Botswana has said it is prioritising the prevention of new HIV infections as its number one HIV and AIDS strategy, since the cost of keeping people alive on treatment is no longer sustainable. National AIDS Council spokesperson, Lorato Mongatane, said there is need for a comprehensive public awareness campaign to ensure the nation is made aware of the cost of the national response to HIV and AIDS and its impact on economic growth. Mongatane said with over 150,000 people on treatment and HIV and AIDS budget for 2010/2011 exceeding US$500 million, the Botswana government is prioritising the prevention of new infections to ensure that the number of people living with HIV and AIDS stabilises to help contain the cost over time. She pointed out that HIV prevention knowledge has not translated into major behaviour changes that could ultimately reduce the number of new infections.
Equity and HIV/AIDS
This study, conducted between May 2009 and January 2010, undertook to explore the social, economic and cultural factors related to engagement in multiple concurrent sexual partnerships in Zambia. In-depth interviews were conducted at seven geographically diverse sites across Zambia. Interviews were conducted with 301 men and women who perceived themselves to be in stable relationships. Researchers used structured interviews and careful probing to elicit detailed information on all sexual partnerships during the previous 12 months. They found that overlapping concurrency was frequent among both men (71%) and women (46%) who identified themselves as being in stable relationships. Men who reported overlapping concurrency averaged three partners compared with women who had approximately two partners over the 12-month recall period. Quantitative data indicated that a high degree of mobility, with more than three-quarters of the entire sample indicating some degree of travel in their daily lives. The study calls for more research into the role of mobility in HIV transmission, as well as more national surveillance (biological and behavioural) data on mobile and migrant populations in Zambia. Currently, there is no systematic framework for collecting behavioral or biomedical data from migrant/mobile populations, and numerous gaps exist in data with regard to these groups. In addition, HIV prevention efforts must reflect a better understanding of the social and cultural nuances of mobility and migration that affect decisions to engage in sexual concurrency.
Based on field experience in environments with limited resources, this paper aims to illustrate the various strategies developed by Medicins sans Frontiers (MSF) to simplify patient screening and follow-up in order to increase access to anti-retroviral treatment. These include decentralising and streamlining treatment protocols, transferring skills, beginning treatment earlier, using new biological monitoring tools, gaining access to new drugs with fewer side effects, and not leaving out patients with complicated cases. The new strategies tend to place more responsibility on patients and simplify their treatment. Medical teams can then focus on treating the most complicated cases. Decentralising medical care and delegating responsibilities to less-qualified personnel (task shifting) are crucial, the paper argues. By giving patients more autonomy and making them responsible for their health, this paper argues, health facilities can spread out their medical consultations to every six months and thus reduce their workload. Simplifying medical follow-up may be achieved by decentralising and streamlining patient care and ensuring that two essential blood tests are available to patients - measuring the CD4 cell count, and the viral load.
This study found that farm workers in South Africa's Limpopo and Mpumalanga provinces have the highest HIV prevalence among any working population in Southern Africa. Conducted from March to May 2010 on 23 commercial farms, the survey included 2,810 farm workers, who anonymously gave blood specimens for HIV testing. The survey found that an average of 39.5% of farm workers who tested were HIV positive, which is more than twice the UNAIDS estimated national prevalence for South Africa of 18.1%. HIV prevalence was significantly higher among female employees, with almost half of the women (46.7%) testing positive compared to just under a third (30.9%) of the male workforce. The study could not pin-point a single factor causing this high rate of HIV infection on these farms, but cites a combination of factors such as multiple and concurrent partnerships, transactional sex, irregular condom use, presence of sexually transmitted infections (STIs) and tuberculosis, and high levels of sexual violence. The authors of the study note that a major research gap exists with regard to HIV among farm workers in southern Africa and they call for more research. The report makes several recommendations including increasing farm worker access to healthcare and implementing prevention programmes that are goal driven and monitored. The programmes should address gender norms that increase risky behaviour and vulnerability to HIV, such as the belief that a man has to have multiple partners. Both permanent and seasonal farm workers should be included in workplace health and safety policies.
Adolescents continue to be at high risk for HIV infection, with young men who have sex with men and youth with drug abuse and/or mental health problems at particularly high risk, according to this study. Multiple factors may interact to confer risk for these youth. Engaging vulnerable youth in HIV prevention research can present unique challenges in the areas of enrollment, retention, and trial adherence. Examples of successful engagement with vulnerable youth offer encouraging evidence for the feasibility of including these youth in clinical trials. Ethical challenges must be taken into consideration before embarking on biomedical HIV prevention studies with vulnerable youth, especially in the global context. Given the many individual and contextual factors that contribute to their high-risk status, the study urges that vulnerable youth populations be included in HIV prevention clinical research studies.
