By Gabrielle Wade
6 August 2008 [MEDIAGLOBAL]: Although HIV is still a global epidemic, efforts to combat its spread are proving effective, with 2.7 million new infections in 2007 compared to 3.0 million in 2001, according to the 2008 AIDS report presented at the United Nations last Wednesday. The report, which highlights global trends in addition to providing specific information on the disease by region, shows strong points in the global HIV and AIDS response, as well as offers insights into areas for improvement.
Joint United Nations Programme on HIV/AIDS (UNAIDS) Director of Policy, Evidence and Monitoring Dr. Paul De Lay told MediaGlobal in an exclusive interview, “Putting out a global report like this alerts donors and the global community to progress and problems with the disease, but the real value is that countries are collecting information now that they didn’t collect before.”
By asking countries to contribute information to the report, UNAIDS is asking countries to monitor the disease locally. With the information gathered, countries are able to see which groups have the highest rates of HIV infection and what risk factors lead to such high rates.
The report shows the breakdown of the disease by region and country. Special Adviser on Africa and High Representative for Least Developed Countries (LDCs), Land Locked Developing Countries (LLDCs) and Small Island Developing States (SIDS) Cheick Sidi Diarra told MediaGlobal, “The 2008 report shows that sub-Saharan Africa, which is home to the majority of LDCs, continues to be the most affected by HIV/AIDS. While most LDCs have managed to halt an increase in the rates of infection, they remain unacceptably high. A few LDCs are still experiencing an increase in infection rates.”
For such countries, like Mozambique, the report should be used as a tool to see why and where the epidemic is still growing and curb its growth.
Not all areas of sub-Saharan Africa, which accounted for 67 percent of all people living with HIV and 72 percent of AIDS deaths in 2007, are still experiencing an increase in infection rates. Even in countries where the epidemic is no longer growing, such as Uganda, where HIV prevalence dropped in the 1990s and seems to have stabilized today, the report has proved useful; officials found signs that a reappearance of risky sexual behavior could cause a re-growth of the epidemic.
The officials at UNAIDS hope that with this information gathered, governments of sub-Saharan Africa and elsewhere will be able to create prevention strategies specifically for their problems and spot risk-areas before they grow.
Prevention strategies are particularly vital to combating the epidemic. Since a campaign in 2006, about 80 percent of countries now have targets to battle the disease, but most have treatment targets. According to De Lay, “It is much harder to come up with prevention targets, so we are working with countries to set those because prevention targets are great for motivating people.”
To see what prevention strategies will be most successful in countries, UNAIDS helps countries test both modes of transmission, meaning which groups are most heavily hit by the disease, as well as comprehensive knowledge about the disease. “We use a very specific set of questions that give us a sense of what a person knows about AIDS, and we use that information to tailor messages,” said De Lay.
After gathering country data and creating the 2008 AIDS Report, it became clear to officials where the gaps in the response to HIV and AIDS are most dramatic.
In terms of treatment, one big problem lies in newborn infection percent. Although the report shows that the annual number of new HIV infections among children worldwide has declined since 2002 due to expansive mother-to-child transmission prevention services, it remains difficult for people in LDCs to accurately diagnose newborns with the testing materials they use.
“Right now, the test looks for antibodies, but mothers often pass on antibodies to their children, so a child can have a positive test but that does not mean they have the disease,” said De Lay. Countries need to use an antigen test to ensure that newborns are immediately diagnosed and able to begin treatment, but such test requires more expensive equipment that many LDCs cannot currently afford.
Arguably the biggest problem in treatment today lies in treating both HIV and Tuberculosis (TB) in patients that are positive for both. Of all people worldwide who have both HIV and TB, only about 30 percent are getting treatment for both, and TB is still the leading cause of death in AIDS patients everywhere except in the developed world. “There is a huge overlap in these two diseases, and I think we still have a long way to go,” said De Lay.
Regarding specific plans in the works to combat this problem, UNAIDS Executive Director Peter Piot told MediaGlobal, “The development agencies are actively discussing the possibility of comprehensive global health budgets for all diseases and not just HIV/AIDS — that would include tuberculosis and malaria.”
While the report was able to point out important areas where individuals are still unable to receive proper treatment, it often showed that, specifically in LDCs, there is still not enough data to pinpoint individuals most at risk, and there is discrimination and stigma associated with some individuals most in need of help. The report showed populations most at risk of HIV exposure often face barriers to HIV treatment access, and a third of countries still lack laws against such discrimination.
De Lay said, “What’s generally being done are essentially awareness campaigns that indicate, ‘these people are the same as you.’ Generally, stigma is much harder to deal with than discrimination, so we are going after the bad laws that discriminate against individuals.”
After analyzing the data collected from all countries, it is clear that there is a great deal to be done in fighting the HIV/AIDS epidemic worldwide. Treatment strategies are constantly in use and have made great progress to help those already infected, but the key to battling the disease lies in preventing it.
Although HIV infection rates have declined, there were still an estimated 33 million people living with HIV globally in 2007. Diarra says, “The report, coming ahead of the High Level Meeting on Africa’s Development Needs in September, should help galvanize both the LDCs and the international community to redouble efforts to contain the epidemic through expanding access to prevention, treatment and care.”