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AIDS action  >  Issue 18 - AIDS and work
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AIDS action  -  Issue 18 - AIDS and work

Work against AIDS!

Issue Contents 
 

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Work against AIDS!

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Education, not discrimination

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Beyond the work place

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AIDS and work

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The high cost of the epidemic

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Lost productivity and skills

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Impact on families

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Pressure on health care

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'Solidarity is a big enterprise!'

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Steaming ahead

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Action in the workplace

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AIDS is everybody's business

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Educators at work

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Caring companies?

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Prevention: who pays?

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It's all in the rubber!

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Clinical update - Coping with dual infection: HIV and tuberculosis

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How are TB and HIV related?

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How is TB diagnosed in people with HIV?

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What are the principles of TB treatment?

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Does HIV infection affect how TB should be treated?

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Spread the word, not TB!

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Preventive chemotherapy

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Some possible treatment regimens

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News

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Resources

 

 

 

AIDS action  Issue 18        Page 1   2  top of page

  Issue 18  September 1992

Work against AIDS!

The AIDS epidemic is having a major impact on people's working lives. In particular, lack of knowledge and fears about HIV infection mean that people with HIV/AIDS are discriminated against, by both workmates and employers. For example, some employers have introduced routine HIV testing for employees or people who apply for work. Those who test positive may be refused work or dismissed. These practices increase workers' fears of unfair treatment and contribute to prejudice against colleagues with HIV/AIDS.

But many employers are beginning to realise that testing is expensive, discriminatory and a waste of time. A negative test does not mean that a person is not infected, detected by the test to develop. Also, people with HIV are usually healthy, and, as one employer in Zambia said: 'If we did not employ HIV-positive people, we would lose many of our skilled workers.'


Education, not discrimination
Resources are much better used for developing AIDS education activities in places where people work and improving health services for all workers. As Susan Foster describes on page 2,  it is vitally important that workers are involved in AIDS prevention efforts. They need to know that day-to-day contact with colleagues does not involve any risk of HIV infection, as well as how to prevent sexual transmission.

Some types of work do of course have their own risk. Sex workers, for example, are at risk through unprotected sexual intercourse. Health workers and people who give first aid need special training in how to protect themselves (when necessary) from contact with blood products and other body fluids.
 

From a leaflet produced in Zambia by th Copperbelt Health Education Project's workplace programme.

More is needed than education and training activities in the workplace. Some employers have developed guidelines on HIV/AIDS which are part of their overall health and safety policies. These include commitments to oppose discrimination, to treat people with AIDS/HIV in the same way as anyone else with a life-threatening disease, and to keep workers' medical records confidential.

Four groups have a key role in work-place initiatives.



Governments are major employers, as well as having the power to legislate against discrimination. The Ministry of Health in Zimbabwe has opposed compulsory testing, and is drawing up national policy guidelines with union and employer organisations. In Botswana the National AIDS Programme is sponsoring workplace campaigns with 50 firms.

NGOs have enormous experience and expertise to contribute. And, as described in this issue, employers are often willing to pay for training and other activities carried out by NGOs.

Employers are increasingly aware of the threat AIDS poses to their staff, as well as to the survival of their businesses.

Trade unions have a key role in developing education programmes, and in negotiating guidelines and policy with employers.


Beyond the work place 
People who have similar occupations, or who work together, may have leisure, activities in common that could increase, the risk of spreading HIV Infection. For example, a group of male workmates might go to a bar on a Friday evening after work. This may lead to some having sex (possibly unprotected) with a girlfriend, or sex worker afterwards. Migrant workers, living away from their families, may have unprotected sex with many partners. Appropriate interventions must be developed with specific groups of workers, to help them reduce the risk it is vitally important that workers are of infecting themselves or others.

In addition, education strategies described on pages 4 and 5 are useful for reaching those who are not in formal employment. Workplace programmes also have a ripple effect, benefiting employees' families and the wider community.

