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.
Equity and HIV/AIDS
The HIV/AIDS Epidemic in Mozambique
Kates J and Wilson Leggoe A: HIV/ AIDS Policy Fact Sheet 7361: 1-2, Kaiser Family Foundation, October 2005
WHO report says 9.7 million at risk of death from AIDS today; AHF renews call for US Congress to commit to scale up treatment to save seven million lives
AIDS Healthcare Foundation, 4 June 2008
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.
Access to AIDS medicines stumbles on trade rules
Wise J: WHO Bulletin 84(5): 337-424, May 2006
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.
ARVs reduce mortality in Malawi
Health-e, 9 May 2008
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.
Population-level effect of HIV on adult mortality and early evidence of reversal after introduction of antiretroviral therapy in Malawi
Jahn A, Floyd S, Crampin A, et al: The Lancet 371: 1603-1611, 2008
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.
Pregnant women rejecting HIV test results
Medicine Access Digest 4(1), Mar 2008
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.
Further details: /newsletter/id/33158
Reasons for loss to follow-up among mothers registered in a prevention-of-mother-to-child transmission program in rural Malawi
Bwirire LD, Fitzgerald M, Zachariah R, Chikafa V, Massaquoi M, Moens M, Kamoto K, Schouten EJ: Transactions of the Royal Society of Tropical Medicine and Hygiene, 16 May 2008
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.
Role of governmental and non-governmental organisations in mitigation of stigma and discrimination among Hiv/Aids persons In Kibera, Kenya
Odindo MA, Mwanthi MA: East African Journal of Public Health 5(1), 2008
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.
South Africa: Government urged to raise treatment standards
PlusNews, 06 May 2008
HIV/AIDS treatment guidelines for South Africa's public health sector are out of sync not only with those of many other countries in the region, but also with the latest research on how to most effectively treat people living with HIV. Various studies indicating that patients who start antiretroviral therapy (ART) earlier respond better to treatment and are less likely to develop AIDS-related illnesses have led the United States, the United Kingdom and a number of countries in Africa to change their treatment protocols. Deciding when to start a patient on life-long ARV drugs is usually based on a combination of CD4 cell count test results [which indicate the strength of the immune system] and HIV disease progression, which the World Health Organisation (WHO) has defined according to four clinical stages, with stage four being AIDS. The WHO revised its guidelines in 2003 to recommend that a patient who has reached stage three of the disease and has a CD4 count of less than 350 should begin treatment. Most countries in the region have revised their guidelines accordingly, but South Africa's national ART guidelines are still based on earlier WHO recommendations that ART be prescribed only for patients with stage four disease, or a CD4 count of less than 200. In April, the Southern African HIV Clinicians Society published guidelines in the Southern African Journal of HIV Medicine recommending that people living with HIV begin ART when their CD4 cell count drops below 350, regardless of disease progression. These guidelines are endorsed by the region's leading HIV specialists but have no direct influence on the South African government's ART programme.
UNAIDS calls on World Health Assembly to support the elimination of HIV-related travel restrictions and advance HIV prevention, treatment, care and support for migrants
UNAIDS, 22 May 2008
Since the beginning of the HIV epidemic, governments have prevented people living with HIV from entering or residing in their countries based solely on their HIV status. Such restrictions have stopped HIV positive people from travelling for business, family visits, or tourism; and from entering a country for study, labour migration, and political asylum. Seldom is HIV testing linked to any treatment, heath care, counselling or support, either in country of origin or destination. Nor are the results necessarily kept confidential. Though countries focus on excluding HIV positive migrants, little is done to protect migrants from HIV infection while in destination countries – and indeed some do get infected. There have also been reports of HIV-positive migrants dying for lack of treatment while abroad, including in immigration detention facilities pending deportation. HIV-travel restrictions are anachronisms that are inappropriate in the age of globalisation, increased travel, increased access to treatment for HIV, and national and international commitments to universal access to HIV prevention, treatment, care and support. They are also discriminatory and contribute to stigmatisation. No evidence suggests that HIV-related travel restrictions protect the public health, and they may in fact impede efforts to stop the epidemic. UNAIDS recognizes that States impose immigration and visa restrictions as a valid exercise of their national sovereignty. However, in imposing any restrictions on entry and stay relating to HIV or health, UNAIDS calls upon States to adopt non-discriminatory laws and regulations which rationally achieve valid objectives through the least restrictive means possible.