Although Madagascar and its neighbouring islands states of Comoros, Mauritius and Seychelles have extremely low HIV prevalence rates at around 0.37% (or 24,000 confirmed cases), they are reporting problems with supplying health services to HIV-positive people. Recent stock-outs have sometimes left patients without treatment for months, exposing them to the risk of developing drug-resistance. The Malagasy Ministry of Health and its private sector distributor, Salama, have reported experiencing problems placing orders because suppliers are not interested in providing small quantities, making it difficult to keep adequate supplies of antiretrovirals in stock. One possibility being explored is putting in place a central purchasing mechanism for the four Indian Ocean countries. This facility would fall under the oversight of the High Level Partnership Forum, which is expected to be set up after discussions with the Indian Ocean Commission, an inter-governmental cooperation group. The forum would include Ministers of Foreign Affairs, Ministers of Health, networks of people living with HIV, support groups and various financial partners.
Equity and HIV/AIDS
"The introduction of antiretroviral drugs will bring with it new challenges because this treatment is different from that for opportunistic infections, palliative care, home based care and cotrimoxasol prophylaxis which we have been providing and will continue to provide. It is different in the sense that these drugs are delicate, have a variety of side effects and have to be taken regularly and correctly for life. However, I am confident that Uganda will succeed to roll out this treatment to our people."
In collaboration with local stakeholders, this study designed and assessed a referral system to link persons diagnosed at a voluntary counselling and testing (VCT) clinic in a rural district in northern Tanzania with a government-run HIV treatment clinic in a nearby city. Two-part referral forms, with unique matching numbers on each side were implemented to facilitate access to the HIV clinic, and were subsequently reconciled to monitor the proportion of diagnosed clients who registered for these services, stratified by sex and referral period. Delays between referral and registration at the HIV clinic were calculated, and lists of non-attendees were generated to facilitate tracing among those who had given prior consent for follow up. The study found that referral uptake at the HIV clinic averaged 72% among men and 66% among women during the first three years of the national antiretroviral therapy (ART) programme, and gradually increased following the introduction of the transportation allowances and community escorts, but declined following a national VCT campaign. It concluded that the referral system reduced delays in seeking care, and enabled the monitoring of access to HIV treatment among diagnosed persons. Similar systems to monitor referral uptake and linkages between HIV services could be readily implemented in other settings.
AIDS activists from the advocacy group, AIDS Therapeutic Treatment Now, South Africa (ATTN SA) expressed outrage and frustration over the move by the South African government to cut by two-thirds its AIDS budget. According to the Financial Times (UK) newspaper (2/2/04), "The initial budget of R296m (pounds Sterling 22m, $42m, euro 34m) for the first phase of the roll-out of treatment, up to the end of next month, has been cut to R90m by the Treasury, without explanation."
Support for Ethiopian families affected by the AIDS pandemic has come from an unexpected source - local funeral associations, known as edirs. An edir is a traditional 'burial society' to which members make monthly contributions and receive a payment to help cover funeral expenses in return. Nearly every modern Ethiopian is thought to be a member of at least one edir, either a neighbourhood association, one based at work, or operating along age or gender lines. Now one edir changed its constitution to allow members to draw a quarter of their 2,000 birr (US$238) funeral payout before death, and permit a small extra fee to be levied to pay for additional social support from Tesfa, an organisation providing help, particularly in the area of HIV, to 26 affiliated edirs.
This study estimates mean life years gained using different treatment indications in low-income countries. It carried out a systematic search to identify relevant studies on the treatment effect of highly active antiretroviral therapy (HAART) and data was applied to a hypothetical Tanzanian HIV population. It found that providing HAART early when CD4 is 200-350 cells/μl is likely to be the best outcome strategy with an expected net benefit of 14.5 life years per patient. The model predicts diminishing treatment benefits for patients starting treatment when CD4 counts are lower. Patients starting treatment at CD4 50-199 and <50 cells/μl have expected net health benefits of 7.6 and 7.3 life years. Without treatment, HIV patients with CD4 counts 200-350; 50-199 and < 50 cells/μl can expect to live 4.8; 2 and 0.7 life years respectively. This study demonstrates that HIV patients live longer with early start strategies in low-income countries. Since low-income countries have many constraints to full coverage of HAART, this study provides input to a more transparent debate regarding where to draw explicit eligibility criteria during further scale up of HAART.
