In South Africa a generation of children who were born HIV-positive is reaching young adulthood, but they are not getting the type of message or psychosocial support they need from the public sector. ‘These kids are getting older on treatment and surviving on treatment; they're becoming sexually active, they want to get married,’ HIV paediatrician Dr Harry Moultrie told the annual University of the Witwatersrand AIDS Research Symposium in Johannesburg at the end of August. We’re seeing a lot of teen pregnancies, sexually transmitted diseases and poor developmental outcomes.’ Studies in the United States have shown that HIV-positive teens may be more likely to engage in risky behaviour. Similar studies have yet to be carried out in South Africa, but Moultrie noted that if the findings were similar, many doctors in South Africa would not be ready to deal with the challenge. Only 12 clinics in the country are offering specialised services to HIV-positive youth. Moultrie called on the government to re-examine the guidelines that sent children aged 14 years or older away from paediatric clinics and into adult facilities, which might not be able to offer them the services they needed. ‘You have to realise that a lot of these children have gone through multiple childhood traumas, including multiple changes in caregivers,’ he said.
Equity and HIV/AIDS
Food parcels are finally being offered to HIV positive mothers in KwaZulu Natal who want to exclusively breastfeed their babies as part of a new government policy. In the past, positive mothers were advised to either exclusively formula feed or, in cases where there was no supply of clean water, to exclusively breastfeed to protect their babies from getting HIV. But while free formula milk was dished out, no practical support was offered to those who wanted to breastfeed. The mothers, particularly those who were poor, tended to see the formula milk as an incentive. They then tended to opt to get the formula milk and feed their babies both breast and formula milk – the most risky feeding choice for passing on HIV. An exuberant Professor Nigel Rollins, head of the Centre for Maternal and Child Health at the University of KwaZulu-Natal, said he was “delighted” that government had chosen to help HIV positive breastfeeding women meet their increased nutritional needs (of breastfeeding) by offering six months’ worth of food parcels.
With increased levels of school enrolment, more adolescents in Ethiopia are in school today than ever before, but few studies have assessed the sexual behaviour of these learners. This study addresses the research gap by assessing pre-marital sex and factors associated with it among school-going adolescents in Eastern Ethiopia. A cross-sectional school-based study was conducted using a facilitator-guided, self-administered questionnaire. Respondents were students attending regular school classes in fourteen high schools. Results showed that about one in four respondents who were unmarried (24.8%) reported pre-marital sex – of these 28.8% were males and 14.7% were females. Pre-marital sexual debut was more common among adolescents who had their parents in urban areas, who received higher pocket money per month, who perceived low self-educational rank and who lived in rented houses. The girls and those who were less influenced by external pressure were more protected against pre-marital sexual debut than their counterparts. The authors argue that public health interventions should consider the broader determinants of premarital sex, including the ecological factors in which the behaviour occurs.
Researchers conducted a retrospective cohort study analysing data on patients who presented to McCord Hospital, Durban, and started ART between 1 January 1999 and 29 February 2004. Univariate and multivariate analysis were performed and Kaplan-Meier curves were created to assess predictors. Simple clinical and laboratory data independently predict mortality and allow for risk stratification in patients initiating ART in South Africa. Interventions enabling patients to be identified before they develop these clinical markers and earlier initiation of ART will help to ensure maximum benefits of therapy.
The paper assessed preference and uptake for the enabling environment created to deliver the different community-based HIV testing services to female sex workers along the Malaba-Kampala highway. Malaba – Kampala high way is one of the major high ways with many different hot spots where the actual buying and selling of sex takes place. The authors defined female sex workers as any female, who undertakes sexual activity after consenting with a man for money or other items/benefits as an occupation or as a primary source of livelihood irrespective of site of operation within the past six months. The authors assessed the preference and uptake of different community-based HIV testing services delivery model among female sex workers based on the proportion of female sex workers who had an HIV counseling and testing in the last 12 months and the proportion of female sex workers who were positive and linked to care. Overall, 86% of the female sex workers had taken an HIV test in the last 12 months. Of the 390 Female Sex workers, 72% had used static facilities, 25% had used outreaches, and 3.3% used peer to peer mechanisms to have an HIV test. Overall, 35% of the female sex workers who had taken an HIV test were HIV positive. Of the 159, 83% were successfully linked into care. Ninety one percent reported to have been linked into care by static facilities. Challenges experienced included; lack of trust in the results given during outreaches, failure to offer other testing services including hepatitis B and syphilis during outreaches, inconsistent supply of testing kits, condoms, STI drugs, and unfriendly health services due to the infrastructure and non-trained health workers delivering KP HIV testing services. Most of the Female Sex workers had HIV counseling and testing services and were linked to care through static facilities. Community-based HIV testing service delivery models are challenged with inconsistent supply of HIV testing commodities and unfriendly services. The authors recommended strengthening of all HIV testing community-based HIV testing service delivery models by ensuring constant supply of HIV testing/AIDS care commodities offering Female Sex workers friendly services, and provision of comprehensive HIV/AIDS health care package.
