Community health workers and home-based care programs for HIV clients

In Nyanza Province, Kenya, estimated HIV prevalence is 22%. Given that more than 80% of the population resides in rural areas, the majority of individuals in Nyanza Province do not have access to medical facilities on a regular basis. In response to the growing demands the HIV epidemic has placed on the people and communities in this region, hundreds of lay individuals have been trained as community health workers to provide home-based care to sick or dying HIV/AIDS clients in rural areas. This paper discusses the role and impact of these community health workers in Nyanza Province, Kenya. It outlines the collaborative relationship between community health workers and the Ministry of Health, examining community health workers' use of extant biomedical structures at the district level to provide services that government-run health facilities lack the monetary resources or personnel to provide. Finally, it explores the role played by community health workers in providing HIV/AIDS education to individuals in an attempt to prevent further infections.     

Knowledge of HIV/AIDS and attitude towards voluntary counseling and testing among adults

BACKGROUND: Nigeria has the third highest population of people living with human immunodeficiency virus (HIV). Despite this, the knowledge of HIV/AIDS and uptake of voluntary counseling and testing (VCT) is still low, especially in the rural areas. This study assessed knowledge of HIV/AIDS and attitude towards VCT among adults in a rural community in northern Nigeria. METHODS: A pretested questionnaire was administered on a cross-section of 210 adults in Danbare village, northern Nigeria. Information about knowledge of HIV/AIDS and attitudes toward VCT was elicited among respondents. RESULTS: The majority of respondents (59%) did not know the causative agent of AIDS; however, knowledge of route of disease transmission was high, with 71% and 64% of study participants mentioning sexual activity and unscreened blood transfusion, respectively, as possible transmission routes. Respondents listed avoidance of premarital sex, outlawing prostitution, condom use and screening of blood before transfusion as protective measures. Overall, 58 (27.6%), 80 (38.1%) and 72 (34.3%) of the respondents had good, fair and poor knowledge of HIV/AIDS, respectively. After adjusting for confounders, female gender and formal education remained significant predictors of HIV/AIDS knowledge. Reasons for rejection of VCT included fear of stigma, marital disharmony, incurable nature of the disease and cost of treatment. Formal education, female gender and HIV knowledge significantly predicted positive attitude toward VCT for HIV/AIDS among the study population. CONCLUSION: More than half of the respondents had adequate knowledge of HIV/AIDS, and the majority were willing to have VCT. However, misconceptions, fear, gaps in knowledge and limited access to VCT remain prevalent. Our findings suggest the need to provide health education and scale up VCT services in northern Nigeria by targeting the efforts of international and local development partners to underserved rural areas.     

Profil sociodémographique, biologique et clinique de patients suivis dans un Centre de conseil et dépistage volontaire du VIH en zone rurale dans la province du Bas-Congo (RDC) 2006–2011

AIDS remains a public health problem in the Democratic Republic of Congo (DRC). However, there is little information on the medical situation of the disease in rural areas. The objective of this study is to describe the HIV infection in a rural zone in the province of Bas-Congo, DRC. The medical records of patients with a diagnosis of HIV/AIDS, followed in the centre of voluntary counselling and testing (VCT) of the general hospital Nsona-Nkulu in the city of Mbanza-Ngungu, DRC, from January 2006 to June 2011, were retrospectively reviewed. Socio-demographic profile, laboratory data and mode of detection were analyzed. During this study, 167 patients were identified as HIV positive (112 females and 54 males). The majority of patients were aged between 30 and 44 years and two out of three patients were not married; 77.3% had primary schooling. Testing for HIV was performed in 78% of patients during an episode of illness. Screening for unprotected sex was a rare event (0.7%). Co-infection with tuberculosis was present in 32% of our patients while 26% had shingles and 44.5% had sexually transmitted infection. Smoking was found slightly (14%) and alcoholism was reported in 37% of patients. Weight loss greater than 10% was found in 61% of patients. Over 80% of people tested positive for HIV were in later stages (stages 3 and 4). This study demonstrates that HIV infection remains a serious public health problem in rural zone. The factors militating for the use of awareness program for preventive measures need to be urgently addressed.     

