Tag Archives: UNAIDS

Heightened HIV risk for people with disabilities

Inaccessible health services for people with disabilities (PWD), combined with social stigma and violence, contribute to high HIV risk – a gap that must be filled if the disabled are not to remain disproportionately vulnerable to HIV/AIDS, say health experts and activists.
“People with disabilities are at increased risk for exposure to HIV infection. HIV, in some cases in itself, can cause disability,” said Jill Hanass-Hancock, a senior researcher at the Health Economics & HIV/AIDS Research Division (HEARD), a South African research institute.

Globally there are an estimated one billion people living with a mental or physical disability, according to the UN World Health Organization. Many live in low- or middle-income countries and have poorer health and little formal education compared to the general population.

“We cannot talk about reducing HIV and its co-morbidities if you exclude this 15 percent of the world’s population,” added Hanass-Hancock, speaking at the AIDS 2014 Conference, hosted by the International AIDS Society in Melbourne on 20-25 July.

Data are scarce; most national HIV monitoring or surveillance programmes do not specifically track incidence among people with disabilities.

An 2014 meta-analysis of data and data from STD testing by STDAware.com from Sub-Saharan African countries showed that PWD are 1.3 times (1.48 for women) more at risk of contracting HIV than people without disabilities.

The 2014 “Gap Report” published by the Joint UN Programme on HIV/AIDS (UNAIDS) listed PWD as one of the key populations “left behind” in the global HIV response.

The no sex myth

Central to the struggle of PWD to gain inclusion in HIV response is breaking down the assumption that they are not sexually active and therefore do not need HIV services.

A 2014 Human Rights Watch (HRW) report on Zambia documented PWD describing how healthcare workers thought of them as “asexual”.

“People with disabilities are people first. They have the same needs and desires when it comes to relationships and being sexually active,” said Rosangela Berman Bheler, senior adviser at the UN Children’s Fund (UNICEF).

Others caution that PWD are at greater HIV risk due to other factors.

“PWD are four times more vulnerable to sexual abuse and violence. This increases their risk for HIV infection,” said Muriel Mac-Seing, HIV/AIDS protection technical adviser of Handicap International.

According to UNAIDS, “vulnerability, combined with a poor understanding and appreciation of their sexual and reproductive health needs, places people with disabilities at higher risk of HIV infection.” A 2012 article in The Lancet showed that people with mental and intellectual disabilities were at particularly high risk of abuse and violence.

Access barriers

Betty Babirye Kwagala, a medical counsellor for The AIDS Support Organization in Uganda, said the root of the heightened risk for people with disabilities can be seen in basic infrastructure.

“Services are not accessible – literally. Many health facilities do not have ramps or doors wide enough to accommodate people in wheelchairs,” said Kwagala who has had a physical disability since a car accident when she was 19. Five years ago she was diagnosed with HIV.

In her work as a medical counsellor, Kwagala has seen first-hand the lack of information and education materials suited for the needs of PWD, and a parallel lack of knowledge among health workers about how to communicate.

“How can a health worker who does not know how to use sign language communicate with someone who is deaf? They usually use gestures. But you cannot use gestures when prescribing medication,” said Kwagala.

Hanass-Hancock acknowledges bridging communication and understanding between health workers and PWD is critical to increasing the uptake of HIV services. But, she warns, such interventions need to take social conditions into consideration.

“People with disabilities often depend on a care-giver. This has a great impact on getting information privately and confidentially,” said Hanass-Hancock, adding that strategies such as SMS outreach and counselling for hearing impaired people, or easy-to-understand picture books for people with intellectual disabilities need to be developed.

Data gap

HRW’s research in Zambia, where one in 10 people has a disability, recommends a “twin-track approach starting with existing healthcare services more accommodating to PWD by simple things like widening doors”. PWD-specific interventions should be developed as well, they argue, and needs for either approach should be supported by improved data.

“We need to disaggregate the data to break it down by disability because all disabilities are different and will require different interventions. Then we can talk about creating tailor-fit services for them,” said Rashmi Chopra, a researcher on disability rights at HRW.

