The war against HIV/AIDS, which has too often been fought in plush offices and conference centres, needs to be reclaimed by people in developing countries, who are most affected, or it will continue to be a losing battle. This was the message from the Global Citizens Summit in Nairobi, Kenya from 27-29 May 2009, organised by international anti-poverty agency ActionAid, and attended by a broad range of organisations in the field of HIV and AIDS to discuss using social mobilisation to ‘repackage’ the HIV response. ‘The fight against HIV did not originate in boardrooms’, said ActionAid. ‘It was citizens rising up to make their voices heard and to put AIDS on the agenda. We need to go back there.’ Participants pointed out that although community-based organisations did the lion's share of HIV-care work, they received only a fraction of global AIDS funding.
Equity and HIV/AIDS
Despite the estimated 22.4 million HIV-infected adults in Africa, culturally appropriate ‘prevention with positives’ guidelines have not been developed for this region. In order to inform these guidelines, the authors of this study conducted 37 interviews with purposefully selected HIV-infected individuals in care in Uganda. Participants reported increased condom use and reduced intercourse frequency and numbers of partners after testing HIV-positive. Motivations for behaviour change included concerns for personal health and the health of others, and decreased libido. Interventions addressing domestic violence, partner negotiation, use of lubricants and alternative sexual activities could increase condom use and/or decrease sexual activity and/or numbers of partners, thereby reducing HIV transmission risk.
A one billion rand (US$123 million) shortfall in South Africa's public sector antiretroviral (ARV) programme could jeopardise treatment programmes as soon as September, a health expert has warned. Mark Heywood, deputy chairman of the South Africa National AIDS Council (SANAC), commented on the lack of funding at the relaunch of the National AIDS Charter on 18 June. Among the additions to the charter were an increased focus on vulnerable groups, and the inclusion of traditional leaders and their role in the epidemic. ‘We've made major strides, and one of the strengths of the charter was that it guided our progress on the national strategic framework at a time when people were still stoned to death [...] when kids were still taken out of school and people were chased out of their homes for being HIV-positive,’ Heywood said. ‘But […] we don't actually have ARV treatment for most of the people who need it.’ An estimated 700,000 people are on treatment in South Africa, but an estimated 1,000 die daily as a result of AIDS.
Increasing emphasis is being placed on the need for 'structural interventions' (SIs) in HIV prevention internationally. There is great variation in how the concept of an SI is defined and operationalised, however, and this has potentially problematic implications for their likely success. This paper clarifies and elucidates what constitutes an SI, with particular reference to the structured distribution of power and to the role of communities. It summarises the background to the growing emphasis being placed on the concept of SIs in HIV prevention policy and illustrates the nature of HIV vulnerability and its implications for the design and targeting of successful SIs. The paper draws attention to the dual importance of: attending to local complexities in the micro and macro-level structures that produce vulnerability; and clarifying the meaning and role of communities within SIs.
A qualitative study was conducted to comprehensively describe the experience of orphanhood and its impact on mental health from the culturally specific perspective of Ugandan youths. The researchers conducted interviews with a purposeful sample of 13 youths (ages 12 to 18) who had lost one or both parents to AIDS illness and who were supported by a non-governmental organisation. The orphaned youths experienced significant ongoing emotional difficulties following the death of their parent(s). The youths in this study were unfamiliar with the term ‘mental health’; however, they easily identified factors associated with good or poor mental health. The findings of this study suggest that Western terminologies and symptom constellations in the Diagnostic and Statistical Manual IV may not be applicable in an African cultural context.
This study presents the experiences of a cohort of 17 patients enrolled in the first integrated TB and HIV treatment pilot programme, in Durban, South Africa, as a precursor to a pivotal trial to answer the question of when to start antiretroviral treatment (ART) in patients co-infected with HIV and TB. Individual interviews, focus group discussions, and observations were used to understand patients’ experiences with integrated TB and HIV treatment. The patients described incorporating highly active antiretroviral therapy (HAART) into their daily routine as ‘easy’; however, they experienced difficulties with disclosing their HIV status. Being on TB treatment created a safe space for all patients to conceal their HIV status from those to whom they did not wish to disclose. Directly observed therapy for TB may have the added benefit of creating a safe space for introducing ART to patients who are not ready to disclose their HIV+ status.
A coalition of health advocates from Sub-Saharan Africa has warned that the lives of millions of people in Sub-Saharan Africa are in jeopardy because of the lack of political will and investment to realise the right of access to life-saving treatment. ‘If the current cost constraints faced by HIV treatment programmes are not addressed, while the demand for expensive second-line treatment increases, we will find ourselves in a situation similar to the ’90s, where millions of lives were lost unnecessarily because people could not afford the treatment they needed to stay alive’, they said. The coalition rejects pitting HIV against other diseases because they believe there is ample evidence that ARV roll-out has strengthened health systems, and the work done by AIDS service organisations has revolutionised healthcare in the developing world.
The aim of the study was to evaluate data on behavioural indicators in relation to HIV prevention and occurrence in a rural youth population in South Africa. A representative community sample of youth using a three-stage cluster sampling method was chosen for a household survey, and qualitative data were obtained from the youths using ten focus group discussions. Results indicated a moderately adequate knowledge of HIV. HIV/AIDS knowledge was associated with more consistent condom use, and with a more supportive attitude towards persons with HIV or AIDS. Among female youth, 15.2% reported to have become victims of forceful sex during the last 12 months. For youth the major reasons for not using a condom with a non-commercial partner were 'not available', followed by 'did not like them', 'did not think of it', 'other' (mainly trust in partner), and 'partner objected'.
Conflict has long been assumed to contribute significantly to the spread of HIV infection. However, new research is casting doubt on this assumption. Studies from Africa suggest that conflict does not necessarily predispose to HIV transmission and indeed, there is evidence to suggest that recovery in the ‘post-conflict’ state is potentially dangerous from the standpoint of HIV transmission. There has also been concern that high rates of HIV infection among many of the militaries of sub-Saharan Africa poses a threat to regional security. However, data is lacking on this. These issues are of vital importance for HIV programming and health sector development in conflict and ‘post-conflict’ societies and will constitute formidable challenges to the international community. Further research is required to better inform the discussion of HIV, conflict and security in sub-Saharan Africa.
The HIV status of surgeons, in the context of the informed consent obtained from their patients, is a contentious matter. We surveyed the views of practising surgeons in South Africa regarding aspects of HIV and its impact on surgeons. A cross-sectional survey was conducted with surgeons who were members of the Association of Surgeons of South Africa to find out their attitudes to the preceding issues. The salient findings included the view that a patient-centred approach requiring HIV status disclosure to patients would be discriminatory to surgeons and provide no clear benefit to patients, and that HIV-positive surgeons should determine their own scope of practice. Patient-centred approaches and restrictive policies do not accord with clinicians’ sentiments. In the absence of comparable local or international data, this study provides clinicians' views with implications for the development of locally relevant policies and guidelines.