A new report suggests that 50% of projected HIV infections by 2015 could be prevented if governments and donors increase their HIV expenditure to UNAIDS target levels and implement prevention programmes that have been proven to work. The Global HIV Prevention Working Group’s report, Bringing HIV Prevention to Scale: An Urgent Global Priority, shows that prevention efforts are not keeping pace with expanding access to antiretroviral therapy. For every person who started effective anti-HIV treatment in 2006, six become newly infected with the virus. It is estimated that there will be 60 million new HIV infections by 2015, but the report suggests that 30 million of these could be avoided if scientifically proven methods of HIV prevention were implemented.
Equity and HIV/AIDS
The rate of new HIV infections, which has fuelled the global HIV/AIDS epidemic since the 1980s, has peaked throughout the world and is now declining. But population growth and the life-prolonging effects of antiretroviral (ARV) treatment mean that the total global number of HIV-infected people is likely to remain about the same for another two decades and will continue to increase in sub-Saharan Africa. Based on these findings the authors say it is time for the international community and governments to rethink their prioritisation of AIDS over other infectious diseases.
The meeting was focused on ensuring universal treatment access through sustainable public health systems. The goal of the meeting was to develop resolutions on the principles for strengthening health systems for treatment access, and to develop potential areas for work for EQUINET related to EQUINET’s programme of work areas. In the introductory remarks, it was indicated that while there were various prevention activities, focused on for example, workplace education, condom promotion, sexually transmitted infection treatment and control, youth, women, commercial sex workers, men who have sex with men, etc, there was 2.2 million Tanzanians living with HIV out of which 800 000 have full-blown AIDS.
Severe shortages of health staff are compromising the quality and availability of HIV/AIDS care across southern Africa. There is wide acknowledgement of the human resource crisis, but little action on the ground. MSF is urging governments to develop and implement emergency plans to retain and recruit health care workers that include measures to raise pay and improve working conditions.
This study assessed the health-related quality of life and HIV symptoms of a sample of people living with HIV (PLHIV) in South Africa. The sample included 607 PLHIVs from all districts of the Eastern Cape Province, recruited either through a health facility, from the community through key informants, or through support groups. The findings indicate a low degree of overall quality of life, with spirituality, environment, psychological health and level of independence as predictors for overall quality of life. Among medical variables and HIV symptoms, CD4 cell count and having fewer HIV symptoms (but not an AIDS diagnosis) were identified as predictors for overall quality of life. Among socio-economic variables, having sufficient food and a higher educational level were identified as predictors. The results highlight the need for better access to psychosocial support and medical services for PLHIV in South Africa, as well as the need to consider a patient's general health perceptions during the course of ART.
The roll-out of antiretroviral therapy (ART) in Africa will have significant resource implications arising from its impact on demand for healthcare services. Existing studies of healthcare utilisation on HAART have been conducted in the developed world, where HAART is commenced when HIV illness is less advanced. This paper describes healthcare utilization from program entry by treatment-naïve patients in a peri-urban settlement in South Africa.
This study set out to determine the incidence of HIV during pregnancy as defined by seroconversion using a repeat HIV rapid testing strategy during late pregnancy. It adopted a cross-sectional design within a prevention of mother-to-child transmission programme. Pregnant women were retested between 36 and 40 weeks of gestation, provided that they had been tested HIV negative at least three months prior. Single women were at 2.5 times higher risk of seroconverting during pregnancy. In general, HIV incidence during pregnancy was four times higher than in the non-pregnant population. Public health programmes need to continue to reinforce prevention strategies and HIV retesting during pregnancy. The latter also offers an additional opportunity to prevent mother-to-child transmission and further horizontal transmission. Further research is required to understand the cause of primary HIV infection in pregnancy.
The Soweto Men’s Study assessed HIV prevalence and associated risk factors among men who have sex with men (MSM) in Soweto, South Africa. Using respondent-driven sampling (RDS) recruitment methods, researchers recruited 378 MSM over 30 weeks in 2008. All results were adjusted for RDS sampling design. Overall HIV prevalence was estimated at 13.2%, with 33.9% among gay-identified men, 6.4% among bisexual-identified men, and 10.1% among straight-identified MSM. In multivariable analysis, HIV infection was associated with being older than 25, gay self-identification, monthly income less than ZAR500, purchasing alcohol or drugs in exchange for sex with another man and reporting between six and nine partners in the prior six months, including a regular female partner. The results of the study confirm that MSM are at high risk for HIV infection, with gay men at highest risk. HIV prevention and treatment for MSM are urgently needed, the authors conclude.
Increased fertility rates in HIV-infected women receiving antiretroviral therapy (ART) have been attributed to improved immunological function; it is unknown to what extent the rise in pregnancy rates is due to unintended pregnancies. In this study, non-pregnant women ages 18–35 from four public-sector ART clinics in Johannesburg, South Africa, were enrolled into a prospective cohort and followed from August 2009 to March 2011. Fertility intentions, contraception and pregnancy status were measured at participants' routine ART clinic visits. Of the 850 women enrolled, 170 pregnancies were detected, of which 105 (62%) were unplanned. Unmet need for contraception was 50% higher in women initiating ART in the past year as compared to women on ART for longer than one year. Eight hormonal contraceptive failures were detected. Overall 47% (80/170) of pregnancies were not carried to term. The researchers conclude that integration of contraceptive services and counselling into ART care is necessary to reduce maternal and child health risks related to mistimed and unwanted pregnancies. Further research into injectable contraceptive failures on ART is warranted.
This research analysed data from the Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS) from 25 sub-Saharan African countries to determine prevalence of cigarette smoking and use of smokeless tobacco according to HIV status. Cross-sectional data were collected between 2005 and 2015 from adults aged between 15 and 59 years. As well as HIV status, data were also collected on gender, marital/relationship status, level of education, income, area of residence (rural/urban) and employment status. These factors were taken into account in statistical analyses of the association between HIV status and tobacco use. Turning to HIV, the prevalence of smoking was higher among HIV-positive than HIV-negative individuals (10.6% vs 8.1%). Analysis by gender showed that 25.9% of HIV-positive men and 1.2% of HIV-positive women smoked, significantly higher than the 16.1% and 0.7% prevalence seen in HIV-negative men and women, respectively. Country-level analyses showed considerable variability in tobacco use between individual countries. The prevalence of smoking ranged from 2.4% in Ghana to 19.9% in Lesotho. Over half of countries (14 of 25) showed a higher smoking prevalence among people with HIV. The difference was significant in five countries: Gambia, Niger, Swaziland, Zambia and Zimbabwe. But in Ethiopia and Namibia, HIV-positive participants were less likely to smoke than HIV-negative ones. The investigators acknowledge a number of limitations, including the cross-sectional design of their study, failure to collect data on frequency and intensity of tobacco use and a lack of data on use of antiretroviral therapy.