Sub-Saharan Africa carries a massive dual burden of HIV and alcohol disease, and these pandemics are inextricably linked, says this study. 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. HIV and alcohol also share common ground with sexual violence. 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. According to this study, 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. It recommends that brief interventions for people with problem drinking must incorporate specific discussion of links between alcohol and unsafe sex, and consequences thereof. Additionally, implementation of known effective interventions could alleviate a large portion of the alcohol-attributable burden of disease, including its effects on unsafe sex, unintended pregnancy and HIV transmission.
Equity and HIV/AIDS
This study estimates mean life years gained using different treatment indications in low-income countries. It carried out a systematic search to identify relevant studies on the treatment effect of highly active antiretroviral therapy (HAART) and data was applied to a hypothetical Tanzanian HIV population. It found that providing HAART early when CD4 is 200-350 cells/μl is likely to be the best outcome strategy with an expected net benefit of 14.5 life years per patient. The model predicts diminishing treatment benefits for patients starting treatment when CD4 counts are lower. Patients starting treatment at CD4 50-199 and <50 cells/μl have expected net health benefits of 7.6 and 7.3 life years. Without treatment, HIV patients with CD4 counts 200-350; 50-199 and < 50 cells/μl can expect to live 4.8; 2 and 0.7 life years respectively. This study demonstrates that HIV patients live longer with early start strategies in low-income countries. Since low-income countries have many constraints to full coverage of HAART, this study provides input to a more transparent debate regarding where to draw explicit eligibility criteria during further scale up of HAART.
This study strategised a way to integrate mobile telephony into the health management of subjects receiving anti-retroviral (ARV) medications. It took the form of a randomised controlled trial to assess health, social, and economic outcomes, involving two sub-studies in Nairobi, Kenya, and two surrounding districts. Significant time and cost are often incurred for patients to personally attend the clinics. However, the majority of subjects screened reported being comfortable with using cell phones for communicating their health issues. Note that the average travel cost to attend the clinic was US$3 (return). The current cost of an SMS is US$0.08 and a one-minute voice call is US$0.23. The most positive feedback from early enrollees in the SMS-protocol is that the participants feel 'like someone cares'. Many participants suggested that they would prefer more frequent SMS reminders. However the most common barrier to responding to the clinic SMS on time is lack of network credit at the time they are intended to respond. Overall, the once weekly protocol appears agreeable to most. Several instances of health problems have already been identified by the protocol and hence triaged by the nurse.
Kenya has launched an ambitious strategy to fight HIV and AIDS that aims to reduce new infections by at least 50% over the next four years and focus more on most at-risk populations (MARPs). The third Kenya National AIDS Strategic Plan, which runs from 2009/2010 till 2012/2013 and was launched in the capital, Nairobi, on 12 January, also aims to reduce AIDS-related mortality by 25%. 'We cannot achieve our target unless we close new taps of HIV infections – this involves putting most at-risk populations at the centre of our HIV programmes and prevention strategies,' said Alloys Orago, director of the National AIDS Control Council. In Kenya, female and male sex workers, injecting/intravenous drug users, and men who have sex with men (MSM) are considered primary MARPs. Speaking at the launch, UNAIDS executive director Michél Sidibé highlighted the paradox of the intention to increase HIV programming among MARPS while at the same time criminalising the activities that put them at an elevated risk of contracting and transmitting HIV. 'Criminalisation puts most at-risk populations, like commercial sex workers, injecting drug users and men who have sex with men, in the shadows,' he said. 'It is difficult to reach groups whose actions are deemed to be at odds with the law.' Sex work, homosexual acts and the use of illicit drugs are all outlawed in Kenya and are punishable by long terms in prison.
By the end of September 2009, there were 236 static ART clinics in Malawi in the public and private health sector; 22 of these static clinics provided ART at a total of 103 outreach or mobile sites, bringing the total to 339 ART service delivery points in Malawi in Q3 2009. In the third quarter of 2009 (July to September) a total of 18,292 new patients initiated ART and 3,030 ART patients transferred between clinics, resulting in a total of 21,322 ART clinic registrations (39% male, 61% female; 91% adults and 9% children). Improved integration of the supervision system for the public and private sector has led to a revision of previous M&E data in the private sector and patient outcomes in the private sector are similar to those in the public sector. The National programme has been affected by serious ARV drug supply shortage during Q3 due to the delayed release of funding and the ensuing logistical complications resulting in widespread drug re-allocations between sites. However a targeted survey revealed that patients were affected only in isolated cases, requiring regimen changes or short-term treatment interruption.
