This report describes the implementation and short-term results of a peer group intervention for HIV prevention on the HIV-related attitudes, knowledge and behaviours of primary school teachers in Malawi. The intervention, based on the social-cognitive learning model, took place in 2000 at two teacher training colleges with a distance-learning programme. Primary school teachers attending a final six-week training session before certification volunteered to participate. The 286 trainee teachers largely reported positive changes in their HIV-prevention-related knowledge, attitudes, self-efficacy, behaviour change and condom-use intentions. However, at post-test immediately after the intervention they did not show a higher level of perceived-risk, a greater hope that people could change their high-risk sexual behaviour, or greater agreement that persons infected with HIV should be allowed in public places. This research demonstrates the feasibility of an HIV-prevention intervention for primary school teachers during their training. The Malawi Ministry of Education has since made the programme available to over 90 per cent of all trainee teachers through an NGO.
Equity and HIV/AIDS
This report looks at the armies of Botswana, Swaziland, Tanzania, Zambia and Zimbabwe in the context of the HIV and AIDS epidemic. These armies report HIV rates between 20 to 40 percent, with some sections having a rate between 50 to 60 percent. The report explores approaches to reduce HIV rates among soldiers and recognises that the inherent structure and discipline of armies and their ability to follow set regimes, means that they can become change agents in their societies in the fight against HIV and AIDS.
HIV/AIDS and water-borne diseases account for a substantial degree of morbidity and mortality in different age groups across the globe, but their ripple effects are more devastating in developing countries. Estimates of the HIV/AIDS epidemic in South Africa vary but attest to a mature and generalised epidemic. In rural areas, devoid of electricity and potable water, the impact is more profound because of the role of water in cooking, drinking, consumption of anti-retrovirals and in the preparation of milk supplements for infants. Improving water quality will lead to a decline in child and adult mortality as well as diarrhoeal diseases in people living with HIV and AIDS. The cross-paths between HIV/AIDS and water have long-term implications for effective water resource management and the provision of wholesome water to communities. Such implications include faltering payment for water supply because HIV and AIDS are financially dis-empowering, erosion of social capital and waning productivity. Mainstreaming of HIV and AIDS in the water sector is of utmost importance, including development of work-place policies, adaptation and reorganisation of workload, development of strategies for reserve staff, adjustment of performance appraisal systems, pro-poor financing with a focus on water for health and economic benefit and integration of HIV and AIDS into training activities.
Large-scale surveys have reported that about 55% of orphans worldwide are adolescents. In Kenya, the majority of HIV-infected adolescents are females. The current study used the anthropological methods of in-depth case studies to analyse how migratory life situations of individual female adolescent orphans in the Luo community of Western Kenya may increase their exposure to HIV. The study shows that the ability of the female adolescent orphans to adopt risk-preventive behaviour in relation to HIV is determined by a range of factors beyond their control of individual sexual behaviour. Although analysis of a single case study limits generalisation of the findings, the results provide insights into the reason for sex differentials in HIV infection rates among adolescents as reported in some large-scale surveys. The paper recommends that HIV prevention strategies for adolescents should examine the specific life situations of female orphans by focusing on the impacts of HIV and AIDS and poverty on the protective role of the family. It also recommends that keeping female adolescent orphans in school or in vocational training can be an effective HIV prevention strategy for them.
Previous research has identified high levels of mental health problems among people affected by HIV. This study surveys specifically adolescents in southern Malawi on their experience of the impacts of living with HIV or AIDS on one's mental health. At the same time, the study explores the link between mental health problems and subsequent HIV-risk behaviour. Short texts relating everyday scenarios that depicted symptoms of three mental health problems (i.e. depression, anxiety and HIV-related brain impairment) formed the basis of in-depth discussions in 12 existing groups of secondary school students, orphans and vulnerable children, teenage mothers, and out-of-school youths, in both rural and urban settings. The responses show that these young people recognised the mental health sequelae of HIV/AIDS as impacting upon many aspects of one's life. The young people traced these ‘interruptions' and ‘disruptions' through deteriorating psychological and socio-economic conditions. They showed awareness of a two-way interaction between HIV/AIDS and mental illness, indicating that the latter can increase thoughts of suicide and HIV risk-taking behaviour. More importantly, they identified a number of locally derived community interventions, which if supported by statutory health and education services, can significantly ameliorate their situations. The findings provide avenues for practical integration of mental health provision within HIV prevention, education and care initiatives.