 

In this Issue
 

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Economic impact on the epidemic

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Reaching people at work: programmes in Brazil,
India, Uganda and Zimbabwe

Plus
 

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TB and HIV infection: Treatment options



AIDS action  Issue 18   1   Page 2   3  top of page

  AIDS and work

The high cost of the epidemic

Many people living with HIV are in the prime of their working lives. Susan Foster describes the economic impact of AIDS.

With each death from AIDS, 15 to 20 years of work experience are lost, as well as a human life. Education for people at work is one way to reduce the cost of AIDS.


Every level of society is deeply affected by AIDS - from individuals and their families to the national economy. Currently, most people either living with, or at risk of, HIV infection are sexually active adults in the prime of their working lives. 

A substantial proportion of people in developing countries work for large private companies or in the public sector - health and civil services, the army, and nationalised industry.


However, the majority work in what is sometimes called the informal sector, such as small family farms, market or street trading and small businesses. Many women care for their families, as well as earning an income through selling produce or goods, or other work.

Lost productivity and skills 
With each death from AIDS, an average of 15 to 20 years' work experience, related skills and investment in schooling and training are lost, together with three quarters of a lifetime's earnings. The estimated increase in deaths from AIDS has enormous implications for national economies, in terms of producing goods for internal consumption and the export market.

AIDS also means that, as well as taking more days off sick, workers may also need time off to look after sick relatives and to attend funerals. Benefits, such as health care and insurance, provided by some employers for workers (and sometimes their families), may be threatened by the increase in demand due to AIDS related illness.

Another cost of AIDS in the workplace is the effect on the morale of colleagues when someone dies. Productivity slows down while people attend funerals, and afterwards take on extra work until a replacement can be found and trained.

Impact on families 
AIDS related illness leads to a fall in family income, in addition to the costs of care for the sick and dying. Funeral expenses can take all the family savings: the cost of even a modest coffin in Zambia equals four months' salary for an unskilled worker. Families also carry the costs of looking after the children of relatives who have died.

Pressure on health care 
AIDS is putting huge pressure on health budgets and services, especially where government health expenditure is low. Up to 80 per cent of beds in some urban hospitals in Africa are occupied by patients with AIDS related illnesses. Choices have to be made about how to spend limited funds, if people with AIDS are to be cared for.

Dr Susan Foster, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK.

 

Migrant workers need safer sex too

Migrant or mobile workers are at risk of HIV infection, and of infecting others. 

For example, thousands of young men move from poor areas in rural Mexico to the USA in search of work. Studies are finding that these men have high risk sex with other men and with female sex workers. 

Growing numbers of women, with their children, are also crossing the border. They often sell sex in order to survive, before eventually returning home. In the Mexican state of Michoacan, 34 per cent of people with HIV infection have lived in the USA. 

Truck drivers, and business and sales representatives, travel as part of their jobs. Many men work in mines, the construction industry, and in seasonal agricultural work, returning home only once or twice a year. In some countries, such as South Africa, restrictive laws and policies mean that migrant workers' families must remain in rural areas. Unions are campaigning for reforms in the migrant labour system and in miners' living situations - poorly serviced hostels for single men.

Women migrants may be at particular risk of sexual exploitation, in the sex industry. Women who remain at home may be more vulnerable to HIV too, because they may be more likely to seek other partners, especially if their migrant partners are unable to send them regular payments.



AIDS action  Issue 18   2   Page 3   4  top of page

  AIDS and work

'Solidarity is a big enterprise!'

With help from outside the business sector, companies in Brazil are joining the fight against AIDS
 

Companies pay for staff members from, for example, their personnel departments to be trained in how to set up and run AIDS education activities in the workplace.


The Brazilian Interdisciplinary AIDS Association (ABIA) has been encouraging companies in Brazil to develop AIDS education programmes for their employees since 1987. At first, collaboration with the business sector was limited to organising activities on World AIDS Day or giving lectures to company employees. Although these events were popular, the employers themselves did not set up long term programmes. ABIA felt that it was repeating the same activities again and again to no great effect. 
 
