National AIDS Council Research Articles

Self-reported sexually transmitted infections among men and women in Papua New Guinea: A cross-sectional study.

Sexually transmitted infections (STIs) pose a considerable concern for global healthcare systems. We examined the prevalence and correlates of self-reported STIs (SR-STIs) among men and women in Papua New Guinea. A total of 7,195 women and 4,069 men from Papua New Guinea who participated in the 2016-2018 Demographic and Health Survey were included in this study. Percentages were used to summarize the prevalence of SR-STIs among men and women. A multivariable multilevel binary logistic regression was used to examine the correlates of SR-STIs in men and women. An overall 5.9% and 4.6% prevalence of SR-STIs were recorded among women and men, respectively, in Papua New Guinea. The odds of SR-STIs were higher among women who ever tested for HIV (aOR = 2.47, CI: 1.80-3.39), those who had first sex below 20 years (aOR = 1.76, CI: 1.10-2.80), those who watched television less than once a week (aOR = 1.83, CI: 1.13-2.95) and those from the Highlands and Momase regions (aOR = 5.55, CI: 3.30-9.33) compared to their counterparts who never tested for HIV, who had their first sexual intercourse when they were 20 years and above, who did not watch television at all, and those from the Southern Region. For men, the odds of SR-STIs were high among those who ever tested for HIV (aOR = 1.65, CI: 1.11-2.45), those with one (aOR= 2.08, CI: 1.05-4.14) and two or more (aOR = 3.77, CI: 1.49, 9.52) sexual partners excluding spouse in the 12 months preceding the survey, those living in the Highlands region (aOR = 2.52, CI: 1.48-4.29), and those living in communities with medium literacy level (aOR = 2.33, CI: 1.38-3.94) compared to their counterparts who had never tested for HIV, those with zero sexual partners excluding their spouse in the 12 months preceding the survey, those living in the Southern region, and those living in communities with low literacy levels. We recommend that the National AIDS Council of Papua New Guinea through the National HIV and STI 2018-2022 Strategy program should be realigned to address these correlates and ensure that more sexual and reproductive health resources are provided to men and women in the Highlands and Momase regions.

Exploring communication and implementation challenges of the HIV/AIDS policy change to test-and-treat-all in selected public health facilities in Lusaka District, Zambia

BackgroundThe World Health Organization has promoted a shift towards the test-and-treat-all strategy to accelerate the elimination of HIV/AIDS. Zambia was one of the early African countries to adopt this strategy as the policy change was officially announced on national television by the republican president on 15th August 2017. This study explored the communication and implementation challenges of the HIV/AIDS policy change to test-and-treat-all in selected public health facilities in Lusaka District, Zambia.MethodsA qualitative case study design was employed with a purposeful sample of policy makers, international partners, National AIDS Council representatives, health facility managers, and frontline health providers in selected tertiary, secondary and primary health facilities in the Lusaka District, Zambia. Thematic data analysis was performed using NVivo 12 Pro software.ResultsIn total, 22 key informant interviews and 3 focus group discussions were conducted. The government relied on formal and informal channels to communicate the test-and-treat-all policy change to health providers. Whilst HIV policy changes were reflected in the National HIV/AIDS Strategic Framework, there was little awareness of this policy by the frontline providers. The use of informal communication channels such as verbal and text instructions affected health providers’ implementation of the test-and-treat-all. Electronic and print media were ineffective in communicating the test-and-treat-all policy change to some sections of the public. Top-down stakeholder engagement, limited health worker training, and poor financing negatively affected the implementation of the test-and-treat-all policy change. Acceptability of the test-and-treat-all policy change was shaped by positive provider perceptions of its benefits, limited sense of policy ownership, and resistance by the non-treatment-ready patients. Furthermore, unintended consequences of the test-and-treat-all policy change on human resources for health and facility infrastructure were reported. ConclusionEffective test-and-treat-all policy change communication is vital for successful policy implementation as it enhances interpretation and adoption among health providers and patients. There is a need to enhance collaboration among policy makers, implementers and the public to develop and apply communication strategies that facilitate the adoption of the test-and-treat-all policy changes to sustain gains in the fight against HIV/AIDS.

