The achievement of the Millennium Development Goals (MDGs) depends on sufficient supply of health workforce in each country. Although country-level data support this contention, it has been difficult to evaluate health workforce supply and MDG outcomes at the country level. The purpose of the study was to examine the association between the health workforce, particularly the nursing workforce, and the achievement of the MDGs, taking into account other factors known to influence health status, such as socioeconomic indicators. The main factors in understanding HIV prevalence rates are physician density followed by female literacy rates and nursing density in the country. Using general linear model approaches, increased physician and nurse density (number of physicians or nurses per population) was associated with lower adult HIV prevalence rate, even when controlling for socioeconomic indicators. Increased nurse and physician density are associated with improved health outcomes, suggesting that countries aiming to attain the MDGs related to HIV would do well to invest in their health workforce. Implications for international and country level policy are discussed.
Equity and HIV/AIDS
Much of the progress in recent years in the fight against HIV may be attributed to increased use of antiretrovirals (ARVs), argues the World Health Organisation (WHO) in this short article to commemorate World AIDS Day on 1 December 2012. The latest global statistics suggest that, provided countries are able to sustain current efforts, the goal of getting 15 million HIV-infected people worldwide on ARVs will be reached by 2015. Currently eight million people in low- and middle-income countries are accessing the treatment they need, up from only 0.4 million in 2003. However, vulnerable and marginalised groups are still not able to access HIV prevention and treatment services, including adolescent girls, sex workers, men who have sex with men, drug users and migrants. And children are lagging badly behind: only 28% of children who need ARVs can obtain them. Some countries are considering initiating treatment at an even earlier stage in the course of HIV, as well as offering all HIV-positive pregnant women ARV therapy for life. WHO is currently reviewing new scientific research and country experiences in order to publish updated and consolidated guidance on the use of ARVs in mid-2013.
In this new report, UNAIDS reports that there are 700,000 fewer new HIV infections globally in 2011 than in 2001, eight million people on life-saving antiretroviral (ARV) therapy (a 60% increase in the last two years), and a drop of more than half a million deaths from AIDS-related illnesses between 2005 and 2011 in people living with HIV. However, new HIV infections continue to outpace ARV treatment coverage. Sub-Saharan Africa has realised a 25% reduction in new infections, although the region still accounted for 72% of new HIV infections globally in 2011. Progress in treatment has been impressive, saving lives and transforming HIV into a chronic illness rather than a death sentence. In addition to their therapeutic effects, ARVs have been found to play a preventive role by significantly reducing the amount of virus in the blood and therefore reducing the risk of transmission to sexual partners. A major weakness in both prevention and treatment programmes in many countries is reported by UNAIDS to be their failure to decrease mother-to-child transmission of HIV, which is the most easily preventable form of transmission.
AIDS. It killed roughly 3 million people last year, most of them poor, and most of them in Africa. Between 34 and 42 million people are living with HIV. Absent antiretroviral therapies, AIDS will have killed the vast majority of them by 2015. In such a world, time can seem a luxury, and the rigours of critical enquiry an indulgence. We need things done now, yesterday, last year. Indeed, an overdue sense of urgency has taken hold in the past five years - much of it thanks to relentless AIDS advocacy efforts. Along with sets of received wisdoms, a more or less standardized framework for understanding the epidemic and its effects has evolved, and a lexicon for expressing this knowledge has been established. All this has helped put and keep AIDS in the spotlight. It has popularized knowledge of the epidemic, countered the earlier sense of paralysis or denial, helped marshal billions of dollars in funding and goad dozens of foot-dragging countries into action. It has worked wonders. But alongside these achievements are some troubling trends.
