African journal of AIDS research : AJAR最新文献

{"title":"A human rights-based approach to coercive public health interventions: lessons from the HIV and COVID-19 pandemics.","authors":"Petronell Kruger,&nbsp;Safura Abdool Karim","doi":"10.2989/16085906.2022.2073897","DOIUrl":"https://doi.org/10.2989/16085906.2022.2073897","url":null,"abstract":"<p><p>The SARS-CoV-2 outbreak and its impact on countries across the globe has been unprecedented. The lack of pharmaceutical interventions to prevent or treat infection have left States with limited avenues to control the spread of the virus. Many countries have introduced stringent lockdowns along with regulatory regimes that give governments new powers to compel compliance with these regulations and to punish non-compliance. This article investigates the use of compelled public health interventions during both the HIV and COVID-19 pandemics and how these can be aligned to human rights. This includes discussion on the use of interventions such as mandatory quarantine and isolation, compelled testing, criminalisation of HIV and SARS-CoV-2 transmission in Africa. This article also outlines what State obligations are in relation to pandemic responses, both in terms of mandating an effective response and which human rights principles should underscore these responses.Using South Africa as a case study, this article analyses whether the use of these interventions complies with international human rights law. We assess the use of compelled public health interventions in both the HIV and COVID-19 pandemics against established human rights principles applicable to pandemic responses. This article discusses lessons to be learnt about the relationship between human rights and public health interventions across both pandemics so as to guide human rights-based approaches to future pandemics as well as subsequent stages of the SARS-CoV-2 pandemic.</p>","PeriodicalId":520548,"journal":{"name":"African journal of AIDS research : AJAR","volume":" ","pages":"123-131"},"PeriodicalIF":1.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40556155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"History matters: AIDS in the time of COVID-19.","authors":"Charles Birungi,&nbsp;Warren Parker,&nbsp;Alan Whiteside","doi":"10.2989/16085906.2022.2106064","DOIUrl":"https://doi.org/10.2989/16085906.2022.2106064","url":null,"abstract":"","PeriodicalId":520548,"journal":{"name":"African journal of AIDS research : AJAR","volume":" ","pages":"iii-iv"},"PeriodicalIF":1.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40556157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of COVID-19 on older adults 50 years and above living with HIV in a less-developed country.","authors":"Mathew Nyashanu,&nbsp;Derrick Amooti Lusota,&nbsp;Martin Muddu,&nbsp;Scovia Nalugo Mbalinda","doi":"10.2989/16085906.2022.2091464","DOIUrl":"https://doi.org/10.2989/16085906.2022.2091464","url":null,"abstract":"<p><p><i>Introduction</i>: Globally, control measures have been communicated to reverse the COVID-19 pandemic. In Uganda, as soon as the first case of COVID-19 was identified, strict lockdown measures were enforced, including a ban on all public and private transport, night curfew, closure of schools, and suspension of religious and social gatherings and closure of non-essential shops and markets. These measures affected access to health services, which could have been worse for older people living with HIV (PLHIV). In this study, we explored how COVID-19 affected the health and social life of older PLHIV.<i>Methods</i>: We conducted a qualitative study in HIV clinics of two hospitals in Uganda. We completed 40 in-depth interviews with adults above 50 years who had lived with HIV for more than 10 years. The interviews explored the effect of COVID-19 on their health and social life during the lockdown. We analysed data thematically.<i>Results</i>: The overarching themes regarding the effects of COVID-19 on older adults living with HIV were fear and anxiety during the lockdown, lack of access to health care leading to missing HIV clinic appointments and not taking their ART medicines, financial burden, loss of loved ones, and effect on children's education. Some patients overcame health-related challenges by sending motorcycles to their health facilities with their identifying documents to get the medicines refilled. Some health care providers took the ART medicines to their patients' homes.<i>Conclusion</i>: The COVID-19 lockdown negatively affected the health and social well-being of older PLHIV. This calls for strategies to improve HIV care and treatment access during the lockdown to sustain the HIV program gains in this vulnerable population.</p>","PeriodicalId":520548,"journal":{"name":"African journal of AIDS research : AJAR","volume":" ","pages":"207-212"},"PeriodicalIF":1.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40553608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To end AIDS and COVID-19, end inequalities.","authors":"Matthew M Kavanagh","doi":"10.2989/16085906.2022.2106066","DOIUrl":"https://doi.org/10.2989/16085906.2022.2106066","url":null,"abstract":"","PeriodicalId":520548,"journal":{"name":"African journal of AIDS research : AJAR","volume":" ","pages":"v-vi"},"PeriodicalIF":1.