The US Government Accountability Office (GAO) have released a long-awaited report analyzing the effects of the abstinence-until-marriage earmark in the US Global Leadership on HIV, Tuberculosis, and Malaria Act of 2003, also known as the President's Emergency Plan for AIDS Relief, or PEPFAR. In theory, the law supports a comprehensive approach often described as ABC or Abstain, Be Faithful, Use Condoms, and argues that prevention programs should be designed to meet local needs and realities. In practice, the law requires that, as of FY 2006, at least 33 percent of prevention funding be set aside for so-called "abstinence-until-marriage" programs. Key findings in the GAO report are reported to indicate that PEPFAR prevention programs have responded in design more to the agenda of the Bush Administration and Congress than to local prevention needs, epidemiological needs and cultural realities.
The Kenyan government is considering a policy of repeat HIV testing during pregnancy. 'Currently, the lack of it is a gap in our policies,' said Peter Cherutich, head of HIV prevention at the National AIDS and Sexually Transmitted Infections Control Programme. 'Testing should be done periodically, even after childbirth, because a mother can become infected even during the breastfeeding period.' At present, HIV-positive mothers and their babies in Kenya are given a combination of three antiretroviral drugs after a single test, usually carried in the early stages of the pregnancy. 'If a woman tests negative during her prenatal test, gets infected during the pregnancy, and is not given the necessary medication during labour to protect the child, she stands a chance of infecting her child at birth or even during breastfeeding and you go back to square one,' Cherutich said. Infants contracting HIV through their mothers account for about 20% of an estimated 166,000 annual HIV infections in Kenya.
The article argues that people and communities perceive and deal with HIV and AIDS as only one of the many problems and tensions they experience as affecting their well being. It is also noted that the discussion of the issues related to HIV and AIDS and sexuality is blocked by deeply held views that men have about women and sex. This is the reason why the issue of gender is central when discussing with people to determine the health they want and how to manage AIDS. The study team brought together rural youth of 13-25 years and men and women of 26-45 years and used participatory action research methodologies to reflect and exchange information, knowledge and skills on the issues related to gender and HIV/AIDS. This empowering knowledge was useful for launching advocacy for attitude and behaviour change toward risky sexual behaviours and for supporting communities in developing visions of healthy communities the people truly cherish.
This study, conducted between May 2009 and January 2010, undertook to explore the social, economic and cultural factors related to engagement in multiple concurrent sexual partnerships in Zambia. In-depth interviews were conducted at seven geographically diverse sites across Zambia. Interviews were conducted with 301 men and women who perceived themselves to be in stable relationships. Researchers used structured interviews and careful probing to elicit detailed information on all sexual partnerships during the previous 12 months. They found that overlapping concurrency was frequent among both men (71%) and women (46%) who identified themselves as being in stable relationships. Men who reported overlapping concurrency averaged three partners compared with women who had approximately two partners over the 12-month recall period. Quantitative data indicated that a high degree of mobility, with more than three-quarters of the entire sample indicating some degree of travel in their daily lives. The study calls for more research into the role of mobility in HIV transmission, as well as more national surveillance (biological and behavioural) data on mobile and migrant populations in Zambia. Currently, there is no systematic framework for collecting behavioral or biomedical data from migrant/mobile populations, and numerous gaps exist in data with regard to these groups. In addition, HIV prevention efforts must reflect a better understanding of the social and cultural nuances of mobility and migration that affect decisions to engage in sexual concurrency.