A global shortage of funds for the fight against HIV means universal access to prevention, treatment and care is unlikely unless HIV programmes get better value for their investments, according to this report. It argues that there is a need to ‘enhance the impact of current investments by improving the efficiency, effectiveness and quality of programmes, strengthening links between programmes, and building systems for a sustainable response. Although 5.25 million people accessed life-prolonging antiretroviral medication in 2009 - up 1.2 million from 2008 - the report notes that funding shortages, limited human resources, weak procurement and supply management systems for HIV drugs and diagnostics, and other bottlenecks continued to hamper the scale-up of treatment. An estimated 53% of pregnant women worldwide in need of prevention of mother-to-child transmission services received them in 2009, but only 28% HIV-positive children received treatment in 2009, compared to 36% for adults, and just 15% of children born to HIV-positive mothers were given appropriate infant diagnostics.
Equity and HIV/AIDS
This paper sought to study the progress and challenges with regard to universal antiretroviral (ARV) access in Free State Province, South Africa. Data from the first four years of the public sector ARV roll-out and selected health system indicators was used. Data was collected from the public sector ARV database in Free State Province for new patients on ARVs, average waiting times and median CD4 counts at the start of treatment. Information on staff training, vacancy rates and funding allocations for the ARV roll-out was obtained from official government reports. Projections were made of expected new ARV enrolments for 2008 and 2009 and compared with goals set by the National Strategic Plan (NSP) to achieve universal access to ARVs by 2011. The researchers found that new ARV enrolments increased annually to 25% of the estimated need by the end of 2007. Average waiting times to enrolment decreased from 5.82 months to 3.24 months. Median CD4 counts at enrolment increased from 89 to 124 cells/mm3. There is a staff vacancy rate of 38% in the ARV programme and an inadequate increase in budget allocations. The paper concludes that current vertical model of ARV therapy delivery is unlikely to raise the number of new enrolments sufficiently to achieve the goals of universal access by 2011 as envisaged by the NSP. The Free State is implementing a project (STRETCH trial) to broaden the ARV roll-out in an attempt to increase access to ARVs.
Adherence to antiretroviral medication in the treatment of HIV is critical, both to maximise efficacy and to minimise the emergence of drug resistance. The aim of this prospective study in three public hospitals in KwaZulu-Natal, South Africa, is to assess the use of traditional complementary and alternative medicine (TCAM) by HIV patients and its effect on antiretroviral (ARV) adherence 6 months after initiating ARVs. 735 (29.8% male and 70.2% female) patients who consecutively attended three HIV clinics completed assessments prior to ARV initiation and 519 after six months on antiretroviral therapy (ART) Results indicate that the use of herbal therapies for HIV declined significantly from 36.6% prior to antiretroviral treatment (ART) initiation to 7.9% after being on ARVs for six months. Faith healing methods, including spiritual practices and prayer for HIV declined from 35.8% to 22.1% and physical/body-mind therapy (exercise and massage) declined from 5.0% to 1.9%. In contrast, the use of micronutrients (vitamins, etc.) significantly increased from 42.6% to 87.4%. In multivariate regression analyses, ARV non-adherence (dose, schedule and food) was associated with the use of herbal treatment, not taking micronutrients and the use of over-the-counter drugs. The use of TCAM declined after initiating ARVs. As herbal treatment for HIV was associated with reduced ARV adherence, patients’ use of TCAM should be considered in ARV adherence management.
The provision of HIV treatment and care in resource-limited settings is expanding rapidly. Health-worker training is one of many factors critical to the rapid scale-up of high-quality care. Large numbers of health workers require HIV training; yet, few countries have a comprehensive training plan, a clear assessment of ongoing training needs, a plan to operationalize training on a large scale, or adequate funds budgeted for training. In this setting, an extensive variety of HIV-related training programs have sprung up over the past few years. Unfortunately, there are limited data measuring their effectiveness, and there is no consensus about what constitutes effective training.
Tanzania is one of the countries hardest hit by the HIV/AIDS epidemic. The Tanzania Commission for AIDS was established as part of the government response to the HIV epidemic. This manual is part of the Tanzania Commission for AIDS strategic plan to coordinate and strengthen the efforts of stakeholders involved in the fight against HIV/AIDS. It is intended as a training manual for local government authorities.
Populations at risk for HIV and other sexually transmitted infections (STIs) include those living in rural areas. The authors describe a statewide training programme that targeted rural-based health professionals. This program focused on HIV, STIs, and viral hepatitis and was designed to enhance participants’ ability to conduct sexual histories and risk assessments, educate clients about risk reduction and prevention, screen for and diagnose these infections, clinically manage clients with positive screening test results, access prevention and other educational materials, and conduct other clinical and public health activities. A total of 122 participants reflecting a wide variety of practice settings attended trainings at five sites throughout Minnesota; 74% of participants were nurses and 81% characterised employment settings as rural. Nurses and other health professionals in rural settings are an important training priority and can play an important role in education, prevention, screening, and clinical care for HIV and other STIs.
Young women aged 15 to 24 years in sub-Saharan Africa continue to be disproportionately affected by HIV. A growing number of studies have suggested that the practice of transactional sex may in part explain women’s heightened risk, but evidence on the association between transactional sex and HIV has not yet been synthesised. The authors set out to systematically review studies that assess the relationship between transactional sex and HIV among men and women in sub-Saharan Africa and to summarise the findings through a meta-analysis. Nineteen papers from 16 studies met the inclusion criteria. Of these 16 studies, 14 provided data on women and 10 on men. The authors found a significant, positive, unadjusted or adjusted association between transactional sex and HIV in 10 of 14 studies for women, one of which used a longitudinal design. Out of 10 studies involving men, only two indicate a positive association between HIV and transactional sex in unadjusted or adjusted models. The meta-analysis confirmed general findings from the systematic review. Transactional sex is associated with HIV among women, whereas findings for men were inconclusive. Given that only two studies used a longitudinal approach, there remains a need for better measurement of the practice of transactional sex and additional longitudinal studies to establish the causal pathways between transactional sex and HIV.
Ugandan AIDS activists were outraged after antiretroviral (ARV) drugs worth an estimated US$500,000 were reported to have expired in government stores. "For drugs to expire in stores when we have only 80,000 HIV-positive Ugandans enrolled on ARVs is inexcusable," Beatrice Were, of the anti-poverty group, ActionAid International, told IRIN/PlusNews. Between 150,000 and 200,000 Ugandans are reported to need the life-prolonging medication.
Uganda's rising HIV prevalence is forcing policy makers to look for inventive ways of educating people about the virus. Their latest tool is mobile phone technology, whose rapid growth has provided an avenue that could potentially reach millions with messages. Text to Change (TTC) , an NGO that uses a bulk short message service (SMS) platform for HIV/AIDS education, recently partnered with the AIDS Information Centre in Uganda and Celtel, a local mobile phone network, to pilot a project in western Uganda aimed at communicating knowledge about the disease and encouraging subscribers to volunteer for HIV testing. The Uganda Communications Commission expects the number of mobile phone users to hit the six million mark by the end of 2008 – however, in urban areas, as many as 50% of people have mobile phones, compared to only 10% in rural areas.
A Bill is to be introduced in the Ugandan parliament with a maximum penalty of death for HIV-positive people who wilfully infect minors. According to Doctor Elioda Tumwesigye, a member of parliament, the proposed bill seeks to amend the 'Penal Code Amendment Bill of 2004', and was to be introduced in parliament for a first reading in July 2006.