Equity and HIV/AIDS

Abuja AIDS Summit - promises, promises?
IRIN PlusNews

African leaders meeting at a special summit on HIV/AIDS, tuberculosis and malaria, in the Nigerian capital, Abuja, threw down a challenge to their governments by setting bold new targets to be achieved by 2010. At the end of the gathering to review progress in implementing the 2001 Abuja Declaration on AIDS, TB and Malaria, a major resolution was passed, declaring that at least 80 percent of those in need, especially women and children, should have access to HIV/AIDS treatment, including antiretroviral (ARV) drugs, care and support. Civil society organisations welcomed the ambitious continental targets, but it remains to be seen whether these will be met, particularly when considering how little progress has been made in implementing goals set in 2001. Of particular concern is that leaders reiterated their commitment to devote 15 percent of their national budgets to improving the health sector, while the African Union (AU) found that Nigeria, Burundi and Ethiopia scored worst in this respect, having set aside only four, three and two percent of their annual budgets respectively for health. Only a third of African countries spend 10 percent of their budget or more on health. African countries also pledged that at least 80 percent of pregnant women would have access to medication for preventing mother-to-child transmission (PMTCT) by 2010, and at least 80 percent of target populations would have access to voluntary testing and counselling services.

Acceptance of HIV testing for children ages 18 months to 13 years identified through voluntary, home-based HIV counseling and testing in western Kenya
Vreeman RC, Nyandiko WM, Braitstein P, Were MC, et al: Journal of Acquired Immune Deficiency Syndromes 55(2), 1 October 2010

Home-based voluntary counseling and testing (HCT) presents a novel approach to early diagnosis. This study sought to describe uptake of pediatric HIV testing, associated factors, and HIV prevalence among children offered HCT in Kenya. HCT was offered to 2,289 children (18 months to 13 years) and accepted for 1,294 (57%). Children were more likely to be tested if more information was available about a suspected or confirmed maternal HIV infection, if parents were not in household, if they were grandchildren of head of household, or if their father was not in household. Of the eligible children tested, 60 (4.6%) were HIV infected. The paper concludes that HCT provides an opportunity to identify HIV among high-risk children, but acceptance of HCT for children was limited. Further investigation is needed to identify and overcome barriers to testing uptake.

Access to AIDS medicines stumbles on trade rules
Wise J: WHO Bulletin 84(5): 337-424, May 2006

Developing countries have several international trade law provisions at their disposal to help them buy life-saving medicines at affordable prices for public health needs, particularly HIV/AIDS. But only a few countries are using these because of red tape and political pressure. This article looks at what WHO is doing to support countries in using international trade law effectively to secure medicines.

Access to Antiretroviral therapy in Africa
UNAIDS: 2013

Africa is leading the world in expanding access to antiretroviral therapy, with 7.6 million people across the continent receiving antiretroviral therapy as of December 2012, including 7.5 million people in sub-Saharan Africa. Eastern and Southern Africa is scaling up faster, by more than doubling the number of people on treatment between 2006 and 2012. At least 10 countries (Botswana, Cape Verde, Eritrea, Kenya, Namibia, Rwanda,
South Africa, Swaziland, Zambia and Zimbabwe) reported reaching 80% or more
of adults eligible for antiretroviral therapy, under the 2010 WHO guidelines. However, new WHO guidelines on HIV treatment in 2013 have since made many more people eligible for treatment.

Access to antiretroviral treatment in Africa
Rene Loewenson and David McCoy, Equinet

The demand for people living with HIV and AIDS in Africa to access treatment cannot be ignored. At the same time the challenges to meeting this demand are many. They include the shortfalls in health services and lack of knowledge about treatment, making decisions about newer regimens, and the risk of resistance to antiretrovirals. The challenges also include ensuring uninterrupted drug supplies, laboratory capacities for CD4 monitoring, accessible voluntary counselling and testing, trained healthcare workers, and effective monitoring of resistance to antiretroviral drugs. A series of papers produced in 2003 through the southern African regional network on equity in health raised further concerns about measures to ensure fairness in the rationing of scarce treatment resources and the diversion of scarce resources from strained public health services into vertical treatment programmes.

Access to treatment associated with declining stigma in Botswana
Smart T: AIDSmap, 18 August 2006

Over the last few years, since the roll-out of antiretroviral therapy (ART), there has been a substantial decrease in HIV-related stigma in Botswana, according to a population-based study presented on Monday at the Sixteenth International AIDS Conference in Toronto. Although there could be several possible explanations for this (including anti-stigma campaigns, the higher visibility of people living with HIV and AIDS and routine HIV testing), survey participants who knew that ART was accessible in Botswana were the least likely to stigmatise people with HIV.

