Reports

Reports published on HIV/AIDS and TB

Reports published and available for download are listed here in chronological order.  These include:

DOH 2011 HIV Prevalence Report

The HIV epidemic in South Africa has a profound impact on society, the economy, as well as the health sector. It contributes to a decline in life expectancy, increased infant and child mortality and maternal deaths as well as a negative impact on socio-economic development.

In 2010, the South African Government adopted an outcome-based approach to service delivery and performance management, using 12 key outcomes. The public health sector has been mandated to play a pivotal role in leading the country in its efforts to ensure: “A long and healthy life for all South Africans”.  The findings presented in this report contribute directly to the Negotiated Service Delivery Agreement’s (NSDA) objectives of “Increasing Life Expectancy; Decreasing maternal and child mortality;  Combating  HIV, AIDS  and  Tuberculosis”  and  “Strengthening  of  the Health  System Effectiveness”.

Download the report.

South Africa Antenatal Survey  for 2008

South Africa has almost two decades (1990-2008) of good sentinel surveillance data that assists in monitoring the HIV epidemic trends in the 15-49 years old female population. At the end of 2007, the estimated prevalence of HIV in the general adult population was 17.5 %. The Government has responded to the HIV and AIDS epidemic by facilitating a multi-sectoral approach to implement and monitor appropriate treatment, prevention, care and support interventions. The Ministry of Health has played a leading role in these efforts, including the provision of strategic information for monitoring the magnitude of the HIV and AIDS epidemic. South Africa has one of the largest HIV sentinel surveillance systems in the world. Since 1990, the Department of Health has monitored the HIV epidemic using this surveillance system. Currently the HIV sentinel survey is carried out
in 1 457 sentinel sites strategically located in all the 52 Health Districts targeting 36 000 pregnant women seeking antenatal care for the first time during the current pregnancy within the survey
period.

Click here to view the Executive Summary:   Antenatal Survey 54.66 Kb

Click here to access the survey on the Deparment of Health website.

Joint Learning Initiative on Children and HIV/AIDS: Home truths: facing the facts on children, AIDS, and povertyFebruary 10, 2009

London – The global response to HIV/AIDS must be significantly reoriented to address the unmet needs of millions of children and their families in the worst affected countries, according to a new report by the independent Joint Learning Initiative on Children and HIV/AIDS (JLICA).

The report, “Home truths: facing the facts on children, AIDS, and poverty” calls for change in global, regional and national responses to the epidemic, including greater emphasis on strengthening families and communities to enable them to give children the care and support they are uniquely suited to provide.

The report also recommends new approaches to address the simultaneous impacts of HIV, poverty, food insecurity and social inequality that many countries confront today.

For more information, click here.

Makerere University and Family Health International: Research shows support for medical male circumcision

February 2, 2009

Kampala – Most men and women in Uganda support medical male circumcision as a way of lowering HIV risk, and up to 62 percent of uncircumcised men would consider being circumcised, a new study has found.

The study, conducted by Uganda’s Makerere University and Family Health International, surveyed 1 675 men and women in four districts; the results were released in the capital, Kampala, in December 2008.

Support for circumcising sons was even greater: almost 100 percent of circumcised men supported the circumcision of their male children, while 59 percent to 77 percent of uncircumcised men were in favour of having their sons circumcised, and between 49 percent and 95 percent of women wanted the procedure performed on their male children.

Three randomised trials in South Africa, Kenya and Uganda in 2005 and 2006 found that circumcision could reduce the risk of HIV infection among men by up to 60 percent.

World Health Organization: Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model

November 27, 2008

Nairobi – Universal HIV testing and immediate antiretroviral (ARV) drugs could reduce new infections in high-prevalence countries by as much as 95 percent within ten years, according to a new study by scientists from the UN World Health Organization (WHO).

The findings of the mathematical modelling exercise, published on 26 November 2008 in the British medical journal, The Lancet, suggest that immediate treatment – regardless of clinical or immunological evaluations such as CD4 count (which measures the strength of the immune system) – could significantly reduce new infections in many sub-Saharan African countries.

