HIV/AIDS Archives - Page 2 of 6

December 7, 2011December 24, 2011

Depression Often Overlooked in Treating HIV Patients

Depression is the most common psychiatric disorder among HIV-positive people, Photo: Eva-Lotta Jansson/IRIN

ADDIS ABABA, 7 December 2011 (PlusNews) – HIV patients in Africa frequently suffer shame and depression but the continent’s health systems are ill-equipped to handle the issue, which not only affects their quality of life, but can lead to poor adherence to HIV treatment regimens.

While HIV programmes focus heavily on reducing externalized stigma and ill-treatment of HIV patients by society, little is done to deal with a patients’ self-perception and how that might deteriorate following an HIV diagnosis, speakers said at a session on stigma at the 16th International Conference on AIDS and Sexually transmitted infections in Africa in Addis Ababa.

Studies show that depression is the most common psychiatric disorder among people living with HIV, and is more prevalent among HIV-positive people than the general population.

“Operational research carried out in Zambia has found a positive correlation between patients who self-stigmatized and failure to adhere to treatment,” said Sikazwe Izukanyi from Zambia’s Ministry of Health. “Self-stigma was often found in patients who did not disclose their status to partners or family members – making it difficult to maintain strict adherence to regimens while trying to hide the drugs.”

Izukanyi noted that while counselling was a standard part of HIV care in Zambia, counsellors needed to be made aware of the prevalence of self-stigma and how to deal with it.

A 2010 Ugandan study by Makerere University found that HIV-positive patients were more critical of themselves, had significantly greater problems making decisions, poorer sleep, tired more easily, experienced more appetite changes and had more cognitive impairment.

ARVs and self-stigma

According to a study by Yordanos Tiruneh, an Ethiopian academic with US-based Northwestern University, antiretroviral (ARV) therapy has been key to reducing external stigma by minimizing the visibility of physical imperfections and restoring functional daily activities such as the ability to work. The study, which used 105 interviews with Ethiopian men and women on ARVs, also found that the support networks formed by people living with HIV gave them much-needed social capital.

However, according to Yordanos, while ARVs were linked to a reduction in external stigma, the study found that they tended to increase internalized stigma, sometimes resulting in failure to properly adhere to ARVs.

“When I think of the two tablets that keep me alive, I hate myself and I feel that I am dead,” one of the study’s interviewees is quoted as saying. “Sometimes I get furious to see myself like a walking corpse, and other times I see myself as a doll that functions with a battery. I would say, without these batteries [pills], I am nothing.”

According to a US study, adherence to ARVs was higher in patients for whom anti-depressants were prescribed.

A severe shortage of mental health professionals in Africa means that HIV-associated depression is largely ignored. For instance, according to the UN World Health Organization, Burundi has just one psychosocial care provider per 100,000, against a target of at least eight, while Ethiopia has less than one, against a similar target.

“The problem is largely a human resources one; while strengthening health systems, governments should remember to focus on mental-health issues,” said Izukanyi. “As it is, we have no systems for screening, diagnosing and treating patients with mental-health issues.”

Among other things, experts recommend integrating mental-health services into primary healthcare activities, developing mechanisms to ensure a good supply of psychotropic medication and more research into mental-health issues in Africa.

December 1, 2011

HIV/AIDS: Countries Feeling the Funding Pinch

JOHANNESBURG/NAIROBI, 1 December 2011 (PlusNews) – Faced with the global economic downturn and less money from donors, national HIV programmes in East and Southern Africa – the region hardest hit by HIV/AIDS – are struggling to stay afloat. IRIN/PlusNews brings you a wrap of countries feeling the biggest pinch.

Democratic Republic of Congo (DRC)

According to medical relief agency Médecins Sans Frontières (MSF), funding shortfalls caused the government to cap the number of people starting on antiretroviral (ARV) treatment at 2,000 new patients for 2011, even though an estimated 15,000 people are on waiting lists for the drugs. Only 12 percent of those in need of the life-prolonging medication are receiving it.

