PLWHIV are placing themselves at the centre to End the Epidemic by 2030

UNAIDS calls for greater urgency as global gains slow and countries show mixed results towards 2020 HIV targets

Impressive advances in some countries, troubling failures in others as available resources for HIV fall by nearly US$ 1 billion

ESHOWE/GENEVA, 16 July 2019—The pace of progress in reducing new HIV infections, increasing access to treatment and ending AIDS-related deaths is slowing down according to a new report released today by UNAIDS. UNAIDS’ Global AIDS Update, Communities at the centreshows a mixed picture, with some countries making impressive gains while others are experiencing rises in new HIV infections and AIDS-related deaths.

“We urgently need increased political leadership to end AIDS,” said Gunilla Carlsson, UNAIDS Executive Director, a.i., “This starts with investing adequately and smartly and by looking at what’s making some countries so successful. Ending AIDS is possible if we focus on people, not diseases, create road maps for the people and locations being left behind, and take a human rights-based approach to reach people most affected by HIV.”

Report shows that less than 50% of key populations were reached with combination HIV prevention services in more than half of the countries that reported. This highlights that key populations are still being marginalized and being left behind in the response to HIV. (KEY POPULATION INCLUDES DISCORDANT PARTNERS)

This segment of serodiscordant couples (SDC) is aware of their discordance (that one of them has HIV and the other does not) and have had their relationship disrupted by it in some way. They may be experiencing blame over who brought HIV into the relationship, disconnection around sex, and/or discouragement around conceiving. The discordance has been so disruptive for some that they now face the “discordance dilemma.” They see the avoidance of HIV transmission at odds with preserving their relationship. Other couples endure the discordance out of love and commitment, but the risk of HIV transmission is still disruptive, complicating the things they want and value in their relationship—intimacy and children. For Serodiscordant partners enrolling in PrEP is often perceived as more burdensome than helpful. Bringing up PrEP may resurface undesirable, negative feelings associated with the discordance, such as blame, guilt, and even violence. In visiting an HIV clinic, SDC risk disclosing their discordance to others, and partners without HIV risk being mislabelled as HIV positive. And taking PrEP may bring on undesirable stigma from others. Thus, when SDC compare PrEP to other HIV-prevention tools like condoms, many struggles to be convinced of its relative effectiveness and appeal.

A five-year-old can grasp the concept of germs and that they need to take medication daily — what the guidelines call “partial disclosure”. But a 12-year-old can understand not only that they have HIV, but also how it’s spread and the implications of infecting someone else.

Covering up a child’s HIV status, say the guidelines, does more harm than good.

There is no comparable framework for HIV-positive parents who want to disclose their own status to their children but Marnie Vujovic, a clinical psychologist  believes many of the same rules apply.

“As they mature, children are able to take in more and more information and absorb it in a meaningful way,” she says. “Parents can get a pretty good sense of where a child is just in a conversation — and often they’ll give you natural opportunities to tell them more just by asking questions. That’s a perfect time to say, ‘Okay this child needs more information. He or she has seen something and is concerned about it and I need to answer it honestly and openly as I can rather than side-stepping the issue.’”

The Amagugu intervention sought to teach the participating mothers an age-appropriate way of telling their HIV-negative kids about their status, with toys and games specifically targeted at six- to 10-year-olds.

A sticker activity can be used to explain how HIV attacks a body: the virus becomes angry red dots, the CD4 cells — bodies that typically help the immune system’s response — are depicted as spears trying to fight it off, and antiretrovirals (ARVs) emerge as green shields.

A memory card game helped mothers to explain their monthly clinic visits and everything the children could expect to see there: doctors, nurses, ambulances, needles.

Mothers need to keep the emphasis on their love for the child — to keep their arms wrapped around their shoulders, to speak calmly and reassuringly.

“For this age group of children, the disclosure goes better with more preparation and if mom is more emotionally contained,” says Rochat. For the mothers, it meant counselling sessions before their disclosure to help them to come to terms with their own narrative about how they had contracted HIV.

“You don’t have to tell your kids the whole truth,” says Rochat. “They don’t have to know if you were raped or that your partner cheated on you.”

Elimination of Stigma=Elimination of HIV transmission


12Jun

Breast milk is the best

Many HIV positive mothers worry about the safety of breastfeeding.  ~ 

After living in denial of being HIV positive, a rural mother has finally come to accept her status through a process of questioning whether or not to breastfeed her new baby.

Mother of five children, Johana Mahabeledzha (36), has been given a new lease on life after living in denial for years. The woman, who lives in Mangondi village, outside Thohoyandou, says it is not easy to be HIV positive because the discrimination and stigma that goes along with living with the virus in rural communities.

