In light of increasing access to antiretroviral therapy in sub-Saharan Africa, the authors conducted a longitudinal study to assess the impact of antiretroviral therapy on sexual risk behaviours among HIV-infected South Africans in urban and rural primary care clinics. This prospective observational cohort was conducted at rural and urban primary care HIV clinics, consisting of 1,544 men and 4,719 women enrolled from 2003 to 2010, and representing 19,703 clinic visits. The primary outcomes were being sexually active, unprotected sex and more than one sex partner and were evaluated at six-monthly intervals. Generalised estimated equations assessed the impact of antiretroviral therapy on sexual risk behaviours. Among 6,263 HIV-infected men and women, over a third (37.2%) initiated antiretroviral therapy (ART) during study follow-up. In comparison to pre-ART follow-up, visits while receiving antiretroviral therapy were associated with a decrease in those reporting being sexually active. Unprotected sex and having more than one sex partner were reduced at visits following ART initiation compared to pre-ART visits. Sexual risk behaviour significantly decreased following antiretroviral therapy initiation among HIV-infected South African men and women in primary care programmes. The study concludes that further expansion of ART programmes could enhance HIV prevention efforts in Africa.
Equity and HIV/AIDS
In 2003, Family Health International (FHI) and its donor and country partners launched antiretroviral therapy (ART) "learning sites" in Ghana, Kenya and Rwanda, hoping to demonstrate that ART services could be provided safely and effectively in resource-constrained settings. At each site, ART was introduced as an integral component of comprehensive care and support for HIV-infected patients and their families. The sites are part of closely linked referral networks within defined geographic areas, such as districts or municipalities. In the two years since the initial sites were launched, FHI and its partners have learned valuable lessons that can guide development and expansion of ART services in Africa and other regions.
Condom promotion and HIV testing for the general population have been major components of HIV prevention efforts in sub-Saharan Africa’s high prevalence HIV epidemics, although little evidence documents their public health impact. The authors analysed the latest demographic and health surveys (DHS) and AIDS information surveys (AIS) from four sub-Saharan African countries with high prevalence, heterosexually transmitted HIV epidemics (Côte d’Ivoire, Swaziland, Tanzania and Zambia; N = 48 298) to answer two questions: 1) Are men and women who use condoms less likely to be HIV-infected than those who do not?; and 2) Are men and women who report knowing their HIV status more likely to use condoms than those who do not? Consistent condom use was associated with lower HIV infection rates for Swazi men but with higher HIV infection rates for women in Tanzania and Zambia; it made no significant difference in the other five sex/country subgroups analysed. Inconsistent condom use was not significantly associated with HIV status in any subgroup. Knowing one’s HIV status was consistently associated with higher rates of condom use only among married people who were HIV-positive, even though condom use in this group remained relatively low. Effects of knowing one’s HIV status among other subgroups varied. These results suggest that condoms have had little population-wide impact for HIV/AIDS prevention in these four countries. HIV testing appears to be associated with increased condom use mainly among people in stable partnerships who test positive. HIV testing and condom promotion may be more effective when targeted to specific groups where there is evidence of benefit rather than to general populations.
In this statement, the South African Department of Health has given the go-ahead for patients on antiretroviral treatment (ART) to be given three months supply of medicines instead of one month. It will be more convenient for patients because they will have to make fewer trips to their health facility. It will also reduce patient-load on the health system, particularly on health facility pharmacies given the shortage of pharmacists in the public health system. The Department of Health states: ‘There is no indication of any legislation prohibiting the supply of medicines for three months to any one patient. This practice should only be implemented once the patient has proved stable on the regimen.’
A three-day summit on HIV and AIDS in May this year called on governments to depoliticise the fight against HIV and AIDS and take the lead in fighting the scourge rather than leave it to donors and lobbyist. the Global Citizens Summit held in Nairobi represented citizens from 32 nationals among them National AIDS Control Council representatives (commissioners) from seven countries in Africa and donors from Europe and the Americas. There were calls to ensure that citizens take their rightful place in the fight. Two recommendations that came from the meeting were: expand and diversify testing options (door to door, self testing and male-targeted testing) and make HIV testing a universal agenda. National governments must also provide incentives to promote care and support initiatives for citizens, such as tax exemptions for caregivers, social protection for caregivers and people living with HIV and AIDS (PLWHAs), and micro-enterprise funds targeted at caregivers and PLWHAs. Nutrition should be made part of treatment – both national governments and donors should aim to promote food sovereignty at the household level.
