Win32 Virus Removal

Human Immunodeficiency Virus 1/Acquired Immunodeficiency Syndrome (HIV/AIDS) is a global pandemic which infects and affects the young, the old, the middle-aged, the rich, the poor, the middle-class, gay, straight, black, white, asian, mixed race… But in 2008, ‘97% of all new HIV infections occurred in developing countries’, and ‘98% of all AIDS-related deaths occurred in those parts of the world’ Michel Sidibe, Executive Director of the Joint United Nations Program (UNAIDS).

As 33.4 million people live with HIV/AIDS globally, there are many representatives from varied groups to act as spokespeople for the variety of lives touched and claimed by the HIV/AIDS pandemic. But HIV/AIDS continues to disproportionately affect the poor and the marginalised. The pandemic disproportionately affects sub-Saharan Africa. 71% of those living with HIV/AIDS live in sub-Saharan Africa, and mostly in Southern Africa. The nine countries with elevated rates (10-30%) of HIV are within Southern African region.

The launch of the 2009 AIDS Epidemic Update report in Shanghai on 24^th November was an occasion to acknowledge the 17% decline in new HIV infections over the past 8 years. Comparing rates between 2001 and 2008, in sub-Saharan Africa the reduction in new HIV infections was 15%, in East Asia 25%, and in South and South East Asia 10%. With this World Health Organisation (WHO) and UNAIDS report came the welcome news that the apparent that the peak of the pandemic is over. But passing the 1996 peak of 3.5 million new HIV infections does not mean the trend for this pandemic will now be a smooth slide downwards. The 17% decline in new HIV infections is indeed welcome news, and a result of difficult work by a host of varied workers and activists. But there remains much work to be done, and much awareness to be raised before this pandemic, which has spread so rapidly, and with devastating consequence, can really begin to abate.

It is not widely acknowledged that in Eastern and Southern Africa, HIV spread was not through promiscuity, but through a network of long-term concurrent partnerships. Uganda’s 1987-1992 ‘Zero Grazing’ campaign offered a model of grassroots activism with government support which was effective in limiting the spread of the pandemic. Heterosexual transmission of HIV is common. But this pandemic also disproportionately affects men who have sex with men (MSM). Ignoring or stigmatising these individuals will neither serve them nor the wider community. Either approach will mean that MSMs will not acknowledge and limit high risk behaviour, they will not learn their HIV serostatus and they will pass the virus to both homosexual and heterosexual partners. In Eastern Europe, 57% new infections occurred among drug users in 2008, but the focus of investment is has not been on this high risk group in this part of the world.

The WHO/UNAIDS 2009 AIDS Epidemic Update describes that an estimated 2.9 million lives are thought to have been saved as a result of antiretroviral use. In high income countries treatment has been widely available. The number of deaths averted in Western Europe and North America is 1.1 million, and similar to the 1.2 million in sub-Saharan Africa, ‘despite the much larger epidemic in sub-Saharan Africa’ (report p 17). Currently, more than 4 million people in middle and low income countries receive antiretroviral treatment; this 10 fold increase has come between 2003 and 2008, but still leaves nearly around 25 million individuals without hope of any treatment intervention. Last year 2.7 million new HIV infections were acquired and 2 million AIDS-related deaths occurred.

The launch of the 2009 AIDS Epidemic Update was an opportunity for WHO to praise their Chinese hosts for progress made in stemming the spread of HIV/AIDS. China’s low HIV/AIDS prevalence rates were described by Hiroki Nakatani, Assistant Director General of WHO, as ‘another example that China has shown to the world’. There are now reportedly 319,000 people living with HIV/AIDS in China; an almost miniscule prevalence rate for a country of nearly 1.5 billion people. However, it is also important to be mindful that for every officially reported HIV positive individual in China, 2 more are officially estimated to remain undiagnosed. Chinese HIV/AIDS social worker and activist, Zhao Chunki, speaking at the launch, described her own personal and working experience. She described ‘AIDS (as) the disease of those who love their children’, as villagers became paid blood donors in order to feed their families, they also became infected with HIV and began dying from AIDS. They left devastated homes, HIV positive infants and orphans. This moving experience gives the easier to swallow side of the pandemic. Current data shows that over 70% of HIV transmission China occurred by sexual transmission, with 32% of new infections last year occurring between men who have sex with men (MSM).

There are preventative strategies, proven to work efficiently and effectively to reduce the spread of this pandemic. The ‘Zero grazing’ and other grassroots awareness raising campaigns, condom use and male circumcision are known and important intervention which have proven efficacy in preventing and reducing the spread of HIV/AIDS. Removal of stigma and criminalisation around HIV/AIDS is also an essential component of effective prevention and intervention strategies.

So, why are some strategies so easily overlooked? Why aren’t existing preventative interventions being used effectively? Will new treatment interventions present the same implementation challenges and the same ill-fitting solutions as existing treatment interventions? Will the result be a failure to reach those most in need? 

Although there is much promise in new antiretroviral drugs treatments, at best new drugs will not be available for several years to areas with highest HIV/AIDS prevalence. While a vaccine which results is 32% fewer HIV infections is indeed a significant result, a vaccine with high efficacy remains a distant dream. Building awareness of how the virus is transmitted and supporting grassroots community activism is an effective intervention for stopping the spread of this pandemic today.

HIV/AIDS is sexy disease. Research is essential and there is money to fund it. However, HIV scientific research has been shaped by quests for high impact publications and prizes, with such concentration on proprietory research that the scale, impact and challenge of the pandemic has often been obscured. While the large bounty may still seem within reach for those who might crack the code with which to break HIV/AIDS, the mood of compromise does seem to slowly be reaching HIV/AIDS researchers. Possibly previous vaccine trial failures, and inability to fully understand what constitutes an effective immune response to fight HIV, will deepen lessons about the necessity of collaboration. Complementary societal, scientific, artistic and cultural tools will be required to beat this pandemic… there is no magic bullet. In many ways, the challenge of the HIV/AIDS global pandemic begins today.

1^st December 2009 is World AIDS Day.