This commentary was written on the International AIDS Conference in Melbourne 20-25 July 2012, the 20th gathering of the largest regular conference of any health or development issue, bringing together politicians, scientists, epidemiologists, practitioners, policy makers, the private sector and communities of people living with and affected by HIV. There is uniqueness in this fight against HIV in that it is a social movement, pulling people together and putting people at the forefront of the response to sustain efforts on addressing HIV. The theme of the 2014 conference was ‘Stepping up the Pace,’ and the author comments that we must redouble our efforts on areas like stigma and discrimination, which after 30 years is still increasing in some regions. 'We have the tools; we need to step up the pace.’ Today, there are 15 million people on treatment, yet there are still alarming challenges that must be tackled in order to even contemplate an AIDS free generation. Statistics from 2013 show there were 1.5 million HIV deaths, 2.1 million new infections and 35 million people living with HIV. Of the 35 million people living with HIV, 55% (19 million) don’t know they have the virus. They haven’t been tested and if they don’t find this out, they will die. The conference highlighted many reasons as to why people do not access or drop out of treatment. The author argues that people must not become those tired advocates beating the same drum, but come back from the conference championing the successes of work over the last 30 years and enter a phase of renewed energy to step up the pace and most importantly leave no one behind.
Equity and HIV/AIDS
The author lists ten things raised at the 2014 Global AIDS conference in Melbourne Australia, listing backwards from 10 to 1: 10. There may be fewer people living with HIV than we thought. 9. Decriminalizing commercial sex work could significantly decrease new HIV infections among sex workers. 8. Ninety is the new zero. For years now, we’ve been hearing a chorus of ‘zero new HIV infections, zero HIV-related discrimination, and zero AIDS-related deaths.’ But this week, UNAIDS changed course, promising to have 90% of all people with HIV aware of their status, 90% of people on treatment, and 90% of those on treatment with lasting viral suppression by the year 2020. 7. Women using injectable hormonal contraceptives are at greater risk of contracting HIV, but WHO isn’t planning to inform women before they choose birth control methods. 6. UNAIDS is still leaving out one of the most at-risk groups of all: women. 5. Children and adolescents are dying at an alarming rate. 4. There is a huge shortfall in funding for harm reduction. 3. HIV-positive women are being pressured to undergo sterilization by health workers. 2. Undetectable viral loads.Calling it “the closest thing we have to a cure for HIV,” activists issued a challenge this week to bring viral loads to undetectable levels by 2020. and 1. Funding for activists is drying up, and with it, the voices to spur governments and agencies to action. Section27's Mark Heywood issued a cri de coeur to delegates of AIDS 2014, lamenting that "AIDS is fast becoming just another disease of the poor, criminalised and marginalised...just another manifestation of global complacency about poverty and inequality."
Sex with older men is not placing women under 30 at higher risk of HIV infection in rural South Africa, and relationships with older men may even be protecting women over 30 from infection, according to results from a eight-year study presented at the 21st Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.
If President Museveni assents to the new HIV/Aids Prevention and Control Bill, 2010, passed by Parliament in May, it will be criminal for a person to ‘willfully’ or ‘intentionally’ infect another with the HIV/Aids virus.
Under Clause 41(1), a person who knowingly transmits HIV/Aids to another shall, on conviction, be liable to a fine of not more that Shs4.8 million or imprisonment for a term not exceeding 10 years or both. Additionally, Clause 14 of the BIll makes it mandatory for men to test alongside their pregnant partners with a view of placing an obligation on both parents to be responsible and protect the unborn child from acquiring the disease. The Bill also establishes a fund, the HIV Trust Fund, which will help boost the fight against the pandemic. The proposed fund imposes an obligation on the government to make quarterly contributions to ministry of Health. Government will contribute 2 per cent to the fund off levies from beer, bottled water and soft drinks.
There is growing interest in expanding public health approaches that address social and structural drivers that affect the environment in which behaviour occurs. Half of those living with HIV infection are women. The sociocultural and political environment in which women live can enable or inhibit their ability to protect themselves from acquiring HIV. This paper examines the evidence related to six key social and structural drivers of HIV for women: transforming gender norms; addressing violence against women; transforming legal norms to empower women; promoting women’s employment, income and livelihood opportunities; advancing education for girls and reducing stigma and discrimination. The paper reviews the evidence for successful and promising social and structural interventions related to each driver. This analysis contains peer-reviewed published research and study reports with clear and transparent data on the effectiveness of interventions. Structural interventions to address these key social and structural drivers have led to increasing HIV-protective behaviours, creating more gender-equitable relationships and decreasing violence, improving services for women, increasing widows’ ability to cope with HIV and reducing behaviour that increases HIV risk, particularly among young people.
