From treatment to prevention: The interplay between HIV/AIDS treatment availability and HIV/AIDS prevention programming in Khayelitsha,South Africa

There is a paucity of research that illustrates the interplay between HIV/AIDS treatment and prevention programs. We describe the central role that public access to antiretroviral (ARV) medication has played in the development and efficacy of HIV/AIDS prevention programming in Khayelitsha, a resource-poor township in the Western Cape of South Africa. We document the range of preventive interventions and services available in Khayelitsha since the early 1990s and explore the impact of ARV availability on prevention efforts and disease stigma on the basis of extensive indepth interviews, supplemented by data collection. The information gathered suggests that the introduction of the mother-to-child-transmission (MTCT) prevention programs in 1999 and the three HIV treatment clinics run by Doctors Without Borders/ Médecins Sans Frontières (MSF) in 2000 were turning points in the region’s response to the HIV/AIDS epidemic. These programs have provided incentives for HIV testing, galvanized HIV/AIDS educators to reach populations most at risk, and decreased the HIV incidence rates in Khayeltisha compared to other areas in the Western Cape. Lessons learned in Khayelitsha about the value of treatment availability in facilitating prevention efforts can inform the development of comprehensive approaches to HIV/ AIDS in other resource-poor areas.     

HIV/AIDS and economic growth: Evidence from West Africa

Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is one of the leading causes of morbidity and mortality in West Africa. Prevalence among the most productive age group in West and Central Africa stood at 1.5%, 3.4.0%, 2.5%, and 2.1% in 1990, 2000, 2010, and 2015 respectively. This study examined the effect of HIV/AIDS on economic growth in West Africa with focus on 11 countries. The augmented Solow model, rooted in the neoclassical growth theory, was used, which was operationalized using dynamic panel data modeling approach. Incidence, prevalence, number of people living with HIV/AIDS (PLWHA), and AIDS‐related deaths were used to measure HIV/AIDS. Estimations using system GMM returned statistically significant results while those of first difference and difference GMM were not. From the outcome of system GMM analysis, a percentage increase in incidence, prevalence, PLWHA, and AIDS deaths correspondingly reduced growth significantly through their effects on life expectancy by 0.15%, 0.02%, 0.004%, and 0.03%. Acquired immune deficiency syndrome deaths and PLWHA lowered economic growth through enrolment but not significantly. The import of the findings is that HIV/AIDS threatens growth through life expectancy in West Africa. Therefore, its spread in the subregion should be effectively contained while proper treatment should be provided for all infected persons.     

Homosexuality and HIV/AIDS prevention: the challenge of transferring lessons learned from Western Europe to Central and Eastern European Countries

In order to stem the rapidly growing HIV/AIDS epidemics in Eastern Europe a transfer of prevention know-how and experience from Western European countries is necessary. The success of such a transfer is contingent on addressing a number of challenging issues. Monolithic ideas of East/West difference need to give way to the growing empirical evidence which not only shows a tremendous diversity but also many similarities among the 51 countries within the WHO European region. These include similarities regarding sexual attitudes and HIV prevention needs. Western constructs such as a gay identity need to be de-emphasized however, when it comes to promoting human rights (and thus improving HIV prevention for men who have sex with men) in Central and Eastern Europe. In asking the question of what should be transferred from Western Europe to other countries, both the strengths and weaknesses of the last 20 years of prevention need to be considered. In terms of Western European research the strength lies in identifying the social structural causes of HIV transmission. In terms of practice, the successes of instituting country-level structures while also working within the gay community are to be emphasized. Short-comings are evident in terms of reaching men of lower socio-economic status, cultural minorities and sex workers. On such questions, the expertise of Europe as a whole is needed in order to find new answers.     