NGOs have been asked by the Ministry of Health to limit HIV testing because there is no money available to buy drugs to treat those eligible for ARVs. Access to drugs for opportunistic infections and testing for CD4-counts or viral loads is extremely limited.

DRC is largely dependent on the Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria to finance its treatment programmes, and other donor projects are winding up, making the country even more dependent on dwindling Global Fund grants.

Uganda

Poor funding in 2010 led HIV care facilities to reduce patient enrolment. Service providers said they were afraid to encourage people to test for HIV in case they needed ARVs and were unable to provide the medication. In August PEPFAR responded to appeals from healthcare providers overwhelmed by patients by making a commitment to increase its support to the national treatment programme.

However, HIV programmes remain poorly funded and Uganda’s appeal for $270 million from the Global Fund in Round 8 was rejected. Although the government now contributes some $60 million annually to buying HIV drugs from a local manufacturer, critics say HIV/AIDS efforts will remain stunted unless the government makes a more meaningful contribution.

South Africa

In November 2011, South Africa’s leading HIV/AIDS lobby group, the Treatment Action Campaign (TAC), which is largely dependent on the Global Fund, released a statement warning that without this money, TAC will be forced to close its doors and retrench 280 employees in 130 branches at the end of January 2012. TAC volunteers distribute over 5 million condoms a year and the group’s treatment literacy project educates patients about HIV treatment in many of the country’s public health facilities.

As some donors pull out entirely and others shift from programme implementation to technical assistance, many patients who previously got their treatment from well run NGOs are being transferred to already overcrowded public health facilities.

Burundi

Following a Global Fund rejection of its application for money in November 2007, the government said there was a gap of $83 million to cover all the needs of the national AIDS strategic plan from 2007 to 2011.

In 2010, HIV-positive patients in some parts of the country complained that they were unable to access drugs to treat opportunistic infections and many could not afford a CD4 test, which measures immune strength and is required before health facilities can initiate patients on ARVs.

At the end of June 2011, World Bank funding – more than $50 million over a nine-year period – for Burundi’s AIDS response ended and has not been renewed. The Global Fund and the World Bank have been Burundi’s largest HIV donors. In September, associations of people living with HIV reported that several of their members had died due to an ongoing shortage of ARV drugs.

Swaziland

The country with the highest HIV prevalence has been grappling with shortages of HIV treatment, testing kits and laboratory tests essential for initiating and managing patients on ARV treatment, caused mainly by a drop in revenue from the Southern Africa Customs Union (SACU) as a result of the global economic downturn.

Swaziland recently received emergency funding from PEPFAR to help supply first-line ARVs until the end of April 2012, but further ARV shortages have been predicted.

Mozambique

An estimated 96 percent of the HIV budget is donor-funded, with the Global Fund and PEPFAR providing the largest portion. Mozambique’s Round 9 funding has not yet been released due to concerns over poor financial and supply management, and its Round 10 grant proposal was not approved. Other donors, including the Clinton HIV/AIDS Initiative, have withdrawn support as the UNITAID grant comes to a close.

Mozambique is expected to face shortages of first-line ARVs by the end of 2012 or even earlier, unless an emergency funding request to the Global Fund is approved. The country is looking for other funding alternatives to help bridge the projected shortfall.

Kenya

HIV/AIDS funding received a blow when the Global Fund rejected its proposals in rounds eight and nine. Kenya has a projected $167 billion shortfall to cover its HIV programmes up to 2013. The country has put more than 400,000 people on ARVs, but another 600,000 need the drugs and have no access to them.

At the end of November 2011, HIV-positive people in Coast Province, eastern Kenya, held demonstrations over the lack of drugs in health facilities, forcing people to purchase the drugs from private pharmacies, but many who can’t afford the drugs are going without.

