The International Labour Organization’s (ILO) Code of Practice on HIV and AIDS, which aims to strengthen the global response to HIV in the workplace, was adopted by governments, employers and workers at the annual conference of the ILO, held in Switzerland from 2–18 June 2010. As a new labour standard, it is intended to reinforce and extend anti-discrimination policies in the workplace. It reaffirms the right to continued employment regardless of HIV status and asserts that workers should not be screened for HIV for employment purposes. The standard also recognises the need for focused action to protect the rights of populations that may be more vulnerable to HIV infection, and is expected to provide support to the goal of universal access to HIV prevention, treatment, care and support. The labour costs of HIV are recognised in the standard, especially since HIV affects the most economically active age range in every population and the loss of most the 33.4 million people living with HIV would represent a major loss of skills and experience that might have a negative effect on economies and communities. The standard is the first internationally-sanctioned instrument that focuses specifically on HIV in the workplace. It is expected to significantly enhance the impact of HIV prevention and treatment programmes in the workforce globally.
Equity and HIV/AIDS
There is emerging data from Southern Africa that key populations such as female sex workers (FSW) carry disproportionate burden of HIV; however, their burden of HIV and prevention needs remains unknown in Swaziland. To address this gap, a respondent-driven-sampling survey was completed between August and October, 2011 of 328 FSW in Swaziland. Unadjusted HIV prevalence was found to be 70.3% among a sample of women predominantly from Swaziland with a mean age of 21, which was significantly higher than the general population of women. Just 23.5% reported always wearing condoms with sexual partners in the past month, while rape was common at 40% reporting at least one rape, with torture reported at 53.2%. While Swaziland has a highly generalised HIV epidemic, FSW represent a distinct population with a high burden of HIV compared to other women, according to the authors. These women are understudied and underserved resulting in a limited characterisation of their HIV prevention, treatment, and care needs and only sparse targeted programming. The authors argue that FSW are an important population for further investigation and rapid scale-up of combination HIV prevention including biomedical, behavioural and structural interventions.
Nearly 500 delegates from all over the world met at the Rio de Janeiro Global Forum to discuss how men can help improve gender equality, prevent domestic and sexual violence, and improve maternal and reproductive health for themselves and their partners. Gender roles play a major role because they can determine the extent of our vulnerability to the HIV infection. Research in nine Latin American countries found that young men, aged 10 to 24, were far more concerned with achieving and preserving their masculinity than with their health. Another study found that expectations about male behaviour may result in early sexual initiation and more sexual partners, less intimacy in relationships and reluctance to use condoms.
There are the four pillars that will ensure that Africa and Asia are both able to respond to the challenges of HIV and also apply the painful lessons learned from this epidemic in cultures and societies that may – at first glance – seem so different. These are: Visionary leadership; people-centred policies; innovative evidence-informed programmes and passionate participation.
Trial sponsors and implementers are ethically obligated to refer HIV infected Individuals identified in a research study at screening for HIV care and treatment. Makerere University Walter Reed Project is conducting HIV surveillance among high risk uninfected female sex workers. This study describes patterns in participants’ receipt of HIV results and response to referral for HIV care and treatment. Results indicated HIV prevalence was 35% at screening. Out of the 221 prevalent cases, only 96 participants (43%) received HIV confirmatory results and were referred for care, while 9 (4%) declined referral. The majority did not return for either their initial or confirmatory HIV result; while a few declined a blood re-draw. Of the 96 participants referred, 58% are currently in care, 14% did not report for care predominately citing indecisiveness while 28% could not be tracked. Most of the acutely infected participants (6/8) are in care. The authors argue that, although trial implementers may fulfil their obligation in referring study participants for HIV care, participants have a key role to play in facilitating this process. The large number of HIV prevalent female sex workers who did not return for their HIV results and may not be aware of their status could be a potential driver of the epidemic in Uganda, the paper concludes.