“We took available data from southern Africa, where the epidemic is generalised and transmitted mainly through heterosexual sex, and plugged it into a computer model,” Reuben Granich, a medical officer with WHO’s department of HIV/AIDS and lead author of the study, told IRIN/PlusNews.

“The model found that if all adults were tested at least once a year and put on treatment immediately, then theoretically prevalence would reduce from 20 000 per million people annually to 1 000 per million people annually within 10 years.”

Granich said the model worked on the assumption that once patients started taking ARVs, their viral load – the amount of HIV in the blood – was significantly reduced and they became much less likely to transmit the virus.

To read the full report, click here.

To read the media release, click here: Universal HIV testing could eliminate HIV within a decade – WHO.

 World Health Organization: Beyond fragmentation and towards universal coverage: insights from Ghana, South Africa and the United Republic of Tanzania

November 2008

In the November 2008 edition of the World Health Organization Bulletin, health economists explore the extent of fragmentation within the health systems of three African countries. Fragmentation is when there are a large number of separate funding mechanisms (for example, many small insurance schemes) and a wide range of health care providers paid from different funding pools, which leads to an inequitable system.

Its report concludes that there is a growing international consensus that out-of-pocket payments are contrary to the goal of universal coverage, particularly given the ineffectiveness of fee waivers in providing financial protection to the poor.

“There is also consensus that universal coverage can only be achieved through prepayment funding mechanisms. However, it is of concern that financing strategies … that inevitably further fragment health systems are still being promoted as useful financing mechanisms for low- and middle-income countries,” reads the report.

“The analysis presented indicates that South Africa has made the least progress in addressing fragmentation, while Ghana appears to be pursuing a universal coverage policy in a more coherent way … Ultimately, there is a need to achieve as much integration of financing mechanisms as possible to promote universal cover with strong income and risk cross-subsidies in the overall health system.”

To read the full report, click here.

Department of Health: 2007 National HIV and syphilis antenatal prevalence survey

September 2008

The report on the 2007 National HIV and Syphilis Antenatal Prevalence Survey suggests that South Africa may be making some real progress in its response to the HIV epidemic.

Released by the national Department of Health, these are the first results to show a comparison of the impact of HIV infection between districts over two consecutive years.

The epidemic is progressing at a different pace in the different provinces, and the findings suggest that the South African HIV epidemic is on a downward trend.

Another important observation in the 2007 survey is that HIV prevalence among younger women (in the 15 to 24 years age group) continues to show a significant decline. A decline in this age group is suggestive of a decline in HIV incidence and is a good indicator of the impact of intervention programmes.

More concerted efforts in prevention strategies are needed in the older age groups, where declines have not been observed.

The need for targeted strategies cannot be overemphasized in the country’s comprehensive approach to reducing new HIV infections and reducing AIDS-related morbidity. Differences in site and age group imply that different age groups at the different geographical areas need to have specific interventions, depending on their situation if the overall low prevalence is to be sustained.

To read the full report, click here.

IOM: HIV risk and vulnerabilities of migrant farm workers in South Africa

Within Southern Africa, livelihoods are increasingly based on mobility, with the search for income opportunities in different locations and sectors seen as a sound risk management by many.

Poverty and exploitation, separation from regular partners and social norms, and a lack of access to HIV prevention and care services and programmes make labour migrants and mobile workers vulnerable to HIV infection.

To address this, the International Organization for Migration (IOM) developed the Partnership on HIV and Mobility in Southern Africa (Phamsa), which aims to reduce the HIV incidence and impact of AIDS among migrant and mobile workers and their families.

Regional Guidelines on HIV in the Commercial Agriculture, Construction and Informal Cross Border Trade sectors have been developed to encourage key players to adopt policies that help reduce the HIV risk environment of migrant workers.

Founded in 1951, the IOM is an intergovernmental agency with 120 member states that is committed to the principle that humane and orderly migration benefits migrants and society. Phamsa is funded by the Swedish International Development Co-operation Agency (Sida).

The IOM has presented the study, HIV risk and vulnerabilities of migrant farm workers in South Africa: good practice in addressing migrants’ rights to health

It focuses on the organisation’s HIV Prevention and Care Project, which targets seasonal farm workers on 38 commercial farms in South Africa. The project started in 2005.

