Zimbabwe. Using a qualitative case study methodology, semi-structured interviews of key informants were undertaken from May 2004 to March 2005, and a document review was carried out. Most respondents in the study strongly favoured one strategy over the other – IRS versus ITNs. In all three countries, national policy makers favoured IRS, and only in Mozambique did national researchers support ITNs. Outside interests also played a significant role in influencing policy. Research evidence, local conditions, logistic feasibility, past experience, reaction to outside ideas, community acceptability, the role of government and non-governmental organisations, and harm from insecticides used in spraying influenced the choice of strategy. In conclusion, it may be time for policy makers to consider changing from their favoured IRS strategy, while those intending to promote new policies such as ITNs should examine the interests and ideas motivating key stakeholders and their own institutions, and identify where shifts in thinking or coalitions among the like-minded may be possible.
WHO international guidelines for the control of tuberculosis (TB) in relation to air travel require – after a risk assessment – tracing of passengers who sat for longer than eight hours in rows adjacent to people with pulmonary TB who are smear positive or smear negative. A further recommendation is that people with active TB should not carry out commercial air travel until the person has two consecutive negative sputum smears for drug-susceptible TB or two consecutive cultures for multidrug-resistant TB. This review examines the evidence put forward to support these recommendations and assesses whether such an approach is justifiable. A systematic review identified 39 studies of which 13 were included. The majority of studies found no evidence of transmission. Only two studies reported reliable evidence of transmission. Various factors made the screening process highly inefficient, including time and money spent on tracing and investigating passengers who tested positive and contacting different national authorities in the course of investigations. The analysis suggests that there is reason to doubt the value of actively screening air passengers for infection with TB and that the resources used might be better spent addressing other priorities for the control of the disease.
More than a decade after world leaders agreed to eliminate all forms of discrimination against women, their empowerment remains a necessary element in attaining development targets, said United Nations (UN) Secretary-General Ban Ki-moon, addressing the Commission on the Status of Women in the run-up to International Women’s Day, which is observed annually on 8 March. ‘Until women and girls are liberated from poverty and injustice, all our goals – peace, security, sustainable development – stand in jeopardy,’ Ban said. This year is the 15th anniversary of the adoption of the Beijing Declaration and Platform for Action – the outcome of the Fourth World Conference on Women in Beijing in 1995 – which remains the most comprehensive global policy framework to achieve the goals of gender equality, development and peace. In September 2009, it was announced that four UN agencies and offices – including the UN Development Fund for Women (UNIFEM) – will be amalgamated to create a new single entity within the world body to promote the rights and well-being of women worldwide and to work towards gender equality. Mr Ban urged the General Assembly to adopt a resolution ‘without delay’ to set up this new entity.
AIDS activists in Zimbabwe have launched a major drive to ensure that the rights of people living with HIV are enshrined in the new constitution. The Global Political Agreement signed in September 2008 between Zimbabwe's various political rivals, which gave rise to the coalition government in February 2009, includes writing the new constitution expected to be introduced in 2010. ‘We are not calling for a token participation, but significant and meaningful involvement that will go a long way in promoting our welfare and rights when the constitution is adopted,’ Tonderai Chiduku, advocacy coordinator of Zimbabwe National Network of People Living with HIV and AIDS (ZNNP+) said. The Southern Africa AIDS Information Dissemination Service (SAFAIDS) and ZNNP+ are calling for a bill of rights that would promote better access to health services. An estimated two million people are living with HIV and AIDS in Zimbabwe, one of the countries hardest hit by HIV and AIDS, but have never before been actively involved in such legislation and do not have representation in parliament, Chiduku said. The activists have also urged policy-makers to include a clause that would commit the government to spending a minimum of 10–15% of the national budget on healthcare.
This paper reports on an interview with Professor Savitri Goonesekere, an international expert on the rights of women and children and a member of the United Nations Committee on the Elimination of Discrimination against Women between 1999 and 2002. In the interview she notes ‘a cynicism about rights and what they can do, especially in developing countries. This just encourages states not to implement the treaties they have signed'. She notes that human rights laws create a culture of support for implementing health policies by helping the community to monitor the state’s actions and programmes. She notes that some argue that if health policies are in place, health rights do not need to be put in the constitution and other laws. However she suggests that political systems are very fragile and a change in a health minister can bring in someone with a different attitude, leading everything to change. 'If a right is not in place in a law or constitution, it’s very easy to pull it back.’
In the context of South Africa's intense preparation for hosting the 2010 FIFA World Cup, anxiety over HIV transmission in the context of sex work has sparked debate on the most appropriate legal response to this industry. Drawing on existing literature, the authors highlight the increased vulnerability of sex workers in the context of the HIV pandemic in southern Africa. They argue that laws that criminalise sex work not only compound sex workers' individual risk for HIV, but also compromise broader public health goals. International sporting events are thought to increase demand for paid sex and, particularly in countries with hyper-endemic HIV such as South Africa, likely to foster increased HIV transmission through unprotected sex. The 2010 FIFA World Cup presents a strategic opportunity for South Africa to respond to the challenges that the sex industry poses in a strategic and rights-based manner. Public health goals and growing evidence on HIV prevention suggest that sex work is best approached in a context where it is decriminalised and where sex workers are empowered. In short, the authors argue for a moratorium on the enforcement of laws that persecute and victimise sex workers during the World Cup period.
In late 2009 the South African government announced that it had approved a new HIV and AIDS policy in the South African National Defence Force (SANDF). This was widely welcomed by AIDS and human rights lobbyists. A November 2009 statement by the SANDF noted that the new policy made provision for the recruitment and selective deployment of HIV-positive members of the military. The new policy complies with a High Court ruling in May 2008, which found that the previous policy of excluding HIV-positive people from recruitment and foreign deployment was unconstitutional. The new policy draws on a system of classifying soldiers according to their health status and needs. An HIV-positive soldier who is stable and asymptomatic can now be classified as a ‘G2K1’, meaning they have a chronic but treatable disease and can be deployed ‘anywhere at any time’. An HIV-positive recruit is required to be on ante-retrovirals for three to six months before being considered for deployment, and failure to adhere to treatment is grounds for being declared ‘temporarily unfit for deployment and military courses’.