Kenya’s Cabinet has proposed that the Ministry of Finance create an HIV/AIDS Trust Fund to support scaling up the HIV response. If approved, the government will contribute 1 percent of its annual revenue to the fund.

kr/kn/he

Theme(s): Care/Treatment – PlusNews, HIV/AIDS (PlusNews),

[This report does not necessarily reflect the views of the United Nations]

December 1, 2011December 1, 2011

HIV Deadly Funding Crisis

JOHANNESBURG, 1 December 2011 (PlusNews) – This World AIDS Day on 1 Dec should have been a much more joyous event: the global HIV/AIDS response has turned a significant corner, with record numbers of people on antiretroviral (ARV) treatment and fewer new HIV infections. But the announcement by the Global Fund to Fight AIDS Tuberculosis (TB) and Malaria, cancelling its next funding round, has cast a shadow over any celebrations and highlighted the precarious nature of HIV/AIDS funding.

That money for HIV/AIDS efforts is not as plentiful as in previous years hardly comes as a surprise. UNAIDS notes that the global economic crisis appears to have put an end to a decade of funding increases by donors – after flattening out in 2009 for the first time, international AIDS assistance fell by 10 percent in 2010.

Nandini Oomman, director of the HIV/AIDS Monitor, which tracks AIDS spending at the Washington-based Centre for Global Development, admits that “we are in a bad situation” and faced with “less money and more [health] priorities”. Moreover, non-communicable diseases have overtaken HIV/AIDS as the leading cause of death worldwide. Global and national leaders are now confronted with a “set of tough choices”, she noted.

Zimbabwe’s Minister of Health, Dr Henry Madzorera, believes it is still too early to gauge the full impact of the global funding decline. “We do anticipate that [this] will have a negative impact on our universal access goal… that the consequences of this global economic meltdown will be catastrophic to our programmes… [and] will take us back many years,” he told IRIN/PlusNews.

The big squeeze

As the world’s largest donor to HIV/AIDS efforts, the United States contributes 54 percent of international AIDS financing, but the Centre for Global Development warns that in America’s current political and fiscal climate, this level of support for AIDS funding may have reached a “tipping point” and “will be increasingly difficult to maintain in coming years”.

Oomman pointed out that the US President’s Emergency Plan for AIDS Relief (PEPFAR) was protected by legislation until 2013, so cuts in the funding mechanism may not be as deep as feared. “The real questions [about the future of PEPFAR] will open up in two years, when the US is faced with reauthorizing PEPFAR,” she noted.

In the meantime, the US global AIDS budget has been cut for the second year running – funding for PEPFAR in 2012 will be US$90 million less than the current allocation – and support for the Global Fund has flat-lined.

The cost implications are huge, particularly for countries such as Uganda that rely heavily on PEPFAR. According to Médecins Sans Frontières (MSF), less than half of the people needing treatment in Uganda get it, and PEPFAR currently supports 75 percent of all patients receiving ARVs in the country. International donors are increasingly requesting that Uganda look for domestic funds to support its response.

Although South Africa is better resourced and funds more than 80 percent of its treatment costs, it still receives substantial amounts from foreign donors. PEPFAR’s shift from direct service provision to technical assistance has caused hospices and institutions that were providing ARVs to close down, and patients have been referred to a public health system that is overstretched and poorly equipped to deal with the growing numbers, Nokhwezi Hoboyi, district coordinator for the Treatment Action Campaign, told journalists at a press briefing.

The UK’s Department for International Development (DfID) is also cutting bilateral aid for HIV/AIDS projects in developing countries by 32 percent, from £59.9 million ($92 million) to £41 million ($64million), between now and 2015.

Bailing out of the Fund?

With many donor countries preoccupied with the economic crises on their doorsteps and slowly starting to reduce their HIV/AIDS funding, the Global Fund remains a crucial player despite its latest setback. The amount of money that the multilateral body has made available since it was created in 2001 was “absolutely unprecedented” said Dr Eric Goemaere, head of MSF South Africa’s medical unit.

On 28 November, MSF warned that many low-income countries with a high HIV/AIDS burden were relying heavily on money from the Global Fund to continue providing treatment as well as to scale up their programmes. Some countries have been unable to implement the most recent World Health Organization guidelines, which call for earlier initiation of treatment and better first-line drugs.

