This report from the South African Budget Information Service (IDASA) analyses budget allocations and funding flows from the national fiscus for HIV/AIDS interventions. It investigates the best way to deliver funds to the provinces of South Africa to tackle HIV/AIDS. Analysis of official budget documents and interviews with national and provincial social service and treasury officials reveals that provinces are generally improving their spending on the HIV/AIDS conditional grants and beginning to allocate significant funds from provincial budgets to tackling HIV/AIDS.
Equity and HIV/AIDS
Building capacity for antiretroviral delivery in South Africa: A qualitative evaluation of the PALSA PLUS nurse training programme
Stein J, Lewin S, Fairall L, Mayers P, English R, Bheekie A, Bateman E and Zwarenstein M: BMC Health Services Research 8(24) 18 November 2008
South Africa recently launched a national antiretroviral treatment programme. This has created an urgent need for nurse-training in antiretroviral treatment (ART) delivery. The PALSA PLUS programme provides guidelines and training for primary health care (PHC) nurses in the management of adult lung diseases and HIV/AIDS, including ART. A process evaluation was undertaken to document the training, explore perceptions regarding the value of the training. It found that nurse uptake of PALSA PLUS training was high. Ongoing on-site training of PHC nurses enhanced their experience of support for their work by allowing not only for ongoing experiential learning, supervision and emotional support, but also for the ongoing managerial review of all those infrastructural and system-level changes required to facilitate health provider behaviour change and guideline implementation.
Bush accused of blocking access to cheap AIDS drugs
International health charities have accused George Bush's administration of trying to block developing countries' access to cheap AIDS drugs by questioning the quality of "three in one" generic combination drugs. At a meeting last month in Gaborone, Botswana, the US global AIDS coordinator, Randall Tobias, said that the World Health Organisation's drug pre-qualification programme is not a sufficiently stringent approval process to ensure consistency and quality of fixed dose combination drugs. Médecins Sans Frontières and other non-governmental organisations working with AIDS patients in Africa accused the US government of trying to escape the 2001 Doha agreement on affordable drugs by the side door.
Call for focus and urgency on universal access to treatment
Dr Paulo Teixeira Senior Adviser of the São Paulo’s STD/AIDS State Program argues the importance of the adoption of clear targets as one of the main factors that accounted for a dramatic change in access to treatment under the 3x5 program. He argues that access to ARV treatment has become an international consensus but that extreme measures still have to be taken to make this process irreversible and universal in the next few years. Some of these measures are technical support, the provision of international funds, the reduction in the prices of second line medications, and the inclusion of the most vulnerable groups like MSM, IDU, SW and inmates. He expressed concern at a weakening of measures towards addressing universal access to prevention and treatment.
Call to Sign: The Second Durban Declaration: Access Equity Rights - Now!
International AIDS Society: Geneva, July 2016
There has been remarkable progress in the response to AIDS since the global HIV community last convened in Durban in 2000. Curbing the spread of HIV was the first step . Accelerating investment and action on a robust human rights and social justice agenda is the next. Despite significant scientific advancements, the authors argue that we continue to encounter structural barriers that impede real world progress. Realising the promise of scientific achievement requires a greater commitment to removing barriers between discovery and implementation. The 21st International AIDS Conference (AIDS 2016) must bring these pieces together – the key scientific advances needed to end the epidemic and the key structural barriers impeding progress – and secure greater political commitment including financial resources to get the job done. They argue that it is key to focus on five key scientific advances; ensuring access to antiretroviral therapy for all people living with HIV, scaling up modern combination HIV prevention packages, treating and managing co-infections and co-morbidities, amplifying research efforts for a vaccine and a cure, optimising implementation research. They argue that there is a need to address five key structural barriers; focusing on key populations within and across various HIV epidemic scenarios, addressing gender inequality and empowering young women and girls, challenging laws, policies and practices that stigmatise and discriminate against people living with HIV and key populations, increasing investment in civil society and community lead responses, and enhancing the capacity of front-line healthcare workers.
Caring for AIDS-orphaned children: A systematic review of studies on caregivers
Maro CN, Roberts GC and S rensen M: Vulnerable Children and Youth Studies 4(1): 1–12, March 2009
This article presents the first known systematic review of the research literature on carers of AIDS-orphaned children. Twenty-nine studies of caregivers of AIDS-orphaned children were identified and assessed, mostly in the developing world. Most studies included identifying the individuals who were providing care, assessing the capacity of the extended family to care for AIDS orphans and exploring the process of care placement. Few examined the caregiving experience in any depth, including the challenges of caring for orphans or the effects of caring for these children on the caregivers' health and wellbeing. The article concludes with suggestions for future research to guide policy and programming efforts.
