A key feature of South Africa’s HIV epidemic, where 5.7 million people are positive, is that among the 15-24 year olds infected, women and girls account for more than 90% of new infections. This needs a special focus on this group when designing prevention programmes, says UNAIDS. The HIV and AIDS epidemic in South Africa is stabilising, according to a report released last week by the Joint United Nations’ Programme on HIV and AIDS. This means that there has not been a recognisable increase in the rate of new infections over the last few years. Instead, the infection rate has remained relatively constant. This, however, does not mean that the epidemic is declining, as the country still holds the unenviable world number one position in the stakes of the total number of people living with HIV. The fact that women and girls continue to be disproportionately infected points to a failure of HIV programmes in addressing the issues that place females at risk of HIV infection, says the United Nations’ Special Envoy on AIDS in Africa, Elisabeth Mataka.
Equity and HIV/AIDS
Over 22,000 of the world’s key HIV and AIDS scientists, academics and activists attended 17th international AIDS conference in Mexico City. The HIV/AIDS sector has been under attack recently by some health practitioners who argue that too much money is being spent on HIV and AIDS to the detriment of other diseases. However, Craig McClure, the executive director of International AIDS Society (IAS) says it is unfortunate that the criticism that HIV is distorting health systems comes at a time ‘when success is finally in our hands’. ‘There is no doubt that in order for us to achieve the 2010 Universal Access targets, health systems must be further strengthened,’ said Cahn. ‘This will require an increase in resources, including additional resources for commodities like drugs and diagnostic tools, basic health care infrastructure and the training and retaining of the health care workforce. With the life-long interventions brought by antiretroviral therapy, the success of HIV and AIDS programmes around the world is dependent on health systems strengthening.’
This study examines clinical waste disposal and handling in the context of a community home-based care (CHBC) programme in Kanye, southern Botswana. This qualitative study involved 10 focus group discussions with a total of 82 AIDS primary caregivers in Kanye, one-to-one interviews with the five nurses supervising the programme, and participant observation. Numerous aspects of clinical or healthcare waste management were found to be hazardous and challenging to the home-based caregivers in the Kanye CHBC programme, namely: lack of any clear policies for clinical waste management; unhygienic waste handling and disposal by home-based caregivers, including burning and burying healthcare waste, and the absence of pre-treatment methods; inadequate transportation facilities to ferry the waste to clinics and then to appropriate disposal sites; stigma and discrimination associated with the physical removal of clinical waste from homes or clinics; poor storage of the healthcare waste at clinics; lack of incinerators for burning clinical waste; and a high risk of contagion to individuals and the environment at all stages of managing the clinical waste.
Correct and consistent condom usage remains a pivotal strategy in reaching the target set by the South African government to reduce new HIV infections by 50% in the next 5 years. Studies have found that there has been an increase in condom usage by some categories of the population, but usage has not yet reached the desired levels in order to meet the target. This article reports on the findings of a study on condom usage in eight communities in the North West Province, which was part of a wider HIV and AIDS programme evaluation commissioned by the North West Provincial Department of Health. The main aim was to assess accessibility to condoms, and knowledge, attitudes and practices around condom use by four sampled communities in the North West Province. Eight focus group discussions were held and 50 households were interviewed. The study found positive results regarding accessibility and awareness of condoms. However, this often did not lead to the desired behavioural change of using condoms in risky sexual interactions. The majority of respondents still resisted condom usage, used condoms inconsistently, or were not in a position to negotiate protected sexual intercourse. The main reasons reported for this were: reduced pleasure, perceived and real physical side-effects, myths, lack of information, status, financial reasons, distrust in the efficacy of condoms, family planning, cultural reasons, gender-related reasons and trust. Many of the barriers to consistent condom use cannot be overcome by strategies that target the individual. Interventions need to address underlying developmental factors such as the non-biological factors that increase the susceptibility of women to HIV infection. As this falls outside of the scope of the mandate of the Department of Health, various partnerships with other key role players need to be established and/or strengthened, such as with local government, non-governmental organisations and faith-based organisations.
A comprehensive care and treatment program requires a well functioning laboratory services. This study assessed satisfaction of medical personnel to the laboratory services to guide process of quality improvement of the services. A cross-sectional survey in 24 randomly selected health facilities in Mainland Tanzania was conducted to assess the satisfaction of the medical personnel with the laboratory services. About one quarter of medical personnel in sending or receiving laboratories were dissatisfied with the services. Comparing the personnel in public and private, the personnel in public laboratories were 4 times more dissatisfied with the timely test and correct results; and 5 times more dissatisfied with clear and complete test results.
HIV-infected women need support to deal with their diagnosis as well as with the stigma attached to HIV. As part of their practical training, Master's-level psychology students negotiated with the staff of four clinics in townships in Tshwane, South Africa, to establish support groups for HIV+ women and offered to assist them in facilitating the groups. This study aimed to understand why the implementation of groups was successful in one clinic and not other clinics. The student reports on their experiences, and interactions with clinic staff and clients were used as a source of data. Using qualitative data analysis, different dynamics and factors that could affect project implementation were identified in each clinic. Socio-ecological and systems theories were used to understand implementation processes and obstacles in implementation. Valuable lessons were learnt, resulting in the development of guiding principles for the implementation of support groups in community settings.
The rate of new HIV infections, which has fuelled the global HIV/AIDS epidemic since the 1980s, has peaked throughout the world and is now declining. But population growth and the life-prolonging effects of antiretroviral (ARV) treatment mean that the total global number of HIV-infected people is likely to remain about the same for another two decades and will continue to increase in sub-Saharan Africa. Based on these findings the authors say it is time for the international community and governments to rethink their prioritisation of AIDS over other infectious diseases.
This study assessed the health-related quality of life and HIV symptoms of a sample of people living with HIV (PLHIV) in South Africa. The sample included 607 PLHIVs from all districts of the Eastern Cape Province, recruited either through a health facility, from the community through key informants, or through support groups. The findings indicate a low degree of overall quality of life, with spirituality, environment, psychological health and level of independence as predictors for overall quality of life. Among medical variables and HIV symptoms, CD4 cell count and having fewer HIV symptoms (but not an AIDS diagnosis) were identified as predictors for overall quality of life. Among socio-economic variables, having sufficient food and a higher educational level were identified as predictors. The results highlight the need for better access to psychosocial support and medical services for PLHIV in South Africa, as well as the need to consider a patient's general health perceptions during the course of ART.
This publication defines the essential interventions the health sector should deliver and provides key references as well as links to web-based resources. The document provides WHO’s best attempt to assemble and package normative advice for the health sector concerning the essential response to HIV/AIDS. We hope it will prove useful for all those who work in the health sector, whatever their capacity, as they confront the realities of HIV/AIDS throughout the world.
This paper examines the history of HIV/AIDS in Kenya since it was first diagnosed in the country. The introduction of highly active antiretroviral therapy (HAART) has dramatically improved the prognosis for individual patients with AIDS, but education and changing attitudes towards condoms have led to a progressive fall in incidence, so that the worst of the epidemic may now be over. Limited personal experience suggests that steroids may also have a role in salvaging critically ill AIDS patients, who need to be treated as emergencies. With an educated public and attention to alternative routes of infection such as blood transfusion, the epidemic should be increasingly contained during the next 25 years, and may even fizzle out.