AIDS Care Watch

Monday, November 26, 2007

SA on track to halve mother-to-child HIV by 2010

By, The Times, November 26, 2007

South Africa is on track to meet a United Nations target for reducing mother-to-child HIV transmission (PMTCT) by 2010, the United Nations Children’s Fund (Unicef) said yesterday.

“SA is one of 17 low- and middle- income countries that are set to achieve the ... target of reducing mother-to-child infections by 50percent,” read a recent report by Unicef on PMTCT, paediatric HIV care and treatment in low- and middle-income countries.

In SA the PMTCT programme had been expanded to cover 90percent of public health facilities. More than 32000 children with HIV had started antiretroviral therapy by September this year . The report would be presented in Johannesburg today at a two-day Global Partners Forum on PMTCT, organised jointly by Unicef, the World Health Organisation and 18 other organisations and representatives from regions affected by HIV/Aids, including Asia, the Caribbean, Eastern Europe and Latin America.

Unicef reported that by December last year 127000 children were on ARVs worldwide.

Health department spokesman Sibani Mngadi said: “We want to offer a comprehensive package of care and treatment to those infected and affected. The health of women and children is our priority.”


130,000 Swazi children orphaned and vulnerable: report

By, AFP, November 24, 2007

Nearly a third of Swaziland's children are considered orphaned and vulnerable as AIDS takes its toll on the country, a study commissioned by the state's emergency response council said Friday.

"There are currently 130,000 OVCs (orphaned and vulnerable children) in the country, which represents 31.1 percent of all children countrywide," the study said.

"However, it is projected that the OVC figure could rise to 200,000 by the year 2010."

It added: "HIV and AIDS is permanently altering the structure of Swazi society. It is expected that by 2025 there will be a thinning of the older age groups and the very young."

Life expectancy in the country dropped from 60 years in 1997 to the world's lowest of 31.3 in 2004, while the mortality rate has sharply increased across the entire population over the past 15 years, the report added.

According to UNICEF's website, HIV prevalence among 20 to 30-year-olds is nearing 50 percent, higher than the national adult average.

In Swaziland, close to 40 percent of adults are living with HIV and AIDS, the highest infection rate anywhere in the world, UNICEF said.


Mozambuque: Rains, pregnancy and AIDS - a recipe for malaria

By, IRIN Plusnews, November 23, 2007

On a cloudy Monday morning in Maputo, capital of Mozambique, Cremilda Bulha, 28, dressed in a white T-shirt and traditional capulana cloth skirt, waits in the outpatient line at Maputo Central Hospital.

With the same certainty as she comments "there's going to be more rain today," to the patient next to her, she tells IRIN/PlusNews: "I've got malaria."

The viral disease is spread the Anopheles mosquito and causes headaches, fatigue, high fever, nausea and, in some cases, death. The number of malaria cases goes up during the rainy season, because mosquitoes breed in stagnant water.

Besides having to deal with these symptoms, Bulha is pregnant with her second child and is also HIV-positive, which increases her likelihood of catching malaria.

Susana Nery, a public health specialist from the Malaria Consortium organisation, explains that in countries like Mozambique, where the disease is endemic, people are bitten various times and gradually build up resistance.

This protective shield weakens in pregnant women, HIV-positive people and children, making them more susceptible. "These people's immunological system falls and their natural resistance diminishes," Nery stresses.

In the first six months of 2007, 2.5 million cases of malaria were recorded after floods hit the country, and 1,518 patients died, according to the Ministry of Health's 19th Epidemiological Bulletin.

Only half right

After two hours the nurse calls Bulha's name and the rain starts again. Her first forecast was right, but second was wrong: her malaria test came back negative.

She is three months pregnant and began antiretroviral (ARV) treatment two months ago, but it is her pregnancy, more than the HIV, that makes her more vulnerable to the malaria virus.

"The weak immunological system takes longer to react against malaria," says Maputo Central Hospital physician Rui Bastos. He explains that HIV-positive individuals are more likely to get malaria only when their immunological system is debilitated - in other words, when HIV infection has progressed to AIDS, which is not the case with Bulha.

Her defence cell (CD4) count is high, and she is only taking ARVs to prevent transmission of the HIV virus to her unborn child. In the AIDS phase it is important for HIV patients to take special care with regard to malaria, says Eduardo Mondlane Medical School professor Armindo Tiago Junior.