'I lived in denial'

Now, despite having accepted her HIV status, she faces the challenge of raising her two-month old HIV-negative child as she cannot afford to purchase baby milk formula as she is currently unemployed and fears breastfeeding.

“It was while I was lying helpless in my hospital bed that I realised that I cannot allow HIV to be the end of me and leave my children without a mother. When I was tested and told that I am HIV positive four years ago, I insulted the nurses and told them that it cannot be true. I lived in denial until I became too sick to do anything,” she said.

“I have now come to accept that there is nothing I can do to change the fact that I am now HIV positive,” said Mahabeledzha.

Now when she goes to collect her treatment at Magwedzha Clinic in Dumasi village, outside Thohoyandou, Mahabeledzha usually gives talks, encouraging people to get tested and know their status.

“People here will judge and discriminate against you for living with HIV. Like as if you choose to have the virus. I suffered in denial because of my fear of being discriminated against by the community. People around here still lack knowledge and information and believe that HIV is a death sentence. That is not true. I also used to think that HIV is a death sentence, but through several counsellings I now think of HIV like any other illness,” she said.

Formula milk 'very expensive'

When Mahabeledzha gave birth to her youngest child two months ago, she was advised not to breastfeed but to use baby formula milk, which she cannot afford because she is not working.

“My child is HIV negative and I do not want to pass the virus to him. But formula milk is very expensive. Sometimes I get confused when some people tell me that I can breastfeed without passing the virus to my child, but I fear that I might pass the virus to him. Sometimes I breastfeed when I run out of formula milk. I just hope my child will remain HIV negative,” she said.

In 2016 the Limpopo Department of Health launched the province’s first breast milk bank at Mankweng Hospital, with the aim of helping mothers who cannot breastfeed their babies due to various reasons.

The World Health Organization (WHO) recommends exclusive breastfeeding for mothers living with HIV in resource-poor settings provided that they have access to ARTs. – Health-e News.

Image credit: iStock

Ndivhuwo Mukwevho

30Apr

The sexual partners and drug injecting partners of people diagnosed with HIV infection have an increased probability of also being HIV-positive . However, partner testing services, including partner notification, for people diagnosed with HIV have not been routinely offered or implemented, therefore, uptake and coverage remains low. The benefits of partner and couples HTS have been well documented, including mutual support to access prevention, treatment and care services, as well as improved adherence and retention in treatment and prevention of mother-to-child transmission programmes . Partner testing also allows those in serodiscordant partnerships to prioritize effective HIV prevention, such as the use of condoms, immediate antiretroviral therapy (ART), medication adherence by HIV-positive partners, and pre-exposure prophylaxis (PrEP) for HIV-negative partners

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26Apr

Provides a venue for mutual disclosure of HIV status in an environment where support can be provided by a counsellor or health worker. Risk-reduction messages can be tailored depending on the outcome of the test results of both partners. Decisions about prevention, accessing treatment, care and support, and family planning options can be made together. Moreover, through couples testing, the counsellor can help create a safe environment in which the couple can discuss potentially difficult issues, such as sexual agreements. Sexual agreements are mutually agreed upon conditions or limitations about sexual behaviours within and outside of the relationship. Couples HIV testing and counselling provides a forum for open discussion about sexual agreements, with the help of a counsellor. This helps both partners fully understand the agreement which may better protect them from HIV

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01Jun

There are many factors that determine whether or not someone becomes infected with HIV. There may be one or multiple reasons why you have not been infected with HIV. • HIV viral load The amount of virus in your partner’s blood (viral load) is very important for determining if you become infected or not. The higher the viral load, the greater the chance that you will become infected. • The type of virus The type of HIV that infects one person may be very different to the type that infects another. Some types are more likely to spread. Your partner may be infected with a type that spreads less easily. • Frequency of sexual intercourse The more often you have unprotected sex with someone who is HIV positive, the more likely you are to become infected. • Sexual practices Receptive anal sex carries the highest risk of infection. Women are more likely to become infected during vaginal sex than men. • Male circumcision Men who have been circumcised, i.e. the entire foreskin has been removed, are less likely to become infected with HIV than those who have not.

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30May

With the successful introduction of ART, the life expectancy of children living with HIV (CLHIV) is substantially increased. However, strict compliance is a necessary step at the outset, as noncompliance is associated with its own drawbacks, including incomplete suppression and reduced overall survival in patients. S.A is lagging behind in procuring friendly drugs for children, which is affecting their quality of life. It's time to act now, the challenges require collaborative efforts, these children cannot speak for themselves, but we can. This is a call for ACION!