Training-of-trainers in rural Zimbabwe

Many people in African cities are exposed to some form of HIV/AIDS information, but rural dwellers have little or no access to such information. The Family AIDS Caring Trust (FACT) in Zimbabwe, however, noted that rural inhabitants both need and want AIDS education. FACT therefore mounted a Training-of-Trainers Project to increase the coverage of AIDS education among people outside urban areas. Potential trainers must be motivated self-starters and interested in the project, able to converse well in English, respected in their community, and have ample time for training and to hold their own training courses. Evaluation workshops are important in the ongoing refinement of the project while supervisory support is provided. The paper describes training materials and the course, evaluation workshops, supervisor and trainee recruitment, lessons learned, changes made, and project expansion.     

Laos: rural economy threatened by AIDS

Laos is a rural country in which more than 70% of the work force depends upon the agricultural sector for its livelihood. Crop production in Laos is a low-productivity, labor-intensive affair which is highly vulnerable to disruption by natural disasters and outbreaks of disease. Laos is also a crossroads for trade from Cambodia, China, Thailand, and Vietnam. While such trade has some positive effect upon the domestic economy, it also facilitates the spread of sexually transmitted diseases into Laos from neighboring countries with high rates of HIV infection. The northwestern trading corridor bordering Thailand, Myanmar, and China is of particular concern with regard to the spread of HIV. The Lao government identified eleven individuals infected with HIV and had officially reported only one case of AIDS to the World Health Organization (WHO) as of April 1992. Although WHO has not yet confirmed or projected the number of HIV-seropositive and AIDS cases in Laos, scant available data suggest that AIDS is concentrated in urban areas. Poverty and isolation will not, however, protect rural villages from HIV. The implications of a growing HIV/AIDS epidemic for rural social structures are considered. It is clear that such a situation could lead to agroeconomic dislocation and jeopardize national food security. The following measures are recommended to confront HIV/AIDS in the agricultural sector: change cropping systems, provide AIDS prevention education and technical assistance, and recruit village cadres to increase AIDS awareness among young Lao and care for the very ill.     

Experiences and ways PLWHA deal with their lives

The issue of HIV and AIDS and people living with HIV and AIDS is very sensitive which needs great attention. The population of infected individuals seems not to seek help and health services due to their illness. The barriers which prevent this population experience the meaning of social construction of their illness. The main objective of this study is to understand the day-to-day lives and the ways PLWHA deals with their lives. Qualitative method and participatory action research were used to gather information. The study found out that PLWHA have much to fight for in the complex and frightening areas of HIV research and treatment. Though there have been lacking scientific skills, all PLWHA can bring unique experiences and perspectives to an open discussion. The study concluded that facing the challenges of working with HIV and AIDS -individuals; consider the participatory research approach because it can reach out to individuals, groups and organizations. It was recommended that the ultimate goals of AIDS treatment and research activism are to accelerate scientific research knowledge that contributes towards cure, and to win an early widespread access to treatment for everyone infected with HIV. Developing a well-designed research can help PLWHA learn how to ask themselves different questions and ask if the medical and research establishments will address their concerns.     

Border restrictions and HIV / AIDS: a public health policy disaster

Some governments restrict people with HIV/AIDS from entering their countries, claiming that doing so reduced HIV transmission. Yet, this claim does not stand to reason in the US which has the world's highest number of AIDS cases or in countries with no reported AIDS cases since some people may already be HIV infected. Some countries require HIV testing for people crossing borders. Yet, some people cross borders illegally. Further, HIV tests only detect HIV antibodies, but they are not present for a period after HIV infection. Some countries claim that people with HIV/AIDS burden the pubic health system. Yet, the countries do not apply this economic standard to travelers with other life-threatening diseases, thus, it is discriminatory. Besides, it is immaterial for short-term visitors and visitors with health insurance. HIV-related border restrictions violate the human right of freedom of movement. Some countries require HIV testing of just certain travelers, often based on country of origin or sexual orientation another form of discrimination. These practices set a bad precedent and encourage local governments to adopt like measures, leading to discrimination of HIV seropositive citizens. These national policies may keep tourists from traveling to some countries, perhaps affecting national revenues. Compulsory testing is very costly and takes money away from needed HIV prevention programs. People in countries with low HIV prevalence often think they are not at risk because HIV-infected foreigners are kept out of their country, so those who partake in risky behavior do not examine this behavior. Further, citizens from such countries will not consider AIDS information necessary. In those cases where HIV/AIDS information is presented in combination with mandatory testing, people will tend not to be interested in the messages. In conclusion, border restrictions based on HIV testing are counter productive and impede efforts to contain the pandemic.     

