Malawi has developed an excellent, nation-wide system for monitoring HIV patients and keeping track of key epidemic markers. The success of the Malawi system lies in two things: the focus on simplicity and the use of the data collection process not only to track the epidemic and identify problems to be dealt with but also to give regular feedback and support to every clinic in the country. We in South Africa have much to learn from them.
The HIVR4P conference is a global scientific conference focusing on biomedical HIV prevention research. HIVR4P 2018 supported research on HIV vaccines, microbicides, PrEP, treatment as prevention, and other biomedical prevention approaches. Numerous presentations highlighted the growing knowledge of HIV immune responses, HIV vaccine approaches, the impact of PrEP in HIV prevention, new PrEP drugs and diverse potential delivery options.
Evidence that age-disparate relationships (ADR) between young women and older men are an important route of transmission of HIV infection is limited. The results from recent studies indicate that heterosexual relationships between young women and older men may help sustain the epidemic within some populations of South Africa and Malawi. However, the way in which age differences serve to sustain the epidemic of HIV may be different than what has been previously described in observational studies. This article proposes several public health intervention recommendations in relation to ADR and the epidemic of HIV.
City leaders across the world are showing commitment and are providing political and technical leadership in dealing with local issues and barriers to delivering health and social services where they are needed. Cities are taking action, through their networks and by involving affected communities, to achieving the HIV Fast-Track targets by 2020. Ending the AIDS epidemic in cities will have profound, long-lasting benefits for urban communities and for countries and the global community.
Abstract: Twenty years ago, in 1997, I wrote the following piece reflecting on the Mothusimpilo project, an early attempt to understand and help to manage the epidemic of HIV in South Africa. I thought it might be interesting for you to look back on where we have come from.
Recent advances in ART have improved the success of treating infected individuals and have provided valuable tools to prevent infection. Early ART also offers one of the most practicable components in attempting to achieve functional cures, but diagnosing and treating HIV early remains a challenge.
Interventions to curb age-disparate relationships (ADR) are ongoing in spite of conflicting evidence that ADR are a risk factor for HIV transmission. There is a real need to explore the prevalence of ADR and understand what they mean for HIV transmission. We must first understand and describe these relationships; second, establish a causal relationship with HIV. We recently published a paper that explores those objectives in a population of 1,922 adult men and women living in Likoma Island, Malawi.
Early initiation of antiretroviral therapy (ART) significantly improves the survival of people living with HIV (PLWH) and reduces HIV transmission to uninfected partners. Mathematical models suggest that treatment-as-prevention programmes could lead to HIV elimination. How the clinical efficacy of ART in preventing HIV transmission translates to real-life settings depends in large part on the capacity of HIV programmes to engage and retain PLWH. The effects of ART on HIV incidence may also depend on changes in sexual network dynamics during the course of ART scale-up which are discussed in this article.
This article is based on the presentation given by John Hargrove at the NRF Science for Society Lecture entitled Ending HIV/AIDS in South Africa held on 1 December 2016 in Stellenbosch. He argues that the proactive use of ART (Treatment as Prevention or TasP) provides a powerful weapon for combatting the HIV epidemic, and that we also have the tools for monitoring and evaluating the progress of that programme. Mathematical modelling has played an important role, both in suggesting appropriate interventions, and in developing new monitoring methods, but we are still in for a long journey.
Despite the importance of youth sexual behaviour for sexual and reproductive health and the severity of the HIV/AIDS there is relatively little empirical research on factors affecting the age at sexual debut in South Africa. In my dissertation I used survival analysis techniques to identify significant predictors of early sexual debut in a South African context. The results may assist in devising strategies and action plans to be used to educate adolescents in making informed and safe decisions regarding sexual debut.