Increasing the uptake of HIV testing among black Africans in England
2 Public health need and practice
In mid 2008, an estimated 33 million people worldwide were living with HIV – around 2.7 million were newly infected. The previous year, 2 million people died from AIDS-related illnesses (UNAIDS 2009).
HIV among black Africans
Black Africans living in England are disproportionately affected by HIV. A third of new HIV diagnoses in the UK are among this group, which makes up only approximately 1% of the UK population. For example, during 2009 there were 2206 new diagnoses of HIV infection among black Africans, representing 33% of all new diagnoses in the UK (Health Protection Agency 2010a).
It is estimated that a total 4% of black Africans living in England have been diagnosed with HIV, compared with 0.1% of the white population (Health Protection Agency: personal communication 2010).
Of the 23,288 black African people who received care for HIV in the UK in 2009, 91.3% reported having acquired the infection through heterosexual intercourse (Health Protection Agency 2010b). Most black Africans (80%) who were newly diagnosed in that year acquired their infection heterosexually in Africa (Health Protection Agency: personal communication 2010).
Late diagnosis, that is, after antiretroviral treatment should have begun, or when the person already has an AIDS-defining illness, is one of the most important factors associated with HIV-related disease and death in the UK. It is a particular problem among black Africans (Burns et al. 2001). In 2007, more than 40% of new diagnoses among black Africans were classified as late (Health Protection Agency 2008a). In addition, approximately 30% of HIV-positive sub-Saharan Africans are estimated to leave genitourinary clinics without a diagnosis (Health Protection Agency 2008b).
Lack of a diagnosis – or late diagnosis – can deprive people (including the partners of those infected) of treatment and support. It can also increase the potential for onward transmission of HIV. There might be several reasons for late diagnosis, including fear of the stigma surrounding HIV/AIDS, and general misinformation about the infection and lack of perceived individual risk (Sigma Research 2008; Burns et al. 2007).
Sexual behaviour
More than 75% of African people living in England who responded to a community-based survey reported having been sexually active in the previous year (Sigma Research 2009).
Of the 2580 respondents, 10% reported 'definitely' or 'probably' having had serodiscordant, unprotected intercourse. Serodiscordant unprotected intercourse (that is, one HIV-positive and one HIV-negative person having unprotected anal or vaginal sex) is the main risk for HIV transmission.
More than half of respondents had a regular sexual partner, but 25% of this group also had sex with someone else during the past year.
Twenty five per cent of all those who said they had had sex said they did not use a condom. Among those who had used condoms in the past year, one third reported that on at least one occasion the condom broke or came off (Sigma Research 2008).
The role of testing and treatment in prevention
HIV testing and treatment can help reduce transmission of the virus. People who find out they have HIV may change their sexual behaviour as a result. For example, they may start using condoms with partners who are not HIV-positive or whose HIV status is unknown (Coates et al. 2000; Marks et al. 2005; Weinhardt et al 1999). In addition, they may choose to receive antiretroviral therapy, which suppresses the virus and can reduce further transmission.
Regardless of the result, testing also provides an opportunity to address any unmet HIV prevention needs that people may have. For example, their understanding and awareness of HIV risk, their empowerment and negotiation skills, or access to condoms (National African HIV Prevention Programme, 2008).
Increasing the frequency of testing may result in earlier detection of HIV, thereby providing greater opportunity to reduce transmission.
The introduction of antiretroviral therapies in the mid 1990s made HIV a manageable medical condition and meant that people could have a healthier and longer life on treatment. As a result, perceptions among experts and professionals of the importance of HIV testing changed substantially, with the benefits of having a diagnosis outweighing the risks.
It is estimated that someone aged 35 who is living with HIV in a developed country is likely to live for a further 37 years with treatment. On that basis, it is estimated that it would cost an average £5485 a year to treat them in the UK. At 2009 prices, this amounts to between £200,000 and £360,000 over their lifetime (Devine A: personal communication 2010).