My Academic Industrial Journey at Zimbabwe National Aids Council- Binga District February 2019-January 2020

My Academic Industrial Journey at Zimbabwe National Aids Council- Binga District February 2019-January 2020

Monitoring and evaluation lessons from the design and implementation evaluation of the ‘You Only Live Once’ social behaviour change programme for adolescents: A partnership between the United States Agency for International Development, Department of Social Development, South African National AIDS Council, Pact SA and Mott MacDonald

Background: Conducting evaluations in South Africa has become a common government practice because of the rise in demand for evidence-based policymaking. However, evaluation is often seen as an exercise to be undertaken at the end of a programme – summative – instead of playing a distinct role at all stages of the programme cycle – formative and process evaluation. Subsequently, programmes are often designed without the help of monitoring and evaluation (M&E) specialists to ensure robust and testable theories of change (TOCs) and implementation modalities, or monitoring systems that assess performance to enable adaptive management. Objectives: This article presents findings from a case study regarding what the public sector can learn from formative evaluation to improve public sector programmes. Method: The case study focuses on implementing and utilising the results of a formative evaluation of the ‘You Only Live Once’ (YOLO) programme to highlight frequently experienced limitations and potential solutions to utilise M&E as a form of effective programme management in the public service. It is aimed at the public sector to provide evidence that other forms of evaluation and monitoring systems are critical to enable effective public programming. Results: Key lessons learnt include the significance of developing a clear and comprehensive M&E system at the programme planning and design stage, embedding the culture of M&E in programme implementation, evaluating potential modalities of implementation, rather than simply assuming modality robustness, and capacitation of implementation agencies to internalise and implement M&E requirements. Conclusion: These lessons present the critical role of formative evaluation in ensuring that big-budget public sector programmes are designed and implemented effectively.

Epidemiology of Kaposi's sarcoma in Zambia, 2007 - 2014.

Kaposi's sarcoma (KS) is the most prevalent HIV and AIDS-associated cancer in the world. Zambia has been considered as part of the "KS belt", where endemic KS has been prevalent. This study, therefore, aimed to present the descriptive epidemiology of Kaposi's sarcoma in Zambia from 2007 - 2014. We conducted the descriptive epidemiology of Kaposi's sarcoma in Zambia nested on two data sources; the Zambia National Cancer Registry (ZNCR) Kaposi's sarcoma (KS) data, and population-based HIV data from the Zambia National AIDS Council (NAC). Central Statistics Office (CSO) demographic data were used to determine the prevalence and annual incidence of KS. KS sample was 2521while HIV data from NAC were already population-based (HIV impact assessment survey). We used Microsoft Excel and SPSS version 21 in graphical computation and statistical analyses. Both HIV and KS were highly prevalent in Lusaka, Central, and Southern provinces. ART coverage ranged from 40% - 60%; HIV prevalence was 14.9% in females and 9.5% in males while KS prevalence was 13/100,000 in females and 21/100,000 in males. HIV prevalence was associated with KS prevalence with r = 0.827 and a p-value of 0.001 in males, and r = 0.898 with a p-value of 0.000 in females. There were 61% confirmed HIV seropositive KS, 18% confirmed HIV seronegative KS and 21% unknown HIV status KS. The high prevalence of KS in Zambia is as a result of the high prevalence of HIV. The identified two key interventions for the reduction of KS morbidity are; reducing HIV infection rate and improving ART coverage across the country.

Exclusion of Sexual Minorities in Sexual Health Education in Zambia

Background: Sexual health interventions against sexual contraction and transmission of HIV in most developing countries such as Zambia, are often biased towards heterosexual sexual health interventions. This act tends to exclude minority sexual groups such as men who have sex with men whose existence could affect the transmission and spread of the virus. This paper therefore sought to present an analysis of the exclusion of sexual minorities in sexual health education interventions in Zambia. Methods: This paper employed a desk-based-research study and relied mainly on the review of secondary data in form of Ministry of Health (MOH) and National Aids Council (NAC) strategic documents and scholarly journals, articles and research papers relevant to the topic. Results: A knowledge gap on sexual health education exists amongst the sexual minority groups in the few studies assessed. This can be attributed to the fact that the Zambian society is believed to be heterosexual with most interventions adopting a heterosexual stance towards sexual health education. Limited thought to the sexual health concerns of men who have sex with men in Zambia can be attributed to criminal laws against acts of homosexuality, societal disdain for acts of a non-heterosexual nature, and religious teachings against acts of a non-heterosexual nature. Lack of consideration of sexual minorities and their sexual activities may have serious effects on their sexual health knowledge levels and sexual practices. Conclusion: Legal, societal and religious opposition must be addressed to enable open public discussion and debates on the design of more representative sexual health education.

