Field experiences integrating family planning into programs to prevent mother-to-child transmission of HIV

This article reviews field experiences with provision of family planning services in prevention of mother-to-child transmission (PMTCT) programs in ten countries in Africa, Asia, and Latin America. Family planning is a standard component of most antenatal care and maternal-child health programs within which PMTCT programs are offered. Yet PMTCT sites often miss opportunities to provide HIV-positive clients with family planning counseling. Demand for family planning among HIV-positive women varies depending on the extent of communities' openness about HIV/AIDS, fertility norms, and knowledge of PMTCT programs. In Kenya and Zambia, no differences were observed in use of contraceptives between HIV-positive and HIV-negative women in the study communities, but HIV-positive women have more affirmative attitudes about condoms and use them significantly more frequently than do their HIV-negative counterparts. In the Dominican Republic, India, and Thailand, where HIV prevalence is low and sterilization rates are high, HIV-positive women are offered sterilization, which most women accept. This article draws out the policy implications of these findings and recommends that policies be based on respect for women's right to informed reproductive choice in the context of HIV/AIDS.     

Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa

AIDS stigmas interfere with HIV prevention, diagnosis, and treatment and can become internalized by people living with HIV/AIDS. However, the effects of internalized AIDS stigmas have not been investigated in Africa, home to two-thirds of the more than 40 million people living with AIDS in the world. The current study examined the prevalence of discrimination experiences and internalized stigmas among 420 HIV-positive men and 643 HIV-positive women recruited from AIDS services in Cape Town, South Africa. The anonymous surveys found that 40% of persons with HIV/AIDS had experienced discrimination resulting from having HIV infection and one in five had lost a place to stay or a job because of their HIV status. More than one in three participants indicated feeling dirty, ashamed, or guilty because of their HIV status. A hierarchical regression model that included demographic characteristics, health and treatment status, social support, substance use, and internalized stigma significantly predicted cognitive-affective depression. Internalized stigma accounted for 4.8% of the variance in cognitive-affective depression scores over and above the other variables. These results indicate an urgent need for social reform to reduce AIDS stigmas and the design of interventions to assist people living with HIV/AIDS to adjust and adapt to the social conditions of AIDS in South Africa.     

AIDS spread most rapid in South Africa

Between the end of 1993 and the end of 1994, the prevalence of HIV infection increased 70% (4.3-7.6%) in South Africa, the largest increase of HIV in Africa and perhaps even the world. HIV seroprevalence is highest in Kwa/Zulu (20%). Complacency is more common place in South Africa than in other African countries. In a survey, 75% of Black women in Johannesburg wanted to use condoms, but only 2% used them. People in South Africa have a higher standard of living and are healthier so they may remain healthy longer after HIV infection than those in other African countries. UNAIDS is focusing its attention on sub-Saharan Africa, largely because Africa does not have its own financial resources to fight against AIDS. Physicians in developing countries tend to not know that they can use locally-made drugs to treat opportunistic infections. Some recent beneficial publications on AIDS are the new issue of The AIDS Handbook, the latest booklet in ActionAid's Strategies for Hope series, and the Cote d'Ivoire's Filling the Gaps. The handbook presents information on transmission and symptoms of AIDS and prevention as well as advice on counseling.     

AIDS spread most rapid in South Africa [letter

Between the end of 1993 and the end of 1994, the prevalence of HIV infection increased 70% (4.3-7.6%) in South Africa, the largest increase of HIV in Africa and perhaps even the world. HIV seroprevalence is highest in Kwa/Zulu (20%). Complacency is more common place in South Africa than in other African countries. In a survey, 75% of Black women in Johannesburg wanted to use condoms, but only 2% used them. People in South Africa have a higher standard of living and are healthier so they may remain healthy longer after HIV infection than those in other African countries. UNAIDS is focusing its attention on sub-Saharan Africa, largely because Africa does not have its own financial resources to fight against AIDS. Physicians in developing countries tend to not know that they can use locally-made drugs to treat opportunistic infections. Some recent beneficial publications on AIDS are the new issue of The AIDS Handbook, the latest booklet in ActionAid's Strategies for Hope series, and the Cote d'Ivoire's Filling the Gaps. The handbook presents information on transmission and symptoms of AIDS and prevention as well as advice on counseling.     

