Pandemic In sub-Saharan Africa Research Articles

Disseminated AIDS-associated Kaposi's sarcoma in pregnancy.

Extracted from text ... July 2006, Vol. 96, No. 7 SAMJ SAMJ FORUM 602 Epidemic or AIDS-related Kaposi's sarcoma (AKS) has been reported to occur more frequently among males than females. However, the HIV/AIDS pandemic in sub-Saharan Africa has led to a shift in the ratio, with more women being affected. We report on 2 HIV-infected women with clinically disseminated AKS during pregnancy who represent 2 ends of the spectrum with regard to the degree of immunosuppression as evidenced by their contrasting CD4 cell counts. Both women exhibited gross lesions in the lower limbs (making walking difficult), and had disseminated disease affecting the skin, ..

Do Firms with Unique Competencies for Rescuing Victims of Human Catastrophes Have Special Obligations? Corporate Responsibility and the Aids Catastrophe in Sub-Saharan Africa

Firms possessing a unique competency to rescue the victims of a human catastrophe have a minimum moral obligation to devote substantial resources toward best efforts to aid victims. The minimum amount that firms should devote to rescue is the largest sum of their most recent year's investment in social initiatives, their five-year trend, their industry's average, or the national average. Financial exigency may justify a lower level of investment. Alternative social investments may be continued if they have an equally compelling rationale. These duties apply to the global pharmaceutical companies in the context of the AIDS pandemic in sub-Saharan Africa.

HIV/AIDS mitigation strategies and the State in sub-Saharan Africa – the missing link?

BackgroundThe HIV/AIDS pandemic in sub-Saharan Africa is widely recognised as a development disaster threatening poverty reduction, economic growth and not merely a health issue. Its mitigation includes the societal-wide adoption and implementation of specific health technologies, many of which depend on functional institutions and State.DiscussionDonor and International Institutions' strategies to mitigate HIV/AIDS in sub-Saharan Africa are premised on a single optimal model of the State, one which focuses on the decentralised delivery of public goods alone (such as healthcare) – the service delivery state. The empirical evidence, though sparse, of "successful" and "unsuccessful" sub-Saharan Africa states' performance in mitigating HIV/AIDS does not support this model. Rather, the evidence suggests an alternative model that takes a country context specific approach – encompassing political power, institutional structures and the level of health technology needed. This model draws on the historical experience of East Asian countries' rapid development.SummaryFor international public health policies to be effective, they must consider a country tailored approach, one that advocates a coordinated strategy designed and led by the State with involvement of wider society specific to each country's particular history, culture, and level of development.

The “Securitisation” of HIV/AIDS in Sub-Saharan Africa: A Critical Feminist Lens

This paper offers an account of how the HIV/AIDS pandemic in Sub-Saharan Africa (SSA) is understood as a threat to security, placing the various accounts of the securitisation of AIDS in the context of the human security situation in SSA. The first section examines in a very general way, the context of the “security crisis” of AIDS in Africa. The second part identifies the ways in which the HIV/AIDS pandemic is being “securitised”, and some of the potential implications of emerging security discourses for HIV/AIDS policy on the continent. It closes with an account of some of the more critical human security accounts on HIV/AIDS in SSA and finally, suggests how a critical feminist lens might broaden and deepen these perspectives.

Ethics and the AIDS pandemic in the developing world.

