UNAIDS, in collaboration the World Food Programme (WFP) and the World Health Organization (WHO), has developed a policy brief on HIV, food security and nutrition. This policy provides guidance for governments, civil society and other partners on how to address food and nutrition concerns in the context of HIV, keeping in mind the commitment made by all UN member states through the Millennium Development Goals both to reduce chronic hunger and halt and reverse the spread of HIV by 2015.
Equity and HIV/AIDS
Women, HIV and AIDS, and violence
Minter W (Ed): Africafocus, 28 April 2008
Based on interviews in two South African provinces and extensive consultation with South African agencies involved with the issue, this report provides a detailed portrait of the situation of rural women, and the interaction among violence, poverty, and the risk of HIV/AIDS. The overview has a concise survey of the development of the AIDS epidemic in South Africa including the debates about government policy and the active role of civil society.
Agriculture in the time of HIV/AIDS: Examining the relationship between agriculture and HIV/AIDS
Bie, SW: Department of International Environment and Development Studies, Norwegian University of Life Sciences, 2008
Few sub-Saharan African countries have substantial analyses of the rural and agricultural situations in their Poverty Reduction Strategy Papers (PRSPs) and the link between agriculture and HIV and AIDS is therefore missed. Rural poverty is at the root of risky behavior (sexual services for food, cash or other resources), which can often lead to an HIV infection, hence the rate of HIV transmission can only be effectively reduced by reducing rural poverty. The report recommends improvements in agriculture, food supply, local social security networks (which provide information and behavioural advice) and access to assets that can be mobilised as alternatives to transactional sex. Gender issues also need to be addressed.
Assessing the quality of data aggregated by antiretroviral treatment clinics in Malawi
Makombe SD, Hochgesang M, Jahn A, et al: Bulletin of the World Health Organization 86 (4):241-320, April 2008
By 31 December 2006, Malawi had enrolled 82 000 patients in its free national antiretroviral treatment (ART) programme. Each quarter, data from all ART clinics are aggregated for national reporting on ART scale-up. This information is essential to monitoring site performance, guiding national planning and supporting sustained funding. Despite increasing reliance on sites to aggregate data, the completeness and accuracy of sites’ reports was unknown. The authors therefore conducted an operational study during regular supervisory visits to assess the quality of data in the site reports. Specific objectives were to: i) determine the completeness and accuracy of key case registration and outcome data compiled by ART clinics, ii) compare national data summarized from site reports versus supervision reports, and iii) analyse characteristics associated with sites’ capacity to compile quality data.
Baseline for the evaluation of a National Action Plan for Orphans and Other Vulnerable Children using the UNAIDS core indicators: A case study in Zimbabwe
Saito S, Monasch R, Keogh E, Dhlembeu N, Bergua J, Mafico M: Vulnerable Children and Youth Studies 2(3):198 - 214, December 2007
This paper describes the experience of Zimbabwe in establishing a baseline for its National Action Plan for Orphans and Other Vulnerable Children (NAP for OVC) using the 10 core indicators developed by the UNAIDS Global Monitoring and Evaluation Reference Group in 2004. Through a population-based household survey in rural and urban high-density areas and the OVC policy and planning effort index assessment tool, a baseline was established. The survey found that 43.6% of children under 18 years were orphaned or made vulnerable by HIV/AIDS. Half of all households with children care for one or more OVC. While the large majority of OVC continued to be cared for by the extended family, its capacity to care for these children appeared to be under pressure. OVC were less likely to have their basic minimum material needs met, more likely to be underweight, less likely to be taken to an appropriate health provider when sick and less likely to attend school. Medical support to households with OVC was found to be relatively high (26%). Other support, such as psychosocial support (2%) and school assistance (12%), was lower. The OVC Effort Index assessment indicates that serious efforts are being made. The increase in the effort index between 2001 and 2004 in the areas of consultative efforts, planning and coordinating mechanisms reflects the strengthened commitment. Monitoring and evaluation and legislative review are the weakest areas of the OVC response. The findings of the baseline exercise point to the need for continued and additional efforts and resources to implement the NAP for OVC, the priorities of which were confirmed by the survey as critical to improve the welfare of the OVC in Zimbabwe.
