Equity and HIV/AIDS

A comprehensive programme addressing HIV/AIDS and gender based violence
Janse van Rensburg MS: SAHARA Journal 4 (3): 695-706, 2007

A survey was administered to 304 respondents participating from three areas near Welkom, South Africa. Face-to-face interviews were conducted with women from randomly selected households to evaluate the impact of a service provision programme targeting women living with HIV/AIDS and gender based violence. Gender based violence (GBV) awareness and knowledge was high. Respondents had high perceived levels of risk. The key findings of this study support the notion of using a holistic approach, targeting more than one issue. There is lower stigma levels associated with combined conditions, which might allow easier access to vulnerable groups. Coordination and collaboration of services are however needed to enable this benefit.

A decline in new HIV infections in South Africa: Estimating HIV incidence from three national HIV surveys in 2002, 2005 and 2008
Rehle TM, Hallett TB, Shisana O, Pillay-van Wyk V, Zuma K et al PLoS ONE 5(6), 14 June 2010

This study used a validated mathematical method to estimate the rate of new HIV infections (HIV incidence) in South Africa using nationally representative HIV prevalence data collected in 2002, 2005 and 2008. The observed HIV prevalence levels in 2008 were adjusted for the effect of antiretroviral treatment on survival. In the period 2002–2005, the HIV incidence rate among men and women aged 15–49 years was estimated to be 2 new infections each year per 100 susceptible individuals. The highest incidence rate was among 15–24 year-old women, at 5.5 new annual infections per 100 individuals, which declined to 60% to 2.2 There was evidence from the surveys of significant increases in condom use and awareness of HIV status, especially among youth. The analysis demonstrates how serial measures of HIV prevalence obtained in population-based surveys can be used to estimate national HIV incidence rates. It also underlines the need to determine the impact of ART on observed HIV prevalence levels. The estimation of HIV incidence and ART exposure is crucial to disentangle the concurrent impact of prevention and treatment programs on HIV prevalence.

A flagging commitment on AIDS
The New York Times, 1 June 2006

In early June 2006, United Nations members are meeting in a follow-up to the successful UN special session in 2001, which pushed the world to take AIDS more seriously.The nations now are supposed to be reporting on whether their targets are being met, and devising a plan of action for the next few years. Instead, they are watering down the original plan.

A global assessment of the role of law in the HIV/AIDS pandemic
Gable L, Gostin L and Hodge JG: Public Health 123(3):260–264, March 2009

This article examines the dynamic role of law as a tool, and potential barrier, to public health interventions designed to ameliorate the negative impacts of HIV and AIDS globally. Laws may empower public health authorities, reinforce the human rights of persons living with HIV or AIDS and protect them from social risks, stigma and other harms by respecting privacy and prohibiting unwarranted discrimination. However, laws can also create legal barriers by penalising HIV+ people through criminal sanctions or other policies. As a result, it is recommended globally that laws should facilitate the prevention and treatment of HIV/AIDS consistent with scientific and public health practices and with a human rights framework.

A longer interval between first sex and first marriage is correlated with a higher rate of HIV
Bongaarts J: Population Council, 2006

One of the most puzzling features of the HIV epidemic in sub-Saharan frica is the large variation in its size among countries. For example, the proportion of adults infected ranges from 33% in Swaziland to less than 1% in Mauritania, Madagascar and Senegal. This study investigates the possibility that late age at first marriage, and a long period of premarital sexual activity, may be risk factors for HIV infection. The relationship between marital status and the prevalence and incidence of HIV is examined.

A longitudinal review of national HIV policy and progress made in health facility implementation in Eastern Zimbabwe
Tlhajoane M; Masoka T; Mpandaguta E; Rhead R; et al: Health Research Policy and Systems 16 (92) 1-13, 2018

In this longitudinal study from 2013 to 2015 the authors sought to establish how World Health Organization (WHO) HIV guidelines changes have been translated into national policy in Zimbabwe and to measure progress in implementation within local health facilities. National HIV programme policy guidelines published between 2003 and 2013 and 2014 and 2015 were reviewed to assess adoption of WHO recommendations on HIV testing services, prevention of mother-to-child transmission of HIV, and provision of antiretroviral therapy (ART). Changes in local implementation of these policies over time were measured in two rounds of a survey conducted at 36 health facilities in Eastern Zimbabwe in 2013 and 2015. High levels of adoption of WHO guidance into national policy were recorded, including adoption of new recommendations made in 2013–2015. New strategies to implement national HIV policies were introduced such as the decentralisation of ART services from hospitals to clinics and task-shifting of care from doctors to nurses. The proportions of health facilities offering free HIV testing and counselling, prevention of mother-to-child transmission and ART services increased substantially from 2013 to 2015, despite reductions in numbers of health workers. Provision of provider-initiated HIV testing remained consistently high. At least one test-kit stock-out in the prior year was reported in most facilities. Stock-outs of first-line ART and prophylactic drugs for opportunistic infections remained low. Repeat testing for HIV-negative individuals within 3 months decreased. Laboratory testing remained low across both survey rounds, despite policy and operational guidelines to expand coverage of diagnostic services. Good progress has been made in implementing international guidance on HIV service delivery in Zimbabwe. The authors suggest that further novel implementation strategies may be needed to achieve the latest targets for universal ART eligibility.

