AIDS an African Emergency - Zuma 30/05/2013
News24 reports that according to President Zuma (South Africa):
HIV/AIDS is major problem facing Africa, which has borne a significant burden as a result of the disease, President Jacob Zuma said on Sunday.
"The leadership of the African Union considers AIDS, tuberculosis (TB), malaria and other infectious diseases as emergencies requiring bold action, unprecedented levels of financial investments and sustained political leadership," Zuma told an AIDS Watch Africa heads of state and government luncheon in Addis Ababa, Ethiopia.
In the past two decades, significant progress had been made fighting the disease through a wide variety of mechanisms.
"Whilst a significant component of resources dedicated to addressing these epidemics and diseases came from the development community, Africa is now in a stronger position to lead, define and drive its own development," he said, according to a copy of his speech.
"More importantly, an increasing number of African governments are increasing their domestic allocation to the health sector and in particular to the fight against HIV/AIDS, TB, malaria and other diseases."
Success would be slowing down and eventually eradicating these diseases, and to do this, bold leadership, innovation, flexibility and investment in research to inform policy was required.
Zuma said Aids Watch Africa was a consolidation of the African Union's (AU) efforts to fight HIV/Aids. It would monitor the implementation of important declarations made by the AU to fight HIV/AIDS.
New frontiers were also being explored, such as the BRICS (Brazil, Russia, India, China, South Africa) platform, and partnerships with the private sector.
"The efforts and investments are starting to bear fruit as highlighted by some of the most recent reports that have been published by the United Nations joint Aids programme," Zuma said.
"[The reports] show that access to antiretroviral drugs has increased from 2.95 million in 2008, to 3.9m in 2009 and to seven million people in 2013."
While this was good news, it needed to be kept in mind that many people still did not have access to life-saving therapy.
"In South Africa, we have made some huge strides in the fight against HIV/AIDS since its discovery some 30 years ago," Zuma said.
"As a country at the grip of this epidemic, South Africa has indeed been hardest hit by the impact of not only HIV, but the TB epidemic as well."
South Africa had developed several strategies and interventions to reduce the number of new HIV infections, and had expanded access to treatment for people living with HIV, especially pregnant women.
The results were that 20 million people had been tested since April 2010, 10 million people had been screened for TB, 500 000 new patients were on antiretroviral treatment and HIV/Aids-related deaths had been reduced by 50% to less than 270 000.
The transmission of HIV from mother-to-child in South Africa had also significantly decreased in the past three years, from a high of eight percent in 2010, to 2.7% this year.
These achievements had not made South Africa complacent, and the country continued to review programmes, and introduce new approaches in line with international guidelines, Zuma said.
African National Strategic Plans
Most current publicly available national strategic plans to address HIV
This database hosts the most current publicly available national strategic plans to address HIV, representing both PEPFAR-funded and non PEPFAR-funded countries.
Country ownership is fundamental to an effective HIV response. Development partners including PEPFAR, UNAIDS, and the Global Fund have reaffirmed their support of country-led national planning. PEPFAR II funds services "aligned with the national plans of partner governments and integrated with existing health care delivery systems."
Plan National Strategique de lutte contre les IST/VIH/Sida (1.01MB PDF)
National Strategy Plan on HIV/AIDS (400.29KB PDF)
Cadre Strategique National de Lutte Contre Le VIH/SIDA/IST (639.67KB PDF)
National Strategic Framework for HIV/AIDS (3.42MB PDF)
Cadre Strategique de Lutte Contre Le VIH/SIDA et les IST (CSLS) 2006-2010 (1.25MB PDF)
Plan Strategique National de lutte contre le VIH/SIDA 2007-2011 (3.32MB PDF)
Cadre Strategique National de Lutte contre le VIH/SIDA, 2006-2010 (June 2006) (558.42KB PDF)
Cadre Stratégique National de lutte contre le VIH/SIDA et les IST 2007-2011, Janvier 2007 (916.45KB PDF)
Plan Stratégique National de lutte contre les IST/VIH/SIDA 2008-2012. Union des Comores. (288.58KB PDF)
Plan Stratégique National de Lutte contre le VIH/SIDA 2006-2010 (5.09MB PDF)
Cadre Strategique de Lutte contre le SIDA en Guinee Equatoriale 2001-2005 (No date) (423.8KB PDF)
National Strategic Plan on HIV/AIDS/STIs 2003-2007, April 2003 (655.68KB PDF)
Plan D'Action Sectorie de Lutte Contre les IST et let VIH/SIDA (2.26MB PDF)
Ghana HIV/AIDS Strategic Framework (4.39MB PDF)
Cadre Stratégique National 2008 - 2012 (4.18MB PDF)
Kenya National AIDS Strategic Plan 2009/10-2012/13 (4.4MB PDF)
Lesotho National HIV and AIDS Strategic Plan (2006-2011) (557.1KB PDF)
National HIV/AIDS Strategic Framework II, 2010-2014 (954.16KB PDF)
Madagascar Plan Stratégique National de lutte contre le VIH/Sida 2001-2006 (594.04KB PDF)
Malawi HIV and AIDS Extended National Action Framework (NAF), 2010 - 2012 DRAFT (1.11MB PDF)
Haut Conseil National De Lutte Contre Le VIH/Sisa (6.64MB PDF)
Cadre Strategique de Lutte contre les IST/VIH/SIDA (3.83MB PDF)
Mozambique National Strategic Plan for the Combat Against HIV/AIDS OPERATIONALISATION 2005-2009 (2.42MB PDF)
National Strategic Framework for HIV and AIDS Response in Namibia 2010-2016 (7.03MB PDF)
Coordination intersectorielle de lutte contre les IST/VIH/SIDA (1.1MB PDF)
Nigeria HIV/AIDS National Strategic Framework for Action (2005 - 2009) (4.91MB PDF)
National HIV and AIDS Strategic Plan 2005-2009 (844.52KB PDF)
Cadre Strategique National de Lutte contre le VIH/SIDS et les IST 2009-2013 (2.14MB PDF)
Rwanda National Strategic Plan on HIV and AIDS 2009-2012 (1.38MB PDF)
Plan Strategique de Luttle Contre le SIDA (2.25MB PDF)
Sudan National Strategic Plan and Sectoral Plans on HIV/AIDS 2004-2009 (1.46MB PDF)
National Strategic Framework for HIV and AIDS 2009 - 2014 (682.63KB PDF)
National Multi-Sectoral Strategic Framework on HIV and AIDS (2008 - 2012) (1.31MB PDF)
Plan Strategique National de Lutte Contre le SIDA et les IST (1.81MB PDF)
Moving Toward Universal Access - National HIV & AIDS Strategic Plan 2007/2008 - 2011/2012 (1.32MB PDF)
Union of the Comoros Plan Stratégique National de lutte contre les IST/VIH/SIDA 2008-2012 (304.48KB PDF)
National HIV and AIDS Strategic Framework 2006 - 2010 (1.76MB PDF)
National HIV and AIDS Multi-Sectoral Action Plan 2007/8 - 2008/9, 3rd Draft (834.11KB PDF)
Zimbabwe National HIV and AIDS Strategic Plan (ZNASP) 2006 - 2010 (2.53MB PDF)
Boksburg Communiqué on the Tweet@ble Regional Policy Dialogue on Integrated SRHR and HIV Services for Key Populations in Eastern and Southern Africa (ESA). 3/4/2014
We, the delegates to the Regional Policy Dialogue on Integrated Sexual and Reproductive Health and Rights and HIV Services for Key Populations in ESA, including His Excellency the former president of the Republic of Mozambique, Joaquim Chissano, former heads of state and governments from ESA, the African Union Commission, national AIDS co-ordinating agencies, international co-operating partners, the United Nations Joint Programme on HIV and AIDS, development partners and key populations, gathered in Boksburg, Johannesburg, South Africa, from 2 - 3 April, 2014:
Recognising the urgent need to address the sexual and reproductive health and rights (SRHR) and needs of key populations in eastern and southern Africa;
Concerned that violations against key populations undermine their basic rights and wellbeing as enshrined in the Universal Declaration of Human Rights (1948);
Concerned that the voices of key populations are silent or overlooked in making policy decisions about their health, wellbeing and development; inadequate evidence exists to inform interventions, policies and laws that reflect the SRH service needs of key populations;
Aware of the urgent need to develop policy that addresses the SRH and HIV service concerns of key populations in the post 2015 development agenda;
Noting the economic cost and development impact of stigma, discrimination and exclusion of key populations from mainstream public health interventions;
Convinced of the need to stop human rights violations experienced by different key populations in the region;
And determined to scale up access to and uptake of quality, integrated SRH and HIV information and services by key populations;
Deeply alarmed about:
- High rates of HIV infections in Africa - particularly in the ESA region, gender-based violence and poor SRH outcomes among key populations;
- Limited involvement of key populations in design and implementation of HIV and SRHR information and programmes;
- Lack of a conducive policy environment to support access to and uptake of SRH and HIV information and services by key populations;
- Continued isolation, discrimination, persecution, rejection and violence against key populations;
- Gross violations of human rights of key populations and continued criminalisation, founded on prejudice, hate and blackmail.
- Public health issues be depoliticised;
- Based on data drawn from the principles of Know Your Epidemic - Know Your Response the definition of key populations be harmonised within country contexts;
- Disaggregated data for key populations (by age, equity dimensions, sex, sexual orientation, gender identity, sexual orientation, ethnicity) be collected to inform policy and programmes;
- Greater investment in SRH policy and services to reduce the HIV and SRH burdens faced by key populations.
And specifically recommend the following for various key population groups:
For people living with HIV:
- The implementation of the Positive Health, Dignity and Prevention policy framework at country level;
- Monitoring of human rights violations experienced by people living with HIV;
- Meaningful involvement of people living with HIV in the design, conceptualisation, implementation, monitoring and evaluation of all policies and programmes that affect their lives.
For lesbian, gay, bisexual, transgender and intersex (LGBTI) people:
- Country policies should recognise and address the needs of LGBTI populations using a fundamental human rights approach;
- Develop and adopt minimum SRH service packages that address the needs of LGBTI populations;
- Continued and systematic advocacy against criminalisation laws, guidelines, policies and constitutions;
- Continued sensitisation of all key stakeholders using an evidence-based approach.
For sex workers:
- Decriminalise all laws and policies against sex work;
- Policy implementation to be done through a multi-sectoral approach;
- Recognise sex work as a legitimate form of work, using the human rights approach;
- Provision of integrated life skills, entrepreneurship training, HIV and SRH services that reach the most marginalised sex workers;
- Engaging political, religious and traditional leaders to play a pro-active role in protecting sex workers.
For persons with disabilities:
- Domesticate the Convention on the Rights of Persons with Disabilities, and other declarations and commitments on people with disabilities;
- Service delivery models should mainstream the needs of people with disabilities;
- Meaningful involvement of people with disabilities in policy formulation and implementation.
For young people:
- Accountability of national governments towards the ESA ministerial commitment and other regional and international commitments on SRHR and Comprehensive Sexuality Education;
- Comprehensive sexuality education for young people, including young people who identify with different key populations (PLHIV, sex workers, LGBTI people, people with disabilities);
- Deliver youth friendly services that adequately address young people’s health and social needs;
- Conduct comprehensive operational research and data analysis of laws and policies to understand how they impact on the SRHR of adolescents and young people.
We pledge to:
- Take concrete measures to work with key populations, African Union Commission, East African Community, Southern African Development Community (SADC), governments, development partners, civil society and communities to ensure policies address the SRHR needs and concerns of key populations in ESA and promote their access to sexual and reproductive health services and commodities that respond to HIV and other SRHR elements;
- Establish a supportive environment for policy to be operationalised across the region.
Thus done and agreed on this 3rd day of April, 2014, by the delegates to the Tweet@ble Regional Policy Dialogue on Integrated Sexual and Reproductive Health and Rights and HIV Services for Key Populations in ESA.
Contact SAfAIDS Media Desk
Southern African Development Community (SADC) leaders met for special session of AIDS Watch Africa. 26/08/2013
LILONGWE, 26 August 2013 (UNAIDS) - Heads of State and Government from countries in the Southern African Development Community (SADC) met on 18 August to discuss the progress made and the challenges that the region is facing regarding HIV, tuberculosis and malaria.
Given the financial down-turn for the AIDS response, SADC leaders underlined the need to explore ways to increase domestic resources and expressed their support for the replenishment of the Global Fund to fight AIDS, TB and malaria. They also agreed to push for global solidarity and shared responsibility for HIV, TB and malaria responses in Africa in line with the African Union roadmap adopted in July 2012.
SADC Member States underlined the need for regional production and procurement of essential medicines and commodities for AIDS, TB and malaria. They stressed that with increasing demand for HIV treatment, the SADC region should step up its efforts to ensure favourable polices, encourage technology transfer and build capacity of African countries to produce high quality drugs and other pharmaceutical goods.
Despite progress made in the AIDS response in recent years—coverage of antiretroviral treatment for people living with HIV has increased considerably in several countries—SADC remains the region most affected by HIV, with millions of people still lacking access to life saving treatment and care services.
Discussing the need to scale up access to HIV testing and treatment, structural, financial, human resources and human rights challenges were identified by the SADC leaders as the main obstacles to attain the goal of universal access. HIV testing and counselling is a critical and essential gateway to HIV services. WHO and UNAIDS, having endorsed the concept of universal access to knowledge of HIV status, recommend that HIV testing be conducted on a voluntary basis, consistent with WHO/UNAIDS guidelines. In this context, SADC leaders welcomed WHO’s new treatment guidelines which provides for earlier initiation of HIV treatment.
The meeting took place on the margins of the 33rd SADC Summit held from 17–18 August in Lilongwe, Malawi. It was attended by many Heads of States, including Presidents of Botswana, the Democratic Republic of Congo, Mozambique, United Republic of Tanzania, South Africa and Zimbabwe.
Was Higher Viral Load Responsible for the African HIV Epidemic? 14/02/2013
Co-infections may have increased incidence, especially in low-risk groups
Gus Cairns (Published: 12 February 2013)
Researchers from Cornell University in New York have found that the average HIV viral load of people not taking antiretroviral medication (ART) in Africa, and especially in southern and eastern Africa, is higher than the viral loads of untreated patients on other parts of the world. The so-called 'community viral load' (CVL) off treatment was nearly four times higher on average in sub-Saharan Africa as a whole, and 5.5 times higher in southern African countries excluding South Africa, than it was in North America.
Speculating that these higher viral loads might be the reason Africa has experienced a far more serious epidemic of HIV than other regions, and one that has spread into the general population, the researchers used a mathematical model to estimate that one-in-seven HIV infections in sub-Sarahan Africa would not have happened if the CVL in untreated people had been the same as in richer regions. Their model found that this effect was especially marked in low-risk populations such as heterosexual people with few partners.
Off-treatment viral load is higher in Africa
The observed community viral loads were gathered from a number of cohort studies of people with HIV who were not on ART in various parts of the world. Viral loads from over 66,000 people in 39 different cohort groups were gathered and divided into four CD4 count ranges (under 200, 200 to 350, 350 to 500, and over 500 cells/mm3). There was a big geographical imbalance, with nearly half of all samples from Europe and under 400, from a single cohort study, from South America, limiting the precision of the CVL estimate from this region.
There were significant differences in average viral loads off treatment around the world. As expected, they were lower in people with the highest CD4 counts, where they ranged from approximately 5000 in the US to 15,000 in east Africa (3.65 to 4.18 logs); and they were highest in people with the lowest CD4 counts, ranging from 15,000 in South America to 220,000 in west Africa (4.17 to 5.33 logs).
Viral loads in west Africa, east Africa and southern Africa were consistently higher than viral loads elsewhere – they were twice (0.29 logs) as high in west Africa as in North America, and 5 and 5.5 times higher respectively (0.71 and 0.74 logs) in east and southern Africa. The community viral load was also significantly, but modestly, higher in Asia (about 40% or 0.14 logs higher). The country of South Africa itself was considered separately because of its relatively better health system than other countries in the area; there, the average viral load was about 50% or 1.9 logs higher than in the North America.
Implications for HIV infection
Putting these viral load data into a model using previous findings on the degree to which rising viral load increases infectiousness, and using population data from the epidemic in Kisumu, Kenya, the researchers calculated that by 2010 cumulative HIV prevalence in an untreated population was 13.9% greater than it would have been had untreated CVL been at the level seen in North America rather than in Africa; in other words one-in-seven HIV infections was directly attributable to the higher viral load.
However, raised viral load also skews demographics because it disproportionately affects people at lower risk of HIV (because people at higher risk would become infected even if CVL was lower, due to greater frequency of unprotected sex). This means that HIV prevalence in lower-risk heterosexuals was 22.5% higher than it otherwise would have been; nearly one-in-four infections in this group was directly attributable to higher CVL.
The researchers also calculated that a 34% decline in the frequency of sex (or a 51% increase in protected sex) would be needed to compensate for the viral load effect seen.
Their model showed that the effect of higher CVL would be particularly marked at the mid-point of the epidemic’s growth. Using an assumption that HIV prevalence first started to rise significantly in 1980, they found that, with the observed CVL, the steepest point in the epidemic’s growth occurred about 1988. If CVL had been the global average in Africa, this point would not have been reached till seven years later, leading to a modelled HIV prevalence of about 20% in the mid-90s rather than 8% – pretty close to what actually happened in southern Africa.
Questions and conclusions
The question these data beg, of course, is what is causing the excess viral load? The researchers speculate that the higher rate of untreated co-infections in Africa could be to blame, and cite a 2002 paper from Uganda that shows that a herpes attack can raise HIV viral load by 50%, active tuberculosis by 150%, and acute malaria by 370% (a nearly fivefold increase).
This fact has been known for some time, and although trials that attempt to reduce HIV incidence by treating other diseases such as herpes and inflammatory STIs have tended to produce negative results, the concept is not dead; a trial in Kenya is currently looking at the effect on HIV of treating worm infestations.
This study shows that raised viral load cannot be the entire explanation for south and east Africa’s dramatically larger HIV epidemics: a combination of factors ranging from it being HIV’s home continent to war and poverty contributed to its unique spread into the general population.
It does, however, show that higher viral load probably made a very significant contribution at a key point in the epidemic in Africa and underlines, as the researchers say, the idea that controlling HIV viral load with antiretrovirals is key to stopping further infection. It also suggests that, until universal ART coverage is achieved, treating co-infections with the right cheaper therapies “may offer a complementary strategy for the control of HIV in sub-Saharan Africa”.
Abu-Raddad LJ et al. Have the explosive HIV epidemics in sub-Saharan Africa been driven by higher community viral load? AIDS 24, early online edition, DOI:10.1097/QAD.0b013e32835cb927, 2013.
“Protect the Goal” Campaign Launched at Opening of the Africa Cup of Nations 19/01/2013
UNAIDS: The campaign aims to harness the power of football to raise awareness of HIV
JOHANNESBURG, 19 January 2013— The President of South Africa, Jacob Zuma, UNAIDS Executive Director, Michel Sidibé and the President of the Confederation of African Football, Issa Hayatou launched the “Protect the Goal” initiative on January 19 at the opening ceremony of the Orange Africa Cup of Nations in Johannesburg.
The “Protect the Goal” campaign aims to raise awareness of HIV and mobilize young people to commit to HIV prevention. Globally, an estimated 4.6 million young people (15-24 years of age) are living with HIV. About 2 300 young people are infected with HIV each day. Many young people living with HIV, who are eligible for treatment lack access or do not know their HIV status. The “Protect the Goal” campaign also stresses the need for ensuring all the 15 million people eligible for life-saving antiretroviral treatment can access it by 2015.
“Accelerating large-scale efforts for HIV prevention and treatment is imperative in Africa,” said President Jacob Zuma. “With strong leadership from government and community support, South Africa is showing results and its commitment to ending AIDS.”
During the Africa Cup of Nations, UNAIDS is partnering with the Confederation of African Football, the South African Football Association and the Tobeka Madiba Zuma Foundation to implement the “Protect the Goal” initiative. During the campaign, UNAIDS and its partners will disseminate HIV prevention messages on large electronic screens to football fans in all stadiums where the Africa Cup of Nations football games are taking place. The captains of each of the 16 teams participating in the games will read a statement calling on players, football fans and young people to support the campaign. The “Protect the Goal” campaign will continue until the 2014 FIFA World Cup in Brazil.
“Football appeals so much to young people and I am thrilled to have such a groundswell of support from the stars of African soccer,” said UNAIDS Executive Director, Michel Sidibé. “I know this is just the start of an astonishing campaign which will generate much enthusiasm among fans all the way to Rio 2014.”
As part of advocacy activities in the lead-up to the tournament, UNAIDS country offices were able to enlist the support of national football federations to the Protect the Goal campaign. As a result, team captains from Algeria, Democratic Republic of Congo (DRC), Ethiopia, Ghana, and Niger signed a pledge to support the campaign. Other countries are expected to join the initiative during the three week-long Africa Cup of Nations tournament.
“We are extremely happy to support UNAIDS in their efforts to roll out this campaign across the continent,” said President of the Confederation of African Football, Issa Hayatou. ”Our teams are committed to an Africa where AIDS is no longer a threat.”
The 29th edition of the Orange Africa Cup of Nations will last until 10 February, the day of the finale. It is the most prestigious football tournament on the continent and happens every two years. The sixteen teams participating in this year’s championship are: Algeria, Angola, Burkina Faso, Cape Verde, Côte d’Ivoire, Democratic Republic of Congo, Ethiopia, Ghana, Mali, Morocco, Niger, Nigeria, South Africa (host), Togo, Tunisia, and Zambia.
Extra-couple Relationships a Significant Driver of HIV Epidemic 06/02/2013
Heterosexual couples in long-term relationships who have sexual encounters outside their established partnership (extra-couple relationships) are one of the main drivers of the HIV epidemic in sub-Saharan Africa, according to new research published in The Lancet journal.
The researchers added that their mathematical model showed that transmission within cohabiting couples occurred largely from men to women.
The findings of the mathematical modelling study indicate that current HIV-prevention efforts, which chiefly target couples where one partner is HIV-positive and the other is not (serodiscordant couples), will be insufficient to bring about major reductions in HIV incidence in the general population.
“Because of the large contribution of extra-couple transmission (from outside partnerships) to new HIV infections, interventions should target the larger sexually active population and not just serodiscordant couples”, said Steve Bellan from the University of Texas, Austin, who led the research.
“Pre-couple (prior to relationship), extra-couple, and within-couple transmission are all common, and HIV control policies that address all these routes are needed to stem the HIV epidemic in Africa,” he said.
In sub-Saharan Africa, where most new HIV infections occur, defining the most-at-risk groups is crucial to targeting intervention efforts effectively. But the proportion of heterosexual HIV transmissions that occur within couples—compared with the proportions that occur in single people or in people in extra-couple relationships—has been hotly debated.
University of Cape Town actuary and epidemiologist, Leigh Johnson said the findings of the latest study appeared to be consistent with what Johnson and colleagues had published previously.
The latest findings are also consistent with a recent study by Hiam Chemaitelly of Weill Cornell Medical College in Qatar (published in the journal AIDS), which found that only a fraction of new HIV infections occur within identifiable stable discordant couples in sub-Saharan Africa.
To help clarify HIV risk for African couples, the authors of this new study in The Lancet developed a sophisticated modelling system that, unlike previous models, combines serostatus and relationship data from Demographic and Health Surveys (DHS) with country-specific trends for the prevalence of HIV, and estimates of HIV survival times.
They used the model to distinguish the specific routes by which individuals became infected in 27 201 cohabiting couples from 18 sub-Saharan African countries.
The estimates suggest that between 30 and 65 percent of all new HIV infections in men and between 10 and 47 percent in women within stable partnerships are the result of extra-couple transmission.
Other important findings to emerge were that transmission in couples occurs more from men to women than vice versa, and that women have a period of high infection risk before entering a cohabiting partnership—emphasising the continuing need for prevention strategies aimed at young women.
The researchers believe that despite its expense and logistic demands, a test-and-treat strategy that targets all heterosexual routes of transmission could be key to fighting the HIV epidemic. Test-and-treat involves placing individuals on antiretroviral treatment as soon as they are diagnosed, no matter the progression of the disease. – Health-e News Service
Review: 'Our Kind of People' Details AIDS Crisis in Africa. 15/7/12
Uzodinma Iweala shows the devastating effects of the crisis in sub-Saharan Africa and how desperately education is needed to counter deeply ingrained attitudes.
Los Angeles Times
By David L. Ulin, Los Angeles Times Book Critic
15 July 2012
About halfway through "Our Kind of People: A Continent's Challenge, A Country's Hope," a stunning inquiry into the AIDS crisis in sub-Saharan Africa, Uzodinma Iweala makes the thrust of his investigation clear.
"I found his words interesting," he writes of a Nigerian politician who blames the disease's spread on long-distance truckers and rest-stop sex workers, "because they seemed to externalize both the epidemic and its primary means of transmission — sex. By focusing on these groups of people that Nigerians traditionally consider promiscuous or of lax morality, he seemed to suggest that normal people with normal monogamous sexual relationships exist outside the reach of the virus. Or, as one woman I interviewed, who had recently graduated from college, put it: 'Everybody wants to believe that they're very good and they're too clean for all of that; that people that die of AIDS or have HIV are dirty people, people that sleep around or do rubbish and stuff, not our kind of people.'"
There you have it, not just the source of Iweala's title, but also the challenge that AIDS provokes. From the start, it has come with an agenda, "understood," to borrow a phrase from Susan Sontag, "as a disease not only of sexual excess but of perversity." For Iweala, Sontag's observation offers a vivid lens on AIDS as both medical and cultural condition, a source of physical and spiritual despair.
"The disease," he notes, "is … seen as a commentary on a person's moral standing. As one doctor I spoke with briefly about HIV put it, 'Whenever people see you, they say, "Oh! Here is a sinner — somebody must have gone and done something really bad." ' "
And later: "If to be open about one's status is to don a set of scarlet letters that says 'not one of us,' not human, then it is understandable why so many would remain silent about or ignorant of their status. The more the virus spreads, the more people die, and the stronger the stigma grows."
That's an important point because, for all that medical advances have helped make AIDS something of a chronic condition for some in the West, it remains a killer in Africa.
"[W]hat does it mean to say," Iweala asks, "that 33.4 million people in the world are HIV positive and 28.2 million of those in sub-Saharan Africa? What does it mean to say that 1.8 million people in Africa died last year as a result of the virus and its effects?" This is more than just a health-care issue, he goes on to argue, but one with implications for the economy and social polity.
"Countries affected by HIV/AIDS deaths," he writes, "face a declining workforce, which can translate into a drastic drop in productive capacity. Household incomes drop dramatically when working members of a family die from HIV/AIDS. Most alarmingly, when adults die from HIV/AIDS, they leave behind children, orphans, who will likely have decreased access to nutrition, educational opportunities, and other economic advantages that would make them productive members of society.… Death from HIV/AIDS comes to mean a loss of opportunity, not just for those who die, but for those they leave behind."
What Iweala evokes is the human cost of AIDS, and this is where "Our Kind of People" excels. A fiction writer as well as a physician — his novel "Beasts of No Nation" won a 2005 Los Angeles Times Book Prize — he is adept at making the numbers personal through a series of character portraits, primarily from his native Nigeria, where 3 million people live with the disease. This is a key idea, that of living with the disease, especially in a country where religious and cultural pressures have made AIDS difficult to talk about.
In that sense, Iweala's focus on narrative, on sharing the voices and experiences of his subjects, becomes an act of redemption, a way to dignify the struggle of activists and survivors, not to mention those who have died. "You know this story," he writes in the first chapter. "You have heard it many times. This is the story of HIV/AIDS in Africa.… Or is it?" The point is that only through stories will we ever understand or, more essentially, question our preconceptions about AIDS and what it means.
That brings us back to the Nigerian politician and his argument that AIDS is a disease of truckers and sex workers when in fact it affects everyone. It also allows Iweala to address certain stereotypes that give us permission in his view to explain away the disease. "For some both on and off the continent, the presence of HIV/AIDS in Africa confirms that there is indeed something untoward about the way Africans approach sex," he reflects, before recalling an encounter with a woman who asked, "Isn't HIV the disease that started because someone in Africa had sex with a monkey?"
It's a ridiculous question, but Iweala pushes us to reckon with its ramifications, citing a report by medical anthropologist Daniel Hrdy that compares "promiscuity as a risk factor" in African society with the "promiscuous behavior" of (yes) a species of monkeys known as vervets. "We are left to conclude," Iweala suggests, with no small trace of irony, "that even if HIV/AIDS isn't the result of some African having sex with a monkey, it has certainly spread because Africans were having sex like monkeys."
Such pointed commentary appears throughout "Our Kind of People," infusing the book with an insider's edge. Yet Iweala is also clear about his status as an outsider — as much because of his privilege as because he does not have HIV. These parallel strands come together when he visits a brothel to interview a pair of female sex workers. "How many men do you see in a day?" he asks, only to be brought up short when one of the women responds, "Why do you ask?… There is no need of that." Her reaction provokes an act of soul-searching as compelling as it is unexpected, as Iweala is driven to question his assumptions about the disease.
"Why did I ask?" he wonders. "[I]f I am honest … [i]t is the same sentiment that caused the politician to associate HIV/AIDS with the sexual practices of prostitutes and truck drivers. It is the same sentiment that initially led some to look at the scope of the HIV/AIDS epidemic in Africa and suggest that … Africans must be more promiscuous and perverse than the general population." Here, Iweala turns the tables on himself by highlighting his complicity in the crisis — a complicity that can't help but implicate all of us as well.
Devastating Impact of Global Fund Crisis. 25/7/12
New research from Malawi, Swaziland and Zimbabwe has highlighted just how devastating the cancellation of Round 11 funding has been on the HIV and TB response in the region.
By Richard Lee
25 July 2012
Everyone knew that the crisis at the Global Fund to Fight AIDS, TB and Malaria would have a serious impact across southern Africa, which is still the epicentre of the HIV and AIDS pandemic. But no one knew exactly how serious it would be - or what would be most affected.
But now new research from Malawi, Swaziland and Zimbabwe has highlighted just how devastating the cancellation of Round 11 funding has been on the HIV and TB response in the region.
Funded by the Open Society Initiative for Southern Africa (OSISA) and the Open Society Foundations (OSF), the report - entitled The First to Go: How communities are being affected by the Global Fund Crisis - details how the funding crisis has severely undermined efforts to tackle HIV and AIDS in southern Africa by weakening civil society organisations, diverting funds away from critical support programmes and preventing countries from targeting some of the most-at-risk groups.
"Forced to choose between providing essential medical services or funding the initiatives that support them, these countries have shifted budgets away from civil society organisations, human rights programming, community mobilisation and politically-sensitive programmes," said the report's author, Laura Lopez Gonzalez. "UNAIDS believes that these activities are crucial to the overall success of any national HIV response but they are the First to Go."
Round 11 funding would have supported community-based NGOs to provide treatment literacy and adherence support; lead community education, mobilisation and prevention efforts; and address barriers to treatment, care and support. It would also have allowed countries to fill critical gaps in HIV and TB treatment, diagnostics, and other commodities; scale-up prevention interventions such as the prevention of mother-to-child HIV transmission services and medical male circumcision; and strengthen health systems.
Civil society organisations (CSOs) in all three countries were already facing a funding crisis when Round 11 was cancelled. This new research reveals that the organisations most vulnerable to current cuts in resources are community-based organisations working at the local or district levels - and particularly organisations for People Living with HIV (PLWH).
"Years after UNAIDS and the Global Fund drove the involvement of PLWH, their organisations are among those most at risk of closure," said Lopez Gonzalez. "With little hope of sourcing alternate funds, civil society networks are in danger of collapse."
Indeed, 100 percent of the CSOs interviewed for the study reported that their networks have been adversely affected by shrinking budgets in recent years. With the closure of CSOs, their networks and governments lose the advantages and structures they have grown to rely on, especially in countries facing huge challenges in domestically financing HIV and TB responses.
Round 11 would have been a watershed moment in southern Africa. Under its HIV application, Swaziland planned to include interventions for sex workers, men-who-have-sex-with-men (MSM) and a small community of injecting drug users in its Global Fund proposal for the first time. Malawi's application would have been the second to include MSM and sex workers but possibly the first to be funded.
"Considering that same-sex relationships, sex work and drug use are criminal offences in Malawi and Swaziland, targeting these most-at-risk groups would have been a major step forward," said Chivuli Ukwimi, Marginalised Populations Coordinator for the Open Society Initiative for Southern Africa (OSISA).
Given the serious impact of the cancellation of Round 11, the report calls on the Board of the Global Fund to issue a new call for applications as soon as possible and to emphasise the importance of investing in 'critical enablers' to increase the effectiveness of core programme activities.
The report also urges the Board to reaffirm the importance of CSOs in health responses and to call on the Secretariat to develop a strategy that outlines how CSOs will be supported through the implementation of the new Global Fund strategic plan (2012-2016).
At a time when US Secretary of State, Hillary Clinton, has announced earmarked US support for reaching vulnerable populations, such as sex workers, the Fund's technical partners must take an active role in safeguarding the involvement of CSOs that are best placed to reach these most-at-risk groups.
"Technical partners, like UNAIDS and the Stop TB Partnership, should provide concise technical guidance to countries applying for Global Fund money to safeguard support for critical enablers, including community-based service design and delivery," said Shannon Kowalski, programme officer at the Open Society Foundations Public Health Programme. "Strengthening community systems to support decentralising healthcare, moving healthcare out of clinics and into communities, is crucial to making sure services reach those in need."
"The Global Fund is one of only a handful of donors that support this kind of community systems strengthening," she added.
Finally, the report calls on all donor countries, including new and emerging donors, to meet their commitments to funding sustainable HIV, TB and malaria programmes through increased - and long-term - pledges to the Global Fund at its next replenishment conference in 2013.
ETHIOPIA: Safe Water Critical to Health of HIV-Positive People. 27/8/2012
ADDIS ABABA, 27 August 2012 (PlusNews) - Beletu Hailemariam, 32, is HIV-positive and knows she should avoid contracting opportunistic infections that could further compromise her immune system. But she lives in one of poorer suburbs of Ethiopia's capital, Addis Ababa, and has to share a toilet with dozens of people and walk long distances to access clean water. A year ago, she was diagnosed with typhoid.
"At that time, I didn't know how an easily curable disease like that... put my life at risk. The doctors told me it has to do with me having the virus in my blood that makes me too weak to cope with the disease," the mother of seven told IRIN/PlusNews. "They told me to be cautious and make an effort to avoid other opportunistic infections for a second time."
Opportunistic infections reduce one's quality of life and can speed the progression of HIV to AIDS, resulting in premature death.
Since her recovery, Hailemariam says she is being "extra careful" not to contract another illness. However, her access to safe water and sanitation has not improved, leaving her at continued risk of waterborne diseases.
"The nearest communal toilet and water points are several minutes' walk away... Twenty-seven households share this dirty toilet, while 11 families share the communal water point," she said.
Beletu is too weak to work, and her husband's US$16-a-month pension is insufficient to pay for the construction of a private latrine or for piped water.
"Health workers have taught me how to protect myself using a simple but efficient way," she said. "I clean my hands with soap after using the toilet. I always treat the water my family drinks... I know not doing this could risk me getting diarrhoea and other opportunistic diseases."
Health workers say a lack of information on the prevention of common opportunistic infections means many Ethiopians living with HIV continue to contract easily preventable diseases.
"Most of them reach our hospital's emergency outpatient department after opportunistic diseases - such as diarrhoeal diseases and typhoid fever - have compromised their immune system," Daniel Teshome, a public health officer at Zewditu Memorial Hospital in Addis Ababa, told IRIN/PlusNews. "They have little knowledge of what caused it, though."
Access to water
According to the NGO Wateraid, people living with HIV are often unable to access community water sources or latrines because of stigma and discrimination.
Although patients usually recover with treatment, many will get repeat infections unless their access to safe water is improved. A 2009 assessment of the water and sanitation situation of HIV-positive home-based care clients in Addis Ababa found that only 62.5 percent had access to improved sanitation, only 6.9 percent had access to bathing facilities and only 4.3 per cent had access to hand-washing facilities near latrines.
The assessment found that the water, sanitation and hygiene needs of home-based care clients were not met, and that safe water, sanitation and hygiene should be essential components of basic preventive care packages for home-based care clients at policy, service provision and community levels.
Experts say HIV-positive children are particularly vulnerable to waterborne infections. "HIV-infected children are at higher risk of getting infectious diseases often associated with poor hygiene and sanitation conditions," said Muhammad Irfan, a water sanitation and hygiene specialist with the UN Children's Fund (UNICEF) in Ethiopia.
More than 180,000 Ethiopia children are infected with HIV, according to Ethiopian government statistics, and according to the 2011 Demographic and Health Survey (DHS), about 60,000 children under the age of five die due to diarrhoea every year in Ethiopia.
Safe water is especially important for people on life-prolonging antiretroviral (ARV) drugs. According to Wateraid, ARVs must be taken with at least 1.5 litres of safe water a day to be effective.
Experts are calling for water and sanitation issues to be addressed by the country's HIV care and treatment programmes and the country's national HIV policy. "Integrating these special needs of people living with the virus in various policies is critically important now," said Mahider Tesfu, a water and sanitation expert with Wateraid.
The Ethiopian government appears to be doing just that. It has laid out ambitious plans for water, sanitation and hygiene through its Universal Access Plan II, which seeks to reach 98.5 percent of its population with access to safe water and 100 percent with access to sanitation by 2015.
The country is also drafting a document called "Guidelines to Integrate Water, Sanitation and Hygiene into HIV Programmes", which lays the groundwork for incorporating safe water, sanitation and hygiene practices into all HIV care services being delivered at all levels.
According to UNICEF, the implementation of simple steps such as treating water and washing hands with soap can have a significant impact on prevention of waterborne diseases. "Handwashing with soap has been shown to reduce the incidence of diarrhoeal disease by over 40 percent," said UNICEF's Irfan.
Criminalization of Drug Use Fuelling HIV. 27/6/12
The war against drugs is hurting the fight against HIV, according to a new report by the Global Commission on Drug policy
27 June 2012
Nairobi- The war against drugs is hurting the fight against HIV, according to a new report by the Global Commission on Drug policy, an international panel that advocates science-based strategies to reduce the harm caused by drugs.
"The public health implications of HIV treatment disruptions resulting from drug law enforcement tactics have not been appropriately recognized as a major impediment to efforts to control the global HIV/AIDS pandemic," the authors said. "The war on drugs has also led to a policy distortion, whereby evidence-based addiction treatment and public health measures have been downplayed or ignored."
Among measures that hamper drug users' access to HIV services, the report cited fear of arrest, restrictions on the provision of sterile syringes to drug users, prohibition of opioid substitution therapy and other evidence-based treatment, as well as the lack of HIV prevention measures in prisons, disruptions in HIV antiretroviral therapy, and in adequate investment in proven HIV prevention strategies.
"High rates of incarceration among drug users with, or at risk of, HIV infection are a matter of deep concern, given that incarceration has been associated with syringe-sharing, unprotected sex and HIV outbreaks in many places around the world," the authors noted.
Globally, an estimated 16 million people inject illegal drugs, of whom about three million - nearly one in five - are living with HIV.
"In addition to promoting the sharing of syringes and other HIV-risk behaviour, punitive drug law enforcement measures create barriers to HIV testing and treatment [among injecting drug users (IDUs)]," the authors said.
The Kenyan government reported that according to a 2011 survey, people who inject drugs have an HIV prevalence of 18.3 percent - one of the highest rates in any population.
Drug use is illegal in Kenya, and a recent plan by the government to distribute around 50,000 free syringes has faced opposition, with critics suggesting the move will increase drug abuse and crime.
Jackson*, 25, a heroin addict, voluntarily admitted himself in February for rehabilitation at a private facility in the Kenyan capital, Nairobi. Not long after he checked himself in, the police raided the centre, bundled him into a police vehicle and charging him with trafficking.
"I knew drugs would kill me because I had even tested HIV-positive. I wanted help and went to the rehabilitation [facility], but the police spoilt all that," he told IRIN/PlusNews. "Yes I was an addict, but there was no evidence at the time and the court released me."
His incarceration in police cells during the seven months that the court process took meant he had no access to treatment for HIV or for his addiction. He says now he is too afraid to even walk into a health facility to get treatment, and instead lives on the streets where he is still using drugs.
"This is the only place where I feel I am safe. Even the hospital belongs to the government, and you don't know if there are informers there," he said. "I can't go - I will die using drugs."
Experts told IRIN/PlusNews that treating drug addiction and abuse as a criminal act rather than as a public health concern was endangering the lives of drug users and their sexual partners.
"The best way to reduce the market for illegal drugs is to sensitize people on its health dangers, rather than to criminalize it. When you criminalize, people simply hide but do not stop using drugs," criminology lecturer Vincent Ombasa told IRIN/PlusNews.
Cynthia Masiga, a health worker in a government health facility in Nairobi, said: "So long as drug abuse is criminal… if a drug addict comes in, I know I am dealing with a criminal. It is very easy for somebody to blame you for not reporting to the police. It is complicated."
Research shows that encouraging IDUs to test for HIV, treating the addiction and the infection, and keeping the individuals in care, is a more successful strategy for preventing the spread of HIV than incarcerating addicts.
The Global Commission on drug Policy report cited a Swiss programme for injecting drug users that distributed syringes, supervised injecting facilities, and made methadone therapy, heroin prescription, and ARVs easily accessible, and saw HIV prevalence among drug users drop from 68 percent in 1985 to about 5 percent in 2009.
The report called for public health bodies in the United Nations system to lead the response to drug use, to push governments to halt the practice of arresting and imprisoning drugs users, and to "replace ineffective measures focused on the criminalization and punishment of people who use drugs with evidence-based and rights-affirming interventions proven to meaningfully reduce the negative individual and community consequences of drug use".
"Act urgently," the authors recommended. "The war on drugs has failed, and millions of new HIV infections and AIDS deaths can be averted if action is taken no."
11.3m Infected and Counting! 28/4/11
Increase of 31 percent from the 8,6 million of a decade earlier.
28 April 2011
Windhoek (Southern Times) – Southern Africa now has 11,3 million people living with HIV and AIDS, an increase of 31 percent from the 8,6 million of a decade earlier.
While it is acknowledged that much work has been done over the last ten years to contain the pandemic, governments and experts are in agreement that much work still needs doing. Domestic resource mobilization for HIV and AIDS intervention programmes remains low with few countries dedicating at least 10 percent of their national budgets despite prevalence rates being above this percentile.
The dependence on foreign funding has also been cited as a problem as it comes with specific intervention conditions that may not tally with individual countries' long-term plans.
For countries like Zimbabwe, foreign funding generally has not been forthcoming for political reasons. Experts also say prevention strategies often fail to address key drivers of national epidemics, including people in stable relationships and adults over 25 years of age.
According to UNAIDS, nine countries in Southern Africa continue to bear a disproportionate share of the global burden. Approximately 5.6 million of PLWHA in Southern Africa reside in South Africa alone and all countries in the region – except Angola – have HIV prevalence rates greater than 10 percent.
In Lesotho, prevalence of more than 15 percent has been noted across all education, income, and migration strata while Swaziland has the world's highest prevalence rate. In 2009, the region accounted for 34 percent of all PLWHA and AIDS-related deaths worldwide. It is not all doom and gloom though.
There has been an encouraging trend towards safer sexual behaviors in the 15 to 24 year age group, according to UNAIDS data from 2000 to 2007. In South Africa, for example, the proportion of 15 to 49-year-olds reporting condom use in their most recent sexual encounter more than doubled from 31.3 percent in 2002 to 64.8 percent in 2008.
Zimbabwe has continued to register a gradual decline in HIV prevalence over the past decade. In 2001, the estimated HIV prevalence in adults aged between 15 to 49 years was 23,7 percent but it dropped to 18,1 percent in 2005. The national estimates for 2009 revealed a further decline and it now stands at 14,3 percent, a trend that the UN has commended. This has been attributed to behaviour change, delayed sexual debut and increased condom use among other factors. Zimbabwe's Health and Child Welfare Deputy Minister Douglas Mombeshora, in an interview with the Southern Times on Wednesday, said the country had done very well in reduction of the HIV prevalence rate.
'I am happy with the progress Zimbabwe has made but I would want to see more being done and virtually eliminate new HIV infections,' he stressed. According to the 2010 MDG Status Report for Zimbabwe: 'A combination of both prevention efforts and scaling up treatments is likely to have a greater impact that either singular effort.' The report said by December 2009, only 53 percent of all HIV positive patients were on anti-retroviral treatment.
Zimbabwe has probably the least donor funding for HIV in Africa, with per capita spending of just US$4 compared to more than US$300 in other countries. This has impacted negatively on the government's efforts to put as many people as possible on ART. Of the 11 rounds of funding under the Global Fund to Fight HIV and Aids, TB and Malaria, Zimbabwe has only benefited thrice.
This is despite experts acknowledging that the country's technical capacity and proposals are very good. South Africa's Health Minister Aaron Motsoaledi also told the Southern Times that the government was working at full throttle to combat the virus but conceded that more needed to done. 'We have a big problem. In South Africa we have put up a lot of programmes. For example we have done away with Voluntary Counseling and Testing and we introduced HIV Counseling and Testing. 'The main difference is that with HCT we go to the people and ask them to volunteer for testing and not wait for them to come on their own to VCT centers.' The HCT drive seems to be paying dividends.
More than 600 000 people have been tested for HIV in the North West province in the past 12 months, according to provincial health and social development spokesperson Tebogo Lekgethwane. The province is on track to reach its target of testing one-third of its 3.2 million inhabitants before the end of June.
Lekgethwane said 20 410 people had been put on antiretroviral treatment (7 044 men, 11 805 women and 1 523 children under the age of 15). Some 2 216 pregnant women were also put on ARV treatment together with 542 infants. In 2007, only 28 percent of people in South Africa with advanced HIV or AIDS were on ART. President Jacob Zuma's government has been upping the ante and among its more controversial proposals has been introduction of HIV testing at schools.
Allen Thompson, deputy president of the National Teachers' Union has responded to this saying the health department wanted to have the world's biggest HIV testing scheme at any cost.
Namibia's Health and Social Services Minister Richard Kamwi said they remained worried by the high prevalence rates. 'Namibians are still getting infected by the day therefore my message is prevention, prevention and prevention,' Kamwi said.
Treatment as Prevention is Starting to Work in Parts of Africa. 18/3/12
Study in KwaZulu Natal province in South Africa is the first study from the global south to relate an increase in the proportion of adults on HIV treatment to a fall in HIV incidence
18 March 2012
A longitudinal study from KwaZulu Natal province in South Africa is the first study from the global south to relate an increase in the proportion of adults on HIV treatment to a fall in HIV incidence, the 19th Conference on Retroviruses and Opportunistic Infections was told last week.
The study found evidence of a threshold effect; incidence started to fall once the proportion of all adults diagnosed with HIV in the area who were on treatment exceeded 30%.
Meanwhile, a study that took place in a week-long intensive health campaign in Uganda, as well as studies from areas as diverse as San Francisco and Swaziland, documented large increases in the proportion of people with HIV who are on treatment.
Falls in incidence in KwaZulu Natal
National surveys in South Africa have found evidence of significant falls in HIV incidence in recent years, but have related this to behavioural change rather than treatment. In the study presented at CROI, of a rural area of northern KwaZulu Natal centred on the mining town of Somkhele (Tanser), the researchers found a relationship between HIV treatment and a fall in infections.
They made use of a population-based HIV surveillance survey that has sampled 10,000 adults a year from 2004 onwards, by identifying 16,558 people who had taken at least two HIV tests during this period in order to gauge incidence rates. They then compared these data to individually linked data from the district-based HIV treatment and care programme.
Adult HIV prevalence in the area is high – 24%. The rate of new infections peaks at 8% a year in women in their early 20s and 5% a year in men in their late 20s. HIV testing rates are also high; researchers estimate that only 30% of the HIV-positive population is undiagnosed, a low proportion for Africa, and 75% of HIV-negative adults who have tested for HIV have done so more than once.
Since 2004, there has been a huge scale-up of HIV treatment, with 20,000 patients starting antiretroviral therapy since then, and by 2001 more than 40% of all adults diagnosed with HIV were on antiretroviral therapy (ART), and over 60% with a baseline CD4 count below 350 cells/mm3. HIV treatment at this CD4 threshold was only introduced in August 2011; previous to this it was 200 cells/mm3.
HIV incidence between 2004 and 2011 averaged 2.64% a year but was lower after 2009, when for the first time more than 30% of the diagnosed population was on ART. It was 3.0 to 3.5% 2007-09 but fell to 2.5% in 2010 and 2.0% in 2011.
After adjusting for HIV prevalence in the immediate area and demographic and behavioural variations, the researchers found that for every 10% increase in the proportion of adults on ART, the HIV incidence rate fell by 17%. Incidence was 40% lower when over 30% of the adult population was treated than when fewer than10% were.
Viral load in Western Uganda
In Uganda, Makerere University, in partnership with UCSF and North Carolina Universities in the US, conducted a so-called “high throughput community-wide health campaign” conducted over five days in the rural parish of Kakyerere near the town of Mbarara in western Uganda (Jain). The population of Kakyerere is 6300, and during the campaign researchers managed to test 4343 (72%) of them for HIV, 2282 adults and 1826 children.
Fingerprick tests were used for HIV status and the samples of those testing HIV-positive were further tested for viral load, CD4 count and the presence of efavirenz and nevirapine as indicators of being on ART.
One hundred and eighty-nine people tested positive for HIV, 179 adults (7.8%) and ten children (0.5%). Of the adults, 46% were new diagnoses.
Viral load was determined in 174 HIV positive adults (92%). The researchers determined that the mean ‘community viral load’ (CVL) amongst adults was 64,000 copies/ml.
Thirty-seven per cent of adults had an undetectable viral load and of these 88% had detectable efavirenz or nevirapine in their blood; 83% of adults who were prescribed ART had undetectable viral load, as did 10% of adults not prescribed ART.
The viral load in adults not on ART was influenced by a few adults with very high viral loads, probably in early HIV infection: whereas the median viral load in adults off treatment was 19,048 copies/ml; the mean was 100,319 copies/ml. Apart from being on ART, the only other association with lower viral load was being married; married adults had on average a viral load that was 45% lower than unmarried adults. Encouragingly, greater distance from the local health centre was not associated with a higher viral load.
Early treatment in San Francisco
San Francisco Health Authority was the first body in the world to take the decision to offer treatment to all people diagnosed with HIV regardless of CD4 count, and it claims that considerable falls in HIV diagnoses seen in recent years (from 681 in 2994 to 434 in 2010) are largely due to this policy. In a study presented at CROI reviewing people diagnosed with a CD4 count over the US DHHS HIV treatment guidelines of 500 cells/mm3, Truong and colleagues observed that 89% of this section of the HIV-positive population was put on treatment in 2010, compared with 31% in 2004. With a shorter period between diagnosis and ART initiation, the mean CD4 drop before starting ART reduced from 135 in 2004 to 54 in 2010. The survey found evidence of considerable inequality in ART access, however, with patients starting ART at CD4 counts over 500 cells/mm3 more likely to be well-off white gay men who were diagnosed by private providers.
National testing and treatment survey in Swaziland
Finally, considerable progress is being made towards ART coverage in the country with the highest HIV prevalence in the world, Swaziland, where 26% of the adult population has HIV. Researchers from the country’s Ministry of Health conducted a survey of randomly sampled households in the first half of 2011(Nkambule), using rapid anonymous HIV testing and asking participants about a variety of behavioural and demographic factors.
HIV prevalence peaked at 54% in women aged 30 to 34 and 48% in men aged 35 to 39; the age at peak prevalence has shifted five years older in the last five years, indicating fewer infections amongst youth.
Seventy-two per cent reported having tested for HIV and self-reported HIV prevalence amongst those who tested was 28% – very near the actual figure, which was 31%. There was, however, high prevalence amongst those who had not tested recently: 28% who had never tested had HIV, as did 13% who had previously tested negative, and 48% of men and 32% of women who had HIV did not know it.
Of those who had HIV exactly one-third was taking ART, but the researchers comment that: “While HIV testing and ART services seem accessible, major efforts are needed to expand access.”
To Invest in Africa's Future, Finish the Fight against AIDS. 14/3/12
Africa is now poised to push towards a new vision of: zero new HIV infections, zero discrimination and zero AIDS-related deaths
By Michael Sidibé
Africa is breaking records. Its economy is growing at around 6% annually, comparable with many of the new emerging economies. Lack of roads is no longer a barrier to information -- mobile phones are the new drumbeat. Democracy is becoming firmly entrenched. More children are in school, especially girls, than ever before. Poverty is on the decline. Access to health care has increased. Polio is history in most parts of Africa. And now AIDS is beginning to recede, country by country, village by village.
Africa has not done it alone. Global solidarity, combined with strong political leadership and community action has produced results -- results unimaginable a decade ago. Millions of men and women are back to work -- healthy again and looking after their children and the elderly. Ten years ago, the roles were reversed; it was the elderly and children who were forced to look after people living with HIV, as AIDS decimated families.
