The Lancet, Volume 377, Issue 9777, Pages 1571 – 1572, 7 May 2011
Making a difference to health in slums: an HIV and African perspective
Liz Thomas, Jo Vearey, Pinky Mahlangu
Priya Shetty’s World Report (Feb 19, p 627) makes a valuable contribution by highlighting the enormous challenges in health-care provision in slum contexts, the home of 33% of the developing world’s urban population.
An important yet missing factor in Shetty’s piece is that of HIV. Although the extensive concentration of 67% of the global HIV epidemic in sub-Saharan Africa is widely acknowledged, the spatial concentration of urban HIV in slum settings has received minimal attention. Research from South Africa and some other African countries shows that the HIV prevalence in slum populations is double (or more) that in the non-slum population of the same city.
This difference might be partly due to riskier behaviour of women living in slum settings.3 However, there is a complex interplay of upstream factors (before HIV infection) in slums, which include earlier sexual debut, lower condom use, and more partners than in non-slum areas in the same cities. A combination prevention approach, taking into account gender, education, overcrowding, food insecurity, and migration, is thus very important.
There is a real need for health-care and other service providers to “get the basics right”,4 including the provision of water, sanitation, and housing. Health services must also specifically address tuberculosis, HIV prevention, mother-to-child transmission of HIV, treatment of opportunistic infections, sustained access to antiretroviral therapy, and palliative care.
Accessibility, affordability, and acceptability are some of the challenges slum residents experience with the formal heath system. It is no longer possible to consider addressing health care for the urban poor in southern and eastern Africa without a strong focus on the HIV epidemic in slum settings.
Complete article with references
