Aids Prevention Policy - Essay Example

?Literature Review: HIV/Aids Prevention Policy in Sub-Saharan Africa (Zambia) The literature review has been conducted out of the frustration that the HIV/AIDS prevention efforts are outpaced by the spread of the pandemic. The inclusion criteria include the sources covering the topic on HIV/Aids Prevention Policy in Sub-Saharan Africa (Zambia) and spanning from 2000 to date. The exclusion criteria involved the removal of the duplicates, articles not relevant to the topic, those that lack conclusive data as well as other reasons. The main factors that will form the scope of the study include HIV/AIDS prevalence in Zambia, policy overview, interventions, recommendations and challenges. The review will also identify the information gaps that require further review. Search Strategy The inclusion criteria include the sources covering the topic on HIV/Aids Prevention Policy in Sub-Saharan Africa (Zambia) and spanning from 2000 to date. The exclusion criteria involved the removal of the duplicates, articles not relevant to the topic, those that lack conclusive data as well as other reasons (Figure 1). However, information from the older sources will be included i.e. published or evaluated before 2000 in cases where the identified sources import information from older sources. The main factors that will form the scope of the study include HIV/AIDS prevalence in Zambia, policy overview, interventions, recommendations and challenges. The review will also identify the information gaps that require further review. Figure 1: Flow Diagram of the Study Selection Process The identified literature offered a conclusive literature review on the topic of the study. Pubmed and Ovid were the first search engines used using the terms and inclusion criteria stated above (Aveyard, 2007; Oliver, 2012). They were both useful because they are quick and easy to perform and enabled original research papers (primary data) were found. In addition it was possible to combine terms and hence narrow research to more relevant data. The pubmed search initially identified 112 references of which 66 were considered relevant for further reading based on title and abstract (Figure 1). PubMed provided more useful papers than Ovid. This is because the usefulness of alternate appropriate terms and the clinical section was realised when the term prevention of mother to child transmission (PTMC) and limiting to systematic reviews led to addition of five more sources that were previously not shown. However, PubMed is limiting because it only contains abstracts which do not normally contain controls for the initially randomised trials. The Cochrane Database of Systematic reviews, a valuable resource providing summary information on the results of several use of ARVs, was also searched providing three references for consideration. The WHO website was also searched and included the necessary information for achieving a global perspective. A key WHO guidance was found: Scaling up HIV prevention: why routine or mandatory testing is not feasible for sub-Saharan Africa. Source: http://www.who.int/bulletin/volumes/85/8/06-037671/en/index.html A modification of the research would be to limit search to the under-developed countries especially the African countries. Use of the Worldwide Web led to the identification and inclusion of other sources that wee useful to the topic under investigation. Top of Form Recent queries Search Add to builder Query Items found Time #5 Add Search challenges facing HIV/AIDS prevention activities 4 02:52:13 #4 Add Search HIV/AIDS intervention strategies in sub-Saharan Africa 55 02:49:19 #3 Add Search HIV/AIDS policy in Zambia 26 02:47:52 #2 Add Search prevention of mother to child transmission of HIV/AIDS in Zambia 7 02:46:58 #1 Add Search HIV/Aids Prevention Policy in Sub-Saharan Africa (Zambia 10 02:45:13 Results HIV/AIDS Prevalence in Zambia The 2011 HIV/AIDS statistics show that sub-Saharan Africa is the most affected region, accounting for 69% of the global totals of HIV/AIDS related infections i.e. 23.5 million victims (Jones et al., 2006 and UNAIDS, 2012). Earlier studies show that the life expectancy for Zambians has also fallen from 54 to 43 years with future projection indicating that life expectancy is expected to fall further (UNAIDS-WHO, 2004). UNAIDS (2012) report affirms that 92% of the HIV pregnant women are found in the Sub-Saharan region, with one in five pregnant women being infected with the HIV/AIDS. The report also estimates that 25-35% of HIV positive pregnant women have a high probability of transmitting the virus to their newborns. The reason why women in Zambia are highly vulnerable to contracting HIV according to Shezongo-Macmillan and WLSA (2007) is due to genital vulnerability, gender-based power bias and their engagement in risky sexual habits such as failure to use protection geared towards avoiding marital infidelity among men. This has also been blamed as the contributory factors to the high HIV prevalence rates among the children