Yet there was no doubt that AIDS was affecting the workforce more and more. One bank in Rio de Janeiro reported that, in four years, 14 employees had become sick with AIDS related illnesses out of a total workforce of 2,000. Brazilian employers were becoming more aware of the need to participate in the effort to curb the AIDS epidemic. 

In 1990, ABIA launched a programme called 'Solidarity is a Big Enterprise', designed to support companies in setting up AIDS programmes. Through the programme, ABIA offers expertise in AIDS education and in policy development, technical consultancies, regular and up-to-date information, training, and monitoring and evaluation services. 

In return the company offers the services of its publicity and marketing departments and financial support. Companies also contribute valuable experience gained from other health and safety programmes.

Training is essential 
ABIA is now eighteen months into the programme, and working with 11 major Brazilian companies from both the private and government sector, some with as many as 15,000 employees.

Over 180 staff have been trained, including management, clerical and technical staff, and personnel officers. Personnel officers often co-ordinate AIDS programmes within their own companies, and are trained in how to run a peer education programme and give workshops. Some work on developing and distributing materials in the workplace. Company social workers, nurses and doctors are trained in pre-and post-test counselling skills. 

The companies are responding very positively. The relationship with ABIA gives the programme continuity, and guarantees that programme co-ordinators receive help and advice when needed. ABIA's experience shows effective ways to: 
 

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develop AIDS programmes that build on past experience, and use company and NGO resources to maximum benefit;

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involve companies in the fight against AIDS;

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strengthen employees' confidence in their company;

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develop discussions about the role and the contribution of both NGOs and companies in the fight against the epidemic, taking into account different social aspects, costs and benefits, and services available.



Veriano Terto Jr, Project Co-ordinator, ABIA, Rua Sete de Setembro 48, 12Q andar, Centro CEP 20050, Rio de Janeiro, Brazil.





AIDS action  Issue 18   3   Page 4   5  top of page

  Action in the workplace

AIDS is everybody's business

Reaching people at work: programmes in Uganda, India and Zimbabwe. 

Educators at work

AIDS Action talked to Ajonye Fermina Acuba about her work as a trainer with the Federation of Uganda Employers (FUE).

Cartoons telling the story of how one man realises the need for safer sex help peer educators to talk with their workmates about changing sexual behaviour.


AA
: What is FUE's AIDS programme? 
Ajonye Fermina Acuba: FUE is a national organisation with about 150 member companies. In 1988 FUE included AIDS education in its health and safety programme. Now over 900 volunteer employees (30 from each of 30 different companies) have been trained in face-to-face peer education techniques. 

AA: What are the secrets of the programme's success?
AFA: To start with, the people who join the peer education training courses must be the right ones for the job. We found that company managers were not the best people to select people for training, because they chose those who had a good relation ship with management rather than with their work-mates!

So, after gaining management agreement, we ask union representatives and department heads to nominate interested people, who then go on a three day training course (in work time) organised by FUE. Three-quarters are men (reflecting the make-up of the workforce in formal employment in Uganda). Men and women want to be trained together, because this helps them in discussing the issues with each other.

The way we train is another secret of our success. Through group participation exercises, video showings. role plays and quizzes, we discuss what makes a good peer educator, facts about HIV transmission and the role of STDs, behaviour change, negotiating safer sex, discrimination issues and living positively with HIV/AIDS. Individuals from local groups for people with HIV/AIDS are invited to share their experience with the trainees.
 
Follow-up is very important too. After the initial training I go back to the company at least once a month to discuss any problems with the educators. We encourage them to meet up together occasionally, and we run regional half-day refresher courses annually for at least one representative from each company's group of educators. The drop-out rate is very low, only about 5 per cent.

