The International Labour Organization’s (ILO) Code of Practice on HIV and AIDS, which aims to strengthen the global response to HIV in the workplace, was adopted by governments, employers and workers at the annual conference of the ILO, held in Switzerland from 2–18 June 2010. As a new labour standard, it is intended to reinforce and extend anti-discrimination policies in the workplace. It reaffirms the right to continued employment regardless of HIV status and asserts that workers should not be screened for HIV for employment purposes. The standard also recognises the need for focused action to protect the rights of populations that may be more vulnerable to HIV infection, and is expected to provide support to the goal of universal access to HIV prevention, treatment, care and support. The labour costs of HIV are recognised in the standard, especially since HIV affects the most economically active age range in every population and the loss of most the 33.4 million people living with HIV would represent a major loss of skills and experience that might have a negative effect on economies and communities. The standard is the first internationally-sanctioned instrument that focuses specifically on HIV in the workplace. It is expected to significantly enhance the impact of HIV prevention and treatment programmes in the workforce globally.
Equity and HIV/AIDS
In this report, research findings from a population-based household survey are presented on the general health status of infants, children, and adolescents in South Africa including morbidity, utilisation of health facilities, immunisation coverage, HIV status and associated risk factors. The study also investigates the exposure of children and adolescents to HIV communication programmes. Major recommendations were that the number and scope of community health workers be expanded to include high-impact but low-cost health and nutrition interventions. The report found very little exclusive breastfeeding, with 51.3% of babies on mixed feeding. The report highlighted the lack of HIV communication programmes in rural areas, and for English, Afrikaans, Tsonga and Venda speakers, recommending that future campaigns also focus more strongly on complementing school-based programmes and on children. It recommends implementing an accreditation system ‘as a matter of urgency’ to regularly monitor the quality of health facilities and to serve as a mechanism to hold managers accountable for the health outcomes of mothers and children. The report may be used by policy makers and stakeholders in targeting and prioritising key issues in planning and programming efforts focusing on the broad health issues of South African children.
The writer of this article argues that FIFA, as the world’s football authority, has an ethical responsibility for social action, especially with regard to HIV and AIDS and the World Cup. As the overwhelming percentage of professional footballers come from poverty or financially disadvantaged childhoods, world football owes a tremendous debt to these poorer communities who, by their resourcefulness, allowed world‐class footballers to develop. FIFA President, Sepp Blatter, claims that FIFA has been ‘committed to a wide range of humanitarian projects’ but the author argues these are largely insufficient. For example, the FIFA ‘Football for Hope’ project is costing only about US$17 million, while FIFA is expected to net revenues of US$3.3 billion and profits of US$1.7 billion from the Cup. The project costs amount to a mere 0.5% of the revenues and 1% of the earnings for South African charities. The author challenges FIFA to recognise that other sports have already done more per capita than world soccer for human development, specifically HIV and AIDS education and empowerment.
This study used a validated mathematical method to estimate the rate of new HIV infections (HIV incidence) in South Africa using nationally representative HIV prevalence data collected in 2002, 2005 and 2008. The observed HIV prevalence levels in 2008 were adjusted for the effect of antiretroviral treatment on survival. In the period 2002–2005, the HIV incidence rate among men and women aged 15–49 years was estimated to be 2 new infections each year per 100 susceptible individuals. The highest incidence rate was among 15–24 year-old women, at 5.5 new annual infections per 100 individuals, which declined to 60% to 2.2 There was evidence from the surveys of significant increases in condom use and awareness of HIV status, especially among youth. The analysis demonstrates how serial measures of HIV prevalence obtained in population-based surveys can be used to estimate national HIV incidence rates. It also underlines the need to determine the impact of ART on observed HIV prevalence levels. The estimation of HIV incidence and ART exposure is crucial to disentangle the concurrent impact of prevention and treatment programs on HIV prevalence.
This study assessed the contributions of rising mortality, falling HIV incidence and sexual behaviour change to the decline in HIV prevalence in Zimbabwe. Comprehensive review and secondary analysis was conducted of national and local sources on trends in HIV prevalence, HIV incidence, mortality and sexual behaviour covering the period 1985–2007. Data from eastern Zimbabwe showed substantial rises in mortality during the 1990s, levelling off after 2000. Estimates of HIV incidence indicated that HIV incidence may have peaked in the early 1990s and fallen during the 1990s. Household survey data showed reductions in numbers reporting casual partners from the late 1990s and high condom use in non-regular partnerships between 1998 and 2007. These findings provide the first convincing evidence of an HIV decline accelerated by changes in sexual behaviour in a southern African country. However, in 2007, one in every seven adults in Zimbabwe was still infected with a life-threatening virus and mortality rates remained at crisis level.
