This paper presents data to show how under-financing the global response to AIDS has proven disastrous in the past. The lack of an early, well-financed and effective response to AIDS in the 1980s and 1990s provided an opportunity for this epidemic to grow rapidly when a sustained, global response could have prevented the spread of HIV and the resulting impact on the health, economies and communities of the world’s poorest nations. Recent increases in dedicated AIDS financing, however, particularly over the last five years, have produced impressive gains across a wide range of health, development, economic and social indicators. Increases in the number of people on HIV treatment tracks the increase in donor financing for AIDS. In 2008 alone, funding for HIV-specific programmes from wealthy countries grew to US$7.7 billion – a 56% increase from 2007. The brief urges governments and other stakeholders to adopt progressive financing mechanisms for health. It notes that, if full investments were made in country-level universal access targets by 2010 that: the number of new HIV infections averted in 2009-2010 alone would be 2.6 million; the number of deaths averted over that year would be 1.3 million; and incidence of HIV over that year would be cut by nearly 50%.
Equity and HIV/AIDS
This study investigated a theoretical strategy of universal voluntary HIV testing and immediate treatment with ART, and examined the conditions under which the HIV epidemic could be driven towards elimination. Data from South Africa was used as the test case for a generalised epidemic, and it was assumed that all HIV transmission was heterosexual. The study found that the strategy could greatly accelerate the transition from the present endemic phase, in which most adults living with HIV are not receiving ART, to an elimination phase, in which most are on ART, within five years. It could reduce HIV incidence and mortality to less than one case per 1,000 people per year by 2016. Universal voluntary HIV testing and immediate ART, combined with present prevention approaches, could have a major effect on severe generalised HIV/AIDS epidemics.
The authors of this study set out to determine the relative roles of stigma versus health systems in non-uptake of prevention of mother to child transmission of HIV-1 interventions by conducting a cross-sectional assessment of all consenting mothers accompanying infants for six-week immunisations. Between September 2008 and March 2009, mothers at six maternal and child health clinics in Kenya's Nairobi and Nyanza provinces were interviewed regarding PMTCT intervention uptake during recent pregnancy. Among 2,663 mothers, 2,453 (92.1%) reported antenatal HIV-1 testing. Although internal or external stigma indicators were reported by between 12% and 59% of women, stigma was not associated with lower HIV-1 testing or infant HIV-1 infection rates; internal stigma was associated with modestly decreased antiretroviral uptake. Health system factors contributed to about 60% of non-testing among mothers who attended antenatal clinics and to missed opportunities in offering antiretrovirals and utilisation of facility delivery.
Nearly US$1.3 billion spent on US-funded programmes to promote abstinence and faithfulness in sub-Saharan Africa is argued by the author of this paper to have had no significant impact on sexual behaviour in 14 countries in sub-Saharan Africa, as shown from an analysis of sexual behaviour data. The preliminary findings were presented by Nathan Lo of Stanford University School of Medicine at the Conference on Retroviruses and Opportunistic Infections (CROI 2015) in Seattle, USA. The Pepfar programmes aimed to delay sexual debut in order to reduce the period of high risk during adolescence, especially for girls, and to reduce partner numbers. The study investigated trends in sexual behaviour derived from national Demographic and Health Surveys in 14 PEPFAR focus countries before and after the beginning of PEPFAR funding in 2004, and compared these to a counterfactual: trends in eight other African countries – largely in West Africa – where PEPFAR funding was not determining the content of prevention campaigns. They found no significant change in PEPFAR countries relative to non-PEPFAR countries over time for any of the measures assessed, for men or women, although there was a trend towards a lower number of reported sexual partners for men in both PEPFAR and non-PEPFAR countries.
The author argues in this paper that United States government policy has violated the rights of African people living with HIV and AIDS through its ‘moral’ restrictions prioritising abstinence-only sex education, restricting condom distribution and stigmatising sex workers. The author argues that the focus on technocratic approaches such as biomedical quick fixes, like the recent emphasis on male circumcision, ignores the deeply gendered, racial and sexual dimensions of the disease or its social, economic and cultural pathology in Africa.