In Africa, the number of people dying from AIDS has rapidly declined in the last five years. More than 5 million people are on antiretroviral treatment for HIV, the virus that causes AIDS. The rate of people becoming newly infected with HIV has dropped by more than 26%.
Africa is now poised to push towards a new vision of: zero new HIV infections, zero discrimination and zero AIDS-related deaths. And it needs everyone's support -- as an equal partner, with 'shared responsibility' as the guiding principle. President Obama believes. Africa's leaders believe. The AIDS community believes.
That is why the African Union at its summit meeting in January tasked the African Union Commission and its executing body NEPAD to work with UNAIDS to create a road map for shared responsibility. With a goal to "draw on African efforts for viable health funding streams with support of traditional and emerging partners to address the AIDS dependency response". Prime Minister Meles of Ethiopia is on the frontline of this call.
UNAIDS estimates that there is a gap of US $3-4 billion between what is available today and what is needed in 2015 for Africa. We can find this money.
African countries too have to increase their investments. UNAIDS recommends countries spend between 0.5% and 3% of government revenue on their AIDS response -- depending on the severity of the epidemic. Botswana, Malawi, Tanzania and Zimbabwe are some of the countries that meet this target. South Africa in recent years has increased its domestic AIDS budget by nearly 300% -- they invest more than US $1.5 billion on AIDS each year. Domestic investments in Africa have increased significantly in the last five years and there is scope for them to do more. Even with increased domestic investments few will be able to fully fund their AIDS response without international assistance. But the balance could be tipped by end of 2016, when most low-middle income countries can begin to fund the majority of their HIV programmes.
Investments in AIDS also have to be smart. Take our goal of eliminating new HIV infections among children by 2015. In the United States virtually all children are born free from HIV, thanks to effective maternal and child care and access to antiretroviral treatment. But elsewhere in the developing world, nearly 390 000 children are infected each year. More than 90% are in 22 countries of the world, 21 in Africa. By focusing on these countries and ensuring pregnant women living with HIV have access to antiretroviral treatment, you save both -- the mother and the child. African leaders are doing just that, with support from UNAIDS and United States' PEPFAR programme. New HIV infections among children in Africa are beginning to decline.
Finally, the increase in access to HIV treatment is also paying a prevention dividend. In South Africa, new research shows for the first time that in areas where more than one in three people had access to HIV treatment, the chance of a person becoming newly infected with HIV dropped by 40%. Similar observational effects are being seen in Namibia, Botswana and Zimbabwe.
Finally, the case for providing all eligible people with HIV treatment cannot be stronger. Yet there are about 5.3 million people who do not have access to HIV treatment today, even as the average cost of first line treatment has dropped to under US$ 150 per person per year.
Recent funding cuts have lengthened the waiting line for people who urgently need lifesaving treatment and assurance of treatment continuity is precarious. African leaders cannot guarantee availability of HIV medicines without predictability of international assistance and the continued ability of countries like India and China to produce generic drugs. Africa can also scale up local production capacity.
To continue to break records and sustain advancements, the results of the AIDS response must be an impetus for increasing investments, not decreasing them. Preventing AIDS is a smart investment that Africa and the world need to make.
The State of AIDS in Africa Today. 4/1/12
The year 2011 concluded with the convening of the International Conference on HIV/AIDS and Sexually Transmitted Infections in Africa (ICASA) in Addis Ababa, Ethiopia.
The Swazi Observer
With James Hall
4 January 2011
THE year 2011 concluded with the convening of the International Conference on HIV/AIDS and Sexually Transmitted Infections in Africa (ICASA) in Addis Ababa, Ethiopia.
This was where medical experts and health officials from all parts of the continent and some international players like former President George Bush (whose administration launched the PEPFAR initiative) took stock of the state of the “War Against AIDS”.
The annual event is described as “opportunity for dialogue and exchange among scientists, communities, people living with HIV, leaders and development partners about recent developments and research findings in prevention, treatment, care and support and to distil their implications for dealing with the AIDS epidemic in Africa”.
The year’s theme was “Own, Scale Up, Sustain” referring to individual African nation’s AIDS efforts.
One prominent speaker is known for his interest in Swaziland’s AIDS situation. Dr. Stephen Lewis is now co-director of the Canadian-based organisation, AIDS-Free World.
At the ICASA conference, he roundly condemned the suspension of new Global Fund Grants, which will certainly hinder progress against AIDS in Swaziland, as “unconscionable, indefensible, and outrageous. It’s murder. And the donor countries expect to get away with it because there is a culture of fiscal impunity”.
He called upon African leaders to address the Global Fund directly and demand that AIDS funding not be interrupted. Lewis, who is Canadian, was quite militant in his comments and insisted that the developed world “owes” Africa financial assistance to combat AIDS, given the developed world’s historic exploitation of the continent, in his view.
Dr. Michel Sidibe, the Executive Director of UNAIDS was also critical of the Global Fund’s decision to halt future grants until at least 2014.
Medicins san Frontiers (MSF) released the results of its survey of nine sub-Saharan African countries which found that a majority of these countries had to suspend or reduce health programmes, including an upscale of their ARVs rollout campaigns. The reasons were all the same: lack of funding.
Back in 2001, all African countries committed themselves to government spending on public health that is the equivalent of 15% of their government budgets. At the ICASA meeting it was revealed that a decade later only six countries - Rwanda, Botswana, Niger, Burkina Faso, Zambia and Malawi – are in fact spending this amount on health care for their peoples.
Even these six countries have to rely on international donor funding to provide services, and if left to their own resources would not be able to achieve the target.
Officials at the ICASA conference argued that the money to fight AIDS exists in government budgets, but it is being channelled to other uses. They called for “new priorities” in government spending.
Swaziland is certainly not alone in its funding needs. In fact, throughout Africa 85% of HIV and AIDS funding comes from international donors. Only a much smaller fraction (15%) of AIDS funding comes from African countries themselves.
The Kaiser Family Foundation released its 2011 survey of international funding on health care, and the report documented a significant drop of 10% international funding for AIDS programmes in developing countries.
The Kaiser survey concluded; “Now many African countries are facing the real threat of not meeting their budget requirements for implementing the much needed scale up of ART programmes, relying heavily on the Global Fund and PEPFAR to sustain these programmes”.
No wonder the Global Fund crisis is being described as a “wake up call” aimed at rousing officials into action. What is needed is for Swaziland and all other African countries to develop and sustain an HIV/AIDS funding strategy that is not hostage to external “shocks” like the Global Fund grants suspension.
The ICASA conference looked ahead to a future which is much like the present: no AIDS vaccine yet developed and thus a sustained need for mitigation and treatment programmes like those ongoing today.
Between now and 2032, the worldwide cost of AIDS will be about twice what is currently spent on the disease. In Africa, where AIDS is most prevalent amongst the general population, the cost of AIDS will more than double.
Officials like UNAIDS’ Sidibe referred to the funding crisis and AIDS efforts as being at a break or make point. “Of all the parts of the world where the global funding crisis has an impact, Africa’s (AIDS) crisis would be most affected,” he said.
The conference conclusion had implication for the way the AIDS battle will play out in 2012 and beyond: International funding may not soon return and so it is imperative that African countries devise new funding strategies aimed inward, to local resources and re-examine all other manner of government spending that is not directed toward an epidemic that is sabotaging the health of their people’s health and the performance of their countries’ economies.
ICASA 2011 to Focus on Ownership, Commitment and Support to the AIDS Response in Africa. 4/12/11
This year’s conference theme: ‘Own, Scale-up and Sustain,’
4 December 2011
The XVI International Conference on AIDS and STIs in Africa (ICASA 2011) opened on Sunday 4 December in Addis Ababa. Delegates from across the world are convening in Ethiopia to discuss the HIV-related challenges faced by Africa, as well as future strategies for consolidation and development of national AIDS responses.
Ethiopian Prime Minister H.E. Meles Zenawi welcomed all participants and encouraged them to fully participate and share experiences than can contribute to bring an end to the AIDS epidemic in Africa. The Prime Minister also recognized the important contribution of international partners in providing antiretroviral treatment, but he stressed that it is time for Africa to own the response. “We must urgently devise African led innovations to defeat HIV,” said Prime Minister Zenawi.
This year’s conference theme, ‘Own, Scale-up and Sustain,’ was selected to emphasize the need for increased country ownership and commitment in the AIDS response. Statements at the opening ceremony were made by former President of the United States of America George W. Bush, UNAIDS Executive Director Michel Sidibé, young women living with HIV, Melao Phillipus and Professor Robert Soudré, President of the Society for AIDS in Africa.
Mr Sidibé, in his key note, emphasized that 2012 would be a crucial year for the AIDS response. He welcomed the recent progress made in both scientific research and expanding access to HIV treatment, but also cautioned against losing ground as a result of the global financial crisis.
“We have seen unprecedented progress. But I am scared by unfolding events. We need to continue investing in areas where we are producing results,” said Mr Sidibé. “But to scale up and sustain the progress made, we must create a new framework for Africa, based on country ownership, shared responsibility, mutual accountability and social justice,” he added.
President Bush, who is currently travelling through Africa to promote the Pink Ribbon Red Ribbon initiative, made a stop in Ethiopia to participate in the conference. In his address, President Bush praised the Obama Administration for their continued support to the global AIDS response. “We are breaking the grip of AIDS—but this only the beginning. There is a lot of work to be done,” said President Bush. “In moments of economic crisis there can be a temptation for Americans to disengage from the world. But we cannot retreat. There is no greater priority than saving a human life.”
We must create a new framework for Africa, based on country ownership, shared responsibility, mutual accountability and social justice
UNAIDS Executive Director Michel Sidibé
Representing young people, Ms Phillipus denounced the nonexistence of comprehensive sexual education and HIV services adapted for adolescents and young people in most African countries. She highlighted the heterogeneity of youth groups and their varied needs which are not being addressed. She said that the needs of young parents are not the same as those of students or young professionals. “I challenge all delegates to spell out what actions they will take to empower the youth,” concluded Ms Phillipus.
Sessions, workshops and community development
ICASA 2011 is intended to provide a forum to link political and national leaders, the scientific community, practitioners, communities, civil societies, the private sector and partners to scale-up and sustain the AIDS response. The conference is organizing a series of plenary and satellite sessions, workshops and community development programmes that are designed to generate support for the AIDS response, discuss common values and share best practices.
In addition, the conference will also host the community dialogue space and the human rights networking zone. The community dialogue space is dedicated to highlighting stories of grassroots achievements in AIDS responses and the challenges faced by community-led action around the world. The human rights networking zone is an open space to share good practices around HIV, TB and human rights in Africa as well as to discuss HIV and human rights challenges that are common to many countries on the continent. The networking zone sessions will cover key topics such as the criminalization of HIV transmission and exposure, coercive practices in sexual and reproductive health, including HIV testing, coerced sterilization and termination of pregnancy.
Hosted by the government of Ethiopia, the international partners for ICASA 2011 include the Joint United Nations Programme on HIV/AIDS (UNAIDS), as well as its Cosponsors the World Health Organization (WHO), the United Nations International Children’s Emergency Fund (UNICEF), and the United Nations Population Fund (UNPF); and the United States President’s Emergency Plan for AIDS Relief (PEPFAR).The conference will run until December 8.
Rwanda Turning Tide on HIV/AIDS. 8/11
HIV prevalence rate has fallen below 3% from a staggering 13% in the 1990s.
Rwanda appears to be stemming the tide of the HIV/AIDS epidemic as health experts report that the HIV prevalence rate in this small East African nation has fallen below 3% from a staggering 13% in the 1990s.
The country has “dramatically” reduced the burden of HIV/AIDS by scaling up education and awareness programs, prevention activities and access to treatment, says Dr. Placidie Mugwaneza, head of HIV prevention at TRAC Plus, the nation’s centre for infectious disease control.
The first case of HIV in Rwanda was reported in 1983. Just three years later, with a national HIV prevalence of more than 17% among urban populations, Rwanda was one of the African nations hardest hit by the epidemic.
Much of the country’s health infrastructure was gutted during the 1994 genocide (in which an estimated 20%, or 800 000, of the Tutsi population was massacred by the Hutu regime), and widespread rape caused HIV infection to spread rapidly, particularly in “squalid, violent” refugee camps.
Today, the country’s adult HIV prevalence rate has dropped to less than 3%, or about half the rate of other East African nations such as Uganda and Kenya, down from 13% in 2000, says Dr. Anita Asiimwe, executive secretary of Rwanda’s National AIDS Control Commission.
Rates of new HIV infections and AIDS deaths also decreased in the same period, she adds. “Quite a lot has been done to be able to achieve this,” not least the “massive sensitization of the population to understand the HIV epidemic, and be able to take preventative measures.”
“Most people are now aware there is an HIV/AIDS epidemic in our country, and understand both how they can contract and prevent HIV/AIDS,” Asiimwe explains.
The expansion of preventive testing and counselling services has played a “critical role,” she says. “Back in 2000, barely any health facilities offered voluntary counselling and testing services, but now more than 85% of the health facilities across the country offer these services to Rwandans.”
Some 417 Rwandan health facilities now provide voluntary counselling and testing services, up from just 15 in 2001. Testing has become far more commonplace among Rwandan couples, rising to 84% in 2009, from 13% in 2003.
Services for preventing mother-to-child transmission of HIV have also been scaled up, with the number of facilities offering dedicated mother-to-child-transmission prevention services having mushroomed to 382 in 2010 from 11 in 2001.
Some 98% of pregnant women who receive antenatal care are now tested for HIV, and 90% of HIV-infected pregnant women receive antiretroviral drugs to prevent transmission to their newborns, says Mugwaneza. As a result, mother-to-child transmission rates decreased to 2.3% in 2010 from 30.5% in 2001. HIV prevalence among pregnant women dropped to 2.6% from 9.1% over the past decade.
Moreover, Rwanda has now achieved one of the highest coverage rates of antiretroviral therapy in Africa, with more than 97% of those who are eligible for the therapy receiving it. As of 2007, Rwanda boasted 150 antiretroviral therapy centres and, for most patients, treatment is free.
Although more than three-quarters of Rwandans now live within five kilometers of a health facility, gaps in coverage remain, Asiimwe says. “There are still, for example, Rwandans who have to travel quite a distance to get to the facilities that offer these services.”
Many Rwandans, particularly in urban areas, also continue to engage in risky behaviours, she adds. To achieve a “HIV-free generation,” Rwandans must “take full responsibility for their sexual health and not leave the fight against HIV/AIDS to national programs and institutions.”
Sub-Saharan Africa Girls Face High HIV/AIDS Risk. 16/6/11
Teen girls three-to-five times more likely to be infected than boys
16 June 2011
Teenage girls in sub-Saharan Africa are three-to-five times more likely to be infected with the virus that causes AIDS than boys their age. A new study in Malawi, Mozambique and Botswana explores why that is.
Carol Underwood, senior research scientist at Johns Hopkins University's Bloomberg School of Public Health, directed the initiative called Go Girls!.
She says community meetings helped define the problem. “We found that girls who were orphans, who were not in school or never attended school, who live in impoverished conditions or are socially isolated are more likely to be HIV-positive.”
According to Underwood, girls who don’t have supportive relationships with adults are also more likely to be HIV-positive
A 14-year-old girl from Malawi named Mary fits that profile. Orphaned after her parents died, Mary tried supporting herself by home-brewing beer on the street. Willard Mwambo, who put “Go Girls!” in place in Malawi, shared Mary’s story at a briefing in Washington.
In a country where 15 percent of the population has the virus that causes AIDS, Mwambo says Mary was at great risk. She couldn't support herself and made bad decisions.
“Her solution was the wrong one," he says. Mary sold sex for money, got pregnant and dropped out of school. “And again the situation was so tough because she was failing to divide time, time to process beer and time again to take care of the baby."
Things began to change after Mary attended a Go Girls! community meeting. Mwambo says such meetings - at the heart of the program - empower locals to solve problems. “And that’s when she heard about the importance of going to school. She learned that it is possible that even if someone has a baby, she can go back to school.”
Mary’s aunt was also at the meeting, where she was encouraged to help Mary, who has since stopped selling beer, quit prostitution and returned to school, with hopes of becoming a nurse.
Johns Hopkins University Bloomberg School of Public Health - with support from the U.S. government - used that research to set up a community program with one mission: to keep girls out of harm’s way.
Underwood says the findings led to actions to protect girls. “We developed structural interventions to make schools safer. And we also worked on what we call legal literacy, getting communities to become aware of laws that are on the books to protect girls and also empowering them to take action to make sure that those laws are in force.”
Underwood adds that Go Girls! also helped foster better parent-adult-child-communication and among girls themselves to increase their knowledge about HIV. She says country reports document changes in how girls are cared for at school and at home.
“And in those schools where we worked we found that girls felt safer than in the schools where we didn’t work. We also found that girls said teachers’ demands for sex in exchange for good grades or favors had decreased in the schools where we worked. We found that there was an increase in legal literacy among adults and girls over time.”
Malawi youth organizer Willard Mwambo says Go Girls! works because it empowers community residents to take charge. “You can say it’s everybody’s responsibility in the community to at least protect the girl child.”
Funding for Go Girls! expires this month. Organizers are hoping United Nations agencies, the U.S. Peace Corps and other groups will not only continue the efforts, but expand their reach to other countries where adolescent girls are at high risk from HIV/AIDS.
AIDS at 30: Africa Bearing the Brunt. 30/5/11
Short reports on the key issues from five AFP bureaux.
30 May 2011
Cape Town - Home to 22.5 million people with HIV - nearly 70% of the world's total - sub-Saharan Africa bears the brunt of the 30-year-old Aids pandemic.
Millions of lives have been destroyed, yet the war now shows signs of progress: infection rates are stabilising or dropping in many countries as access to life-saving drugs widens.
But the challenges are huge.
From Kampala to Mbabane, the following are short reports on the key issues from five AFP bureaux.
Access to drugs
Microphone in hand, the receptionist calls over the public address system to the next person waiting to grasp a lifeline: the precious drugs that will keep the deadly Aids virus at bay.
The Nigeria Institute of Medical Research, located in the working-class suburb of Yaba, is often overwhelmed by the numbers. Hundreds queue daily at the clinic, and hours can pass in the waiting room.
The drugs are free, as in many African countries, but just 360 000 people receive treatment - about one third of the Nigerians who need it.
The health system struggles to expand treatment and ensure people take their pills in the face of sharp social stigma. Then there are simple practicalities for the poor, like paying for transport to fetch the drugs.
"You don't really think about it, but just coming here is a very great task. I have to wake up very early, like today I woke up at 04:00 - and I spend between five and six hours" at the clinic, said a 42-year-old woman, one of Nigeria's 3.1 million people with HIV.
She has been on treatment for nine years, since a time when such medicines were rare.
Even so, treatment has transformed the pandemic from a looming death sentence into a chronic manageable disease.
"Thank God the drugs work," she said.
After six years of campaigning about safe sex in a Kampala suburb, Kenneth Mukwaya worries Ugandans are suffering from Aids fatigue.
Uganda has been hailed as one of Africa's successes in the fight against Aids, with infections slashed from 18% in 1992 to 6.1% in 2002.
But in recent years, the decline has stagnated, even rising slightly to around 6.5%.
"Before, we were focusing on the youth by going to schools, talking to young people and they really picked it up. Now we are trying to reach older people and married couples," said the 26-year-old.
"Although Uganda has had a lot of success against Aids, the fight is still on and it's now the older groups that are being more affected."
Around 43% of new infections come from people in long-term relationships, with doctors pointing to a rise in risky behaviour among older people and married couples.
Now, a series of campaigns targets the older generations and urges couples to get tested together and to avoid extramarital affairs.
"With time people became complacent. The people started taking the information for granted and levels started rising again," said Tom Kabugu, manager of the Aids Information Centre Kampala branch. "This is why we have to intensify the campaigns again."
Women in the front line
The first question the raped women ask is: "Am I HIV positive?"
"For those who have been raped and infected with Aids, it is catastrophic, it's very, very traumatic," said Nene Rukunghu, a doctor at the Panzi Hospital in the conflict-ridden eastern Democratic Republic of Congo.
"It's already very difficult for the victims of sexual violence to integrate into society. It's a disaster for those who are also affected by Aids."
Sixty percent of people with HIV in Africa are women, compared with 50% elsewhere in the world. Many have contracted the disease through coercive sex.
In DR Congo, more than 1 100 women are raped every day according to one study, with marauding gangs of militia and soldiers sweeping through villages in cold-blooded mass attacks.
"When the female victims of sexual violence arrive at the hospital for treatment, except for the ones who are seriously hurt, the first question that they ask is if they are infected by the 'disease'," said Rukunghu.
Up to 30% of rape victims here catch HIV, according to the World Health Organisation (WHO). Panzi Hospital has treated 920 women living with HIV this year, including 16 rape victims.
"We had a case of one woman who was raped and then went home," said Rukunghu.
"Then, she was raped for a second time and was infected with HIV. After that, she refused to go home. 'I returned the first time, and then I got Aids,' she said."
The bold letters on the hand-written posters are stuck to a bedroom wall in Cape Town's shack-filled outskirts: "I am not just a number... I am strong".
They were penned by one of South Africa's nearly two million Aids orphans, "Sandile", a skinny, HIV-positive 10-year-old whose mother died when he was just nine months old.
"I was young," is his simple observation of his arrival at the Khumbulani Children's Place of Safety in 2002.
Sub-Saharan Africa is home to one in nine of the world's 16.6 million children who have lost one or both parents to Aids.
Some like Sandile are scooped into humble shelters where small bedrooms are shared with three other boys and the living room is full of baby cots.
But they have a foster mother to call "mama", someone who worries about food prices, ensures anti-Aids drugs are taken, checks on school, and is a generous hugger.
Despite gains in slowing HIV's spread and expanded treatment, which has also cut infections from pregnant mothers to newborns, orphan numbers are rising.
The parentless children are a potential timebomb for Africa's already stretched systems: falling through cracks, absorbed into extended families to live off meagre welfare grants, and even forced to head households.
"It's huge. There's no question about it and it's scary - it gives me sleepless nights actually," Health Minister Aaron Motsaoeledi told AFP.
Mfanzile Nxumalo averts his eyes and screws up his face while his foreskin is sliced off, but he declares his mettle as the nurse stitches him up. He's joining in a push by Swaziland to curb HIV infections with male circumcisions.
"I am the bravest man alive!" he declares from the hospital trolley. "I’ve tested negative - that’s what motivates me."
As a 29-year-old Swazi, Nxumalo has a nearly one in two chance of being infected with HIV in the small mountainous kingdom which has the world's highest prevalence rate and lowest life expectancy, 32 years.
After trials suggested circumcision could reduce HIV infection risk to men by up to two-thirds, Swaziland decided to revive a tradition that had been abandoned in the 19th century.
"Everybody seems to want to use a condom in the research we've done," said Derek von Wissel, who heads Swaziland's emergency response council on Aids.
"But often they are too drunk to use a condom. Or round one they use a condom, round two they don’t."
The ambitious, US-funded campaign hopes to reach one in eight Swazi men, but has had disappointing results so far.
The clinic performing Mfanzile’s procedure is geared to see 80 patients a day. At best 15 trickle in - fewer than even before the campaign began in February.
Adverts urging men to "circumcise and conquer" are everywhere but organisers now admit they may not reach their targets as quickly as hoped.
"Most of the time in Swaziland, men are the decision makers. Men must be in the forefront of this battle," said Health Minister Benedict Xaba. "It takes time for a Swazi person to accept something new; to accept change."
Education and Health Appear to Increase Risk of HIV. 16/5/11
Money may drive some to believe that they can do anything their hearts desire with poorer people being on the receiving end as the wealthy increase the spread of HIV in society.
By Munesu Benjamin Shoko
16 May 2011
A recent report has suggested that the so-called educated and wealthy people are derailing efforts to prevent the spread of the killer HIV/ Aids in Zimbabwe.
A shocking thought.
The same people who are highly regarded in society are found to be on the ignorant side and letting the community down when it comes to issues relating to sexual health.
Money has proved to be the root of all evil in this regard.
Women Action Group advocate Olga Makoni was quoted expressing dismay at the manner in which this highly rated group of people proved ignorant to sexual health.
"Professional women and men are a high-risk group because of their economic status in society. They can afford to go on vacation with boyfriends, and have a small house, when ordinary women or men with low or no income cannot afford that," she said.
The observation sounds realistic with rich people often abusing their privilege for the wrong reasons.
Money may drive some to believe that they can do anything their hearts desire with poorer people being on the receiving end as the wealthy increase the spread of HIV in society.
The educated also appear to think that they know enough and are immune to any information relating to sexual issues.
Unfortunately the consequences are suffered by the whole community.
Use ARVs to Eliminate HIV in the Next 30 Years. 29/4/11
SACEMA scientist unveils plan to eliminate HIV using ARVs within the next 30 years
By Mary Dukti
29 April 2011
A plan to eliminate HIV and AIDS using antiretroviral drugs (ARVs) within the next 30 years has been unveiled by scientists from the South African Centre for Epidemiological Modeling and Analysis (SACEMA).
The plan which was unveiled last month in San Diego, California at a meeting of the American Association for the Advancement of Science proposes the aggressive use of blanket HIV testing followed with ARVs for all individuals testing positive for HIV.
With 33.4 million people living with HIV/AIDS in 2008, 2.7 million new HIV infections and 2 million deaths due to AIDS within the same year, scientists are turning their focus on antiretroviral therapy which they consider to be the only real success so far in HIV prevention. Antiretroviral therapy lowers the amount of the HIV virus in the blood to levels that render HIV positive individuals virtually non-infectious.
The scientists argue that antiretroviral treatment has so far been given too late in the course of many individuals' lives and thus treatment has not helped in reducing transmission rates.
This time however they are suggesting early testing and treatment, targeting the most sexually active population.
This plan is based on a mathematical modelling. The model developed assumes a population of very high prevalence which is tested once a year and those found HIV positive started on ARVs immediately; with this early antiretroviral intervention, the model shows that in three decades the new infections would be reduced sufficiently to eliminate the epidemic.
Although the cost of this program is expected to be very high, costing up to 3 billion US dollars to South Africa alone, the scientists argue that the cost would approximately be the same over a 40 year period whether or not the new intervention were adopted.
AIDS Slowing Economic Growth. 29/4/11
Ugandan Ministry Of Health predicts that with the current trend of HIV/AIDS infections the economy will be 39% smaller by 2025.
By Mark Muhumuza
29 April 2011
Kampala — The Ministry Of Health predicts that with the current trend of HIV/AIDS infections the economy will be 39% smaller by 2025. Uganda currently has an average prevalence rate of 6.2% with atleast 135,000 new infections annually.
The effect on the economy stems from the fact that the most affected are the productive youth who are supposed to engage in income generating activities but who are rendered unproductive because of AIDS.
Uganda which had been hailed by the world for its fight against AIDS, has since 2007 recorded new infection figures rise.
The current GDP projection for 2010 according to AIG Investments is expected to be 6.5% but according to the Ministry Of Health, this number will come down to atleast 5.3% due to AIDS.
However, according to AIG investments AIDS is not indicated in the potential factors that affect the GDP and economic growth to fall.
"The government subsidises ARVs, condoms and also spends money on running preventive campaigns and this would increase government expenditure on health," Dr Oleke adds.
The government is advocating for the increased use of condoms reversing the trend whereby emphasis was on abstinence. This is blamed for the rise in infections especially among married.
Leadership, Cooperation Responsible for "Remarkable Progress" Against HIV/AIDS in Africa, UNAIDS Report Says. 22/5/2013
From Henry J. Kaiser Family Foundation
"As the African Union (AU) begins its 21st summit in Addis Ababa, celebrating 50 years of African unity, [UNAIDS] has released "Update," a new report [.pdf] on the AIDS response in Africa, documenting the remarkable recent progress against HIV on the continent," a UNAIDS press release reports. "The number of people in Africa receiving antiretroviral treatment increased from less than one million in 2005 to 7.1 million in 2012, with nearly one million added in the last year alone," the press release states, adding, "AIDS-related deaths are also continuing to fall -- reducing by 32 percent from 2005 to 2011 as are the numbers of new HIV infections which have fallen by 33 percent from 2001 to 2011″ (5/21). The report "attributes this success to strong leadership and shared responsibility in Africa and among the global community," according to the U.N. News Centre. The report "also urges sustained commitment to ensure Africa achieves zero new HIV infections, zero discrimination and zero AIDS-related deaths," the news service writes.
"Despite positive trends, Africa continues to be more affected by HIV than any other region of the world, and accounts for 69 percent of people living with HIV globally," the U.N. News Centre writes, noting, "In 2011 there were still 1.8 million new HIV infections across the continent, and 1.2 million people died of AIDS-related illnesses." The news service says "[t]he report also stresses AU leadership is essential to reverse the epidemic." At the ongoing AU Summit, "AIDS Watch Africa, a platform for advocacy and accountability for the responses to AIDS, tuberculosis and malaria founded by African leaders in 2001, will review progress on health governance, financing, and access to quality medicines, among other areas, and measure whether national, regional, continental and global stakeholders have met their commitments," the news service writes, noting, "The AU, UNAIDS and the New Partnership for Africa's Development (NEPAD) will also launch the first accountability report on the AU-G8 partnership, focusing on progress towards ending AIDS, tuberculosis and malaria in Africa" (5/21). In the report, UNAIDS Executive Director Michel Sidibé "emphasizes that sustained attention to the AIDS response post-2015 will enhance progress on other global health priorities," the press release states (5/21).
Back to other news for May 2013
This information was reprinted from kff.org with permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Global Health Policy Report, search the archives, and sign up for email delivery. © Henry J. Kaiser Family Foundation. All rights reserved.
More Older People Living with HIV. 19/10/12
Lack of focus on older people a challenge.
Sub-Saharan Africa is likely to see a more than 200% increase in the number of older people living with HIV in the next 30 years, thanks to improvements in lifesaving treatment, experts said Thursday.
"The proportion of people living with HIV aged 50 and over is going to increase a lot," Robert Cumming of the school of public health at the University of Sydney told a conference on ageing in Africa.
Three million people aged 50 or older currently live with HIV and that figure is expected to rise to 9.1 million by 2040.
"It's mainly driven by the fact that people are being treated with antiretroviral drugs and therefore will survive to be old," Cumming said.
More older people with HIV living longer
But the number of older people living with the disease and without treatment is also expected to rise. That has doctors and other health professionals worried.
"It's a huge problem that is being ignored. It's a huge problem for the older people themselves who are often going to miss out on treatment so they are going to die sooner than they should otherwise do," said Cumming.
Guiseppe Liotta of the University of Rome said many patients in Africa arrived for treatment when very sick, and often with other diseases and conditions like malnutrition and anaemia, but that HIV-caused deaths fell a year into treatment.
"HIV positive elderly would need special attention because they seem to start ARV treatment very late," said Liotta.
What the research shows
An analysis by HelpAge International found only 68 of 119 country progress reports submitted to United Nations agency UNAIDS had some data or reference to older people. Only four had details on prevalence for those living with HIV.
"The lack of data just means we don't have a clear picture of what's happening in relation to HIV and ageing and that means that we can't respond appropriately," said the NGO's Rachel Albone.
AIDS data and policy efforts in Africa have overwhelmingly focused on the 15- to 49-year-old grouping.
Older people know less about the disease and are less likely to be tested, and face difficulties with access to care, said Cumming.
"I guess it's reasonable to focus on young people because that is where most new infections occur. But there seems to be an attitude that people over 50 don't have sex and therefore can't get infected and that's clearly incorrect."
According to UNAIDS, access to treatment in sub-Saharan Africa had reached 37 percent in 2009 up from two percent seven years earlier.
(Sapa, October 2012)
Of Course Africa is Ready for PrEP! 12/4/11
Whether or not Africa is ready for PrEP interests me because of several underlying assumptions in some of the answers about how we define Africa.
12 April 2011
Whether or not Africa is ready for PrEP interests me because of several underlying assumptions in some of the answers about how we define Africa.
Africa’s MSM, Africa’s people who engage in anal sex and Africa’s public health prevention campaigns have been desperately in need of new HIV prevention options for a very long time. Issues of affordability can be strategically handled through diverse modalities. However, there is no doubt in my mind that access and availability remainsburning questionsat the heart of providing interventions to those who need it. Because there are many people in Africa who need HIV prevention, I say “Africa is ready for PrEP!”
It is important to recognise that there are many faces to Africa. There is the Africa which is poor, under-resourced, without cash reserves and unable to meet the costs of its survival. That’s the Africa in need of greatly subsidised if not entirely free interventions – be it lubes, gels, condoms or even PrEP.
But there are also many African MSM who can afford PrEP. There are many MSM communities that can innovatively strategise through their local and international networks to find the resources to meet the costs of the drugs used for PrEP. There are many ways in which activism and negotiation with the powerful public organisations and actors can win unanticipated victories for providing access to PrEP to MSM who need it.
I have witnessed how innovative local LGBTI support groups and networks can be to access essential sexual health commodities in Kampala. I have observed “wealthier” MSM dispatching materials such as condoms, lubes and education pamphlets to those who cannot afford them or don’t have access to HIV prevention information. I have attended lobbying campaigns where small but significant successes were made to put MSM health onto the health and human rights agendas, particularly through arguing that it contribute to the fight against HIV/AIDS.
At the risk of sounding like a neoliberal capitalist who is blind to the needs of the less financially empowered in Africa, I think that current market trends in Kampala indicate that putting a product on the market, where there is both demand and need, results into the product being bought and used. And again, there is a need for PrEP in Africa.
The bigger question for me is, “Are the manufacturers of the ARVs used for PrEP (whether they are generics or the patented version) ready to meet the terms of the African clientele?” What are the possibility and the margins for negotiating the price of PrEP drugs? We could always argue that there is a sizeable market for PrEP in Africa because of relatively higher prevalence and incidence rates of HIV among those who engage in anal sex (whether MSM, MSW, WSM …). Therefore there is economic sense in reducing the price of drugs in order to capture the African market. If the current price of drugs cannot be negotiated, is it possible to find innovative ways to ensure that Africa can meet the cost of providing PrEP to those who need it? Philanthropists, funding organisations, multi-lateral organisations, and the giants like the Global Fund for AIDS, Malaria and Tuberculosis can be engaged to consider making PrEP available to those who need it but cannot afford it.
Many of our public health systems in Africa are inadequately providing the essential services needed by the Poor in our communities and there are gaps in public health provisioning of mosquito nets, condoms, ARVs and many other essential health saving drugs and interventions. However this is no ground or rationale for claiming that Africa is not ready for another critically essential HIV prevention product.
It is important that we conduct meaningful acceptability trials of rectal microbicides and oral PrEP that have already shown sign of success in previous clinical trials, so that a wide range of people in Africa who practice anal sex can try and test them out. The feedback from these acceptability trials should be the basis upon which decisions about what form(s) of PrEP Africa is ready for are made.
At the micro level of individuals, people, lovers, sex partners, bodies who desire and consummate our passions anally, Africa is ready for PrEP. The macro issues of cost and affordability, acceptability, supply chains, rolling out and scaling up of PrEP interventions, can all be negotiated and strategically resolved.
Africa was ready for PrEP the day that Africa got HIV and AIDS. No question about it.
New Treatment Guidelines Rolled Out – A Year Later. 12/4/11
Zimbabwe's government adopted new guidelines set by the World Health Organization
12 April 2011
Zimbabwe's government adopted new guidelines set by the World Health Organization (WHO) for treating people living with HIV almost a year ago, but funding constraints have made it difficult to implement them - until now.
On 1 April 2011, Zimbabwe started phasing out the combination antiretroviral treatment (ARV) Stavudine, Lamivudine and Nevirapine as its first-line option for the national programme, replacing it with the less toxic Tenofovir-based regimens for adults and Zidovudine-based regimens for children, as recommended by the 2010 WHO guidelines. Stavudine is widely used in developing countries because of its lower cost, but produces more serious side-effects.
Following the new WHO guidelines, the National Drug and Therapeutics Policy Advisory Committee and the Ministry of Health and Child Welfare’s AIDS and Tuberculosis (TB) Unit revised and produced the National Guidelines for ART Therapy in Zimbabwe in May 2010.
These suggest starting ARV therapy at a CD4 cell count of 350 for adults, while pregnant women and infants living with the virus should begin treatment regardless of their CD4 count and clinical stage.
In a circular to implementing partners, Permanent Secretary in the Ministry of Health and Child Welfare, Gerald Gwinji, said due to resource constraints the implementation of the new guidelines would be phased in over three years from April.
Gwinji said because the country still had a lot of Stavudine stock, all new patients would continue to be initiated on the drug while those already experiencing side-effects would be moved to the new drug regimen until stocks were finished.
However, Gwinji said all HIV-positive pregnant women eligible for ART would be immediately placed on the new ARV regimens. Children eligible for treatment would be given paediatric Stavudine until stocks at national and facility levels are finished because of the high stock levels.
"We therefore encourage all workers, at all levels, to follow this guidance until further notice is issued in order to prevent ARV drug supply interruptions. Drug stock-outs at facility level may lead to HIV drug resistance," wrote Gwinji in the circular.
The newer drugs are estimated to be one-and-a-half times more expensive than Stavudine
With HIV/AIDS funding levels already worryingly low, AIDS activists have expressed concern that if these new expensive regimens are adopted, many people may fail to access treatment in the long run.
Around 226,000 people are obtaining ARVs from Zimbabwe's public health system, leaving a treatment gap of about 340,000, but the new guidelines mean that at least half a million people will now qualify for treatment, at a cost of US$7 per person per month.
"Zimbabwe already has a very high treatment gap and many people in need of treatment are failing to access it as we speak," said the deputy president of the Zimbabwe HIV/AIDS Activist Union, Stanley Takaona.
"We all know that these new ARVs are expensive and we wonder how government will be able to ensure everyone has access to these expensive drugs when it can’t afford to provide treatment for everyone with the older and cheaper ARVs," he added.
National Coordinator of the Ministry of Health and Child Welfare’s AIDS and TB Unit, Owen Mugurungi, said the new ARV regimen would be initially funded by the National AIDS Council's "AIDS Levy" or the National AIDS Trust Fund (NATF) while government engages the donor community to help it adopt the new WHO guidelines. The AIDS levy - a three percent tax on income - was introduced in 1999 to help finance HIV/AIDS programmes, particularly ARV purchases.
He admitted that the new drug regimen was expensive but said in the long term it would turn out much cheaper. "When you do a cost-benefit analysis adopting the new drug regimen is recommendable," Mugurungi said.
"We may be able to put many people on ARVs now using the cheaper regimens but five years from now we will be losing a lot of money... treating people for side-effects from Stavudine-based regimens. Many people require physiotherapy, for example [as a result of side-effects], and we know how expensive this is... our hope is that our development partners will assist us fund the implementation of these new guidelines, we cannot do it alone."
Is Africa Ready for PrEP? 29/3/11
The results of the iPrEX trial raised hope but also many questions and concerns as showed by the ensuing debate about what the next step should be
29 March 2011
One of the biggest breakthrough in HIV clinical research, since the outbreak of the epidemic 30 years ago, is the recent success in a clinical trial of a new HIV prevention approach based on the daily use of the antiretroviral drug Truvada by HIV negative person to prevent HIV transmission (Called PrEP, for Pre-Exposure Prophylaxis).
The results of the iPrEX trial raised hope but also many questions and concerns as showed by the ensuing debate about what the next step should be. Divergences culminated with the Aids Health Foundation (AHF) petitioning the FDA not to consider Gilead’s request for a licence to use Truvada for the prevention of HIV infection and a joint counter response by a number of HIV advocacy organisations. Despite differences, the debate emphasises the importance of the discovery and confirms that we have a very vibrant community of both HIV advocates and clinicians passionate and determined to find a lasting solution to end the HIV epidemic.
But for me as an advocate and an African living in Europe, the most important thing on my mind is “Will Africa be able to access PrEP?” Providing ARV to HIV negative people in Africa needs to be considered in light of the challenge of accessing treatment in Africa, where more than 50% of HIV positive people in the world live and which accounts for the lowest number of people on treatment (UNAIDS report).
During a community forum organised by AVAC in parallel to the CROI conference in Boston, Julie Davids from the HIV Prevention Justice Alliance asked about the future availability of PrEP for those who needed it most, stressing the danger of PrEP being a “boutique intervention available only to the privileged few”. This point was later repeated by Jim Pickett, director of advocacy for the AIDS Foundation of Chicago, who added that “PrEP is an intervention that has a number of moving parts that all need to be working for it to be safe and effective”. Shouldn’t one of the main concerns be to ensure that the drug would be available for those who need it worldwide? With an estimated cost of the Truvada put at $36 a day or up to $14,000 a year, what are the chance of millions of poor people in Africa to access what might be a life saving drugs?
What’s more, the new EU trade agreement with India on intellectual property on ARVs and generic drugs that is set to extend protection of Intellection Property for innovation and drug research, will limit further the production and availability of generic drugs in low-income countries. If the war of intellectual property between EU and India is anything to go by, then it is obvious that as far as Africa is concerned, PrEP will most likely be a “boutique intervention” and just another dream for Africans. With African countries currently providing the testing grounds for new HIV prevention approaches we should therefore ask now how and what advocacy can do to ensure that Africa will benefit from contributing to the development of these new interventions. Though this might be a very big question, it will need a proactive African advocacy and the recognition by other well establish advocacy organisations that their advocacy efforts, as well as their concerns, need to go well beyond their borders and that what they advocates (more research, more options) have an impact beyond their borders. Western advocacy for PrEP needs to extend to the rest of the world and take into account that in many African countries advocacy is still in its infancy or does not even exist at all.
Even if PrEP drugs become available, what are the mechanisms in place to ensure that it will not be tribalized in a continent where there are some indications that access to ARVs is based on political and ethnical loyalty and where there are evidences of bribery at the delivery point, misused of funds and a non-negligible ARVs black market leading to ARVs being dispensed to increasing numbers of patients at the periphery of the health system. One has to be skeptical about the PrEP implementation process in this context.
The whole idea of PrEP is to make it available to the person that needs it most. In Africa the dynamics of “people that needs it most” is different from America and Europe. For the latter, the most at needs group is Men who have Sex with other Men (MSM), but in Africa HIV transmission is mostly through heterosexual sex and new infections occurs mostly among young women aged 19-24. However, research has shown (when available as this is a difficult area to research) that the ongoing and increasing criminalization and stigmatisation of MSM all over the African continent results in a higher number of infections in this group than national average. Therefore MSM are becoming a growing concern for HIV prevention as it is very hard to reach MSM and deliver services, thereby failing to control an important part of the epidemic.
PrEP might be a good thing, but the underlying issues of access, human rights, cost, political and moral will power to act will not go away. Despite hope and guidelines designed for countries who could eventually afford it, the people that most need it in Africa will not have access to PrEP before long. If PrEP becomes the basis for prevention as we have seen with condoms, or even just part of HIV prevention, then Africa is not ready for PreP, and that will be another missed opportunity. The forthcoming International Conference in HIV and STI in Africa ICASA 2011 which bring together African advocates, clinicians, government officials and international advocates, and will be a key event to discuss PrEP in Africa and might, hopefully, prove me wrong.
Gaddafi’s HIV Shakedown. 13/3/11
Libya fraudulanlty gained access to aid
By Mike Elkin
13 March 2011
By falsely accusing a Palestinian doctor and five Bulgarian nurses of infecting hundreds of children, Libya managed to blackmail its way to hundreds of millions of dollars’ worth of aid.
Zakia Saltani has been warned not to talk to the press. She doesn’t care. She has waited 13 years to tell her story, and the Libyan government’s threats can’t stop her now. “After what happened to my family, what more can they do?” she asks. “I am beyond fear.”
At her friend’s house in Benghazi, with the red-black-and-green flag of the anti-Gaddafi rebellion spread proudly across her shoulders, she shows a framed photograph of her son, Ashur. He died of AIDS-related complications in May 2005, when he was 8. He had been one of more than 400 Libyan children who were admitted to the Al Fateh pediatric hospital in Benghazi 13 years ago with routine complaints like colds and earaches. They left with HIV. Like Ashur, roughly 60 have since died. Others are hanging on.
Until the Feb. 20 liberation of Benghazi by anti-Gaddafi protesters, the regime was able to bully people like Saltani into silence. Meanwhile, the government blamed the outbreak on five Bulgarian nurses and a Palestinian doctor at the hospital, falsely accusing them of deliberately infecting their young patients, and sentencing them to death. The medics were finally released in 2007, but not before the regime had extorted an Eastern European debt-forgiveness package and roughly three quarters of a billion dollars in supposed compensation and health-care assistance, together with a civilian nuclear-development deal and a “very good military accord” (in the words of Gaddafi’s British-educated son Saif al-Islam) with the French government “and other confidential stuff we shouldn’t discuss on the record,” the smiling Saif told NEWSWEEK at the time.
Now Saltani and other ordinary Libyans are starting to speak out at last. She says this is the first interview she has ever given—and her anger against Muammar Gaddafi and his 41-year dictatorship begins to spill out. “On Feb. 2, 1998, we went to the hospital because Ashur had a fever and a cough,” she says. “He was 4 months old, and we stayed two days. We went back two weeks later for the same problems.” Shortly afterward she took her 5-year-old daughter, Mouna, to the same hospital with a high fever. Mouna also went home with HIV, although at the time Saltani had no way of knowing that either child had become infected.
The truth began to emerge a few months later. “In October we learned that the doctors were hiding something,” Saltani recalls. “They said there was something in his blood that they couldn’t identify. The head of the hospital told us not to say anything. When we found out it was HIV, the government told us the infection originated from outside Libya, and that it only affected 10 kids. Another doctor even tried to convince us that it wasn’t HIV, but tuberculosis.” When the families finally discovered just how many children had been infected, the regime sent many of the patients to Italy for analysis and treatment.
Foreign medics made useful scapegoats—and lucrative hostages.
Even then the regime still did its best to cover up the outbreak. Mohammed El Agili, 20, says he was 8 when his parents took him to Al Fateh for an eye operation in March 1998. Three days later he returned, still dizzy from the procedure. When rumors of AIDS swept through the city, he underwent HIV testing, along with all the other children who had been admitted to the hospital in early 1998. The result came back positive. “When I found out, I ran shouting through the streets like a lunatic,” says his father, Mahmoud. “And we made sure the government heard our cries. Gaddafi invited all the families to a tent in the desert outside Sert, saying he would give us whatever we wanted, but we had to keep quiet. ‘We don’t want foreigners to become involved in this,’ Gaddafi told us. ‘We don’t want this to get out of Libya.’ He warned us that our relatives outside Libya would be in danger if we talked. We were afraid. We had to keep quiet.”
The news blackout may have suited Gaddafi’s purposes, but it didn’t help young Mohammed deal with insensitive classmates. They bullied him until he finally gave up school at 12. A rabid fan of the Real Madrid football team, he now helps his brother run a mobile-phone shop near their house. Asked about his future, the HIV patient smiles at the question’s naivete. “My generation doesn’t think about the future,” he says. “Even without this disease, Gaddafi has destroyed all our futures.”
Although the cause of the outbreak remains a mystery, outside studies implicate poor hygiene at the hospital rather than any of the conspiracy theories that abound in Libya. According to a 2002 report by Italian medical investigators, all the infected children had received intravenous fluids, antibiotics, steroids, or bronchodilators, but no blood or blood products. Saltani says she found it hard to accept the regime’s allegations against the hospital’s foreign medical workers. “At first I didn’t believe it was them,” she says. “The Palestinian doctor and the Bulgarians had always taken good care of the children, but everyone was blaming them, so we believed it. We wanted to confront them face to face, but the government wouldn’t let us.”
Still, the foreign medics made useful scapegoats—and lucrative hostages. The ransom Gaddafi received for freeing them enabled him to pay the victims’ families roughly $1 million each, helping him to buy a little more silence. For 41 years he has controlled the country through a combination of violence, intimidation, and strategic payoffs. To test the regime’s limits on free speech was to risk imprisonment, torture, and death. And old habits persist, even in liberated Benghazi, where anti-Gaddafi rallies occur daily. The current director of Al Fateh Hospital, who was working there as a doctor when the infections took place, refuses to speak as long as Gaddafi holds sway in Tripoli.
Just before Saltani’s interview, her phone rings. The caller is Ibrahim El Oraibi, the representative who deals with the regime on behalf of the HIV families. She puts it on speakerphone so a reporter can hear. He screams at Saltani for violating the government’s gag order. “If Tripoli finds out, they will get angry and will stop sending AIDS medication to Benghazi!” Oraibi shouts. That could be a death sentence for Saltani: she herself contracted HIV from breast-feeding Ashur. Doctors say it’s a thing that happens only rarely, but it can happen. She has been taking antiretroviral drugs for a year, and has only two months’ supply left.
But she refuses to back down. “I don’t believe anything Gaddafi says anymore,” Saltani tells Oraibi. “I have been quiet for 13 years and I’m tired of it. I want to fight.” The intermediary pleads: “Don’t talk until we receive the medicine.” Saltani is unmoved. “Gaddafi needs to go—and you can go with him,” she says. “I’ve been waiting 13 years and I’m not going to wait any longer. He’s a liar, and I’m going to talk with whomever I wish.”
She hangs up on the caller and begins her interview.
Five-Year Plan to Halve New HIV Infections. 10/3/11
Ethiopia to quadruple its annual condom distribution and put 85 percent of people who need life-prolonging HIV medication on treatment within five years.
10 March 2011
Addis Ababa — Ethiopia's government has come up with an ambitious plan to halve new HIV infections, quadruple its annual condom distribution and put 85 percent of people who need life-prolonging HIV medication on treatment within five years.
An estimated 1.2 million Ethiopians are HIV-positive. According to the government, the country's national prevalence is 2.4 percent, with stark differences between urban HIV prevalence, which stands at about 7.7 percent and rural levels of under 1 percent.
According to UNAIDS, Ethiopia has already managed to bring down new HIV infections by over 25 percent since 2001. The country's HIV/AIDS Prevention and Control Office (HAPCO) says prevalence among young people is dropping.
"Data obtained from studies since 2007/08 and a draft national survey show that there are fewer and fewer young ones entering puberty being infected with the virus both in urban and rural areas," said Yibeltal Assefa, director of planning, monitoring and evaluation at HAPCO.
"When you see the capital Addis Ababa for example, [the] prevalence rate among the young ones [aged 15-24] was above 12.1 percent in 2005... Two years later, in 2007, it went down to 6.2 percent, exhibiting [an] almost 50 percent decline."
In its latest global report on the epidemic, UNAIDS reported decreases in prevalence among antenatal care attendees in both rural and urban areas of Ethiopia, and improved behavioural indicators such as fewer people who have had sex by the age of 15 and fewer people reporting sex with more than one partner in the past year.
According to the five-year plan, presented to parliament by HAPCO on 16 December, the government also plans to increase the coverage of antiretroviral therapy from 60 to 85 percent. Close to 400,000 Ethiopians require treatment for HIV.
Ethiopia is in the process of expanding the number of health centres to over 3,000 to reach its treatment targets. The plan also aims to increase national condom distribution from 97 to 400 million annually.
Ignorance still a challenge
While the country's progress is impressive, analysts say there is still much to be done. A recently released survey by research group Population Council and the UN Population Fund, UNFPA, found that stigma and ignorance were still common among young people.
"A considerable percentage of young people had never heard of condoms or had no exposure to them," the study found. "One third of young people [aged 12-24] felt that moral people do not use condoms; 48 percent of young people felt that condoms should not be used within marriage; and roughly half felt that condoms are used by promiscuous people."
The authors recommended increased attention to marital transmission of HIV/AIDS and use of condoms within marriage.
Including MSM in the HIV agenda
The country's HIV plan aims to be comprehensive, but glaringly absent from its HIV strategies is any programming specifically for men who have sex with men (MSM), who generally fall into "most at-risk" populations.
According to Israel Tadesse, a lawyer at Addis Ababa city municipality, Ethiopia's criminal code imposes prison terms of 3-12 months on people found having sex with members of the same sex. Fear of legal repercussions is often a hindrance for gay people seeking HIV prevention and treatment services.
"There is anecdotal belief that the number of MSM is increasing but we don't have any credible or official study or data," HAPCO's Yibeltal said. "Ethiopia is no island to the global state of things so I am sure in the near future it will be a threat. Therefore, necessary intervention should be implemented but the problem so far is a hidden agenda."
Warning of Drug-resistant HIV. 4/3/11
African countries need to take steps to monitor and prevent the spread of drug-resistant HIV. This was the warning from researchers at the annual conference on retroviruses in Boston last week.
By Kerry Cullinan
4 March 2011
African countries need to take steps to monitor and prevent the spread of drug-resistant HIV. This was the warning from researchers at the annual conference on retroviruses in Boston last week.
Evidence presented to the conference showed that people who had never taken antiretroviral (ARV) medicine were increasingly being infected with HIV that was resistant to common ARVs.
They were probably infected by people who had either stopped taking ARVs or their ARV treatment had failed.
Countries where ARV programmes have been running for a long time were most likely to report drug-resistant HIV.
In parts of Brazil, for example, almost 20 percent of people tested had HIV that was resistant to at least one ARV.
In a study of almost 2 500 people in six African countries, drug resistance was highest in Uganda, which introduced ARVs earlier than the other countries surveyed, including South Africa and Nigeria.
