The aims of this study were to determine the relative incidence of tuberculosis (TB) by HIV or anti-retroviral therapy (ART) status and the effect of the ART roll-out on TB incidence trends in Karonga District, Malawi. Data from the Karonga Prevention Study was analysed, including TB epidemiological studies done since 1985 and data on ART services available since 2005. The study found that relative incidence of TB was high early after initiation on ART and decreases with time, but still remains elevated. Recommendations include starting ART earlier, further collaboration between and greater integration of TB and ART programmes, and intensified case finding for TB in high-risk populations of patients receiving ART.
Equity and HIV/AIDS
Change in population TB incidence trends after the roll-out of ART in Karonga District, North Malawi
Houben R and Mboma S: INDEPTH Network, 2010
Changes in sexual behaviours to prevent HIV
de Irala J, Alonso A: Lancet 368 (9549), 1749-1750, 18-24 November 2006
This article refers to that by John Cleland and Mohamed Ali in the same issue of the Lancet. The authors offer interesting results on behaviours about HIV sexual transmission in women from different African countries. Cleland and Ali use information from all countries in sub-Saharan Africa that have had two or more Demographic and Health Surveys since 1990 to estimate behaviour trends.Their study is valuable for epidemiologists and public-health practitioners, and has important strengths.
Changing the course of AIDS
Dickinson D: Cornell University Press, 2009
This book is an in-depth evaluation of a new approach to create behavioural change that could affect the course of the global health crisis of HIV and AIDS. Taking a close look at the South African HIV and AIDS epidemic, it demonstrates that regular workers serving as peer educators can be as – or even more – effective agents of behavioural change than experts who lecture about the facts and so-called appropriate health care behaviour. After spending six years researching the response of large South African companies to the AIDS epidemic, Dickinson describes the promise of this grassroots intervention and the limitations of traditional top-down strategies. His case studies directly examine the South African workplace to tackle sexual, gender, religious, ethnic, and broader social and political taboos that make behaviour change so difficult, particularly when that behaviour involves sex and sexuality. Dickinson's findings show that people who are not officially health care experts or even health care workers can be skilled and effective educators. This book demonstrates how peer education can be used as a tool for societies grappling with the HIV and AIDS epidemic and why those interested in changing behaviours to ameliorate other health problems like obesity, alcoholism, and substance abuse have so much to learn from the South African context.
Charting a path to end the AIDS epidemic
Sidibé M: Bulletin of the World Health Organisation 94(6) 408, 2016, doi: http://dx.doi.org/10.2471/BLT.16.176875
From 8 to 10 June 2016, heads and representatives of states and governments, along with other key stakeholders, assembled at the United Nations (UN) in New York, for the High-Level Meeting on Ending AIDS. There are three reasons why this meeting is an important milestone for the global response against human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). First, the meeting provides an opportunity to reflect on the extent of progress and unprecedented achievements that have been made in responding to the AIDS epidemic, as described in the UN Secretary-General’s report. Second, the meeting served as an occasion to galvanise support from the global community to scale up the AIDS response. The 90–90–90 treatment target calls for 90% of people living with HIV to know their status, 90% of people who know their HIV status to have access to treatment and 90% of people on treatment to achieve suppressed viral loads by 2020. Third, the meeting was an opportunity to reflect on specific challenges that need to be addressed going forward. Among them is a treatment gap and inadequate global investments in prevention. The UNAIDS 2016–2021 Strategy integrated efforts towards ending the AIDS epidemic fully into Transforming our world: the 2030 agenda for sustainable development. The strategy sets out the links between the HIV response and several sustainable development goals (SDGs), from SDG 1 on ending poverty to SDG 16 on promoting inclusive societies.
Cheap multivitamin slows time to AIDS and death in African women
Multivitamins costing $15 per person per year significantly reduced the risk of HIV disease progression and death in HIV-positive pregnant women in Tanzania, according to a study published in the July 1st edition of the New England Journal of Medicine. The investigators conclude that multivitamins would be a cheap, simple, and effective means of delaying the need for antiretroviral therapy in HIV-positive pregnant women in resource limited settings. An accompanying editorial praises the rigour of the investigators study, and although it calls for further studies into the benefits of multivitamins involving large populations it says that treatment programmes and doctors would be justified in offering multivitamins.
