21st century

HIV-positive teachers were not getting the antiretroviral drugs they desperately needed because the departments of education and health each believed the treatment was the other's responsibility, a Commonwealth Secretariat workshop heard yesterday.

A new report from the Health Communication Partnership (HCP) demonstrates how a powerful television serial drama about young adults living in a rural South African town impacted by HIV/AIDS led to improved attitudes about HIV/AIDS, stigma, living openly and positively with HIV and faithfulness among its viewers.

The government would require an additional 3 200 doctors, 2 400 nurses, 765 social workers and 112 pharmacists in the public health system by 2009 to complete the rollout of the antiretroviral (ARV) programme, journalist and writer Hein Marais said yesterday at the launch of his new book Buckling: The Impact of AIDS in South Africa.

Despite new evidence suggesting that prevention efforts are having a positive effect in a small but growing group of countries, the big picture remains bleak, a joint UNAIDS and World Health Organisation report revealed on Monday.

Rapid Increases in Newer HIV Epidemics in Asia and Eastern Europe Despite Improvements, Current Prevention and Care Efforts are Inadequate The global AIDS epidemic shows no signs of abating. Five million people became infected with HIV worldwide and 3 million died this year alone – the highest ever. The findings are featured in “AIDS Epidemic Update 2003,” a comprehensive new report on the global HIV/AIDS epidemic issued today by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) in advance of World AIDS Day, commemorated on 1 December. One in five adults across southern Africa are now living with HIV/AIDS, the highest rate since the beginning of the epidemic. While infection rates across sub-Saharan Africa vary widely, from less than 1% in Mauritania to almost 39% in Botswana and Swaziland, the breadth of the epidemic indicates that HIV/AIDS now has a firm hold on most countries in the region. In several countries in sub-Saharan Africa, high levels of AIDS mortality now match the high rate of new infections, creating a cycle of illness and death due in great part to the almost complete absence of large-scale HIV prevention or antiretroviral treatment programmes. According to the new report, an estimated 40 (between 34 and 46)* million people are living with HIV worldwide, including 2.5 (between 2.1 and 2.9) million children under the age of 15. Globally, an estimated 5 (4.2-5.8) million people were newly infected and 3 (2.5-3.5) million people died of AIDS in 2003. Sub-Saharan Africa, the most severely affected region of the world, accounted for over 3 million of these new infections and 2.3 million AIDS deaths. Every day in 2003 an estimated 14,000 people were newly infected with HIV. More than 95% of those live in low- and middle-income countries. “The world is now mounting a greater response to AIDS through individual initiatives like the US Government’s Emergency Plan on AIDS and the Global Fund to Fight AIDS, TB and Malaria,” said Dr Peter Piot, UNAIDS Executive Director. “However it is quite clear that our current global efforts remain entirely inadequate for an epidemic that is continuing to spiral out of control. AIDS is tightening its grip on southern Africa and threatening other regions of the world. Today’s report warns regions experiencing newer HIV epidemics that they can either act now or pay later – as Africa is now having to pay.” AIDS Maintains a Stranglehold in Africa, Hitting Women Disproportionately An estimated 26.6 (25-28.2) million people in sub-Saharan Africa were living with HIV in 2003, and an estimated 3.2 (3-3.4) million people in the region were newly infected during the past year. About 30% of people living with HIV/AIDS worldwide live in southern Africa, an area that is home to just 2% of the world’s population. South Africa alone was home to an estimated 5.3 million people with HIV at the end of 2002 — more than any other country in the world. “The most devastating social and economic impacts of AIDS are still to come,” said Dr Piot. “Widespread treatment access would substantially mitigate the devastating impact of HIV/AIDS, which affects everything from agriculture to national defense. Effective HIV prevention programmes must be scaled up dramatically if we want a realistic chance at reducing the number of new infections.” The epidemic is particularly devastating for women in sub-Saharan Africa, where women are more likely to be infected with HIV than men. Among young people this discrepancy is particularly high, with young women aged 15-24 up to 2.5 times more likely to be infected than young men in the same age group. Rapid HIV Spread in Many Regions Driven by Injection Drug Use, Unsafe Sex A new wave of HIV epidemics is threatening China, India, Indonesia and Russia, mostly due to HIV transmission through injecting drug use and unsafe sex. The new UNAIDS/WHO report presents many clear warning signs that Eastern Europe and Central Asia could become home to serious new HIV epidemics. Prevalence rates in these regions continue to grow and show no signs of abating. Young people are among the hardest hit by HIV/AIDS in this part of the world. While young men still bear the brunt of the epidemic, 33% of those infected at the end of 2002 were women, up from 24% the year earlier. Despite the growing prevalence of HIV infection, too little prevention outreach, such as safe sex education or adoption of safer injection techniques, is being employed in these areas. The epidemic is also growing in areas where, until recently, there was little or no HIV present, including many areas in Asia and the Pacific. Recent rapid increases in HIV infections in China, Indonesia, and Viet Nam show how suddenly an epidemic can erupt wherever significant levels of drug injecting occur and, as seen in Eastern Europe, illustrate the urgent need to increase prevention efforts before the epidemic expands beyond high-risk groups. Response, While Improving, Falls Far Short of What is Needed “AIDS Epidemic Update 2003” notes that the response to HIV/AIDS as measured by spending and political action has improved dramatically in recent years, but improvements are still far too small and slow in coming to adequately respond to the growing global epidemic. The report indicates that the rapid scale-up of treatment access is urgently needed to help avoid the devastating effects of millions of anticipated illnesses and deaths. In an effort to scale up treatment, the World Health Organization, the convening agency for HIV care in UNAIDS, and partners are developing a comprehensive global strategy to bring antiretroviral treatment to 3 million people by 2005, known as the ‘3 by 5’ initiative. “The World Health Organization will unveil detailed implementation plans for ‘3 x 5’ next week, to coincide with the commemoration of World AIDS Day,” said Dr LEE Jong-Wook, Director-General of the World Health Organization. “This represents an unprecedented drive to increase the number of people receiving treatment. For ‘3 x 5’ to succeed, however, and for treatment access to increase further in the future, the international community must continue to increase its financial and logistical support.” In addition to treatment gaps, the report finds that surprisingly little is being done to implement even the most basic cost-effective HIV-prevention efforts. Prevention resources remain scarce, especially in sub-Saharan Africa where, outside of Senegal and Uganda, few prevention success stories can be identified. In many of the hardest-hit countries, there are no national orphan programmes in place, coverage of voluntary counselling and testing is threadbare, and prevention of mother-to-child HIV transmission is virtually non-existent. “With increased focus on the urgent issue of access to treatment, there is also a danger that the equally important issue of prevention will continue to be overlooked,” said Dr Piot. “There has been an upsurge in the past few years in political support, policy formulation, and funding on HIV/AIDS. This momentum must be maintained and expanded — for both treatment and prevention — if the epidemic is to be reversed.” “AIDS Epidemic Update 2003” also notes that close to 40% of countries that have reported on progress made in implementing the Declaration of Commitment on HIV/AIDS (adopted at the UN General Assembly Special Session on HIV/AIDS in 2001) have not yet adopted legislation to prevent discrimination against people living with HIV/AIDS. Such legislation is vital to prevention efforts, as it can help individuals get tested for HIV without fear of persecution and discrimination. Combating HIV-related stigma and discrimination is the theme of the UNAIDS World AIDS Campaign this year. Improved Epidemiological Surveillance While last year’s “AIDS Epidemic Update” estimated the total number of people living with HIV to be 42 million, improved epidemiological monitoring shows that the population living with HIV, while continuing to grow, is slightly smaller than previously believed. The report emphasizes that this apparent reduction reflects an improvement in HIV surveillance only, and does not represent a decrease in either infections or illnesses – both of which continue to rise. To emphasize the need for better HIV surveillance in many countries, the report this year also includes ranges for the HIV/AIDS estimates provided. Improved data and understandings of the epidemic are vital for effective planning and programming at country and regional levels. For more information, please contact Anne Winter, UNAIDS, Geneva, (+41 22) 791 4577 or mobile (+41 79) 213 4312, Dominique de Santis, UNAIDS, London, (+41 22) 791 4509 or mobile (+41 79) 254 6803, Gavin Hart, UNAIDS, New York, (+ 1 212) 584 5024 or mobile (+1 917) 686-9221, or Iain Simpson, WHO, Geneva, (+41 22) 791 3215. You may also visit the UNAIDS Home Page on the Internet for more information about the programme (http://www.unaids.org)( Source: WHO 25 November 2003).

