Hospital Fails to Make ARV Order for the Month of June

via allafrica.com, by Jennifer Dube

SCORES of people receiving anti-retroviral (ARV) drugs from Harare Central Hospital were early last week told to buy their own drugs as the hospital allegedly "forgot" to order the life-prolonging drugs.

A beneficiary of the government-free ARV programme showed The Standard his health card where "out of stock" had been written against the second line drug alluvia which is used together with tenolam.

"They said they do not have the drugs," the beneficiary said. "I was advised to buy the drugs but I currently do not have the money to do so. This will affect me as I may take long to get the money for the drugs."

Vice-president of Zimbabwe HIV and Aids Activists Union, Stanley Takaona said his organisation had been told the hospital did not make an order for the month of June.

"We have made a follow-up with the hospital together with the ministry and we were told the drugs are there at the national pharmacy but the hospital did not make an order for this month," Takaona said.

"Those are the most expensive ARV drugs, costing US$120 for a month's supply and most people who are on the government programme cannot afford them."

Takaona said such alleged negligence on the part of the hospital was disturbing as those on ARVs were supposed to take the tablets consistently, without skipping any days, for effectiveness.

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position. Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]

The Importance of Having New Prevention Technologies

via AllAfrica.com

One would wonder why at a time when financing for HIV and Aids is decreasing such that governments are failing to provide treatment to all in need, others continue to channel millions into trials for new prevention technologies.

Others have argued that the world already has preventive interventions that have been proved to work and the billions earmarked for these new interventions for prevention should, for now, be channelled towards scaling up already existing strategies for effective response to the HIV and Aids pandemic.

Statistics from the National Aids Council show that Zimbabwe has 1,2 million people living with HIV and Aids with a prevalence rate of 14,26 percent.

About 60 percent of these are women.

About 347 000 people are on life-prolonging anti-retroviral drugs (ARVs) against a total of 593 168 with CD4 count level of 350 who are in urgent need of treatment.

In terms of funding for treatment, Government says the gap continues to widen in line with set targets. This year alone, Government will need about US$9,1 million to provide treatment to 66 532 people in dire need of ARVs. Some strategies that have already been proved to work include the male and female condom, which is between 94 and 97 percent effective.

Male circumcision and the Prevention of Mother to Child Transmission (PMTCT) have also been proved to prevent HIV transmission by 60 and 50 percent respectively.

Other interventions known to work effectively in combating HIV are behavioural change and blood screening

Read the Rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

What it really takes to prevent mother-to-child HIV transmission

via PLoS Medicine, by Andrea L. Ciaranello, Freddy Perez, Jo Keatinge, Ji-Eun Park, Barbara Engelsmann, Matthews Maruva, Rochelle P. Walensky

Background

The World Health Organization (WHO) has called for the “virtual elimination” of pediatric HIV: a mother-to-child HIV transmission (MTCT) risk of less than 5%. We investigated uptake of prevention of MTCT (PMTCT) services, infant feeding recommendations, and specific drug regimens necessary to achieve this goal in Zimbabwe.

Methods and Findings

We used a computer model to simulate a cohort of HIV-infected, pregnant/breastfeeding women (mean age, 24 y; mean CD4, 451/µl; breastfeeding duration, 12 mo). Three PMTCT regimens were evaluated: (1) single-dose nevirapine (sdNVP), (2) WHO 2010 guidelines' “Option A” (zidovudine in pregnancy, infant nevirapine throughout breastfeeding for women without advanced disease, lifelong combination antiretroviral therapy for women with advanced disease), and (3) WHO “Option B” (pregnancy/breastfeeding-limited combination antiretroviral drug regimens without advanced disease; lifelong antiretroviral therapy with advanced disease). We examined four levels of PMTCT uptake (proportion of pregnant women accessing and adhering to PMTCT services): reported rates in 2008 and 2009 (36% and 56%, respectively) and target goals in 2008 and 2009 (80% and 95%, respectively). The primary model outcome was MTCT risk at weaning.

The 2008 sdNVP-based National PMTCT Program led to a projected 12-mo MTCT risk of 20.3%. Improved uptake in 2009 reduced projected risk to 18.0%. If sdNVP were replaced by more effective regimens, with 2009 (56%) uptake, estimated MTCT risk would be 14.4% (Option A) or 13.4% (Option B). Even with 95% uptake of Option A or B, projected transmission risks (6.1%–7.7%) would exceed the WHO goal of less than 5%. Only if the lowest published transmission risks were used for each drug regimen, or breastfeeding duration were shortened, would MTCT risks at 95% uptake fall below 5%.

Conclusions

Implementation of the WHO PMTCT guidelines must be accompanied by efforts to improve access to PMTCT services, retain women in care, and support medication adherence throughout pregnancy and breastfeeding, to approach the “virtual elimination” of pediatric HIV in Zimbabwe.