“一带一路”沿线国家HIV/AIDS流行现状及变化趋势研究

目的了解"一带一路"沿线国家HIV/AIDS的流行现状及变化趋势, 为防范HIV/AIDS跨境传播提供依据。方法选取与我国签署了共建"一带一路"合作文件的145个国家为本研究的"一带一路"沿线国家;145个国家2013-2019年HIV/AIDS年龄标化的发病率、患病率数据来源于2019年全球疾病负担研究。使用2019年年龄标化的发病率、患病率描述145个国家HIV/AIDS的流行现状。通过计算年估计百分比变化(EAPC), 分析HIV/AIDS发病率在2013-2019年的变化趋势。结果 2019年, 在非洲、亚洲、欧洲、北美洲、南美洲和大洋洲中, HIV/AIDS发病率≥40.00/10万的国家占比最高的地区是非洲, 为56.86%(29/51);最低的是亚洲, 为5.41%(2/37)。145个国家中, HIV/AIDS患病率≥100.00/万的国家多数位于非洲, 占20.69%(30/145)。2013-2019年, HIV/AIDS发病率呈上升趋势的国家共50个(34.48%, 50/145);呈下降趋势的国家共69个(47.59%, 69/145);无显著变化的国家共26个...     

HIV epidemic -- a global update. Excerpts from the UN World AIDS Day report

According to the 1997 United Nations World AIDS Day Report, over 30 million adults and children worldwide are HIV-infected and, if current transmission rates remain constant, 40 million people will be infected by the year 2000. In 1997, an estimated 5.8 million people became HIV-infected and 2.3 million died of AIDS-related infections. Nearly half of these deaths were in women and 460,000 were in children under 15 years. In sub-Saharan Africa, where the epidemic is progressing most rapidly, 7.4% of the population aged 15-49 years is HIV-positive. Unprotected sex accounted for most of the 3.4 million new HIV infections among adults in sub-Saharan Africa in 1997. In Asia, the epidemic is more diverse, both in terms of intercountry variation and modes of transmission. In the developed world, newly available antiretroviral drugs are reducing the speed at which HIV-infected people develop AIDS. Of particular concern is the impact of HIV/AIDS on reversing gains in life expectancy and child survival in developing countries. Moreover, an estimated 9 out of 10 HIV-positive people worldwide are not aware they are infected. The future course of the epidemic depends in large part on expanded access to information about how HIV is transmitted and how to avoid infection.     

Masculinity and the persistence of AIDS stigma

With the expansion of access to HIV testing and antiretroviral therapy in sub-Saharan Africa, questions have emerged as to whether stigma remains a useful concept for understanding the effects of AIDS. There is, however, a paucity of research on how HIV-positive Africans--especially African men--experience living with AIDS. This paper addresses this gap and draws on findings from ethnographic fieldwork in 2004 and 2009 with a support group for HIV-positive men in Kampala, Uganda. The paper demonstrates that stigma is central to how men in this context coped with HIV and AIDS and it provides a conceptual framework that links men's experiences of AIDS stigma to conceptions of masculinity. In so doing, findings highlight both the possibilities and challenges of involving African men more fully in HIV prevention.     

What if the HIV/AIDS pandemic were an opportunity to improve the relevance of breastfeeding promotion programs in Africa?

