In this position paper, the Coalition raises demands for the improvement of health care in African countries in terms of: improving political commitment and leadership; strengthening civil society to improve absorption of available resources; immediately delivering on the 15% Abuja commitment; scaling up investment in youth empowerment and education to enhance participation of young people in HIV/AIDS; ensuring sustainability of financing and programmes; fast tracking implementation of the global strategy and plan of action on public health, innovation and intellectual property; scaling up HIV prevention, treatment and care; dealing effectively with and invest in programmes for TB/HIV co-infection; addressing the needs of older people and empowering and engaging with PLWHAs.
Equity and HIV/AIDS
The study seeks to raise awareness and expand knowledge about the deleterious effect of HIV/AIDS mortality on South Africa's life expectancy, a country with a relatively high HIV/AIDS prevalence rate (19%). Using the multiple and associated single decrement life table techniques, the study estimates the total number of South Africans who would die from HIV/AIDS by the time they reach age 75 from a hypothetical cohort of 100,000 live births, assuming that the mortality conditions of 1996 for South Africa prevailed. The findings indicate that 5.7% of babies will eventually die of AIDS. Furthermore, 7.7% and 11.5% of those aged 60 years, and 75 years and above respectively will die of AIDS. Overwhelming majority of deaths will come from persons within the reproductive and productive age groups. A tremendous gain in life expectancy to the tune of about 26 years would result in the absence of HIV. The elderly persons, who are the grandmothers and grandfathers, are likely to manage family affairs following the death of their adult children. This condition is likely to impoverish the elderly population. Everything should be done to reduce AIDS mortality in order to increase life expectancy in the country.
There has been a great deal of progress over the past few years in AIDS. Despite the still staggering death toll and the wave of new infections, there are now, for instance, 3 million people on antiretroviral therapy, something that would have been unbelievable 10 years ago. This modest progress is in danger though. We've entered the era of the AIDS backlash - those who say AIDS gets too much money, from those who say AIDS programmes are distorting health systems. But the backlash takes more insidious forms. This discussion reports on the progress we've made with HIV/AIDS, the innovations that we've pioneered and the need to stop the backlash.
More than 400,000 HIV-positive South Africans have begun antiretroviral treatment (ART) since the government launched its programme in 2004. But this impressive-sounding figure still only represents one third of the estimated number of people in need of treatment, and that number is expanding by an additional half a million people every year. If South Africa is to achieve its ambitious goals for expanding treatment access, as well as the UN Millennium Development Goal of universal access, the current models for delivering treatment will need an overhaul. Despite the existence of national policies and guidelines for ARV treatment, implementation is strongly driven by what happens at provincial and district level. A comparison of 16 facilities providing treatment in the three provinces revealed wide variations in referral systems and staffing levels, but in all three provinces the researchers found a lack of integration of ARV services with other health services. Patients frequently had to go to other facilities for the treatment of TB, or for other opportunistic infections, or for antenatal care. The study also found that in many districts there were too few doctors and pharmacists providing ARV services, creating service bottlenecks. Systems for monitoring and evaluating patients on ARV treatment were also generally weak, and the use of data to improve services even weaker.
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.
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.