HIV prevalence in young people and children living on the streets, Kenya

Objective To obtain an estimate of the size of, and human immunodeficiency (HIV) prevalence among, young people and children living on the streets of Eldoret, Kenya. Methods We counted young people and children using a point-in-time approach, ensuring we reached our target population by engaging relevant community leaders during the planning of the study. We acquired point-in-time count data over a period of 1 week betweethe hours of 08:00 and 23:00, from both a stationary site and by mobile teams. Participants provided demographic data and a finger print(to avoid double-counting) and were encouraged to speak with an HIV counsellor and undergo HIV testing. We used a logistic regression (model to test for an association between age or sex and uptake of HIV testing and seropositivity. Findings Of the 1419 eligible participants counted, 1049 (73.9%) were male with a median age of 18 years. Of the 1029 who spoke with a counsellor, 1004 individuals accepted HIV counselling and 947 agreed to undergo an HIV test. Combining those who were already aware of their HIV-positive status with those who were tested during our study resulted in an overall HIV seroprevalence of 4.1%. The seroprevalence was 2.7% (19/698) for males and 8.9% (23/259) for females. We observed an increase in seroprevalence with increasing age for both sexes, but of much greater magnitude for females. Conclusion By counting young people and children living on the streets and offering them HIV counselling and testing, we could obtain population-based estimates of HIV prevalence

Extent to which low-level use of antiretroviral treatment could cure the AIDS epidemic in sub-Saharan Africa

Despite growing international pressure to provide HIV-1 treatment to less-developed countries; potential demographic and epidemiological impacts have yet to be characterised. We modelled the future impact of antiretroviral use in south Africa from 2000 to 2005. methods: We produced a population projection model that assumed zero antiretroviral use to estimate the future demographic impacts of the HIV-1 epidemic. We also constructed four antiretroviral-adjusted scenarios to estimate the potential effect of antiretroviral use. We modelled total drug cost; cost per life-year gained; and the proportion of pe-person health-care expenditure required to finance antiretroviral treatment in each scenario. Findings: With no antiretroviral use between 2000 and 2005; there will be about 276000 cumulative HIV-1-positive births; 2;302;000 cumulative new AIDS cases; and the life expectancy at birth will be 46.6 years by 2005. By contrast; 110;000 HIV-1-positive births could be prevented by short ourse antiretroviral prophylaxis; as well as a decline of up to 1 year of life expectancy. The direct drug costs of universal coverage for this intervention would be US$54 million - less than 0.001of the per-person health-care expenditure. In comparison; triple-combination treatment for 25of the HIV