The article examines the incidence of HIV infection among women of reproductive age in Malawi and Zimbabwe. Of the 2,016 women who participated in the study, 1,679 were tested for HIV during follow up and 113 seroconverted resulting in an overall HIV incidence rate of 4.7 per 100 women. HIV incidence continues to be high among women in both countries despite counselling and condom promotion.
Equity and HIV/AIDS
HIV incidence among women of reproductive age in Malawi and Zimbabwe
Kumwenda N, Hoffman I , Chirenje M, et al: Sexually Transmitted Diseases 33 (11), 646-651, 2006
HIV infection and sexual risk behaviour among youth who have experienced orphanhood: Systematic review and meta-analysis
Operario D, Underhill K, Chuong C and Cluver L: Journal of the International AIDS Society 14(25), 18 May 2011
Do orphaned children and adolescents have elevated risk for HIV infection? In this study, researchers examined the state of evidence regarding the association between orphan status and HIV risk in studies of youth aged 24 years and younger. Using systematic review methodology, they identified 10 studies reporting data from 12 countries comparing orphaned and non-orphaned youth on HIV-related risk indicators, including HIV serostatus, other sexually transmitted infections, pregnancy and sexual behaviours. Meta-analysis of HIV testing data from 19,140 participants indicated significantly greater HIV seroprevalence among orphaned (10.8%) compared with non-orphaned youth (5.9%). Trends across studies showed evidence for greater sexual risk behaviour in orphaned youth. In conclusion, studies on HIV risk in orphaned populations, which mostly include samples from sub-Saharan Africa, show nearly two-fold greater odds of HIV infection among orphaned youth and higher levels of sexual risk behaviour than among their non-orphaned peers. Interventions to reduce risk for HIV transmission in orphaned youth are needed to address the sequelae of parental illness and death that might contribute to sexual risk and HIV infection.
HIV infection and tuberculosis in South Africa: An urgent need to escalate the public health response
Karim SSA, Churchyard GJ, Karim QA and Lawn SD: The Lancet 374(9692): 921–933, 5 September 2009
In 2007, South Africa, with 0·7% of the world's population, had 17% of the global burden of HIV infection, and one of the world's worst tuberculosis epidemics, compounded by rising drug resistance and HIV co-infection but, until recently, the government's response to these diseases has been marked by denial, lack of political will and poor implementation of policies and programmes. Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts and scale-up of free antiretroviral therapy (ART). Using the framework of the Strategic Plans for South Africa for Tuberculosis and HIV/AIDS, this paper provides a prioritised four-step approaches for tuberculosis control, HIV prevention, and HIV treatment. Strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health-care services are needed for successful implementation of these approaches.
HIV infection in older adults in sub-Saharan Africa: Extrapolating prevalence from existing data
Negin J and Cumming RG: Bulletin of the World Health Organization 88(11), November 2010
This study sought to quantify the number of cases and prevalence of human immunodeficiency virus (HIV) infection among older adults in sub-Saharan Africa. It reviewed data from Demographic and Health Surveys (DHS), of which 8 surveys contained data on HIV infection among men aged ≥ 50 years. Data was also extrapolated from the Joint United Nations Programme on HIV/AIDS on the estimated number of people living with HIV and on HIV infection prevalence among adults aged 15–49 years. The study found that, in 2007, approximately 3 million people aged ≥ 50 years were living with HIV in sub-Saharan Africa. The prevalence of HIV infection in this group was 4.0%, compared with 5.0% among those aged 15–49 years. Of the approximately 21 million people in sub-Saharan Africa aged ≥ 15 years that were HIV+, 14.3% were ≥ 50 years old. The study concludes that to better reflect the longer survival of people living with HIV and the ageing of the HIV+ population, indicators of the prevalence of HIV infection should be expanded to include people > 49 years of age. Little is known about comorbidity and sexual behaviour among HIV+ older adults or about the biological and cultural factors that increase the risk of transmission. HIV services need to be better targeted to respond to the growing needs of older adults living with HIV.
HIV infection in patients with sexually transmitted infections in Zimbabwe – Results from the Zimbabwe STI etiology study
Kilmarx P; Gonese E; Lewis D; et al.: PLoS One, doi: https://doi.org/10.1371/journal.pone.0198683, 2018
HIV and other sexually transmitted infections (STI) frequently co-occur. The authors conducted HIV diagnostic testing in an assessment of the etiologies of major STI syndromes in Zimbabwe. A total of 600 patients were enrolled at six geographically diverse, high-volume STI clinics in Zimbabwe in 2014–15: 200 men with urethral discharge, 200 women with vaginal discharge, and 100 men and 100 women each with genital ulcer disease (GUD). Patients completed a questionnaire, underwent a genital examination, and had specimens taken for etiologic testing. Patients were offered, but not required to accept, HIV testing using a standard HIV algorithm in which two rapid tests defined a positive result. A total of 489 participants accepted HIV testing; 201 tested HIV-1-positive, including 16 of 134 participants who reported an HIV-negative status at study enrollment, and 58 of 206 participants who reported their HIV status as unknown. Of 147 who self-reported being HIV-positive at study enrollment, 21 tested HIV negative. HIV infection prevalence was higher in women than in men, and was 28.5% in men with urethral discharge, 40.5% in women with vaginal discharge, 45.2% in men with GUD, and 59.8% in women with GUD. The high prevalence of HIV infection in STI clinic patients in Zimbabwe is argued by the authors to underscore the importance of providing HIV testing and referral for indicated prevention and treatment services for this population. The discrepancy between positive self-reported and negative study HIV test results highlights the need for operator training, strict attention to laboratory quality assurance, and clear communication with patients about their HIV infection status.
HIV is not in recession! TB is not in recession!