Permanent and seasonal farm employees were found to be highly vulnerable to HIV: of the 1 500 employees who voluntarily participated, 28,5 percent were living with HIV. Female workers had higher HIV prevalence than male workers (32,5 percent versus 20,9 percent).

The IOM’s response was a comprehensive HIV prevention and care project in large agri-estates that includes creating a conducive work environment; primary health care and access to health services; peer education; gender: male role models; recreational activities, and integrated social change communication.

For more information on Phamsa, click here.

For the full report, click here.

Center for Global Development: Seizing the opportunity on AIDS and health systems August 2008

A report by the Washington-based Center for Global Development, Seizing the opportunity on AIDS and health systems, launched at the International AIDS Conference, suggests that donors may actually have weakened the health systems necessary for an effective AIDS response.

The conference was held in Mexico City, from 3 to 8 August 2008.

“The big HIV donors are creating AIDS-specific systems that compete for health workers and administrative talent, share the same inadequate infrastructure, and further complicate already complex flows of information,” said Nandini Oomman, the lead author of the report.

Noting that “the future of the global HIV/AIDS response cannot be considered independently from that of national health systems”, the study examined interactions between the three donors and health systems in three countries in which they work – Mozambique, Uganda and Zambia.

UNAIDS: Report on the global AIDS epidemic

July 2008

The rate of new HIV infections is slowing in a number of countries, but the AIDS epidemic is not over in any part of the world, and is gaining pace in some.

This was the message from UNAIDS in its new data, which gives the most up-to-date snapshot of the global epidemic and the world’s response to it.

The 2008 Report on the Global AIDS Epidemic notes that the number of people living with HIV around the world has stabilised at about 33 million.

There is some evidence that prevention campaigns have played a role, but the plateau in prevalence is also the result of deaths due to AIDS occurring at a similar rate as new HIV infections. About two million adults and children died from AIDS-related illnesses in 2007, but 2,7 million were newly infected; down slightly from three million in 2001.

Heterosexual intercourse is still driving the epidemic in sub-Saharan Africa, which shouldered two-thirds of the global AIDS burden and three-quarters of all AIDS-related deaths in 2007.

Nine countries in southern Africa are bearing the brunt of the AIDS crisis, accounting for one-third of global infections. The epidemics in Malawi, Zambia and South Africa appear to have stabilised, and in Botswana and Zimbabwe they have started to decline, but Mozambique’s epidemic is growing.

In East Africa, the epidemics in most countries have receded or remained at about 5 percent.

SANAC: Civil society position paper on male circumcision as an HIV prevention strategy

May 2008

The South African National AIDS Council, SANAC, released a position paper on male circumcision as an HIV prevention strategy in May 2008.

It was endorsed by several sectors – traditional leaders, men’s sector, PWA sector, law and human rights sector, NGO sector, children’s sector, and research sector.

The paper concluded that adult male circumcision (MC) was already a part of South Africa’s cultural landscape and that knowledge of the outcomes of MC trials was also already in the public domain, although linked to misunderstanding.

Many men were getting circumcised and there was a need for public messaging that spoke to their needs and the needs of their partners to help them avoid risky behaviour and to best protect their health.

The SANAC civil society sectors that were consulted believe that male circumcision offers:

  • An additional HIV prevention measure that is of proven benefit;
  • An opportunity to assist the men’s sector to discuss broader HIV prevention and sexual health issues;
  • An opportunity for making information about sexual health in general more widely available so as to enable boys and men to take responsibility for their health and to make informed choices; and
  • An opportunity to reduce the number of new HIV infections and reach the targets of the HIV/AIDS and STI National Strategic Plan 2007 – 2011 (NSP).

As a result, the SANAC paper concluded not whether circumcision and appropriate messaging needed to be introduced but that public messaging was needed to provide clear and unambiguous guidance that spoke to the needs those who elected to be circumcised and the needs of their partners.

To read the full position paper, click here.

To read the paper published in AIDS 2008, Male circumcision for HIV prevention – from evidence to action, click here.

To read the latest recommendations of UNAIDS and the World Health Organisation, click here.

To read the latest recommendations of WHO-AFRO (the Regional Office for Africa), click here.