AA: How have you overcome any common problems during training?
AFA: Talking about changing sexual behaviour is difficult sometimes. We start off by discussing other forms of behaviour change, because people find it much easier to talk about how or why they stopped drinking or smoking heavily, rather than about sex. But, as people get more relaxed, someone usually says that they used to have more sexual affairs. This leads us into talking about changing sexual behaviour.

AA: What has been the experience of educators in their workplaces?
AFA: At first some employees think that it is just another condom promotion campaign, and they don't want to listen. But once they realise that they are free to choose whichever risk reduction strategy feels most appropriate, they become more interested. Most of the educators talk to about ten people a month, not just once but many times, during lunch or tea breaks. The educators talk to a lot of people in their communities too, where they have more time than at work! With management support, we also arrange for AIDS discussion sessions and video showings during work hours.

AA: How has the programme developed since 1988?
AFA: During programme evaluation, the educators have asked for more training in what we call 'first-aid' counselling. People come to them for support because they are anxious that they might be infected, or are frightened of discrimination. The peer educators want to be able to give them basic support, before referring them to counselling or self-help organisations.

We are introducing education specifically designed for managers, which has helped overcome their resistance to workplace education. Sometimes managers are thinking only in the short term or do not know much about AIDS. But, resistance is decreasing, partly due to increasing numbers of workers with AIDS, but mainly because of FUE's seminars, because these enable managers from different companies to learn from each other. 

We are now training company employees in how to train peer educators. I hope that, in the future, more companies will finance their own programmes.

Ajonye Fermina Acuba, Federation of Uganda Employers, PO Box 3820, Kampala, Uganda.





AIDS action  Issue 18   4   Page 5   6  top of page

  Action in the workplace

Caring companies?

Commercial farm owners in Zimbabwe are promoting AIDS prevention activities that have the support of employees and their families.

Many workers live with their families in settlements owned by agricultural or mining companies. These include large commercial farms in Zimbabwe; sugar, tobacco and tea plantations in Tanzania and India; and mines in Brazil and Botswana. Management usually provides basic housing, health care and education.

In Zimbabwe, the Commercial Farmers' Union (CFU), representing over 4,500 farm owners and managers, has been developing HIV prevention programmes for farm workers since 1986. Once they are familiar with the issues, volunteer co-ordinators from branch associations of the CFU begin with discussions with village leaders, and then with the wider community. 

Condoms, paid for by the farm owners, are available from the village health worker or farm clerk, and from farm shops and in pay packets (with the agreement of workers), and also from selected individuals.

AIDS committees are set up at the village level, involving local men and women. There is now a greater demand for condoms, arid fewer cases of STDs. Single women are turning from selling sex to seeking paid farm work (which farmers try to make available).

Points highlighted to the workers are:
 

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AIDS is fatal and there is no cure;

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STDs are a co-factor in the spread of AIDS, and condoms prevent STD and HIV transmission;

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STDs can cause sterility in women;

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the price of not spreading the word is the real likelihood of having to take care of relatives' children.


There is now considerable community pride that the challenge has been faced. AIDS is treated like any other disease, and the degree of stigma, together with associated accusations of witchcraft have been reduced.

Source: Peter Fraser-MacKenzie, c/o Commercial Farmers' Union, PO Box 1241, Harare, Zimbabwe.
 

Prevention: who pays?

Dr Sundararaman reports on how the AIDS Research Foundation of India is financed by local companies to train key employees.
 

'Protecting people's jobs and countering prejudice are key issues for trade unions,' says Halima Kasungu, of the Organization of Tanzanian Trade Unions. She has launched an education campaign targeted mainly at women union members. 


The most difficult part of developing a workplace programme and policy is persuading company directors to accept their responsibilities towards their employees. We find that they are more willing to listen to us if we meet with them on their own turf, such as through social clubs and civic organisations, like the Rotary Club. 

In our presentations we stress that AIDS will affect business profits in the long term, and that the way to minimise this impact is through setting up prevention programmes, not only for the workers, but for customers too. Our relationship with them is made easier because I have worked for some of them as a medical adviser, and therefore our programmes have more credibility.