An ambitious, door-to-door voluntary counselling and testing (VCT) exercise launched in November 2009 has resulted in more than 1.5 million Kenyans being tested for HIV, according to a senior government official. 'Our preliminary data show that during the [first] three weeks… [] … we tested 1.5 million people and, as we continue putting our records together, we could go way above this number,' said Nicholas Muraguri, director of the National AIDS and Sexually transmitted infections Control Programme (NASCOP). 'Normally men do not come forward to be tested but this time round we are impressed... Our results show they formed 40% of the total number tested,' he added. 'Those above 50 also turned out in large numbers. Government research shows they are at risk because they too are sexually active.' He noted that the campaign reached out to most at-risk populations such as commercial sex workers through 'moonlight' VCT centres that opened out of regular business hours. The campaign was part of the government's initiative to have at least 80% of Kenyans tested for HIV by the end of 2010.
Adherence to antiretroviral medication in the treatment of HIV is critical, both to maximise efficacy and to minimise the emergence of drug resistance. The aim of this prospective study in three public hospitals in KwaZulu-Natal, South Africa, is to assess the use of traditional complementary and alternative medicine (TCAM) by HIV patients and its effect on antiretroviral (ARV) adherence 6 months after initiating ARVs. 735 (29.8% male and 70.2% female) patients who consecutively attended three HIV clinics completed assessments prior to ARV initiation and 519 after six months on antiretroviral therapy (ART) Results indicate that the use of herbal therapies for HIV declined significantly from 36.6% prior to antiretroviral treatment (ART) initiation to 7.9% after being on ARVs for six months. Faith healing methods, including spiritual practices and prayer for HIV declined from 35.8% to 22.1% and physical/body-mind therapy (exercise and massage) declined from 5.0% to 1.9%. In contrast, the use of micronutrients (vitamins, etc.) significantly increased from 42.6% to 87.4%. In multivariate regression analyses, ARV non-adherence (dose, schedule and food) was associated with the use of herbal treatment, not taking micronutrients and the use of over-the-counter drugs. The use of TCAM declined after initiating ARVs. As herbal treatment for HIV was associated with reduced ARV adherence, patients’ use of TCAM should be considered in ARV adherence management.
In what is being hailed as a boost for African involvement in AIDS research, Uganda has been selected to host the African AIDS Vaccine Programme (AAVP), formerly based in Geneva, Switzerland. The AAVP, a network of African HIV vaccine stakeholders whose mission is to promote HIV vaccine development for Africa, has operated under the stewardship of the World Health Organization's department of immunization vaccines and biologicals since its formation in 2000. The transition to a fully functional African programme began more than a year ago and will be completed in 2010. The Uganda Virus Research Institute (UVRI), a leading research institute based in Entebbe, will be its new headquarters.
This annual report examines evidence of progress in four key areas in 2008: prevention of mother-to-child transmission (PMTCT), paediatric HIV care and treatment, prevention of HIV among adolescents and young people, and protection and support for children affected by HIV and AIDS. The most significant progress was in PMTCT, with 45% of HIV-positive pregnant women globally receiving antiretroviral (ARV) treatment to prevent them passing HIV to their children; up from 24% in 2006. Several countries with high HIV prevalence expanded PMTCT coverage to most pregnant women needing treatment: 73% in South Africa, 91% in Namibia and 95% in Botswana. Other countries lagged behind: for example, in Nigeria only 10% of pregnant women with HIV were tested and treated to prevent transmission to their babies. The countries most successful at scaling up PMTCT incorporated their programmes into existing maternal and child health services, the report noted. The authors conclude that in the near future, it is not impossible to envisage a generation of children who are free of HIV.
Thanks to the international recession, the author argues that external funders are either decreasing or opting not to increase their funding of AIDS treatment. Medecins Sans Frontieres (MSF) recently reported that two key international programmes supporting AIDS treatment in the developing world are not increasing their grants: For two successive years the Global Fund Against AIDS, Tuberculosis and Malaria has reduced funding for approved grants, while the American President’s Emergency Plan for AIDS Relief (PEPFAR) is now practicing what it calls ‘flat-funding’, which ‘basically means that you can only recruit when someone dies, when someone empties a seat or a treatment slot’, as explained by Dr Erci Goemaere, co-ordinator of MSF missions in South Africa and Lesotho. The authors warn that a funding crisis could lead to the reversal of gains made since the start of antiretroviral treatment in developing countries.