Recent research findings in the fight against the global HIV & AIDS epidemic have engendered renewed hope and expectation. These highlight alternative HIV interventions targeting male and female reproductive anatomy. Females engaging in vaginal sex, especially in heterosexual relationships, are prone to contracting sexually transmitted infections (STIs) and HIV due to vaginal penetration, which renders the vagina the viral receptor in the event of exposure. For males, the penile foreskin is the viral point of entry during sexual intercourse. Consequently, scientists have been exploring microbicides and male medical circumcision as STI/HIV infection reduction tools. This CAI discussion paper explores the promises and some of the challenges associated with male circumcision and microbicides as means of stemming the HIV pandemic.

There is an unprecedented increase in the incidence of tuberculosis (TB) in most sub-Saharan African countries, especially those with a high prevalence of the human immunodeficiency virus (HIV).  Like HIV & AIDS, TB is a multi-causal health crisis requiring multi-faceted, integrated and comprehensive responses. Globally, 14 million people or one third of HIV-positive people are co-infected with TB.  There is a complex interaction existing between TB and HIV: as HIV weakens the immune systems, it increases vulnerability to TB. HIV complicates the response to TB management in various ways, especially as the risk of developing active TB is ten times higher in HIV-positive people, resulting in astronomical numbers of cases of TB. This CAI discussion paper explores the relationship between HIV and TB.  It also looks at the challenges associated with low Voluntary Counselling and Testing (VCT) uptake by adult tuberculosis patients.

This CAI discussion paper seeks to highlight intervention strategies that can be socially constructed in southern Africa to militate against the devastating effects of the HIV & AIDS pandemic. According to UNAIDS, “sub-Saharan Africa remains the region most heavily affected by HIV. In 2009, sub-Saharan Africa accounted for 67% of HIV infections worldwide, 68% of new HIV infections among adults and 91% of new HIV infections among children. The region also accounted for 72% of the world’s AIDS-related deaths in 2008.” One does not need to be a medical doctor to fully understand the debilitating effects of the HIV & AIDS scourge in southern Africa in the new millennium. Grassroots engagement and economic empowerment intervention strategies can alleviate some of the burdens that are disproportionately placed on the shoulders of the vulnerable groups such as widows and HIV & AIDS-orphaned children.

The Centre for the AIDS Programme of Research in South Africa (CAPRISA) at the University of KwaZulu-Natal in Durban has produced giant advances in HIV prevention. Now a vaginal gel with an antiretroviral drug has been confirmed to protect about four out of 10 women from HIV. This breakthrough was announced last month at the International AIDS Society Conference in Vienna by the South African husband-and-wife team who led the research. The finding by CAPRISA has seen microbicide emerge as the current silver bullet in HIV prevention worldwide. However, there is no room for complacency because general access to and use of the therapy is still far off. This CAI discussion paper explores an idea of ensuring that microbicides become effective tools for HIV prevention and women’s empowerment.

When the AIDS Training, Information and Counselling Centre (ATICC) delivered the first HIV & AIDS training in the Western Cape in August 1989, it was part of a limited set of national interventions managed by the National Party (NP) conducted from the first HIV-positive diagnosis in 1982 to 1989. During the ATICC’s first courses, health care workers’ main fear was that of occupational exposure to HIV & AIDS – and not concern for HIV patients. This CAI discussion paper explores the evolving role of lay counsellors in HIV & AIDS prevention from these heady early days.