Equity and HIV/AIDS

This report shows that the AIDS epidemic is beginning to change course as the number of people newly infected with HIV is declining and AIDS-related deaths are decreasing. Together, these are contributing to the stabilisation of the total number of people living with HIV in the world. Data from the report indicates that an estimated 2.6 million people became newly infected with HIV, nearly 20% fewer than the 3.1 million people infected in 1999. In 2009, 1.8 million people died from AIDS-related illnesses, nearly one-fifth lower than the 2.1 million people who died in 2004. At the end of 2009, 33.3 million people were estimated to be living with HIV, up slightly from 32.8 million in 2008. This is in large part due to more people living longer as access to antiretroviral therapy increases, the report argues. From 2001 to 2009, the rate of new HIV infections stabilised or decreased by more than 25% in at least 56 countries around the world, including 34 countries in sub-Saharan Africa. Of the five countries with the largest epidemics in the region, the report notes that four countries - Ethiopia, South Africa, Zambia and Zimbabwe - have reduced rates of new HIV infections by more than 25%, while Nigeria’s epidemic has stabilised. Sub-Saharan Africa continues to be the region most affected by the epidemic, with 69% of all new HIV infections.

The objectives of this study were to compare undernutrition between groups of HIV-positive and HIV-negative children undergoing anti-retroviral therapy (ART) in Dar es Salaam, Tanzania. From September to October 2010, researchers conducted a cross-sectional survey among 213 ART-treated HIV-positive and 202 HIV-negative children in Dar es Salaam, Tanzania. They found that ART-treated HIV-positive children had higher rates of undernutrition than their HIV-negative counterparts. Among the ART-treated HIV-positive children, 78 (36.6%) were stunted, 47 (22.1%) were underweight, and 29 (13.6%) were wasted. Food insecurity was prevalent in over half of ART-treated HIV-positive children's households. Furthermore, ART-treated HIV-positive children were more likely to be orphaned, to be fed less frequently, and to have lower body weight at birth compared to HIV-negative children. The researchers conclude that HIV and AIDS is associated with an increased burden of child underweight status and wasting, even among ART-treated children. In addition to increasing coverage of ART among HIV-positive children, interventions to ameliorate poor nutrition status may be necessary in this and similar settings. Such interventions should aim at promoting adequate feeding patterns, as well as preventing and treating diarrhoea.

This study explored facilitators and barriers to linkage to HIV care at individual/patient, health care provider, health system, and contextual levels to inform the design of interventions to improve linkages to HIV care. The authors conducted a descriptive qualitative study nested in a cohort study of 1012 newly diagnosed HIV-positive individuals in Mbeya region Tanzania between August 2014 and July 2015. The authors identified multiple factors influencing linkage to care. HIV status disclosure, support from family/relatives and having symptoms of disease were reported to facilitate linkage at the individual level. Fear of stigma, lack of disclosure, denial and being asymptomatic, belief in witchcraft and spiritual beliefs were barriers identified at individual’s level. At providers’ level; support and good patient-staff relationship facilitated linkage, while negative attitudes and abusive language were reported barriers to successful linkage. Clear referral procedures and well-organized clinic procedures were system-level facilitators, whereas poorly organized clinic procedures and visit schedules, overcrowding, long waiting times and lack of resources were reported barriers. Distance and transport costs to HIV care centres were important contextual factors influencing linkage to care. The authors argue that interventions must address issues around stigma, denial and inadequate awareness of the value of early linkage to care.

This paper looks at the modes of transmission model, which has been widely used to help decision-makers target measures for preventing HIV infection. The model estimates the number of new HIV infections that will be acquired over the ensuing year by individuals in identified risk groups in a given population using data on the size of the groups, the aggregate risk behaviour in each group, the current prevalence of HIV infection among the sexual or injecting drug partners of individuals in each group, and the probability of HIV transmission associated with different risk behaviours. The strength of the model is its simplicity, which enables data from a variety of sources to be synthesised, resulting in better characterization of HIV epidemics in some settings. However, concerns have been raised about the assumptions underlying the model structure, about limitations in the data available for deriving input parameters and about interpretation and communication of the model results. The aim of this review was to improve the use of the model by reassessing its paradigm, structure and data requirements. The authors identified key questions to be asked when conducting an analysis and when interpreting the model results and make recommendations for strengthening the model’s application in the future.