At three Ugandan sites, almost 12 percent of people who had never been on ARVs before were infected with drug-resistant HIV.
Uganda was one of the first African countries to introduce ARVs, but in the mid-1990s some people were treated with one or two ARVs because of the exorbitant costs.
As the HI virus mutates easily, three different ARVs need to be taken at the same time every day for the patient’s entire life to prevent drug resistant HIV mutations.
In Uganda, there was most resistance to nevirapine and efavirenz, two of the most common ARVs used in Africa. Nevirapine has also been used for a number of years to prevent mothers from infecting their children with HIV.
PharmAccess, which conducted the African study, estimated that the risk of resistance increased by 38 percent for each year of ARV provision.
PharmAccess’s Dr Raph Hamers also reported on a study of young, newly infected Ugandans run last year which showed that over 8 percent had drug-resistant HIV.
A World Health Organisation (WHO) survey identified a number of factors that could drive the spread of drug-resistant HIV in Africa, including patients dropping out of ARV programmes, picking up their medication late and clinics running out of ARVs. – Health-e News.
HIV/AIDS Cases in Rwandian Prisons On the Decrease. 18/2/11
Massive awareness campaign that have been carried out in the prisons caused fall in HIV cases
18 February 2011
Kigali — The number of HIV/Aids cases among inmates has dropped drastically, the Commissioner General of Prisons said yesterday.
Mary Gahonzire, attributes the fall in HIV cases to the massive awareness campaign that have been carried out in the prisons.
"Prisoners and prison staff were sensitised about the virus and ways to prevent its transmission, with special reference to the likely risks of transmission within prisons," she said.
Gahonzire further explained that good prison conditions, such as access to clean water and ventilation, as well as good facilities for personal hygiene offered an ideal environment to those infected.
According to Dr. Anita Asiimwe, the Executive Secretary of National Aids Control Commission (CNLS), follow up is made on infected prisoners after they have been released.
"Inmates receive treatment from prisons and when they are released, we link them to the health centre in their area of residence where they continue getting treatment," she said.
Dr. Asiimwe added that CNLS pays particular attention to prisoners because they are most at risk.
Pelly Uwera Gakwaya the Director of Remera Prison said, the preventive programmes work well at the prison.
"HIV/AIDS among prisoners in Remera Prison has declined and we are continuing to fight it. We have also improved the healthcare and welfare of the inmates," She said.
Mubarak’s AIDS Legacy: Torture, Deportation and Arrest for HIV-Positive People. 3/2/11
Government frequently uses charges designed to criminalize homosexuality to also criminalize HIV-seropositivity.
3 february 2011
In Egypt, the victims of Hosni Mubarak’s 30-year autocratic rule haven’t just been government dissenters — they’ve also been people living with HIV.
While receiving a hefty amount of U.S. foreign aid, Egypt has conducted mass deportations of HIV-positive foreigners and arrested, tortured and convicted HIV-positive people based on their status.
“Police have blanket authority to intimidate certain populations,” said Joe Amon, director of the HIV/AIDS program at Human Rights Watch. “There’s a lot of homophobia, and police have targeted the communities, arrested gay men, gone through their address books [and] conducted forceful anal exams.”
Egypt’s National AIDS Program reports that there were 1,155 people living with HIV/AIDS in Egypt in 2007. UNAIDS, however, put the number much higher — at 5,300 — in 2005.
Between 1986 and 2006, Egypt deported more than 700 foreigners with HIV, nearly all of whom were of African descent. All foreigners who apply for a work or residency visa must test for HIV, and those who test positive are immediately expelled.
The government frequently uses charges designed to criminalize homosexuality to also criminalize HIV-seropositivity.
In 2007 and 2008, the government launched a crackdown on people living with HIV, arresting at least twelve men suspected of being HIV-positive, calling them a public health threat. Police beat several of them, later subjecting the arrested individuals to anal examinations to “prove” they had engaged in homosexual conduct. Authorities charged them with “habitual debauchery,” a term Human Rights Watch says Egypt uses to punish homosexuality, which is not specifically penalized in the country’s legal code.
Some were chained to their beds for days in a Cairo hospital. Authorities gave all of the men HIV tests without consent — those who tested positive were convicted to a maximum of three years in jail. “People like you should be burnt alive,” a prosecutor reportedly told one of the men, when informing him that he was HIV-positive. “You do not deserve to live.”
Omitting the facts
While Egypt is considered a low-HIV prevalence country, its own National AIDS Program warned in a 2009 report that “unless concerted efforts are made, this status might not prevail.” Indeed, Mubarak’s Egypt presents a number of troublesome risk factors that could foment a wider epidemic, including rising poverty, low condom use and an increasing number of people engaging in premarital sex. AIDS education is sparse: Less than five percent of females ages 15 to 24 have comprehensive knowledge of HIV, according to the government survey.
Not surprisingly, however, the 21-page piece says nothing about how government-sanctioned brutality against homosexuals and HIV-positive people contributes to the spread of the virus. The government also left of out large pieces of information, such as the percentage of people who have had sex with more than one partner in the last year. That information, the report says, “is not relevant to country epidemic status.”
It’s unclear what a new government in Egypt would look like: It could be more repressive, which might mean continued attacks on HIV-positive people. If it’s one bent on expanding human rights, however, a measure of relief could be in sight.
“The issue of police brutality in Egypt is larger than just the experience of men who have sex with men and of people with HIV,” said Amon. “Hopefully this pressure on the government and these protests bring real reform to the kinds of abuses that were taking place to a wide range of individuals that the government saw as dangerous or deviant or a threat to Egyptian society.”
Condom Gap “Quite Disturbing” According to PEPFAR. 2/2/11
There is a pervasive pattern of stockouts of condoms, both male and female condoms, in African countries
By David Bryden
2 February 2011
There is a pervasive pattern of stockouts of condoms, both male and female condoms, in African countries confronting HIV/AIDS, according to Carolyn Ryan, M.D., M.P.H, the Director of Technical Leadership at the Office of the Global AIDS Coordinator.
She called the condom gap “really quite disturbing,” given that condoms are a crucial tool for HIV prevention. While HIV incidence has fallen in recent years, in 2009 there were an estimated 2.6 million people newly infected with HIV, meaning that about 7000 people are acquiring the infection each day.
She made her comments at the January 6-7, 2011 meeting of PEPFAR’s Scientific Advisory Board. Many of the slides delivered at this meeting have now been made public on the PEPFAR website, including the presentation by Dr. Ryan on prevention and one by Dr. Charles Holmes on care and treatment, including PMTCT.
Dr. Ryan said that OGAC surveyed a number of high HIV prevalence African countries and found that in 9 out of 10 there were persistent, sector-wide stock-outs of condoms during 2008-2010 and that it was common for these stock-outs to last more than 2 months.
She said the median availability of male condoms is only 9.65 condoms per man per year, with large variations from country to country. In 2008 Ethiopia, Cote d’Ivoire and Zambia received the fewest condoms per man from donors among the countries surveyed.
Uganda has had a history of such stockouts, and Ryan’s presentation shows that in 2008 donors shipped only 7.9 condoms per man. A news report from last month indicates that in some northern districts in Uganda, health facilities have no condoms in stock for free distribution. HIV prevalence in the northern-central region of the country is about 8.2 percent, compared with the national average of 6.4 percent.
OGAC is working to understand the complex reasons behind the stockouts, and in a forthcoming report the agency will address how the US intends to respond. Ryan listed a number of factors leading to the shortages:
-Insufficient donor support for both condom provision and demand creation
-Ineffective funding mechanisms, such as ineffective basket funding
-Confusion over the US Government position on condoms
-Lack of prioritization of condoms by host governments
-Weak public sector supply chain systems
-Unfavorable regulatory policies – including import taxes and unnecessary post‐shipment testing
Ryan also noted that similar issues led to insufficient supplies of female condoms. The Center for Health and Gender Equity states that the U.S. has dramatically increased its distribution of female condoms in recent years, with shipments growing from 1.1 million in 2003 to 14.6 million in 2009. However, the Center notes that female condoms still represented just 3.2 percent of total U.S. condom shipments in 2009 and that “U.S. government investment in female condom procurement falls short.” In addition, the Center, which will be releasing a new report on access to female condoms, states that the US is “not investing enough in programming to see the product really succeed.”
Ryan’s presentation listed a number of overall gaps in HIV prevention:
-Gap 1 – prevention efforts do not reach those who most need them
-Gap 2 – structural and human rights factors increase risk and vulnerability
-Gap 3 – fragmented interventions miss opportunities to interrupt transmission
-Gap 4 – prevention efforts lack resources and remain limited in scope
Condoms are an essential component in the fight against HIV/AIDS. Increased condom use is considered to have played a role in the decline in HIV incidence in Africa since 2001. According to the latest UNAIDS report, young people in a large number of African countries are reporting more condom use, as well as declines in sex before 15 and in multiple partners.
Yet, tracking US spending on condoms is difficult. One study has shown a decline in US support for condom provision between 2005 and 2008, however, it is unclear if the analysis considered all US government funding sources, including PEPFAR. In FY 2009, PEPFAR spent $272.5 million, including headquarters spending, in the budget category that includes condoms, “Other Prevention”, primarily through USAID, up from $229 million in FY 2008, according to PEPFAR’s Operational Plans.
Insufficient donor support and a history of mixed signals on condoms have been top concerns of HIV/AIDS advocates. Concerns are also growing that the momentum for foreign aid cuts in the US Congress will affect funding for HIV programs, including resources for purchase and distribution of condoms.
Notwithstanding objections to condom distribution by some conservatives, there is evidence that Americans from a wide variety of backgrounds, including Christian Evangelicals and Catholics, strongly support condoms for HIV prevention, and advocates hope that a strong message for prevention funding will lead to greater support in the Congress.
Preventing New HIV Infections among Children is the Focus of a Meeting of African First Ladies. 1/2/11
Preventing mother-to-child transmission of HIV (PMTCT) was high on the agenda
1 February 2011
Preventing mother-to-child transmission of HIV (PMTCT) was high on the agenda at a General Assembly of the Organization of African First Ladies Against HIV/AIDS (OAFLA), held 31 January in Addis Ababa, Ethiopia.
“For every dollar spent preventing HIV among children, we save thousands more in treatment avoided,” said UNAIDS Executive Director Michel Sidibé, addressing the gathering of African First Ladies, as well as representatives from civil society and the United Nations. “We are making so much progress for mothers and children, but gains are fragile.”
In recent years, African countries—together with national and international partners—have made great strides in reducing the rate of new HIV infections among children. In 2009, an estimated 54% of pregnant women living with HIV in sub-Saharan Africa received antiretroviral medicines to prevent HIV transmission from mother to child, up from 15% in 2005. Several countries are leading the way, including Botswana, Namibia, South Africa and Swaziland, where coverage of antiretroviral drugs for PMTCT is now higher than 80%.
In the 10 countries of southern Africa*, the number of children under 15 who became newly infected with HIV fell from 190 000 in 2004 to 130 000 in 2009—a 32% reduction. AIDS-related deaths among children in southern Africa have declined by 26%, from an estimated 120 000 in 2004 to 90 000 in 2009.
Despite progress, some 2.3 million children in sub-Saharan African are living with HIV. In many countries across the continent, stigma and discrimination prevent HIV-positive pregnant women from accessing the services they need.
“I am pleading with you all to join hands and save our future,” said 11-year-old Oluebuechukwu Sylvia Taylor, the daughter of an HIV-positive woman who spoke at the OAFLA meeting. “No child should have to die because of HIV. Let’s work together to ensure zero mother-to-child transmission of HIV in Africa.” Ms Taylor was born HIV-negative as a result of her mother taking antiretroviral drugs during the pregnancy.
In nearly all countries in sub-Saharan Africa, a majority of people living with HIV are women, especially girls and women aged 15-24. The most recent prevalence data show that 13 women in sub-Saharan Africa become infected with HIV for every 10 men. Addressing gender inequalities and empowering women and girls are seen as critical to effective HIV responses in the region.
“Empowering women is not an abstract term,” said H.E. Woizero Azeb Mesfin, First Lady of Ethiopia and Chair of OAFLA. “It means ensuring that African women have adequate food and shelter, are free from disease, deliver their babies safely and stand alongside men equally and confidently.” With funding from UNAIDS, the First Ladies recently launched a campaign aimed at increasing PMTCT services and eliminating mother-to-child transmission of HIV.
African Union Summit
The meeting of First Ladies was held alongside the 16th African Union Summit, a gathering of 24 Heads of State from across the African continent and a host of other leaders and dignitaries, including United Nations Secretary-General Ban Ki-moon.
“We are seeing success in the fight against HIV/AIDS,” said Mr Ban, in his remarks at the opening ceremony of the Summit. “As partners of Africa, our challenge is to maintain and increase this momentum,” he added.
The HIV response is one successful example of “humanity acting in solidarity,” said Bingu wa Mutharika, the President of Malawi and outgoing Chair of the African Union, in discussions with the UNAIDS Executive Director. “We must continue our efforts to deploy antiretroviral treatment to those affected, and we should not be complacent about fighting stigma,” he said.
Transport Sector Launches HIV Policy. 17/1/11
Ethiopian government aims to get people in the transport sector to test for HIV as part of the new policy
17 January 2011
Addis Abbaba - The Ethiopian government has unveiled an HIV policy for its transport sector, which has grown significantly in recent years alongside the rapidly expanding road network.
"Various national studies have shown that those working across the transport sector - especially drivers and their assistants - are vulnerable to HIV infection as they spend considerable time away from their families," said Ethiopia's transport authority director Kassahun Hailemariam.
The country's Federal Transport Authority (FTA) and commercial transporters jointly issued the policy in December. It sets up a national taskforce to raise funds from state and non-state actors to finance projects, including condom distribution, and helping transport staff and family members living with the virus.
The government has earmarked 2 percent of the FTA's annual budget to work towards an HIV-free transport sector. Although exact figures for the number of transport workers - from drivers to drivers' assistants and loaders - are hard to come by, an FTA official said the figure was "in the tens of thousands".
Transport workers often have sex with local sex workers when on the road for days at a time. According to the latest UN General Assembly Special Session on HIV/AIDS country progress report on Ethiopia, a 2009 study found that truckers and intercity bus drivers formed 22 percent of the client base of sex workers.
A 2009 government survey from mobile counselling and testing clinics in 40 towns located on the major transportation corridors that link Addis Ababa to Ethiopia's borders found that 25.3 percent of the sex workers who received the service were HIV-positive.
The country's national HIV prevention programme has increased levels of knowledge about how HIV is spread and how to prevent infection, but some transport workers are still taking risks.
"If I am going to get HIV/AIDS, I am sure I have it by now as I have never used condoms so far," said Hailu Wondwossen, a driver's assistant for a minibus that travels between Addis and Hawassa, five hours south of the capital. "If I have AIDS already, and there is a good chance, what is the use?"
The new policy aims to get people like Hailu to test for HIV; if they test negative they can begin to behave more responsibly, and if positive, they can receive the necessary medical and psychosocial support they need.
"The transport sector is of huge importance to the trade and industry growths across the country and our economic performance hugely relies on their performance, which has been hindered by HIV/AIDS-related challenges," said Transport Minister Diriba Kuma.
Global Fund Terminates One Mali Grant and Suspends Two Others. 17/12/10
Due to misappropriation of funds and unjustified expenditures
17 December 2010
Responding to revelations from its Office of the Inspector General (OIG) of misappropriation of funds and unjustified expenditures, the Global Fund has terminated one grant to Mali and suspended two others. In addition, the Global Fund has placed grants in five countries on its "Additional Safeguards Policy" list.
The Global Fund has terminated or suspended three grants to Mali, following revelations by the Office of the Inspector General (OIG) of misappropriation of funds and unjustified expenditures. One TB grant was terminated. Two malaria grants were suspended. Management of the two suspended grants will be transferred to a new principal recipient (PR). This information is contained in a news release issued by the Global Fund on 7 December.
In addition, the Global Fund is placing grants in Mali and four other countries on its "Additional Safeguards Policy" list. The other countries are Cote d'Ivoire, Djibouti, Mauritania and Papua New Guinea. Grants on this list are subject to closer scrutiny of their grant activities and certain restrictions on cash movements.
The decision to suspend the grants in Mali follows an on-going investigation by the OIG, which found that approximately $4 million in grant funds has been misappropriated. The investigation uncovered fraud by senior officials working for grant implementers, committed through the submission of false invoices, creation of fake bid documents and overcharging for goods and services, particularly in relation to training activities.
GFO reported on the OIG's preliminary investigation on the Mali grants in GFO 125 (see "OIG Reports Evidence of Fraud by a PR in Mali"). More current information on the investigation is expected to be included in the OIG's progress report for the period March-October 2010, which should be released shortly. GFO will report on this when the information has been made public.
(The Associated Press reported that the Minister of Health in Mali, Oumar Ibrahima Toure, resigned "without explanation" two days before the Global Fund issued its news release. One African-based news agency reported that the minister was fired specifically because of the problems with the Mali grants.)
The two grants being suspended are: a $14.8 million Round 6 malaria grant to buy and distribute insecticide-treated nets for the benefit of pregnant women and children under the age of five, for which the PR is Groupe Pivot Santé Population; and a $3.3 million Round 6 grant for anti-malaria drugs, for which the PR is the Ministry of Health.
The grant being terminated is a $4.5 million Round 7 TB grant targeting, among others, prisoners and people in mining communities, and patients with multidrug resistant (MDR) strains of TB. The PR is the Ministry of Health. The Global Fund will ensure that essential services funded by the TB grant, including drugs for patients with MDR TB, will be maintained after the grant is terminated.
Other grants to Mali are also under investigation and further action may be taken at a later date. There are three active HIV grants in Mali, for which the PRs are Groupe Pivot Santé Population, the Ministry of Health and the National High Council for HIV Control in Mali. The only other active grant in Mali is a Round 4 TB grant, for which the PR is the Ministry of Health. No proposals were approved for Mali in Round 9. However, two proposals were approved for Mali in Round 10, one for malaria and one for TB, for which the nominated PRs are Groupe Pivot Santé Population and the Ministry of Health. When the Board approved Round 10 proposals at its meeting this week in Sofia, Bulgaria, there was no discussion of how to handle the two Mali proposals; one possibility is that the Global Fund Secretariat will ask the CCM to nominate different PRs.
The OIG has been working in close cooperation with the Malian authorities. The authorities arrested and imprisoned 15 people in connection with the fraud after an investigating judge was assigned to the case by the President of Mali.
Information for this article was taken from "Global Fund Suspends Two Malaria Grants, Terminates TB Grant to Mali," news release, Global Fund, 7 December 2010, here; and from the Mali country page on the Global Fund website. The media stories referred to in this article are: "Global Fund Suspends Malaria, TB Grants in Mali," Martin Vogl, Associated Press, 7 December 2010, here; and "Malian Health Minister Fired for Embezzling AIDS [sic] Funds," Pan-African Press (Panapress), 7 December 2010 here
HIV/AIDS - Looking Forward to an AIDS-Free Generation. 7/12/10
Achieving an HIV-free generation by 2015 is feasible
7 December 2010
Achieving an HIV-free generation by 2015 is feasible, but will require innovative approaches to reach marginalized populations, says the UN Children's Fund (UNICEF).
Attaining virtual elimination - meaning fewer than 5 percent of babies born to HIV-positive pregnant mothers contract the virus - will not require new scientific breakthroughs, said Jimmy Kolker, HIV/AIDS chief of UNICEF. Innovative financing and outreach are needed to enable people, especially women, youth and infants, to take advantage of available HIV prevention and treatment therapy.
"If you look at current programmes, we don't have enough money to do the kinds of dramatic increases and innovations we need to make these programmes actually result in an AIDS-free generation by 2015," Kolker told IRIN/PlusNews before the official launch of Children and AIDS: Fifth Stocktaking Report, at UNICEF headquarters on 30 November.
"We do need to think differently about children and AIDS, especially the prevention of mother-to-child transmission [PMTCT]."
PMTCT programmes have been significantly scaled up in countries such as Tanzania, Kenya, Mozambique, Malawi, Rwanda and Lesotho, which are set to achieve "universal access" of treatment for HIV and AIDS, reaching 80 percent of the affected population in need, by next year. But that has not translated into a steep decline in babies born HIV-positive.
While antiretroviral (ARV) treatment for HIV-positive pregnant women expanded from 45 percent in 2008 to 53 percent in 2009, infants born to these women did not experience a comparable jump in coverage, increasing only from 32 percent in 2008 to 35 percent in 2009.
About 370,000 infants are born with HIV each year.
Kolker called the significant drop-off between the two rates of expectant mothers and infants receiving ARV treatment "disturbing", attributed in part to mothers who give birth at home, without access to a health clinic. There is also the stigma factor, as some women fear exposing their children to judgment.
"The number of infants who are exposed to HIV from positive mothers and come back for testing within the first 12 weeks of life is very low. Not thinking that PMTCT ends at birth is a very important element," said Kolker.
The figure for under-15s shows more improvement, with a rise from 22 percent of children in low- and middle-income countries receiving ARV therapy in 2008 to 28 percent in 2009.
The recent introduction of UNICEF's "mother-baby packs" could make it easier to bring ARV therapy to infants in remote areas. The comprehensive take-home ARV kits could fill the role of health clinic visits, testing and possible treatment.
Ninety percent of mother-to-child-transmission cases occur in sub-Saharan Africa and the pilot phase of the mother-baby packs is under way.
Ten thousand packs, which cost US$70 each, have been distributed in Kenya and Zambia and 30,000 additional packs will go out in 2011 to expectant HIV-positive mothers in their 14th week of pregnancy. UNICEF has raised $8 million for the pilot project and expects to raise several million more within the next year so the packs will be free.
The packs mark the kind of innovative thinking - and financing - that UN health officials say will be necessary in future.
"The biggest problem we are going to face is availability of resources," George Tembo, HIV/AIDS chief of the UN Population Fund (UNFPA), told IRIN/PlusNews. "There's a huge shortfall and we are thinking about innovative ways of financing. In as much as it is important to have donors put in more money, increasingly national governments will need to put more and more of their resources into HIV for prevention and treatment."
The total number of young people aged 15-24 living with HIV has dropped since 2001, however, from 5.7 million to 5.0 million by the end of 2009. The report attributes the decline to safer sex practices.
HIV Risk in a Booming Construction Industry. 6/12/10
Country's booming construction sector is attracting thousands of labourers,
6 December 2010
ADDIS ABABA - Everywhere in Addis Ababa, the Ethiopian capital, modern buildings are popping up and wide roads are being built. The country's booming construction sector is attracting thousands of labourers, and government officials are increasingly recognizing the need to target these workers with HIV prevention services.
"We don't yet have a [clear idea of] Ethiopia's construction labourers' status and lifestyles, though the sector is growing massively," Bekele Desalegn, social mobilization expert at the Federal HIV/AIDS Prevention and Control Office (HAPCO), told IRIN/PlusNews.
"We need to assess how increasing labourers - mainly youth - employed by the construction sector are living away from their family; are they informed about HIV/AIDS and how to protect themselves? Do they take HIV tests when they go back to their families? All this needs to be answered and necessary interventions should be put in place," he added.
A visit to a construction site near Addis provides some answers. Bikila Gurmu makes 30 Ethiopian Birr - about US$1.85 - a day working at a construction project in the Sendafa area, 42km north of the capital. The married father of two admits he sleeps with local women when he is away from his family, who live a four-and-a-half hour walk away; he only manages the trek once a week.
Lack of knowledge
"Few times; I do it only sometimes," he said. Until he came to the city, Bikila had never used or even seen a condom. "I first saw a condom when a woman I paid for sex insisted I wore it first before we had sex."
He has since got into the habit of using condoms when he has sex with women other than his wife, but is still hesitant to take an HIV test.
Bikila says the way he found out about condoms highlights the need for HIV prevention programmes in the construction sector, where men often spend weeks away from their families. Evenings are spent in local bars where waitresses and bar owners sometimes double up as sex workers.
In addition, unlike other construction sectors in East Africa, women form an important part of the construction labour force.
"When you have a big group of employees, there is also a good chance of dating among them; I have seen girls getting pregnant and [losing] work subsequently," Bethlehem Endalkachew, civil engineer in charge of the Sendafa site where Bikila works. "Most of labourers are not aware of pregnancy or sexually transmitted disease prevention methods."
However, while a national policy for the construction sector is not yet in place, some of the sectors' main actors are taking steps to address HIV among construction workers.
"When we award any road project, we include in a contractual agreement a clause that obliges a contractor to allocate 1 percent of the total project cost to combat HIV/AIDS and protect labourers against the epidemic," said Ethiopia's Roads Authority spokesman, Samson Wondimu.
And some of the larger private companies are also working to protect their workforces. Sunshine Construction, which is undertaking road projects worth more than $100 million, has created a department dedicated to HIV.
"It is responsible to educate labourers and give them necessary support, including providing condoms," said Samuel Tafesse, managing director of Sunshine Construction.
A three-year project, run by the NGO, World Learning, and funded by the US government, is also working with government agencies to create workplace interventions and policies to reduce the HIV risk among construction workers.
Ethiopia's construction sector has increased from an annual growth rate of about 3 percent in 2000 to 11.3 percent by 2008, and covers wide areas of the country. Experts say urban areas, where HIV prevalence is estimated at about 7 percent, clearly need HIV prevention urgently. However, rural areas - where prevalence remains relatively low at 0.9 percent - must not be left behind as small towns crop up along the country's growing road network, blurring the distinction between rural and urban
12,000 New HIV-AIDS Patients Initiated on Art. 6/12/10
1000 of them are children below the age of 15 years while the rest are adults between the age of 30 and 35 years.
By Eriosi Nantaba
6 December 2010
Kampala, Uganda — An annual health sector performance report by the Ministry of Health for the financial year 2009/10 has revealed that more than 12000 new patients have started medication on Antiretroviral Therapy (ART). 1000 of them are children below the age of 15 years while the rest are adults between the age of 30 and 35 years.
"This indicates that more children contracted the virus as compared to the adults calling for strengthened efforts to control HIV among children," said Dr Nathan Kenya-Mugisha, the acting Director General of Health Services.
Nathan attributed the increased number of people to the improvement in accessibility of Early Infant Diagnosis in the last financial year. "The integration of EID to child days plus is one of the basic tools that the ministry in conjunction with Development Partners used in the research," added Nathan.
This was revealed in a ceremony held at Speke Resort Munyonyo to launch the 16th Government of Uganda-Development Partners Joint Review Mission (JRM) recently. "Government puts priority on the health sector because a healthy person is a productive person and thus with such efforts HIV is at the foot of being controlled in Uganda," said Dr Specioza Wandera Naigaga, the senior presidential advisor on health and population.This she said stressing the continuous efforts that the government laying emphasis on the good stock of health workers and drugs to treat malaria and HIV among others that the country is equipped with.
The Development Partners spearheaded by the United Nations Population Fund (UNPF) and the African Union Commission pledged to give priority to human resource in their budgets. "Dialogue with stake holders, NGO's and Development Partners can help Uganda have an excellent service delivery in terms of health workers," added Nathan.
Nathan pledged that even lower cadres in the health sector will be used to improve on the health sector performance of the economy. The JRM is a joint designation of the government of Uganda spearhead by the Ministry of health, in conjunction with Health Development Partners, Civil society and other key stakeholders who came together to delineate a way forward for health in Uganda.
A New Report Says Some Cultural Factors Influencing Spread of AIDS are Specific to Africa. 09/06/08
ECA Press Release No. 09/2008
New York , 09 June 2008 (ECA) – A new report released today on the state of HIV and AIDS in Africa says many cultural factors, including gender inequalities, wife inheritance and some sexual practices, that influence the AIDS epidemic and response are specific to the continent and must be better understood and changed.
“Securing Our Future ”, the report of the Commission on HIV/AIDS and Governance in Africa (CHGA) which was presented to UN Secretary-General BAN Ki-moon today at the UN headquarters calls for serious “discussion and action” on cultural issues which many societies find uncomfortable and challenging, but which determine the spread of HIV and undermine the effectiveness of national response to the epidemic.
The report says while polygamy had always been thought to be one of the major factors promoting the spread of HIV in Africa, the evidence supporting this notion was inconsistent, adding that in Ghana, for instance, the prevalence of HIV infection was lowest in the north, where 44 percent of marriages are polygamous.
The report says married women were at a high risk of contracting HIV when cultural norms condone male promiscuity or patriarchal control of the married couple's sexual activities. It says in many African cultures, widows have very limited legal rights to claim their family property.
“Besides being a violation of human rights and individual dignity, such traditional practices undermine women's economic security and fuel the vicious cycle of poverty and sexual risk behavior,” it says.
But the report says while some cultural norms and practices can fuel HIV transmission and impede access to prevention interventions, “it should be acknowledged that some traditional practices can have a positive impact as part of the response to AIDS”.
“For example”, says the report, “male circumcision, which has been practiced for centuries in some cultures and communities, has been found to decrease the risk of HIV transmission in men.
Citing the example of Zambia where the penal code has been amended to criminalize certain cultural practices such as widow cleansing, the report says many African countries had begun to reform their laws to address harmful cultural norms.
For more information, please contact: Yinka Adeyemi (email@example.com), +1- 646-359-2736
AFRICA: Falling HIV Rates Tell Complex Story. 02/08/07
JOHANNESBURG, 2 August (PLUSNEWS) - When it comes to sub-Saharan Africa's devastating AIDS crisis, there is an understandable tendency to latch onto any scrap of good news.
Figures suggesting the epidemic is waning in some countries are being trumpeted by governments and international donor agencies as evidence that their prevention efforts are succeeding.
Kenya's National AIDS Control Council recently ascribed a small drop in the country's HIV infection rate to people absorbing the messages in awareness campaigns and changing their behaviour accordingly.
South Africa's health minister, Manto Tshabalala-Msimang, claimed that the first evidence of declining HIV prevalence in pregnant women - from 30.2 percent in 2005 to 29.1 percent in the latest survey - was mainly due to "our continued focus on prevention as the mainstay of our response to combat HIV".
But the real story behind increases and decreases in HIV prevalence is far less clear. "There's an awful lot of vested interests, but it's sufficiently murky that no one really knows what's going on," Prof John Hargrove, director of the Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA) at the University of Stellenbosch, South Africa, told IRIN/PlusNews.
Twenty-five years is not long to get to grips with an epidemic that has evolved very differently in different parts of the world: in Europe, North America and Asia it has largely been confined to high-risk groups like injecting drug users, sex workers and men who have sex with men; in southern Africa it has spread rapidly via heterosexual networks.
Although theories abound, "nobody really knows why southern Africa is worst affected", said Dr Brian Williams, another epidemiologist at SACEMA. "And if we don't know that, it's very difficult to explain why prevalence is going up or down."
Lack of reliable data
Part of the problem was having adequate, reliable surveillance figures. In general, said Hargrove, the data had been "bitty" and mostly derived from urban populations.
The first generation of HIV-prevalence figures were obtained by testing pregnant women at antenatal clinics, but the age groups of the women, and the fact they were clearly having unprotected sex, meant the numbers tended to overestimate HIV infections in the general population.
Where possible, antenatal surveys are now combined with more representative data gathered in household surveys, but UNAIDS noted in its 2005 epidemic update that the high numbers of people who refused to be tested in household surveys, or were absent from home, could lead to underestimations of HIV prevalence.
While prevalence only tells us how many people are living with HIV and AIDS, incidence measures the number of new HIV infections occurring during a specific period. Incidence provides the most up-to-date and revealing snapshot of an epidemic, but the technology for determining recent infections is still quite new and prohibitively expensive for most African countries.
In the absence of such surveys, HIV prevalence in people aged 15 to 20 is often used as a proxy, because it is probable that most infections in this age group are recent.
The variety and unreliability of most surveillance methods causes epidemiologists like Hargrove and Williams to take any news of apparent declines in HIV prevalence with a large pinch of salt.
For years, Uganda has been held up as the poster child of successful prevention policies: from a peak adult HIV-infection rate of about 15 percent in the early 1990s, UNAIDS now estimates Uganda's prevalence at 6.7 percent.
President Yoweri Museveni swiftly responded to the emerging crisis as early as the late 1980s, and grassroots campaigns communicated basic prevention messages, such as abstinence from sex before marriage, being faithful to one's partner and the use of condoms. The ABC approach, as it has now been dubbed, combined with Museveni's leadership, have been widely credited with reducing risky sexual behaviour and lowering the prevalence rate.
But Williams pointed out that the evidence for Uganda's falling infection rate was "not really clear", and was based on a handful of antenatal surveys in the capital, Kampala. "We're desperate for a success story, so Uganda will be a success story regardless of the lack of evidence," he said.
Justin Parkhurst, of the London School of Hygiene and Tropical Medicine, also questioned the "so-called proof" of Uganda's success in reducing HIV infections in the British medical journal, The Lancet. He pointed out that the evidence supporting prevalence declines had been based on "selective pieces of information, which have been falsely presented as representative of the nation as a whole."
Parkhurst suggested that governments in low- and middle-income countries were under pressure to respond to donor fatigue by exaggerating the success of their AIDS programmes. "The standard of proof for policy recommendations seems to have been lowered, to provide the international community with the African success story it wants, or even needs," he concluded.
If Uganda's prevalence had indeed declined, there was still no sure way of determining why. Parkhurst cautioned against attributing the decline to "a few specific interventions introduced by the Ugandan government": not only were there numerous players in the AIDS fight besides the government, but "individuals can change their behaviour for reasons unrelated to intervention programmes".
Williams believed that while real behaviour changes, such as having fewer partners and higher condom use, might have taken place, they had less to do with the government's efforts and more with the widespread experience of watching friends and relatives die from AIDS-related illnesses.
Natural history of an epidemic
The dynamics of an epidemic can also bring about changes in HIV prevalence: in the early phases, HIV infections have tended to rise steeply and then level off as they reached a "saturation" point in the population; at a later stage, HIV prevalence might start declining, not necessarily because of widespread behaviour change, but because the number of people dying from AIDS-related illnesses has outpaced the number of new infections.
When the mortality rate of those infected reaches a balance with the incidence of new infections, prevalence will plateau - the stage South Africa is currently experiencing.
Paradoxically, the impact of a national antiretroviral (ARV) programme that keeps large numbers of HIV-infected people alive for longer might actually increase prevalence, or offset a lower rate of new infections.
This could explain why a country with a large ARV programme, like Botswana, has not seen significant declines in HIV prevalence, while Zimbabwe, with it's relatively small programme, has. But the real story is probably far more complex, and impossible to decipher at present, due to the lack of investment in research, monitoring and tracking national AIDS epidemics.
"Billions have been spent on virology, but we just haven't done enough basic public health research," said Williams. "Very few studies have been done trying to understand what's actually going on."
Ideally, such a study would need to monitor several thousand people over a period of at least five years, testing them regularly for HIV. According to Williams, such studies have not been done, and even in-depth evaluations of the impact of specific prevention programmes have been few and far between.
The case of Zimbabwe
When news broke in 2006 that Zimbabwe's HIV prevalence had fallen from a peak of around 36 percent in 1996 to 21 percent by 2004, it was greeted in many sectors with puzzlement and even disbelief, in light of the country's social and economic collapse in recent years.
Prof Alan Whiteside, director of the Health Economics and HIV/AIDS Research Division (HEARD) of the University of KwaZulu-Natal, in South Africa, said government prevention campaigns in the mid-1990s had probably contributed to Zimbabwe's falling HIV infection rates, but the country's economic collapse could have played an even bigger role. With less disposable income and mobility, people were perhaps less likely to maintain multiple sexual partners.
Michael Chome, country director for Population Services International (PSI), an international NGO that partners the Zimbabwean government in prevention programmes, was ambivalent for nearly a year about the real causes of Zimbabwe's decline in prevalence.
Eventually he was swayed by PSI's own data, showing large increases in condom sales - a figure considered more telling than a greater distribution of free condoms - as well as significant increases in reported condom use and decreases in non-regular sexual partners.
He attributed these changes to a "very open-minded ministry of health and a very literate population", as well as the concentrated efforts of donors, which had created "a needle-like focus".
Zimbabwe's pariah-like status has tended to scare away donors but, according to Chome, news of the country's declining HIV prevalence was helping to attract more funding for AIDS programmes.
On the thorny question of whether prevention programmes have had a direct impact on HIV prevalence, Whiteside was as reluctant to give a definitive answer as the epidemiologists: "We can't say for sure, but equally we can't say they haven't," he said.
"There is a natural history [of an epidemic], and perhaps we've underestimated it ... The trouble is, we're looking at things that are going to take years to develop, and our monitoring and evaluation tends to be short-term."
In the absence of reliable long-term data, Whiteside believed the key to interpreting HIV/AIDS figures was "to understand what is going on in our societies more broadly".
He suggested that looking at social indicators such as the rates of rape and teenage pregnancies, or the numbers of children completing school, could provide indirect evidence of behaviour change, or lack of it.
AFRICA: Mapping Health Budgets and Child Deaths. 28/7/10
They agreed to commit at least 15 percent of their national budgets to health
28 July 2010
Johannesburg - As many African countries battle to bring down staggering rates of maternal and child mortality, maternal and child health made for a fitting theme at the African Union (AU) Summit this week in Kampala, Uganda.
At the summit, African leaders came under fire for failing to live up to the 2001 Abuja Declaration, in which they agreed to commit at least 15 percent of their national budgets to health. To date, only about five countries have done so.
Using data from a recent report by Countdown to 2015, a group monitoring maternal and child health, IRIN/PlusNews has mapped the percentage of national budgets allocated to health against mortality rates of children younger than five years.
View the map to see what percentage of child deaths were AIDS-related, and how deaths in young children match up against efforts to meet the Abuja targets.
AIDS Denialism: The Lie That Has Killed Millions. 2/12/10
One out of every six people in the world living with HIV resides in South Africa.
By Oliver Meth
2 December 2010
Even with Mbeki gone, South Africa remains plagued by quacks selling ZAR80 juices they claim can cure a disease that only ARVs can treat, writes Oliver Meth.
One out of every six people in the world living with HIV resides in South Africa. This staggering amount is especially resounding when accounting for the considerable efforts made by the Treatment Action Campaign (TAC).
The TAC was responsible for mass mobilisations to demand access to anti-retroviral (ARV) medications at no cost for all South Africans. The TAC movement was initially spurned by, and therefore vehemently opposed by, the residing president at the time: Thabo Mbeki.
Epidemiological studies have confirmed that Mbeki's policies towards HIV are directly responsible for 300,000 deaths and 35,000 mother-to-infant HIV infections during his presidency.
Under the advice of a group of rogue scientists, Mbeki directed his nation against the scientific consensus by stating that AIDS was not caused by HIV.
While these views may have been respectable during the 1980s when the science surrounding HIV was still new, Mbeki's position, collectively known as AIDS denialism, caused appalling consequences within South Africa.
His position culminated in an exceedingly delayed rollout of ARVs, despite intense pressure from the TAC.
As such, South Africa's HIV prevalence starkly contrasts with Brazil, which experienced similar HIV rates but began ARV rollouts in the late 90s. Brazil is now widely regarded a success story in the battle against HIV and has one of the lowest prevalence rates in the Third World. As such, many regard AIDS denialism as a form of genocide, which makes it horrifying that this ideology still exists in South Africa.
Joachim 'Kim' Cools is a Belgian immigrant living in the rural Zulu community of Kwa-Ngcolosi. Kim is a prominent figure within the small village; he's the resident doctor at Kwa-Ngcolosi's only clinic, despite having no formal medical training.
Cools' position is reinforced through the production of 'umlingo wanagcolosi'; a juice purporting to have cured 400 people of AIDS.
As a show of transparency, Cools has posted his recipe on Facebook, allowing virtually anyone to recreate his juice and heal themselves from AIDS. Strangely, all of those cured by Cools have chosen to remain anonymous.
To reinforce his claims, he states that he has personally injected himself with HIV-positive blood on three separate occasions.
However, this is where Cools' story starts to get dicey. He confirms that he's been unaffected by these HIV injections, stating that HIV is a disease of the mind, created by the CIA as a form of population control and since he doesn't believe in HIV, the virus hasn't infected him.
His HIV conception is only a small part in an elaborate and grandiose 'conspiracy theory' story he tells involving deception within economies, politics, religion and science.
More importantly, Cools is a firm believer in the notion that HIV does not cause AIDS, that AIDS is caused by poor nutrition and poverty, the same position held by Mbeki.
Despite this, he still sells his juice (ZAR80 per bottle) and asks his patients to adhere to a strict diet of organic fruits and vegetables.
Furthermore, he openly broadcasts his beliefs about ARVs: Sinister and toxic constructions by pharmaceutical corporations designed to keep infected individuals sick, despite keeping 700,000 people within South Africa alive.
These are just a few of the many corollaries with Cools' dictum, the extent of which is limited by the length of this article.
Despite appearing to be motivated by positive intentions and his notwithstanding contradictory beliefs regarding the existence of HIV, Cools' message contains several misleading and ultimately, life-endangering errors.
Cools' contention involving the toxicity of ARVs is misleading. Fundamentally, every medication used by man is inherently toxic, and the specific toxicity of a drug is formally assessed through clinical trials.
Toxicity level is carefully balanced with the medicinal benefit when considering medical approval. While all ARVs have some negative side-effects, these side-effects are mitigated by the subsequent decrease in viral load and increase in CD4 count in patients who use them.
ARVs have consistently been shown to reduce illness, viral load, and death irrespective of race, gender, age, and sexual orientation.
And while ARVs are subject to unpleasant side-effects, these effects are greatly outweighed by the risks of not treating the HIV infection.
Perhaps Cools' most brash declaration is the distinction that HIV does not cause AIDS. This belief is created under two pieces of evidence: First, the associated belief that AIDS is caused by poor nutrition and poverty and, secondly, the claim that HIV has not been shown to cause AIDS and that the HI virus itself has never been physically discovered.
Cools' first assertion is radically misleading; poverty and malnutrition are significant predictors of the progression from HIV to Aids, they are not causes.
Living in poverty is a risk factor for HIV transmission: The poor are often uneducated about HIV and are much less likely to have access to appropriate routes of transmission prevention such as condoms and adequate medical services, thus they experience higher rates of disease.
Furthermore, Cools' view that HIV has not been shown to cause Aids and the lack of physical evidence for a virus presents additional fallacious conceptions.
Firstly, numerous studies have shown that almost every person diagnosed with AIDS has HIV present. Obviously, there have been rare cases of misdiagnoses, as occurs with any other disease. Additionally, the virus has been photographed under electron microscope on several occasions and these images are readily accessible.
Finally, in a study of unprecedented extent, a survey of 230,179 AIDS patients within the US revealed 299 HIV sero-negative individuals.
A further evaluation of 172 of these 299 showed that 131 were actually sero-positive, while 34 died before their sero-status could be confirmed. A study of this sheer size should certainly uphold as evidence of the direct connection between HIV and AIDS.
There is no other way around it, our present understanding of HIV and AIDS has resulted from the efforts of thousands of scientists and research going back 25 years; the connection simply cannot be ignored. No disease in the history of man has ever been studied in such depth.
Although nowhere near as influential as Mbeki, Cools' message is still a dangerous one. Cools has the potential to facilitate the unnecessary transmission of and death resulting from HIV.
Pseudo-practitioners such as Cools assert corruption within the legitimate field of science and seek to promote their unjustified alternative theories.
And while alternative theories reveal weaknesses within current approaches and also drive scientific innovation, these pseudo-scientists ignore the rules governing legitimacy and choose to appeal to fears and misperceptions.
AIDS denialism is a slap in the face to the memory of all those who have died of AIDS, as well as to the dignity of the survivors, families and friends. It is utterly outrageous that these individuals are able to propagate such dangerous messages and not be subject to any form of social or legal actions.
Africa - Global Fund Results. 15/7/10
15 July 2010
Washington, DC — According to a new report from the Global Fund to Fight AIDS, TB, and Malaria, the Fund's efforts have contributed to saving an estimated 4.9 million lives by December 2009.
The coming years will see even more results, as half of the total disbursements by the Global Fund were delivered in 2008 and 2009. Much of the US$ 5.4 billion of financing approved in Rounds 8 and 9 will reach countries in 2010 and 2011, and will continue to significantly boost health outcomes.
This is among the findings of a extensive series of detailed reports from the Fund presented at its meeting earlier this year, and available at http://www.theglobalfund.org/en/replenishment/hague/documents
This AfricaFocus Bulletin contains the executive summary of the document Innovation and Impact and a summary of one of the additional documents, which analyzes the mixed results of African government pledges to provide additional funding. That report finds that the percentage of the average government expenditure on health, as a percentage of total government expenditure, rose only marginally from 8.8% in 2001 to 9.0% in 2007, despite the 15% commitment of the Abuja Declaration. But a number of countries showed substantially greater increases. By 2007 three countries had met the 15% target (Djibouti, Botswana and Rwanda).
Another AfricaFocus Bulletin, sent out by e-mail today and available on the web at http://www.africafocus.org/docs10/hiv1007a.php, contains excerpts from a UNAIDS press release and from the 2010 UNAIDS Outlook report, outlining new recommendations for "Treatment 2.0" as well as noting progress in HIV/AIDS prevention, particularly among young people in Africa.
For previous AfricaFocus Bulletins on health issues, see http://www.africafocus.org/healthexp.php
The Global Fund 2010
Innovation and Impact Results Summary
For this and other reports on the current status and record of Global Fund programs, see http://www.theglobalfund.org/en/replenishment/hague/documents
1. Every day, programs supported by the Global Fund save at least 3,600 lives, prevent thousands of new infections and alleviate untold suffering.
2. The Global Fund to Fight AIDS, Tuberculosis and Malaria is a public-private partnership established in 2002 to mobilize and intensify the international response to three global epidemics and thereby help achieve the Millennium Development Goals (MDGs). From its founding through December 2009, the Global Fund Board approved proposals totaling US$ 19.2 billion, and disbursed US$ 10 billion for HIV, tuberculosis (TB) and malaria control efforts. To maximize impact, every dollar donated goes to fund programs in country. The Global Fund has no country offices, and its operating expenses are almost entirely covered by the interest earned on the Trustee account at the World Bank.
3. The results and impact outlined in the report are the achievements of all the partners that collaborate as part of the Global Fund model. The success of the Global Fund relies on the financial pledges of donors, the technical guidance of - and collaboration with - multilateral partners, and particularly the management and implementation of programs by in-country partners including governments, civil society organizations and the private sector.
4. HIV. At the end of December 2009, programs financed by the Global Fund were providing antiretroviral therapy (ART) to 2.5 million people. Approved HIV proposals have totaled close to US$ 10.8 billion covering 140 countries. The Global Fund is estimated to have contributed about one-fifth of all disbursements by bi- and multilaterals for the HIV response in low- and middle-income countries in 2008. In addition to providing ART, programs funded by the Global Fund have also distributed 1.8 billion male and female condoms and have provided 790,000 HIV-positive pregnant women with treatment to prevent mother-to-child transmission of HIV, as well as 4.5 million basic care and support services to orphans and other children made vulnerable by AIDS, and 105 million HIV counseling and testing sessions. There is a growing body of evidence showing that Global Fund financing - alongside that of other financiers - has resulted in declines in AIDS mortality in countries in which provision of ART has been scaled up rapidly, accompanied by other significant impacts, such as improved survival and productivity of key professionals and other workers, and systemwide improvements in health care delivery.
5. Tuberculosis. Through 2009, programs funded by the Global Fund have provided treatment to 6 million people who had active TB. The Global Fund provides 63 percent of the external financing for TB and multidrugresistant TB (MDR-TB) control efforts in low- and middle-income countries. Approved TB proposals have totaled close to US$ 3.2 billion covering 112 countries, contributing 48 percent of the projected coverage required to achieve the Stop TB Partnership targets for the detection and treatment of new smear-positive TB cases. TB programs supported by the Global Fund have also provided 1.8 million TB/HIV services. In many countries in which the Global Fund supports programs, TB prevalence is declining, as are TB mortality rates.
6. Malaria. By the end of 2009, Global Fund-supported programs had distributed 104 million insecticide-treated nets (ITNs) to prevent malaria. They also supported indoor residual spraying of insecticides in dwellings more than 19 million times and treated 108 million cases of malaria in accordance with national treatment guidelines. Approved malaria proposals have totaled US$ 5.3 billion covering 83 countries. In 2008, the Global Fund contributed 57 percent of international disbursements for malaria control. Global Fund investments have played a critical role in introducing and expanding coverage of novel, effective malaria treatments in many countries where drug resistance to older treatments is high. In conjunction with re-energized national and international efforts to combat malaria, increased Global Fund financing is having a substantial impact on malaria morbidity and mortality worldwide, with an increasing number of countries reporting a reduction in malaria deaths of more than 50 percent.
7. The Global Fund supports community-based interventions. Since 2003, these efforts have delivered 138 million community outreach prevention services for at least one of the three diseases and provided 11.3 million "person-episodes" of training for health and community workers.
8. These combined efforts saved an estimated 4.9 million lives by December 2009 and restored hope for the 33 million people living with HIV, the hundreds of millions of people who contract malaria or who are at risk each year, and the 9.4 million who contract active TB annually. The coming years will see even more results, as half of the total disbursements by the Global Fund were delivered in 2008 and 2009. Much of the US$ 5.4 billion of financing approved in Rounds 8 and 9 will reach countries in 2010 and 2011, and will continue to significantly boost health outcomes.
Having a wider impact: Strengthening health systems and contributing to progress on the Millennium Development Goals
9. The Global Fund investments to combat HIV, TB and malaria are having a much wider impact - beyond individuals, their families and communities. They are major investments in health systems - bolstering infrastructure, strengthening laboratories, expanding human resources, augmenting skills and competencies of health workers, and developing and supporting monitoring and evaluation (M&E) activities. These enhancements, in turn, improve the sustainability of services, increase national capacity to expand programs further and increase countries' ability to improve services for other health issues. Ultimately, the investments translate into a healthier population and increased productivity, enabling countries to further their development.
10. These investments have helped accelerate progress towards the MDGs by contributing directly to MDGs 4, 5, 6 and 8, and indirectly to the others. The US$ 19.2 billion of approved investment by the Global Fund is a direct contribution to MDG 6 ("Combat HIV/AIDS and malaria and other diseases"). In addition, major contributions have also been made to MDG 4 (on child mortality) and MDG 5 (on maternal mortality) by reducing the largest causes of mortality among women and children. This is particularly the case in sub-Saharan Africa, where HIV, TB and malaria are responsible for 52 percent of deaths among women of childbearing age and malaria alone accounts for 16 to 18 percent of child deaths.
Africa Stands at a Threshold in HIV Response. 24/07/09
Business Day Online
The examinations of extremely drug resistant tuberculosis (XDR-TB) and immune control of HIV in South Africa’s KwaZulu-Natal Province was a major focus of the 2009 conference organised by the International AIDS Society in Cape Town from July 19 to 22. The conference dwelt on HIV pathogenesis, treatment and prevention in the world’s most HIV-impacted country. At Tuesday’s plenary session, the more than 5,000 researchers, clinicians and community leaders attending the conference also took a comprehensive look at research on biomedical interventions to prevent HIV infection and financing the long-term response to HIV amid growing concerns about the impact of the global recession on scale-up.
“The XIII International AIDS Conference in Durban gave birth to the call for access to HIV treatment for rich and poor alike and the IAS has returned to South Africa as the continent stands at a threshold,” said IAS 2009 local co-chair Hoosen (Jerry) Coovadia who is chairman of Dira Sengwe and scientific director of the Doris Duke Medical Research Institute at the University of KwaZulu-Natal in Durban. “We have made real progress since 2000 but South Africa still has the worst epidemic in the world and we once again need the leadership of scientists, political leaders, international donors and community to turn the pandemic around.”
An estimated 5.7 million people in South Africa - one in every five adults - is HIV positive, and an estimated 600,000 patients had access to life-saving antiretroviral therapy (ART) by mid-2008. South Africa’s HIV/AIDS National Strategic Plan set targets to treat 80 percent of people who need ART by 2011, to give 95 percent of women access to prevention-of-mother-to-child transmission services by 2011, and to reduce new infections by 50 percent by 2011.
“In light of what is at stake, we are unwilling to accept the idea that HIV funding must fall victim to the global economy,” said IAS president Julio Montaner, who is IAS 2009 chair and director of the BC Centre for Excellence in HIV/AIDS in Vancouver, Canada. “We must always drive for an efficient response that includes rigorous evaluation, but there is nothing we can do that is more efficient in the long run than treating people early and in a sustained way.”
In his plenary presentation, Ronald Gray summarised the results of the 28 completed biomedical HIV prevention trials of STD control, microbicides, pre-exposure prophylaxis (PrEP), HIV vaccines and male circumcision. Of these trials, only four, including three of male circumcision, have reported significant efficacy. According to him, one of the conclusions to be drawn from positive and negative results is that phase III prevention trials are difficult, expensive and time-consuming. Ultimately, according to Gray, researchers would need to more carefully screen candidate interventions prior to trials and may need to conduct fewer trials, but with a greater investment in rigor and quality. Gray is Robertson Professor of Reproductive Epidemiology in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health.