IOM and Hoedspruit Training Trust: HIV prevalence survey in commercial agriculture

April 2008

Some 1 500 farmworkers on 10 farms in the Hoedspruit area in Limpopo Province took part in an Integrated Biological and Behavioural Survey on HIV prevalence among commercial agriculture farmworkers run by the International Organization for Migration (IOM) and the Hoedspruit Training Trust (HTT).

It found that farm workers were highly vulnerable to HIV, and that female workers were significantly more at risk than male workers. Dr Clive Evian, who conducted the survey, characterised the results as a “serious epidemic” and highlighted the need to strengthen current HIV testing, care and support services.

The key findings suggested that 60 percent of all employees and 53 percent of HIV-positive employees did not know their HIV status; and that 25 percent of HIV-positive employees who reported to know their status did not use condoms.

To read a summary of the report, click here.

UNICEF: Children and AIDS: Second stock taking report

April 2008

More mothers and children in developing countries are receiving treatment than ever before. But stigma, limited information and fragile health systems still pose hurdles to achieving the Millennium Development Goals (MDGs).

Coverage of mother-to-child transmission prevention (PMTCT) services continues to expand, especially in southern and eastern Africa.

The proportion of HIV-positive pregnant women receiving antiretroviral therapy (ART) in developing countries increased from 10 percent in 2004 to 23 percent two years later. In eastern and southern Africa, the figure more than doubled in roughly the same period, reaching 31 percent in 2006.

The report is part of the “Unite for Children, Unite against AIDS” initiative started by UNICEF in 2005, and noted that 21 middle and low-income countries are on track to meet the MDG of 80 percent coverage.

World Health Organisation: Global tuberculosis control – surveillance, planning, financing

March 2008

This report is WHO’s twelfth annual report on global tuberculosis control in a series that started in 1997.

The report presents WHO’s latest assessment of the epidemiological burden of TB (numbers of cases and deaths), as well as progress towards the 2015 targets for global TB control that have been established within the context of the Millennium Development Goals (MDGs). It also includes a thorough analysis of implementation and financing of the WHO’s Stop TB Strategy and the Stop TB Partnership’s Global Plan to Stop TB, since in combination these have set out how TB control needs to be implemented and funded to achieve the 2015 targets. The report gives particular attention to the period 2005–2008, but selected epidemiological, implementation and financial data are presented for previous years as well. This includes epidemiological data back to 1990 and financial data back to 2002.

Bringing together data reported by 202 out of 212 countries and territories in 2007, as well as data collected from these countries and territories in previous years, Global tuberculosis control 2008 is the definitive source of information about the national and international response to the worldwide TB epidemic.

Click here to view the WHO report summary.

Click here to download the full report (3.51MB).

Business coalitions tackling AIDS: A worldwide review

January 2008

The report presents the current Business Coalition landscape and suggests next steps for all stakeholders to build on the global momentum and success with engaging the private sector. The “World Directory of Business Coalitions tackling AIDS” at the back of this report is a resource included to help strengthen the global network through increased dialogue and coordinated action.

To date, there are four regional Business Coalitions and 47 national Business Coalitions with a further 10 national Business Coalitions scheduled for launch in 2008-2009. Collectively, these coalitions have already reached more than one million (1,088,000) organizations with HIV and AIDS policies and programmes.

Click here to acces the individual regional and country profiles.

Click here to read the Executive Summary.

Click here to access the Sept 2006 report: The state of Business Coalitions in Sub-Saharan Africa.

Business and the HIV/AIDS governance gap in South Africa

November 2007

By Antoinette Handley, University of Toronto – Paper for conference on “Governance of HIV/AIDS Response: Making Participation and Accountability Count” At the University of Warwick, November 5-6, 2007)

The paper explores a number of inter-related sets of questions: First, what has the role of the South African private sector been in responding to the epidemic?  Here it is important to disaggregate “business” as a category, as responses have varied widely within the sector, across time, across firm size and across sectors of the economy.  Second, how can we account for these variations? Third, how – if at all- have the nature of the epidemic and the need to respond to it begun to shape and change business, in turn? And finally, what do these developments tell us about the capacity of business to respond to the epidemic? The paper concludes by considering the limitations of such a set of responses.