There is a huge interest by faith-based organizations (FBOs) in sub-Saharan Africa and elsewhere in HIV prevention interventions that build on the religious aspects of being. Successful partnerships between the public health services and FBOs will require a better understanding of the conceptual framing of HIV prevention by FBOS to access for prevention intervention, those concepts the churches of various denominations and their members would support or endorse. This paper reports the findings of a study on the conceptual framing of HIV prevention among church youths in Botswana. The findings suggest the church youth to conceptually frame their HIV prevention from both faith-oriented and secular-oriented perspectives, while prioritizing the faith-oriented concepts based on biblical teachings and future focus. In their secular-oriented framing of HIV prevention, the church youths endorsed the importance to learn the facts about HIV and AIDS, understanding of community norms that increased risk for HIV and prevention education. However, components of secular-oriented framing of HIV prevention concepts were comparatively less was well differentiated among the youths than with faith-oriented framing, suggesting latent influences of the church knowledge environment to undervalue secular oriented concepts. Older and sexually experienced church youths in their framing of HIV prevention valued future focus and prevention education less than contrasting peer cohorts, suggesting their greater relative risk for HIV infection.
There is growing interest in expanding public health approaches that address social and structural drivers that affect the environment in which behaviour occurs. Half of those living with HIV infection are women. The sociocultural and political environment in which women live can enable or inhibit their ability to protect themselves from acquiring HIV. This paper examines the evidence related to six key social and structural drivers of HIV for women: transforming gender norms; addressing violence against women; transforming legal norms to empower women; promoting women’s employment, income and livelihood opportunities; advancing education for girls and reducing stigma and discrimination. The paper reviews the evidence for successful and promising social and structural interventions related to each driver. This analysis contains peer-reviewed published research and study reports with clear and transparent data on the effectiveness of interventions. Structural interventions to address these key social and structural drivers have led to increasing HIV-protective behaviours, creating more gender-equitable relationships and decreasing violence, improving services for women, increasing widows’ ability to cope with HIV and reducing behaviour that increases HIV risk, particularly among young people.
Condom promotion and HIV testing for the general population have been major components of HIV prevention efforts in sub-Saharan Africa’s high prevalence HIV epidemics, although little evidence documents their public health impact. The authors analysed the latest demographic and health surveys (DHS) and AIDS information surveys (AIS) from four sub-Saharan African countries with high prevalence, heterosexually transmitted HIV epidemics (Côte d’Ivoire, Swaziland, Tanzania and Zambia; N = 48 298) to answer two questions: 1) Are men and women who use condoms less likely to be HIV-infected than those who do not?; and 2) Are men and women who report knowing their HIV status more likely to use condoms than those who do not? Consistent condom use was associated with lower HIV infection rates for Swazi men but with higher HIV infection rates for women in Tanzania and Zambia; it made no significant difference in the other five sex/country subgroups analysed. Inconsistent condom use was not significantly associated with HIV status in any subgroup. Knowing one’s HIV status was consistently associated with higher rates of condom use only among married people who were HIV-positive, even though condom use in this group remained relatively low. Effects of knowing one’s HIV status among other subgroups varied. These results suggest that condoms have had little population-wide impact for HIV/AIDS prevention in these four countries. HIV testing appears to be associated with increased condom use mainly among people in stable partnerships who test positive. HIV testing and condom promotion may be more effective when targeted to specific groups where there is evidence of benefit rather than to general populations.
This article explores how international funders influence civil society organisations (CSOs) in Mozambique through funding mechanisms, the creation of partnerships, or inclusion in targeted programmes. The main focus is the relationship between external funders and AIDS non-governmental organisations (NGOs). The main questions the paper aims to answer are: Who is setting the agenda? What power mechanisms are in place to fulfil planned projects and programmes? Are there any forms of resistance from civil society AIDS-organisations in the face of the donor interventions? The actions are analysed through the lens of governmentality theory. The study concluded that external funders have the power to set the agenda through predetermined programmes and using various technologies. Their strongest weapons are audit mechanisms such as the result based management model used as a control mechanism, and there is still a long way to go to achieve a situation with multiple forms of local resistance to the conditions set by economically powerful funders. The standardisation imposed through clustering external funders into like-minded groups and other constellations gives them power to govern the politics of AIDS.
In a context of inadequate human resources for health, this study investigated whether traditional healers have the knowledge and skill base which could be utilised to assist in the scaling up of HIV prevention and treatment services in South Africa. Using a cross-sectional research design a total of 186 traditional healers from the Northern Cape province were interviewed. Responses on the following topics were obtained: socio-demographic characteristics; HIV training, experience and practices; and knowledge of HIV transmission, prevention and symptoms. Descriptive statistics and chi square tests were used to analyse the responses. Traditional healers’ knowledge of HIV and AIDS was not as high as expected. Less than 50% of both trained and untrained traditional healers would treat a person they suspected of being HIV positive. However, a total of 167 (89%) respondents agreed using a condom can prevent HIV and a majority of respondents also agreed that having one sexual partner (127, 68.8%) and abstaining from sex can prevent HIV (145, 78.8%). Knowledge of treatment practices was better with statistically significant results being obtained. The results indicate that traditional healers could be used for prevention as well as referring HIV positive individuals for treatment. Traditional healers were enthusiastic about the possibility of collaborating with bio-medical practitioners in the prevention and care of HIV and AIDS patients. This is significant considering they already service the health needs of a large percentage of the South African population. However, further development of training programmes and materials for them on HIV and AIDS related issues would seem necessary.