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40556158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pandemic of inequality: reflections on AIDS and COVID-19 in the southern African context.","authors":"Arnau van Wyngaard","doi":"10.2989/16085906.2022.2078730","DOIUrl":"https://doi.org/10.2989/16085906.2022.2078730","url":null,"abstract":"<p><p>In 2020, COVID-19 started spreading from Wuhan in China to the USA, the UK and Europe and then to the rest of the world. In Africa, the first case of COVID-19 was reported in Egypt on 14 February, while South Africa's first case was identified on 5 March. On 11 March, the World Health Organization declared a pandemic. At the time, it was said that COVID-19 would become the great equaliser because the virus made no distinction between first and third world countries, between the rich and the poor, and nor was it influenced by gender, sexual orientation or race. When someone contracted SARS-CoV-2, no guarantee could be given that the patient would survive, regardless of who they were or their status in the community.This stood in contrast to the early experience of AIDS before antiretrovirals existed and when HIV was spreading like wildfire in sub-Saharan Africa and other countries with low or lower-middle-income status. It seemed as if these countries were doubly cursed - by poverty and the AIDS pandemic that was causing as many as 6 000 mortalities per day in sub-Saharan Africa. This led to the South African president at the time, Thabo Mbeki, to assert that poverty was an even greater problem than HIV and AIDS.It did not take long to see that COVID-19 was not the anticipated equaliser. As lockdowns were enforced within most countries across the globe and resulting in economic slumps, differences between rich and poorer countries and their respective citizens were thrown into sharp relief once again. This article reports how both AIDS and COVID-19 adversely affected women, the impoverished and those without access to sustainable souces of food and medicine.</p>","PeriodicalId":520548,"journal":{"name":"African journal of AIDS research : AJAR","volume":" ","pages":"152-161"},"PeriodicalIF":1.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40556154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pandemic triad: HIV, COVID-19 and debt in low- and middle-income countries.","authors":"Charles Birungi,&nbsp;Jaime Atienza Azcona,&nbsp;Daniel Munevar","doi":"10.2989/16085906.2022.2104168","DOIUrl":"https://doi.org/10.2989/16085906.2022.2104168","url":null,"abstract":"<p><p>This article assesses the impact of the HIV and COVID-19 pandemics and debt dynamics on health, HIV and pandemic preparedness and response-related financing in developing countries. Using a novel dataset, we did a cross-national systematic analysis of all data sources available for government expenditures on health, HIV, COVID-19 and debt servicing in selected developing countries. We found an inadequate multilateral response with the ensuing gaps allowing both pandemics to thrive. The G20 Debt Service Suspension Initiative and the Common Framework only covered countries with a third of the global population of people living with HIV. Rising and unsustainable debt levels are limiting the capacity of governments to protect the health of their populations. Government spending is already falling in response to high debt payments. Specifically, debt servicing is crowding out lifesaving investments. In 2020, for every USD 5 available, USD 4 was spent on debt servicing. Only USD 1 was invested in health. This is a binding constraint on countries' efforts to control COVID-19. Even with a gargantuan effort to increase health expenditure, the outlook for health financing remains negative. Fiscal consolidation, with a heavy emphasis on expenditure cuts, is expected to take place across 139 countries in the coming years. These findings suggest that fiscal policymakers should be concerned about the crowding-out and constraining effects of public debt. To this end, pragmatic recommendations are made to treat and cancel debt as a critical policy lever to accelerate the end of the HIV and COVID-19 pandemics in developing countries as a key condition to addressing the growing inequalities and to ensure debt can be a benefit, not a burden.</p>","PeriodicalId":520548,"journal":{"name":"African journal of AIDS research : AJAR","volume":" ","pages":"110-122"},"PeriodicalIF":1.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40556156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with poor access to HIV and sexual and reproductive health services in Nigeria for women and girls living with HIV during the COVID-19 pandemic.","authors":"Morenike Oluwatoyin Folayan,&nbsp;Olujide Arije,&nbsp;Amaka Enemo,&nbsp;Aaron Sunday,&nbsp;Amira Muhammad,&nbsp;Hasiya Yunusa Nyako,&nbsp;Rilwan Mohammed Abdullah,&nbsp;Henry Okiwu,&nbsp;Veronica Akwenabuaye Undelikwo,&nbsp;Pamela Adaobi Ogbozor,&nbsp;Oluwaranmilowo Amusan,&nbsp;Oluwatoyin Adedoyin Alaba,&nbsp;Erik Lamontagne","doi":"10.2989/16085906.2022.2104169","DOIUrl":"https://doi.org/10.2989/16085906.2022.2104169","url":null,"abstract":"<p><p><i>Aim</i>: To determine the proportion of women and girls living with HIV (WGLHIV) who had poor access to HIV, tuberculosis and sexual and reproductive health (SRH) services in Nigeria during the COVID-19 pandemic and associated factors.