Attitudes to voluntary counselling and testing (VCT) for HIV among young men and women in a slum area of Kampala, Uganda, were studied through 22 individual semi-structured interviews and 5 focus group discussions. Attitudes to VCT ranged from having no problem with the procedure to being very reluctant. Despite fear of stigma, the participants perceived ‘positive living' after HIV testing as realistic. VCT was regarded as an important step to avoid HIV infection, but informants expressed the need for the service to be more accessible in terms of cost, time and quality of pre- and post-test counselling. We argue that counselling without HIV testing should be available for those who are reluctant to test. Poverty and gender power imbalances appeared to limit youths' possibility of making rational decisions about sexual behaviour and accessing VCT. The importance of considering the context in which such issues are being negotiated and decided is highlighted.
Equity and HIV/AIDS
This report delivers a summary of the impact and results the Global Fund partnership was able to achieve by 2015, showing cumulative progress since the Global Fund was created in 2002. It is a collective effort, combining the strong contributions made by governments, civil society, the private sector and people affected by HIV, TB and malaria. Here are the cumulative highlights: 17 million lives saved; on track to reach 22 million lives saved by the end of 2016, a decline of one-third in the number of people dying from HIV, TB and malaria since 2002, in countries where the Global Fund invests, 8.1 million people on antiretroviral treatment for HIV, 13.2 million people have received TB treatment and 548 million mosquito nets distributed through programs for malaria. Building resilient and sustainable systems for health is critically important to end HIV, TB and malaria as epidemics. Overall, more than one-third of the Global Fund’s investments go to building resilient and sustainable systems for health. The Global Fund estimates that approximately 55 to 60 percent of its investments benefit women and girls, with a positive impact on reproductive health.
The authors of this study assessed retention in HIV care for individuals not yet eligible for antiretroviral therapy (ART) and explored factors associated with retention in a rural, public health HIV programme in South Africa. During the period January 2007 to December 2007, HIV-infected adults (≥16 years) who were not yet eligible for ART, with a CD4 count of >200, were included in the analysis. Retention was defined by repeat CD4 count within 13 months. A total of 4,223 participants were included in the analysis, of whom 83.9% were female. Overall retention was 44.9%, with 201 days as median time to return to the clinic. Males were independently associated with lower odds of retention, and older participants with higher odds of retention. The authors conclude that retention in HIV care before eligibility for ART is poor, particularly for younger individuals and those at an early stage of infection. Further work to optimise and evaluate care and monitoring strategies is required to realise the full benefits of the rapid expansion of HIV programmes in sub-Saharan Africa.
This study compared risks of perinatal HIV transmission between multiparous women who had previously received a dose of single-dose nevirapine (SDNVP) (exposed) and those that had not (unexposed) and who were given SDNVP for the index pregnancy within a prevention of mother-to-child HIV transmission (PMTCT) clinical study. We also compared transmission risks among exposed and unexposed women who had two consecutive pregnancies within the trial. Transmission risks did not differ between 59 SDNVP-exposed and 782 unexposed women in unadjusted analysis or after adjustment for viral load and disease stage. Transmission risks for women who had two consecutive pregnancies were 7% at both the first (unexposed) and second (exposed) delivery, suggesting that the efficacy of SDNVP may not be diminished when reused in subsequent pregnancies.
The world needs a dramatic change in thinking – and action from external funders, policymakers, and programme managers in the public, private and nongovernmental (NGO) sectors – to focus on strengthening health systems in the countries most affected by HIV and AIDS. To meet the Millennium Development Goal of reversing the epidemic by 2015, stakeholders must change how services are designed and delivered. A lesson learned in the 1990s and 2000s was that a host of separate activities cannot be scaled up in a sustainable way and that strengthening health systems is essential for long-term sustainability. The time has come to take a systems approach to HIV & AIDS programming. This holistic approach will create a strong foundation by focusing all efforts on integration, effectiveness and sustainability.
The situation in Swaziland has deteriorated since the beginning of the
1990’s.While HIV/AIDS is not solely to blame for the reduction in living standards and life expectancy, it has compounded the effects of other events such as drought and falling foreign direct investment (FDI). Swazi society is in distress - overwhelming sickness, an increasing dependency ratio and thousands of OVC are placing households and communities under extreme duress. In Swaziland, HIV amd AIDS is creating a chronic emergency that is permanently altering development. This demonstrates a ‘new’ disaster that exceeds emergency thresholds and requires a new style of holistic response. While the traditional threshold approach to identifying emergencies remains useful for classifying ‘traditional’ disasters, a new framework of analysis is needed for HIV/AIDS. This could take the form of an index system or a series of thresholds. Within this it is crucial that the indicators measured are considered over time, with a sustained fall being the prime indication of an emergency. The element of ‘time’ has been missing from the debate surrounding humanitarian response.