A person with malaria may be hospitalised for an average of three days; for an AIDS patient this increases to a week. "The weak immunological system takes longer to react against malaria," the physician explains.

Aware of this problem, the Red Cross of Mozambique has prepared its eleven health technicians throughout the country to take extra-special care with cases of malaria in HIV patients.

"HIV-positive individuals are more likely to catch illnesses such as malaria," says Frieda Draisma, the Red Cross of Mozambique's community work coordinator. Mozambique has a seroprevalence of 16.2 percent in a population of 19.8 million.

Nets and medication

The prevalence of malaria among pregnant Mozambican women is approximately 20 percent, according to data from the National Malaria Control Programme.

In 2004, Health Alliance International, a US-based global healthcare organisation, analysed 5,528 pregnant women in the provinces of Sofala and Manica, and in all instances found more cases of malaria among HIV-positive women than among HIV-negative ones.

As a Health Ministry policy, from the 20th week of pregnancy all expecting mothers must undergo intermittent presumptive treatment (IPT), in which they take a series of prophylactic pills that reduce the probability of contracting malaria. If they are undergoing ARV treatment, care needs to be doubled, said Tiago Junior.

When taken together, the ARV, nevirapine, and the anti-malarial medication, sulfadoxine-pyrimethamine, provoke vomiting and abdominal pain as well as reactions in the skin, such as blemishes, and in the mucous membranes, so the two drugs are never prescribed simultaneously.

The doctor makes a choice according to what he concludes is more important to the patient. If necessary, a different medication is used in place of the anti-malarial or the ARV.

The distribution of mosquito nets, especially to pregnant women, is one of Mozambique's main strategies to combat the disease. In the past three years, the Malaria Consortium and the Red Cross of Mozambique have distributed more than 700,000 nets in the northern provinces of Cabo Delgado and Nampula, the central provinces of Manica and Sofala, and Inhambane Province in the south.

The provinces included in the programme were chosen by the Ministry of Health due to the incidence of the disease and the shortage of health assistance.

While she waits for the rain to let up, Bulha comments: "This is just the kind of weather malaria likes." Although she is taking ARVs and undergoing anti-malaria treatment, Bulha covers her bed every night with the mosquito net she got at the beginning of the year. "That's what's going to protect me. Since I got it I haven't had malaria again."


Thursday, November 22, 2007

HIV-infected woman gives birth

By, Statesman News Service, November 21, 2007

An HIV-infected woman who had initially refused to terminate pregnancy gave birth to a healthy boy yesterday at the government-run hospital here, with health personnel lending a helping hand in realising her dream of ‘motherhood’.

In a related development, the district wing of the state health department ordered that inpatients delivering babies in government-run hospitals would have to undergo an HIV-detection diagnostic test. It has now been made mandatory as a safety concern, official sources said.

There was fears of inmates and attendants getting panicky. Even medical staff were scared as never before had any HIV-infected person been operated upon at a local hospital.

An effort, however, was made to help the woman in distress. “The steely resolve and indomitable spirit of the expectant mother overwhelmed us,” said Mr Manoj Kumar Behera, additional district medical officer of the district hospital. Both the infected mother and the newborn are safe, hospital sources said.

Medical attention is being paid to the mother and the child. Medical expenses for the child birth and post-maternal care are being born by the Zilla Swasthya Samity, Dr Behera said.

“We took precautionary measures while delivering the child. A special kit provided by the AIDS control society-run Voluntary Counselling and Confidential Treatment Centre came in handy,” said Dr Akhyaya Kumar Taria, who conducted the child birth.

“My world has fallen apart. Everything is finished. I can seek solace in my child. He is God's Gift to a cursed woman like me. God will act as his saviour,” said Sabitri (not the real name) with tears welling in her eyes.


Wednesday, November 21, 2007

AIDS label hurts kids

By, Patricia Watson, The Jamaica Gleaner, November 19, 2007

There are hundreds of children in Jamaica living with or affected by HIV. In January 2007, 5,125 children under the age of 15 were estimated to have been orphaned by AIDS. In 2006, 73 children aged zero to nine years old were diagnosed with HIV. Many of these children live and play in your neighbourhood, go to your church and attend your school. They are, however, forced to be silent about the disease they live with out of fear related to how persons will react. They also fear the discrimination they and their families would face if they revealed their status.

