AFRICA: Money no protection from HIV
JOHANNESBURG, 6 July 2010 (PlusNews) - A new study has challenged widely held assumptions about income level in relation to HIV, finding that neither wealth nor poverty are reliable predictors of HIV infection in Africa.
Previously, the argument that poverty drove HIV epidemics was supported by the World Bank and UNAIDS, as well as less reliable authorities like former South African President Thabo Mbeki, who told the International AIDS Conference in Durban in 2000 that the disease was a partner with "poverty, suffering, social disadvantage and inequity".
More recent research suggests that the reality is far more complex. For example, Botswana and South Africa, described as two of the wealthiest countries on the continent, also have among the highest rates of HIV infection.
Nevertheless, the idea that poverty fuels the spread of HIV has persisted as "a very dominant narrative", according to Justin Parkhurst of the London School of Hygiene and Tropical Medicine.
Parkhurst analyzed and compared data on HIV and wealth from demographic and health surveys in 12 sub-Saharan African countries with generalized epidemics (national prevalence rates higher than 1 percent); his findings are published in the July issue of the Bulletin of the World Health Organization.
He noted that in lower-income countries HIV prevalence tended to rise in tandem with wealth - in Uganda and Cote d'Ivoire, for example, women in the highest income bracket had the highest HIV prevalence.
In countries with a per capita gross domestic product higher than US$2,000, the link between wealth and prevalence was less clear.
Parkhurst also found that the relationship between wealth and HIV changed over time. A survey was conducted In Tanzania in 2003, and another in 2008; in the intervening five-year period, HIV prevalence declined among women in higher income brackets and rose among those in the lower income groups. Among men, prevalence stayed the same in the poorest group but was lower in all other groups, with the biggest declines in the highest income groups.
"HIV spreads through sexual behaviours, and these are social behaviours that change over time and are responsive to outside influences," Parkhurst told IRIN/PlusNews.
He compared the way HIV affected different social groups with the way tobacco use and obesity once affected mainly the rich, but were now bigger problems among the poor.
Wealthier people were often harder hit early in an HIV epidemic, probably because of their broader social and sexual networks. "Over time, the wealthy tend to be more educated [about HIV risk] and more likely to think about their future health," said Parkhurst.
However, these trends are by no means universal and the patterns for men and women differ. In Swaziland, for example, which has the highest HIV prevalence of all the countries Parkhurst looked at, there was little evidence of a link between household wealth and individual prevalence.
Know your epidemic
Parkhurst's findings have implications for one-size-fits-all prevention campaigns that do not take into account the complex and changing ways in which wealth, education level and gender can affect risk-taking behaviours.
"We need to educate people [about HIV] in a way that's relevant to their context," he said. "It's about letting local actors to find out what's going to work best. If we try to work out the solution from London ... it's unlikely to work."
Parkhurst said "bottom-up" HIV prevention initiatives targeting the specific lifestyles and risk behaviours of a community were more likely to work. This approach is already catching on, with UNAIDS urging countries to "know your epidemic" and design prevention programmes accordingly.
"Health practitioners know they have to diagnose a problem before they can treat it," he said. "I think the international community is starting to recognize the importance of addressing structural drivers of HIV, not just broadly, but to look at the specifics for specific communities
Women infected as often as men in discordant African couples
A large study of HIV-discordant couples (one partner infected and the other not) found that
nearly half of infected partners were women (TUAC0205). This systematic review and metaanalysis
focused on 27 sub-Saharan cohorts including 12,865 couples, as well as on 1,145
couples in demographic and health surveys from 14 countries. Women were the infected
partner in 47% of the cohort couples and in 46% of the health survey studies.
Psychological problems persist for years in AIDS orphans
A four-year study of more than 1,000 South African children found significantly higher rates
of psychological problems in AIDS orphans than in other orphans and nonorphans, and most
of those problems persisted through 4 years of follow-up (TUAD0206). Researchers found
that AIDS orphans reported significantly more depression, post-traumatic stress syndrome,
peer problems, and delinquency than other orphans or children who were not orphans. Four
years after the initial survey, the investigators found that AIDS orphans still reported
significantly more depression and post-traumatic stress syndrome than other orphans or
nonorphans. Three factors raised the risk of psychological problems in AIDS orphans: AIDS
stigma, hunger, and bullying and victimization.
