The objective of this study was to gain a greater understanding of published safety data for candidate vaginal microbicides. It systematically reviewed twenty-one human safety trials in peer-reviewed journals, involving the use of 11 vaginal microbicides by a total of 1,465 women. There were few findings of significant difference between women in active and control arms of trials. Confidence intervals in the analyses were generally very wide, and most studies were unable to exclude differences of a substantial magnitude between treated and control women. Larger and longer safety studies are necessary to detect clinically important toxicities, including those that indicate a potential increase in HIV risk, before they are ready for large-scale effectiveness trials and use in the public sector.
Equity and HIV/AIDS
It is becoming clear that HIV/AIDS spreads most rapidly among poor, marginalised, women, colonised and disempowered groups of people more than others. The HIV/AIDS epidemic is exacerbated by the social, economic, political, and cultural conditions of societies such as gender, racial, class, and other forms of inequalities. Sub-Saharan African countries are severely hit by HIV/AIDS. For these countries the pandemic of HIV/AIDS requires them to go the extra mile in their efforts. The objective of this paper is to promote the need to go beyond the biomedical model of ‘technical fixes’ and the traditional public health education tools, and come up with innovative ideas and strategic thinking to contain the epidemic. It argues that containing the HIV/AIDS epidemic and improving family and community health requires giving appropriate attention to the social illnesses that are responsible for exacerbating biological disorders.
A new report released before The High-Level Forum on Advancing Global Health in the Face of Crisis, which took place on 15 June 2009, suggests that the response to AIDS is an opportunity to improve health systems worldwide. Other areas that contribute to health solutions, such as human rights, the law and education, need to be embraced to maximise outcomes, and health equity must be addressed. The report argues that the main issues that need to be addressed are: the shortfall in health resources, despite increases in investment in global health; the need to strengthen community services, despite the beneficial effects from an increase in AIDS resources being spent on health and community systems; the need to link AIDS treatment and HIV prevention to other health issues, such as sexual reproductive health, tuberculosis and safe motherhood. A lesson learned is that social determinants, such as gender inequality, lack of education and poverty, must be addressed when addressing global health needs.
A three-day summit on HIV and AIDS in May this year called on governments to depoliticise the fight against HIV and AIDS and take the lead in fighting the scourge rather than leave it to donors and lobbyist. the Global Citizens Summit held in Nairobi represented citizens from 32 nationals among them National AIDS Control Council representatives (commissioners) from seven countries in Africa and donors from Europe and the Americas. There were calls to ensure that citizens take their rightful place in the fight. Two recommendations that came from the meeting were: expand and diversify testing options (door to door, self testing and male-targeted testing) and make HIV testing a universal agenda. National governments must also provide incentives to promote care and support initiatives for citizens, such as tax exemptions for caregivers, social protection for caregivers and people living with HIV and AIDS (PLWHAs), and micro-enterprise funds targeted at caregivers and PLWHAs. Nutrition should be made part of treatment – both national governments and donors should aim to promote food sovereignty at the household level.
Research conducted by civil society activists in various countries, including Uganda and Zimbabwe, shows that efforts to prevent vertical transmission are failing to reach the very group they were designed for – HIV-positive pregnant women. One of the key reasons for this is that the national programmes have been narrowly focused on providing antiretroviral prophylaxis and not on the other essentials – prevention, counselling, care and treatment for women and children. ‘On paper, the existing global programme is a model of sound design, human rights principles and a comprehensive approach’, the researchers noted. ‘In practice, it is a shameful demonstration of double standards and another instance of women's programming for which everyone and no one at the United Nations is in charge.’ In every country, the researchers found rampant fear of stigma among women and discrimination by health care workers.
Between 2007 and 2008, UNAIDS and the World Bank partnered with the national AIDS authorities of Kenya, Lesotho, Swaziland, Uganda and Mozambique to find out how and where most HIV infections were occurring in each country, and whether existing prevention efforts and expenditure matched these findings. The recently released reports reveal that few prevention programmes are based on existing evidence of what drives HIV and AIDS epidemics in the five countries surveyed. For example, in Mozambique, 19% of new HIV infections resulted from sex work, 3% from injecting drug use, and 5% from men who have sex with men (MSM), yet there are very few programmes targeting sex workers, and none aimed at drug users and MSM. The research also found that spending on HIV prevention was often simply too low: Lesotho spent just 13% of its national AIDS budget on prevention, whereas Uganda spent 34%, despite having an HIV infection rate of only 5.4%.
The war against HIV/AIDS, which has too often been fought in plush offices and conference centres, needs to be reclaimed by people in developing countries, who are most affected, or it will continue to be a losing battle. This was the message from the Global Citizens Summit in Nairobi, Kenya from 27-29 May 2009, organised by international anti-poverty agency ActionAid, and attended by a broad range of organisations in the field of HIV and AIDS to discuss using social mobilisation to ‘repackage’ the HIV response. ‘The fight against HIV did not originate in boardrooms’, said ActionAid. ‘It was citizens rising up to make their voices heard and to put AIDS on the agenda. We need to go back there.’ Participants pointed out that although community-based organisations did the lion's share of HIV-care work, they received only a fraction of global AIDS funding.
Despite the estimated 22.4 million HIV-infected adults in Africa, culturally appropriate ‘prevention with positives’ guidelines have not been developed for this region. In order to inform these guidelines, the authors of this study conducted 37 interviews with purposefully selected HIV-infected individuals in care in Uganda. Participants reported increased condom use and reduced intercourse frequency and numbers of partners after testing HIV-positive. Motivations for behaviour change included concerns for personal health and the health of others, and decreased libido. Interventions addressing domestic violence, partner negotiation, use of lubricants and alternative sexual activities could increase condom use and/or decrease sexual activity and/or numbers of partners, thereby reducing HIV transmission risk.
A one billion rand (US$123 million) shortfall in South Africa's public sector antiretroviral (ARV) programme could jeopardise treatment programmes as soon as September, a health expert has warned. Mark Heywood, deputy chairman of the South Africa National AIDS Council (SANAC), commented on the lack of funding at the relaunch of the National AIDS Charter on 18 June. Among the additions to the charter were an increased focus on vulnerable groups, and the inclusion of traditional leaders and their role in the epidemic. ‘We've made major strides, and one of the strengths of the charter was that it guided our progress on the national strategic framework at a time when people were still stoned to death [...] when kids were still taken out of school and people were chased out of their homes for being HIV-positive,’ Heywood said. ‘But […] we don't actually have ARV treatment for most of the people who need it.’ An estimated 700,000 people are on treatment in South Africa, but an estimated 1,000 die daily as a result of AIDS.
Increasing emphasis is being placed on the need for 'structural interventions' (SIs) in HIV prevention internationally. There is great variation in how the concept of an SI is defined and operationalised, however, and this has potentially problematic implications for their likely success. This paper clarifies and elucidates what constitutes an SI, with particular reference to the structured distribution of power and to the role of communities. It summarises the background to the growing emphasis being placed on the concept of SIs in HIV prevention policy and illustrates the nature of HIV vulnerability and its implications for the design and targeting of successful SIs. The paper draws attention to the dual importance of: attending to local complexities in the micro and macro-level structures that produce vulnerability; and clarifying the meaning and role of communities within SIs.