While the dearth of health workers is undermining the huge scale up of HIV/AIDS prevention, care, and treatment that Africa needs so desperately, conversely the emphasis on HIV/AIDS services is drawing resources away from other vital health services that are also in short supply, according to testimony by Holly J. Burkhalter of Physicians for Human Rights to the US House International Relations Committee. "For example, at the 970-bed the Lilongwe Central Hospital in Malawi, only 169 nurses were practicing in mid-2004, compared to the 520 nurses whom the hospital was authorized to employ. The hospital's former staff of 38 laboratory technicians had fallen to only six. The nurses and laboratory technicians were moving to HIV/AIDS programs sponsored by NGOs and overseas universities, precipitating a staffing crisis at this major national referral hospital."
Equity and HIV/AIDS
Four years after world leaders at the UN General Assembly Special Session (UNGASS) on AIDS pledged to scale up their fight against the disease, many countries are falling short of their targets, a new report has found. Under the Declaration of Commitment on HIV/AIDS of July 2001, UN member governments set time-bound goals for reversing the spread of the pandemic by scaling up treatment, prevention and care in their countries. Much still has to be done before the people directly affected realise the benefits of these commitments.
The link between HIV/AIDS and hunger in rural communities has received a great deal of attention over the past few years - particularly in Southern Africa, where HIV/AIDS has added a new dimension to the recent food crisis. But research emerging from the recent international conference on 'HIV/AIDS and Food and Nutrition Security' in Durban, South Africa, showed that very little is know about the actual impact of the pandemic on rural communities.
Since 1997, The Joint United Nations Programme on AIDS (UNAIDS) and the World Health Organisation (WHO) have provided estimates for the number of people living with HIV in different countries every two years. As new methods are developed for calculating existing and future trends in the disease, figures can be startlingly different. How can accurate decisions be made on health spending if policy-makers are unclear about how many people are HIV positive? Researchers review the process, methods and procedures that have been used in the past and current round of estimates of HIV/AIDS burden.
A University of the Western Cape School of Public Health and Health Systems Trust study to assess the extent of inequalities in availability and utilisation of HIV services across South Africa found marked inequalities in service delivery between the three sites sampled. "Compared with two poorer sites, clinics at the urban site had greater availability of HIV services, including voluntary counselling and testing , better uptake of this service and greater distribution of condoms. Extra counsellors had also been employed at the urban site in contrast to the other 2 sites." The study concludes that the process of scaling up of HIV services seems to be accentuating inequalities.
Botswana will soon be embarking on the clinical trials of the anti-AIDS drug, tenofovir, despite concerns over how the tests were conducted in Cameroon, Nigeria and Cambodia. The antiretroviral drug, manufactured by US pharmaceutical company Gilead and sold under the brand name, 'Viread', will be tested as a possible prophylactic to prevent people becoming infected with the HI virus.
Zambian Health Minister Brian Chituwo has lamented India's decision to stop manufacturing cheap anti-AIDS drugs, noting that the medicines were his country's "lifeline" against the HI virus. However, in an interview with the local 'Post' newspaper, Chituwo said Zambia was busy exploring ways of procuring affordable antiretrovirals from South Africa.
This joint policy brief from the World Health Organization (WHO) and UNAIDS identifies key actions needed to address the gender dimensions of equity in access to antiretroviral therapy (ART). Gender-based inequalities put women and girls at increased risk of HIV infection. These inequalities also affect women's access to and interaction with health services, including HIV prevention and AIDS care. The brief argues that to address these inequalities in HIV treatment, care and prevention, it is essential to consider the different needs and constraints of women and men in different settings.
"We describe a number of pitfalls that may occur with the push to rapidly expand access to antiretroviral therapy in sub-Saharan Africa. These include undesirable opportunity costs, the fragmentation of health systems, worsening health care inequities, and poor and unsustained treatment outcomes. On the other hand, AIDS "treatment activism" provides an opportunity to catalyze comprehensive health systems development and reduce health care inequities. However, these positive benefits will only happen if we explicitly set out to achieve them. We call for a greater commitment toward health activism that tackles the broader political and economic constraints to human and health systems development in Africa, as well as toward the resuscitation of inclusive and equitable public health systems."
Near hysterical media reports last week reported on a strain of HIV resistant to drugs from three main classes of antiretrovirals. But this article from HIV information site www.aidsmap.com says that perhaps the reason for the reaction to the case- reported in New York - and its reporting lies not in its medical significance, but in its importance to current US debates on comprehensive or abstinence-only HIV prevention. Visit the site to read the full article.