Testing policy
In 2001, the government's Strategy for HIV and Sexual Health (DH 2001) set a 10-year target to reduce the levels of undiagnosed HIV infection. However in 2004, a report found a significant number of missed opportunities for earlier diagnosis of HIV infection. As a result, a high proportion of patients (17%) who had symptoms and sought medical care in the preceding 12 months remained undiagnosed (Sullivan et al. 2005).
In 2008, the government strategy was reviewed (Medical Foundation for Aids and Sexual Health 2008). Audits of late presentation and death undertaken by specialist providers of HIV services prompted the development of a set of guidelines on how to increase HIV testing. These were developed by the British HIV Association, the British Association for Sexual Health and HIV and the British Infection Society (British HIV Association et al. 2008).
The Health Protection Agency has recommended that initiatives to expand HIV testing in clinical and community settings should be promoted to reduce late diagnosis and undiagnosed HIV infections (Health Protection Agency 2009b). It has also highlighted the need to reinforce prevention messages and promote regular HIV testing within black African communities.
The US Centers for Disease Control and Prevention (Branson et al. 2006) and the World Health Organisation (World Health Organization 2007) have recommended more widespread HIV testing. In the US this includes the introduction of opt-out testing systems in some healthcare settings. (This involves notifying the patient that an HIV test will be performed unless the patient declines.)
HIV strategies aimed specifically at African communities include:
· The 'HIV and AIDS in African communities framework for prevention and care' (DH 2005).
· The National African HIV prevention programme (National African HIV Prevention Programme et al. 2008).
Provision of Antiretroviral Therapy for HIV-Positive TB Patients — 19 Countries, Sub-Saharan Africa, 2009–2013
Weekly
November 28, 2014 / 63(47);1104-1107
E. Kainne Dokubo, MD1, Annabel Baddeley, MPH2, Ishani Pathmanathan, MD1, William Coggin, MSA3, Jacqueline Firth, MD4, Haileyesus Getahun, MD, PhD2, Jonathan Kaplan, MD1, Anand Date, MD1 (Author affiliations at end of text)
Considerable progress has been made in the provision of life-saving antiretroviral therapy (ART) for persons with human immunodeficiency virus (HIV) infection worldwide, resulting in an overall decrease in HIV incidence and acquired immunodeficiency syndrome (AIDS)–related mortality (1). In the strategic scale-up of HIV care and treatment programs, persons with HIV and tuberculosis (TB) are a priority population for receiving ART. TB is the leading cause of death among persons living with HIV in sub-Saharan Africa and remains a potential risk to the estimated 35 million persons living with HIV globally (1). Of the 9 million new cases of TB disease globally in 2013, an estimated 1.1 million (13%) were among persons living with HIV; of the 1.5 million deaths attributed to TB in 2013, a total of 360,000 (24%) were among persons living with HIV (2). ART reduces the incidence of HIV-associated TB disease, and early initiation of ART after the start of TB treatment reduces progression of HIV infection and death among HIV-positive TB patients (3–5). To assess the progress in scaling up ART provision among HIV-positive TB patients in 19 countries in sub-Saharan Africa with high TB and HIV burdens, TB and HIV data collected by the World Health Organization (WHO) were reviewed. The results found that the percentage of HIV-positive TB patients receiving ART increased from 37% in 2010 to 69% in 2013. However, many TB cases among persons who are HIV-positive go unreported (2), and only 38% of the estimated number of HIV-positive new TB patients received ART in 2013. Although progress has been made, the combination of TB and HIV continues to pose a threat to global health, particularly in sub-Saharan Africa.