Community health workers and the response to HIV/AIDS in South Africa: tensions and prospects

After a decline in enthusiasm for national community health worker (CHW) programmes in the 1980s, these have re-emerged globally, particularly in the context of HIV. This paper examines the case of South Africa, where there has been rapid growth of a range of lay workers (home-based carers, lay counsellors, DOT supporters etc.) principally in response to an expansion in budgets and programmes for HIV, most recently the rollout of antiretroviral therapy (ART). In 2004, the term community health worker was introduced as the umbrella concept for all the community/lay workers in the health sector, and a national CHW Policy Framework was adopted. We summarize the key features of the emerging national CHW programme in South Africa, which include amongst others, their integration into a national public works programme and the use of non-governmental organizations as intermediaries. We then report on experiences in one Province, Free State. Over a period of 2 years (2004--06), we made serial visits on three occasions to the first 16 primary health care facilities in this Province providing comprehensive HIV services, including ART. At each of these visits, we did inventories of CHW numbers and training, and on two occasions conducted facility-based group interviews with CHWs (involving a total of 231 and 182 participants, respectively). We also interviewed clinic nurses tasked with supervising CHWs. From this evaluation we concluded that there is a significant CHW presence in the South African health system. This infrastructure, however, shares many of the managerial challenges (stability, recognition, volunteer vs. worker, relationships with professionals) associated with previous national CHW programmes, and we discuss prospects for sustainability in the light of the new policy context.     

动员佛教僧人以特殊身份参与艾滋病防治宣传工作

通过佛教僧人在当地的特殊地位，通过动员僧人，建立组织网络，制定工作计划，培训僧侣/宗教干部及管理人员，收集、整理相关资料并翻译成傣文宣传材料，到泰国学习“取经”等措施，发挥了佛教僧人在控制和预防艾滋病的作用，取得较好的效果，值得推广。     

Integrating cervical cancer prevention initiatives with HIV care in resource-constrained settings: A formative study in Durban,South Africa

Cervical cancer screening rates remain suboptimal among women in South Africa (SA), where cervical cancer prevalence is high. The rollout of HIV-related services across SA may provide a means to deliver cervical cancer screening to populations with limited access to health care systems. In this mixed methods study, psychosocial factors influencing cervical cancer prevention and perceptions of the provision of Pap smears in HIV care settings were examined. Structured interviews were conducted with women (n = 67) from a municipal housing estate in Durban, SA. Key informants (n = 12) also participated in semi-structured interviews. Findings revealed that participants had low cervical cancer knowledge, but desired more information. Relevant themes included the normalisation of HIV and beliefs that cervical cancer might be worse than HIV. A comprehensive community clinic was desired by most, even if HIV-positive patients were treated there. This study provides important insight into integrating cervical cancer screening with HIV clinics, which may increase cancer screening among South African women.     

Improving resource allocation decisions for health and HIV programmes in South Africa: Bioethical,cost-effectiveness and health diplomacy considerations

The escalating expenditure on patients with HIV/AIDS within an inadequately funded public health system is tending towards crowding out care for patients with non-HIV illnesses. Priority-setting decisions are thus required and should increasingly be based on an explicit, transparent and accountable process to facilitate sustainability. South Africa's public health system is eroding, even though the government has received extensive donor financing for specific conditions, such as HIV/AIDS. The South African government's 2007 HIV plan anticipated costs exceeding 20% of the annual health budget with a strong focus on treatment interventions, while the recently announced 2012–2016 National Strategic HIV plan could cost up to US$16 billion. Conversely, the total non-HIV health budget has remained static in recent years, effectively reducing the supply of health care for other diseases. While the South African government cannot meet all demands for health care simultaneously, health funders should attempt to allocate health resources in a fair, efficient, transparent and accountable manner, in order to ensure that publicly funded health care is delivered in a reasonable and non-discriminatory fashion. We recommend a process for resource allocation that includes ethical, economic, legal and policy considerations. This process, adapted for use by South Africa's policy-makers, could bring health, political, economic and ethical gains, whilst allaying a social crisis as mounting treatment commitments generated by HIV have the potential to overwhelm the health system.     