Cash released for free anti-AIDS treatment in Tanzania
People living with HIV/AIDS in Tanzania will soon have access to free antiretroviral drugs under the government's four-year treatment programme. More than US $1.8 million was recently released by the Treasury Department for the Ministry of Health to purchase anti-AIDS drugs, a local newspaper, The Guardian, reported.
Causes of acute hospitalization in adolescence: Burden and spectrum of HIV-related morbidity in a country with an early-onset and severe HIV epidemic: A prospective survey
Ferrand RA, Bandason T, Musvaire P, Larke N, Nathoo K, Mujuru H, Ndhlovu CE, Munyati S, Cowan FM, Gibb DM and Corbett EL: Public Library of Science Medicine 7(2): 2 February 2010
Survival to older childhood with untreated, vertically acquired HIV infection, which was previously considered extremely unusual, is increasingly well described. However, the overall impact on adolescent health in settings with high HIV sero-prevalence has not previously been investigated. Adolescents (aged 10–18 y) systematically recruited from acute admissions to the two public hospitals in Harare, Zimbabwe, answered a questionnaire and underwent standard investigations including HIV testing, with consent. Pre-set case-definitions defined cause of admission and underlying chronic conditions. Participation was 94%. One hundred and thirty-nine (46%) of 301 participants were HIV-positive, but only four were positive for herpes simplex virus-2 (HSV-2). Case fatality rates were significantly higher for HIV-related admissions (22% versus 7%, p<0.001), and significantly associated with advanced HIV, pubertal immaturity, and chronic conditions. The paper concluded that HIV is the commonest cause of adolescent hospitalisation in Harare, mainly due to adult-spectrum opportunistic infections plus a high burden of chronic complications of paediatric HIV/AIDS. Low HSV-2 prevalence and high rates of maternal orphanhood provide further evidence of long-term survival following mother-to-child transmission. Better recognition of this growing phenomenon is needed to promote earlier HIV diagnosis and care.
Challenges of Childhood TB/HIV Management in Malawi
Poerksen P, Kazembe PN, Graham SM: Malawi Medical Journal 19(4):142-148, 2007
The diagnosis and management of childhood tuberculosis (TB) are major challenges in countries such as Malawi with high incidence of TB and human immunodeficiency virus (HIV) infection. Diagnosis of TB in children often relies only on clinical features but clinical overlap with the presentation of HIV and other HIV-related lung disease is common. The tuberculin skin test (TST), the standard marker of M. tuberculosis infection in immune competent children, has poor sensitivity in HIV-infected children and is not usually available in Malawi. HIV test should be routine in children with suspected TB as it improves clinical management. HIV-infected children are at increased risk of developing active disease following TB exposure which justifies the use of isoniazid preventive therapy (IPT) once active disease has been excluded but this is difficult to implement and appropriate duration of IPT is unknown. HIV-infected children with active TB experience higher mortality and relapse rates on standard TB treatment compared to HIV-uninfected children, highlighting the need for further research to define optimal treatment regimens. HIV-infected children should also receive appropriate supportive care including co-trimoxazole prophylaxis and anti-retroviral treatment (ART) if indicated. There are concerns about concurrent use of some anti-TB drugs such as rifampicin with some ARTs.
Challenges to antiretroviral adherence among MSM and LGBTI living with HIV in Kampala, Uganda
Therkelsen D: HEARD, Durban, December 2015
‘Treatment as prevention’ has become the cornerstone of UNAIDS’s post-2015 global strategy to end AIDS by 2030. As the expansion of treatment provision continues, and access improves, adherence becomes a determining factor in the impact of ART for both treatment and prevention. HEARD are conducting a number of small scoping studies on challenges to ART adherence in men who have sex with men (MSM) and lesbian, gay, bisexual, transgender, and intersex (LGBTI) communities living with HIV in East and Southern Africa (ESA), as key populations in the AIDS response. This report presents findings from a scoping study carried out in Kampala, Uganda, in December 2015. The findings suggest that (double) stigma and criminalisation of behaviour of people living with HIV (PLHIV) in MSM and LGBTI communities cut across almost every perceived challenge to ART adherence as a driving or contributory factor. As a result, indications suggest MSM and LGBTI experience challenges that are similar in type to the general population, but that these population groups experience the challenges more often, more acutely, and with less opportunity to overcome the challenges.