“There is no proof that HIV causes AIDS”: AIDS denialism beliefs among people living with HIV/AIDS

AIDS denialists offer false hope to people living with HIV/AIDS by claiming that HIV is harmless and that AIDS can be cured with natural remedies. The current study examined the prevalence of AIDS denialism beliefs and their association to health-related outcomes among people living with HIV/AIDS. Confidential surveys and unannounced pill counts were collected from a convenience sample of 266 men and 77 women living with HIV/AIDS that was predominantly middle-aged and African American. One in five participants stated that there is no proof that HIV causes AIDS and that HIV treatments do more harm than good. AIDS denialism beliefs were more often endorsed by people who more frequently used the internet after controlling for confounds. Believing that there is a debate among scientists about whether HIV causes AIDS was related to refusing HIV treatments and poorer health outcomes. AIDS denialism beliefs may be common among people living with HIV/AIDS and such beliefs are associated with poor health outcomes.     

Training tribal leaders in Thailand

More than 500,000 hill tribe people with distinct languages and cultures live in Thailand. Extensive reforestation reducing the amount of land which they are entitled to cultivate and a ban on opium production have resulted in increased trafficking of opium and heroin from neighboring countries as well as a higher level of prostitution. The frequent injection of heroin with shared needles, turnaround migration between urban and rural areas, tourism, extensive body tattooing, infant ear piercing under unsterile conditions, and unsterile injection practices by barefoot doctors in the context of prostitution and heroin use bode ill for the prevention of widespread HIV transmission. The government has distributed AIDS information, but most tribal people cannot understand the materials. High illiteracy rates and less than mainstream Thai impede their understanding of explanations about disease. The Health Project for Tribal People therefore developed an HIV/AIDS program which is culturally and linguistically relevant for the hill tribes. The training of village leaders as educators is an important component of the project. Teams of lay people were trained in basic techniques of surveying, pretesting materials, and teaching. Project start-up, the selection of educators, training methodologies, practice teaching, extra support, follow-up, successes and problems, and the next phase are described.     

Perceived employment barriers and their relation to workforce-entry intent among people with HIV/AIDS

As treatments have improved health and quality of life for people with HIV/AIDS, many have contemplated workforce reentry. Workforce reentry rarely occurs among people with illness-related disability. The authors mailed a survey that included workforce-entry-related concerns to 1,991 HIV/AIDS clients. Factor analysis extracted 6 areas of concern (benefits loss, work-related health, job skills, discrimination, personal health care, workplace accommodation). Levels of concern generally increased with HIV acuity level and time since last worked. Work-related health concerns predicted consideration of workforce entry, and work-related health concerns and benefits-loss concerns predicted estimated time to return to work. Findings provide quantitative validation of intuitive categories of workforce-entry concerns among people with HIV/AIDS and suggest that concerns may shift with progress toward workforce entry.     

AIDSCAP. Saving a generation: Ethiopian youth rally to prevent AIDS

Afraid that they were infected with HIV and would die in several years, several young adults formed the Save Your Generation Association (SYGA) to warn other young people about the threat of HIV/AIDS. SYGA has since become a registered Ethiopian nongovernmental organization (NGO) with a paid staff of 14 and more than 6000 dues-paying members. It is one of seven NGOs which received support from the AIDS Control and Prevention (AIDSCAP) project over 3 years to bring HIV/AIDS prevention education to out-of-school youth in six urban areas of Ethiopia. The projects recruited young volunteers and enlisted the aid of community organizations to inform and motivate the tens of thousands of school dropouts and other unemployed young people. Bored and hopeless, these youths often turn to dangerous escape mechanisms involving drugs, alcohol, and sex with multiple partners. The local government helped the NGOs find their target population and provided meeting space for HIV/AIDS prevention activities.     