Accounting for variations in ART program sustainability outcomes in health facilities in Uganda: a comparative case study analysis
Zakumumpa H; Bennet S; Ssengooba F: BMC Health Services Research 16(584),2016

Uganda implemented a national ART scale-up program at public and private health facilities between 2004 and 2009. Little is known about how and why some health facilities have sustained ART programs and why others have not sustained these interventions. This study in 2015 identified facilitators and barriers to the long-term sustainability of ART programs at six health facilities in Uganda which received donor support to commence ART between 2004 and 2009. A case-study approach was adopted. Six health facilities were purposively selected for in-depth study from a national sample of 195 health facilities across Uganda which participated in an earlier study phase. The six health facilities were placed in three categories of sustainability; High Sustainers (2), Low Sustainers (2) and Non- Sustainers (2). Semi-structured interviews with ART Clinic managers (N = 18) were conducted. Several distinguishing features were found between High Sustainers, and Low and Non-Sustainers’ ART program characteristics. High Sustainers had larger ART programs with higher staffing and patient volumes, a broader ‘menu’ of ART services and more stable program leadership compared to the other cases. High Sustainers associated sustained ART programs with multiple funding streams, robust ART program evaluation systems and having internal and external program champions. Low and Non Sustainers reported similar barriers of shortage and attrition of ART-proficient staff, low capacity for ART program reporting, irregular and insufficient supply of ARV drugs and a lack of alignment between ART scale-up and their for-profit orientation in three of the cases. The authors found that ART program sustainability was embedded in a complex system involving dynamic interactions between internal (program champion, staffing strength, M &E systems, goal clarity) and external drivers (donors, ARVs supply chain, patient demand). ART program sustainability contexts were distinguished by the size of health facility and ownership-type. The study’s implications for health systems strengthening in resource-limited countries are discussed.

Achieving and sustaining universal ART access in rural areas: The PHC approach to HIV services in Lusikisiki, Eastern Cape
Medecins Sans Frontiers, October 2006

The chronic shortage of health care workers is recognised as a major bottleneck to scaling up antiretroviral therapy (ART) , and this has the biggest impact in rural areas where the human resource crisis is most acute. There is a need to develop innovative, effective delivery models, particularly for rural areas with weak health systems. This document reports how the HIV/AIDS programme in Lusikisiki, a partnership between Médecins sans Frontières (MSF) and the Department of Health of the Eastern Cape, has managed to achieve universal ART access in one of the most under-resourced and disadvantaged areas of South Africa without compromising on quality.

Addressing the fear and consequences of stigmatisation: a necessary step towards making HAART accessible to women in Tanzania: a qualitative study
Theilgaard ZP, Katzenstein TL, Chiduo MG, Pahl C, Bygbjerg IC, Gerstoft J et al: AIDS Research and Therapy 8(28), 2 August 2011

Highly Active Antiretroviral Therapy (HAART) has been available free of charge in Tanga, Tanzania since 2005, yet many women referred from prevention of mother-to-child transmission services to the Care and Treatment Clinics (CTC) for HAART never registered at the CTCs. In this study, researchers focused on the motivating and deterring factors to presenting for HAART, particularly in relation to women. A qualitative approach was used, including in-depth interviews and focus group discussions. Researchers found that the main deterrent to presenting for treatment appears to be fear of stigmatisation including fear of ostracism from the community, divorce and financial distress. Participants indicated that individual counselling and interaction with other people living with HIV would encourage women to present for HAART, to do so, and indicated that the entrance to the CTC should be placed to allow discreet access. Necessary steps towards encouraging HIV infected women to seek treatment include reducing self-stigma, assisting them to form empowering relationships and to gain financial independence and emphasising the beneficial effect of treatment for themselves and for their children by example.

Addressing the needs of orphans in the context of HIV/AIDS

This report, commissioned by the South African National Department of Health, aims to inform a co-ordinated response to the needs of orphans and vulnerable children in the context of the HIV/AIDS pandemic in South Africa. Divided into two parts, the first details findings from research conducted across five South African provinces and the second offers a set of recommendations. One of the study's objectives was to develop an understanding of the health and social needs of orphans and children at risk, with specific emphasis on access to health, social development and education.

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