We encourage companies to feel that they are working together against AIDS. For example condom manufacturers are encouraged to donate condoms, while other companies give financial support. 

The way it works is that local companies agree to fund both the salary and training costs of workplace AIDS educators at ARFI. After a year of training and hands-on experience, these staff are placed in the personnel offices of the various corporations where they can encourage AIDS education and prevention activities within the company, through training workers as peer educators. We also train students at universities in Madras who are in their final year in social studies, so that they are made aware of the issues before they start work.

It's all in the rubber! 
We develop a specific campaign with each company. Most employers agree to condom distribution at the workplace, through medical dispensaries and through individual workers selling condoms.

For one tyre manufacturing company, interventions were designed not only for the factory workers and sales representatives, but also for the small trucking businesses and drivers who buy the tyres.

Condoms are sold in roadside stalls and to women selling sex to both drivers and salesmen. The company may also finance the duplication of a cassette tape of songs on safer behaviour, along with tyre advertisements, for playing in the teashops along the road. The songs feature the slogan, 'It's all in the rubber! ' (see AIDS Action 15).

Dr S Sundararaman, AIDS Research Foundation of India, 20/2 Bargharithy Ammal St, T Nagar, Madras 600 017, India.



AIDS action  Issue 18   5   Page 6   7  top of page

  Clinical update

Coping with dual infection: HIV and tuberculosis

AIDS Action describes how HIV affects TB control

The HIV epidemic is causing a huge increase in the number of people with tuberculosis (TB), particularly in Africa. TB is also common in parts of Asia-Pacific and Latin America, and an increase in HIV-related cases in those regions is also likely.

How are TB and HIV related? 
In countries where TB is common most people become infected with Mycobacterium tuberculosis (which causes the disease) during their childhood. They do not usually develop TB because their immune systems can prevent further multiplication of the bacteria. However the bacteria are not destroyed, but lie dormant in the body. 

The immune system In people with HIV infection is weakened by the virus. TB is more likely to develop because: 
 

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a person with HIV who is infected with M. tuberculosis for the first time as an adult is less likely to be able to prevent the bacteria from multiplying;

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a person who was infected with the bacteria as a child, and who later becomes infected with HIV, loses their immune protection against the bacteria that have remained in their body. The bacteria may reactivate, causing TB to develop.


It is also likely that more people who are HIV-negative will be infected by the bacteria, because of the increase in numbers of people who have developed TB (as a result of being HIV positive). 

The increase in the number of HIV-related cases of TB has serious implications for both TB control programmes and AIDS programmes, requiring collaboration in developing prevention and treatment strategies.

How is TB diagnosed in people with HIV?
TB shows the usual pattern in some people with HIV infection. This includes fever, weight loss and cough, with cavities in the upper part of the chest X-ray and a positive sputum smear test for tubercle bacilli. But HIV-positive TB patients are more likely than HIV-negative TB patients to have: 
 

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disease in uncommon sites, such as lymph nodes, and the double membrane sac enclosing the lungs (pleura) and heart (pericardium);

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a negative sputum smear for TB;

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a negative tuberculin skin test;

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an X-ray showing disease in the middle or lower part of the lungs (instead of the upper part), which does not show cavities in patients with pulmonary tuberculosis.


It may be appropriate to treat the patient for TB if the disease is suspected, and if he or she has not responded to simple antibiotics such as ampicillin or cotrimoxazole. Patients with TB usually show improvement after a few weeks of regularly taking treatment. If a patient does not improve (for example, with increase in weight and improved symptoms) after this time then they probably do not have TB. The patient should be reassessed.

 

Spread the word, not TB! 
 

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HIV infection increases the risk of TB, but not everyone with TB has HIV infection. TB is preventable and curable. It is spread through contact with infected sputum (coughing, mucus etc).

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Treatment helps to stop the spread of infection. If someone has had a cough for more than a month, they should go to a clinic, where their sputum should be tested for M. tuberculosis.

