According to this article, the evidence that concurrency is driving the African AIDS epidemics is limited. There is as yet no conclusive evidence that concurrency is associated with HIV prevalence, nor that it increases the size of an HIV epidemic, the speed of HIV transmission and the persistence of HIV in a population. The article admits that concurrency could theoretically play a dominant role in transmission of HIV through networks, but it argues that this should not be taken to mean that it is or it has played that role. Little evidence supports the hypothesis that sexual behavior differs dramatically in Africa compared to the rest of the world, nor that sexual behavior in Africa is different in countries with high versus low HIV prevalence. Without strong data showing that people have more concurrent partnerships in Africa than elsewhere and that places with high levels of concurrency also have high levels of HIV, the authors conclude that only under certain conditions may concurrency be a significant driver of the HIV epidemics in sub-Saharan Africa. To definitively answer this question, additional studies are needed. Improved methods for measuring sexual behavior and particularly partnership duration and overlap are also required, with better study designs. Designing prevention interventions around concurrency without a better understanding of the intricacies of the relationship between concurrency and HIV transmission may well not produce the intended result of preventing new HIV infections.
Equity and HIV/AIDS
In this statement, the South African Department of Health has given the go-ahead for patients on antiretroviral treatment (ART) to be given three months supply of medicines instead of one month. It will be more convenient for patients because they will have to make fewer trips to their health facility. It will also reduce patient-load on the health system, particularly on health facility pharmacies given the shortage of pharmacists in the public health system. The Department of Health states: ‘There is no indication of any legislation prohibiting the supply of medicines for three months to any one patient. This practice should only be implemented once the patient has proved stable on the regimen.’
This review aimed to identify the current modes of transmission of HIV in Uganda, as well as where and among whom incident HIV infections are occurring. It indicates that the previously heralded decline in prevalence from a peak of 18% in 1992 to 6.1% in 2002 may have ended. There is stabilisation of prevalence between 6.1 and 6.5% in some antenatal care sites and even a rise in others. This is accompanied by deterioration in behavioural indicators especially an increase in multiple concurrent partnerships. There has also been a shift in the epidemic from spreading mainly in casual relationships to also seeing a large proportion of new infections in people in long-term stable relationships. The main risk factors for transmission were identified as having, multiple partners, discordance and non-disclosure, lack of condom use, transactional sex, cross-generational sex, presence of herpes simplex and sexually transmitted infections, alcohol and drug use, and behavioural disinhibition due to anti-retroviral therapy.
This article argues that a population-wide interruption of risk behaviour for a set period of time could reduce HIV incidence and make a significant contribution to prevention efforts. If everyone in a population abstained from high-risk sex for a given period of time, in theory the viral loads of all recent seroconverters should pass through the acute infection period. When risk behaviour resumed there would be almost no individuals in the high-viraemic phase, thereby reducing infectivity, and HIV incidence would fall. The article calls for mathematical modelling of periodic risk behaviour interruptions, as well as encouragement of policy interventions to develop campaigns of this nature. A policy response, such as a ‘safe sex/no sex’ campaign in a cohesive population, deserves serious consideration as an HIV prevention intervention. In some contexts, periods of abstinence from risky behaviour could also be linked to existing religious practices to provide policy options, for example sexual abstinence practiced during the Muslim holy month of Ramadaan.
This review of the HIV and AIDS national strategic plan (NSP) since the NSP's inception in 2007, reports that condom use has almost doubled, treatment coverage among adults living with HIV has almost tripled, and prevention of mother-to-child HIV transmission (PMTCT) services among HIV-positive pregnant women has reached 76%. In contrast, the uptake of dual ARV therapy PMTCT has been problematic, and there are major shortcomings in monitoring and evaluation (M&E) that could leave decision-makers operating in a vacuum, the report warns. It notes that while provinces had adopted the dual therapy regimen and were training health workers to administer it, some districts were still using the outdated single dose of Nevirapine because funding to buy the ARVs for dual therapy was problematic. It also highlights a dearth of data on babies born HIV-positive, but quotes department of health estimates showing that almost 40% of infants exposed to HIV were put at risk of contracting the virus by incomplete provision of PMTCT services. Problems with monitoring and evaluation were also highlighted, with inadequate data on mothers, babies and HIV-positive patients awaiting treatment. The report suggests that measuring South Africa's success against numerous goals and objectives set by the NSP may be logistically and bureaucratically challenging. Despite a wealth of information on HIV and AIDS that is collected to fulfill government reporting requirements, the uneven quality, scope and availability of the data has presented considerable challenges to those trying to implement evidence-based HIV interventions.
