The Ugandan parliament's house Committee on HIV/AIDS and related matters has appealed to the government to increase its funding for HIV, especially as infection rates remain high and the country continues to experience frequent shortages of anti-retroviral medicines. ‘As a committee we are advocating for the government to increase its funding on HIV/AIDS activities in the country to at least 15% [of the national budget],’ said Beatrice Rwakimari, chair of the committee. Uganda's most recent budget allocated about US$30 million to the purchase of anti-retrovirals and anti-malaria medication, and gave the Uganda AIDS Commission about US$3 million to fight HIV, while US$500,000 was earmarked for prevention programmes. The total allocation to HIV programmes – which makes up 6% of the national budget –marks an increase on previous years, but members of Parliament say it is still not nearly enough to roll back the effects of the pandemic. ‘This funding is too little, as we continue to get new infections every year,’ Rwakimari said. Uganda's HIV prevalence has risen marginally from a low of 6% in 2000 to 6.4%, according to the government.
Equity and HIV/AIDS
Zimbabwe's adult HIV prevalence rate is continuing its downward trend, showing a drop from 14.1% in 2008 to 13.7% in 2009, according to new estimates released by the Ministry of Health and Child Welfare. The 2009 Antenatal Clinic (ANC) Surveillance Survey, based on blood specimens collected from 7,363 pregnant women anonymously screened at 19 clinic sites throughout the country, estimated that 1.1 million Zimbabweans in a probable population of around 11 million were living with HIV. The prevalence rate is expected to continue decreasing; investigations have shown that the decline ‘most likely resulted from a combination of an increase in adult mortality and a decline in HIV incidence, resulting from adoption of safer sexual behaviours’, said Douglas Mombeshora, Deputy Minister of Health and Child Welfare. ‘When prevention programmes achieve heightened awareness, significant changes in behaviour will occur, and one of the main outcomes is the significant reduction in the need for PMTCT [prevention of mother-to-child transmission] services, as well as a reduced number of new HIV infections,’ he noted.
As part of a broader initiative to monitor the implementation of the national antiretroviral therapy (ART) programme, this qualitative study investigated the impact of ART availability on perceptions of HIV in a rural ward of north Tanzania and its implications for prevention. A mix of qualitative methods was used including semi-structured interviews with 53 ART clinic clients and service providers. Four group activities were conducted with persons living with HIV. People on ART often reported feeling increasingly comfortable with their status reflecting a certain ‘normalisation’ of the disease. Overcoming internalised feelings of shame facilitated disclosure of HIV status, helped to sustain treatment, and stimulated VCT uptake. However ‘blaming’ stigma – where people living with HIV were considered responsible for acquiring a ‘moral disease’ – persisted in the community and anticipating it was a key barrier to disclosure and VCT uptake. As long as an HIV diagnosis continues to have moral connotations, a de-stigmatisation of HIV paralleling that occurring with diseases like cancer is unlikely to occur.
A large supply of paediatric antiretroviral medication donated by the Clinton Foundation could expire in Ugandan medical stores because of low demand. ‘There are few children who are receiving the drugs; they are going to expire by March [2010],’ said Zainabu Akol, head of HIV programming in the Ministry of Health. Fewer than a quarter of the 125,000 Ugandan children who need life-prolonging anti-retroviral treatment (ART) have access to it, mainly because of stigma and inadequate education of parents, say specialists. ‘Due to stigma, parents have failed to take their children for ART,’ said Goretti Nakabugo, from a local non-governmental organisation, called Strengthening HIV/AIDS Counsellor Training. ‘They believe if their children start ART, they will be shunned by the community and pupils at school. People don't yet believe that HIV/AIDS is not transmitted through casual contact; a child with rashes is always shunned,’ she added. Many parents cannot face the idea of telling their children they have a potentially life-threatening illness and they live in denial.
South Africa's Free State Province is again experiencing a crisis in the delivery of antiretroviral (ARV) treatment, with understaffed clinics, erratic drug supplies and long waiting lists preventing many dangerously ill patients from accessing the life-prolonging drugs, according to AIDS activists. Runaway overspending by the provincial health department in 2008 led to a moratorium on new patients starting ARV treatment that lasted from November until February 2009. The Southern African HIV Clinicians Society estimated that 30 people a day died during this three-month period because they could not access treatment. Now, several reports from the Free State suggest that many of the factors leading to last year's moratorium have not been addressed, and patients are again suffering the consequences. Trudie Harrison, director of the Anglican Church's Mosamaria AIDS Ministry, said that the crisis was the result of drug shortages and a dearth of health workers. At one ARV site she recently visited, normally staffed by three doctors, about 200 patients were waiting to see just one doctor.
