KwaZulu-Natal Health MEC, Peggy Nkonyeni, is attempting to introduce traditional medicine for AIDS patients at a hospice with the help of traditional healers. The Treatment Action Campaign said African traditional healers have a role in combating HIV but they are concerned that disreputable stakeholders are included, especially those who are not traditional healers and who have caused harm with so-called ‘alternative’ remedies.
Equity and HIV/AIDS
South African Health MEC wants traditional medicine in hospice
Kerry Cullinan: Health-e, 23 November 2008
Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: A mathematical model
Granich RM, Gilks CF, Dye C, de Cock KM and Williams BG: The Lancet, 26 November 2008
This study investigated a theoretical strategy of universal voluntary HIV testing and immediate treatment with ART, and examined the conditions under which the HIV epidemic could be driven towards elimination. Data from South Africa was used as the test case for a generalised epidemic, and it was assumed that all HIV transmission was heterosexual. The study found that the strategy could greatly accelerate the transition from the present endemic phase, in which most adults living with HIV are not receiving ART, to an elimination phase, in which most are on ART, within five years. It could reduce HIV incidence and mortality to less than one case per 1,000 people per year by 2016. Universal voluntary HIV testing and immediate ART, combined with present prevention approaches, could have a major effect on severe generalised HIV/AIDS epidemics.
US trade policy and HIV treatment: The struggle for treatment access
Petcheskey R: Id21 Insights 75, November 2008
The United States government policy has violated the human rights of people living with HIV and AIDS through its ‘moral’ restrictions prioritising abstinence-only sex education, restricting condom distribution and stigmatising sex workers. The government’s close ties with pharmaceutical companies and manipulation of trade in medicines have also infringed on the human right to health by undermining international efforts to enshrine access to essential medicines as a human right. By sanitising and de-sexualising the politics of HIV and AIDS, and focusing on technocratic approaches such as biomedical quick fixes, like the recent emphasis on male circumcision, it ignores the deeply gendered, racial and sexual dimensions of the disease or its social, economic and cultural pathology.
ART in the public and private sectors in Malawi: Results up to 30 June 2008
HIV Unit, Malawi Ministry of Health; MBCA; MSF; Area 18 Health Centre; QECH; KCH, Lilongwe; Lighthouse, Lilongwe; Mlambe Mission Hospital; SUCOMA Clinic
This report presents data on anti-retroviral therapy (ART) in both the public and private sectors in Malawi. By the end of June 2008, there were 207 health facilities in Malawi in the public and private health sector delivering ART to HIV-positive eligible patients. In the second quarter of 2008 (April to June), there were 19,849 new patients registered on ART. Cumulative treatment outcomes by end of June were: 66% alive and on ART at the site of registration, 11% dead, 11% lost to follow-up, 12% transferred out to another facility (and were presumably alive) and <1% stopped treatment. By the end of June 2008, there were 32 sites with over 1,000 patients alive and on treatment and 10 sites with over 2,000 patients alive and on treatment. Of the 10 sites with more than 2,000 patients, four did not have an electronic data system in place.
Building capacity for antiretroviral delivery in South Africa: A qualitative evaluation of the PALSA PLUS nurse training programme
Stein J, Lewin S, Fairall L, Mayers P, English R, Bheekie A, Bateman E and Zwarenstein M: BMC Health Services Research 8(24) 18 November 2008
South Africa recently launched a national antiretroviral treatment programme. This has created an urgent need for nurse-training in antiretroviral treatment (ART) delivery. The PALSA PLUS programme provides guidelines and training for primary health care (PHC) nurses in the management of adult lung diseases and HIV/AIDS, including ART. A process evaluation was undertaken to document the training, explore perceptions regarding the value of the training. It found that nurse uptake of PALSA PLUS training was high. Ongoing on-site training of PHC nurses enhanced their experience of support for their work by allowing not only for ongoing experiential learning, supervision and emotional support, but also for the ongoing managerial review of all those infrastructural and system-level changes required to facilitate health provider behaviour change and guideline implementation.