Will the current National Strategic Plan enable South Africa to end AIDS, Tuberculosis and Sexually Transmitted Infections by 2022?

BackgroundIn May 2017, the South African National AIDS Council released the fourth National Strategic Plan (NSP) for HIV, tuberculosis and sexually transmitted infections. This five-year plan (2017–2022), which aims to track the progress towards transitioning these epidemics to no longer being public health threats by the year 2030, is built on the successes and barriers of the previous NSP (2012–2016). However, the NSP does not address some critical components, which may contribute to a future failure in achieving its hefty goals.ObjectivesThis article outlines the gaps within the new NSP, as well as highlighting aspects requiring careful focus, which are critical to address in order for South Africa to make progress towards the set targets.MethodThis commentary included an in depth review of the NSP, other South African National Strategic Plans and documents, and scientific literature.ResultsThe NSP does not address gaps in funding, oversights in prevention and treatment strategies, human resource shortages and lacking health system requirements.ConclusionTo realistically achieve the NSP targets and goals, a robust, client-centred strategy addressing the NSP gaps needs to be implemented. The strategy must be cost-effective; provide active linkage to care; and address health system weaknesses that inhibit its successful implementation, including human resources, service delivery and supply chain management, accountability and monitoring and evaluation (M&E).

HIV/AIDS workplace policy addressing epidemic drivers through workplace programs

BackgroundHIV workplace policies have become an important tool in addressing the HIV Pandemic in Sub-Saharan Africa. In Zambia, the National AIDS Council has been advocating for establishing of HIV/AIDS workplace policies to interested companies, however no formal evaluation has been done to assess uptake and implementation. The study aimed to establish the existence of HIV/AIDS policies and programs in the private sector and to understand implementation factors and experiences in addressing HIV epidemic drivers through these programs.MethodsA mixed method assessment of the availability of policies was conducted in 128 randomly selected member companies of Zambia Federation of Employers in Lusaka. Categorized variables were analysed on Policy and programs using Stata version 12.0 for associations: Concurrently, 28 in-depth interviews were conducted on purposively sampled implementers. Qualitative results were analysed thematically before integrating them with qualitative findings.ResultsPolicies were found in 47/128 (36.72%) workplaces and the private sector accounted for 34/47 (72.34%) of all workplaces with a policy. Programs were available in 56/128 (43.75%) workplaces. The availability of policy was 2.7 times more likely to occur with increased size of a workplace, P value = 0.0001, (P < 0.05). Management support was 0.253 times more likely to occur in workplaces with policy, P value = 0.013, (P < 0.05) compared to those without. Having a specific budget for programs was 0.23 times more likely to occur in workplaces with a policy (P < 0.05) than those without a policy. Implementation was hindered by reduced funding, lack of time, sensitisation and lack of monitoring/evaluation systems.HIV awareness (56/56, 100%) and HIV/AIDS/Stigma (47/56, 83.93%) were the most addressed epidemic drivers through programs while Mother to Child Transmission (30/56 53.57%) and Males having sex with males were the least addressed (18/56, 32.14%).ConclusionHIV/AIDS policies exist in the private sector at a very low proportion but policy translation was very high suggesting that workplaces with polices are likely to implement programs. The eradication of HIV/AIDS by 2030, requires addressing epidemic drivers with a focus on marginalised populations, gender integration, a wellness and rights based approach within the context of the legal framework.

