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.
Equity and HIV/AIDS
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.
Much of the progress in recent years in the fight against HIV may be attributed to increased use of antiretrovirals (ARVs), argues the World Health Organisation (WHO) in this short article to commemorate World AIDS Day on 1 December 2012. The latest global statistics suggest that, provided countries are able to sustain current efforts, the goal of getting 15 million HIV-infected people worldwide on ARVs will be reached by 2015. Currently eight million people in low- and middle-income countries are accessing the treatment they need, up from only 0.4 million in 2003. However, vulnerable and marginalised groups are still not able to access HIV prevention and treatment services, including adolescent girls, sex workers, men who have sex with men, drug users and migrants. And children are lagging badly behind: only 28% of children who need ARVs can obtain them. Some countries are considering initiating treatment at an even earlier stage in the course of HIV, as well as offering all HIV-positive pregnant women ARV therapy for life. WHO is currently reviewing new scientific research and country experiences in order to publish updated and consolidated guidance on the use of ARVs in mid-2013.
In light of the emerging debate on what a post-2015 development agenda and accountability framework should look like, the authors of this paper call on policy makers and other stakeholders to look at the AIDS response for lessons in global health responses, where the most marginalised are at the centre of the debate, human rights are protected under the rule of law, strong accountability is in place for results for people, and community and participatory processes are the norm. These hard-won principles of the AIDS response should be incorporated into the post-2015 global health agenda, while at the same time acknowledging that a rapidly changing world, including a shifting geopolitical and economic landscape, requires policy responses that are context sensitive. Three years ago, UNAIDS articulated what was then considered to be an ambitious vision: zero new HIV infections and zero-AIDS related deaths by 2015, underpinned by zero discrimination. The authors argue that the post-2015 development agenda calls for the reconceptualision of this vision as a set of concrete goals. They discuss the Shared Responsibility-Global Solidarity agenda, as pioneered by the African Union in its recent Roadmap on AIDS, Tuberculosis, and Malaria, to illustrate ways in which global health can be re-thought to tackle twenty-first century challenges.
Doubts have been cast about the ability of Home-Based HIV Counseling and Testing (HBHCT) to adhere to ethical practices including consent, confidentiality, and access to HIV care post-test. This study explored client experiences in relation these ethical issues. Researchers conducted 395 individual interviews in Kumi district, Uganda, where teams providing HBHCT had visited 6–12 months prior to the interviews. They found that 95% of respondents had ever tested (average for Uganda was 38%). Among those who were approached by HBHCT providers, 98% were informed of their right to decline HIV testing. Most respondents were counseled individually, but 69% of the married/cohabiting were counseled as couples. Most respondents (94%) were satisfied with the information given to them and the interaction with the HBHCT providers. These findings show a very high uptake of HIV testing and satisfaction with HBHCT, a large proportion of married respondents tested as couples, and high disclosure rates. HBHCT can play a major role in expanding access to testing and overcoming disclosure challenges. However, access to HIV services post-test may require attention.
Trial sponsors and implementers are ethically obligated to refer HIV infected Individuals identified in a research study at screening for HIV care and treatment. Makerere University Walter Reed Project is conducting HIV surveillance among high risk uninfected female sex workers. This study describes patterns in participants’ receipt of HIV results and response to referral for HIV care and treatment. Results indicated HIV prevalence was 35% at screening. Out of the 221 prevalent cases, only 96 participants (43%) received HIV confirmatory results and were referred for care, while 9 (4%) declined referral. The majority did not return for either their initial or confirmatory HIV result; while a few declined a blood re-draw. Of the 96 participants referred, 58% are currently in care, 14% did not report for care predominately citing indecisiveness while 28% could not be tracked. Most of the acutely infected participants (6/8) are in care. The authors argue that, although trial implementers may fulfil their obligation in referring study participants for HIV care, participants have a key role to play in facilitating this process. The large number of HIV prevalent female sex workers who did not return for their HIV results and may not be aware of their status could be a potential driver of the epidemic in Uganda, the paper concludes.