Initialisms

The Synergy Project is a five-year, performance-based contract that provides technical assistance and services to the United States Agency for International Development (USAID) to design, evaluate, and coordinate HIV/AIDS programs and identify and disseminate lessons learned from these programs. This website offers HIV/AIDS Technical and Programming resources including newsletter, links to HIV/AIDS focussed websites, publications and a calendar of events.

AIDSMap is produced by NAM in collaboration with the British HIV Association and the International HIV/AIDS Alliance. Initial funding was generously provided by St Stephen's AIDS Trust. NAM exists to support the fight against AIDS with independent, accurate, accessible and comprehensive information. NAM aims to create and disseminate information resources rooted in the experiences of those most affected, enabling individuals and communities to take action and control in responding to HIV and AIDS.

Journ-AIDS is a project being undertaken by the Centre for AIDS Development, Research and Evaluation (CADRE) that supports media professionals to provide indepth, accurate and critical reporting on HIV/AIDS in South Africa.

The HIV epidemic in South Africa has progressed rapidly over the past eighteen years. It is estimated that by 2007, 5.5 million people in South Africa were living with HIV/AIDS (ASSA model 2003). The annual Antenatal National HIV and Syphilis Prevalence Survey, conducted since 1990, shows an exponential growth in prevalence, with the national HIV sero-prevalence rate peaking at 30.2% in 2005, but declining to 29.1% in 2006 and 28% in 2007. Despite all its inherent limitations, this is currently the most reliable form of HIV surveillance in South Africa.

The various provinces have different prevalence rates in 2007 the Western Cape had the lowest prevalence at 12.6%. However, in some areas in the Western Cape the prevalence exceeds the national average. There is also variation in prevalence by age group, with the highest prevalence in 2007 in the 20-39 year age groups. In the 30-34 year age group the prevalence was as high as 40.2%. The national prevalence in the 15-29 year age group has declined from 2005 to 2007.

In the Western Cape, from 2004 to 2006, the prevalence in pregnant women less than 25 years of age has reduced each year possibly suggesting a reduction in incidence in this age group. In 2006, 21.1% of pregnant women in the 25-29 year age group were HIV-infected. This still constitutes a considerable disease burden for women in their reproductive years. By 2003, non-pregnancy related infections (NPRI) were found to be the most common primary cause of maternal death. Of these NPRIs, AIDS was the most common sub-category, and TB and pneumonia the most common causes of death in this group of women.

An estimated 60,000 to 70,000 children are newly infected with HIV each year. In 2006 there were approximately 257,900 HIV-infected children under 14 years of age in this country. Mother-to-child transmission (MTCT) is the overwhelming source of HIV infection in young children.

HIV infection is currently one of the leading direct and indirect causes of morbidity and mortality amongst South African mothers and children, and is a threat to the country's ability to meet the Millennium Development Goals.

Prevention of Mother-to-Child Transmission of HIV
In the absence of any interventions to prevent MTCT, an estimated 25-45% of HIVinfected mothers will pass the virus to their infants. HIV may be transmitted during pregnancy, labour and delivery or during breastfeeding.

Since the mid-1990s, clinical trials have shown the effectiveness of antiretroviral drugs in lowering the rate of transmission of HIV from infected mothers to their newborn infants. In 1994, the findings of the PACTG 076 study showed a two thirds reduction of MTCT with antenatal oral Zidovudine and intrapartum continuous Zidovudine infusion. In 1999 a study from Thailand showed a 50% reduction in MTCT with antenatal oral AZT and 3 hourly oral AZT during labour. Shortly thereafter the HIVNET 012 study showed a 47% reduction in MTCT with single dose NVP to mother and infant.

Subsequently the problem of rapid emergence of viral NNRTI resistance after such limited exposure to NVP and its negative impact on maternal and neonatal ART became a major concern, particularly as the national ART program rolled out.

In 2004, the Thailand group published a study showing that intrapartum and early neonatal NVP added to their AZT regimen (including 1 week of neonatal AZT) reduced early MTCT to a startlingly low 1 - 2%. With dual therapy and a restriction of maternal NVP to only a single dose, NNRTI resistance was less evident, but still of concern.

Prevention of mother to child transmission of HIV (PMTCT) with maternal HAART and replacement feeding in the developed world has been shown to be almost 100% effective. There is also evidence that elective caesarean section, safe obstetric practices and safe infant feeding practices reduce MTCT of HIV. However, in developing countries with resource constraints, HAART may not always be deliverable to pregnant women. In these settings where infectious diseases are common replacement feeding (or lack of breastfeeding) may also be associated with an increase in morbidity and mortality due to malnutrition and infections.

Closing date: 31 August 2009

We are seeking to recruit a suitably qualified and experienced candidate to develop and implement qualitative research components for existing ECHO projects and to develop a qualitative research programme within ECHO.

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.

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.

By virtue of the physical nature of their jobs, South African miners receiving treatment for HIV and AIDS are vulnerable to discrimination when they are not at peak performance, because of the drugs' side-effects. This is one of the challenges that workers in the mining sector deal with, as HIV rips through the industry. Benchmarks Foundation estimates that about 16 to 30 percent of mineworkers are HIV-positive, a problem which, according to experts, has yet to receive adequate attention.

AIDS activists are hoping that the country's new administration will make good on promises to urgently improve access to affordable HIV/AIDS treatment and services at state hospitals. The country's three political parties - ZANU-PF and the two factions of the majority Movement for Democratic Change (MDC) - signed a power-sharing deal on 15 September, ending one of the worst periods of inter-party political violence since Zimbabwe gained independence in 1980. Despite scepticism that the three parties will be able to work together, the deal has brought hope to many ordinary Zimbabweans, particularly those living with HIV, who have been battling to cope in the current harsh economic and political environment. Of the estimated 320,000 people in need of antiretroviral (ARV) treatment, only about 100,000 are accessing the medication at public health facilities. Besides the treatment gap, government hospitals are struggling to deliver services in the face of shortages of drugs, medical staff and foreign currency.

This is a fixed term position for an initial period of 2 years, renewable based on performance and availability of funds.