AIDS crisis looming?

There is a lot of prejudice and coldness out there because most people don't understand the seriousness of the affliction. Presumably, the task before the government is formidable. If AIDS is to be defeated, war must be waged against poverty, ignorance, stigmatisation, violence and promiscuity.

In the 20 years since its effects were first medically recognised, the immunodeficiency virus is thought to have infected almost 60 m people around the world and that number grows by 16,000 a day. Plainly speaking, in human terms HIV is a disaster. Of those 60 m people, more than 22 m have already died of AIDS, the disease it causes without any medical intervention. Shockingly, around 3 m more will die over the next 12. But death caused by AIDS is something that is avoidable than deaths caused by nature. Moreover, AIDS kills predominantly in poor countries, compounding the problem.

Almost 70 per cent of new infections and existing cases -- a daunting 28.1 m people -- are in sub-Saharan Africa. AIDS is now cutting 15 years of average life expectancy in this region. According to some estimates, it will slice 8 per cent of national incomes in the worst afflicted countries by 2010. Although a few countries such as Uganda are coming to grips with the disease through education, condom distribution and other preventive measures, lack of money and political will is thwarting efforts elsewhere.

But Africa is not alone in its suffering. Eastern Europe now has the world's fastest growing AIDS epidemic, with 2,50,000 new cases in 2001. A projection by Imperial College, London suggests Russia may have 5 m people infected with HIV in five years time, 4 m of them suffering the symptoms of AIDS. Most worrisome, not only sub-Saharan Africa or Eastern Europe and Latin American countries, two of the world's most populous countries China and India are threatened. The Chinese government admits to 1 m infections -- widely regarded as an underestimate. India admits to 4 m.

In China, the same old story of downplaying the diseases still goes on. After China's first AIDS victim died in 1985, hospital authorities burned the man's belongings -- and even the furniture he used -- in a bonfire. HIV patients in China and in most of the African countries are facing social ostracism and government indifference. Shockingly true, in 1996, in China, Li Ning 9, a young kid got the affliction because of tainted blood transfusion. His father Li Suijun, a factory worker was fired from his job for his son being diagnosed to be infected with HIV. Many of the country's hospitals and health agencies are still will fully ignoring such grave health issues. To them, HIV was a foreigner's disease. But without effective countermeasures, says UNAIDS, the number of HIV cases in China could skyrocket -- reaching 10 million by 2010. However, the grim fact is: for HIV patients everywhere, contracting the virus evokes feelings of helplessness and isolation. In China, only a few individuals are lucky or well-connected enough to obtain AIDS "cocktail" -- a mix of drugs from Western countries that has proved effective in fighting the virus.

It's now a common knowledge that by far the worst affected continent is Africa. That is where HIV, leapt the species barrier from chimpanzees to people some 70 years ago. But infection rates are rising, in several cases rapidly, in many Asian countries and in many of the successor states to the Soviet Union. At the moment, the place with the largest number of cases is South Africa.

Encouragingly, the mood in Barcelona, Spain where the 14th AIDS Conference was held in the early part of 2002 took stock of the whole situation and agreed to take measures to stop the rot. The conference in the first place agreed to spread the use of condoms. Second, the best way to stop infection in children is to curb mother-to-child transmission with cheap, one-shot drugs given just before birth. Third, empower women to choose freely whether and with whom they have sex, and what sort of contraception they use. Fourth, perhaps above all, educate people about the risks they face. Encouragingly, several countries most notably Uganda, Senegal and Thailand have shown the way to mount steps in that direction.

The drug treatment situation has changed much in the meantime. There was a time when the cure was too expensive to be worth considering: a year's course of highly active anti-retroviral therapy (HAART) cost $10,000 - 15,000. But now with the emergence of Global AIDS Fund and because of the drug companies "tiered pricing" for poorer parts of the world, and due to bilateral donations by the drug firms themselves, the cost per patient is just one dollar a day. But even then it is beyond the purse of most Africans. Only 30,000 people in that continent use it. Only diamond rich Botswana has an official anti-AIDS drug programme in place. Other countries await, fairy "godmothers" who will help them pick up the bill. According to estimate made public by Peter Piot, head, UNAIDS and Kofi Annan, UN Secretary General, the "Global Fund announced will require $ 7 billion -- $Ê10 billion a year, but in practice it has attracted $ 2.1 billion in its first year of existence, chipped in largely from the Gates Foundation along with U.S government funding. A mathematical model developed in 2001 by Bernhard Schwartlander of the World Health Organisation and his colleagues estimated the maximum amount that could be spent usefully per year by 2005 as about $ 9 billion. Of that, $ 4.8 billion would be allocated to prevention, and $ 4.2 billion to treatment. At the moment, according to the Global HIV Prevention Working Group, a group of experts financed by the Gates and Kaiser Foundation, about $ 1.2 billion is spent on prevention in the world's poor countries. In a paper published in the "Lancet", another group of experts John Stover of Futures Group International and his colleagues, estimate that increasing spending on prevention to the tune of $ 4.8 billion that Dr. Schwartlander recommended could avoid 29 m infections by 2010 -- if the money were spent well.

