Since 1997, The Joint United Nations Programme on AIDS (UNAIDS) and the World Health Organisation (WHO) have provided estimates for the number of people living with HIV in different countries every two years. As new methods are developed for calculating existing and future trends in the disease, figures can be startlingly different. How can accurate decisions be made on health spending if policy-makers are unclear about how many people are HIV positive? Researchers review the process, methods and procedures that have been used in the past and current round of estimates of HIV/AIDS burden.
Equity and HIV/AIDS
How can the real scale of the HIV/AIDS pandemic be measured?
How climate change is undermining the war against HIV in Africa
Lazareva I: Business Day, January 2019
In a study looking at the link between climate change and HIV infection since antiretroviral (ARV) treatment drugs became widely available in Sub-Saharan Africa, researchers found that severe drought threatens to drive new HIV infections. In the urban areas of Lesotho researchers looked at, droughts were linked to an almost five-fold increase in the number of girls selling sex and a three-fold increase in those being forced into sexual relations. Such findings mean climate shocks — which can bring displacement, loss of income and other problems — threaten to undermine progress made in HIV treatment, said Andrea Low, an assistant professor of epidemiology at the International Centre for AIDS Care and Treatment Programmes at Columbia University. “I think the real concern is that we have gained a lot in terms of epidemic control ... but there is always a possibility of losing all those gains if a lot of people are displaced due to climate extremes [and] forced migration.” People forced to migrate as a result of drought may no longer have easy access to the support of family and friends or to HIV treatment. The researchers indicate that said ways of reducing HIV risk associated with climate shocks include providing easier access to medical care, distributing HIV self-testing kits and offering cash transfers to pay school fees for drought-hit families forced to migrate.
How equitable is the scaling up of HIV service provision in South Africa?
A University of the Western Cape School of Public Health and Health Systems Trust study to assess the extent of inequalities in availability and utilisation of HIV services across South Africa found marked inequalities in service delivery between the three sites sampled. "Compared with two poorer sites, clinics at the urban site had greater availability of HIV services, including voluntary counselling and testing , better uptake of this service and greater distribution of condoms. Extra counsellors had also been employed at the urban site in contrast to the other 2 sites." The study concludes that the process of scaling up of HIV services seems to be accentuating inequalities.
How far will we need to go to reach HIV-infected people in rural South Africa?
Wilson DC, Blower SM: BMC Medicine 5:16, 19 June 2007
The South African Government has outlined detailed plans for antiretroviral (ART) rollout in KwaZulu-Natal Province, but has not created a plan to address treatment accessibility in rural areas in KwaZulu-Natal. This paper calculates the distance that People Living With HIV/AIDS (PLWHA) in rural areas in KwaZulu-Natal would have to travel to receive ART in rural KwaZulu-Natal. The results show that many PLWHA in rural KwaZulu-Natal are unlikely to have access to ART, and that the impact of an additional 37 HCFs on treatment accessibility in rural areas would be less substantial than might be expected. There is a great length to go to reach many PLWHA in rural areas in South Africa, and specifically in KwaZulu-Natal.
How HIV/AIDS scale-up has impacted on non-HIV priority services in Zambia
Brugha R, Simbaya J, Walsh A, Dicker P and Ndubani P: BMC Public Health 10(540), September 2010
Much of the debate as to whether or not the scaling up of HIV service delivery in Africa benefits non-HIV priority services has focused on the use of nationally aggregated data. This paper analyses and presents routine health facility record data to show trend correlations across priority services. The authors conducted a review of district office and health facility client records for 39 health facilities in three districts of Zambia, covering four consecutive years (2004-2007). Intra-facility analyses were conducted, service and coverage trends assessed and rank correlations between services measured to compare service trends within facilities. Voluntary counselling and testing, antiretroviral therapy and prevention of mother-to-child transmission client numbers and coverage levels were found to have increased rapidly during the period. There were some strong positive correlations in trends within facilities between reproductive health services (family planning and antenatal care) and antiretroviral therapy and prevention of mother-to-child transmission. Childhood immunisation coverage also increased. Stock-outs of important drugs for non-HIV priority services were significantly more frequent than were stock-outs of antiretroviral drugs. The analysis shows scale-up in reproductive health service numbers in the same facilities where HIV services were scaling up. While district childhood immunisations increased overall, this did not necessarily occur in facility catchment areas where HIV service scale-up occurred. The paper demonstrates an approach for comparing correlation trends across different services, using routine health facility information. Larger samples and explanatory studies are needed to understand the client, facility and health systems factors that contribute to positive and negative synergies between priority services.
