HIV and AIDS treatment in developing countries is being dealt a double blow that will mean treatment recommendations cannot be implemented and the promise of new scientific research will remain unfulfilled, according to the international medical humanitarian organization, Médecins Sans Frontières (MSF). The prices of the newer anti-retrovirals (ARVs) are expected to be astronomical, while donors are retreating from their commitments to expand AIDS treatment. The World Health Organization’s (WHO) latest recommendations for treatment include treating people with better tolerated drugs, and earlier. The revised strategy calls for treating people before they become ill from opportunistic infections such as tuberculosis. MSF data from Lesotho shows the value of this new strategy: providing people with treatment earlier led to a 68% reduction in deaths, a 27% reduction in new diseases, a 63% reduction in hospitalisation and a 39% reduction in people defaulting from care. Even South Africa, a middle-income country with the largest ARV treatment programme in the world, is expected to struggle to implement the full WHO recommendations if its proposal to the Global Fund is not approved.
Equity and HIV/AIDS
This briefing paper provides an overview of the achievements of the 'Unite for Children, Unite against AIDS initiative' in improving prevention of and treatment for HIV and AIDS among children. The report concludes that, while some progress has been made, many children and mothers are not receiving the services and treatments they require. To redress this, significantly more resources are needed, together with policy changes in affected countries. Appendices to the report provide data on all countries’ HIV infection rates and access to services and medicines.
In this study, researchers assessed whether HIV testing could be increased by combination of community mobilisation, mobile community-based voluntary counselling and testing (VCT), and support after testing. Ten communities participated in Project Accept in Tanzania, and eight in Zimbabwe. At each site were paired according to similar demographic and environmental characteristics, and one community from each pair was randomly assigned to receive standard clinic-based VCT (SVCT), and the other community was assigned to receive community-based VCT (CBVCT) plus access to SVCT. The researchers found that the proportion of clients receiving their first HIV test during the study was higher in CBVCT communities than in SVCT communities in all three countries. Although HIV prevalence was higher in SVCT communities than in CBVCT communities, CBVCT detected almost four times more HIV cases than did SVCT across the three study sites. Repeat HIV testing in CBVCT communities increased in all sites to reach 28% of all those testing for HIV by the end of the intervention period. The researchers conclude that CBVCT should be considered as a viable intervention to increase detection of HIV infection, especially in regions with restricted access to clinic-based VCT and support services after testing.
This article preventive measures for reducing the prevalence and incidence of HIV by weighing the potential benefits of promoting self testing for HIV in developing countries and the concerns that need to be raised.
Non-governmental organisations have raised concern over the lack of female condoms claiming that it undermines efforts to curb new infections. The health department is looking for donors to finance the procurement and distribution of female condoms, citing lack of funds. Meanwhile, a tender has been issued. Tian Johnson, Advocacy Officer of the Thohoyandou Victim Empowerment Programme (TVEP), raised concern over the awarding of the tender for the manufacture of female condoms. ‘The current situation pertaining to the inadequate access to the female condom in South Africa today is a violation of the rights of women and men of this country. The tender for female condom supply has been awarded to a company called the Female Health Company. That means there are no options for competition, there are no options for bringing prices down. That enables us to use the excuse that we have been using for far too long, the excuse that female condoms are too expensive. It’s an excuse with no basis and with no merit’, he said.
In this documentary, the stories of three ‘ordinary men' from South Africa, Kenya and Sierra Leone are presented as they deal with the realities of HIV. The producer of the documentary is a gender activist who deliberately avoided using experts and non-governmental organisation workers to provide facts and advice, instead relying on personal narrative to reveal the relevant social and economic issues surrounding condom use and to make the documentary more relatable to its intended audience – African men. The film was envisioned as a way to stimulate debate about the challenges and complexities these men face on condom use. It may be useful as a tool for local civil society organisations, which could use the film to aid discussions about condoms.
A paper developed by the Health Systems Resource Centre on behalf of the Department for International Development (DFID) and in collaboration with the World Health Organisation (WHO) aims to increase understanding of the requirements for introducing and scaling up provision of antiretroviral therapy (ART) as part of comprehensive HIV/AIDS programmes in resource-poor countries. The paper provides an overview of experience and lessons learned with regard to: The feasibility of ART in resource-poor settings; The different approaches being taken to delivery of ART; and The issues to be considered in scaling up ART provision. The review is based on published and unpublished literature, interviews with key informants, web searches and country information.
In this study, researchers investigated whether anti-retroviral therapy (ART) services for urban HIV-positive adults in two urban areas in South Africa are distributed in an equitable manner, in terms of socio-economic status and gender. HIV-positive people were found to be relatively poor. Over 60% of those with HIV fell into the poorest 40% of the South African population. The users of ART services were in general poorer than the HIV-positive population. Seventy percent of these users fell into the poorest 40% of the South African population. This finding was however not statistically significant, and the proportion of HIV-positive people that were women (or men) was no different to the sex distribution in the users of ART services. Taken together, these findings suggest that the use of ART services in urban South Africa is equitable. The researchers expressed hope that their study will add impetus to commitments to reaching and sustaining full coverage of ART for all in need.
The provision of highly active antiretroviral therapy (HAART) in resource-limited settings follows a public health approach, which is characterised by a limited number of regimens and the standardisation of clinical and laboratory monitoring. In industrialised countries doctors prescribe from the full range of available antiretroviral drugs, supported by resistance testing and frequent laboratory monitoring. This study compared virologic response, changes to first-line regimens, and mortality in HIV-infected patients starting HAART in South Africa and Switzerland. The study team analysed data from the Swiss HIV Cohort Study and two HAART programmes in townships of Cape Town, South Africa. Compared to the highly individualised approach in Switzerland, programmatic HAART in South Africa resulted in similar virologic outcomes, with relatively few changes to initial regimens. Further innovation and resources are required in South Africa to both achieve more timely access to HAART and improve the prognosis of patients who start HAART with advanced disease.
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.