Strengthening the medical infrastructure of the poorer countries is a vital necessity and obviously it will cost more. The Commission for Macro-economics and Health (CMH), headed by Jeffrey Sachs, a well-known development economist based at Columbia University, reckons that infrastructure development would raise the price to $ 15 billion.

The impoverished world have the example of Brazil in front of them, to have a grasp of what a well-organized treatment campaign can achieve in a country that is struggling an economic mess. In the backdrop of the prediction of the World Bank Model that about 1.2 m people in Brazil would be infected with HIV by 2002, effective anti-AIDS fighting campaign was launched. The actual figure is now 600,000. This is in part because 1,50,000 people are on HAART. Since HAART reduces a person's viral load to a negligible level, it helps to curb transmission to others besides maintaining the health of the patient. This treatment was made free at point of use by the Brazilian government in 1996, and as a direct result, the number of people dying of AIDS in Brazil has fallen by 50 per cent.

In Bangladesh, tragedy and ruin stare the middle class in the face as the virus that causes AIDS moves beyond the red-light areas. The UNICEF report made public in the early part of December last year revealed that the country has now about 310 under-14 HIV infected children. Although the official figure puts the HIV infected persons at 248, the number has spiraled to 13,000 according to AIDS Epidemic Research Report published by UNAIDS in 2001. Most worrisome, the report adds, each day 6000 children are being infected with HIV in Bangladesh. Perhaps the most worrying aspect is the growing evidence of what HIV experts call "transmission chains" by which the virus percolates insidiously through social sub-strata and afflicts low risk individuals like housewives and children.

Even in China where authorities viewed community organisations and independent researchers with suspicion, government has woken up. Like China, AIDS awareness classes should now be mandatory in all schools, colleges and universities in Bangladesh. Often the classes are the students' first exposure to sex education -- and other stark facts of life. Volunteers in the class would demonstrate how to sterilize hypodermic needles. Till now 70 percent of HIV cases in this region are spread via needle-sharing by drug users.

Experts reason out the rise in HIV cases in the country other than tainted blood transfusion and needle-sharing to dramatic shift in the sexual behaviour of the middle class. Changes in workplace is cited as a major reason. Unemployment situation in the country has spawned a breed of travelling migrant workers who spend nearly half their working lives away from home. At the same time women in the country have become an increasingly visible part of the professional workforce. Put these factors together and you have the settings for an increasing number of casual sexual relationships. Experts further feel that the growing affluence of the middle class and influence of blue films proliferating the homes and clubs of a certain class of people have something to do with changing moral values. While in the West having multiple sexual partners is now considered a "high risk behaviour", in our region it has just become fashionable. Undoubtedly true, with pre-marital sex gaining increasing acceptance among the new generation, the incidence of sexually transmitted diseases including AIDS has risen. Teenagers and those in the early 20s constitute a majority of the cases testing HIV positive. On the other hand, prostitutes these days are not confined to the restricted areas, they are roaming the streets, parks and secluded posh houses and hotels in the cities and towns. Doctors indicate these trends as danger signals.

With HIV cases growing alarmingly, Bangladesh's over-burdened and crumbling health system apparently isn't able to cope with the looming epidemic -- not medically, not financially and certainly not emotionally. Some NGOs are quietly working to fill the gap. But there is a lot of prejudice and coldness out there because most people don't understand the seriousness of the affliction. Presumably, the task before the government is formidable. If AIDS is to be defeated, war must be waged against poverty, ignorance, stigmatisation, violence and promiscuity.

Md Asadullah Khan, a former teacher of Physics, is Controller of Examination, BUET.