Bruce Walker analysed the roles of CD4 and CD8 T-cell responses in controlling HIV infection. Drawing from data collected from collaboration with South African researchers at a site in KZN, Walker focused on T-cell-driver immune responses in people infected with HIV-1 subtype C virus, the most common subtype. This ongoing work involves people of Zulu/Xhosa ethnicity who are chronically infected with subtype C virus. Walker explored several facets of how T lymphocytes fall short in fighting off HIV, including how genetics of the infected person affect HIV control, how mutations in cytotoxic (cell-killing) T lymphocytes can impair HIV’s ability to replicate, and why specific genes in the human leukocyte antigen (HLA) system affect viral control differently in people infected with different HIV-1 subtypes. Walker is Professor of Medicine at Harvard Medical School and director of the Ragon Institute of MGH, MIT and Harvard.
According to Stefano Bertozzi, the threats to HIV/AIDS funding from the global financial crisis would place a greater emphasis on getting value from investments, and require a shift in thinking from a short-term, emergency response to a more efficient, long-term approach. Bertozzi is Executive Director of the Centre for Evaluation Research and Surveys at Mexico’s National Institute of Public Health (INSP). He pointed to several tactics to improve efficiency, including strategic selection and improved targeting of HIV interventions, and better management and strategic integration of those interventions into other services.
He also called for more balance between investing for long-term benefit and funding activities to achieve short-term results, including evaluation.
Prashini Moodley, chief specialist and head of the Department of Infection Prevention and Control at the Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, examined the emergence and spread of XDR-TB in KZN, explaining the interconnections between the local TB and HIV epidemics. Based on the experience of Tegula Ferry, site of a major XDR-TB outbreak, she discussed the roles of both nosocomial spread and the increasing numbers of immune-compromised patients in the community as factors in the spread of TB. According to Moodley these findings indicate the need for a multi-pronged approach to TB control that includes active case finding through rapid diagnostic methods, appropriate and early treatment for all patients with TB, timely initiation of antiretroviral treatment for all HIV-infected individuals and appropriate hospital infection control.
Africa not on Track to Halve Poverty by 2015, Economic Commission for Africa Head Says. 29/3/10
Africa was thought to be largely insulated against the worst effects of the global economic crisis but saw healthy growth projections slashed due to the crisis.
29 March 2010
U.N. Economic Commission for Africa (ECA) Executive Secretary Abdoulie Janneh said the global economic downturn will keep Africa from meeting the Millennium Development Goal (MDG) of halving poverty by 2015, Reuters reports. According to the news service, "Africa was thought to be largely insulated against the worst effects of the global economic crisis but saw healthy growth projections slashed due to the crisis."
"The global financial crisis has affected growth in Africa, with dire consequences for African countries to reduce poverty," Janneh said at the joint ECA/Africa Union (AU) conference this week in Lilongwe, Malawi. Janneh named HIV/AIDS, natural disasters and ongoing conflicts as factors also hampering Africa's economic growth (Banda, 3/25).
In a statement, Janneh said that a report on Africa's progress towards meeting the MDGs would be discussed at the ECA/AU gathering in preparation for the High-Level U.N. Meeting on the MDGs in New York in September (3/25).
Business Day analyzes the findings of that report: "The progress reports on the achievement of MDGs reveal that Sub-Saharan African countries are still lagging behind other regions, even as the target date of 2015 is close. Though United Nations statistics reveal that many countries in the Sub-Saharan African region are now experiencing improved growth, the region still lags behind on all Millenium Development Goals (MDGs), including poverty reduction. Some of the factors that have hindered the achievement of the MDGs are poor governance, neglect for critical infrastructure, poor leadership, policy inconsistency, amongst others" (Nwachukwu, 3/26).
This information was reprinted from globalhealth.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Global Health Policy Report, search the archives and sign up for email delivery at globalhealth.kff.org.
Africa: 'Winning the War On Aids'. 4/7/10
Africa is succeeding in the war on Aids, malaria and tuberculosis, African Union ministers say.
By Paul Juma
4 July 2010
Nairobi — Africa is succeeding in the war on Aids, malaria and tuberculosis, African Union ministers say.
In a recent progress report, the ministers say there is increased funding for programmes targeting the three diseases, and reduction of new Aids infections in high prevalence countries.
Increased number of health facilities providing voluntary HIV counselling and testing, and rising number tests in recent years were also noted as good signs.
The report on the AU Conference of Ministers on Health, assessed how the continent was faring on with programmes to increase access to health services.
Dubbed, Five-Year Review of the Abuja call for Accelerated Action Towards Universal Access to HIV/Aids, Tuberculosis and Malaria Services by 2010, the report was published ahead of an AU meeting to take place later this month in Uganda.
Malaria deaths had reduced due to artemisin treatment coupled with increased supply of treated nets and indoor residual spray, says the report.
"At the end of 2009, six AU member states had reached the goal of allocating 15 per cent or more of their national budgets to health," it said on funding.
That goal is among others agreed on by AU health ministers under the Abuja Declaration of 2001 (a set of health goals for African countries) and later the Abuja Call, reached in 2006.
The report, which covered the last four years, also notes that more than half of African countries had allocated at least nine per cent of their national expenditures to health.
The report will be tabled for adoption at the AU assembly, which will discuss Africa's progress on health Millennium Development Goals.
It recommends, among others, that the deadline for meeting the Abuja Declaration be extended to 2015. It also asks African countries to ensure timely access to appropriate, effective diagnosis, treatment care and support for the three diseases.
Africa: Challenges Remain in Accessing HIV Prevention, Treatment - UN Official. 21/4/10
HIV has been the major cause of child and infant mortality in major parts of Africa, with about 390,000 children under 15 newly infected with HIV in 2008 alone
21 April 2010
Despite the progress that has been made in the AIDS response in Africa, many challenges remain that prevent people from accessing the HIV prevention and treatment services they need, a top United Nations official said during a visit to Senegal.
Michel Sidibé, the Executive Director of the Joint UN Programme on HIV/AIDS (UNAIDS), noted that in 2008, about 45 per cent of pregnant women living with HIV in Africa were receiving antiretroviral drugs to prevent transmission to their children, up from 35 per cent the previous year.
"Tens of thousands of new HIV infections have been prevented as a result of prevention programmes and thHIV has been the major cause of child and infant mortality in major parts of Africa, with about 390,000 children under 15 newly infected with HIV in 2008 alonee efforts of African governments, civil society and youth," he stated, while adding that in spite of this progress, access to treatment and services needs to be improved.
Mr. Sidibé made his comments in Dakar, where he arrived earlier this week to take part in the agency's Sub-Saharan Africa Regional Management Meeting, with the aim of leveraging HIV for broader health and development outcomes in Africa.
While in Senegal, he also met with top officials to discuss the country's progress on universal access. Meeting with President Abdoulaye Wade on Monday, Mr Sidibé thanked the leader for taking the initiative to include an item on eliminating mother-to-child transmission of HIV in Africa on the agenda of the African Union (AU) summit, scheduled to be held in Kampala, Uganda, in July.
HIV has been the major cause of child and infant mortality in major parts of Africa, with about 390,000 children under 15 newly infected with HIV in 2008 alone, the Executive Director noted.
Mr Sidibé also thanked Mr. Wade for the progress made by Senegal in the fight against HIV, particularly in the eradication of the transmission of the virus from mother to unborn child.
In addition, he met the Prime Minister of Senegal, Souleymane Ndéné Ndiaye, who reaffirmed the country's commitment to total eradication of mother-to-child transmission.
Africa: It's How You Spend the Money that Saves Lives. 28/7/10
Countries could spend more than 15 percent and still show no real reduction in the deaths of children younger than five
28 July 2010
Kampala/Johannesburg — Members of the African Union (AU) reaffirmed at the end of their meeting on 27 July in Kampala, Uganda, that they would strive to spend 15 percent of their national budgets on health, but at the end of the day it is about how "effectively and efficiently" you spend the money, not about how much.
The promise to spend 15 percent on health was made in Abuja, Nigeria, in 2001, but health experts like Chikezie Anyanwu, Africa Advocacy Advisor to Save the Children, which works to promote children's rights, were left wondering whether the percentages actually made a difference.
Countries could spend more than 15 percent and still show no real reduction in the deaths of children younger than five, or among women during or after childbirth, as specified in the Millennium Development Goals (MDGs) set by the UN.
Rwanda, Liberia and Tanzania are the only three African countries devoting more than 15 percent of their national spending on health, said Anyanwu, citing a 2010 World Health Organization (WHO) report, based on data from 2007. "But they have made insufficient progress in meeting MDGs [Millennium Development Goals] four and five [reducing maternal and child mortality]."
In South Africa, one of the most developed and richest countries in the continent, the infant mortality rate has escalated and the country will probably not achieve the MDG target by the deadline of 2015.
An under-five mortality rate of 67 per 1,000 live births put South Africa at 141 out of 193 countries; in 1990 the rate was 56 deaths per 1,000 live births, according to the UN Children's Fund (UNICEF). HIV/AIDS is cited as the leading cause of death among children in South Africa.
Rwanda, Liberia and Tanzania are the only three African countries devoting more than 15 percent of their national spending on health...But they have made insufficient progress in meeting MDGs.
Mortality audits by the government's Child Healthcare Problem Identification Programme indicated that more than 60 percent of children who died in hospital between 2005 and 2007 were underweight, and according to the most recent national food consumption survey in 2005 nearly one in five children was stunted or chronically malnourished.
Yet Malawi, poorly resourced and with a high HIV prevalence rate, is on track for achieving its MDG targets, but since 2007 it has pushed its spending on health beyond 15 percent, said Health Minister Prof Moses Chirambo.
Malawi is now one of only 10 African nations that could meet MDG 4 - reducing child deaths by two-thirds of the 1990 levels by 2015 - according to an African Scorecard prepared by Save the Children, using WHO and UN Children's Fund (UNICEF) data.
The case of South Africa
"In 2006, the South African government spent seven times more money on health than Malawi, and 17 times more than Madagascar - two countries that have reduced child mortality by more than one-third between 1990 and 2008," said an article written jointly by Prof David Sanders of the University of the Western Cape, Debbie Bradshaw of the South African Medical Research Council, and Ngashi Ngongo of UNICEF.
"South Africa is one of 12 countries going backwards on reducing infant mortality," said Sanders. The other 12 countries include Zimbabwe Botswana, Kenya and Sierra Leone.
The article was among several in the latest edition of South African Child Gauge 2009/10, an annual snapshot of the status of South Africa's children published by the University of Cape Town (UCT), which took critical stock of spending on child health.
Malawi and Madagascar started with a mortality baseline even more abysmal than South Africa's. Eight percent of South Africa's gross domestic product is spent on health, but about five percent of that is spent by the private sector; 60 percent of the remaining roughly three percent that goes to the public sector is spent on personnel, Sanders told IRIN.
HIV was a major cause of death in South Africa, accounting for between 35 and 40 percent children younger than five, but other diseases such as diarrhoea also chalked up heavy casualties.
Sanders and his co-authors cited recent analyses implicating South Africa's high HIV prevalence of about 18 percent in its poor health performance, and mother-to-child transmission in high morbidity and mortality among infants and young children.
There are lessons that Malawi, with an HIV prevalence of 14 percent, extreme shortages of paediatricians, doctors and midwives, can offer South Africa and other countries, said Sanders.
It has focused on improving community-based health services and recruiting health surveillance assistants to administer antiretroviral drugs, supervise the directly observed treatment short course (DOTS) for TB, and contribute to maternal, newborn and child healthcare, which includes paying postnatal visits, an often critical service.
Malawi has also prioritized spending on nutrition - a sector run by the Malawian president himself - as a key preventive action to ensure that children's and women's immune systems are not compromised.
The South African government should ensure that quality foods like vegetables, fruits and good animal protein sources were cheaper than foods with poor nutritional value, said Sanders.
In another article Michael Hendricks of UCT and Lesley Bourne of the Medical Research Council said 80 percent of households could not afford an average nutritionally adequate food basket.
"But this calls for addressing broader issues, such alleviating poverty and ensuring people have access to good living environments, with water and well ventilated homes," said Sanders.
In 2008, 64 percent of children lived in poor households, said Hendricks and Bourne, who called for a multi-sectoral approach to tackling malnutrition by using several ministries, such as health, education, agriculture and social development.
Africa: Miseducation of Sexually Active Varsity Students. 26/4/10
Majority of university students are sexually active but less than half of them use condoms for protection against HIV/Aids infection
By Alex Ndirangu
26 April 2010
Nairobi — The majority of university students are sexually active but less than half of them use condoms for protection against HIV/Aids infection, a new study says.
It puts the figures at 70 per cent sexually active students, out of whom only 45 per cent use condoms.The study was conducted by I Choose Life organisation, in partnership with the United States Agency for International Development (USAid).
It indicated that 35 per cent of male and about 20 per cent of female students had between two and five sexual partners.
The findings, released last week, also noted that a third of the students were unlikely to abstain from sex in the next three months.
About 40 per cent of sexually active students do not know their HIV status, the study said. It indicated that the rate of infection is highest in the 15-24 year age group to which most of the students belong.
Maina Kiranga, the head of youth affairs at USAid, said 50 per cent of all new HIV infections are in the 15-24 year age group.
The research was carried out on a sample of 1,300 students from the University of Nairobi and the United States International University. It projected similar trends and student behaviour in all tertiary institutions in Kenya. This calls for rapid implementation of ABC [Abstaining, Being faithful to one partner and use of Condoms] to prevent HIV infection and unintended pregnancies.
Mike Mutungi, the director of I Choose Life, said first year female students were the most vulnerable to sexual exploitation by male students at higher levels. "We found out that about half of the girls are virgins at the time of admission to the university," says Mr Mutunga, adding that the figure dropped to below 35 per cent by the time the girls were in second year.
Relationship experts say the freedom that comes with university life is to blame for unprotected sex on campus. "The students tend to explore needlessly" says Gertrude Mungai, a sexologist.
"At their age, they are not ready psychologically for sex and can hardly sustain good romantic relationships." A bachelor of commerce student at the University of Nairobi, said sex boosts his ego and confidence.
"I should live life to the fullest and exploit this opportunity I have on campus," he said, adding that he uses condoms all the time.
He spoke of a prevalent syndrome dubbed "sexually transmitted degrees (STD)" where lectures award marks to female students for sexual favours granted.
Substance abuse was also blamed for the students' erratic sexual behaviour, with 42 per cent admitting to misuse of alcohol and other intoxicants.
A third of the students said they were unlikely to abstain from sex in the next three months. A communications student who vowed to abstain, said it was an uphill task.
"Friends shun you if you don't have a sexual partner," she said.
The research also found that most female students were more afraid of getting pregnant than of being infected with HIV and other sexually transmitted diseases.
Of the girls polled, 45 per cent said they were likely to use condoms to prevent pregnancy, against 35 per cent who would use condoms to protect themselves against sexually transmitted diseases.
It was also noted that many students engaged in romantic relationships outside campus.
Pascal Wambua, the lead researcher, said: "It is common to see female students with sexual partners on campus and outside." He added that sexual relationships between students and lecturers were also common.
Charles Wachichi, a HIV specialist, said only sex education can curb the risky behaviour. Meanwhile, the Ministry of Health and the Commission for Higher Education are working with I Choose Life in a programme to train about 4,000 HIV peer educators.
Most universities, including Nairobi, have compulsory HIV courses. They also have free condom dispensers at strategic points.
Africa: Obama Angry Over Spread of HIV/AIDS. 4/8/10
President Obama has told African governments to change the behaviour of their citizens to prevent HIV spread
Tabu Butagira and Charles Mwanguhya
4 August 2010
President Obama has told African governments to change the behaviour of their citizens to prevent HIV spread, saying treating patients while others are catching the virus is untenable.
"We are never going to have enough money to simply treat people who are constantly getting infected," he said. "We've got to have a mechanism to stop the transmission rate."
Mr Obama, who held a meeting with 115 young African leaders at the White House on Tuesday, blamed the upswing in new HIV/Aids infections in Africa on retrogressive culture that makes females satisfy the pleasure of men.
"In Africa, empowering women is going to be critical to reducing the transmission rate because so often women, not having any control over sexual practices and their own body, end up having extremely high transmission rates," he said.
He said US has a huge interest in public health systems in Africa because reducing HIV/Aids transmissions, will have a positive effect on HIV rates internationally, due to transmigration of diseases.
The Aids pandemic has swept through Africa to devastating effect; snatching bread-winners and skilled, productive workers while generating orphans and other dependants.
In Uganda where the infection rate was about 30 per cent in the late 1980s, a politically-led three-themed campaign - for Abstinence, Being faithful and Condom use or ABC model - helped drive down the rate to an average six per cent.
The country became a global poster for success against HIV/Aids, attracting huge funds from the Presidential Emergency Plan for Aids Relief and Global Fund yet mixed messages, one emphasising abstinence for sexually-active citizens, have confused official response to the pandemic first causing stagnation and lately, experts say, signs of a raise in new infections.
Mr Obama said the US, the largest contributor to the global HIV/Aids purse, has not slashed its allocation as alleged by some critics but caring for people living with HIV.
The alternative, he said, is to explore workable preventive programmes; build greater public health infrastructure and institutionalise country-specific interventions as his administration increases funding under the Global Health Initiative.
In a one-hour question-and-answer session with the delegates from across Sub-Saharan Africa including two Ugandan women, Obama criticised corrupt, dictatorial leaders in Africa and challenged the youth to lead the turnaround of their communities.
Africa: One-Hour TB Test "Must Be Affordable" for Poor Countries. 16/9/10
One-hour test for tuberculosis will only have an impact in the global fight against the disease if it is made affordable to poor countries
16 September 2010
Nairobi — A new one-hour test for tuberculosis will only have an impact in the global fight against the disease if it is made affordable to poor countries, experts say.
"If it comes out and costs a million dollars, then clearly it won't be feasible; it needs to be cheap enough for poor countries to use widely," said Mario Raviglione, director of the World Health Organization's Stop TB Department.
The one-hour test, developed by the UK's Health Protection Agency (HPA) follows the recent announcement of a two-hour "Xpert MTB/RIF test" for TB.
According to the HPA, the rapid test, which uses DNA identification to diagnose TB, is more sensitive than other tests currently available. It is, however, unlikely to be available until trials - due to take place over the next year - are completed.
The most basic TB test in use takes about 24 hours to yield results, and more thorough confirmatory tests can take up to eight weeks.
Raviglione noted that it would be crucial for the test, once available, to be simple enough to use at basic health facilities.
"It needs to be simple enough to administer at the point of care, so that when someone walks in with a cough, they can be diagnosed and treatment can be started immediately," he noted. "It should be as simple as the HIV test."
Late diagnosis is one of the major hurdles to global TB programmes; early diagnosis would help to cut transmission levels. "Not only are we not diagnosing about one-third of TB patients globally, but many of those who are diagnosed are caught at a late stage, which has implications for health systems and also for public health, because these people are walking around, unknowingly spreading the disease," Raviglione said.
According to Joseph Sitienei, head of Kenya's National TB and Leprosy Control Programme, faster diagnosis is long overdue.
"We have been using a 125-year-old system - the sputum test - so it is about time we had something more efficient," Sitienei said. "At the moment, patients have to go away and come back for results the next day or may have to wait several weeks for confirmation; some patients never return to get results or start treatment."
We have been using a 125-year-old system - the sputum test - so it is about time we had something more efficient
Sitienei noted that if the test became widely available and resulted in more diagnoses, more funds would be needed. "This will need extra resources, extra health workers, more training and so on," he said.
"TB is one of the cheapest diseases to treat, and there should be no excuse not to expand services," WHO's Raviglione said. "We must find a way to cover the additional costs of care."
It costs between US$20 and $25 to treat one TB patient using the WHO-recommended "directly observed treatment short course", DOTS.
Globally, an estimated 440,000 TB cases are diagnosed annually. TB is the biggest killer of HIV-infected people in Africa. According to the WHO's 2009 Global TB Control Report, about 1.37 million new cases of tuberculosis occurred among HIV-infected people in 2007.
Africa: Poll Ranks AIDS as Top Health Issue. 14/7/10
Nearly half of all respondents were optimistic that the spread of HIV could be stopped by 2015
14 July 2010
Johannesburg — AIDS is the world's most important health-care issue according to people all over the world who were polled for their perceptions of the AIDS epidemic in a new survey commissioned by UNAIDS.
Optimism about the state of the global AIDS epidemic and progress in responding to it varied widely, often along geographical lines. In sub-Saharan Africa, where most HIV infections occur, 31 percent of respondents chose the term "getting worse" to describe the issue, while another 30 percent chose "tragic". In South and Southeast Asia participants were more likely to see the situation as "hopeful" or "manageable".
Nearly half of all respondents were optimistic that the spread of HIV could be stopped by 2015 with the proper use of resources, although pessimism reigned in some countries, including Japan, the United Kingdom and Ukraine.
While 44 percent of all respondents said the world was not responding effectively to AIDS, those in Eastern Europe, the USA and sub-Saharan Africa were most likely to express this view, yet 75 percent of respondents in the Caribbean, and 53 percent in South and Southeast Asia, believed the opposite was true.
Perceptions of country and community responses were also divided, with Senegal giving their country the highest approval rating, closely followed by Uganda and Jamaica.
Less than one percent of Ukrainian respondents believed their country was responding effectively to AIDS; Russia and Latvia fared slightly better, and just 16 percent of South Africans were convinced that their country's response was effective.
Respondents were more likely to agree that AIDS was a problem in their country than in their community. In the USA, for example, about 70 percent thought it was a problem for the country but only a third felt it was a problem in their community.
One in three people considered public awareness about AIDS as the greatest achievement of responses to the epidemic, but more than half the respondents also viewed a lack of awareness as the greatest obstacle to HIV responses.
A lack of funding and resources were also seen as major obstacles, but nearly six in 10 felt governments had a role to play in providing treatment for their HIV-positive citizens. The perception that people living with HIV should receive subsidized treatment was strongest in the Caribbean and Asia, but less than half the participants in the USA agreed.
Almost half the respondents felt stigma and discrimination towards people living with HIV were significant obstacles to HIV responses, but 20 percent said they would not work with an HIV-positive person. Acceptance of people living with HIV was highest in sub-Saharan Africa and the Caribbean.
Most people did not feel they were personally at risk of acquiring HIV, regardless of where they lived. Only 25 percent of people in sub-Saharan Africa felt they were at risk, while people in Australia and the USA were least worried about contracting HIV.
Nearly 12,000 adults in 25 countries responded to the online survey, which was conducted between March and May 2010.
Africa: Twenty-two Percent of Sub-Saharan Africa's HIV/AIDS Rate Down. 17/9/10
Twenty-two of the most affected countries in sub-Saharan Africa have reduced new HIV infections by more than 25%
17 September 2010
Twenty-two of the most affected countries in sub-Saharan Africa have reduced new HIV infections by more than 25%
New UNAIDS data show significant progress towards Millennium Development Goal 6: to halt and begin to reverse the spread of HIV by 2015
Ahead of the United Nations Summit on the Millennium Development Goals (MDGs) on 20-22 September 2010, UNAIDS today released data on progress towards MDG 6 and called for leveraging the AIDS response to support all MDGs.
The data shows that countries with the largest epidemics in Africa—Côte d’Ivoire, Ethiopia, Nigeria, South Africa, Zambia and Zimbabwe—are leading the drop in new HIV infections. Between 2001 and 2009, 22 countries in sub-Saharan Africa have seen a decline of more than 25% in new HIV infections. The number of new HIV infections is steadily falling or stabilising in most parts of the world.
“We are seeing real progress towards MDG 6,” said UNAIDS Executive Director Michel Sidibé. “For the first time change is happening at the heart of the epidemic. In places where HIV was stealing away dreams, we now have hope.”
However challenges remain. Eastern Europe and Central Asia continue to have expanding HIV epidemics, and in several high-income countries there has been a resurgence of HIV infections among men who have sex with men.
There are now 5.2 million people on HIV treatment, which is a 12-fold increase in six years. AIDS deaths have dropped significantly since the widespread availability of treatment—there were 200,000 fewer deaths in 2008 than in 2004. Young people are leading the prevention revolution by choosing to have sex later, having fewer multiple partners and using condoms, resulting in significantly fewer new HIV infections in many countries highly affected by AIDS.
Among adults, male condom use has doubled in the past five years. Tradition is giving space to pragmatism, as communities embrace male circumcision. Research has shown that male circumcision has the potential to reduce HIV infection among men by nearly 60%. New HIV prevention research reported efficacy in a microbicide controlled and initiated by women.
“To sustain the gains we are making, further investments in research and development are needed—not only for a small wealthy minority—but also focused to meet the needs of the majority,” Mr Sidibé said.
Many countries are showing good progress in the AIDS response. For example, in Asia, where the epidemic is concentrated among high-risk populations, China has scaled up access to harm reduction programmes for people who use drugs. Data from its national sentinel surveillance show that the percentage of drug users who used sterile injection equipment the last time they injected drugs increased from 40.5% in 2007 to 71.5% in 2009.
South Africa is rapidly accelerating efforts to achieve universal access to HIV prevention, treatment, care and support. New HIV infections among adults and young people have dropped by more than 25% and record numbers of women are accessing treatment to prevent mother-to-child transmission of HIV from previous years. The country has also significantly increased its domestic investments for the AIDS response in the current fiscal year. However in many low- and middle-income countries, the lack of resources is seriously hampering the scale up of programmes.
US $10 billion shortfall for the AIDS response
In 2009, an estimated US$ 15.9 billion was available for the global AIDS response, which is US$ 10 billion short of the estimated need. In 2009 international investments for AIDS were down from investments made in 2008.
“At this turning point flat-lining or reductions in investments will set-back the AIDS response and threaten the world’s ability to reach MDG 6,” said Mr Sidibé. “Investing for AIDS is a shared responsibility—between development partners and national governments.”
UNAIDS recommends national governments allocate between 0.5% and 3% of government revenue on HIV, depending on the HIV prevalence of the country. Domestic investments for AIDS have increased over the past decade, but for a majority of the countries severely affected by AIDS, domestic investments alone will not suffice to meet all their resource needs.
On the other hand, AIDS programmes can be made sustainable and affordable by increasing the efficiency and effectiveness of HIV programmes. This means knowing what to do and investing resources in the right direction—task shifting among health care workers, reducing unit costs, and focusing on effectiveness are all options that will help lower global resource needs in the long run. In addition, the resource availability must become predictable. Countries cannot respond effectively to the epidemic on a fiscal year basis.
Leveraging the AIDS response for all Millennium Development Goals
Current strategies for resource investments are failing the AIDS response. AIDS programmes must be taken out of isolation. By situating the AIDS response within the broader development agenda and integrating AIDS with other health, development and human rights efforts, the world can accelerate progress across the array of MDGs, optimize efficiency in the use of resources and save and improve more lives.
For example, new UN estimates show that there were 42,000 deaths due to HIV among pregnant women in 2008. About half of these deaths were estimated to be maternal.
“Integrating HIV investments for maternal health, sexual and reproductive health, as well as child health will leverage better results for millions of people most in need,” said Mr Sidibé. “As we move ahead, the HIV response can help accelerate progress across all eight development goals.”
UNAIDS will co-host the event AIDS plus MDGs along with China, Nigeria and South Africa on 22 September at the UN Summit. The aim is to look at ways of integrating the AIDS response with other health and development efforts.
“World leaders and UNAIDS are joining together to give the message that we must invest strategically to address multiple MDGs. Releasing the power, capacity and innovation of the AIDS movement may provide one of the best opportunities to ‘do the MDGs’ differently,” said Mr Sidibé.
The AIDS movement should be the bridge that connects other movements: maternal and child health, sexual and reproductive health, gender equality, sexual violence and the fight against women’s cancer.
African Activists Decry Backtracking on Health Funding Commitments at Opening of World Economic Forum on Africa. 4/5/2010
Donors and African governments are making callous and unwise decisions on funding commitments to HIV and global health.
4 May 2010
Dar Es Salaam – Donors and African governments are making callous and unwise decisions on funding commitments to HIV and global health, according to a group of African health and human rights activists gathered in Dar Es Salaam, Tanzania, to carry out strategic planning and advocacy in the lead-up to the World Economic Forum on Africa from 5-7 May.
Vuyiseka Dubula of South Africa-based Treatment Action Campaign highlighted the far-reaching benefits of initiatives such as the Global Fund to fight AIDS, TB & Malaria, and the United States’ government’s President’s Emergency Plan for AIDS Relief (PEPFAR), both of whose future is uncertain due to funding cutbacks. “Thanks to the combined effort of the Global Fund and PEPFAR, more than 5,000 lives a day have been saved for the past ten years”, she said, “but we know that the success does not end there”.
There is a large body of scientific evidence demonstrating that HIV funding has strengthened health systems, improved maternal and child health and reduced the incidence of other major diseases like TB. By 2015, HIV in newborns could be ended if adequate funding is provided. Dubula warned that “if we do not invest adequately to sustain and build on this hard-won success, then we are effectively dismissing the right to health and throwing out the health-related Millennium Development Goals”.
There is increasing political hostility towards funding the universal access to HIV prevention, treatment and care that has been repeatedly promised by leaders around the world. Paula Akugizibwe from the AIDS and Rights Alliance for Southern Africa said that clear public health and socio-economic gains do not appear to have convinced funders of the need to sustain scale-up of HIV programs, stating that “we have heard every line in the book from funders except the truth – namely, that because HIV treatment is expensive, they are no longer interested in universal access. This is callous and short-sighted, and sets an unacceptable precedent for the global response to costly health needs in the future such as drug-resistant tuberculosis.”
Bactrin Killingo of the International Treatment Preparedness Coalition (ITPC) described the backtracking on universal access as “heartbreaking”. He outlined the findings of a 6-country community-driven research report issued by ITPC last week, which warned that HIV could once again become a “death sentence” for people in the developing world if funding cutbacks persist.
He further warned that “all that these cutbacks achieve is to defer and increase costs,” pointing out that research by various institutions including the World Bank has shown that the long-term costs associated with neglect of HIV and other health needs are far greater than the immediate costs of associated with mounting an adequate response to these needs.
Florence Umunna-Ignatius from Nigerian group Positive Action from Treatment Access elaborated on some of the consequences of funding cutbacks that have already been witnessed in Nigeria, where shortages of test kits are restricting access of new clients to testing and treatment. Similar reports have emanated from Uganda, where people in need of HIV treatment to stay alive are being turned away from clinics due to flat-lined PEPFAR funding, and the National AIDS Commission recently announced that treatment for the 350,000 people in need is unaffordable. “Let us not forget that each of the figures in these big numbers represents a real person for whom decisions on funding are literally a life or death matter,” she urged.
But to governments, these decisions are often more a matter of political sport – according to James Kamau of the Kenyan Treatment Access Movement. “In 2001 in Abuja, African heads of state promised us 15% of budget spending on health – where is this money?” he asked. Only two countries in the continent have met the Abuja target, which African finance ministers recently dismissed as a colossal mistake.
According to Kamau, “the true colossal mistakes are the wasteful spending habits of many governments who prioritise wars, luxury for politicians and sports over social spending, which cost thousands of lives every day”. He brandished spoof dollar bills highlighting examples such as the cost of President Yoweri Museveni of Uganda’s private jet, which could have paid for HIV drugs for more than 200,000 people.
Tapiwa Kujinga of the Pan-African Treatment Access Movement outlined the activists’ demands to leaders at the World Economic Forum on Africa, which include setting a clear time-bound roadmap to achieving the Abuja target of 15% of health and ensuring more transparent and accountable use of health funding. They are also calling on global leaders, particularly the G8 and G20, to fully replenish the Global Fund in October 2010; and on President Obama to ensure that PEPFAR supports addition of new patients onto treatment in future. Tomorrow (Wednesday 5 May) they will stage a demonstration at the World Economic Forum where a memo detailing these demands will be handed over to a representative of the Tanzania Minister of Health and the Global Fund, to champion these messages at the WEF.
Paula Akugizibwe (ARASA), +27 83 642 0817
Bactrin Killingo (ITPC), +27 73 392 3377
Florence Umunna-Ignatius (PATA), +234 805 958 8858 / +234 806 001 4885
James Kamau (KETAM), +254 722 88 66 94
Catherine Tomlinson (TAC), +27 21 422 5463
Tapiwa Kujinga (PATAM), +263 912 318 638
Lydia Muhengera (TASO), +256 772 448 102
African First Ladies Summit Agree. 22/04/09
Wed Apr 22, 3:53 AM
LOS ANGELES--(BUSINESS WIRE)--Closing a summit of 14 African first ladies that mixed Hollywood stars and top experts on health policy and development, organizers announced Tuesday, April 21, 2009, that a majority of the women had agreed to strengthened leadership roles in their countries and to work with teams of U.S.-based specialists in the coming months.
Summit organizers said they would spend the coming weeks assembling teams of experts to travel to Africa and collaborate with individual first ladies on ways to launch new efforts and improve existing ones to address issues such as basic healthcare for women and children, HIV/AIDS and malaria on the continent.
“These are some of the gravest problems faced by the African continent, needlessly claiming the lives of millions of people. To solve these problems we need the kind of African leadership announced today, as well as the engagement of a global partnership of experts,” said Ted Alemayhu, founder of U.S. Doctors for Africa, one of the groups that convened the two-day summit.
“There is tremendous work to be done, but we have taken the first steps and in the coming months more steps will be taken on the long road to ending the preventable, tragic deaths of so many African mothers and children.”
Participating in the summit were the wives of leaders from Angola, Cameroon, Cape Verde, Central African Republic, Kenya, Lesotho, Mozambique, Namibia, Niger, Nigeria, Sierra Leone, Tanzania, Swaziland, and Zambia. Several other African countries sent delegations. The summit also featured addresses by California First Lady Maria Shriver, as well as Sarah Brown, wife of UK Prime Minister Gordon Brown. Brown called for a renewed focus on maternal health and hosted a “working tea” with all of the first ladies.
Noted Hollywood actors joined portions of the gathering, including: Sharon Stone, Danny Glover, Jessica Alba, Rosario Dawson, Diane Lane, Robin Wright Penn, Maria Bello, Blair Underwood, Joely Fisher, Kristin Davis, and Camryn Manheim. A Beverly Hills gala on Tuesday night featured performances by Patty Austin and Natalie Cole.
Partners in the summit included a wide-range of groups with long track records of working to improve healthcare in Africa, organizations that support the new initiatives put forth by the summit. Summit partners were: RAND Corporation, General Electric, ONE, Procter & Gamble, The David and Lucile Packard Foundation, Vital Voices Global Partnership, White Ribbon Alliance, World Health Organization, Dalberg, Chevron, Global Health Council, Pfizer, Women Deliver, Africare, AllAfrica.com, Qiagen, Until There’s A Cure and UCLA’s Center for International Medicine.
for African First Ladies Summit
African First Ladies To Meet Experts in LA. 06/05/09
Fifteen African first ladies will convene in Los Angeles on Monday for a two-day meeting to promote their work in advancing heath care and education for African women and girls, Reuters reports. The first ladies of Angola, Kenya, Nigeria, Swaziland, Tanzania, Zambia and 10 other African nations will attend the event -- along with Maria Shriver, the first lady of California, Sarah Brown, wife of British Prime Minister Gordon Brown, and others. The event is being organized by the Los Angeles-based not-for-profit group U.S. Doctors for Africa and African Synergy Against AIDS and Suffering, an organization founded by 22 African first ladies in 2002. Ted Alemayhu, USDFA founder, said, "These are some of Africa's most important leaders, and aiding their efforts is critical to improving health throughout Africa." He added that the meeting "will pair these leaders with U.S. experts, key political figures and important organizations to create ongoing partnerships."
According to Reuters, the meeting is considered the first of its kind for the first ladies in the U.S., and it will introduce the women to business leaders, health policy experts and entertainment figures in California. Jean Stephane Biatcha, executive director of African Synergy, said the first ladies "already know" Washington, D.C., and New York and "thought that by coming to Los Angeles, some of the inspiration that inspires movie makers could also inspire them in their objectives" (Serjeant, Reuters, 4/16).
Africans Women are More Vulnerable to HIV/AIDS. 19/9/10
Among youth aged 15 to 24 years, for every one man, four women are infected with HIV.
19 September 2010
The African continent has more people living with HIV but women are more at risk compared to men. Dr David Tigawalana explains how and why this is the case
Whereas Africa has 10 per cent of the world’s population, about 70 per cent of HIV infections are found in Africa. Out of the 33 m people who were living with HIV in
Women more affected than men
There is increasing concern that Sub-Saharan Africa is the region where more women are infected by HIV than men. 60 per cent of people living with HIV infections in Africa are women. On average about eight out of every 100 Ugandan women are infected with HIV compared to five out of 100 Ugandan men. Among young men and women aged 15 to 24 years, for every one man, four women are infected with HIV. And moreover, women are more subjected to HIV stigma and discrimination. Vulnerability of women and girls to HIV infections cannot be explained by biological factors alone but gender inequalities that exist in African society.
Women more vulnerable
In Africa, the HIV virus that causes Aids, is transmitted through two major routes. The first, which accounts for 80 per cent of the cases, is through unprotected sex between men and women. This is followed by HIV transmission from mother to child during pregnancy, labour and breastfeeding, which is responsible for about 20 per cent of the cases.
It has been scientifically proved that the risk of HIV transmission during sex is greatest for anal sex, followed by vaginal sex and least for oral sex. During vaginal sex, which is commonly practiced in Africa, the chance of HIV transmission from a man to a woman is two to three times greater than transmission from a woman to a man. This is due to the biological make up of the female genital tract.
The female genital tract is made up of a larger exposed area. Semen has higher viral load than vaginal fluids and the semen stays longer in the female genital tract after acts of sex which increases the chances of HIV transmission. It has also been proved that the genital tract of young girls is immature and more prone to invasion by HIV.
Sexually transmitted infections, which increase the chances of HIV transmission and acquisition of HIV, can occur in women without being recognised. This increases the chances of HIV transmission and acquisition by women. Furthermore, women in some African cultures use herbs to tighten the vagina to remedy what they call “dry sex” which causes tears in the genital tract during sex and makes women more likely to transmit or acquire HIV. Lastly forced or coerced sex, which is common but rarely reported by women, increases the chances of HIV transmission.
The roles of gender in HIV/Aids
Gender refers to differences in social roles and relations between men and women. Gender roles are learned through socialisation and vary widely amongest cultures. Gender roles are also affected by age, class, race, ethnicity and religion, as well as geographical, economic and political environments. The gender dimensions that are relevant to HIV and Aids include economic, legal, cultural, religious, political and sexual status of women. Some of the gender inequalities do not only increase vulnerability of women to HIV and Aids but also become factors that fuel the spread of the epidemic.
There is a multitude of socio-cultural factors that increase vulnerability of women to HIV and Aids. The subordination of African women creates vulnerability to HIV infection through economic dependency, lack of assets, and lack of protection against abuse and exploitation. Most women in African societies are subjected to discrimination right from their youth and denied access to education and gainful employment. Women end up being engaged in subsistence farming or low paying jobs. Economic pressures lead women to engage in vices like sex work and transactional sex. In urban settings, cohabitation and temporary sexual relationships are common because women need support for items like house rent and feeding.
Also, social construction of masculinity and femininity renders women powerless to demand for their rights, including not questioning infidelity of their husbands. The patriarchal system in Africa affects women directly by legitimisation of male dominance.
Effects of culture
In many African cultures there is tolerance for multiple sexual partnerships, including extra-marital sex by men. Marriage and monogamous relationships do not protect women. Ironically, an unmarried woman will be more protected than a married one because of the unfaithfulness of men. There are common sayings such as, “Aids can meet you in the bedroom,” “In polygamous societies, a man can have many sexual partners but a woman has to be faithful to one,” “A woman who has been paid a bride-price for is even more vulnerable to HIV”.
Intergeneration sex is common in Africa. Young girls have sex with older men (sugar daddies), for money, gifts or status. Even culturally, women are found to marry men who are much older than them and more sexually experienced, thus exposing them to the risks of HIV. There is a danger of young women seeking sexual satisfaction outside marriage, thus exposing them to risks of HIV.
Sexual violence is also common, including rape and defilement. In some instances men who are infected with HIV believe that a virgin can "cleanse" them of HIV. A number of young girls have reported forceful initiation into sex by older sexual partners. Sexual violence can also occur at work places, even among educated women, during job hiring, promotion and to avoid dismissal. Fear of violence leads to acceptance of sex and lack of protection. Orphans and domestic workers are also sexually abused.
Women in Africa need protection and this can be done by addressing gender inequalities. Women need a fair share of treatment. We need to address the root cause of HIV transmission, protect the rights of girls and women and target activities that improve the status of girls and women by providing training, life skills and access to work. Education opportunities should be provided to girls to create awareness and increase HIV prevention methods, delay and have choice in marriage, improve the status of women in society and achievement of autonomy. Poverty among women should be addressed through including women in poverty eradication programmes. Lastly, governments should institute legislation to protect women’s rights, access to resources, fair allocation of treatment, address violence and abuse against women, enforce legislation against Female Genital Mutilation and other actions to address the low status of women.
Angola: Charity Association Campaigns against HIV/AIDS. 6/9/10
Change their mentality and attitude
Luanda — An awareness campaign aimed at informing, educating and holding an interpersonal communication with residents of Samba District, in Luanda, was held Sunday here by the Christian Charitable Association ( ABC), in light of its programme of fight against decease.
Speaking to ANGOP the coordinator of the ABC for HIV affairs, Ana Maria Borges, explained that the campaign dubbed "Stop AIDS" will be held monthly and was based in the dissemination of information on the proper use of condoms, talks, counselling and handover of booklets about the disease.
According to the source, other goal of the campaign is to prevent the spread of the virus by making people aware of the basic ways of contamination and prevention methods.
The campaign, held at the main avenue of Samba District, called also on citizens to change their mentality and attitude, avoiding discriminating people with the disease.
Botswana Attends SADC PF’s ‘50 by 15 Campaign’. 31/1/10
Workshop aims to focus on developing practical strategies for ensuring the reduction of new HIV infections by 50 percent by 2015.
by Kagiso Madibana
31 January 2010
The Southern African Development Community parliamentary Forum (SADC PF), in collaboration with UNAIDS RST, World AIDS Campaign, Soul City Institute, SAT, SAFAIDS, and HEARD recently invited parliaments and civil societies from across the SADC region for its second annual three-day workshop titled the ‘50 by 15 campaign’ which will be held in Johannesburg on Tuesday.
The’ 50 by 15” campaign, an initiative of the SADC PF since July 2009, addresses the issue of legislative and social co-operation on the Millennium Development Goals(MDGs) of 50% reduction in new infections by 2015, together with the virtual elimination of mother-to-child HIV transmission.
The workshop serves as a follow-up on the commitments and priority actions that were decided on at the first meeting that was held in July 16-17th 2009.
Botswana, a country at the forefront of the fight against HIV/AIDS sent two of its representatives to attend the workshop amongst other Members of Parliament from different SADC countries. In attendance are SADC Parliaments of Angola, DRC, Lesotho, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe as well as civil society representatives from the region.
The chairman of the parliament special select committee on HIV/AIDS, Shimane Mangole, will leave tomorrow (Monday) for Johannesburg to attend the workshop. He is accompanied by a Member of the SADC PF standing committee on HIV/AIDS, Edwin Batshu.
The ‘50 by 15 campaign’ first came to light in July 2009 when parliamentarians and civil societies from across southern Africa met and came up with a HIV/AIDS prevention agenda.
It was during this meeting that commitments between MPs and civil societies were exchanged and a ten point action plan was developed. A conclusion was reached and then it was agreed that the workshop should focus on commitment to immobilizing leaders and communities in the region around this target and around prevention in general.
It also appreciates the role of legislators and legislatures in providing national leadership on HIV prevention and the participants had made a commitment to working with parliamentary leaders in forwarding prevention.
The SADC PF press release written by Sabelo Mbokazi (Capacity Development Officer -SADC PF), revealed that the workshop will provide a platform for dialogue between legislators and civil society to deliberate on ways in which they can collaborate and partner more effectively, motivating them to introduce motions on the increasing complexity of preventing the spread of HIV in the region.
“The workshop aims to focus on developing practical strategies for ensuring that the “50 by 15 movement is on track to meet the agreed targets that will lead to the realization of preventing new HIV infections by 50 percent by 2015, as well as merge it with other ongoing collaborative efforts by the SADC PF and other Parliamentary-centric organizations, including CSOs, International NGOs.”
Botswana Ex-President in Plea Over Homosexuals. 19/10/10
Leaders must not enact laws that criminalise homosexuality and sex work,
By Elias Mbao
19 October 2010
Nairobi — Botswana's former president Festus Mogae yesterday said African governments and leaders must not enact laws that criminalise homosexuality and sex work, warning that such legislation would inhibit the fight against HIV/Aids.
Mr Mogae, who chairs a team dubbed 'Champions of an HIV-Free Generation' that comprise prominent African anti-Aids activists, told Zambian President Rupiah Banda at State House in Lusaka that homosexuals and sex workers were part of society and they should not be stigmatised or discriminated.
Mr Mogae said he had written to some African Presidents, without mentioning names, who wanted to pass laws to criminise homosexuality, advising them not to do so.
The former President, who explained that he is heterosexual, said in Botswana homosexuality was illegal but he had been engaging the government to repeal the law that criminalises homosexuality.
Due to his advocacy, Mr Mogae said "nobody has been prosecuted over the last three years" for being homosexual.
And President Banda, whose government is anti-gay rights, accused the foreign donors were making youths believe that "homosexuality is a human right and that if you appear to speak against it then you are a reactionary and you don't understand the world".
Without categorically backing Mr Mogae's position, President Banda said to "hear it from the position of the Champions in the fight against Aids then you understand why we should not criminalise them [homosexuals], understand them and at the same time try and sensitize our young people" about homosexuality
British NGO Funds $ 40.000 in Projects Against AIDS. 2/11/10
"Tearfund" funded this year with about USD 40.000
2 November 2010
Lubango — The English ecclesiastical NGO "Tearfund" funded this year with about USD 40.000 the group of Christian bible students in Angola (Gbeca) for awareness activities and campaigns for voluntary testing of HIV/AIDS in the province of Huila.
Speaking Tuesday to ANGOP, in the development of activities debating themes relating to this disease in Huila, the coordinator of Gbeca, Canda Justino, said that the funding is being applied to a project called "Atalaia", which promotes awareness in institutions of primary and high schools.
He added that the project will end late December, and is characterised by lectures, Bible studies, and campaigns to help people living with HIV/Aids.
The group of christian students from Angola has existed since 1990 with the mission to evangelise students and professionals from institutes and universities on care for HIV/Aids positive people.
Campaign to End Paediatric HIV/AIDS (CEPA). 10/09
Saving Africa’s Children. 29/10/09
Living with AIDS # 410
29.10.2009 Khopotso Bodibe
Africa has the largest number of children living with HIV. A campaign launched recently seeks to mobilize political will and financial resources to overcome the bottle-necks that hinder services for children who have HIV and to prevent HIV infection in children.
The campaign will initially launch in six African countries. These are Kenya, Uganda, Tanzania, Nigeria, Zambia and Mozambique. Chairperson of the Campaign to End Paediatric HIV/AIDS (CEPA), former Mozambican and South African First Lady, Graca Machel, said CEPA seeks to address the bottlenecks encountered in delivering diagnostic, treatment and care services in these countries.
“In Zambia, 95 000 children are living with HIV/AIDS, yet it can take anything from eight to 16 weeks for the results of an infant’s HIV test to be returned from the lab. In Mozambique, 100 000 children are living with HIV and we know that 22 000 children under the age of 15 died as a result of this disease in 2008 alone. In Uganda 130 000 children are living with HIV, in Tanzania 140 000, in Kenya 155 000, in Nigeria 220 000, yet an estimate of 40% of those children who need treatment do not have access to it”, Machel said, painting a gloomy picture from figures released by the World Health Organisation (WHO) in 2007 on the scale of paediatric HIV.
But that’s just a tiny fraction of the burden of paediatric HIV in Africa. In South Africa alone, 280 000 children are said to be having HIV. It is estimated that 1.8 million of the world’s HIV-positive children are in Africa.
One of CEPA’s goals is to prevent HIV infection from parent to child. Openly HIV-positive TV host and head of Nigeria’s Positive Action for Treatment Access Movement (PATAM), Rolake Odetoyinbo, knows that that can be achieved.
“The best news I got was in 2006 when I was told that my eight-week old baby was HIV-negative. I had lived with HIV for seven years. I made a conscious decision to get pregnant and have a child knowing that I have a chance of passing the virus. But I dared to believe in science”, Odetoyinbo says of how prevention of mother-to-child anti-retroviral medication help save her baby from HIV infection three years ago.
“I can deal with my status, but I dare say I’m not sure I would have been able to deal with my child being HIV-infected. And that’s what we are committing to. Can we stop infection in children? Can we speak for the voiceless and say we need to stop our children from getting infected?”, Odetoyinbo pleaded.
The campaign also aims to unblock the bottle-necks that prevent easy access to prevention, treatment and care services for HIV-positive mothers and children. The rigidity of the roles of health care providers is an example of a bottle-neck hampering service provision, says Director of Communications for the Global AIDS Alliance in Washington DC, Skip Morskey.
“There’s a certain model that says doctors do this, nurses do this, pharmacists do this. But in the context of a very urgent health epidemic, like AIDS and paediatric AIDS in particular, we may need to change some of our assumptions about the best way to dispense medications.
“We wouldn’t suggest that a doctor’s role be abrogated or be eliminated, but that once the doctor or nurse has made the evaluation, under task-shifting, the job of dispensing medications or renewing prescriptions could be done by a lower level, but qualified health care worker. That’s an example of a bottle-neck and we want to help each country find the mechanism to open up the bottle-necks so that the supply of life-saving medications is available to all who needed them”, Morskey explains.
The campaign, formed by the United States’s Global AIDS Alliance, has set itself a bold target to increase prevention of mother-to-child HIV transmission and paediatric treatment services from the current average of 30 – 40% to 80% in three years in the countries it’s working in. A total budget of $6 million has been set aside to benefit the six countries that are currently being targeted.
Campaign to End Pediatric HIV/AIDS Launched. 25/10/09
“We are facing a potential human and economic devastation of the African continent’s future generations,” says Mrs. Graça Machel.
Johannesburg, South Africa – At a press conference held today in Johannesburg, South Africa, Mrs. Graça Machel announced the launch of the Campaign to End Pediatric HIV/AIDS(CEPA). The campaign will mobilize the political will and financial resources needed to overcome bottlenecks to scaling up pediatric HIV diagnosis, treatment, and care programs, initially in six sub-Saharan African nations.
“On the continent we are facing a potential human, social, and economic devastation of Africa’s future generations as a consequence of the impact of HIV and AIDS on our children,” said Mrs. Machel, who will chair the campaign’s pan-African Leadership Council. “We must hold our governments accountable to the promises they made to children; they must put systems in place to implement these promises; they must create good public policies and do all in their power to end pediatric HIV and AIDS on our continent,” she said.
The campaign’s ultimate goal is to overcome implementation and policy bottlenecks to increasing coverage rates for prevention of mother-to-child transmission and pediatric treatment services from the current average of 30 to 40 percent to the globally agreedupon target of 80 percent. Implementation bottlenecks include inadequate health care worker training, and insufficient transportation systems for health care commodities; policy bottlenecks include lack of long-term predictable financing, and the lack of clear national policies and targets for scaling up access to pediatric HIV/AIDS services.
CEPA will operate initially in Kenya, Uganda, Tanzania, Nigeria, Zambia, and Mozambique, and over time will be expanded to include other countries and regions of the world.
“Our strategy is to engage countries at two different stages of scaling up pediatric and family HIV/AIDS services: ‘tipping point countries’ where scale-up of pediatric HIV/AIDS services is well under way (Kenya, Uganda, Tanzania) and ‘transition countries’ that are earlier in the process of scaling up pediatric HIV/AIDS services (Nigeria, Zambia, Mozambique),” said Dr. Paul Zeitz, executive director of the Global AIDS Alliance, which is providing financial and technical resources to civil society organizations in the six focus countries. “The campaign will facilitate the cross-pollination of best practices and exchanges of ideas and knowledge among in country partners, among countries at different stages of the pediatric HIV epidemic, and through local-to-global partnerships,” he said.
Local-to-global partnerships are a distinctive feature of the campaign. “Under this model, CEPA partners will work through a network approach with groups in the focus countries to achieve campaign goals and ensure effective monitoring and evaluation of progress,” said Zeitz.
“CEPA’s advocacy approach is to target key decision-makers and others who can create and influence evidence-based policies and funding, and implement programs to prevent and treat pediatric HIV/AIDS; we will hold them accountable for concrete results,” said Ms. Rolake Odetoyinbo, Project Director of Nigeria’s Positive Action for Treatment Access group. “CEPA’s advocacy targets include the World Health Organization; UNICEF; UNAIDS; UNITAID; the Global Fund to Fight AIDS, Tuberculosis and Malaria; G-8 and G- 20 countries; and governments in the six focus countries.”
