Much has been achieved in just over a decade of democracy in South Africa by facilitating access of the poor to health and other services. However much more needs to be done if the constitutional rights of citizens to dignity is to become universal. Under the strain of an HIV onslaught the health systems serving the poor are being incredibly strained. Women in poor communities are having to fill the gap through self-devised homedbased care as the public health care system that most South Africans rely on is unable to cope.
Equity and HIV/AIDS
Essential services: HIV, health services and gender in South Africa
Motala M, Noel T: Oxfam International, 1 September 2006
Establishing support groups for HIV-infected women: Using experiences to develop strategies
Visser MJ and Mundell JP: SAHARA Journal 5(2):65-73, 2008
HIV-infected women need support to deal with their diagnosis as well as with the stigma attached to HIV. As part of their practical training, Master's-level psychology students negotiated with the staff of four clinics in townships in Tshwane, South Africa, to establish support groups for HIV+ women and offered to assist them in facilitating the groups. This study aimed to understand why the implementation of groups was successful in one clinic and not other clinics. The student reports on their experiences, and interactions with clinic staff and clients were used as a source of data. Using qualitative data analysis, different dynamics and factors that could affect project implementation were identified in each clinic. Socio-ecological and systems theories were used to understand implementation processes and obstacles in implementation. Valuable lessons were learnt, resulting in the development of guiding principles for the implementation of support groups in community settings.
Estimated HIV trends and programme effects in Botswana
Stover J, Fidzani B, Molomo BC, Moeti T and Musuka G: PloSOne 3(11) November 2008
Data from sentinel surveillance at antenatal clinics and a national population survey were used to estimate the trend of adult HIV prevalence from 1980 to 2007 in Botswana. Prevalence has declined slowly in urban areas since 2000 and has remained stable in rural areas. The number of new adult infections has been stable for several years and number of new child infections has declined due to coverage of ART that reaches over 80% in need and nearly complete coverage of an effective program to prevent mother-to-child transmission (PMTCT). The need for ART will increase by 60% by 2016. Botswana's PMTCT and treatment programs have achieved significant results in preventing new child infections and deaths among adults and children. The number of new adult infections continues at a high level. More effective prevention efforts are urgently needed.
Estimates of the Potential Impact of the COVID-19 Pandemic on Sexual and Reproductive Health in Low- and Middle-Income Countries
Riley T; Sully E; Ahmed Z; Biddlecom Z: International Perspectives on Sexual and Reproductive Health 46, 73-76, 2020
The strain that the COVID-19 outbreak imposes on health systems will undoubtedly impact the sexual and reproductive health of individuals living in low- and middle-income countries (LMICs); however, sexual and reproductive health will also be affected by societal responses to the pandemic, such as when local or national lockdowns close services not deemed to be essential, as well as from consequences of travel restrictions and economic slowdowns. Previous public health emergencies have shown that the impact of an epidemic on sexual and reproductive health often goes unrecognized, because the effects relate to indirect consequences of strained health care systems, disruptions in care and redirected resources. The authors argue for the learning from prior epidemics to be used to put in place critical resources and systems, and ensuring the provision of essential sexual and reproductive health services to avoid health system disruptions that would have devastating, lasting effects on individuals and communities.
Estimating the cost of care giving on caregivers for people living with HIV and AIDS in Botswana: A cross-sectional study
Ama NO and Seloilwe ES: Journal of the International AIDS Society 13(14), 20 April 2010
Community home-based care is the Botswana Government's preferred means of providing care for people living with HIV (PLHIV). However, primary (family members) or volunteer (community members) caregivers experience poverty, are socially isolated, endure stigma and psychological distress, and lack basic care-giving education. This study estimated the cost incurred in providing care for PLHIV through a stratified sample of 169 primary and volunteer caregivers drawn from eight community home-based care groups in four health districts in Botswana. The results show that the mean of the total monthly cost (explicit and indirect costs) incurred by the caregivers was US$90.45, while the mean explicit cost of care giving was US$65.22. This mean of the total monthly cost is about one and a half times the caregivers' mean monthly income of US$66 and more than six times the Government of Botswana's financial support to the caregivers. The study, therefore, concludes that as the cost of providing care services to PLHIV is very high, the Government of Botswana should substantially increase the allowances paid to caregivers and the support it provides for the families of the clients. The overall costs for such a programme would be quite low compared with the huge sum of money budgeted each year for health care and for HIV and AIDS.
