According to this paper, a growing number of studies highlight men's social disadvantage in making use of HIV services. Drawing on the perspectives of 53 ARV users and 25 healthcare providers, researchers examined qualitatively how local constructions of masculinity in rural Zimbabwe impact on HIV testing and treatment uptake. They found that informants reported a clear and hegemonic notion of masculinity that required men to be and act in control, to have know-how, be strong, resilient, disease free, highly sexual and economically productive. However, such traits were in direct conflict with the 'good patient' persona who is expected to accept being HIV positive, take instructions from nurses and engage in health-enabling behaviours such as attending regular hospital visits and refraining from alcohol and unprotected extra-marital sex. This conflict between local understandings of manhood and biopolitical representations of 'a good patient' can provide a possible explanation to why so many men do not make use of HIV services in Zimbabwe. The researchers urge HIV service providers to consider the obstacles that prevent many men from accessing their services.
Equity and HIV/AIDS
The authors of this study aimed to increase case-finding of infection with human immunodeficiency virus (HIV) in Zambia and their referral to HIV care and treatment by supplementing existing client-initiated voluntary counselling and testing (VCT), the dominant mode of HIV testing in the country. Lay counsellors offered provider-initiated HIV testing and counselling (PITC) to all outpatients who attended primary clinics and did not know their HIV serostatus. After the addition of PITC to VCT, the number tested for HIV infection in the nine clinics was twice the number undergoing VCT alone. Over 30 months, 44,420 patients were counselled under PITC and 31,197 patients, 44% of them men, accepted testing. Of those tested, 21% were HIV+; 38% of these HIV+ patients enrolled in HIV care and treatment. The median time between testing and enrolment was 6 days. The acceptability of testing rose over time. In conclusion, the introduction of routine PITC using lay counsellors into health-care clinics in Lusaka, Zambia, dramatically increased the uptake and acceptability of HIV testing. Moreover, PITC was incorporated rapidly into primary care outpatient departments. Maximizing the number of patients who proceed to HIV care and treatment remains a challenge and warrants further research.
The introduction of the South African government's HIV tests on schoolchildren has been delayed by legal and confidentiality concerns, but officials insist a pilot project will start later in the year. After the national Department of Health announced the planned testing in January 2011, a pilot project to test pupils, voluntarily, was due to start at several schools in February. But it was shelved because crucial ethical and legal questions had not been answered. A team was set up to test the feasibility of the project, but four months later it has still not completed its research and consultations. Most teachers' unions and parents' organisations supported the proposal in principle, saying HIV screening could help curb the spread of HIV and reduce teenage pregnancies. But some expressed misgivings about how it might affect pupils and the learning environment. Parents must consent to tests and counselling must be provided by the schools.
The authors of this study reviewed the cost-effectiveness of interventions to prevent mother-to-child transmission (MTCT) of HIV in low- and middle-income countries (LMICs). They identified 19 articles published in nine journals from 1996 to 2010, 16 concerning sub-Saharan Africa. Collectively, the articles suggest that interventions to prevent paediatric infections are cost-effective in a variety of LMIC settings, as measured against accepted international benchmarks. The authors conclude that interventions to prevent HIV MTCT are compelling on economic grounds in many resource-limited settings and should remain at the forefront of global HIV prevention efforts. Future cost-effectiveness analyses should focus on local assessment of rapidly evolving HIV MTCT options, strategies to improve coverage and reach underserved populations, evaluation of a more comprehensive set of MTCT approaches, and the integration of HIV MTCT and other sexual and reproductive health services.
Since 2000, access to antiretroviral drugs to treat HIV infection has dramatically increased to reach more than five million people in developing countries. Essential to this achievement was the dramatic reduction in antiretroviral prices, the authors of this paper argue, which was a result of global political mobilisation that cleared the way for competitive production of generic versions of widely patented medicines. Despite these promising changes, a "treatment timebomb" awaits, the authors warn. First, increasing numbers of people need access to newer antiretrovirals, but treatment costs are rising since new ARVs are likely to be more widely patented in developing countries. Second, policy space to produce or import generic versions of patented medicines is shrinking in some developing countries. Third, funding for medicines is falling far short of needs. Expanded use of the existing flexibilities in patent law and new models to address the second wave of the access to medicines crisis are required. One promising new mechanism is the UNITAID-supported Medicines Patent Pool, which seeks to facilitate access to patents to enable competitive generic medicines production and the development of improved products. Such innovative approaches are possible today due to the previous decade of AIDS activism. However, the Pool is just one of a broad set of policies needed to ensure access to medicines for all; other key measures include sufficient and reliable financing, research and development of new products targeted for use in resource-poor settings, and use of patent law flexibilities. Governments must live up to their obligations to protect access to medicines as a fundamental component of the human right to health.