Challenges of Childhood TB/HIV Management in Malawi
Poerksen P, Kazembe PN, Graham SM: Malawi Medical Journal 19(4):142-148, 2007
The diagnosis and management of childhood tuberculosis (TB) are major challenges in countries such as Malawi with high incidence of TB and human immunodeficiency virus (HIV) infection. Diagnosis of TB in children often relies only on clinical features but clinical overlap with the presentation of HIV and other HIV-related lung disease is common. The tuberculin skin test (TST), the standard marker of M. tuberculosis infection in immune competent children, has poor sensitivity in HIV-infected children and is not usually available in Malawi. HIV test should be routine in children with suspected TB as it improves clinical management. HIV-infected children are at increased risk of developing active disease following TB exposure which justifies the use of isoniazid preventive therapy (IPT) once active disease has been excluded but this is difficult to implement and appropriate duration of IPT is unknown. HIV-infected children with active TB experience higher mortality and relapse rates on standard TB treatment compared to HIV-uninfected children, highlighting the need for further research to define optimal treatment regimens. HIV-infected children should also receive appropriate supportive care including co-trimoxazole prophylaxis and anti-retroviral treatment (ART) if indicated. There are concerns about concurrent use of some anti-TB drugs such as rifampicin with some ARTs.
Evaluation of prevention of mother-to-child HIV transmission program in rural Kwazulu-Natal, South Africa
Hocque M, Van Den Heuvel M, Hocque E: Clinics in Mother and Child Health 4(2):753-762, 2007
In 2004, South Africa had one of the highest rates of HIV infection in the world and the province of KwaZulu-Natal (KZN) reported the peak of 40.7% positivity among the antenatal population. The purpose of this study was to identify measures to improve the quality of an HIV prevention program targeted at reducing the rate of mother-to-child transmission of HIV infection (MTCT). A cross-sectional observational (non-experimental) study was conducted from Empangeni hospital (i) using antenatal clinic registers between May 2002 and April 2003 and (ii) applied a questionnaire survey to a randomly selected sample of 306 HIV infected women who delivered between April and June 2004. The results showed that among 3774 antenatal attendees, 2528 (67%) accepted pre-test counselling and 2390 (63%) HIV testing. Majority (95%) of those who had (2528) pre-test counselling accepted HIV testing, post test counselling and test results. The prevalence of HIV infection was 41% (980) (95% CI, 39%-43%). Among them (980 HIV positive), 73% (716) received nevirapine during the antenatal period yielding an overall antenatal nevirapine prophylaxis (uptake) rate of 46% (based on an estimate of 41% HIV prevalence rate for total antenatal population of 3774 during the study period). Between April to June 2004, 2393 women delivered at Empangeni hospital of which 39% (933) were HIV positive. The coverage of pretest counselling for HIV testing (67%) and nevirapine use (46%) was low. We found in the questionnaire survey that the participating women had adequate knowledge and compliance on the use of nevirapine. Strategies are needed to improve program uptake and effectiveness of the prevention of mother-to-child transmission of HIV infection (PMTCT) program in rural South Africa.
HIV-TB co-infection: Meeting the challenge
The Forum for Collaborative HIV Research, 2007
Ten per cent of individuals infected with TB develop the active disease but this is greatly increased in those whose immune systems have been weakened by HIV. This report from the Forum for Collaborative HIV Research highlights the difficulty in managing the co-epidemic of HIV and TB that is rapidly spreading in Sub-Saharan Africa. The report concludes that strategies for dealing with TB and HIV currently exist in isolation, often reinforced by vertical programme financing. Efforts must be made to integrate these disease treatment programmes that will involve stakeholders working together within an evidence-based collaborative framework.
International Politics of HIV/AIDS: Global Disease-Local Pain
Seckinelgin H: Routledge UK, 2007
This book examines the global governance of the AIDS epidemic, interrogating the role of this international system and global discourse on interventions. The geographical focus is Sub-Saharan Africa since the region has been at the forefront of these interventions. There is a need to understand the relationship between the international political environment and the impact of resulting policies on HIV and AIDS in the context of people's lives. There is a certain disjuncture between this governance structures and the way people experience the disease in their everyday lives. Although the structure allows people to emerge as policy relevant target groups and beneficiaries, the articulation of needs and design of policy interventions tends to reflect international priorities rather than people's thinking on the problem and the nature of the system does not allow interventions to be far reaching and sustainable.
Joint tuberculosis/HIV services in Malawi: Progress, challenges and the way forward
Chimzizi R, Harries A: International Journal of Public Health, 2007
This review of progress made on a three-year tuberculosis TB/HIV plan implemented in Malawi between 2003 and 2005 found that barriers to testing TB patients for HIV include: irregular supplies of HIV-testing reagents, staff forgetting to refer patients or patients themselves not undergoing HIV testing and counselling after being registered and placed on anti-TB treatment. The authors recommend that ways to improve HIV-testing uptake need to be found, including the integration of HIV testing with the TB registration process itself. The monitoring systems for HIV and TB need to explicitly include the relevant parameters, for example, TB monitoring tools which include data on numbers of TB patients who have been tested for HIV, who are HIV-positive, and who have started antiretroviral therapy.