HIV/AIDS

TB patients uptake of HIV counselling and testing (HCT) is affected by a wide variety of health systems/ services-related and patient/community-related factors. This research set out to explain comparatively low rates of HCT among TB patients in Lejweleputswa and Thabo Mofutsanyana Districts in the Free State Province. By interviewing patients, community health workers, front-line providers and health managers this fact-finding research sought to identify and illuminate barriers to and facilitators of uptake of HCT by TB patients.

The initial CD4 cell counts of patients newly infected with HIV fell significantly between 1985 and 2001, US research published in the May 1st edition of Clinical Infectious Diseases has shown. This suggests that the virus may have evolved to become more virulent during this time period, which could have clinical implications, shortening the interval between infection with HIV and the need to start HIV treatment. In people with HIV, CD4 cell counts provide an important indication of the strength of the immune system, of HIV disease progression and of when to start antiretroviral treatment.

In South Africa, the issues surrounding HIV/AIDS have long been contested and are, in themselves, complex. Treatment has been normalized, embraced and guided by the National HIV/AIDS and STI Strategic Plan (NSP), which is the overall guiding plan for HIV/AIDS in South Africa. The Plan is implemented in partnership with the South African National AIDS Council (SANAC). The NSP has gaps in the key areas of sexual and reproductive health and rights (SRHR), and this has been an important critique of policy guidelines. SRHR are only identified in the indicators of prevention and are absent from other provisions in the Plan. These gaps are also challenges in the Southern African region and globally. While the process of addressing SRHR in South Africa has started, these comments have the potential for wider application globally.

Starting antiretroviral therapy earlier, before the development of symptoms, is the most likely way to reduce the high death rates after treatment initiation seen in people with HIV in resource-limited settings, two large cohort analyses show. The studies also show that the major disadvantage of starting treatment late an increased risk of death may persist for some years, burdening already overstretched health systems with illness that could be avoided by earlier treatment.

Candidate microbicide PRO 2000 cuts HIV transmission by 30 percent, falling just short of the one-third required to be deemed a success. But scientists say this trial offers proof that the concept of a vaginal gel to block HIV is possible. For the first time in over a decade of research, a vaginal gel called PRO 2000 has been show to cut HIV transmission by 30 percent. Principal investigator Professor Gita Ramjee described this as extremely hopeful at the simultaneous launch of the results in Durban and Montreal, Canada, yesterday (9 Feb). This is the first microbicide study in over a decade that shows promise. It suggests that we are on the right track and we will be able to develop a women-controlled product to prevent HIV in the future, said Ramjee, who heads HIV research at the Medical Research Council (MRC).

For many women, pregnancy is a time of anticipation and celebration, but for those living positively it can be frustrating when their status and not their pregnancy takes centre stage. Being pregnant and positive often comes with its own brand of stigma. In a study among HIV-positive women in the United States, released at the international AIDS conference in Mexico in 2008, about half the respondents thought HIV-positive women could have children if they received appropriate care. But roughly the same number said they felt society strongly discouraged them from doing so, revealing what researchers said was a dichotomy between the women's views about their bodies and society's.

HIV is thought to have a kill rate of close to 100%, higher than even the notorious haemorrhagic diseases such as Ebola. But, unlike such virulent attackers, HIV kills its hosts through a steadily attrition of the immune system, giving ample time for new infections to occur. The result is a slow-burning epidemic steadily destroying lives and eroding South Africa's development potential. HIV/AIDS was regarded as effectively untreatable in South Africa. The drugs were too expensive: Supreme Court of Appeal Judge Edwin Cameron had to have financial help to afford the antiretrovirals that have now kept him alive for so many years. Effectively, antiretroviral therapy (ART) was seen as something for the wealthy elite - and, so the argument went, even if it were affordable, then poor and unsophisticated people were unlikely to be able to take it properly.

It is a truth universally acknowledged, that a country in possession of economic growth will find the health of its citizens improving. But almost uniquely, South Africa's growing financial strength has been accompanied by a fall in key indicators of health. The tie between health and wealth has held true for most of the world, and for as long as there appear to have been economists to notice it. Wealthier countries tend to be healthier at least until they start to encounter the diseases of affluence such as obesity. In South Africa, and some other surrounding countries, this link has broken. South Africa's Gross Domestic Product per capita has increased by an average of 3% per year for the last decade. Yet the most obvious indicators of health are falling. The easiest way to get snapshot of a nation's health is to look at key indicators: life expectancy at birth, maternal mortality and infant mortality. These are such fundamental markers that they were written into the Millennium Development Goals (MDGs), which South Africa signed in 2000.