By Scott Barnhart
The world is too complicated for disease-specific approaches to health, as the ravages of Ebola in weak health systems have shown. A health-system strengthening approach will ensure that, especially in times of austerity, there are local institutions and infrastructure in place to provide care for all.
|The President’s Emergency Plan for AIDS Relief (PEPFAR) 3.0 has embarked on an important refocusing to achieve epidemic control through 90-90-90 (90% of HIV-positive individuals knowing their status, 90% of those receiving antiretroviral therapy, and 90% of those achieving viral suppression).1 and 2 Despite good intentions, the implementation is creating health-system disruption. For example, in Zimbabwe, a voluntary medical male circumcision programme will now serve ten instead of 21 districts. Ambassador Birx, referring to these programme cuts as “efficiencies”, touted that funds will be freed up “for the greatest impact.3” Although this might optimise impact in areas of the highest HIV/AIDS burden, medical sites are being triaged, with patients losing services and investments being wasted. Concentration on fewer districts also leads to poaching of health workers from already understaffed sites elsewhere.|
On International Women’s Day, 8 March, we mark progress in the fight for gender equality, and we face a reality that is still starkly unjust. Today, 62 million girls are still denied the right to education, half a billion women cannot read and 155 countries still have laws that discriminate against women.
That is unacceptable, and we must work together to change it. In a report entitled “Poverty is Sexist,” published by ONE, leaders in global development call on the world to act on gender inequality and create more opportunity for women.
Gender inequality often leaves women and girls prone to diseases and other life-threatening conditions. Adolescent girls and young women are disproportionately affected by HIV. Currently, more than 7,000 young women and girls are getting infected with HIV every week.
We must address social factors that put adolescent girls and young women at increased risk for infectious diseases, and provide them with more opportunities in life. Education can make a transformative difference, and keeping girls in school can create a solid foundation for better choices on building a career, owning property, and deciding whether and when to marry and have children. We must strive for a world where human beings, no matter their gender, can live a successful and healthy life.
By Carole Leach-Lemens
Engaging lay counsellors to provide a combination package of evidence-based interventions in Nyanza, Kenya and addressing partner disclosure, as well as pre-treatment education about the benefits of antiretroviral therapy (ART) for maternal and child health in Malawi’s Option B+ programme, improved retention in care and reduced loss to follow-up of mothers with HIV and their infants, studies presented last week at the Conference on Retroviruses and Opportunistic Infections (CROI 2016) in Boston show.
Poor retention in care of mothers with HIV and their infants across the prevention of mother-to-child transmission (PMTCT)/paediatric care continuum continues to undermine what is otherwise a remarkable success. If retention is not adequately addressed, programme success and maternal and infant health are threatened. In resource-poor settings, studies have shown 17% of pregnant women with HIV initiated on ART do not return after their first antenatal care visit; one third of women with HIV who give birth in a clinic are lost to follow-up three months after delivery.
By Bob Roehr
01 March 2016
A new understanding of the role gut microbiota plays in HIV disease is beginning to emerge, suggesting potential new strategies to manage the infection
HIV is a disease of the gut, a concept that’s easy to lose sight of with all the attention paid to sexual transmission and blood measurements of the virus and the CD4+ T cells it infects and kills. But the bottom line is that about two thirds of all T cells reside in the lymphoid tissue of the gut, where the virus spreads after exposure, even before it shows up in blood. Blood, however, has been the focus of research and care because it is easy to sample and broadly represents what is going on throughout the entire body.
The gut is a lot harder to access, which is why much of it remains a crudely delineated terrain that can only be examined with blunt and invasive tools. But a better understanding of the gut environment will be necessary to achieve the next level of advances in comprehending the disease and fashioning better interventions, researchers said last Wednesday at the annual Conference on Retroviruses and Opportunistic Infections in Boston. “Why do we care about the microbiome?” asked Nichole Klatt, a University of Washington (U.W.) pathobiologist, whose lab focuses on mucosal immunology. Klatt, who organized and chaired the conference session, answered her own rhetorical question, summarizing that HIV infection decreases the number and diversity of beneficial bacteria and increases those that have negative effects on the gut.
By Kathryn Doyle
28 January 2016
Healthcare providers need to understand that for HIV-positive African women, following advice not to breastfeed in order to protect their babies from the virus takes a high emotional toll, a U.K. study suggests. “Firstly, we need to understand that avoiding breastfeeding may carry significant emotional, social and financial cost to women,” lead author Dr. Shema Tariq of University College London told Reuters Health. “It is important to build a safe and non-judgmental space where expectant mothers can openly discuss their concerns.”
The risks and benefits of breastfeeding while HIV-positive depend on the setting, Tariq and her colleagues write in the journal Sexually Transmitted Infections. In high-income settings like the U.K., there is little risk of malnutrition or diarrheal illness for babies raised without the protective factors in breast milk, so women are advised not to breastfeed, which carries some risk of transmitting the virus. But in low-income settings, like some areas of Africa, infant death due to malnutrition or diarrhea is much more common, so HIV-positive women are advised to exclusively breastfeed for six months and to be on antiretroviral therapy (ART).