In this paper, the author investigates uptake of prevention of mother-to-child transmission of HIV (PMTCT) services, infant feeding recommendations and specific drug regimens necessary to achieve the virtual elimination of paediatric HIV in Zimbabwe. She used a computer model to simulate a cohort of HIV-infected pregnant or breastfeeding women, and evaluated three PMTCT regiments: single-dose nevirapine; ‘Option A’ from the 2010 World Health Organisation guidelines (zidovudine in pregnancy, infant nevirapine throughout breastfeeding for women without advanced disease, lifelong combination antiretroviral (ARV) therapy for women with advanced disease); and WHO ‘Option B’ (limited combination ARV drug regimens without advanced disease during pregnancy and breastfeeding; lifelong ARV therapy with advanced disease). Results indicated that the latest WHO PMTCT guidelines (Options A and B) plus better access to PMTCT programmes, better retention of women in care, and better adherence to drugs are needed to eliminate paediatric HIV in Zimbabwe.
Equity and HIV/AIDS
Punitive laws and human rights abuses are costing lives, wasting money and stifling the global AIDS response, according to a report by the Global Commission on HIV and the Law, an independent body of global leaders and experts. The Commission report, "HIV and the Law: Risks, Rights and Health," finds evidence that governments in every region of the world have wasted the potential of legal systems in the fight against HIV. The report also concludes that laws based on evidence and human rights strengthen the global AIDS response - these laws exist and must be brought to scale urgently."Bad laws should not be allowed to stand in the way of effective HIV responses," said Helen Clark, United Nations Development Programme Administrator. "In the 2011 Political Declaration on HIV and AIDS, Member States committed to reviewing laws and policies which impede effective HIV responses."
In recent years, innovative contraceptive methods that are discreet and female-initiated have expanded contraceptive access to millions of women who wish to prevent, space, or limit pregnancies but must do so without their partners’ cooperation. The International Partnership for Microbicides (IPM), developers of a new microbicide ring currently undergoing clinical trial in South Africa, hope to apply this same principle to HIV prevention. If proven safe for long-term use, the monthly vaginal ring, which steadily releases the antiretroviral (ARV) drug dapivirine, will serve as a valuable HIV prevention option for women, particularly those who wish to become pregnant or who are unable to safely negotiate condom use or monogamy with their partners. Offering new HIV prevention options to women is particularly important in high-prevalence regions like sub-Saharan Africa, where 60 percent of HIV infections are among women and girls.
This book is a collection of essays that critique leadership on HIV and AIDS in Africa from the 1980s to the present. They examine the rhetoric on HIV and AIDS, which has influenced culture and behaviour, service delivery, policy, the design of national interventions and the varied success of different countries in containing the pandemic. African scholars contextualise a host of public and scholarly disputes, ranging from AIDS exceptionalism, racialised data manipulation and ‘denialism’ to the racist debates on ‘African promiscuity’ and the recent revival of assertions that homosexuality is not ‘African’ behaviour. The book refers to the record of governments in a wide range of African countries with case studies drawing on the rhetoric of governments and the nature of leadership in Ethiopia, the Gambia, Morocco, South Africa and Zambia. What emerges is that the rhetoric is diverse, occasionally logical and effective in terms of informing systemic HIV and AIDS interventions that improve the welfare of people, and sometimes it is contradictory to the point of absurdity.
The World Health Organisation recommends HIV-infected mothers exclusively breastfeed their infants, unless replacement feeding is Acceptable, Feasible, Affordable, Sustainable and Safe (AFASS). The aim of this study was to develop and content validate an AFASS assessment tool that could be used for infant feeding counselling in sub-Saharan Africa (SSA). An AFASS assessment tool consisting of 15 questions was developed based on the evidence and tools available regarding why replacement feeding is not AFASS in the region. Fifty-seven experts involved in prevention of mother-to-child HIV transmission (PMTCT) programmes in five SSA countries were approached to participate as members of the Delphi expert panel, reduced to a final panel of 15 experts. Thirteen of the 15 questions in the tool achieved consensus agreement among panel members and they also reached consensus regarding the applicability and appropriateness of the tool within the regional context. Suggestions made by the expert panel were incorporated into the revised tool. Ideally the revised tool should be tested by providers of infant feeding advice with the aim of adoption into routine PMTCT programmes in SSA, but within the context of the 2010 WHO guidelines which advocate a public health rather than an individualised approach, it may inform the WHO process of improving counselling tools for health care workers involved in PMTCT programmes.
