This paper conducted four phase III and one phase IIb trials of women-initiated HIV prevention options in KwaZulu-Natal between 2003 and 2009. A total of 7,046 women participated, with HIV prevalence between 25% and 45% and HIV incidence ranging from 4.5-9.1% per year. Community benefits from the trial included education on HIV prevention, treatment and care and provision of ancillary care (such as pap smears, reproductive health care and referral for chronic illnesses). Social benefits included training of home-based caregivers and sustainable ongoing HIV prevention education through peer educator programmes. Several challenges were encountered, including manipulation by participants of their eligibility criteria in order to enrol in the trial. Women attempted to co-enrol in multiple trials to benefit from financial reimbursements and individualised care. The trials became ethically challenging when participants refused to take up referrals for care due to stigma, denial of their HIV status and inadequate health infrastructure. Lack of disclosure of HIV status to partners and family members was particularly challenging. The researchers concluded that conducting these five trials in a period of six years provided them with invaluable insights into trial implementation, community participation, recruitment and retention, provision of care and dissemination of trial results.
Equity and HIV/AIDS
In collaboration with local stakeholders, this study designed and assessed a referral system to link persons diagnosed at a voluntary counselling and testing (VCT) clinic in a rural district in northern Tanzania with a government-run HIV treatment clinic in a nearby city. Two-part referral forms, with unique matching numbers on each side were implemented to facilitate access to the HIV clinic, and were subsequently reconciled to monitor the proportion of diagnosed clients who registered for these services, stratified by sex and referral period. Delays between referral and registration at the HIV clinic were calculated, and lists of non-attendees were generated to facilitate tracing among those who had given prior consent for follow up. The study found that referral uptake at the HIV clinic averaged 72% among men and 66% among women during the first three years of the national antiretroviral therapy (ART) programme, and gradually increased following the introduction of the transportation allowances and community escorts, but declined following a national VCT campaign. It concluded that the referral system reduced delays in seeking care, and enabled the monitoring of access to HIV treatment among diagnosed persons. Similar systems to monitor referral uptake and linkages between HIV services could be readily implemented in other settings.
South Africa has launched an extensive programme of HIV testing, treatment and prevention that United Nations officials say is the largest and fastest expansion of AIDS services ever attempted by any nation. In the past month alone the government has enabled 519 hospitals and clinics to dispense AIDS medicines, more than it had in all the years combined since South Africa began providing antiretroviral drugs to its people in 2004, according to this article. The government has trained the hundreds of nurses now prescribing the drugs — formerly the province of doctors — and will train thousands more so that each of the country’s 4,333 public clinics can dispense AIDS medicines. President Jacob Zuma has inaugurated a campaign to test 15 million of the country’s 49 million people for HIV by June 2011.
African church leaders met in Johannesburg in May 2010 to find common ground in response to HIV and AIDS. At the meeting, the church acknowledged that it has failed to react timeously and effectively to the challenge of AIDS. At the meeting, church leaders spoke out about the silence and judgmental stance that characterised their response to the HIV and AIDS epidemic. The church resolved to amend its ways.
While health outcomes of HIV and AIDS treatments in terms of increased longevity has been the subject of much research, there appears to be very limited research on the improved health-related quality of life (HRQL) that can be applied in cost-utility analyses in Africa south of the Sahara. In this study, a systematic review of the literature on HRQL weights for people living with HIV and AIDS in Africa was performed, and the study also used focus group discussions in panels of clinical AIDS experts to test the preference based on a generic descriptive system EQ-5D. It contrasted quality of life with and without antiretroviral therapy (ART), and with and without treatment failure. It found that only four papers estimated the HRQL weights for HIV and AIDS in sub-Saharan Africa with generic preference based methodologies that can be directly applied in economic evaluation. A total of eight studies were based on generic health profiles. The focus group discussions revealed that HRQL weights are strongly correlated to disease stage. Furthermore, clinical experts consistently report that ART has a strong positive impact on the HRQL of patients, although this effect appears to rebound in cases of drug resistance. The study concluded that EQ-5D appears to be an appropriate tool for measuring and valuing HRQL of HIV and AIDS in Africa. More empirical research is needed on various methodological aspects in order to obtain valid and reliable HRQL weights in economic evaluations of HIV and AIDS prevention and treatment interventions.