The Global Fund has also been hit by a crisis in confidence in recent months, after reports of grant mismanagement found by the Fund’s Office of the Inspector General and the findings of a high-level independent review panel that recommended major changes to its accountability structures.

Oomman told IRIN/PlusNews that rather than “buckling down” to fix the Global Fund model, however, donors were “bailing out” by failing to live up to their commitments. “This doesn’t absolve the Fund of the responsibility to fix itself and reform… but it was created by the donors and should be fixed by the donors,” she commented.

High-burden nations need to do more

With its future at stake, the Global Fund has been encouraging emerging markets to pick up the baton, but the reality is that financial backing from traditional donors such as America and the European countries is still vitally important. “If I were an emerging market government, would I put my money in [an organization] which Western donors are pulling out of?” Oomman asked.

Activists agree that although some countries with high HIV prevalence rates still can’t afford to put a lot of money into their AIDS response, they cannot be completely absolved.

“Sustainability depends on domestic funding. Even in this hard economic environment, countries can at least lay down the enabling instruments that will grow over time and take over from donor funds when these funds dry up,” Zimbabwe’s Madzorera acknowledged.

“African governments are not doing enough at this stage,” he said, “and it cannot be allowed to be ‘business as usual’ in the face of this global economic crisis.”

UN IRIN NEWS

November 21, 2011

Aids-related Deaths ‘Down 21% From Peak’, says UNAids

Aids-related deaths are at the lowest level since their 2005 peak, down 21%, figures from UNAids suggest.

Globally, the number of new HIV infections in 2010 was 21% down on that peak, seen in 1997, according to UNAids 2011 report.

The organisation says both falls have been fuelled by a major expansion in access to treatment.

Its executive director, Michel Sidibe, said: “We are on the verge of a significant breakthrough.”

He added: “Even in a very difficult financial crisis, countries are delivering results in the Aids response.

“We have seen a massive scale up in access to HIV treatment which has had a dramatic effect on the lives of people everywhere.”

‘End in sight?’

This latest analysis says the number of people living with HIV has reached a record 34 million.

Sub-Saharan Africa has seen the most dramatic improvement, with a 20% rise in people undergoing treatment between 2009 and 2010.

About half of those eligible for treatment are now receiving it.

UNAids estimates 700,000 deaths were averted last year because of better access to treatment.

That has also helped cut new HIV infections, as people undergoing care are less likely to infect others.

In 2010 there were an estimated 2.7m new HIV infections, down from 3.2m in 1997, and 1.8m people died from Aids-related illnesses, down from 2.2m in 2005.

The figures continue the downward trend reported in previous UNAids reports.

The UN agency said: “The number of new HIV infections is 30-50% lower now than it would have been in the absence of universal access to treatment for eligible people living with HIV.”

Some countries have seen particularly striking improvements.

In Namibia, treatment access has reached 90% and condom use rose to 75%, resulting in a 60% drop in new infections by 2010.

UNAids says the full preventive impact of treatment is likely to be seen in the next five years, as more countries improve treatment.

Its report added that even if the Aids epidemic was not over: “The end may be in sight if countries invest smartly.”

‘Promising moment’

The charity Medecins Sans Frontieres urged governments to keep up their funding.

MSF’s Tido von Schoen-Angerer, said: “Never, in more than a decade of treating people living with HIV/Aids, have we been at such a promising moment to really turn this epidemic around.

“Governments in some of the hardest hit countries want to act on the science, seize this moment and reverse the Aids epidemic. But this means nothing if there’s no money to make it happen.”

The International HIV/Aids Alliance said: “We welcome the ongoing commitment of UNAids to changing behaviours, changing social norms and changing laws, alongside efforts to improve access to HIV treatment.

“For bigger and better impact though, we must not be complacent. There is still much more to do.”

June 8, 2011

UNICEF and Partners Launch Report on Preventing HIV Among Young People

JOHANNESBURG, South Africa, 2 June 2011 – In South Africa, the nation with the largest number of young people living with HIV, the destructive nature of the epidemic can be better understood than anywhere else in the world. According to a global report released here yesterday by UNICEF and its partners, one in three young people newly infected with the virus each year is from either South Africa or Nigeria.

