The aim of this study was to determine the knowledge, attitudes and practices of women regarding the prevention of mother-to-child transmission (PMTCT) programme at a community health centre. Thirty-six educated women aged 18 - 39 years and attending the clinic took part, from informal settlements and mostly unemployed, receiving government grants. Most scored 80% or more with regard to general HIV knowledge. Attitudes were found to be positive with regard to both breastfeeding and formula feeding, but HIV status influenced it significantly. In conclusion, the women were knowledgeable about HIV transmission and mother-to-child transmission (MTCT), but an informed decision-making process was not followed, the sustainability of formula feeding after six months is a problem and health workers need to be trained about feeding options.
Equity and HIV/AIDS
While clinical care providers, programme managers and other stakeholders increasingly recognise the critical importance of nutrition for the treatment of HIV and AIDS, interventions that link nutritional support to treatment are relatively new. The Academic Model for Prevention and Treatment of HIV/AIDS (AMPATH) initiated one such intervention in 2002 in western Kenya with a large-scale expansion currently underway with the support of World Food Programme commodity donations and fresh food grown on AMPATH production farms. The intervention is designed to bolster nutrition security of the most vulnerable patients on antiretroviral regimens over a short period of time by providing supplemental household food rations. Weaning or transitioning clients off food supplementation is the major programmatic challenge facing this and similar nutrition interventions - especially given its critical importance in sustaining nutritional, health and productivity gains. The growing global interest in linking nutrition care to ARV treatment must not overlook the parallel need for long-term strategies to ensure nutrition security. In resource-poor settings, a high proportion of people living with HIV will be chronically food-insecure.
More and more HIV-positive pregnant women are testing for the virus and seeking out prevention of mother-to-child transmission (PMTCT) services in Sofala Province, in central Mozambique, but local health officials say much work remains to be done. During the first three months of 2008, HIV tests were offered to 34,200 women during pre-natal checkups; of the 31,303 who agreed to be tested, 16% were HIV-positive, and 70% of these women were given nevirapine to prevent the virus being passed to their babies. During the same period in 2007, HIV tests were only offered to 60% of the women attending pre-natal clinics, and only 19% of them accepted. The increase in uptake of PMTCT is particularly significant in Sofala, which has one of the highest HIV infection rates in the country - 25% - compared to the national average of 16%.
All around the world, people with HIV are being charged for endangering the lives of others. But this doesn't stop the spread of HIV because most of those infected don't know they have the virus, argues Judge Edwin Cameron, addressing the World AIDS Conference. ‘Criminalisation is warranted only in cases where someone sets out well-knowing he has HIV, to infect another person, and achieves this aim,’ argued Cameron. In general, the laws would not protect people from HIV: ‘In the majority of cases, the virus spreads when two people have consensual sex, neither of them knowing that one has HIV. That will continue to happen, no matter what criminal laws are enacted,’ said Cameron. ‘Criminalisation places blame on one person instead of responsibility on two,’ said Cameron.
The consequences of HIV and AIDS are exponential in Kenya, touching not only the health of those infected, but also depleting socioeconomic resources of entire families. Access to financial services is one of the important ways to protect and build economic resources. Unfortunately, the norm of financial viability discourages microfinance institutions from targeting people severely impacted by HIV and AIDS. Thus, HIV- and AIDS-service NGOs have been increasingly getting involved in microcredit activity in recent years for economic empowerment of their clients. Despite limited human resources and funding in the area of microcredit activity, these NGOs have demonstrated that nearly 50% of their microcredit beneficiaries invested money in income-generating activities, resulting in enhancement in their livelihood security. In the short term these NGOs need to improve their current practices. However, this does not mean launching microfinance initiatives within their AIDS-focused programmes, as financial services are best provided by specialised institutions. Longer-term cooperation between microfinance institutions and other HIV- and AIDS-service organisations and donors is necessary to muster appropriate and rapid responses in areas experiencing severe impacts of the disease.
