Antiretroviral therapy (ART) for HIV/AIDS in developing countries has been rapidly scaled up through directed public and private resources. Data on the efficacy of ART in developing countries are limited, as are operational research studies to determine the effect of selected nonmedical supportive care services on health outcomes in patients receiving ART. We report here on an investigation of the delivery of medical care combined with community-based supportive services for patients with HIV/AIDS in four resource-limited settings in sub-Saharan Africa, carried out between 2005 and 2007. The clinical and health-related quality of life (HRQOL) efficacy of ART combined with community support services was studied in a cohort of 377 HIV-infected patients followed for 18 months, in community-based clinics through patient interviews, clinical evaluations, and questionnaires. Patients exposed to community-based supportive services experienced a more rapid and greater overall increase in CD4 cell counts than unexposed patients. They also had higher levels of adherence, attributed primarily to exposure to home-based care services. In addition, patients receiving home-based care and/or food support services showed greater improvements in selected health-related QOL indicators. This report discusses the feasibility of effective ART in a large number of patients in resource-limited settings and the added value of concomitant community-based supportive care services.
The magnitude and characteristics of sexual violence in two urban areas of Lesotho are described based on a random household survey of 939 sexually active women aged 18-35. Sexual violence is defined as nonconsensual sex ranging from the use of threats and intimidation to unwanted touching and forced sex. Twenty-five percent of women surveyed reported ever being physically forced to have sex; 13 percent reported that forced sex was attempted; 31 percent said that they were touched against their will; and 11 percent reported being forced to touch a man's genitals. Boyfriends were the most common perpetrators of actual and attempted forced sex (66 percent and 44 percent, respectively); known community members were the most common perpetrators of touching the respondent against her will (52 percent). Currently married women and those with more education were less likely than others to report that sex was forced upon them by an intimate partner or by another type of perpetrator. Women living in areas where a program raising awareness about sexual violence was ongoing were more likely to report a history of sexual violence. Given the high prevalence of HIV in Lesotho, programs should address women's right to control their sexuality.
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