This report evaluates the work that Medicins sans Frontiers (MSF) has done in HIV and AIDS in Mozambique over the past ten years. MSF’s HIV and AIDS programmes offer HIV testing and counseling, treatment and prevention of opportunistic infections, paediatric diagnosis and treatment, prevention of mother-to-child transmission, and the provision of anti-retroviral therapy. At the end of August 2010, more than 33,000 people in Mozambique were being treated for HIV and AIDS through MSF’s projects. However, the report cautions that MSF’s model of care is not a prescriptive cure, and significant challenges remain. More than 350,000 people in Mozambique are in need of ARV treatment but do not have access to it, which equates to two-thirds of all HIV-positive Mozambicans. After years of political willingness and financial commitment to combat HIV and AIDS, external funders are now either flatlining, reducing or withdrawing their funding for HIV, thus abandoning those who are still in dire need of lifesaving treatment. HIV-infected people continue to face major barriers in their access to services, even in a context of free treatment. A shortage of qualified health workers is also considered a major barrier to access in Mozambique, with only 3 doctors and 143 nurses per 100,000 people, one of the lowest workforce per population ratios in the world.
Men who have sex with men (MSM) do not make headlines in South African media and HIV experts have warned that a lack of accurate coverage prevents targeted HIV prevention and care for these men. Human rights activists have spoken up about the South African media's tendency to divide men into two groups - heterosexual or homosexual - and caution against reinforcing stereotypes that deter them from accessing target HIV services for fear of being labelled. About 6% of lesbian, bisexual, transgender or intersex people and MSM surveyed have reported being turned away from government clinics, the government estimates. According to the national strategic plan (NSP), at least 70% of MSM should have been reached with a comprehensive, customised HIV prevention package by 2011. But the country is unlikely to meet this target. According to a recently released government review of NSP progress, nobody is systematically collecting data on HIV prevention among MSM.
The government of Rwanda, through the National AIDS Commission, is intensifying condom use campaigns with plans to install seven hundred condom vending machines countrywide in 2011, the executive secretary of the National Aids Commission, Anita Asiimwe, has said. The Commission plans to install the vending machines at places of hospitality like hotels, bars, and restaurants for easy access. The machines helped many people avoid the embarrassment of buying condoms in ordinary shops, she said. The condom use campaigns were launched in 2009 and had proved positive with people changing attitude towards the method. The campaign launched to mark 2009’s World Aids Day was meant to sensitise the public on condom use on top of abstinence and faithfulness – topics which were given much publicity but without quantified results. The seven hundred condom vending machines follow another one hundred and fifty machines that were installed in 2009.
Life-prolonging antiretroviral (ARV) medication is reaching more HIV-positive Ugandans than ever before, but health workers are concerned about how they will deal with the inevitable rise in drug resistance. An estimated 400 accredited facilities are providing about 218,000 Ugandans with ARVs, and more than 300,000 have enrolled on HIV treatment, but many patients have died and some have simply abandoned treatment. Although studies show that ARV adherence is generally high, frequent drug stock-outs as a result of funding shortages and supply-chain problems as well as food insecurity mean that patients have experienced interruptions in their treatment regimens, predisposing them to resistance. The Europe-Africa Research Network for Evaluation of Second-line Therapy (EARNEST) trial is trying to determine the best option for resource-limited settings at the Infectious Disease Institute (IDI), part of the Mulago Hospital Complex in the capital, Kampala. Currently, about 3% of adults and 4.6% of children on ARVs are taking second-line drugs. According to the previous World Health Organization's CD-4 count cut-off of 200, the Ministry of Health has estimated that 379,551 more people would require ARVs.
This report shows that the AIDS epidemic is beginning to change course as the number of people newly infected with HIV is declining and AIDS-related deaths are decreasing. Together, these are contributing to the stabilisation of the total number of people living with HIV in the world. Data from the report indicates that an estimated 2.6 million people became newly infected with HIV, nearly 20% fewer than the 3.1 million people infected in 1999. In 2009, 1.8 million people died from AIDS-related illnesses, nearly one-fifth lower than the 2.1 million people who died in 2004. At the end of 2009, 33.3 million people were estimated to be living with HIV, up slightly from 32.8 million in 2008. This is in large part due to more people living longer as access to antiretroviral therapy increases, the report argues. From 2001 to 2009, the rate of new HIV infections stabilised or decreased by more than 25% in at least 56 countries around the world, including 34 countries in sub-Saharan Africa. Of the five countries with the largest epidemics in the region, the report notes that four countries - Ethiopia, South Africa, Zambia and Zimbabwe - have reduced rates of new HIV infections by more than 25%, while Nigeria’s epidemic has stabilised. Sub-Saharan Africa continues to be the region most affected by the epidemic, with 69% of all new HIV infections.