in Sub-Saharan region; 90% of the global totals. Other than breastfeeding, mother-child transmission can also occur through utero or during delivery. Policy Overview According to Shezongo-Macmillan and WLSA (2007), the HIV policy in Zambia is characterised by elements such as the National HIV/AIDS/STD/TB Council, HIV/AIDS Strategic Framework 2001-2003, Macroeconomic Policy, Non-Governmental Organizations and Decentralization. The National HIV/AIDS/STD/TB Council was established in 2000 with an aim of serving as the most powerful institution for national leadership, technical and strategic leadership on all the intervention programs geared towards reducing the spread of the virus (Kandala et al., 2011). The HIV/AIDS Strategic Framework 2001-2003 is made up of key intervention measures that ensure that the preventive initiatives are results-based. Such strategies include behavioural change, mobilizing the multispectral response and increase in voluntary Counselling and Testing programs. Macroeconomic Policy allows all the HIV/AIDS prevention programs to be included in the country’s overall development programs. The decentralisation policy frame work has enabled the prevention programmes to be distributed at the district levels through the establishment of District Basket Funding System that enhances prevention in their catchment areas. The Non-Governmental Organizations coordinate prevention activities at the community and district level. Interventions According to Stringer et al (2005:1310), more than 10 000 babies are born to HIV infected mothers. Intervention measures ensure that most of these children are protected from contracting the disease. De Cock et al (2000) estimated the risk at 40% due to high vulnerability to transmission through various channels such as delivery, gestation and breastfeeding. However, antiretroviral prophylaxis can be used to address the risk. The prominent intervention strategy has been led by the government whereby HIV prevention strategies have been integrated into the country’s development agenda. According to Garbus (2003) and Kandala et al. (2011), the objective of the policy is to prevent and reverse the spread of HIV/AIDS disease in Zambia. For example, according to National HIV/AIDS/STI/TB Council (2010), the PMTCT experienced a reduction from 30 to 12.4% and increased HIV screening from 29.7% in 2006 to 50% in 2009. The HIV infection among infants and unborn children can be prevented through use of antiretroviral prophylaxis. According to WHO/UNAIDS/UNICEF (2011), the method has assisted more than 350 000 children at the risk of acquiring HIV from their parents, with 88% of these children living in Sub-Saharan region of Africa. All pregnant women are required to undergo testing. WHO/UNAIDS/UNICEF (2011) advises that they should be counselled to prepare them for the outcome. Some of the strategies involved in counselling activities include education on the importance of the maternal health care, impact of AIDS on the pregnancy and issues on prenatal transmission. In reducing the high rate of mother-child infection, the Zambian government has proposed that HIV infected women will be required to be tested every three months for the gestation as well as lactation period (Wilson and National Bureau of Economic Research, 2012). This provides the information on CD4 count for the determination of the appropriate period for offering intervention strategies. According to Stringer et al, (2005), those with CD4 count>350 are required to start using Zidovudine prophylaxis at the gestation age of 14 weeks. Those with the CD4 count less than 350 are advised to start highly active antiretroviral therapy (HAART) early regardless of the age of the gestation period. The government provides children born of mothers under HAART Nevirapine prophylaxis for six weeks after birth on a daily basis. Challenges Kandala et al. (2011) asserts that reduction of the HIV prevalence was identified by the United Nations Millennium Summit as one of the essential elements of enhancing the human development. However, monitoring the HIV prevalence through use of the national statistics masks the crucial data related to the accurate inter-regional disparities of the prevalence levels. For instance, the 2007 Zambian Demographic and Health Survey found out that the national prevalence of HIV/AIDS was 14.7% although the prevalence of Northern Province and Lusaka Province was 95% and 20% respectively (Kandala et al., 2011: 96). Accurate prevalence rates can only be ascertained if the studies are conducted in every region. The HIV prevalence rates are also affected by age and gender. According to a demographic and health survey 2007 by CSO (2009), women are more vulnerable to HIV/AIDS infection than men. The study found out that 16.1% of Zambian women was HIV-positive compared to 12.3% men. This implies that the national figures on prevalence rates can only be reflective of the actual situation if they incorporate the factors that affect the HIV/AIDS prevalence. As asserted by