HIV/AIDS has a deep impact on every aspect of their lives - emotional, social, spiritual, physical and economic. Children infected or affected by HIV are rarely heard but, despite the silence, they have much to say about childhood, children's rights, parenting, family life, sexual and reproductive health issues, the Church and AIDS, and employment for people living with HIV.

Children and HIV/AIDS

Children living with HIV/AIDS in Jamaica have, in general, been silent about issues affecting them. Their opinions are rarely sought in the development of policies and programmes which have an impact on their lives. Even when they take part in consultations, they feel this participation is merely tokenistic. Up to 20,000 children in Jamaica are estimated to have been made vulnerable by HIV. Overall, five to seven per cent of all orphans in Jamaica are orphaned by HIV/AIDS, according to the Ministry of Health.

The Rapid Assessment of the Situation of Orphans and Other Children living in Households Affected by HIV/AIDS in Jamaica (2002) highlights the many economic, social and emotional problems faced by these children, including increased vulnerability of those whose parents are ill or have died; lack of psychosocial support to help them cope with their parents' illness or death, or their own HIV-positive status; stigmatisation in schools, churches, children's homes and the wider community; and the challenges facing HIV-positive children who are in institutional care.

Recent focus group discussions by the Panos Caribbean Institute revealed some concerns facing children infected with or affected by HIV. Younger participants identified the following as adults' actions which make them unhappy: "They call us names", "They scorn us", "They call us AIDS victim", "They make us feel that we are not important", "They chase us out of the community".


Older participants said adults' actions which make them unhappy include discrimination from persons who should know better; violence, insults and threats; stress; lack of access to services and medicines; shame and guilt, and lack of family and community support.

The Special Delivery initiative was born out of the issues which these children identified and their desire to highlight these issues to the wider society. Children understand childhood best - they live it. Children infected and affected by HIV/AIDS know their situation best and can guide others to respond to their greatest needs. People will listen when children speak. Children can bring much more than emotion to the issue of HIV/AIDS - they can bring information and solutions. Providing them with the information and skills required to speak for themselves is an important component of the advocacy process.

Over the coming weeks, children living with HIV, supported by Panos Caribbean and The Gleaner Company, will be delivering letters advocating for positive change on the issues they have identified to influential movers and shakers in Jamaica. Letters will be delivered to the Prime Minister and other government leaders, heads of development agencies and the media.


U.N. estimates 33 million infected with HIV

By, Reuters, November 20, 2007

More than 33 million people are infected with the AIDS virus -- far fewer than original estimates of close to 40 million, the United Nations said in its latest report.

Here are some facts about AIDS, according to UNAIDS:

-- An estimated 33.2 million people were infected with the human immunodeficiency virus in 2007. This included 30.8 million adults and 2.5 million children under the age of 15. Women made up half of those infected.

-- 2.1 million people died of AIDS in 2007, including 1.7 million adults and 330,000 children.

-- 2.5 million people were newly infected with AIDS in 2007, including 2.1 million adults and 420,000 children.

-- Every day more than 6,800 people become infected with HIV and more than 5,700 die from it.

-- There is no cure for HIV, which gradually destroys the immune system. Drug cocktails called highly active antiretroviral therapy or HAART can control infection and keep patients healthy.

-- HIV is now commonly passed through sexual contact between a man and a woman. It can also be passed from man to man, by infected needles, and from a mother to a baby. (Reporting by Maggie Fox)


Children who care for the sick

By, Gloria Ganyani(Zimbabwe), HDN Key Correspondent Team, November 8, 2007

Four-year-old Mavis Phiri* looks after her sick mother. She knows where her mother’s tablets are kept and she knows when to give them to her.

Every morning she cleans the house using oil to make the floor shiny. If she goes out to play with friends in the neighbourhood, she rushes back home whenever people come to their house. She knows she has a responsibility to attend to visitors who come to see her mother.

Mavis is one in a growing number of children who are affected by HIV and are being forced by circumstance to care for a sick parent.

"We are realizing that there is an increasing number of children who are caring for a sick parent" said Mrs Veronica Nhemachena, Programmes Manager for the Midlands AIDS Service Organisation (MASO), in Zimbabwe.

"In most cases, there is no other person who can be a caregiver in that household. Sometimes one parent will have passed on. The extended family structures no longer exist and people are now separated from relatives. This leaves the children with little, if any, choice but just to look after the sick parent."