Traditional ethics provide insight, but often fall short of guiding the complex biomedical ethical concerns of research conducted in developing countries. The need to create research within a framework that is appropriate to the social, medical, and political context of developing countries is examined through the current AIDS pandemic in sub-Saharan Africa. A specific case study focuses on this issue. Over 70 percent of the 40 million people with HIV/AIDS live in sub-Saharan Africa. With at least one in five African adults infected with the disease, sub-Saharan Africa is now acknowledged as the epicenter of HIV/AIDS. The scale and scope of the disease in the environment of a developing economy presents unique issues that challenge the role and practices of traditional ethics in healthcare research programs. Medical research within developing countries, particularly for HIV/AIDS, requires a distinctive approach. For these populations, investigators must incorporate new thinking into traditional biomedical research ethics which will address the role of innovation; access to treatment; the impact of fear, stigma, and denial; concerns around autonomy for vulnerable populations; capacity building; and sustainable care to communities. Since May 1999, Secure the Future, a philanthropic program that focuses on care and support for women and children infected and affected by HIV/AIDS, has attempted to fulfill these ethical concepts in its processes. The program is a public and private sector partnership between governments, communities, practitioners, academia, and Bristol-Myers Squibb Company to respond to AIDS in five countries in sub-Saharan African countries: Botswana, Lesotho, Namibia, South Africa, and Swaziland. To ensure symmetry between ethical principles and local context, collaborative projects undergo a comprehensive review process. This includes review and approval by a national secretariat to ensure projects support objectives of national policies and local communities; approval by an ethics committee comprised of participating institutions; blinded peer review; and an examination by an external advisory board comprised of local and international medical experts, persons living with AIDS (PLWA), religious communities, governments, and nongovernmental organizations (NGOs). An independent monitor also oversees the approved programs. Cost-effective and practical interventions against HIV/AIDS must encompass ethical approaches appropriate to the contexts of the respective developing countries. Lessons learned to date are to focus on innovation; establish unassailable ethical standards that are sensitive to local contexts; ensure transparent communications among partners and the broader community; and build sustainable capacity.

At Law: Aids in Africa among Women and Infants: A Human Rights Framework

It is difficult to overestimate the devastation of the AIDS pandemic in sub-Saharan Africa. In that region, 9 percent of all adults are HIV-infected. Africa will soon reach premature death rates not seen since the end of the nineteenth century. In eleven countries, a baby born in 2010 will live, on average, barely beyond his or her thirtieth birthday. (1) The rate of HIV infection among women attending antenatal clinics in sub-Saharan Africa ranges from 10 to 50 percent, with an average rate in some countries of around 30 percent. (2) Women transmit infection to their infants in this region at a rate of 21 to 43 percent. The tragedy is that AIDS in Africa is largely preventable, with models of success found in Uganda and Senegal, where HIV incidence among pregnant women and infants has significantly declined. In North America and Europe, mother-to-infant transmission has been dramatically reduced using a regimen of antiretroviral medication administered to pregnant women and newborns. (3) The estimated cost of the regimen ($200 with discounts in pricing) makes the treatment unavailable to most people in sub-Saharan Africa where the annual health expenditure per person is between $2 and $40. (4) Additional barriers include the difficulty of complying with a regimen that entails administering a drug four to five times daily for weeks, the limited infrastructure for distributing drugs and monitoring compliance, and inadequate maternal-child health services. Research in sub-Saharan Africa and Southeast Asia has shown that less expensive short-course antiretroviral regimens diminish perinatal transmission by one-third to one-half. A trial in Uganda of a single oral dose of nevirapine given to the mother and newborn had similar benefits. (5) These results held regardless of whether women breastfed the child, although the formula-fed groups had greater reductions in transmission. Economic analyses suggest that short-course therapies can achieve significant health and financial benefits compared with the cost of the therapy. (6) As a result, WHO and UNAIDS recommend short-course perinatal antiretroviral therapy and advise HIV-infected women not to breastfeed their infants, where this can be accomplished safely. (7) Despite the clinical research, economic analysis, and public health guidance, few developing countries have national policies for integrating antiretroviral therapy into antenatal clinics. Those resisting these kind of interventions object on grounds of economics and ethics, but neither argument is convincing. Thabo Mbeki, president of South Africa, has seen the HIV/AIDS pandemic as part of institutionalized racism and has resisted guaranteeing all pregnant women antiretroviral treatment; he made nevirapine available only at a number of limited pilot sites. (8) In response to his intransigence, the Treatment Action Campaign (TAC) sued, claiming a human right to health for pregnant women and infants. (9) Treatment Action Campaign v. Minister of Health and Others Under the South African Bill of Rights, Everyone has the right to have access to health services, including reproductive health care ([section] 27(1)(a)). The state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights. Additionally; every child has the right to basic nutrition, shelter, basic health serves and social services ([section] 28(1)(c)). The Constitutional Court of South Africa has made clear that the state must afford citizens access to these socio-economic rights, although there is no self-standing, enforceable right to a minimum core level of services. (10) In its suit, the TAC challenged the government policy of limiting the use of nevirapine only to specific research and training sites. The Constitutional Court rejected all four reasons proffered by the government for preventing the vast majority of pregnant women from gaining access to treatment: ineffectiveness, drug resistance, safety, and capacity. …