Campaign partners in each of the six focus countries are currently launching National Advocacy Action Plans for 2010 that have been developed in each country over the past three months through a broad-based process of collaboration and consultation among civil society organizations. “The National Advocacy Action Plans in each of the six countries call for responses to the highest-priority needs of our countries,” said Mr. Felix Mwanza, of the Treatment Advocacy & Literacy Campaign of Zambia (TALC). “We are bringing together the right people at the right time to give a boost to the continent’s pediatric HIV/AIDS prevention programs,” he said.
Africa Should Protect Children From AIDS-Machel. 22/10/09
By Peroshni Govender
JOHANNESBURG, Oct 22 (Reuters
) - African leaders should be more serious about protecting the continent's children from AIDS and it is time for them to change state spending priorities, Nelson Mandela's wife Graca Machel said on Thursday.
"No matter how small our budgets, we must do something. We will not get there (HIV reduction) with African leaders who don't get moved by people dying," she said during her launch of the Campaign to End Paediatric HIV/AIDS (CEPA).
Sub-Saharan Africa is home to 60 percent of people living with HIV/AIDS and 1.8 million of the 2 million children globally infected, a reality Machel said should jolt African leaders into action.
"I am not really convinced that some of the budgets we have for defence are absolutely necessary," Machel, an advocate for women and children's rights, told Reuters.
"There is a need to re-direct resources from defence. For me the priorities are health, education, water supply, agriculture."
CEPA seeks to work with African governments and community-based organisations to ease bottlenecks in the provision of mother-to-child-transmission drugs which will can prevent the spread of HIV to newborns.
By 2012, it aims to reach at least 80 percent of children at risk, more than double the number who currently have access to treatment.
"It is time to say, 'let us re-engineer our budgets, lets use the little resources we have much more wisely'," Machel said. (Editing by Jon Hemming)
Cost of Anti-Retroviral Treatment On Developing Nations. 29/10/10
For every two people on ART, five more are in need.
By Catherine Mwauyakufa
29 October 2010
Harare — For every two people on ART, five more are in need.
Currently, there are 260 000 people on treatment nationwide and 593 000 are in need right now, according to Dr Tsitsi Mutasa the national ART co-ordinator.
This paints a grim picture for those testing HIV+.
It makes it even more difficult to persuade a friend or relative to take an HIV test if ART is not easily accessible.
One is bound to ask what would be the use if one does not afford the medication and expects to be registered on the Government ART programme?
I would still maintain that having your health monitored still makes sense.
This puts the figure at only 7 percent of those in need of ART being able to access it.
Only 20-30 percent of orphans and vulnerable children are receiving assistance.
The majority are not accessing it.
The figure is far off the expected region.
The principle of universal access tries to cover as many of the vulnerable groups to ensure equity.
It really sounds depressing, but should not dissuade one from knowing one's status.
Zimbabwe's population stands at 13 million and for this 1,1 million people today are living with the HIV virus.
The prevalence rate has gone down, possibly due to ART and behaviour change as presently 1:6 people are infected with the virus.
In the past, the prevalence rate was 1:3 and stood at a dangerous level.
The current figure is still unacceptably high but this move in the right direction should be applauded and more effort should be made to ensure the figure keeps going down.
Inspite of the gloomy picture painted above, one still needs to know one's status.
The advantages of knowing your status are many.
As scary as it could be, not knowing your status could be equal to a captain in a radarless ship with no compass taking into the stormy oceans.
In does not follow that everyone who tests HIV+ should take ART.
If one's CD4 count is still able to see the person lead a healthy life then that person has not yet got to a stage of needing ART.
A person testing HIV+ and has a CD4 count of 600 has no need to commence ART.
A CD4 count of 350 and below according to new WHO regulations is a requirement for one to commence ART.
Medical personnel assess any person who tests HIV+ and one can be recommended to start the prophylaxis regimen and not ART.
On this stage one is only on antibiotics and cotrimoxazole which is affordable and easily accessible is used.
The WHO recommendation to up the threshold is not sustainable in the case of Zimbabwe and other developing nations in my opinion.
My concern with these regulations are that Zimbabwe as a developing country has many challenges and the health sector also feels the pain of funding shortages.
Currently when it required one to have a CD4 count of a threshold of 200 and below to commence ART we had a waiting list on the national programme.
This figure of 593 000 in need of ART means the figure will double if the WHO recommendation is implemented.
The reasoning that putting a person early on ART has merits can not be argued, but my argument lies in the fact that as a country we cannot sustain that requirement.
We depend on the Global Fund and NAC, which are struggling with the swelling numbers on the waiting list already using the threshold of 200.
What is suitable for a first world country can not be suitable for a developing country.
I have no conflict of interest but what is suitable for Zimbabwe as a country cannot be suitable for say Italy.
WHO should not have a blanket dose for the whole world.
Assessment and suitability to contain situations should be used as a ranking and recommendations should be made regionally on suitability.
This implies that an additional burden of HIV+ infected people countrywide should now be considered eligible for ART.
For those who afford it on their own there is no problem, but for those who need to be put on the free Government programme, then there is a hiccup.
Scaling up access to antiretroviral drugs (ARVs) will soon become an impossible task under the new guidelines.
Ten years ago testing HIV+ was like a death sentence.
Medication was expensive in the region of 12 000 pounds to 15 000 pounds annual for a person. This prohibitive price meant poor countries could not even dream of supporting national programmes.
Then only brand names were in circulation and the introduction of generic medicines saw the prices plummet to affordable levels.
Today with generic medication the prices have even gone down to US$88 annually for a person.
There is debate currently taking place that use of generic brands should be stopped.
This could lead to massive deaths in Zimbabwe and countries in the same economic status. The country relies on the use of generic brands.
For the layman a generic medication works the same way as a brand medication.
A brand is patented and no other companies can make it for a duration of twenty years.
Were it to be equated to electrical gadgets it would be a brand name say in a television.
So under those conditions generic medicine which is mainly made by Indian companies and of late a local company Varichem has opened a plant to make generic ARVs could see their efforts being thwarted.
Since the full implementation of the Trade-Related Aspects of Intellectual Property Rights Agreement (TRIPS) by the World Trade Organisation in 2005, supply of generic drugs for new ARVs has no longer been possible, unless through the use of compulsory licensing systems.
However, the use of such systems in their present form remains not only complex but also unattractive to developing nations.
Can the developing nations remain silent when it is a matter of life and death for their populations when the new measures are implemented?
The WHO recommendation could be on the framework of what is good for the goose should be good for the gander. It is not necessarily so.
Those who afford to buy brand names for electrical gadgets can buy the brand names, but the poor should be allowed to buy any form of television, it still functions in the same manner they can watch the same programmes.
This could be the nearest explanation of brand and generic medicine.
A doctor who commented on condition of anonymity said that affordability of ART remains a challenge and for as long as we rely on donor funding we remain a dumping ground.
"Stavudine which is mainly used in the first line has long been discarded in the developed world for better replacements, but that is what we still have donated here, for me no medication is better than giving something that has been proved to have severe side effects," he said.
He pointed out that he stopped prescribing it to his patients three years ago.
He urged people on ART to call their health centres or doctors if they experienced any of the following allergic reactions: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
- liver damage leading to -- nausea, stomach pain, low fever, loss of appetite, dark urine, clay-coloured stools, jaundice (yellowing of the skin or eyes);
- lactic acidosis -- muscle pain or weakness, numb or cold feeling in your arms and legs.
- uneven fat deposition.
He recommended those who could afford to change from using Stavudine which is not user friendly.
This change can only be done by professional health personnel not by backyard friends and relatives in the Diaspora sending family and friends replacement ART.
Your health matters, only let the professionals handle that.
In all your gettings, get understanding.
Countering the Discrimination of Those With HIV. 2/12/10
"What makes HIV very different to other diseases? It's the stigma and the discrimination associated with it," he said.
2 December 2010
On World AIDS Day the former Executive Director of UNAIDS, Professor Peter Piot, told staff at the Commonwealth Secretariat that tackling HIV will be twice as difficult if HIV-positive people continued to be discriminated against.
Professor Piot, now the director of the London School of Hygiene and Tropical Medicine, was addressing staff and London-based High Commissioners on the advances and obstacles to treating and preventing HIV at an event to commemorate the World AIDS Day theme Universal Access and Human Rights, at the Secretariat's headquarters in London on Wednesday 1 December.
"What makes HIV very different to other diseases? It's the stigma and the discrimination associated with it," he said.
"If people with HIV are pushed underground, if you cannot discuss marginalised groups in society, it makes it doubly hard to do something about the virus. A pragmatic approach is the one that saves lives."
Two-thirds of those who are HIV-positive today live in the Commonwealth. In the last year, around one-and-a-half million Commonwealth citizens have lost their lives due to AIDS-related illnesses and in some of its member countries, one in four people carry the virus.
The Commonwealth Secretariat has a long tradition of AIDS work, including devising national programmes to counter prejudice and stigmatisation of those with HIV.
A documentary exploring the stigma and discrimination faced by those living with HIV and AIDS in Nigeria was shown. Afterwards, Dr Sylvia Anie, Director of the Social Transformation Programmes Division, gave her reflections by rhetorically asking the audience key questions.
Amongst other key points, directors and staff were asked "how the stigma associated with HIV could be addressed when talk of its transmission remained taboo."
The Secretary-General of the Commonwealth, Kamalesh Sharma, reiterated Professor Piot's message that the answer to dealing with the pandemic lied partly in healthcare and its attendant issues such as human resources, infrastructure, drugs and money, but also advocating for the human rights of HIV-positive and marginalised people, so they could access the services they needed to deal with the virus.
"In the battle against HIV and AIDS, too many countries across the Commonwealth and the world are marginalising the people who most need their help," said Mr Sharma.
"These include sex workers, injecting drug users, and - most worryingly of all - women, simply because of their gender.
"The simple fact is that for as long as we fall short in promoting universal human rights, we will continue to fall short on achieving universal access for those with HIV and AIDS."
Professor Piot concluded by saying a long-term approach was needed to tackle the pandemic.
"AIDS is not over. It's the number one killer in sub Saharan Africa," he said.
"For some of the poorest countries in Africa that are heavily affected by HIV, international support will be necessary for many years in order to respond to AIDS and cope with it."
He advocated for education, especially on prevention; community engagement; investment to build the capacity of local providers; collaboration on health and development programmes; leadership and innovations in funding mechanisms.
He added that this already corresponded to the work and vision of the Secretariat, which had played an important role in the global response to AIDS.
Declare HIV/AIDS a "Humanitarian Emergency". 06/11/07
JOHANNESBURG, 6 November (PLUSNEWS) - The impact of HIV/AIDS in southern Africa, which has nine of the world's most affected countries, needs to be reassessed as a "humanitarian emergency" on its own, enabling interventions to be made timeously, a leading AIDS researcher argues in a new paper.
For this to happen, Alan Whiteside, director of the Health Economics and HIV/AIDS Research Division of the University of KwaZulu-Natal, South Africa, said in the paper, co-authored by researcher Amy Whalley, the conventional understanding of a humanitarian emergency has to be rethought.
"Traditional humanitarian thinking focuses on the short term, and is often aimed at returning affected populations to 'normality'," he said in Reviewing 'Emergencies' for Swaziland: Shifting the Paradigm in a New Era.
To make the point, the authors used Swaziland, which has an HIV prevalence rate of 33.4 percent among people aged between 15 to 49 years - the world's highest, according to UNAIDS - and the world's lowest life expectancy, just 31.3 years in 2004, as noted in the UNDP's Human Development Report. The paper was commissioned by Swaziland's National Emergency Council on HIV/AIDS (NERCHA).
"HIV/AIDS in Swaziland has been characterised by a slow onset of impacts that have failed to command an emergency response. With insufficient resource allocation and a lack of capacity, slow onset events can become emergencies," Whiteside maintained.
Part of the problem was that, spurred by its consistent economic growth in the 1990s, Swaziland had been classified as a "low-middle-income country" by the World Bank, and a "medium human development country" by the UN Development Programme (UNDP). This classification altered the perception of the country in donor and international eyes as a 'poor' country to that of one able to support itself, restricting potential external funding.
Whiteside has tried to establish a correlation between the ever-increasing HIV prevalence recorded by national sero-sentinel surveillance surveys - which has shot up from 3.9 percent in 1992 to 42.6 percent in 2004 and declined slightly to 39.2 percent in 2006 - and the falling social and economic indicators. "If negative trends were noticed earlier in Swaziland, some wider shocks may have been preventable".
Over the past 15 years, Swaziland has become characterised by a decline in economic growth, spreading poverty, and a rise in mortality and morbidity rates. "Current death rates now exceed the daily mortality thresholds used by agencies as an indicator of a disaster."
The number of people living below poverty line climbed from 65 percent in 1995 to 69 percent in 2001, while annual Gross Domestic Product (GDP) plunged from 6 percent in the 1990s to a current level of around 2 percent, resulting in negative per capita growth.
Whiteside said maize production had more than halved in AIDS-affected households and cited a 2004 study, A Systematic Review of the Economic Impact of HIV/AIDS on Swaziland, by F.T. Muwanga, published by the University of the Witwatersrand in Johannesburg, South Africa, showing that the average loss in GDP growth attributable to HIV/AIDS was around 1.6 percent per year.
"Had interventions happened on time, the impact of HIV/AIDS might not have been that severe," commented Derek von Wissell, director of NERCHA.
Whiteside noted that in the absence of an adequate response, Swaziland still "stands to lose the next generation of human capacity through a lack of investment in human capital, health and the continued low morale that affects workers in such contexts".
According to the paper, the UN has argued that responses require adjustment to consider a triple threat: a lethal epidemic, deepening food insecurity and a hollowing out of government capacity.
"But the point that we are trying to make," said von Wissell, "is that the response does not take into account HIV/AIDS as the root cause - and is designed as such, rather responding to the triple threat on a short-term basis - and the conditions imposed by other UN agencies such as the International Monetary Fund on funding."
Mark Stirling, the Regional Director for Eastern and Southern Africa at UNAIDS, told IRIN/PlusNews that in 2002 the UN system had recognised the triple threat posed by HIV/AIDS, and that this constituted an emergency. He acknowledged that the "low-middle-income" classification had prevented the country from accessing much-needed funds, saying, "There is a need to change the rules."
It was the "job of every government to protect and serve their people", he said, but not all of them had the funds to respond in time to implement effective strategies, such as universal access to antiretroviral therapy (ART). Despite the world's highest HIV prevalence rates, none of the southern African countries, including Swaziland, has achieved the goal of universal access to ART.
Fiona Napier, of the UK-based non-governmental organisation (NGO), Save the Children, in South Africa, pointed out that "The impact of HIV/AIDS in high-prevalence countries in southern Africa is profound. Many in government, donor and NGO communities know this, but we fail to approach HIV/AIDS with the same urgency as we approach other disasters, yet the impacts are widespread.
"A recent study Save the Children conducted found that 4 out of 10 children who had crossed borders in the southern Africa region said that the death of a family member was the main reason as to why they had left home and were seeking improved livelihoods elsewhere," she said.
Drawing comparisons from Malawi and Zambia, Whiteside and Whalley found that, as in Swaziland, HIV/AIDS was "altering the structure of society", and all three countries were experiencing falling population growth.
"This is projected to continue to fall over the next fifty years. Malawi and Zambia are both expected to experience gradual falls in population growth. Swaziland, meanwhile, has a sudden drop into negative figures over two years."
By 2025 "there is expected to be a thinning of both the older age groups and the very young [in Swaziland]; by 2050 an overall drop in population is anticipated. A recent vulnerability assessment found deaths are concentrated among 16-35 year olds. These accounted for around 45 percent of all deaths, a significant departure from the norm, where death rates remain low until people age".
Failure of HIV prevention strategies
Save the Children's Napier said it was time to acknowledge that "prevention strategies over the past 20 years have not proven successful enough to prevent the spread of HIV/AIDS in southern Africa".
"We all need to acknowledge this, and develop concerted, out-of-the-box thinking now, if we are to prevent thousands more children becoming orphaned, or having to cross borders, or resorting to other more desperate measures in order to keep food on the table and their siblings in school," she suggested.
"For a start, more resources at an international and national level need to be made available to heavily promote and offer PMTCT [Prevention of Mother to Child Transmission of HIV] at community level."
At UNAIDS Stirling said that despite the drop in HIV prevalence rates recorded in some countries in the region, he had to acknowledge that prevention strategies, particularly those targeting behavioural change, such as inconsistent use of condoms and having multiple concurrent partners, had failed.
The Swazi government itself had responded promptly to the crisis, declaring the disease a national disaster in 1999, he said. Aid workers pointed out that governance issues like the perception of the ruler, King Mswati III, "as a big spender", doling out millions for expensive cars every year, had made donors reluctant to part with their money for programmes in Swaziland.
"But donors must disassociate humanitarian issues from political and governance issues - you cannot just walk past millions dying because of that," said von Wissell, who has served as a health minister in the Swazi cabinet.
Out of the box
Whiteside's paper harks back to a long-simmering debate in the humanitarian community on acknowledging the impact of HIV/AIDS on conventional humanitarian emergencies.
A few years ago, when Whiteside and Alex de Waal, a British writer and activist, outlined the concept of HIV-induced famine there were few takers. Unlike traditional drought-related famines, which kill dependents first, HIV-related famine affects the most 'productive' family members first.
In 2002, senior UN officials trying to respond to one of the biggest food shortages in Southern Africa, when 14.4 million people faced the threat of starvation, acknowledged that the impact of HIV/AIDS would exacerbate the famine.
"But this time it is different," Whiteside told IRIN/PlusNews. "I am calling for the declaration of HIV/AIDS as a humanitarian emergency - not a global one, but in the most affected countries in Southern Africa."
EU-India Deal Could Threaten Access to Essential HIV Drugs. 9/11/10
The deal could mean tighter intellectual property protections that could reduce access to cheap Indian generic drugs.
9 November 2010
Nairobi — As Indian and European officials meet in Brussels to thrash out the details of a Free Trade Agreement (FTA), civil society activists are concerned the deal could mean tighter intellectual property protections that could reduce access to cheap Indian generic drugs.
"The European Union is pushing for data exclusivity, which means Indian generics manufacturers would no longer be able to use existing studies to make identical drugs, a practice recommended by WHO [UN World health Organization] - they would have to conduct their own clinical trials, which would be unethical and redundant since we already have evidence that the drug works, but also, the data exclusivity could last anywhere between five and 10 years, delaying poor countries' access to these drugs for long periods," Michelle Childs, director of policy and advocacy for Médecins Sans Frontières' campaign for access to essential medicines, told IRIN/PlusNews.
More than 80 percent of all donor-funded antiretroviral drugs used in developing countries are Indian generics; the availability of cheap ARVs has enabled more than five million people globally to access essential HIV treatment. Until 2005, the country did not grant patents on medicines, but World Trade Organization (WTO) rules now require India to grant patents. Indian law only grants patents on drugs that show a therapeutic benefit over existing ones; activists fear that trade agreements like the EU-India one could override these public health concerns.
According to a 2010 study published in the Journal of the International AIDS Society this year, "future scale-up using newly recommended ARVs will likely be hampered until Indian generic producers can provide the dramatic price reductions and improved formulations observed in the past". The authors recommend that rather than agreeing to inappropriate intellectual property obligations through FTAs, India and its trade partners "should ensure that there is sufficient policy space for Indian pharmaceutical manufacturers to continue their central role in supplying developing countries with low-priced, quality-assured generic medicines".
Childs accused Europe of employing "dirty legal tricks" to circumvent India's public health protections and boost its own pharmaceutical industry, which could have fatal consequences.
Data exclusivity could last anywhere between five and 10 years, delaying poor countries' access to these drugs for long periods
However, European officials deny that the FTA with India will interfere with the capacity of India's generics industry. The EU spokesman for trade, John Clancy, told IRIN/PlusNews by email that the EU intended to follow the Trade Related Aspects of International Property (TRIPS) laid out by the WTO, which include - under the Doha Declaration - provisions for countries to override intellectual property rights in the interests of public health.
For example, TRIPS gives countries the right, in specific situations such as public health emergencies, to issue compulsory licences - an authorization given by a government to a third party to produce a patented invention without the permission of the patent-holder.
"Data exclusivity is an issue we are discussing with India but taking fully into account India's specific needs and interests - such as India's legal system, its policy developments, its developing country status and the role it plays in producing generic medicines for the developing world," Clancy said. "The [European] Commission explicitly recognizes India's right to issue compulsory licences for life-saving medicines."
But Childs says on its own, data exclusivity is an example of TRIPS-plus, which refers to tougher or more restrictive conditions than required by TRIPS.
"Europe is using the fact that few people understand the technicalities of TRIPS and the implications of data exclusivity to appear virtuous by claiming that they will abide by the Doha Declaration while at the same time tying India into an agreement that could make generics more expensive and delay their access to people in the developing world who need them," she said.
James Kamau, who has lived with HIV for more than a decade and heads the Kenya Treatment Access Movement, says if India "got into bed" with Europe, it could have catastrophic consequences for people living with HIV in Africa.
"This would be a marriage of convenience with a child called profit, but this marriage would also result in death for many Africans, particularly those who need newer, second-line drugs that may now take years to reach them," he said. "This would not only affect HIV - most of the drugs we take here are Indian generics, so anything that harms that industry harms the health of millions in Africa."
East Africa: Community HIV Drug Distribution Improves Adherence. 7/7/10
Mobile drug distribution improves HIV-positive patients' adherence to ART
7 July 2010
Nairobi — Local East African programmes are discovering the benefits of bringing HIV services closer to rural communities, with mobile drug distribution improving HIV-positive patients' adherence to antiretroviral treatment (ART).
"While there might be health facilities in rural areas, they are normally far flung; by using mobile care and treatment centres, it is easy to reach populations, many of whom are normally too poor to have transport to the established health centres," Waziri Rashid Njau from the Support for International Change (SIC), a local HIV-focused NGO in Tanzania, told IRIN/PlusNews.
"We have used this in northern Tanzania and we have seen reduced cases of loss [of contact with patients] to follow up; local health facilities record higher cases of drop-out amongst patients than we do," he added.
Patients must visit a hospital for their initial diagnosis and ART prescription, and are required to visit the health centre periodically, but in between visits, SIC uses community-based volunteers and trained medical workers to drive around villages refilling prescriptions as well as providing education on condom use and the prevention of opportunistic infections.
SIC in Tanzania reaches nearly 2,500 people with mobile ART clinics and has so far trained around 200 health workers in Babati District in northern Tanzania.
Bridging health system gaps
Tanzania suffers from a critical shortage of medical personnel, so the mobile drug distribution is performing a much-needed function. The Ministry of Health reported in 2007 that the country had 1,339 doctors; many regions have a doctor-to-patient ratio as low as 0.1 to 10,000.
Community drug distribution has also been successful in neighbouring Uganda, where a 2008 study carried out in the eastern district of Tororo by local NGO The AIDS Support Organization (TASO) found that out of 2,115 active clients enrolled for antiretroviral therapy at the community drug distribution points, only 22 - about one percent - were lost to follow up.
In comparison, a 2009 Ugandan study found that about a quarter of HIV-positive patients in clinical settings dropped out of programmes during the clinical assessment stage, even before they were put on ART. One of the main reasons given for not returning to health centres was the high cost of transport.
"Our experience is that it is a lot easier to deal with large numbers of antiretroviral clients with this model... Space at health centres is limited, and it is easy to visit them where they are," said Emmanuel Patta, a field officer with TASO.
TASO has 77 community drug distribution points in Tororo, each catering for an average of 30 antiretroviral therapy clients.
Involving HIV-positive people
"Because follow-up is normally done by people living with HIV themselves, this provides an avenue to use them as a resource in the fight against HIV/AIDS," SIC's Njau noted.
"You get to create awareness among community members and not only those who are infected, but even those who are not infected or might not know their status," he added. "Through these models, you get an opportunity that is community-owned to reach out to them and create awareness."
At the community drug distribution points, clients have the opportunity to share experiences and support each other on issues related to side effects, adherence, community awareness and stigma, and this also provides an opportunity for optimal use of limited resources.
Njau noted that despite efforts to involve people living with HIV in the programme, and to teach their communities to accept them, stigma remained a concern. "Stigma might make these clients not want to go where people will know them ... [They] would rather go far away [for treatment]," he said.
And in many areas poor nutrition remains a challenge to the adherence of clients of community-based drug distribution. "Poverty inhibits good nutrition among many ART clients, which can at times hinder the effectiveness of treatment programmes," Njau said.
Despite the problems, TASO's Patta said community drug distribution had for the most part worked extremely well and could "work effectively in places that experience shortages of staff and health facilities"
East Africa: One Region, One HIV Law. 31/3/10
As the East African Community (EAC) becomes more integrated, countries in the region are developing a common HIV Prevention and Management Bill that will establish minimum standards for HIV services in the five states.
31 March 2010
KIGALI - As the East African Community (EAC) becomes more integrated, countries in the region are developing a common HIV Prevention and Management Bill that will establish minimum standards for HIV services in the five states - Burundi, Kenya, Rwanda, Tanzania and Uganda.
The East African Common Market comes into effect in July; in a region with a combined population of 126 million and significant variations in HIV prevalence, experts say the anticipated growth in cross-border movement necessitates a regional view of - and uniform response to - the HIV epidemic.
A recent one-day stakeholders' consultative meeting in the Rwandan capital, Kigali, brought together national health officials, parliamentarians, development partners and civil society organizations to develop a common understanding of the proposed bill.
"If I'm doing business in Rwanda and I am an HIV-positive Kenyan, I should be able to access HIV services just like a Rwandan while there," said Catherine Mumma, lead consultant on drafting the bill.
The legislation is intended to provide a basic legal framework in countries where no HIV laws exist, and to address disparities in HIV/AIDS responses across the region. Under the EAC Treaty, regional law supersedes national law.
"The regional law provides guidelines and principles... they can adopt the law wholesale or develop their own regulations and laws, as long as they don't contravene the spirit and letter of the regional one," Julius Sabuni, of The Eastern Africa National Networks of AIDS Service Organizations, explained.
The bill promotes a human rights approach to HIV, outlawing discrimination, guaranteeing rights to privacy and ensuring the provision of healthcare regardless of HIV status. However, some aspects have already led to controversy: delegates from the EAC armed forces have reiterated the need for commanders to know the HIV status of their soldiers and for mandatory HIV screening before deployment.
Disappointingly for human rights activists and HIV programmers, the latest draft of the bill makes no mention of high-risk groups such as commercial sex workers, men who have sex with men or intravenous drug users.
In addition, following a previous consultation in the Ugandan capital, Kampala, the authors of the bill agreed that because criminal law is not an area of cooperation under the EAC treaty, laws criminalizing the deliberate transmission of HIV – which exist in Kenya and in a draft Ugandan bill - are more appropriately addressed in the penal codes of partner states.
Activists and programme implementers are acting to try to repeal sections of the bill that contravene human rights.
According to Mumma, these compromises were made to achieve consensus. "If the five countries do not agree on the law it will not happen, period," she said.
Despite being less than ideal, she noted, the bill's development had generated important debate around some of the more complicated aspects of the pandemic.
"Even if this [bill] won't pass this year, in my view it has pushed the EAC on health, HIV and human rights," she added.
The bill has been submitted to the East African Legislative Assembly for discussion during the next session, which starts in April.
East Africa: The Military as 'Agents for Change'. 30/3/10
East African armies should be used as a resource to fight HIV/AIDS in the general population.
30 March 2010
Kigali — East African armies should be used as a resource to fight HIV/AIDS in the general population, a workshop on HIV/AIDS in the peace and security sectors heard in the Rwandan capital, Kigali.
"Persons in uniform are an important part of the overall AIDS response in these countries; they can be critical agents of change in that they provide an opportunity to alter wider social norms and often pilot innovative responses to HIV," Nertila Tavanxhi, the UNAIDS representative at the workshop, told IRIN/PlusNews. "In many countries, the army has been at the forefront of the response to HIV."
In Rwanda, the military has played a pioneering role in extending the relatively new practice of male circumcision as an HIV risk-reduction strategy.
"Given the role they play in our society - ensuring security - there are parts of the population that look to them as examples," said Anita Asiimwe, executive secretary of the Rwandan National AIDS Commission, CNLS.
The three-day workshop brought together delegates from Burundi, Kenya, Rwanda, Tanzania and Uganda and their partners to review HIV trends within their armed forces.
Daniel Nyamwasa, Rwanda's Assistant Commissioner of Police and one of the coordinators, said it was a step towards "a common HIV/AIDS policy and strategy in the armed forces and the police in East Africa".
The East African Community is aiming for greater regional integration and harmonization of responses in the region to reduce HIV incidence and impact; for instance, the Ugandan People's Defence Forces (UPDF) has been instrumental in supporting the Southern Sudan People's Liberation Army in developing its HIV programme.
"In a sense integration is difficult because we have seen... that each country has very strong programmes already in place," said Lt Col Dr Stephen Kusasira, director of HIV/AIDS for the UPDF. "We hope to see what is happening elsewhere... and share experiences."
As well as having a strong role in managing the epidemic, armed forces have been identified as a high-risk group - most of them are sexually active males under 25, spend long periods away from their families and may be deployed to high prevalence settings. Their mobility also makes it harder to run HIV programmes for them.
"We are dealing with both fluid populations and fluid geographic coverage, which makes the response much trickier," said Kusasira.
Measures used by regional armies to counter these difficulties include mobile counselling and testing centres, task shifting to allow dispensing of life-prolonging antiretroviral drugs at post, ongoing behaviour change communication and male circumcision.
UN delegates attending the workshop were keen to reiterate the UN stance that HIV tests should not be required or used to exclude new recruits. They noted that infection alone did not signify an inability to perform duties, that confidentiality of test results was critical to the effectiveness of HIV programmes and that exclusion due to HIV status encouraged stigma and infringed on individuals' rights.
However, regional armies - many of which exclude HIV-positive people from recruitment - defended their policies.
I need to know how many people are HIV-positive in my team if I am to ensure they receive treatment... if one of my men is hit on the battlefield, I need to know this.
"We screen recruits for many health issues prior to recruitment. Why is HIV different? The important thing is, once you're inside you are now our responsibility and we can't discharge you if you test positive," Kusasira said. "I need to know how many people are HIV-positive in my team if I am to ensure they receive treatment on missions in remote areas; if one of my men is hit on the battlefield, I need to know this."
While recruitment of HIV-positive soldiers remains controversial, the workshop reached a consensus that nobody found HIV-positive during employment be discharged, that testing be accompanied by adequate counselling and that all persons found to be HIV-positive receive care and treatment.
Participants also agreed to set up task forces to examine the development of an HIV/AIDS workplace policy for the East African armies, and while HIV policies must continue to be tailored to national conditions, it was agreed that the role of regional collaboration be to establish minimum standards for the regional response to the pandemic.
[ This report does not necessarily reflect the views of the United Nations ]
Education Sector is Vital in Reversing HIV/ AIDS. 21/11/10
There have been calls to accelerate the mainstreaming of interventions against HIV/AIDS in the education sector
21 November 2010
The 6th Annual National Paediatric Conference On Children Infected and Affected by HIV and Aids, with a major focus on the education sector ended on Friday.
There have been calls to accelerate the mainstreaming of interventions against HIV/AIDS in the education sector, among others.
Education provides the necessary capacity for young people to make important life decisions that can help them remain free from HIV. This is based on evidence that indicates that the youth who remain in school, are less likely to be infected with HIV compared to those who drop out.
Besides, it is also important to note that the vital role of the education sector in the fight against HIV/ AIDS has been augmented by the fact that a sizeable number of children, born HIV positive, have survived as a result of availability of Anti Retroviral Treatment and attend school like other children. However, they have special needs and thus special meals, counselling and adherence to treatment, impact on their schooling. This makes it critical for the education sector to be highly involved in providing the necessary support.
At the same time, school provides the opportunity to teach the young about HIV before they become sexually active. This can help to prevent new infections especially in adolescents. The struggle against HIV still needs adequate allocation of resources for prevention, treatment and care services. This calls for a multi-sectoral approach that also focuses on eradication of Mother to Child Transmission. Consequently, such a holistic approach can help realize an AIDS-free generation.
Ethiopia: Firm Signs 25 Million Br HIV Equipment Support Deal. 12/7/10
For the next five years Becton Dickinson will provide maintenance services for the 150 FACS Count and 15 FACS Caliburs laboratory devices it sold in Ethiopia
By Eden Sahle
12 July 2010
The Ethiopian Health and Nutrition Research Institution (EHNRI) signed a five-year medical equipment maintenance agreement worth 25 million Br with Becton Dickinson International on Wednesday, July 7, 2010.
For the next five years Becton Dickinson will provide maintenance services for the 150 FACS Count and 15 FACS Caliburs laboratory devices it sold in Ethiopia, which are used to test the CD4 count in HIV-positive blood, free of charge, according to the agreement. The company will also provide training for local technicians on how to maintain and fix the equipment.
"The training and maintenance will be conducted by seven engineers from Kenya," Nick Bright, regional director of Becton Dickinson International East Africa, told Fortune.
Although Becton Dickinson has been providing maintenance for equipment and training of local technicians for the past three year, this is the first time it signed an agreement with the EHNRI to continue to do so for a fixed period of time.
Ethiopia is the first East African country to receive this kind of support from Becton Dickinson, Bright said.
This laboratory equipment is used to test the CD4 count of HIV-positive people to determine whether they should start taking antiretroviral medication as well as to determine their progress.
"The maintenance of this equipment will ensure that patients get uninterrupted laboratory service," Tsehaynesh Mesele (MD), director of the EHNRI, said.
The maintenance support will go to all public hospitals that have the equipment, both at the regional and federal levels. The five-year support agreement will also reduce the cost of spare parts, according to the medical director.
Fifty-Ninth Session Of Who Regional Committee For Africa Ends, Nominates Regional Director, Adopts Resolutions. 4/09/09
Kigali, 4 September 2009 -- The fifty-ninth Session of the WHO Regional Committee for Africa ended on Friday in Kigali, Rwanda, after nominating a Regional Director and adopting resolutions aimed at scaling up action in areas that are key to improving the health situation in the Region.
On Monday, the session voted to re-nominate incumbent Regional Director, Dr Luis Gomes Sambo of Angola, to steer the affairs of WHO in the African Region for another five years. Dr Sambo's nomination will be submitted for appointment to the WHO Executive Board scheduled to meet in Geneva in January 2010. He begins his second term on 1 February 2010.
The Regional Committee adopted resolutions on tackling drug resistance related to AIDS, tuberculosis (TB) and malaria; accelerating progress towards malaria elimination in the African Region, and strengthening outbreak preparedness and response in the context of the current influenza pandemic. Another resolution related to policy orientations on the establishment of centres of excellence for disease surveillance, public health laboratories, food and medicines regulation.
The resolution on drug resistance related to AIDS, TB and malaria, urged countries to establish drug resistance and drug efficacy monitoring systems; strengthen procurement and management of HIV/AIDS, TB and malaria supplies, and develop and implement policies and strategies to improve diagnosis and effective early treatment.
On prospects for malaria elimination in the Region, the meeting adopted a resolution calling on Member States to integrate malaria control in their national development plans and poverty reduction strategies; support ongoing research and development initiatives; strengthen national health information systems, and invest more in health promotion, community education and participation.
Regarding the current influenza A (H1N1) pandemic, the meeting urged countries to: ensure the highest level of government support in addressing this threat; strengthen national capacity for influenza diagnosis, and of health services to reduce transmission; periodically update preparedness and response plans; implement communication strategies that regularly provide updated information, and contribute regularly to the African Health Emergency Fund.
To boost national capacities for effective and comprehensive disease surveillance and response, laboratory investigation and food and medicines regulation, the meeting urged countries to: conduct an assessment of existing infrastructure and human capacity to determine their state of preparedness to set up centres of excellence; develop a national policy framework on centres of excellence; sensitize relevant national departments and ministries to the need to create centres of excellence and secure multiple funding for centres of excellence in order to guarantee their sustained performance.
The sixtieth session of the Regional Committee will take place in 2010 in Equatorial Guinea.
Grandmas Hold AIDS Key in Africa. 1/6/10
The backbone of their communities, they have the power to invoke change
The Hamilton Specator
By Lisbie Rae
1 June 2010
I'm still reeling from my two-week trip to Swaziland and South Africa with the Grandmothers to Grandmothers Campaign of the Stephen Lewis Foundation.
I was expecting to hear some heartbreaking stories and to recognize the courage these grandmothers show. But I wasn't expecting the depth of the need, or the sheer inventiveness these women display in order to hold their families together.
The grandmothers I met came together in Swaziland from May 6 to 9, 2010, at the invitation of Siphiwe Hlope of SWAPOL -- Swaziland Positive Living. The 500-strong group came from 13 African countries to take part in the first-ever Grandmothers Gathering held on African soil, and were joined by 42 of us -- Canadian grandmothers who raise funds and awareness for our African sisters.
They shared stories of desperate need and devastation as a result of poverty and the ravages of the HIV/AIDS epidemic.
Miraculously, they also shared stories of inventive ideas, community building and income-generating projects that, in community after community, country after country, are turning loss and despair into reconstruction and support.
Ann from the WEMIHS project in Kenya shocked and then delighted me with her story of how she counselled suicidal grandmothers.
In the year before she was hired, she said, 12 grandmothers, in despair at the deaths of their children, sat on the graves of their children to wait for death.
"If you dare die on me," she threatened her therapy group with a laugh, "I will come to your funeral, take you out of your coffin and beat you back to life. And, if you want to die again, you'll have to get my permission first. You can't die -- your grandchildren need you."
As she spoke, her face sparkled with the liveliest energy and good humour; I could just imagine her chasing despair from those women.
Only two grandmothers died that year, and the others went on to become leaders of other grandmother groups, reaching out further into the community. They are now sharing ways to make money and to deal with rebellious teenagers.
"First you stop them dying, then you help them find a reason to live; once they're on their feet again, they'll develop amongst themselves a means to live better," said Ann.
On May 7, we went to workshops to learn from each other such innovative ideas as Table Banking. Once a month, a group of 10 to 12 grandmothers put about $2 into the pot, which is split between two grandmothers for their income generating project that month.
They must repay the borrowed amount with agreed interest. If they do, all is well, and another two grandmothers share the new larger pot.
If not, then all the others put in extra for the one who defaults; as close neighbours, they know well what problems she may have faced.
"But," asked one cautious grandmother, "what if I hoe, but my neighbour doesn't?"
The workshop leader smiled.
"Then, my friend, you all DISCUSS what to do with her."
The laughter around the room left no doubt it would be better to have the bank foreclose on you than to be DISCUSSED by your friends.
One day in South Africa sticks out in my memory, when we went to Pretoria to visit Tateni, a project supported by the Stephen Lewis Foundation.
As I walked into St. Francis Church hall, the waiting African grandmothers burst into song, so rich and full of harmony it felt like a physical wave wrapping around me.
What a welcome!
One grandmother pointed to a photo of my two grandsons with my daughter Helen and said: "Your daughter? Ah, still alive. Not mine."
She told me that she had lost eight of her nine children, most to AIDS.
The African grandmothers repeatedly thanked us for coming, but we were the ones who felt an immense gratitude to them for welcoming us so warmly and for teaching us about courage and perseverance in the face of overwhelming loss.
On the Grandmothers March, as I marched through the streets of Manzini, Swaziland, with up to 2,000 African grandmothers and supporters chanting songs of power and solidarity, I felt a growing conviction in my heart: African grandmothers are the backbone of their communities, and they have the power to turn the tide of AIDS in Africa.
Their clarion call to the international community goes out in the Manzini Statement: "True sustainability is in the hands of grandmothers and other community activists. Africa cannot survive without us. We call on you to deliver on your promises."
Lisbie Rae is a member of Grandmothers of Steel, part of the Grandmothers to Grandmothers Campaign, supporting the work of the Stephen Lewis Foundation in more than 300 projects in sub-Saharan Africa. On June 12, she will join grandmothers across the country as they walk between them the distance across Canada in a National Walk. The Hamilton walk starts at Hutch's at Van Wagner's Beach at 9 to 11 a.m. Support African grandmothers by sponsoring Lisbie Rae or another walker at grandmotherscampaign.org/ nationalwalk.html
Grandmothers Seek Support, Caring for AIDS Children. 21/5/10
The first-ever African Grandmothers Gathering convened 500 grandmothers from 14 African countries and 42 of their counterparts from Canada.
21 May 2010
Recently in Swaziland, the first-ever African Grandmothers Gathering convened 500 grandmothers from 14 African countries and 42 of their counterparts from Canada.
"This event is the beginning of a process for Africa to recognize grandmothers who have been valiantly coping with the HIV/AIDS pandemic for over two decades," said Siphiwe Hlophe, director of Swaziland Positive Living.
Hlophe said the idea was conceived in 2006 in Toronto with the help of the Stephen Lewis Foundation, named for Canada's former UN special envoy on HIV/AIDS in Africa. Ilana Landsberg-Lewis, the foundation's executive director, said a key tactic is to provide seed money to start businesses, allowing caregivers in AIDS-hit communities to become self-sufficient.
"That's what these grandmothers are asking for," said Landsberg-Lewis. "They are demanding for better policies that would support them in their communities."
The foundation is funding income-generating programs for grandmothers in several African nations. In Uganda, the non-governmental group St. Francis helps the grannies establish businesses and save their profits. It has assisted 120 women, most of whom are living with HIV/AIDS, since 2007.
The organization also helps grandmothers decide how to apportion their savings among necessities like food and school fees for their grandchildren.
In addition, conference delegates discussed HIV/AIDS coping strategies. Some voiced concern about escalating violence against grandmothers, including rape. "In other cases we hear that thugs attack and rob elderly women of the little that they have," said Ntombi Tfwala, the queen mother of Swaziland. "I take this opportunity to rebuke these evils that are making life uncomfortable for all of us."
HIV Mother-to-Child Transmission Down to Eight Percent. 12/11/10
The mother to child transmission of HIV/AIDS in the country reduced by 8.3 percent from 11 percent in 2004 to 2.7 percent by the end of last year.
By Bosco R Asiimwe
12 November 2010
Kigali — The mother to child transmission of HIV/AIDS in the country reduced by 8.3 percent from 11 percent in 2004 to 2.7 percent by the end of last year.
Dr. Placidie Mugwaneza, the head of HIV Prevention in Trac-Plus, revealed this yesterday at a press conference organised by the National AIDS Control Commission (CNLS), to brief journalists on the upcoming 6th Annual National Paediatric Conference on children infected and affected by HIV/AIDS, scheduled for November 17-19.
Mugwaneza attributed the downward trend to attention given to HIV positive pregnant women. She said that currently, 384 health centres across the country provide services to pregnant women to help them produce healthy babies.
"We have reduced weeks of HIV/AIDS infected pregnant women when they start accessing drugs from 28 weeks to 14 weeks to effectively combat the virus from being transmitted to unborn babies," Mugwaneza said.
About 23,000 children are born to HIV positive mothers each year and more than 7, 000 children are in need of ARV therapy, Mugwaneza noted.
Dr. Anita Asiimwe, CNLS Executive Secretary, said that 72 percent of HIV infected children currently access antiretroviral therapy (ART), up from 10 percent in 2005.
According to statistics from CNLS, there are 210,000 AIDS orphans, 27,000 of them under the age of 14 infected with HIV.
The paediatric conference will be held under the theme "Economic Development Poverty Reduction Strategy (EDPRS) Response to HIV and AIDS - Focus on the Education Sector."
Dr. Asiimwe said that it will further help to strengthen and advocate for the needs of children with HIV as well as having HIV free born babies.
The Minister of Gender and Family Promotion, Jeanne d'Arc Mujawamariya, who also disclosed that the 6th National Children Summit will be held between November 14-17, called upon everyone to join hands to fight HIV infection among children which stands at 3 percent.
The children's summit under the theme "The role of children in education fit for them," is in the framework of the Rwanda education policy which seeks to ensure access to universal nine-year education, the suppression of gender based disparities, targeting quality education with measurable learning outcomes.
The press conference was also attended by Dr. Joseph Foumbi, UNICEF Representative, who promised further commitment in having AIDS free children in the country.
HIV Prevention and Treatment Not Accessible to Southern Africa’s Migrant Workers. 23/2/10
Report recommends several ways to help reduce the HIV vulnerability of migrant workers and mobile populations.
Sango Net Pulse
Pretoria -- The International Organization of Migration (IOM) has released the results of an eight-country 2009 survey into the health risks and needs of migrants and mobile populations. The survey was funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) for the Southern Africa Prevention Initiative of USAID (U.S. Agency for International Development).
The assessment researched migrants employed in the agriculture, mining, transport, construction, informal cross border trade and maritime sectors. Conducted over a five-month period, July to November 2009, the study identified several factors that increase HIV vulnerability of migrant workers, mobile populations and the communities with whom they interact. Main factors include:
Boredom and loneliness resulting from long periods of time spent away from home and family
Poor social environments in which alcohol and sex are the most accessible forms of entertainment
Multiple and concurrent sexual partnerships, including commercial and transactional sex
Low HIV knowledge and inconsistent condom use
Limited access to HIV prevention services
Low availability of social and behaviour change communication programmes
The report recommends several ways to help reduce the HIV vulnerability of migrant workers and mobile populations. These include: the need to look at migrants within a public health context and develop programs for migrants and the communities with which they interact or “spaces of vulnerability” (such as truck stops and border areas); the need for further research to examine sexual behavior patterns within the migration process; and the need for governments to introduce comprehensive HIV/AIDS policies that cover the specific vulnerabilities faced by migrants - in particular, access to healthcare at their work places and in their home countries.
USAID’s Southern Africa Mission Director, Mr. Jeff Borns, said, “USAID supported this valuable research to find out how susceptible the migrant workers are to HIV and AIDS, and to gain valuable guidance for those seeking to address the needs of such a vulnerable and underserved group.” The findings of this assessment will assist USAID in forming a regional strategy for addressing HIV prevention within migrant settings.
IOM is implementing a number of HIV prevention interventions for migrant populations regionally, including the USAID supported Ripfumelo (“believe” in the xiTsonga language) project that reaches out to 20,000 migrant farm workers and their families on 120 farms across South Africa’s Limpopo and Mpumalanga Provinces. USAID has previously sponsored IOM’s research into human trafficking across South Africa.
The complete report, Regional Assessment on HIV-prevention needs of Migrant and Mobile Populations in Southern Africa, can be downloaded here.
The assessment was conducted in Angola, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland and Zambia. For further information, please contact Nosipho Theyise on +2712 342 2789, firstname.lastname@example.org
Elizabeth Kennedy Trudeau
Deputy Press Attaché
American Embassy Pretoria
Telephone: 27-12-431-4000, ext. 4217
HIV Research 'On the Rise'. 27/10/10
5.5 per cent of South Africa's research effort goes towards HIV/AIDS
By Carol Campbell
27 October 2010
Oudtshoorn — Research on HIV/AIDS is on the rise in South Africa, a country with the largest number of HIV infections in the world, while Western research efforts have levelled out, a study has found.
Only around two per cent of all research articles produced by the United States, the biggest producer of HIV/AIDS studies, are about HIV/AIDS, according to the study in Scientometrics. Such studies take up less than two per cent of the total publication output of most European countries, and just 0.5 per cent of Japan's output.
By contrast, 5.5 per cent of South Africa's research effort goes towards HIV/AIDS - mainly clinical medicine and social studies. This is six times as much as expected given its size, but still only around three per cent of the global total.
Globally HIV/AIDS research was on the rise until 1995, and has since levelled out at around 8,000 articles per year. This compares, for example, with 30,000 papers on cancer research.
At the AIDS Vaccine 2010 conference in the United States last month (28 September-1 October), Alan Berstein, executive director of the Global HIV Vaccine Enterprise, said the money going into HIV/AIDS research had decreased because of the economic downturn and competing global health priorities.
Anastassios Pouris, director of the Institute for Technological Innovation at the University of Pretoria and co-author of the study, told SciDev.Net that the levelling out of HIV/AIDS publications started in 1996 when highly active antiretroviral therapies (HAART) reduced death rates in developed countries.
But while South African HIV/AIDS research output is on the rise, there is "no way" South African researchers can resolve the HIV/AIDS issue on their own, Pouris said. HIV/AIDS has to an extent become mainly a developing world concern, he said, calling on South Africa to involve the rest of the world in researching the disease.
"The emphasis [in South Africa] is on social sciences because the pandemic creates social concerns," Pouris said. "However, it will be hard science that provides the solution." Hard sciences, such as biochemistry and pharmacology, are under-emphasised in South African HIV/AIDS research, he said.
Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition in New York, said: "Compared to 20 years ago much more money is being invested in AIDS vaccine research." But he added that "maybe some countries have been less supportive than they could have been."
"What is needed from the international donor community now is sustained funding," said Warren. "Otherwise good work that has taken years to build will be lost."
A funding conference in New York this month (5 October) failed to raise the US$20 billion estimated by the Global Fund to Fight AIDS, Tuberculosis and Malaria to be needed to stop the spread of HIV/AIDS by 2015.
HIV, TB Cut Lesotho Life Expectancy to a Mere 36. 24/3/10
Medical workers are increasingly concerned that the lethal combination of HIV infection and tuberculosis may become the world's next major health crisis.
By Natasya Tay
24 March 2010
MORIJA, Lesotho - Medical workers are increasingly concerned that the lethal combination of HIV infection and tuberculosis may become the world's next major health crisis.
To mark World TB Day on Wednesday, Medecins Sans Frontieres drew attention to Lesotho, which has the world's third-highest prevalence of HIV, the virus that causes AIDS, and the fourth-highest prevalence of tuberculosis. Here, poverty and violence complicate treatment in a country where life expectancy is a mere 36 years.
Michel Sidibe, head of the U.N. AIDS program, fears the double infection could become the next new epidemic.
"I'm calling for serious attention to TB, and serious attention to TB-HIV co-infection," he said in an interview.
In this mountainous kingdom surrounded by South Africa, some patients battling HIV and tuberculosis must walk five hours to reach a clinic for their medication.
"It is a problem for us to come to the clinic because sometimes there are gangster men waiting down by the side of the river ... and yes, sometimes women are raped," said Tlalane Tsiane, a 21-year-old woman infected with TB and HIV.
Many men in Lesotho travel to South Africa to work in the mines and some return with HIV and a form of tuberculosis that is resistant to multiple antibiotics. The World Health Organization believes drug-resistant strains present a major challenge to the global effort to control the disease.
Helen Bygrave, a medical coordinator for Medecins Sans Frontieres, also known as Doctors Without Borders, estimated that between 80 to 90 percent of Lesotho's TB patients are infected with HIV.
A person whose immune system is compromised by HIV is particularly susceptible to tuberculosis, which is caused by bacteria that usually attack the lungs. The disease is spread through the air when an infected person coughs or sneezes.
There are nearly 9 million new cases of TB worldwide and the disease kills more than 1.5 million people every year, according to the World Health Organization, even though it can be cured with a six-month course of antibiotics that costs only $20.
Sera Thoola, a retired miner of 47, believes that he contracted TB in South Africa. It is also where he first tested positive for HIV. He has multi-drug-resistant TB, and is currently taking an average of 49 pills a day to control his diseases.
Most clinics in Lesotho were set up through partnerships between the government and international groups. In seeking ways to make the most of scarce resources, Medecins Sans Frontieres is helping to support and run a program in which nurses are given training to take on roles doctors might have carried out. Community health workers later make sure patients are sticking to their treatment regime.
HIV-infected Children in Africa Face Stigma. 09/01/2010
Children face stigma, inadequate treatment and heightened vulnerability
Ramona Vijeyarasa |
January 9th, 2010
The stigma facing adults living with HIV has been the target of extensive advocacy, law reform and awareness-raising. However, the stories of children living in Africa with HIV are often not told, despite the fact that they face similar stigma, inadequate treatment and heightened vulnerability when orphaned by the epidemic.
A study presented at a regional consultative meeting on HIV law reform in East Africa held in Arusha, Tanzania in early December, has revealed an absence of laws and policies preventing HIV-stigma against children in States of the East Africa Community (EAC). Conducted by Africa Vision Integrated Strategies on behalf of the Eastern African National Networks of AIDS Service Organizations, the study found that in addition to the absence of legal protections, there is not enough awareness about HIV and AIDS in schools, with some teachers doubting students’ HIV status or questioning students for taking anti-retrovirals (ARVs). As a result, children living with HIV/AIDS do not want to attend, and if forced to do so, face difficulties in concentrating, performing and staying in school.
The EAC is moving towards a common response to HIV/AIDS across Uganda, Kenya, Tanzania, Burundi and Rwanda, with free access to ARV treatment for citizens infected by the virus traveling across the five states. Commenting on the needs of children living with HIV, Allan Achesa Maleche of Africa Vision Integrated Strategies noted the importance of making specific provisions that cover children when legislating on HIV-related issues. “This is fundamental as children’s issues raise special concerns as compared to those of adults…It is thus imperative to have specific clauses that directly address the human rights concerns of children in the context of HIV and AIDS.”