Poverty reduction and the HIV / AIDS epidemic in Kenya:What are the core issues

The government of Kenya has recently attempted to develop a national budget that gives priority to two pertinent constraints to national development efforts. These are poverty and HIV/AIDS. The poor are those members of society that are unable to afford minimum basic human needs comprising food and non-food items. Slightly over 50% of Kenyans live bellow poverty line. Also, about 700 Kenyans are lost to the HIV/AIDS epidemic everyday. 75% of those infected live in the rural areas and the majority of those are aged 15-39 years. Any efforts to reduce poverty and contain the epidemic will require an integrated approach because of the interplay between the effects of HIV/AIDS and poverty. Both poverty and HIV/AIDS are direct, non-selective and universal, both affects males, females and children ,reduce the labour force as well as food production, strain medical services and generally aggravate the performance of the economy. There is therefore an absolute need to protect the poor from infection and re-infection especially those located in the rural areas and the youth who are at risk. An essential component of this protection is public education of these groups, accompanied by economic empowerment through creation of self-employment opportunities. The recently developed Poverty Reduction Strategy paper (PRSP) clearly identifies these lines of attack. What remains is the translation of these noble ideas into concrete implementable projects and programmes with the participation of all stakeholders.     

The forgotten tenth: AIDS in the older generation

While nearly ten percent of diagnosed cases of AIDS occur in people 50 years old and older, there has been little attention given to this group in the areas of prevention, education, psychosocial support, or treatment because HIV/AIDS is thought to be the disease of the young and sexually active. Evidence points to many infected older people contracting the disease through homosexual contact. Also, older people are often finding themselves dating again due to divorce or being widowed, and engaging in sexual activity without protection. Elderly people presenting with confusion or altered mental status or having severe bouts of pneumonia may first be evaluated for other possibilities before HIV is considered. HIV should be considered in the initial assessment in diagnosis when older patients are having more serious opportunistic-type infections in order to begin HIV treatment as early as possible. Statistics of AIDS cases by age at diagnosis reported through June 1997 are presented.     

HIV/AIDS awareness among hospital employees

The present cross sectional study was carried out to assess the basic knowledge and attitude of class III and Class IV hospital employees (n = 250) regarding HIV/AIDS. Of the 250 study subjects 232(92.8) had heard or read about AIDS. Chief sources of information were television, newspapers and doctors. Though the study subjects had some factual knowledge about HIV/AIDS, certain misconceptions and myths persisted. They were also found to have a biased and negative attitude towards people with AIDS. 223(96.1%) study subjects said that they would like to learn more about HIV/AIDS. The results of this study indicate that action is needed to increase the level of knowledge of this group so that they reject biased information and myths relating to AIDS and thus carry out their duties effectively and help in forming an enlightened opinion against AIDS.     

Global update: Cambodia

Between 1991 and 1993 in Cambodia, the number of blood donors who tested seropositive for HIV multiplied by 10. During March-December 1993, 30 of 4000 (0.75%) blood donors were HIV positive. These same 30 were among 91 HIV-positive cases reported to the World Health Organization [WHO] office in Phnom Penh in the last 9 months of 1992. As Cambodia attempts to recover from many years of political and social upheaval, the recent repatriation of 370,000 Khmer refugees from Thailand intensifies the increasing AIDS threat. Thailand already has a relatively high HIV prevalence. The number of tourists and visiting business professionals is increasing, and 22,000 people from the UN Transitional Authority in Cambodia have been assigned to positions countrywide. In 1991, WHO officials designed a 1-year short-term AIDS prevention program aimed at people practicing high-risk behavior and the health, education, and media sectors. It targeted mainly Phnom Penh residents, WHO and the UN Development Programme (UNDP) are helping the National AIDS Committee in designing a more comprehensive national plan. UNDP plans to give US$ 1 million to AIDS prevention efforts in Cambodia. 20-30% of people in Cambodia are not familiar with condoms. Government AIDS prevention efforts are intended for the general public, but they also are going to target high-risk areas, especially the provinces bordering Thailand and the pot of Kompong Som. The government is working on ways to work with the many health-centered nongovernmental organizations in Cambodia. Even though it is inundated with many other problems, the government recognizes the need to combat AIDS.     