Developing countries like Malawi are calculating the cost of adhering to new World Health Organization (WHO) guidelines that recommend starting HIV-positive people on antiretroviral drugs (ARVs) sooner. Malawi is one of three African countries that have conducted WHO-supported feasibility studies to assess what adopting the new guidelines would mean, and has announced plans to roll out the new WHO guidelines by mid-2011, said Dr Frank Chimbwandira, head of the HIV and AIDS department in the Ministry of Health. According to the feasibility study, the number of people on treatment would rise by about 50%, which could double the cost of the national ARV programme in terms of additional personnel and equipment, and would probably also mean waiting lists at many clinics. Implementing the WHO guidelines would mean major changes to national treatment protocols: HIV-positive people would start taking ARVs at a much higher CD4 count of 350, regular CD4 count and viral load monitoring would be conducted, and potentially more expensive treatment regimens would be adopted - including phasing out the ARV, stavudine, which has been associated with increased side-effects.
In this report, Médecins Sans Frontières (MSF) notes that major funders now seem to be withdrawing HIV and AIDS funding to countries like Malawi, Mozambique, Zimbabwe, South Africa, Lesotho, Kenya, Uganda and the Democratic Republic of Congo. According to MSF, PEPFAR has flatlined its funding for 2009-2014 and as of 2008-9, further decreased its annual budget allocations for the coming years by extending the period to be covered with the same amount of money. The World Bank currently prioritises investment in health system strengthening and capacity building in planning and management over HIV-dedicated funding, thereby reducing their support for HIV and AIDS care. In addition, UNITAID is phasing out its funding for drugs and other medical commodity procurement through the Clinton Foundation. By 2012, funding for second-line anti-retrovirals (ARVs) and paediatric commodities should end in Zimbabwe, Mozambique, the Democratic Republic of Congo and Malawi. The Global Fund is also currently facing a serious funding shortfall. To compound the problem further, MSF adds that all current funding scenarios are inadequately reflecting demand, as none includes the additional resources required to implement the new World Health Organization guidelines on earlier treatment and improved drug regimens.
In this study, the main objectives were to establish the proportion of adolescents among children infected with human immunodeficiency virus (HIV) in Zimbabwe who receive HIV care and support, and what clinic staff perceive to be the main problems faced by HIV-infected children and adolescents. In July 2008, the researchers sent a questionnaire to all 131 facilities providing HIV care in Zimbabwe, requesting an age breakdown of the children (aged 0–19 years) registered for care and asking to identify the two major problems faced by younger children (0–5 years) and adolescents (10–19 years). Nationally, 115 (88%) facilities responded. Of the 98 (75%) that provided complete data, 196,032 patients were registered and 24,958 (13%) of them were children. The main problems for younger children were identified as malnutrition and lack of appropriate drugs (cited by 46% and 40% of clinics, respectively), while adolescents were most concerned about psychosocial issues and poor drug adherence (cited by 56% and 36%, respectively).
Two new studies have confirmed fears that the use of antiretroviral (ARV) drugs to prevent HIV could lead to drug resistance if inadvertently used by people who were already infected. The findings, presented at the International Microbicides Conference in the United States earlier in May, suggest that regular HIV testing would have to be an integral part of any prevention programme using ARVs. Prevention approaches incorporating ARVs are still being tested in clinical trials, but are thought to be among the most promising potential interventions against HIV. One approach, called pre-exposure prophylaxis (PrEP), would involve giving a daily dose of a single ARV drug to people who were HIV-negative but at high risk. This could be effective in preventing HIV, but if someone who is already infected is treated, this could raise the risk of developing resistant strains of the virus.
Community home-based care is the Botswana Government's preferred means of providing care for people living with HIV (PLHIV). However, primary (family members) or volunteer (community members) caregivers experience poverty, are socially isolated, endure stigma and psychological distress, and lack basic care-giving education. This study estimated the cost incurred in providing care for PLHIV through a stratified sample of 169 primary and volunteer caregivers drawn from eight community home-based care groups in four health districts in Botswana. The results show that the mean of the total monthly cost (explicit and indirect costs) incurred by the caregivers was US$90.45, while the mean explicit cost of care giving was US$65.22. This mean of the total monthly cost is about one and a half times the caregivers' mean monthly income of US$66 and more than six times the Government of Botswana's financial support to the caregivers. The study, therefore, concludes that as the cost of providing care services to PLHIV is very high, the Government of Botswana should substantially increase the allowances paid to caregivers and the support it provides for the families of the clients. The overall costs for such a programme would be quite low compared with the huge sum of money budgeted each year for health care and for HIV and AIDS.