People living with HIV in Kenya do not have adequate access to family planning services, even though most HIV-infected women do not want children in the immediate future. A recent study by the reproductive health NGO, Family Health International (FHI), in the Nakuru district of Rift Valley Province, found that 80% of HIV-positive women had no intention of having a child in the next two years. However, according to the 2007 Kenya AIDS Indicator Survey, only half the HIV-positive people needing family planning services had access to them. ‘Most prevention of mother-to-child transmission [PMTCT] programmes... looked at it only in the context of preventing transmission to an already conceived child, but meeting contraceptive needs of those living with HIV is a sure way of reducing transmission by avoiding unwanted pregnancies in the first place,’ said Maurine Kuyo, a project director at FHI. About 56% of women in the FHI study mentioned a fear of vertical transmission of HIV to their children as one the reasons they would not want another pregnancy, while 50% mentioned the risk of lowered immunity during pregnancy.
Equity and HIV/AIDS
A six-year clinical trial in Thailand has yielded the first ever evidence that an AIDS vaccine can provide some protection against HIV infection. The trial team in Bangkok, Thailand's capital announced on 24 September that rates of HIV infection were 31% lower in trial participants who got the vaccine than in those who received a placebo. ‘These new findings represent an important step forward in HIV vaccine research,’ said Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases (NIAID), the main funder of the trial. The study began enrolling 16,000 HIV-negative men and women between the ages of 18 and 30 in October 2003. Half the volunteers received a placebo; the other half were given shots containing two different vaccines. The trial was designed to evaluate whether the combined vaccines (ALVAC-HIV and AIDSVAX) lowered HIV infection risk, and whether they had any impact on viral load [the amount of HIV circulating in the bloodstream] in the volunteers who became infected. Of 8,197 people given the vaccine regimen, 51 became infected, compared to 74 of the 8,198 volunteers who received the placebo.
Carrying placards that read, ‘Huwezi Die Uki Abstain’, Swahili slang for ‘You won't die if you abstain [from sex]’, more than 3,000 young people recently marched through Nairobi in an effort to re-energise the campaign to keep teens from having sex too early. But beyond the placard-waving and slogan-chanting, march organisers were also trying to give young people the skills to avoid being pushed into sex before they are ready. James Kabucho, programmes director at Life Skills Promoters, one of the non-governmental organisations that organised the march, explained that the campaign was teaching young people negotiation skills. By acting out real-life scenarios, writing essays, and engaging peer educators in question and answer sessions, young people were able to talk about their experiences and learn to say ‘No’ to unwanted sexual advances. Research shows that early sexual initiation is associated with increased risk of HIV infection, while adolescents who engage in sex at an early age are likely to have more sexual partners than those who delay their sexual debut. Girls who engage in sex in their teens may also face the challenges of teenage pregnancy, unsafe abortions and dropping out of high school.
In 2007, South Africa, with 0·7% of the world's population, had 17% of the global burden of HIV infection, and one of the world's worst tuberculosis epidemics, compounded by rising drug resistance and HIV co-infection but, until recently, the government's response to these diseases has been marked by denial, lack of political will and poor implementation of policies and programmes. Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts and scale-up of free antiretroviral therapy (ART). Using the framework of the Strategic Plans for South Africa for Tuberculosis and HIV/AIDS, this paper provides a prioritised four-step approaches for tuberculosis control, HIV prevention, and HIV treatment. Strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health-care services are needed for successful implementation of these approaches.
Male-to-female transgender individuals, or transgender women (TW), are at high risk for HIV infection and face multiple barriers to HIV care. This article examines how a community-based clinic that offers free or low-cost care addresses the health care needs of TW. A total of twenty TW who attended a health care clinic dedicated to community-based health were interviewed regarding best practices for HIV prevention and primary care. In-depth interviews were conducted, transcribed, coded, and analysed. Factors reported to be effective for HIV prevention and primary care included access to health care in settings not dedicated to serving transgender and/or gay communities, a friendly atmosphere and staff sensitivity, and holistic care, including hormone therapy. Community-based health care settings can be ideal locales for HIV prevention and primary care for TW.
