HARARE, 11 January 2013 (PlusNews) – Chronic shortages of generic and antiretroviral drugs, stock-outs, high medication costs, and long distances to clinics are some of the hurdles people face in their quest to access essential medicines in Zimbabwe.
At any given time, public health facilities in much of Zimbabwe have in stock only half of a core set of critical medicines, according to findings from civil society groups working to improve access to medicines in Southern Africa.
Zimbabwe is still recuperating from a drastic decline in health services caused by sub-optimal investments in healthcare and an unprecedented economic crisis in 2008, during which the local currency crashed.
To make matters worse, over 80 percent of the country’s drugs are externally funded.
A poorly resourced local pharmaceutical industry can barely provide the country with its essential medicine requirements, and government-backed institutions, such as the National Pharmaceutical Company of Zimbabwe (NatPharm), which is mandated with securing drugs and healthcare products on behalf of state institutions, are struggling to survive. Continue reading “ZIMBABWE: Still Struggling with Drug Shortages” »
KAMPALA, 7 January 2013 (PlusNews) – Uganda continues to fall short of achieving its goal of ensuring that 80 percent of people living with HIV receive antiretroviral drugs (ARVs) by 2015, according to the Uganda AIDS Commission (UAC).
Some 62 percent of those needing HIV treatment were on ARVs in March 2012, up from 50 percent in 2010. Uganda managed to enroll an estimated 65,493 new HIV cases on life-prolonging ARVs in 2012, bringing to 356,056 the number of those receiving ARVs, according to UAC statistics.
But just 8 percent of these cases were children. A recent government survey has revealed that just 49 percent of infants in need of treatment are receiving it. (The government recommends that all HIV-positive infants under age two receive ARVs.) Some 20,000 to 24,000 children are infected with HIV each year, according to the Ministry of Health. Continue reading “Uganda Still Behind on HIV/AIDS ARV target” »
NAIROBI, 19 July 2012 (PlusNews) – Many sub-Saharan African nations – traditionally the beneficiaries of international HIV funding – are gradually increasing their financial contributions to the fight against the virus, boosting the number of people on treatment to record highs according to a new UNAIDS report, Together We Will End AIDS, released on 18 July.
Low- and middle-income countries invested US$8.6 billion in the response in 2011, an increase of 11 percent compared to 2010, whereas the international community contributed $8.2 billion, a figure that has remained flat since 2008. The United States contributed nearly half of all international assistance for HIV/AIDS.
“This is an era of global solidarity and mutual accountability,” Michel Sidibé, executive director of UNAIDS, said in a statement. “Countries most affected by the epidemic are taking ownership and demonstrating leadership in responding to HIV.”
Increased local funding
In several African countries, including Kenya, Namibia, Sierra Leone and Uganda, domestic spending on HIV/AIDS rose by more than 100 percent between 2006 and 2011. In Botswana, Comoros, Mauritania, Mauritius, the Seychelles and South Africa, domestic investment accounted for more than 70 percent of AIDS funding.
The increases in funding allowed a record 6.2 million Africans to access life-prolonging antiretroviral treatment in 2011, compared to 5.1 million in 2010. The most impressive numbers in 2011 were seen in South Africa, which initiated 300,000 people on treatment, Zimbabwe (150,000) and Kenya (100,000). The recently released 2012 UN Millennium Development Goals report notes that Botswana, Namibia and Rwanda have achieved universal access to ARVs. Continue reading “Africa Domestic Investment in HIV Goes Up But It’s Uneven” »
A group of Zimbabwean MPs is getting circumcised as part of a campaign to reduce HIV and Aids cases.
A small makeshift clinic for carrying out the procedures was erected in Parliament House in the capital Harare.
Blessing Chebundo, chairman of Zimbabwe Parliamentarians Against Aids, said his main objective was to inspire other citizens to follow suit.
Research by the UN has suggested male circumcision can reduce the spread of HIV and Aids.
A report by UNAids and the World Health Organisation said the risk of HIV infection among men could be reduced by 60%.
More than a million people in Zimbabwe are believed to be HIV-positive, with about 500,000 receiving anti-retroviral treatment.
Mr Chebundo said more than 120 MPs and parliamentary staff had shown an interest in the circumcision programme.
The BBC’s Brian Hungwe, in Harare says that by 12:00 local time (10:00GMT), four had had the procedure performed, with more expected later
Blessing Chebundo was the first to undergo the 10-minute operation.
He told the BBC there was a possibility that some members of the executive may also attend, including President Robert Mugabe.
The circumcision programme had attracted a lot of attention in Zimbabwe, and had divided opinion, our correspondent said.
The issue was raised in parliament in September 2011, when Deputy Prime Minister Thokozani Khupe made a plea to her fellow politicians.
At the time, many MPs shunned the idea.
As well as a clinic in parliament, the initiative has seen a tent set up across the road from parliament, where counselling sessions will be held.