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Good environmental hygiene is important to prevent infection spread. Exposing bedding or clothes to direct sunlight kills the bacteria in five minutes.

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BCG vaccination helps to protect children against serious forms of TB. WHO recommends that all infants with no obvious HIV related infections should be vaccinated, even if the mother is known to be HIV-positive.



What are the principles of TB treatment?
The principles of treating TB are the same, whether a patient is HIV-positive or not. The patient must take a combination of drugs; and the course must be completed. Treatment is long and costly, and sometimes has unpleasant side-effects. It can be difficult to persuade patients to take the full course of drugs, but this is very important.

Drug resistance: Some strains of M. tuberculosis are resistant to the drugs used. In the USA, in addition to an increase in TB cases since 1986, a number of drug-resistant outbreaks of TB have occurred. It is vitally important to prevent this happening elsewhere.

If the patient takes one drug only, such as isoniazid, he or she may show some improvement at first. However bacteria resistant to isoniazid will soon start to multiply, and the patient will become sick again. If a patient takes two or more drugs during the treatment this is unlikely to happen because bacteria resistant to one drug will be killed by another. One way to make sure that the patient takes the required drugs is to prescribe combination tablets (see table).

Recurrence of TB: Patients must complete a full course of treatment to prevent relapse (recurrence of disease). TB can recur if treatment is stopped too soon, because there may be enough living bacteria in the body to cause disease to return.

There is evidence that HIV-positive patients are in greater danger of relapse because the immune system is weakened. It may be that HIV-positive TB patients should continue the treatment for longer than HIV-negative patients, or even for life, but this is not yet certain. TB patients should have a follow-up appointment after the end of treatment and they should always be advised to attend the clinic quickly if they develop any TB symptoms again.



AIDS action  Issue 18   6   Page 7   8  top of page

  Clinical update

 

Does HIV infection affect how TB should be treated? 
Different drug regimens can be used to treat TB. The regimen depends on which drugs are available locally, their cost, government policy, and the effectiveness of the regimen. Some regimens which are commonly used are shown in the table, with notes on some of their advantages and disadvantages. The ideal treatment regimen for patients with HIV takes into account the following factors.

Dangerous side effects: TB patients with HIV often have more serious ad-verse reactions to drugs than HIV-negative patients. Ideally thiacetazone should not be prescribed for HIV-positive patients. Up to 20 per cent of HIV-positive tuberculosis patients develop skin rashes when treated with thiacetazone. Some rashes may be very severe, affecting the whole skin surface as well as eyes, mouth and genitals. A significant number of patients die due to fluid loss through skin lesions caused by the rash.

If thiacetazone has to be used, patients should be advised to stop their treatment and attend the clinic immediately if any rash occurs. Occasionally other anti-tuberculous drugs may cause a rash, so all drugs should be stopped temporarily if a rash develops.

Patients with a severe rash require hospital care. After the rash has settled the drugs should be restarted one by one to find out which caused the rash. However, because thiacetazone causes such severe reactions, it should not be used again in patients who have had a rash. It should be replaced by another drug (see regimens 1,2 and 3).

Place of treatment: In some places, particularly in urban areas, it is not possible to treat TB cases for long periods in hospitals, because of the increases in patient numbers. In addition, treatment at out-patient clinics may be difficult as many patients may not have transport to attend the clinic. Ideally patients should be able to take their treatment at home, where they will need to be followed up by health workers.

Injections: Drugs such as streptomycin that are given by injection have disadvantages because:
 

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they can be used only when patients can be admitted to hospital or are able to travel to a clinic regularly;

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they must be given using sterile needles and syringes, and obtaining these may be difficult.

 
Cost-effectiveness: Regimen 5 (see table) is used in many countries because the drugs are less expensive. However, studies are now showing that, in the long term, the real costs of this treatment may be much greater than for the shorter, more powerful regimens, because:
 

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the longer the treatment, the more likely that patients may not complete the course;

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the drugs used in the first two months are not very powerful, so patients who stop treatment early are very likely to relapse. This means that many patients will need treatment again, and also may infect people they come into contact with.