The re-use of injecting equipment in clinical settings is well documented in Africa and appears to play a substantial role in generalised HIV epidemics. Several African governments have taken steps to control injecting equipment, including banning syringes that can be reused. However, injection drug use (IDU), of heroin and stimulants, is a growing risk factor for acquiring HIV in the region, having become increasingly common among young adults in sub-Saharan Africa and also associated with high-risk sex. Demand-reduction programmes based on effective substance use education and drug treatment services are very limited, and imprisonment is more common than access to drug treatment services. Drug policies are still very punitive and there is widespread misunderstanding of and hostility to harm-reduction programmes. These new injection risks will take on increased epidemiological significance over the coming decade and will require much more attention by African nations to the range of effective harm reduction tools now available in Europe, Asia and North America.
Multiple partnerships may not be as common in South Africa as previously thought, according to a study presented at the recent AIDS Research Symposium at the University the Witwatersrand, in Johannesburg. Saul Johnson, managing director of Health & Development Africa (HDA), a health consultancy which conducted the research, said findings from four sites across the country showed about 26% of men and 5% of women reported having had more than one partner in the past year. ‘The perception out there is that [having multiple partners] is more common than it really is,’ he said. The reason may be that men tend to inflate their partner counts. Johnson and his team found that when men were asked to write down a figure for the number of partners they had had in the last twelve months they exaggerated, but when asked to plot their sexual encounters in more detail, using a sexual partner calendar, they often revised the number down slightly. Women's responses were more likely to be consistent.
In South Africa a generation of children who were born HIV-positive is reaching young adulthood, but they are not getting the type of message or psychosocial support they need from the public sector. ‘These kids are getting older on treatment and surviving on treatment; they're becoming sexually active, they want to get married,’ HIV paediatrician Dr Harry Moultrie told the annual University of the Witwatersrand AIDS Research Symposium in Johannesburg at the end of August. We’re seeing a lot of teen pregnancies, sexually transmitted diseases and poor developmental outcomes.’ Studies in the United States have shown that HIV-positive teens may be more likely to engage in risky behaviour. Similar studies have yet to be carried out in South Africa, but Moultrie noted that if the findings were similar, many doctors in South Africa would not be ready to deal with the challenge. Only 12 clinics in the country are offering specialised services to HIV-positive youth. Moultrie called on the government to re-examine the guidelines that sent children aged 14 years or older away from paediatric clinics and into adult facilities, which might not be able to offer them the services they needed. ‘You have to realise that a lot of these children have gone through multiple childhood traumas, including multiple changes in caregivers,’ he said.
Non-governmental organisations have raised concern over the lack of female condoms claiming that it undermines efforts to curb new infections. The health department is looking for donors to finance the procurement and distribution of female condoms, citing lack of funds. Meanwhile, a tender has been issued. Tian Johnson, Advocacy Officer of the Thohoyandou Victim Empowerment Programme (TVEP), raised concern over the awarding of the tender for the manufacture of female condoms. ‘The current situation pertaining to the inadequate access to the female condom in South Africa today is a violation of the rights of women and men of this country. The tender for female condom supply has been awarded to a company called the Female Health Company. That means there are no options for competition, there are no options for bringing prices down. That enables us to use the excuse that we have been using for far too long, the excuse that female condoms are too expensive. It’s an excuse with no basis and with no merit’, he said.
A new government initiative to boost local HIV and AIDS research has been launched. The South African HIV/AIDS Research (and Innovation) Platform (SHARP), with backing from the Department of Science and Technology (DST), will support the development of new treatment options and prevention approaches such as microbicides, vaccines, and the role of genetics in controlling HIV infection. ‘The South African government had to revisit its expectations of HIV vaccine research in the light of growing national and international deliberations on the need to modify basic HIV/AIDS research and development strategies,’ the DST noted. So far SHARP has committed R45 million (US$5.8 million) to fund nine research projects over the next three years. One of the projects will validate a method for testing resistance to antiretroviral drugs that is cheaper and more accurate than the current method; another will investigate the role of natural ‘killer’ cells that prevent HIV transmission.