AIDS and drugs

AIDS AND DRUGS

Made by: aiste Stragyte and Deimante Butkute

When AIDS first emerged as a disease over twenty years ago, few people could have predicted how the epidemic would evolve, and fewer still could have described with any certainty the best ways of combating it. Now, in the year 2002, it is known from experience that AIDS can devastate whole regions, knock decades off national development, widen the gulf between rich and poor nations and push already-stigmatized groups closer to tthe margins of society.

Just as clearly, experience shows that the right approaches, applied quickly enough with courage and resolve, can and do result in lower HIV infection rates and less suffering for those affected by the epidemic. An ever growing AIDS epidemic is not inevitable; yet, unless action against the epidemic is scaled up drastically, the damage already done will seem minor compared with what lies ahead. This may sound dramatic, but it is hard to play down the effects oof a disease that stands to kill more than half of the young adults in the countries where it has its firmest hold.

Already, 21.8 million people around the world have died of AIDS, 4.3 million of them children, by the eend of 2001. Nearly twice that many – 42 million – are now living with HIV, the virus that causes AIDS, and most of these are likely to die over the next decade or so. The most recent UNAIDS/WHO estimates show that, in 2002 alone, 5 million people were newly infected with HIV.

Africa

The African countries south of the Sahara have some of the best HIV surveillance systems in the world. They show that the estimated number of newly infected adults and children in Africa reached 3.5 million by the end of 2002. As the rate of HIV infection in the general population rises, the same patterns of sexual risk result in more new infections simply because the chances of encountering aan infected partner become higher.

Altogether, there are now 16 countries in Africa in which more than one-tenth of the adult population aged 15-49 is infected with HIV. In seven countries, all in the southern cone of the continent, at least one adult in five is living with the virus. In Botswana, a shocking 38.8% of adults are now infected with HIV, while in South Africa, 20.1% are infected, up from 12.9% just three years ago. With a total of 5 mmillion infected people, South Africa has the largest number of people living with HIV/AIDS in the world.

Whilst West Africa is relatively less affected by HIV infection, the prevalence rates in some large countries are creeping up. Cōte d_Ivoire is already among the 15 worst affected countries in the world; in Nigeria over 5% of adults have HIV but the prevalence rate in other West African countries remains below 3%.

Infection rates in East Africa, once the highest on the continent, hover above those in the West of the continent but have been exceeded by the rates now being seen in the southern cone. The prevalence rate among adults in Ethiopia and Kenya has reached double-digit figures and continues to rise.

These rises are not inevitable. Uganda has brought its estimated prevalence rate down to around 5% from a peak of close to 14% in the early 1990s with strong prevention campaigns, and there are encouraging signs that Zambia_s epidemic may be following the course charted by Uganda. Yet, even in these countries, the suffering generated by HIV infections acquired years ago continues to grow.

See our web pages AIDS in Africa, AIDS Orphans in Africa and Aids drugs in Africa.

Asia

The diversity of tthe AIDS epidemic is even greater in Asia than in Africa. The epidemic is also more recent and many Asian countries lack accurate systems for monitoring the spread of HIV. This means that the estimates of HIV infection in Asia are often based on less information than in other regions. The lack of research and information on the nature and linkages between sexual networks in Asian countries also makes it difficult to predict the future course of the HIV epidemic. Half of the world_s population lives in Asia, so even small differences in the absolute numbers of people infected, can make huge differences in the infection rates.

UNAIDS estimates that 700,000 adults, 450,000 of them men, became infected in South and South-East Asia during the course of the year 20012 Overall, as of end – 2002, the region is estimated to have 6.0 million adults and children living with HIV or AIDS.

The region of East Asia and the Pacific is still keeping HIV at bay in most of its huge population. Some 270,000 adults and children became infected in the course of the year 2002. This brings the number of people living with HIV or AIDS at end-2002 to 1.2 mmillion, representing just 0.1% of the region_s adult population, as compared with the prevalence rate of 0.6% in South and South -East Asia.

However, the epidemic in East Asia has ample room for growth. The sex trade and the use of illicit drugs are extensive, and so are migration and mobility within and across borders. The fluidity in international markets and especially the lack of economic stability in Asia has erupted into non-stop movement within countries and among countries, mirrored in the growing prevalence of HIV. India, China, Thailand and Cambodia, to name only a few, have highly mobile populations within their borders, with people moving from state to state and from rural to urban areas. In China, permanent and temporary migrants may total as many as 120 million people.

See our individual pages of AIDS in India, China and Thailand.

Eastern Europe and Central Asia

In the countries of the former Soviet Union, the HIV epidemic continues to be heavily concentrated in injecting drug-users. The absolute number of cases has remained small in many countries so far, but overall the growth has been rapid.

In any country with unsafe drug-injecting practises, a fresh outbreak of HIV is liable to occur at any time. This

is especially true of the countries in Eastern Europe where the HIV epidemics are still young and have so far spared some cities and sub-populations. In the Russian Federation, a new outbreak of HIV among injecting drug users in the Moscow region in 1999, resulted in the reporting of more than three times as many new cases in that year as in all the previous years combined. A conservative estimate of the number of adults and children living with HIV oor AIDS in Eastern Europe and the countries of the former Soviet Union is 1.2 million in the year 2002.

See our web page of AIDS in the Russian Federation Ukraine, and Belarus.