In the 1990s, many programs and actions were set up for promoting breastfeeding in Africa, more or less successfully in different countries. The main achievements of these programs were the training of health professionals and the apparent ending of the distribution of formula in Health services. The impact of these programs on breastfeeding practices in countries with prevalent prolonged mixed feeding is less obvious, as many programs did not emphasize "best practices". Health messages delivered on this topic have been poor, because they were often conceived at the international level rather than adapted to African contexts, and because the consensus about the promotion of breastfeeding is so strong that the programs have rarely undergone a critical evaluation. The HIV/AIDS pandemic could be an opportunity to rethink these programs. "Baby friendly" Health services are now considered as the most knowledgeable to deal with breastfeeding in the context of HIV, through the reinforcement of the promotion of "best feeding practices" and through the follow-up of formula-feeding for some HIV-positive mothers. To prevent HIV transmission, health messages will have to promote some practices that are useful for HIV-negative, as well as HIV-positive, mothers, such as exclusive breastfeeding, the prevention, early diagnosis and treatment of abscesses and mastitis, and the management of weaning - all strategies that were undervalued until now. For children of HIV-positive mothers and for orphans, Health services will have to set up a medical follow-up of artificial feeding. These new goals mean that breastfeeding promotion programs will have to develop complementary strategies with an emphasis on care, coordinated with other vertical programs such as AIDS and malnutrition programs.     

Some clinical aspects of HIV infection in Africa

WHO has estimated the cumulative number of AIDS cases in Africa to have grown from 2978 (1986) to 81,019 (1990). The actual numbers are probably much higher due to under reporting, under diagnosis, and delays in notification. Pathogenicity and clinical features of HIV 2, found mainly in west Africa, are similar to those of HIV 1. 2nd generation HIV-ELISA tests can check for both viruses' antigens. These and other ELISA tests can be used to rapidly identify HIV, but clinical criteria alone can usually determine an accurate diagnosis. In developed countries, AZT (zidovudine) shows some promise of stemming the onset of AIDS in asymptomatic patients. Other promising antiretrovirus drugs are being developed, but are all too expensive for Africa. Almost 33% of HIV positive patients in Africa also have tuberculosis (TB) and, up to 1988, around 40% of TB patients tested HIV positive. In Uganda, Zambia, and Malawi the percentages ranged from 50-65% in TB patients. HIV positive TB patients have a substantial higher mortality than HIV negative TB patients. In some areas of Africa, 66% of AIDS patients have chronic, watery diarrhea and weight loss. The most common pathogens include Cryptosporidium and Isopora belli. Cryptosporidium does not respond to treatment, so there is a concern of a hospital based outbreak in AIDS patients. Cytomegalovirus also causes gastrointestinal illness in African AIDS patients as well as pulmonary disease. Toxoplasma and Cryptococcus often attack the central nervous system of AIDS patients. Oral fluconazole can provide some initial relief from cryptococcal meningitis. Bacteremia is also common. Little evidence exists to suggest an important interaction between HIV and traditional tropical diseases. Unlike Western nations, pneumocystosis and Mycobacterium avium intracellular are uncommon in Africa.     

The impacts of AIDS movements on the policy responses to HIV/AIDS in Brazil and South Africa: A comparative analysis

Abstract

Brazil and South Africa were among the first countries profoundly impacted by the HIV/AIDS epidemic and had similar rates of HIV infection in the early 1990s. Today, Brazil has less than 1% adult HIV prevalence, implemented treatment and prevention programmes early in the epidemic, and now has exemplary HIV/AIDS programmes. South Africa, by contrast, has HIV prevalence of 18% and was, until recently, infamous for its delayed and inappropriate response to the HIV/AIDS epidemic. This article explores how differing relationships between AIDS movements and governments have impacted the evolving policy responses to the AIDS epidemic in both countries, including through AIDS programme finance, leadership and industrial policy related to production of generic medicines.     

Inequalities in health: access to treatment for HIV/AIDS

The HIV infection represents a very clear example of the inequalities in access to health care between rich and poor countries: AIDS is a disease that the Western world can treat and the resource-limited countries cannot. In the world scenario a total of 5 million patients with HIV/AIDS who need treatment have no access to therapy: the estimated treatment coverage is 28% in Sub-Saharan Africa, 19% in Asia and only 14% in low and middle-income countries of Eastern Europe and Central Asia. A broad, multisectorial response at national and international levels is required to guarantee access to antiretroviral drugs for all people with HIV/AIDS who need them.     