More than 7 000 local motor sector employees and 42 000 family members have been reached in one of the most wide-ranging efforts by the private sector to deal with the HIV/AIDS pandemic. Mamongalo Mahlatsi, the Automotive Industry Development Centre's project manager for socioeconomic programmes, will reveal in a progress report today at the Autocluster Africa 2003 motor industry conference in Kyalami that 18 companies in South Africa have already put in place HIV/AIDS programmes under the workplace wellness initiative of the centre. The car sector was particularly threatened by the HIV/AIDS pandemic and Mahlatsi would report on how the pioneering efforts by the large vehicle assembly companies were now being followed by the rollout of proactive HIV/AIDS strategies by smaller component suppliers. Retail motor dealers were now joining the centre's programme after awareness of the threat posed by HIV/AIDS right across the motor business had been raised through 130 briefing sessions to senior management. To date 70 line managers, 20 HIV/AIDS co-ordinators and 40 peer educators have undergone training under the programme. Ford, DaimlerChrysler, Volkswagen and BMW were among the vehicle assemblers that pioneered private sector HIV/AIDS initiatives at their South African plants, and their suppliers and dealers were now also initiating programmes. The release of details of the success of the centre's motor industry programme follows the controversial discussion paper, which was written by the Human Sciences Research Council, and which links globalisation and corporate restructuring to the AIDS pandemic. (Source: Business Report, 30 September 2003) //\//Link GLOBALISATION AND THE IMPACT OF HIV/AIDS ON THE LABOUR FORCE http://www.hsrc.ac.za/research/npa/EEP/discussion/20030923.pdf

This report summarizes the results of a survey of 771 AIDS-affected households in different parts of South Africa. The households were randomly selected from the client lists of non-governmental organizations providing support to AIDS-affected households in the regions where the survey was conducted. The survey and this report are an attempt to document the impact of HIV/AIDS on South African households. Although it is not representative of all AIDS-households in South Africa, the report provides a snapshot of the devastating impact of HIV/AIDS on already poor families. As bleak as the findings of this survey are, the households in this survey are likely better off than most since all households in the survey had contact with non-government organizations providing support to HIV-affected households.