<i>Methods:</i> This was a cross-sectional study that recruited WGLHIV with six categories of vulnerability (sex work, transactional sex, injecting or using illegal drugs, people on the move, transgender women and people with a disability) through an online survey conducted in ten Nigerian states between june and October 2021. The associations between the limited access to HIV, tuberculosis and SRH services due to COVID-19, the categories of vulnerability and the financial and non-financial barriers to these services were determined using multivariable logistics regression analysis.<i>Results:</i> Over 6 in 10, almost 2 in 10, and almost 4 in 10 WGLHIV had limited access to HIV, tuberculosis and SRH services respectively during the COVID-19 pandemic. Transgender women had 3.59 (95% CI 2.19-5.91) higher odds, women who engaged in sex work had 4.51 (95% CI 2.28-8.42) higher odds, and women who inject or use illegal drugs had 2.39 (95% CI 1.47-32.90) higher odds of facing limited access to sexual and reproductive health services when it was needed. In addition, the direct consequences of the COVID-19 crisis, such as the closure of HIV services and SRH service points, exacerbated pre-existing barriers significantly. Having no money, having to pay additional unofficial fees and the lack of security on the road to the health facility were the barriers with the greatest impact on access to health services.<i>Conclusions:</i> The COVID-19 pandemic had a negative impact on the access of WGLHIV to essential health services. This impact was disproportionately higher for marginalised groups. WGLHIV need non-discriminatory and affordable access to essential health services during the pandemic.</p>","PeriodicalId":520548,"journal":{"name":"African journal of AIDS research : AJAR","volume":" ","pages":"171-182"},"PeriodicalIF":1.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40553151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons learnt from UNAIDS virtual technical support to countries applying for funding from the Global Fund COVID-19 Response Mechanism.","authors":"Arlette Campbell White,&nbsp;Marc Péchevis,&nbsp;Adriana Jimenez Cuen","doi":"10.2989/16085906.2022.2090394","DOIUrl":"https://doi.org/10.2989/16085906.2022.2090394","url":null,"abstract":"<p><p>In 2020 the Global Fund for AIDS, Tuberculosis and Malaria initiated a new funding modality, the COVID-19 Response Mechanism, to mitigate the pandemic's effects on HIV, TB and malaria programmes and health systems in implementer countries. In 2021 UNAIDS introduced an innovative technical virtual support mechanism for COVID-19 Response Mechanism proposal development to help countries quickly implement COVID-19 interventions while at the same time adapting HIV and related services to the pandemic's circumstances and mitigate its impact while maintaining hard-won gains. It also intended to ensure more attention was paid to communities, human rights and gender considerations in proposal development, resulting in successful proposals to mitigate COVID-19's impact, bring human rights-based and people-centred HIV programmes back on track and even expand their reach through using new delivery platforms. In 2021, applications from 18 sub-Saharan African and Asian countries received in-depth remote peer reviews. We discuss the reviews' key findings and recommendations to improve proposal quality and identify future opportunities for virtual technical support. The model was successful and contributed to better quality funding applications, but also highlighted challenges in pandemic mitigation, adaptations and innovations of HIV programmes. Countries still fell short on comprehensive community, human rights and gender interventions, as well as innovations in HIV service delivery, especially in prevention and gender-based violence. Several other weaknesses meant that some countries would have to refine their programme design and implementation model in the final version of their funding application. There are implications for future assistance to countries trying to mitigate the impact of COVID-19 on their health programmes and innovative ways to deliver technical support using new technologies and local expertise.</p>","PeriodicalId":520548,"journal":{"name":"African journal of AIDS research : AJAR","volume":" ","pages":"100-109"},"PeriodicalIF":1.