Epidemiology of HIV infection among Israeli Arabs

OBJECTIVE: Israeli Arab citizens comprise Israel's largest minority group (15.6% of Israelis>12 years old). The objectives of this study were to describe the epidemiology of human immunodeficiency virus (HIV) in this group for the first time at a national level, and to identify health promotion and treatment needs. METHODS: All HIV/acquired immunodeficiency syndrome (AIDS) cases among Israeli Arab citizens that were notified to the Ministry of Health between 1985 and 2002 were analysed and compared with other Israelis (excluding immigrants from sub-Saharan Africa and their children). RESULTS: Twenty-five AIDS cases and 51 HIV-positive cases were notified in adult/adolescent Israeli Arabs, (3.4% of all adult/adolescent cases). In addition, four child cases were reported. The cumulative rates for Arab and non-Arab Israelis were 10.1 and 37.8/100,000, respectively. The gender ratios (male/female) were 3.3 and 4.4 for AIDS cases and HIV cases, respectively. The median age was 31.5 years [interquartile range (IQR)=12] for AIDS cases and 30 (IQR=12) for HIV cases. Modes of transmission were heterosexual contact (34%), intravenous drug use (21%), male homosexual contact (19%), unknown (14%), haemophilia (6%), children of at-risk parents (4%) and blood (2%). The mean interval from HIV notification to AIDS diagnosis was 1.5 years until 1998 and 2.8 years thereafter. Knowledge, attitudes and practices studies on AIDS in Arabs are also discussed in this article. CONCLUSION: HIV prevalence is lower in Arab Israelis than in non-Arab Israelis and Arabs residing in neighbouring countries. Nevertheless, the shorter interval from HIV notification to AIDS diagnosis in Arab Israelis suggests a lower rate of HIV testing and diagnosis at a later stage of infection. Patterns of transmission in Arab Israelis need further evaluation, including behavioural surveys.     

Impact of HIV/AIDS on African children

In Central and East Africa, pediatric human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are becoming increasing threats to child health due to the predominance of heterosexual transmission of HIV, high HIV infection rates in women of reproductive age and high birth rates. This paper examines the potential impact of HIV/AIDS on orphanhood and under-five mortality in 10 Central and East African countries. The author estimates that, in the 10 countries studied, HIV/AIDS in children under age five will cause between one-quarter and half a million child deaths annually by the year 2000. Whereas the United Nations estimate (without AIDS) and target for the under-five mortality rate in this 10-country region by the year 2000 are 132 and 78, respectively, HIV/AIDS will cause the under-five mortality rate to rise to between 159 and 189. Increasing HIV/AIDS-related adult mortality is creating a large and growing number of children under age 15 whose mothers have died of HIV/AIDS. During the 1990s, HIV/AIDS will kill a total of between 1.5 and 2.9 million women of reproductive age in this region, producing between 3.1 and 5.5 million AIDS orphans--which means that between 6 and 11% of the population under age 15 will be orphaned. National and international government and nongovernment service providers in Central and East Africa need to recognize this potential impact of HIV/AIDS on children, expand AIDS-prevention efforts, and develop policies and programs to address children's HIV/AIDS-related needs.     

Treading the path of least resistance: HIV/AIDS and social inequalities a South African case study

This paper outlines aspects of the HIV/AIDS epidemic scenario and the complexities associated with it. It reveals the socio-epidemiological patterns of the epidemic and in doing so identifies the populations with the greatest and fastest growing rates of infection. From the data presented it is evident that the pattern of HIV/AIDS in developing countries in sub-Saharan Africa in particular is unique. The pattern emerging in South Africa follows closely. The features of this pattern are as follows: the epidemic is mainly a heterosexual epidemic, the rates of infection in the general population are very high and the percentage of HIV-positive women is greater than men. An additional unique feature is the young age of onset of infection for women. These data demonstrate the need to focus our attention on young African women and the factors underpinning their predicament. In order to understand their position we examine the long standing relationship between social inequalities and health in general and further invoke the concepts of vulnerability and social capital to shed light on the position of women in the epidemic. Within the constraints of limited and problematic statistical data, the paper argues that a mixture and complex interaction of material, social, cultural and behavioural factors shape the nature, process and outcome of the epidemic in South Africa. It concludes with recommendations for the way forward.     