Lack of information – including about health and HIV – can leave PWD especially vulnerable inhumanitarian emergencies.

The Sphere Standards, which set out best practice in the delivery of humanitarian aid, encourage humanitarian actors to disaggregate data in their assessments, programming, and monitoring and evaluation tools by, among other things, noting if there is a disability involved.

However, Handicap International has critiqued the Sphere recommendation as insufficient to “mainstream a highly heterogeneous group such as [people with disabilities]”, and says recording the type of disability is crucial.

Despite the data gap, campaigners remain hopeful, saying the discussion has advanced from the days when the intersection between HIV and PWD was not even recognized.

“We must not forget that this is a dignity and human rights issue: most countries in the world – including donor countries – have ratified the UN convention on the rights of persons with disabilities (CRPD). It’s time for them to be responsible for their disabled citizens,” said Muriel Mac-Seing, HIV and AIDS protection and technical adviser for Handicap International.

CRPD, which has been ratified by 147 countries, mandates that governments “provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes as provided to other persons, including in the area of sexual and reproductive health and population-based public health programmes.”
[Courtesy IRIN]

Africa: 7 Million on HIV/Aids Antiretroviral Treatment

23 May 2013:

The number of people in Africa receiving antiretroviral treatment increased from less than 1 million to 7.1 million over seven years, according to a United Nations report which documents the progress in the AIDS response in the world’s second largest continent.

“Africa has been relentless in its quest to turn the AIDS epidemic around,” said the Executive Director of the Joint UN Programme on HIV/AIDS (UNAIDS), Michel Sidibé.

Antiretroviral treatment increased from less than 1 million in 2005 to 7.1 million in 2012, with nearly 1 million added in the last year alone. AIDS-related deaths were also reduced by 32 per cent from 2005 to 2011.

The UNAIDS Update on Africa, which was released to coincide with the beginning of the African Union’s (AU) 21st summit in Addis Ababa, which began Sunday and runs through 27 May, attributes this success to strong leadership and shared responsibility in Africa and among the global community. It also urges sustained commitment to ensure Africa achieves zero new HIV infections, zero discrimination and zero AIDS-related deaths.

“As we celebrate 50 years of African unity, let us also celebrate the achievements Africa has made in responding to HIV–and recommit to pushing forward so that future generations can grow up free from AIDS,” Mr. Sidibé said.

The report states that 16 countries–Botswana, Ghana, Gambia, Gabon, Mauritius, Mozambique, Namibia, Rwanda, São Tomé and Principe, Seychelles, Sierra Leone, South Africa, Swaziland, Tanzania, Zambia, and Zimbabwe–now ensure that more than three-quarters of pregnant women living with HIV receive antiretroviral medicine to prevent transmission to their child.

Despite positive trends, Africa continues to be more affected by HIV than any other region of the world, and accounts for 69 per cent of people living with HIV globally. In 2011 there were still 1.8 million new HIV infections across the continent, and 1.2 million people died of AIDS-related illnesses.

In the report, entitled Update, Mr. Sidibé emphasizes that sustained attention to the AIDS response post-2015 will enhance progress on other global health priorities. He also identifies five lessons in the AIDS response that will improve the world’s approach to global health. These are: focusing on people, not diseases; leveraging the strength of culture and communities; building strong, accountable global heath institutions; mobilizing both domestic and international financial commitments; and elevating health as a force for social transformation.

“These strategies have been fundamental to Africa’s success at halting and reversing the AIDS epidemic and will support the next 50 years of better health, across borders and across diseases,” he said.

The report also stresses AU leadership is essential to reverse the epidemic. At this year’s Summit, AIDS Watch Africa, a platform for advocacy and accountability for the responses to AIDS, tuberculosis and malaria founded by African leaders in 2001, will review progress on health governance, financing, and access to quality medicines, among other areas, and measure whether national, regional, continental and global stakeholders have met their commitments.

