Currently South Africa does not have national HIV incidence data based on laboratory testing of blood specimens. The 2005 South African national HIV household survey was analysed to generate national incidence estimates stratified by age, sex, race, province and locality type, to compare the HIV incidence and HIV prevalence profiles by sex, and to examine the relationship between HIV prevalence, HIV incidence and associated risk factors. HIV incidence in the study population aged 2 years and older was 1.4% per year, with 571 000 new HIV infections estimated for 2005. An HIV incidence rate of 2.4% was recorded for the age group 15-49 years. The incidence of HIV among females peaked in the 20-29-year age group at 5.6%, more than six times the incidence found in 20-29-year-old males (0.9%). Among youth aged 15-24 years, females account for 90% of the recent HIV infections. Non-condom use among youth, current pregnancy and widowhood were the socio-behavioural factors associated with the highest HIV incidence rates. The HIV incidence estimates reflect the underlying transmission dynamics that are currently at work in South Africa. The findings suggest that the current prevention campaigns are not having the desired impact, particularly among young women.
Equity and HIV/AIDS
In settings of armed conflict, traditional HIV prevention programmes that promote risk avoidance via abstinence and fidelity and risk reduction via condom use and needle exchange are not viable. In such contexts, HIV risk depends less on personal choice than on exposure to physical, emotional and structural violence. War in northern Uganda has created three realities (internally displaced people's camps, night commuters and child abductions) which increase vulnerability to HIV transmission. Based upon this analysis of northern Uganda, we offer a conceptual framework for HIV transmission in conflict settings that recognizes the importance of local and global context in creating vulnerability to HIV infection. This framework is then used to delineate strategies for HIV prevention in northern Uganda, namely the provision of a safe physical environment and access to education, medical and psychological support, and the promotion of conflict resolution strategies and human rights law.
The interaction between HIV and AIDS, and nutritional status has been a defining characteristic of the disease since the early years of the epidemic. HIV and AIDS are associated with poor nutritional status and weight loss, and weight loss is an important predictor of death from AIDS. These links suggest that nutrition may have an important role to play in slowing progression of the disease and in contributing to successful antiretroviral (ARV) therapy. HIV and AIDS can also inhibit a person’s ability to secure adequate nutrition through inability to work, loss of appetite or increased need for nutrients as a result of the disease itself. Addressing impact on livelihoods and food security is therefore another important aspect of interventions for HIV and AIDS, and nutrition. This guide reviews the evidence base for current nutrition interventions for HIV and AIDS, and looks at the scientific background, trends and challenges in implementation, and implications for policy and planning.
The objective of this article is to describe the results of a 2-year pilot programme implementing prevention of mother to child HIV transmission (PMTCT) in a refugee camp setting. Interventions used were: community sensitization, trainings of healthcare workers, voluntary counselling and HIV testing (VCT), infant feeding, counselling, and administration of Nevirapine. Main outcome measures include: HIV testing acceptance rates, percentage of women receiving post test counselling, Nevirapine uptake, and HIV prevalence among pregnant women and their infants. Ninety-two percent of women (n=9,346) attending antenatal clinics accepted VCT. All women who were tested for HIV received their results and posttest counselling. The HIV prevalence rate among the population was 3.2%. The overall Nevirapine uptake in the camp was 97%. Over a third of women were repatriated before receiving Nevirapine. Only 14% of male counterparts accepted VCT. Due to repatriation, parent's refusal, and deaths, HIV results were available for only 15% of infants born to HIV-infected mothers. The PMTCT programme was successfully integrated into existing antenatal care services and was acceptable to the majority of pregnant women. The major challenges encountered during the implementation of this programme were repatriation of refugees before administration of Nevirapine, which made it difficult to measure the impact of the PMTCT programme.
