The need for empirical evidence on the state of HIV and AIDS in prisons in Kenya which can influence prison specific policy formulation nationally prompted this study. Its objectives included describing the level of knowledge of HIV among male inmates; describing the sexual health knowledge and practices among male inmates before and during imprisonment; determining the prevalence and predictors of HIV infection among male inmates; and examining policy, practice and legal frameworks around prevention of HIV infection in prisons. A cross sectional study design was utilised. Data was collected from inmates and stakeholders involved in HIV and AIDS policy formulation using quantitative and qualitative approaches respectively. Both the inmates and the key informants agreed that consensual and non-consensual sex occurs between inmates. Although not many inmates were found to be abusing drugs, those who were doing so were likely to be first timers in prison. Without underestimating the role played by condoms in HIV prevention, their provision in prisons is not a panacea to the consequences of sexual practice among inmates. There is therefore a need for a comprehensive approach in programming which will be fundamental in alleviating the HIV/AIDS scourge in prisons.
Equity and HIV/AIDS
In this study, national antiretroviral therapy (ART) policy is examined over the period of 1999 to 2008, which coincided with the government of President Thabo Mbeki and his Minister of Health, Dr Manto Tshabalala-Msimang. The movement towards a national ART programme in South Africa was an ambitious undertaking, the likes of which had not been contemplated before in public health in Africa. One million AIDS-ill individuals were targeted to be enrolled in the ART programme by 2007/08. Fewer than 50% of eligible individuals were enrolled. This failure resulted from lack of political commitment and inadequate public health system capacity. The human and economic costs of this failure are large and sobering. The total lost benefits of ART not reaching the people who need it are estimated at 3.8 million life years for the period, 2000 to 2005. The economic cost of those lost life years over this period has been estimated at more than US$15 billion.
The Zimbabwe Minister of Health and Child Welfare, Dr Henry Madzorera is reported to have announced plans to increase the number of people on anteretrovirals from the current 180,000 to 300,000 (or 60% of the 500,000 adults estimated to need treatment) using resouces from the Global Fund, the United States President's Emergency Plan for AIDS Relief (PEPFAR), and a basket funding mechanism to which donors contribute for various HIV and AIDS interventions, known as the Expanded Support Programme on HIV/AIDS (ESP).
Ten months after being re-launched, a new brand of female condom has proven popular among Ugandan women. FC2 was launched in February; the government stopped distributing the original female condom, FC1, in 2007 on the grounds that women had complained it was smelly and noisy during sex. 'The new condom has improved features and will enable women to have a procedure within their control to give them more choices for prevention [of HIV and unwanted pregnancies],' said Vashta Kibirige, the coordinator of the condom unit at the Ministry of Health. The UN Population Fund and the NGO, Programme for Accessible health Communication and Education, are spearheading the re-launch of the female condom, which is still in the sensitisation stage and will become available to the public in 2010. The women questioned said the new condom was less noisy, more comfortable and well lubricated, increasing their sexual pleasure. It also has no smell and can be inserted in the vagina at least eight hours before sex, which the women liked a lot.
Despite emerging evidence that HIV-positive mothers should breastfeed to maximise their babies’ health prospects, South African health workers face a battle to change attitudes and habits. The 2003 South African Demographic Health Survey found that fewer than 12% of infants are exclusively breastfed during their first three months and this drops to 1.5% for infants aged between three and six months. Some health workers themselves have yet to be convinced of the benefits of breastfeeding, even for mothers who aren’t HIV positive. 'There exists the general idea that it is not important, that there is no critical reason to breastfeed, especially when you can formula feed,' says Linda Glynn, breastfeeding consultant at Mowbray Maternity Hospital in Cape Town. 'Some [health workers] think breastfeeding is a waste of time and an inconvenience.' Yet, the risks of not breastfeeding often go unrecognised. Most children born to HIV-positive mothers and raised on formula do not die of AIDS but of under-nourishment, diarrhoea, pneumonia and other causes not related to HIV. The World Health Organization recommends that all new mothers, regardless of their HIV status, practise exclusive breastfeeding for a minimum of six months.
