Three years ago the Guardian published an award-winning supplement featuring the story of Grace Mathanga, an ordinary African woman with HIV. To launch this year's Christmas appeal, which focuses on Aids in Africa, Sarah Boseley returns to Malawi to find out how Grace is doing now, and what her life can tell us about the future of the continent.
Equity and HIV/AIDS
What Grace did next
Boseley S: Epidemic Report and World AIDS Day 2005, The Guardian (UK), 24 November 2005
What is driving the HIV/AIDS epidemic in Swaziland and what can we do about it?
This report (April 2003) was commissioned by the National Emergency Response Committee on HIV/AIDS and UNAIDS. It examines various biologic, behavioural and socio-economic drivers and discusses the impact of the pandemic on health care, education, agriculture and the private sector. It concludes with some innovative responses. This report should be of interest to persons outside of the immediate Swaziland context.
What is it going to take to move youth-related HIV programme policies into practice in Africa?
Mark D; Taing L; Cluver L; Collins C; Iorpenda K; Andrade A; Hatane L: Journal of the International AIDS Society 20(Suppl 3)21491, 2017
HIV has been reported to be the leading cause of mortality amongst adolescents in Africa. This has brought attention to the changes in service provision and health management that many adolescents living with HIV experience when transferring from specialised paediatric- or adolescent-focused services to adult care. When transition is enacted poorly, adherence may be affected and the continuum of care disrupted. The authors present the case that considerable gaps remain in moving policy to practice on this at global, national, and local levels and that standard operating procedures or tools to support this transition are lacking. Guidance often overlooks the specific needs and rights of adolescents, in particular for those living with HIV. In some cases, prohibitive laws can impede adolescent access by applying age of consent restriction to HIV testing, counselling and treatment, as well as SRH services. Where adolescent-focused policies do exist, they have been slow to emerge as tangible operating procedures at health facility level. A key barrier is the nature of existing transition guidance, which tends to recommend an individualised, client-centred approach, driven by clinicians. In low- and middle-income settings, flexible responses are resource intensive and time consuming, and therefore challenging to implement amidst staff shortages and administrative challenges. They propose that national governments adopt transition-specific policies to ensure that adolescents seamlessly receive appropriate and supportive care, as part of a broader adolescent-centred policy landscape and adolescent-friendly orientation and approach at health system level. Youth involvement and community mobilisation are seen to be essential for this. .
What makes a structural intervention? Reducing vulnerability to HIV in community settings, with particular reference to sex work
Evans C, Jana S and Lambert H: Global Public Health 1744(1706), 8 June 2009
Increasing emphasis is being placed on the need for 'structural interventions' (SIs) in HIV prevention internationally. There is great variation in how the concept of an SI is defined and operationalised, however, and this has potentially problematic implications for their likely success. This paper clarifies and elucidates what constitutes an SI, with particular reference to the structured distribution of power and to the role of communities. It summarises the background to the growing emphasis being placed on the concept of SIs in HIV prevention policy and illustrates the nature of HIV vulnerability and its implications for the design and targeting of successful SIs. The paper draws attention to the dual importance of: attending to local complexities in the micro and macro-level structures that produce vulnerability; and clarifying the meaning and role of communities within SIs.
What positive outcomes for the poor in Bangkok?
Sanjay Basu
Ongoing coverage of the International AIDS Conference in Bangkok is bewildering to those who are familiar with the current political battles in the HIV/AIDS arena, and no doubt disheartening or annoying to those reading from a distance. The AIDS industry is in full swing: government forces delivering glittering generalities; actors and ex-presidents discussing their "outrage" while eating five-course dinners in Bangkok hotel penthouses.
Further details: /newsletter/id/30515
What the rest of Africa could learn about AIDS
Reaves J: Chicago Tribune, 22 April 2007
The infection rate in Senegal is 0.9 percent; similar to the rate in the U.S. (0.6 percent), and far lower than the soaring tolls in African countries such as Namibia (19.6 percent), South Africa (18.8 percent) and Botswana (24.1 percent). What is Senegal doing right, and can those practices be replicated in other countries?
What will it take to eliminate paediatric HIV? Reaching WHO target rates of mother-to-child HIV transmission in Zimbabwe: A model- based analysis
Ciaranello AL: PLoS Medicine 9(1), 10 January 2012
In this paper, the author investigates uptake of prevention of mother-to-child transmission of HIV (PMTCT) services, infant feeding recommendations and specific drug regimens necessary to achieve the virtual elimination of paediatric HIV in Zimbabwe. She used a computer model to simulate a cohort of HIV-infected pregnant or breastfeeding women, and evaluated three PMTCT regiments: single-dose nevirapine; ‘Option A’ from the 2010 World Health Organisation guidelines (zidovudine in pregnancy, infant nevirapine throughout breastfeeding for women without advanced disease, lifelong combination antiretroviral (ARV) therapy for women with advanced disease); and WHO ‘Option B’ (limited combination ARV drug regimens without advanced disease during pregnancy and breastfeeding; lifelong ARV therapy with advanced disease). Results indicated that the latest WHO PMTCT guidelines (Options A and B) plus better access to PMTCT programmes, better retention of women in care, and better adherence to drugs are needed to eliminate paediatric HIV in Zimbabwe.
When HIV is ordinary and diabetes new: Remaking suffering in a South African Township
Mendenhall E, Norris SA: Global Public Health, DOI: 10.1080/17441692.2014.998698 2015
Escalation of non-communicable diseases (NCDs) among urban South African populations disproportionately afflicted by HIV/AIDS presents not only medical challenges but also new ways in which people understand and experience sickness. In Soweto, the psychological imprints of political violence of the Apartheid era and structural violence of HIV/AIDS have shaped social and health discourses. Yet, as NCDs increasingly become part of social and biomedical discussions in South African townships, new frames for elucidating sickness are emerging. This article employs the concept of syndemic suffering to critically examine how 27 women living with Type 2 diabetes in Soweto, a township adjacent to Johannesburg known for socio-economic mobility as well as inequality, experience and understand syndemic social and health problems. For example, women described how reconstructing families and raising grandchildren after losing children to AIDS was not only socially challenging but also affected how they ate, and how they accepted and managed their diabetes. Although previously diagnosed with diabetes, women illustrated how a myriad of social and health concerns shaped sickness. Many related diabetes treatment to shared AIDS nosologies, referring to diabetes as ‘the same’ or ‘worse’. These narratives demonstrate how suffering weaves a social history where HIV becomes ordinary, and diabetes new.
When putting AIDS in the crosshairs, set targets
Palitza K: Inter Press Service News Agency, 25 July 2006
Civil society organisations in South Africa are preparing to push government to meet its commitment for setting national targets on HIV/AIDS, made at the recent United Nations General Assembly Special Sessions on HIV/AIDS (UNGASS). South African officials at UNGASS promised to set national HIV/AIDS targets by the end of the year (2006), however, a pledge that civil society organisations now want to ensure they keep; claiming government's current approach to HIV/AIDS is not delivering the goods.
WHO '3 by 5' target missed in Zimbabwe
Zimbabwe has failed to meet the World Health Organization (WHO) target of providing anti-AIDS drugs to at least 120,000 HIV-positive people by the end of 2005, local newspaper The Daily Mirror reported on Tuesday. The lack of adequate foreign currency to purchase medicines and the low numbers of people being tested for the virus prevented the country from even reaching its own target of 55,000 people receiving the life-prolonging medication by the end of 2005.