Tuberculosis (TB) is the leading cause of morbidity and mortality in the HIV-infected African population. The need for improved integration of HIV and TB services was highlighted by the World Health Organization (WHO) several years ago, but implementation of recommendations has been slow. HIV testing for TB patients is the gateway for combined HIV and TB treatment, care and prevention yet, in 2007, only 37% of TB patients in the WHO African region were tested for HIV. While some countries reported testing rates above 75%, a testing rate of only 39% was reported in South Africa, the country with the largest burden of HIV/TB co-infection. This study describes efforts to ensure high HIV testing rates in TB patients via an integrated programme at primary health care level in rural KwaZulu-Natal.
Equity and HIV/AIDS
In this article, the authors consider a neglected aspect of AIDS and HIV treatment – pain management. With enormous progress in preventing and treating HIV, more people than ever before now live with HIV as a chronic disease, especially in countries like Kenya, where, over the past year, the number of people receiving anti-retroviral (ARV) therapy has risen by 25%. But HIV patients can suffer from various types of chronic pain – and this includes those on ARVs who are living otherwise healthy, active lives – and pain management is usually overlooked, the authors note. They argue that palliative care, which requires caregivers to improve a patient's quality of life by treating pain and other symptoms, should become an essential element of comprehensive HIV care. It can also help patients to keep taking their antiretroviral drugs. Curative and palliative treatment should work side by side for any patient with a life-threatening disease, the authors state. A major barrier is unavailability of essential pain drugs in Kenya's health facilities. Oral morphine, the mainstay medication for moderate-to-severe chronic pain, is available in just seven of Kenya's 250 public hospitals, and even these facilities sometimes run out, even though oral morphine is inexpensive. However, because of a lack of training, healthcare workers often fear giving an overdose or causing addiction, which can be avoided with proper medical practice. The authors argue for greater, monitored use of morphine for pain management in children.
Between 2007 and 2008, UNAIDS and the World Bank partnered with the national AIDS authorities of Kenya, Lesotho, Swaziland, Uganda and Mozambique to find out how and where most HIV infections were occurring in each country, and whether existing prevention efforts and expenditure matched these findings. The recently released reports reveal that few prevention programmes are based on existing evidence of what drives HIV and AIDS epidemics in the five countries surveyed. For example, in Mozambique, 19% of new HIV infections resulted from sex work, 3% from injecting drug use, and 5% from men who have sex with men (MSM), yet there are very few programmes targeting sex workers, and none aimed at drug users and MSM. The research also found that spending on HIV prevention was often simply too low: Lesotho spent just 13% of its national AIDS budget on prevention, whereas Uganda spent 34%, despite having an HIV infection rate of only 5.4%.
This qualitative study set out to identify gaps between policy and practice of HIV and AIDS workplace interventions in the University of Malawi, in particular the College of Medicine, in line with University HIV and AIDS policy. The researchers randomly sampled 25 students and 15 members of staff for interviews. Results indicated that there are a number of activities relating to HIV and AIDS in place while others are still in the pipeline, however the majority of respondents did not know about the University HIV and AIDS policy or any HIV and AIDS activities that are guided by the policy. This is due to lack of interest on their part or lack of knowledge on the existence of the workplace programme. The authors recommend that the University’s HIV and AIDS committee should strive to fast track key programme areas such as the voluntary counseling and testing centre, and clinic and coordination of different activities to increase programme visibility and patronage.
This presentation was made at the 10th Anniversary of the Centre for the Study of Globalisation and Regionalisation Centre at Warwick University; specifically in the session called Challenges of globalisation, regional integration and development of Africa. The presentation systematically dissected the following four key issues surrounding HIV and development challenges for Africa: the absence of one African epidemic (emphasis for each country/region to know epidemic and act on it); upstream effects (adressing structural drivers in Africa, poverty versus income equality, which might be more powerful?); downstream impact (specifically long wave impacts on poverty, GDP, human capital, social capital); and, finally, responding to the interaction between HIV and poverty.