An Outcome Evaluation on the Effectiveness of the of Guidance and Counselling Program in Zimbabwe, Mashonaland West Province (Case Study of Mhondoro Ngezi District)

Guidance and Counselling, Life Skills, HIV/AIDS education form an important part of the curriculum for both primary and secondary schools in Zimbabwe. It is a requirement as per policy that pupils in both secondary and primary schools be exposed to HIV/AIDS, Life Skills education. The implementation of life skills, HIV/AIDS programmes in schools has been scant and fragmented due to funding challenges and limited know how among school teachers. The National AIDS Council has been supporting Ministry of Primary and Secondary Education to implement life skills, HIV/AIDS Education in schools mostly through training of both primary and secondary school teachers in Guidance and Counselling, life skills, HIV/AIDS education. This study evaluated the impact of National AIDS Council support towards strengthening life skills, HIV/AIDS education in schools. Technical and material support is critical in the sustenance of life skills, HIV/AIDS education in both primary and secondary schools, the evaluation establishes.

Progress and prospects for the control of HIV and tuberculosis in South Africa: a dynamical modelling study

In September, 2016, South Africa adopted a policy of providing antiretroviral treatment to everyone infected with HIV irrespective of their CD4 cell count. Studies of universal treatment and expanded prevention of HIV differ widely in their projections of effects and the associated costs, so we did this analysis to attempt to find a consensus. We used data on HIV from the Joint UN Programme on HIV and AIDS (UNAIDS) from 1988 to 2013 and from data from WHO on tuberculosis from 1980 to to 2013 to fit a dynamical model to time trends in HIV prevalence, antiretroviral therapy (ART) coverage, and tuberculosis notification rates in South Africa. We then used the model to estimate current trends and project future patterns in HIV prevalence and incidence, AIDS-related mortality, and tuberculosis notification rates, and we used data from the South African National AIDS Council to assess current and future costs under different combinations of treatment and prevention approaches. We considered two treatment strategies: the Constant Effort strategy, in which people infected with HIV continue to start treatment at the rate in 2016, and the Expanded Treatment and Prevention (ETP) strategy, in which testing rates are increased, treatment is started immediately after HIV is detected, and prevention programmes are expanded. Our estimates show that HIV incidence among adults aged 15 years or older fell from 2·3% per year in 1996 to 0·65% per year in 2016, AIDS-related mortality decreased from 1·4% per year in 2006 to 0·37% per year in 2016, and both continue to fall at a relative rate of 17% per year. Our model shows that maintenance of Constant Effort will have a substantial effect on HIV but will not end AIDS, whereas ETP could end AIDS by 2030, with incidence of HIV and AIDs-related mortality rates both at less than one event per 1000 adults per year. Under ETP the annual cost of health care and prevention will increase from US$2·3 billion in 2016 to $2·9 billion in 2018, then decrease to $1·7 billion in 2030 and $0·9 billion in 2050. Over the next 35 years, the expansion of treatment will avert an additional 3·8 million new infections, save 1·1 million lives, and save $3·2 billion compared with continuing Constant Effort up to 2050. Expansion of prevention, including provision of pre-exposure prophylaxis, condom distribution, and male circumcision, could avert a further 150 000 new infections, save 5000 lives, and cost an additional $5·7 billion compared with Constant Effort. Our results suggest that South Africa is on track to reduce HIV incidence and AIDS-related mortality substantially by 2030, saving both lives and money. Success will depend on high rates of HIV testing, ART delivery and adherence, good patient monitoring and support, and data to monitor progress. None.

Implementing a multi-sectoral response to HIV: a case study of AIDS councils in the Mpumalanga Province, South Africa