Read the rest of the study here.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Pleasure Matters for Females Too!

via 50.50, by Tsitsi B. Masvawure

"Female students placed a premium on the pursuit of pleasurable sex in and of itself. This was especially evident in the manner that they spoke about their sexual experiences. One student made it clear that she, and not her boyfriend, had initiated many of their sexual encounters, while another student matter-of-factly explained that condoms interfered with her full enjoyment of the sexual act: ‘Condoms are too clinical! I know that there isn’t much of a difference between sex with a condom and without, but I like to know that it’s just me to him, not me to him through some plastic!’" 

"The absence of recent research on ‘the joys of sex’ - with the exception of Sylvia Tamale's African Sexualities Reader  - reflects societies’ general discomfiture with young women’s sexual desire and sexual freedom more than it does the actual absence of the phenomena. Indeed the observation by sexologists Gagnon and Simon that ‘the idea of female sexual freedom is intolerable in most societies’  holds true today in many parts of the world, including Africa, as it did of nineteenth century America that they were writing about. Therefore, as we work towards making this years World AIDS Day theme of ‘Getting to Zero’ a reality, HIV interventions will need to be bolder and seriously take into account young African women’s actual sexual experiences and their lived sexual realities, however unsettling these may be for us in the HIV prevention community."

During fieldwork for my doctoral thesis in anthropology in 2007 I recall a female student at a university in Zimbabwe’s capital Harare saying to me, ‘Girls should stop acting as if they don’t like sex…from what I have seen from girls here on campus, they look forward to that [sic] more than guys do’. This statement caught me off-guard, not only because of the contempt with which it was uttered, but also because it was made by a young, unmarried African woman, in the presence of her best friend (another young unmarried woman) and was addressed to me, a virtual stranger. This was my second meeting with the two female students and already, both had stunned me with their frankness around sexual issues and especially around their own sexual experiences. In earlier discussions the two students had been quite vocal on the issue of sex and, in response to a question I had asked, one of them had declared that she never had reason to turn down her boyfriend’s sexual advances: ‘If he asks for sex, I give him. Why not? It’s not like girls don’t enjoy sex. They do!’ 

I was conducting ethnographic research on the relationship between ‘campus sexual cultures’ and female and male students’ HIV risk-taking behaviour and I found this openness by young Zimbabwean women both intriguing and refreshing. It is rare to read about young, heterosexual African women’s positive and pleasurable pre-marital sexual experiences. Often, the policy and academic literature portrays African women in one of two ways: as sexually passive and unwilling participants in the sexual act, or as sexually ‘immoral’ and ‘loose’ if they show any interest in sex at all. Neither of these portrayals fully capture the totality of young, unmarried African women’s lived realities. The views and experiences of the young women I encountered during fieldwork challenge these stereotypical portrayals, and suggest that in reality sex is not always something that is ‘done’ to young women. Neither are young women always passive and reluctant participants in sexual encounters. Feminist scholar Carole Vance, who championed a mini-revolution around women’s sexual pleasure in the US in the late eighties, poignantly observed that ‘danger and pleasure are ever-present realities in many women’s lives’. She further argued that focusing wholly on pleasure or danger oversimplifies women’s actual sexual experiences, which, in reality, are more complicated and unsettling. Dichotomies, as we very well know, are problematic in that one can only ever be one or the other— never both, and certainly never something else entirely.

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

MTN Statement on Decision to Discontinue Use of Oral Tenofovir Tablets in VOICE, a Major HIV Prevention Study in Women

via Microbicide Trials Network

VOICE, an HIV prevention trial evaluating two antiretroviral (ARV)-based approaches for preventing the sexual transmission of HIV in women – daily use of one of two different ARV tablets or of a vaginal gel – will be dropping one of the oral tablets from the study. The decision to discontinue use of tenofovir tablets in VOICE comes after a routine review of study data concluded that the trial will not be able to demonstrate that tenofovir tablets are effective in preventing HIV in the women enrolled in the trial. VOICE will continue to test the safety and effectiveness of the other oral tablet, Truvada®, a combination of tenofovir and emtricitabine, and of the vaginal gel formulation of tenofovir.

Importantly, the review, which was conducted by the National Institute of Allergy and Infectious Diseases (NIAID)’s independent Prevention Trials Data and Safety Monitoring Board (DSMB), identified no safety concerns with any of the products being studied in VOICE.

VOICE – Vaginal and Oral Interventions to Control the Epidemic – involves 5,029 women at 15 trial sites in Uganda, South Africa and Zimbabwe. The trial is being conducted by the Microbicide Trials Network (MTN), an HIV/AIDS clinical trials network funded by the National Institute for Allergy and Infectious Diseases with co-funding from the Eunice Kennedy Shriver Institute for Child Health and Human Development and the National Institute of Mental Health, all components of the U.S. National Institutes of Health.