This study is one of Zimbabwe's national efforts to assess specific HIV and AIDS needs of mobile and migrant populations (MMPs) in the country and the barriers to accessing HIV and AIDS prevention, treatment and care services by these groups. The study also sought to identify the gaps that exist in meeting the HIV and AIDS needs for MMPs. The study was conducted in all major corridors in Zimbabwe, targeting a range of groups of MMPs. It found that the rising poverty levels (and in some cases absolute poverty levels) emanating from the rapid socio-economic decline and political uncertainty in the country, have provided a basis upon which vulnerability to HIV infection of MMPs, as well as that of the general population is premised. The study calls for improved coordination and strategic partnerships, modification of art access regulations, inclusive programming, awareness raising and creating regional approaches.
This study looked at HIV prevalence in the higher education sector in South Africa. It reported both quantitative and qualitative data. Out of a total of 29,856 eligible participants available at testing venues, 79,1% participated fully by completing questionnaires and providing specimens. Because of a substantial amount of missing data in 230 questionnaires, the final database consisted of 23,375 individuals made up of 17,062 students, 1,880 academic staff and 4,433 administrative and service staff. The mean HIV prevalence for students was 3,4%. HIV was significantly more common among men (6,5%) and women (12,1%) who reported symptoms of a sexually transmitted infection (STI) in the last year compared to men (2,5%) and women (6%) who did not report an STI. First-year students appeared to lack the required experience to make good, risk-aware decisions, especially regarding sexual liaisons and the use of alcohol. Qualitative data pointed to underlying causes of HIV transmission on campus as including reported transactional sex, intergenerational sex (a young woman with an older wealthier man), poor campus leadership on HIV and AIDS, limited uptake of voluntary testing and counselling services, poor levels of security on campus and stigma surrounding the disease.
The 2007 Kenya AIDS indicator survey is the first of its type in Kenya and provides data on HIV and other sexually transmitted infections (STIs), which may be used for advocacy and planning appropriate interventions for HIV prevention, treatment and care. It found that, of adults aged 15-64 years, an estimated 7.1%, or 1.42 million people, were living with HIV infection in 2007. Prevalence among adults aged 15-49 years was 7.4%, and was not statistically different from an earlier estimate of 6.7%. Women were more likely to be infected (8.4%) than men (5.4%). In particular, young women aged 15-24 years were four times more likely to be infected (5.6%) than young men of the same age group (1.4%). Knowledge of HIV status was low (16.4% of HIV-infected respondents), likewise with knowledge of partner’s HIV status. Co-infection with STIs and HIV was common: 16.9% of persons with syphilis were infected with HIV, as were 16.4% of persons with HSV-2 infection. At the time of the survey, an estimated 344,000 HIV-discordant couples needed targeted HIV testing and prevention. Overall, 57.5% of women and 56.4% of men reported having had unprotected sex with at least one partner of HIV-discordant or unknown HIV status in the twelve months prior to the survey.
This review of Global Fund projects in 2010 includes some chapters on projects they have funded in the east, central and southern African region. A chapter on HIV prevention in South Africa focuses on peer education in townships, while prevention of mother-to-child transmission of HIV in Namibia is also covered in terms of breaking the stigma surrounding the disease. Malaria prevention in Zambia is presented as a success story, as clinics are reported to be 'empty of patients', and a chapter on malaria prevention in Swaziland outlines the country's ambitious plan to eliminate malaria by 2015.
This paper assesses evidence on the association between educational attainment and risk of HIV infection over time in sub-Saharan Africa through a systematic review of published peer-reviewed articles. Approximately 4,000 abstracts and 1,200 full papers were reviewed, of which 36 were included in the study, containing data on 72 discrete populations from 11 countries between 1987 and 2003, and representing over 200,000 individuals. Studies on data collected prior to 1996 generally found either no association or the highest risk of HIV infection among the most educated. Studies conducted from 1996 onwards were more likely to find a lower risk of HIV infection among the most educated. HIV prevalence appeared to fall more consistently among highly educated groups. In several populations, associations suggesting greater HIV risk in the more educated at earlier time points were replaced by weaker associations later. It seems that HIV infections are shifting towards higher prevalence among the least educated in sub-Saharan Africa, reversing previous patterns. Policy responses that ensure HIV-prevention measures reach all strata of society and increase education levels are urgently needed.