Caribbean

HIV is ravaging the populations of several Caribbean island states. Indeed some have worse epidemics than any other country in the world outside sub-Saharan Africa. In Haiti, it is estimated that over 6% of adults are living with HIV, and in the Bahamas the adult prevalence rate is over 33.5%. In the Dominican Republic, one adult in 40 is HIV-infected, while in Trinidad and Tobago the rate exceeds one adult in 100. At the other end of the spectrum lies Saint Lucia, the Cayman Islands and the British Virgin IIslands, where fewer than 1 pregnant woman in 500 tested positive for HIV in recent surveillance studies. In the most affected countries of the Caribbean, the spread of HIV infection is driven by unprotected sex between men and women, although infections associated with injecting drug use are common in some places, such as Puerto Rico.

Haiti, where the spread of HIV may well have been fuelled by decades of poor governance and conflict, is the worst affected nation in the region. In some areas, 13% of anonymously tested pregnant women were found to be HIV-positive in 1996. Overall, around 8% of adults in urban areas and 4% in rural areas are infected. HIV transmission in Haiti is overwhelmingly heterosexual, and both iinfection and death are concentrated in young adults. It is estimated that nearly 200,000 Haitian children had lost one or both of their parents to AIDS by the end of 2001.

The heterosexual epidemics of HIV infection in the Caribbean are driven by the deadly combination of early sexual activity and frequent partner exchange by young people. In Saint Vincent and the Grenadines, where the prevalence of sexually transmitted diseases is high for the region, a quarter of men and women iin a recent national survey said they had started having sex before the age of 14, and half of both men and women were sexually active at the age of 16. In a large survey of men and women in their teens and early twenties in Trinidad and Tobago, fewer than a fifth of the sexually active respondents said they always used condoms, and two-thirds did not use condoms at all.

A mixing of ages, which has contributed to pushing the HIV rate in young African women to such a high levels, is common in this population too. Whilst most young men had sex with women of their own age or younger, over 28% of young girls said they has sex with older men. As a result, HIV rates are five times higher in girls than boys aged 15-19 in Trinidad and Tobago, and at one surveillance centre for pregnant women in Jamaica, girls in their late teens had almost twice the prevalence rate of older women.

Latin America

The HIV epidemic in Latin America is highly diverse. Most transmission in Central American countries and countries on the Caribbean coast occurs through sex between men and women. Brazil, too, is experiencing a major hheterosexual epidemic, but there are also very high rates of infection among men who have sex with men and injecting drug users. In Mexico, Argentina, and Colombia, HIV infection is also confined largely to these sub-populations. The Andean countries are currently among those least affected by HIV infection, although risky behaviour has been recorded in many groups.

The countries with the highest prevalence rates in the region tend to be found on the Caribbean side of the continent. Over 7% of pregnant women in urban Guyana tested positive for HIV in 1996. Strikingly, the rates in pregnant women were similar to those in patients attending clinics for sexually transmitted diseases (STDs).

In Honduras, Guatemala and Belize there is also a fast-growing epidemic, with HIV prevalence rates among adults in the general population between 1 and 2%. In 1994, less than 1% of pregnant women using antenatal services in Belize District tested positive for HIV, while one year later the prevalence rate had risen to 2.5%, the rate in one health centre, in Port Loyola, hitting 4.8%. Much of the problem is concentrated in teenagers, suggesting that the worst is still to come.

Heterosexual transmission of HIV is rarer in other countries oof Central America. In Costa Rica, for example, HIV is transmitted mainly during unprotected sex between men. In this country, as in many other parts of Latin America, there is little systematic surveillance for HIV among groups with high risk behaviour, but studies among men who have sex with men in Costa Rica showed infection rates of 10-16% as long ago as 1993.

In Mexico, too, HIV has affected mainly men who have sex with men, more than 14% of whom are currently infected. HIV rates among pregnant women, however, are extremely low. Data from a programme to reduce the transmission of HIV from mothers to infants suggest that less than one in every 1000 women of childbearing age is infected. Even among female sex workers in Mexico, the prevalence rate is well under 1%.

A low prevalence of HIV infection among heterosexuals is the norm in the Andean region, at least in the countries for which data are available. For example, Argentina has typically high rates of HIV infection among injecting drug users and men who have sex with men, but a relatively low prevalence of 0.4% among pregnant women.

One of the defining features of the Latin American epidemic is that

several populous countries, including Argentina, Brazil and Mexico, are attempting to provide antiretroviral therapy for all people infected with HIV. Coverage still varies widely, but these efforts are having a definite impact. While they are improving both the length and the quality of people_s lives, they are also increasing the proportion of people living with HIV. Nevertheless, some concern has been voiced over the risk that HIV prevention activities may suffer if too much effort and money is devoted to pproviding treatment.

High-income Countries

In high-income nations, HIV infections are concentrated principally among injecting drug users and gay men. However, in several Western European countries a large proportion of new HIV diagnosis (59% more, overall, between 1997 and 2001) is occuring through heterosexual intercourse. Very early in the epidemic, once information and services for prevention had been made available to most of the population, the level of unprotected sex fell in many countries and the demand rose for reproductive health services, HIV ccounselling and testing and other preventive services.

While the infection rates have been low in high-income countries, some countries have been reporting increases in their HIV rates. For example, Sweden currently has one of the lowest ...