A Durban hospital has cut the transmission of HIV from pregnant mothers to their babies to less than 3% with dual therapy. The study started with all 2 624 pregnant women who attended McCord's antenatal clinic during the 18 months from March 2004 to August 2005. Of these, 338 women tested HIV-positive and 302 delivered at McCord. The study assessed these babies. During their pregnancies 44% of the HIV-positive women received highly active antiretroviral treatment. Of the 297 surviving babies, 290 (98%) received the antiretroviral drug nevirapine after birth and 224 (76%) also received the antiretroviral AZT. In six cases there was no record of the baby receiving any antiretroviral treatment. Six weeks later 239 (81%) of the babies were tested seven of these (2.9%) were HIV positive. The hospital used guidelines developed from international studies for its programme. The researchers said this showed that, despite resource constraints, a state-aided hospital could achieve results which compared favourably to those in developed countries.
Equity and HIV/AIDS
East and southern Africa are the two regions in the world which are the most highly affected by HIV and AIDS. A significant number of people with HIV are educators, ranging from primary school teachers to head teachers and university lecturers. In response, UNESCO together with the three partners convened a consultation with HIV-positive teachers and other key stakeholders from Ministries of Education and teachers’ unions from Kenya, Namibia, United Republic of Tanzania, Uganda, Zambia and Zimbabwe. This report presents a summary of the key points, outcomes and recommendations emerging from the consultation which aimed to share experiences and articulate common, key elements of comprehensive responses for HIV-positive teachers. In order to provide a comprehensive response for HIV-positive teachers, the report argues that there needs to be support for HIV-positive teachers to continue teaching in a supportive environment free of stigma and discrimination. For this to be in place, a number of actions are recommended as necessary, including to: identify and address the varying needs of HIV-positive teachers; tackle stigma and discrimination; ensure access to prevention programmes, treatment, care and support; and build links between teacher’s unions and networks of HIV-positive teachers.
Mozambique had 1.3 million people estimated to be living with HIV by end 2003. The epidemic poses significant development challenges to this low-income country. The Government of Mozambique formed a National AIDS Council (NAC) in 2000, and is currently operating its National Strategic Plan to Combat HIV/AIDS for 2005-2009.
This World Health Organisation/UNAIDS/UNICEF report documents appreciable global progress in the effort to deliver lifesaving antiretroviral treatment (ARVs) to people living with HIV/AIDS in developing countries; however, it also underscores the crucial need to maintain a focus on scaling up and providing lifesaving antiretroviral treatment in programs like PEPFAR (the President’s Emergency Plan for AIDS Relief) notes AIDS Healthcare Foundation (AHF). The report claimed that three million people were on treatment in 2007 (a goal that World Health Organization officials had initially hoped to reach in 2005 in its ambitious ‘3x5’ treatment plan), but it also revealed a more ominous trend that AHF and other advocates believe calls for a renewed and stepped up commitment to delivering care and antiretroviral treatment—more than 9.7 million people with HIV/AIDS around the world are in critical need of antiretroviral treatment (those who would otherwise die within two years) than at the end of 2006; 2.6 million more are in need today than one year ago.
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.
In a rare study of mortality before and after ARVs, researchers have found a drop in deaths of 10 percent. Free antiretroviral therapy has significantly reduced mortality in rural Malawi. The researchers investigated the mortality in a population before and after the introduction of free ARVs, in turn measuring the effects of such programmes on survival rates in the population. Researchers measured the mortality in a population of 32,000 in northern Malawi, from August 2002 when free ARV therapy was not available in the district, until February 2006, eight months after an ARV clinic was opened. Comparisons revealed that overall mortality rates among adults had declined by 10 percent. This equalled nine deaths averted in an eight-month observation period after the introduction of ARVs. Mortality decreased by 35 percent in adults near the district’s main road, where death rates before antiretroviral therapy were highest.