In 2001, the new antiretroviral medicines had started to work miracles, bringing people from their deathbeds back to life. Yet as a Ugandan doctor truly said: ‘the medicine is in the North but the disease is in the South’. The author argues that the pharmaceutical industry was happy to sell the medicines at very high prices in rich countries while turning a blind eye to the rest of the world. It was largely thanks to a huge global mobilisation of civil society led by people living with HIV that leaders and pharmaceutical companies started to feel embarrassed about denying access to life-saving medicines to millions of people. But it was only after generic competition kicked in that access to medicines became something policymakers talked about. An offer by an Indian company to sell a cocktail of the three basic medicines for one dollar a day slashed the prices of antiretrovirals, meaning that today over 9 million people are on treatment,, including over 7 million in Africa. The profit from treatment of HIV infected people in rich country provided the necessary market that has stimulated R&D for antiretroviral medicines. This is not the case for the Ebola market, which consists of small numbers of people in poor countries. Pharmaceutical companies had no commercial incentive to enter into R&D for vaccines or medicines for Ebola – or any other haemorrhagic fever. For this reason Ebola is the other side of the coin to HIV as the intellectual property rights system allows the market to shape R&D priorities, rather than public health needs. The author argues that it is not ethical, sustainable nor safe to leave commercial interests decisions and financing for R&D for products, capable of modifying global health threats, to be dictated by the commercial interests of pharmaceutical companies.
The World Bank and International Monetary Fund, both financial organizations that aim to reduce poverty, are preventing foreign aid from reaching HIV/AIDS programs in developing countries, claims an article in this week’s issue of The Lancet. Ted Schrecker of the University of Ottawa and Gorik Ooms of Médecins Sans Frontières in Brussels, write expenditure ceilings for public health, created by the World Bank and the International Monetary Fund (IMF), stop countries from benefiting from outside investment in their health programmes.
The Horn of Africa is one of the regions most prominently impacted by the HIV/AIDS epidemic. However, the Horn of Africa is also where there is hope that something can be done to bring about change. Recognising the movement of vulnerable populations is a major challenge in the region, on 28 June 2007 the World Bank and IGAD signed a $15 million grant to support the IGAD Regional HIV/AIDS Partnership Program (IRHAPP). The program seeks to mitigate the impact of HIV/AIDS among cross-border and mobile populations in IGAD’s member states: Djibouti, Eritrea, Ethiopia, Kenya, Somalia, Sudan and Uganda. The four-year project, aims to reduce the vulnerability of these mobile populations.
The AIDS epidemic is a disaster on many levels. In the most affected countries in sub-Saharan Africa, where prevalence rates reach 20%, development gains are reversed and life expectancy may be halved. For specific groups of marginalized people injecting drug users, sex workers and men who have sex with men across the world, HIV rates are on the increase. Yet they often face stigma, criminalization and little, if any, access to HIV prevention and treatment services. As this report explains, HIV is a challenge to the humanitarian world whose task is to improve the lives of vulnerable people and to support them in strengthening their capacities and resilience. Disasters, man-made and ‘natural’, exacerbate other drivers of the epidemic and can also increase people’s vulnerability to infection.
The fifth International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention, held in mid-July, was attended by almost 6,000 mostly scientists and researchers eager to deliver their latest studies to a predominantly American and European audience. ‘The gap between evidence and implementation is particularly apparent between North and South’, said IAS president Dr Julio Montaner, referring to inequities in health services and availability of drugs. One of the most talked-about presentations was that of Robert Granich of the World Health Organisation, who claims that HIV could theoretically be eliminated if all people were tested each year and given antiretrovirals straight away if they tested positive, regardless of whether they were actually sick or not. His model predicted a reduction in HIV prevalence to less than 1% within 50 years based on the premise that, when placed on ARV treatment soon after infection, a person’s chances of infecting their partners are reduced to almost zero.
The writer of this article argues that FIFA, as the world’s football authority, has an ethical responsibility for social action, especially with regard to HIV and AIDS and the World Cup. As the overwhelming percentage of professional footballers come from poverty or financially disadvantaged childhoods, world football owes a tremendous debt to these poorer communities who, by their resourcefulness, allowed world‐class footballers to develop. FIFA President, Sepp Blatter, claims that FIFA has been ‘committed to a wide range of humanitarian projects’ but the author argues these are largely insufficient. For example, the FIFA ‘Football for Hope’ project is costing only about US$17 million, while FIFA is expected to net revenues of US$3.3 billion and profits of US$1.7 billion from the Cup. The project costs amount to a mere 0.5% of the revenues and 1% of the earnings for South African charities. The author challenges FIFA to recognise that other sports have already done more per capita than world soccer for human development, specifically HIV and AIDS education and empowerment.