Tag Archives: HIV

A Tentative (Mixed) Public Health Victory: The Slow Retrenchment of HIV-AIDS

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This is from the Economist, on the state of the fight against HIV-AIDS.

The next UN target is that, by 2020, 90% of those infected should have been diagnosed and know their status, 90% of those so diagnosed should be on ARVs, and 90% of those on ARVs should have suppressed viral loads. That is ambitious, but history suggests those in the field will rise to the challenge.

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The blue line is testament to George W. Bush’s No. 1 foreign policy success: PEPFAR.

But we should count our chickens just yet. The trends in the graph above are not uniform across the globe. As I noted in a previous post, there is quite a bit of heterogeneity both across and within countries. For example, in East Africa, Uganda is lagging Kenya and Tanzania in the quest to tame the virus (see below).

On a different note, this is yet another data point to suggest that Yoweri Museveni has hit the inflection point, and from now on all his machinations to stay in power will wipe out the achievements of his first 20 years in power.

The Continuing Deterioration of Uganda Under Museveni: The Case of HIV & AIDS

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In the 1990s Uganda was typically considered to be one of the success stories in the management of the AIDS epidemic in SSA. However, as is shown below, since the early 2000s Uganda has significantly lagged its regional peers (Kenya and Tanzania) in the fight against HIV/AIDS. New infections are declining in Kenya and Tanzania but increasing in Uganda. HIV prevalence also appears to be increasing in Uganda, while either declining or keeping steady in Tanzania and Kenya. Lastly, of the three countries, the rate of decline in AIDS-related deaths has been slowest in Uganda.

It’s not clear to me why the HIV/AIDS situation has deteriorated in Uganda since the late 1990s relative to its neighbors. After all, the three countries have been receiving cash from PEPFAR since 2004 (which explains the decline in AIDS related mortality in the mid-2000s after the use of ARTs became widespread).

My hunch is that this is a reflection of Yoweri Museveni’s gradual loss of control of the state institutions that he has worked hard to build since 1986. It is also probably related to the manner in which Museveni chose to deal with the advent of competitive politics in Uganda after the end of the no-party “movement” era. His strategy has come to be defined by a willingness to basically buy off anyone and everyone — at the expense of state institutions and specific government agencies.

Consider this:

The OIG auditors identified stock-outs of key medicines, particularly those to treat HIV, in 70% of 50 health facilities visited which could result in treatment disruption for patients. Furthermore, 54% of the health facilities visited had accumulated expired medicines. 68% of facilities reported stock-outs of anti-malaria medicines and test kits and 64% of the facilities reported stock-outs of tuberculosis medicines of between one week and three months.

The OIG concluded that the supply chain system does not effectively distribute and account for medicines financed by the Global Fund. There were reported cases of theft, including 40 cartons of artemisinin-based combination therapies; an unexplained difference of US$21.4 million between recorded and actual stocks at the central warehouse; and a difference of US$1.9 million between commodities received and actually dispensed to patients from January 2014 to June 2015 in eight high-volume facilities visited by the auditors.

Screen Shot 2016-03-05 at 9.20.11 AMUganda’s post civil war economic recovery may have been impressive (see graph), but it should no longer be something for Museveni to hang his hat on. It is clear that the longer Museveni stays in office, the more he is going to undo his very own achievements in the earlier years of his three-decade rule.

 

 

UN reports gains in the global fight against AIDS

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There is more good news in the area of public health. A couple of days ago I posted on the decline of human mortality rates in the tropics. Now the UN agency for HIV/AIDS, UNAIDS, reports that HIV infection rates, especially of the mother-to-child variety, are on a downward trend.

The New York Times reports:

New infections with H.I.V. have dropped by half in the past decade in 25 poor and middle-income countries, many of them in Africa, the continent hardest hit by AIDS, the United Nations said Tuesday.

The greatest success has been in preventing mothers from infecting their babies, but focusing testing and treatment on high-risk groups like gay men, prostitutes and drug addicts has also paid dividends, said Michel Sidibé, the executive director of the agency U.N.AIDS.

Adding that:

Some regions, like Southern Africa and the Caribbean, are doing particularly well, while others, like Eastern Europe, Central Asia and the Middle East, are not. Globally, new infections are down 22 percent from 2001, when there were 3.2 million. Among newborns, they fell 40 percent, to 330,000 from 550,000.

Life expectancy in Kenya jumps to 64

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The Daily Nation reports:

The life expectancy of a Kenyan has increased to 64 years up from 55 two years ago, a report released on Sunday shows.

The data compiled by the University of Nairobi in partnership with 12 other universities worldwide notes that the life of Kenyans has improved substantially and they can expect to live longer.

The report, State Of The Tropics, further says that Zimbabwe is the only nation in the world that recorded a decline in life expectancy at 47 years.

Madagascar reported the largest improvement in life expectancy to 65.8 years, with large reductions in infant and adult mortality rates.