Malawi, which has about 80000 deaths from AIDS every year, made free antiretroviral therapy available to more than 80000 patients between 2004 and 2006. The authors aimed to investigate mortality in a population before and after the introduction of free antiretroviral therapy, and therefore to assess the effects of such programmes on survival at the population level. The study used a demographic surveillance system to measure mortality in a population of 32000 in northern Malawi, from August, 2002, when free antiretroviral therapy was not available in the study district, until February, 2006, 8 months after a clinic opened. The probability of dying between the ages of 15 and 60 years was 43% (39-49) for men and 43% (38-47) for women; 229 of 352 deaths (65.1%) were attributed to AIDS. Eight months after the clinic that provided antiretroviral therapy opened, 107 adults from the study population had accessed treatment, out of an estimated 334 in need of treatment. Overall mortality in adults had decreased by 10% from 10.2 to 8.7 deaths for 1000 person-years of observation (adjusted rate ratio 0.90, 95% CI 0.70-1.14). Mortality was reduced by 35% (adjusted rate ratio 0.65, 0.46-0.92) in adults near the main road, where mortality before antiretroviral therapy was highest (from 13.2 to 8.5 deaths per 1000 person-years of observation before and after antiretroviral therapy). Mortality in adults aged 60 years or older did not change. Findings of a reduction in mortality in adults aged between 15 and 59 years, with no change in those older than 60 years, suggest that deaths from AIDS were averted by the rapid scale-up of free antiretroviral therapy in rural Malawi, which led to a decline in adult mortality that was detectable at the population level.
Something is definitely not quite right with the concept or delivery of Prevention of Mother-to-Child HIV Transmission (PMTCT) services. While uptake has been known to be poor, in spite of policy guidelines that require all expectant mothers seeking antenatal care to be counselled and offered an HIV test, it has now emerged that health workers are having to contend with a significant number of rural women who reject positive results. HEPS-Uganda has found worrying cases of expectant mothers who consent to an HIV test in Kamwenge in western Uganda turn around to decline positive tests. In a December 2007 project report, 'Community Empowerment and Participation in Maternal Health in Kamwenge District', HEPS-Uganda says that while its project resulted in more pregnant women seeking ANC services, a big proportion of them still refuse to consent to voluntary HIV counselling and testing (VCT) services and that some of the few who consent do not accept their results.
This study was conducted to identify reasons for a high and progressive loss to follow-up among HIV-positive mothers within a prevention-of-mother-to-child HIV transmission (PMTCT) program in a rural district hospital in Malawi. Three focus group discussions were conducted among a total of 25 antenatal and post-natal mothers as well as nurse midwives (median age 39 years, range 22–55 years). The main reasons for loss to follow-up included: not being prepared for HIV testing and its implications before the antenatal clinic (ANC) visit; fear of stigma, discrimination, household conflict and even divorce on disclosure of HIV status; lack of support from husbands who do not want to undergo HIV testing; the feeling that one is obliged to rely on artificial feeding, which is associated with social and cultural taboos; long waiting times at the ANC; and inability to afford transport costs related to the long distances to the hospital. This study reveals a number of community- and provider-related operational and cultural barriers hindering the overall acceptability of PMTCT that need to be addressed urgently. Mothers attending antenatal services need to be better informed and supported, at both community and health-provider level.
This study assessed the role of governmental and non-governmental organisations in mitigation of stigma and discrimination among people infected and affected by HIV/AIDS in informal settlements of Kibera. More than 61% of the respondents had patients in their households. Fifty-five percent (55%) of the households received assistance from governmental and non-governmental organisations in taking care of the sick. Services provided included awareness, outreach, counselling, testing, treatment, advocacy, home based care, assistance to the orphans and legal issues. About 90% of the respondents perceived health education, counselling services and formation of post counselling support groups to combat stigma and discrimination to be helpful. Stigma and discrimination affects the rights of People Living with HIV/AIDS (PLWHAs). Such stigmatisation and discrimination goes beyond and affects those who care for the PLWHAs, and remains the biggest impediment in the fight against HIV/AIDS in Kibera. Governmental and non-governmental organizations continue to provide key services in the mitigation of stigma and discrimination in Kibera. However, personal testimonies by PLWHAs showed that HIV positive persons still suffer from stigma and discrimination. About 43% of the study population experienced stigma and discrimination.