Health sector reform in South Asia: new challenges and constraints

In early 1990s, Jamison, Mosley and others concluded that a profound demographic and consequent epidemiological transition is taking place in developing countries. According to this classical model, by the year 2015, infectious diseases will account for only about 20% of deaths in developing countries as chronic diseases become more pronounced. These impending demographic and epidemiological transitions were to dominate the health sector reform agenda in developing countries. Following an analysis of fertility, mortality and other demographic and epidemiological data from South Asian and other developing countries, the paper argues that the classical model is in need of re-evaluation. A number of new ‘challenges’ have complicated the classical interplay of demographic and epidemiological factors. These new challenges include continuing population growth in some countries, rapid unplanned urbanization, the HIV/AIDS pandemic in Sub-Saharan Africa (and its impending threat in South Asia), and globalization and increasing marginalisation of developing countries. While the traditional lack of investment in human development makes the developing countries more vulnerable to the vicissitudes of globalization, increasing economic weakness of their governments forces them to retreat further from the social sector. Pockets of poverty and deprivation, therefore, persist giving rise to three simultaneous burdens for South Asia and much of the rest of the developing world: continuing communicable diseases, increasing burden of chronic diseases, and increasing demand for both primary and tertiary levels of health care services. While these complex factors, on the one hand, underscore the need for health sector reform, on the other, they make the task much more difficult and challenging. The paper emphasizes the need to revisit the classical model of demographic and epidemiological transition. It is argued that the health sector in developing countries must be aware of and effectively address these ‘new challenges’. Although it has included data from many developing countries, the focus is primarily on South Asia.

Moral Boundaries

Recent discussion about ‘moral geographies’ has raised the question of how states define and represent norms of sexual morality. The AIDS pandemic in sub-Saharan Africa has forced states to redraw the boundaries of what is considered acceptable for public consumption concerning sexual behaviour. The aim of this article is to show that the ‘moral boundaries’ of educational and publicity materials produced to raise public awareness about HIV/AIDS are determined by negotiation between the state, its institutions and the citizenry. Two types of information transmission are discussed: the public media, in particular posters; and educational materials in schools. These are illustrated by case study material from Malawi and Zambia, two countries in the AIDS-Belt, but with contrasting attitudes towards these moral boundaries. It is shown that in both countries poster campaigns are normally implicit rather than explicit and adopt metaphors that do not offend public taste. Incorporating AIDS education into school curricula is a particularly contentious ‘boundary’ question because it induces anxiety about children's sexuality. The evidence presented shows that HIV/AIDS is causing the moral boundaries of the state to be reconstructed, within an on-going struggle between moralistic and pragmatic forces.

The demo-economic impact of the AIDS pandemic in sub-Saharan Africa

This paper examines the available data on the incidence and spread of AIDS and the associated human immunodeficiency virus (HIV) in Africa. Assessments of the impact of the spread of AIDS on African population growth and economic performance are then offered. The interactions with present economic and public health policy receive particular attention. The paper stresses continued emphasis on rural development and greater efforts to control other sexually transmitted diseases along with increased promotion of condoms as means of slowing the spread of AIDS.