11 December 2003 Edition
Stepping up the fight against HIV/AIDS
Too worried about their Christmas shopping, many would not have even noticed that Monday 1 December marked World AIDS Day. However, tens of thousands of activists and health workers rallied worldwide, while officials hailed new initiatives, new funding and a new pill to fight the disease that has infected 42 million people and killed 3.1 million in 2003, which kills more than 8,000 men, women and children every day.
The global AIDS epidemic shows no signs of abating. Five million people became infected with HIV worldwide in 2003 — the highest ever. One in five adults across southern Africa are now living with HIV/AIDS, the highest rate since the beginning of the epidemic. About 30% of people living with HIV/AIDS worldwide live in southern Africa, an area that is home to just 2% of the world's population.
South Africa alone was home to an estimated 5.3 million people with HIV at the end of 2002 — more than any other country in the world. While infection rates across Sub-Saharan Africa vary widely, from less than 1% in Mauritania to almost 39% in Botswana and Swaziland, the breadth of the epidemic indicates that HIV/AIDS now has a firm hold on most countries in the region The epidemic is particularly devastating for women in sub-Saharan Africa, as they are more likely to be infected with HIV than men. Among young people, this discrepancy is particularly high, with young women aged 15-24 up to 2.5 times more likely to be infected than young men in the same age group. And of the estimated 42 million people who are living with HIV worldwide, 2.5 million are children under the age of 15.
In several countries in sub-Saharan Africa, high levels of AIDS mortality now match the high rate of new infections, creating a cycle of illness and death due in great part to the almost complete absence of large-scale HIV prevention, antiretroviral treatment programmes, and/or the lack of basic food and health care security.
Thousands of activists marched and rallied in Nairobi, Kenya, to show support for people infected with HIV and to demand access to essential drugs. Kenyan President, Mwai Kibaki, highlighted the impact the epidemic is having on social and economic structures all over Africa. "It is depleting our stock of knowledge and re-allocating family and national budgets," President Kibaki said. "Indeed, this disease could lead to the collapse of some economies in the next few generations. We, therefore, owe it to humanity to fight this disease relentlessly."
In Cape Town, former South African President Nelson Mandela urged the world to fight the stigma associated with HIV, saying it was stopping people from being tested and treated. "That is a tragic mistake, because when you do that, you make the people that are suffering feel like they are not human beings," Mandela said. "Many will die because of feeling less than human."
India announced plans to spend $57 million to provide free anti-retroviral drugs to 100,000 AIDS patients, a "significant scale-up" in the fight against the disease in a country that has the world's second-highest number of HIV-infected people. Until now, India has focused on prevention, but starting 1April 2004, it will offer free drugs at government hospitals.
The day also marked the growing awareness that a new wave of HIV is threatening China, India, Indonesia and Russia, mostly due to HIV transmission through injecting drug use and unsafe sex. A new UNAIDS/WHO report entitled "AIDS Epidemic Update 2003" underlines many clear warning signs that Eastern Europe and Central Asia could become home to serious new HIV epidemics that may equal the figures in Africa as prevalence rates in these regions continue to grow and show no signs of abating.
Young people are among the hardest hit by HIV/AIDS in this part of the world. While young men still bear the brunt of the epidemic, the percentage of women is increasing, 33% of those infected at the end of 2002 were women, up from 24% the year earlier. Despite the growing prevalence of HIV infection, too little prevention outreach, such as safe sex education or adoption of safer injection techniques, is being employed in these areas.
Health workers hit Beijing's streets to teach prevention in a country whose leaders have promised to fight the disease more aggressively. The China Daily newspaper, citing a survey by the Health Ministry, WHO and UNAIDS, said 840,000 Chinese are HIV-positive and 80,000 have developed AIDS. But Siri Tellier, head of the UN Theme Group on HIV/AIDS in China, said it was not known whether that figure was accurate. She said there has been no widespread blood testing in the country, and she urged Beijing to improve its monitoring.
Even countries with a smattering of AIDS cases held events on Monday 1 December aimed at boosting awareness. In Albania, with only 116 registered cases since 1993, scores of high school students marched in Tirana with candles and a banner that read, Protect Yourself and Others.
"The world is now mounting a greater response to AIDS through individual initiatives like the US Government's Emergency Plan on AIDS and the Global Fund to Fight AIDS, TB and Malaria," said Dr Peter Piot, UNAIDS Executive Director. "However it is quite clear that our current global efforts remain entirely inadequate for an epidemic that is continuing to spiral out of control. AIDS is tightening its grip on southern Africa and threatening other regions of the world."
"The most devastating social and economic impacts of AIDS are still to come," said Dr Piot. "Widespread treatment access would substantially mitigate the devastating impact of HIV/AIDS, which affects everything from agriculture to national defence. Effective HIV prevention programmes must be scaled up dramatically if we want a realistic chance at reducing the number of new infections."
AIDS Epidemic Update 2003 notes that the response to HIV/AIDS as measured by spending and political action has improved dramatically in recent years, but improvements are still far too small and slow in coming to adequately respond to the growing global epidemic. Rapid scale-up of treatment access is urgently needed to help avoid the devastating effects of millions of anticipated illnesses and deaths. In an effort to scale up treatment, the World Health Organisation, the convening agency for HIV care in UNAIDS, and other partners are developing a comprehensive global strategy to bring cheaper antiretroviral treatment to three-million people by 2005, known as the '3 by 5' initiative.
WHO says more than five million HIV patients need anti-retroviral drugs, but fewer than 400,000 have access to them. Anti-retroviral drugs allow HIV patients to live a relatively normal life by preventing the development of AIDS. The drugs improve their health, but they remain infected and can transmit the disease.
WHO also certified an innovative, generic drug for treating HIV that combines three essential anti-retroviral drugs into one pill to be taken twice a day. WHO and UNAIDS promised to promote international agreements to streamline treatment programmes.
"In two short decades, HIV/AIDS has become the premier disease of mass destruction," said Dr Jack Chow, the assistant director general of WHO. "The death odometer is spinning at 8,000 lives a day and accelerating."
Medecins Sans Frontieres, an aid agency that has led efforts to simplify HIV treatment, welcomed the announcement but said funding will be critical to the availability of treatment. "The treatment has to be free; if the treatment is not free, they will not meet their goals," said Dr Morten Rostrup, president of the group's international council.
In addition to treatment gaps, the report finds that surprisingly little is being done to implement even the most basic cost-effective HIV-prevention efforts. Prevention resources remain scarce, especially in sub-Saharan Africa where, outside of Senegal and Uganda, few prevention success stories can be identified. In many of the hardest-hit countries, there are no national orphan programmes in place, coverage of voluntary counselling and testing is threadbare, and prevention of mother-to-child HIV transmission is virtually non-existent.
The promotion of the use of condoms is a matter of controversy, as many health providers in Africa are funded by religious groups that do not approve the use of contraceptives, even though it is recognised it will help to prevent and stop the spread of the disease. That is the case also of the much published budget approved by the US Congress, as the distribution of the funds will not reach to groups promoting the use of condoms — all this, despite a latest study hosted by WHO and UNAIDS which concluded that unsafe sexual practices continue to be responsible for the overwhelming majority of infections. While a combination of prevention measures are required to tackle all modes of HIV transmission, safer sex promotion must remain the primary feature of prevention programmes.