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Freudian Slip
- Brian McKinstry (24 June 2006)
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The key global perspective on antiretroviral treatment in Africa is human resources for health
- Ntambwe Malangu (26 June 2006)
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New NIH study supports immune therapy treatment model
- Gary J Minter (28 June 2006)
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Brian McKinstry, senior researcher University of Edinburgh, Community Health Sciences Edinburgh EH8 9DR
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They say a Freudian slip is when you say one thing and mean your mother. I presume Professor Deeks did not really mean that highly active retroviral therapy reduces the long term risk of morality (sic) related to HIV! Competing interests: None declared |
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Ntambwe Malangu, Senior Lecturer University of Limpopo, South Africa
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Kober and Van Damme (2004) while writing about the scaling up access to antiretroviral treatment (ART) in Southern, they asked the question “Who will do the job”. Prof. Deeks singled out drug availability, limited resources in terms of equipment as some of the constraints facing Africa with regard to ART. At global level it could be said that financial resources are not regarded as the main immediate constraint anymore, because the World Bank has committed large amounts of funds through its Multicountry HIV/AIDS Programme for Africa (MAP) and private foundations, such as the Bill and MelindaGates Foundation, and the Clinton Foundation are contributing to increased funding for HIV/AIDS. Since 2003, the US President’s Emergency Plan for AIDS Relief (PEPFAR) has provided more funds for procuring ARVs ; other donors have committed substantial amounts of funds globally and, above all, the countries with the highest HIV/AIDS burden have also allocated funds from their own resources. But that the lack of human resources for health is regarded as the single most serious obstacle to the rollout of ART. Although some countries such as South Africa and Tanzania have developed comprehensive human resource strategies, the situation of human resources for health in most countries is precarious. The six dimensions of human resources for health include their number, their geographical repartition, their level of expertise, their commitment, their working conditions, and their production. At the moment not only there is insufficient number of health professionals for national health systems in general, there is even a greater shortage of personnel involved in ART. For instance, the South African government estimated that 13,805 new health professionals (doctors, nurses, pharmacists, dieticians and counsellors) would be needed by 2008 to meet the targets of its Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment, but it has a vacancy rate of 31.1%. And the few human resources available are maldistributed, with most of them residing in urban areas. Two decades into the HIV/AIDS epidemic, there are skill few HIV/AIDS specialists formally trained and the various courses offered are often uncredentialled and uncoordinated particularly those vertically run by international organizations. This is particularly worrying if one considers the fact that the lower level of health care professionals such as pharmacy assistants are seldom targeted for such trainings yet they are the ones doing the job. Moreover, with regard to commitment of health care workers, in many countries, particularly lower cadres are paid salaries that are below subsistence level. This coupled to unsatisfactory working conditions characterised by overwork, lack of support, burnout, lack of equipment; the personnel is simply overwhelmed. Yet the production of health professionals by institutions of higher learning is not on the increase as it could be expected but the capping of number of new entrants through governmental budgetary imperative, the shrinking number of academics through retirement of old “guards’, with no replacement by young ones, contribute to the decreased throughput. Clearly the one way major donors could assist in addressing global perspectives relating to ART and health of populations in developing countries, is to commit to human resources development. This assistance could be unveiled by helping countries to develop a coherent human resources strategy, an implementation plan, and providing more funding to enable access to higher education by the majority of the youth that is currently not at varsity due to financial constraints. References Chen L. Hanvoravongchai HIV/AIDS and human resources [Editorial]. Bulletin of World Health Organization 2005;83(4):243–44. Chen L, Evans T, Anand S, et al. Human resources for health: overcoming the crisis. Lancet 2004;364:1984–90. Dovlo D. Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review. Human Resources for Health 2004;2:7. Hanson K, Ranson KM, Oliveira-Cruz V, et al. Expanding access to priority health interventions: a framework for understanding constraints to scaling up. Journal of International Development 2003;15:1–14. Hongoro C, McPake B. Human resources in health: putting the right agenda back to front [Editorial]. Tropical Medicine and International Health 2003;8:965–6. Kober K, van Damme W. Scaling up access to antiretroviral treatment in southern Africa: who will do the job? Lancet 2004;364(9428):103–07. Liese B, Blanchet N, Dussault G. The Human Resource Crisis in Health Services in Sub-Saharan Africa. Background paper. Washington DC: World Bank, 2003. Loewenson R, McCoy D. Access to antiretroviral treatment in Africa [Editorial]. BMJ 2004; 328:241–42. McCoy D, Chopra M, Loewenson R, et al. Expanding access to antiretroviral therapy in sub- Saharan Africa: avoiding the pitfalls and dangers; capitalizing on opportunities. American Journal of Public Health 2005;95(1):18–22. South African Department of Health. Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa. Pretoria: Department of Health, November 2003. Padarath A, Chamberlain C, McCoy D, et al. Health personnel in southern Africa: confronting maldistribution and brain drain. Equinet Discussion Paper No.3. Zimbabwe: Equinet, Health Systems Trust, MEDACT. Skhosana N et al. HIV disclosure and other factors that impact on adherence to antiretroviral therapy: the case of Soweto, South Africa African Journal of AIDS Research 2006, 5(1): 17–26 USAID. The Health Sector Human Resource Crisis in Africa: An Issues Paper. Washington DC7 USAID, AED, SARA, 2003. Competing interests: None declared |
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Gary J Minter, university instructor Communications University of China Beijing PRC 100024
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New NIH study supports "old" immune-based treatment model for HIV/AIDS
The study described below strongly supports the immune therapy approach to HIV infection, first suggested in the late 1980's, officially submitted as a "treatment model" to the NC DHHS in April, 1992 and later published in the Journal of Naturopathic Medicine, Volume 4, Number 1 (see http://www.healthchina.org/document/doc20041027.html on website www.healthchina.org ) Your comments and suggestions for rapidly developing this immune-based HIV treatment method will be deeply appreciated by the 40+ million people worldwide infected with HIV/AIDS. They deserve the best possible treatment at the lowest possible cost, truthful answers to their questions, and ethical, compassionate help from all of us. Sadly, even the newest and most expensive drugs have failed to cure AIDS, or add years of life to those with HIV infection. After 20 years of costly failure by the pharmaceutical industry, it is time to try the logical, common-sense approach which has proven effective in fighting other viruses such as rabies and hepatitis: vaccines and antibodies. It is too late to save the millions who have already died of AIDS, but there is still hope for a longer life for those now infected with HIV. Sincerely, Gary J. Minter --------------------------------------- Science 9 June 2006:
Reports
Norman L. Letvin,1,2* John R. Mascola,1 Yue Sun,2 Darci A. Gorgone,2 Adam P. Buzby,2 Ling Xu,1 Zhi-yong Yang,1 Bimal Chakrabarti,1 Srinivas S. Rao,1 Jörn E. Schmitz,2 David C. Montefiori,3 Brianne R. Barker,2 Fred L. Bookstein,4,5 Gary J. Nabel1 Vaccine-induced cellular immunity controls virus replication in simian immunodeficiency virus (SIV)–infected monkeys only transiently, leading to the question of whether such vaccines for AIDS will be effective. We immunized monkeys with plasmid DNA and replication-defective adenoviral vectors encoding SIV proteins and then challenged them with pathogenic SIV. Although these monkeys demonstrated a reduction in viremia restricted to the early phase of SIV infection, they showed a prolonged survival. This survival was associated with preserved central memory CD4+ T lymphocytes and could be predicted by the magnitude of the vaccine-induced cellular immune response. These immune correlates of vaccine efficacy should guide the evaluation of AIDS vaccines in humans. 1 Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
Competing interests: None declared |
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