The United States government policy has violated the human rights of people living with HIV and AIDS through its ‘moral’ restrictions prioritising abstinence-only sex education, restricting condom distribution and stigmatising sex workers. The government’s close ties with pharmaceutical companies and manipulation of trade in medicines have also infringed on the human right to health by undermining international efforts to enshrine access to essential medicines as a human right. By sanitising and de-sexualising the politics of HIV and AIDS, and focusing on technocratic approaches such as biomedical quick fixes, like the recent emphasis on male circumcision, it ignores the deeply gendered, racial and sexual dimensions of the disease or its social, economic and cultural pathology.
The United States Agency for International Development (USAID) has instructed its staff to force governments in several African countries to discontinue the provision of US-funded contraceptive commodities to Marie Stopes International (MSI), one of the world’s leading family planning organisations. USAID claims MSI works with the Chinese Government, whom the US State Department accuses of ‘coercive abortion and involuntary sterilisations’. MSI denied that MSI supports coercive abortion or involuntary sterilisation in China or elsewhere. It said the instruction will ‘seriously disrupt’ MSI’s family planning programmes in at least six African countries – Ghana, Malawi, Sierra Leone, Tanzania, Uganda and Zimbabwe - including one where the organisation delivers 25% of all family planning services nationally. Women in these countries will be left with few options other than unsafe abortions, resulting in death or disability.
The objective of this study was to use service data to inform HIV-free survival among HIV exposed children that received antiretroviral drugs to prevent mother-to-child transmission (PMTCT) of HIV. The study was conducted in two rural districts in Malawi between June 2005 and June 2009. Out of 438 children whose home addresses were available, 33 (8%) were lost to follow-up, 35 (8%) were alive but not tested for HIV by the time home visit was conducted, and 52 (12%) were confirmed deceased. A total of 318 children were alive at the time of the home visit and had an HIV antibody test done at median age 15 months. The resulting estimated 24-month probability of HIV-free survival over all children was 78%. Among children who did not receive nevirapine, the estimated 24-month probability of HIV-free survival was 61%, and among those who did receive it, the estimate was 82%. When mothers and newborns received nevirapine, the estimated 24-month probability of HIV-free survival among children was high at 82%. However, the authors warn that these promising findings should be interpreted cautiously due to the wide confidence interval and because the confidence interval range includes 55%, which is the natural HIV-free survival rate in the absence of a PMTCT intervention. This analysis highlighted the need of quality data and well-structured home visits to assess PMTCT effectiveness.
Stigma is increasingly regarded as a key driver of the HIV and AIDS epidemic and has a major impact on public health interventions. The objective of this ‘creativity initiative’ was to provide activities in an HIV clinic while patients waited to be seen by healthcare professionals. It was envisaged this would contribute to reduction of clinic-based stigma felt by clients. The study took the form of a cross-sectional survey carried out in October-November 2005 and March-April 2007 at the Infectious Diseases Institute clinic (IDC) at Mulago, the national referral hospital in Uganda. Comparisons were made between patients who took part in activities and those who did not. Results suggest that clients who attended the IDC before the creativity intervention were about twice as likely to fear catching an infection as those who came after the intervention. The proportion that had fears to be seen by a friend or relative at the clinic decreased. Thus during the implementation of the creativity intervention, HIV-related stigma was reduced in this clinic setting.
Two new studies have confirmed fears that the use of antiretroviral (ARV) drugs to prevent HIV could lead to drug resistance if inadvertently used by people who were already infected. The findings, presented at the International Microbicides Conference in the United States earlier in May, suggest that regular HIV testing would have to be an integral part of any prevention programme using ARVs. Prevention approaches incorporating ARVs are still being tested in clinical trials, but are thought to be among the most promising potential interventions against HIV. One approach, called pre-exposure prophylaxis (PrEP), would involve giving a daily dose of a single ARV drug to people who were HIV-negative but at high risk. This could be effective in preventing HIV, but if someone who is already infected is treated, this could raise the risk of developing resistant strains of the virus.