Access to and impact of HAART

Using a sample of HIV-positive women (n=353) and men (n=299) from Nigeria and Zambia as well as their health care providers (n=179), we examine attitudes towards childbearing and abortion among HIV-positive women on individual measures as well as an index. Support for HIV-positive women to have a child was greatest if she was nulliparous or if her desire to have a child was not conditioned on parity and lowest if she already has an HIV-positive child. Support for childbearing among the HIV-positive was found to be lower among HIV-positive women than among HIV-positive men, both of which were lower than support from providers. Support for abortion varied more depending on the measure. Half of all respondents indicated no/low support for abortion on the index measure while between 2 to 4 in 10 respondents were supportive of HIV-positive women being able to terminate a pregnancy. The overall low levels of support for abortion for HIV-positive women indicate that HIV does not seem to qualify for most respondents as a medical condition which justifies abortion. While integrating HIV and family planning services remains challenging, increased medical and social education about childbearing while managing HIV may have the potential to reduce stigma and help HIV-positive individuals meet their reproductive goals.

Using hierarchical linear models, we identify both individual and teacher/school level factors that affect voluntary HIV testing among young people attending secondary schools in Kenya. Separate models are built for males and females. Results indicate that young Kenyans, both males and females, are more likely to test for their HIV serostatus when they have specific knowledge related to VCT, are involved in HIV/AIDS activities from primary school, have HIV information available in their respective secondary schools, perceive themselves at high risk of contracting HIV, know whether someone is infected or has died of HIV/AIDS and have ever engaged in sexual intercourse. On the other hand, indicating that they are afraid to go to a VCT centre, and cannot go to a VCT centre because people will think they are HIV positive are barriers to testing among the young secondary school students. Teacher/school level characteristics are relevant in explaining HIV testing, especially among female students. Female students with teachers who incorporate HIV information into their academic curriculum are more likely to test for HIV.

Many countries are contemplating introducing immediate lifelong highly active antiretroviral therapy (HAART) for all women diagnosed with HIV during pregnancy (“Option B+”).

A prospective cohort study was carried out comprising 100 women attending Naivasha Hospital, Kenya, who had been diagnosed with HIV during their current pregnancy. Attrition along the pathway to HAART, and associations with registration at an HIV clinic were assessed. 19 of these women and eight of their health service providers were interviewed to better understand women’s experiences and care-seeking behaviours. 30 HIV testing sessions were observed.

The uptake of services along the pathway to HAART was low. Women who felt that they had enough information to decide whether or not to be tested for HIV were 3.6 times more likely to register at an HIV clinic within three months than women who did felt insufficiently informed in this regard. Most women were unprepared for the test itself and for a positive test result, and described needing time to accept their HIV diagnosis.

To maximize the potential benefits of Option B+, linkage into HAART services following an HIV diagnosis in pregnancy-related services must be improved. A range of innovative approaches to counselling should be introduced and rigorously tested.

In the era of accessibility to HAART, one challenge is growing-up of children born from HIV-positive mother in earlier of HIV epidemic since HIV can positively and negatively effect on their current and future living.

The cross-sectional survey was done by using questionnaire of socio-demography and life events and the PedsQL™4.0 to explore life experiences and well-being among children aged 5-18 years who born from HIV-positive mothers in 2 selected provinces of Thailand. There were 115 HIV-positive children and their caregivers voluntarily participated and completed questionnaires.

Preliminary results showed that two-third of children lose father and/or mother. Stigma & discrimination were occurred outside more than inside of home. Around 60% knew their HIV-status. About 70% had severely illness and nearly 100% received ARV. Besides, children had problems on physical and intellectual developments higher than emotional development. Mean of total score of PedsQL4.0 was 78%. Score of physical health were higher a bit than psychosocial health. The lowest score of psychosocial health was schooling functioning.

The results suggest that to support these HIV-positive children living with well-being, it needs intervention to support them coping with problems concerning school functioning and its related problem.

Adherence to ARV (antiretroviral) is a significant factor that prolong the life expectancy of people living with HIV AIDS (PLHIVs). This research aimed to identify the sociocultural factors that facilitate or inhibit adherence to ARV.
This research is a qualitative research conducted in West Java province (Bandung and Cimahi districts) and Bali province (Denpasar and Badung districts) from September to November 2011. Data collected by doing in depth interview with the staffs of district health office, Local AIDS Commission, district hospitals, NGOs and 17 PLHIVs who ever or still consuming ARV. Data were analyzed descriptively by triangulation and content analysis methods.
It is concluded that the internal supporting factors of adherence to ARV are the motivation to live longer, the eagerness to get cured and to be healthy, considering ARV as vitamin, and the faith in their own religion. Other supporting factors are the social support family, responsibility and affection for their children, willingness to get married, support from peer groups, NGO staffs, and good relationship with health provider staffs. Adherence to ARV should be improved by motivating PLHIVs and including family, peer groups, NGO staff and health provider to be ARV taking watchers, and providing better accessibility and affordability to ARV