More than 75% of 500 SA companies surveyed by finance group Sanlam have no idea of the prevalence of HIV/AIDS in their organisations, and more than 60% of these firms have no strategy to manage the disease.This will alarm analysts, given the recent pressure on companies to report on HIV/AIDS prevalence within their organisations as part of their corporate governance responsibilities. Sanlam polled the 500 firms as part of its retirement funds survey, which was released yesterday. It concluded that besides the ignorance of prevalence, 46% of companies had no AIDS policy whatsoever and 85% did not offer voluntary AIDS testing. The Johannesburg Securities Exchange SA is expected to release guidelines on AIDS reporting next year. This will mean that companies will have to reflect what measures they are taking to deal with the disease alongside their financial statements. SA would be the first country to insist on AIDS reporting of this kind anywhere in the world. The JSE's director of new business and general counsel, Nicky Newton-King, said companies would also be judged according to how they respond to the AIDS epidemic in the new socially responsible investment index being launched by the JSE. It is expected to be launched early next year, rating companies on non-financial grounds, including empowerment initiatives and AIDS programmes. Rob Rose: Business Day, 4 October 2002

The global AIDS epidemic is still in an early phase, and 68 million people could die of the disease in the 45 most affected countries by 2020, the United Nations agency dealing with the pandemic (UNAIDS) warned on Tuesday. In its latest report - released in anticipation of the 14th International AIDS Conference in Barcelona from July 7 to 11 - UNAIDS says HIV prevalence rates are climbing higher than previously believed possible in the worst-affected countries, and the virus was spreading rapidly into new populations in Africa, Asia, the Caribbean and Eastern Europe. A statement accompanying the report says that in Botswana - the country with the highest HIV infection rate in the world - almost 39 percent of all adults are now living with HIV, up from less than 36 percent two years ago, when the 13th conference took place in Durban. In Zimbabwe, a country in which already one quarter of adults were HIV-positive in 1997, one-third were infected by the end of 2001. In five other countries, the HIV prevalence rate in adults now also exceeds 20 percent, the report says. Young people remain at greatest risk for infection with about half of all new adult infections occurring among young people aged 15 to 24.Almost 12 million young people are now living with HIV, and about 6000 more become infected every day. Of the six million people in the developing world, just 230 000, less than four percent, were receiving antiretroviral drugs at the end of 2001. In Africa, however, where only some 30 000 of the 28,5 million people infected were receiving antiretroviral treatment, AIDS killed 2,2 million people. The report says that while efforts to reduce the prices of drugs have been effective, more has to be done by governments and the private sector to ensure that treatment reaches those most in need. Therefore, the cost of treatment has to continue falling. Uganda, once the most affected country in the world, has managed to bring its HIV infection rate down to five percent. HIV prevalence is also falling among young Zambian women - from 28 percent in 1996 to 24 percent in 1999 in cities, and from 16 percent to 12 percent in rural areas. In South Africa, government-supported youth prevention efforts have led to high levels of HIV/AIDS awareness, and there appears to be an increase in safer sexual practices among young people, the report says. (Source: SAPA, 2 July 2002)

HIV/AIDS is devastating farming and worsening hunger in sub-Saharan Africa, the United Nations world food body said on Tuesday. In Africa's 25 most affected countries, seven million farm workers had died from AIDS since 1985 and 16 million more might die within the next 20 years, the UN Food and Agriculture Organisation (FAO) said in a report entitled The State of Food and Agriculture 2001. Africa, with about 10 percent of the world's population, accounts for nine out of each 10 new cases of HIV infection. Eighty three percent of all AIDS deaths are in Africa. The FAO said recent UN studies showed output by smallholders in parts of Zimbabwe might have fallen by 50 percent over the past five years, mainly as a result of AIDS. Labour shortages were particularly serious for agriculture since production was seasonal and timing was crucial. A shortfall in household labour meant more land became fallow and the household's output declined. HIV/AIDS was also having a big impact on agricultural estates, FAO said. Over an eight-year period in the 1990s, spending on funerals and health costs at the estate rose fivefold and tenfold respectively. The company, which was not identified, had estimated that about three-quarters of all illnesses among employees were related to HIV infection. The impact on the livestock sector was also severe. Evidence from Namibia and Uganda indicated that livestock was often sold to support the sick and to cover funeral expenses. Recent evidence from Tanzania suggested that food spending by poor households could drop by nearly a third after the death of a young adult. (Source: Business Report, 12 September 2001)