A plague of inequality
Mail and Guardian, 19 May 2006: Marais H

The mainstays of South Africa’s efforts to fend off the impact of the HIV/AIDS epidemic are anti-retroviral (ARV) therapy provision and home based care. While vitally important, each in current form also expresses the kinds of prevailing inequalities that warp society. Today, of the estimated one million South Africans in need of ARVs, only about 200 000 are receiving such therapy -- half of them through the private health sector, which is accessible to a small minority of South Africans. This crisis demands nothing less than a new strategy (and struggle)for realising social rights.

A surprising prevention success: Why did the HIV epidemic decline in Zimbabwe?
Halperin DT, Mugurungi O, Hallett TB, Muchini B, Campbell B et al: PLoS Med 8(2): 8 February 2011

In the context of growing recognition that primary prevention, including behavioural change, must be central in the fight against HIV and AIDS, the authors of this study conducted an extensive multi-disciplinary synthesis of the available data on the causes of the remarkable HIV decline that has occurred in Zimbabwe (29% estimated adult prevalence in 1997 to 16% in 2007) despite severe social, political, and economic disruption in the country. The behavioral changes associated with HIV reduction - mainly reductions in extramarital, commercial and casual sexual relations, and associated reductions in partner concurrency - appear to have been stimulated primarily by increased awareness of AIDS deaths and secondarily by the country's economic deterioration. These changes were probably aided by prevention programs utilising both mass media and church-based, workplace-based, and other inter-personal communication activities, the authors surmise. They conclude that focusing on partner reduction, in addition to promoting condom use for casual sex and other evidence-based approaches, is crucial for developing more effective prevention programmes, especially in regions with generalised HIV epidemics.

A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in sub-Saharan Africa
Musheke M, Ntalasha H, Gari S, Mckenzie O, Bond V, Martin-Hilber A and Merten S: BMC Public Health 13(220), 11 March 2013

In this study, researchers synthesised published qualitative research to identify the factors enabling and deterring uptake of HIV testing in sub-Saharan Africa (SSA). A total of 42 papers from 13 countries were synthesised in the final analysis. Results indicated that the predominant factors enabling uptake of HIV testing were deterioration of physical health and/or death of sexual partner or child. Other enabling factors were the roll-out of various new HIV testing initiatives, such as ‘opt-out’ provider-initiated HIV testing and mobile HIV testing, availability of treatment and social network influence and support. Major barriers to uptake of HIV testing were perceived low risk of HIV infection, perceived health workers’ inability to maintain confidentiality and fear of HIV-related stigma. Other barriers were direct and indirect financial costs of accessing HIV testing, and gender inequality, which undermines women’s decision making autonomy about HIV testing. The authors conclude that improving uptake of HIV testing requires addressing perception of low risk of HIV infection and perceived inability to live with HIV. There is also a need to continue addressing HIV-related stigma, which is intricately linked to individual economic support.

A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in sub-Saharan Africa
Musheke M, Ntalasha H, Gari S, Mckenzie O, Bond V, Martin-Hilber A and Merten S: BMC Public Health 13:220, 11 March 2013

While qualitative studies have been undertaken to investigate factors influencing uptake of HIV testing in sub-Saharan Africa (SSA), systematic reviews to provide a more comprehensive understanding are lacking. In this study, researchers synthesised 42 papers from 13 countries to investigate these factors. They found that predominant factors enabling uptake of HIV testing are deterioration of physical health and/or death of sexual partner or child. The roll-out of various HIV testing initiatives such as ‘opt-out’ provider-initiated HIV testing and mobile HIV testing has improved uptake of HIV testing by being conveniently available and attenuating fear of HIV-related stigma and financial costs. Other enabling factors are availability of treatment and social network influence and support. Major barriers to uptake of HIV testing comprise perceived low risk of HIV infection, perceived health workers’ inability to maintain confidentiality and fear of HIV-related stigma. While the increasingly wider availability of life-saving treatment in SSA is an incentive to test, the perceived psychological burden of living with HIV inhibits uptake of HIV testing. Other barriers are direct and indirect financial costs of accessing HIV testing, and gender inequality which undermines women’s decision making autonomy about HIV testing. Despite differences across SSA, the findings suggest comparable factors influencing HIV testing.

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