…. In regional terms, Zimbabwe has a low infant mortality rate, but a very high adult mortality rate (the highest in the world)

Overall, there has been massive improvement in life expectancy in the tropics since the fifties:

…. life expectancy in the tropics has increased by 22.8 years to 64.4 years between 1950 and 2010 and the gap between the life expectancy of women and men has widened in favour of women over the same period.

I guess this calls for an investigation of the real causes of the drop (if the data hold up) in mortality rates (especially infant mortality). Is it better healthcare, diet or just a natural secular trend? Or could it be better economic prospects (since the mid-1990s) that inspire greater investment in healthcare? Also, has the AIDS epidemic peaked in the tropics? Over to you, epidemiologists.

It is a bit odd that a country like Zimbabwe has a low infant mortality rate but a high adult mortality rate – why has the total collapse of state institutions disproportionately affected health provision to adults?

More good news on the fight against AIDS

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AIDS researchers, many of whom have been meeting this week in Rome under the auspices of the International AIDS Society, are rightly pleased with the progress they have made. In particular, the use of antiretroviral drugs has not only revolutionised treatment of HIV infection, but also offers the prospect of stopping the spread of the virus. In a matter of weeks, these drugs reduce the number of viruses per millilitre of infected blood from millions to less than 50. That deals with both symptoms and infectivity. Unless a patient stops taking the drugs, or goes on to develop resistance to them, he can expect to live almost as long as an uninfected individual.

……. there is a glimmer of hope on the horizon. To deal with dormant viruses several researchers are taking what sounds like a counterintuitive approach. They are trying to wake the viruses up and so boost, rather than reduce, the amount of active HIV in a patient’s body. Their reasoning is that the now-active viruses will either kill the cells they are in (and thus themselves) or encourage the immune system to attack those cells.

That is the Economist in its latest issue. For more on the details of the state of AIDS research go here.

The Economist’s optimism is supported by empirical data. According to the Vancouver Sun:

HIV patients in Uganda who are receiving regular treatment can expect to live a near-normal lifespan, Canadian researchers have suggested in the world’s first large-scale study to examine HIV patients’ life expectancy in Africa.

After studying 22,315 patients who were using combined antiretroviral therapy (cART), scientists from the B.C. Centre for Excellence in HIV/AIDS along with experts at the Universities of British Columbia and Ottawa found that with early initiation and access to regular treatment, those infected with HIV were living about two-thirds of a normal lifespan.

More on this here.

 

southern adventurism?

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Charles Onyango-Obbo, in Africa Review, has a piece documenting the cases of infidelity in Southern Africa involving the wives of heads of state. From Swaziland to South Africa to Zambia heads of state have had to manage spouses with “restless skirts.” Mr. Onyango-Obbo argues that part of the reason is that “Southern Africa as a region tends to have a more liberal take on sexual matters” adding that

“It is a mining region, and for over two generations men have left their families behind to go and work in the mines in a neighbouring. Some never returned, others did infrequently – often with second wives they had married. Just like lonely miners sought out newscompanionships in the new areas they worked and lived in, the wives they left at home eventually also filled the void left by their long-absent husbands.”

Although I don’t quite agree with Onyango-Obbo’s assertion that Southern Africans are more liberal when it comes to sexual matters, I do think that labor migration necessitated by the mining sector in the sub-region has had a profound impact not only on the institution of marriage but also on health outcomes. As a result the sub-region has the highest HIV infection rates in the world. I must also add that governments in the region have realized this and are trying to deal with the problem. Botswana, for instance, has an elaborate and fairly well run programme of providing HIV positive individuals with ARVs. South Africa, emerging from years of denial under Mbeki, is also trying to catch up.

mbeki’s legacy

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Partial results of Thabo Mbeki’s beetroot response to the South African AIDS epidemic are out. Life expectancy in South Africa declined between 1990-2007 (from 62 to 50). It is expected to decline even further over the next few years. Read more about this here.

It is worth noting that the new South African administration took an about-turn from Mbeki’s bizarre AIDS policy, as was articulated by his health minister. The South African Ministry of Health has on its website an HIV and AIDS and STI strategic plan designed to tackle the HIV problem. Over 5 million South Africans, out of a total population of 49.3 million, are infected.

i still don’t get how the church justifies this

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The Catholic Church, among other churches, continues to be opposed to birth control measures that also help in the prevention of AIDS. This is such a disappointment. Millions of people have died from the disease since its emergence in the 1980s. Currently there are more than 20 million infected people on the Continent, and 11 million orphans as a result of HIV-related deaths. Clearly this is a situation that calls for a rethink of the Church’s policy on the use of condoms.

This is separate from the abortion debate. This is about disease prevention. I find it hard to reconcile church teachings of love with the heartless condemnation of millions to their graves. Now, individuals can make their own decisions regarding whether to engage in unprotected sex or not. But I also think that it matters if their priest or pastor tells them to do so. As long as the church is against AIDS prevention (yes, refusal to allow condom use amounts to being against AIDS prevention) government efforts to tame the disease will continue to founder.