How home HIV testing and counselling with follow-up support achieves high testing coverage and linkage to treatment and prevention: a qualitative analysis from Uganda
Ware N; Wyatt M; Asiimwe S; Turyamureeba B; Tumwesigye E; van Rooyen H; Barnabas R; Celum C: Journal of the International AIDS Society 19(20929), 2016
The successes of HIV treatment scale-up and the availability of new prevention tools have raised hopes that the epidemic can finally be controlled and ended. Reduction in HIV incidence and control of the epidemic requires high testing rates at population levels, followed by linkage to treatment or prevention. As effective linkage strategies are identified, it becomes important to understand how these strategies work. The authors use qualitative data from The Linkages Study, a recent community intervention trial of community-based testing with linkage interventions in sub-Saharan Africa, to show how lay counselor home HIV testing and counselling (home HTC) with follow-up support leads to linkage to clinic-based HIV treatment and medical male circumcision services. They conducted 99 semi-structured individual interviews with study participants and three focus groups with 16 lay counselors in Kabwohe, Sheema District, Uganda. The participant sample included both HIV+ men and women (N=47) and HIV-uncircumcised men (N=52). Interview and focus group audio-recordings were translated and transcribed. The transcripts were analysed to identify emergent themes. Trial participants expressed interest in linking to clinic-based services at testing, but faced obstacles that eroded their initial enthusiasm. Follow-up support by lay counselors intervened to restore interest and inspire action. Together, home HTC and follow-up support improved morale, created a desire to reciprocate, and provided reassurance that services were trustworthy. In different ways, these functions built links to the health service system. They worked to strengthen individuals’ general sense of capability, while making the idea of accessing services more manageable and familiar, thus reducing linkage barriers. Home HTC with follow-up support leads to linkage by building “social bridges,”, viz: interpersonal connections established and developed through repeated face-to-face contact between counselors and prospective users of HIV treatment and male circumcision services. Social bridges are found to link communities to the service system, inspiring individuals to overcome obstacles and access care.
How important is the recent HIV resistance scare?
Near hysterical media reports last week reported on a strain of HIV resistant to drugs from three main classes of antiretrovirals. But this article from HIV information site www.aidsmap.com says that perhaps the reason for the reaction to the case- reported in New York - and its reporting lies not in its medical significance, but in its importance to current US debates on comprehensive or abstinence-only HIV prevention. Visit the site to read the full article.
How nurses in Cape Town clinics experience the HIV epidemic
Uta Lehmann and Jabu Zulu, School of Public Health, University of the Western Cape
HIV/AIDS care encompasses a range of different programmes, including voluntary counselling and testing (VCT), prevention of mother to child transmission (PMTCT), health education, nutrition and psycho-social support, treatment of opportunistic infections and staging. Yet, since government’s decision to introduce anti-retroviral therapy in public health facilities, research and debate has focused almost exclusively on the delivery of ARVs. Most of these essential HIV/AIDS services are rendered or supported by nurses at primary care facilities (clinics or community health centres). Yet primary care nursing is in danger of being seriously undermined in South Africa (and elsewhere in Africa) by an accelerating brain drain of nurses, decreasing productivity, lack of skills, and overwhelming anecdotal evidence of burnout and low morale amongst nursing staff.
Further details: /newsletter/id/31024
Human Resources for Health and the Global HIV/AIDS Pandemic
While the dearth of health workers is undermining the huge scale up of HIV/AIDS prevention, care, and treatment that Africa needs so desperately, conversely the emphasis on HIV/AIDS services is drawing resources away from other vital health services that are also in short supply, according to testimony by Holly J. Burkhalter of Physicians for Human Rights to the US House International Relations Committee. "For example, at the 970-bed the Lilongwe Central Hospital in Malawi, only 169 nurses were practicing in mid-2004, compared to the 520 nurses whom the hospital was authorized to employ. The hospital's former staff of 38 laboratory technicians had fallen to only six. The nurses and laboratory technicians were moving to HIV/AIDS programs sponsored by NGOs and overseas universities, precipitating a staffing crisis at this major national referral hospital."
Human rights and AIDS organisations condemn rise of HIV denialism and quack cures in Zambia
Clayton M, Gonsalves G: AIDS and Rights Alliance for Southern Africa (ARASA), 7 March 2007
The AIDS and Rights Alliance for Southern Africa (ARASA), a partnership of human rights and HIV/AIDS organisations in the 14 countries of Southern Africa, denounced American charlatan, Boyd E. Graves, for peddling false AIDS cures in Zamiba, where his claims to be able to treat HIV infection are creating mass confusion across the country among people living with HIV/AIDS. "We are hearing reports from our partner organisations that people are stopping their AIDS medications now that they are being led to falsely believe that a cure for AIDS has been found," said Michaela Clayton, the Director of ARASA. The article claims that in fact, the Treatment Advocacy and Literacy Campaign in Zamiba is reporting that individuals are being told by agents of Mr Graves to stop taking their antiretroviral drugs, stop using condoms and stop immunizing their children against infectious diseases.