People around the world face barriers to accessing quality health care and enjoying the highest attainable standard of health. Why this occurs varies between countries and communities, but some barriers are present everywhere. These include the various forms of discrimination faced by people who are marginalized, stigmatized, criminalized and otherwise mistreated because of their gender, nationality, age, disability, ethnic origin, sexual orientation, religion, language, socio-economic status, or HIV or other health status, or because of selling sex, using drugs and/or living in prison. One in eight people living with HIV report having been denied health care. Examples of HIV-related stigma and discrimination go beyond denial of care or lower quality care, and include forced sterilization, stigmatizing treatment, negative attitudes and discriminatory behaviour from providers, lack of privacy and/or confidentiality and mandatory testing or treatment without informed consent. UNAIDS argue that such discriminatory practices undermine people’s access to HIV prevention, treatment and care services and the quality of health-care delivery, as well as adherence to HIV treatment.
Equity and HIV/AIDS
Few sub-Saharan African countries have substantial analyses of the rural and agricultural situations in their Poverty Reduction Strategy Papers (PRSPs) and the link between agriculture and HIV and AIDS is therefore missed. Rural poverty is at the root of risky behavior (sexual services for food, cash or other resources), which can often lead to an HIV infection, hence the rate of HIV transmission can only be effectively reduced by reducing rural poverty. The report recommends improvements in agriculture, food supply, local social security networks (which provide information and behavioural advice) and access to assets that can be mobilised as alternatives to transactional sex. Gender issues also need to be addressed.
A new report released before The High-Level Forum on Advancing Global Health in the Face of Crisis, which took place on 15 June 2009, suggests that the response to AIDS is an opportunity to improve health systems worldwide. Other areas that contribute to health solutions, such as human rights, the law and education, need to be embraced to maximise outcomes, and health equity must be addressed. The report argues that the main issues that need to be addressed are: the shortfall in health resources, despite increases in investment in global health; the need to strengthen community services, despite the beneficial effects from an increase in AIDS resources being spent on health and community systems; the need to link AIDS treatment and HIV prevention to other health issues, such as sexual reproductive health, tuberculosis and safe motherhood. A lesson learned is that social determinants, such as gender inequality, lack of education and poverty, must be addressed when addressing global health needs.
This paper highlights the socio-economic impacts of HIV on women. It argues that the socio-cultural beliefs that value the male and female lives differently lead to differential access to health care services. The position of women is exacerbated by their low financial base especially in the rural community where their main source of livelihood, agricultural production does not pay much. But even their active involvement in agricultural production or any other income ventures is hindered when they have to give care to the sick and bedridden friends and relatives. This in itself is a threat to household food security. The paper proposes that gender sensitive policies and programming of intervention at community level would lessen the burden on women who bear the brunt of AIDS as caregivers and livelihood generators at household level. Improvement of medical facilities and quality of services at local dispensaries is seen as feasible since they are in the rural areas. Other interventions should target freeing women's and girls' time for education and involvement in income generating ventures. Two separate data sets from Western Kenya, one being quantitative and another qualitative data have been used.
This book tracks the progress and pitfalls of the global fight against HIV and AIDS over the past 30 years. The book's strength lies in its methodical documenting of the medical community's response to the virus. Harden also seeks to explain how political and cultural ideas influenced the science of AIDS. In specific instances, such as explaining how stigma about a sexually transmitted disease initially associated with the gay community hampered early research in the United States, she succeeds. But she does not make the same effort to explain later shifts in political perceptions. There is very little discussion of former President George W Bush's decision to launch the President's Emergency Plan for AIDS Relief, for instance, or what impact it had. At a time when the US is projecting a vision of an AIDS-free generation, Harden's history shows that constant monitoring and new perspectives remain critical. She reminds us that the world only arrived at the idea of an AIDS-free generation through constant trial-and-error: first, in determining the causes and later in producing effective therapies to prolong the lives of infected people.
According to this UNAIDS report, the global rate of new HIV infections declined by nearly 25% between 2001 and 2009. In South Africa, the rate of new HIV infections fell by more than 35%, with above-average declines in new HIV infections recorded in sub-Saharan Africa. The report found that in the third decade of the epidemic, people were starting to adopt safer sexual behaviours, reflecting the impact of HIV prevention and awareness efforts. However, there are still important gaps – for example, young women are less likely to be informed about HIV prevention than young men. While the rate of new HIV infections has declined globally, the total number of HIV infections remains high, at about 7,000 per day. According to the report, investments in the HIV response in low- and middle-income countries rose nearly 10-fold between 2001 and 2009, from US$ 1.6 billion to US$ 15.9 billion. However, in 2010, international resources for HIV declined, despite the fact that many low-income countries remain heavily dependent on external financing.
A key feature of South Africa’s HIV epidemic, where 5.7 million people are positive, is that among the 15-24 year olds infected, women and girls account for more than 90% of new infections. This needs a special focus on this group when designing prevention programmes, says UNAIDS. The HIV and AIDS epidemic in South Africa is stabilising, according to a report released last week by the Joint United Nations’ Programme on HIV and AIDS. This means that there has not been a recognisable increase in the rate of new infections over the last few years. Instead, the infection rate has remained relatively constant. This, however, does not mean that the epidemic is declining, as the country still holds the unenviable world number one position in the stakes of the total number of people living with HIV. The fact that women and girls continue to be disproportionately infected points to a failure of HIV programmes in addressing the issues that place females at risk of HIV infection, says the United Nations’ Special Envoy on AIDS in Africa, Elisabeth Mataka.
Over 22,000 of the world’s key HIV and AIDS scientists, academics and activists attended 17th international AIDS conference in Mexico City. The HIV/AIDS sector has been under attack recently by some health practitioners who argue that too much money is being spent on HIV and AIDS to the detriment of other diseases. However, Craig McClure, the executive director of International AIDS Society (IAS) says it is unfortunate that the criticism that HIV is distorting health systems comes at a time ‘when success is finally in our hands’. ‘There is no doubt that in order for us to achieve the 2010 Universal Access targets, health systems must be further strengthened,’ said Cahn. ‘This will require an increase in resources, including additional resources for commodities like drugs and diagnostic tools, basic health care infrastructure and the training and retaining of the health care workforce. With the life-long interventions brought by antiretroviral therapy, the success of HIV and AIDS programmes around the world is dependent on health systems strengthening.’
The rapidly spreading virus of free trade has proved as fatal to those living with HIV/AIDS as the disease itself according to Health NOW!, a global alliance of activist groups fighting the patenting of life-saving medicine by drug multinationals. Speaking at the XV international AIDS conference in Bangkok a Health NOW! spokesperson argued that millions of lives could be saved if developing world nations were not forced to sign unfair trade agreements by developed countries. Multilateral as well as bilateral free trade pacts he said were devastating the lives of the poor, contributing to the spread of HIV/AIDS and compounding the devastation caused by the pandemic.
Although the objective of the World Health Organization's 3 by 5 Initiative - treating three million people with antiretroviral drugs by 2005 - is behind schedule, it is still possible, according to the first progress report for the initiative. The report - released in advance of the XV International AIDS Conference in Bangkok, Thailand - estimates that 440,000 people currently are receiving treatment under the program.