Limited research has been conducted outside Western settings on how HIV-positive parents decide to test and disclose their own HIV status to children. This qualitative study was conducted in 2001 and 2005 to assess parent attitudes and current counselling policy and practice regarding child testing and parental disclosure in Uganda prior to the roll-out of antiretroviral therapy. Concerns over disclosure to children of parent's HIV status and testing children for HIV represent a major psychological burden for HIV-positive parents. Further research is reported to be needed, but current counselling practice could be improved now by adapting lessons learned from existing research.
Equity and HIV/AIDS
‘What if they ask how I got it?’ Dilemmas of disclosing parental HIV status and testing children for HIV in Uganda
Rwemisisi J, Wolff B, Coutinho A, Grosskurth H, Whitworth J: Health Policy and Planning 23: 36-42, 2008
“One-stop shop” brings life-saving HIV care, reproductive health to Botswana’s women
United Nations Population Fund (UNFPA), Geneva, September 2016
When Rose Matuulane was pregnant five years ago, she had to wait for a nurse to visit her small village, Otse in Botswana, to provide antenatal check-ups. When the nurse could not make it, Ms. Matuulane had to travel 84 km to the nearest clinic, in Shoghong, arriving the day before so that she could rise early and queue for hours. If she or any other woman additionally needed a family planning consultation, cervical cancer screening, HIV testing and counselling, or HIV treatment, they would have to come back another day, waiting again for hours. Ms. Matuulane, 24, is now a mother of two. The experience she had with her second pregnancy was worlds apart from the first. In 2011, shortly after she had her first baby, UNFPA helped to introduce integrated reproductive health care services at the Otse Health Post. It meant Ms. Matuulane no longer had to travel all the way to Shoshong. The new approach – called a “one-stop shop model” – also meant women no longer had to return time and again for different sexual and reproductive health services. The one-stop shop model is helping to increase women’s access to life-saving maternal health care and family planning. It is also a critical tactic in the fight against Botswana’s devastating HIV epidemic. The country has an HIV prevalence of 22 per cent among 15-to-49 year olds, according to 2015 UNAIDS estimates. A staggering 18 per cent of maternal deaths in the country are due to HIV-related causes. By integrating a full suite of reproductive health care together with a full range of HIV services – including prevention, testing and antiretroviral treatment – health workers have more opportunities to provide both kinds of care. The project – a partnership between the Ministry of Health, UNFPA and UNAIDS, with funding from the European Union, and the Swedish and Norwegian development agencies – is being piloted in seven countries in the East and Southern Africa Region. Botswana is the first of the pilot countries to implement the approach nationwide. Since the programme’s launch, the number of women visiting clinics for post-natal care, who are then able to simultaneously receive HIV and family planning services, has increased by 63 per cent, according to a recent report. The number of women seeking family planning, who are now able to access HIV services at the same time, has increased by 89 per cent.
“We cannot leave lives of nationals to development partners”
Gonzalez LL: Inter Press Services: 16 March 2011
As external funders retreat from funding HIV prevention and treatment, national programmes reliant on external funding have become exceedingly vulnerable. Activists from East and Southern Africa are calling on governments to take increased ownership of these programmes to ensure treatment continues after donor funds have gone. According to Dr Mbulawa Mugabe, UNAIDS deputy regional director for East and Southern Africa, the region has made considerable progress towards reaching the universal HIV treatment access target of 80% coverage among those in need of antiretrovirals (ARVs). He added that the region is performing above average for low and middle-income countries. However, he indicated that hardly any of the region’s governments are contributing financially to the treatment response. “We cannot leave the lives of nationals to development partners," he emphasised. According to researchers, governments need to bridge the gap between domestic and external spending for ARVs but, without accurate country-level data, this gap is difficult to estimate.
“You are wasting our drugs”: health service barriers to HIV treatment for sex workers in Zimbabwe
Mtetwa S; Busza J; Chidiya S; Mungofa S; Cowan F: BMC Public Health 13(698), July 2013,
In Zimbabwe, despite the existence of well-attended services targeted to female sex workers (SWs), fewer than half of women diagnosed with HIV took up referrals for assessment and ART initiation; just 14% attended more than one appointment. The authors conducted a qualitative study to explore the reasons for non-attendance and the high rate of attrition, through three focus group discussions (FGD) in Harare with HIV-positive SWs. SWs emphasised supply-side barriers, such as being demeaned and humiliated by health workers, reflecting broader social stigma surrounding their work. Sex workers were particularly sensitive to being identified and belittled within the health care environment. Demand-side barriers also featured, including competing time commitments and costs of transport and some treatment, reflecting SWs’ marginalised socio-economic position. Improving treatment access for SWs is critical for their own health, programme equity, and public health benefit. The authors suggest that programmes working to reduce SW attrition from HIV care need to proactively address the quality and environment of public services. Sensitising health workers through specialised training, refining referral systems from sex-worker friendly clinics into the national system, and providing opportunities for SW to collectively organise for improved treatment and rights might help alleviate the barriers to treatment initiation and attention currently faced by SW.