Poverty, family stability, and social policies influence the ability of adolescents to attend school. Likewise, being enrolled in school may shape an adolescent’s risk for HIV and pregnancy. The authors identified trends in school enrollment, factors predicting school enrollment (antecedents), and health risks associated with staying in or leaving school (consequences). Data from the Rakai Community Cohort Study (RCCS) were examined for adolescents 15–19 years (n = 21,735 person-rounds) from 1994 to 2013. Trends, antecedents, and consequences were assessed. Qualitative data were used to explore school leaving among HIV+ and HIV− youths (15–24 years). School enrollment and socioeconomic status (SES) rose steadily from 1994 to 2013 among adolescents and orphanhood declined after availability of antiretroviral therapy. Antecedent factors associated with school enrollment included age, SES, orphanhood, marriage, family size, and the percent of family members <20 years. In qualitative interviews, youths reported lack of money, death of parents, and pregnancy as primary reasons for school dropout. Among adolescents, consequences associated with school enrollment included lower HIV prevalence, prevalence of sexual experience, and rates of alcohol use and increases in consistent condom use. Young women in school were more likely to report use of modern contraception and never being pregnant. Young men in school reported fewer recent sexual partners and lower rates of sexual concurrency.
Poverty, family stability, and social policies influence the ability of adolescents to attend school. Likewise, being enrolled in school may shape an adolescent’s risk for HIV and pregnancy. In this paper the authors identified trends in school enrolment, factors predicting school enrolment (antecedents), and health risks associated with staying in or leaving school (consequences). Data from the Rakai Community Cohort Study (RCCS) were examined for adolescents 15–19 years. School enrolment and socioeconomic status (SES) rose steadily from 1994 to 2013 among adolescents; orphanhood declined after availability of antiretroviral therapy. Antecedent factors associated with school enrolment included age, SES, orphanhood, marriage, family size, and the percent of family members <20 years. In qualitative interviews, youths reported lack of money, death of parents, and pregnancy as primary reasons for school dropout. Among adolescents, consequences associated with school enrolment included lower HIV prevalence, prevalence of sexual experience, and rates of alcohol use and increases in consistent condom use. Young women in school were more likely to report use of modern contraception and never being pregnant. Young men in school reported fewer recent sexual partners and lower rates of sexual concurrency. Rising SES and declining orphanhood were associated with rising school enrolment in Rakai. Increasing school enrolment was associated with declining risk for HIV and pregnancy.
This study assessed the role of governmental and non-governmental organisations in mitigation of stigma and discrimination among people infected and affected by HIV/AIDS in informal settlements of Kibera. More than 61% of the respondents had patients in their households. Fifty-five percent (55%) of the households received assistance from governmental and non-governmental organisations in taking care of the sick. Services provided included awareness, outreach, counselling, testing, treatment, advocacy, home based care, assistance to the orphans and legal issues. About 90% of the respondents perceived health education, counselling services and formation of post counselling support groups to combat stigma and discrimination to be helpful. Stigma and discrimination affects the rights of People Living with HIV/AIDS (PLWHAs). Such stigmatisation and discrimination goes beyond and affects those who care for the PLWHAs, and remains the biggest impediment in the fight against HIV/AIDS in Kibera. Governmental and non-governmental organizations continue to provide key services in the mitigation of stigma and discrimination in Kibera. However, personal testimonies by PLWHAs showed that HIV positive persons still suffer from stigma and discrimination. About 43% of the study population experienced stigma and discrimination.
A large clinical trial of anti-retroviral therapy (ART) for people with HIV infection in Africa has found that regular laboratory tests offer little additional clinical benefit to populations when compared to careful clinical monitoring. The DART trial aimed to find out whether the lab-based strategies used to deliver ART to people with HIV infection in resource-rich countries were essential in Africa, where around four million people still need ART urgently and resources are limited. The trial was carried out in three locations: Entebbe and Kampala in Uganda, and Harare in Zimbabwe, from 2003 to 2008. The results suggest that many more people with HIV in Africa could be treated for the same amount of money as is currently spent if lab tests are not routinely used to monitor ART. ART can be delivered safely and effectively by trained and supervised health workers in remote communities where routine laboratory services are not available – good news for low-income or resource-poor countries that are prioritising ART access over investment in expensive laboratory facilities.