Universal access to anti-retroviral (ARV) medication for HIV/AIDS is the clarion call of the WHO/UNAIDS 3 by 5 Initiative. Treatment coverage, however, remains highly uneven. This sharpens the question of who exactly is accessing ARVs and whether access is challenging inequality or reinforcing it. Issues of distributive justice have long been debated in health policy, but the practical challenges of ARV distribution are relatively new. In exploring what a more equitable process of ARV distribution could involve, this article draws on a human rights framework using case study material from Zambia.
Equity and HIV/AIDS
On a never-ending waiting list: Toward equitable access to anti-retroviral treatment? Experiences from Zambia
One-Million-to-Test Campaign logs first victory in Uganda
PlusNews: 27 November 2008
Between 26 November and 1 December (World AIDS Day) the AIDS Healthcare Foundation (AHF), a US-based NGO, set a goal of testing one million people around the world. More than 1,000 people were tested for HIV at a busy marketplace in the Ugandan capital, Kampala, kicking off a nationwide drive that aims to help at least 20,000 people across the country know their status. HIV prevalence is around 6%, but only 21% of Ugandans know their HIV status. The large turnout for the testing event proved that many people wanted to know their status but hadn't had the opportunity to get tested. The campaign sees AHF partnering with 972 organisations in 72 countries around the world. A standard model is used at all sites, involving pre-test counselling, a one-minute test, post-test counselling and treatment referral.
Open letter to WHO D-G on Universal Access
Public Health Exchange (PHA), April 2007
This letter adresses the World Health Organisation's Director General's meeting with representatives of the International Treatment Preparedness Coalition (ITPC) in March 2007. The letter, written by various representatives of the ITPC, expresses their concern that the world has lost the momentum of the 3 by 5 campaign and that WHO is on the brink of squandering its legacy of leadership role in the battle to bring universal treatment access to people living with HIV/AIDS. In this letter they outline five reasons for concern, make six specific demands to be met before the end of 2007 and give four commitments that ITPC will fulfill to do their part in this most critical global effort.
Further details: /newsletter/id/32222
Operationalising Structural Interventions for HIV Prevention: Lessons from Zambia
Bowa C and Mah TL: AIDStarone, 2013
While global guidance for HIV prevention recognises the importance of structural HIV prevention, evidence for the effectiveness of these interventions, and their implementation, are lagging behind other areas of prevention. The challenges to implementation at the community and national levels are less well understood. This paper examines the United States (US) President’s Emergency Plan for AIDS Relief (PEPFAR)/US Agency for International Development (USAID) experience with implementing structural interventions in Zambia. Despite challenges to implementing, monitoring, and evaluating structural interventions, they can and have been implemented successfully and are necessary for a long-term and sustained response to both HIV and social and economic development needs, the authors argue. Better identification of causal pathways, involvement of key stakeholders and collaborators, and enhanced monitoring will strengthen implementation of structural interventions and provide the necessary data to understand their outcomes and impacts. Such efforts and stronger links between structural interventions and other biomedical and behavioural interventions will result in a true combination approach to HIV prevention, yielding better results.
Opt-out provider-initiated HIV testing and counselling in primary care outpatient clinics in Zambia
Topp SM, Chipukuma JM, Chiko MM, Wamulume CS, Bolton-Moore C and Reid SE: Bulletin of the World Health Organisation 89(5): 328-335A, May 2011
The authors of this study aimed to increase case-finding of infection with human immunodeficiency virus (HIV) in Zambia and their referral to HIV care and treatment by supplementing existing client-initiated voluntary counselling and testing (VCT), the dominant mode of HIV testing in the country. Lay counsellors offered provider-initiated HIV testing and counselling (PITC) to all outpatients who attended primary clinics and did not know their HIV serostatus. After the addition of PITC to VCT, the number tested for HIV infection in the nine clinics was twice the number undergoing VCT alone. Over 30 months, 44,420 patients were counselled under PITC and 31,197 patients, 44% of them men, accepted testing. Of those tested, 21% were HIV+; 38% of these HIV+ patients enrolled in HIV care and treatment. The median time between testing and enrolment was 6 days. The acceptability of testing rose over time. In conclusion, the introduction of routine PITC using lay counsellors into health-care clinics in Lusaka, Zambia, dramatically increased the uptake and acceptability of HIV testing. Moreover, PITC was incorporated rapidly into primary care outpatient departments. Maximizing the number of patients who proceed to HIV care and treatment remains a challenge and warrants further research.
