Limited information about symptom prevalence exists about HIV infected persons in South Africa, in particular in the context of antiretroviral treatment (ART). The aim of this study was to assess HIV symptoms and demographic, social and disease variables of people living with HIV in South Africa. In 2007, 607 people living with HIV or AIDS (PLWHAs), sampled by all districts in the Eastern Cape Province and recruited through convenience sampling, were interviewed by PLWHAs at health facilities, key informants in the community and support groups. Symptom assessment provided information that may be valuable in evaluating AIDS treatment regimens and defining strategies to improve quality of life. Because of the high levels of symptoms reported (26.1 symptoms out of a possible 64), the results imply an urgent need for effective health care, home- and community-based and self-care symptom management.
Equity and HIV/AIDS
Populations at risk for HIV and other sexually transmitted infections (STIs) include those living in rural areas. The authors describe a statewide training programme that targeted rural-based health professionals. This program focused on HIV, STIs, and viral hepatitis and was designed to enhance participants’ ability to conduct sexual histories and risk assessments, educate clients about risk reduction and prevention, screen for and diagnose these infections, clinically manage clients with positive screening test results, access prevention and other educational materials, and conduct other clinical and public health activities. A total of 122 participants reflecting a wide variety of practice settings attended trainings at five sites throughout Minnesota; 74% of participants were nurses and 81% characterised employment settings as rural. Nurses and other health professionals in rural settings are an important training priority and can play an important role in education, prevention, screening, and clinical care for HIV and other STIs.
The Treatment Barometer, a survey by SATAMo on access to AIDS treatment within Southern African Development Community (SADC) countries, calls on regional leaders to keep the promises they made towards the provision of HIV treatment by committing much-needed resources. It’s the first regional treatment monitoring research to be carried out by community-based treatment activists, who noted that more than 80% of SADC governments have not honoured the Abuja Declaration more than seven years after the commitment, barriers to treatment still exist, reports of stigma and discrimination by health care workers remain high, stock-outs of drugs are common in more than 80% of the countries surveyed and most countries are struggling to provide first-line treatment to those who need it, with eight countries in SADC below 35% coverage and only two exceeding 75% coverage.
This paper investigated antiretroviral-treatment strategies in the Children with HIV Early Antiretroviral Therapy (CHER) trial. HIV-infected infants 6 to 12 weeks of age with a CD4 percentage of 25% or more were randomly assigned to receive antiretroviral therapy until the CD4 percentage decreased to less than 20% (or 25% if the child was younger than 1 year), specific clinical criteria were met or the child needed to immediately start on limited antiretroviral therapy. The children were followed up after 40 weeks and, after a review by the data and safety monitoring board, some of the infants were reassessed for the initiation of antiretroviral therapy. The paper concluded that early HIV diagnosis and early antiretroviral therapy reduced early infant mortality by 76% and HIV progression by 75%.
Between 26 November and 1 December (World AIDS Day) the AIDS Healthcare Foundation (AHF), a US-based NGO, set a goal of testing one million people around the world. More than 1,000 people were tested for HIV at a busy marketplace in the Ugandan capital, Kampala, kicking off a nationwide drive that aims to help at least 20,000 people across the country know their status. HIV prevalence is around 6%, but only 21% of Ugandans know their HIV status. The large turnout for the testing event proved that many people wanted to know their status but hadn't had the opportunity to get tested. The campaign sees AHF partnering with 972 organisations in 72 countries around the world. A standard model is used at all sites, involving pre-test counselling, a one-minute test, post-test counselling and treatment referral.
South Africa has flunked with an E-symbol (0-20%) when it come to the amount of money spent on HIV/AIDS, but attained an overall B-symbol for its response to the epidemic on the AIDS Reporting Index, an AIDS Accountability International (AAI) scorecard. South Africa scored a D for data collection, which the AAI said was largely due to poor reporting, with no improvement since the last time the country was assessed. The country showed an improvement in antiretroviral coverage (2% in 2004 to 28% in 2008), but the AAI noted overall performance remained poor (D-symbol) with only just over a quarter of those needing treatment getting it. The overall low score is due to poor performance rather than poor reporting, it added.
KwaZulu-Natal Health MEC, Peggy Nkonyeni, is attempting to introduce traditional medicine for AIDS patients at a hospice with the help of traditional healers. The Treatment Action Campaign said African traditional healers have a role in combating HIV but they are concerned that disreputable stakeholders are included, especially those who are not traditional healers and who have caused harm with so-called ‘alternative’ remedies.
This study investigated a theoretical strategy of universal voluntary HIV testing and immediate treatment with ART, and examined the conditions under which the HIV epidemic could be driven towards elimination. Data from South Africa was used as the test case for a generalised epidemic, and it was assumed that all HIV transmission was heterosexual. The study found that the strategy could greatly accelerate the transition from the present endemic phase, in which most adults living with HIV are not receiving ART, to an elimination phase, in which most are on ART, within five years. It could reduce HIV incidence and mortality to less than one case per 1,000 people per year by 2016. Universal voluntary HIV testing and immediate ART, combined with present prevention approaches, could have a major effect on severe generalised HIV/AIDS epidemics.
The United States government policy has violated the human rights of people living with HIV and AIDS through its ‘moral’ restrictions prioritising abstinence-only sex education, restricting condom distribution and stigmatising sex workers. The government’s close ties with pharmaceutical companies and manipulation of trade in medicines have also infringed on the human right to health by undermining international efforts to enshrine access to essential medicines as a human right. By sanitising and de-sexualising the politics of HIV and AIDS, and focusing on technocratic approaches such as biomedical quick fixes, like the recent emphasis on male circumcision, it ignores the deeply gendered, racial and sexual dimensions of the disease or its social, economic and cultural pathology.
This report presents data on anti-retroviral therapy (ART) in both the public and private sectors in Malawi. By the end of June 2008, there were 207 health facilities in Malawi in the public and private health sector delivering ART to HIV-positive eligible patients. In the second quarter of 2008 (April to June), there were 19,849 new patients registered on ART. Cumulative treatment outcomes by end of June were: 66% alive and on ART at the site of registration, 11% dead, 11% lost to follow-up, 12% transferred out to another facility (and were presumably alive) and <1% stopped treatment. By the end of June 2008, there were 32 sites with over 1,000 patients alive and on treatment and 10 sites with over 2,000 patients alive and on treatment. Of the 10 sites with more than 2,000 patients, four did not have an electronic data system in place.