The Scorecard rates countries on their reporting of six key elements in an AIDS response tuned to the needs of women, including the collection of HIV data specific to women; progress in ensuring that women have equal access to HIV services; and the impact of national responses on reducing infections among women and facilitating their access to treatment. The overall score reflects the extent of data provided on each element. Countries with the highest HIV burdens were doing the best job of reporting data detailing their female-centred AIDS efforts, with 67% earning a high rating. However, the authors noted that a high score for reporting did not necessarily reflect good performance in delivering HIV services for women. Relatively good reporting by South Africa, for example, contrasted with a poor record in improving the maternal mortality of HIV-positive women, or curbing high rates of violence against women. There was also a disturbing lack of data on the situation of young girls, and what countries were doing to address their particular vulnerabilities.
Equity and HIV/AIDS
The main aims of PEPFAR are presented for information. PEPFAR seeks to ensure that HIV and AIDS programmes are sustainable, country-owned and country-driven. The programmes must address HIV/AIDS within a broader health and development context and must build on existing strengths and increase efficiencies. PEPFAR seeks to transit from an emergency response to promotion of sustainable country programmes, strengthening partner government capacity to lead the response to the epidemic and other health demands, expanding prevention, care and treatment in both concentrated and generalised epidemics, integrating and coordinating HIV and AIDS programmes with broader global health and development programmes to maximise impact on health systems, and investing in innovation and operations research to evaluate impact, improve service delivery and maximise outcomes. PEPFAR’s targets for the fiscal period 2010–2014 focus on prevention, care, support, treatment and sustainability, including supporting the training and retention of more than 140,000 new health care workers to strengthen health systems.
This community-based, qualitative study conducted in rural Kisesa District, Tanzania, explores perceptions and experiences of barriers to accessing the national antiretroviral programme among self-identified HIV-positive persons. Part of wider operations research around local introduction of HIV therapy, the study involved consultation with villagers and documented early referrals' progress through clinical evaluation and, if eligible, further training and drug procurement. Data collection consisted of 16 participatory group discussions with community members and 18 in-depth interviews with treatment-seekers. While simple measures to reduce perceived barriers improved initial access to treatment and helped overcome anxiety among early referrals, pervasive stigma remains the most formidable barrier. Encouraging successful referrals to share their positive experiences and contribute to nascent community mobilisation could start to address this seemingly intractable problem.
This study explored factors influencing attendance at HIV clinic appointments among patients in a rural ward in north-west Tanzania. Forty-two in-depth interviews (IDI) and four focus group discussions were conducted with HIV-infected persons who had been referred to a nearby antiretroviral therapy (ART) clinic, and IDI were undertaken with eleven healthcare workers involved in diagnosis, referral and care of HIV-positive patients. Barriers to clinic attendance frequently included health systems factors, while physical and social benefits encouraged regular clinic attendance. Self-confidence in being able to sustain clinic attendance was often determined by patients' expectations or experiences of family support. These findings suggest that multi-faceted interventions are required to promote regular HIV clinic attendance, including on-going education, counselling and support in both clinic and community settings. These interventions also need to recognise the evolving needs of patients that accompany changes in physical health, and should address local beliefs around HIV aetiology. Decentralisation of HIV services to rural communities should be considered.
More than 20 studies in Africa have reported higher occurrence of HIV among people with problem drinking; a finding strongly consistent across studies and similar among women and men. Conflation of HIV and alcohol disease in these setting is not surprising given patterns of heavy-episodic drinking and that drinking contexts are often coterminous with opportunities for sexual encounters. Both perpetrators and victims of sexual violence have a high likelihood of having drunk alcohol prior to the incident, as with most forms of violence and injury in sub-Saharan Africa. Reducing alcohol harms necessitates multi-level interventions and should be considered a key component of structural interventions to alleviate the burden of HIV and sexual violence. Brief interventions for people with problem drinking (an important component of primary health care) must discuss links between alcohol and unsafe sex, and consequences thereof. Interventions to reduce alcohol harm among HIV-infected persons are also an important element in positive-prevention initiatives. Most importantly, implementation of known effective interventions could alleviate alcohol’s effects on unsafe sex, unintended pregnancy and HIV transmission.