The study was designed with five study groups: tenofovir gel, an inactive placebo gel, oral tenofovir, oral Truvada and an inactive placebo tablet. The women in each group (about 1,000) are asked to take their assigned study product daily. VOICE is the only trial evaluating the daily use of an ARV tablet – an approach called oral pre-exposure prophylaxis, or PrEP – and a vaginal gel in the same study. This design is important for determining how each product works compared to its control (placebo gel or placebo tablet) and which approach women prefer.

On September 16, 2011, the NIAID Prevention Trials DSMB reviewed VOICE study data for the period between Sept. 9, 2009, when the study began, and July 1, 2011. Based on this interim review, the DSMB determined that it was not possible to show whether oral tenofovir tablets were any better than a placebo for preventing HIV in the women assigned to that study group. The DSMB therefore recommended that the women randomized to the oral tenofovir tablet group discontinue their use of the study product. This recommendation does not apply to the women in the groups using either the tenofovir gel or oral Truvada tablets, or the corresponding placebos; the DSMB recommended that these four study groups continue in VOICE.

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Disappointing results from two peer education projects in southern Africa

via aidsmap, by Roger Pebody

Two large HIV prevention programmes that recruited people to educate their friends and classmates have both failed to make an impact on sexual behaviour, researchers report in two separate articles published online ahead of print in AIDS and Behavior.

A peer education programme for 15 and 16 year old school students in South Africa did not have any effect on students’ age of sexual debut or their use of condoms. In Zimbabwe, a programme which trained male customers of beer halls to act as peer educators with their friends did not have an effect on how often men used condoms or how many sexual partners they had.

Whereas there are signs that there were problems with the implementation of the schools programme, the beer hall intervention appears to have been well-delivered. Nonetheless the programme seems to have been unable to make an impact in a context of deep-rooted social problems and tensions.

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

The Great Paradox of the HIV Epidemic

Mark Chataway is co-chairman of Baird’s CMC, a Mapping Pathways partner organisation. Here, he discusses the HIV landscape in Botswana and Zimbabwe.

"Every now and then, it strikes me that despite all our progress in the field of HIV, there is still so much for us to find out. This seems most apparent when I consider the HIV situation in two African countries: Botswana and Zimbabwe.

In 2001, Botswana’s then-president, Festus Mogae, said, “We are threatened with extinction. People are dying in chillingly high numbers. It is a crisis of the first magnitude.” The government acknowledged that tackling the epidemic was a matter of national importance, and it acted accordingly – Botswana became the first African country to declare its objective of providing ARV drugs to all its needy citizens. As in so many other fields, Botswana was to become a model for the rest of the world. (Having worked for the Government of Botswana as a consultant, I often wish that we, in the UK, were governed with equivalent honesty, efficiency and vision.)

Botswana has two significant HIV/AIDS-related initiatives with international partners: ACHAP (African Comprehensive HIV/AIDS Partnerships) and BOTUSA. Its own funding for HIV programmes has increased steadily. Botswana has achieved universal treatment access (that means at least 80% of Batswana who need HIV treatment are receiving it). Almost every major political and religious leader has addressed AIDS openly and often. There are enormous, well-financed programmes focussed on behaviour change and risk reduction. Yet, HIV prevalence is not falling nearly as fast as many think it should have done (click here for prevalence details).

On the other hand, there is the puzzling case of Zimbabwe, where HIV prevalence has fallen dramatically over the last decade or so – it peaked at 26.5% in 1997 and, according to government figures, fell to 14.3% in 2010. While this is an excellent development, it is also rather inexplicable. Access to treatment is very limited. A long-serving health minister was accused of sexually molesting adolescents (although he vehemently denied it) and other political leaders have addressed AIDS only sporadically. Sustained persecution of men who have sex with men has driven the gay community underground. Many of the urban poor have been driven from their homes and forced to live as refugees in rural areas. According to everything we know, Zimbabwe’s political upheaval, economic distress, and the collapse of many primary healthcare services should have exacerbated the epidemic. While some researchers claim the declining prevalence is a result of successful public-awareness and behaviour-change programmes, there are many troubling doubts in the international public health community about whether those factors really constitute an adequate explanation. The real explanation is probably complicated and involves the rising mortality from other causes, the inability of people to travel and the disappearance of much of the middle class.

The difference between these two countries brings into sharp relief the great paradox of the HIV epidemic – we just do not know why the epidemic seems intractable in some places but declines rapidly in others (or fails ever to take hold). There is no model that explains Botswana and Zimbabwe. There are similar paradoxes all over the world: for example, in India, Tamil Nadu has more AIDS cases than any other state, but it has an excellent healthcare system, relatively good status for women and very high levels of literacy and health literacy. Bihar is almost the opposite on every count but has very low HIV prevalence.

For me, it highlights how, even after living with HIV/AIDS for nearly three decades, the world still has so much to learn about the dynamics of HIV and how it functions in various scenarios. The need of the hour is well controlled, randomised clinical trials and policy analysis. We can then create more effective programmes based on good science."

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]