The objective of this paper was to quantify the deaths from human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) that are misattributed to other causes in South Africa’s death registration data and to adjust for this bias. Differences between global and South African relative death rates were used to identify the causes to which deaths from HIV and AIDS were misattributed in South Africa and quantify the HIV and AIDS deaths misattributed to each. These deaths were then reattributed to AIDS. In South Africa, deaths from HIV and AIDS are often misclassified as being caused by 14 other conditions. Whereas in 1996–2006 deaths attributed to HIV and AIDS accounted for 2.0–2.5% of all registered deaths in South Africa, the analysis shows that the true cause-specific mortality fraction rose from 19% to 48% over that period. More than 90% of HIV and AIDS deaths were found to have been misattributed to other causes during 1996–2006. In conclusion, adjusting for cause of death misclassification, a simple procedure that can be carried out in any country, can improve death registration data and provide empirical estimates of HIV and AIDS deaths that may be useful in assessing estimates from demographic models.
This study found that farm workers in South Africa's Limpopo and Mpumalanga provinces have the highest HIV prevalence among any working population in Southern Africa. Conducted from March to May 2010 on 23 commercial farms, the survey included 2,810 farm workers, who anonymously gave blood specimens for HIV testing. The survey found that an average of 39.5% of farm workers who tested were HIV positive, which is more than twice the UNAIDS estimated national prevalence for South Africa of 18.1%. HIV prevalence was significantly higher among female employees, with almost half of the women (46.7%) testing positive compared to just under a third (30.9%) of the male workforce. The study could not pin-point a single factor causing this high rate of HIV infection on these farms, but cites a combination of factors such as multiple and concurrent partnerships, transactional sex, irregular condom use, presence of sexually transmitted infections (STIs) and tuberculosis, and high levels of sexual violence. The authors of the study note that a major research gap exists with regard to HIV among farm workers in southern Africa and they call for more research. The report makes several recommendations including increasing farm worker access to healthcare and implementing prevention programmes that are goal driven and monitored. The programmes should address gender norms that increase risky behaviour and vulnerability to HIV, such as the belief that a man has to have multiple partners. Both permanent and seasonal farm workers should be included in workplace health and safety policies.
This report evaluates the work that Medicins sans Frontiers (MSF) has done in HIV and AIDS in Mozambique over the past ten years. MSF’s HIV and AIDS programmes offer HIV testing and counseling, treatment and prevention of opportunistic infections, paediatric diagnosis and treatment, prevention of mother-to-child transmission, and the provision of anti-retroviral therapy. At the end of August 2010, more than 33,000 people in Mozambique were being treated for HIV and AIDS through MSF’s projects. However, the report cautions that MSF’s model of care is not a prescriptive cure, and significant challenges remain. More than 350,000 people in Mozambique are in need of ARV treatment but do not have access to it, which equates to two-thirds of all HIV-positive Mozambicans. After years of political willingness and financial commitment to combat HIV and AIDS, external funders are now either flatlining, reducing or withdrawing their funding for HIV, thus abandoning those who are still in dire need of lifesaving treatment. HIV-infected people continue to face major barriers in their access to services, even in a context of free treatment. A shortage of qualified health workers is also considered a major barrier to access in Mozambique, with only 3 doctors and 143 nurses per 100,000 people, one of the lowest workforce per population ratios in the world.
The author argues in this paper that United States government policy has violated the rights of African people living with HIV and AIDS through its ‘moral’ restrictions prioritising abstinence-only sex education, restricting condom distribution and stigmatising sex workers. The author argues that the focus on technocratic approaches such as biomedical quick fixes, like the recent emphasis on male circumcision, ignores the deeply gendered, racial and sexual dimensions of the disease or its social, economic and cultural pathology in Africa.
In this article, the authors consider a neglected aspect of AIDS and HIV treatment – pain management. With enormous progress in preventing and treating HIV, more people than ever before now live with HIV as a chronic disease, especially in countries like Kenya, where, over the past year, the number of people receiving anti-retroviral (ARV) therapy has risen by 25%. But HIV patients can suffer from various types of chronic pain – and this includes those on ARVs who are living otherwise healthy, active lives – and pain management is usually overlooked, the authors note. They argue that palliative care, which requires caregivers to improve a patient's quality of life by treating pain and other symptoms, should become an essential element of comprehensive HIV care. It can also help patients to keep taking their antiretroviral drugs. Curative and palliative treatment should work side by side for any patient with a life-threatening disease, the authors state. A major barrier is unavailability of essential pain drugs in Kenya's health facilities. Oral morphine, the mainstay medication for moderate-to-severe chronic pain, is available in just seven of Kenya's 250 public hospitals, and even these facilities sometimes run out, even though oral morphine is inexpensive. However, because of a lack of training, healthcare workers often fear giving an overdose or causing addiction, which can be avoided with proper medical practice. The authors argue for greater, monitored use of morphine for pain management in children.