According to a report, Africa’s Orphaned and Vulnerable Generations: Children Affected by AIDS, published by the United Nations Children’s Fund (UNICEF), 12 million children aged between 0–17 years in sub-Saharan Africa have lost one or both parents to AIDS.

"Children are experiencing the greatest parental loss in southern Africa, where HIV prevalence rates are highest," says the report.

Zimbabwe has not been spared and as a result there now exist many child-headed families and child caregivers in the country.

In Gweru, as in many other places in the country, some children are actually given time off from school to go back home to nurse a sick parent. The authorities now accept the responsibilities that such children have, which impact negatively on the child’s social, emotional and economic development. If a child such as Mavis fails to complete her education, chances of advancement are slim.

Besides the numerous challenges of keeping up at school, these children also suffer the consequences of stigma and discrimination because of their association with a person living with HIV.

One child who is taking care of her ailing mother said it was not uncommon for children in school to chase her away from their circles saying: "My mother says we must not play with you because your home is full of AIDS."

Questions arise as to whether having children look after relatives at home is not tantamount to child abuse? Should the children not be the ones to be looked after?

According to the Convention on the Rights of the Child, children are entitled to a standard of living adequate for their physical, mental, spiritual, moral and social development. The convention also states, however, that the parent(s) or others responsible for the child have the primary responsibility to secure, within their abilities and financial capacities, the conditions of living necessary for the child's development.

"It may not be ethical for children to be caregivers but that is the reality on the ground," said Mrs Nhemachena.

She suggests that children should be trained in home-based care and given universal prevention skills so that they know how to look after their parents as well as how to protect themselves from infection.

Most of all, there is need to ensure that children such as Mavis are given adequate psychological support so that they can manage the pressures of looking after a chronically ill relative or cope with the loss of a parent.

* Not her real name.

Health & Development Networks (HDN) 2007

Thursday, November 15, 2007

Global Fund Approves $1B in New Grants

By, Kaisernetwork, November 14, 2007

The board of the Global Fund To Fight AIDS, Tuberculosis and Malaria on Monday announced that it has approved 73 new grants worth $1.1 billion over the next two years, the AFP/Yahoo! Health reports. The Global Fund approved the grants during its 16th board meeting in Kunming, China, a statement said. Forty-eight percent of the total funding goes to HIV/AIDS activities, 42% for malaria and 10% for TB, the fund said. The statement also said that 66% of the projects are in Africa, 13% in Asia, 13% in the Middle East and 5% in Latin America (AFP/Yahoo! Health, 11/12). More than 80% of the grants will go to low-income countries.

The Global Fund Board also approved $130 million for renewal of five grants that are nearing their five-year expiration dates. According to the fund, the seventh round of grants brings the fund's portfolio to $10 billion in 136 countries. About 50% of the proposals submitted for round seven were approved, up from an average of 40% during the previous six rounds. The West Bank and Gaza won approval for their first grant to support an HIV prevention program (Global Fund release, 11/12).

The new grants increased the fund's grant allocation 32% higher than the $846 million initially planned for 2007. The fund has said it needs between $12 billion and $18 billion to pay for existing programs and to launch new ones between 2008 and 2010 (AFP/Yahoo! Health, 11/12).

"Global Fund-supported programs are already making an impact against AIDS, tuberculosis and malaria in many countries around the world," Rajat Gupta, chair of the Global Fund Board, said, adding, "This is the largest funding round in the Global Fund's history. The board is pleased with the strength and high level of ambition of the new grants and is looking forward to scaling up in the fight against the three diseases." Michel Kazatchkine, executive-director of the Global Fund, said, "These new grants show that need is increasingly turned into high-quality demand for resources," adding, "This is a trend we must develop further" (Global Fund release, 11/12).


Wednesday, November 14, 2007

THAILAND: Migrant workers unprotected and uninformed

By, IRIN Plusnews, November 12, 2007

Mae Sot - Seven years ago, in her small Myanmar hometown, Tha Zin, 30, a garment factory worker, watched as one of her closest friends - a girl just a few years younger - sickened and finally died of an AIDS-related illness.

As her condition worsened, most people in the community stayed away but Tha Zin, much to the chagrin of her parents, continued to visit her dying friend, comforting her as best she could, despite her own uncertainty over whether she could be at risk.

