Implementing Comprehensive HIV and STI Programmes with Men Who Have Sex with Men : PRACTICAL GUIDANCE FOR COLLABORATIVE INTERVENTIONS

Men who have sex with men are disproportionately affected by human immunodeficiency virus (HIV) compared to the general population in nearly all countries collecting reliable surveillance data. In low- and middle-income countries they have 19.3-fold greater odds of being infected with HIV compared with the general population. HIV prevalence among men who have sex with men across North, South and Central America, South and Southeast Asia and sub-Saharan Africa ranges from 14% to 18%. Even as HIV incidence is in decline worldwide, the rate of new HIV infections among men who have sex with men remains unchanged and is increasing in some high-income countries like the United States.

In 2011 the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Development Programme (UNDP) and The Global Forum on MSM & HIV (MSMGF) developed a guidance document on Prevention and treatment of HIV and other sexually Transmitted infections among men who have sex with men and transgender people.1 The document sets out technical recommendations on interventions for the prevention and treatment of HIV and other sexually transmitted infections (STIs) among men who have sex with men. In 2014, WHO released the Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations.2 These bring together all existing guidance related to key populations, including men who have sex with men, with updates on selected guidance and recommendations. The recommendations of these two publications are summarized in Table 1 at the end of this Introduction.

Following the dissemination of the 2011 Recommendations and the 2014 Key Populations Consolidated Guidelines describing effective, evidence-based interventions (the what), a need was expressed for guidance focused on implementation (the how). This publication responds to that need by offering practical advice on implementing HIV and STI programmes for men who have sex with men, aligned with the 2011 Recommendations and the 2014 Key Populations Consolidated Guidelines. It contains examples of good practice from around the world that may support efforts in planning programmes and services, and describes issues that should be considered and how to overcome challenges.

The need for this tool

The health and prevention benefits of antiretroviral therapy (ART) in the management of HIV are now strongly supported by research. Behavioural prevention programmes including use of condoms and lubricant, early diagnosis, prompt linkage to sustained care and ART, and viral suppression constitute points along a comprehensive continuum of HIV-related services. When services are easily accessible, implemented effectively and delivered in close partnership with their intended beneficiaries, this comprehensive continuum of health services reduces morbidity, mortality and onward transmission of HIV.

Read the report online: http://www.undp.org/content/dam/undp/library/hivaids/English/MSMIT.pdf

Length of secondary schooling and risk of HIV infection in Botswana: evidence from a natural experiment

Background

An estimated 2·1 million individuals are newly infected with HIV every year. Cross-sectional and longitudinal studies have reported conflicting evidence for the association between education and HIV risk, and no randomised trial has identified a causal effect for education on HIV incidence. We aimed to use a policy reform in secondary schooling in Botswana to identify the causal effect of length of schooling on new HIV infection.

Methods

Data for HIV biomarkers and demographics were obtained from the nationally representative household 2004 and 2008 Botswana AIDS Impact Surveys (N=7018). In 1996, Botswana reformed the grade structure of secondary school, expanding access to grade ten and increasing educational attainment for affected cohorts. Using exposure to the policy reform as an instrumental variable, we used two-stage least squares to estimate the causal effect of years of schooling on the cumulative probability that an individual contracted HIV up to their age at the time of the survey. We also assessed the cost-effectiveness of secondary schooling as an HIV prevention intervention in comparison to other established interventions.

Findings

Each additional year of secondary schooling caused by the policy change led to an absolute reduction in the cumulative risk of HIV infection of 8·1 percentage points (p=0·008), relative to a baseline prevalence of 25·5% in the pre-reform 1980 birth cohort. Effects were particularly large in women (11·6 percentage points, p=0·046). Results were robust to a wide array of sensitivity analyses. Secondary school was cost effective as an HIV prevention intervention by standard metrics (cost per HIV infection averted was US$27 753).

Interpretation

Additional years of secondary schooling had a large protective effect against HIV risk in Botswana, particularly for women. Increasing progression through secondary school could be a cost-effective HIV prevention measure in HIV-endemic settings, in addition to yielding other societal benefits.

Read the full article:  http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)00087-X/fulltext

Making it work: Lessons learnt from three regional workshops to integrate human rights into national HIV strategic plans

To strengthen national response to HIV,  United Nations Programme on HIV/AIDS (UNAIDS) in collaboration with the technical support of the International HIV/AIDS Alliance (the Alliance), initiated a project in 2011 to help national stakeholders (national AIDS programme managers, officials from ministries of health, gender and justice, civil society representatives, members of affected communities and UN staff) integrate human rights programmes into National Strategic Plans (NSPs).