A further problem facing children living with HIV in the EAC is a severe shortage of services. Kenya has as a law providing for free treatment and counseling for HIV-positive people. However, according to a Human Rights Watch (HRW) report released on World AIDS Day concerning HIV treatment for children in Kenya, only about half of those Kenyan children infected with HIV have access to treatment. Over the last year, the number of HIV-infected children on ARVs in Kenya has risen to about 28,000. However, a lack of access to adequate nutrition increases risks for all infected children of dying of the disease. The report also found that while overt discrimination in Kenyan schools is somewhat reduced, children continue to face more subtle forms of discrimination, with many students feeling the need to hide their HIV status from teachers and fellow students and for those living in boarding schools, secretly taking ARV drugs.
Children orphaned as a result of AIDS, many of whom themselves are HIV-infected, need to tackle further prejudice. The number of children orphaned after their parent(s) died from AIDS reached 15.2 million children worldwide in 2005. HRW documents violation of property rights (including disinheritance of AIDS orphans in Kenya), labor exploitation, sexual harassment and abuse, and violence for AIDS orphans living with non-parent guardians.
The new proposed law on HIV/AIDS for the EAC would be the second in Africa after the Southern African Development Community (SADC) developed a Model Law in November 2008 that provides for a comprehensive framework for harmonizing HIV and human rights issues in southern Africa. However, this leaves many West Africa nations which face similar challenges. According to figures released by USAID, AIDS orphans in West Africa face not only a lost childhood but increased health problems related to inadequate nutrition, housing, clothing, and basic care. The problem is particularly serious in Nigeria, where almost 1 million children have lost one or more parents to HIV/AIDS, while UNICEF’s child information database from 2007 documents 420,000 children in Côte d’Ivoire and 300,000 children in Cameroon having lost one or both parents to the epidemic.
In Burkina Faso, stigma manifests itself in reticence to get children HIV-tested. A Joint UN Program on HIV/AIDS estimated that as of 2006, 10,000 children were infected with HIV in Burkina Faso, with 4,600 needing anti-retroviral drugs. However, according to the government’s national HIV and sexually transmitted diseases council, only 46 percent of HIV patients in Burkina Faso who required treatment as of June 2009 – 23,000 people – are taking anti-retroviral drugs. The reluctance to be tested and deal with the potential HIV-status is so great that one pediatrician working in the capital Ouagadougou notices that parents, themselves who have not been tested, sometimes leave the hospital in the middle of the night with their untested children.
Most people are aware that laws and policies alone cannot reverse the stigma facing people living with HIV. However, the EAC’s efforts to pass a regional law on HIV/AIDS are momentous given that the new law will attempt to address some of the most contentious and concerning provisions within each member states’ laws. This includes Uganda, plagued by its draft anti-homosexuality bill, as well as the Penal Codes of Kenya, Rwanda, Burundi and Tanzania that prevent sex workers and homosexual men from accessing treatment. In the process of developing the new law, it is essential that the rights of children living with HIV are not left off the radar. Denied access to health care and schooling and facing discrimination by teachers, continued exclusion from legal protection will only
act to isolate them further. Legal protection can help to prevent a life of discrimination from a very young age and provide greater guarantees for the basic rights of these children.
HIV/AIDS and SADC: How are we Doing. 06/05/09
David R. Patient (MHT) & Neil M. Orr (MA)
The opinions in this article reflect those of the authors based on their combined experiences.
David Patient – a person living with HIV for 26 years - and Neil Orr - a research Psychologist in the area of health - have worked in HIV/AIDS, since 1983 and 1985, respectively, with the last 15 years working in 17 countries in Africa, India and South East Asia.
They are best-selling authors of Positive Health (17 million copies in circulation in 19 languages) and Choices: All about HIV and AIDS (Jacana, 2008), trainers, facilitators and program designers. Their work has covered many aspects of health and HIV/AIDS, from regional N.G.O.’s to whole country interventions.
For more information on the authors and the scope of their work, please visit http://empow.co.za/ or email David Patient on email@example.com
HIV and AIDS has inflicted the “single greatest reversal in human development” in modern history (UNDP 2005, quoted in the UNAIDS 2008 Report on the Global AIDS Epidemic). In this short article, the key points of impact in the SADC region are described, and also areas of success and failure.
The SADC region is without doubt the epicentre of the AIDS pandemic in the world: Prevalence rates vary from 15% to 28% of the population. In 2007, sub-Saharan Africa – primarily SADC countries – was home to 67% (22.1 million) of all people living with HIV in the world. Of these, 60% are women. Almost half (45%) of those infected are between the ages of 15 and 24. Ninety percent of children living with HIV in the world today are in sub-Saharan Africa.
The impact of HIV/AIDS
What has AIDS done to our societies? The scope of the impact of HIV and AIDS in SADC countries is profound: Reduction of the average adult lifespan by more than 20 years; Creation of millions of child-headed households; Deepening of poverty; Reduction in economic output; Increasing resource disparities between rural and urban populations; Reversal of educational progress; Alteration of agricultural output types and production levels; Deaths of young adults. This list is by no means complete.
On the other hand, HIV and AIDS have resulted in equally unprecedented efforts to deal with the multitude of social and infrastructural problems and inequities in our societies. Extraordinary efforts have been made to ensure universal access to ART (antiretroviral treatment), resulting in a slowing down of the deaths from AIDS over the last few years; Gender equity programmes to address vulnerability of women; PMTCT (Prevention of Mother to Child Transmission) programmes have produced remarkable results in reducing infections in newborns.
It is now possible to state – tentatively, and with conditions – that HIV is no longer a death sentence. In those areas and populations with access to the ART and PMTCT and related infrastructure, the life expectancy of a person living with HIV now exceeds the life expectancy of a person with diabetes. Considering the context of the time-span in which this has occurred - 25 years – this is indeed cause for quiet celebration. However, this is a single battle victory in a much larger war against the scourge of our times, and other battles are by no means won. Indeed, it may be argued that we may be winning the war in treatment, and losing the larger war of prevention.
Measuring our efforts
Theoretically, we may measure our combined efforts – prevention and treatment access – by examining national and regional HIV prevalence rates. Essentially, the prevalence for a specific period is the previous year’s total prevalence, plus new infections, and minus AIDS deaths. When HIV prevalence rates stabilise – i.e., do not increase or decrease significantly – this simply means that new infections and AIDS deaths are equal.
If the total prevalence rate increases, this means one of two things: Either new infections have increased faster than AIDS deaths, or more people requiring ART are receiving such live-saving treatment, compared to new infections. Conversely, a drop in total prevalence means one of two things: Either more people are dying from AIDS than those newly infected, or there are fewer new infections compared to AIDS deaths.
In many SADC countries, the total prevalence is stabilising. The question is whether this is due to successful prevention programmes, or AIDS deaths increasing to match new infections.
There is no doubt that there have been significant successes in making ART available to more people, thus reducing AIDS deaths. However, the evidence suggests that the need for ART is currently outpacing its’ availability. I.e., AIDS deaths are still a major factor in determining total prevalence rates. Ironically, if everyone who needed ART was receiving such treatment, the total prevalence rates should increase, not decrease, as the total pool of infected people was not decimated through death, and only newly infected people were added to the total.
We need to keep in mind that HIV/AIDS is a ‘slow wave’ pandemic: It takes between 6 and 8 years from infection until AIDS symptoms develop, and a further 1 to 2 years for death from AIDS to occur, in the absence of ART. Furthermore, infection rates were doubling every 18 to 24 months in the previous decade. The end-result is that, despite massive efforts to provide ART to as many people as possible, these efforts would need to double such access every 18 to 24 months. If this does not occur, AIDS deaths will outpace ART access. This appears to be the case, currently.
What about prevention? The key variable in assessing prevention efforts is new infections per annum. Other key indicators are birth rates and STI (Sexually Transmitted Infections) figures. If standard ABC (Abstinence, Be faithful, Condomise) prevention programmes are working, then all three statistics should logically decline.
The evidence suggests otherwise: For every two people who start ART, there are five new infections (UNAIDS, 2008); Furthermore: “There is also no evidence ... that HIV prevalence is decreasing in the sub-region. In 2005 there were 1,5 (1,3 -1,7) million new HIV infections in the SADC region representing more than 36.5 percent of all new infections globally” (SADC Report: Expert think tank meeting on HIV prevention on high-prevalence on Southern Africa, 2006). It appears, despite the most strenuous efforts, that the ABC prevention model has not been the success we hoped for.
It also needs to be noted that public messaging has not yet fully resolved the conflict between the ‘prevent infection because AIDS can kill you’ message and the ‘get tested and treated – you can live a long life’ message.
Prevention: The long war
There have been significant changes in the epidemiological nature of HIV in the SADC region: For example, commercial sex workers are no longer primary vectors of infection. In many locations, the prevalence rates of commercial sex workers is not significantly different from married and unmarried women in the same area. Commercial sex workers are also more likely to use condoms than other women of the same age. It is also the case that the primary focus of infection has shifted to ‘ordinary’ committed relationships. In other words, the days of focusing upon ‘high risk sex with strangers’ has passed; Instead, the focus is now married couples, and couples who have long-term relationships. For example, it has been found that the probability of a man wearing a condom is 60% if he is having sex with a stranger, 30% if it is a regular girl friend, and only 10% if it is his wife. I.e., people are generally aware of the risk of casual sex, and know how to reduce the risks.
For many years we – HIV/AIDS educators – blamed the failure of prevention efforts on the lack of knowledge regarding prevention (typically ABC), or lack of access to condoms. However, various studies have indicated that most adults – in excess of 90% - are well aware of how HIV is transmitted, and how to prevent it. What was not taken into consideration in our prevention efforts is the basic cultural imperative to reproduce children. In our experience, the need to reproduce children over-rides knowledge of the individual risks regarding HIV. Until this conflict is resolved – having children versus protecting yourself – prevention efforts will produce poor results.
In this regard, there is a glimmer of hope: Recent studies have indicated that sero-discordant couples (one HIV-positive, the other HIV-negative) may safely conceive sexually if the person living with HIV has an undetectable viral load, no untreated STI’s, and is under medical supervision. The implications of these findings have yet to be explored in terms of public messaging.
There have also been significant research findings that may change the course of regional and local prevention efforts: The fact that (medical) circumcision can reduce the chances of a man becoming HIV-infected by up to 60%; Sociological studies that have determined that the presence of concurrent relationships (more than one sexual relationship – often long-term – occurring simultaneously) is a key factor in variations in HIV prevalence. Furthermore, there is emerging evidence that poverty and resource-related issues (clean water, access to medical care, nutrition) cause differences in vulnerability to HIV infection, and also speed of progression to AIDS.
Given the lacklustre outcomes from conventional ABC prevention programmes, these new developments provide new avenues to bolster prevention strategies. Under consideration in some countries is incentivised male circumcision, and circumcision at birth, as is the case in the USA. Concurrent relationships also provide a focus for relationship-based programmes emphasising monogamy. The latter was successfully employed in Uganda in the late 1980’s (Zero Grazing).
The road forward
A review of major global pandemics – the Black Death and Bubonic Plagues as examples – shows that pandemics change the core values of societies. In the 25 years that HIV has been recorded, the pandemic has outpaced our willingness and ability to change: The price of inflexibility has been enormous, and even if a cure was found today, we would continue to pay the price for generations.
However, both sociological and medical understanding of HIV and AIDS is maturing: We are finally coming to grips with the real social forces that are driving the pandemic, and the next five years will see a major reorientation of prevention methodology towards circumcision and the reduction of concurrent relationships. It is particularly the latter that will force societies to discuss the widespread phenomena of what is essentially open-ended polygamy based upon economic factors. We fully expect prevention efforts to shift from the conventional ABC to focus upon monogamy, with condom promotion becoming a secondary strategy.
In terms of treatment access, there is no doubt that this will be systematically expanded, and treatment outcomes improved. However, one of the key issues confronting our medical infrastructure is non-adherence – a behavioural issue – which has led to the current situation where almost 1 in 5 new infections being drug-resistant, potentially creating a scenario similar to drug-resistant TB. If this issue is not addressed with urgency, the respite in deaths from AIDS may fade within a few short years.
Effective prevention is – and should be - the ultimate goal in any HIV/AIDS strategy. SADC countries cannot indefinitely bear the costs of having large segments of the population on life-long chronic medication. Yes, it is cheaper to treat than not to treat. However, it is even cheaper – economically - to prevent, if we are willing to pay the psychological and cultural price for the necessary changes.
Ignored by the Whole World - A Visit to Yambio, Sudan. 17/4/08
They are still afraid, they suffer from insecurity because of the attacks of the Lord's Resistance Army.
17 April 2008
By Juan Michel
Metropolitan Dr Zacharias Mar Theophilus, from the Mar Thoma Syrian Church of Malabar, India, was a member of an ecumenical team that recently visited Sudan's Yambio region. The capital city of West Equatoria state, close to the border with the Democratic Republic of the Congo, Yambio is green and fertile. "But the people we met there feel ignored," says Metropolitan Theophilus, "ignored by Khartoum, ignored by Juba, ignored by the whole world."
Khartoum and Juba, the capital cities of Northern and Southern Sudan respectively, are separated by some 1,700 kilometres and the wounds of 21 years of civil war. The conflict between the predominantly Muslim North and the majority Christian South killed some 2 million people and left more than 4 million internally displaced persons.
A Comprehensive Peace Agreement signed in January 2005 ended the war but not the problems. Not least being the implementation of the many contentious points of the agreement itself, like border demarcation, sharing of oil revenues and proper preparation of a census and elections.
A predominately agricultural area, Yambio was relatively less affected than other regions during the war. But there have been sporadic tensions between the local Zande population and displaced cattle keeping Dinka. An added plight is the presence in the region of the Ugandan Lord's Resistance Army. The rebel movement, whose leaders have been issued with war crimes indictments by the International Criminal Court because of the atrocities committed during a 21-year war against the Ugandan government, is known for its cruelty.
A member of the ecumenical team said: "Yambio could be a paradise, but under the current circumstances is simply terrible."
The five-person team visiting Yambio was part of a bigger international ecumenical solidarity visit to Sudan sent by the World Council of Churches and the All Africa Council of Churches. From 26 to 31 April, in addition to Yambio, three other teams visited Khartoum, Darfur and Rumbek before joining some 80 Sudanese church representatives - leaders, women and youth - for a three-day conference in Juba. The goal of the visits and conference was to listen to the Sudanese churches' concerns and hopes as well as to express the ecumenical family's solidarity with the churches and people of Sudan.
At the end of the visit, we interviewed Metropolitan Theophilus:
What was the one thing that struck you most during the visit?
The plight of the people. They are still afraid, they suffer from insecurity because of the attacks of the Lord's Resistance Army. Many people are sleeping in the bush, they cannot send the children to school. On the other hand, we saw churches full and united. The people's only hope is the church. So, this solidarity visit was something that strengthened them, encouraged them and gave them hope.
What is the impact of the Lord's Resistance Army presence in the region?
It comes from Uganda and enters the Yambio region killing people, attacking young girls. Even the Catholic bishop is under threat. I did not know about this problem before coming and could only understand its magnitude after the visit. Through the news media I only receive information on what is going on in the Darfur region. But the country is facing other tremendous problems, like the implementation of the Comprehensive Peace Agreement, which is not easy. So the visit was an eye-opener.
What do you think is the most pressing issue that needs to be addressed?
Health. There are a lot of people living with HIV and AIDS. The church and the society as well as the government and the agencies should all together address this problem. There are cases of malnutrition too. They need hospitals and health workers.
Another urgent need is education. Churches should get more involved in this field, in skills and technical training, and the government should support that through funding. People need schools and a university. Nowadays, to access higher education they need to go to neighbouring Uganda or to Juba, the capital of Southern Sudan. The high level of unemployment is a consequence of lack of education. Of course the lack of infrastructure does not help and needs to be addressed too.
In Yambio, government and churches have a good cooperation that should be spread to all regions.
How can your church, which is so far away, help the churches in Sudan?
We have been praying for Sudan for several years. Prayer is a very mighty power, a great power that can change things. Once I am back home I will write in the church magazine about what I have seen, and mobilize people to pray and work for peace.
It is true that from a distance we cannot do much, but we can support initiatives taken through the World Council of Churches, for instance supporting its involvement in the CPA process. We could also send teachers - we have plenty of teachers - and maybe some doctors. There should be ways in which we could enter into a relationship with the churches in Sudan.
What do you take back home with you from this visit?
Although the people in Yambio live under very harsh conditions and insecurity, the village system allows them to support each other. They find their security in the love and care of the people, not in the military. This is something the modern world should learn. We think of security in terms of powerful weapons, but if you are bound in a community by love and care for the humanity that is the greatest security. So we have to learn from these villages that our security is ultimately in the hands of God as well as of a loving community. It is hatred that brings insecurity while love brings security. That is something we need to learn.
Is Self-testing for HIV on the Way in Africa? 15/11/10
Radically increase HIV testing rates in tuberculosis programmes
By Keith Alcorn
15 November 2010
Self-testing for HIV using oral tests could radically increase HIV testing rates in tuberculosis programmes, TB researchers argued this weekend at the 41st Union World Conference on Lung Health in Berlin.
Similarly, community sputum collection points where individuals can go to provide a sputum sample for TB detection, without having to wait to see a nurse or doctor, have proved very popular in Zambia.
Rates of diagnosis for both TB and HIV remain very low, and even when a person is diagnosed with one infection, screening for the other infection may not take place.
Furthermore, even if people have symptoms that might indicate active TB, their likelihood of having those symptoms fully investigated is low. A community survey in Zambia in 2006 among 9,000 people who identified themselves as suffering from persistent cough found that only half had attended a health facility as a result, said Dr Helen Ayles of the London School of Hygiene and Tropical Medicine.
Just less than half who attended a health facility were asked to produce sputum in order to test for TB, and just 5% of all those questioned eventually started TB treatment, despite a local TB prevalence of 960 cases per 100,000 and a local HIV prevalence of 26%.
Given these barriers, TB specialists working in countries with a high burden of both TB and HIV have been asking how rates of diagnosis and access to care can be improved, as a first step towards reducing the burden of TB in these settings.
In Zambia the ZAMSTAR study, led by Dr Helen Ayles, is currently comparing approaches to TB case-finding and TB/HIV service delivery. As part of its enhanced community case-finding strategy, the study is running community sputum collection points, as well as open access sputum collection points at health facilities. These require no appointment and no nurse time and will provide a result to patients within 48 hours.
A big advantage of these schemes, said Dr Ayles, is that they avoid concentrating patients with potentially infectious TB in crowded waiting rooms for long periods. People with suspected TB are very happy with the speed of the process, and keen to be tested when the barrier of extended waiting time is removed. Nearly 40% of the sputum samples being processed in the laboratories used by ZAMSTAR now come from community collection points, showing how much the innovative method is extending the reach of TB case-finding efforts.
Community sputum collection is also having other unforeseen benefits.
“Almost as soon as we set it up the community sputum collectors decided that the sputum collection points were going to be condom distribution points too,” said Dr Ayles.
From condom distribution it should be only a short step to offering HIV testing, but at the moment programmes predominantly offer conventional voluntary counselling and testing, or door-to-door testing. Significant resistance remains to voluntary counselling and testing, for a host of reasons, including the difficulty of attending the facility, fears about confidentiality and the quality of the counselling.
In Malawi, for example, research led by Dr Liz Corbett of the London School of Hygiene and Tropical Medicine has found that when compared with door-to-door VCT conducted by health care workers, the possibility of self-testing was much more attractive.
Self-testing using an oral saliva test has already been piloted in Malawi, and proved highly acceptable, said Dr Corbett. Ninety-one per cent of a sample of 260 randomly selected Malawians offered the opportunity to carry out the oral test themselves took the test, and 99.2% got the result right first time.
“Withholding a fabulous diagnostic from the population because of concerns about their ability to handle it seems lunacy to me,” said Dr Corbett.
“The commonest feedback we had was `why don't we know about these tests and why isn't the government in Malawi distributing these tests to everyone each year?`”
Some people are more cautious about the use of self-testing. Jeremiah Chakaya, head of Kenya's National TB Control Programme pointed to the recent case of a Kenyan policeman who went on a rampage and shot ten people after learning that he was HIV-positive.
“HIV and sexually transmitted infections will remain stigmatised for a long time to come. There are absolutely no issues with the accuracy of the test but we shouldn't promote self-testing without dealing with stigma.
“Disclosure is a big problem, as we can see from the preference for self-testing in Malawi. Will people go to their doctor and say `I did a self-test yesterday and I am HIV-positive`, or will they go into themselves and get depressed and get angry?” he asked.
There's also concern about forcible testing; some people raised concerns at the conference about the potential use of the tests to forcibly test partners or family members.
“If you can't even negotiate condom use, how are you going to deal with it when your husband brings an HIV test kit home?” asked one delegate from South Africa during a debate on self-testing.
“One of the big things about self-testing is that couples really like it,” said Dr Liz Corbett. “Women are being tested through the PMTCT programme and men are using their status as a surrogate for their own status. Women told us `if we take the test kits home our men will test with us.`”
Concerns also exist about the effect of self-testing on sexual behaviour in those who test negative. There is some evidence from studies of voluntary counselling and testing that a negative test is not associated with a subsequent reduction in unprotected sex.
Self-testing already happening
Self-testing may now be an unstoppable development, and one that the health care sector and community organisations will have to learn to deal with. The implications of self-testing go far beyond TB programmes.
“I think this is coming whether people like it or not, and it's already happening on quite a scale in South Africa,” said Dr Helen Ayles.
The first over-the-counter oral HIV test that can be conducted entirely at home is likely to be approved in the United States soon, opening the door to approval in many other countries.
Anecdotal evidence suggests that individuals are already gaining access to self-testing kits in South Africa, and the use of rapid antibody tests for self-testing by health care workers in Africa is widespread, acknowledged Dr Liz Corbett.
Dr Renee Ridzon of the Bill and Melinda Gates Foundation warns that self-testing is going to be necessary if antiretroviral-based prevention methods such as microbicides and pre-exposure prophylaxis become available, simply to accommodate the volume of regular testing that will be necessary to use these methods safely.
She expressed concern about the diversity of rapid tests currently available, and the potential for confusion about how to use tests accurately if multiple tests with different operating procedures are in circulation.
“Some test kits remain positive for ten minutes, others for 20 minutes. There's a need for standardisation of the test specifications,” she said.
In a recent article in the South African Medical Journal Marlise Richter of Ghent University, Francois Venter of the Reproductive Health and HIV Research Unit at University of Witwatersrand and Andy Gray of the University of Kwazulu Natal argued that the way in which HIV tests kits are regulated in South Africa is yet another example of `AIDS exceptionalism`.
They say that self-testing should be enabled by a new regulatory regime in South Africa that would allow anyone to buy a test kit, supplied with written information about the test and the window period, together with a clear warning that testing another person without their consent is illegal. The test should be backed up by a toll-free hotline.
“Self testing changes the paradigm from `people with a disease` to people taking responsibility for their health, but it will require empowerment,” said Dr Rony Zachariah of Médecins sans Frontières.
Mapping Progress on Universal Access. 1/12/10
Africa shoulders nearly 70 percent of the global HIV burden
1 December 2010
Johannesburg - In sub-Saharan Africa, which shoulders nearly 70 percent of the global HIV burden, progress on the universal access targets for HIV/AIDS ranges from the good to the bad, and for most countries is somewhere in between.
HIV infection rates in sub-Saharan Africa range between less than 1 percent and nearly 26 percent, with the vast majority of infections concentrated in the 10 countries of southern Africa.
Fortunately, those countries have been some of the best performers when it comes to two key indicators for universal access: the percentage of people medically eligible for antiretroviral treatment (ART) who receive it, and the percentage of HIV-positive pregnant women who receive prevention of mother-to-child transmission services (PMTCT).
Several countries looked set to achieve universal access to ART (defined as coverage of at least 80 percent of the population in need) by the 2010 deadline until the World Health Organization revised its treatment guidelines at the end of 2009. The new guidelines greatly increased the percentage of people eligible for treatment, making universal access to treatment a less attainable goal.
IRIN/PlusNews has used data drawn from the 2010 UNAIDS Report on the Global AIDS Epidemic, to compile three maps comparing progress on the universal access targets across sub-Saharan Africa.
The first map shows the percentage of people in need of treatment, according to the WHO's 2006 guidelines, who were receiving it in each country by the end of 2009.
The second map shows progress on ART access, according to the WHO's 2010 guidelines.
The third map shows the percentage of HIV-positive pregnant women who received PMTCT by the end of 2009.
Looking to Continent for AIDS-Free Generation. 30/11/10
Generation born free of HIV and Aids is within the world's reach -- and Africa is at a tipping point.
By Desmond Tutu and Anthony Lake
30 November 2010
Nairobi — A generation born free of HIV and Aids is within the world's reach -- and Africa is at a tipping point.
Today, paediatric HIV and Aids is virtually a thing of the past almost everywhere in the world. Everywhere except Africa during a decade of progress in using antiretroviral medication to prevent maternal-to-child transmission of HIV.
In fact, nine out of 10 pregnant women with HIV today live in Africa; so do nine out of 10 children living with HIV. Every day, 1,000 African babies are born with HIV. The majority will not receive treatment. Without it, half will die before reaching their second birthdays.
We should all be outraged by this tragic loss of young life. We have the power to prevent mother-to-child transmission of HIV everywhere, and it is time we used that power to save hundreds of thousands of lives. It is not a question of knowledge. It is a question of priorities and political will.
This means a sustained commitment by African governments to include dedicated funding for PMTCT in their national health budgets.
Only five out of 53 African countries have met their commitment to the Abuja Declaration to allocate at least 15 per cent of their annual budgets to health care -- and very few have dedicated funding to paediatric HIV and Aids.
Some countries are taking action. Kenya, for example, has set an ambitious goal of decreasing paediatric HIV infections from 27 per cent to 8 per cent by 2013. Last year, the Kenyan government set aside $11.25 million (Sh900 million) to purchase anti-retroviral medication for pregnant women.
Achieving a generation free of HIV and Aids is also a global imperative, requiring renewed commitment by donors, international agencies, civil society, and the private sector.
Last month Kenya became the first country to begin distributing the Mother Baby Pack, "take-home boxes" that contain all the drugs needed to protect the health of one mother and her infant. Soon, Cameroon, Lesotho, and Zambia will also begin distribution of the packs to accelerate their own PMTCT efforts.
Clearly, the key to success is partnership at every level. The Campaign to End Paediatric HIV/Aids (Cepa), an African civil society partnership, is galvanising action to end paediatric HIV/Aids, starting in six African nations.
The Global Fund to Fight HIV/Aids, Tuberculosis and Malaria, a global public/private partnership, is providing significant funding to expand HIV prevention and treatment efforts in Africa.
But the current funding levels are only enough to sustain existing outreach efforts -- and Africa cannot afford to wait. With inadequate dedicated funding, fewer than half of the HIV-positive pregnant women in sub-Saharan Africa will receive life-prolonging anti-retroviral medication.
Without these medicines, up to 40 per cent of the infants born to these mothers will develop HIV; with them, that rate plummets to 5 per cent.
These numbers speak for themselves -- and the choice is ours to make. It is a matter of priorities. It is a matter of life and death. This World Aids Day, we must all recommit ourselves to saving lives -- by taking bold action today to secure an Aids-free tomorrow.
Number of HIV/AIDS Cases in Sub-Saharan Africa Expected to Greatly Outpace Resources. 29/11/10
African nations forced to make difficult choice
29 November 2010
The number of people infected with HIV/AIDS in sub-Saharan Africa is projected to far outstrip available resources for treatment by the end of the decade, forcing African nations to make difficult choices about how to allocate inadequate supplies of lifesaving antiretroviral therapy (ART), says a new report by the Institute of Medicine. It calls for a renewed emphasis on reducing the rate of new infections, promoting more efficient models of care, and encouraging shared responsibility between African nations and the U.S. for treatment and prevention efforts, which could greatly improve prospects for 2020 and beyond.
In 2008, more than 33 million people globally had HIV/AIDS, 67 percent of whom were in Africa. In addition, more than 90 percent of the 2.7 million new infections reported that year occurred in Africa, and only half of Africans who should have received ART according to World Health Organization guidelines then in place were treated. By 2020, the number of infected people in Africa will grow to over 30 million, with just 7 million of the approximately 12 million who should be treated under current guidelines likely able to receive ART, estimated the committee that wrote the report.
The report notes that because treatment can only reach a fraction of those who need it and its costs are "not sustainable for the foreseeable future," preventing new infections should be a central tenet of a long-term response to HIV/AIDS in Africa. In the meantime, decision makers in Africa will need to expand local capacities for choosing how to allocate scarce resources ethically. Because patients requiring treatment now generally were infected years ago, policymakers can do little to reverse the short-term course of the epidemic.
"Already in Uganda and a few other nations, we don't have enough health care workers or ART to meet demands, and health centers are increasingly turning away patients who need these drugs to survive," said David Serwadda, professor and former dean of the School of Public Health at Makerere University, Kampala, Uganda, and co-chair of the committee. "There is an urgent need for African countries and the U.S. to share responsibility and initiate systematic planning now for the future. If we don't act to prevent new infections, we will witness an exponential increase in deaths and orphaned children in sub-Saharan Africa in just a couple of decades."
The report says that despite increasingly more affordable ART drugs and the tremendous success of the U.S. President's Emergency Plan for AIDS Relief in galvanizing global efforts to fight HIV/AIDS, the gap between infections that require treatment and availability of treatment resources continues to grow and could persist for decades to come. The lack of trained health care workers, for example, already is impacting many African nations' abilities to provide care. In addition, the global financial crisis presents significant challenges to the U.S. and other donor nations in maintaining current levels of support for treatment and prevention in the region, making it essential that African governments take up their share of the responsibility.
"It's going to take careful long-term planning to build adequate work-force and infrastructure capacities for HIV/AIDS prevention and treatment programs in Africa," said Thomas C. Quinn, associate director for international research at the National Institute of Allergy and Infectious Diseases and committee co-chair. "It is absolutely critical that more coordinated efforts between the U.S. and African governments be negotiated and formalized now to enable better planning that will reduce the impact of the HIV pandemic in the future."
The committee developed models to track the course of HIV/AIDS in the next few decades under different scenarios of prevention and treatment. Several plausible scenarios indicate that the proportion of African nations' health budgets devoted to HIV/AIDS treatment could begin to shrink, enabling African governments to move toward greater ownership of treatment, care, and prevention efforts, the report says.
For beyond 2020, the U.S. should develop a road map for HIV/AIDS that makes prevention the focus of a sustainable response and requires shared responsibility with African nations for controlling HIV/AIDS. A more binding, negotiated contract approach should be instituted at the country level when providing funding, the report says. Contracts should offer incentives to African nations who invest in prevention and treatment by giving matching funds based on each country's means.
African countries should begin to develop projections of the future burden of their HIV/AIDS epidemics and assess implications of alternative policies on human welfare and resources in their own nations. In addition, leaders in Africa at multiple levels need assistance in expanding national capacities for making ethical choices about how to allocate limited treatment resources.
African nations will require greater resources at all levels -- from national governments to local communities -- to become full partners in fighting HIV/AIDS, the report says. In particular, African governments and international organizations should plan how to meet the greater national work-force requirements for responding to the long-term burden of HIV/AIDS.
The study was sponsored by the Doris Duke Charitable Foundation; Atlantic Philanthropies; (BD) Becton, Dickinson, and Co.; Bill & Melinda Gates Foundation; Carnegie Corporation of New York; Ford Foundation; Institute of International Education; Johnson & Johnson Services; Merck; Pfizer; and the Rockefeller Foundation.
Region to Have Common HIV Policy. 27/11/10
Harmonising existing policies, protocols, plans, strategies and legislation
27 November 2010
The East African Community (EAC) is harmonising existing policies, protocols, plans, strategies and legislation in partner states on the prevention, treatment, care and management of HIV/Aids.
The EAC deputy secretary general (Productive and Social Sectors) Mr Jean Claude Nsengiyumva, says the aim is to attain an HIV/Aids free population. He explains that the HIV/Aids challenge is cross-cutting and multi-sectoral in character, and hence needs concerted efforts by all key stakeholders.
Mr Nsengiyumva explains that the EAC Treaty puts strong emphasis on joint regional strategies and interventions for the prevention and control of HIV/Aids in EAC partner states.
He says the EAC plays a coordination role for activities within the partner states in support of the existing national policies on the pandemic. He reveals that partner states were currently undertaking joint action towards the prevention and control of communicable and non-communicable diseases. They include HIV/Aids that endangers the overall health and welfare of citizens of EAC member countries.
He notes that HIV/Aids poses a serious threat to sustainable development in the region and the integration agenda. "The focus is on the prevention of HIV/Aids, care and the mitigation of its impact in order to ensure sustainable human development within partner states," said Mr Nsengiyumva.
The EAC official noted that the disease affects everyone, irrespective of the status in society. Generally governments cannot undertake this initiative of fighting the pandemic alone, and thus arises the need to seek private sector partnerships. In this regard, he says the EAC, being people-centred and private sector driven, is partnering with private sectors through the East African Business Council to promote and achieve an HIV/Aids free population.
In an effort to stimulate corporate response to HIV pandemic, Mr. Nsengiyumva says the East African Business Council organized a regional CEO Testing Day on November 11, 2010.
The event was simultaneously carried out in each of the five capital cities across East Africa. The aim of CEOs testing for HIV/Aids was to ensure that the CEOs lead by example and also help reduce the stigmatization that is associated with HIV/AIDS, especially at workplaces.
It also aimed at making HIV/Aids testing a routine activity to reduce the spread of the disease. It involved full service with pre- and post-test counseling. The World AIDS Day kicked off in 1988 for the purpose of increasing awareness, raising funds, fighting prejudice and improving HIV/Aids education.
National Week against HIV-AIDS on November 15. 5/11/10
National Week against Hiv/Aids from November 15 to December 15.
5 November 2010
Namibe — The Angola National Network of Hiv/Aids Services Organisations (ANASO) in southwestern Namibe province will run the National Week against Hiv/Aids from November 15 to December 15.
This was announced by ANASO's Namibe representative, Samuel Carvalho, who told Angop that the event will include a solidarity march, Stop Sida campaigns, lectures, debates, visits to hospitals and homes, as well as a fund raising gala.
Samuel Carvalho informed that the activities aim at raising people's awareness about the dangers of sexually transmitted diseases, the impact of Hiv/Aids on women, families and communities. The dissemination of information on commitment statement and law on Hiv/Aids, promotion of love and solidarity with people living with the virus are some of the purposes of the event.
According to Samuel de Carvalho, the event will take place in the districts of Namibe and Tombwa, including fairs of services linked to Hiv/Aids and great endemics. The Angolan National Network of Hiv/Aids Services Organisations is a pool of non-governmental forums and organisations involved in the fight against the disease.
It was established in August 1994 and seeks to be a response of member organisations to Hiv/Aids in the country. It gathers 278 member organisations.
Massive TB Breakthrough Unaffordable. 11/11/2010
AIDS activists are calling for the price of a machine which drastically cuts the diagnosis of drug-resistant tuberculosis to be reduced
By Anso Thom
11 November 2010
AIDS activists are calling for the price of a machine which drastically cuts the diagnosis of drug-resistant tuberculosis to be reduced making it affordable to the regions where the epidemic is most serious, including South Africa. The development of the Gene Xpert is hailed as one of the greatest breakthroughs in TB control.
Activists yesterday (THURSDAY) handed over a letter to Cepheid, the company which manufactures the Gene Xpert, at the 41st Union Conference on Lung Health in Berlin, Germany, calling for the price of the U$30 000 machine to be reduced.
The Gene Xpert is able to detect active TB and rifampicin (one of the main TB drugs) resistance within 90 minutes. The current test, which involves culturing the bacteria in the sputum at a laboratory, takes up to six weeks and in this time the patient is not receiving any treatment. The patient's sputum sample is gathered in a bottle, a buffer fluid is added, the sample is transferred to a cartridge which is placed in the machine. The operator pushes a button and a result is gained 90 minutes later.
Ironically, the news of the Gene Xpert comes 100 years after the death of one of Berlin's most famous sons, Robert Koch who first identified the TB bacteria using a microscope as well as the method of growing it in pure culture - the mainstay method of TB diagnosis in the world.
Dr Mark Perkins, Chief Scientific Officer of FIND, which collaborated with Cepheid, said the Gene Xpert was a "revolution in diagnostics for TB".
He urged activists "who protested for antiretrovirals to do to the same for TB" adding that it was critical to find ways to make a TB test as easy as a pregnancy test.
Perkins agreed that the technology had to be made less expensive adding that they were negotiating with Cepheid in the hope that the price could be reduced as volumes increased and that "generic" diagnostics could be developed at a much lower cost.
According to activists the current price at which Cepheid is intending to sell the Gene Xpert is in the region of U$20 000 to U$30 000, a small version of the machine which can take four non-reusable cartridges at a time. Each cartridge will sell for between U$20 and U$30.
Professor Anthony Harries, world renowned TB expert and Senior Advisor at The International Union Against Tuberculosis and Lung Disease said the development of the Gene Xpert was the first real advance of TB in 20 years. "A real milestone," he said.
He said he believed the machine, which currently needs an electricity supply, could be made simpler and cheaper adding that he hoped manufacturers would step up to the plate and do their bit for social good rather than commercial good.
The letter contained the signatures of among others the Treatment Action Campaign, the Treatment Action Group, the Southern African HIV Clinicians Society, SECTION27 (incorporating the AIDS Law Project) and the European AIDS Treatment Group
Mass Rape in Africa Ups HIV Spread. 1/10/10
10,000 girls and women could be infected with HIV in Congo each year
1 October 2010
The widespread rape of women and girls in the Democratic Republic of Congo and other conflict-torn African nations could be spurring a significant number of new HIV infections, a new study suggests.
Using a statistical model, researchers estimated that as many as 10,000 girls and women could be infected with HIV in Congo each year as a result of mass rape, assuming "extreme" levels of sexual violence. That figure could be as high as 20,000 in Uganda.
The findings, reported in the journal AIDS, point to one more consequence of the long-running armed conflicts in a number of sub-Saharan African nations.
In Congo alone, it's estimated that war has left more than 5 million dead since 1998. Although the nation held successful elections in 2006, violence simmers in much of the east, where both rebel and government army units roam, often looting and targeting civilians.
1,000 women raped per month
Women and girls have often been the victims. According to a UN report, more than 1,000 women were raped each month in Congo between November 2008 and March 2009. But since many rapes go unreported, the actual numbers could be much higher.
Sub-Saharan Africa is home to the greatest number of armed conflicts in the world, with many of the affected nations also having a high prevalence of HIV, the researchers on the new study note in their report.
That combination means that systematic rape could be helping to fuel the spread of HIV. But actual data have been lacking - in part because the true prevalence of rape in these war-torn areas is difficult to pin down.
For their study, researchers led by Virginie Supervie of the French national research institute INSERM created statistical models to try to estimate the impact of mass rape on HIV rates in Congo, Uganda, Burundi, Rwanda, Sierra Leone, Somalia and southern Sudan.
High prevalence of HIV
All of those areas have a high prevalence of HIV, and mass rape has occurred in each.
The researchers used survey data on rape prevalence, studies on the prevalence of HIV among military forces in the countries, and other sources to estimate the probability of HIV transmission through mass rape.
According to their calculations, Somalia and Sierra Leone would have the fewest transmissions. The median, or midpoint, number of annual infections due to rape would be 127 and 156, respectively.
Congo and Uganda would see the highest numbers - where, according to Supervie's team, a median of 1,120 and 2,172 women, respectively, could be infected each year.
But under "extreme conditions" - assuming 15% of girls and women between the ages of 5 and 49 were raped - as many as 10,000 females in Congo and 20,000 in Uganda could become infected with HIV per year, the researchers estimate.
Research suggests that the prevalence of mass rape in armed conflicts does reach such levels. Supervie's team points to a study of sexual violence against women during Liberia's civil war of the 1980s and 90s; 15% of women said they had been raped or sexually coerced.
These latest findings, the researchers write, underscore the urgent need for support services for rape victims in these countries, as well as medical interventions - including anti-HIV drugs that, taken shortly after an assault, could prevent infection.
However, getting such resources into conflict-torn countries, and then to the women who need them, remains a huge obstacle.
"Even raising the issue of rape in conflict situations can itself prove hazardous," Supervie and her colleagues write.
Women reluctant to report
In the Darfur region of Sudan, for example, women historically could be imprisoned for reporting rape, as could any healthcare provider who helped them. That policy changed in 2005, but many women remain reluctant to come forward, and health workers afraid to treat them, Supervie's team points out.
A report last year from the international humanitarian group Doctors Without Borders (Medecins Sans Frontieres) listed violence against civilians and lack of access to any healthcare in Congo, Somalia and southern Sudan among its top 10 humanitarian crises of 2009.
Also making the list was what the group described as "stagnant" funding for HIV/AIDS treatment in Africa and other areas where the infection is epidemic. The report said that in some African nations, people seeking HIV/AIDS medication are being turned away from clinics. (Reuters Health/ October 2010)
New Cause Suggested for High African HIV Rates. 29/9/10
Kenyan women have more "activated" cells, which are more vulnerable to attack by HIV
By David Njagi And Naomi Antony
29 September 2010
Nairobi — Malaria, and other common African infections, may make women more susceptible to HIV/AIDS than they are in the developed world, according to a study that may help solve the mystery of the vastly different infection rates around the globe.
Researchers who compared immune cells in the genital tracts of women in Kenya and the United States, found that Kenyan women had more "activated" cells, which are more vulnerable to attack by HIV. Cells can become activated as a reaction to infection.
It is the first time that scientists have shown that immune cells in the genital tract are more activated in African women, though higher activation elsewhere in the body has already been demonstrated. The activation may be an "important additional contributor" to the high infection rates in African women, according to the scientists, led by Craig Cohen, of the University of California, San Francisco, in the United States.
"We believe that these findings should also start to dispel some of the preconceptions and stigma surrounding HIV acquisition among young women in Sub-Saharan Africa," said the authors, writing in the journal AIDS.
The scientists compared CD4 cell counts - an indicator of immune system strength - of women aged 18-24 years in San Francisco, with those from Kisumu, Kenya. They found that Kenyan women had more activated CD4 cells. The researchers controlled for other genital infections and sexual behaviour, which are therefore unlikely to be an explanation of the increased activity.
They say that it is possible that other "systemic" infections, such as malaria, that affect the whole body, might cause the increase. Another possible cause is schistosomiasis and similar infections that occur at other mucosal sites in the body. It is also possible that there is a genetic cause.
"Although it has been suggested that reasons for the discrepancy in HIV seroprevalence include higher prevalence of sexually transmitted infections ... as well as structural and sociocultural factors, for the first time our observations suggest that differences in the genital tract immune milieu may be an important additional contributor," said the team.
François Venter, head of the HIV management cluster at the Reproductive Health and HIV Research Unit, University of the Witwatersrand, South Africa, said: "[The study] is exciting, and hopefully will start to answer why the epidemic is so bad in our region - 70 per cent of the entire world's population of HIV-infected people live in Sub-Saharan Africa.
"We've had many theories around culture, behaviour and biology, but none has proven adequate alone to explain this disproportionate vulnerability to infection. This research may help provide some, if not all, of the answers."
Carolyn Deal, chief of the sexually transmitted diseases branch of the National Institute of Allergy and Infectious Diseases, United States, said the study's strength lay in its detailed immunological tests. It "fits into what is an ongoing discussion and a growing recognition that there are differences [in HIV infection rates] in different geographic regions".
But Caroline Kabiru, an associate research scientist with the African Population and Health Research Center, Kenya, said: "Beyond the biological factor, women are more vulnerable due to poverty. It means we need to provide programmes where women can have alternative methods of raising their livelihoods so that they are not turning to sex."
New HIV Infections Down in Sub-Saharan Africa. 19/9/10
East African Community member states have made good progress in increasing access to primary education.
19 September 2010
Pretoria — Twenty-two countries in Sub-Saharan Africa have reduced new HIV infections by more than 25 percent, according to new UNAIDS data on the progress made towards Millennium Development Goal (MDG) 6.
The data released ahead of the United Nations Summit on the MDGs from 20 to 22 September 2010, showed that countries with the largest epidemics in Africa including Côte d'Ivoire, Ethiopia, Nigeria, South Africa, Zambia and Zimbabwe, are leading in the reduction of new HIV infections. MGD 6 aims to combat HIV/AIDS, malaria and other diseases
Between 2001 and 2009, according to the data, the number of new HIV infections steadily fell or stabilised in most parts of the world.
"We are seeing real progress towards MDG 6, for the first time change is happening at the heart of the epidemic, in places where HIV was stealing away dreams, we now have hope," said UNAIDS Executive Director Michel Sidibé.
The data showed that there are now 5.2 million people on HIV treatment and that AIDS deaths have dropped significantly since the widespread availability of treatment. There were 200 000 fewer deaths in 2008 than in 2004.
"Young people are leading the prevention revolution by choosing to have sex later, having fewer multiple partners and using condoms, resulting in significantly fewer new HIV infections in many countries highly affected by AIDS."
Among adults, male condom use has doubled in the past five years and tradition is giving space to pragmatism as communities embrace male circumcision.
The research showed that male circumcision has the potential to reduce HIV infection among men by nearly 60 percent and new HIV prevention research reported efficacy in a microbicide controlled and initiated by women.
Sidibé noted that many continents like Asia, where the epidemic is concentrated among high-risk populations, are showing good progress in the AIDS response with China scaling up access to harm reduction programmes for people who use drugs.
Data from its national sentinel surveillance showed that the percentage of drug users who used sterile injection equipment the last time they injected drugs increased from 40.5 percent in 2007 to 71.5 percent in 2009.
"South Africa is rapidly accelerating efforts to achieve universal access to HIV prevention, treatment, care and support, and the new HIV infections among adults and young people have dropped by more than 25 percent and record numbers of women are accessing treatment to prevent mother-to-child transmission of HIV from previous years.
"The country has also significantly increased its domestic investments for the AIDS response in the current fiscal year," Sidibé said.
However, the data showed that in Eastern Europe and Central Asia, which continue to have expanding HIV epidemics, and in several high-income countries, there has been a resurgence of HIV infections among men who have sex with men.
It also showed that in many low- and middle-income countries, the lack of resources is seriously hampering the scale up of programmes.
Sidibé said that to sustain the gains that have been made, further investments in research and development are needed, not only for a small wealthy minority, but also focused to meet the needs of the majority.
"At this turning point flat-lining or reductions in investments will set-back the AIDS response and threaten the world's ability to reach MDG 6," said Mr Sidibé, adding that investing in the fight against HIV and AIDS is a shared responsibility between development partners and national governments.
The UNAIDS recommended that national governments allocate between 0.5 percent and 3 percent of government revenue on HIV, depending on the HIV prevalence of the country.
Liberians Shun Condoms. 15/9/10
Condom use at first sex is rare
15 September 2010
Despite medical warnings that unprotected sex is a major cause of being infected with STIs, including HIV/AIDS, there is low condom use in Liberia and unprotected sex is the norm, rather than the exception, especially among the most sexually active youthful population, according to Dr. Ivan Camanor, executive director of the National AIDS Commission.
He says the LDHS (Liberia demographic housing survey) shows that condom use at first sex is rare, and only 6% among young people age 15-24 years who ever had sexual intercourse, used a condom during their first sexual intercourse.
In the National HIV AND AIDS Strategic Framework II for 2010-2014, Dr. Camanor reveals that only 14% of women, who reported having had higher-risk intercourse in the past 12 months, used a condom at the last higher-risk sex.
Concerning drivers of HIV/AIDS in Liberia, the document reveals causal links affecting the prevalence of HIV and AIDS in the country are "not known and the true picture of its drivers here is not clear because no mapping of high risk groups has as yet been carried out".
High-risk groups to be determined are globally defined high risk groups such as IDPs and refugees, who constitute a significant proportion of Liberia's population, uniformed persons, long distance bus and truck drivers, and commercial sex workers, men having sex with men and prison populations.
But no studies have been conducted on the level of transactional sex and intergenerational sex that is commonplace urban areas.
Nation Launches National Strategic Framework on HIV-AIDS. 9/8/10
"We thought AIDS was from outside."
9 August 2010
The National AIDS Commission of Liberia on Thursday, August 5, launched the National HIV and AIDS Strategic Framework 2010-2014 at the Monrovia City Hall. The National Strategic Framework was launched on behalf of President Ellen Johnson-Sirleaf, who is also the Chair of the National AIDS Commission, by Dr. Edward McClain, Minister of State for Presidential Affairs.
The National HIV and AIDS Strategic Framework 2010-2014 will provide a framework for efforts aimed at preventing the spread of HIV and mitigating its impact on society. The two main goals of the five-year National Strategic Framework include: containing HIV prevalence among the general population to below 1.5 percent by 2014, and mitigating the impact of the epidemic on the health and wellbeing of persons infected and affected by HIV.
"Those who are HIV positive and have come forward to say we are part of the solution are our heroes," said Dr. McClain. "We must create an environment where we can in earnest contain the spread of HIV at 1.5% and begin reversing it by 2015."
The Liberia Demographic and Health Survey (LDHS) of 2007 shows an HIV rate of 1.5 percent among the general population aged between 15-49, indicating a low-level, generalized epidemic. However, the HIV rate among women is higher (1.8 percent) than among men (1.2 percent), revealing women's higher vulnerability to HIV infection. Experts have warned that Liberia needs to increase the intensity and coverage of HIV prevention and care efforts to avert an epidemic of Eastern and Southern African proportions.
Speaking on behalf of the UN Family, Deputy Special Representative of the Secretary-General for Rule of Law, Ms. Henrietta Mensa-Bonsu said "the prevalence of HIV in Liberia may be low. However, HIV steadily marches on, and now, rather than later, is the best time for us to rally behind Liberia in preventing the HIV from spreading. We cannot allow Liberia to suffer such a fate, in addition to the challenges of extreme levels of poverty and unacceptably high levels of sexual and gender based violence."
"I restate the UN system's commitment to supporting the National AIDS Commission's goal of 'Zero Discrimination, Zero new HIV infections and Zero AIDS related deaths' in Liberia," she added.
In special remarks at the launch, Dr. Ben Chirwa, Director General of the National AIDS Council of Zambia, related that "Liberia has 3000 people on HIV treatment. Zambia has 100 times (300,000 people) the number that Liberia has on treatment." Dr. Chirwa, sponsored by UNAIDS to share experiences with the National AIDS Commission of Liberia, said "this is because Zambia was complacent. We thought AIDS was from outside."
Giving the vote of thanks, Dr. Ivan Camanor, National AIDS Commission Executive Director thanked the National Steering Committee of the National AIDS Strategic Framework that has worked on the document for over 3 years for having brought it to a successful conclusion and setting the platform for implementation.
Key activities under the National Strategic Framework will involve improving the coverage and quality of existing prevention, care and treatment services, as well as strengthening the involvement of non-health government sectors, civil society and the private sector in efforts to prevent the spread of HIV and respond to its effects.
The Government and its partners have taken critical steps towards a national and cross-sectoral response to HIV and AIDS in Liberia. A Secretariat for the National AIDS Commission has been established, the National Strategic Framework has been finalized, while a number of other initiatives are underway, including prevention of mother to child transmission efforts, strengthening of blood safety, provision of post-exposure prophylaxis and condoms, and awareness raising.
Other government personalities who participated in the launch were Ministers of Health & Social Welfare, Labor, Gender & Development, Youth &Sports and Education
Liberia Launches Strategic Framework on HIV and AIDS. 6/8/10
National Strategic Framework was launched by Dr. Edward McClain
6 August 2010
Monrovia: The National AIDS Commission of Liberia on Thursday, August 5, launched the National HIV and AIDS Strategic Framework 2010-2014 at the Monrovia City Hall.
The National Strategic Framework was launched by Dr. Edward McClain, Minister of State for Presidential Affairs, on behalf of President Ellen Johnson-Sirleaf, who is also the Chair of the National AIDS Commission.
The National HIV and AIDS Strategic Framework 2010-2014 will provide a framework for efforts aimed at preventing the spread of HIV and mitigating its impact on society. The two main goals of the five-year National Strategic Framework include: containing HIV prevalence among the general population to below 1.5 percent by 2014, and mitigating the impact of the epidemic on the health and well-being of persons infected and affected by HIV.
“Those who are HIV positive and have come forward to say we are part of the solution are our heroes,” said Dr. McClain. “We must create an environment where we can in earnest contain the spread of HIV at 1.5% and begin reversing it by 2015.”
The Liberia Demographic and Health Survey (LDHS) of 2007 shows an HIV rate of 1.5 percent among the general population aged between 15-49, indicating a low-level, generalized epidemic. However, the HIV rate among women is higher (1.8 percent) than among men (1.2 percent), revealing women’s higher vulnerability to HIV infection.
Experts have warned that Liberia needs to increase the intensity and coverage of HIV prevention and care efforts to avert an epidemic of Eastern and Southern African proportions.
Speaking on behalf of the UN Family, Deputy Special Representative of the Secretary-General for Rule of Law, Ms. Henrietta Mensa-Bonsu said, “The prevalence of HIV in Liberia may be low. However, HIV steadily marches on, and now, rather than later, is the best time for us to rally behind Liberia in preventing the HIV from spreading. We cannot allow Liberia to suffer such a fate, in addition to the challenges of extreme levels of poverty and unacceptably high levels of sexual and gender based violence.”
