This report describes the implementation and short-term results of a peer group intervention for HIV prevention on the HIV-related attitudes, knowledge and behaviours of primary school teachers in Malawi. The intervention, based on the social-cognitive learning model, took place in 2000 at two teacher training colleges with a distance-learning programme. Primary school teachers attending a final six-week training session before certification volunteered to participate. The 286 trainee teachers largely reported positive changes in their HIV-prevention-related knowledge, attitudes, self-efficacy, behaviour change and condom-use intentions. However, at post-test immediately after the intervention they did not show a higher level of perceived-risk, a greater hope that people could change their high-risk sexual behaviour, or greater agreement that persons infected with HIV should be allowed in public places. This research demonstrates the feasibility of an HIV-prevention intervention for primary school teachers during their training. The Malawi Ministry of Education has since made the programme available to over 90 per cent of all trainee teachers through an NGO.
Equity and HIV/AIDS
The authors conducted a systematic review of studies evaluating HIV testing services (HTS) by lay providers using rapid diagnostic tests (RDTs). Peer-reviewed articles were included if they compared HTS using RDTs performed by trained lay providers to HTS by health professionals, or to no intervention. The authors also reviewed data on end-users' values and preferences around lay providers preforming HTS. Searching was conducted through 10 online databases, reviewing reference lists, and contacting experts. Screening and data abstraction were conducted in duplicate using systematic methods. Of 6113 unique citations identified, 5 studies were included in the effectiveness review and 6 in the values and preferences review. One US-based randomised trial found patients' uptake of HTS doubled with lay providers (57% vs. 27%). In Malawi, a pre/post study showed increases in HTS sites and tests after delegation to lay providers. Studies from Cambodia, Malawi, and South Africa comparing testing quality between lay providers and laboratory staff found little discordance and high sensitivity and specificity between them. Based on evidence supporting using trained lay providers, a WHO expert panel recommended lay providers be allowed to conduct HTS using HIV RDTs. Uptake of this recommendation could expand HIV testing to more people globally.
Single-dose nevirapine used for prevention of mother-to-child transmission does not appear to be jeopardising the future treatment responses of mothers who take it, researchers from Zambia reported this week at the Sixteenth International AIDS Conference in Toronto, Canada. Their study is the largest investigation to date of the effects of single-dose nevirapine on subsequent maternal treatment response.
The traditional role of care giving and support provided to orphans by paternal and maternal grandparents, uncles and aunts is slowly being eroded. More and more households are becoming nuclear family centred. Challenges facing Orphans and Vulnerable Children (OVC) include serious shortages of housing and exposure to abuse (including ill-treatment and sexual abuse). This study collected information on conditions of OVC in Kweneng West and Serowe/Palapye districts, Botswana, and the services in place that cater for OVC needs.
HIV serostatus disclosure to community members has been shown to have potential public and personal health benefits. This study examined the impact of bonding and bridging social capital (i.e. close and distant ties) on public disclosure. Data was collected from a public sector ART programme in the Free State province in the form of semi-structured, face-to-face interviews with 268 patients. The study identified bonding social capital as a leverage to maximise potential benefits and minimise potential risks so as to shift the balance toward consistent public disclosure. Furthermore, the importance of bridging social capital initiatives is demonstrated, especially for the most vulnerable patients, namely those who cannot capitalise their bonding social capital by disclosing their HIV serostatus to family and friends at the start of treatment.
This paper presents information on the association between socio-demographic variables and AIDS prevalence in some African and the Organization for Economic Cooperation and Development (OECD) countries. Insignificant difference in the means of AIDS-rates between the OECD countries and the African group was found, but the difference was significant when the USA was excluded from the analysis. As initially expected, life expectancy in the OECD countries was significantly higher than that of the African group while the average rates of infant mortality, population growth, fertility, and death were significantly higher within the African group. Significant association between AIDS-rate and life expectancy was only found for African males, while association with fertility, infant mortality, population density, and calorie intakes was statistically insignificant. No clear difference between urban and rural areas with respect to AIDS-rates was discerned. Communities of Muslims were less subject to the AIDS problem. In conclusion, future studies should devote more attention toward impacts on HIV/AIDS prevalence of other equally important variables such as access to social and health care services, cultural norms, ethnic diversity, and educational facilities.
The authors determined the prevalence and sociodemographic predictors of HIV among pregnant women in Botswana through a cross-sectional study of 407 randomly enrolled women aged 18 to 49 years, attending 7 health facilities between November 2017 and March 2018. The HIV prevalence was 17%. Women aged 35 to 49 years had higher HIV prevalence than those 18 to 24 years. Illiterate and elementary school educated women had higher HIV prevalence than those with a tertiary education. Those with a history of alcohol intake had a higher HIV prevalence than those without. While HIV prevalence was lower than it was in 2011 the authors call for targeted interventions that integrate these identified dimensions of susceptibility.
The authors assessed socioeconomic disparities in mortality indicators in a rural South African population over the period 2001–13 using data from 21 villages of the Agincourt Health and socio-Demographic Surveillance System (HDSS). They calculated the probabilities of death from birth to age 5 years and from age 15 to 60 years, life expectancy at birth, and cause-specific and age-specific mortality by sex (not in children <5 years), time period, and socioeconomic status (household wealth) quintile for HIV/AIDS and tuberculosis, other communicable diseases (excluding HIV/AIDS and tuberculosis) and maternal, perinatal, and nutritional causes, non-communicable diseases, and injury. They quantified differences with relative risk ratios and relative and slope indices of inequality. The authors found significant socioeconomic status gradients for mortality and life expectancy at birth, with outcomes improving with increasing socioeconomic status. An inverse relation was seen for HIV/AIDS and tuberculosis mortality and socioeconomic status that persisted from 2001 to 2013. Deaths from non-communicable diseases increased over time in both sexes, and injury was an important cause of death in men and boys. Neither of these causes of death, however, showed consistent significant associations with household socioeconomic status. The poorest people in the population continue to bear a high burden of HIV/AIDS and tuberculosis mortality, despite free antiretroviral therapy being made available from public health facilities. They argue that integrated strategies are needed to improve access to and uptake of HIV testing, care, and treatment, and management of non-communicable diseases in the poorest populations.
The US-based NGO, AIDS Healthcare Foundation (AHF), has lodged a complaint with South Africa's Competition Tribunal against leading anti-AIDS drug producer, GlaxoSmithKline (GSK), saying Glaxo's high drug prices are preventing the treatment of more HIV-positive South Africans. A local newspaper, Business Day, quoted AHF president Michael Weinstein as saying: "We have had to turn people away from our clinic because we simply don't have the funds to treat all the people who need treatment. If the price of GSK's AIDS drugs had been lower, we might have been able to save their lives."
About 90 non-governmental organisations (NGOs) in South Africa's KwaZulu-Natal province have teamed up to work with the government in rolling out antiretroviral (ARV) drugs, in the first structured civil society response of its kind in South Africa, and possibly even on the continent. When the government announced a national rollout plan for free ARVs in September 2003, Cati Vawda, director of the Durban-based Children's Rights Centre, and a number of her NGO colleagues, quickly realised that "government alone cannot do it".