Prince Mshiyeni Memorial Hospital, just outside the port city of Durban, in KwaZulu-Natal Province, has one of South Africa's busiest maternity wards. About 1,200 women a month give birth there, of which about 40% are HIV-positive, according to figures from the antenatal clinic. For staff working in the hospital's antenatal clinic and maternity ward, implementing the government's new guidelines for the prevention of mother-to-child HIV transmission (PMTCT) has not been easy. HIV-positive mothers with CD4 counts over 200 should now receive zidovudine, also known as AZT, from their 28th week of pregnancy until labour, as well as a single dose of nevirapine during labour. Their infants should get a single dose of nevirapine, and then AZT for seven days (or four weeks if AZT was started late). The new drug regimen means extra work for the hospital staff, while the number of doctors, nurses and counsellors providing PMTCT services at the hospital has not increased. This article reports on the workload and facility issues that arise inimplementing the guidelines.
Equity and HIV/AIDS
The primary purpose of this study was to assess the role, status and scope of workplace HIV/AIDS committees as a means of effective workplace governance of the HIV/AIDS impact, and their role in extending social protective HIV/AIDS-related rights to employees. In-depth qualitative case studies were conducted in five South African small and medium-sized enterprises (SMEs) that were actively implementing HIV/AIDS policies and programmes. Companies commonly implemented HIV/AIDS policies and programmes through a workplace committee dedicated to HIV/AIDS or a generic committee dealing with issues other than HIV/ AIDS. Management, through the human resources department and the occupational health practitioner often drove initial policy formulation, and had virtually sole control of the HIV/AIDS budget. Employee members of committees were mostly volunteers, and were often production or blue collar employees, while there was a notable lack of participation by white-collar employees, line management and trade unions. While the powers of workplace committees were largely consultative, employee committee members often managed in an indirect manner to secure and extend social protective rights on HIV/AIDS to employees, and monitor their effective implementation in practice. In the interim, workplace committees represented one of the best means to facilitate more effective workplace HIV/AIDS governance. However, the increased demands on collective bargaining as a result of an anticipated rises in AIDS-related morbidity and mortality might prove to be beyond the scope of such voluntary committees in the longer term.
Tanzania is one of the countries hardest hit by the HIV/AIDS epidemic. The Tanzania Commission for AIDS was established as part of the government response to the HIV epidemic. This manual is part of the Tanzania Commission for AIDS strategic plan to coordinate and strengthen the efforts of stakeholders involved in the fight against HIV/AIDS. It is intended as a training manual for local government authorities.
The AIDS epidemic is a disaster on many levels. In the most affected countries in sub-Saharan Africa, where prevalence rates reach 20%, development gains are reversed and life expectancy may be halved. For specific groups of marginalized people injecting drug users, sex workers and men who have sex with men across the world, HIV rates are on the increase. Yet they often face stigma, criminalization and little, if any, access to HIV prevention and treatment services. As this report explains, HIV is a challenge to the humanitarian world whose task is to improve the lives of vulnerable people and to support them in strengthening their capacities and resilience. Disasters, man-made and ‘natural’, exacerbate other drivers of the epidemic and can also increase people’s vulnerability to infection.
In this position paper, the Coalition raises demands for the improvement of health care in African countries in terms of: improving political commitment and leadership; strengthening civil society to improve absorption of available resources; immediately delivering on the 15% Abuja commitment; scaling up investment in youth empowerment and education to enhance participation of young people in HIV/AIDS; ensuring sustainability of financing and programmes; fast tracking implementation of the global strategy and plan of action on public health, innovation and intellectual property; scaling up HIV prevention, treatment and care; dealing effectively with and invest in programmes for TB/HIV co-infection; addressing the needs of older people and empowering and engaging with PLWHAs.