The report – ‘Opportunity in Crisis: Preventing HIV from early adolescence to young adulthood’ – confirms that young people worldwide face a significant risk of HIV infection every day. And their vulnerability is heightened by failures to provide them with adequate information and essential services.

“In 2009 alone, these realities, gaps and inefficiencies in response translated to an estimated 890,000 new infections among young people worldwide,” said UNICEF Regional Director for Eastern and Southern Africa Elhadj As Sy.

Opportunities for youth

For the young men and women of ‘loveLife’, South Africa’s largest national prevention initiative for youth, HIV is a central fact of life and work. To ensure that peers in their communities have the information needed to protect themselves, they engage in face-to-face interaction and mass media campaigns. They also produce dramas and radio shows, and organize debates on youth and HIV.

Young activists from loveLife participated in a panel discussion at the launch of ‘Opportunity in Crisis’ along with representatives of the partners who jointly produced the report – including UNICEF, UNAIDS, the UN Educational, Scientific and Cultural Organization, the UN Population Fund, the International Labour Organization, the World Health Organization and the World Bank.

“We need to create opportunities for young people,” said one youth panellist. “If I am a young person who doesn’t work but still have to be a breadwinner at home, it will be very easy for me to submit to peer pressure, to date a sugar daddy and to do all the things that will lead me to be at risk of HIV infection.”

Progress on prevention

Despite such challenges, ‘Opportunity in Crisis’ acknowledges that some progress has been made in preventing new infections among young people. In many high-burden countries, HIV prevalence and incidence have declined.

While in 2001 there were 5.7 million young people living with HIV worldwide, the figure now stands at approximately 5 million. Nevertheless, the actual reduction – 12 per cent – represents less than half the 25 per cent target set by world leaders a decade ago.
Moreover, African youth, and especially young women in Africa, are the most vulnerable in the battle against HIV.

“The grim picture, particularly the harsh reality faced by African youth, should exhort us all to take a pause and reflect on the commitments that were promised to ensure safe passage to a healthy and productive adulthood,” said Mr. Sy. “Prevention of new infections requires much more commitment from families, teachers and leaders to establish a safe and protective environment for the most vulnerable, especially the girls.”

Package of interventions

Participants in the report’s launch pointed out that reducing the number of new infections will require greater attention to prevention, care and support for adolescents and young people at risk. They pointed out, as well, that the world now knows what really works to prevent HIV transmission in young people. This package of interventions includes:

Abstaining from sex and not injecting drugs
Correct and consistent use of male and female condoms
Medical male circumcision
Needle and syringe exchange programmes as part of a comprehensive harm-reduction programme
Using antiretroviral drugs as treatment (which lowers the chance of transmission) or as post-exposure prevention
And communication for social and behavioural change

On the last point in particular, young people themselves are key to the success of prevention efforts. In the process of becoming peer educators like the loveLife activists, they can also build self-confidence and acquire new skills.

‘Making a difference’

“I didn’t know I love radio, but now it has become my favourite thing in the world,” said Xolani Khoza, 19, a radio producer working with loveLife in Orange Farm, an impoverished neighbourhood near Johannesburg.

“Around 400 kids come to our youth centre every day after school just to listen to our shows. Our show doesn’t only educate them on important issues such as teenage pregnancy but all the other issues affecting their lives,” Xolani added.

“I was very shy before,” said Kedibone Segonote, 19, another peer educator. “After meeting and talking to many young people since I joined loveLife, I have gained much confidence and feel that I am really making a difference in their lives.”

June 5, 2011

Going Under the Knife to Cut HIV Chances

Kenya has managed to bring down the high rate of HIV through a campaign promoting male circumcision but a funding crisis is preventing the effective measure from being rolled out on a wider scale.