This paper’s aim is to review facility-based maternal deaths at a tertiary-level centre in Johannesburg, South Africa, from 2003 to 2007, and to investigate the proportion of deaths attributable to human immunodeficiency virus (HIV), the etiology of deaths, and the effects of antiretroviral treatment introduced in late 2004. Patient case files, birth registers, death certificates, and mortality summaries were reviewed. Cause of death was assigned through clinical case discussion. Annual maternal mortality ratios were calculated and disaggregated by HIV status. During the period reviewed, 106 maternal deaths occurred out of 36,708 births. In 72% of cases, HIV status was known, with the majority being HIV-infected (78%). Maternal mortality ratios in HIV-infected women were 95%, 6.2-fold higher than in HIV-negative women. Changes in mortality over time were not detected. Although HIV testing increased 1.4-fold each year and estimated coverage of antiretroviral treatment for pregnant women reached 59.2% in 2007, levels remain suboptimal. In Johannesburg, HIV remains the major cause of maternal mortality despite integration of antiretroviral treatment into prenatal services. Maternal health services should target barriers to uptake of HIV treatment and care.
People living with HIV in Kenya do not have adequate access to family planning services, even though most HIV-infected women do not want children in the immediate future. A recent study by the reproductive health NGO, Family Health International (FHI), in the Nakuru district of Rift Valley Province, found that 80% of HIV-positive women had no intention of having a child in the next two years. However, according to the 2007 Kenya AIDS Indicator Survey, only half the HIV-positive people needing family planning services had access to them. ‘Most prevention of mother-to-child transmission [PMTCT] programmes... looked at it only in the context of preventing transmission to an already conceived child, but meeting contraceptive needs of those living with HIV is a sure way of reducing transmission by avoiding unwanted pregnancies in the first place,’ said Maurine Kuyo, a project director at FHI. About 56% of women in the FHI study mentioned a fear of vertical transmission of HIV to their children as one the reasons they would not want another pregnancy, while 50% mentioned the risk of lowered immunity during pregnancy.
A six-year clinical trial in Thailand has yielded the first ever evidence that an AIDS vaccine can provide some protection against HIV infection. The trial team in Bangkok, Thailand's capital announced on 24 September that rates of HIV infection were 31% lower in trial participants who got the vaccine than in those who received a placebo. ‘These new findings represent an important step forward in HIV vaccine research,’ said Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases (NIAID), the main funder of the trial. The study began enrolling 16,000 HIV-negative men and women between the ages of 18 and 30 in October 2003. Half the volunteers received a placebo; the other half were given shots containing two different vaccines. The trial was designed to evaluate whether the combined vaccines (ALVAC-HIV and AIDSVAX) lowered HIV infection risk, and whether they had any impact on viral load [the amount of HIV circulating in the bloodstream] in the volunteers who became infected. Of 8,197 people given the vaccine regimen, 51 became infected, compared to 74 of the 8,198 volunteers who received the placebo.
Carrying placards that read, ‘Huwezi Die Uki Abstain’, Swahili slang for ‘You won't die if you abstain [from sex]’, more than 3,000 young people recently marched through Nairobi in an effort to re-energise the campaign to keep teens from having sex too early. But beyond the placard-waving and slogan-chanting, march organisers were also trying to give young people the skills to avoid being pushed into sex before they are ready. James Kabucho, programmes director at Life Skills Promoters, one of the non-governmental organisations that organised the march, explained that the campaign was teaching young people negotiation skills. By acting out real-life scenarios, writing essays, and engaging peer educators in question and answer sessions, young people were able to talk about their experiences and learn to say ‘No’ to unwanted sexual advances. Research shows that early sexual initiation is associated with increased risk of HIV infection, while adolescents who engage in sex at an early age are likely to have more sexual partners than those who delay their sexual debut. Girls who engage in sex in their teens may also face the challenges of teenage pregnancy, unsafe abortions and dropping out of high school.
In 2007, South Africa, with 0·7% of the world's population, had 17% of the global burden of HIV infection, and one of the world's worst tuberculosis epidemics, compounded by rising drug resistance and HIV co-infection but, until recently, the government's response to these diseases has been marked by denial, lack of political will and poor implementation of policies and programmes. Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts and scale-up of free antiretroviral therapy (ART). Using the framework of the Strategic Plans for South Africa for Tuberculosis and HIV/AIDS, this paper provides a prioritised four-step approaches for tuberculosis control, HIV prevention, and HIV treatment. Strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health-care services are needed for successful implementation of these approaches.