Treatment Action Campaign: 6 May 2009
A coalition of health advocates from Sub-Saharan Africa has warned that the lives of millions of people in Sub-Saharan Africa are in jeopardy because of the lack of political will and investment to realise the right of access to life-saving treatment. ‘If the current cost constraints faced by HIV treatment programmes are not addressed, while the demand for expensive second-line treatment increases, we will find ourselves in a situation similar to the ’90s, where millions of lives were lost unnecessarily because people could not afford the treatment they needed to stay alive’, they said. The coalition rejects pitting HIV against other diseases because they believe there is ample evidence that ARV roll-out has strengthened health systems, and the work done by AIDS service organisations has revolutionised healthcare in the developing world.
HIV mortality in urban slums of Nairobi, Kenya 2003--2010: a period effect analysis
Oti SO, Mutua M, Mgomella GS, Egondi T, Ezeh A and Kyobutungi C: BMC Public Health 13(588), 17 June 2013
This study aims to demonstrate changes in population level HIV mortality in two high HIV prevalence slums in Nairobi with respect to the initiation and subsequent scale up of the national antiretroviral therapy (ART) programme. The authors used data from 2070 deaths of people aged 15–54 years that occurred between 2003 and 2010 in a population of about 72,000 individuals living in two slums covered by the Nairobi Urban Health and Demographic Surveillance System. Results indicated that, overall, HIV mortality declined significantly from 2.5 per 1,000 person years in the early period to 1.7 per 1,000 person years in the late period. The risk of dying from HIV was 53% less in the late period compared to the period before, controlling for age and gender. Women experienced a decline in HIV mortality between the two periods that was more than double that of men. At the same time, the risk of non-HIV mortality did not change significantly between the two time periods. In conclusions, population-level HIV mortality in Nairobi’s slums was significantly lower in the approximate period coinciding with the scale-up of ART provision in Kenya. However, further studies that incorporate ART coverage data in mortality estimates are needed. Such information will enhance our understanding of the full impact of ART scale-up in reducing adult mortality among marginalised slum populations in Kenya.
HIV prevalence and related factors: Higher education sector study, South Africa, 2008–2009
South African Higher Education HIV/AIDS Programme: 2010
This study looked at HIV prevalence in the higher education sector in South Africa. It reported both quantitative and qualitative data. Out of a total of 29,856 eligible participants available at testing venues, 79,1% participated fully by completing questionnaires and providing specimens. Because of a substantial amount of missing data in 230 questionnaires, the final database consisted of 23,375 individuals made up of 17,062 students, 1,880 academic staff and 4,433 administrative and service staff. The mean HIV prevalence for students was 3,4%. HIV was significantly more common among men (6,5%) and women (12,1%) who reported symptoms of a sexuallty transmitted infection (STI) in the last year compared to men (2,5%) and women (6%) who did not report an STI. First-year students appeared to lack the required experience to make good, risk-aware decisions, especially regarding sexual liaisons and the use of alcohol. Qualitative data pointed to underlying causes of HIV transmission on campus as including reported transactional sex, intergenerational sex (a young woman with an older wealthier man), poor campus leadership on HIV and AIDS, limited uptake of voluntary testing and counseling services, poor levels of security on campus and stigma surrounding the disease.
HIV prevalence and related factors: Higher education sector study, South Africa, 2008–2009
Higher Education HIV/AIDS Programme: 2010
This study looked at HIV prevalence in the higher education sector in South Africa. It reported both quantitative and qualitative data. Out of a total of 29,856 eligible participants available at testing venues, 79,1% participated fully by completing questionnaires and providing specimens. Because of a substantial amount of missing data in 230 questionnaires, the final database consisted of 23,375 individuals made up of 17,062 students, 1,880 academic staff and 4,433 administrative and service staff. The mean HIV prevalence for students was 3,4%. HIV was significantly more common among men (6,5%) and women (12,1%) who reported symptoms of a sexually transmitted infection (STI) in the last year compared to men (2,5%) and women (6%) who did not report an STI. First-year students appeared to lack the required experience to make good, risk-aware decisions, especially regarding sexual liaisons and the use of alcohol. Qualitative data pointed to underlying causes of HIV transmission on campus as including reported transactional sex, intergenerational sex (a young woman with an older wealthier man), poor campus leadership on HIV and AIDS, limited uptake of voluntary testing and counselling services, poor levels of security on campus and stigma surrounding the disease.
HIV prevalence in young people and children living on the streets, Kenya
Braitstein P; Ayuku D; DeLong A; Makori D; et al: Bulletin World Health Organisation 97(1) 33–41, 2019
This paper seeks to obtain an estimate of the size of and human immunodeficiency (HIV) prevalence among, young people and children living on the streets of Eldoret, Kenya. The authors counted young people and children using a point-in-time approach, ensuring the authors reached a target population by engaging relevant community leaders during the planning of the study. The authors acquired point-in-time count data over a period of 1 week between the hours of 08:00 and 23:00, from both a stationary site and by mobile teams. Participants provided demographic data and a fingerprint and were encouraged to speak with an HIV counsellor and undergo HIV testing. Of the 1419 eligible participants counted, 1049 were male with a median age of 18 years. Of the 1029 who spoke with a counsellor, 1004 individuals accepted HIV counselling and 947 agreed to undergo an HIV test. Combining those who were already aware of their HIV-positive status with those who were tested during this study resulted in an overall HIV seroprevalence of 4.1%. The seroprevalence was 2.7% for males and 8.9% for females. The authors observed an increase in seroprevalence with increasing age for both sexes, but of much greater magnitude for females. By counting young people and children living on the streets and offering them HIV counselling and testing, the authors could obtain population-based estimates of HIV prevalence.