The AU, UNAIDS and the New Partnership for Africa’s Development (NEPAD) will also launch the first accountability report on the AU-G8 partnership, focusing on progress towards ending AIDS, Tuberculosis and Malaria in Africa.

[Courtesy AllAfrica News]

HIV/AIDS:Mother-to-Child HIV Rates have Fallen 25% Globally

Fewer babies are being born HIV-positive, but treatment for the more than three million children living with HIV remains under-researched and underfunded. As part of efforts to boost access to paediatric HIV treatment, researchers are getting creative, moving to better pills, kid-friendly treatment “sprinkles”, micro-tabs and even medicine-dispensing pacifiers.

Ahead of the International AIDS Conference, Indian generic drug manufacturer Cipla announced that it would partner with the Drugs for Neglected Diseases initiative (DNDi), a not-for-profit research and development organization, to produce an improved first-line antiretroviral (ARV) combination therapy specifically adapted for infants and toddlers living with HIV. The partnership is just one of the developments in paediatric treatment highlighted at the 19th International AIDS Conference in Washington DC.

Mother-to-child HIV transmission rates have fallen by almost 25 percent globally since 2009, according to the latest UNAIDS report. Governments and donors celebrated these gains and pledged to eliminate mother-to-child – or vertical – transmission by 2015.

Former UN Special Envoy for AIDS in Africa, Stephen Lewis, speaking at the conference, criticized the lack of progress in improving treatment options for the 3.4 million children living with HIV.

“You can’t aim for the virtual elimination of paediatric HIV by 2015 at the continued expense of [treatment] scale-up for children living with HIV now, but that’s exactly what appears to be happening,” said Lewis. “[These children] deserve the right to life, they are not expendable causalities because they didn’t fit into prevention of vertical transmission programmes.”

The latest UNAIDS report shows that about 55 percent of adults living with HIV and in need of treatment are receiving ARVs globally, compared to just 25 percent of the children who need them. In some countries, patent laws still restrict access to some existing paediatric fixed-dose ARV combinations.

Paediatrician and researcher Dr Adeodata Kekitinwa, who works at the Mulago Referral Hospital in the Ugandan capital, Kampala, pointed out that HIV treatment for children is historically under-researched and less efficacious than adult formulations, making it harder to suppress HIV viral loads in children and infants compared to adult patients.

Cipla and the Clinical Trials Unit of the UK Medical Research Council have produced several ARV formulations for babies, and recently announced good results from a new granular, or sprinkle, formulation of lopinavir-ritonavir, a combination of ARVs.

In the recently released CHAPAS-2 trial, which compared the sprinkles with the conventional lopinavir-ritonavir syrup, caregivers reported that the sprinkles were easier for babies to swallow and easier for caregivers to transport and store than the syrup formulations.

According to Diana Gibb, a researcher on the study, the CHAPAS-2 trial also collected important data on how caregivers thought the sprinkles should be administered. For instance, many caregivers reported pouring sprinkles into the baby’s mouth and then immediately breastfeeding.

While this data is yet to be analyzed, Gibbs said it was important for drug manufacturers and developers to understand what treatment options worked best for families. Kekitinwa said these considerations might also factor into trial designs, possibly looking at how drugs interact with breast milk.

Cipla’s newly announced proposed four-in-one therapy will also be developed in sprinkle-form and have a child-friendly taste. The company aims to register the drug by 2015.

As more paediatric ARV formulations are developed, drug companies may be able to move beyond syrups and sprinkles to dissolving microfilms or bulk powders that would make it easier for healthcare providers to calculate doses based on children’s rapidly changing body weight.

Bulk powders could also make drugs cheaper, as pharmaceutical companies would not have to alter the manufacturing process to cater for different age and weight groups. Better-tasting drugs could also eventually be administered in pacifier dispensers.

With an urgent need for more paediatric ARV formulations, the UN World Health Organization (WHO) recently formed a technical working group to draw up guidelines on formulation and dosing in an effort to help guide research and development, said Lulu Muhe, who works in WHO’s Department of Child and Adolescent Health and Development.

[Courtesy IRIN News]