Worldwide, approximately one third of persons are infected with TB. In most persons the infection is latent; however, TB can become active, infectious TB disease. HIV infection is one of the strongest risk factors for developing TB disease. To decrease the global burden of TB and HIV, WHO recommends implementation and scale-up of collaborative TB/HIV activities, including intensified TB case-finding among persons living with HIV, provider-initiated HIV testing and counseling among TB patients, and provision of ART for all HIV-positive TB patients, regardless of CD4 count. Current guidelines recommend starting TB treatment first for persons living with HIV not receiving ART at the time of TB diagnosis, then initiating ART as soon as possible within 8 weeks of TB treatment. HIV-positive TB patients with profound immunosuppression (CD4 <50 cells/µL) should initiate ART within 2 weeks of starting TB treatment (6). The recommendation for universal access to ART for HIV-positive TB patients is in line with the Joint United Nations Programme on HIV/AIDS goal to have 90% of all persons with diagnosed HIV infection on ART by 2020 (7).
How are global HIV/AIDS trends affecting US-African aid policies?
Elsewhere on Medical News Today, we report on the claim from advocacy group ONE that the AIDSpandemic is at the "beginning of the end." ONE say that, in 2013 - for the first time in 30 years - the world has reached a tipping point in the AIDS pandemic, where more people are being treated for AIDS than are becoming newly infected.
However, the campaign group also say there is an annual shortfall of $3 billion a year needed to control the disease. The majority of funds come from just three countries - the US, the UK and France - and ONE's report says that many African countries are reneging on their health spending promises.
A United Nations (UN) report, also released to coincide with World AIDS Day, warns that while deaths from AIDS have decreased by 35% over the past 10 years - and new infection rates have dropped 38% since 2001 - an estimated 35 million people globally are living with HIV, of which 19 million are probably unaware they have the virus.
HIV/Aids cannot be beaten without water
Twenty-six years after the first World Aids Day was declared, on 1 December 1988, the HIV epidemic is still with us. It claims 1.5 million lives each year, 70% of them in sub-Saharan Africa.
There has been progress. Many more people are living longer with HIV, thanks to more advanced drugs and efforts to make them available. Work on prevention, including mother-to-child transmission, has slowed new infections.
But there is one crucial element missing from life in sub-Saharan Africa that disproportionally affects the health and wellbeing of the 25 million people there living with HIV. That element is water. Clean water is critical to keeping them healthy, for taking antiretroviral drugs and for good hygiene to minimise infections – ideally, as much as 100 litres a day. Yet 35% of people in sub-Saharan Africa are without access to clean water and 70% are without basic sanitation, leaving many people living with HIV suffering from chronic diarrhoea and unable to care for themselves or their families.
No one can lead a healthy, productive and dignified life if they do not have access to safe drinking water, a safe and private place to relieve themselves, and the ability to keep their bodies and surroundings clean. Doctors and nurses cannot properly contain infections if hospitals and clinics do not have clean running water, functioning toilets and good hygiene practices.
HIV second highest killer of South African youth: stats office
(Reuters) - HIV was the third leading cause of natural deaths in South Africa in 2013, up three places from the previous year, and the second highest killer of young people, a survey by the national statistics agency showed on Tuesday.
The AIDS pandemic has created gaps in the lives of grandmothers and grandchildren that will never be closed. In addition to the horrific loss of life which can never be reversed, the pandemic has destroyed traditional family structures for a whole generation in sub-Saharan Africa. Fifteen million children orphaned by AIDS have lost their mothers and fathers, their sense of family, and their place in the community. The pain is also felt by the grandparents who have lost their sons and daughters, often after caring for them during their sickness. In addition to their emotional loss, the loss of financial support for both children and grandparents means a lack of food, of medicine, and of housing for the most vulnerable. The gap is formidable.
However, the grandmothers in Africa have responded to the crisis with courage, resilience and love. They are creating new families with their own grandchildren and often also with children of relatives and neighbours. Although these "skipped generation households" are more likely to fall within the highest poverty range, grandmothers have been amazingly resourceful in rearing these children. According to the Overseas Development Institute "children living with grandparents are more likely to be looked after lovingly and treated fairly, compared to those living with other extended family members" (2009).
Africa Analysis: Getting combination tools to fight HIV
Regulatory challenges could delay new, game-changing tools for fighting HIV/AIDS in women, writes Linda Nordling.
One of the most challenging aspects of fighting Sub-Saharan Africa's devastating HIV epidemic has been finding ways for women — who are most at risk of catching the virus — to protect themselves.