Something is definitely not quite right with the concept or delivery of Prevention of Mother-to-Child HIV Transmission (PMTCT) services. While uptake has been known to be poor, in spite of policy guidelines that require all expectant mothers seeking antenatal care to be counselled and offered an HIV test, it has now emerged that health workers are having to contend with a significant number of rural women who reject positive results. HEPS-Uganda has found worrying cases of expectant mothers who consent to an HIV test in Kamwenge in western Uganda turn around to decline positive tests. In a December 2007 project report, 'Community Empowerment and Participation in Maternal Health in Kamwenge District', HEPS-Uganda says that while its project resulted in more pregnant women seeking ANC services, a big proportion of them still refuse to consent to voluntary HIV counselling and testing (VCT) services and that some of the few who consent do not accept their results.
According to this report, projections indicate that new HIV infections will surpass the global community’s capacity to provide treatment. If the burden of HIV and AIDS does reach the projected levels, it will confront decision makers with tough choices about who receives life-saving treatment and who does not. The Institute of Medicine (IoM) argues that capabilities need to be expanded to enable professionals overseeing HIV and AIDS policies, programmes and resource allocation to receive ethical training and to carry out their responsibilities within the structures needed to ensure transparency and accountability in these life-altering decisions. No single strategy will offer a magic bullet to meet the challenge of HIV/AIDS, therefore coun¬tries will need to adopt multi-pronged approaches. In particular, African nations should plan now for how to respond to this rapidly growing epidemic. IOM concludes that shared responsibility between the United States and African nations will empower these nations to take ownership of the challenge of HIV and AIDS and to work together to address the issues. For African nations, the focus should be on strengthening health care systems by making the most of existing capacities, such as health care workers on the ground and local institutions.
This study investigated the socio-demographic determinants of recent HIV testing among older persons in selected rural districts in Uganda using a cross-sectional survey of 649 older men and women age 50 years and older, from central and western Uganda. Prevalence of lifetime HIV testing was 82% and recent HIV testing was 53%. HIV testing in the last 12 months was associated with age, self-reported sexually transmitted infections, male circumcision, and sexual activity in the last 12 months. Recent HIV testing among older persons was associated with younger age, self-reported STIs, male circumcision, and sexual activity among older persons in rural Uganda. The authors propose that HIV testing interventions target persons 70 years and older, who were less likely to test.
This study aimed at determining the prevalence and factors associated with use of traditional herbal medicines (THM) among HIV-infected patients on highly active antiretroviral therapy (HAART) attending the AIDS Support Organisation (TASO), a non-governmental organisation offering HIV and AIDS services in Uganda. This was a cross-sectional study carried out in two TASO treatment centres among 401 randomly selected eligible participants. Participants were 18 years and older, and were enrolled on HAART. The authors found that the average prevalence of THM use was 33.7%. Patients on HAART for less than four years were more likely to use THM, as well as those who experienced HAART side effects. Patients older than 39 years old were less likely to use THM. Participants with HAART adherence levels greater than 95% were less likely to use THM. Overall, the prevalence of THM use among participants on HAART was high, which raises clinical and pharmacological concerns that need attention by the health care service providers, the authors conclude.
The world's highest HIV infection rates are found in Sub-Saharan Africa (SSA), where adult prevalence in most countries exceeds 25%. Food shortages and malnutrition have combined with HIV/AIDS to bring some countries to the brink of crisis. The aim of this study was to describe prevalence of malnutrition among HIV-infected women and variations across socioeconomic status using data from 11 countries in SSA. Prevalence of HIV-related malnutrition among women varies by wealth status, education attainment, occupation, and type of residence (rural/urban). The observed socioeconomic disparities can help provide more information about population subgroups in particular need and high risk groups, which may in turn lead to the development and implementation of more effective intervention programmes.