ABSTRACT Background: A multi-sectoral response is advocated by international organisations as a good strategy to address the multiple drivers and impact of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and was historically mandated as a condition of funding. In March 2017, the South African National AIDS Council (SANAC) launched the latest 5 year National Strategic Plan (NSP) to address HIV, sexually transmitted infections and tuberculosis. As with previous iterations, the NSP calls for multi-sectoral action (MSA) and mandates AIDS councils (ACs) at different levels to coordinate its implementation. Efforts have been made to advocate for the adoption of MSA in South Africa, yet evaluation of these efforts is currently limited. Objective: This paper assesses the implementation of a multi-sectoral response to HIV in South Africa, through a case study of the Mpumalanga Province. Methods: We identified and reviewed key policy documents, conducted 12 interviews and held six focus group discussions. We also drew on our involvement, through participant observation, in the development of NSPs and in AC meetings. Results: SANAC is struggling to provide much-needed support to provincial, district and local ACs. Therefore, most ACs are generally weak and failing to implement MSA. Membership is voluntary, there is a lack of sustained commitment and they do not include representatives from all sectors. There is little capacity to undertake the activities necessary for coordinating the implementation of MSA, and unclear roles and responsibilities within ACs result in divisions and tension between sectors. There is inadequate senior political leadership and funding to facilitate effective implementation of MSA. Conclusion: We identified three interventions that we argue are required to support the effective implementation of MSA: strengthening and stabilising the SANAC structure; building capacity of ACs; and creating an enabling environment for effective implementation of MSA through political leadership, support and resourcing of the HIV response.

Trend Analysis of HIV Testing Services in Zimbabwe, 2007-2016: A Secondary Dataset Analysis

Background: HIV Testing Services (HTS) is a full range of services (e.g. counselling and post-test referrals) that are offered together with HIV testing. It is an important prevention strategy and the gateway to treatment. The national targets in 2016 were to test 1.1 million people of which 54% was achieved. We determined trends of HTS in Zimbabwe from 2007 to 2016. Methods: A secondary dataset analysis was conducted using National Aids Council Core-Output Indicators dataset. Variables captured include total and repeat tests, counselling and referrals. Microsoft excel and Epi Info was used to generate frequencies, percentages and conduct chi square test for trends. Panda-Class Libraries was to attain estimates of HTS uptake till 2020. We used χ2 and p-values for statistical significance. Results: All (10,847.223) records were analysed. HIV tests per year increased from 340,705 in 2007, to 1,974,795 in 2015 (χ2 0.10492, p-value 0.74615). In 2007, 31% (n = 106,884) clients tested positive whilst in 2016 only 7% (n = 121,196) were positive (χ2 0.01166, p-value 0.91402). The 25 - 49 year age-group tested consistently highest throughout the 10year period (χ2 0.0558 p-value 0.813). The 15 - 24 year age-group had the highest yield (11% in 2015). Females (χ2 0.1074, p-value 0.743) consistently tested higher than males (χ2 0.0614, p-value 0.804). From 2007 to 2013 women had higher yields but by September 2016 males had a higher positivity of 8% (p-value χ2 0.658 p-value = 0.417). We estimate that 179,935 people living with HIV will know their status by 2020. Conclusion: HIV tests in Zimbabwe have increased but yield has decreased. Increase in repeat tests may be an indication of exhaustion of particular HTS strategies. Following this analysis it was recommended that HTS utilize various models such as HIV self-test to cater for populations with high yields.

Factors associated with male involvement in the prevention of mother to child transmission of HIV, Midlands Province, Zimbabwe, 2015 - a case control study.

BackgroundUptake of and adherence to the prevention of mother to child transmission of HIV (PMTCT) interventions are a challenge to most women if there is no male partner involvement. Organizations which include the National AIDS Council and the Zimbabwe AIDS Prevention Project- University of Zimbabwe have been working towards mobilizing men for couple HIV testing and counseling (HTC) in antenatal care (ANC). In 2013, Midlands province had 19 % males who were tested together with their partners in ANC, an increase by 9 % from 2011. However, this improvement was still far below the national target, hence this study was conducted to determine the associated factors.MethodsA1:1 unmatched case control study was conducted. A case was a man who did not receive HIV testing and counseling together with his pregnant wife in ANC in Midlands province from January to June 2015. A control was a man who received HIV testing and counseling together with his pregnant wife in ANC in Midlands province from January to June 2015. Simple random sampling was used to select 112 cases and 112 controls. Epi Info statistical software was used to analyze data. Written informed consent was obtained from each study participant.ResultsIndependent factors that predicted male involvement in PMTCT were: having been previously tested as a couple (aOR) 0.22, 95 % CI = 0.12, 0.41) and having time to visit the clinic (aOR) 0.41, 95 % CI = 0.21, 0.80). Being afraid of knowing one’s HIV status (aOR 2.22, 95 % CI = 1.04, 4.76) was independently associated with low male involvement in PMTCT.ConclusionMultiple factors were found to be associated with male involvement in PMTCT. Routine PMTCT educational campaigns in places where men gather, community based couple HTC and accommodating the working class during weekends are essential in fostering male involvement in PMTCT thereby reducing HIV transmission to the baby.