According to this article, Swaziland has made remarkable progress in reducing HIV transmission from infected mothers to their babies, but health activists have raised concerns that this progress may be stalled or even reversed if lapses in basic health services are not addressed. Since prevention of mother-to-child transmission (PMTCT) services became available in 2003, HIV transmission has almost halved, from 40% of children becoming infected by their HIV-positive mothers to 21%. The number of teenage pregnancies has also fallen. As teen mothers are less likely to use antenatal care and PMTCT services, fewer teens giving birth means fewer HIV-positive babies. However, a significant proportion of pregnant women are giving birth at home, and so are not using PMTCT services. A rise in home deliveries appears to be a direct result of poor conditions at underfunded clinics and hospitals. Leaking roofs, unreliable water supplies and a lack of beds at clinics are contributing to the problem of ‘burnout’ among nurses. According to the latest World Health Organization (WHO) guidelines, a pregnant woman's HIV status should be determined in her first trimester so as to provide optimal PMTCT services, but Swazi tradition discourages women from talking about a pregnancy during the first 14 weeks and, as a result, women delay seeking treatment.
The International Labour Organization’s (ILO) Code of Practice on HIV and AIDS, which aims to strengthen the global response to HIV in the workplace, was adopted by governments, employers and workers at the annual conference of the ILO, held in Switzerland from 2–18 June 2010. As a new labour standard, it is intended to reinforce and extend anti-discrimination policies in the workplace. It reaffirms the right to continued employment regardless of HIV status and asserts that workers should not be screened for HIV for employment purposes. The standard also recognises the need for focused action to protect the rights of populations that may be more vulnerable to HIV infection, and is expected to provide support to the goal of universal access to HIV prevention, treatment, care and support. The labour costs of HIV are recognised in the standard, especially since HIV affects the most economically active age range in every population and the loss of most the 33.4 million people living with HIV would represent a major loss of skills and experience that might have a negative effect on economies and communities. The standard is the first internationally-sanctioned instrument that focuses specifically on HIV in the workplace. It is expected to significantly enhance the impact of HIV prevention and treatment programmes in the workforce globally.
In this report, research findings from a population-based household survey are presented on the general health status of infants, children, and adolescents in South Africa including morbidity, utilisation of health facilities, immunisation coverage, HIV status and associated risk factors. The study also investigates the exposure of children and adolescents to HIV communication programmes. Major recommendations were that the number and scope of community health workers be expanded to include high-impact but low-cost health and nutrition interventions. The report found very little exclusive breastfeeding, with 51.3% of babies on mixed feeding. The report highlighted the lack of HIV communication programmes in rural areas, and for English, Afrikaans, Tsonga and Venda speakers, recommending that future campaigns also focus more strongly on complementing school-based programmes and on children. It recommends implementing an accreditation system ‘as a matter of urgency’ to regularly monitor the quality of health facilities and to serve as a mechanism to hold managers accountable for the health outcomes of mothers and children. The report may be used by policy makers and stakeholders in targeting and prioritising key issues in planning and programming efforts focusing on the broad health issues of South African children.
The writer of this article argues that FIFA, as the world’s football authority, has an ethical responsibility for social action, especially with regard to HIV and AIDS and the World Cup. As the overwhelming percentage of professional footballers come from poverty or financially disadvantaged childhoods, world football owes a tremendous debt to these poorer communities who, by their resourcefulness, allowed world‐class footballers to develop. FIFA President, Sepp Blatter, claims that FIFA has been ‘committed to a wide range of humanitarian projects’ but the author argues these are largely insufficient. For example, the FIFA ‘Football for Hope’ project is costing only about US$17 million, while FIFA is expected to net revenues of US$3.3 billion and profits of US$1.7 billion from the Cup. The project costs amount to a mere 0.5% of the revenues and 1% of the earnings for South African charities. The author challenges FIFA to recognise that other sports have already done more per capita than world soccer for human development, specifically HIV and AIDS education and empowerment.
This study used a validated mathematical method to estimate the rate of new HIV infections (HIV incidence) in South Africa using nationally representative HIV prevalence data collected in 2002, 2005 and 2008. The observed HIV prevalence levels in 2008 were adjusted for the effect of antiretroviral treatment on survival. In the period 2002–2005, the HIV incidence rate among men and women aged 15–49 years was estimated to be 2 new infections each year per 100 susceptible individuals. The highest incidence rate was among 15–24 year-old women, at 5.5 new annual infections per 100 individuals, which declined to 60% to 2.2 There was evidence from the surveys of significant increases in condom use and awareness of HIV status, especially among youth. The analysis demonstrates how serial measures of HIV prevalence obtained in population-based surveys can be used to estimate national HIV incidence rates. It also underlines the need to determine the impact of ART on observed HIV prevalence levels. The estimation of HIV incidence and ART exposure is crucial to disentangle the concurrent impact of prevention and treatment programs on HIV prevalence.