While Zambia and South Africa are attempting to integrate public TB and HIV services to reach co-infected people, there is little evidence on how the synergy of co-infection with TB and HIV plays out for affected families in the context of poverty and overstretched public services. An anthropological study carried out in 2006/7 documented the social and economic impact of TB, HIV and food insecurity on poor households in rural Zambia and peri-urban SA. Anthropological research was conducted in 18 households affected by TB throughout the period of TB treatment and in 17 comparative non-affected households. Affected families suffered a double blow: they lost the productivity of an adult family member and at the same time needed to muster resources to seek treatment and adequately care for the patient. TB drugs are perceived as both causing hunger and demanding food intake. In South Africa and Zambia, inequities increased both vulnerability to infection and disease and likelihood of delayed diagnosis and delayed or interrupted treatment and care for TB and HIV. In Zambia, those in treatment for TB fell deeper into poverty and were in debt and short on food. In SA, affected households were kept buoyant by the disability grant and other welfare initiatives, but in the long-term most were unable to resume their previous livelihoods. This research recommends that, in the context of poverty, food aid and transport costs are made available to TB patients and PLWHs on ART.
Equity and HIV/AIDS
The Farmer Life School (FLS) is an innovative approach to integrating HIV education into life skills and technical training for farmers. This study aims to gain insight into the strengths and weaknesses of this relatively new approach, through the implementation of an adapted version in South Africa. The results are presented of a pilot with three groups of community gardeners, predominantly women, attending weekly sessions. Impact was assessed in terms of three key elements: participation, learning and empowerment. Data was collected through extensive session reports, follow-up interviews and reflection exercises with facilitators, participating groups and individuals. The results suggest that a group-based discovery learning approach such as the FLS has great potential to improve food security and wellbeing, while allowing participants to explore issues around HIV/AIDS. However, the analysis also shows that HIV/AIDS-related illness and death, and the factors that drive the epidemic and its impact, undermine farmers' ability to participate, as well as the safety and trust required for learning and the empowerment process. Participatory approaches such as the FLS require a thorough understanding of and adaptation to the context in which they are to be used.
Prevention of mother-to-child transmission of HIV (PMTCT) is a major public health challenge in Zimbabwe. Using trained peer counselors, a nevirapine (NVP)-based PMTCT programme was implemented as part of routine care in urban antenatal clinics. This paper documents the successes and challenges of the programme and concludes that peer counselors were a definite advantage in PMTCT.
To gain a more comprehensive understanding of the impact of HIV and AIDS on rural households in Msinga, South Africa, this paper adapted the sustainable livelihoods framework. An ethnographic perspective was employed to examine the impact of HIV/AIDS-related illnesses on people's mind and spirit (the internal environment) and the influence of institutional structures and processes (the external environment) to better understand the actions taken by individuals and households in response to HIV and AIDS. Members of three support groups at a local drop-in centre were consulted about the impact of HIV and AIDS on their lives through focus groups, a questionnaire and in-depth interviews. The study shows that the psychosocial impact and associated coping strategies, as well as prevailing gender-based power relations and exclusion from social-exchange networks (which are not readily available factors in the sustainable livelihoods framework), affect people's lives in different ways and depend on the specific situation of the individual or household concerned. The study confirms the need to restore a household's resource base and to address psychosocial issues. However, the variation in impact on different households requires a diversified and holistic programme of development interventions.
HIV/AIDS funding to low- and middle-income countries reached a record level in 2007, according to a new report by UNAIDS. AIDS spending by the G8 group of wealthy nations, the European Commission and other donors hit US$ 6.6 billion last year, up from US$ 5.6 billion in 2006. However, despite the largesse, UNAIDS said a US$8.1 billion gap in funding for essential HIV/AIDS programmes remained.
Public health services are becoming increasingly important in Kenya, where more than 2.5 million people are living with HIV/AIDS. This paper in the International Journal for Equity in Health highlights the socio-economic impacts of HIV/AIDS on women. Two separate data sets from Western Kenya, one being quantitative and another qualitative data have been used. The authors argue 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.
Failure to properly manage HIV strategies for employees has led to some workplace programmes being closed down, as audits have revealed unacceptable costs. Individual companies, communities and the South African economy are under threat if companies do not initiate expertly managed, independent and outsourced HIV programmes for their employees. Failure to expertly manage programmes effectively means money spent on them is wasted, with consequent negative impacts on the individuals concerned, and workplace productivity and morale. Companies that try to cut corners are reported to be undermining themselves, as well as the entire local treatment initiative.
The persistent and increasing outbreaks of violence against members of the gay community in Africa are jeopardising efforts undertaken to combat HIV, both within this group and across the population as a whole, AIDS activists warned at a recent meeting in Limbé, Cameroon. The extreme vulnerability of members of the gay community to HIV on the continent was highlighted during a meeting initiated by the French non-governmental organisation, AIDES, and its partners, which took place at the beginning of July in the south west of Cameroon. The meeting brought together many AIDS activists from Francophone African countries. On average it is estimated that HIV infection rates amongst MSM (men who have sex with men) are four to five times higher than the population overall.
Education contributes toward the knowledge and personal skills essential for the prevention of HIV, and the mitigation of the impacts caused by AIDS. Produced by the Joint United Nations Programme on HIV/AIDS (UNAIDS)'s Inter-Agency Task Team (IATT) on Education, this report synthesises case study exercises undertaken to examine the quality, effectiveness, and coordination of the education sector's response to the HIV epidemic in 4 countries - Jamaica, Kenya, Thailand, and Zambia. In each country, stakeholders assessed: critical achievements and gaps in the education sector response to HIV and AIDS; the evolution and effectiveness of coordination mechanisms and structures; progress toward harmonisation and alignment; information-sharing on HIV & AIDS and education; key resources for the response; and monitoring and evaluation. This report presents the overall findings from the study and makes recommendations for the IATT on Education and its partners to improve coordination in support of country level and to facilitate global actions.
The world's highest HIV infection rates are found in Sub-Saharan Africa (SSA), where adult prevalence in most countries exceeds 25%. Food shortages and malnutrition have combined with HIV/AIDS to bring some countries to the brink of crisis. The aim of this study was to describe prevalence of malnutrition among HIV-infected women and variations across socioeconomic status using data from 11 countries in SSA. Prevalence of HIV-related malnutrition among women varies by wealth status, education attainment, occupation, and type of residence (rural/urban). The observed socioeconomic disparities can help provide more information about population subgroups in particular need and high risk groups, which may in turn lead to the development and implementation of more effective intervention programmes.