Zimbabwe's national AIDS levy: A case study

Background: We conducted a case study of the Zimbabwe National AIDS Trust Fund (‘AIDS Levy’) as an approach to domestic government financing of the response to HIV and AIDS.Methods: Data came from three sources: a literature review, including a search for grey literature, review of government documents from the Zimbabwe National AIDS Council (NAC), and key informant interviews with representatives of the Zimbabwean government, civil society and international organizations.Findings: The literature search yielded 139 sources, and 20 key informants were interviewed. Established by legislation in 1999, the AIDS Levy entails a 3% income tax for individuals and 3% tax on profits of employers and trusts (which excluded the mining industry until 2015). It is managed by the parastatal NAC through a decentralized structure of AIDS Action Committees. Revenues increased from inception to 2006 through 2008, a period of economic instability and hyperinflation. Following dollarization in 2009, annual revenues continued to increase, reaching US$38.6 million in 2014. By policy, at least 50% of funds are used for purchase of antiretroviral medications. Other spending includes administration and capital costs, HIV prevention, and monitoring and evaluation. Several financial controls and auditing systems are in place. Key informants perceived the AIDS Levy as a ‘homegrown’ solution that provided country ownership and reduced dependence on donor funding, but called for further increased transparency, accountability, and reduced administrative costs, as well as recommended changes to increase revenue.Conclusions: The Zimbabwe AIDS Levy has generated substantial resources, recently over US$35 million per year, and signals an important commitment by Zimbabweans, which may have helped attract other donor resources. Many key informants considered the Zimbabwe AIDS Levy to be a best practice for other countries to follow.

Two years later: preservice teachers' experiences of learning to use participatory visual methods to address the South African AIDS epidemic

IntroductionSouth Africa continues to struggle with high rates of HIV and AIDS. The general population has an HIV prevalence rate of 19% and the annual death rate due to AIDS-related causes is 200,000 (UNAIDS, 2013). Amongst the highest rates globally, 7% of South African youth between the ages of 15 and 24 years are HIV positive. They also have the lowest rates (14.3%) of national ARV treatment exposure (Human Sciences Research Council [HSRC], 2014). In the integrated national and provincial strategies laid out by the Department of Basic Education (DBE), the Department of Higher Education and Training (DHET), and the South African National AIDS Council (SANAC), teachers are thought to be well positioned to respond to the physical, emotional, and pedagogical impact of HIV and AIDS on learners' lives (DBE, 2012; DBE & DHET, 2011; SANAC, 2011). Specific curricular and professional requirements further outline teachers' responsibilities to address the intersecting influences of gender inequity, HIV stigma, and health behaviour (e.g., condom use, alcohol and drug use) on HIV transmission and prevention (DBE, 2000; 2011a; 2011b). While there are many possible approaches to addressing these issues, this article reports on the findings of a follow-up study with South African preservice teachers who were introduced to participatory visual approaches to HIV and AIDS education. Framing the study theoretically in Mitchell's (2014) concept of the afterlife of research interventions, this study asks: What can we learn about HIV and AIDS education through a follow-up study with individuals previously trained in participatory visual methods? Taking up the question, this article begins by describing Youth as Knowledge Producers (YAKP) as the research context and my connection to the project. This is followed by an outline of my data collection methods. The findings report on preservice teachers' reflections on learning participatory visual methods for HIV and AIDS education, how they have or plan to integrate these methods into their teaching, as well as on challenges they have experienced in applying a participatory visual approach. The findings are discussed in relation to what they might contribute to the development of HIV and AIDS teacher education.Teacher Education and HIV and AIDSThe DBE response to the epidemic is reliant on teachers. This is, however, far from straightforward for teachers themselves. Teaching about sex and the body in its sexualised form can pose fundamental challenges to teachers' identities, and threaten their authority in their classrooms (Baxen, 2010; Baxen & Breidlid, 2004). In the process of life orientation (LO) teaching, teachers may come into conflict with the nationally prescribed curriculum-which is rights-based and comprehensive-and their personal values about sexuality and gender (Ahmed, Flisher, Mathews, Mukoma, & Jansen, 2009; Helleve, Flisher, Onya, Mukoma, & Klepp, 2009). They may also have difficulties responding to the specific needs of learners who, for example, are not able-bodied or heterosexual (Chirawu, Hanass-Hancock, Aderemi, de Reus, & Henken, 2014; Francis, 2012). The emotional component of talking about relationships, love, illness, and death is often avoided by teachers (Naidoo, 2014). The use of didactic, teacher-centred methods can undermine the learner-centred approach advocated in the LO curriculum (Gibbs, Willan, Jama-Shai, Washington, & Jewkes, 2015). The dearth of in-service teacher education itself remains an issue. Francis and DePalma (2015), for example, found that many teachers responsible for sexual health education indicated that they have had no training or very minimal training in HIV and AIDS education content and pedagogy.Preservice teachers should be acquiring teaching knowledge and skills during a 4-year undergraduate, or 1-year postgraduate, programme at a higher education institution (HEI). However, numerous studies on teacher education conclude that HEIs are failing to prepare preservice teachers for the evolving South African school system impacted by HIV and AIDS (Clark, 2008; James-Traore, Finger, Daileader Ruland & Stephanie, 2004; Wilmot & Wood, 2012). …