Speakers at a session on stigma at the 16th International Conference on AIDS and Sexually Transmitted Infections in Africa, held in December 2011 in Ethiopia, noted that HIV patients in Africa frequently suffer shame and depression but the continent’s health systems were ill-equipped to handle the issue, which not only affected their quality of life, but could lead to poor adherence to HIV treatment regimens. They said while HIV programmes focus heavily on reducing externalised stigma and ill-treatment of HIV patients by society, little is done to deal with a patients’ self-perception and how that might deteriorate following an HIV diagnosis. Studies from Zambia and Uganda have shown that depression is the most common psychiatric disorder among people living with HIV, and is more prevalent among HIV-positive people than in the general population. The Mbabane Mental Health Support Group, an advocacy group from Swaziland, calls for the integration of mental health services into primary healthcare as well as that of HIV positive people.
This study aimed at exploring determinants of HIV testing and counselling in two Nairobi informal settlements. Data are derived from a cross-sectional survey nested in an ongoing demographic surveillance system. A total of 3,162 individuals responded to the interview and out of these, 82% provided a blood sample which was tested using rapid test kits. Approximately 31% of all respondents had ever been tested for HIV through client-initiated testing and counselling (CITC), 22% through provider-initiated testing and counselling (PITC) and 42% had never been tested but indicated willingness to test. Overall, 62% of females and 38% of males had ever been tested for HIV. Males were less likely to have had CITC and also less likely to have had PITC compared to females. Individuals aged 20-24 years were more likely to have had either CITC or PITC compared to the other age groups. Although the proportion of individuals ever tested in the informal settlements is similar to the national average, it remains low compared to that of Nairobi province especially among men. Key determinants of HIV testing and counselling include; gender, age, education level, HIV status and marital status. These factors need to be considered in efforts aimed at increasing participation in HIV testing, the authors conclude.
This study examined determinants of facility readiness for integration of family planning with HIV testing and counseling services in Tanzania using data from the 2014–2015 Tanzania Service Provision Assessment Survey. A total of 1188 facilities were assessed and considered ready for integration of family planning with HIV testing and counseling services if they scored ≥ 50% on both family planning and HIV testing and counseling service readiness indices as identified by the World Health Organization. Of all the health facilities, 915 reported offering both family planning and HIV testing and counseling services, while only 536 were considered ready to integrate these two services. Significant determinants of facility readiness for integrating these two services were being government owned, having routine management meetings, availability of guidelines, in-service training of staff, and availability of laboratories for HIV testing. The authors judge the proportion of facility readiness for the integration of family planning with HIV testing and counseling in Tanzania to be unsatisfactory and suggest that the Ministry of Health distribute and ensure constant availability of guidelines, availability of rapid diagnostic tests for HIV testing, and refresher training to health providers, as determinants of facility readiness.
This paper examines determinants of facility readiness for integration of family planning with HIV testing and counselling services in Tanzania using data from the 2014–2015 Tanzania Service Provision Assessment Survey. Facilities were considered ready for integration of family planning with HIV testing and counselling services if they scored ≥ 50% on both family planning and HIV testing and counselling service readiness indices as identified by the World Health Organization. A total of 1188 health facilities were included in the study. Of all of the health facilities, 915 reported offering both family planning and HIV testing and counselling services, while only 536 were considered ready to integrate these two services. Significant determinants of facility readiness for integrating these two services were being government owned; having routine management meetings, availability of guidelines, in-service training of staff, and availability of laboratories for HIV testing. The proportion of facility readiness for the integration of family planning with HIV testing and counselling in Tanzania was noted to be unsatisfactory. The authors argue that Ministry of Health should distribute and ensure constant availability of guidelines, availability of rapid diagnostic tests for HIV testing, and the provision of refresher training to health providers, as these were among the determinants of facility readiness.
This paper seeks to describe the associations between socio-demographic, behavioural and social characteristics and knowledge of HIV status among a nationally representative population in South Africa. A multistage, representative probability sample involving 16,395 male and female respondents, aged 15 years or older was selected. From the total sample 27.6% ever and 7.8% knew their HIV status in the past 12 months. In multivariate analyses, being female, the age group 25 to 34 years old, other than African Black population group (White, Coloured and Asian), higher educational level, being employed, urban residence, awareness of a place nearby where one could be tested for HIV, impact of HIV on the household and having had two of more sexual partners in the past year were associated with knowledge of HIV status. Education about HIV and AIDS and access to HIV counselling and testing in rural areas, in particular among the Black African population group needs to be improved, in order to enhance the uptake of HIV counselling and testing services, an essential step for the initiation of treatment.