Kandala et al. (2011), and Central Statistical Office (2004) the main challenge enhancing the rate of spread among the male population is earlier sex debut and involvement in the risky sexual behaviours. The policy cannot be effective if, as Kandala et al. (2011) asserts, the number of 15-19 years old men using condoms reduced from 35% in 2000 to 31% in 2009. Another crucial challenge affecting the effectiveness of the policy is mobility of the Zambian population. The World Bank (2008) identifies mobility as the major catalyst in the spread of HIV/AIDS virus in Zambia. Truck drivers and seasonal workers register high cases of AIDS transmission while on transit. Poverty has largely contributed to the increase in prevalence of the disease. With unemployment rates of 68%, most young girls and men have resulted into commercial sex activities (Wilson & National Bureau of Economic Research, 2012) Lack of reliable scientific information on the spread of the disease is also a challenge. Hoffmann et al. (2008: 817) asserts that inadequate information on the mother-to-child transmission is a prominent problem in Sub-Saharan Africa whereby the HIV-1 infection is rampant and where the antiretroviral therapy has been introduced recently. The challenge is even more intense considering the fact that most developing countries are faced with absence of prophylactic vaccine and inadequate access to preventive treatment. Most of the intervention strategies applied in enhancing the HIV/AIDS prevention policy in Zambia are unreliable and of low quality. In the study of Effectiveness of a city-wide program to prevent mother-to-child HIV transmission in Lusaka, Zambia, Stringer et al (2005) affirms that monitoring of one of the programmes i.e. Lusaka PMTCT is difficult due to the high cost of the virologic testing of the infants as well as complexity for wide-spread use. The study results also shows that only a few HIV-exposed infants are receiving the appropriate prophylaxis despite the presence of sophisticated programme in Lusaka city. This program is also faced with reduced coverage as well as effectiveness because the probability of failure occurring stepwise is high. The PMTCT is affected by the numerous challenges that emanates from the specialists’ incompetency as well as patients. They include seroconversion between tests and delivery, false results of the studies, specimen mix-ups and inaccurate blood tests (Stringer et al (2005:1313). Challenges to policy implementation may emanate from irresponsive community behaviour. According to Stringer et al (2005:1313), one of these behavioural barriers is ignorance. The study found out that a large population of HIV positive women do not use the HIV/AIDS medications e.g. NVP. The results of the earlier study by Stringer et al, (2003), estimate that the situation could be worse if the whole population is accounted. Lack of proper services as well as non uniform distribution of services is another challenge (Schenk and Michaelis, 2010). Some of the rural areas lack the required services due to lack of insufficient PMTCT programmes despite being provided in other areas. This has created a situation where very few people access HIV/AIDS prevention services e.g. few pregnant women are accessing the (PMTCT) services. Recommendations The government should target international as well as national integration in the formulation of the preventive measures. This enhances reduction in spread. Prevention frame work is normally focused on prevention of the HIV/AIDS virus spread at the national level; the international factors should also be taken into consideration. For instance, the government should ensure that migration does not derail the PMTCT (Scriven & Garman, 2005). Regulatory measures should also be put in place to ensure that change in the international prices does not affect supply of antiretroviral drugs. More funding is required to enhance the effectiveness of the prevention programs (Schenk and Michaelis, 2010). Successful reduction of the HIV/AIDS prevalence is only achievable if effective planning and delivery of prevention strategies and/or programs are applied. This is conducted through understanding the sources and dynamics of the occurrence of the new infections and the behaviours that enhance those infections. Gisselquist et al. (2009) assert that the preventive strategies should focus on awarding men more responsibilities and accountability incentives. This encourages them to regulate their behaviours and adopt accommodative attitudes to HIV preventive efforts. The preventive strategies should also reach out to informal and formal community leaders. Education Programmes Education programmes should be focused, i.e. they should target the most vulnerable groups such as truck drivers and seasonal workers. World Bank (2008) advises that they should be encouraged to use protection when engaging in sexual activities while on transit. Education dissemination should be employed in enacting measures geared towards reducing the high rates of