Women, reproductive rights, and HIV/AIDS: issues on which research and interventions are still needed

From 2002 to 2005, two literature reviews identified a number of reproductive health issues that appeared to be relatively neglected in relation to HIV/AIDS: contraceptive information tailored to the needs of HIV-positive people; voluntary HIV counselling and testing during antenatal care, labour, and delivery; parenting options for HIV-positive people besides pregnancy through unprotected intercourse (i.e. assisted conception and legal adoption or foster care); unwanted pregnancy; and abortion-related care. An additional finding was that stigma and discrimination were frequently cited as barriers to enjoyment of reproductive rights by HIV-positive women. Subsequently, a pilot project was initiated in which non-governmental organizations (NGOs) in developing countries used benchmarks to ascertain whether these neglected issues were addressed in local programmes and interventions serving women affected by HIV and AIDS. The benchmarks also assessed whether policies and programmes paid attention to the human and reproductive rights of HIV-positive women. This paper describes the main findings from the two exercises in relation to contraception for women living with HIV or AIDS, abortion-related care, legal adoption by HIV-positive parents, and reproductive rights. It concludes with a number of recommendations on topics to be incorporated into the international research agenda, policies, and programmes in the field of HIV/AIDS.     

Prevalence and indicators of HIV and AIDS among adults admitted to medical and surgical wards in Blantyre,Malawi

Despite high seroprevalence there are few recent studies of the effect of human immunodeficiency virus (HIV) on hospitals in sub-Saharan Africa. We examined 1226 consecutive patients admitted to medical and surgical wards in Blantyre, Malawi during two 2-week periods in October 1999 and January 2000: 70% of medical patients were HIV-positive and 45% had acquired immune deficiency syndrome (AIDS); 36% of surgical patients were HIV-positive and 8% had AIDS. Seroprevalence rose to a peak among 30-40 year olds; 91% of medical, 56% of surgical and 80% of all patients in this age group were HIV-positive. Seropositive women were younger than seropositive men (median age 29 vs. 35 years, P < 0.0001). Symptoms strongly indicative of HIV were history of shingles, chronic diarrhoea or fever or cough, history of tuberculosis (TB), weight loss and persistent itchy rash (adjusted odds ratios [AORs] all > 5). Clinical signs strongly indicative of HIV were oral hairy leukoplakia, shingles scar, Kaposi's sarcoma, oral thrush and hair loss (AORs all > 10). Of surgical patients with 'deep infections' (breast abscess, pyomyositis, osteomyelitis, septic arthritis and multiple abscesses), 52% were HIV-positive (OR compared with other surgical patients = 2.4). Severe bacterial infections, TB and AIDS caused 68% of deaths. HIV dominates adult medicine, is a major part of adult surgery, is the main cause of death in hospital and affects the economically active age group of the population.     