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40553605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of the COVID-19 pandemic on people living with HIV in Zimbabwe.","authors":"Bernard Madzima,&nbsp;Tatenda Makoni,&nbsp;Owen Mugurungi,&nbsp;Godfrey Mudariki,&nbsp;Amon Mpofu,&nbsp;Freeman Dube,&nbsp;Lameck Munangaidzwa,&nbsp;Isaac Taramusi","doi":"10.2989/16085906.2022.2103004","DOIUrl":"https://doi.org/10.2989/16085906.2022.2103004","url":null,"abstract":"<p><p>The COVID-19 pandemic was reported from March 2020 in Zimbabwe. COVID-19 containment measures which included repeated lockdowns have disrupted community interactions, reduced working hours, restricted travel and restricted HIV services for people living with HIV (PLHIV), among others. The study adopted a cross-sectional design. Both qualitative and quantitative data were collected in all the 10 provinces and analysed. A sample size of 480 was calculated for the cross-sectional survey. Secondary data on HIV early warning indicators from 2018 to 2021 were extracted from 20 randomly selected health facilities and used for modelling. Mathematical modelling was conducted to assess the impact of COVID-19 on PLHIV. AIDS-related deaths increased from 20 100 in 2019 to 22 200 in 2020. In addition, there were significant years of life lost (yLLs) from premature mortality and years of life lost due to disability (yLDs) from COVID-19. Prevalence of COVID-19 among PLHIV was 4%. COVID-19 vaccination coverage was 64%, which is higher than the national average of 42%. Stress and breach of confidentiality as ARV medicines were given out in open spaces and fear of contracting COVID-19 were the perceived psychological issues. COVID-19 disrupted HIV service provision, increased AIDS-related deaths and caused psychological challenges.</p>","PeriodicalId":520548,"journal":{"name":"African journal of AIDS research : AJAR","volume":" ","pages":"194-200"},"PeriodicalIF":1.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40553606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The global HIV response at 40.","authors":"David Wilson,&nbsp;Alethea Wen Lan Cook,&nbsp;Zara Shubber","doi":"10.2989/16085906.2022.2083975","DOIUrl":"https://doi.org/10.2989/16085906.2022.2083975","url":null,"abstract":"&lt;p&gt;&lt;p&gt;It is helpful to divide the global HIV response into three phases: The first, from about 1980 to 2000, represents \"Calamity\". The second, from roughly 2000 to 2015 represents \"Hope.\" The third, from 2015, is unfolding and may be termed \"Choices\" - and these choices may be severely constrained by COVID, so \"Constrained Choices in an era of COVID\" may prove more apt. As we take stock of HIV at 40, there are positive lessons for the wider health response - and challenging reflections for the wider impact of the global HIV response. The positive lessons include: (1) the importance of activism; (2) the role of scientific progress and innovation; (3) the impact of evidence in concentrating resources on proven approaches; (4) the importance of surveillance to understanding transmission dynamics; (5) the use of epidemic intelligence to guide precision implementation; (6) the focus on implementation cascades (diagnosis, linkage, adherence, disease suppression); and finally (7) an overarching execution and results focus.Given this remarkable legacy, it seems churlish to ask whether the HIV response could have achieved more. Yet, consider these approximate figures. Development assistance for HIV totals about 100 billion dollars, 70 billion from the USA matched by roughly 100 billion in domestic resources. For 200 billion dollars, should we not have achieved more than 23 million people initiating treatment (very crudely, 10 000 dollars per person on treatment)? Much of the hundred billion dollars of development assistance (roughly half) focused on about a dozen priority countries in eastern and southern African. The larger PEPFAR recipients, with populations of roughly 50 million, each received 5 billion dollars or more cumulatively. And there are further Global Fund contributions of an additional billion dollars in many of these countries. For 6 billion dollars per country, should we have expected more?The World Bank Human Capital Project posits that to maximize human capital formation, countries must ensure that their children survive, are well nourished and stimulated, learn skills and live long, productive lives. Using the Human Capital Index (a composite index based on these factors), South Africa - the largest HIV financing recipient - ranks 126th of 157 countries, below Haiti, Ghana, the Congo Republic, Senegal and Benin. Consider how many recipients of major HIV development finance fall into the bottom fifth: Namibia, Botswana, Eswatini (formerly Swaziland), Malawi, South Africa, Tanzania, Zambia, Uganda, Lesotho, Ethiopia, Mozambique, Cote D'Ivoire and Nigeria. Of course, causality is unresolved and there are several possible explanations: (1) low human capital formation may increase HIV transmission; (2) the HIV epidemic may have intergenerational impacts; (3) the all-consuming focus on HIV may have displaced other health, education and development priorities. Yet, it remains hard to see these data and to argue that successful HIV responses a","PeriodicalId":520548,"journal":{"name":"African journal of AIDS research : AJAR","volume":" ","pages":"93-99"},"PeriodicalIF":1.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40556153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}