The aim of this study was to investigate knowledge of prevention of mother to child HIV transmission (PMTCT) programmes and to describe potential barriers that might affect their acceptability in a resource poor setting in South Africa. Based on interviews with over 1500 pregnant women, their families and five communities around the PMTCT clinic areas, the authors found that there are several major potential barriers in implementing PMTCT programmes in a resource poor setting. The authors suggest that increased access to HIV testing and counselling would be one of the most effective ways of reducing perinatal transmission. They state that this can be achieved by ensuring that expectant mothers receive antenatal care from trained staff throughout their pregnancy and have a skilled professional childbirth attendant.
This evaluation report from the World Bank’s Operation Evaluation Department (OED) assesses the development effectiveness of the Bank’s country-level HIVand AIDS assistance. The report concludes that Bank assistance has persuaded governments to act earlier or in a more focused and cost-effective way. It also finds that whist Bank assistance has helped raise political commitment, these pledges have sometimes been overestimated and need to be constantly addressed in the country context. The authors recommend that the Bank, in order to have a sustainable impact on the HIV/AIDS epidemic, should help governments use human and financial resources more efficiently and effectively. They also recognise the need to strengthen local monitoring and evaluation practices and help improve the local evidence base for making decisions.
Comparative, multi-country research has been underutilised as a means to inform health system development. South-south collaboration has been particularly poor, even though there have been clearly identified benefits of such endeavours. This commentary argues that in a context of HIV/AIDS, the need for regional learning has become even greater. This is because of the regional nature of the problem and the unique challenges that it creates for health systems. We draw on the experience of doing comparative research in South Africa, Tanzania and Zambia, to demonstrate that it can be useful for determining preconditions for the success of health care reforms, for affirming common issues faced by countries in the region, and for developing research capacity. Furthermore, these benefits can be derived by all countries participating in such research, irrespective of differences in capacity or socio-economic development.
The new Epidemic Updates reflects improved and expanded epidemiological data and analyses that present a better understanding of the global epidemic. These new data and advances in methodology have resulted in substantial revisions from previous estimates. While the global prevalence of HIV infection—the percentage of people infected with HIV — has levelled off, the total number of people living with HIV is increasing because of ongoing acquisition of HIV infection, combined with longer survival times, in a continuously growing
general population. Global HIV incidence — the number of new HIV infections per year — is now estimated to have peaked in the late 1990s at over 3 million [2.4 – 5.1 million] new infections per year, and is estimated in 2007 to be 2.5 million [1.8 – 4.1 million] new infections, an average of more than 6 800 new infections each day. This reflects natural trends in the epidemic, as well as the result of HIV prevention efforts.
This paper discusses the issue of equity in the distribution of ARV drugs in the Malawi health system. Malawi is one of the countries most severely affected by HIV/AIDS in southern Africa. It is also one of the poorest countries in the world.ARV drugs are expensive.The Malawi government, with assistance from the Global Fund on Tuberculosis, Malaria and HIV/AIDS, started providing free ARV drugs to eligible HIV-infected people in September 2004.The provision of free drugs brought the hope that everyone who was eligible would access them. Based on data collected through a qualitative research methodology, it was found that achieving equity in provision would face several challenges including policy, operational and socio-economic considerations. Specifically, the existing policy framework, shortage of medical personnel, access to information and inadequacy of effective community support groups are some of the key issues affecting equity.