Highly active antiretroviral therapy (HAART) drastically reduces mother-to-child transmission of HIV, but where breastfeeding is the only safe infant feeding option, HAART for the prevention of mother-to-child transmission needs to be evaluated in relation to both HIV transmission and infant mortality. One hundred-and-two >=18-year old women on HAART in rural Uganda who delivered one or more live infants between 1 March 2003 and 1 January 2007 were enrolled in a prospective study to assess HIV transmission and infant survival. Of 118 infants born during follow-up, 109 were breastfed. In total, 23 infants died during follow-up at a median age of 3.7 months; 15 of whom with severe diarrhoea and/or vomiting in the week preceding their death. The study concludes that, in resource-constrained settings, HIV-infected pregnant women should be assessed for HAART eligibility and treated as needed without delay, and should be encouraged to breastfeed their infants for at least six months.
Sub-Saharan Africa carries a massive dual burden of HIV and alcohol disease, and these pandemics are inextricably linked, says this study. 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. HIV and alcohol also share common ground with sexual violence. 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. According to this study, 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. It recommends that brief interventions for people with problem drinking must incorporate specific discussion of links between alcohol and unsafe sex, and consequences thereof. Additionally, implementation of known effective interventions could alleviate a large portion of the alcohol-attributable burden of disease, including its effects on unsafe sex, unintended pregnancy and HIV transmission.
This study estimates mean life years gained using different treatment indications in low-income countries. It carried out a systematic search to identify relevant studies on the treatment effect of highly active antiretroviral therapy (HAART) and data was applied to a hypothetical Tanzanian HIV population. It found that providing HAART early when CD4 is 200-350 cells/μl is likely to be the best outcome strategy with an expected net benefit of 14.5 life years per patient. The model predicts diminishing treatment benefits for patients starting treatment when CD4 counts are lower. Patients starting treatment at CD4 50-199 and <50 cells/μl have expected net health benefits of 7.6 and 7.3 life years. Without treatment, HIV patients with CD4 counts 200-350; 50-199 and < 50 cells/μl can expect to live 4.8; 2 and 0.7 life years respectively. This study demonstrates that HIV patients live longer with early start strategies in low-income countries. Since low-income countries have many constraints to full coverage of HAART, this study provides input to a more transparent debate regarding where to draw explicit eligibility criteria during further scale up of HAART.
This study strategised a way to integrate mobile telephony into the health management of subjects receiving anti-retroviral (ARV) medications. It took the form of a randomised controlled trial to assess health, social, and economic outcomes, involving two sub-studies in Nairobi, Kenya, and two surrounding districts. Significant time and cost are often incurred for patients to personally attend the clinics. However, the majority of subjects screened reported being comfortable with using cell phones for communicating their health issues. Note that the average travel cost to attend the clinic was US$3 (return). The current cost of an SMS is US$0.08 and a one-minute voice call is US$0.23. The most positive feedback from early enrollees in the SMS-protocol is that the participants feel 'like someone cares'. Many participants suggested that they would prefer more frequent SMS reminders. However the most common barrier to responding to the clinic SMS on time is lack of network credit at the time they are intended to respond. Overall, the once weekly protocol appears agreeable to most. Several instances of health problems have already been identified by the protocol and hence triaged by the nurse.
Kenya has launched an ambitious strategy to fight HIV and AIDS that aims to reduce new infections by at least 50% over the next four years and focus more on most at-risk populations (MARPs). The third Kenya National AIDS Strategic Plan, which runs from 2009/2010 till 2012/2013 and was launched in the capital, Nairobi, on 12 January, also aims to reduce AIDS-related mortality by 25%. 'We cannot achieve our target unless we close new taps of HIV infections – this involves putting most at-risk populations at the centre of our HIV programmes and prevention strategies,' said Alloys Orago, director of the National AIDS Control Council. In Kenya, female and male sex workers, injecting/intravenous drug users, and men who have sex with men (MSM) are considered primary MARPs. Speaking at the launch, UNAIDS executive director Michél Sidibé highlighted the paradox of the intention to increase HIV programming among MARPS while at the same time criminalising the activities that put them at an elevated risk of contracting and transmitting HIV. 'Criminalisation puts most at-risk populations, like commercial sex workers, injecting drug users and men who have sex with men, in the shadows,' he said. 'It is difficult to reach groups whose actions are deemed to be at odds with the law.' Sex work, homosexual acts and the use of illicit drugs are all outlawed in Kenya and are punishable by long terms in prison.