“I restate the UN system’s commitment to supporting the National AIDS Commission’s goal of ‘Zero Discrimination, Zero new HIV infections and Zero AIDS related deaths’ in Liberia,” she added.
In special remarks at the launch, Dr. Ben Chirwa, Director General of the National AIDS Council of Zambia, related that “Liberia has 3000 people on HIV treatment. Zambia has 100 times (300,000 people) the number that Liberia has on treatment.” Dr. Chirwa, sponsored by UNAIDS to share experiences with the National AIDS Commission of Liberia said “this is because Zambia was complacent. We thought AIDS was from outside.”
Giving the vote of thanks, Dr. Ivan Camanor, National AIDS Commission Executive Director, thanked the National Steering Committee of the National AIDS Strategic Framework that has worked on the document for over 3 years for having brought it to a successful conclusion and setting the platform for implementation.
Key activities under the National Strategic Framework will involve improving the coverage and quality of existing prevention, care and treatment services, as well as strengthening the involvement of non-health government sectors, civil society and the private sector in efforts to prevent the spread of HIV and respond to its effects.
The Government and its partners have taken critical steps towards a national and cross-sectoral response to HIV and AIDS in Liberia. A Secretariat for the National AIDS Commission has been established, the National Strategic Framework has been finalized, while a number of other initiatives are underway, including prevention of mother to child transmission efforts, strengthening of blood safety, provision of post-exposure prophylaxis and condoms, and awareness projects.
Other government personalities who participated in the launch were Ministers of Health & Social Welfare, Labor, Gender & Development, Youth & Sports and Education
Need for African Govts to Increase Health Spending. Living with AIDS # 441. 29/7/10
South Africa is spending 8.5% of the GDP on health.
By Khopotso Bodibe
29 July 2010
At the recent International AIDS Conference in Vienna, Austria, Health Minister Dr Aaron Motsoaledi appealed to donors to desist from cutting aid to support AIDS programmes in sub-Saharan Africa. The irony of his call, however, is that countries in Africa are not increasing their spending on health.
In 2001 at a meeting in Abuja, Nigeria, African countries committed to increase their expenditure on health to 15%. But to date, most African countries spend between 8% - 9% of their Gross Domestic Product (GDP) on health. Only a few countries such as Malawi have honoured the commitment. While they are delaying to improve their health spending, African governments are asking donor nations and agencies to sustain and increase their financing of AIDS programmes. As for South Africa, although it has the highest health budget than any other African country, it also falls far short of meeting the 15% target.
“South Africa is spending 8.5% of the GDP on health. It’s much higher than even the recommendation of the World Health Organisation. In Africa, we are spending more than all of them, but even in the other developing parts of the world, we are spending more than those countries”, says Healyth Minister, Dr Aaron Motsoaledi.
However, the money that South Africa spends on health does not produce better health outcomes. This has raised important questions that have impacted negatively on the allocation of funds for health spending.
“There is something that we are doing wrong. We have got poor outcomes regardless of spending more money than other countries”, Motsoaledi says.
“There was a very disturbing altercation between the Department of Health and the Finance Department, whereby the Health Department believed it is grossly under-funded and the Finance Department said: ‘You are well-funded, but mismanaging’. And I’m supposed to pronounce on that. My pronouncement is that it’s a mixture of the two. There was some bit of under-funding over the years of the public health care system, but there was also gross mismanagement”, he adds.
That is a double-edged sword South Africa is facing. The country has one of the highest rates of maternal, child and infant mortality and Tuberculosis and HIV infection. Increasing the health budget to 15% in the short-term seems improbable and without outside help, South Africa will not be able to nurse the health of its people, especially in the face of an HIV and AIDS epidemic that is not yet under control.
“Even if we look at South Africa, which is probably the richest country in the area, even South Africa, to realise its very good ambitious plan for the HIV fight, they will have to rely, also, in part on international funding”, says Dr Mit Philips, a health policy analyst with Medecins Sans Frontiers (MSF) a humanitarian health care agency, which is spear-heading the call for donors and rich nations to maintain their support of AIDS programmes in Africa.
An audit conducted by the MSF in eight African countries shows that international support for AIDS programmes is waning. Donor agencies including the Global Fund to fight AIDS, TB and Malaria and the US President’s Emergency Plan to fight AIDS (Pepfar) have, in recent years, reduced or kept their funding for AIDS programmes unchanged.
Many have cited the recent recession as the reason for the pulling out of resources. Another school of thought is that donors no longer view HIV and AIDS as a priority. Whatever the reason is the fact is that some regions of the world, especially southern Africa, are still in the tight grip of AIDS. As donors withdraw or reduce support, these governments need to fill the short-fall in funding.
“The resources needed for ARV scale-up will have to increase. The countries themselves in Africa have an important role in there to put money for the HIV fight. But the economic crisis has also hit Africa and several of them see the possibility to increase their budget to compensate for the international funding decrease as reduced. In most of the other low-income countries it’s simply impossible to replace the international funding on the short-term. For the moment there is about 75% of the HIV funding that is paid from international sources”, says Philips.
With the help of Pepfar and the Global Fund, which gets its money through pledges from rich countries, about three million people in poor nations now have life-prolonging antiretrovirals. But five million more are still in need. Waning donor support spells gloom for them. People living with AIDS say this is all the more reason that poor nations have to up their health budgets.
“In Kenya, the commitment to health care is about 8% - 9% only. We still urge our governments and we still fight so that our governments take care of our lives. While this is happening, our President (and) our Prime Minister are earning more money per month than the British Prime Minister, and yet the standard of living in Kenya is way below the standard of living in the UK. Why should they vote themselves so much money when we are dying? Our argument is we want our governments (and) our politicians to be committed to the health of the people”, says Jimmy Gidey, an AIDS activist from Nairobi, Kenya.
The African Union held a heads of state summit in Uganda this week. It was expected that it will pronounce on making progress towards reaching targets they adopted in 2001 in the Abuja Declaration to increase health spending to 15%. Host leader, president of Uganda, Yoweri Museveni, said “Africa has struggled to get resources”. He urged heads of states and governments to “look for multiple and cheaper ways to deliver health services”.
Preparing for the Worst. 01/03/2010
JOHANNESBURG, 1 March, (PLUSNEWS) - When a crisis strikes, access to antiretroviral (ARV) drugs can be among the first casualties, particularly in countries where many people are on treatment.
But experience in Southern Africa has shown that although preventing treatment disruptions may be wishful thinking, preparing for them has become a pressing need.
New research by the Health Economics and HIV/AIDS Research Division (HEARD) at South Africa's University of KwaZulu-Natal compared three recent crises that caused treatment disruption - Mozambique's 2008 floods, Zimbabwe's ongoing public healthcare crisis, and South Africa's 2007 public sector strike - to identify potential strategies for keeping patients on treatment during emergencies.
The HEARD report, Unplanned ARV Treatment interruptions in southern Africa: what can we do to minimise the long-term risks?, identified poor planning as the biggest weakness in responding to gaps in treatment access, and suggested that doctors and patients receive better training on what do during disruptions.
"Despite crises - whether political, economic or environmental - being relatively common in southern Africa, there has been very little systematic planning for them within ARV programmes," said HEARD's Andy Gibbs, who co-wrote the report. The region's weak health systems were often the cause of disruptions.
"Strong health systems have strong planning capacity, an ability to monitor what's happening and [to mobilize] the skills and resources to cope with unexpected issues," Gibbs said. Research has linked disrupted treatment to increased risks of drug resistance and treatment failure.
Weathering the storm
Southern Africa has some of the highest HIV prevalence rates in the world, while droughts, floods and cyclones typically spark humanitarian emergencies in this chronically vulnerable region. The Southern African Development Community (SADC) has pushed member states to integrate ARV treatment into national disaster preparedness planning.
The UNAIDS regional humanitarian response advisor for East and Southern Africa, Mumtaz Mia, said Mozambique, Zimbabwe and Namibia had taken the lead in ensuring that people did not miss ARV doses amid disasters.
Mozambique experienced some of the worst flooding in the country's history in 2007, and more than 56,000 people were affected by floods in 2008, but Mia noted that planning by UNAIDS, the national AIDS council and the National Institute for Disaster Management had helped minimize treatment disruptions.
HEARD found that Mozambique had mapped the location of ARV patients in flood-prone areas, and had educated community outreach workers in the vicinity in ARV provision ahead of the devastating floods in 2008.
Dr Mit Philips, a health policy analyst at the international medical and humanitarian organization, Medicines Sans Frontiers (MSF), pointed out the importance of giving patients information before and during treatment interruptions. MSF has been working in Mozambique, Zimbabwe and South Africa, and also provided ARV treatment during Kenya's 2008 post-election violence.
"When the [post-election violence] happened in Kenya, we set up a free hotline, we used radio spots and peer networks so that patients knew how to find us to pick up their pills and continue treatment," she told IRIN/PlusNews.
"You don't need to go and find patients, you need to make sure patients know how to go and find you. If you can foresee it, it's important that the patients know how to deal with possible disruptions at their usual health centres - it should be part of treatment literacy."
When the public sector isn't so public
In 2007, South Africa was rocked by a public servant strike that lasted for a month and affected up to half a million employees, including health workers. Data from South Africa's Gauteng Province showed that the number of patients initiated on treatment in areas like Johannesburg's inner city dipped to one of the lowest in four years.
Testimony gathered in the Western Cape Province by Treatment Action Campaign, an AIDS lobby group, showed that during the strike some pharmacies were so short-staffed they were only able to fill 25 percent of orders.
Patients and doctors used varying coping strategies to deal with the treatment disruptions and the South African HIV Clinicians Society released guidance on how to cope with treatment interruptions. Some patients were able to get more than one month's supply of drugs.
HEARD researchers argued that the South African authorities could have foreseen such an interruption and provided both patients and doctors with better training on what to do when ARVs cannot be obtained.
In Zimbabwe ARV treatment in the public health sector has also seen its share of hard times. The economic crisis sparked migration among doctors and nurses as well as patients, while hyperinflation and high levels of unemployment meant the tests required before starting ARVs were often unavailable or prohibitively expensive.
To help migrants continue treatment in other countries, MSF gives patients portable copies of their medical records, including which ARV regimen they are on.
SADC has received funding to implement a similar regional "health passport" system, but national health ministers would have to get draft legislation passed to implement it. Access to treatment, even for documented migrants like asylum seekers and refugees, is problematic.
Funding flows pose their own threat
MSF's Philips said interruptions in financial flows posed as big a threat to ARV programmes as any flood or bout of civil unrest, and might become a threat of increasing importance as HIV and AIDS funding constricted in the global financial crisis.
"What we have been seeing in the last six months to one year are increasing disruptions to programmes ... many of these are due to delays in funding, or delays in the supply chain," she commented. "IN a way, it's more difficult to prepare for these [than for natural disasters] because the information on the risk of treatment disruption isn't always shared with implementing partners in a transparent way ahead of time."
In 2009, South Africa's Free State Province experienced widespread treatment disruption due to a combination of funding problems and allegations of poor management.
Philips noted that several countries including Malawi, Mozambique and Uganda had experienced problems with funding or drug procurement, and were more vulnerable to disruptions not only because of weak health systems but also because of a heavy reliance on a single funding source. According to an MSF report, Punishing Success, the bulk of Malawi's ARV funding as of 2009 came from the Global Fund to Fight AIDS, Tuberculosis and Malaria.
"What we are seeing is that quite a lot of donors seem to see the Global Fund as a main channel of international funding for HIV treatment. If there is only one channel and something happens, there's nothing you can do," she said. "Countries depend on the timely arrival of supplies; when money for drugs was delayed in Malawi, there was no buffer."
Few countries carry ARV buffer stocks - surplus drugs kept aside and used in the event of a drug shortage. Philips said this strategy was successfully employed in the Democratic Republic of Congo, which put a pool of donor-funded ARVs under World Health Organization management.
Fareed Abdullah, director of the Fund's Africa Unit, said the Global Fund had begun addressing funding delays after the issue was raised at the organization's highest level.
"Clearly, the reasons behind stock-outs are multi-factorial, and responsibility for them lies with various donors and implementing agencies, not least of all, governments," he told IRIN/PlusNews. "Having said that, there are certainly a number of steps within our financing process where the Global Fund considers the risk of drug stock-outs."
The Fund offers countries emergency disbursements to cover unexpected treatment shortages, and allows two years of gap funding to cover ARV treatment specifically, between grant disbursements, Abdullah said. The Fund has also taken on additional responsibilities in an effort to reduce treatment disruptions due to problematic procurement.
"Sometimes we finance drugs that make their way to the central store, and they don't get from the central store to the clinics - that's really for countries to address, alongside implementing partners," Abdullah commented.
"However, in some countries we have a failure of procurement and, even though we have resisted taking over those functions because we believe in country ownership, we now have a mechanism where we will procure drugs for a country."
Proposed Law Comes to the Aid of People Living with HIV. 28/2/10
The rights of people living with Aids could get a boost once a Bill that seeks to secure them becomes law.
28 February 2010
The rights of people living with Aids could get a boost once a Bill that seeks to secure them becomes law.
The East Africa HIV Prevention and Management Bill seeks to correct errors in current laws which criminalise the transmission of the virus.
The draft Bill is set for debate at the East Africa Legislative Assembly’s next sittings in Kigali, Rwanda, in April.
According to Mr Joe Muriuki of the HIV Aids Tribunal, the Bill requires member states to provide protection guarantees for the rights of people infected with the virus.
“The greatest challenge in the fight against the scourge has been curtailing of the rights of those who live with the virus. It’s not uncommon to find widows being disinherited once their spouses pass on,” said Mr Muriuki.
He was speaking on Friday at Silver Springs Hotel in Nairobi during a meeting to find ways of addressing the continued violation of the rights of people infected with HIV.
The tribunal, established under the HIV and Aids Prevention and Control Act of 2006, provides a forum through which those discriminated against by relatives or the public can seek redress.
Stigmatisation and discrimination of persons infected and affected by the virus remain some of the greatest impediments to open discussions on HIV and Aids. In the region, only Kenya and Tanzania have laws governing the fight against the HIV/Aids pandemic under an Act of Parliament whereas other countries have theirs at various stages of formulation.
Mr Muriuki said the Bill sought to provide a model law designed to be a reference point for all laws relating to the scourge at country level.
“It’s the desire of the region to carry out coordinated activities aimed at preventing the disease from spreading further,” he added.
The Act, although in operation, has some sections of it suspended, and civil society groups at the Friday meeting called for their speedy enforcement.
According to advocate Allan Maleche, section 18 which makes provision for the confidentiality of the results of an HIV test, is not operational.
“What happens in situations where one spouse forces the other to take the test and demands to know the results?” he asked.
For persons living with the virus in Kenya, the only consolation for now is that the section that criminalises the transmission of the disease is suspended, says Mr Muriuki.
“The Bill, once it becomes law, renders such provisions ineffectual and should subsequently be expunged from the Act,” he said.
“The provisions of the Act, if well enforced, will definitely enhance the ability of persons living with HIV to enjoy their social-economic rights,” said Mr Maleche.
Delay in the full enactment of the Act has been blamed on resistance from international organisations and agencies supporting biomedical research in the country, hesitant employers and some players in the insurance industry.
Judiciary Urged To Join Response Against AIDS. 18/02/10
The legal fraternitys is being called upon to play a meaningful role in the response to AIDS, especially to combat prejudice and discrimination against people living with HIV and AIDS.
The legal fraternity is being called upon to play a meaningful role in the response to AIDS, especially to combat prejudice and discrimination against people living with HIV and AIDS.
Many an African country’s Constitutions claim that everyone is equal before the law. But in the face of HIV, some African countries use the law to discriminate against their own citizens. At least 18 countries in sub-Saharan Africa have laws that criminalise the transmission of HIV. In addition, some countries have laws or are tabling laws that criminalise same sex relations, drug use and sex work. A case in point is Uganda, which has attracted criticism from the international community with its proposed “Anti-Homosexuality Bill”. The Bill calls for the life imprisonment of people involved in homosexual acts and the death penalty for HIV-positive people who commit what the Bill calls “aggravated homosexuality”. This has raised concerns that such laws will hamper national HIV prevention and treatment efforts to reach marginalized groups. In response to this, the United Nations’ Joint Programme on HIV/AIDS (UNAIDS) has now started a series of consultative meetings with judges across Africa to sensitise them about how they can use the law to promote human rights and to protect high-risk groups such as homosexuals, men in prisons, sex workers and injecting drug users from punitive laws.
“In many countries we have either existing law that could be protective of HIV issues or we have very specific law that is either protective or punitive. In both cases we need the judges to take that law and ensure that it protects human rights in the context of HIV and that it reduces discrimination, reduces vulnerability to HIV infection and to the impact. But we don’t have enough judgments of this sort of progressive jurisprudence that would protect people in the context of HIV”, says Susan Timberlake, Human Rights and Law senior advisor for UNAIDS.
Traditionally, UNAIDS has worked with governments and parliaments in various countries to encourage them to employ scientifically-backed responses to HIV/AIDS. Now Timberlake says it’s crucial to target judges.
“Over the years of the epidemic we realise that the law and the legal environment are critical. So, this is all about supporting the judiciary to be leaders in the response against HIV, both in the courts when they are making judgments and outside the courts when they are community leaders”, she says.
The Chief Justice of Ghana, Georgina T. Wood admits that judges don’t have the necessary tools to enable them to join the response against AIDS.
“There is an urgent need for the judiciary and its partner institutions to be better educated on a broad spectrum of issues connected with the HIV pandemic. This is crucial… vital to better position us to interrogate complaints”, Wood says.
“They should also learn some of the commitments that the executive branch has made about what the role of the law should be to protect people living with HIV, to protect women against violence, to ensure that children have access to treatment, to ensure that vulnerable groups are not discriminated against and criminalized. The judges, potentially, can be incredibly powerful community leaders and national leaders if they are willing and able to speak out”, adds Timberlake.
But why is it important to protect the rights of people living with HIV/AIDS?
“If we don’t protect the rights of people living with HIV, then people living with HIV will go underground and they will not seek services for HIV testing, for counseling, for treatment and it will be very difficult for us to control the epidemic”, says Mark Heywood, head of South Africa’s AIDS Law Project.
Millions At Risk If AIDS Focus Fades, Says Expert. 05/02/10
Global attention is turning away from the AIDS epidemic at just the wrong time and means a fresh wave of the disease could infect millions of people in high-risk countries, a leading expert said Friday.
Alan Whiteside, director of the health economics & HIV/AIDS research division (HEARD) at Kwazulu Natal University said many African countries, where the disease poses the biggest threat, were failing to implement long-term prevention measures and needed help to plan for the battle ahead.
The AIDS threat is still very real in places like Swaziland, Lesotho, Botswana, Namibia, Zimbabwe, Zambia and Malawi and South Africa, he said, and a sense that the international community is ticking it off as "dealt with" is highly risky.
"(Fighting) the AIDS epidemic had a huge amount of support for many years, but there seems to be a perception now that it has been dealt with and we can turn our attention to other issues.
"This is most emphatically not the case in a number of parts of the world. It is not appropriate to turn our backs on it," Whiteside told Reuters in a telephone interview from South Africa, where the disease kills an estimated 1,000 people a day.
Some 33.4 million people in the world have HIV, the sexually transmitted human immunodeficiency virus that causes AIDS. Since AIDS emerged in the early 1980s, almost 60 million people have been infected and 25 million have died of HIV-related causes.
Sub-Saharan Africa is by far the worst affected region, accounting for 67 percent of people infected with HIV and 91 percent of all new infections in children, according to United Nations data.
HEALTH WORKERS, EDUCATION PROGRAMMES
Whiteside said health ministries needed to use aid funds now to equip and train health workers and produce safe-sex education programs to combine the importance of AIDS with a better grasp of the long-term impact of the disease on their countries.
The United States and South Africa recently pledged renewed efforts in the fight against AIDS,. In December the international health funding agency UNITAID approved plans for a drug "patent pool" to help make newer HIV and AIDS medicines available at lower prices to poorer countries.
But Whiteside said a growing sense that AIDS is no longer an emergency was bound to feed politicians' desire to be seen to be taking on new threats.
Climate change and the environment are the big issues now, and politicians may abandon the battle against AIDS, he said.
"At the moment, millions of Africans ore on HIV/AIDS treatment courtesy of the Americans, the Global Fund and other donors. Those treatments have to be for life, so if we see a redeployment of funding, people are simply going to die."
Whiteside pointed to "hyper-endemic" African countries like Malawi and Swaziland, where AIDS is so widespread that half of all women aged 25 to 29 have HIV or AIDS.
Prevention programs are crucial in such countries, he said, but are often patchy and suffer from governments' lack of leadership and cross-department, long-term vision.
Though clearly a personal and community disease, AIDS also threatens civil institutions like the health, agriculture and education sectors, which are needed to cut poverty, spur economic growth and raise living standards.
"We don't seem to have got our head around prevention in the hyper-endemic countries," he said. "We've still got new cases occurring -- and that's ridiculous, it's stupid, especially when you look ahead and see what that means in terms of the numbers of people that will need treatment. If we don't put our effort into prevention, we're likely to see more waves."
By Kate Kelland
(Editing by Tim Pearce)
Judges Join AIDS Fight. 11/12/09
Twenty-five years into the HIV epidemic, a multitude of laws, international guidelines and government commitments have been drafted to ensure the rights of people living with HIV, but few cases have found their way into the courts, and even fewer have led to successful outcomes.
JOHANNESBURG, 11 December, (PLUSNEWS)
"There is an epidemic of discrimination and human rights violations that exists around HIV," said Mark Heywood, director of the South Africa-based AIDS Law Project and deputy chairperson of the South African National AIDS Council. "If we don't protect the rights [of people living with HIV], they will go underground and it will be very difficult for us to control this epidemic."
Heywood was addressing senior judges from more than 15 sub-Saharan countries at the opening of a two-day meeting in Johannesburg to discuss how the judiciary could play a more significant role in the HIV response.
The 30 jurists attending will not only review HIV-related judgements from the region and meet local NGOs working on HIV and the law, but will learn about the latest science around HIV.
Ghana's Chief Justice, Georgina Wood, noted that a survey among her country's judiciary had revealed worrying levels of ignorance about how HIV was transmitted and apathy towards people living with the virus.
Susan Timberlake, Senior Advisor on Human Rights and Law at UNAIDS, agreed: "There is a lot of work to be done in educating the judiciary." UNAIDS organized the meeting in partnership with the UN Development Programme, the International Association of Women Judges, and the International Commission of Jurists.
Recent reports submitted to the UN on progress in reaching the goals of the 2001 Declaration of Commitment on HIV/AIDS indicated that only 45 percent of African countries had done any training to sensitize their judiciaries about HIV/AIDS.
Although 60 percent of the countries in Africa had passed laws to protect the rights of people living with HIV, Heywood noted that a much smaller proportion had mechanisms to help HIV-positive people obtain access to legal assistance. Affordability, geographic location, gender and education were all factors preventing them from taking cases to court.
"Court procedures can be intimidating for many applicants," said Heywood. Simplifying some of those proceedings, and reducing the cost and duration of trials could improve the situation, but would be of little use unless court orders were enforced.
Heywood cited the example of a 2006 South African judgement ordering access to antiretroviral treatment for HIV-positive prisoners. "The situation facing prisoners with AIDS in South African prisons is no better today than it was two years ago, despite the existence of clear court orders about the duties of the prison services to provide people with access to treatment."
In many African countries the legal system has actively worked against efforts to contain the spread of HIV by marginalizing and discriminating against the groups most vulnerable to infection.
Justice Georgina Wood said rates of HIV infection among men who have sex with men were rising rapidly in Ghana, but the criminalization of homosexuality prevented them from accessing HIV services, and encouraged the risky practice of maintaining female sexual partners to avoid detection.
In Uganda, where homosexuality is also illegal, a draft bill currently being debated would create the crime of "aggravated homosexuality", for which the death penalty could be imposed if the offender was HIV-positive or had sex with anyone under the age of 18.
"We're working very hard with the Ugandan authorities to try to get this law removed from consideration," Timberlake of UNAIDS told IRIN/PlusNews. She added that while judges were not responsible for passing legislation, "They can be powerful community leaders if they're willing to speak out."
Launch of ‘Securing Our Future’ Report on HIV/AIDS in Africa. 10/06/08
10 June 2008
HIV and AIDS must be at the centre of development strategies in Africa, Kenneth Kaunda, former President of Zambia and patron of the Commission on HIV/AIDS and Governance in Africa, said in New York today.
At a Headquarters press conference to mark the launch of the Commission’s report entitled “Securing Our Future”, President Kaunda said that one of the fundamental findings was that AIDS still seriously challenged Africa’s stability and ability, especially in terms of Governments’ effective response.
President Kaunda, who was joined by Pascoal Mocumbi, former Prime Minister of Mozambique and co-patron of the Commission, said that the report, presented to United Nations Secretary-General Ban Ki-moon at a special event at Headquarters today, noted that modest successes had been achieved in the fight against the pandemic, but said that more needed to be done.
He said thatmore action was needed to secure the well-being of succeeding generations. The report stressed the need for collective efforts in combating the pandemic and argued that it was by working together that success could be ensured; all stakeholders should join hands in implementing the report’s recommendations.
President Kaunda said that the report provides a wealth of information on the adverse effects of HIV/AIDS in Africa, including the effects on the populations’ productivity. Africa, particularly Southern Africa, had been the most seriously affected area in the world, and it was to address that situation that the Commission had been set up by former Secretary-General Kofi Annan in 2003.
In the past, response by most African Governments to the HIV/AIDS pandemic had been slow, he stated. That had changed, however, and the trend was also changing in the private-public sector. The Commission had recognized those welcome developments, but still felt that more needed to be done.
During its work, the Commission consulted widely with stakeholders, including with Governments and civil society, the private sector and individuals, in order to ensure that its findings were representative of the AIDS-related challenges facing society, the President added.
Mr. Mocumbi said he hoped the report would catalyse efforts to address the HIV/AIDS challenge at the country level, with the recommendations guiding adoption of strategies adapted to the realities in individual countries. He also hoped that the report would strengthen partnerships between Governments and stakeholders, leading to action to reduce the risk of HIV infection.
Responding to a correspondent’s question, President Kaunda said that, during his presidency, he had lost a child to AIDS at a time when it was taboo to talk about the disease. In order to fight the stigma, his family had made the cause of death public two weeks later. He now ran the Kenneth Kaunda Children of Africa Foundation, through which he was reaching out to the corners of Zambia and Africa with the message of HIV/AID prevention and running clinics to fight the disease.
On relations between Brazil and Mozambique in the fight against HIV/AIDS, Mr. Mocumbi said that his country had benefited from Brazil through its use of Portuguese-language advocacy materials. Also, the Brazilian strategy of involving community and non-governmental organizations in preventing infection and expanding access to the means of prevention had been a model for Mozambique, which had integrated the strategy into the training programme for activists. Mozambique was also exploring ways to achieve self-sufficiency in the local manufacture of antiretroviral medications through technology transfer.
HIV/AIDS did not respect borders, and efforts were ongoing to promote trans-border cooperation to combat the disease, he said. Strategies had been adopted along the inland corridors in Mozambique, which served neighbouring countries, with the goal of helping all those who travelled along them to protect themselves from HIV/AIDS by using condoms when they engaged in risky sexual relations.
Replying to another question, Mr. Mocumbi said that condoms were the least costly technology for HIV/AIDS prevention and were more accessible than antiretroviral medications. Thus, Governments had focused on their use. The cheapest way of preventing infection, however, was to take the personal decision not to infect loved ones.
President Kaunda added that, in Zambia, the emphasis was on reaching out to young people via schools and churches, and many women’s organizations were working very hard in that regard. The wife of the current Zambian President had been elected Chair of Mothers in Africa, an organization of African first ladies devoted to fighting HIV/AIDS.
Mapping Healthcare for African Truckers.
Inefficiencies along Africa’s all-important road transport routes are one of the causes of health risks such as the spread of HIV/Aids and tuberculosis.
By Stef Terblanche
Inefficiencies along Africa’s all-important road transport routes, with downtime at border crossings often accounting for more than 50% of journey duration, are one of the major root causes of health risks such as the spread of HIV/Aids and tuberculosis. A major private sector initiative, however, has been launched recently to help alleviate the negative impact of these health hazards on workers in the transport sector and the communities with whom they come into contact; while there remains much to be done by governments throughout the continent.
A transport sector report on HIV-prevention needs of migrants and mobile populations in southern Africa, released recently by the International Organization for Migration (IOM), highlights the risks associated with long delays at border crossings.
The report, prepared by the United States Agency for International Development (USAID), reveals by way of example that “the journey from Kolwezi in the Democratic Republic of the Congo (DRC) to Johannesburg… takes on average 15-20 days for general cargo, with 10-15 days downtime at the border crossings.”
The report states that in southern Africa, much of the freight which moves between north and south, between east and west, is by road because it is a more flexible mode, more reliable and generally cheaper per tonne/kilometre.
“However, due to various infrastructural challenges and/or delays experienced at border crossings, the work of transporting goods… is neither an easy nor a fast one. Thus many truck stops or ‘hot spots’ have sprung up along the routes and borders to cater for long-distance truck drivers and others travelling along transport corridors.”
One of the results of this situation highlighted by the report is that “with limited facilities at these ‘hot spots’, truck drivers often look for women who can offer them comfort, food and a place to wash.”
Thousands of truck drivers in Africa, however, now have a new navigation tool to help them easily find healthcare centres along the subcontinent’s major transport corridors. In a unique partnership between Shell, Maplecroft and North Star Alliance, four maps have been published – showing the exact locations of more than 160 roadside wellness centres in West, East and southern Africa. All the maps are in English, with the West African map also available in French.
Some of the services provided by the wellness centres include sexual health education and counselling, HIV/Aids testing, blood pressure testing, TB screening, treatment of minor infections and wounds, and the distribution of free condoms.
“For the first time, truckers can see where they can access health services along major trucking corridors and transport hubs on the subcontinent,” says Paul Matthew, director: Africa for North Star Alliance. “Our ultimate goal is to get these maps into the hands of all truck drivers in Africa.”
The maps, produced by Maplecroft, are funded by Shell. “This joint initiative provides truck drivers with the latest information on where to find roadside wellness centres on the subcontinent,” says George Wandera, downstream road safety co-ordinator: Africa.
Shell is co-ordinating distribution of the maps to its road transport managers in Guinea, Mali, Burkina Faso, Ivory Coast, Togo, Kenya, Tanzania, Uganda, Namibia, Botswana and South Africa. The maps will be distributed also through the national road transport associations of these countries, and to Shell’s contracted haulier partners, as well as Shell Driving Schools and Shell depots.
North Star Alliance is distributing the maps also to drivers who visit their roadside wellness centres, and to other roadside clinic networks in sub-Saharan Africa. Occasionally, drivers have referred their spouses to nearby clinics.
Alyson Warhurst, chief executive officer of Maplecroft, said the company became involved in the project after conducting research on the link between the spread of HIV/Aids and truck drivers in Africa. “Drivers were getting ill with no effective support. Our experience in issue mapping allowed us to pinpoint the best locations for the wellness centres.”
North Star Alliance is a multinational, public-private partnership originally co-founded in 2006 by courier company TNT and the United Nations World Food Programme. Besides other similar facilities, North Star Alliance has established 12 data-linked roadside health clinics at major truck stops and border crossings in Africa. The clinics are housed in specially converted and equipped shipping containers.
Although this private sector initiative makes an important contribution to alleviate some of the effects of the health risks associated with the road transport sector in Africa, it is clear from the IOM report that much still needs to be done – particularly at the level of government – to deal with these health problems on a proper holistic basis.
The report, which mainly concentrates on the Southern African Development Community (SADC), among others recommends that more research should be conducted on the “various determinants of HIV in the transport sector.”
It further recommends that specific effort should be made by national authorities and employers to reach families of truck drivers in the places of origin. “Such efforts should also take into consideration issues related to stigma and discrimination.”
Fleet management in Africa – not for the faint-hearted
As more South African companies explore and expand into Africa, the need for a comprehensive fleet risk assessment has almost become mandatory.While one can be adequately covered in South Africa, the moment a loaded truck crosses a border different insurance risks come into play.
Beyond SA borders, political risk becomes a major consideration. In some African countries, civil war is a constant threat while in others, invasion or the threat of invasion makes headlines every day. Transporters have evolved to managing risk actively in response to the dynamic nature and rapid changes that happen in the emerging markets.
Brendan Horan, General Manager Sales and Marketing for MiX Telematics, says that trading in the global village has a very different set of dynamics to those governing the unique African village and businesses have had to adjust to the demands that an unstable and unpredictable environment presents.
The improvement in cell phone network coverage in Africa and subsequent roll out of GPRS and GSM has created a demand for higher-end fleet management.
“Customers want to have access to live-tracking facilities where they are able to monitor their vehicles on a real-time basis.
Where there is no cellular coverage, MiX Telematics makes use of satellite communication to track vehicles. The satellite solution is more expensive so GPS positioning communicated via GPRS is first prize. Our technology makes use of least cost routing to optimise the cost of satellite communication and GPRS,” says Horan. Horan says as living standards improve however, the need to advance technologically grows too and since fixed-lines are so limited many Africans have laptops and 3G access which has facilitated the growth in fleet management.
MiX Telematics offers fleet manager’s two unique feature-rich products to not only reduce fleet costs but to track and trace your fleet anywhere in the world.
The FM Communicator has been specially designed for high-end fleet management. It is a full-package solution starting with a driver identification feature and including driver performance monitoring, advanced movement management and vehicle utilisation features. “All the functions of this product are essential for advanced and accurate fleet management.
Fleet managers want to know firstly who is driving the vehicle, then how to manage driving performance based on specified criteria and have the ability to track and monitor vehicle movement. All these bases are covered. It is interesting to note that owners can save significantly on the cost of maintaining a vehicle by simply monitoring speed, revs, braking, acceleration and excessive idling. Being able to monitor these aspects and finding ways to save costs is essential in today’s economic climate,” said Horan.
The FM Tracer is scaled down in terms of its features and is ideal for entry level fleet management or smaller fleets when cost to function is crucial. It offers limited but essential features including tracking and utilisation and is still an excellent solution for managing your fleet with real time or historical vehicle and driver information from any Internet-enabled computer anywhere in the world.
Data for both systems is hosted at Mix Telematics’ hosting centre in Cape Town site, including all data pertaining to Africa.
Horan says MiX Telematics offers a stand-alone or home-based solution but experience has proved that customers in emerging countries cannot source the skills to do the administration themselves so are more likely to do the fleet management side and leave the data hosting and delivery capabilities to the MiX Telematics team.
Commenting on the success of the product to date, Horan says the secret to effective fleet management is heavily reliant on the usage of the information delivered. “At MiX Telematics the method of service delivery is pro-active and the product is completely transparent, there are no hidden costs. Other companies may offer a perceived lower introductory cost but what the customer gets in the end is far more expensive. We take the no-nonsense, single-fee approach,” he says. Moving forward Horan says he believes the current increase in cargo versus vehicle theft is expected to continue. “Fuel theft is also a major challenge in the industry. There is an understanding that it is far more lucrative to hijack trucks than cars which has led to an increase in this type of crime. We are working on solutions to combat this growing trend,” he says.
Last years economic downturn resulted in a noticeable drop in the activity of line haulage and transportation and a reduction in fleet sizes or a stagnation fleet growth. He anticipates this trend will stabilise but the impact of the recession is still being felt. “However, as long as there is a poor rail infrastructure in SA and parts of Africa there will always be a need for trucks and there will always be a need to protect them,” he concludes.
Transnet’s limited capacity to deliver, particularly with regard to ports, is not having a positive impact
Transport and logistics companies continue to suffer heavy traffic congestion and backlogs due to Transnet’s capacity restraints at its container terminals. This has resulted increasingly in freight traffic being diverted from South African ports to the highly competitive Port of Maputo.
However, Transnet has been hard at work upgrading its facilities to meet demand and improve efficiency, and more innovative initiatives are in the pipeline.
But industry leaders, from Sturrock Shipping managing director Andrew Sturrock to Road Freight Association (RFA) Technical and Operations manager Gavin Kelly, agree that South African ports have been losing market share to Maputo.
Operators in the road transport and logistics chain – which moves 80% of all freight in South Africa – point out that while trucks can be stuck in queues for 12 hours or even more in ports such as Durban, the turnaround time in Maputo is much quicker and without any holdups.
The Port of Maputo is managed privately by Mozambique International Port Services (MIPS), and owned jointly by South African company Grindrod, Dubai Ports World and the Mozambican government. The container terminal currently has excess capacity and is expected to more than double its freight volumes by 2010 to 91 000 20-metre equivalent units (TEUs) a year, up from the 44 000 units handled in 2005. Conservative estimates by MIPS project volumes in excess of 121 000 TEUs annually by 2013.
The efficient management of the port, the upgraded facilities, the reduction in bureaucratic red tape and the fact that there is no traffic congestion and delays, backed up by the improved road and rail infrastructure and services of the Maputo Corridor project that offers the shortest route to the sea from Gauteng, is proving to be an attractive lure for operators from particularly Gauteng, Mpumalanga, Limpopo and Swaziland.
The Port of Maputo has shown steady growth since MIPS was awarded a lease and management agreement in 1996. Since then, large volumes of citrus, automobile and coal exports have exited through this port as well as general containerised cargo. The port boasts modern car, container, coal and bulk-liquid terminals.
In July last year, Antonio Almeida Matos, co-chairperson of the Maputo Corridor Logistics Initiative (MCLI), said the port was moving close to eight million tonnes of cargo a year and hoped to increase this to 40 million tonnes a year within the next few decades. Upgrading projects to the value of US$300m to handle the anticipated increased traffic are already in the pipeline.
One problem, though, is the fact that trucks offloading in the port mostly return empty to South Africa. Therefore, attention will now be focused on turning it also into a major port for imports to South Africa.
That South African ports are experiencing serious capacity restraints at their container terminals, particularly in Durban, has been acknowledged boldly by Tau Morwe, acting chief executive of Transnet Port Terminals (TPT), a division of state-owned Transnet. According to him, Transnet would have to increase its capacity both in respect of its container terminals and its rail capacity, while not taking away business from the road freight industry.
However, Transnet, which operates 15 terminals at six ports, has already done much to alleviate the problem. By its last financial year-end, capital investments had increased by 59.1% to R3.1 billion, resulting in significant progress being made with an efficiency drive, for example, resulting in average moves per gross crane hour at the Durban container terminals improving by up to 26%.
Among the other projects undertaken by Transnet is the construction of the new container terminal at Pier 1 in the Port of Durban and the R3.9-billion widening and deepening of the harbour entrance channel that will enable the port to handle the larger new generation ships as well as improve the safety standards to match international norms; the R4.2-billion doubling of the Cape Town Container Terminal’s current capacity of 700 000 TEUs; the new deepwater Port of Ngqura in the Eastern Cape going operational with its 800 000 TEUs capacity container terminal that has state-of-the-art handling equipment; improved productivity at Richards Bay Dry Bulk Terminal, following the re-engineering and refurbishment of equipment; vastly improved productivity at Saldanha Iron Ore Terminal through the doubling of loading operations; and increasing maintenance at terminals by 78%.
However, TPT has also been facing severe challenges due to the recession with volumes – including in the container sector – decreasing after five years of consistent growth.
In June last year, Morwe told delegates at the South African Association of Freight Forwarders conference in Gauteng that it was critical for Transnet to start investing in infrastructure and port capacity.
He said the lack of investment over the previous 20 years was causing significant congestion at terminals such as in Durban, which handles two-thirds of the country’s container traffic.
Work already has been completed to improve the efficiency of waterside operations at the Durban terminal, while work is under way to improve landside efficiency.
According to transport operators, it is the latter where the major problems are being experienced, resulting in severe congestion causing hundreds of trucks to line up in queues of up to 5km every day with turnaround times of around 12 hours.
Morwe also believes the lack of technology at port terminals and in the trucking industry added to the problems.
From Transnet’s side, attempts have been made to upgrade technology.
For example, it has installed automated gates at Durban’s Pier 1, allowing trucks to move through without stopping.
Another system, PierPASS, has been imported from the United States to enable trucks to use the terminal facilities 24 hours a day, but container depots will have to be convinced to remain open 24 hours a day, too, to make the system work.
And a parking facility called A-Check is being installed to help streamline co-ordination between submission of documents and the loading or offloading of goods.
Finally, a number of other projects also have been undertaken or are in the pipeline to help ease the situation at the Durban container terminals, among these improvement of access roads by the municipality, a new rail link, and possibly converting Durban’s existing airport into a dugout container terminal.
Morwe added that Transnet plans to invest some R9bn in its ports over the next five years.
Meanwhile, the new Ngqura container terminal – recently used for the first time – could help ease some of the congestion at other facilities. The facility, which can accommodate the new generation of ultra-mega and post-Panamax ships with capacities ranging from 6 000 to 10 000 TEUs, is said to have the potential to become South Africa’s major container shipping port and a major container hub for all of Africa south of the equator.
OVC in Africa Conference. Don't Turn a Blind Eye
31 October - 3 November 2010 at the Sandton Convention Centre Jojannesburg
2nd Call for Abstracts: DON’T TURN A BLIND EYE! SUBMIT YOUR ABSTRACT NOW!
Track 1 - Prevention, Treatment and Care
HIV remains the single biggest global threat, appearing under number 4, 5 and 6 of the Millennium Development Goals (MDG’s) - which also places a high emphasis on the urgent need for combating HIV in children. This is a second call for abstracts on; research findings, operations research, as well as evaluations. Evaluations include what has and has not worked in the areas of preventing orphan hood and the mitigation of the vulnerability in children with regards to the impact of HIV and other threats. Academic institutions, NGOs and CBOs are welcome.
Track 2 - Psychosocial support
The recent global economic meltdown is virtually over according to reports from the international money markets. Unfortunately the developing world continues to lag behind as the unemployment rate continues to grow - with South Africa included despite positive economic indicators.. Here is an opportunity to share positive lessons with other colleagues who are possibly facing similar challenges. Come share your knowledge.
Track 3 - Disaster and risk mitigation
This year we celebrate the 21st year of the adoption of the UN General Assembly’s Convention on the Rights of the Child. Do we have enough regulations and conventions in place to protect the rights of the child at this time of celebration? Do we have the political will, structures and personnel to ensure these rights are protected, not only during times of peace but also in times of hardship - be it natural disasters or humanity caused challenges? Here is an opportunity to act on these challenges, while highlight ongoing issues and risks. Your abstracts on this complex area would be appreciated.
Please click here to submit your abstract for consideration in any of the above tracks by no later than 30 June 2010. The user-friendly online abstract submission system will guide you through the submission procedure. Please follow the instructions as shown on the webpage. The earlier you submit your abstract, the sooner the committees can start the assessment and evaluation.
Visit the conference website here to register for the conference.
Ms Monica Chipeta
Tel: 012 816 9069
Older People Need Help To Raise The Next Generation. 11/11/09
Without support, there are huge demands on older carers.
NAIROBI, 11 November (PLUSNEWS) - When the working members of a household die from HIV-related illnesses in northern Tanzania, older dependants have to work longer hours to cope financially, according to recently published World Bank study
"Adult death is associated with increased farm hours ... Older women who suffer the loss of a co-resident member among their baseline household are working five hours more each week," the study found.
More than 1,000 men and women older than 50 were surveyed over a 13-year period between 1991 and 2004 in the Kagera region.
Older adults who had relied on remittances and other in-kind support from their adult children were left with the burden of caring not only for themselves but also their orphaned grandchildren.
"Grandparents who should be in retirement are forced to start working and parenting again, often when they are not in the best physical condition," said Wamuyu Manyara, portfolio manager at the Africa Regional Development Centre of HelpAge
International . "An older woman with thinning bones should really not be forced to return to the field and farm."
The study noted that the shocks caused by the death of adult children were primarily felt by older people living with the children when they died. Women had less secure access to land and assets than men, but shouldered most of the labour after their children died, and also felt the shocks more than men. Owning more assets, such as land and animals, could act as a buffer.
"Policies which help ensure complete markets for livestock and other forms of assets, provide asset accumulation, and preserve women's rights to property may help mitigate the long-run negative impact of prime-age [15-50 years] deaths," the report said.
The elderly were often marginalised by state welfare programmes. "Older people are not organised enough to advocate for their needs, and they wind up being grouped in government departments with either children or people with disabilities - both these groups have powerful lobbies that drown out the needs of older people," said HelpAge's Manyara.
"In Kenya we are currently in the process of identifying community spokespeople to give them a public voice, but because many of them can't speak English or are illiterate, they are not always willing to take on the challenge."
Several African governments were doing more to include older people in social welfare programmes, particularly older carers. "There is now an appreciation of the magnitude of the problem, and there are some programmes catering for older people's economic needs," Manyara noted.
"Old-age pensions and child-care grants provided to older South Africans, and cash transfer programmes for older Kenyans, are practical examples of the types of programmes that need to be rolled out across the region ... [but the need] is still much higher than the numbers being catered for."
Research by the UN Children's Fund, UNICEF, in five African countries found that between 40 percent and 60 percent of all orphans in Kenya, Namibia, Tanzania, Uganda and Zimbabwe were being cared for by grandparents, particularly grandmothers.
Need for targeted programming
"Some of these older people can still work - they have energy and should be supported in their work with income-generating projects," Manyara suggested. "The conditions for accessing microfinance are usually so rigid that older people do not qualify; something should be done to encourage older people still able to work to access these funds."
Kavutha Mutuvi, HelpAge International's regional advocacy coordinator, said older people needed secure incomes. "There should be social pensions ... especially for those who are caring for households in their old age," she said.
Yet the bureaucratic hurdles in accessing support were considerable. "When a grandmother wants to claim a foster care grant, she may be asked for death certificates for her children or birth certificates of the grandchildren," Mutuvi pointed out.
"She may not have or have access to this documentation, but the fact that she is their grandmother can easily be verified by consulting community leaders - there should be a way to do away with much of the red tape they go through to claim support."
Older people also needed psychosocial assistance when their children died and they were left to raise the grandchildren. "We have tried to form support groups, which are more successful among women than men, but when it comes to helping grandparents with parenting skills, there is a definite need ... because they do come to us with questions when kids, for instance, want to know about sexuality," Mutuvi said.
The role of older people should be acknowledged when drawing up national home-based care policies and programmes, she said, by providing meaningful support such as physical help from community workers.
No MDG 4 for Sub-Saharan Africa. 15/9/09
Despite industrialised countries being on track to meet the MDG 4 goals by reducing their under 5 mortality rate, many countries in Africa are lagging well behind with one in seven children in sub-Saharan Africa dying before their fifth birthday.
In a sub-region of this region—West and Central Africa—this was even higher, at one in six children, according to figures published in The Lancet.
Figures released by UNICEF, based on the work of the Inter-agency Group for Child Mortality Estimation (IGME), show that the overall average annual rate of reduction is much higher from 2000-2008 than it was 1990-2000. However, the rate of decline is still grossly insufficient for the world overall to achieve Millennium Development Goal (MDG) 4.
The latest data, relating to 2008, has heightened concerns that many regions (and countries within them), are not on-track to meet MDG 4, which aims to reduce under-5 mortality by two thirds between 1990 and 2015.
The highest under-5 mortality rates continue to be in Africa, with 132 deaths per 1000 live births across the whole continent. In sub-Saharan Africa, the rate is 144 deaths per 1000 live births. This is 24 times the rate in industrialised countries.
Africa has reduced its under-5 mortality rate by 21% 1990-2008; this is not enough to reach MDG4. Asia has done better, reducing its own rate by 38%; but this is still insufficient to reach MDG4.
The highest numbers of deaths also occurred in sub-Saharan Africa, with 4.4 million children under-5 dying during 2008—half of the total world deaths. Due to high fertility in this region, combined with high mortality, numbers of deaths have actually increased from 4.0 million in 1990 to 4.4 million in 2008.
However, the authors highlight that the effect of interventions such as various vaccination programmes and insecticide-treated bednets, may have happened too recently to appear in the estimates.
Some other key findings are:
· The estimated global mortality for children under-5 in 2008 is 65 per 1,000 live births, versus 90 in 1990;
· Around 8.8 million children under 5 died during 2008, compared with 12.5 million in 1990;
· In 2008, around 10,000 fewer children die every day, as compared to 1990 the baseline year for the MDGs;
· Together, Africa (51%) and Asia (42%) represented 93% of all deaths globally;
· In terms of progress towards MDG4, the best performing region is Latin America and the Caribbean, which has reduced under-5 mortality by 56% between 1990 and 2008, and is on-track to meet MDG4. The region comprising central and eastern Europe (CEE) and the Commonwealth of Independent States (CIS—formerly USSR) is also on track, with a 55% reduction 1990-2008;
· The only other two regions on track to meet MDG4 are industrialised (high-income) countries (40% reduction 1990-2008) and East Asia and Pacific (48% reduction 1990-2008);
· 99% deaths occurred in developing countries, with 1% in high-income countries;
· Mortality in developing countries (71 deaths per 1000) was 12 times that in industrialised countries (6 per 1000);
· Under-5 mortality is increasingly concentrated: 75% of the world’s under-5 deaths in 2008 occurred in only 18 countries. Half of the deaths occurred in only five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan, and China. And India and Nigeria together account for nearly one-third of the total number of under-5 deaths worldwide (21% and 12%, respectively);
· At country level, the best performers (based on the average annual rate of reduction among countries with under-5 mortality of 40 or higher) include Nepal, Bangladesh, Eritrea, Lao, Mongolia, Bolivia, and Malawi which have all consistently achieved annual rates of reduction of under-5 mortality of 4·5% or higher. Additionally, Niger, Malawi, Mozambique, and Ethiopia have achieved absolute reductions of more than a 100 per 1000 livebirths since 1990.These countries are providing proof of concept that MDG4 is achievable, even in the poorest environments;
· Most of the recent survey data incorporated in these estimates generally reflect mortality over the preceding 3–5 years. Thus the major improvements in coverage in recent years for insecticide-treated bednets for malaria, prevention of mother-to-child transmission and paediatric HIV, HiB vaccine, and further progress on measles, tetanus, and vitamin A supplementation, for instance, might not yet be fully reflected in these mortality data;
· The rate of decline in under five mortality is still grossly insufficient to obtain the goal by 2015, particularly in sub-Saharan Africa and South Asia, and it is alarming to note that among the 67 countries with high mortality rates (40 per 1000 or more), only ten countries are on track to meet MDG 4;
· In addition to the countries with highest mortality rates, a renewed focus on high-burden countries with the greatest numbers of deaths is required, such as India, Nigeria, Democratic Republic of the Congo, Pakistan, and China (which make up nearly 50% of all under-5 deaths);
· An analysis of countries with the highest mortality levels, or slowest progress, shows that those in conflict or transition are over-represented. Best practices must be adopted in these countries, and donors must prioritise these nations in support programmes.
Dr Danzhen You of UNICEF in New York commented in The Lancet article: “Accelerated progress can be achieved, even in the poorest environments, through: integrated, evidence-driven, and community-based programmes that focus on addressing the major causes of death, including pneumonia, diarrhoea, newborn disorders, malaria, HIV, and undernutrition; reaching the unreached with a basic package of interventions at large scale and achieving coverage with equity; and using data for action and advocacy.”
Overworked, Under-Protected. 04/12/08
DAKAR, 4 December (PLUSNEWS) - While healthcare workers in sub-Saharan Africa struggle to deal with unmanageable workloads resulting from HIV/AIDS, a new study has found that their needs are being neglected.
Hospitals are failing to protect their workers from HIV and tuberculosis (TB) infection, and healthcare workers often do not have adequate access to HIV/AIDS services, according to a World Health Organisation (WHO) study conducted in Kenya, Malawi, Zimbabwe, Mozambique and Ethiopia.
The WHO survey, released on Wednesday at the International Conference on AIDS and STIs in Africa (ICASA), in Dakar, Senegal, noted that despite the extremely high risk of acquiring TB in health facilities, not enough was being done to protect staff.
Mark Wheeler, a health policy consultant who presented the study findings, told delegates that the risk of acquiring TB was up to 20 times higher for the average health worker than for the general population.
The risk was even greater for staff working in TB wards: they were 80 times more likely to be infected with TB. "Employers, however, don't recognise [this] and don't provide adequate protection," Wheeler said.
Basic infection-control measures, such as providing handkerchiefs to TB patients to cover their mouths while coughing, and building separate TB wards, were not being applied, despite widespread knowledge about the effectiveness of such interventions.
The chances of becoming infected with HIV at work may be low, but Wheeler said the survey had found that the "fear of this happening is widespread and very real" among healthcare workers.
Nearly 70 percent said that they were inadequately protected from HIV at work, as they lacked gloves, soap, water and proper containers to dispose of needles.
Needle-stick injuries were "extremely frequent" in developing countries, but carried a low risk of HIV transmission. In fact, occupational transmission of HIV accounted for only between 2.5 and 4 percent of HIV infections among healthcare workers.
The study found that when staff were exposed to the virus at work, very few chose to use post-exposure prophylaxis (PEP) as a preventative measure because they often misunderstood how PEP worked, and believed that by using it they would be forced to have an HIV test.
