The HIV status of surgeons, in the context of the informed consent obtained from their patients, is a contentious matter. We surveyed the views of practising surgeons in South Africa regarding aspects of HIV and its impact on surgeons. A cross-sectional survey was conducted with surgeons who were members of the Association of Surgeons of South Africa to find out their attitudes to the preceding issues. The salient findings included the view that a patient-centred approach requiring HIV status disclosure to patients would be discriminatory to surgeons and provide no clear benefit to patients, and that HIV-positive surgeons should determine their own scope of practice. Patient-centred approaches and restrictive policies do not accord with clinicians’ sentiments. In the absence of comparable local or international data, this study provides clinicians' views with implications for the development of locally relevant policies and guidelines.
Equity and HIV/AIDS
In this study, the main objectives were to establish the proportion of adolescents among children infected with human immunodeficiency virus (HIV) in Zimbabwe who receive HIV care and support, and what clinic staff perceive to be the main problems faced by HIV-infected children and adolescents. In July 2008, the researchers sent a questionnaire to all 131 facilities providing HIV care in Zimbabwe, requesting an age breakdown of the children (aged 0–19 years) registered for care and asking to identify the two major problems faced by younger children (0–5 years) and adolescents (10–19 years). Nationally, 115 (88%) facilities responded. Of the 98 (75%) that provided complete data, 196,032 patients were registered and 24,958 (13%) of them were children. The main problems for younger children were identified as malnutrition and lack of appropriate drugs (cited by 46% and 40% of clinics, respectively), while adolescents were most concerned about psychosocial issues and poor drug adherence (cited by 56% and 36%, respectively).
The experiences of the past ten years have shown that it is feasible to treat HIV infected patients with ART even in severely resource constrained settings. Achieving the levels of antiretroviral (ARV) coverage necessary to impact the course of the HIV epidemic remains a challenge and ARV coverage in most nations remains short of even current recommendations. Though treatment as prevention and seek, test, treat and retain strategies are attractive, the authors of this article argue that realising the benefits of these strategies means that they must cover hard to reach populations such as sex workers. While evidence on reach of these populations in research settings is encouraging, there are questions on the sustainability of these efforts as patients are transitioned back into national HIV control programmes, many of which are struggling even to maintain the current coverage in the face of declining external funding. The authors conclude that advocacy from both medicine and public health providers will be critical to sustain and enhance the necessary HIV and AIDS treatment and prevention programmes worldwide.
Swaziland not only has the world's highest HIV prevalence rate, it now also has the highest tuberculosis (TB) rate, but health officials warn that not enough is being done to integrate TB and HIV services. One in four adults is infected with HIV. By the end of 2007, an estimated 170,000 people were living with HIV, and every year an estimated 13,000 people develop TB, the primary opportunistic disease in HIV-positive people. Themba Dlamini, manager of Swaziland's National TB Control Programme, said 80% of Swaziland's TB cases were also HIV-positive. But with governments focused on HIV/AIDS, TB has not been getting enough attention. Swaziland's Health Minister, Benedict Xaba, said that, although the country provided free TB medicines, other costs, such as hospital fees and transport, made it difficult for many people to access health services. About 58% of TB patients completed their six-month course of treatment last year, falling far short of the 85% target recommended by the World Health Organization. International guidelines also set a 70% detection target for TB, but in Swaziland the case detection rate is below 60%.
Anecdotal evidence that entrenched cultural beliefs among Swazis actively encourage the spread of HIV/AIDS has been confirmed by a joint government and UN report. The study, called 'The State of the Swaziland Population', echoes warnings by local NGOs that 'AIDS cannot be stopped unless there is a change in people's sexual behaviour.' 'Swazis are very traditional people, and their sexual behaviour is inbred and totally against safe sexual practices, like condom use and monogamous relationships, that limit the spread of HIV,' noted an HIV testing counsellor in Manzini, the country's main commercial city. The report, based on focus groups and surveys, found that maintaining a centuries-old cultural belief in procreation to increase the population size, was having devastating consequences in the age of AIDS.
Groups representing Swaziland's HIV-positive population are angry at a proposed Sexual Offences and Domestic Violence Act mandating life prison terms for rapists who infect their victims with HIV, claiming that the law will criminalise the victim. "Negative and positive persons must be accorded equal rights. But what are we criminalising here? Sleeping with someone without his or her consent, in other words rape, or HIV?" said Thembi Nkambule, National coordinator of the Swaziland National Network of People Living with HIV and AIDS (SWANNEPHA).
Swaziland's truck drivers are twice as likely to be HIV-positive than other citizens and are finally to get the programmes required to provide them with treatment and support, a conference was told this week. At the Federation of Swaziland Employers (FSE) conference held in Manzini, 35km east of the capital, Mbabane, it was announced that a comprehensive set of initiatives were to be put in place to test, counsel and treat HIV-positive transportation workers after studies showed "truckers as a group have an HIV infection rate double that of the general population," Khosi Hlatshwayo, coordinator of the FSE’s Business Council HIV/AIDS initiative, said.
Swaziland is still short of lab reagents needed for CD4 count testing, used to initiate and monitor patients on antiretroviral treatment. Shortages of HIV programme supplies in Swaziland were first reported in mid-2011. Although the stock-outs have been largely blamed on reduced revenues from the Southern African Customs Union (SACU), the country also opted not to apply for funding in Round 10 from the Global Fund to Fight AIDS, TB and Malaria. Instead, it chose to assume financial responsibility for HIV treatment itself, at a time when SACU revenues were already expected to decline. Health Minister Themba Xaba said in a statement that the government needed US$875,000 to purchase the CD4 machine reagents.
This paper assesses evidence on the association between educational attainment and risk of HIV infection over time in sub-Saharan Africa through a systematic review of published peer-reviewed articles. Approximately 4,000 abstracts and 1,200 full papers were reviewed, of which 36 were included in the study, containing data on 72 discrete populations from 11 countries between 1987 and 2003, and representing over 200,000 individuals. Studies on data collected prior to 1996 generally found either no association or the highest risk of HIV infection among the most educated. Studies conducted from 1996 onwards were more likely to find a lower risk of HIV infection among the most educated. HIV prevalence appeared to fall more consistently among highly educated groups. In several populations, associations suggesting greater HIV risk in the more educated at earlier time points were replaced by weaker associations later. It seems that HIV infections are shifting towards higher prevalence among the least educated in sub-Saharan Africa, reversing previous patterns. Policy responses that ensure HIV-prevention measures reach all strata of society and increase education levels are urgently needed.
Various factors make young people vulnerable to HIV/AIDS: earlier puberty and later marriage, sexual and gender norms, sexual abuse, poverty, mixed messages about sexual behaviour and lack of condoms. Schools and communities in Zambia work together to build knowledge, values and skills and create positive peer pressure to help young people. The International HIV/AIDS Alliance supports 'Young, Happy, Healthy and Safe' (YHHS), a Zambian non-governmental organisation, to implement a pilot project for improving young people's sexual and reproductive health and preventing HIV.