South African AIDS activist organisations, SECTION27 and the Treatment Action Campaign (TAC), have welcomed the government’s successful new anti-retroviral (ARV) tender, which covers the period 1 January 2011 to 31 December 2012 and will see the state procuring ARVs at the best prices available globally. This is in stark contrast to the previous tender, which resulted in South Africa paying significantly more than necessary for ARVs. For example, South Africa will now be paying – on average – about R115 per patient per month on standard combination treatment of three ARVs, compared to a previous cost of R110 for just one ARV. Also, the price of the paediatric version of abacavir has nearly halved since the last tender. SECTION27 notes, however, that the tender did not include any TDF-containing three-in-one fixed dose combinations, which would allow patients the convenience of taking all their medications in just one pill. The organisation calls for call for greater transparency in future tenders, with more autonomy for the Department of Health and less influence on the tendering process by the Treasury.
Equity and HIV/AIDS
The aim of this study was to identify risk factors that could explain the large differences in HIV-1 prevalence among pregnant women in Harare, Zimbabwe, and Moshi, Tanzania. Cross-sectional data from a two-centre study that enrolled pregnant women in Harare and Moshi was used. Consenting women were interviewed about their socio-demographic background and sexual behaviour, and tested for presence of sexually transmitted infections and reproductive tract infections. The prevalence of HIV-1 among pregnant women was 26% in Zimbabwe and 7% in Tanzania. The HIV prevalence in both countries rises constantly with age up to the 25-30 year age group. After that, it continues to rise among Zimbabwean women, while it drops for Tanzanian women. Risky sexual behaviour was more prominent among Tanzanians than Zimbabweans. Mobility and such infections as HSV-2, trichomoniasis and bacterial vaginosis were more prevalent among Zimbabweans than Tanzanians. In conclusion, the higher HIV-1 prevalence among pregnant women in Zimbabwe compared with Tanzania could not be explained by differences in risky sexual behaviour: all risk factors tested for in the study were higher for Tanzania than Zimbabwe. Non-sexual transmission of HIV might have played an important role in variation of HIV prevalence.
AIDS exceptionalism is the idea that the disease requires a response above and beyond ‘normal’ health interventions. More recently, the term has come to refer to the disease-specific global response and the resources dedicated to addressing the epidemic. The authors of this study argue that AIDS exceptionalism began as a Western response to the originally terrifying and lethal nature of the virus. There has been a backlash against this exceptionalism, with critics claiming that HIV and AIDS receive a disproportionate amount of international aid and health funding. This paper situations this debate in historical perspective. By reviewing histories of the disease, policy developments and funding patterns, it charts how the meaning of AIDS exceptionalism has shifted over three decades. The authors argue that, while the connotation of the term has changed, the epidemic has maintained its course, and therefore some of the justifications for exceptionalism remain.
In this study, researchers investigated gender differences in treatment outcome during first line antiretroviral treatment (ART) in a hospital setting in Tanzania, assessing clinical, social demographic, virological and immunological factors. They used structured questionnaires and reviewed patients’ files, including a total of 234 patients about to start ART, and followed up one year later. Seventy percent of participants were females. After one year of standard ART, a higher proportion of females survived although this was not significant. They showed a worse CD4 cell increase than men, even though they had a higher BMI. Although women were starting treatment at a less advanced disease stage, they had a lower socio-economical status. After one year, both men and women had similar clinical and immunological conditions. It is not clear why women lose their immunological advantage over men despite a better virological treatment response.
Evidence for the association between religiosity and HIV infections is limited. Sujda, the hyper-pigmented spot on the forehead due to repeated prostration during prayers and fasting to worship, involving abstaining from food, drink and sex during daytime in Ramadhan and other specified days, are measures of religiosity among Muslims In this study, researchers assessed the association between religiosity and HIV infections. They included 29 HIV positive cases and 116 HIV negative controls, from a total of 1,224 Muslims, 15-24 years. Respondents without Sujda had more HIV infections. Those with Sujda were more likely to abstain from sex and be faithful in marriage. Respondents without Sujda were more likely to have ever taken alcohol before sex and to have ever used narcotics.
