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Column: The drugs do work - but there are new obstacles in the fight against AIDS

Yes, AIDS-related deaths are decreasing – but there are several huge threats in the fight against HIV and AIDS, writes Breda Gahan on World Aids Day.

Breda Gahan

SINCE 1981, MORE than 60 million people have been infected with human immunodeficiency virus (HIV) and nearly 30 million have died of acquired immune deficiency syndrome (AIDS), although it took them awhile to put a name of these conditions.

For many of a certain age, the death of Freddie Mercury in November 1991, just a day after he publicly announced he had AIDS, was a landmark moment in pop culture, but also a very real – and high-profile – human tragedy.

Thankfully, since then and especially from the mid 1990s, AIDS-related deaths began to decline largely due to the positive impact of highly active antiretroviral therapy (HAART).

“AIDS-related deaths have fallen to lowest levels since the peak of the epidemic”

The November 2011 report by the Joint United Nations Programme on HIV and AIDS (UNAIDS), released last week, shows that 2011 was monumental in the AIDS response with unprecedented progress in science, political leadership and results.

The report also shows that new HIV infections and AIDS-related deaths have fallen to the lowest levels since the peak of the epidemic. New HIV infections were reduced by 21 per cent since 1997, and deaths from AIDS-related illnesses decreased by 21% since 2005. More good news: People living with HIV are also living longer and AIDS-related deaths are declining due to the lifesaving effects of antiretroviral therapy. At the end of 2010 estimates suggest that there were roughly:

  • 34 million people globally living with HIV
  • 2.7 million  new HIV infections in 2010
  • 1.8 million  people died of AIDS-related illnesses in 2010 (UNAIDS Report Nov. 2011)

Globally, over 7,000 new HIV infections per day were transmitted in 2010. About 1,000 were in children under 15 years of age. Prevention-of-mother-to-child transmission (PMTCT) is now achievable in most countries and cost-effective.

There were 331 new HIV diagnoses reported in Ireland last year

Access to life saving anti-retroviral drugs has dramatically changed the lives of people living with HIV in Ireland since the early 1990s. HIV is ‘technically’ 100% preventable yet a total of 331 new HIV diagnoses (240 men and 89 women) were reported to the Health Protection Surveillance Centre (HPSC) during 2010. In addition, there were 54 cases of AIDS and 10 deaths among AIDS cases also reported to the HPSC during 2010.

There were 152 new HIV diagnoses in Ireland in Quarter 1&2 of 2011, which is less than the number reported in Q1&2 2010 (166) and Q3&4 2010 (164). The absolute number of newly diagnosed cases reported in the first half of this year suggests that the transmission of HIV in Ireland is on a downward trend. This is indeed good news.

However, looking at the Big Picture globally, there is no room for complacency.

The big ‘but’…

Recent global gains however are being threatened by lowered leadership, complacency and reduced investments in the global HIV and AIDS response.

Most of the recorded deaths since 1981 have been in the developing and poorest countries of the world.

It took until 2005 for the World Health Organisation, UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria to announce joint efforts to increase availability of antiretroviral drugs in developing countries.

Let’s look to one of the poorest countries where Concern Worldwide is working for some perspective. Mr. Emmanuel Ssegawa, HIV and AIDS Programme Advisor with Concern in Uganda tells us that from the Pader and Karamoja Districts where he is working, “HIV is not in recession”.

Despite the advances, women in developing countries are still at particular risk

Risk and vulnerability among extremely poor people, and inequality in particular, is increasing HIV infection among women.

There has been a lessening of leadership at all levels in recent years as treatment has expanded, and Emmanuel argues that “re-engaging leadership for effective HIV prevention” is more critical now than ever given the downturn in HIV programme investment due to the global economic recession.

“We cannot lose the gains made in saving lives in Uganda from AIDS. Too many people have died in this country. Sustained investment and investment in the right way by government and donors can prevent future deaths,” he says.

Concern has been working globally on the HIV and AIDS response since the 1980s with an overall strategic objective to reduce HIV incidence, and to minimise the impact of HIV and AIDS among people living in extreme poverty.

In 2010 Concern’s HIV and AIDS response programmes with local partners were active in nine countries reaching 359,416 direct beneficiaries and 1.2 million indirect beneficiaries.

In Uganda in 2009, it was reported that hunger-vulnerable HIV-positive patients abandoned taking their ARVs. An estimated 11.6 million people are currently struggling for basic nutrition and sanitation in the humanitarian crisis in the Horn of Africa – and experts have warned that this situation could have a serious effect on the health of people undergoing HIV treatment.

The worst drought in 60 years has led to large-scale food scarcity, which is a well-known barrier to antiretroviral (ARV) effectiveness. ARVs increase the appetite and a lack of food has been known to worsen the side-effects.

Additionally, HIV-positive mothers may have to feed their children with a mixture of solid food and breast milk, thereby increasing the risk of transmission.

The number of sexual assault and rape cases also increases in refugee camps as regular societal and legal protection systems break down. With that, the risk of new HIV infections also rises.

The official theme for World AIDS Day 2011 is: Zero New HIV Infection, Zero Discrimination, and Zero AIDS Related Deaths.

We’ve been working with local government and NGO partners in these overseas locations and, supported by our donors, can contribute effectively to these ‘zero goals’.

Every child born today in 2011 has a right to be born HIV free, and to live a HIV free life.

Well targeted and monitored HIV investment can save lives.

Breda Gahan is Concern’s Senior HIV Adviser.

About the author:

Breda Gahan

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