No room for complacency

AIDS is a relentless enemy. Photo: Noor Alam/ DrikNewsNicholas Biswas

ACCORDING to new data in Epidemic Update published by UNAIDS and WHO very recently, HIV infections have decreased by 17% over the past eight years. In East Asia, HIV infections declined by nearly 25% and in South and South East Asia by 10% in the same time period. The number of AIDS-related deaths has declined by over 10% over the past five years as more people gained to access to life saving treatment. UNAIDS and WHO estimate that since the availability of effective treatment in 1996, some 2.9 million lives have been saved.

The latest epidemiological data indicate that globally the spread of HIV appears to have peaked in 1996, when 3.5 million [3.2 million3.8 million] new HIV infections occurred. In 2008, the estimated number of new HIV infections was approximately 30% lower than at the epidemic's peak 12 years earlier. Consistent with the long interval between HIV Sero-conversion and symptomatic disease, annual HIV-related mortality appears to have peaked in 2004, when 2.2 million [1.9 million2.6 million] deaths occurred. The estimated number of AIDS related deaths in 2008 is roughly 10% lower than in 2004.

However, in some countries there are signs that new HIV infections are rising again. HIV prevalence is still increasing in some parts of our region, such as Bangladesh and Pakistan. Bangladesh has transitioned from a low-level epidemic to a concentrated epidemic, with especially elevated rates among injecting drug users (Azim et al., 2008). The overwhelming majority of people with HIV, some 95% of the global total, live in the developing world. The proportion is set to grow even further as infection rates continue to rise in countries where poverty, poor health care systems and limited resources for prevention and care fuel the spread of the virus. There is increased evidence of risk among key populations. While high HIV prevalence has long been documented among sex workers in diverse countries worldwide, evidence was extremely limited regarding the contribution of men who have sex with men and injecting drug users to epidemics in sub-Saharan Africa and parts of Asia.

What is HIV/AIDS
HIV stands for: Human Immunodeficiency Virus. HIV is a virus that cannot grow or reproduce on its own, it need to infect the cells of a living organism in order to replicate. The human immune system usually finds and kills viruses, but HIV attacks the immune system itself. As HIV progressively damages these cells, the body becomes more vulnerable to infections, which it will have difficulty in fighting off.

AIDS stands for: Acquired Immune Deficiency Syndrome. AIDS is a medical condition. A person is diagnosed with AIDS when his/her immune system is too weak to fight off infections. It takes around ten years on average for someone with HIV to develop AIDS. However, this average is based on the person with HIV having a reasonable diet, and someone who is malnourished may well progress from HIV to AIDS more rapidly. Since AIDS was first identified in the early 1980s, an estimated 33.4 people have been attacked by HIV/AIDS.

A person first develops an AIDS-related condition or symptom, called an "opportunistic infection." AIDS can be diagnosed when the number of immune system cells (CD4 cells) in the blood of an HIV positive person drops below a certain level. It is important to remember that a person who has HIV can pass on the virus immediately after becoming infected, even if he/she feels healthy. The only way to know for certain if someone is infected with HIV is for them to be tested.

How is HIV passed on
HIV is found in the blood and the sexual fluids of an infected person, and in the breast milk of an infected woman. There are various ways a person can become infected with HIV:

-Unprotected sexual intercourse with an infected person;

-Contact with an infected person's blood;

-Use of infected blood products: Many people in the past have been infected with HIV by the use of blood transfusions and blood products which were contaminated with the virus;

-Injecting drugs: HIV can be passed on when injecting equipment that has been used by an infected person is then used by someone else.

-From mother to child: HIV can be transmitted from an infected woman to her baby during pregnancy, delivery and breastfeeding.

Certain groups of people, such as injecting drug users, sex workers, prisoners, and men who have sex with men have been particularly affected by HIV. However, HIV can infect anybody, and everyone needs to know how they can and can't become infected with HIV.

Minimising measures
Minimising the impact of HIV will require massive response at the national and international levels:

-People need to challenge the myths and misconceptions about human sexuality that translate into dangerous sexual practices;

-Legislation is needed to reduce prejudice felt by HIV+ people around the world and the discrimination that prevents people from "coming out" as being HIV positive;

-HIV prevention initiatives need to be increased, people across the world need to be made aware of the dangers, the risks, and the ways they can protect themselves;

-Condom promotion and supply need to be increased;

-Appropriate sexual health education must be provided to young people before they reach an age where they become sexually active;

-Medication and support need to be provided to people who are already HIV+, so that they can live longer and more productive lives.

-Support and care must be provided for those children who have been orphaned by AIDS.

AIDS out of Isolation
One of the significant findings of the report is that the impact of the AIDS response is high where HIV prevention and treatment programs have been integrated with other health and social welfare services. Asia's epidemic has long been concentrated in specific populations, namely injecting drug users, sex workers and their clients, and men who have sex with men. However, the epidemic in many parts of Asia is steadily expanding into lower-risk populations through transmission to the sexual partners of those most at risk. In China, where the epidemic was previously driven by transmission during injecting drug use, heterosexual transmission has become the predominant mode of HIV transmission (Wang et al., 2009).

Several countries have taken steps to scale up medical male circumcision for HIV prevention, including Botswana, Kenya and Namibia (Forum for Collaborative HIV Research, 2009). Botswana is integrating male circumcision into its national surgery framework, with the aim of reaching 80% of males aged 049 by 2013 (Forum for Collaborative Research, 2009). As of March 2009, Swaziland had drafted a formal male circumcision policy (Mngadi et al., 2009). A recent analysis determined that the scale-up of adult male circumcision in 14 African countries would require considerable funding (an estimated $ 919 million over five years) and substantial investments in human resources development, but that scale-up would save costs in the long run by altering the trajectory of national epidemics (Auvert et al., 2008).

Policy measures
To be successful, a comprehensive HIV prevention program needs strong political leadership. This means politicians and leaders in all sectors must speak out openly about AIDS and not shy away from difficult issues like sex, sexuality and drug use.

An effective response requires strategic planning based on good quality science and surveillance, as well as consideration of local society and culture. All sectors of the population should be actively involved in the response, including employers, religious groups, non-governmental organisations and HIV-positive people. Many of the world's most successful HIV prevention efforts have been led by the affected communities themselves.

HIV epidemics thrive on stigma and discrimination related to people living with the virus and to marginalised groups such as sex workers. Their spread is also fueled by gender inequality, which restricts what women can do to protect themselves from infection. Protecting and promoting human rights should be an essential part of any comprehensive HIV prevention strategy. This includes legislating against the many forms of stigma and discrimination that increase vulnerability.

Concluding message
"International and national investment in HIV treatment scale-up have yielded concrete and measurable results,” said Dr Margaret Chan, Director General of WHO. “We cannot let this momentum wane. Now is the time to redouble our efforts, and save many more lives."

Nicholas Biswas is a Researcher and Development Activist. E-mail: nicbi@live.com