This commentary was written on the International AIDS Conference in Melbourne 20-25 July 2012, the 20th gathering of the largest regular conference of any health or development issue, bringing together politicians, scientists, epidemiologists, practitioners, policy makers, the private sector and communities of people living with and affected by HIV. There is uniqueness in this fight against HIV in that it is a social movement, pulling people together and putting people at the forefront of the response to sustain efforts on addressing HIV. The theme of the 2014 conference was ‘Stepping up the Pace,’ and the author comments that we must redouble our efforts on areas like stigma and discrimination, which after 30 years is still increasing in some regions. 'We have the tools; we need to step up the pace.’ Today, there are 15 million people on treatment, yet there are still alarming challenges that must be tackled in order to even contemplate an AIDS free generation. Statistics from 2013 show there were 1.5 million HIV deaths, 2.1 million new infections and 35 million people living with HIV. Of the 35 million people living with HIV, 55% (19 million) don’t know they have the virus. They haven’t been tested and if they don’t find this out, they will die. The conference highlighted many reasons as to why people do not access or drop out of treatment. The author argues that people must not become those tired advocates beating the same drum, but come back from the conference championing the successes of work over the last 30 years and enter a phase of renewed energy to step up the pace and most importantly leave no one behind.
In Southern Africa, only 100 000 out of 4.1 million people who need HIV/AIDS anti-retroviral therapy (ART) are able to access it. The drop in the price of ART has led to opportunities to increase the numbers receiving treatment, but problems remain. Increasing health service focus on HIV might poach staff and resource from other important programs like TB, malaria or child health. Developing countries need to balance resources for treatment and prevention.
Inequitable gender-based power in relationships and intimate partner violence contribute to persistently high rates of HIV infection among South African women. The authors examined the effects of two group-based HIV prevention interventions that engaged men and their female partners together in a couples intervention (Couples Health CoOp [CHC]) and a gender-separate intervention (Men’s Health CoOp/Women’s Health CoOp [MHC/WHC]) on women’s reports of power, communication, and conflict in relationships. Of the 290 couples enrolled, 255 women remained in the same partnership over 6 months. Following the intervention, women in the CHC arm compared with those in the WHC arm were more likely to report an increase in relationship control and gender norms supporting female autonomy in relationships. Women in the MHC/WHC arm were more likely to report increases in relationship equity, relative to those in the CHC arm, and had a higher odds of reporting no victimisation during the previous 3 months. Male partner engagement in either the gender-separate or couples-based interventions led to modest improvements in gender power, adoption of more egalitarian gender norms, and reductions in relationship conflict for females. The aspects of relationship power that improved, however, varied between the couples and gender-separate conditions, highlighting the need for further attention to development of both gender-separate and couples interventions.
The objective of this study was to establish the reliability of the scored Patient-Generated Subjective Global Assessment (PG-SGA) in determining nutritional status among antiretroviral therapy (ART) naive HIV-infected adults. A descriptive, cross sectional study was conducted among outpatient medical clinics in the AIDS Support Organisation (TASO), Mulago Centre, Kampala, Uganda. The study sample totalled 217 HIV-positive patients, consisting of 60 male and 157 female patients, aged 18-67 years old. Data collection was done from April-May 2008. Results showed that only 12% of the subjects were underweight and over half (58.2%) had normal weight. The PG-SGA had low sensitivity (69.2%) and specificity (57.1%) at categorising the risk for malnutrition indicated by Body Mass Index of less than 18.5. The authors note that there was a high prevalence of malnutrition among the study group, but the PGSGA could not adequately discriminate between underweight and normal patients. The tool was not reliable enough for determining nutritional status in this population.
A self-administered survey was distributed to a convenience sample of church-goers in both urban and rural areas, which included questions about religious beliefs, opinions about HIV, and knowledge and attitudes about anti-retrovirals (ARVs). Results indicated that shame-related HIV stigma is strongly associated with religious beliefs such as the belief that HIV is a punishment from God or that people living with HIV/AIDS (PLWHA) have not followed the Word of God. Most participants said that they would disclose their HIV status to their pastor or congregation if they became infected. Although most respondents believed that prayer could cure HIV, almost all said that they would begin ARV treatment if they became HIV-infected. So, the decision to start treatment was hinged primarily on education level and knowledge about ARVs, rather than on religious beliefs.