Couples’ HIV testing and counselling (CHTC) is associated with greater engagement with HIV prevention and care than individual testing and is cost-effective, but uptake remains suboptimal. The authors aimed in this work to determine the impact of incentives for CHTC on uptake of couples testing and HIV case diagnosis in rural Zimbabwe. 68 rural communities (the clusters) in four districts receiving mobile HIV testing services were randomly assigned to incentives for CHTC or not. Allocation was not masked to participants and researchers. Randomisation was stratified by district and proximity to a health facility. Within each stratum random permutation was done to allocate clusters to the study groups. In intervention communities, residents were informed that couples who tested together could select one of three grocery items worth US$1·50. Standard mobilisation for testing was done in comparison communities. The primary outcome was the proportion of individuals testing with a partner. Analysis was by intention to treat. 3 months after CHTC, couple-testers from four communities per group individually completed a telephone survey to evaluate any social harms resulting from incentives or CHTC. The study indicated that small non-monetary incentives, which are potentially scalable, were associated with significantly increased CHTC and HIV case diagnosis. Incentives did not increase social harms beyond the few typically encountered with CHTC without incentives. The authors suggest that the intervention could help achieve UNAIDS 90-90-90 targets.
Equity and HIV/AIDS
This article, published in the Bulletin of the World Health Organization, explores how the HIV epidemic has affected the infant feeding experiences of HIV-positive mothers in South Africa. The paper finds that the HIV epidemic has changed the context in which infant-feeding choices are made and implemented. HIV positive mothers are struggling to protect their decision-making autonomy; uncertainty about the safety of breastfeeding has increased the power and influence of health workers who act as gatekeepers to knowledge and resources such as formula milk. Women who chose to exclusively formula feed experience difficulties accessing formula milk because of inflexible policies and a lack of supplies at clinics. Limited support for mothers with newborn babies can result in social isolation and mothers doubting their ability to care for their children.
This study assessed the effectiveness of a peer-led HIV prevention intervention in secondary schools in Rwanda on young people's sexual behaviour, HIV knowledge and attitudes. Fourteen schools were selected in two neighbouring districts, Bugesera (intervention group) and Rwamagana (control group), and 1,950 students participated. Researchers found that time trends in sexual risk behaviour (being sexually active, sex in last six months, condom use at last sex) were not significantly different in students from intervention and control schools, nor was the intervention associated with increased knowledge, perceived severity or perceived susceptibility. However, stigma was reported as significantly reduced. To explain the failure of the intervention, the authors argue that young people may prefer receiving HIV information from sources other than peers. In addition, outcome indicators were not adequate. They call for integration of peer-led prevention in holistic interventions, as well as redefining peer educators' role as focal points for sensitisation and referral to experts and services. Interventions with a narrow focus on sexual risks should be avoided.
The objective of this study was to report the rates of mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV), and the coverage of interventions designed to prevent such transmission, in KwaZulu-Natal, South Africa. Mothers with infants aged ≤16 weeks and fathers or legal guardians with infants aged 4–8 weeks who, between May 2008 and April 2009, attended immunisation clinics in six districts of KwaZulu-Natal were included. Findings indicated that, of the 19,494 mothers investigated, 89•9% reported having had an HIV test in their recent pregnancy. Of the 19,138 mothers who reported ever having had an HIV test, 34.4% reported that they had been found HIV-positive and, of these, 13.7% had started lifelong antiretroviral treatment and 67.2% had received zidovudine and nevirapine. Overall, 40.4% of the 7,981 infants tested were found positive for anti-HIV antibodies, indicating HIV exposure. The low levels of MTCT observed among the infants indicate the rapid, successful implementation of interventions for the prevention of such transmission and suggest that the elimination of paediatric HIV infections is feasible, although this goal has not yet been fully achieved in KwaZulu-Natal.
Where have the billions of dollars poured into Africa to fight AIDS gone? A lot of this money is channelled through non-governmental organisations (NGOs) mainly to pay for life-prolonging drugs and education campaigns on a continent where many national healthcare systems are broke and in tatters. Donors increasingly prefer to fund NGOs rather than African governments, many of which are seen as corrupt. But because the NGOs number in the thousands, it is unclear how much money they have received or how it was used.
The issue of violence exacerbating the spread of HIV/AIDS, particularly in women, has remained a hot one at the World Social Forum (WSF). From Africa to Asia, activists are reiterating that violence against women remains a threat to the HIV/AIDS fight, and that without governments addressing the matter, winning the war against the disease will be an uphill task.
Local non-governmental organizations (NGOs), faith-based organization(FBOs), and community-based organizations (CBOs) have always been and continue to be a driving force in response to the HIV/AIDS epidemic. In many countries, they have been responsible for the majority of the resources reaching individuals and have played a leading role in developing and implementing sustainable strategies to mitigate and prevent HIV/AIDS. In December 2005, Pact's Community REACH program released this important document entitled "Engaging Local NGOs in the Response to HIV/AIDS", highlighting their essential role in the fight against HIV/AIDS.
Conflation of HIV and alcohol disease in African settings is not surprising given patterns of heavy-episodic drinking and that drinking contexts are often coterminous with opportunities for sexual encounters. HIV and alcohol also share common ground with sexual violence. Reducing alcohol harms necessitates multi-level interventions and should be considered a key component of structural interventions to alleviate the burden of HIV and sexual violence. Brief interventions for people with problem drinking must incorporate specific discussion of links between alcohol and unsafe sex, and consequences thereof. Interventions to reduce alcohol harm among HIV-infected persons are also an important element in positive-prevention initiatives. Most importantly, implementation of known effective interventions could alleviate a large portion of the alcohol-attributable burden of disease, including its effects on unsafe sex, unintended pregnancy and HIV transmission.
Sub-Saharan Africa carries a massive dual burden of HIV and alcohol disease, and these pandemics are inextricably linked, says this study. Conflation of HIV and alcohol disease in these setting is not surprising given patterns of heavy-episodic drinking and that drinking contexts are often coterminous with opportunities for sexual encounters. HIV and alcohol also share common ground with sexual violence. Both perpetrators and victims of sexual violence have a high likelihood of having drunk alcohol prior to the incident, as with most forms of violence and injury in sub-Saharan Africa. According to this study, reducing alcohol harms necessitates multi-level interventions and should be considered a key component of structural interventions to alleviate the burden of HIV and sexual violence. It recommends that brief interventions for people with problem drinking must incorporate specific discussion of links between alcohol and unsafe sex, and consequences thereof. Additionally, implementation of known effective interventions could alleviate a large portion of the alcohol-attributable burden of disease, including its effects on unsafe sex, unintended pregnancy and HIV transmission.
More than 20 studies in Africa have reported higher occurrence of HIV among people with problem drinking; a finding strongly consistent across studies and similar among women and men. Conflation of HIV and alcohol disease in these setting is not surprising given patterns of heavy-episodic drinking and that drinking contexts are often coterminous with opportunities for sexual encounters. Both perpetrators and victims of sexual violence have a high likelihood of having drunk alcohol prior to the incident, as with most forms of violence and injury in sub-Saharan Africa. Reducing alcohol harms necessitates multi-level interventions and should be considered a key component of structural interventions to alleviate the burden of HIV and sexual violence. Brief interventions for people with problem drinking (an important component of primary health care) must discuss links between alcohol and unsafe sex, and consequences thereof. Interventions to reduce alcohol harm among HIV-infected persons are also an important element in positive-prevention initiatives. Most importantly, implementation of known effective interventions could alleviate alcohol’s effects on unsafe sex, unintended pregnancy and HIV transmission.