ABSTRACT
Globally; in the last 20 years health has improved. In this generally optimistic setting HIV and AIDS accounts for the fastest growing burden of disease. The data show the bulk of this is experienced in Southern Africa. In this region; HIV and AIDS (and tuberculosis [TB]) peaks among young adults. Women carry the greater proportion of infections and provided most of the care. South Africa has the dubious distinction of having the largest number of people living with HIV in the world; 6.4 million. HIV began spreading from about 1990 and today the prevalence among antenatal clinic attendees is 29.5. A similar situation exists in other nations of the region. It is an expensive disease; requiring more resources than are available; and it is slipping off the global agenda; both in terms of attention and international funding. Those halcyon days of the decade from 2000 to 2010 are over. This paper explores the concept of three transition points: economic; epidemiological and programmatic. The first two have been developed and written about by others. We add a third transition point; namely programmatic; argue this is an important concept; and show how it can become a powerful tool in the response to the epidemic.The economic transition point assesses HIV incidence and mortality of people infected with HIV. Until the number of newly infected people falls below the number of deaths of people living with HIV; the demand for treatment and costs will increase. This is a concern for the health sector; finance ministry and all working in the field of HIV. Once an economic transition occurs the treatment future is predictable and the number of people living with HIV and AIDS decreases. This paper plots two more lines. These are the number of new people from the HIV infected pool initiated on treatment and the number of people from the HIV infected pool requiring treatment. This introduces new transition points on the graph. The first when the number of people initiated on treatment exceeds the number of people needing treatment. The second when the number initiated on treatment exceeds the new infections.That is the theory. When we applied South African data from the ASSA2008 model; we were able to plot transition points marking progress in the national response. We argue these concepts can and should be applied to any country or HIV epidemic
Subject(s)
Acquired Immunodeficiency Syndrome , Communicable Disease Control , Cost of Illness , HIV InfectionsABSTRACT
Epidemiological modelling has concluded that if voluntary medical male circumcision (VMMC) is scaled up in high HIV prevalence settings it would lead to a significant reduction in HIV incidence rates. Following the adoption of this evidence by the WHO; South Africa has embarked on an ambitious VMMC programme. However; South Africa still falls short of meeting VMMC targets; particularly in KwaZulu-Natal; the epicentre of the HIV/AIDS epidemic. A qualitative study was conducted in a high HIV prevalence district in KwaZulu-Natal to identify barriers and facilitators to the uptake of VMMC amongst adolescent boys. Focus group discussions with both circumcised and uncircumcised boys were conducted in 2012 and 2013. Analysis of the data was done using the framework approach and was guided by the Social Cognitive Theory focussing on both individual and interpersonal factors influencing VMMC uptake. Individual cognitive factors facilitating uptake included the belief that VMMC reduced the risk of HIV infection; led to better hygiene and improvement in sexual desirability and performance. Cognitive barriers related to the fear of HIV testing (and the subsequent result and stigmas); which preceded VMMC. Further barriers related to the pain associated with the procedure and adverse events. The need to abstain from sex during the six-week healing period was a further prohibiting factor for boys. Timing was crucial; as boys were reluctant to get circumcised when involved in sporting activities and during exam periods. Targeting adolescents for VMMC is successful when coupled with the correct messaging. Service providers need to take heed that demand creation activities need to focus on the benefits of VMMC for HIV risk reduction; as well as other non-HIV benefits. Timing of VMMC interventions needs to be considered when targeting school-going boys