Dangerous medicines: Unproven AIDS cures and counterfeit antiretroviral drugs
Amon JJ: Globalization and Health, 2008
This paper looks at anecdotal evidence that unproven AIDS 'cures' are widely used, and promoted by some countries' governments, instead of evidence based antiretroviral therapy (ART). Ot focuses on reasons why these 'cures' are used, including the high cost of conventional medicine and stigma associated with accessing healthcare systems. The authors discuss case studies from Gambia, South Africa and Iran where governments have promoted unproven treatment creating confusion over the legitimacy of AIDS medicines. Governments appear reluctant to dismiss these 'cures' for fear of being seen to criticise traditional medicine. The authors conclude that the full extent of the availability and use of unproven 'cures' and counterfeit antiretrovirals (ARVs) has not been fully documented, and that more research, as well as scaling up of ARV programmes, is needed.
Estimated HIV trends and programme effects in Botswana
Stover J, Fidzani B, Molomo BC, Moeti T and Musuka G: PloSOne 3(11) November 2008
Data from sentinel surveillance at antenatal clinics and a national population survey were used to estimate the trend of adult HIV prevalence from 1980 to 2007 in Botswana. Prevalence has declined slowly in urban areas since 2000 and has remained stable in rural areas. The number of new adult infections has been stable for several years and number of new child infections has declined due to coverage of ART that reaches over 80% in need and nearly complete coverage of an effective program to prevent mother-to-child transmission (PMTCT). The need for ART will increase by 60% by 2016. Botswana's PMTCT and treatment programs have achieved significant results in preventing new child infections and deaths among adults and children. The number of new adult infections continues at a high level. More effective prevention efforts are urgently needed.
Estimating the lost benefits of antiretroviral drug use in South Africa
Chigwedere P, Seage GR, Gruskin S, Lee T and Essex M: Journal of Acquired Immune Deficiency Syndromes, 16 October 2008
The South African government’s health department controversially declined to accept freely donated nevirapine and grants from the Global Fund, despite the fact that it is one of the countries most severely affected by HIV and AIDS, because they claimed antiretroviral (ARV) drugs were not useful for patients. This study aimed to assess the department’s assertion. Using modeling, it compared the number of persons who received ARVs for treatment and prevention of mother-to-child HIV transmission between 2000 and 2005 with an alternative of what was reasonably feasible in the country during that period. It calculated that more than 330,000 lives were lost because a feasible and timely ARV treatment programme was not implemented in South Africa. Thirty-five thousand babies were born with HIV, resulting in 1.6 million person-years lost by not implementing a mother-to-child transmission prophylaxis programme using nevirapine. The total lost benefits of ARVs are at least 3.8 million person-years for the period 2000–2005.
Good adherence to HAART and improved survival in a community HIV/AIDS treatment and care programme: The experience of the AIDS Support Organisation (TASO), Kampala, Uganda
Abaasa AM, Todd J, Ekoru K, Kalyango JN, Levin J, Odeke E and Karamagi CAS: BMC Health Services Research 8(241) 20 November 2008
This study assessed the effect of adherence to HAART on survival in The AIDS Support Organization (TASO) community HAART programme in Kampala, Uganda. It took the form of a retrospective cohort of 897 patients who initiated HAART at TASO clinic, Kampala, between May 2004 and December 2006. A total of 7,856 adherence assessments were performed on the data. The study study showed that good adherence and improved survival are feasible in community HIV/AIDS programmes such as that of TASO, Uganda. However, there is need to support community HAART programmes to overcome the challenges of funding to provide sustainable drug supplies, the provision of high quality clinical and laboratory support and achieving a balance between expansion and quality of services. Measures for the early identification and treatment of HIV infected people should be strengthened.
Uganda’s draft HIV bill's good intentions could backfire
PlusNews: 24 November 2008
AIDS activists in Uganda have criticised a proposed new law that will force HIV-positive people to reveal their status to their sexual partners, and also allow medical personnel to reveal someone's status to their partner. The HIV Prevention and Control Bill (2008) is intended to provide a legal framework for the national response to HIV, as well as protect the rights of individuals affected by HIV. While activists agree that Uganda needs legislation to guide its HIV policy, they are concerned that the bill in its current form could worsen the difficulties many HIV-positive people experience, such as stigmatisation.