The Kenyan government has launched an ambitious HIV campaign to test at least one million people across the country over a three-week period. The programme is the first step in a national campaign that intends to test 10 million people by June 2010. According to the 2007 Kenya AIDS Indicator Survey, 80% of HIV-positive adults in the country do not know their status. The initiative, dubbed ‘Jitambue leo, ni haki yako’, Swahili for ‘Know yourself today, it is your right’, was launched on 23 November in the Kenyan capital, Nairobi. ‘We want to target everybody in our campaigns...no group is safe; the youth are becoming increasingly vulnerable, the old initially thought of as safe are equally at risk, and those in marriage account for 50% of new infections,’ said Dr Nicholas Muraguri, head of the National AIDS and Sexually transmitted infection Control Programme. ‘Infants and unborn children benefit too when their parents are tested.’
Equity and HIV/AIDS
The lack of newer AIDS drugs in Africa could jeopardise the lives of people already receiving the treatment, medical humanitarian organisation Medecins Sans Frontieres (MSF) has warned. With many countries on the continent embarking on national programmes to provide antiretrovirals (ARVs), the first-line drug regimen has become cheaper and widely available. But as resistance to the basic drugs inevitably builds up, there will be a need for a second generation of drugs within a few years.
An estimated 82,700 Zambians will become newly infected with HIV in 2009, up from just over 70,000 in 2007, according to new figures from the National AIDS Council. As many as 71 out of every 100 new infections occur as a result of sex with a non-regular partner, while people who reported having only one sexual partner accounted for around 21% of new infections. Although Zambia has recorded successes in its prevention of mother-to-child transmission (PMTCT) programme, ensuring a safe blood supply, and behaviour-change communication campaigns, practices such as having multiple concurrent partners, transactional sex and inter-generational sex are still common. Multiple concurrent partnerships are the leading cause of HIV infection in Zambia. Within these relationships, correct and consistent use of condoms remains dismally low. However, the report revealed that the annual estimated requirement was 200 million male condoms and 2 million female condoms, yet only 96 million male and 500,000 female condoms were available.
The new HIV/AIDS drugs recommended by WHO raises the cost for patients by nearly 500%, according to Medecins Sans Frontieres. This could affect the availability of these drugs in developing countries. This finding by MSF was in the latest edition of its report "Untangling the Web of Price Reductions" released at the fourth International AIDS Society Conference, in Sydney, Australia.
The long wait is over. South Africa's HIV-positive pregnant women will now have access to medication that could further reduce the risk of passing the virus to their babies after the health department released guidelines for administering more effective dual therapy instead of single antiretroviral (ARV) treatment. The challenge now is to make sure that healthcare workers at public health facilities receive the guidelines and the medicines so that new mothers and babies will benefit as soon as possible.
Three South Africans are part of a special group of HIV positive people that may provide valuable clues to scientists searching for a vaccine. Scientists call them ‘elite controllers’, as they have virtually undetectable levels of HIV in their blood and normal immune systems (CD4 counts), despite the fact that some have been infected for a number of years. Harvard University’s Professor Bruce Walker heads an international study of about 1,300 controllers that is trying to unravel how they control HIV so that this knowledge can be used to help boost the immunity of ordinary people. Over two-thirds of the controllers have a gene called B57 that is able to process antigens (foreign substances such as viruses that enter the body). A range of studies presented at the international AIDS Vaccine conference in Paris in October identified this gene as being able to protect against HIV. But not all controllers have B57. Another small clue is that the controllers’ immune systems seem to target a particular HIV gene called Gag more than the other HIV proteins, when it enters their cells, indicating that Gag may be more dangerous than other viral genes. Finally, the elite controllers have abnormally active dendritic cells, which are the key cells that ‘conduct’ the body’s immune response.
A new model for determining the demographic impact of HIV and AIDS in South Africa has been designed by two researchers, Leigh Johnson of the Centre for Infectious Disease Epidemiology and Research and Rob Dorrington of the Centre for Actuarial Research at the University of Cape Town. The new model is to replace the ASSA 2003 model for estimating HIV prevalence, HIV-related deaths, the numbers of those in need of ARVs and the impact of HIV interventions to integrate new data emerging from South Africa’s antenatal HIV-prevalence survey. The new model includes the ARV rollout data for up to the end of 2008. Because data shows that two-thirds of people starting ARVs are females, the model allows for different rates of ARV initiation in males and females, as well as for children and adults. It also recognises that the variable attrition rate across provinces.
Kenya has launched an ambitious strategy to fight HIV and AIDS that aims to reduce new infections by at least 50% over the next four years and focus more on most at-risk populations (MARPs). The third Kenya National AIDS Strategic Plan, which runs from 2009/2010 till 2012/2013 and was launched in the capital, Nairobi, on 12 January, also aims to reduce AIDS-related mortality by 25%. 'We cannot achieve our target unless we close new taps of HIV infections – this involves putting most at-risk populations at the centre of our HIV programmes and prevention strategies,' said Alloys Orago, director of the National AIDS Control Council. In Kenya, female and male sex workers, injecting/intravenous drug users, and men who have sex with men (MSM) are considered primary MARPs. Speaking at the launch, UNAIDS executive director Michél Sidibé highlighted the paradox of the intention to increase HIV programming among MARPS while at the same time criminalising the activities that put them at an elevated risk of contracting and transmitting HIV. 'Criminalisation puts most at-risk populations, like commercial sex workers, injecting drug users and men who have sex with men, in the shadows,' he said. 'It is difficult to reach groups whose actions are deemed to be at odds with the law.' Sex work, homosexual acts and the use of illicit drugs are all outlawed in Kenya and are punishable by long terms in prison.
Delayed test results often mean HIV patients in Mozambique fail to get timely treatment, but new technology is reducing the need to send tests to far away laboratories, and speeding up test results and HIV treatment. After a successful 2009 pilot, the country has nationally rolled out SMS or text message printers, which transmit the results of infant HIV tests electronically from two central reference laboratories in Maputo and the northern provincial capital, Nampula, to more than 275 health centres. Previously, test samples and results would have taken on average three weeks and up to several months to be transported to and from clinics via car, plane and even kayak in remote parts of the country. According to research conducted by the Ministry of Health and the Clinton Health Access Initiative (CHAI), who developed the technology, the time it took for clinics to receive test results dropped from an average of about three weeks to about three days after the printers were introduced. This, in turn, reduced the time it took to start infants on antiretroviral (ARV) treatment as part of national prevention of mother-to-child (PMTCT) HIV transmission services by about four months. The number of infants starting treatment also increased by 60%.
The link between HIV/AIDS and hunger in rural communities has received a great deal of attention over the past few years - particularly in Southern Africa, where HIV/AIDS has added a new dimension to the recent food crisis. But research emerging from the recent international conference on 'HIV/AIDS and Food and Nutrition Security' in Durban, South Africa, showed that very little is know about the actual impact of the pandemic on rural communities.