Equity and HIV/AIDS

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.

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.

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.

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.