Dr Owen Mugurungi, Director for Aids and TB unit with the Ministry of Health and Child Welfare, applauded those involved, the Zimbabwe Mail reported.
“We are happy with this initiative and we are happy more leaders will come on board,” he was quoted as saying.
DURBAN, 14 June 2012 (PlusNews) – South Africa’s move to decentralize the treatment of drug-resistant tuberculosis (TB) has given rise to a crop of nurses equipped not only to initiate patients on HIV treatment, but also to prescribe for and monitor drug-resistant TB (DR-TB) patients. However, experts and government officials say the need for specialist physicians and hospitals will continue, based on research presented at the South African TB conference in the port city of Durban. Continue reading “SOUTH AFRICA: Decentralizing care and treatment for drug-resistant TB” »
"When you are a woman and you want to get into the business of selling fish, you must be ready to lose your pride and use your body for bargaining," "Being ready to give sex as and when it is needed by the fishermen... it guarantees your survival here on the beach."
ADDIS ABABA, 9 December 2011 (PlusNews) – Unless African governments increase their funding for and engagement in HIV research, the continent cannot hope to attain equal status in determining its research agenda and priorities, speakers said at the 16th International Conference on AIDS and Sexually Transmitted Infections (STIs) in Africa.
“In most low-income or poor countries, health research is donor-driven, with insignificant local budgets compared to the 2 percent annual budget recommended by WHO [World Health Organization],” said Dr Beyene Petros, chair of the Ethiopian Bioethics Initiative.
Donor-driven funding often means that research starts and ends on the say-so of funders, rather than being based on a country’s needs. Beyene noted a Dutch grant of approximately US$13 million to the Ethiopian government to investigate capacity development in HIV/AIDS research for eight years.
When the grant ended in 2002, the Ethiopian government applied for a renewal. It was denied, leaving scientists, who had been hoping to launch a local vaccine initiative, at a loss. The Dutch government instead decided to fund family planning and HIV prevention activities in the country.
The field of HIV research – largely donor-driven – is vibrant in eastern and southern Africa. But “West Africa, in particular, is characterized by an absence in of clinical trials of potential HIV vaccines, and or microbicides, and a lack of data on drug-resistant tuberculosis,” said Dr Souleymane Mboup, of Senegal’s Cheikh Anta Diop University.
Prof Nelson Sewankambo, principal of the College of Health Sciences at Uganda’s Makerere University, said heavy donor involvement in local research can actually harm existing national institutions, which may lose strategic direction and become retarded by the loss of key staff to research projects and distortion of institutional structures and governance.
“Inequities in collaboration can lead to lack of transparency in the decision-making process, as well as disputes over publication rights, ownership of data, specimens and equipment,” Sewankambo said.
Speakers also noted that inadequate community engagement was common when partnerships were skewed in favour of the donor priorities. “There ought to be distributive justice and fair partnerships between sponsors, investigators, subjects, communities and countries,” said Cameroonian writer Prof Godfrey Tangwa, of the University of Yaounde.
Sewankambo noted that in the past, weak local institutions had allowed ethical violations in research projects, such as the use of placebos in studies on mother-to-child HIV transmission.
“Even when these issues were pointed out, the debate began in the North. Where were we Africans when these wrongs were going on? It is not enough for us to blame countries in the North for the state of health research – we need to look at what we in the South are not doing right in government funding of research and in negotiation of research partnerships,” he said.
Sewankambo noted that there was a need to build new, more equitable partnership models and expand local capacity to sustain research activities once donor-funded projects ended.
The involvement of policy-makers is key to ensuring that research is turned into evidence-based policy, said Anne Cockroft, of Canada’s Global Health Research Initiative (GHRI). She pointed out that there was often a gap in “knowledge translation” between researchers and policy-makers, leading to poor decisions being taken.
“[HIV] prevention research results have to be translated into policies and action, and research users and decision-makers need skills to evaluate findings and prioritise for action,” she said, adding that outside interests and funding often led to externally driven policy decisions, while poor understanding of research led to policies based partly on evidence, or based on poor evidence.
GHRI has been working with parliamentarians in Botswana to expand their ability to make decisions based on evidence after many said they experienced difficulties in interpreting scientific evidence.
There has been some progress in the past few decades. Wen Kilama, managing trustee of the African Malaria Network Trust, said partnerships have largely moved on from “colonial style” research, in which Africans had little or no say in research conducted in their countries, and African scientists are now more involved in priority-setting and actual research.
“The Ugandan government has created an enabling environment for research and recently came up with a law which led to the creation of the Uganda National Health Research Organization, which, if managed properly, has the potential to greatly improve the way research is conducted in the country,” Sewankambo said.
Kenya and Tanzania have similar bodies, and African scientists have created several networks to strengthen research capacity, but regulation has lagged behind the development of research capability.
