WUNRN
http://www.wunrn.com
 
HIV/AIDS - WOMEN & CHILDREN - SUB-SAHARA AFRICA - MOZAMBIQUE +
 
 
 
http://www.nytimes.com/2007/06/06/health/06aids.html?_r=1&oref=slogin
 
New AIDS Cases in Africa Outpace Treatment Gains
 
Joao Silva for The New York Times

Isabel Quembo, standing, said her husband beat her and destroyed their hut when he learned she had H.I.V.

By SHARON LaFRANIERE
June 6, 2007

BEIRA, Mozambique — Four years ago, the region surrounding this somnolent seaport, Mozambique’s second largest city, offered hardly any AIDS-prevention advice to pregnant women. Today, two dozen health clinics give mothers-to-be H.I.V. counseling, tests and medicine to protect their newborns from catching the virus.

Clinic workers persuade four in five women to be tested, and one in six tests comes back positive. Last year alone, the clinics identified 5,018 women who were poised to pass H.I.V., the virus that causes AIDS, to their babies.

Beira might be regarded as a beachhead in Africa’s effort to halt the spread of AIDS, but for one hitch: more than half of those women never returned to the clinics for medicine to limit the risk of transmitting H.I.V. to their children.

“After the test, the problems start,” said Alberto Baptista, the provincial health director. “We lose a lot of women.”

There is a bright side to sub-Saharan Africa’s war on AIDS: hundreds of thousands of infected people once doomed to die are now receiving life-saving treatment. Fully 28 percent of those who need drug treatment get it, compared with just 2 percent in 2003.

But Beira also represents the less noticed, stubborn umbra — the pandemic’s continued spread. For each sub-Saharan African who was placed on anti-AIDS drugs last year, experts say, five more were newly infected. The region’s rate of new infections has not budged since the late 1990s, experts say.

If current trends persist, sub-Saharan Africa, already reeling under the burden of nearly 25 million infected people and in the midst of a population boom, will face 36 million additional new infections by 2015, according to a report to be released this June by the Global H.I.V. Prevention Working Group. Treatment clinics will confront an ever-growing clientele and countless millions will die, said the panel of experts, which was convened by the Kaiser Family Foundation and the Bill and Melinda Gates Foundation.

“It is like running on a treadmill,” said Salim S. Abdool Karim, who directs the Center for the AIDS Program of Research in South Africa. “The faster you run, the more you stay in place.”

The panel blamed the lack of an intensive prevention effort for the continuing high rate of new infections. To some extent, the panel said, prevention has taken a back seat to treatment in the last several years. Developing nations are spending progressively less on prevention programs, the report said. Studies show donors are also gravitating toward financing treatment over prevention.

“Despite their promise, H.I.V. prevention efforts have received short shrift in the global H.I.V. response,” the report says.

That is partly because treatment programs produce tangible, dramatic evidence of money well spent, while an averted infection is almost impossible to show, even though prevention is more cost-effective in the long run, the panel’s experts say.

Worldwide, prevention programs reach fewer than one in five people at high risk of infection, the United Nations AIDS agency estimates. In 2005, $3.2 billion was spent on prevention, $2.5 billion less than what was needed, the agency says.

The working group estimated that a properly financed and executed prevention campaign could reduce the number of global infections in 2015 by nearly two-thirds. “This degree of success would likely disable the epidemic,” the report said.

One the most glaring examples of flagging prevention, experts agree, is the high percentage of pregnant women who pass on H.I.V. during birth or breast-feeding.

Most pregnant women in sub-Saharan Africa visit a health clinic at least once before giving birth, according to the United Nations AIDS agency. Preventing them from infecting their babies is relatively simple: a single antiretroviral pill called nevirapine — or better yet, a combination of drugs — is given at the onset of labor. The newborn receives nevirapine and other medicine.

Clinical trials showed that those methods can cut the risk of H.I.V. transmission in half, according to the H.I.V. working group. Yet while the mother-to-child prevention program is growing, it still reaches only 11 percent of infected mothers-to-be. Last year alone, 460,000 sub-Saharan children were infected with H.I.V., a vast majority by their mothers.

“The level of coverage is ridiculously low,” said José Izazola-Licea, a senior resource adviser for Unaids.

In the Mozambican province that includes Beira, the new focus on prevention represents a huge come-from-behind effort. But with just one nurse for each 8,000 residents and AIDS still regarded largely as a humiliation, success is elusive. Last year, only one in 12 mothers-to-be who needed preventive medication in Mozambique received it, the Ministry of Health said.

At the Chota health clinic near Beira, a single nurse, Anna Manocua, struggles vainly to track infected mothers while caring for an average of 60 patients a day. How many receive their medication is just a guess. Her handwritten log suggests that at least eight women have missed their drug doses since December. There is no hope of finding them: Ms. Manocua did not record any addresses or cellphone numbers.

“I am alone,” she said. “I have a lot of work. Last week, when I was sick, there was no one here at all.”

Stephen S. Gloyd, the director of Health Alliance International, said the Chota nurse epitomized the problem. His nonprofit organization is trying to jump-start the province’s mother-to-child prevention program. But he said, “it all comes down to the same, single nurse.”

Shortages of health care workers are hardly the only problem. For the typical Mozambican woman, the nearest health facility is an hour’s walk away. Nearly half of the women in Beira’s province give birth without help from a health care worker, who must give anti-H.I.V. drugs to newborns within 72 hours of birth.

Breast-feeding is another obstacle. Even infected mothers who have chosen nevirapine tend to ignore the risk of breast-feeding longer than six months because of tradition and a lack of other food, a United Nations report states.

Nor is persuading mothers-to-be to take the right steps easy.

At a support group in Nhamatanda, a town of 5,000, H.I.V.-positive new mothers recounted how they followed medical advice and told their husbands they had H.I.V., with disastrous results. Aida Estefani, 29, said her husband abandoned her midpregnancy, telling her, “The child will be contaminated also.”

Rita Louise, who did not give her last name for fear of ostracism, said her husband demanded that the police arrest her. Isabel Quembo, 30, said her husband beat her and tore their hut to the ground. He threw out pots, pans, food — and then her.

The husband of Rosa, a 37-year-old mother of twins, stood by her, but her monthly trips to the hospital aroused suspicions among her neighbors.

“Always when I walk by I hear them,” she said. “They speak loudly enough so I can hear them. They say, ‘She is a person of AIDS.’ ” She consoles herself with a grim thought. “Today it is me,” she said. “But tomorrow, it can be them.”





================================================================
To leave the list, send your request by email to: wunrn_listserve-request@lists.wunrn.com. Thank you.