This paper explores the importance of using research to promote gender and equity in the provision of anti-retroviral therapy (ART) in Malawi. The purpose of the paper is to highlight the importance of operational research in advocating for programmes that are gender sensitive and can contribute to overall national economic growth and poverty reduction. The paper uses a synthesis of the findings of research in Malawi on how gender roles and relations affect access and adherence to anti-retroviral therapy and to illustrate how these can be used to advocate for more equitable policy and practice.
Equity and HIV/AIDS
Using research to promote gender and equity in the provision of anti-retroviral therapy in Malawi
Using VCT statistics from Kenya in understanding the association between gender and HIV
Otwombe KN, Ndindi PN, Ajema C, Wanyungu J: SAHARA Journal 4 (3): 707-710, 2007
This paper demonstrates the importance of utilising official statistics from the voluntary counselling and testing centres (VCT) to determine the association between gender and HIV infection rates in Kenya.The study design adopted was a record based survey of data collected from VCT sites in Kenya between the second quarter of 2001 and the second quarter of 2004. Of those who were tested, significantly more females tested positive (P<0.0001) and had twice as high a chance of being infected by HIV (Odds ratio 2.27 with CI 2.23 to 2.31) than males.We conclude that VCT statistics may lead to better planning of services and gender sensitive interventions if utilised well.
Vaginal gel blocks HIV, but not enough to be scientific success
Cullinan K: Health-e, 10 February 2009
Candidate microbicide PRO 2000 cuts HIV transmission by 30%, falling just short of the one-third required to be deemed a success. But scientists say this trial offers proof that the concept of a vaginal gel to block HIV is possible. The gel was tested on over 770 women in a huge three-year study involving over 3 000 women in southern Africa and the USA. Only 36 women using PRO 2000 became HIV positive in comparison with around 50 women in the other three groups, who were given either a gel called BufferGel, a water-based placebo gel or no gel at all. This translates into a success rate of 30% for PRO 2000 and a success rate of zero for the other microbicide candidate, BufferGel. Researchers are waiting for the results of another study involving PRO 2000, which will be released in December, and this may push up the success rate of PRO 2000.
Veteran activists in Uganda disillusioned with direction of HIV response
Plus News: 18 October 2011
Uganda's longstanding campaigners in its 30-year fight against HIV have expressed discontent with the government's treatment and prevention approaches. Milly Katana, a long-term activist and one of the inaugural board members of the Global Fund to fight HIV, Tuberculosis and Malaria, said that while the injection of millions of dollars had saved lives through treatment, it had also commercialised the industry, leaving it open to abuse by those not truly interested in defeating the epidemic. For Rubaramira Ruranga, executive director of the National Guidance and Empowerment Network of People Living with HIV/AIDS in Uganda, the lack of proper co-ordination at the top of the HIV response has led to disorganisation in the rest of the sector. He noted that Uganda has strong policies to fight HIV, that are not fully implemented. Gideon Byamugisha, founder member of the International Network of Religious Leaders Living with and Personally Affected by HIV/AIDS, argued that the focus on prevention through safe sex has meant that the 21% of new infections that occur through mother-to-child transmission are being overlooked.
Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa
World Health Organisation: WHO, Geneva, 2017
This progress brief outlines key highlights of the VMMC (Voluntary Medical Male Circumcision) intervention in Eastern and Southern Africa. Nearly 15 million VMMCs have been performed for HIV prevention in 14 countries of eastern and southern Africa. These circumcisions are reported to potentially avert over half a million new HIV infections through to 2030. In 2016, 2.8 million VMMCs were performed and all countries in the region, except Uganda and Rwanda, increased the number of VMMCs performed in the year. The majority of clients were aged 15 years or older.
Vulnerability to HIV infection among Luo female adolescent orphans in Western Kenya
Nyambedha EO: African Journal of AIDS Research 6(3): 287–295
Large-scale surveys have reported that about 55% of orphans worldwide are adolescents. In Kenya, the majority of HIV-infected adolescents are females. The current study used the anthropological methods of in-depth case studies to analyse how migratory life situations of individual female adolescent orphans in the Luo community of Western Kenya may increase their exposure to HIV. The study shows that the ability of the female adolescent orphans to adopt risk-preventive behaviour in relation to HIV is determined by a range of factors beyond their control of individual sexual behaviour. Although analysis of a single case study limits generalisation of the findings, the results provide insights into the reason for sex differentials in HIV infection rates among adolescents as reported in some large-scale surveys. The paper recommends that HIV prevention strategies for adolescents should examine the specific life situations of female orphans by focusing on the impacts of HIV and AIDS and poverty on the protective role of the family. It also recommends that keeping female adolescent orphans in school or in vocational training can be an effective HIV prevention strategy for them.
Walking on the Edge of a Chasm: The youth of Africa
Statement by Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa, released at a satellite session: \"Africa-Asia Interaction, Lessons to Be Learned\" at the XV International AIDS Conference, Bangkok, Monday, 12 July 2004
"Yesterday, July 11th, at the opening of the Conference, UN Secretary-General, Kofi Annan, used the words "a terrifying pattern" to describe the toll that the pandemic has taken on the women of the world, and the women of Africa in particular. He was both scathing and unsparing in his characterization of male behaviour which has led to the carnage. In the process of his remarks, he talked particularly of the vulnerability of young women and girls in Africa, the 15-24 year-old age group, and then noted that on a world-wide basis, the numbers of women and girls in that age group represented nearly two-thirds of the total infected."
Further details: /newsletter/id/30562
Wealthy nations neglecting need, says AIDS envoy
With pointed jabs at the United States, a U.N. special envoy told a gathering of leading AIDS scientists that wealthy nations must make up for a "decade of financial abstinence'' to battle the global epidemic. Stephen Lewis, a Canadian diplomat who has been the United Nations' special representative for AIDS in Africa, made his case on Sunday for a dramatic increase in spending to fight the disease at the opening session of the 11th Conference on Retroviruses and Opportunistic Infections, held in San Francisco.
What breakthrough is needed to combat HIV/AIDS?
Maoulidi S, Phambuzuka News 280
For an HIV/AIDS breakthrough to happen in Tanzania, a radical approach to tackling HIV/AIDS and its impact is needed, writes Salma Maoulidi, who asks “How can any progress be made in the HIV/AIDS battle if current strategies are superficial and isolated?"
What do the implementation outcome variables tell us about the scaling-up of the antiretroviral treatment adherence clubs in South Africa? A document review.
Mukumbang F; Zaida Orth Z; van Wyk B: Health Research Policy and Systems 17(28) 1-12, 2019
This study reviewed the effectiveness of the rollout of the antiretroviral adherence clubs in South Africa. The authors did a thematic analysis of 32 documents on the adherence clubs programme found in various databases from December 2017 to July 2018. The analysis showed that adherence clubs were highly acceptable as they decongested clinics, increased social support for patients and had a low cost of implementation. Evidence suggests that the model was effective in improving adherence to antiretroviral treatment and retention in care. Based on the success of the clubs in the Western Cape, adherence clubs are currently being implemented in all of the other South African provinces. The challenges include acquiring additional resources and support and the efficient use of available resources. They can be addressed by increasing communication between stakeholders and fostering a culture of learning between facilities, and the authors recommend this as the programme expands.