The HIV and AIDS epidemic feeds on, and worsens, unacceptable situations of poverty, gender inequity, social insecurity, limited access to healthcare and education, war, debt and macroeconomic and social instability. This paper introduces a series of eight papers from a programme of work reported in this supplement of AIDS Care with an analysis of background evidence of community responses to HIV and AIDS. It explores how interventions from state institutions and non-governmental organizations (NGOs) support and interact with these household, family and community responses. Through review of literature, this background paper sets out the questions that the studies reported in this supplement have, in various settings, sought to explore more deeply.
Equity and HIV/AIDS
A trial in Zimbabwe has shown that a programme of integrated peer education, condom distribution, and management of sexually transmitted infections did not reduce the overall incidence of HIV-1. The study, published in PLoS Medicine, by Simon Gregson and colleagues from Imperial College London, randomised different communities in eastern Zimbabwe over a 3 year period. Six pairs of communities in Eastern Zimbabwe were compared, each of which had its own health center. Control communities received the standard government services for preventing HIV. According to the author, the results are disappointing given the urgent need for control measures for HIV-1 in sub-Saharan Africa. The authors conclude that they “emphasise the need for alternative strategies of behaviour change promotion.”
The AIDS and Rights Alliance for Southern Africa (ARASA), a partnership of human rights and HIV/AIDS organisations in the 14 countries of Southern Africa, denounced American charlatan, Boyd E. Graves, for peddling false AIDS cures in Zamiba, where his claims to be able to treat HIV infection are creating mass confusion across the country among people living with HIV/AIDS. "We are hearing reports from our partner organisations that people are stopping their AIDS medications now that they are being led to falsely believe that a cure for AIDS has been found," said Michaela Clayton, the Director of ARASA. The article claims that in fact, the Treatment Advocacy and Literacy Campaign in Zamiba is reporting that individuals are being told by agents of Mr Graves to stop taking their antiretroviral drugs, stop using condoms and stop immunizing their children against infectious diseases.
This paper situates the findings of the diverse studies reported in this journal supplement in a global context that both fuels the epidemic through inequality and poverty and also provides new opportunities for global commitments, solidarity and resources. The studies in this issue signal that, while information and awareness about HIV and AIDS is now high, there is still poor access to services for people to know their own risk and a deeper need to address the asymmetries of power and access to resources that influence the control people have over their sexual relationships and lives.
Namibia is hailed as one of the front-runners in AIDS treatment rollout, yet there is growing fear that this success might be short-lived if services do not reach rural communities. The government has increased the number of sites offering antiretroviral (ARV) treatment from seven three years ago to 34 at present, but most of the clinics were set up in the densely populated northern regions, far from people living on farms and in rural villages.
The number of tuberculosis cases in Tanzania has risen from 39,000 a decade ago to 64,200 in 2005, a trend blamed on high HIV/AIDS prevalence, the Health Minister, David Mwakyusa, said on Thursday. "Research conducted in many parts of the country by the Ministry of Health between 2003 and 2004 established that HIV/AIDS contributes to increased TB cases by about 60 percent," the minister said.
The provision of life-saving antiretroviral (ARV) treatment has emerged as a key component of the global response to HIV/AIDS, yet little is known about the impact of this intervention on the welfare of children whose parents receive treatment. In this working paper CGD post-doctoral fellow Harsha Thirumurthy and his co-authors use longitudinal household survey data collected in collaboration with a treatment program in western Kenya to provide the first estimate of the impact of ARV treatment on children’s schooling and nutrition. They find that children's weekly hours of school attendance increase by over 20 percent within six months after treatment is initiated for the adult household member. Young children's short-term nutritional status also improves dramatically. Since the improvements in children’s schooling and nutrition at these critical early ages will affect their socio-economic outcomes in adulthood, the authors argue that the widespread provision of ARV treatment is also likely to generate significant long-run macroeconomic benefits.
The Pan African Treatment Access Movement (PATAM) is a social movement comprised of individuals and organizations dedicated to mobilising communities, political leaders, and all sectors of society to ensure access to antiretroviral (ARV) treatment, as a fundamental part of comprehensive care for all people with HIV/AIDS in Africa. However, the year 2005 saw some changes that affected the movement’s effectiveness and threatened its survival. These made it necessary for the PATAM leadership to convene a strategic planning workshop and make decisions concerning the movement’s future. The workshop, which was hosted by the ALCS and funded by ActionAid, was divided into two parts. This document provides a detailed report of the workshop highlights.
Understanding the epidemiological HIV context is critical in building effective setting-specific preventive strategies. We examined HIV prevalence patterns in selected communities of men and women aged 15–59 years in Zambia.
The United Nations refugee agency, UNHCR, has launched a new policy to ensure that HIV-positive refugees and other displaced people around the world have access to life-prolonging antiretroviral (ARV) medication. The policy, designed to offer guidance to UNHCR and its partners as well as host governments, aims to integrate ARV provision as part of a comprehensive HIV/AIDS programme for refugees that includes prevention, care and support.