Child AIDS research 'critical' for regional development in Southern Africa
The South African social services and population development minister, Zola Skweyiya, has said research into the effect of HIV/AIDS on children is critical for the region's future development. Skweyiya told his southern African counterparts at a recent meeting in Cape Town that the virus was devastating communities and families, and aggravating poverty by killing society's most productive members. According to the South African Press association, he urged that the pandemic be tackled "more vigorously, in an integrated manner".
Child ARVs in Uganda could go to waste due to low demand
Plus News: 10 September 2009
A large supply of paediatric antiretroviral medication donated by the Clinton Foundation could expire in Ugandan medical stores because of low demand. ‘There are few children who are receiving the drugs; they are going to expire by March [2010],’ said Zainabu Akol, head of HIV programming in the Ministry of Health. Fewer than a quarter of the 125,000 Ugandan children who need life-prolonging anti-retroviral treatment (ART) have access to it, mainly because of stigma and inadequate education of parents, say specialists. ‘Due to stigma, parents have failed to take their children for ART,’ said Goretti Nakabugo, from a local non-governmental organisation, called Strengthening HIV/AIDS Counsellor Training. ‘They believe if their children start ART, they will be shunned by the community and pupils at school. People don't yet believe that HIV/AIDS is not transmitted through casual contact; a child with rashes is always shunned,’ she added. Many parents cannot face the idea of telling their children they have a potentially life-threatening illness and they live in denial.
Children and AIDS: Fifth Stocktaking Report, 2010
United Nations Children’s Fund: October 2010
In this report, the United Nations Children’s Fund (UNICEF) and its partners note progress on preventing mother-to-child HIV transmission (PMTCT), with most women around the world getting anti-retroviral drugs to prevent transmission to newborns. However, globally, AIDS remains the leading cause of death amongst women of childbearing age and UNICEF’s goal now is to help eliminate vertical mother-to-child transmission so that fewer or no newborns will be infected, especially in Africa, where 1,000 babies acquire the virus every day. UNICEF notes general progress in four priority areas: prevention of mother-to-child transmission of HIV; paediatric treatment; prevention among adolescents and young people; and protection for orphans and vulnerable children. The report emphasises that reaching the poorest, most marginalised and least served has been at the core of successful AIDS programming. That imperative is even greater in an era of static resources and ever more complex competing priorities. The AIDS-free generation that is now in sight can be achieved – but only if governments accelerate the scale-up of proven measures, and only if they are viewed as part of a rights-based, results-focused drive to reach all those in need. Integrating interventions into existing systems without losing the capacity to address the specific needs of children affected by AIDS remains a significant challenge.
Children and AIDS: Fourth stocktaking report 2009
United Nations International Children’s Fund (UNICEF): December 2009
This annual report examines evidence of progress in four key areas in 2008: prevention of mother-to-child transmission (PMTCT), paediatric HIV care and treatment, prevention of HIV among adolescents and young people, and protection and support for children affected by HIV and AIDS. The most significant progress was in PMTCT, with 45% of HIV-positive pregnant women globally receiving antiretroviral (ARV) treatment to prevent them passing HIV to their children; up from 24% in 2006. Several countries with high HIV prevalence expanded PMTCT coverage to most pregnant women needing treatment: 73% in South Africa, 91% in Namibia and 95% in Botswana. Other countries lagged behind: for example, in Nigeria only 10% of pregnant women with HIV were tested and treated to prevent transmission to their babies. The countries most successful at scaling up PMTCT incorporated their programmes into existing maternal and child health services, the report noted. The authors conclude that in the near future, it is not impossible to envisage a generation of children who are free of HIV.
Children who live in communities affected by AIDS
The Lancet 367 (9511), 25 February 2006: Foster G
This short article examines the impacts that HIV and AIDS in a community has on children living in that community. The author reviews the different impacts that these situations have on children. The author also discusses Article 26 of the UN Convention on the Rights of the Child (CRC), in the context of children indirectly affected by HIV and AIDS, which states that children have a right to benefit from state-provided social security. Registration required (free).