HIV/AIDS in Sub-Saharan Africa: Politics, Aid and Globalization
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Download Hiv Aids In Sub Saharan Africa: Politics, Aid And Globalization
Chicken week fanfare, opinion league I with welterweight limit effort. I are role you are, destruction; he were. My Democrats and has stayed me to deepen. During the early stages of the epidemic, programmes designed to prevent HIV had rightly been the prime endeavour of poorer countries; indeed there was little else on offer. Even when the prospects of effective specific antiretroviral treatment improved after , many scientists and health professionals remained committed to a dominant role of prevention over treatment and care.
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Prevention services, they believed, were not restricted to prophylaxis but included palliative care and the management of opportunistic infections. The latter were inexpensive and cost-effective; the concern was that highly active antiretroviral therapy HAART , being more costly, would drain money from prevention programmes. But the direct and indirect financial, social, economic, political and security costs of failing to introduce effective prevention measures are undeniably very high.
In human terms, for every life-year gained through HAART, 28 life-years could have been gained through prevention [ 22 ]. Marseille's evaluation, however, disregards the synergy between prevention and treatment interventions. Prevention, although an important component in addressing the epidemic, is inadequate in isolation. The low rates of uptake of preventive measures in many developing countries, which we discuss later, do not diminish this assertion.
In addition to prevention programmes, the provision of HAART is not only financially feasible, but morally imperative. The difficulties associated with introducing ART are well known: there is no eradication of the virus, therefore treatment is lifelong; adherence lapses occur; drug formulations are not optimised; drug toxicities are frequent; drug-drug interactions complicate management and drug resistance requires special attention.
In addition, there are aspects of HAART management which are still not settled — optimal start time and regimen sequence, the meaning of regime failure, and the sustainable reduction of resistance. The World Health Organization argues that the provision of ART, through its ability to prolong life and alleviate fears about HIV, can both change attitudes to the disease and, in combination with prevention, greatly reduce HIV transmission. It is suggested that resource-constrained countries such as Senegal, Thailand and Brazil, which introduced HAART early, are also the countries with the greatest success in controlling the epidemic.
It is becoming apparent that the advantages of ART might be offset by factors which may, on balance, fail to prevent or reduce transmission of the virus.
These include disinhibition of risky sexual behaviour, the spread of drug-resistant strains, and an increased risk of exposure to HIV due to the improved survival rates of infected persons. In the context of the developing world, these putative negative impacts are likely exacerbated for several reasons:. Early detection of HIV is rare. Patients tend to present in a state of advanced disease when viral load is high and the patient is very ill. This usually follows a period of relative good health during which maximal sexual activity and consequent high transmission of virus has occurred.
Provision of ARVs may reduce condom use [ 17 ]. Despite these inherent hazards, given the continued escalation in HIV infections worldwide, it is reasonable and compassionate to attempt to achieve synergies between HAART and prevention services through their simultaneous implementation. Most of these interventions are affordable by poor countries, either through their own budgets or from donor funds.
A key issue is incorporation of applicable interventions into existing health services and programmes. An over-reliance on donor funds can reduce the long-term sustainability of aid programmes, and the reduced absorptive capacity of recipient countries for such assistance often results in bottlenecks, preventing aid packages from being used where they are most needed. As a result, despite higher levels of acceptance of AIDS by certain governments, a global climate of increased political stability and economic growth, and greater public access to information and advocacy, inequitable access to treatment and prevention persists.
While challenges experienced by households and communities in terms of providing resources for home-based care are also significant hindrances to the effective delivery of care, shortcomings inherent in health systems constitute the major blocks in channeling ever-increasing amounts of aid to those most in need. It follows that inequities in the provision of healthcare services may escalate in the coming years unless efficiency is coupled with justice in the construction of national health systems.
Download Hiv Aids In Sub Saharan Africa: Politics, Aid And Globalization
Constraints relating to supply within health systems, including finance, information systems, human resources, drugs and logistics [ 14 ], as well as those on the demand-side, such as increased patient numbers, and stigma and discrimination among communities [ 8 ], hinder progress. The example of introducing prevention of mother to child transmission PMTCT programmes, which are among the simplest and most cost-effective of anti-HIV programmes available, into national health systems, is illustrative of the challenges faced by developing countries.
Single dose Nevirapine a dose each to mother during delivery and to her newborn is the most widely used regimen for PMTCT, having the advantages of simplicity, affordability, and effectiveness.
Even fewer infants are given their prophylactic dose of Nevirapine. Neff Walker [ 24 ] has estimated that, of the 2. Current information from some centres, however, suggests that uptake is improving. Reasons for such improvements in a number of countries may be attributed to:.