The rate of new HIV infections, which has fuelled the global HIV/AIDS epidemic since the 1980s, has peaked throughout the world and is now declining. But population growth and the life-prolonging effects of antiretroviral (ARV) treatment mean that the total global number of HIV-infected people is likely to remain about the same for another two decades and will continue to increase in sub-Saharan Africa. Based on these findings the authors say it is time for the international community and governments to rethink their prioritisation of AIDS over other infectious diseases.
Equity and HIV/AIDS
Has the HIV epidemic peaked?
Bongaarts J, Buettner T, Heilig G and Pelletier F: Population and Development Review 34(2), June 2008
Health-related quality of life in a sample of HIV-infected South Africans
Peltzer K and Phaswana-Mafuya N: African Journal of AIDS Research, 7(2): 209–218, 2008
This study assessed the health-related quality of life and HIV symptoms of a sample of people living with HIV (PLHIV) in South Africa. The sample included 607 PLHIVs from all districts of the Eastern Cape Province, recruited either through a health facility, from the community through key informants, or through support groups. The findings indicate a low degree of overall quality of life, with spirituality, environment, psychological health and level of independence as predictors for overall quality of life. Among medical variables and HIV symptoms, CD4 cell count and having fewer HIV symptoms (but not an AIDS diagnosis) were identified as predictors for overall quality of life. Among socio-economic variables, having sufficient food and a higher educational level were identified as predictors. The results highlight the need for better access to psychosocial support and medical services for PLHIV in South Africa, as well as the need to consider a patient's general health perceptions during the course of ART.
HIV/AIDS prevention, treatment and care in the health sector
World Health Organization, September 2008
This publication defines the essential interventions the health sector should deliver and provides key references as well as links to web-based resources. The document provides WHO’s best attempt to assemble and package normative advice for the health sector concerning the essential response to HIV/AIDS. We hope it will prove useful for all those who work in the health sector, whatever their capacity, as they confront the realities of HIV/AIDS throughout the world.
HIV/AIDS: The first 25 years: A view from Nairobi
Rees PH: East African Medical Journal 85(6):292–300, 2008
This paper examines the history of HIV/AIDS in Kenya since it was first diagnosed in the country. The introduction of highly active antiretroviral therapy (HAART) has dramatically improved the prognosis for individual patients with AIDS, but education and changing attitudes towards condoms have led to a progressive fall in incidence, so that the worst of the epidemic may now be over. Limited personal experience suggests that steroids may also have a role in salvaging critically ill AIDS patients, who need to be treated as emergencies. With an educated public and attention to alternative routes of infection such as blood transfusion, the epidemic should be increasingly contained during the next 25 years, and may even fizzle out.
Knowledge, attitudes and practices of women regarding the prevention of mother-to-child transmission programme at the Vanguard Community Health Centre, Western Cape: A pilot study
Petrie KE, Schmidt SD, Schwarz CE, Koornhof HE and Marais D: South African Journal of Clinical Nutrition 20(2)71–75
The aim of this study was to determine the knowledge, attitudes and practices of women regarding the prevention of mother-to-child transmission (PMTCT) programme at a community health centre. Thirty-six educated women aged 18 - 39 years and attending the clinic took part, from informal settlements and mostly unemployed, receiving government grants. Most scored 80% or more with regard to general HIV knowledge. Attitudes were found to be positive with regard to both breastfeeding and formula feeding, but HIV status influenced it significantly. In conclusion, the women were knowledgeable about HIV transmission and mother-to-child transmission (MTCT), but an informed decision-making process was not followed, the sustainability of formula feeding after six months is a problem and health workers need to be trained about feeding options.
Linking nutritional support with treatment of people living with HIV: Lessons being learned in Kenya
Byron E, Gillespie S and Nangami M: International Food Policy Research Institute and RENEWAL, Brief 2, 2008
While clinical care providers, programme managers and other stakeholders increasingly recognise the critical importance of nutrition for the treatment of HIV and AIDS, interventions that link nutritional support to treatment are relatively new. The Academic Model for Prevention and Treatment of HIV/AIDS (AMPATH) initiated one such intervention in 2002 in western Kenya with a large-scale expansion currently underway with the support of World Food Programme commodity donations and fresh food grown on AMPATH production farms. The intervention is designed to bolster nutrition security of the most vulnerable patients on antiretroviral regimens over a short period of time by providing supplemental household food rations. Weaning or transitioning clients off food supplementation is the major programmatic challenge facing this and similar nutrition interventions - especially given its critical importance in sustaining nutritional, health and productivity gains. The growing global interest in linking nutrition care to ARV treatment must not overlook the parallel need for long-term strategies to ensure nutrition security. In resource-poor settings, a high proportion of people living with HIV will be chronically food-insecure.