Northern Uganda and paradigms of HIV prevention: The need for social analysis

Abstract

In settings of armed conflict, traditional HIV prevention programmes that promote risk avoidance via abstinence and fidelity and risk reduction via condom use and needle exchange are not viable. In such contexts, HIV risk depends less on personal choice than on exposure to physical, emotional and structural violence. War in northern Uganda has created three realities (internally displaced people's camps, night commuters and child abductions) which increase vulnerability to HIV transmission. Based upon this analysis of northern Uganda, we offer a conceptual framework for HIV transmission in conflict settings that recognizes the importance of local and global context in creating vulnerability to HIV infection. This framework is then used to delineate strategies for HIV prevention in northern Uganda, namely the provision of a safe physical environment and access to education, medical and psychological support, and the promotion of conflict resolution strategies and human rights law.     

Women's perceptions and experiences of HIV prevention trials in Soweto, South Africa

Persistently high rates of HIV infection in sub-Saharan Africa have driven the exploration for additional methods of prevention, such as microbicides. Multi-site, field-based clinical trials of microbicides are conducted in diverse social and cultural contexts. Local social and cultural perceptions of HIV/AIDS and sexual risk can have profound implications in shaping community responses to the clinical trials, thereby affecting enrollment and retention. Moreover, clinical trials may have a significant impact on trial participants with regard to their views of AIDS, health and relationships. Following these issues, this paper explores the subjective experiences of women enrolled in a microbicide feasibility study. Qualitative data were collected in two phases. The first phase took place prior to the inception of the feasibility study. Men and women from Soweto participated in focus group discussions about their perceptions and experiences of the AIDS epidemic and sexual risk. The second phase started once enrollment into the feasibility study had begun. Twenty-one women who were enrolled in the microbicide feasibility study were interviewed and participated in focus groups, and were asked about their experiences of participating in the microbicide feasibility study. Special attention was placed on how they felt their participation had affected their everyday lives. Interviews and discussions were conducted in local languages, recorded, translated and transcribed. Data were analysed thematically. The central finding of this study is the sense of empowerment that feasibility study participants felt in spite of their being embedded in a culture that has come to fear, deny or ignore AIDS. We discuss the critical role of repeated, voluntary counselling and testing, knowledge of HIV status, and heightened awareness of sexual and reproductive health in reshaping study participants' approaches to sexual relationships and AIDS, as well as the benefits that participation entailed.     

Understanding the experiences of married Southern African women in protecting themselves from HIV/AIDS: a systematic review and meta-synthesis

Background: Whilst marriage has been repeatedly identified in the literature as an HIV risk factor amongst Southern African women, not much is known about women’s perception of their role, experiences and strategies used to address HIV risks in the context of a marriage.

Aims: The aim of the study was to synthesise perceptions, experiences and strategies of married Southern African women in the prevention of HIV.

Methods: A systematic review of qualitative studies was conducted. Three electronic databases (Medline, Cinahl and PsycINFO) were systematically searched to identify relevant literature. The meta-synthesis process followed Sandelowski and Barroso’s [2007. Handbook for Synthesizing Qualitative Research. Springer Publishing Company] recommendations.

Results: Of 7 609 papers, 15 were included in the review. The quality of the included studies was variable. In the final synthesis stage, three broad analytic themes emerged: contextual background, cues to preventive behaviour, and HIV prevention strategies.

Implications: Findings were used to develop a conceptual framework for studying HIV/AIDS prevention experiences of married Southern African women.     

2007—2012年我国女性HIV／AIDS报告病例流行病学特征分析

目的分析我国2007—2012年新报告女性艾滋病病毒感染者和艾滋病患者（HIV／AIDS）流行病学特征,探讨女性艾滋病防控工作重点。方法收集“艾滋病网络直报信息系统”2007-2012年HIV／AIDS报告病例及哨点监测系统孕产妇HIV抗体检出率资料,利用SPPS软件进行统计分析。结果2007-2012年我国女性HIV／AIDS报告病例数呈逐年增长趋势;西南、西北、华南和华中地区报告病例数较多;以20,．~39岁年龄组为主;婚姻状况多为已婚;文化程度多为小学或初中;15岁及以上年龄组以异性性传播途径为主;艾滋病监测哨点孕产妇HIV抗体阳性总检出率处于较低水平。结论近年我国新报告女性HIV／AIDS病例数呈逐年上升趋势,应继续加强我国西南和华南地区女性,尤其是20~39岁育龄妇女艾滋病防控工作。     

