Zambia and Kenya scale up detection and treatment of HIV

An estimated 16% of adults in Zambia are infected with HIV. In the Zambian capital Lusaka 22% of adults are infected. In 2004 the Zambian government started a programme of delivering antiretroviral treatment to people in need. Previously, the treatment had been available through private insurance only. The programme depends largely on primary care practices and nurses, and on non-physician clinical officers.

In the first year and a half of the programme, more than 20 000 adults were enrolled into care and about three quarters of them received antiretroviral treatment. With high rates of uptake and adherence and a good response to treatment, the programme seems feasible and continues to expand delivery of care. By April 2006 it enrolled nearly 40 000 people infected with HIV.

In Kenya, about 9% of adults are infected with HIV, but three quarters of adults do not know their HIV status. In 2000, there were only three centres where people could get a test. Since then, the provision and use of voluntary HIV counselling and testing has expanded rapidly: by the end of 2005 there were nearly 700 centres countrywide. Research has shown that voluntary counselling and testing reduces risky health behaviour.

HIV positive mothers in Africa shouldn't stop breast feeding

Preventing transmission of HIV from infected mothers to their newborns in Africa needs to balance the benefits of breast feeding against the risk of HIV transmission. A trial in Botswana randomised 1200 women and their newborns to formula feeding and one month of zidovudine or exclusive breast feeding and six months of zidovudine.

At seven months, significantly fewer babies randomised to formula were infected with HIV (5.6% v 9.0%, respectively; P = 0.04), but mortality was lower in the group randomised to breast feeding (9.3% v 4.9%; P = 0.003). At …