More than 20 studies in Africa have reported higher occurrence of HIV among people with problem drinking; a finding strongly consistent across studies and similar among women and men. Conflation of HIV and alcohol disease in these setting is not surprising given patterns of heavy-episodic drinking and that drinking contexts are often coterminous with opportunities for sexual encounters. Both perpetrators and victims of sexual violence have a high likelihood of having drunk alcohol prior to the incident, as with most forms of violence and injury in sub-Saharan Africa. Reducing alcohol harms necessitates multi-level interventions and should be considered a key component of structural interventions to alleviate the burden of HIV and sexual violence. Brief interventions for people with problem drinking (an important component of primary health care) must discuss links between alcohol and unsafe sex, and consequences thereof. Interventions to reduce alcohol harm among HIV-infected persons are also an important element in positive-prevention initiatives. Most importantly, implementation of known effective interventions could alleviate alcohol’s effects on unsafe sex, unintended pregnancy and HIV transmission.
Equity and HIV/AIDS
There has been a renewed debate over whether AIDS deserves an exceptional response because of the amount of funding targeted to the disease and the belief that AIDS activists prioritise it above other health issues. The strongest detractors of exceptionalism claim that the AIDS response has undermined health systems in developing countries. This paper argues that AIDS should be normalised in countries with mid-level prevalence, except when life-long treatment is dependent on outside resources – as is the case with most African countries – because treatment dependency creates unique sustainability challenges. And AIDS must always require an exceptional response in countries with high prevalence (over 10%). In these settings there is substantial morbidity, filling hospitals and increasing care burdens, and increased mortality, which most visibly reduces life expectancy. The idea that exceptionalism is somehow wrong is an oversimplification. The AIDS response must be based on human rights principles, and it must aim to improve health and well-being of societies as a whole.
A planned national survey of men who have sex with men (MSM) will be the first step in the government's plan to incorporate this high-risk group into the country's HIV programme, a senior government official has said. There have been few studies on HIV among MSM in Kenya. A survey of 285 men in Mombasa in 2007 found an HIV prevalence of 43% among men who had sex with men exclusively, compared with 12.3% among men who had sex with both men and women. Kenya's national HIV prevalence is 7.4%. The survey – due to start in December and last six months – will attempt to discover information such as the specific sexual health risks and needs of MSM, and identify MSM ‘hot spots’ around the country and the number of MSM-friendly health facilities available. It will use respondent-driven sampling, recruiting openly gay men to reach out to other MSM who may not be out of the closet, and using existing MSM-friendly facilities to help conduct the research.
A two-day joint meeting of SADC Ministers of Health and Ministers responsible for HIV and AIDS was officially opened in Mbabane, Swaziland, on 12 November 2009, by the Right Honourable Sibusiso Dlamini, prime minister of Swaziland. In his address, the prime minister urged SADC member states to implement SADC policy documents on HIV and AIDS, TB and malaria. The ministers approved a number of policy documents, including the Draft HIV and AIDS Strategic Framework 2010-2015. Ministers urged member states who are in the process of updating their frameworks to align them with the regional framework. The ministers also approved the SADC HIV and AIDS Business Plan and Budget, which emphasises multi-sector and inter-programme links reflecting the inter-relationships between HIV and AIDS, poverty, conflict, governance, socio-cultural and economic development and the SADC HIV and AIDS Fund. On the control of communicable diseases, HIV and AIDS, Tuberculosis and Malaria, the ministers approved the functions and minimum standards for national reference laboratories in the SADC region; functions and minimum standards for supranational reference laboratory and regional centres of excellence; and the proposed selection criteria for supranational reference laboratory and regional centres of excellence. The ministers further approved the regional minimum standards for HIV testing and counselling and urged member states to adhere to them.
A campaign launched recently seeks to mobilise political will and financial resources to overcome the bottle-necks that hinder services for children who have HIV and to prevent HIV infection in children. The Campaign to End Paediatric HIV/AIDS (CEPA) will initially launch in six African countries: Kenya, Uganda, Tanzania, Nigeria, Zambia and Mozambique. Its chairperson, Graca Machel, said CEPA seeks to address the bottlenecks encountered in delivering diagnostic, treatment and care services in these countries. ‘In South Africa alone, 280,000 children are said to be having HIV. It is estimated that 1.8 million of the world’s HIV-positive children are in Africa,’ she said. One of CEPA’s goals is to prevent HIV infection from parent to child. Openly HIV-positive TV host and head of Nigeria’s Positive Action for Treatment Access Movement (PATAM), Rolake Odetoyinbo, knows that that can be achieved. The campaign, formed by the United States’s Global AIDS Alliance, has set itself a bold target to increase prevention of mother-to-child HIV transmission and paediatric treatment services from the current average of 30–40% to 80% in three years in the countries it’s working in. A total budget of US$6 million has been set aside to benefit the six countries that are currently being targeted.
