On 3 December 2011, a meeting was held at the All-Africa AIDS Conference (ICASA) addressing the health and human rights of African men who have sex with men (MSM) and the lesbian, gay, bi and intersex (LGBTI) community in general. The meeting was attended by global agencies, including UNAIDS and the African Commission on Human Rights, but by few international non government organisations. Speakers from the United States (US) President’s Fund for Emergency AIDS Relief (PEPFAR) and the African Commission outlined the health needs of MSM in Africa regarding their vulnerability to HIV and AIDS. They made commitments to scale up efforts in this area. Participants called for public health and human rights approaches to be more inclusive, to take into account the full spectrum of LGBTI health issues, including violence, victimisation, psychiatric disorders and substance abuse.
Equity and HIV/AIDS
Although South Africa is committed to providing anti-retroviral treatment (ART) to all South Africans who need it, there are insufficient pharmacists working in public sector facilities to dispense ART to all these patients, according to this policy brief, which means that dispensing tasks must be shifted to pharmacists assistants and/or nurses. The Health Economics Unit (HEU) argues that the pharmacists assistant pharmaceutical care model has the lowest cost to the health system and would support a more integrated primary health care service. Patients getting their ART by attending facilities staffed by pharmacists assistants and nurses experienced relatively better geographic access to facilities and lower transport costs, compared to those attending more central facilities that employ pharmacists. Patients prefer a nurse to dispense their ARTs as this reduces the risk of being identified by other patients as being HIV-positive. The pharmacists assistant model can be made more acceptable to patients by ensuring that there are no differences between patient folders (e.g. those on ART should not have differently coloured folders) and dispensing all medication (not only anti-retrovirals) in brown paper bags.
In this study researchers explored the level of awareness and practice on HIV prevention among married couples from selected communities in Malawi. They carried out the study from October to December 2008 in four communities, two each from Chiradzulu and Chikhwawa districts of Malawi. They conducted face-to-face in-depth interviews with 30 couples in each district using a semi-structured interview guide. The couples’ ages ranged from 20 to 53 years, most (52%) being in the 20-31 year-old age group. All couples were aware of HIV prevention methods and talked about them in their marriages. For most couples (54) there was mutual trust between husbands and wives, and members of only a few couples (six) doubted their partners’ ability to maintain mutual fidelity, but researchers detected infidelity among 25 couples. A few couples (5) had been tested for HIV. No couples favoured the use of condoms with a marriage partner as an HIV prevention method. The researchers conclude that the level of HIV prevention awareness among couples in Malawi is high and almost universal. However, there is low adoption of the HIV prevention methods among the couples because they are perceived to be couple unfriendly due to their incompatibility with the socio-cultural beliefs of the people. There is a need to target couples as units of intervention in the adoption of HIV prevention methods by rural communities.
This policy brief draws on evidence from a recent study that investigated the factors influencing the choices of infant feeding of HIV-positive mothers in Ghana through an assessment of the perspectives of HIV-positive mothers and family members (i.e., fathers and grandmothers) in two districts in Ghana. Results from the study showed that HIV-positive mothers had good knowledge and understanding of exclusive breastfeeding and exclusive replacement feeding, however adherence to these feeding options was poor and mixed feeding was common. HIV-positive mothers had access to counseling on replacement infant feeding options but there was an emphasis on exclusive breastfeeding and exclusive replacement feeding and not on other replacement options. HIV-positive mothers faced various obstacles (socio-economic, familial and stigma) in carrying out replacement feeding. Family members and communities have a strong influence on mothers’ infant feeding practices. The authors of the study recommend introducing a multi-dimensional behaviour change strategy which involves mothers, family members and significant community members in order to change perceptions, understanding and attitudes to exclusive replacement feeding and exclusive breastfeeding and at the same time, explicitly deal with the risk in terms of infant survival associated with mixed feeding. Male partners should be involved and counselors should explore why the full range of feeding options (like heat-treated breast milk, animal milk and wetnursing) are not discussed.
Since the establishment of free HIV and AIDS care and treatment services in Tanzania a lot of research has been done to assess how health care providers discharge their duties in these clinics. Little research however has been done regarding satisfaction of HIV patients with free health care services provided. The authors of this study aimed to determine satisfaction of HIV patients with health care services provided at the HIV clinics and specifically, to determine patients’ satisfaction with the general physical environment of the clinic and with services offered by doctors, nurses, laboratory, and pharmacy. A cross-sectional study was conducted at Muhimbili National Hospital (MNH) and Amana hospital. A total of 375 patients attending outpatient HIV clinics were selected randomly and interviewed using a questionnaire, after obtaining a verbal consent. Results showed that patients at Amana Hospital clinic were either very satisfied (44.3%) or satisfied (55.7%) and none were dissatisfied, while at MNH clinic 1.1% patients were very satisfied while (94.7%) were satisfied and (4.2%) were dissatisfied with health care services provided. Lack of privacy when consulting with doctors and the dispenser contributed to patients’ dissatisfaction with the services.