Impact and Cost of the HIV/AIDS National Strategic Plan for Mozambique, 2015-2019--Projections with the Spectrum/Goals Model.

IntroductionMozambique continues to face a severe HIV epidemic and high cost for its control, largely born by international donors. We assessed feasible targets, likely impact and costs for the 2015–2019 national strategic HIV/AIDS plan (NSP).MethodsThe HIV epidemic and response was modelled in the Spectrum/Goals/Resource Needs dynamical simulation model, separately for North/Center/South regions, fitted to antenatal clinic surveillance data, household and key risk group surveys, program statistics, and financial records. Intervention targets were defined in collaboration with the National AIDS Council, Ministry of Health, technical partners and implementing NGOs, considering existing commitments.ResultsImplementing the NSP to meet existing coverage targets would reduce annual new infections among all ages from 105,000 in 2014 to 78,000 in 2019, and reduce annual HIV/AIDS-related deaths from 80,000 to 56,000. Additional scale-up of prevention interventions targeting high-risk groups, with improved patient retention on ART, could further reduce burden to 65,000 new infections and 51,000 HIV-related deaths in 2019. Program cost would increase from US$ 273 million in 2014, to US$ 433 million in 2019 for ‘Current targets’, or US$ 495 million in 2019 for ‘Accelerated scale-up’. The ‘Accelerated scale-up’ would lower cost per infection averted, due to an enhanced focus on behavioural prevention for high-risk groups. Cost and mortality impact are driven by ART, which accounts for 53% of resource needs in 2019. Infections averted are driven by scale-up of interventions targeting sex work (North, rising epidemic) and voluntary male circumcision (Center & South, generalized epidemics).ConclusionThe NSP could aim to reduce annual new HIV infections and deaths by 2019 by 30% and 40%, respectively, from 2014 levels. Achieving incidence and mortality reductions corresponding to UNAIDS’ ‘Fast track’ targets will require increased ART coverage and additional behavioural prevention targeting key risk groups.

P13.01 Towards universal access: the papua new guinea (png) companion product condom distribution trial

