Estimating needs for HIV services: current shortfalls and future forecasts

Background: Knowledge about HIV/AIDS and importance of knowing ones status has increased even among rural dwellers in the northern Nigeria. However, access to laboratory test, ART and drugs for opportunistic infections remains a major challenge for the people.
Methodology: In 2008, USAID through Management Sciences for Health (MSH) supported HIV/AIDS programs in five local communities. MSH provided mobile HTC and referred positive clients to the nearest hospital. Most of them did not visit hospital for further tests and ART commencement. They complained of transport fair which was about #1,000 ($7)-85km. Advocacy visits were paid to the local authorities.
Findings: The intervention increased access to lab tests and ART uptake. The support covered January-December 2009 & 2011. The local government supported (35%) 116 patients out of the 332 eligible in 2009 and 72 out of about 220 in 2011 that live on $1 or less daily. In all, the LACA paid about #118,000 ($826) as support for 118 patients during the period. At the end of 2009 and 2011, (86%) and (56%) percent of patients enrolled who secured support were still assessing care.
Recommendations: Community leaders’ inclusion in HIV/AIDS program and referral networking using existing community structures could further reduce stigmatization and loss-to-follow up.

In the early phase of the epidemic, Uganda scored impressive success when the whole nation got together in solidarity to fight the epidemic in its early phase. Here success was realized in bringing down the prevalence rates together with the rate of new infections. However, despite all the funding from AIDS development partners and the interventions, the prevalence of HIV has increased from 6.4% in 2005 to 7.3 % in 2011 questioning the level of implementation of the intervention. From the findings, it was realized that successful prevention of HIV/AIDS involves Voluntary Counselling and Testing as an entry point and the results of the test determines the behaviour of an individual. Prevention of HIV/AIDS should be done by combination prevention where structural behavioural and biomedical interventions are done in combination. If a holistic approach is not employed in regard to the HIV state, the prevalence will in the long run come to alarming levels.

The exact mechanisms of HIV infection on biological fecundity are not fully understood, but epidemiological evidence provides support for the hypothesis that HIV-positive women have lower pregnancy rates, take longer to become pregnant, and experience higher rates of fetal loss. However, these studies often fail to disentangle behavioral and biological responses to HIV acquisition on reproduction. The present study attempts to isolate the biological effects of HIV infection on fecundity by employing a time-to-pregnancy (TTP) study design. Using contraceptive calendar and HIV serostatus information from 9 Demographic and Health Surveys, we use cox proportional hazard models to assess the relative TTP among HIV-negative and HIV-positive women who desire children. Our analysis demonstrates that HIV-positive women who desire a child present with a longer TTP. The findings from this study can inform reproductive and maternal health program strategies for HIV-positive women, which include ensuring future integration of fertility awareness education, and providing subfertility and infertility diagnostic and management services.

Condoms have been proven to be effective in prevention of HIV and STIs. Using data from a bio-behavioural survey (2009-10), we examined the extent of condom breakage and factors associated with the breakage among men who have sex with men (MSM) in three Indian states. We analyzed data for 3,812 MSM identified from cruising sites, selected using time location cluster sampling. Of the total MSM who ever used a condom, 16.8% reported condom breakage in the previous month in the three states: 22.2% in Maharashtra, 13.2% in Andhra Pradesh and 28.3% in Tamil Nadu. Results from the multivariate analysis show that MSM were much more likely to report condom breakage if they were above 25 years of age (AOR: 1.31; C.I-1.10, 1.55), consumed alcohol (AOR: 1.40; C.I-1.12, 1.74) and had any STI (either syphilis/NG/CT-AOR:1.54; C.I-1.08, 2.20). No significant association was observed between condom breakage and exposure to HIV prevention intervention and use of oil/water based lubricants. Condom breakage rate is high among this sample of MSM and younger MSM especially need to be provided targeted information about proper use of condoms and to avoid breakage. Data suggest alcohol use may be related to condom breakage and hence prevention interventions need to address alcohol abuse.

HIV testing is an integral component to HIV prevention strategies and a gateway to treatment and care. Over the past decade, the MEASURE DHS project has noted a substantial increase in HIV testing uptake across sub-Saharan African countries, sometimes by more than ten-fold. Drawing from repeated cross-sectional DHS/AIS data in Cameroon, Congo-Brazzaville, Ethiopia, Ghana, Kenya, Lesotho, Madagascar, Malawi, Mozambique, Nigeria, Rwanda, Senegal, Tanzania, Uganda, and Zimbabwe, this paper analyzes demographic divergence in HIV testing uptake within and across countries, with special attention to HIV positive adults. While testing uptake has increased in all 15 countries with repeated DHS/AIS surveys, gains have been uneven. Using logistic decomposition on pooled cross-national data we differentiate factors associated with being tested that relate to time period of survey and to country-level endowments related to access and outreach from individual socio-demographic characteristics associated with having ever been tested for HIV. Despite dramatic increases in testing uptake, the majority of HIV-positive adults in six countries have no way of knowing their HIV serostatus. Continued expansion of outreach and access to HIV testing will help determine future demand for medical treatment and support for persons living with HIV/AIDS.