Although Madagascar and its neighbouring islands states of Comoros, Mauritius and Seychelles have extremely low HIV prevalence rates at around 0.37% (or 24,000 confirmed cases), they are reporting problems with supplying health services to HIV-positive people. Recent stock-outs have sometimes left patients without treatment for months, exposing them to the risk of developing drug-resistance. The Malagasy Ministry of Health and its private sector distributor, Salama, have reported experiencing problems placing orders because suppliers are not interested in providing small quantities, making it difficult to keep adequate supplies of antiretrovirals in stock. One possibility being explored is putting in place a central purchasing mechanism for the four Indian Ocean countries. This facility would fall under the oversight of the High Level Partnership Forum, which is expected to be set up after discussions with the Indian Ocean Commission, an inter-governmental cooperation group. The forum would include Ministers of Foreign Affairs, Ministers of Health, networks of people living with HIV, support groups and various financial partners.
This integrated biological and behavioural surveillance survey of migrant sex workers in Nairobi, Kenya's capital, reveals that HIV prevalence among migrant and Kenyan female sex workers stands at 23.1%, more than three times the national average of 6.3%. However, Kenyan sex workers were found to have better knowledge of HIV and health-seeking behaviour than their migrant counterparts, and nearly all Kenyan female sex workers (98%) had heard of sexual transmitted infections, compared to 70% of migrant female sex workers. The study was conducted in 2010, when just over half of the 628 participants said they had ever tested before for HIV, and 25.8% did not know that condoms protected against HIV. Only 72% of migrant female sex workers knew where to go for an HIV test, compared to 92% of women in the general population. Services for migrant sex workers need to be integrated into programmes for general sex workers, the authors argue. However, special care must be given to the language and cultural needs of the migrants. The authors also propose that role players lobby the Kenyan government to provide a legal framework for the regulation of sex work, which would increase access to services and provide protection for sex workers.
With increased levels of school enrolment, more adolescents in Ethiopia are in school today than ever before, but few studies have assessed the sexual behaviour of these learners. This study addresses the research gap by assessing pre-marital sex and factors associated with it among school-going adolescents in Eastern Ethiopia. A cross-sectional school-based study was conducted using a facilitator-guided, self-administered questionnaire. Respondents were students attending regular school classes in fourteen high schools. Results showed that about one in four respondents who were unmarried (24.8%) reported pre-marital sex – of these 28.8% were males and 14.7% were females. Pre-marital sexual debut was more common among adolescents who had their parents in urban areas, who received higher pocket money per month, who perceived low self-educational rank and who lived in rented houses. The girls and those who were less influenced by external pressure were more protected against pre-marital sexual debut than their counterparts. The authors argue that public health interventions should consider the broader determinants of premarital sex, including the ecological factors in which the behaviour occurs.
The objective of this study was to use service data to inform HIV-free survival among HIV exposed children that received antiretroviral drugs to prevent mother-to-child transmission (PMTCT) of HIV. The study was conducted in two rural districts in Malawi between June 2005 and June 2009. Out of 438 children whose home addresses were available, 33 (8%) were lost to follow-up, 35 (8%) were alive but not tested for HIV by the time home visit was conducted, and 52 (12%) were confirmed deceased. A total of 318 children were alive at the time of the home visit and had an HIV antibody test done at median age 15 months. The resulting estimated 24-month probability of HIV-free survival over all children was 78%. Among children who did not receive nevirapine, the estimated 24-month probability of HIV-free survival was 61%, and among those who did receive it, the estimate was 82%. When mothers and newborns received nevirapine, the estimated 24-month probability of HIV-free survival among children was high at 82%. However, the authors warn that these promising findings should be interpreted cautiously due to the wide confidence interval and because the confidence interval range includes 55%, which is the natural HIV-free survival rate in the absence of a PMTCT intervention. This analysis highlighted the need of quality data and well-structured home visits to assess PMTCT effectiveness.
This study describes the design, implementation and evaluation of Project Mwana, a pilot project in Zambia’s rural Southern Province. The main aim of this project was to reduce the time between blood sampling for the detection of infant HIV infection and notification of the test results to the relevant point-of-care health facility by using an SMS-based system. Ten public health facilities within two districts in Zambia’s Southern Province were purposively selected for inclusion in the pilot SMS project. Results from this study suggest that in Zambia, particularly in rural areas, mobile phone texting can overcome the logistical and distance barriers that can impede the early diagnosis of HIV infection in infants. An automated SMS allowed the results of PCR testing of infant dried blood samples to be reported to the relevant point-of-care health facility or infant caregivers much faster than would have been possible by using a courier to deliver the results on paper to the relevant health facility. In addition, the results delivered through SMS texting were highly accurate by comparison with the results recorded on paper.