The East Africa Consortium for Clinical Research has been established, but it has yet to develop a regional policy to guide the regulation of health research and clinical trials, and remains largely donor-dependent in the development of health research policy.
Ethiopia’s Beyene pointed out that “Unless we strengthen our own research capacity, dependence on donors will be perpetuated.”
[This report does not necessarily reflect the views of the United Nations]
ADDIS ABABA, 9 December 2011 (PlusNews) – The latest guidelines on infant-feeding options for HIV-positive mothers in Africa have not been disseminated in many countries, leaving women dangerously confused about the best nutritional path to protect their children from contracting the virus, a new report shows.
The UN World Health Organization’s (WHO) 2010 guidelines recommend exclusive breastfeeding with an antiretroviral (ARV) treatment intervention for the first six months of a child’s life to reduce transmission, and continued breastfeeding – with complementary feeding – until the child is at least a year old. Alternatively – where it is acceptable, feasible, affordable, sustainable and safe – WHO recommends complete avoidance of all breastfeeding.
For HIV-positive mothers in most sub-Saharan African nations, exclusive breastfeeding is the most practical option. According to a large African study, Kesho Bora, giving HIV-positive mothers a combination of three ARVs during pregnancy, delivery and breastfeeding cuts HIV infections in infants by 43 percent by the age of 12 months and reduces transmissions during breastfeeding by 54 percent compared with WHO’s 2006 recommendations, where ARV drug regimens ended at delivery.
“The six months of exclusive breastfeeding is what is crucial for mothers to understand – that not doing it is what raises the child’s HIV risk; but we are finding that while many countries have officially adopted the WHO guidelines, they have not trickled down, and health centres, policy-makers and communities are still unclear on what advice to give mothers,” said Aditi Sharma, of the International Treatment Preparedness Coalition (ITPC), and coordinator of a report, The Long Walk: Ensuring comprehensive care for women and families to end vertical transmission.
Based on new research by community health workers from Cameroon, Cote d’Ivoire, Ethiopia and Nigeria, the report – launched at the 16th International Conference on AIDS and STIs in Africa (ICASA) in Addis Ababa, Ethiopia – found that prevention of mother-to-child transmission programmes were focused too narrowly on the provision of ARVs to HIV-positive pregnant women, rather than more comprehensive approaches that involved family planning, maternal healthcare and exclusive breastfeeding.
“Nutritional counselling doesn’t exist in rural areas,” the report quoted one Cameroonian woman as saying. “Health personnel are not trained and women do not know how to care for their children.”
In Cote d’Ivoire, the report found that national guidelines did not meet the most recent WHO recommendations on infant feeding.
Although the Nigerian government had revised guidelines to comply with the WHO, consensus did not exist in support of the recommendations, and some clinicians and researchers continued to oppose breastfeeding because they believed it deliberately exposed babies to possible HIV infection. Several focus group participants indicated they assumed that replacement feeding was preferable to breastfeeding, and that it had been recommended by health practitioners.
“The guidance on infant-feeding options needs to urgently get into the curriculum and training of health workers and other people who support community healthcare, such as traditional birth attendants,” said Sharma, adding that efforts needed to be made to support mothers to exclusively breastfeed their children.
“It is not enough to issue guidelines – in places where women may complain of insufficient breast milk or inadequate nutrition, they need nutritional support to ensure they can continue to exclusively breastfeed,” she added.
Conference speakers said community health systems were crucial to the success of prevention of mother-to-child HIV transmission services, as community health workers and traditional birth attendants were often the first port of call for a confused mother. Community health systems can also be used to engage men – frequently absent from ante-natal visits – in their wives’ experiences.
Beatrice Ochieng, author of a study on infant feeding choices in poor settings in the Kenyan capital, Nairobi, noted that just 23 percent of 357 women in the study discussed their chosen feeding option with their partners. “There is a need to support partner involvement through partner counselling and testing, during antenatal and postnatal care,” she said.
According to Ncumisa Vika, who works with the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) in South Africa, male involvement in reproductive health services, including PMTCT, remains low, creating challenges and barriers around disclosure of HIV-positive status to a partner, psychosocial support, adherence to treatment, and infant-feeding decisions. In 2010, in collaboration with community health organizations in South Africa’s Tshwane District, EGPAF was able to send invitation letters to the partners of all HIV-positive women who attended antenatal clinics, which boosted male participation in reproductive and family health matters.
Overall, ITPC’s Sharma said, there was a need for more comprehensive delivery prevention of mother-to-child services in Africa. “Countries must ensure that policy filters down to the women in all aspects of PMTCT – from HIV prevention for women to family planning, to the best ARV prophylaxis option to proper infant feeding to proper healthcare for the mother, child and family,” she said. “It is the only way we can achieve the 2015 targets of reducing vertical transmission by 90 percent.”
Theme (s): HIV/AIDS (PlusNews),
[This report does not necessarily reflect the views of the United Nations]
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