Click here to view the report: handleyreport

HIV/AIDS, TB and nutrition

July 2007

Scientific inquiry into the nutritional influences on human immunity with special reference
to HIV infection and active TB in South Africa by the Academy of Science of South Africa.

An exhaustive analysis of all scientific research on the links (if any) between improved nutrition and the treatment of both HIV/AIDS and tuberculosis has found no evidence that healthier eating is any substitute for correctly-used medical drugs.

The detailed report by a 15-member consensus panel of the prestigious Academy of Science of South Africa (ASSAf) has been given to government and is now available online. ”The panel has concluded that no food, no component made from food, and no food supplement has been identified in any credible study as an effective alternative to appropriate medication,” said Wits professor and National Health Laboratory Services pathologist Barry Mendelow, a specialist in blood disorders who chaired the study.

Click here to view the ASSAF press release.

Click here to view the full pdf report.

Taking action: The UK government’s strategy for tackling HIV and AIDS in the developing world

8 June 2007

This is the final report of an interim evaluation of Taking Action, the UK’s strategy for tackling HIV and AIDS in the developing world, which was launched in July 2004. The objective of this interim evaluation is to make recommendations in four areas: (1) to improve implementation and monitoring of the current strategy; (2) on how best to measure the success of the strategy, looking forward to the final evaluation of Taking Action in 2008/9; (3) for the UK Government’s next steps on AIDS from 2008; and (4) regarding future UK (especially DFID) strategies on development issues.

Taking Action and its spending targets galvanised the UK Government, in general, and DFID, in particular, to give a higher profile to HIV and AIDS. It is a broad and bold strategy which fits well into DFID’s poverty focus and strong championing of the Millennium Development Goals. It sets out the UK’s position on a wide range of issues relating to HIV and AIDS and is seen as an ‘empowering’ rather than a ‘restrictive’ framework, i.e. focused on what can be done, rather than on what can not. – UK Department for International Development, Global AIDS Policy Team

Click here to access the full report on the DFID website.

The state of business coalitions in sub-Saharan Africa

October 2006

At least 20 coalitions exist in sub-Saharan Africa today, with more than 16 having been established in the last five years.

For five years the Global Health Initiative and World Bank’s AIDS Campaign Team for Africa (ACTafrica) have been working together to catalyze public-private partnerships in health by building and supporting business coalitions across Africa, and hence are well placed to coordinate the mapping and evaluation of the work done to date.

The study, completed in October 2006, provides guidance to newly-launched and those soon to be formed coalitions; shares best practices, benefits, achievements; and highlights key challenges facing coalitions. Other businesses and donors are now being urged to back the approach and help strengthen these coalitions as an important part of the solution to the epidemic, which is devastating Africa’s people and economy.

According to the WEF, the emergence of business coalitions is a recent development in sub-Saharan Africa: most have only been created in the last two to five years.

Click here to view  a summary of the report.

Click here to access the report  on the World Economic Forum website.

The private sector and HIV/AIDS in Africa: Taking stock of six years of applied research

June 2006

Center for International Health and Development Boston University: Sydney Rosen, Rich Feeley, Patrick Connelly, and Jonathon Simon

Until recently, little was known about the costs of the HIV/AIDS epidemic to businesses in Africa and business responses to the epidemic. This paper synthesizes the results of a set of studies conducted between 1999 and 2006 and draws conclusions about the role of the private sector in Africa’s response to AIDS.

Methods: Detailed human resource, financial, and medical data were collected from 14 large private and parastatal companies in South Africa, Uganda, Kenya, Zambia, and Ethiopia. Surveys of small and medium-sized enterprises (SMEs) were conducted in South Africa, Kenya, and Zambia. Large companies’ responses or potential responses to the epidemic were investigated in South Africa, Uganda, Kenya, Zambia, and Rwanda.

Results: Among the large companies, estimated workforce HIV prevalence ranged from 5 percent to 37 percent. The average cost per employee lost to AIDS varied from 0,5 to 5,6 times the average annual compensation of the employee affected. Labour cost increases as a result of AIDS were estimated at anywhere from 0,6 percent to 10,8 percent but exceeded 3 percent at only two of 14 companies.