This brief report outlines some short term outcomes and lessons learnt from this initiative. It is available at:

http://www.aidsalliance.org/publicationsdetails.aspx?id=90616

The Global Fund's Uncertain Future

Between 2001 and 2010, The Global Fund’s top 20 government donors contributed US$18 billion. For the period from 2002 to 2015, governments have pledged $28.3 billion to the Fund, $20.7 billion of which has actually materialized. The money spent by the Global Fund since 2001 has put 3.3 million people on antiretroviral therapy, helped detect and treat 8.6 million cases of TB, and has been used to distribute 230 million insecticide-treated bed nets to households across sub-Saharan Africa."But after years of steady growth in both the number of donors and the amount of their contributions, The Global Fund now faces a $2 billion shortfall that Feachem says will carry devastating consequences for developing countries unless the fund is replenished.

Thari Ya bana: Reflections on children in Botswana 2011

This second edition of Thari Yabana brings together research and reflections on children's issue in Botswana. However, the issues themselves are not unique to Botswana and thus the findings reported in this publication will also benefit children in other countries. The publication is divided into the following five sections: young child survival, child development, child protection, HIV and AIDS and child sensitive social protection. Articles from ORI students and staff include: "Feeding practices, feeding environment and growth status of children (2-5 years in Tubu, Shorobe and Xobe Molapo farming villages by G. Ramolefhe, M.Nyepi, M.J. Chimbari and N.O.Ama and "Predictors of household food insecurity and implications for child nutrition by D. Mmopelwa, M.Nnyepi and P. Codija. The publication is now available in the ORI Library.

Africa must spend 'a lot more' on non-communicable disease

To overcome the barriers and deal with a changing health situation on the continent, African health scientists need more funding and support according to the the World Health Summit held in Berlin, Germany recently. Infectious diseases, such as tuberculosis, malaria and HIV/AIDS, are expected to decline while non-communicable diseases, including cardiovascular disease, cancer and diabetes, will increase in Africa over the coming decades. Olive Shisana, chief executive officer of the South African Human Sciences Research Council said thet "Africa's investment in infrastructure is inadequate, especially at a time when our continent is going through an epidemiological transition. Many of these diseases can be prevented by putting scientific research and health technologies to work and affords the continent the opportunity to build capacity and to collaborate to tackle these diseases together for the benefit of the globe".

Traditional medicine gains ground in African universities

According to a report published on traditional medicine on the continent, the number of African countries with national policies on traditional medicine increased almost fivefold 2001 and 2010, The report, published by WHO, Regional Committee for Africa two weeks ago , also found that the number of countries with strategic plans for traditional medicine increased from zero to 18 in the same period, and those with national regulatory frameworks rose from one to 28. For example in 2010, 22 countries conducted research on traditional medicines for malaria, HIV/AIDS, sickle-cell anaemia, diabetes and hypertension using WHO guidelines. According to WHO, roughly 80 per cent of people in developing countries depend on traditional medicine for their primary healthcare. Some African universities had incorporated traditional medicine into the curricula for medical and pharmacy students, the report found. Health ministers and the WHO African regional office agreed at the meeting to promote this integration as a way of increasing research in the field.

The Southern African Quadrant Jeopardy: Interlinkages between Culture, GBV, HIV and Women's Rights

This position paper articulates the stance of civil society and communities on the inter-linkages between culture, gender-based violence (GBV), HIV, and women's rights. It looks at current interventions to address the problem, and offers recommendations for states, custodians of culture, civil society organizations, policy makers, and media organizations. According to the discussions, the drivers of the HIV epidemic in southern Africa do not lie only in gender inequalities, but also in the sociocultural, economic, and political contexts of the countries in the region, which form a sharp backdrop against which the increased vulnerability of women to HIV infection must be viewed. For more details go to: http://www.safaids.net/files/SAfAIDS_GBV_position_paper.pdf

Professor Moses Chimbari appointed to ESPA Advisory Committee

The Deputy Director, Research Services, of the Okavango Research Institute, Professor Moses Chimbari has been appointed Africa's representative to the prestigious Ecosystems Services for Poverty Alleviation Programme (ESPA) Advisory Committee (I-PAC). The Programme aims to deliver high quality cutting edge research that will improve understanding on the way ecosystems function, the services they provide and their relationships with political economy and sustainable growth. Professor Chimbari brings to the fore a wealth of experience in research management having worked in various institutions in Southern Africa. His areas of interest are extensive :ranging from public health aspects on diseases like malaria and HIV to fisheries and limnology. Congratulations Professor Chimbari!

We are all in the same boat

Stigma is a major cause of suffering for people living with HIV. This toolkit is part of the growing international response to do something about stigma. Its aim is to educate about HIV stigma and discrimination and build their skills, confidence and commitment to act against stigma.
Children in HIV affected households also face stigma – they may be badly treated by their extended family or the family that decides to take them in, they may face verbal and physical abuse and may be forced to drop out of school.
Access this document at:
http://www.aidsalliance.org/includes/Publication/All_in_the_same_boat.pdf