Heavy financial, emotional toll in caring for adult child with AIDS
A survey of 859 households in urban and rural Zambia confirmed that caring for an adult
child who died of AIDS had heavy financial and emotional impacts on caregivers, despite
governmental programmes to ease these burdens (MOAE0205). Nearly half of the
caregivers were 60 or older, 96% lacked financial resources to care for their dying child, and
75% experienced “emotional upheaval.” In urban areas, one third of caregivers sold assets
to support children. Only 10% mentioned HIV-related social stigma as a problem.
Studies analyze integration and decentralization of HIV care
Integrating HIV care into other health programmes can have multiple benefits, ranging from
increased HIV testing to more sustained treatment of conditions prevalent in a given region.
Three studies in a Wednesday oral session explore integrating HIV services with malaria
prevention in Kenya (WEAE0104), mass immunization in Zimbabwe (WEAE0105), and
primary health care in nine sub-Saharan countries (WEAE0101).
Four reports in the same Thursday session focus on strategies to decentralize, and thereby
expand, HIV care. Researchers in Malawi assessed the feasibility of shifting some tasks
from nurses to lesser-skilled personnel in vertical (mother-to-child) transmission programmes
(THAE0301). Another Malawi group sought to expand HIV testing and other basic health
services via mobile clinics (THAE0302). In rural Mozambique, Medecins Sans Frontieres
investigators piloted distribution of antiretrovirals through self-forming patient groups
(THAE0303). And in Kenya, nurse-centered “low risk express care” helped retain HIVpositive
patients in care while maintaining clinical benefits (THAE0305).
Sub-Sahara Africa leads global decline in new HIV cases
The UN called for greater global investment in HIV/Aids prevention
Countries in Sub-Saharan Africa are leading a global decline in new HIV infections, the UN has said.
UNAids said 22 countries in the world's worst affected region had seen a drop in new cases of more than 25%.
The fall was because of greater awareness and better use of preventative measures, it said.
But UNAids also noted that cases of HIV were increasing in Eastern Europe and Central Asia, and among gay men in developed countries.
Michel Sidibe, UNAids executive director, said the world was making "real progress" towards achieving the sixth Millennium Development Goal (MDG6) of halting and reversing the spread of HIV/Aids by 2015.
"For the first time change is happening at the heart of the epidemic. In places where HIV was stealing away dreams, we now have hope," he said.
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UNAids says there are now 5.2 million people worldwide receiving treatment for HIV/Aids, which has helped to ensure that 200,000 fewer people died from the virus in 2008 than in 2004.
The agency said young people "are leading the prevention revolution by choosing to have sex later, having fewer multiple partners and using condoms, resulting in significantly fewer new HIV infections in many countries highly affected by Aids".
The use of male condoms has also doubled in the past five years, while the report notes that "tradition is giving space to pragmatism" in many communities as they embrace male circumcision, which research shows has the potential to reduce HIV infections among men by nearly 60%.
'Challenges remain'
China, where cases are largely concentrated within high-risk groups, was praised for its efforts to increase preventative measures for drug users.
UNAids said South Africa had also rapidly increased "efforts to achieve universal access to HIV prevention, treatment, care and support".
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But there was a warning that "challenges remain" in the global fight against HIV/Aids, including expanding epidemics in Eastern Europe and Central Asia, and resurgence in new infections in wealthier nations among men who have sex with men.
The UN also called for greater investment in HIV/Aids prevention, warning that there was a $10bn (£6.4bn) shortfall in 2009.
It said those countries most severely affected by HIV/Aids could not handle the crisis with their own resources alone.
"At this turning point flat-lining or reductions in investments will set-back the Aids response and threaten the world's ability to reach MDG 6," said Mr Sidibe.
"Investing for Aids is a shared responsibility - between development partners and national governments."
