Africans much better than North Americans at taking anti-HIV meds

More HIV-infected Sub-Saharan Africans took their anti-HIV medications as directed than HIV-infected N. Americans did, according to the largest and most extensive review of adherence studies to date.

The review was directed by researchers from the Centre for International Health and Human Rights Studies and the University of California, San Francisco.

“This review contradicts a historical anticipation of poor adherence by Africans to antiretroviral regimens that was offered as a rationale to delay providing these therapies. If one had considered adherence simply on the basis of evidence, Sub-Saharan Africans would have had access to these life-saving therapies earlier,” said study lead author Edward Mills, PhD, MSc, director of the Centre for International Health and Human Rights Studies.

The review, published in the August 9 issue of the Journal of the American Medical Association, looked at data from 31 studies from North America involving 17,573 HIV-infected patients and 27 studies from Sub-Saharan African involving 12,116 HIV-infected patients. Findings showed that 59 percent of North Americans took their medications as directed, while 77 percent of Sub-Saharan Africans adhered to their antiretroviral regimens.

“Thinking that poverty was a risk factor for non-adherence was a mistake. Not all poverty is the same; poverty in resource-limited settings presents a different set of challenges than poverty in the U.S. Missed doses among the poor in resource-limited settings is less about neglected doses due to complex behavioral and social problems and is more about structural barriers to reliable medication access,” said study senior author David R. Bangsberg, MD, MPH, UCSF associate professor of medicine and director of the UCSF Epidemiology and Prevention Interventions Center at San Francisco General Hospital Medical Center.

While these high levels of adherence in resource-limited settings are reassuring, the authors call for programs to monitor and sustain this level of adherence.

“Adherence in Africa will decline as benefits of treatment plateau and long-term side effects accumulate and when people no longer see AIDS as a terminal disease. The challenge will be to detect and intervene on these declines prior to rising population levels of resistance,” said Bangsberg.

The review notes the World Health Organization’s intent to increase access to antiretrovirals in Sub-Saharan Africa and its estimates of the proportion of HIV/AIDS patients urgently needing therapy. The estimates range from 56 percent in Botswana and Uganda to 3.2 percent in Tanzania and the Democratic Republic of Congo.

“When we talk about AIDS in Africa, it is usually in broad terms–‘millions of people infected’ etc. In making policy, we must always be mindful that we are talking about someone’s mother, daughter, brother, sister, father or son. Policymakers make decisions that have life and death consequences and those decisions should be based on evidence, not conjecture,” said Mills.

From UC San Francisco

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  1. Globalization and AIDS

    K. Mustafa Ali
    New Chuburji Park,
    92-42-741 44 56
    [email protected]

    AIDS has become one of the major health problems affecting people around the world. As of 2006, more than 39.5 million people are currently living with HIV, and By 2010 it is estimated that approximately 100 million people will have been infected and that there will be 25 million AIDS orphans worldwide. By 2006 an estimated 39.5 million (34.1- 47.1 million) people were living with HIV/AIDS. Sub-Saharan Africa has been the region hardest hit by the HIV/AIDS epidemic; more than two-thirds of all people with HIV/AIDS are in this region.

    Asia is also grappling with the increasing feminization of the epidemic and its impact on children and families. The prevailing poverty among women and its further accentuation or ‘feminization of poverty’ due to adverse effects of globalization make the women in the region highly vulnerable to the epidemic. The impact of Globalization, which effect directly in some individual culture in some region, the opinion of AIDS researcher Mohammad Khairul Alam, “the mixed effect of traditional norm and globalization has brought frustration in the man. For these two things people are forgetting traditional social norms, social values and the social structure are facing a great threat following the western and others cultures. Familitical ties are breaking; family sexual behaviour is changing, attitudes of peoples towards sex is changing very fast. Besides migration for jobs, an increasing number of women taking up jobs outside the home, a decline in the traditional joint family system, and conflict to global culture were considered to have contributed to this phenomenon.” The situation is further aggravated by the presence of all forms of violence against women including those in conflict and disaster situations.

    From about 20% a decade ago, the percentage of women accounting for new infections has risen to 30 per cent indicating a constantly rising vulnerability of women and girls to HIV. Severe gender inequality in political, social, educational and economic areas and absence of informed choices in the region, render women extremely vulnerable to HIV and subject them to intense stigma and discrimination. Often, women have no control over their sexual lives and have extremely limited access to prevention information and services. However, even the best knowledge on prevention does not guarantee protection for women due to the overpowering dominance of patriarchy. It is not merely coincidental that about 14 per cent and 60 per cent of the girls over the age of 15 in South East Asia and South Asia respectively are illiterate. The Rainbow Nari O Shishu Kallyan Foundation survey focuses on the attitude, behavior and practice of commercial & non- commercial / casual sex workers (so-called sex workers), floating/ street sex workers in Dhaka city in Bangladesh, this study did point out that almost 16% of sex workers enter the profession before the age of 18 years, and 30% enter between 18 to 24 years of age. Approximately 10% of prostitutes belong to the scheduled castes minority people; about 90% floating sew workers enrolled due to poverty, and 85% are illiterate.

    Meanwhile, an issue that has a far reaching socio-economic impact, but is not acknowledged and measured in economic terms, is the stigma and discrimination faced by people living with HIV. The spread of HIV/AIDS presents a challenge to all of us in the Asia region, which is threatening to offset gains in human development. It underlines the urgency of effective prevention and changes in behaviors and attitudes in order to combat HIV/AIDS and mitigate its effects.

    1. WHO report, HIV/AIDS in Asia and the Pacific Region, 2003.
    2. Asia Pacific’s Opportunity: Investing to avert an HIV/AIDS Crisis, July 2004. ADB/UNAIDS study series.
    3. “Oh! This one is infected!”: Women, HIV & Human Rights in the Asia Pacific Region, paper commissioned by the UN Office of the High Commissioner of Human Rights, ICW, 2004
    4. “From Involvement to Empowerment”, UNDP, 2004
    5. AIDS in Asia: Face the Facts. Monitoring the AIDS Panedmic (MAP) Report, 2004, HDR, 2003
    6. Rainbow Nari O Shishu Kallyan Foundation

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