Less than 40 percent of the 1,000 healthcare workers surveyed were aware of policies to protect them from infection and discrimination in the workplace, Wheeler noted.
Dr Yohannes Chanyalew of the International Labour Organisation (ILO) told delegates that workplace policies in the health sector could not stay "locked away in a drawer", and called on employers to educate their personnel about their right to be protected from HIV.
Wheeler admitted that not enough was known about HIV prevalence levels among healthcare workers, but it was generally accepted that infection levels were about the same as in the general population.
WHO official Mwansa Nkowane warned that HIV and TB were among the major causes of death in healthcare workers, and said urgent steps should be taken to provide them with adequate HIV/AIDS services.
According to Nkowane, 17 percent of healthcare workers' deaths between 1999 and 2005 in Botswana were due to HIV. "If no action is taken, this could rise to 40 percent by 2010," she told delegates at the conference.
The fear of HIV discrimination prevented many health workers from being tested for HIV; most were also not willing to be tested by colleagues. Wheeler noted that there were often high levels of mistrust between staff and management, which meant that self-testing was the most preferred method.
Levels of access to antiretroviral (ARV) treatment were more encouraging: easy access to the life-prolonging medication was reported by 72 percent of health workers, and staff were more willing to access the drugs at their own health facility, although many raised the need for a staff clinic.
Reviewing Impacts of HIV/AIDS in Africa. 8/12/10
In Africa in general and Nigeria in particular, hundreds of thousands of people have lost their lives as a result of the disease
By Stella Odueme
8 December 2010
Lagos — On December 1, 2010, the world marked the World AIDS Day with the theme; "Universal Access and Human Right" as directed by the United Nations. There were walks and seminars in parts of the world in commemoration of the day.
As handlers of young people, the Skyflers International Schools, Ibafo, Oguns State celebrated the day with various activities such as health seminar, drama, talk show and quiz competition. Director of the school, Asuoha Chijoke said; "we believe that when the young ones are provided with broad information about HIV/AIDS' causes, transmission, prevention and management, much would have been done to save these our future gems from the dreaded scourge."
In deed, the deadly scourge has defied cure and has been causing the world a lot of pains. In Africa in general and Nigeria in particular, hundreds of thousands of people have lost their lives as a result of the disease, leaving behind hundreds of thousands orphans. Though awareness campaign against the disease seems to be high, yet many Africans cannot access antiretroviral drugs leading to their pre-mature deaths. Medical practitioners maintained that Africans are yet to harness the mechanics -- of PMTCT, preventing mother to child transmission of HIV.
According to Archbishop Emeritus of Cape Town and Honorary Chairman of the Global AIDS Alliance, Desmond Tutu and, United Nations Children's Fund (UNICEF) Executive Director, Anthony Lake; "a generation born free of HIV and AIDS is within the world's reach - and Africa is at a tipping point."
They lamented that today, pediatric HIV and AIDS is virtually a thing of the past almost everywhere in the world except Africa -- and few other places left behind during a decade of progress in using antiretroviral medication to prevent maternal to child transmission of HIV.
"In fact, nine out of 10 pregnant women with HIV today live in Africa; so do nine out of 10 children living with HIV. Every day, 1,000 African babies are born with HIV. The majority will not receive treatment. Without it, half will die before reaching their second birthdays. We should all be outraged by this tragic loss of young life - all the more tragic because it is needless. We have the power to prevent mother to child transmission of HIV everywhere, and it is time we used that power to save hundreds of thousands of lives in Africa. The time has come to recognise that because we can virtually eliminate pediatric HIV and AIDS, we must," they noted.
To them, it is not a question of knowledge because in the last 10 years, Africans have learned a great deal about the miracle of the mechanics -- of PMTCT. "It is a question of priorities and political will. First and foremost, this means a sustained commitment by African governments to include dedicated funding for PMTCT in their national health budgets. Only five out of 53 African countries have met their commitment to the Abuja Declaration to allocate at least 15 per cent of their annual budgets to health care of all types - and very few have dedicated funding to pediatric HIV and AIDS."
For instance they cited example of some countries that are taking action like Kenya that has set an ambitious goal of decreasing pediatric HIV infections from 27 per cent to 8 per cent by 2013.
It was gathered that last year, the Kenyan government set aside $11.25 million to purchase anti-retroviral medication for pregnant women and that the country has also been working to bridge critical gaps in its PMTCT programme - including new efforts designed to reach the hardest hit and often hardest to reach communities.
Also, last month Kenya became the first country to begin distributing the Mother Baby Pack, "take-home boxes" that contain all the drugs needed to protect the health of one mother and her infant - even mothers who live in remote locations far from clinics. Both Tutu and Lake described the initiative developed by UNICEF, World Health Organisation (WHO), UNITAID and other partners as promising, saying that soon, Cameroon, Lesotho and Zambia would also begin distribution of the packs to accelerate their own PMTCT efforts.
"We are inspired by such transformational leadership in Kenya and in other countries, like South Africa and Nigeria that are making historic changes in their own HIV/AIDS policies. We hope other African governments soon follow suit."
They also reiterated that achieving a generation free of HIV and AIDS is also a global imperative, requiring renewed commitment by donor nations, international agencies, civil society and the private sector.
"We must all focus greater attention on -- and increase investment in scaling up cost-effective initiatives to ensure that clinics are properly staffed and supplied, so that more women and newborns are tested early and receive ARV treatment in time to prevent transmission of HIV. Further funding is also needed to expand access to quality care, treatment and support for women and children living with HIV. And, without question, we must invest in innovative ways of reaching the poorest and most vulnerable women and families," they noted.
They added that clearly, the key to success was partnership at every level.
The Campaign to End Pediatric HIV/AIDS (CEPA), an African civil society partnership, is galvanizing action to end pediatric HIV/AIDS, starting in six African nations.
The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, a global public/private partnership, has been providing significant funding to expand HIV prevention and treatment efforts in Africa. Last month, pledges to the Global Fund hit $11.7 billion. The U.S. generously increased its pledge to the Fund by 38 per cent, and several G20 nations still have time to pledge. However, they noted that the current funding levels were only enough to sustain existing outreach efforts - and that Africa cannot afford to wait. "With inadequate dedicated funding, fewer than half of the HIV-positive pregnant women in Sub-Saharan Africa will receive life-prolonging anti-retroviral medication. Without these medicines, up to 40 percent of the infants born to these mothers will develop HIV; with them, that rate plummets to 5 per cent. These numbers speak for themselves - and the choice is ours to make, it is a matter of priorities, life and death. This World AIDS Day, we must all recommit ourselves to saving lives - by taking bold action today to secure an AIDS-free tomorrow, in Africa and everywhere."
Rise in HIV and AIDS Cases among Older Africans. 01/12/09
Most new HIV and AIDS infections in sub-Saharan Africa are among older heterosexual couples.
1 December 2009
A new report, The AIDS 2009 Epidemic Update, by UNAIDS and WHO reveals that the majority of new HIV and AIDS infections in sub-Saharan Africa are among older heterosexual couples.
This is in spite of the fact that the number of new HIV infections around the world has dropped by 17% in the past eight years.
Rachel Albone, HIV and AIDS Policy Adviser at HelpAge International says:
“This year the theme of World AIDS Day 2009 is universal access and human rights. Despite the target of universal access, the response to HIV and AIDS around the world rarely includes older people.
“As the 2009 AIDS report highlights, few prevention programmes specifically focus on older adults. The report’s data shows progress towards achieving the target still focuses largely on the 15-49 age group.
“This means older people continue to be neglected in the HIV and AIDS response. It also perpetuates the myth that HIV is simply a young person’s disease that doesn’t affect older people. It does.
“Studies show that older people are less likely than younger people to practice safe sex, one reason being perhaps that the threat of pregnancy has gone. This indicates that older people need different types of prevention education to young people.
Contributions left unrecognised
“Older people are not only living with and affected by HIV. Like other population groups, they suffer stigma and discrimination and rights abuses because of their own HIV status or that of their family members.”
“In addition, millions of grandparents around the world, and specifically in Africa, are caring for their sick adult children and orphaned grandchildren.
“The huge contribution these older carers make to the response to the HIV and AIDS epidemic remains largely unrecognised, and is not addressed in this new report,” said Albone.
Stigma and abuse
HelpAge works globally with older people’s groups that daily witness the discrimination that accompanies HIV and AIDS.
In Tanzania, older women are accused of witchcraft if a member of their family has HIV. These women are ostracised from their communities and subjected to violence and even death.
In Vietnam, injecting drug users account for more than 50% of recorded HIV and AIDS infections. Older people face the dual stigma of having children that use drugs and are living with HIV. Many keep their children’s HIV status a secret for fear of how people will react and how they will be treated.
In Uganda, older men and women suffer abuses of their inheritance rights as a result of HIV and AIDS. Younger family and community members claim older people’s land as their own and try to remove them from their homes, sometimes using threats and physical force.
Many of these older people care for orphaned children. If they lose their homes, they have nowhere to live and no land to farm for food for themselves or their grandchildren.
Time to include older people
Rachel Albone concludes:
“HelpAge International is very clear what needs to be done. UNAIDS must address this specific issue in 2010. Any new targets and commitments made in the HIV and AIDS response in 2010 must meaningfully include older people in recognition of the impact HIV and AIDS has on their lives.”
Risk of Spreading HIV is Greater Outside Vaginal Sex. 11/10/10
Lyn's Comment: Please remember that CABSA does not agree with all news articles published. The use of terminilogy in this article can be seen as discriminatory.
Some non-conventional methods such as anal sex are 10 times riskier than normal sex.
By Alex Ndirangu
Nairobi — Many people assume vaginal sex is the only mode through which HIV/Aids and other sexually transmitted diseases are spread.
But experts warn that some non-conventional methods such as anal sex are 10 times riskier than normal sex. "The anus is not anatomically designed as a sex organ, and functions performed by the vagina cannot be performed by the anus. The lack of lubrication and rich blood supply in the rectum make it susceptible to rupturing easily and exposing partners to infection," says Francis Nyamibo a HIV/Aids expert with the Kenya Aids Control Project.
Dr Nyamibo adds that due to the lack of lubrication, partners assume they are safe and therefore avoid condoms, which exposes them further to infection. Anal sex can also lead to rectal incontinence, which is characterised by leaking stool, thereby compromising one's hygiene and eventually leading to social stigma.
Another common non-conventional method is oral sex. However, chances of HIV transmission through this mode are minimal. "Semen is a protein, and when swallowed it is digested just like other proteins. Unless one has sores in the mouth, the chances of HIV transmission are minimal," says Dr Nyamiobo.
According to Pius Mutie, a sociologist and lecturer at the University of Nairobi, our changing lifestyle as well as Westernisation contribute towards increased non-conventional sex.
"We are fast adapting foreign cultures, but unfortunately our society is not ready to accept that non-conventional modes of sex are here with us," he says. The 2008 Mode of Transmission survey reveals that about 15 per cent of all new HIV infections are transmitted by men who have sex with men.
The study also shows that 60 per cent of the men are in heterosexual relationships. The study was conducted by a consortium of institutions including the World Bank, United Nations Joint Programme on HIV/Aids (UNAids) and the National Aids Control Programme.
UNAids also estimates that at least 5-10 per cent of all HIV infections globally occur through male to male sexual activity. Activists have been at the forefront of lobbying the government to recognise non-conventional modes of sex, especially homosexuality as a public health concern, and not a moral, cultural or religious matter, if any gains in HIV/Aids prevention are to be achieved.
According to Gay and Lesbian Coalition of Kenya chairman David Kuria, hundreds of the organisation's members have married women due to societal stereotypes. "MSMs (men having sex with men) often live double lives; they still marry to avoid being ostracised by the society. This is likely to hamper efforts made towards HIV prevention if they are not involved," he says.
The Kenya Aids Indicator Survey 2007 notes that 65 per cent of MSM also have sex with women. The National Aids and STI Control Programme estimates that risky population segments such as gay men contribute up to one-third of the country's 90,000 new infections annually.
It is estimated that less than 5 per cent of MSMs have access to HIV prevention and care. However, despite the interventions being made, same sex activity remains a crime under Kenyan law.
Rwanda: New Gel to Protect Women From HIV/AIDS. 20/9/10
New vaginal gel microbicide could be one of the key ways to curb the spread of virus among females
By Bosco Asiimwe
20 September 2010
Kigali — Prof. Joseph Vyankandondera, the Principle Investigator on HIV incidence at Project Ubuzima, announced last Friday that Tenofovir, a new vaginal gel microbicide could be one of the key ways to curb the spread of virus among females.
Project Ubuzima, a local organization that carries out clinical research on microbicides, recently recruited women volunteers to facilitate their research on Tenofovir . The Gel was referred to as "a new advance in HIV prevention" during the International AIDS conference in Vienna recently.
Tenofovir, believed to 39 percent effective in reducing women's risk of being infected with HIV, during sexual intercourse, is set to be released next year.
"If this method is proved to be effective, we hope women can protect themselves from HIV/AIDS infection using Tenofovir," Prof. Vyankandondera said.
The gel can be applied, 12 hours before sexual intercourse. It then prevents the HIV virus from starting the process of replicating its genetic material, thus saving a woman from acquiring the virus.
The ground breaking proof from a concept study carried out by Centre for AIDS Program of Research in South Africa showed that Tenofovir can become an important component in reducing HIV infection, particularly in women.
Vyankandondera said that the gel was also found to bear no side effects.
The event organised by Project Ubuzima brought together stakeholders including the Ministry of Health, University teaching hospital of Kigali (CHUK), CNLS and the international partnership for microbicide, Amsterdam. It was also attended by Evelyne Kestelyn, the Scientific Manager at Project Ubuzima.
SA Lagging Behind Tiny Rwanda in Fight against HIV/AIDS. 17/8/10
Our country is failing in some developmental projects when compared to smaller and poorer African countries, writes Loyiso Langeni
By Loyiso Langeni
17 August 2010
SA COULD learn valuable lessons from Rwanda’s structural reforms that have prioritised education and healthcare — especially the fight against HIV/AIDS — as fundamental cornerstones of national policy .
Rwanda is one of the world’s poorest countries, with a gross domestic product (GDP) per capita of 1150, according to statistics from the International Monetary Fund (IMF).
In comparison, SA’s GDP per capita is 10291, nine times bigger than that of Rwanda, according to the World Bank. Yet SA is lagging behind this tiny central African country in terms of achievements in education and the fight against HIV/AIDS.
The United Nations Development Programme (UNDP) has commended Rwanda’s political leadership for being adept in addressing hurdles in education and HIV/AIDS.
Rwanda scores an impressive primary school enrolment rate of 97%, as primary education is free and mandatory, figures from the UNDP show. Since 1994 , Rwanda has also been able to achieve gender parity in primary and secondary education.
The investment in education is already bearing fruit as women have been elevated to occupy major roles of responsibility within Rwanda’s economy and government.
Women now make up 50% of parliamentary seats as part of a government quota to encourage more women to participate in politics.
“Women now comprise 43% of elected local government leaders and hold close to half the seats in parliament. With this, Rwanda offers an outstanding example, not only to other African countries but to the entire world,” UN Secretary-General Ban Ki-moon said on a visit to the country two years ago.
Similar successes have been realised in the fight against HIV/AIDS. In 2000, Rwanda had one of the region’s highest infection rates of HIV at 13%, according to the UNDP. However, the latest UNDP figures indicate that this rate has been successfully brought down to 3% of Rwanda’s 10-million- strong population .
Maternal mortality has also been significantly reduced, by 30% between 2000 and 2005.
Through these achievements, Rwanda has met two of the Millennium Development Goals.
In contrast, SA — despite being wealthier and having a more sophisticated economy than Rwanda and most African countries — is yet to record significant improvements in education and healthcare.
In fact, the World Bank report SA: Second Investment Climate Assessment, released last month, cited the lack of skills and training among SA’s workforce as obstacles that hindered productivity and competitiveness.
Data from the UN Children’s Fund show that primary school enrolment in SA was recorded at 86% between 2003 and 2008.
Azar Jammine, chief economist at Econometrix, last month said: “SA’s role in Africa has declined over the last 15 years” because of a failure to invest resources creatively in education and training, among other things.
“Lack of education among the youth has discouraged them from participating in SA’s economy,” Mr Jammine said. This was compounded by the mismatch between the availability of skills and jobs on the market.
Most schools, especially in townships and rural areas, do not have the resources to prepare the youth for opportunities in SA’s first world economy once they have graduated from this phase.
SA’s Department of Health, in its 15-year overview of health and healthcare in SA from 1994 to 2010, lays bare the progress and challenges.
The report admits that SA has achieved “limited effort to curtail (the spread) of HIV/AIDS”. Until recently, SA gained international notoriety for its controversial and unconventional position on how to treat people infected with HIV/AIDS.
While there are no reliable figures available on infection rates in SA, the country is reported to have 5-million people infected with HIV/AIDS .
The Department of Health’s report blamed “insufficient leadership and innovation” for SA’s failure to address challenges in the health sector.
On the other hand, Rwanda has demonstrated that even with limited resources a nation can improve its competitiveness and productivity, as well as its population’s health and education . In comparison, SA is running out of excuses.
SADEC Should Do More To Fight HIV/AIDS. 26/03/09
Parliamentarians across the Southern African Development Community should do more to address HIV/AIDS in the region, Kasuko Mutukwa, SADC Parliamentary Forum secretary-general, said recently at a media briefing in Zambia's capital of Lusaka, the Inter Press Service reports. Mutukwa said, "Considering SADC is at the epicenter of the HIV pandemic, not enough is being done to address it. HIV has a very negative impact on (the region's) development." SADC's 4,000 parliamentarians are responsible for guaranteeing that governments in the region consider HIV/AIDS issues, according to the Inter Press Service. "Elections can come and go in our countries, but issues of HIV are hardly discussed," Mutukwa said, adding, "If all parliamentarians rose to the occasion, they could make a major impact on combating the pandemic." He called for the creation of HIV/AIDS desks within each parliament in the region to push for HIV-specific legislation and programs.
Although SADC countries have committed themselves to several international goals regarding HIV, "there has been little progress in meeting them," the Inter Press Service reports. Advocates say that although the intentions to achieve such goals exist, little has been done to implement strategies to achieve those goals and that setting targets is not enough. A 2008 UNAIDS
study reports that more than half of all Southern and Eastern African countries have planned HIV prevention strategies but that about 20% are being implemented. Boemo Sekgoma, SADC HIV/AIDS policy adviser, said, "This indicates a huge gap in prevention." Michael Kelly, a Zambian AIDS advocate, said, "We don't want to see promises, but promises fulfilled."
According to Sekgoma, governments and parliaments should focus on "capacity building, analysis, finding funding gaps and better budgeting." In addition, more resources are needed to focus on issues such as multiple partnerships, inconsistent condom use and low levels of male circumcision. Kelly said more focus needs to be placed on reaching all eight of the United Nations Millennium Development Goals, not just those directly related to HIV/AIDS. Kelly said, "Politicians should realize that if they improve access to primary education, our children will be better educated and therefore less likely to be infected with HIV." Kelly noted that reducing poverty and hunger would also benefit people living with HIV/AIDS by providing them with better nutrition.
According to Kelly, rather than consult with their constituents, some parliaments have begun to over-legislate HIV by criminalizing transmission of the virus. Kelly said such laws can be "self-defeating" and increase HIV prevalence and discourage testing. Kelly said, "Bad laws can increase the spread of the virus," adding that instead of "over-legislating, parliamentarians should ensure that more resources are invested in HIV prevention" (Palitza, Inter Press Service, 3/23).
Reprinted from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv . The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Safer Sex by Africa's Young Drives HIV Rates Down. 14/7/10
"Young people have shown that they can be agents of change in the prevention revolution"
14 July 2010
Young people in Africa are leading a "revolution" in HIV prevention and driving down rates of the disease by having safer sex and fewer sexual partners, the United Nations Aids programme said on Tuesday.
The prevalence of the human immunodeficiency virus (HIV) that causes Aids is falling among young people in 16 of the 25 countries most affected by the disease, a study by UNAIDS found, with many of them on track to hit a 25 percent reduction target in HIV/AIDS rates in 15- to 24-year-olds by the end of the year.
"Young people have shown that they can be agents of change in the prevention revolution," the report said.
It called on governments worldwide to learn from this progress and provide comprehensive programmes for sexual health education, access to HIV testing and wide availability of prevention methods such as condoms.
5 million young people infected
An estimated 5 million young people around the world aged between 15 and 24 are living with HIV, the often fatal and incurable virus that causes Aids. Nearly 80 percent of those people live in sub-Saharan Africa. HIV is spread during sex, in blood and breast milk, and by contaminated needles.
According to UNAIDS, an estimated 900 000 new infections occurred among young people in 2008 and the vast majority of those cases were in young women in Africa.
In a study published ahead a global Aids conference due to be held in Vienna next week, UNAIDS found that in 16 of the 25 worst affected countries, rates of HIV had been falling among young people, with some of the most dramatic declines seen in Kenya, where there was a 60 percent change between 2000 and 2005.
Botswana, Ivory Coast, Ethiopia, Kenya, Malawi, Namibia and Zimbabwe have all achieved a goal set agreed in 2001 to reduce HIV prevalence in 15 to 24-year-olds by 25 percent by 2010, it said. Burundi, Lesotho, Rwanda, Swaziland, the Bahamas and Haiti were all "likely to achieve" it.
Changes in sexual behaviour
The study found the main drivers of the reductions were changes in sexual behaviour. Young people in 13 of the 25 countries were waiting longer before they become sexually active. In more than half of the 25 countries, young people were choosing to have fewer sexual partners.
Condom use was also on the increase, the study found, with 10 countries reporting more use of condoms among women and 13 reporting increased condom use among men. Cameroon, Tanzania and Uganda reported increases in condom use by both sexes.
UNAIDS said in November that an estimated 33.4 million people worldwide were currently infected with the Aids virus. - (Reuters Health, July 2010)
Seeking Justice before African Courts. Living with AIDS # 417. 28/01/10
Discrimination against people living with HIV and AIDS continues to thrive in many parts of Africa because of insufficient laws to protect human rights.
Discrimination against people living with HIV and AIDS continues to thrive in many parts of Africa because of insufficient laws to protect human rights. A conference of African jurists held in Johannesburg, recently, heard that although judges do not implement laws, they are suitably placed to make progressive decisions that can end the discrimination.
“Often the case, jurists are perceived by society as implementing the law and, therefore, are rigid with regard to new developments. However, none other than jurists are better positioned to understand the limitations of prevailing legal frameworks and, accordingly, the basis and possibilities of shifting the frontiers of what is legally possible and permissible”, said South Africa’s Justice Minister, Jeff Radebe, in his address at the opening of the meeting.
Minister Radebe described HIV as “an epidemic of discrimination” and said that that has to be challenged.
“Our attitude towards those against whom we discriminate on the basis of their HIV status can be regarded as a conduct that has consequences in law and one that affects those fundamental rights that must enjoy protection in our Constitution. I’m mindful that we are the continent with the highest infliction of the HI-virus in the world. Whilst countries such as China pride themselves with the greatest economic growth of our times, we in Africa seem to be renowned for our regressive aspects such as poverty and, in this case, the high incidence of HIV prevalence. This meeting will help our beloved continent to make a turn-around on this human rights issue as we collectively seek to reposition Africa as a success story”, he said.
Ghana’s Chief Justice, Georgina T. Wood, told the meeting that the judiciary should “form part of each country’s national response to HIV and AIDS”.
“We need to formulate appropriate responses to discrimination… strategic interventions aimed at enhancing legal mechanisms to protect persons living with it from unwarranted discrimination”, she said.
Head of the AIDS Law Project in Johannesburg, Mark Heywood, said “there are two reasons why it’s important to have a discussion around ensuring that the law promotes the protection of the rights of people living with HIV”.
“It’s because we all work and live under legal regimes that require us to protect the human rights of the individual. Another powerful reason is because if we don’t protect the rights of people living with HIV, then people living with HIV will go underground and they will not seek services for HIV testing, for counseling, for treatment and it will be very difficult for us to control the epidemic – as it is very difficult for us to control the epidemic”, said Heywood.
Signs of Slowing HIV/AIDS. 14/06/07
KIGALI, June 14, 2007 — A new World Bank report on HIV/AIDS launched today in the Rwandan capital, Kigali, says the mobilization of empowered 'grassroots' communities, along with delivering condoms and life-saving treatments, are beginning to slow the pace of the continent's epidemic, which last year killed more than 2 million African adults and children, and left another 24.7 million Africans struggling to live with its deadly effects.
According to the new report—The Africa Multi-Country AIDS Program 2000-2006: Results of the World Bank's Response to a Development Crisis—ultimate success in defeating HIV/AIDS will depend on marshalling effective prevention, care, and treatment, measures to boost 'social immune systems' in African countries—changing their beliefs, perceptions, and social and individual behaviors around the disease so that eventually they can reverse the advance of HIV and stop the damage done by AIDS.
The report says these changes are taking place as the epidemic shows signs of slowing in Uganda, Kenya, and Zimbabwe, and in urban Ethiopia, Rwanda, Burundi, Malawi, and Zambia. But Southern Africa remains the epicenter of the continent's epidemic with unprecedented infection rates. In one recent household survey, a staggering 70 percent of women, aged 30-34, and men, aged 40-44, in Botswana's second largest city, Francistown, have HIV. In Eastern Africa, countries are facing a mixed epidemic pattern with significant numbers of new infections originating in the commercial sex trade, and in the general population.
Southern Africa Life Expectancy Rising Slightly: UN. 21/10/10
New treatments bringing a slight rise in recent years
By Patrick Worsnip
21 October 2010
United Nations - A dramatic fall in life expectancy in southern Africa caused by AIDS in the 1990s appears to have bottomed out, with new treatments bringing a slight rise in recent years, a U.N. report said on Wednesday.
But the region remains the only one in the world where life expectancy is currently less than it was in the early 1990s -- and in the case of women, much less, the report said.
Women form the majority of HIV-positive adults in sub-Saharan Africa, as well as in North Africa and the Middle East, said the report, "The World's Women 2010." The human immunodeficiency virus (HIV) causes AIDS.
In the period 1990-95, life expectancy at birth in southern Africa -- South Africa, Namibia, Botswana, Swaziland and Lesotho -- was 64 for women and 59 for men. That fell to 51 for women and 49 for men in 2000-05, but rose slightly in 2005-10 to 52 for women and 51 for men.
In Eastern, Central and Western Africa, where some countries were also hard-hit by AIDS, life expectancy increased slowly but steadily over the same period and now stands at 57 for women and 54 for men.
The report by the U.N. department of economic and social affairs attributed the modest uptick in southern Africa to the development and improved availability of medical treatments for
Sub-Saharan Africa remains the region worst affected by HIV, accounting for some two thirds of all people living with the virus worldwide. But a U.N. report last month said new infections fell by more than a quarter in 22 countries between 2001 and 2009.
In South Africa, at least 5.7 million people out of a population of 50 million are infected with HIV and an estimated 1,000 people die each day due to AIDS-related complications.
But the country now has the world's largest program to treat the disease with anti-retroviral drugs (ARVs), which can prolong the life of those suffering from the incurable illness. Former President Thabo Mbeki was criticized for questioning accepted AIDS science and not making ARVs widely available.
MORE MEN THAN WOMEN
The latest U.N. report found that women live longer than men in all regions of the world, typically by about five years, but are more likely than men to die from cardiovascular diseases, especially in Europe.
The longest-lived women are to be found in Japan, with an average life expectancy of 86, and the longest-lived men in Iceland, where the figure is 80. At the other end of the scale, life expectancy in Afghanistan and Zimbabwe is below 45 for both men and women.
The report said there had been a "noticeable recovery" in longevity in eastern Europe and the former Soviet Union, where life expectancy plummeted following the collapse of communist rule in the late 1980s and early 1990s. Men in particular are living longer due to reductions in heart disease deaths.
Southern Africa: HIV Testing and Treatment to Prevent TB. 19/5/10
Diagnosing HIV early and starting antiretroviral (ARV) treatment could be the most important weapons in the battle against HIV-associated tuberculosis
19 May 2010
Johannesburg - Diagnosing HIV early and starting antiretroviral (ARV) treatment could be the most important weapons in the battle against HIV-associated tuberculosis, but this would need a huge injection of resources in southern Africa, where the dual epidemics of TB and HIV claim the most lives.
The authors of a paper, part of a series on TB in the British medical journal, The Lancet, note that the disease accounted for more than a quarter of the two million deaths attributed to AIDS-related diseases in 2008, and is the number one cause of illness and death in people living with HIV in Africa, yet efforts to contain TB-HIV co-infection have been "timid, slow and uncoordinated".
A move towards earlier HIV testing and treatment is already underway. Many countries have adopted the 2009 World Health Organisation (WHO) guidelines, which raised the threshold for starting ARV treatment from a CD4 count of less than 200, to 350.
Earlier ARV treatment as a tool to prevent TB has received less attention, but the reality is that "Many people with HIV infection start ART [antiretroviral therapy] too late, especially in Africa, and have already developed TB by the time that they present to health services for care," the authors said.
Prof Anthony Harries, a senior adviser to the International Union Against Tuberculosis and Lung Disease and lead author of the paper, welcomes the WHO guidelines but supports the more radical approach, yet to undergo field trials, of testing all adults for HIV once a year and immediately starting everyone who tests positive on ARVs.
This strategy, based on findings from a mathematical model published in The Lancet in November 2008, could reduce HIV prevalence to less than 1 percent within 50 years in a country with a generalized epidemic such as South Africa.
Using the same model, Harries and his co-authors estimated that the incidence of HIV-related TB could be more than halved if ARV treatment were started within five years of infection.
Studies to test the efficacy of such an approach still need to be done, but Harries believes it is feasible "if decision-makers are prepared to think and act out of the box".
The upfront costs would be significant, and donors appear to be decreasing or flat-lining their support for HIV/AIDS treatment as a result of the global economic slowdown, but Harries pointed out that a universal test-and-treat approach would result in cost savings in the long term.
"It would not be easy but, if you go back five years, ART scale-up wasn't easy and there was a lot of opposition, but we had good, clear leadership from the WHO," he told IRIN/PlusNews.
In the absence of early HIV diagnosis and treatment, The Lancet paper argues that many lives could be saved by better implementation of a policy for preventing HIV-associated TB known as the 3Is: Intensified TB case-finding, Infection control, and Isoniazid preventive therapy.
One of the main difficulties in implementing the 3Is has been diagnosing TB in HIV-positive patients, particularly in low-income countries that lack the equipment to conduct culture testing - the most reliable way to diagnose TB, in which samples are cultivated in a special liquid.
Problematic diagnosis has in turn hampered the use of Isoniazid to treat latent TB infection. Fear of creating drug resistance by prescribing it to patients with undetected TB has meant that Botswana is the only country in southern Africa to have incorporated this approach into its national TB policy.
Harries, who has worked as a technical adviser to Malawi's HIV/AIDS department and its TB control programme, said HIV programmes should take responsibility for implementing the 3Is by ensuring that patients diagnosed with HIV received regular care before starting ARV treatment.
"In most of poor Africa, you get HIV tested and maybe don't even get a CD4 count, so somebody does a clinical assessment and decides if you're stage 3 or 4 [when ARV treatment usually starts]. If you're stage 1 or 2 [asymptomatic], then basically you're told, 'Go away and we'll see you when you're sick'," he said.
"We need pre-ART care: a clinic where people would come every three months to be checked and given co-trimoxazole [an antibiotic that helps prevent opportunistic infections] or Isoniazid."
A more innovative but as yet untested approach, which Harries and his co-authors propose in The Lancet paper, would be providing TB treatment to all HIV-infected patients who are sick and have low CD4 counts.
"We know it's difficult to diagnose TB in [a low-income] setting," he said, but by putting such patients on TB treatment, "you stop that person transmitting TB every time he comes to the clinic, and if he hasn't got TB, this is a very good preventive therapy."
Harries urged greater collaboration between TB and HIV programmes. "In the HIV/AIDS world, activism has played such a big part; in the TB community we're not good at that. We need to get TB patients who've been cured, who are articulate, and they need to be advocates for TB and work with HIV activists to tackle policy-makers."
Straight Talk with Sheila Tlou, new UNAIDS head for Eastern and Southern Africa. 29/11/10
Tlou talked to IRIN/PlusNews about the value of setting goals and what countries should aim for next.
29 November 2010
Johannesburg - Sheila Tlou, former Minister of Health in Botswana, took over as UNAIDS director for East and southern Africa in November, just a month before the deadline for achieving universal access to treatment, prevention, care and support expires.
With only two countries in the region having met the target for treatment, Tlou talked to IRIN/PlusNews about the value of setting goals and what countries should aim for next.
QUESTION: How do you think the targets have contributed to the AIDS response, in light of the fact that many countries have not met them?
ANSWER: Universal access to me means access not just to treatment but prevention, care and support. And from the report, we’ve seen that a lot of countries have moved towards universal access. In the ones that have reached it – Botswana and Rwanda – it’s really contributed in that we’ve seen deaths from HIV go down... you’ve seen quite a lot of reductions even in countries that may not reach it and once people are on treatment their infectivity goes down so it contributes even to the prevention side.
So it’s come up with a good momentum in terms of looking at all the indicators such as child mortality, maternal mortality, including even the overall economy of countries, as more and more people are not absent from work - we’re finding that productivity increases thanks to universal access.
Q: Do you think having the targets is useful in terms of galvanizing a response?
A: People need targets. This is where you really get to see that we are a global community… especially when you review them occasionally because then you create competition between countries. With “3 by 5” [UNAIDS initiative to provide three million people living with HIV in low- and middle-income countries with antiretroviral treatment by the end of 2005] for example, all countries knew how many at a minimum they should put on ARVs (antiretroviral drugs) and a lot of countries reached that, especially in southern Africa. So we need targets.
Q: Were the targets realistic?
A: To me they were a little bit too high, but I feel they were realistic in the sense that we always say, ‘Aim for the sky and you’ll reach somewhere’. Had countries been given targets that were just mid-way, chances are they would actually by now only have realized half of that. As long as we don’t have sanctions for countries that don’t meet the targets; the main thing is to encourage, to say ‘We can make it’.
Chances are, once we get to 2015, we’ll set some more targets and I have a feeling those targets will not be as harsh as the ones we’re having because, let’s face it, the world was suffering [when the targets were set in 2005], ARVs were very expensive, so we needed that impetus.
Q: As far as you are concerned, the next set of goals to focus on would be the Millennium Development Goals (MDGs)?
A: Well, the MDGs have number six in there – to halt and reverse the spread of HIV. I would say we are reaching that goal so by 2015, we will be saying, have we reached our vision of zero new HIV infections, zero deaths and zero discrimination? We won’t have, so I can see us now taking that vision and saying, let’s see how by 2020, for example, we can reach that particular target.
Q: Is this vision of zero new infections new?
A: Yes, it’s a new vision we’re now aiming for… because as you put more and more people on ARVs, it means the prevalence increases - those people are not dying. So you can no longer look at prevalence because it’s going up, but you can look at incidence, which is the number of new infections and we’re saying we’re aiming for zero.
Q: Besides money, what do you think are the greatest barriers to achieving universal access?
A: The greatest barriers so far are really stigma and discrimination. There is still criminalization of certain groups that we call key populations: men who have sex with men, sex workers, injecting drug users, transgender populations. To me, that is still the barrier in the sense that we have already statistics that show that in Africa, [34 percent of] men who have sex with men also reported that they were married and 54 percent reported that they had had sex with both men and women in the past six months.
You are now seeing that because these populations are excluded, if you criminalize them, they will go underground and… even before you talk about human rights it means you’ll never achieve zero infections because we have a group that’s not accessing services.
Of course, when you look at human rights, these people have the same rights to access HIV prevention, care and support services as the other populations. So I think in the next two years, those are the issues that we’ll be grappling with. We’re seeing that certain countries are putting them in jail, it doesn’t help at all; some countries have gone backwards. But fortunately it’s not all African countries. We have South Africa that recognizes men who have sex with men, and Rwanda. Little by little we’ll get there.
Sub-Saharan Africa Leads Drop in New HIV Infections. 17/9/10
Between 2001 and 2009, 22 countries in sub-Saharan Africa, which is the worst affected region, have posted a drop of more than 25% in new HIV infections.
17 September 2010
Sub-Saharan Africa, the region worst affected by Aids, is leading a decline in new HIV infections, UNAids said on Friday, with new infections in the area declining by over a quarter in the last decade.
"The data shows that countries with the largest epidemics in Africa -- Côte d'Ivoire, Ethiopia, Nigeria, South Africa, Zambia and Zimbabwe -- are leading the drop in new HIV infections," said the Joint UN Programme on HIV/Aids in a statement.
Between 2001 and 2009, 22 countries in sub-Saharan Africa, which is the worst affected region, have posted a drop of more than 25% in new HIV infections.
"For the first time change is happening at the heart of the pandemic. In places where HIV was stealing away dreams, we now have hope," said UNAids executive director Michel Sidibe.
Better prevention measures and awareness are contributing to the decline.
A 12-fold jump in the number of people on HIV treatment has also been recorded in the past six years, bringing the total number of patients receiving medication to 5,2-million.
But while progress is made in the worst-hit areas, regions such as Eastern Europe and Central Asia are reporting growing pandemics, said UNAIDS.
In addition, a resurgence of new infections is occurring among male homosexuals in several developed nations. -- AFP
Surprising AIDS-Treatment Benefits, Prevention Strategy in Epidemic Regions of Africa; Anti-Retroviral Therapy Yields 'Lazarus Effect' 1/12/10
Significant spillover benefits of a drug therapy to combat AIDS symptoms
1 December 2010
Two teams of researchers at UC San Diego and other U.S. and African universities and the World Bank have documented significant spillover benefits of a drug therapy to combat AIDS symptoms and a novel prevention strategy that focuses on girls in Sub-Saharan Africa, an area with two-thirds of the world's HIV infections.A recently published paper in Public Economics documents a dramatic "Lazarus effect" in AIDS-affected households in rural Kenya when infirmed members received anti-retroviral therapy (ART). The study found that not only did the health of those treated improve, but the households also began to accumulate livestock and other assets and they increased their investments in the education of their children.
"Most successful AIDS relief initiatives have been lopsided in their focus on anti-retroviral therapy, but behavioral dimensions of the epidemic are equally significant," said Joshua Graff-Zivin, co-author of the study and associate professor of economics at UC San Diego's School of International Relations and Pacific Studies (IR/PS). "Anti-retroviral therapy may be achieving much more far-reaching impacts than just the medical benefits, and anti-retroviral therapy may help the continent escape a much broader set of behavioral poverty traps that would otherwise arise from stratospheric HIV-prevalence rates."
The study was supported by a partnership of the U.S. Agency for International Development. Graff-Zivin worked with Harsha Thirumurthy, assistant professor of health economics at the University of North Carolina, and Markus Goldstein, a senior economist at the World Bank. The team showed that when affected members of rural Kenyan households received the drug therapy, a range of household investment indicators suddenly improved. In addition, children's nutritional status went up and their school attendance increased more than 20 percent within six months after treatment was initiated for the adult patient.
"This Lazarus effect, whereby those who had expected a swift decline and death are granted a new lease on life by treatment, suggests that without effective anti-retroviral treatment, the epidemic may be having pervasive negative effects on people's willingness to think long-term and to invest for the future," Graff-Zivin said. "This study shows that effective treatment yields significant economic dividends such as improved capital investment. Based on our latest field research we also think anti-retroviral therapy enhances environmental stewardship and a host of other positive effects as households switch from a sense of hopelessness to planning for their long-term futures."
In a separate study conducted in the southern African nation of Malawi and recently published in Health Economics, researchers found that providing small monthly cash payments to girls significantly reduced sexual activity, teen pregnancy and marriage. New results from a series of working papers report that the prevalence of HIV and Herpes is also significantly reduced by the intervention. In order to continue receiving the money as part of the study, the girls were required to remain in school as part of a "conditional cash transfer" program.
Two dramatically positive results were measured:
-About 18 months after the program began, HIV prevalence among the participating schoolgirls was 60 percent lower than the control group (1.2 percent vs. 3.0 percent).
-The prevalence of Herpes Simplex Virus type 2, the common cause of genital herpes, was more than 75 percent lower among the girls participating in the study compared to a control group (0.7 percent vs. 3.0 percent).
"This study was the first rigorously estimated evidence that a behavioral intervention may have meaningful effects on the trajectory of the HIV epidemic," said Craig McIntosh, a co-author of the study and associate professor of economics at IR/PS. "Similar programs in Mexico, Brazil and Nicaragua have demonstrated efficacy in improving school enrollment, learning or labor-market outcomes, but we suspected that the conditional-cash-transfer approach could also have a strong impact on the health of girls living in an epicenter of HIV infections."
The conditional-cash-transfer program virtually eliminated sexual relationships between teen-age girls and men over 25. "This is very important because this approach greatly reduces HIV transmission from an older demographic group to a younger one, which could lead to the epidemic burning itself out," McIntosh said. "This study shows how the lives of girls can be improved, vulnerable households can be protected, and spread of the HIV epidemic can be significantly slowed."
The study was supported by the Global Development Network and the Bill and Melinda Gates Foundation. The research team included McIntosh; Sarah Baird, an assistant professor of global health at George Washington University; Ephraim Chirwa, associate professor of economics at the University of Malawi, and Berk Özler, an economist with the World Bank.
Texting Saves Lives of HIV Patients, Study Confirms. 12/11/10
Long awaited proof that mobile phone technology can be used by healthcare workers to save lives
By TV Padma
12 November 2010
New Delhi — Long awaited proof that mobile phone technology can be used by healthcare workers to save lives in Africa has finally been published.
Findings from the first scientific trial on the link between mobile phones and HIV treatment outcomes - conducted in Kenya by scientists from Canada, Kenya and the United States - are reported in The Lancet this week (9 November).
So far there has been limited field data about the use of mobile health technologies to improve patient outcomes in developing countries - and there are no published clinical trials.
The trial was conducted on HIV patients, many of whom lived in remote areas and were receiving treatment in three Kenyan clinics. Patients received a weekly text message in their local language, Swahili, from a nurse enquiring how they were feeling. Patients were expected to respond within 48 hours.
If a response was not received within this period, a healthcare worker promptly rang to enquire what was wrong and, if needed, visited them. Patients in the control group received standard care without any text messaging.
The study, conducted from May 2007 to October 2008, showed that nearly 63 per cent of mobile phone users reported treatment adherence; compared with only 50 per cent in the control group.
Viral loads were undetectable in 57 per cent of patients who received the weekly text messages compared with 48 per cent in the control group.
A scale up of the programme in Kenya could suppress viral loads in 26,000 extra people at the cost of less than US$8 per person per year, said Richard Lester, of the British Columbia Centre for Disease Control and one of the researchers in the Nairobi trial.
But it needs a formal, cost-effectiveness assessment first.
"We have also developed some innovative business models to strategise scaling up the [Kenyan] programme nationally and regionally," he told SciDev.Net. "This may have huge implications for global HIV control since it may be a cost effective way to strengthen health systems for Millennium Development Goals."
This week's 2010 mHealth Summit in Washington DC (8-10 November) repeatedly called for more data to advance evidence-based implementation of mHeath concepts, Lester told SciDev.Net. The conference also heard several examples of mobile phone use for remote diagnostics.
Because mobile phones are wireless they overcome many of the infrastructural barriers to communications in resource-limited settings, Lester said. But other aspects of infrastructure, such as drug supply chains, remain challenges.
The next frontier, he suggested, is the mobile power supply - there are already exciting advances being made in this field.
Two Percent Rate of HIV/AIDS Infection Reported. 1/12/10
Country registered a 2.1 percent of HIV/AIDS positive rate
1 December 2010
Dundo — The Angolan deputy Health minister, Evelise Frestas, Wednesday in Lunda Norte province, said that the country registered a 2.1 percent of HIV/AIDS positive rate
The government official was speaking at the central act of the World Aids Day, celebrated this Wednesday, as a way to warn and show international solidarity to HIV/AISD patients.
Evelise Frestas underlined that in Angola the Aids epidemic established around a general prevalence rate of 2.1 percent, stressing that the figures are not the same in the provinces and substantially higher in group of risks.
She said that countries that border with Angola maintain an intense migratory flux present, in general, higher prevalence rate by HIV infection.
The deputy minister said that the government keeps on supporting and reinforcing the National Programme of Fighting against Aids, enabling mobilisation and sufficient usage of the resources in all aspects from the international community, passing by public administration, till the lowest department of health sector.
According to the World Health Organisation (WHO), at least 33.4 millions people live with HIV/AIDS all over the world and 67 percent of the HIV/AIDS positive are in Africa.
The recent global report of 2010 issued by the UN common programme for Aids present relevant information, such as, 62 percent of the total cases of death related to Aids in the world, third new infections in adults and over 90 percent of children.
The act was attended by provincial governor of Lunda Norte, Ernesto Muangala, national directors of Health Ministry, workers of the local government and population
UN Agency Joins Forces with Sony to Halt Spread of HIV and AIDS. 24/3/10
Thousands of people in Cameroon and Ghana will have the chance to watch this year's football World Cup matches live - and have the opportunity to receive HIV and AIDS counselling
24 March 2010
Thousands of people in Cameroon and Ghana will have the chance to watch this year's football World Cup matches live - and have the opportunity to receive HIV and AIDS counselling - thanks to a new partnership announced today by electronics giant Sony and the United Nations Development Programme (UNDP).
Public Viewing in Africa, a scheme which the Japan International Cooperation Agency (JICA) will also take part in, aims to bring health information to vulnerable communities in Cameroon and Ghana.
Sony will set up large screens in both countries to broadcast, for free, some 20 World Cup matches, allowing people to watch the games live in areas where televisions are scarce.
Throughout the World Cup, to be held in South Africa in June and July, UNDP, JICA and local partners will also be offering viewers HIV and AIDS counselling. They seek to reach some 13,000 people and administer HIV tests to nearly 2,000 of them.
Combating HIV and AIDS, as well as malaria and other diseases, is one of the eight Millennium Development Goals (MDGs), anti-poverty targets agreed upon by world leaders with a 2015 deadline.
"The World Cup brings people together, both as teams and as nations cheering on their players," said UNDP Administrator Helen Clark. "There can be no spectators in the fight against poverty. Everyone has a role to play in scoring the eight Millennium Development Goals, which if reached would improve the quality of life for many hundreds of millions of people across developing countries."
The agency and Sony said they will join forces on other global initiatives this year to promote progress towards achieving the MDGs.
Why HIV Prevalence May Decline. 07/01/09
Wednesday, January 07, 2009
The declines in HIV prevalence and incidence seen in recent years in some countries may be largely due to differences in people’s susceptibility to the virus rather than behaviour change, according to a mathematical model based on a survey of Kenyan sex workers, published in the January 14th edition of AIDS.
The model suggests that HIV infections in the early stage of an epidemic occur more frequently in a subgroup of the population who are genetically most vulnerable to HIV. This means that as time goes by and most of these people become infected, HIV can only be passed on to those less genetically vulnerable, resulting in drastic declines in incidence and – as the first generation dies – declines in prevalence.
HIV prevalence in a number of African countries has declined substantially in the last decade, for instance from 31 to 16% in Zimbabwe and 14 to 5% in Kenya. Estimates of HIV prevalence in India have also been more than halved – see this report. When this phenomenon was originally seen in Uganda in the 1990s, it was attributed to the success of early prevention programmes conducted in the late 1980s.
However in a long-standing longitudinal study of initially HIV-negative Nairobi sex workers (Kimani), HIV incidence declined despite no apparent changes in sexual risk behaviour. In this study the risk of acquiring HIV per sex act declined fourfold between 1985 and 1995, from one infection per 225 sex acts in 1985 to one per 1000 in 2005. This cannot be explained by a difference in HIV prevalence among the sex workers’ clients, as it pre-dated HIV prevalence declines in the Kenyan male population by a decade.
The authors hypothesised that HIV incidence might be declining because the virus was disproportionately infecting the most genetically vulnerable women first. They devised a model of a typical African population. They divided the population into high-risk persons (namely female sex workers and their clients) and the general population, and modelled movement between these groups. They then modelled the way the epidemic would develop if they divided this population into three groups of 30% each, who could be respectively infected with HIV easily, quite easily, and with difficulty, and 10% who were completely resistant to infection.
Ten per cent deliberately overestimates the proportion likely to be totally resistant to HIV because the authors wanted to build the most conservative possible estimates of susceptibility to infection into their model in order to find out if it still explained observed declines in incidence. For the same reason they assumed there was no difference in infectiousness between people in early infection and chronic infection, and made no allowances for other factors that influence infectiousness and susceptibility, such as sexually transmitted infections.
They found that a version of this model almost completely explained the observed decline in infections seen in the Nairobi female sex workers and fitted fairly closely the observed increase and later decline in prevalence in the general Kenyan population.
It is difficult to directly measure people’s susceptibility to HIV, as they can be infected only once. This may explain why differing susceptibilities of people to infection has received less attention as a possible driver of the epidemic than differential infectiousness in those already with the virus. However it may provide a better explanation of why, for instance, the risk of infection after ten heterosexual contacts with a person with HIV has been found to be as high as 10%, but only increases to 23% after 2000 contacts.
This model implies that predictions of the spread of HIV in a mature epidemic may be drastically overestimated if they are based on the infection rate seen in the first few years. It may also explain the lower-than-expected infection rates seen in some HIV prevention trials. It also implies that the effectiveness of some HIV prevention programmes may have been overestimated.
The authors comment: “We propose that the phenomenon of heterogeneity in HIV susceptibility may have contributed to the observed declines in HIV incidence and prevalence.”
They add that although there is compelling evidence that at least part of the HIV prevalence declines in parts of Africa were caused by changes in risk behaviour, “some of this decline may have occurred without behavioural change, confounding our ability to attribute HIV epidemic shifts to specific interventions.”
Nagelkerke NJD et al. Heterogeneity in host HIV susceptibility as a potential contributor to recent HIV prevalence declines in Africa. AIDS 23:125-130, 2009.
Kimani J et al. Reduced rates of HIV acquisition during unprotected sex by Kenyan female sex workers predating population declines in HIV prevalence. AIDS 22:131-7, 2008.
Winning the Battle Against HIV/AIDS ? Strong Leadership and Innovative Partnerships Needed, Says Kofi A. Annan. 31/10/10
Five more people still contract the virus for every two who start treatment.
31 October 2010
St Maarten — In a keynote speech on Sunday 31 October, former UN Secretary-General Kofi A. Annan will argue that we need strong leadership, more innovative partnerships and a firm focus on human rights to win the battle against HIV/AIDS.
Speaking at the 10th anniversary meeting of the Pan-Caribbean Partnership against HIV/AIDS (PANCAP) in St Maarten, Mr. Annan will:
Stress that thirty years on from the start of the epidemic, the battle against HIV/AIDS has still to be won – five more people still contract the virus for every two who start treatment.
-Emphasize that the fight against HIV/AIDS must be seen as part of the wider battle to uphold human rights, with stigma and discrimination still deterring many people from seeking treatment or ensuring prevention.
-Call for innovative partnerships that include governments, NGOs and pharmaceutical companies to work together to defeat HIV/AIDS.
-Pay tribute to the leadership shown by the regional organization CARICOM in setting up PANCAP, “a model for others to follow”, to tackle HIV/AIDS in the Caribbean region.
Also speaking at the event will be Michel Sidibé, Executive Director of UNAIDS.
Mr. Annan will say: “Thirty years since the start of this terrible epidemic, too many people still get infected and too many die of AIDS-related illness. While we have seen real progress across the board, five more people still contract the virus for every two who start treatment. Despite the tremendous efforts of PANCAP, the Caribbean has not been spared. With the exception of Sub-Saharan Africa, this region faces the greatest HIV/AIDS challenge. An estimated 240,000 people live today with HIV in the Caribbean. Twenty thousand more are newly infected each year.”
“We have to view the fight against HIV/AIDS within the wider battle to uphold human rights. Sexual minorities, drug users, and people infected by HIV/AIDS suffer from daily discrimination and prejudices, discouraging them from seeking help and treatment. Women and girls are particularly at risk. Too many suffer sexual abuse or feel unable to insist on protected sex. They must be empowered to speak up and protect themselves and their children.”
“Winning this battle requires the support and commitment of all sectors of society. The HIV epidemic is not only a health issue. We need the meaningful involvement of community-based groups, NGOs and faith-based organizations. Employers and trade unions can play a key role by making the workplace an access point for HIV prevention, treatment and support. Researchers, doctors and pharmaceutical companies can help to develop drugs to treat the virus. With strong encouragement from outside, drug companies can make medicines more cheaply so that more people could afford them.”
PANCAP is a regional partnership which was established in February 2001 to respond to the HIV and AIDS epidemic in the Caribbean. Its vision is to substantially reduce the spread and impact of HIV and AIDS in the Caribbean through sustainable systems of universal access to HIV prevention, treatment, care and support. By 2012, it aims to reduce: the estimated number of new infections by 25%; HIV mortality by 25%; and the social and economic impact of HIV and AIDS on households by 25%.