Equity and HIV/AIDS

Antiretroviral Therapy in Resource-Poor Countries: Illusions and Realities
American Journal of Public Health

The landscape for antiretroviral (ARV) therapy in resource-poor settings has recently changed considerably with the availability of generic drugs, the drastic price reduction of brand drugs, and the simplification of treatment. However, such cost reductions, while allowing the implementation of large-scale donor programs, have yet to render treatment accessible and possible in the general population. Addressing the problem of HIV treatment in high prevalence/high caseload countries may require redefining the problem as a public health mass therapy program rather than a multiplication of clinical situations. (abstract only)

Antiretrovirals and the use of traditional, complementary and alternative medicine by HIV patients in KwaZulu-Natal, South Africa: a longitudinal study
Peltzer K, Friend-du Preez N, Ramlagan S, Fomundam H, Anderson J and Chanetsa L: African Journal of Traditional, Complementary and Alternative Medicines. 8(4):337-345, 2011

The aim of this prospective study (20 months) was to assess HIV patients' use of Traditional, Complementary and Alternative Medicine (TCAM) and its effect on anti-retroviral (ARV) adherence at three public hospitals in KwaZulu-Natal, South Africa. Seven hundred and thirty-five (29.8% male and 70.2% female) patients who consecutively attended three HIV clinics completed assessments prior to ARV initiation, 519 after 6 months, 557 after 12 and 499 after 20 months on antiretroviral therapy (ART). Results indicate that following initiation of ARV therapy the use of herbal therapies for HIV declined significantly from 36.6% prior to ARV therapy to 8% after 6 months, 4.1% after 12 months and 0.6% after 20 months on ARVs. Faith healing methods (including spiritual practices and prayer) declined from 35.8% to 22.1%, 20.8% and 15.5%, respectively. In contrast, the use of micronutrients, such as vitamin supplements, significantly increased from 42.6% to 78.2%. Herbal remedies were mainly used for pain relief, as immune booster and for stopping diarrhea. As herbal treatment for HIV was associated with reduced ARV adherence, patient's use of TCAM should be considered in ARV adherence management, the authors conclude.

ARASA Regional HIV/AIDS and Human Rights Report
ARASA

2006 marks the tenth anniversary of the development of the International Guidelines on HIV/AIDS and Human Rights. To celebrate this occasion, the AIDS and Rights Alliance for Southern Africa (ARASA) has conducted research to evaluate the extent to which the International Guidelines have been used and implemented in the Southern African Development Community (SADC) region. This report details the findings of that research. It focuses on the guidelines dealing with: • Structures and partnerships to support a multi-sectoral response; • A protective legal and policy framework; • Access to treatment; and • Access to legal services.

ART alone cannot halt the AIDS epidemic in Africa
id21 Health, October 2006

It has been hoped that antiretroviral therapy (ART) could be used to combat AIDS on a wide-scale in developing countries. However as treatment allows patients to live longer, healthier lives, they are likely to be sexually active for longer. This could allow the disease to spread more rapidly unless communities receive counselling and practise safe sex. ART has been very effective treatment in the developed world. The drugs not only improve health and prolong the life, but patients are also less likely to infect other people because the drugs decrease their viral load. If ART can prevent the transmission of AIDS it could be a useful tool for fighting the AIDS epidemic in Africa. Imperial College London, UK, carried out a study, using mathematical modelling, to determine the effect widespread ART could have in Africa.

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.

ART in the public and private sectors in Malawi: Results up to 31 March 2008
Ministry of Health Malawi

Anti-retroviral therapy (ART) scale up in Malawi continues to progress well. Sites are doing well, despite the increasing burden of work. The majority are taking the initiative of doing quarterly and cumulative cohort analysis, although nearly one third of sites are still not coming up with correct outcomes. This will require continued and regular vigilance and supervision. The treatment outcomes for ART are reasonable. Early death rates are still a problem, and defaults still constitute a significant proportion of the outcomes. ARV drug stocks were again assessed, and nationally drugs stocks are adequate. However, some sites are over-performing to a large extent and causing problems with drug stocks (both for starter packs and continuation packs). The quarterly drug stocktaking assists in the activity of re-distributing drugs from under- to over-performing sites. Some drugs for HIV-related diseases, particularly morphine and vincristine, are out of stock in most facilities.

ART in the public and private sectors in Malawi: Results up to 31st March 2008
HIV Unit, Malawi Ministry of Health; MBCA; MSF; Area 18 Health Centre; QECH; KCH, Lilongwe; Lighthouse, Lilongwe; Mlambe Mission Hospital; SUCOMA Clinic: 2008

This report presents data on the number of patients accessing ART in both the public and private sectors in Malawi. By the end of March 2008, there were 157 free-standing facilities in Malawi in the public health sector delivering ART free of charge to HIV-positive eligible patients. In the first quarter of 2008 (January to March), there were 17,642 new patients started on ART (39% male, 61% female; 91% adults and 9% children. By the end of March 2008, there were 159,111 patients who had ever started on ART (39% male, 61% female; 92% adults and 8 % children). By the end of March 2008, there were 45 facilities in Malawi in the private health sector delivering ART at a subsidised rate to HIV-positive eligible patients. In the first quarter of 2008 (January to March), there were 669 new patients started on ART (44% male, 56% female, 95% adult, 5% children). By the end of March 2008, there were 6,076 patients who had ever started on ART (51% male, 49% female, 95% adults, 5% children).

ARV fact sheet: HIV/AIDS and treatment

This International HIV/AIDS Alliance fact sheet provides an introduction to antiretroviral (ARV) treatment for HIV and AIDS. The fact sheet is meant to be used as a participatory tool to support community engagement in ARV treatment. It aims to provide non-governmental and community-based organisation (NGO/CBO) staff with tools and information to support people living with HIV and AIDS (PLHA) and their communities. The fact sheet initially describes HIV and AIDS, including how it is transmitted, initial signs and symptoms and the potential health risks. It then outlines what a person living with HIV needs and details what treatment options are available.

ARV therapy due to be provided in Zimbabwe, say reports

Owen Mugurungi, program coordinator for the Zimbabwean Ministry of Health and Child Welfare Tuberculosis and AIDS Program, has announced that the government will begin providing antiretroviral drugs to some of its HIV-positive citizens as part of the country's implementation of the World Health Organisation's 3 by 5 Initiative, Xinhua News Agency reports. The $5.5 billion WHO plan aims to treat three million people throughout the world with antiretroviral drugs by 2005.

ARV's and the prevention of MTCT in resource-constrained settings

Interventions focusing on HIV-infected pregnant women need to be complemented by interventions that address primary prevention of HIV infection, particularly in women of child-bearing age and their partners, and prevention of unintended pregnancies among HIV-infected women. This is one of the findings of a paper that analyses the different alternatives that are available for the prevention of mother-to-child transmission (MTCT) of HIV in resource-constrained settings, and makes recommendations about the best course of action in a number of situations.

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