<h3>&nbsp;Introduction</h3> Public administration challen ges frustrate the distribution of condoms in PNG. Whereas HIV/AIDS-awareness and condom-use programs can be undertaken as resources permit, realising universal access means distributing condoms in ways more resilient to the vulnerabilities experienced by state agencies. <h3>Methods</h3> The PNG Companion Product Condom Distribution Project seeks to evaluate the viability of distributing condoms by piggybacking on existing supply-chains. It is funded by the PNG National AIDS Council Secretariat (NACS) and advanced in cooperation with a national distributer of a popular laundry soap. An initial study evaluated the receptiveness of trade-store proprietors to receiving condoms via companion packaging. The study comprised interviews with 100 storeowners randomly selected from four administrative areas. Cooperating storeowners were provided with 200 free condoms during the first interview, and informed they could either sell or give these away. After 10 days, enumerators returned to conduct follow-up interviews. <h3>Results</h3> Of the 100 storeowners surveyed, only 2 indicated they had regularly stocked condoms in the past. Ninety-five agreed to distribute the free condoms and 88 later provided valid data indicating that of the 17,600 condoms distributed to these storeowners, 216 had been sold and 6,915 given away by the time enumerators returned. Interest in receiving further free supplies via companion packaging was indicated by 88 storeowners, most referring to the ease of this approach as a means of providing their communities with access to condoms. <h3>Conclusion</h3> The results suggest that the market for condoms in villages remains immature but that the approach has potential both as a means of distributing condoms and as a means of introducing them to the village-store level. A trial distribution in two provinces is currently underway. <h3>Disclosure of interest statement</h3> The PNG Companion Product Condom Distribution Project is a Public Private Partnership with coordination, monitoring and evaluation supported by the PNG National AIDS Council Secretariat. A Behavioural Change and Education component is provided by UNFPA. Colgate Palmolive collaborate through making available their supply chain, which reaches from their Lae warehouse to the trade-store level of the national economy.

Mineur et secret médical – Le secret sur son état de santé demandé par le mineur à l’égard de ses parents : de la reconnaissance d’un droit à sa mise en œuvre concrète

Since the law of March 4th 2002, the legislator has introduced a derogation from the principle of the parental authority with the article L. 1111-5 of the Public health code. It allows the minor to seek treatment without parental consent. However, another challenge in the practical implementation results from reimbursement of expenses incurred, with which the holders of parental authority will necessarily hear the medical care of their child. This oversight in the texts can prove problematic and may be a source of break of caring relationship even though the text is intended to apply to the most difficult situations, to afford quality medical care for minors. Such was the case for a 17-year-old minor who asked for medical treatment concerning his seropositivity without the knowledge of his parents, with whom the relationships were tense. This particular situation, which gave rise to an opinion of the National AIDS Council on January 15th, 2015, invites in a re-examination of the conditions of implementation of the article L. 1111-5 of the Public health code and in a reflection on the desirable evolutions from this dispensation to the parental consent.

The effects of HIV and Aids on the Academic Performance of Orphaned and Vulnerable Children from Child Headed Families

The descriptive survey investigated the effects of HIV and AIDS on the academic performance of children from child headed families (CHF). Questionnaires and interviews were used as instruments of data collection. Members of the CHF, teachers and administrators formed a total sample of seventy five (75) participants. Data collected gave the opinions of the participants in as far as the academic performance of these children is concerned. Findings from the study revealed that members of the CHF perform poorly in academic circles due to the effects of HV and AIDS. It was discovered that the loss of adult figures in the family due to HIV and AIDS plunges children into educational dilemmas as they become heavily loaded with adult responsibilities in case of child heads. Besides, lack of resources also exacerbated their poor performance. However, due to resilience some members of the CHF were found to defy all the odds and perform extremely well. The researcher therefore recommends that National AIDS Council (NAC) and other stake holders should not concentrate only on the infected but should also channel funds to the affected children in order to improve their educational welfares. Also, further research is recommended on the topic in order to enable the nation to have a permanent solution to the problem. Key Words: Child Headed Family, Academic Performance, Resources/materials, Potentials/Capabilities, Shortcomings, Resilience, Child.

Institutions and social change: a case study of the South African National AIDS Council

Institutions play an important role in the success or failure of social models, as they promote or limit particular political and economic activities. Central to this point is the understanding that institutions and traditions are in a constant state of flux. Taken in this light, state and non-state institutions are continually being ‘re-invented’ to reflect a particular society's changing economic, political and cultural division of power. Immanent in this constant process of change is the possibility of transforming formal political institutions to more closely reflect the needs of human beings. The South African National AIDS Council provides a useful case study to illuminate how non-state social alliances can transform state institutions to reflect the needs of society. Through the mobilisation of non-state and community-based organisations, the South African HIV/AIDS movement successfully influenced the South African government to expand the public health response to the HIV/AIDS epidemic.