This study’s main aim was to determine what US$577 million in funding from the US President’s Fund for AIDS Relief (PEPFAR) between 2004 and 2008 has achieved in Zambia. Its findings are based on interviews with HIV and AIDS organisations, activists, medical professionals, community leaders, policymakers and programme participants. PEPFAR followed the ABC (abstain, be faithful and use a condom) approach to HIV prevention in Zambia but, according to this report, in 2008, US$20.5 million was channelled to programmes focused on abstinence and being faithful, compared to only US$12.4 million allocated to programmes promoting other approaches, including the use of condoms. Only four organisations received funding to promote condom use. ‘The disproportionate emphasis on abstinence-until-marriage [...] has created a distinctly anti-condom atmosphere,’ the authors noted. They recommended more extensive sex education programmes.
Equity and HIV/AIDS
All around the world, people with HIV are being charged for endangering the lives of others. But this doesn't stop the spread of HIV because most of those infected don't know they have the virus, argues Judge Edwin Cameron, addressing the World AIDS Conference. ‘Criminalisation is warranted only in cases where someone sets out well-knowing he has HIV, to infect another person, and achieves this aim,’ argued Cameron. In general, the laws would not protect people from HIV: ‘In the majority of cases, the virus spreads when two people have consensual sex, neither of them knowing that one has HIV. That will continue to happen, no matter what criminal laws are enacted,’ said Cameron. ‘Criminalisation places blame on one person instead of responsibility on two,’ said Cameron.
Malawi aims to more than triple the number of HIV-positive people in the country who are receiving antiretroviral drugs at no cost by July with the help of a $14 million grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria, a Malawian health official said on Monday, AFP/Independent Online reports. Malawi in May 2004 began a five-year, $196 million nationwide program to provide antiretroviral drugs to HIV-positive people at no cost.
Developing countries like Malawi are calculating the cost of adhering to new World Health Organization (WHO) guidelines that recommend starting HIV-positive people on antiretroviral drugs (ARVs) sooner. Malawi is one of three African countries that have conducted WHO-supported feasibility studies to assess what adopting the new guidelines would mean, and has announced plans to roll out the new WHO guidelines by mid-2011, said Dr Frank Chimbwandira, head of the HIV and AIDS department in the Ministry of Health. According to the feasibility study, the number of people on treatment would rise by about 50%, which could double the cost of the national ARV programme in terms of additional personnel and equipment, and would probably also mean waiting lists at many clinics. Implementing the WHO guidelines would mean major changes to national treatment protocols: HIV-positive people would start taking ARVs at a much higher CD4 count of 350, regular CD4 count and viral load monitoring would be conducted, and potentially more expensive treatment regimens would be adopted - including phasing out the ARV, stavudine, which has been associated with increased side-effects.
This recently published national policy document has eight chapters covering, inter alia, a multi-sectoral response to HIV/AIDS; issues of prevention, treatment and care; the empowerment of People Living with HIV/AIDS and of vulnerable populations; traditional and religious practices and services; HIV/AIDS in the workplace and research questions. Will also be of interest to organisations outside Malawi.
In a small village in Kaswela in Karonga district in the northern region of Malawi, 35-year-old Lucy Banda has been critically ill for a year, and her neighbours suspect she is HIV-positive. Despite numerous visits to the hospital, Banda shows no signs of improvement and spends most of her time lying on her mat, unable to talk or eat properly. A community based NGO in the district, Chipulikano Orphan Care (COC), is trying to address the problem of caring for orphans and vulnerable children, as well as raising awareness about AIDS within families - traditionally a taboo subject.
Despite being largely preventable, mother-to-child transmission of HIV accounts for 30% of all new infections in Malawi and is the second major mode of transmission after unprotected sex. Every year, an estimated 30,000 babies are born HIV positive. Relatively simple interventions to lower the risk of infection are available to only a small number of women and lag far behind the country's antiretroviral (ARV) treatment programme, which now reaches 70,000 HIV-infected people, or about 40 percent of those who need them.
This study in the Kenyan capital, Nairobi, noted reduced HIV risk when the male partner of a pregnant woman attended antenatal clinic visits and was also tested for HIV. The study enrolled 532 HIV-positive pregnant women, 140 of whom were accompanied by their male partners on antenatal visits. Results showed that the one-year-old children of women whose partners had attended the clinics had an HIV-free survival rate 59% higher than those whose partners did not attend. These findings indicate that promotion of programmes aimed at increasing male attendance in antenatal care could function to reduce the risk of vertical transmission and infant mortality. About 80% of antenatal clinics in Kenya offer prevention of mother-to-child HIV transmission (PMTCT) services, but the uptake of counselling and testing is below 50%. The government is considering various incentives, such as waiving maternity fees for couples who attend PMTCT sessions together, to boost male participation.
A Zambian government initiative to begin the local manufacture of cheap generic antiretroviral (ARV) drugs has been welcomed by AIDS activists. "We have been lobbying for affordable drugs for 10 years. This is a dream come true," said coordinator of the Network of Zambian People Living with HIV/AIDS (NZP+), Clement Mfuzi. "As NZP+, our hope has not only been accessibility, but also affordable drugs. We also hope the supply will be sustainable, because once you take these drugs, it is for life."
WHO and many other organisations are very interested in implementing treatment-as-prevention as a global policy to control the HIV pandemic.1 Widespread treatment of HIV-infected individuals with antiretroviral therapy will reduce HIV transmission, because it decreases viral load and hence infectiousness. To implement the rollout of treatment-as-prevention in an efficient manner, estimation of the number of HIV-infected individuals and where they live is needed. This assessment will be difficult to accomplish, particularly in areas of sub-Saharan Africa with severe HIV epidemics. The authors propose a solution to this problem by using geospatial statistical techniques and global positioning system (GPS) data.