Traditional prevention methods such as condoms or faithfulness to one partner are often outside women's control. Sex workers, who have a very high risk of HIV infection, usually get paid more for sex without condoms. As for faithfulness, there is little a woman can do to stop her partner from cheating.
Recent years have seen advances in the development of biomedical HIV prevention technologies. By combining these technologies with contraceptive tools, scientists are now working on multipurpose prevention tools that could make a big difference to African women facing HIV risk.
One of the most challenging aspects of fighting Sub-Saharan Africa's devastating HIV epidemic has been finding ways for women — who are most at risk of catching the virus — to protect themselves.
Traditional prevention methods such as condoms or faithfulness to one partner are often outside women's control. Sex workers, who have a very high risk of HIV infection, usually get paid more for sex without condoms. As for faithfulness, there is little a woman can do to stop her partner from cheating.
Recent years have seen advances in the development of biomedical HIV prevention technologies. By combining these technologies with contraceptive tools, scientists are now working on multipurpose prevention tools that could make a big difference to African women facing HIV risk.
Europe and Africa double research efforts to tackle AIDS, Ebola and other infectious diseases
02 December 2014
Cape Town, South Africa
The EU and Africa are today doubling the research efforts to develop new and better medicines for poverty-related diseases affecting sub-Saharan Africa such as AIDS, tuberculosis, malaria, hookworms and Ebola.
Building on the success of the first programme, the second European and Developing Countries Clinical Trials Partnership programme(EDCTP2) will work with a budget of €2 billion over the next ten years to fight infectious diseases in developing countries. For this, the EU will contribute €683 million from Horizon 2020, the EU's research and innovation programme, and around €1.5 billion will come from European countries. EDCTP2 heralds a new era of cooperation between Europe and Africa in medical research with countries from both continents working as equal partners.
Carlos Moedas, European Commissioner for Research, Science and Innovation, said: "Infectious diseases like AIDS, Ebola or malaria are a major global threat, but they hit poor communities hardest. The latest Ebola outbreak reminds us that more research is needed to find new medicines and vaccines that will help save millions of lives. Today, Europe and Africa are stepping up their efforts to fight the spread of infectious diseases together. With the investment of EUR 700 million from Horizon 2020, the EU will boost research efforts to prevent new epidemics in the future."
Ambassadors urge increased investment in health to end AIDS by 2030 in Africa
Addis Ababa, 27 November 2014- Ahead of the continental World AIDS Day commemorations on 1 December 2014 Ambassadors based in Addis Ababa met to discuss the key priorities for Ending AIDS by 2030.The African Union Commission has already started the process of consultations on the future of the AIDS epidemic that include post 2015 development negotiations, meeting with technical experts in Member States and theevaluation of health policy frameworks that will expire in 2015.These consultations will inform the development of a new continental strategy for ending AIDS, TB and Malaria by 2030.
"Addressing AIDS is a key priority under our African Common African Position on the Post 2015 Development Agenda" said H.E Erastus Mwencha, the Deputy Chairperson of the African Union Commission, "To end AIDS by 2030 the African Union Member States will need to invest more domestic resources to ensure sustainability of the responses" he added.
The fundamental pillars of the African Common Position on the 2015 Development Agenda including AIDS, TB and Malaria were all taken into consideration in the report to the Secretary General of the United Nations on the Post 2015 development agenda. All the pillars directly impact on Africa's ability to address health and development challenges.
"In order to sustain the results in responding to the AIDS epidemic there is need to ensure that there is increased domestic financing for health and increased accountability for resources available" said Ambassador Hamadi Meimou on behalf ofPresident of the Islamic Republic of Mauritania, Chairperson of the African Union and AIDS Watch Africa, H.E. President Mohamed Ould Abdel-Aziz.
