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- Southern African Journal of HIV Medicine
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- Volume 2006, Issue 25, 2006
Southern African Journal of HIV Medicine - Volume 2006, Issue 25, 2006
Volumes & issues
Volume 2006, Issue 25, 2006
An update on female-controlled methods for HIV prevention : female condom, microbicides and cervical barriers : preventionSource: Southern African Journal of HIV Medicine 2006, pp 7 –11 (2006)More Less
Worldwide, nearly 5 million new HIV infections occurred in 2005 with more than 3 million of these in sub-Saharan Africa. Despite declines in the HIV prevalence in some sub-Saharan African countries, many continue to be heavily affected. In Zimbabwe data have shown a decrease in prevalence from 22.1% to 20.1% since 2003, yet there is no sign of a similar trend in South Africa, where the adult prevalence rate is 18.8%. National-level prevalence rates, however, may not reveal the full impact of the epidemic on different populations. For example, 30.2% of pregnant women in South Africa attending public antenatal clinics in 2005 were HIV positive, with rates varying by province from 15.7% in the Western Cape to 39.1% in KwaZulu-Natal. In addition, female youth aged 15 - 24 years were three times more likely to be infected than young men in the same age group. <br>Women are increasingly bearing the burden of the epidemic. Of the 39 million people worldwide living with HIV / AIDS , half are women. UNAIDS estimates that of the new infections expected to occur between 2002 and 2010, 70% will be among women in the developing world. Several factors account for women's higher risk of infection, including biological, socio-cultural and economic factors. For instance, the female reproductive tract is more susceptible to HIV infection than the male reproductive system, and young women are at highest risk of HIV infection due to an immature physiology. Further, sexual violence and gender inequalities frequently play a role in women's and girls' ability to practise safer sex. <br>Current HIV prevention methods are male-initiated or require a male partner's co-operation, leaving women without sufficient means to protect themselves from infection. New female-controlled prevention methods are urgently needed to reduce women's and girls' risk of HIV infection. This article provides an update on currently available methods and others being tested and/or developed to provide women and girls with more HIV prevention options.
Decreased sexual risk behaviour after the diagnosis of HIV and initiation of antiretroviral treatment - a study of patients in Johannesburg : preventionSource: Southern African Journal of HIV Medicine 2006, pp 12 –15 (2006)More Less
<I>Objectives.</I> An extended programme for free antiretroviral treatment (ART) of HIV was launched in South Africa in April 2004. It is essential to assess the effects on sexual risk behaviour. <br><I>Design and setting.</I> A questionnaire was distributed to patients on ART at Helen Joseph Hospital, Johannesburg, between 17 January and 22 February 2005. <br><I>Results.</I> The percentage of men who had sexual contacts outside their relationship decreased from 48% before HIV diagnosis to 11% after starting ART. Condom use with casual partners increased from 53% among the men and 46% among the women before the diagnosis of HIV to 87% and 81% respectively on ART. <br>The majority of patients were tested for HIV because they presented with symptoms of illness. We noted no significant difference in disclosure rate after the start of ART. All participants were positive about the treatment and felt physically better. The majority of the patients experienced a better quality of life. <br><I>Conclusions.</I> The ART had an overall positive effect on health with no increase of sexual risk behaviour.
Sustainability of long-term treatment in a rural district : the Lusikisiki model of decentralised HIV / AIDS care : HIV managementSource: Southern African Journal of HIV Medicine 2006, pp 17 –22 (2006)More Less
Antiretroviral therapy (ART) is slowly rolling out across South Africa, but coverage is highly variable between and within provinces. The chronic shortage of health care workers is recognised as one of the major bottlenecks to scaling up treatment, and this has the biggest impact in rural areas where the human resource crisis is most acute. <br>For the past three years Médecins sans Frontières (MSF) has been supporting a programme to provide care and treatment for people with HIV / AIDS in the local service area of Lusikisiki, a subdistrict of 150 000 inhabitants in the Eastern Cape serviced by one hospital and 12 clinics. Lusikisiki represents one of the poorest and most densely populated rural areas of South Africa. Less than half the population live in formal housing and up to 80% live below the poverty line. <br>With just 5 doctors per 100 000 people, Lusikisiki is 14 times below the national average and less than the average for Sierra Leone, DRC and Zimbabwe. An assessment done by MSF in early 2003 found that electricity was only available in a third of clinics and the supply of electricity was unreliable in half of those; only 8% had running water or a phone, and half lacked nursing accommodation. Drug supply management was a major problem, with up to 60 Essential Drugs List drugs missing at some clinics. Around half of all nursing posts were (and remain) vacant, and a chronic lack of auxiliary staff meant an increased burden of tasks that further limited direct patient care. <br>Nevertheless, the implementation of HIV care at the primary care level, through task shifting, community mobilisation, and the use of volunteers, has allowed the rapid scale-up of treatment even in this understaffed and poorly equipped setting. Within 2 weeks of the National Operational Plan for Comprehensive HIV Care being launched in October 2003, the first person was initiated on ART, and in less than 3 years, by October 2006, there were almost 2 200 people on antiretrovirals (ARVs), including 110 children. <br>This paper describes how the integration of HIV care and treatment including ART into primary health care in Lusikisiki managed to overcome the challenges of working in a resource-poor rural area to achieve good coverage and outcomes in a relatively short space of time.