Tha Zin, then 22, didn't really know what caused the condition, though the rumours in the neighbourhood were that it had to do with her friend's relationship with a certain 'sugar daddy'. "At that time, I didn't know much about this disease and how it could be transmitted, but I thought that I had a pure heart so I should be okay."

Today, she has a far better grasp of HIV transmission. In the Thai border town of Mae Sot, where she arrived 3 years ago in search of work, she has attended several AIDS awareness sessions organised by the charity, World Vision, as part of a US$12 million, 5-year project to help foreign migrant workers in Thailand reduce their risk of contracting the virus.

Tha Zin is now an informal peer educator in the factory where she works, sharing her newly acquired knowledge with other workers, mainly younger Burmese women who have come to Thailand alone.

Talking about HIV to these young women is a tough task. "It's very difficult to share awareness and knowledge," she told IRIN/PlusNews. "When I explain, some people look down on me. They think, 'she knows everything about this disease, so she must have been a prostitute'. In their experience, they think the disease is only from sex workers and drugs. They don't know you can get it from needles and bleeding."

Low levels of knowledge and awareness

Thailand is thought to have nearly 2 million foreign migrant workers, mainly toiling in low-paying jobs in factories, on farms, construction sites, and fishing boats - the so-called "three Ds", for "dirty, dangerous or degrading" - jobs many Thai's are unwilling to do.

Most foreign workers live in highly concentrated areas like Mae Sot, a town on the Burmese border that has become a centre of the Thai garment industry, and Samut Sakhon, 28km southwest of Bangkok and a hub of the labour-intensive seafood processing industry.

While precise figures on the number of migrant workers in Thailand are not available, the overwhelming majority - an estimated 90 percent - are from neighbouring Myanmar. In Myanmar, the highly conservative military junta publicly recognised HIV/AIDS as a threat to its population only about six years ago, after years of insisting that the country had no such problem.

The regime still tightly controls efforts to raise awareness about the disease: non-governmental organisations (NGOs) have complained of limits on the number of people who can attend HIV workshops, and prohibitions on their operating in many parts of the country, particularly sensitive ethnic minority areas.

This means most Burmese workers arrive in Thailand with little understanding of HIV/AIDS or how to protect themselves when they move away from their families and find themselves at greater risk of HIV. Similarly, migrants from Cambodia and Laos, coming from the poorest regions of their countries, often also have a poor understanding of the virus.

HIV prevalence statistics for migrant workers are not available, as the Thai government does not survey migrants separately, but sample reports, primarily among foreign fishermen and sex workers in border towns, showed high but fluctuating prevalence rates between 2002 and 2004, according to the Prevention of HIV/AIDS Among Migrant Workers Project (PHAMIT) in 20 of Thailand's provinces.

For example, in 2004, HIV prevalence among fishermen, who are mainly Burmese, was 9.6 percent in Chumpon Province, and 5.6 percent in Phuket Province;
among the mainly Burmese sex workers in Ranong, a major port in Ranong Province, which borders Burma, HIV infection rates stood at 28 percent; and among the mainly Cambodian sex workers in the province of Trad, bordering Cambodia, it reached 38 percent, the health ministry said.

PHAMIT, funded by the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, consists of NGOs and works with the Ministry of Health to increase foreign labourers' knowledge about HIV/AIDS.

As part of the project, the Global Fund has financed the development of information, education and behaviour-change communication material in Burmese, Cambodian and several ethnic minority Burmese languages to help migrants understand issues like HIV, reproductive health and family planning, and how to access Thai health care.

Reaching out to migrants

Yet, even with the support of the Thai health ministry, efforts to reach out to foreign workers have been beset with difficulties, mostly stemming from their precarious position, given their illegal status, constant risk of deportation and often gruelling work schedule.

Although Thailand depends heavily on foreign workers, around half of them are unregistered and, technically, illegal, leaving them vulnerable to police harassment as well as serious exploitation by their employers, according to labour rights organisations.

In Mae Sot, where World Vision and other humanitarian groups have sought to train women in every garment factory to serve as informal peer counsellors, many of the women, who are in Thailand illegally, are forced to work six days a week and late into each night, with some getting only a single day off each month, which gives them little or no free time to attend training sessions on health or other issues.

