How is the war on AIDS going?
Progress is varied. Overall, epidemiologists believe rates of infection
peaked in the 1990s and are stabilising - and, in some countries, beginning to
decline. The latest report by the Joint United Nations Programme on HIV/AIDS (UNAIDS)
estimates that 38.6 million people worldwide are living with HIV. More than 4
million were newly infected last year and 2.8 million died from AIDS.
Prevention, testing and treatment services have all improved massively over
the past few years. The number of people who undergo HIV tests and counselling
has quadrupled since 2001 to 16.5 million. More than 1.3 million people now
receive life-prolonging antiretroviral (ARV) therapies compared with just
240,000 five years ago.
Funding has also increased more than 4bn a year is now spent on
researching and treating the disease. But the World Health Organisation's
Three by Five goal of having 3 million people on ARV treatment by
the end of last year was not met - only 20 per cent of those infected are on
such therapies.
Is it only
Africa
that has to worry?
Sub-Saharan
Africa
remains the epicentre of the epidemic two-thirds of people infected with HIV
live in the region. One in three adults in
Swaziland
is HIV positive and
South Africa
,
Botswana
,
Lesotho
and
Namibia
have similarly high rates of prevalence that have shown no clear signs of
decline. But it is by no means simply an African problem. More than 8 million
people in Asia are infected and two-thirds of them live in one country -
India
- where less than 10 per cent of patients are on ARV treatment. Prevalence is
also increasing in
China
,
Indonesia
,
Papua New Guinea
and
Vietnam
.
The tipping point in any HIV epidemic is 1 per cent - when more than this
proportion of the population is infected, the spread of the virus moves from
high-risk marginal groups (such as injecting drug users, sex workers and gay
men) and into the wider community.
Burma
, the
Bahamas
,
Trinidad and Tobago
,
Belize
and
Honduras
are among the countries outside
Africa
with an HIV prevalence of more than 1 per cent. The number of people living
with HIV in Eastern Europe and
Central Asia
has increased twentyfold in less than a decade.
Russia
now has the biggest AIDS epidemic in
Europe
, with an estimated 1.5 million people infected with HIV and has also reached
the tipping point of 1 per cent.
In the
UK
, there were more than 6,000 newly diagnosed cases of HIV last year, more than
3,000 of which were thought to have been acquired through heterosexual sex.
Are some countries better than others at fighting AIDS?
Six out of 11 African countries heavily affected by HIV last year reported a
decline in prevalence of at least 25 per cent among the key demographic of 15-24
year olds in capital cities. For the first time last year
Kenya
,
Zimbabwe
,
Burkina Faso
and
Haiti
also began to show signs that infection rates are falling.
One of the biggest success stories has been
Uganda
, where prevalence has fallen from 15 per cent in the early 1990s to 6.7 per
cent in 2005.
Uganda
adopted an A-B-C campaign, which promotes abstinence, followed by
encouragement to be faithful but also teaches condom use.
Lesotho
has announced a 7m programme to test its entire population for HIV in an
attempt to increase access to treatment and reduce stigma.
What is the focus of scientific research?
Until 10 years ago, there was little doctors could do to help the victims of
HIV/AIDS. Then along came Haart (highly effective antiretroviral therapy) which
revolutionised treatment.
Last month the US Food and Drug Administration approved a new type of ARV
that combines three drugs in one pill and is taken just once a day, compared
with older style treatments that involve several pills a day and have proven to
be hard regimes for patients to follow.
Trials of a vaccine are under way in
Thailand
and results are expected next year. The first HIV vaccine may be available by
2012, but most experts believe it will take far longer, partly because the HIV
virus keeps changing.
One of the most exciting breakthroughs could come from the world of
microbicide gels that women apply before sex to kill the HIV virus. British
scientists from Imperial College London are at the forefront of the research,
with the development of a vaginal gel called Pro 2000 which is being tested on
more than 10,000 women in
South Africa
and
Uganda
.
Five other gels and creams are also in final-stage trials, and Bill Gates
said yesterday that he believed their development could be a turning
point in the fight against AIDS, not least because it gives women a way of
protecting themselves.
Recent research has also found that male circumcision reduces a man's risk of
acquiring HIV by up to 60 per cent, a success rate which experts say a vaccine
should achieve.
What does the future hold?
The solution may lie not in the laboratory but in education and awareness. A
fundamental change in cultural attitudes towards sex and women, not just in
sub-Saharan
Africa
but across the world is key.
A report published yesterday by the charity ActionAid showed that girls with
secondary level education were more likely to wait before having sex, much more
likely to use condoms - and therefore much less likely to become infected with
HIV. As Bill Gates told the
Toronto
conference: We need to put the power to prevent HIV in the hands of
women.
Will AIDS ever be eliminated?
Yes...
* The success of countries like
Uganda
has shown that a combination of treatment and education can have astonishing
results
* Preventative measures that focus on women are in the final stages of
development and could revolutionise the battle
* If an effective vaccine is ever developed, HIV/AIDS could go the way of
smallpox and polio before it
No...
* The HIV virus has showed itself to be capable of constantly changing and
adapting to evade the drugs thrown at it
* Cultural attitudes and sexual mores are too ingrained to expect that all
people will follow the advice and education given to them
* While governments like that of the
US
continue to preach abstinence over condoms, there is little hope of an
AIDS-free world
Printer-friendly version