Long road to successful PMTCT in Mozambique
PlusNews, Tuesday 19 August 2008
More and more HIV-positive pregnant women are testing for the virus and seeking out prevention of mother-to-child transmission (PMTCT) services in Sofala Province, in central Mozambique, but local health officials say much work remains to be done. During the first three months of 2008, HIV tests were offered to 34,200 women during pre-natal checkups; of the 31,303 who agreed to be tested, 16% were HIV-positive, and 70% of these women were given nevirapine to prevent the virus being passed to their babies. During the same period in 2007, HIV tests were only offered to 60% of the women attending pre-natal clinics, and only 19% of them accepted. The increase in uptake of PMTCT is particularly significant in Sofala, which has one of the highest HIV infection rates in the country - 25% - compared to the national average of 16%.
Making those who transmit HIV into criminals doesn’t protect people from the virus
Cullinan K: Health News Service, 8 August 2008
All around the world, people with HIV are being charged for endangering the lives of others. But this doesn't stop the spread of HIV because most of those infected don't know they have the virus, argues Judge Edwin Cameron, addressing the World AIDS Conference. ‘Criminalisation is warranted only in cases where someone sets out well-knowing he has HIV, to infect another person, and achieves this aim,’ argued Cameron. In general, the laws would not protect people from HIV: ‘In the majority of cases, the virus spreads when two people have consensual sex, neither of them knowing that one has HIV. That will continue to happen, no matter what criminal laws are enacted,’ said Cameron. ‘Criminalisation places blame on one person instead of responsibility on two,’ said Cameron.
Microcredit for people affected by HIV and AIDS: Insights from Kenya
Datta D and Njuguna D: SAHARA Journal 5(2): 94-102, 2008
The consequences of HIV and AIDS are exponential in Kenya, touching not only the health of those infected, but also depleting socioeconomic resources of entire families. Access to financial services is one of the important ways to protect and build economic resources. Unfortunately, the norm of financial viability discourages microfinance institutions from targeting people severely impacted by HIV and AIDS. Thus, HIV- and AIDS-service NGOs have been increasingly getting involved in microcredit activity in recent years for economic empowerment of their clients. Despite limited human resources and funding in the area of microcredit activity, these NGOs have demonstrated that nearly 50% of their microcredit beneficiaries invested money in income-generating activities, resulting in enhancement in their livelihood security. In the short term these NGOs need to improve their current practices. However, this does not mean launching microfinance initiatives within their AIDS-focused programmes, as financial services are best provided by specialised institutions. Longer-term cooperation between microfinance institutions and other HIV- and AIDS-service organisations and donors is necessary to muster appropriate and rapid responses in areas experiencing severe impacts of the disease.
Missing the Target 6: The HIV/AIDS response and health systems: Building on success to achieve health care for all
International Treatment Preparedness Coalition (ITPC), July 2008
Some voices in the health care debate are claiming that the response to HIV and AIDS is weakening primary care in many countries, diverting funding and health care personnel and distorting health systems. The new Missing the Target report provides some of the first research to inform this debate, with on the ground studies in Argentina, Brazil, Dominican Republic, Uganda, Zambia and Zimbabwe. The results were distinct in each country but point to several broad conclusions: the response to HIV and AIDS has had far-reaching positive impacts on health care in many settings: building infrastructure and systems, raising the bar on quality, extending the reach of health care to socially marginalised groups, and engaging consumers; significant new investments in HIV and AIDS services have revealed existing fragilities in health systems, and in some cases have placed increasing burdens on these systems by expanding demand and stretching already overextended human resources. The push for treatment access has not been just about the money although these efforts have brought considerable new financing. The mobilisation of activists and health care consumers themselves has also forced global and national leaders toward a more vigorous sense of accountability and urgency. If the UN’s health-related Millennium Development Goals (MDGs) are to have any chance of being realised, we need to do for health systems what we have done for AIDS while increasing the momentum of AIDS service scale-up.