MTCT. This is the most viable solution that Zambia can apply due to the fact that preventive treatments and prophylactic vaccines are not readily available. The success of the PMTCT programme can be enhanced through maximising coverage as it is the most crucial indicator of the program performance. Medical specialists should be trained and motivated to ensure that the tests they perform are not risky. Therefore, they should ensure appropriate treatment and handling of the mother, providing advice and enhancing future planning methods. The grassroots counsellors, home-based care providers and peer educators should be well trained and equipped with the necessary information regarding HIV/AIDS. This enhances the effectiveness of the preventive policies (Gisselquist et al., 2009). PMTCT Programmes The PMTCT programmes should be incorporated within the existing public health systems to enhance coverage. The services would be provided by mother-care clinics to ensure that all women that visit these facilities receive the necessary information on the programme. Women should be encouraged to visit antenatal clinics, especially through influencing men to support them. Men can also be influenced to encourage their HIV positive pregnant wives to use the antiretroviral drugs. The PMTC programmes should exercise high safety standards e.g. disposing of blood, placenta and waste safely after delivery and use of plastic aprons. The Zambian government has applied various practices that portray its commitment to the policy. Such practices include; preventing the transmission of the virus, caring for the victims including the affected relatives and reducing the economic as well as social impacts (UNAIDS World Aids Day Report, 2012). The preventive strategies applied by the government stems from work place programmes, focus on mother to child prevention programmes (PMTCT), enhancing measures related to blood safety, reduction of stigma and discrimination and post-exposure prophylaxis. Conclusion Most studies affirm the government’s commitment to reduce the prevalence of HIV/AIDS in Zambia. Most of the intervention strategies focus on encouraging the use of protection when engaging in sexual activities, as well as voluntary counselling and testing (Jones et al., 2006). Voluntary counselling and testing has proven to be the most effective strategy because use of condoms is subject to cultural opposition. The common intervention strategies applied in Zambia include promoting the use of condoms, limiting sexual partners, encouraging VCT and enhancing the prevention of other sexually transmitted ailments. However, the application of the prevention strategies is not uniform leading to the variability in the prevalence rates among provinces. Other strategies that can enhance preventive potential of the policy include ensuring that antiretroviral treatment is offered fairly and creating HIV awareness through health education and counselling. However, research should be enhanced to identify the contribution of homosexuality in relation to HIV/AIDS prevalence in Zambia. Most of the studies have only focused on prostitution among girls ignoring the fact that homosexuality is currently rife in most of the African cultures. More research on efficacy of the antiretroviral combinations should be conducted to assess the impact of the increased complexity on coverage rates and the viral resistance patterns. References Aveyard, H (2007) Doing a Literature Review in health and Social Care: a Practical Guide OUP McGraw- Hill Ed. Central Statistical Office (CSO), Ministry of Health (MOH), Tropical Diseases Research Centre (TDRC), University of Zambia, and Macro International Inc. (2009) Zambia demographic and health survey 2007 Calverton, Maryland, USA, CSO and Macro International Inc. De Cock, K.M., Fowler, M.G., Mercier, E., De Vincenzi, I., Saba, J., Hoff, E. et al. (2000) ‘Prevention of mother-to-child HIV transmission in resource-poor countries: Translating research into policy and practice’ JAMA, vol. 283, pp. 1175–1182. Garbus, L. (2003) ‘“HIV/AIDS in Zambia” San Francisco: AIDS policy research centre’ University of California San Francisco. Gisselquist, D., Potterat, J.J., Hogan, M., Arora, N.K., Correa, M., Dinsmore, W.W. & Ounga, T. (2009) ‘How to contain generalized HIV epidemics? A plea for better evidence to displace speculation’ International Journal of Std. and Aids, vol. 20, no.7, pp. 443-446. Hoffmann, F.G., He, X., West, J.T., Lemey, P., Kankasa, C. & Wood, C. (2008) ‘Genetic variation in mother-child acute seroconverter pairs from Zambia’ Aids, vol. 22, no. 7, pp. 817-824. Jones, D.L., Weiss, S.M., Bhat, G.J. & Bwalya, V. (2006) ‘Influencing sexual practices among HIV-positive Zambian women’ Aids Care, vol. 18, no. 6, pp. 629-34. Kandala, N.B., Brodish, P., Buckner, B., Foster, S. & Madise, N. (2011) ‘Millennium development goal 6 and HIV infection in Zambia: What can we learn from successive household surveys?’ Aids, vol. 25, no. 1, pp. 95-106. 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