To conduct all-day in-depth trainings, charities have to appeal directly to factory owners to release some of their workers for a day. Many are reluctant to do so, or agree, only to change their minds on the day of the planned training.

"It's up to the employer," said Mie Mie, a Burmese HIV/AIDS coordinator with World Vision. "Sometimes they say, 'Yes, you can come and do counselling,' but on the day we come, they say, 'we have so many orders'." The charities also have to pay the women for the wages lost during training time.

Dr Ei Ei Khin, a Burmese physician and technical advisor to World Vision's migrant worker projects in Thailand, said even when workers understood how to protect themselves from HIV, their more immediate fear was the risk that they would be arrested and held in immigration detention centres before being either freed or deported, thus losing many days of work and wages.

This often deters garment workers in Mae Sot from leaving their factory compounds, where they normally live, and restricts access to condoms unless charitable groups supply them to directly to the workers quarters in the compound. "If there is no NGO working for that factory, it's very difficult for the workers to get access to condoms," Khin said.

In recent years, the authorities' attitudes towards the migrants, especially in some provinces, have been hardening, with new restrictions being introduced to curtail the mobility of migrant workers. In several provinces, local authorities have prohibited migrants from using mobile phones, riding motorbikes, being out after 8 p.m., or gathering in groups of more than five.

Despite these hurdles, Khin believes the message is slowly reaching Thailand's foreign labourers. "Behaviour is changing," she said. "It's not enough, but it's changing."


Tuesday, November 06, 2007

Zimbabwe: HIV rate falls again

By, IRIN PlusNews, November 4, 2007

When Zimbabwe registered a decline in HIV prevalence rates in 2004, and again in 2006, the news was met with scepticism, but new official figures released on Wednesday indicate the downward trend has continued, with rates falling by 10 percent over the past 5 years.

The Zimbabwe Ministry of Health and Child Welfare, assisted by a group of international experts, based the new seroprevalence rate on HIV infection in pregnant women attending antenatal clinics, and estimate the level among the adult population at 15.6 percent, according to a UN statement.

"Zimbabwe's HIV rate has been falling since the late 1990s. This is a continuing fall," Roeland Monasch, Deputy Representative of the UN Children's Fund (UNICEF), told IRIN/PlusNews. The rate has steadily decreased from 25.7 percent in 2002 to 21.3 percent in 2004, dropping to 17.7 in 2006. Zimbabwe's population is around 11.6 million.

"The biggest falls among pregnant women were recorded among the 15-24 year age group, showing a drop in HIV from 20.8 percent to 13.1 percent in just four years (2002 to 2006)," the statement said.

But Monasch warned that "15.6 percent remains high, and this is not the moment for complacency. Rather, we must take advantage of this positive action by youth and put even greater energy and resources into Zimbabwe's fight against HIV and AIDS."

Sound statistics

Despite some disbelief in previous years, most observers now acknowledge that Zimbabwe's HIV prevalence rate is in fact dropping. "There is not another country in Southern Africa that has this much detailed, scrutinised data, and it shows progressive falls in the HIV rate," Monasch commented.

Representatives from the US Centres for Disease Control and Prevention, the Imperial College, London, the UN Population Fund (UNFPA), UNAIDS, the World Health Organisation and UNICEF were involved in the latest review.

"The drop over the years is statistically significant - pregnant women are a proxy for the overall sexually active population. This information is used as input in the HIV/AIDS epidemiological models to estimate overall prevalence for men and women in reproductive age ... these models are continuously reviewed by independent experts to ensure the most accurate estimates are derived," UNICEF spokesman James Elder explained.

Awareness changes behaviour

The dramatic plunge in prevalence rates has been attributed to the success to programmes aimed at soliciting behavioural change among the country's youth. Survey data showed that the adoption of protective behavioural measures had improved, especially in reducing number of sexual partners and increasing condom use.

Zimbabwe was one of the first countries to develop a comprehensive epidemiological review, which resulted in an evidence-based, behaviour-change strategy with the promotion of partner reduction and consistent condom use at its core. According to Bruce Campbell, the UNFPA representative in Zimbabwe, "young people are having fewer partners and using more condoms. They have heard the messages, taken action, and are being safer."

Given the severe economic and food security difficulties faced by Zimbabweans, some suggest the falling prevalence rates might point to factors other than behaviour, such as mortality, which could mean that the number of people dying from AIDS were outnumbering those newly infected with HIV.