In this article, the authors summarise the main points of the UNAIDS World AIDS Day Report 2012 (included in this newsletter), which evaluated global progress in reaching the goals of Zero New HIV Infections, Zero Discrimination and Zero AIDS-Related Deaths. While the report includes quantitative information on two of the “Getting to Zero” goals – zero new infections and AIDS-related deaths – there is very little information on the third - zero discrimination - the authors note. Challenges persist in treatment and prevention, and progress is further impacted on by politics, poor governance, prohibitive costs and failure to build on evidence in the multisector response. Despite the flagging global response, countries have managed to move ahead, albeit slowly, to treat HIV-affected people, prevent transmission from mother to child and promote safe sexual behaviour. With treatment now available for only US$100 annually in some countries, the authors argue it is time for another bold move such as 3 by 5, focused on direct support to countries and a more strategic and efficient allocation of global resources toward evidence-based strategies that have been shown to work.
In this new report, UNAIDS reports that there are 700,000 fewer new HIV infections globally in 2011 than in 2001, eight million people on life-saving antiretroviral (ARV) therapy (a 60% increase in the last two years), and a drop of more than half a million deaths from AIDS-related illnesses between 2005 and 2011 in people living with HIV. However, new HIV infections continue to outpace ARV treatment coverage. Sub-Saharan Africa has realised a 25% reduction in new infections, although the region still accounted for 72% of new HIV infections globally in 2011. Progress in treatment has been impressive, saving lives and transforming HIV into a chronic illness rather than a death sentence. In addition to their therapeutic effects, ARVs have been found to play a preventive role by significantly reducing the amount of virus in the blood and therefore reducing the risk of transmission to sexual partners. A major weakness in both prevention and treatment programmes in many countries is reported by UNAIDS to be their failure to decrease mother-to-child transmission of HIV, which is the most easily preventable form of transmission.
This cross-sectional study was carried during 2009 to assess water, sanitation status and hygiene practices and associated factors among People Living with HIV and AIDS (PLWHAs) in home-based care services in Gondar City, Ethiopia. Researchers collected data from 294 PLWHAs in the form of in-depth interviews (72.8% females and 27.2% males). They found that 42.9% of the households had “unimproved” water status, 67% had “unimproved” sanitation status, and 51.7% had poor hygienic practice. Diarrhoea with associated with water status, while educational status and latrine availability were associated with sanitation status. Lack of hand washing devices and the unaffordable cost of soap reduced hygienic practices. In conclusion, the authors found a high burden of water, sanitation and hygiene problems in home-based care services for PLWHAs. They recommend hygiene education and additional support for the provision of water, sanitation and hygiene services.
The Southern and Eastern Africa Youth Conference on HIV and AIDS and Reproductive Health Rights for Sustainable Development (SEYCOHAIDS 2012) was held in Malawi, 6-8 November 2012, and delegates produced this statement at the end of the conference. During the conference, delegates were able to share best practices and lessons in HIV and adolescent Sexual Reproductive Health (SRH) interventions in the region. Although regional governments have ratified the African Youth Charter; the signatories to this statement recommend that it is domesticated and used to inform the Youth policies and development programmes in the respective countries. Funding alone cannot deal with the issues of child marriages, as well as HIV and SRH support. The community systems require strengthening in order to support effective HIV and SRH programmes and interventions for adolescents at the community level to achieve universal access to health and the Millennium Development Goals by 2015. The statement points to best practices and models of HIV and SRH capacity building in the region that can be replicated and scaled up, including improved family planning programmes targeted at the youth, to prevent unplanned pregnancies and unsafe abortions.
The South African Government has taken a major step towards improving HIV treatment compliance and cost with the announcement that the new antiretroviral (ARV) tender will include a triple fixed dose combination (FDC) tablet, which combines three pills into one. FDCs have shown to have major benefits for ART patients in terms of easier compliance and fewer side effects, with the added benefit for hospitals of reduced logistics and less storage space needed. The cost of the FDC is only R89.37, making it arguably the world’s lowest priced FDC. From April 2013 all pregnant women will be given the fixed dose combination during pregnancy and breast feeding and thereafter if their CD4 count is less than 350. According to Health Minister Aaron Motsoaledi, the fixed dose combination is more effective than dual therapy and has fewer side effects for the pregnant mother, in addition to its convenient dosage regimen. He confirmed that the most of the patients currently on the three ARV drugs would switch to the FDC from April 2013. Government will continue to stock the current ARVs for those unable to switch. Activists, who have been campaigning for FDCs for a number of years, welcomed the decision.