It is easy for moralists perched up in far off places to dictate to their faithfuls on the Continent that they should not use birth control or protect themselves against AIDS. But African governments should know better than to stand by and let this be. They are the ones who are losing hundreds of thousands of teachers, doctors, engineers, civil servants and most importantly PARENTS every year. Millions of children are left orphaned and therefore a burden to the state. Rome or the evangelical churches will never have to deal with the losses that these governments have to deal with as a result.

There is a huge disconnect between the church and the realities on the ground on the Continent. The fact of the matter is that people are having sex outside of wedlock. The church (and even the state) should have good reasons to worry about this (the concern here being the hordes of unplanned pregnancies, especially among teenagers). But the best way to deal with it is not to preach abstinence and then pretend that people will listen. Governments and the church should be aggressive with ALL preventive measures. Once the disease is down to negligible levels then perhaps we can revive the moralizing crusades. Now is simply not the time.

kenyan new aids figures, cause for concern

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Late last year I wrote a peace congratulating the Kenyan government and all those involved of having done a commendable job in reducing the HIV prevalence rate to 5.1%. But new figures out indicate that things are much worse than this. It turns out that the prevalence rate is 7.4% with about 1.4 million Kenyans between the ages of 15 and 64 infected.

Even more worrying is the fact that more than 83% of those infected do not know that they’ve been infected and less than half of them use condoms. The new figures also reported that 10% of married couples in Kenya are infected.

It goes without mention that this should sound an alarm among Kenyans. The truth needs to be put out there. It is true that Kenyan men, and to some extent women, are behaving badly. It is also true that they are not using condoms while at it.

What needs to be done is (I am no expert but this is sort of common sense):

1. The public should be educated bluntly about proper sexual behavior. There is no point in acting like people are not having indiscriminate sex while they are. Men especially should be constantly reminded that they should not be putting their families in danger by their bad habits.

2. Condoms. Condoms. Condoms. I don’t care what the church says. People are having sex. Abstinence is, I concede, the best prevention method. But what do you when people, in their fallibility cannot put down the natural urge to have sex? I say the government should avail condoms, not just to teenagers but to married men as well.

3. Empower women. Empower women. Empower women. Empowered women will be able to say no to unprotected sex. Empowered women will not be forced to have sex in exchange for food on the table for their children. Empowered women will raise well mannered, morally upright children who will not grow into deviants running around having indiscriminate sex.

EMPOWERED WOMEN WILL PROVIDE A SOUND FOUNDATION TO SOCIETY.

These are just three things that the government can do to prevent the figures rising further than 7.4%. They may seem sort of naive, but the truth is they are achievable. They are achievable if the folks in Nairobi behaved like the leaders they ought to be and strove at changing society – for this is part of leadership. Kenya and indeed African leaders can change the course of this terrible disease if they want to.

Some of them like our dear president have more than one wife (or some other hazy definition – partner, wife, concubine etc). What message are we sending to the young. When leaders are allowed to run around having illegitimate children we set a bad example. It should start with leaders having responsible sexual relations and then preaching to the masses to have responsible sexual relations.

Otherwise millions more will die. Millions more will be orphaned. And millions that could have been spent building roads and schools will instead be spent on funerals and health costs.

the church and aids in africa: some inconvenient truths

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It is quite a shame that the church is somewhat contributing to the spread of the HIV virus on the continent of Africa. Church leaders, especially of the Catholic variety, have always maintained that the use of contraceptives – including condoms – is against the will of God. Given Africans’ religiosity and respect for these men of God, many of them have ended up not using any form of protection or contraceptives while having sex. The result has been the very high fertility and HIV infection rates on the continent.

African governments have been fighting the AIDS scourge with very costly campaigns while turning a deaf year to the churches.Because in most cases the churches are the ones that provide much needed public goods and social services, they’ve come to have a stronger grip on the people’s minds and hearts than the government. It is therefore a no brainer that even on the life and death issue of condom use they tend to listen more to the men of God than to Caesar.

This should not be the case. To echo Wole Soyinka, “Even in a purely theocratic state, there comes a point – surely – at which the state must restrict clerical interference in clearly scientific matters, most especially where human well being and survival are at issue.” Although the percentage of those infected because of their religious persuasions may be small, the fact is that their infection is preventable. It is because of this that governments should step in and rid pulpits of this madness. Church leaders should stop deluding themselves that their call for abstinence is in God’s people’s interest.The truth is that God’s people will always have sex and therefore need ways to control their fertility and protect themselves against terrible sexually transmitted diseases.

This does not mean that the churches should stop preaching about chastity and sexual purity. On the contrary, I say they should redouble their effort. But they should also be flexible on contraceptives, including condoms, for the safety of the many of their flock who fall to the temptations of the flesh.

The continent’s men of God should take time off next time they are in Rome, London or Texas – from where they get their cue – to inquire about the rates of condom use and fertility of their fellow believers in these places.