A survey of HIV and HCV among female prison inmates in Portugal

HIV and hepatitis C virus (HCV) monitoring among prison inmates is instrumental in countries with concentrated HIV/AIDS epidemics. Knowledge on these dynamics in imprisoned women in Portugal is scarce. The HIV and HCV prevalence was estimated among inmates in the largest Portuguese prison for women, which holds 57% of all female inmates in Portugal, according to sociodemographic and behavioural variables and characterised attitudes towards HIV/AIDS according to serological status. Collected variables included age, education, country of birth, penal status, and accumulated time in prison. Drug injection and sharing of injection material were inquired, as well as age at first sexual intercourse. Inmates also characterised their attitudes towards HIV/AIDS. A venous blood sample was collected and tested for anti-HIV and anti-HCV antibodies. In this sample of 445 female inmates, 10% were HIV-positive, while 11% were HCV-positive. Longer imprisonment periods were associated with relatively higher HCV prevalence and women with later ages at first sexual intercourse were less frequently HIV-positive, regardless of drug injecting behaviour. HIV prevalence was 44% in women who had ever injected drugs and 6% in those who had never injected. HCV frequency was 69% among injecting drug users (IDUs) and 4% among non-IDUs. In women who injected drugs both HIV and HCV were more frequent when the number of injections was higher and when women reported sharing of injection material. Similar attitudes towards HIV/AIDS were found for HIV-positive and negative women, but those living with HIV had more tolerant positions. This study emphasizes the role of injecting drug use in the transmission of HIV and HCV in women in Portuguese prisons and reinforces the need for the systematic adoption of harm reduction measures.     

Clinical research, prophylaxis, therapy, and care for HIV disease in Africa.

By the end of the century, citizens of resource-poor countries will constitute 90% of the world's human immunodeficiency virus (HIV)-infected people. Clinical management of such persons in developing countries has been neglected; most AIDS research has concentrated on epidemiology, and donor agencies have generally invested in the prevention of HIV infection. The heavy burden of HIV disease in Africa requires that care for AIDS be addressed, and prevention and care should be seen as interrelated. Prevention and treatment of tuberculosis, the commonest severe infection in persons with AIDS in Africa, illustrate this interrelationship. We outline priorities for applied research on the management of HIV disease in a resource-poor environment, and discuss prophylaxis, therapy for opportunistic diseases, terminal care, and use of antiretroviral therapy. Research should define the standard of care that can realistically be demanded for HIV disease in a resource-poor environment. Research and public health programs for AIDS in developing countries must address AIDS care and attempt to reduce the widening gap between interventions available for HIV-infected persons in different parts of the world.     

Targeted interventions required against genital ulcers in African countries worst affected by HIV infection.

It remains unclear why there is such marked variation in the severity of the human immunodeficiency virus (HIV) epidemic between African countries. The prevalence of HIV infection has reached high levels in many parts of southern Africa but in most countries of West Africa the levels are much lower. Although there is good evidence that sexually transmitted infections (STIs) and genital ulcers in particular facilitate heterosexual transmission of HIV, there is little comparative STI data from the African countries worst affected by HIV infection. A MEDLINE search covering the period 1966 to August 2000 using the keywords "sexually transmitted diseases", "genital ulcers" and "Africa" was performed to identify factors that might be relevant to the spread of HIV infection in countries with the highest prevalences of the virus. In the countries worst affected by HIV infection, the proportions of men and women with STI who had genital ulcers lay in the ranges 45-68% and 13-68%, respectively. The proportions were much lower in countries of West Africa than in those of southern Africa. The African countries worst affected by HIV infection should adopt a more specialized approach to STI control than hitherto and specifically target the high incidence of genital ulceration. Locally, technical STI committees should draw up country-specific guidelines taking into account the prevalence of the various causes of genital ulceration. In these countries, national AIDS control programmes and donor agencies should develop a specific focus for decreasing the incidence of genital ulcer disease.     

HIV self-testing in adolescents living in Sub-Saharan Africa

Less than 20% of African adolescents aged 10–19 years are aware of their HIV status, whereas HIV screening remains the gateway to care and while AIDS has become the leading cause of death among adolescents in Sub-Saharan Africa. According to the UNAIDS target, scalable HIV testing strategies specific to various age groups, populations, and geographical areas must be implemented to end the AIDS epidemic by 2030. Many African countries have implemented policies supporting HIV self-testing (HIVST). Evidence of practicability and efficiency of HIVST in Sub-Saharan Africa settings has been reported, including HIVST data among adolescents. Adapted strategies of HIVST are urgently needed to promote HIV testing among adolescents living in sub-Saharan Africa.