试论艾滋病防治中的性道德问题

艾滋病防治的途径之一是在全社会树立正确的性道德观念，而道德信仰的实践是有条件的，我们的责任就是使每一个人崇尚性道德的同时有充足的生存环境去实践之。     

县级区域性艾滋病预防控制的策略与经验

云南省临沧县开展了艾滋病社区健康教育项目和艾滋病预防控制与关怀项目，对县级区域性艾滋病预防控制工作进行总结：1）以充分的组织领导为基础，强化艾滋病预防控制工作，将行政领导措施与具体业务工作有机结合：2）以大众宣教为基础，辅以社区关怀工作；3）营造一个良好的社会环境和氛围，突出“人性”，辅以必要的物质关怀和生活帮助；4）让HIV感染者主动参与艾滋病预防控制工作；5）学校对广大学生与青年开展健康教育。     

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.     

HIV/AIDS and the construction of Sub-Saharan Africa: heuristic lessons from the social sciences for policy

There is no doubt that Sub-Saharan African countries face major problems due to the HIV/AIDS pandemic that has ravaged the region. Yet the Eurocentric construction of the region as the source of the virus not only creates negative stereotypes in social science disciplines like geography, but also glosses over the potential of social science disciplines to provide knowledge and influence policy about HIV/AIDS. This oppositional construction of the region has unfortunately contributed to a glossing over of many aspects of Sub-Saharan Africa's people, their environment, culture, history, politics, economics, gender relations, and the region's global status that would provide important input for policy aimed at curbing the devastating spread of HIV in the region. This paper argues that once we recognize that HIV is a global virus with trans-cultural implications, social science disciplines, such as geography, can reveal certain attributes about the region and its HIV/AIDS pandemic that can be used in policy formulation to combat the spread of the virus.     

Stigma by association: the effects of caring for HIV/AIDS patients in South Africa

The shortage of healthcare workers caring for South Africa's 5-6 million persons living with HIV/AIDS (PLHA) calls for inquiry into workers' challenges and experiences. This exploratory study examines one little-studied challenge: stigmatisation of HIV/AIDS healthcare workers based on their association with PLHA. The authors tested the hypotheses that HIV/AIDS healthcare workers experience stigmatisation due to their association with PLHA, and that such association stigma is correlated with thoughts of leaving the HIV/AIDS field. A sample of 100 participants who provided direct care to PLHA was recruited from a variety of public and private HIV/AIDS care centres in Eastern Cape province, South Africa. Participants attended one of 12 focus groups held between June and August, 2008. They completed a 17-item questionnaire and discussed each item. Findings exhibit the presence of an adverse differentiation and labelling of HIV/AIDS healthcare workers, leading to status loss and discrimination, creating an impetus for HIV/AIDS healthcare workers to leave AIDS work altogether. A significant relationship (χ(2) (TREND) = 3.86, df = 1, P = 0.049) was found between contemplation of leaving AIDS work and perception of others' responses to their work with PLHA. In addition, associations emerged between type of AIDS worker and contemplation of working in AIDS care outside of South Africa (Kruskal-Wallis χ(2) = 6.96, df = 2, P = 0.031), with doctors and nurses reporting higher frequency of contemplating leaving South Africa to work with PLHA elsewhere (Mann-Whitney z = -2.53, P = 0.011). The study lays the foundation for additional research on the effects of association stigma. In turn, increased efforts to retain and recruit new HIV/AIDS healthcare workers will expand the pool of healthcare personnel to PLHA.     

