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%.
Equity and HIV/AIDS
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.
While Zambia and South Africa are attempting to integrate public TB and HIV services to reach co-infected people, there is little evidence on how the synergy of co-infection with TB and HIV plays out for affected families in the context of poverty and overstretched public services. An anthropological study carried out in 2006/7 documented the social and economic impact of TB, HIV and food insecurity on poor households in rural Zambia and peri-urban SA. Anthropological research was conducted in 18 households affected by TB throughout the period of TB treatment and in 17 comparative non-affected households. Affected families suffered a double blow: they lost the productivity of an adult family member and at the same time needed to muster resources to seek treatment and adequately care for the patient. TB drugs are perceived as both causing hunger and demanding food intake. In South Africa and Zambia, inequities increased both vulnerability to infection and disease and likelihood of delayed diagnosis and delayed or interrupted treatment and care for TB and HIV. In Zambia, those in treatment for TB fell deeper into poverty and were in debt and short on food. In SA, affected households were kept buoyant by the disability grant and other welfare initiatives, but in the long-term most were unable to resume their previous livelihoods. This research recommends that, in the context of poverty, food aid and transport costs are made available to TB patients and PLWHs on ART.
The Farmer Life School (FLS) is an innovative approach to integrating HIV education into life skills and technical training for farmers. This study aims to gain insight into the strengths and weaknesses of this relatively new approach, through the implementation of an adapted version in South Africa. The results are presented of a pilot with three groups of community gardeners, predominantly women, attending weekly sessions. Impact was assessed in terms of three key elements: participation, learning and empowerment. Data was collected through extensive session reports, follow-up interviews and reflection exercises with facilitators, participating groups and individuals. The results suggest that a group-based discovery learning approach such as the FLS has great potential to improve food security and wellbeing, while allowing participants to explore issues around HIV/AIDS. However, the analysis also shows that HIV/AIDS-related illness and death, and the factors that drive the epidemic and its impact, undermine farmers' ability to participate, as well as the safety and trust required for learning and the empowerment process. Participatory approaches such as the FLS require a thorough understanding of and adaptation to the context in which they are to be used.