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injections are required, so patients must be in hospital or attending a clinic.


Patient support: Patients are more likely to take all their treatment if the regimen is short and has few side effects. They also need to be able to obtain the drugs easily. Health workers need training and clear guidelines on how to treat a person who has HIV infection and TB, and how to counsel patients and family members about care and prevention (see box). 

Ideally patients who have newly diagnosed TB disease in countries where there is a high incidence of HIV should be offered a voluntary HIV test, with appropriate pre-and post-test counselling. However, in many places this is not possible, given the pressure on re-sources and the need for trained counsellors. All patients with TB should receive information about preventing HIV transmission.

Preventive chemotherapy 
Treatment with isoniazid may prevent the development of clinical TB in people who are HIV-positive. WHO is currently supporting trials in countries including Uganda and Zambia.

Drs Alison Elliott and Alwyn G Mwinga, School of Medicine, University of Zambia, PO Box 50110, Lusaka, Zambia.


Ref: HIV-associated TB in developing countries: epidemiology and strategies for prevention. WHO/TB/92.166.

Clinical Tuberculosis is available from TALC, PO Box 49, St Albans, Herts, AL 1 4AX, UK, to readers in developing countries for £5.50 (airmail) or £5.00 (surface mail). (Payment by International Money Order or Eurocheque in sterling, with orders.)

  

Some possible treatment regimens 

Regimen 1: 
2 months ethambutol, Isoniazid, rifampicin, pyrazinamide followed by 4 months rifampicin and Isoniazid.

Advantages 

Disadvantages

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Short 

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No thiacetazone

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No injections

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Combined tablets (rifampicin and isoniazid)

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Hospital/clinic treatment not essential

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Patient more likely to complete treatment

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More expensive drugs

Regimen 2: 
2 months ethambutol, isoniazid, rifampicin, pyrazinamide followed by 6 months ethambutol and isoniazid.

Advantages 

Disadvantages

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Shorter

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No thiacetazone

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No injections

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Hospital/clinic treatment not essential

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Useful where drugs in short supply

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Continuation phase maybe inadequate and does not use combined tablet

Regimen 3: 
2 months ethambutol, isoniazid, rifampicin, pyrazinamide followed by 2 months ethambutol and isoniazid, then 4 months isoniazid. 

Advantages 

Disadvantages

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Shorter

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No thiacetazone 

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No injections 

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Hospital/clinic treatment not essential

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Useful where drugs in short supply 

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Continuation phase maybe inadequate and does not use combined tablet

Regimen 4: 
2 months streptomycin, thiacetazone, isoniazid, rifampicin, pyrazinamide followed by 6 months thiacetazone and isoniazid. 

Advantages

Disadvantages

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Shorter

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Combined tablets (Thiazina)

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Thiacetazone toxicity

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Injections required

Regimen 5: 
2 months streptomycin, thiacetazone, isoniazid, followed by 10 months thiacetazone and isoniazid.

Advantages

Disadvantages

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Less expensive drugs

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Combined tablets (Thiazone)

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Long

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Thiacetazone toxicity

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Injections required



AIDS action  Issue 18   7   Page 8       top of page

  News / Resources

 

Action needed 

The international conference on AIDS held in Amsterdam in July this year brought over 10,000 people together, although only 15 per cent of participants were from developing countries. 

People with HIV/AIDS had a strong presence at the conference. The urgent need for full respect of their human rights was confirmed, in addition to their essential participation in education and in research design. Other key issues raised at the conference included:
 

Epidemiology 
 

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The proportion of women with HIV/AIDS is growing, and it is acknowledged that they are more vulnerable to infection than men.

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Numbers of people infected are growing in Asia, the Americas and Europe, as well as in Africa.

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It is estimated that over 1 million children worldwide have been infected, and that this will increase to 10 million by 2000.