According to 'Evidence for HIV decline in Zimbabwe', a review of the epidemiological data by UNAIDS in late 2005, "the decline in national HIV prevalence between 2000 and 2004 resulted from a combination of declining HIV incidence and rising adult mortality," but also that "sexual behaviour change has contributed to the declines in HIV prevalence and HIV incidence in Zimbabwe."

Monasch said, "Additional research is still [being] done to assess how big each factor is contributing to the decline. This is not an easy or quick exercise, but we remain confident that combined Government and UN behaviour-change strategies throughout the 1990s were absorbed and applied by Zimbabwe's educated populace ... the evidence clearly indicates that mortality alone is not responsible for the drop."

The migration of Zimbabweans to other countries "was not found to be a significant factor," Elder said. The UNAIDS review agreed: "International migration is believed to have been extensive, and the possibility that it contributed in a small way to the decline in HIV prevalence cannot be ruled out ...

"Nonetheless, the evidence available does not support the view that the overall level of migration, and (particularly) the degree of over-representation of symptomatic and asymptomatic HIV-positive individuals amongst migrants needed to cause a decline in national HIV prevalence."

Monasch was confident the positive trend could hold. "It's sustainable, but it requires funds to keep the programmes running. We know what works in Zimbabwe, and it's now been proved that, given the right behaviour change programmes, Zimbabwe's educated youth will absorb the messages and act accordingly," he said.

"Young people are having fewer partners and using more condoms; Zimbabwe has one of the highest rates of condom use in Southern Africa." Nonetheless, he warned that there was room for improvement.

"We must continue our combined efforts to ensure national HIV-prevention programmes are maintained and enlarged. HIV-positive children in need of treatment are still inadequately reached with treatment, and less likely to receive treatment compared to adults."

Mary Sandasi, Executive Director of the Women's AIDS Support Network, told IRIN, "There is a lot of education going out to people and that could assist the fall of HIV infection, but I also look at the deaths that are still happening and there is a lot that can still be done."


Monday, November 05, 2007

HIV Prevalence in Zimbabwe Decreases to 15.6%, Health Official Says

By, Kaisernetwork, November 2, 2007

HIV prevalence in Zimbabwe during the past four years has decreased from 18.1% to 15.6%, Owen Mugurungi, head of the AIDS and TB unit at the Ministry of Health and Child Welfare, said on Wednesday when announcing national HIV/AIDS estimates for 2007, the Herald/ reports (Chipunza, Herald/, 11/1).

According to Zimbabwe Health and Child Welfare Minister David Parirenyatwa, the decrease in HIV prevalence was seen among people ages 15 to 49. Weekly AIDS-related deaths also declined from 3,000 to 2,300, Parirenyatwa said. He added that the decline in HIV prevalence is a "significant drop, but the figures are still very high, and more should be done to further lower the numbers."

About 1.3 million people in Zimbabwe are expected to be living with HIV/AIDS by the end of the year, Xinhua News Agency reports. However, the number could increase if people do not change their behaviors and attitudes toward the disease, Parirenyatwa said (Xinhua News Agency, 11/1). In addition, the number of HIV cases among children younger than age 15 has increased from 125,161 cases in 2003 to 132,938 currently. Mugurungi attributed the increase to the extended survival of children receiving antiretroviral drugs and the low-cost antibiotic cotrimoxazole. According to the Herald/, about 18,000 of the 194,000 children in need of cotrimoxazole have access to it, and of the approximately 24,000 children in need of antiretrovirals, about 7,000 have access to them. "We take cognizance of our efforts attained in the antiretroviral rollout program for the decline in the prevalence rate," Mugurungi said, adding, "If we take out the impact of antiretrovirals, the prevalence rate could have been 15.3%."

The 2007 estimates were compiled using data from prenatal clinics at 19 sites in the country, the Zimbabwe Demographic Health Survey 2005-2006, the national census, testing and counseling data, and the Prevention of Mother-to-Child Transmission Program, the Herald/ reports (Herald/, 11/1).

According to the AP/International Herald Tribune, some analysts were "skeptical" of the figures because of the "lack of medical care" in the country. In addition, although Zimbabwe said its estimates were verified by the United Nations, UNAIDS disagreed. "It looks like they've used the methodology that we recommended," UNAIDS spokesperson Sophie Barton-Knott said, adding that "however, as we haven't received this data officially, we cannot validate it."