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June 4, 2011June 4, 2011

30 Years of HIV

Where we are after 30 years

5 June 1981: Center for Disease Control mentions a new virus in its weekly mortality report

1982: The term Aids (acquired immunodeficiency syndrome) first used

1984: Virus identified and named HIV

1985: Rock Hudson dies of Aids, teenage haemophiliac Ryan White expelled from school because infected through treatment

1987: First showing of Aids Memorial Quilt on National Mall in Washington DC

1991: Jeremy Irons wears red ribbon and basketball’s Magic Johnson has the virus

1993: Philadelphia film wins two Oscars

2000: Infection rate in US among African Americans overtakes that in gay men

2011: Global death toll 22m, infections 60m

June 4, 2011

UN Urges More Funds for Early HIV Treatment

The UN Programme on HIV/Aids (UNAids) has called for increased funding for the early treatment of people with HIV.

The head of the agency, Michael Sidibe, said a new study showed it could reduce the risk of HIV transmission by 96%.

He said the challenge was to expand access to drugs, and deal with social factors which stigmatise the disease.

On Thursday, a UN report said there had been a nearly 25% decline in new HIV infections and a reduction in Aids-related deaths during the past decade.

It was published ahead of the 30th anniversary on Sunday of the first official report on Aids by the US Centers for Disease Control and Prevention.

The General Assembly is to meet at UN headquarters to discuss the epidemic next week, with 20 world leaders and more than 100 ministers expected to attend.

An estimated 34 million people were living with HIV at the end of 2010 and nearly 30 million have died from Aids-related causes since 1981, the report said.

‘Shunned disease’

In the report published ahead of the anniversary, UNAids said the global rate of new HIV infections had declined by nearly 25% between 2001 and 2009.

In India, the rate of new HIV infections fell by more than 50% and in South Africa by more than 35%; both countries have the largest number of people living with HIV on their continents.

The report found that in the third decade of the epidemic, people were starting to adopt safer sexual behaviour, reflecting the impact of HIV prevention and awareness efforts. But there were still important gaps, it warned, with young men more likely to be informed about HIV prevention than young women.

There has also been significant progress in preventing new HIV infections among children as increasing numbers of mothers living with HIV have gained access to antiretroviral prophylaxis during pregnancy, delivery and breastfeeding.

About 6.6 million people in low- and middle-income countries were receiving antiretroviral drugs at the end of 2010, a nearly 22-fold increase since 2001.

“Thirty years ago this mystery disease was called a gay plague – it was a shunned disease, people were scared about each other,” Mr Sidibe said. “Now it’s a completely different world – we’ve been breaking the conspiracy of silence.”

However, the report found that at the end of last year nearly nine million people who needed treatment were not getting it, and that treatment access for children was lower than for adults.

And while the rate of new HIV infections has declined globally, the total number of HIV infections remains high, at about 7,000 per day.

The report also noted that there had been an increase in the rate of new HIV infections in Eastern Europe and in the Middle East and North Africa, and that HIV was the leading cause of death among women of reproductive age.

‘Game-changer’

UNAids also said that while funding for HIV treatments in low- and middle-income countries had risen 10-fold between 2001 and 2009, international resources had declined in 2010. Many states remain dependant on external financing.

“I am worried that international investments are falling at a time when the Aids response is delivering results for people,” Mr Sidibe said. “If we do not invest now, we will have to pay several times more in the future.”

He stressed the importance of a recent trial, which found that if a person living with HIV adhered to an effective antiretroviral regimen, the risk of transmitting the virus to their uninfected sexual partner could be reduced by 96%.

“Access to treatment will transform the Aids response in the next decade. We must invest in accelerating access and finding new treatment options.

“Antiretroviral therapy is a bigger game-changer than ever before – it not only stops people from dying, but also prevents transmission of HIV to women, men and children,” he added.

Mr Sidibe said the challenge was to expand access to drugs, and deal with social factors that in some countries continue to stigmatise the disease and make women particularly vulnerable.

To do this, UNAids believes an investment of at least $22bn is needed by 2015, $6bn more than is available today. It estimates such funds would stop 12m new HIV infections and 7.4m Aids-related deaths by 2020.