Outcomes of the South African National Antiretroviral Treatment (ART) programme for children: The IeDEA Southern Africa Collaboration
Davies M, Keiser O, Technau K, Eley B, Rabie H, van Cutsem G, Giddy J, Wood R, Boulle A, Egger M and Moultrie Harry: South African Medical Journal 99(10): 730–737, October 2009
This study set out to assess paediatric antiretroviral treatment (ART) outcomes and their associations from a collaborative cohort representing 20% of the South African national treatment programme. It took the form of a multi-cohort study of 7 public sector paediatric ART programmes in Gauteng, Western Cape and KwaZulu-Natal provinces. The subjects were ART-naïve children (≤16 years) who commenced treatment with ≥3 antiretroviral drugs before March 2008. The study found that the median (IQR) age of 6,078 children with 9,368 child-years of follow-up was 43 months, with 29% being <18 months. Most were severely ill at ART initiation. More than 75% of children were appropriately monitored at 6-monthly intervals with viral load suppression (<400 copies/ml) being 80% or above throughout 36 months of treatment. Mortality and retention in care at 3 years were 7.7% (95% confidence interval 7.0 - 8.6%) and 81.4% (80.1 - 82.6%), respectively. Dramatic clinical benefit for children accessing the national ART programme is demonstrated. Higher mortality in infants and those with advanced disease highlights the need for early diagnosis of HIV infection and commencement of ART.
Pain in amaXhosa Women Living With HIV/AIDS: Translation and Validation of the Brief Pain Inventory–Xhosa
Parker R; Jelsma J; Stein D: Journal of Pain and Symptom Management 51(1)126-132, 2016
Pain has been reported as the second most commonly reported symptom in people living with HIV. In South Africa, there are more than five million people living with HIV. Approximately, two million belong to the Xhosa cultural group. A culturally appropriate, valid, and reliable instrument is required to measure pain and its impact in this population. This article documents the process of translation of the Brief Pain Inventory (BPI) into the BPI-Xhosa and presents the results of the validity and reliability testing of the instrument. The translated BPI-Xhosa, a demographic questionnaire and the European Quality of Life-5 Dimensions Xhosa version (EQ-5D-Xhosa) health-related quality of life instrument were administered to 229 amaXhosa women living with HIV in a resource-poor urban settlement in South Africa. A 74% prevalence of pain was recorded. The BPI-Xhosa had good concurrent validity when compared with the previously validated EQ-5D-Xhosa. The BPI-Xhosa was found to be a valid instrument to measure pain prevalence, severity, and interference in amaXhosa women living with HIV.
Parents' perceptions of HIV counselling and testing in schools: Ethical, legal and social implications
Gwandure R, Ross E, Dhai A and Gardner J: South African Medical Journal;104(1) 40-42 January 2014
In view of the high prevalence of HIV and AIDS in South Africa, particularly among adolescents, the South African Departments of Health and Education proposed a school-based HIV counselling and testing (HCT) campaign to reduce HIV infections and sexual risk behaviour. Through the use of semi-structured interviews, this qualitative study explored perceptions of parents regarding the ethico-legal and social implications of the proposed campaign. Despite some concerns, parents were generally in favour of the HCT campaign. However, they were not aware of their parental limitations in terms of the Children’s Act. Their views suggest that the HCT campaign has the potential to make a positive contribution to the fight against HIV and AIDS, but needs to be well planned. To ensure the campaign’s success, there is a need to enhance awareness of the programme. All stakeholders, including parents, need to engage in the programme as equal partners.
Parliamentary oversight, HIV and AIDS
IDASA, February 2006
From 22–24 February 2006 MPs from Ghana, Kenya, Malawi, Mozambique, Namibia, Zambia, Tanzania and Zimbabwe met in Johannesburg and deliberations at the meeting centred around three major themes related to parliamentary oversight of HIV and AIDS: the challenges and opportunities relating to the parliamentary structures and the environment within which MPs operate; the extra parliamentary partnerships that could strengthen parliamentary oversight of HIV and AIDS such as partnerships with civil society and the media; and the benefits of and practical suggestions for a network of African MPs at regional and Pan African level. These themes are discussed in this report.
Partners at risk: Motivations, strategies and challenges to HIV transmission risk reduction among HIV-infected men and women in Uganda
Lifshay J, Nakayiwa S, King R, Reznick OG, Katuntu D, Batamwita R, Ezati E, Coutinho A, Kazibwe C and Bunnell R: AIDS Care 21(6):715–724, June 2009
Despite the estimated 22.4 million HIV-infected adults in Africa, culturally appropriate ‘prevention with positives’ guidelines have not been developed for this region. In order to inform these guidelines, the authors of this study conducted 37 interviews with purposefully selected HIV-infected individuals in care in Uganda. Participants reported increased condom use and reduced intercourse frequency and numbers of partners after testing HIV-positive. Motivations for behaviour change included concerns for personal health and the health of others, and decreased libido. Interventions addressing domestic violence, partner negotiation, use of lubricants and alternative sexual activities could increase condom use and/or decrease sexual activity and/or numbers of partners, thereby reducing HIV transmission risk.