The study seeks to raise awareness and expand knowledge about the deleterious effect of HIV/AIDS mortality on South Africa's life expectancy, a country with a relatively high HIV/AIDS prevalence rate (19%). Using the multiple and associated single decrement life table techniques, the study estimates the total number of South Africans who would die from HIV/AIDS by the time they reach age 75 from a hypothetical cohort of 100,000 live births, assuming that the mortality conditions of 1996 for South Africa prevailed. The findings indicate that 5.7% of babies will eventually die of AIDS. Furthermore, 7.7% and 11.5% of those aged 60 years, and 75 years and above respectively will die of AIDS. Overwhelming majority of deaths will come from persons within the reproductive and productive age groups. A tremendous gain in life expectancy to the tune of about 26 years would result in the absence of HIV. The elderly persons, who are the grandmothers and grandfathers, are likely to manage family affairs following the death of their adult children. This condition is likely to impoverish the elderly population. Everything should be done to reduce AIDS mortality in order to increase life expectancy in the country.
There has been a great deal of progress over the past few years in AIDS. Despite the still staggering death toll and the wave of new infections, there are now, for instance, 3 million people on antiretroviral therapy, something that would have been unbelievable 10 years ago. This modest progress is in danger though. We've entered the era of the AIDS backlash - those who say AIDS gets too much money, from those who say AIDS programmes are distorting health systems. But the backlash takes more insidious forms. This discussion reports on the progress we've made with HIV/AIDS, the innovations that we've pioneered and the need to stop the backlash.
More than 400,000 HIV-positive South Africans have begun antiretroviral treatment (ART) since the government launched its programme in 2004. But this impressive-sounding figure still only represents one third of the estimated number of people in need of treatment, and that number is expanding by an additional half a million people every year. If South Africa is to achieve its ambitious goals for expanding treatment access, as well as the UN Millennium Development Goal of universal access, the current models for delivering treatment will need an overhaul. Despite the existence of national policies and guidelines for ARV treatment, implementation is strongly driven by what happens at provincial and district level. A comparison of 16 facilities providing treatment in the three provinces revealed wide variations in referral systems and staffing levels, but in all three provinces the researchers found a lack of integration of ARV services with other health services. Patients frequently had to go to other facilities for the treatment of TB, or for other opportunistic infections, or for antenatal care. The study also found that in many districts there were too few doctors and pharmacists providing ARV services, creating service bottlenecks. Systems for monitoring and evaluating patients on ARV treatment were also generally weak, and the use of data to improve services even weaker.
A Durban hospital has cut the transmission of HIV from pregnant mothers to their babies to less than 3% with dual therapy. The study started with all 2 624 pregnant women who attended McCord's antenatal clinic during the 18 months from March 2004 to August 2005. Of these, 338 women tested HIV-positive and 302 delivered at McCord. The study assessed these babies. During their pregnancies 44% of the HIV-positive women received highly active antiretroviral treatment. Of the 297 surviving babies, 290 (98%) received the antiretroviral drug nevirapine after birth and 224 (76%) also received the antiretroviral AZT. In six cases there was no record of the baby receiving any antiretroviral treatment. Six weeks later 239 (81%) of the babies were tested seven of these (2.9%) were HIV positive. The hospital used guidelines developed from international studies for its programme. The researchers said this showed that, despite resource constraints, a state-aided hospital could achieve results which compared favourably to those in developed countries.
East and southern Africa are the two regions in the world which are the most highly affected by HIV and AIDS. A significant number of people with HIV are educators, ranging from primary school teachers to head teachers and university lecturers. In response, UNESCO together with the three partners convened a consultation with HIV-positive teachers and other key stakeholders from Ministries of Education and teachers’ unions from Kenya, Namibia, United Republic of Tanzania, Uganda, Zambia and Zimbabwe. This report presents a summary of the key points, outcomes and recommendations emerging from the consultation which aimed to share experiences and articulate common, key elements of comprehensive responses for HIV-positive teachers. In order to provide a comprehensive response for HIV-positive teachers, the report argues that there needs to be support for HIV-positive teachers to continue teaching in a supportive environment free of stigma and discrimination. For this to be in place, a number of actions are recommended as necessary, including to: identify and address the varying needs of HIV-positive teachers; tackle stigma and discrimination; ensure access to prevention programmes, treatment, care and support; and build links between teacher’s unions and networks of HIV-positive teachers.