Equity and HIV/AIDS

Conflict has long been assumed to contribute significantly to the spread of HIV infection. However, new research is casting doubt on this assumption. Studies from Africa suggest that conflict does not necessarily predispose to HIV transmission and indeed, there is evidence to suggest that recovery in the ‘post-conflict’ state is potentially dangerous from the standpoint of HIV transmission. There has also been concern that high rates of HIV infection among many of the militaries of sub-Saharan Africa poses a threat to regional security. However, data is lacking on this. These issues are of vital importance for HIV programming and health sector development in conflict and ‘post-conflict’ societies and will constitute formidable challenges to the international community. Further research is required to better inform the discussion of HIV, conflict and security in sub-Saharan Africa.

A meeting to address issues around HIV and men who have sex with men went ahead as scheduled in Addis Ababa, Ethiopia, on 3 December 2011, despite protests and calls for its cancellation by local religious leaders. The meeting - held a day before the opening of the 16th International Conference on AIDS and Sexually transmitted infections in Africa (ICASA) - was organized by the South African-based NGO, African Men for Sexual Health and Rights (AMSHeR). Originally due to be held at a local hotel, the venue quietly shifted to the UN compound in Addis Ababa. According to participants, it attracted more than 150 participants from 25 African countries, and focused on addressing the problems MSM faced in accessing HIV services. Speakers included UNAIDS executive director, Michel Sidibe. Before the meeting, four religious leaders had called a press conference to denounce it. Ethiopia's Minister of Health, Tedros Adhanom Ghebreyesus, persuaded them to cancel the press conference. Even at the new venue, there were hundreds of protesters outside for half the day, said one participant, Homosexuality is illegal in Ethiopia and punishable by between three and 10 years in prison. While the government allowed the meeting to go ahead, gay rights activists doubt it will lead to a positive change for MSM in Ethiopia.

This paper examines the history of HIV/AIDS in Kenya since it was first diagnosed in the country. The introduction of highly active antiretroviral therapy (HAART) has dramatically improved the prognosis for individual patients with AIDS, but education and changing attitudes towards condoms have led to a progressive fall in incidence, so that the worst of the epidemic may now be over. Limited personal experience suggests that steroids may also have a role in salvaging critically ill AIDS patients, who need to be treated as emergencies. With an educated public and attention to alternative routes of infection such as blood transfusion, the epidemic should be increasingly contained during the next 25 years, and may even fizzle out.

Failure to properly manage HIV strategies for employees has led to some workplace programmes being closed down, as audits have revealed unacceptable costs. Individual companies, communities and the South African economy are under threat if companies do not initiate expertly managed, independent and outsourced HIV programmes for their employees. Failure to expertly manage programmes effectively means money spent on them is wasted, with consequent negative impacts on the individuals concerned, and workplace productivity and morale. Companies that try to cut corners are reported to be undermining themselves, as well as the entire local treatment initiative.