Rural ARV provision - policy implications for accelerated ARV roll-out : reflections on a national dialogue on rural ARV programmes : HIV managementAuthor Bernhard GaedeSource: Southern African Journal of HIV Medicine 2006, pp 23 –25 (2006)More Less
As the Médecins sans Frontières (MSF) project of setting up ARV provision in Lusikisiki, Eastern Cape, draws to a close after 3 years (as reported in a separate article in this edition), the Nelson Mandela Foundation and MSF organised a 2-day dialogue to explore antiretroviral (ARV) provision in rural South Africa. What follows are some reflections on the 2 days - it is not meant to be a report-back (indeed, a publication based on the proceedings is available free of charge from the Nelson Mandela Foundation). I would rather reflect on some issues that arose from the meeting that were particularly poignant from the perspective of trying to provide a good-quality ARV service in a poor rural community. Some of these have implications to review national legislation and policies to make them more 'rural ARV roll-out friendly'.
On a never-ending waiting list : toward equitable access to antiretroviral treatment? experiences from Zambia : HIV managementAuthor Peris Sean JonesSource: Southern African Journal of HIV Medicine 2006, pp 26 –36 (2006)More Less
Universal access to antiretroviral (ARV) medication for HIV / AIDS is the clarion call of the WHO/UNAIDS 3 by 5 Initiative. Treatment coverage, however, remains highly uneven. This sharpens the question of who exactly is accessing ARVs and whether access is challenging inequality or reinforcing it. Issues of distributive justice have long been debated in health policy, but the practical challenges of ARV distribution are relatively new. In exploring what a more equitable process of ARV distribution could involve, this article draws on a human rights framework using case study material from Zambia.
Author E.M. Okunga-NambassiSource: Southern African Journal of HIV Medicine 2006, pp 37 –43 (2006)More Less
The World AIDS Conference is an event that one should experience at least once, in order to appreciate the way that the world has truly become a global village. The week of 13 -18 August 2006 saw over 20 000 delegates and 5 000 volunteers congregate at the Metro Toronto Convention Center, to network and discuss issues that it was hoped would bring the scourge of HIV / AIDS to an end. One had so many emotions each and every day, ranging from hope and optimism, excitement and exhilaration, to despair, despondency and even disgust. By the end of the conference one felt overwhelmed by fatigue, yet still eager to get home and get on with the job at hand. That job is stopping the epidemic of HIV. The relentless loss of lives and breakdown of society have been so devastating, especially in developing countries, that urgent calls for innovative ways of thinking and acting seem to have been the main theme of most of the sessions. <br>The key message throughout the conference was that the time to deliver on the promises by world leaders, the United Nations General Assembly and local politicians in their various constituencies was fast running out. The upward trend in prevalence of HIV in some areas was a sign that prevention of new infections was not keeping up with efforts to treat with ARV. The value and role of lifesaving antiretroviral (ARV) medications can not be underplayed. Indeed, their role in prevention was highlighted on numerous occasions throughout the conference. <br>An account of some of the highlights during the week follows. Most significant is the fact that focus must remain on prevention of new infections. The plight of women and children, especially in developing countries, is opening up new areas of practice in many fields, such as education, business and health services. The crucial role of all individuals in the world makes it mandatory to adopt a way of thinking that crosses all barriers, in much the same way that HIV knows no barriers. <br>The opening ceremony on Sunday night was spectacular, remembered most by the impressive presentation by Bill and Melinda Gates (of Microsoft fame). The stage was set for the rest of the week. Prevention of new infections and empowering of women to prevent themselves becoming infected was the main message, culminating in a pledge from the Gates Foundation of $500 million for research into microbicides and other technologies that could lead to reduction in the spread of the epidemic.