Is immune oversuppression the direct cause of AIDS?

AIDS is presumably caused by HIV, a retrovirus. The main support for this view comes from the consistent epidemiological correlation between AIDS and the presence of antibody against HIV. Several HIV-associated mechanisms have been described to explain the cytopathic effects on helper-T-lymphocytes observed in vitro but so far, none of these mechanisms has been confirmed in vivo. On the other hand, there is virtually no free virus and HIV RNA synthesis is very low both in AIDS patients and in asymptomatic carriers. Thus it is unlikely that HIV causes AIDS by acting as a conventional cytocidal virus. Here it is proposed, on the basis of current experimental evidence, that an active immune suppression mediated by T8+ cells is the direct culprit for a gradual decline of helper-T-lymphocyte numbers leading to an immunocompromised state in AIDS. The role of HIV in triggering and perpetuating a state of immune oversuppression is discussed.     

Ethical and legal issues

At the 9th International Conference on AIDS and Sexually Transmitted Diseases in Africa (ICASA), issues concerning the legal and ethical aspects of HIV/AIDS are brought to the fore. Throughout the world, people living with HIV/AIDS are experiencing various forms of human rights abuses including testing abuses, lack of confidentiality, refusal to treat patients, dismissal of HIV-positive employees without sufficient reason, invasion of privacy, and placement of infected subjects in quarantine. This discrimination and stigmatization is not justified and gravely compromises the considerable efforts already made in fighting the epidemic. Participants suggested that the law should be used to support the authority of individuals infected with HIV/AIDS. Legislation should follow a double objective: it should know that victims of AIDS should be protected and supported, and it should clearly indicate what the responsibility of seropositive persons vis a vis society could be. The controversy of whether it is necessary to enact a legislation concerning HIV/AIDS, however, remained. While some people believed that the existing legal framework could be exploited to develop the necessary protocol concerning the responsibilities and rights of patients, an opposing viewpoint is that current legislation should not be applied in solving the problems associated with HIV/AIDS. But the important interest is that numerous recommendations of the ICASA will not remain simple declarations of intention, but translated into correct actions.     

Global impact of human immunodeficiency virus and AIDS

This review provides information on the epidemiology, economic impact, and intervention strategies for the human immunodeficiency virus (HIV)/AIDS pandemic in developing countries. According to the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) at the end of 1999, an estimated 34.3 million people were living with HIV/AIDS. Most of the people living with HIV, 95% of the global total, live in developing countries. Examples of the impact of HIV/AIDS in Africa, Asia, Latin America, the Caribbean, and the Newly Independent States provide insight into the demographics, modes of exposure, treatment and prevention options, and the economic effect of the epidemic on the global community. The epidemic in each region of the world is influenced by the specific risk factors that are associated with the spread of HIV/AIDS and the responses that have evolved to address it. These influences are important in developing HIV/AIDS policies and programs to effectively address the global pandemic.     

Antimicrobial and toxicological evaluation of the leaves of Baissea axillaries Hua used in the management of HIV/AIDS patients

Background  

Persistent diarrhea is a common endemic disease with high incidence among the Africans including Nigerians. It also represents a frequent opportunistic disease in people living with HIV. Diarrhea represents one of the most distressful and persistent symptoms of HIV/AIDS, which may or may not be accompanied by an infection. The leaves decoction of Baissea axillaries Hua (Apocynaceae) is used by traditional herbalists in Edo state, Nigeria for the management of people living with HIV/AIDS. Determination of its antimicrobial activity and toxicological profile will provide supportive scientific evidence in favour of its continuous usage.