This International Food Policy Research Institute (IPFRI) discussion paper examines the scaling-up of the STEPS initiative (Scaling Up HIV/AIDS Interventions Through Expanded Partnerships) in Malawi, and the factors which interfere with this process. Topics explored in this paper include: Malawi's national response to HIV/AIDS; the pilot project and the development of the community mobilisation model (formerly known as COPE); the scaling up and progress of STEPS; and factors that effect the scaling up process, including the catalysts, institutional arrangements, and organisational capacities. The paper also looks at community-level factors and financing, as well as threats to scaling up, including HIV/AIDS and the ongoing food crisis in the context of widespread and deep poverty, and underdevelopment.
Equity and HIV/AIDS
The annual AIDS epidemic update reports on the latest developments in the global HIV/AIDS epidemic. With maps and regional summaries, the 2004 edition provides the most recent estimates of the epidemic’s scope and human toll, explores new trends in the epidemic’s evolution, and features a special section on women and AIDS.
Access to good quality antiretroviral treatment has transformed the prognosis for people with AIDS in the developed world. Although it is feasible and desirable to deliver antiretroviral drugs in resource poor settings, few of the 95% of people with HIV and AIDS who live in developing countries receive them. The World Health Organization has launched a programme to deliver antiretroviral drugs to three million people with AIDS in the developing world by 2005, the "3 by 5" initiative. This article identifies some of the challenges faced by the initiative, focusing on delivery of care.
In an effort to mobilise leaders to fight HIV/AIDS, the parliament of Lesotho and the UN Children's Fund (UNICEF) have launched a publication called "What Parliamentarians can do about HIV/AIDS Action for Children and Young People". The publication provides parliamentarians with guidelines for responding to the challenge of protecting children and young people through laws, policies, advocacy, education and providing these vulnerable groups with tools to empower them.
The South African social services and population development minister, Zola Skweyiya, has said research into the effect of HIV/AIDS on children is critical for the region's future development. Skweyiya told his southern African counterparts at a recent meeting in Cape Town that the virus was devastating communities and families, and aggravating poverty by killing society's most productive members. According to the South African Press association, he urged that the pandemic be tackled "more vigorously, in an integrated manner".
All people with HIV/AIDS should have equal opportunity to access effective and appropriate treatment. However, in the context of existing social and health inequities, widespread poverty, high rates of new HIV infections, famine and budgetary constraints, increasing access to HIV care and treatment must be organised in a manner that balances HIV prevention and treatment efforts; HIV interventions and the broader strengthening of the health system as a whole; and HIV care and treatment with other public health and social needs.
A giant bright yellow condom was the centre of attraction in Namibia's capital, Windhoek, in November. Namibian civil society organisations - united in the fight against HIV/AIDS - had kicked off a series of activities in the run-up to World AIDS Day on 1 December. "By December 2003 over 100,000 HIV/AIDS cases were [officially] reported in Namibia," deputy health minister Dr Richard Kamwi told the crowd assembled around the condom. "Although these figures are extreme, it should be noted that it is only the tip of the iceberg."
With assistance from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), Malawi is scaling-up the delivery of antiretroviral (ARV) therapy to HIV-positive eligible patients. The country has developed National ARV Treatment Guidelines, which emphasize a structured and standardized approach for all aspects of ARV delivery, including monitoring and evaluation. This paper describes the standardized ARV treatment regimens and the treatment outcomes to assess the impact of treatment, the registration and monitoring systems and how the cohort analyses are carried out.
AIDS. It killed roughly 3 million people last year, most of them poor, and most of them in Africa. Between 34 and 42 million people are living with HIV. Absent antiretroviral therapies, AIDS will have killed the vast majority of them by 2015. In such a world, time can seem a luxury, and the rigours of critical enquiry an indulgence. We need things done now, yesterday, last year. Indeed, an overdue sense of urgency has taken hold in the past five years - much of it thanks to relentless AIDS advocacy efforts. Along with sets of received wisdoms, a more or less standardized framework for understanding the epidemic and its effects has evolved, and a lexicon for expressing this knowledge has been established. All this has helped put and keep AIDS in the spotlight. It has popularized knowledge of the epidemic, countered the earlier sense of paralysis or denial, helped marshal billions of dollars in funding and goad dozens of foot-dragging countries into action. It has worked wonders. But alongside these achievements are some troubling trends.
By the end of 2001, the number of HIV/AIDS infected adults stood at 180,000, while children orphaned by the death of their AIDS-infected parents numbered around 73,000. With a total population of just under two million, the situation in Lesotho is clearly severe. Added to this pandemic is a poorly performing economy, unable to generate the necessary finances to implement a comprehensive strategy to tackle this disease. This paper looks at Lesotho's policy response to the HIV/AIDS pandemic, and looks at the capacity the country has for meeting the challenges posed by the disease.