Treatment of eligible employees with ART at a cost of $360/patient/year was shown to have positive financial returns for most but not all companies. Uptake of employer-provided testing and treatment services varied widely. Among SMEs, HIV prevalence in the workforce was estimated at 10 percent to 26 percent. SME managers consistently reported low AIDS-related employee attrition, little concern about the impacts of AIDS on their companies, and relatively little interest in taking action, and fewer than half had ever discussed AIDS with their senior staff.

AIDS was estimated to increase the average operating costs of small tourism companies in Zambia by less than 1 percent; labor cost increases in other sectors were probably smaller.

Conclusions: Although there was wide variation among the firms studied, clear patterns emerged that will permit some prediction of impacts and responses in the future.

Click here to download the report:pdf Private_sector_and_aids_in_africa 289.46 Kb

UNAIDS 2006 Report on the global AIDS epidemic

May 2006

New report cites positive trends in HIV prevention and treatment; calls for significant acceleration of the AIDS response

According to new data in the UNAIDS 2006 Report on the global AIDS epidemic the AIDS epidemic appears to be slowing down globally, but new infections are continuing to increase in certain regions and countries. The report also shows that important progress has been made in country AIDS responses, including increases in funding and access to treatment, and decreases in HIV prevalence among young people in some countries over the past five years.

Click here to download the full report from the UNAIDS website.

SABCOHA/BER: The impact of HIV/AIDS on selected business sectors in South Africa

2005

The SABCOHA survey on the impact of HIV/AIDS on selected business sectors in South Africa was conducted by the Bureau for Economic Research (BER) among respondents in the mining, manufacturing, retail, wholesale, motor trade, building & construction, financial services and transport & storage sectors. The survey took place from 20 July to 6 September 2005 and 1032 companies participated in the survey.

Apart from the fact that the survey was expanded to the transport & storage sector and certain new questions were introduced, the 2005 survey is a repetition of the 2003 and 2004 HIV/AIDS surveys by the BER and SABCOHA. The results from the 2005 survey did not differ dramatically from that of the 2004 survey. This serves to affirm the findings of the previous surveys and validate the findings of the 2005 survey.

The survey results suggest that the mining sector, followed by the manufacturing and transport & storage sectors, are the worst affected among the sectors surveyed. Responses also differ significantly between companies of varying sizes and skills levels and between companies from different provinces. Compared to medium and large companies, a considerably lower percentage of small companies (with less than 100 employees) have noted HIV/AIDS related impacts.

Similarly, companies that employ predominantly semi- & unskilled workers have been much harder hit by the epidemic than companies that employ mainly highly skilled workers. Companies based in the Western Cape have experienced a significantly smaller impact compared to companies located in KwaZulu-Natal and Gauteng, two provinces with some of the highest HIV prevalence rates.

Click here to download the full report.

South African Cities Network: South African cities and HIV/AIDS: Challenges and responses

2004

South African cities and HIV/AIDS: Challenges and responses is the result of a study commissioned by the South African Cities Network (SACN) on responses to HIV/AIDS by local metropolitan municipalities.

The publication contains information on the current initiatives taken by municipalities in combating the pandemic. South Africa must redress historical inequalities while creating a competitive economic environment in the face of an increasingly pervasive HIV/AIDS pandemic. The pandemic is increasingly affecting governance, and social and economic sectors nationwide. The full consequences for infected and affected populations have not yet been realised, but will be borne by all.

This report is based on information from SACN member cities. It highlights emerging good practices and outlines the components of a possible “gold-standard response” that is based mainly on the initiatives of the nine largest cities in South Africa, as well as good practice standards suggested by international models and research.

It is devoted largely to a review of the distinct efforts on the part of municipalities that could be further strengthened by capacity building, networking and the effective use of information in developing comprehensive city-level responses to HIV/AIDS.

The SACN will use the material gathered in the preparation of this report to formulate, develop and implement a support programme for its member cities. It will also contribute to efforts to strengthen the capacities of municipalities to respond to the HIV/AIDS pandemic.

For the full report, click here.