Farm workers are vulnerable working populations face significant inequalities in accessing health services, including those for human immunodeficiency virus (HIV) prevention, treatment and care. This study explored through in-depth interviews and focus group discussions farm workers’ experiences when accessing HIV services in Limpopo province, South Africa. The results reveal that farm workers report multiple interdependent factors that inhibit or enable their access to HIV healthcare services, including transport affordability, health worker attitudes, stigma and discrimination, models of HIV healthcare delivery, geographic location of health facilities and difficult working conditions. Key facilitators for their HIV healthcare access were reported to include the availability of mobile health services, the presence of community health workers and a supportive work environment. The findings suggest disparities in farm workers’ access to HIV services, with work being the main determinant of access. The authors recommend a review of HIV policies and programmes for the agricultural sector and models of HIV healthcare delivery that address the unique needs of farm workers.
Equity and HIV/AIDS
This paper examines Zimbabwe's transition toward sustainable domestic financing for HIV programs as external funder support declines. With Zimbabwe's economy projected to achieve middle-income status by 2030, driven by mineral exports (gold, platinum, lithium) and diaspora remittances totalling US$1.9 billion in 2024, the country has opportunities to strengthen health system financing. The authors analyse existing domestic revenue mechanisms including the AIDS levy (generating ~US$40 million annually), Health Fund Levy, and sugary drinks tax. Key findings highlight Zimbabwe's achievement of UNAIDS 95-95-95 targets in 2023, but emphasize the critical need to integrate HIV services into mainstream health systems rather than maintaining standalone programs. The paper proposes innovative financing approaches, strengthening local pharmaceutical manufacturing capacity for ARV drugs, improving accountability mechanisms to prevent corruption and mismanagement, engaging informal sector and private sector stakeholders, and addressing regulatory barriers like the Private Voluntary Organisations Amendment Act that restricts NGO participation.
This paper describes HIV infection trends over eleven years in women attending selected antenatal care clinics in southern Mozambique. The authors performed a secondary analysis of data registered at the ANC clinic of the Manhiça District Hospital and from the Ministry of Health's HIV National Program Registry between 2010 and 2021. HIV incidence was calculated using prevalence estimates. HIV incidence trends over time were obtained by fitting splines regression model. Data from 21,810 pregnant women were included in the analysis. Overall HIV prevalence was 29.3%, with a reduction from 28.2% in 2010 to 21.7%, except for a peak in prevalence in 2016. Over the study period, by maternal age group, the largest reduction in HIV prevalence was in the 15–20 year-old group, followed by the 20–25 year old group and the 25–30 year old group. Incidence of HIV infection increased from 12.75 per 100 person-years in 2010 to 18.65 per 100 person-years in 2018, and then decreased to 11.48 per 100 person-years in 2021. The prevalence of HIV decreased while the overall incidence stayed similar in Mozambican pregnant women, during 2010 to 2021. However, both estimates remain unacceptably high, which authors suggest indicates the need to revise current preventive policies and implement effective ones to improve HIV control among pregnant women.
This report outlines how Pepfar-funded HIV organisations in South Africa, who receive their funds through the United States Agency for International Development, USAID, woke up to letters that were sent overnight telling them their grants have been ended - permanently. USAID-funded district health projects, supported outside of Pepfar, but with other US government funds administered by USAID, have also been instructed to close down, including several projects working on fighting HIV within key populations such as LGBTQI+ groups, and also those working with orphans and vulnerable children, to close down their projects immediately. South African organisations say they have also had reports from Pepfar-funded projects in Kenya and Malawi saying they had received similar letters. The article outlines responses from organisations working on HIV. The Treatment Action Campaign chairperson is reported to have said " It is so painful that these terminations mean death to poor people of the world. Key and vulnerable populations are the most affected". Many organisations noted that HIV related deaths and infections will increase and called for a more urgent government and global response. As one public health specialist noted ""The people - the patients, the frontline workers, the programme recipients who relied on these services for survival - are now left stranded, abandoned by a system that once promised progress and partnership. Every contract cancelled is not just a number; it represents a life, a community, a future now in jeopardy. The sheer disregard for the impact on millions of vulnerable people is unfathomable, and the ripple effects of these decisions will be felt for generations to come".
