A systematic review of longitudinal studies suggests that intimate partner violence is associated with reduced contraceptive use. The authors used seven waves of data from the Rakai Community Cohort Study in Rakai, Uganda to estimate the effect of prior year intimate partner violence at one visit on women's current contraceptive use at the following visit. The analysis included 7923 women interviewed between 2001 and 2013. Women who experienced any form of prior year intimate partner violence were 20% less likely to use condoms at last sex than women who had not. The authors did not find evidence that intimate partner violence affects current use of modern contraception, however, current use of a partner-dependent method was 27% lower among women who reported any form of prior-year intimate partner violence compared to women who had not. Women who experienced prior-year intimate partner violence were less likely to use condoms and other forms of contraception that required negotiation with their male partners and more likely to use contraception that they could hide from their male partners. Longitudinal studies in Rakai and elsewhere have found that women who experience intimate partner violence have a higher rate of HIV than women who do not. The finding in this paper that women who experience IPV are less likely to use condoms may help explain the relation between intimate partner violence and HIV.
Equity and HIV/AIDS
Since November 2009, WHO recommends that adults infected with HIV should initiate antiretroviral therapy (ART) at CD4+ cell counts of ≤350 cells/µl rather than ≤200 cells/µl. South Africa decided to adopt this strategy for pregnant and TB co-infected patients only. The authors estimated the impact of fully adopting the new WHO guidelines on HIV epidemic dynamics and associated costs. For Hlabisa subdistrict, KwaZulu-Natal, they predicted the HIV epidemic dynamics, number on ART and programme costs under the new guidelines relative to treating patients at ≤200 cells/µl for the next 30 years. Calculations indicated that during the first five years, the new WHO treatment guidelines will require about 7% extra annual investments, whereas 28% more patients receive treatment. Furthermore, there will be a more profound impact on HIV incidence, leading to relatively less annual costs after seven years. The resulting cumulative net costs reach a break-even point after on average 16 years. The findings strengthen the WHO recommendation of starting ART at ≤350 cells/µl for all HIV-infected patients.
Over the last several years, countries in the eastern and southern Africa (ESA) region have made significant and commendable progress in preventing mother-to-child transmission (PMTCT) of HIV and in scaling up HIV treatment efforts. However, despite these gains, there have been no significant reductions in new HIV infections and the region continues to be the hardest hit by the epidemic, highlighting the need to place stronger emphasis on HIV prevention. The risk of HIV infection among adolescent girls and young women (AGYW) in the ESA region is of particular concern. The 2016 UNAIDS World AIDS Day report, Get on the Fast-Track – The life-cycle approach to HIV, stated that efforts to reduce new HIV infections among young people and adults have stalled, threatening to undermine progress towards ending AIDS as a global public health threat by 2030. This evidence brief reviews the background and makes recommendations for steps to develop a comprehensive approach to HIV prevention for AGYW in the context of sexual and reproductive health and rights. Firstly, it calls for measures to build on current commitments and national priorities and in a comprehensive approach. Further steps include reviewing evidence-based interventions for AGYW, operationalising and evaluating multisectoral approaches through reviewing different country strategies and identifying funding opportunities. Several next steps were proposed, including exploring and developing a few case studies of specific programme experience or coordination processes and mechanisms to illustrate possible best practices and address outstanding questions and monitoring, evaluating and documenting the scale-up of integrated HIV-prevention and SRHR interventions for AGYW in the context of different initiatives, to identify optimal approaches to scaling up the delivery of successful interventions.
HIV/AIDS and water-borne diseases account for a substantial degree of morbidity and mortality in different age groups across the globe, but their ripple effects are more devastating in developing countries. Estimates of the HIV/AIDS epidemic in South Africa vary but attest to a mature and generalised epidemic. In rural areas, devoid of electricity and potable water, the impact is more profound because of the role of water in cooking, drinking, consumption of anti-retrovirals and in the preparation of milk supplements for infants. Improving water quality will lead to a decline in child and adult mortality as well as diarrhoeal diseases in people living with HIV and AIDS. The cross-paths between HIV/AIDS and water have long-term implications for effective water resource management and the provision of wholesome water to communities. Such implications include faltering payment for water supply because HIV and AIDS are financially dis-empowering, erosion of social capital and waning productivity. Mainstreaming of HIV and AIDS in the water sector is of utmost importance, including development of work-place policies, adaptation and reorganisation of workload, development of strategies for reserve staff, adjustment of performance appraisal systems, pro-poor financing with a focus on water for health and economic benefit and integration of HIV and AIDS into training activities.
This letter was written by and to represent the various groups of people living with HIV/AIDS across the world. Adressed to the Director General of the WHO, Dr Lee, the letter begins by thanking Dr Lee for the truly visionary leadership in launching WHO’s 3x5 campaign in 2003. However, the letter proceeds to express concern that the new Universal Access initiative may lack the specificity of WHO's 3x5 campaign and is not accompanied by any clear and concrete operational goals.
This paper reviews published quantitative research on the mental health of HIV-infected adults in Africa. Twenty-seven articles published between 1994 and 2008 reported the results of 23 studies. Most studies found that about half of HIV-infected adults sampled had some form of psychiatric disorder, with depression the most common individual problem. People living with HIV or AIDS (PLHIV) tended to have more mental health problems than non-HIV-infected individuals, with those experiencing less problems less likely to be poor and more likely to be employed, educated and receiving antiretroviral treatment (ART). While some key findings emerged from the studies, the knowledge base was diverse and the methodological quality uneven, so studies lacked comparability and findings were not equally robust. Priorities for future research should include replicating findings regarding common mental health problems among PLHIV, important issues among HIV-infected women, and the longer-term mental health needs of those on ART. Research is also needed into predictors of mental health outcomes and factors associated with adherence to ART, which can be targeted in interventions.
Home based care of HIV/AIDS patients is a health need recommended but not often available in Africa. Population based assessment helps to identify unmet health needs to plan services. Careful assessment and follow up of patients receiving home based care in a defined population of Bangwe, Malawi provides details of the frequency and severity of common symptoms.
"The private pharmaceutical industry remains the most important source for the global supply of ARVs today. While the research-based pharmaceutical companies have been responsible for development of many of the medicines used to treat HIV/AIDS, the generic industry for its part has contributed enormously to making widespread treatment possible in the developing world, because of their innovative fixed dose combination tablets (FDCs) and their more affordable prices relative to their brand-name equivalents. FDCs mean that all the required medicines can be combined into one pill which often patients take just once or twice a day."
This book analyzes successive governments' management (and mismanagement) of the AIDS epidemic in South Africa. The book covers the years 1982-2005, using expert thinking regarding public policy making to identify gaps in the public sector's handling of the epidemic. The book highlights critical lessons for policy makers and other public health managers.
Women with HIV infection have between 25% and 40% lower fertility than non-infected women. As antiretroviral therapy (ART) becomes increasingly accessible in sub-Saharan Africa, it is important to understand whether and how the associated clinical improvements correspond with changes in the incidence of pregnancy and fertility. Accordingly, this paper reviews the literature on the potential impact of ART on the fertility of women with HIV infection in sub-Saharan Africa. The authors use Bongaarts' proximate determinants of fertility framework (adapted for conditions of a generalised HIV epidemic) to examine the underlying mechanisms through which use of ART may impact the fertility of women with HIV infection.