艾滋病流行影响因素的社会性别分析

\t\t\t\t\t  目的  \t\t\t\t\t对艾滋病流行影响因素的社会性别进行分析, 分析艾滋病流行中的社会性别问题。\t\t\t\t\t  方法  \t\t\t\t\t定性访谈和定量问卷调查相结合。\t\t\t\t\t  结果  \t\t\t\t\t本次调查普通人群和艾滋病病毒感染者及男女患者间在预防知识方面无差异; 定量调查发现在性观念方面, 男女都较开放, 但在对待两地分居婚外性行为的态度、性伴数方面男性更开放, 发生婚前性行为时社会对男性持更宽容态度。对艾滋病病毒感染者和患者的访谈发现, 男性经静脉吸毒感染为主, 女性经性感染为主。男性感染后在使用安全套和通知性伴方面缺乏责任心。\t\t\t\t\t  结论  \t\t\t\t\t艾滋病预防控制中要有社会性别意识, 要针对男女两性的特点进行艾滋病防范意识教育, 对把艾滋病流行阻断在以男性为主的阶段, 维护妇女健康有着重要的现实意义。     

1990-2018年云南省大理州HIV/AIDS生存分析

目的 分析1990-2018年云南省大理州HIV/AIDS生存状况及影响因素。方法 通过中国艾滋病综合防治数据信息系统收集1990-2018年现住址为大理州的10895 HIV/AIDS病例相关信息,应用寿命表法分析HIV/AIDS研究对象的生存率,采用乘积极限法（Kaplan-Meier法）计算研究对象的中位生存时间并绘制生存曲线。用Log-rank法比较治疗组与未治疗组的生存曲线。用Cox比例风险回归模型分析生存时间的影响因素。结果 10895例HIV/AIDS,全死因死亡3337例,中位生存时间15.58年（95%CI:14.83~16.5）。研究对象1、5、10、15、20年的累积生存率,抗病毒治疗组均高于未治疗组。根据不同防治措施分成1990-2004年、2005-2010年2011-2018年3个时期。相较于第一个时期,后两个时期5年生存率和7年生存率均有所升高而死亡风险均下降。Cox回归结果显示男性、初中及以下文化水平、样本来源于医疗机构、未进行抗病毒治疗、病程阶段是艾滋病、首次CD4水平低是研究对象死亡的危险因素。 结论 早发现,早治疗能降低HIV/AIDS患者死亡风险     

南昌市艾滋病自愿咨询检测的单位成本及成本-效果分析

目的 对2016—2018年南昌市艾滋病自愿咨询检测（VCT）的开展情况进行单位成本及成本-效果分析,为合理分配艾滋病防控资源提供依据。方法 采用文献检索、专家咨询制定南昌市VCT卫生经济学评价调查表,采用现场面对面结构式问卷调查及访谈的方法收集VCT工作环节、相应成本、VCT人数及检测结果,对各项成本进行分类计算,并进行成本-效果分析方法。结果 研究主要测算了宣教干预、检测费用及固定资产的成本费用及总费用,结果发现四个机构三年内的宣教与干预、检测费用及固定资产的成本费用保持相对稳定。在控制影响因素后选择青云谱区疾控中心和新建区疾控中心的VCT进行成本效果分析,青云谱区疾控中心和新建区疾控中心3年内检出阳性的平均单位成本分别为10 993.52元、13 020.88元,3年内每避免一例感染的资金成本分别为32 980.57元、39 062.63元。结论 南昌市四个机构VCT活动开展均已具有良好的运转规模,在此基础上加大宣教与干预的成本投入、合理进行资金分配、控制资产浪费等可更好的开展VCT工作。     

HIV/AIDS prevention in China: A challenge for the new millennium

China’s first HIV infection was officially reported in 1985 and by the end of 1996, there may have been up to 200,000 people affected nationwide. In 2001, this figure probably exceeded 600,000. By 2003, the predicted number of HIV cases had reached 1.5 million. At least 80,000 individuals now have fullblown AIDS. China may soon have the largest HIV-infected population in the world, possibly 6 million cases by 2005. With infection rates rising at about 30% per year, it is feared this figure might exceed 10 million by 2010. Although the Chinese government was initially slow to accept the problem, in the late 1990s definite changes began occurring. In 2003 Premier Wen Jiabao publicly shook the hand of an AIDS patient and his government promised to introduce a range of free HIV-related services. Large preventive education campaigns are now underway. Unfortunately, there will still be many obstacles in controlling the epidemic and preventing further spread of this disease. Without doubt, China faces a serious predicament in the new millennium, and one which will pose numerous challenges for preventive medicine.