In this study, researchers aimed to identify the infant-feeding challenges that Malawian women with HIV faced when they were advised to wean their children at an early age of six months, and explore how the women adhered to their infant-feeding options while facing and managing these challenges. The study was conducted between February 2008 and April 2009 at two public health facilities in Malawi where services to prevent mother-to-child transmission of HIV were implemented. Repeated in-depth interviews were conducted with 20 HIV-positive women. Several interdependent factors including the conflicting pressures of sexual morality and the demands of nurturing and motherhood in conditions of abject poverty, impeded the participating women from following medical advice on infant feeding. If they adhered to the medical advice, the women would encounter difficulty maintaining their ascribed roles as respected wives, mothers and members of the society at large. Given that the infant-feeding dilemmas for women with HIV are complex, the integration of public health efforts with context-specific socio-cultural understanding is essential, the authors argue, pointing to the recent 2010 WHO guidelines on breastfeeding, which recommend breastfeeding for two years for HIV-positive Malawian mothers.
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."
This study assessed the contributions of rising mortality, falling HIV incidence and sexual behaviour change to the decline in HIV prevalence in Zimbabwe. Comprehensive review and secondary analysis was conducted of national and local sources on trends in HIV prevalence, HIV incidence, mortality and sexual behaviour covering the period 1985–2007. Data from eastern Zimbabwe showed substantial rises in mortality during the 1990s, levelling off after 2000. Estimates of HIV incidence indicated that HIV incidence may have peaked in the early 1990s and fallen during the 1990s. Household survey data showed reductions in numbers reporting casual partners from the late 1990s and high condom use in non-regular partnerships between 1998 and 2007. These findings provide the first convincing evidence of an HIV decline accelerated by changes in sexual behaviour in a southern African country. However, in 2007, one in every seven adults in Zimbabwe was still infected with a life-threatening virus and mortality rates remained at crisis level.
Recent data from antenatal clinic surveillance and general population surveys suggest substantial declines in human immunodeficiency virus (HIV) prevalence in Zimbabwe. The authors assessed the contributions of rising mortality, falling HIV incidence and sexual behaviour change to the decline in HIV prevalence. Comprehensive review and secondary analysis of national and local sources on trends in HIV prevalence, HIV incidence, mortality and sexual behaviour covering the period 1985-2007 was conducted. HIV prevalence fell in Zimbabwe over the past decade (national estimates: from 29.3% in 1997 to 15.6% in 2007). National census and survey estimates, vital registration data from Harare and Bulawayo, and prospective local population survey data from eastern Zimbabwe showed substantial rises in mortality during the 1990s levelling off after 2000. Direct estimates of HIV incidence in male factory workers and women attending pre- and post-natal clinics, trends in HIV prevalence in 15-24-year-olds, and back-calculation estimates based on the vital registration data from Harare indicated that HIV incidence may have peaked in the early 1990s and fallen during the 1990s. Household survey data showed reductions in numbers reporting casual partners from the late 1990s and high condom use in non-regular partnerships between 1998 and 2007. These findings provide the first convincing evidence of an HIV decline accelerated by changes in sexual behaviour in a southern African country. However, in 2007, one in every seven adults in Zimbabwe was still infected with a life-threatening virus and mortality rates remained at crisis level.
Contemporary lived experiences of the human immunodeficiency virus (HIV) are shaped by clinical and cultural encounters with illness. In sub-Saharan countries such as Zimbabwe, HIV is treated in very different ways in various therapeutic contexts including by biomedical experts, traditional medicine and faith healers. The co-existence of such expertise raises important questions around the potencies and limits of medicalisation and alternative healing practices in promoting HIV recovery. First, in this study, drawing on in-depth qualitative interviews with 60 people from poor urban areas in Harare, the authors explore the experiences of people living with and affected by HIV. They sought to document, interrogate and reflect on their perceptions and experiences of biomedicine in relation to traditional medicine and spiritual healing. Their accounts indicate that traditional medicine and spiritual beliefs continue to significantly influence the way in which HIV is understood, and the forms of help and care people seek. The authors observe the dramatic and overwhelmingly beneficial impact of Antiretroviral Therapy and conclude through Zimbabwean’s own stories that limitations around delivery and wider structural inequalities impede its potential. The authors explore some practical implications of the biomedical clinic (and alternative healing practices) being understood as sites of ideological and expert contestation.