An estimated 82,700 Zambians will become newly infected with HIV in 2009, up from just over 70,000 in 2007, according to new figures from the National AIDS Council. As many as 71 out of every 100 new infections occur as a result of sex with a non-regular partner, while people who reported having only one sexual partner accounted for around 21% of new infections. Although Zambia has recorded successes in its prevention of mother-to-child transmission (PMTCT) programme, ensuring a safe blood supply, and behaviour-change communication campaigns, practices such as having multiple concurrent partners, transactional sex and inter-generational sex are still common. Multiple concurrent partnerships are the leading cause of HIV infection in Zambia. Within these relationships, correct and consistent use of condoms remains dismally low. However, the report revealed that the annual estimated requirement was 200 million male condoms and 2 million female condoms, yet only 96 million male and 500,000 female condoms were available.
Three South Africans are part of a special group of HIV positive people that may provide valuable clues to scientists searching for a vaccine. Scientists call them ‘elite controllers’, as they have virtually undetectable levels of HIV in their blood and normal immune systems (CD4 counts), despite the fact that some have been infected for a number of years. Harvard University’s Professor Bruce Walker heads an international study of about 1,300 controllers that is trying to unravel how they control HIV so that this knowledge can be used to help boost the immunity of ordinary people. Over two-thirds of the controllers have a gene called B57 that is able to process antigens (foreign substances such as viruses that enter the body). A range of studies presented at the international AIDS Vaccine conference in Paris in October identified this gene as being able to protect against HIV. But not all controllers have B57. Another small clue is that the controllers’ immune systems seem to target a particular HIV gene called Gag more than the other HIV proteins, when it enters their cells, indicating that Gag may be more dangerous than other viral genes. Finally, the elite controllers have abnormally active dendritic cells, which are the key cells that ‘conduct’ the body’s immune response.
Swaziland not only has the world's highest HIV prevalence rate, it now also has the highest tuberculosis (TB) rate, but health officials warn that not enough is being done to integrate TB and HIV services. One in four adults is infected with HIV. By the end of 2007, an estimated 170,000 people were living with HIV, and every year an estimated 13,000 people develop TB, the primary opportunistic disease in HIV-positive people. Themba Dlamini, manager of Swaziland's National TB Control Programme, said 80% of Swaziland's TB cases were also HIV-positive. But with governments focused on HIV/AIDS, TB has not been getting enough attention. Swaziland's Health Minister, Benedict Xaba, said that, although the country provided free TB medicines, other costs, such as hospital fees and transport, made it difficult for many people to access health services. About 58% of TB patients completed their six-month course of treatment last year, falling far short of the 85% target recommended by the World Health Organization. International guidelines also set a 70% detection target for TB, but in Swaziland the case detection rate is below 60%.
This paper reviews published quantitative research on the mental health of HIV-infected adults in Africa. Twenty-seven articles published between 1994 and 2008 reported the results of 23 studies. Most studies found that about half of HIV-infected adults sampled had some form of psychiatric disorder, with depression the most common individual problem. People living with HIV or AIDS (PLHIV) tended to have more mental health problems than non-HIV-infected individuals, with those experiencing less problems less likely to be poor and more likely to be employed, educated and receiving antiretroviral treatment (ART). While some key findings emerged from the studies, the knowledge base was diverse and the methodological quality uneven, so studies lacked comparability and findings were not equally robust. Priorities for future research should include replicating findings regarding common mental health problems among PLHIV, important issues among HIV-infected women, and the longer-term mental health needs of those on ART. Research is also needed into predictors of mental health outcomes and factors associated with adherence to ART, which can be targeted in interventions.
This paper sought to determine whether individuals’ risk perceptions and efficacy beliefs could be used to meaningfully segment audiences to assist interventions that seek to change HIV-related behaviours. A household-level survey of 968 individuals was conducted in four districts in Malawi. Cluster analysis was used to create four groups within the risk perception attitude framework: responsive, avoidant, proactive, and indifferent. The researchers ran analysis of covariance models (controlling for known predictors) to determine how membership in the risk perception attitude framework groups would affect three variables: knowledge about HIV, HIV-testing uptake and condom use. A significant association was found between membership in one or more of the four Risk Perception Attitude Framework groups and the three variables. In conclusion, the Risk Perception Attitude Framework can serve as a theoretically sound audience segmentation technique to determine whether messages should augment perceptions of risk, beliefs about personal efficacy or both.