Background
The use of home-based peer counselling has widely
resulted in significant increase in the rate of EBF in both developed and developing countries. Unfortunately barriers to implementation of interventions rarely prioritized the needs of HIV positive women
during the design and conduct of the interventions even in countries with high rates of HIV among pregnant women.

Method
We conducted qualitative in-depth interviews between January to August 2012 targeting HIV positive women, peer counsellors and health professionals who were directly involved in the community based intervention conducted by MaiMwana Project in the rural Malawi between 2005 to 2010. A total of 39 respondents were purposively selected and interviewed once using a pre-designed interview guide.

Results
Lack of time because of household chores and farming, poverty, transportation and non-disclosure of HIV status were seen as main barriers to effectively visit and counsel women in their homes. In fact the presence of other family members during the visit and fear of stigma made many HIV positive women not to disclose their HIV status to the counsellors which made it difficult for the counsellors to effectively counsel the woman. The needs of HIV positive women need to be considered when developing these community based interventions.

This paper examines the impact of HIV/AIDS on household income and productivity in Nigeria using North Centre Region (NCR). The HIV/AIDS prevalence rate in the region is the highest among the six regions in the Country and is estimated to be 7.2 percent which is above the National prevalence rate of 4.1 (National Bureau of Statistics, 2010). The focus states in NCZ include: Benue, Niger, Nasarawa and the Federal Capital Territory (FCT). These four states have the highest HIV/AIDS prevalence rate in NCZ as revealed by National Bureau of Statistics (2009).The theory of production was utilized as the theoretical framework for the study and the empirical analysis will be carried out using primary data of 1000 households that have a member(s) suffering from the illness. Both the logistic regressions and Pseudo regression was adopted for the analysis. The preliminary result (pivot study) has shown that HIV/AIDS has adverse impact on household income and productivity in each states and the region as a well. It is recommended that, the government should assist household experiencing the illness through provision of cheap antiretroviral drugs, financial aims and provide jobs to infected economic active persons.

Resource burden to provide necessary care, treatment, support and prevention for HIV is huge on scarce government resources. The current study tries to quantify the resource burden for HIV in India during 2009-2015. The premise being, even after revision of the estimate of PLHA from 5.2 million to 2.5 million in 2006, India still has the third largest share of PLHA in the world. We have used UNAIDS methodology to calculate PLHA, new infection, treatment needs, etc. by Spectrum and Workbook assuming three alternative scenarios which are derived based on treatment and care needs. Components of resource needs that have been considered in this study include prevention among high risk groups, service delivery and health care. The data sources include UNAIDS, Census of India, SRS, NFHS and BSS. Under the three scenarios, PLHA is projected to vary from 2.29-2.73 million in 2015 with an uncertainty bound of 2.24-2.95 million. The number of adults in need of first line ART will range from 0.6 to 1.1 million in 2015. Total resource needs for HIV is projected to be 28 percent of the health budget of Government of India in 2015.

The main objective of this paper is to understand the gender disparity among PLWHA. The specific objectives selected for this study are,
1) To study the living condition of selected PLWHA in India.
2) To explore the gender dynamics on PLWHA in India.
3) To analyse the awareness and attitude of the head of the households where these PLWHA are living, so as to identify challenges these PLWHA had to face as men and women.

National Family Health Survey NFHS-3 (DHS-India) which was conducted in 2005-06 is selected for this study. NFHS-3 is the first national survey in India which included HIV testing. HIV/AIDS testing was conducted for 53,332 women and 46,506 men. HIV/AIDS tests were conducted in almost all the states of India, except one state where the local opposition prevented it .

This paper uses the men and women NFHS-3. First, the persons tested positive for HIV were identified and these PLWHA are analysed according to the objectives of the paper using both the male and female NFHS-3 datasets separately. Secondly, the head of the households where these PLWHA were living are selected separately and their awareness and attitude towards HIV/AIDS are analysed so as to explore the situation these PLWHA are living in. The findings of this paper are based on men and women in the age group 15-49.

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.