Estimating the lost benefits of antiretroviral drug use in South Africa
Chigwedere P, Seage GR, Gruskin S, Lee T and Essex M: Journal of Acquired Immune Deficiency Syndromes, 16 October 2008
The South African government’s health department controversially declined to accept freely donated nevirapine and grants from the Global Fund, despite the fact that it is one of the countries most severely affected by HIV and AIDS, because they claimed antiretroviral (ARV) drugs were not useful for patients. This study aimed to assess the department’s assertion. Using modeling, it compared the number of persons who received ARVs for treatment and prevention of mother-to-child HIV transmission between 2000 and 2005 with an alternative of what was reasonably feasible in the country during that period. It calculated that more than 330,000 lives were lost because a feasible and timely ARV treatment programme was not implemented in South Africa. Thirty-five thousand babies were born with HIV, resulting in 1.6 million person-years lost by not implementing a mother-to-child transmission prophylaxis programme using nevirapine. The total lost benefits of ARVs are at least 3.8 million person-years for the period 2000–2005.
European Parliament resolution on World AIDS Day
"The European Parliament ...Calls on the EU to continue to prioritise sexual and reproductive health issues through funding programmes on family planning, and in particular to influence sexual behaviour through risk-reduction strategies, to educate young people, and especially girls and young women, about STIs and HIV, and to encourage condom usage in combination with other contraceptive methods and combat any misinformation spread on the effectiveness of condoms..."
Further details: /newsletter/id/30736
Evaluating traditional healers knowledge and practices related to HIV testing and treatment in South Africa.
George G, Chitindingu E and Gow J: BMC International Health and Human Rights 13(45): 23 October 2013
In a context of inadequate human resources for health, this study investigated whether traditional healers have the knowledge and skill base which could be utilised to assist in the scaling up of HIV prevention and treatment services in South Africa. Using a cross-sectional research design a total of 186 traditional healers from the Northern Cape province were interviewed. Responses on the following topics were obtained: socio-demographic characteristics; HIV training, experience and practices; and knowledge of HIV transmission, prevention and symptoms. Descriptive statistics and chi square tests were used to analyse the responses. Traditional healers’ knowledge of HIV and AIDS was not as high as expected. Less than 50% of both trained and untrained traditional healers would treat a person they suspected of being HIV positive. However, a total of 167 (89%) respondents agreed using a condom can prevent HIV and a majority of respondents also agreed that having one sexual partner (127, 68.8%) and abstaining from sex can prevent HIV (145, 78.8%). Knowledge of treatment practices was better with statistically significant results being obtained. The results indicate that traditional healers could be used for prevention as well as referring HIV positive individuals for treatment. Traditional healers were enthusiastic about the possibility of collaborating with bio-medical practitioners in the prevention and care of HIV and AIDS patients. This is significant considering they already service the health needs of a large percentage of the South African population. However, further development of training programmes and materials for them on HIV and AIDS related issues would seem necessary.
Evaluation of prevention of mother-to-child HIV transmission program in rural Kwazulu-Natal, South Africa
Hocque M, Van Den Heuvel M, Hocque E: Clinics in Mother and Child Health 4(2):753-762, 2007
In 2004, South Africa had one of the highest rates of HIV infection in the world and the province of KwaZulu-Natal (KZN) reported the peak of 40.7% positivity among the antenatal population. The purpose of this study was to identify measures to improve the quality of an HIV prevention program targeted at reducing the rate of mother-to-child transmission of HIV infection (MTCT). A cross-sectional observational (non-experimental) study was conducted from Empangeni hospital (i) using antenatal clinic registers between May 2002 and April 2003 and (ii) applied a questionnaire survey to a randomly selected sample of 306 HIV infected women who delivered between April and June 2004. The results showed that among 3774 antenatal attendees, 2528 (67%) accepted pre-test counselling and 2390 (63%) HIV testing. Majority (95%) of those who had (2528) pre-test counselling accepted HIV testing, post test counselling and test results. The prevalence of HIV infection was 41% (980) (95% CI, 39%-43%). Among them (980 HIV positive), 73% (716) received nevirapine during the antenatal period yielding an overall antenatal nevirapine prophylaxis (uptake) rate of 46% (based on an estimate of 41% HIV prevalence rate for total antenatal population of 3774 during the study period). Between April to June 2004, 2393 women delivered at Empangeni hospital of which 39% (933) were HIV positive. The coverage of pretest counselling for HIV testing (67%) and nevirapine use (46%) was low. We found in the questionnaire survey that the participating women had adequate knowledge and compliance on the use of nevirapine. Strategies are needed to improve program uptake and effectiveness of the prevention of mother-to-child transmission of HIV infection (PMTCT) program in rural South Africa.
Evaluation of WHO's contribution to '3 by 5'
WHO, 15 June 2006
This report examines the administrative, technical, managerial guidance and strategic leadership that WHO provided during the initiative and includes evaluations of three levels of WHO: headquarters, regional offices and country offices. The report identifies future collaboration opportunities between WHO and partners and gives recommendations for the "way forward".