Judy Mandelbaum

Judy Mandelbaum
Brooklyn, New York, United States
June 01
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JULY 14, 2010 8:19AM

AIDS - a scourge whose time is running out?

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When HIV/AIDS first collided with public awareness in the early 1980s, many observers feared the emergence of a global, all-consuming pandemic beyond human control. Their concerns appear justified: so far the disease has killed over 25 million persons around the world. But today, three decades later, a new UN study suggests that the AIDS scourge may be following on the heels of other pandemics such as smallpox and the Black Death on its way to gradual extinction. 

According to the UNAIDS OUTLOOK Report 2010, published in Geneva yesterday in the runup to the XVIII International AIDS Conference in Vienna next week, the twenty-five countries most strongly affected by AIDS are not only treating the disease as a priority issue, but are also showing great progress in slowing its spread. In fifteen of these countries, most notably in Côte d’Ivoire, Ethiopia, Kenya, Malawi, Namibia, the United Republic of Tanzania, Zambia, and Zimbabwe, physicians have noted a twenty-five percent reduction in HIV infection among young people. In Kenya, there was a 60% decline in HIV prevalence between 2000 and 2005. Ethiopia has registered a decline of 47% of HIV cases among pregnant women in the cities and 29% in rural areas.

Outlook Report 2010
Click image to access the full UNAIDS report  

In thirteen countries, mainly in Africa, young people are waiting longer before engaging in sexual behavior, and they also have fewer sexual partners than before. At the same time, condom use has soared. This dramatic improvement is largely due to a decline in taboos surrounding this subject and the spread of safe sex behaviors.

All this means that AIDS awareness programs and the development and deployment of new antiretroviral drugs are having a dramatic impact. But this is no time to declare victory: In many areas a solution to the crisis appears as distant - and downright utopian - as ever. For example, the report says, “In Africa the majority of infections occur through heterosexual sex, but in 2008 each adult male had access to only four condoms [emphasis added]. In Ghana more than 40% of infections occur through sex work, men having sex with men and injecting drug use, but only 0.24% of prevention spending went towards services for these populations.” In South Africa alone, up to a third of women in the 25-29 range are infected with HIV. The Catholic Church and other organizations systematically spread disinformation and block effective prevention measures in many areas. Today UNAIDS estimates that 33.4 million persons were living with AIDS at the end of 2008. 2.7 new HIV infections occurred that year and 2 million people died of the disease.

Currently only about a third of those requiring medications are receiving the right kind – if any. As a solution, UNAIDS is calling for a combination of approaches called “Treatment 2.0,” which it believes could prevent up to 10 million new AIDS-related deaths by 2025. Treatment 2.0 consists of the following measures: 

1.                  Create a better pill and diagnostics: UNAIDS calls for the innovation of a smarter, better pill that is less toxic and for diagnostics that are easier to use. Monitoring treatment requires complex equipment and specialized laboratory technicians. A simple diagnostic tool could help to reduce the burden on health systems. Such a simplified treatment platform could defray costs and increase people’s access to treatment.
2.                  Treatment as prevention: antiretroviral therapy reduces the level of the virus in the body. Evidence shows that when people living with HIV have lowered their viral load they are less likely to transmit HIV. It is estimated that ensuring everyone in need has access to treatment, according to the current treatment guidelines, could result in up to a one third reduction in new HIV infections annually.  Optimizing HIV treatment coverage will also result in other health prevention benefits, including much lower rates of tuberculosis and malaria among people living with HIV.
3.                  Stop cost being an obstacle: despite drastic reductions in drug pricing over the past ten years, the costs of antiretroviral therapy programmes continue to rise. Drugs can be even more affordable—however, potential gains are highest in the area of reducing the non-drug-related costs of providing treatment, such as hospitalization, monitoring treatment, and out-of-pocket expenses. Currently these costs are twice the cost of the drugs themselves. Treatment 2.0 is expected to reduce the cost per AIDS-related death averted by half.
4.                  Improve uptake of voluntary HIV testing and counselling and linkages to care: when people know their HIV status they can start treatment when their CD4 count is around 350, rather than waiting until they are feeling sick. Starting treatment at the right time increases the efficacy of current treatment regimens and increases life expectancy. 
5.                  Strengthen community mobilization: by involving the community in managing treatment programmes, treatment access and adherence can be improved. Demand creation will also help bring down costs for extensive outreach and help reduce the burden on health care systems.