This paper presents information on the association between socio-demographic variables and AIDS prevalence in some African and the Organization for Economic Cooperation and Development (OECD) countries. Insignificant difference in the means of AIDS-rates between the OECD countries and the African group was found, but the difference was significant when the USA was excluded from the analysis. As initially expected, life expectancy in the OECD countries was significantly higher than that of the African group while the average rates of infant mortality, population growth, fertility, and death were significantly higher within the African group. Significant association between AIDS-rate and life expectancy was only found for African males, while association with fertility, infant mortality, population density, and calorie intakes was statistically insignificant. No clear difference between urban and rural areas with respect to AIDS-rates was discerned. Communities of Muslims were less subject to the AIDS problem. In conclusion, future studies should devote more attention toward impacts on HIV/AIDS prevalence of other equally important variables such as access to social and health care services, cultural norms, ethnic diversity, and educational facilities.
This is a protocol for a pragmatic cluster randomised trial to evaluate the effectiveness of a complex intervention based on and supporting nurse led antiretroviral treatment (ART) for South African patients with HIV/AIDS, compared to current practice in which doctors are responsible for initiating ART and continuing prescribing. The trial will randomly allocate 31 primary care clinics in the Free State province to nurse-led or doctor-led ART. Two groups of patients aged 16 years and over will be included: a) 7400 registering with the programme with CD4 counts of 350 cells/mL or less (mainly to evaluate treatment initiation) and b) 4900 already receiving ART (to evaluate ongoing treatment and monitoring). The primary outcomes will be time to death (in the first group) and viral suppression (in the second group). Patients' survival, viral load and health status will be measured at least 6-monthly for at least one year and up to 2 years, using an existing province-wide clinical database linked to the national death register.
As part of quarterly national reports on the scale up of antiretroviral therapy (ART), demographic and clinical characteristics are recorded including data on occupation. The largest occupational category is that of “other”. As there is no information on the composition of the different occupations of patients placed in this category, a formal study was therefore conducted in six representative public sector facilities in the Southeastern Region of Malawi. Between January to June 2006, there were 126 adult patients recorded as “other” in the occupation column. A great variety of different occupations was recorded including no employment 30%, administration jobs 24%, general labourers 11%, builders 10%, tailors 9% and drivers 7%. A wide range of people with different jobs are accessing ART, and this should help in improving the economy of the patients as well as the country at large.
At the 2006 United Nations High Level Meeting on HIV/AIDS, world leaders reaffirmed that “the full realization of all human rights and fundamental freedoms for all is an essential element in the global response to the HIV/AIDS pandemic.” Yet, 25 years into the AIDS epidemic, this “essential element” remains the missing piece in the fight against AIDS. Now more than ever, law and human rights should occupy the center of the global HIV/AIDS struggle. This booklet, published by OSI's Law and Health Initiative, presents 10 reasons why.
This paper highlights the socio-economic impacts of HIV on women. It argues that the socio-cultural beliefs that value the male and female lives differently lead to differential access to health care services. The position of women is exacerbated by their low financial base especially in the rural community where their main source of livelihood, agricultural production does not pay much. But even their active involvement in agricultural production or any other income ventures is hindered when they have to give care to the sick and bedridden friends and relatives. This in itself is a threat to household food security. The paper proposes that gender sensitive policies and programming of intervention at community level would lessen the burden on women who bear the brunt of AIDS as caregivers and livelihood generators at household level. Improvement of medical facilities and quality of services at local dispensaries is seen as feasible since they are in the rural areas. Other interventions should target freeing women's and girls' time for education and involvement in income generating ventures. Two separate data sets from Western Kenya, one being quantitative and another qualitative data have been used.
Active tuberculosis (TB) is common among HIV-infected persons living in tuberculosis endemic countries, and screening for tuberculosis (TB) is recommended routinely. The study sought to determine the role of chest x-ray and sputum culture in the decision to treat for presumptive TB using active case finding in a large cohort of HIV-infected patients. Many ambulatory HIV-infected patients with CD4 counts >200/mm3 are treated for presumptive TB. Data suggests that optimal detection requires comprehensive evaluation, including CXR and sputum culture on both symptomatic and asymptomatic subjects.