Daily HIV/Aids Report
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Kaisernetwork.org (Washington, DC)
September 20, 2004
Posted to the web September 20, 2004
Global Challenges
Washington Post Examines How Peace, Poverty, Poor Health Infrastructure Leading to Higher HIV Prevalence in Angola
[Sep 20, 2004]
The Washington Post on Sunday examined how two years of peace in war-torn Angola have highlighted the social dislocation, poor public health programs and low education levels that could contribute to rising HIV prevalence in the country. Currently, Angola's estimated HIV prevalence is less than 10% among adults, a rate that is less than half the HIV prevalence in the neighboring countries of Congo and Zambia and about one-fourth the HIV prevalence in Botswana. Angola's decades-long civil war kept the country "in a kind of medical time warp" as a result of closed borders and little movement among civilians, according to the Post. However, two years after the war's end, increased movement among civilians, a surge of refugees returning from camps located in countries with higher HIV prevalence and the return of soldiers are bringing HIV to areas where it previously was rare. Increased prevalence already has been recorded among commercial sex workers and pregnant women in the capital city of Luanda, and a national study to be completed in the coming months is expected to show an increase in HIV prevalence among the entire population. UNICEF officials estimate that 500,000 Angolans are HIV-positive, according to the Post.
Country Lacks Funds, Adequate Health Care System
As a result of Angola's relatively low HIV prevalence rate, the country has received much less international funding aimed at fighting HIV/AIDS than other African countries, the Post reports. For example, Angola is not one of the 12 African countries set to receive funding to fight HIV/AIDS under the Bush administration's five-year, $15 billion President's Emergency Plan for AIDS Relief. The country's lower HIV prevalence also has led to a lag in medical response and public understanding of HIV/AIDS. Much of the country's public health system was destroyed during the war, contributing to a shortage of hospital beds and medications, such as antiretroviral drugs. Angola currently has only 12 HIV testing and counseling centers nationwide, and the country has fewer billboards and public education campaigns about the disease than other African countries, the Post reports (Timberg, Washington Post, 9/19).
Opinion
Increased Focus on TB Treatment Could Help HIV/AIDS Patients Live Longer, Opinion Piece Says
[Sep 20, 2004]
An "explosion" in the number of tuberculosis cases among HIV-positive people could be responsible for half of all AIDS-related deaths, and granting the disease "the respect it deserves offers a crucial, and unheralded, way of delivering hope to AIDS suffers," New York Times editorial writer Tina Rosenberg writes in an opinion piece for the Times Magazine. While TB "is still regarded as a relic," about two million people -- many of whom are HIV-positive -- die annually from the disease, according to Rosenberg. While antiretroviral drugs for HIV/AIDS treatment are expensive, treating TB with the strategy known as directly observed treatment, short-course -- a six- to eight-month treatment course developed in Africa in the 1980s and introduced by the World Health Organization in 1994 -- costs only about $11 and could allow HIV-positive patients to live "years longer" and "buy [them] years of health while they wait for antiretrovirals," Rosenberg says, adding that "[e]ven the poorest countries" can cure more than 90% of TB cases using DOTS. However, Rosenberg says that DOTS -- which is considered to be one of the world's most cost-effective health interventions -- is used "far too little" because many of the countries where the majority of HIV-TB co-infected people live are unable to employ DOTS. The program requires both an uninterrupted supply of drugs and mandates that clinics providing the treatment also provide a simple and low-cost method to diagnose patients, track and report progress and find ways to ensure that patients are taking the drugs every day for at least the initial two months of treatment.
Relevant Links
Central Africa
Southern Africa
HIV-Aids and STDs
Health and Medicine
Angola
Post-Conflict Challenges
Tuberculosis
HIV/AIDS, TB Offer 'Double Opportunity'
The "horrifying collision" of TB and HIV "offers a double opportunity to save lives" by combining treatments, which could provide a solution to "one of the most vexing problems in both the prevention and treatment of AIDS -- finding the sick and getting them testing and counseling," Rosenberg says. However, "TB is still invisible" both because of the lack of funding targeting the disease and because of the nature of the disease, which is curable and generally afflicts only the poor and prisoners, according to Rosenberg. The Global Fund to Fight AIDS, Tuberculosis and Malaria in its last round of grants allocated only 10% of the funds to programs aimed at fighting TB, according to Rosenberg. In addition, TB has no "citizen-activists," and doctors "who care passionately" about TB have been "working in a ghetto," Rosenberg says. "The world needs to join [the doctors'] battle -- both to stop a tuberculosis explosion and to save lives in the fight against AIDS," Rosenberg concludes (Rosenberg, New York Times Magazine, 9/19).
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