Year 2011 witnessed two milestones acknowledging issues of “International-Migrant-PLHIVs” globally, Political Declaration HIV/AIDS which targeta at ‘eliminating HIV-related restriction on entry, stay and residence by 2015’ and US president ‘ending the ban prohibiting PLHIV from entering America.’ India-Nepal and India-Bangladesh are two prominent cross-border migration corridors, prior being open-boarder and later an illegal gateway. This study explores ART related issues of Nepali and Bangladeshi PLHIVs residing in Mumbai. Data is collected through in-depth-interactions and FGDs with PLHIVs during July-August, 2012. Unavailability of entitlements including bank account results in disposable cash migrants usually spend on various risk-behavior. Despite free ART services at India, factors like self-stigma, fear of discrimination at and losing employment, language incompatibility, lack of local identity documents/proof hurdles treatment initiation. Secrecy regarding nationality to avoid being deported restricts the Bangladeshis. Non-Indian status often demands extra effort, time, and additional formalities, sometimes-even money. Unfavorable provider’s attitude, side effects leads to default and non-disclosure to spouse and family and unavailability of ART when visiting native country result even in discontinuation.

Public health policies in Thailand have now addressed the problem of mother-to-child HIV transmission. However, a large number of children who were born with HIV infection are now reaching adolescence, a critical period when their survival is at risk. The 'Teenagers Living with Antiretrovirals' TEEWA survey, undertaken by PHPT-INED interviewed 662 adolescents from 12 to 19 years old who were born with HIV across Thailand. The adolescents were asked about their daily lives and the survey also interviewed their parents or caregivers about their life histories. These children are entering adolescence, often after a traumatic childhood: a family history disrupted by the illness and the subsequent death of one or both parents; a difficult relationship with the grandparents who appear to often be their carers; periods of serious illness; and above all the discovery that they are infected with HIV. In this presentation we will give a first overview of their family situation and living arrangements in order to assess the social and health challenges faced by these teenagers.

HIV/AIDS STATUS IN THIMPHU DZONGKAHG:WOMEN’S
AWARENESS LEVEL

Deki
Senior Lecturer
Departmemt of School of Social Science
Royal Thimphu College, Bhutan
dekitenzin@rtc.bt


ABSTRACT
Thimphu Dzongkhag (District) is the capital city of Bhutan and is the most developed and urbanized region of our country. The Dzongkhag has all the facilities, like education, health and telecommunications. As a result, living standard of the people is high and the incidence of poverty is low as compared to other Dzongkhags. It is a common misconception that the people of Thimphu are aware of HIV/AIDS because of people being more educated and having a higher living standard as compared to other region. But, despite the availabilities of all facilities and being more developed, overall awareness on HIV/AIDS are not so positive. This paper will analyze the secondary data - based on Bhutan Multiple Indicator Survey, 2011, conducted by National Statistical Bureau, Bhutan. The study will focus on finding the relation between education level, wealth index, place of residence, age of women, number of sexual partners, condom use, marital status etc and women’s knowledge on HIV/AIDS and its related issues.

Antiretroviral Therapy (ART) has two well-described beneficial effects. First, it drastically prolongs the life expectancy of those receiving treatment, and second, it reduces HIV transmission to uninfected partners. The expansion of ART programs is thus expected to elevate HIV prevalence rates and reduce HIV incidence at the same time. These expectations are largely confirmed in a pooled dataset of five African demographic surveillance sites with HIV status information. Further, we find that the F/M sex ratio of prevalent infections increases over time and that suggests that ART coverage is better among women than men. This is corroborated by an increasing F/M sex ratio of incidence, suggesting that although the pool of HIV infected women is increased, less are infectious compared to the pool of HIV positive men. Our results thus indicate that higher ART coverage rates benefit HIV positive women (more than men) in term of increased survival, but benefit HIV negative men (more than women) because of a greater reduction in new infections.

Introduction: In Cambodia, the HIV prevalence was 2.4% in 1999 and 1.1% in 2006. Overall access to and uptake of HIV testing and antiretrovirals (ARVs) for prevention of mother-to-child transmission (PMTCT) of HIV was low and limited for most pregnant women (PW) at that time. The Linked Response (LR) was launched to integrate PMTCT into maternal and child health services.
Methods: A descriptive analysis of routine data collected at LR sites, then of PMTCT program data including all antenatal care (ANC)/ PMTCT sites at national level from 2008 to 2011 was conducted.
Results: The number of operational districts (ODs) where LR was implemented increased from 5 to 71 between 2008-2011. The coverage of HIV testing among PW from 62% to 69% from 2009 to 2011.
Countrywide, the proportion of PW who attended ANC increased from 74% to 97% and the coverage of expected PW tested for HIV at ANC augmented from 25% in 2007 to 86% in 2011. In 2011, 62% of eligible PW received ARV prophylaxis. The proportion of exposed infants (EI) who received ARVs augmented from 27% in 2008 to 62% in 2011.
Discussion: The LR increased HIV testing, ARV uptake and follow up among PW and EI.
Conclusion: The LR contributed to the results of PMTCT. The effectiveness of the LR has been used to expand the provision of comprehensive PMTCT services nationwide.