An expanding body of evidence challenges the conventional hypothesis that sexual transmission is responsible for more than 90% of adult HIV infections in Africa. Differences in epidemic trajectories across Africa do not correspond to differences in sexual behaviour. Studies among African couples find low rates of heterosexual transmission, as in developed countries. Many studies report HIV infections in African adults with no sexual exposure to HIV and in children with HIV-negative mothers. Unexplained high rates of HIV incidence have been observed in African women during antenatal and postpartum periods. Many studies show 20%-40% of HIV infections in African adults associated with injections (though direction of causation is unknown). These and other findings that challenge the conventional hypothesis point to the possibility that HIV transmission through unsafe medical care may be an important factor in Africa's HIV epidemic. More research is warranted to clarify risks for HIV transmission through health care.
Human Resources
A group of American researchers now suggest that the community in which one lives is as important as an individual's behavior in determining the risk of HIV infection. "The risk of individual behavior is enhanced or lessened by the type of place in which it takes place," said study lead author Dr. Shelah S. Bloom of the University of North Carolina at Chapel Hill. Bloom and her colleagues reported their findings in Sexually Transmitted Infections (2002;78:261-266). The researchers analyzed data from surveys conducted in a rural northern Tanzanian region with about 20,000 inhabitants between 1994 and 1997.
In scaling up antiretroviral treatment (ART), financing is fast becoming less of a constraint than the human resources to ensure the implementation of the programmes. In the countries hardest affected by the acquired immunodeficiency syndrome (AIDS) pandemic, AIDS increases workloads, professional frustration and burn-out. It affects health workers also directly, contributing to rising sick leave and attrition rates. This burden is shouldered by a health workforce weakened already by chronic deficiencies in training, distribution and retention.
This paper from Norwegian Church Aid states that established workers' rights are often not followed when facing an HIV positive employee and therefore need to be given a renewed focus. This report concludes that workers are seldom aware of their rights, and are therefore easy victims for unjust treatment from their employers. Workers' rights seldom regulate work in the informal sector. It is probably in this sector that we find the poorest of the poor, often at high risk of contracting HIV. And when infected, they have few or no possibilities of access to proper health care, and only very rarely access to any kind of social welfare.
Not only is the HIV/AIDS pandemic a "humanitarian disaster," but the disease could also cause an "economic crisis" in "emerging markets" such as South Africa, China and the former Soviet Union, where the virus is "spreading fast," the Toronto Globe and Mail reports. Labor-intensive industries, such as mining, have been particularly hard hit by HIV/AIDS, and service industries such as banking and food products may have to project slower growth in coming years due to a declining consumer base.
In the health sector, HIV/AIDS increases the demand for care, the level and complexity of work and the risk of infection, whilst also placing a strain on resources. These burdens exacerbate problems of sickness, absenteeism and workload, increasing losses of health workers. The stress and fear lowers health worker morale and adds to factors pushing them out of low-income countries and into the international labour market. This paper, produced by EQUINET, discusses the implications for health personnel of the HIV epidemic, and health sector responses to it, in southern Africa, using Malawi as a case study. The paper first covers the context of health sector organisations in southern Africa, and then in Malawi.
Medical professionals working in the public sector often supplement their salaries through second jobs in the private sector. Their dual job activities have both positive and negative implications for the public health sector. What policy options exist for regulating dual job holding and what is their likely effect?
Medical professionals working in the public sector often supplement their salaries through second jobs in the private sector. Their dual job activities have both positive and negative implications for the public health sector. What policy options exist for regulating dual job holding and what is their likely effect?
Close to 30 Home Based Carers from the Andara community in the north are undergoing a four-week training of trainers course being held by the Johanniter-Hilfswerk in Namibia. More than 16 000 Namibians have succumbed to HIV-related complications since the first case was detected in the country in 1986. With over 250 000 people infected with the virus, it is clear that HIV/Aids is the leading cause of death in Namibia.
In 2007, when Médicins Sans Frontières (MSF) came to Swaziland to assist the Ministry of Health in its response to HIV co-infection with tuberculosis (TB) in the Shiselweni region, treatment for co-infection was not available at any of the rural region’s 21 clinics. Instead, patients had to travel to urban facilities. MSF worked with government to bring services to the clinics, but some patients were either too weak or too poor to reach the clinics. So the organisation trained 80 community caregivers, who live close to the patients, on how to administer multi-drug resistant TB injections. Experts from MSF, from time to time, visit the patients and their caregivers to monitor if the medication is administered properly. MSF reports that task-shifting has helped in the decentralisation of HIV/TB services in the region, where trained lay people help with basic responsibilities such as collecting sputum, counselling and education. Critics maintain that administering a TB injection incorrectly can cause complications, and the legal implications of a lay person administering the injection incorrectly are not clear, but MSF argues that a health service provided by a lay person is better than no service at all.