UNICEF said the decline in prevalence is "one of the most significant and rapid declines of any country in the world." The organization added that "mortality also played a hand in the drop." Other analysts said that they doubt the estimates because of the problems with Zimbabwe's economy and infrastructure, lack of access to health care and the difficulty of using statistics when as much as one-third of the population has left the country. "I think with the current state of affairs in Zimbabwe, one would be kind of skeptical about statistics, which could also be caused by an undercount, by mass migration," David Bourne of the University of Cape Town said (AP/International Herald Tribune, 11/1).

Thursday, November 01, 2007

HIV Arrived in U.S. From Haiti 10 Years Earlier Than Previously Believed, Study Says

By, Kaisernetwork, October 31, 2007

The most widespread HIV subtype outside Africa likely emerged in Haiti in the 1960s and arrived in the U.S. a few years later -- about 10 years earlier than previously believed -- according to a study published Tuesday in the Proceedings of the National Academy of Sciences, the Los Angeles Times reports.

For the study, Michael Worobey, an evolutionary biologist at the University of Arizona, and colleagues analyzed five blood samples collected in 1982 and 1983 from Haitian HIV/AIDS patients in Miami that had been frozen and stored by CDC (Chong, Los Angeles Times, 10/30). In addition, the researches examined genetic data from 117 early HIV/AIDS patients worldwide (Dunham, Reuters, 10/29). The researchers examined two viral genes and compared their sequences with viruses found worldwide, using HIV samples from Central Africa considered to be some of the earliest forms of HIV as a baseline.

The researchers then constructed a timeline of HIV development by measuring how much the genes in recent blood samples differed from early samples. According to the study, samples from Haitians were genetically the most similar to the African virus, indicating the Haitian viruses were among the earliest to branch off. The researchers found a 99.7% certainty that HIV subtype B originated in Haiti, Worobey said.

Worobey concluded that the virus was brought to Haiti by Haitians who traveled to the Democratic Republic of Congo after it became independent in 1960. He added that the virus was then carried to the U.S. by Haitian immigrants between 1966 and 1972 (Los Angeles Times, 10/30). The researchers believe an unknown Haitian immigrant likely arrived in a large U.S. city, such as New York or Miami, and the virus circulated in the U.S. population and then to other nations before it was discovered. The mutation timeline of the virus presented in the study places the virus in the U.S. about 12 years before the disease was recognized by scientists in 1981, Reuters reports (Reuters, 10/29).

The study's findings confirm many scientists' suspicions that the virus was imported to the U.S. from Haiti and subsequently spread to Australia, Canada, Europe and Japan, AFP/Yahoo! News reports. HIV/AIDS prevalence among Haitians living in the U.S. was 27 times higher than in the broader U.S. population in the early days of the U.S. epidemic, according to AFP/Yahoo! News. In addition, the researchers concluded that HIV spread from Haiti to Trinidad and Tobago, fueling the Caribbean epidemic (AFP/Yahoo! News, 10/29).


"Once the virus got to the U.S., then it just moved explosively around the world," Worobey said (AFP/Yahoo! News, 10/29). Worobey added that there likely were "hundreds of thousands of infections" before HIV was discovered. Arthur Pitchenik, a study co-author from the University of Miami, said the study "gives [scientists] more clear insight into the history of" the HIV/AIDS pandemic and "what path the virus took" (Reuters, 10/29).

Worobey added that the study did a "good job of settling the debate" over whether the virus arrived in the U.S. from Africa or Haiti. "This shows quite clearly that the data is really only consistent with a Haiti-first origin," Worobey said. Beatrice Hahn, a virologist at the University of Alabama-Birmingham who was not involved with the study, said the study's "calculations are as good as the currently available methods allow." Hahn cautioned against blaming the spread of HIV/AIDS on Haitians or Central Africans. "These viruses are fairly clever, and they have to survive. They will find niches. ... You realize chance events play a very important role," Hahn said (Los Angeles Times, 10/30).

The Miami Herald on Wednesday examined how the study's findings have "stoked controversy among researchers and Haitians" by "reopening deep wounds over the medical community's role in perpetuating a stigma against people from the island" (Tasker/Charles, Miami Herald, 10/31).