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All STDs increase the risk of HIV infection: there is a need for more education and access to treatment.


Clinical care and science 
 

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Numbers of people with TB are increasing because of the HIV epidemic. TB is now the most important opportunistic infection worldwide (see pages 6 and 7 in this issue).

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Infections specific to women are not included in the definition of AIDS, which has meant that some women's illnesses have not been diagnosed as HIV related. The definition is now under revision.


Social impact 
 

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Human rights were given a high profile, focusing on how people have been discriminated against because of HIV/AIDS. Sex workers, drug users, men who have sex with men and minority groups were acknowledged to be particularly vulnerable to abuse, because they are already widely discriminated against.

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Poverty, powerlessness and ill health increase vulnerability to the virus. AIDS is highlighting the need for economic and social development that ensures adequate living standards, access to health care and respect of human rights for everyone.


Prevention 
 

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Many delegates emphasised that it is very difficult for individuals to change their behaviour unless the attitudes of people around them, and the social context in which they live, also change.

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There is a need for more targeted interventions, for example, for:
 

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women who feel they are in stable relationships with men, and do not see themselves to be at risk;

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men who define themselves as heterosexual, but who sometimes have sex with other men;

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injecting drug users (who are at risk of infection through sharing contaminated needles and syringes, as well as unsafe sex). Injecting drug use is on the increase, not only in Europe and the USA, but in big cities in Asia, Latin America and Africa.

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The social and ethical issues of how vaccine trials are carried out need to be considered. Even if an effective vaccine is developed, it will be difficult to make it widely available, because of the costs involved and problems of reaching everyone in need. Prevention through behaviour change will always be a priority.

Resources

Workplace information 

Working towards understanding: a workplace training pack on HIV infection and AIDS. 
Available at Sw fr 60 (with slide set) from the Federation of Red Cross and Red Crescent Societies, PO Box 372, CH-1211 Geneva 19, Switzerland.


Guidelines on AIDS and first aid in the workplace. WHO AIDS Series no. 7, 1990. 
Available at Sw.fr.4 from WHO Publications, CH-1211 Geneva 27, Switzerland. 

All against AIDS: the Copperbelt Health Education Project (CHEP), Zambia. Chandra Mouli, Strategies for Hope no 7, 1992. 
Describes the project's experience since 1988 in developing a range of interventions, including workplace campaigns.
Available at £2.00 from TALC, PO Box 49, St Albans, Herts AL1 4AX, UK. Contact CHEP, PO Box 23567, Kitwe, Zambia for information about their materials on HIV/AIDS, STDs and TB.


It's not easy 
48 minute video, all formats, in English, French and Swahili. Suna finds out that he is infected with HIV. It's not easy tells the story of how his employer, colleagues and neighbours become allies, not enemies, in the fight against AIDS.
Available at US$95 from: Zimbabwe: Media for Development Trust, PO Box 6755, Harare; Kenya: Development through Self-Reliance (DSR), PO Box 38941, Nairobi; USA: DSR, 9650 Santiago Rd, Suite 10, Columbia MD 21045. 

Suppliers advise readers to contact donor agencies in their countries for assistance with purchasing this video.

 

Managing Editor: Kathy Attawell 
Executive Editor: Nel Druce 
Production: Celia Till 
 
Editorial advisory group: Calle Almedal (Norway), Professor E M Essien (Nigeria), Dr U Küpper (Germany), Professor K McAdam (UK), Dr A Pinching (UK), Dr P Poore (UK), Barbara Wallace (UK), Dr M Wolff (Tanzania).
 
With special thanks to: Dr Chandra Mouli

With support from HIVOS (Netherlands), ICCO, Memisa Medicus Mundi, Misereor, Norwegian Red Cross, Oak Foundation, Oxfam, Save the Children Fund, SIDA and WHO/GPA. 

 

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AIDS Action
The International Newsletter on AIDS Prevention and Care


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