In addition to working with heterosexual AIDS sufferers in the developing world, the report says, “UNAIDS has added a new priority area focusing on empowering men who have sex with men, sex workers and transgender people to protect themselves from HIV infection and to fully access antiretroviral therapy.”  

The OUTLOOK report also contains the findings of a recent Zogby International poll surveying global attitudes towards AIDS. Among other things, it reveals astonishingly optimistic assessments of the chances of eradicating the disease by 2025: “The Caribbean region is the most positive of all the regions, where 91% are optimistic that with proper use of resources the spread of HIV can be stopped. They are followed by South and South-East Asia (75%) and Latin America (63%). In sub-Saharan Africa four in ten (40%) were optimistic—for example, in Senegal 48.7% were overall optimistic that HIV could be stopped by 2015.” 

This upbeat attitude coincides with positive news on research to develop a reliable anti-AIDS vaccine. Today it looks as if such a vaccine, whether it takes five or fifteen years to develop, is no longer just a pipedream but a genuine work in progress. So while HIV/AIDS remains a scourge, it increasingly looks as if it’s a scourge whose time is running out. The question of how much time it has left has less to do with the virus itself than with our collective resolve to stamp it out forever.  

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Slowing then stopping the spread of HIV/AIDS is a great thing. The UNAIDS report seems to say we are heading the right way. Their call for " the innovation of a smarter, better pill that is less toxic and for diagnostics that are easier to use." has a major problem here. It requires that the evil BIG PHARMA has to get in gear and develop something!

So, pick your devil. Which is it going to be HIV/AIDS or BIG PHARMA?
I'd say that as far as global scourges are concerned, HID/AIDS and BIG PHARMA are running neck and neck. The good news, of course, is that BIG PHARMA probably could solve the AIDS problem if they could make a profit doing so. But as long as most of their patients are dirt poor, we won't likely see AIDS becoming their top priority.
Thanks for such an informative post. Rated.
This is encouraging, but I would have felt better about this report if it had addressed ALL of the factors that are currently in play, however.

* The Catholic Church ACTIVELY working against the use of condoms. The have applied everything from Pope Benny condemning it to Catholic missionaries and health workers refusing to provide medical services they deem immoral.

* Fundamentalist churches who withhold support and funding if certain "targeted" groups are not reduced (gays, sex workers, "unbelievers"). This results in an under counting of the actual HIV/AIDS infected population out of fear of reprisal/funding cuts.

* Child mortality is rarely blamed on HIV/AIDS, even though it may be the primary cause of death; autopsies are not performed to prove it. Therefore deaths are VERY often assigned an incorrect / fictitious cause.

The net result is that, while head way is being made, their are MANY groups working to undermine this progress.

How about we call a cease fire in Iraq for a year and take that money we save and apply it towards eradicating AIDS in Africa.
really nicely done Judy
Judy -

I keep reading this but just shaking my head. I undertand the impulse to cast some light on a situation that has been so dire so dark for so long. However, to imply that it's somehow going the way of smallpox, or the epidemic is coming to an end anytime soon, is inaccurate, misleading and in some respects just dangerous.

One of the biggest problems in the spread of the diesease these days is this very attitude, young people that brush the whole thing off with a "oh it's no big deal these days" or "oh they have a pill for it now."

It's great there's some good statistics coming out of a few countries, but still the virus is spreading. These are some of the worst hit countries, so there statistics had a lot of room for improvement. In some countries things really were getting to the point they just really couldn't get much worse. You mention Kenya, where the statistics are better, but where now the first lady is preaching her belief that condoms actually spread the virus - so there's still a lot of education to be done.

There's a lot of good info here, there really is some progress being made, but let's not get ahead of ourselves. There's still so much to be done, if anything we need a big surge to finish this thing off. The last thing we probably need is a false sense of security and progress - that will enable people to put this issue onthe back burner.
This is very encouraging. It goes to show that people spread HIV/AIDS and people can stop its spread too. It is NOT a divine punishment, regardless of what the Catholic Church and others would have us believe, and we have it in our power to end it.