Some voices in the health care debate are claiming that the response to HIV and AIDS is weakening primary care in many countries, diverting funding and health care personnel and distorting health systems. The new Missing the Target report provides some of the first research to inform this debate, with on the ground studies in Argentina, Brazil, Dominican Republic, Uganda, Zambia and Zimbabwe. The results were distinct in each country but point to several broad conclusions: the response to HIV and AIDS has had far-reaching positive impacts on health care in many settings: building infrastructure and systems, raising the bar on quality, extending the reach of health care to socially marginalised groups, and engaging consumers; significant new investments in HIV and AIDS services have revealed existing fragilities in health systems, and in some cases have placed increasing burdens on these systems by expanding demand and stretching already overextended human resources. The push for treatment access has not been just about the money although these efforts have brought considerable new financing. The mobilisation of activists and health care consumers themselves has also forced global and national leaders toward a more vigorous sense of accountability and urgency. If the UN’s health-related Millennium Development Goals (MDGs) are to have any chance of being realised, we need to do for health systems what we have done for AIDS while increasing the momentum of AIDS service scale-up.
At the XVII International AIDS Conference in Mexico City WHO unveiled a package of priority interventions designed to help low- and middle-income countries move towards universal access to HIV/AIDS prevention, treatment, care and support. The package includes everything from how to expand condom programming to the latest in treatment recommendations, guidelines and standards. The document is intended to help countries with limited resources meet the commitment made two years ago at the UN General Assembly High-Level Meeting on AIDS to provide universal access to HIV prevention, treatment, care and support by 2010.
In South Africa, numerous strong policy statements emphasise the importance of involving communities in HIV and AIDS management, yet in practice such involvement tends to be tokenistic and minimal. Social representations in the public sphere constitute the symbolic dimension within which responses to HIV and AIDS are conceptualised and transformed into action. Through an analysis of newspaper articles, the dominant representations of HIV and AIDS management circulating in the South African public sphere are examined to see how community engagement is depicted. Media representations reflect narrow understandings of HIV and AIDS as a predominantly medical problem, while depicting HIV and AIDS management as a top-down activity dominated by prominent individuals, such as national leaders, health professionals and philanthropists, thus marginalising the role played by communities, who are often depicted as passive recipients of interventions by active outsiders. These representations fail to reflect the key role played by members of grassroots communities in responding to the HIV epidemic. Such representations provide flawed conceptual tools for shaping responses to the epidemic, given that HIV-related programmes are unlikely to have optimal outcomes unless they resonate with the perceived needs and interests of their target communities. Effective HIV and AIDS management is best achieved through active participation by communities in HIV and AIDS management strategies. The paper also discusses the implications of a more ‘civic-minded journalism'.
The dynamics of HIV transmission in developing countries is compromised by unreliable data concerning sexual behaviour. This paper represents an effort to investigate young people’s reporting of sexual behaviour. It summarises the results from an interview-mode experiment conducted with unmarried young women aged 15–21 in rural southern Malawi in which respondents were randomly assigned to either an audio computer-assisted self-interview (ACASI) or a conventional face-to-face (FTF) interview. In addition, biomarkers were collected for HIV and three STIs: gonorrhea, chlamydia, and trichomoniasis. In both Kenya and Malawi, clear evidence indicates that the mode of interviewing and probing concerning various sexual partnerships affects respondents’ reporting of their sexual activity. Yet the results are not always in accordance with expectations. Reporting for ‘ever had sex’ and ‘sex with a boyfriend’ is higher in the FTF mode. When asked about other partners as well as multiple lifetime partners, however, the reporting was consistently higher with ACASI, in many cases significantly so. As in Kenya, in Malawi the interview-administered mode produced more consistent reporting of sexual activity between the main interview and a subsequent interview. Finally, the association between infection status and reporting of sexual behaviour is stronger in the FTF mode, although, in both modes, some young women who denied ever having had sex tested positive for STIs/HIV.
Tuberculosis (TB) is the biggest killer of people living with HIV in Africa, but only 1% of HIV-positive people accessing treatment were screened for TB in 2006, an oversight that activists say threatens to roll back the gains made in placing more than three million people on life-prolonging anti-retroviral (ARVs) treatment.