There has been a renewed debate over whether AIDS deserves an exceptional response because of the amount of funding targeted to the disease and the belief that AIDS activists prioritise it above other health issues. The strongest detractors of exceptionalism claim that the AIDS response has undermined health systems in developing countries. This paper argues that AIDS should be normalised in countries with mid-level prevalence, except when life-long treatment is dependent on outside resources – as is the case with most African countries – because treatment dependency creates unique sustainability challenges. And AIDS must always require an exceptional response in countries with high prevalence (over 10%). In these settings there is substantial morbidity, filling hospitals and increasing care burdens, and increased mortality, which most visibly reduces life expectancy. The idea that exceptionalism is somehow wrong is an oversimplification. The AIDS response must be based on human rights principles, and it must aim to improve health and well-being of societies as a whole.
A planned national survey of men who have sex with men (MSM) will be the first step in the government's plan to incorporate this high-risk group into the country's HIV programme, a senior government official has said. There have been few studies on HIV among MSM in Kenya. A survey of 285 men in Mombasa in 2007 found an HIV prevalence of 43% among men who had sex with men exclusively, compared with 12.3% among men who had sex with both men and women. Kenya's national HIV prevalence is 7.4%. The survey – due to start in December and last six months – will attempt to discover information such as the specific sexual health risks and needs of MSM, and identify MSM ‘hot spots’ around the country and the number of MSM-friendly health facilities available. It will use respondent-driven sampling, recruiting openly gay men to reach out to other MSM who may not be out of the closet, and using existing MSM-friendly facilities to help conduct the research.
A two-day joint meeting of SADC Ministers of Health and Ministers responsible for HIV and AIDS was officially opened in Mbabane, Swaziland, on 12 November 2009, by the Right Honourable Sibusiso Dlamini, prime minister of Swaziland. In his address, the prime minister urged SADC member states to implement SADC policy documents on HIV and AIDS, TB and malaria. The ministers approved a number of policy documents, including the Draft HIV and AIDS Strategic Framework 2010-2015. Ministers urged member states who are in the process of updating their frameworks to align them with the regional framework. The ministers also approved the SADC HIV and AIDS Business Plan and Budget, which emphasises multi-sector and inter-programme links reflecting the inter-relationships between HIV and AIDS, poverty, conflict, governance, socio-cultural and economic development and the SADC HIV and AIDS Fund. On the control of communicable diseases, HIV and AIDS, Tuberculosis and Malaria, the ministers approved the functions and minimum standards for national reference laboratories in the SADC region; functions and minimum standards for supranational reference laboratory and regional centres of excellence; and the proposed selection criteria for supranational reference laboratory and regional centres of excellence. The ministers further approved the regional minimum standards for HIV testing and counselling and urged member states to adhere to them.
A campaign launched recently seeks to mobilise political will and financial resources to overcome the bottle-necks that hinder services for children who have HIV and to prevent HIV infection in children. The Campaign to End Paediatric HIV/AIDS (CEPA) will initially launch in six African countries: Kenya, Uganda, Tanzania, Nigeria, Zambia and Mozambique. Its chairperson, Graca Machel, said CEPA seeks to address the bottlenecks encountered in delivering diagnostic, treatment and care services in these countries. ‘In South Africa alone, 280,000 children are said to be having HIV. It is estimated that 1.8 million of the world’s HIV-positive children are in Africa,’ she said. One of CEPA’s goals is to prevent HIV infection from parent to child. Openly HIV-positive TV host and head of Nigeria’s Positive Action for Treatment Access Movement (PATAM), Rolake Odetoyinbo, knows that that can be achieved. The campaign, formed by the United States’s Global AIDS Alliance, has set itself a bold target to increase prevention of mother-to-child HIV transmission and paediatric treatment services from the current average of 30–40% to 80% in three years in the countries it’s working in. A total budget of US$6 million has been set aside to benefit the six countries that are currently being targeted.
An estimated 82,700 Zambians will become newly infected with HIV in 2009, up from just over 70,000 in 2007, according to new figures from the National AIDS Council. As many as 71 out of every 100 new infections occur as a result of sex with a non-regular partner, while people who reported having only one sexual partner accounted for around 21% of new infections. Although Zambia has recorded successes in its prevention of mother-to-child transmission (PMTCT) programme, ensuring a safe blood supply, and behaviour-change communication campaigns, practices such as having multiple concurrent partners, transactional sex and inter-generational sex are still common. Multiple concurrent partnerships are the leading cause of HIV infection in Zambia. Within these relationships, correct and consistent use of condoms remains dismally low. However, the report revealed that the annual estimated requirement was 200 million male condoms and 2 million female condoms, yet only 96 million male and 500,000 female condoms were available.