This study aimed at determining the prevalence and factors associated with use of traditional herbal medicines (THM) among HIV-infected patients on highly active antiretroviral therapy (HAART) attending the AIDS Support Organisation (TASO), a non-governmental organisation offering HIV and AIDS services in Uganda. This was a cross-sectional study carried out in two TASO treatment centres among 401 randomly selected eligible participants. Participants were 18 years and older, and were enrolled on HAART. The authors found that the average prevalence of THM use was 33.7%. Patients on HAART for less than four years were more likely to use THM, as well as those who experienced HAART side effects. Patients older than 39 years old were less likely to use THM. Participants with HAART adherence levels greater than 95% were less likely to use THM. Overall, the prevalence of THM use among participants on HAART was high, which raises clinical and pharmacological concerns that need attention by the health care service providers, the authors conclude.
The objective of this study was to establish the reliability of the scored Patient-Generated Subjective Global Assessment (PG-SGA) in determining nutritional status among antiretroviral therapy (ART) naive HIV-infected adults. A descriptive, cross sectional study was conducted among outpatient medical clinics in the AIDS Support Organisation (TASO), Mulago Centre, Kampala, Uganda. The study sample totalled 217 HIV-positive patients, consisting of 60 male and 157 female patients, aged 18-67 years old. Data collection was done from April-May 2008. Results showed that only 12% of the subjects were underweight and over half (58.2%) had normal weight. The PG-SGA had low sensitivity (69.2%) and specificity (57.1%) at categorising the risk for malnutrition indicated by Body Mass Index of less than 18.5. The authors note that there was a high prevalence of malnutrition among the study group, but the PGSGA could not adequately discriminate between underweight and normal patients. The tool was not reliable enough for determining nutritional status in this population.
The objectives of this study were to compare undernutrition between groups of HIV-positive and HIV-negative children undergoing anti-retroviral therapy (ART) in Dar es Salaam, Tanzania. From September to October 2010, researchers conducted a cross-sectional survey among 213 ART-treated HIV-positive and 202 HIV-negative children in Dar es Salaam, Tanzania. They found that ART-treated HIV-positive children had higher rates of undernutrition than their HIV-negative counterparts. Among the ART-treated HIV-positive children, 78 (36.6%) were stunted, 47 (22.1%) were underweight, and 29 (13.6%) were wasted. Food insecurity was prevalent in over half of ART-treated HIV-positive children's households. Furthermore, ART-treated HIV-positive children were more likely to be orphaned, to be fed less frequently, and to have lower body weight at birth compared to HIV-negative children. The researchers conclude that HIV and AIDS is associated with an increased burden of child underweight status and wasting, even among ART-treated children. In addition to increasing coverage of ART among HIV-positive children, interventions to ameliorate poor nutrition status may be necessary in this and similar settings. Such interventions should aim at promoting adequate feeding patterns, as well as preventing and treating diarrhoea.
Paediatric antiretroviral adherence is difficult to assess, the authors of this paper argue, and subjective measures are affected by reporting bias, which in turn may depend on psychosocial factors such as alcohol use and depression. In this study, they enrolled 56 child caregiver dyads from Cape Town, South Africa, and followed their adherence over one month via various methods. The Alcohol Use Disorder Inventory Tool and Beck Depression Inventory 1 were used to assess participants’ alcohol use and levels of depression and their effect on drug adherence. The median age of the children was four years, and median time on antiretroviral therapy (ART) was 20 months. Increased time on ART was associated with poorer adherence via three-day recall. Alcohol use was inversely associated with adherence. Having a mother as a caregiver and shorter time on highly active antiretroviral therapy (HAART) were significantly associated with better adherence. The authors conclude that paediatric adherence is affected by caregiver alcohol use, but the caregiver’s relationship to the child is most important. This small study suggests that interventions should aim to keep mothers healthy and alive, as well as alcohol-free.
In this study, researchers aimed to assess the prevalence of primary resistance in six African countries after anti-retroviral therapy (ART) roll-out and to determine if wider use of ART in sub-Saharan Africa is associated with rising prevalence of drug resistance. They conducted a cross-sectional study in antiretroviral-naive adults infected with HIV-1 who had not started first-line ART, recruited between 2007 and 2009 from 11 regions in Kenya, Nigeria, South Africa, Uganda, Zambia, and Zimbabwe. Of a total of 2,590 participants, 2,436 (94.1%) had a pretreatment genotypic resistance result. Drug class-specific resistance prevalence was 2.5% for nucleoside reverse-transcriptase inhibitors (NRTIs), 3.3% for non-NRTIs (NNRTIs), 1.3% for protease inhibitors, and 1.2% for dual-class resistance to NRTIs and NNRTIs. The most common drug-resistance mutations were K103N (1.8%), thymidine analogue mutations (1.6%), M184V (1.2%), and Y181C/I (0.7%). The higher prevalence of primary drug resistance in Uganda than in other African countries is probably related to the earlier start of ART roll-out in Uganda, the authors conclude. Resistance surveillance and prevention should be prioritised in settings where ART programmes are scaled up.