This study aimed to identify women’s HIV Self-Testing (HIVST) knowledge, utilization, and its associated factors in Sub-Saharan Africa (SSA). The data used were gathered from the most recent demographic and health surveys conducted in 21 SSA nations between 2015 and 2022. The level of knowledge and utilization of HIVST among women in SSA was very low. To improve this situation, the authors suggest facilitating institutional delivery, promoting access to modern contraception, increasing ANC coverage, empowering women’s associations, creating culturally respectful mass media content, and involving rural and economically disadvantaged women.
This study conducted in 2022 aimed to elucidate the experiences of these in a small group of young, HIV + men who have sex with men and transgender women in Zambia through in-depth interviews and a questionnaire. The authors recruited 56 participants from three sites: Lusaka, Chipata, and Solwezi districts. Participants’ mean age was 23 years. The study found that 36% of all participants had moderate to significant symptoms of depression, 7% had major depression, 30% had moderate signs of anxiety, 11% had high signs of anxiety, 4% had very high signs of anxiety and 36% had contemplated suicide at least once. A greater proportion of transgender women had moderate to significant symptoms of depression or major depression compared to men who have sex with men, at 33% and 6%, respectively. Similarly, more transgender women had contemplated suicide than MSM peers. Overall, having to hide both one’s sexuality and HIV status had a compounding effect and was described as living a private lie. The authors argue that effectively addressing stigma and poor mental health outcomes among young HIV-positive MSM and transgender women requires a socio-ecological approach that focuses on structural interventions, more trauma-informed and identity-supportive care for young people with HIV, as well as strengthening community-informed public health efforts.
This paper assessed the socioeconomic inequalities in HIV testing during antenatal care in sub-Saharan Africa, using Demographic and Health Surveys data spanning from 2015 to 2022. Overall, 73.9% of women in sub-Saharan Africa tested for HIV during antenatal care. Being among the richer and richest wealth quintiles increased the odds of HIV testing during antenatal care. The authors emphasize the necessity for sub-Saharan Africa public health programs to think about concentrating their limited resources on focused initiatives to reach poorer women and should provide women with comprehensive HIV knowledge and decrease the number of lost opportunities for women to get tested for HIV.
An advisory group to UNAIDS has released “overwhelming and undeniable” evidence on the harm that criminalisation is having on public health and the goal of ending AIDS by 2030. Criminalising certain groups, such as sex workers, gay and trans people and people who use drugs was found to be driving HIV infections and violating human rights, as a barrier to achieving the goal of ending AIDS by 2030. Their report shows a clear link between the legal status of groups most affected by HIV and the level of stigma and discrimination they experience. The UNAIDS Reference Group on HIV and Human Rights is calling on UN member countries to work with community-led organisations to “immediately repeal or reform” laws that criminalise the following things: consensual same-sex sexual conduct and the expression of gender identity, sex work and related activities, drug use and simple possession of drugs for personal use and HIV transmission and non-disclosure.
Deaths from COVID-19 have fallen much less sharply in people with HIV compared with the rest of the population since the arrival of the Omicron variant of SARS-CoV-2, the World Health Organization (WHO) reported at the 12th International AIDS Society Conference on HIV Science (IAS 2023). Data from 821331 people admitted to hospital with COVID-19 in 38 countries found that one in five people with HIV admitted to hospital with COVID-19 died during the Omicron wave compared to one in ten people without HIV. The WHO study team say that the consistent finding that low CD4 counts increase the risk of death from COVID-19 highlights the need for intensified HIV testing and treatment initiation to reduce the risk of severe outcomes, and to give booster vaccine doses for all people living with HIV even during the less severe and low incidence SARS-CoV-2 variant waves.
This participatory qualitative study using in-depth interviews and focus group discussions explored how gender-based violence affects uptake and utilisation of HIV prevention, treatment, and care services among transwomen in the Greater Kampala Metropolitan Area, Uganda. At the individual level, emotional violence suffered by transwomen led to fear of disclosing their HIV status and other health conditions to intimate partners and healthcare providers respectively; inability to negotiate condom use; and non-adherence to antiretroviral therapy. Sexual violence compromised the ability of transwomen to negotiate condom use with intimate partners, clients, and employers. Physical and emotional violence at the community level and in services led to fear among transwomen traveling to healthcare facilities, and limited use of pre-exposure prophylaxis and HIV testing services, denial of healthcare services, and delays in receiving appropriate care. Given its effects on HIV transmission, the authors argue for strategies/ interventions targeting a reduction in gender-based violence and to sensitize communities to accept transwomen, including in healthcare settings.