Toward a global partnership for an AIDS-free generation
Over 30 years into the HIV and AIDS epidemic, the need to work together to solve the sometimes monumental challenges the disease presents is without question. The Elizabeth Glaser Pediatric AIDS Foundation has witnessed first-hand the exponential impact of bringing together the resources, experience, ideas, and capacity of many to build a multi-national, multi-sectoral global HIV and AIDS response.
The global health community must continue to forge dynamic partnerships of every shape and size, between nongovernmental organizations, the private and public sector, country governments, and international bodies to address the myriad obstacles and barriers that lay ahead of us on the road to the end of AIDS — particularly when it comes to ending AIDS in children.
During our 25-year history, EGPAF has been committed to working together with a host of public and private sector partners to realize the best outcomes for children, families, and communities affected by HIV and AIDS. Truthfully, EGPAF would not be the global organization it is today, working in 15 countries around the world to end AIDS in children, without our partners. We suspect that many of our partners might say the same about us.
One of the most valuable outcomes of any partnership is that it often yields new ideas and innovation. And now, as the global community sets ambitious new goals to end AIDS in children around the world, we need innovation more than ever.
It is now widely recognized that children have been left behind in the global progress towards access to safe and effective HIV treatment. Of the 3.2 million children currently living with HIV, only one quarter have access to lifesaving antiretroviral therapy. And often the medications they do have aren't conducive to ensuring long-term adherence. They can be bitter, hard to swallow, and sometimes the side effects including nausea are worse than the symptoms of HIV. This is unacceptable if we are going to meet our goal of an AIDS-free future.
However, in 2014 there have been encouraging signs that international momentum and resources are finally being marshaled to change this.
16 Days of Activism: End Violence Against Women Living with HIV/AIDS
"We are told that it is not good to get pregnant when you are HIV positive, so when we get pregnant, we abort, we fear…and many have died, even a few weeks ago a woman died after abortion" (Woman living with HIV, Busia Uganda).
Violence against women living with HIV is on the rise. Since ICWEA started implementing the Sexual and Reproductive Health & Rights (SRHR) programme in 2010, reports from members indicate increased cases of violence against women living with HIV because of their HIV status.
Activists have paid a lot of attention to violence against women and girls but there has been little emphasis on the intersection between HIV&AIDS and violence against women. Women living with HIV have been killed, tortured and denied access to public services as a result of their HIV status. In Sub Saharan Africa, women living with HIV have reported violence from healthcare workers ranging from abuse, denial of services, coerced and forced sterilisation and forced abortion.
Services are not only inefficient but also not appropriate especially for women living with HIV. For example, when a woman is raped, in most cases she is treated as just a rape victim and normally not given the much-needed Post Exposure Prophylaxis (PEP); women living with HIV queue in hospitals for long hours. Service providers and employers stigmatize and discriminate against women living with HIV.
It is important to sensitize women about their right to prevention, treatment and where to go to receive HIV and Sexual Reproductive Health and Rights services. There is need to pay specific attention to policies, legislation and role of the state in fueling Violence against Women. In Uganda for example the recently enacted laws like the HIV Prevention and AIDS Control ACT 2014, the anti-pornography ACT and the Public Order Management ACT will definitely lead to increased violence against women as has already been witnessed.
World Aids Day 2014: Zero stigma, zero discrimination
On today's World Aids Day 2014, the South African National Aids Council (Sanac) has called on all the people of the country to join its campaign for the next 12 months: Zero Stigma, Zero Discrimination.
World Aids Day, commemorated on 1 December every year, gives all communities the opportunity to unite in the fight against HIV, show support for people living with HIV and remember those who have died.
· Download Sanac's World Aids Day 2014 toolkit
The UNAids Words Aids Day theme for the period 2011 until 2015 is "Getting to Zero". This year South Africa will focus on zero discrimination, while not losing sight of the other zeros: zero new HIV infections, and zero Aids-related deaths.
The aim of this campaign is to ensure that the rights of people living with HIV and Aids are not violated, and that discrimination on the basis of HIV, Aids and TB is not only reduced, but eliminated.
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Posted by: Tim Mugane <timmugane@yahoo.com>
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