World AIDS Day: Getting to Zero

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A couple of days ago, I had a moment of great joy in the clinic we work in the community health center when a person came up to me and unhesitatingly asked for a pack of condoms (they are distributed for free, along with basic medicines from our center). While it might surprise a lot of people when I say this, but the cultural environment and mental make up of people in India is still such, that talking about sex is taboo. So, when this person asked for protection, I was pleasantly surprised.

This shows the rising trend of awareness about prevention of STIs and HIV, one of the benefits of running the clinic focusing on the community needs, with an approach to give health education and counseling in addition to treatment to ailments. In India, diseases of the mind and thought-processes can sometimes be more destructive than those of the body actually.

The focus of the World AIDS Day is to involve more people, mobilize more resources, and spread awareness regarding the disease, its prevention, treatment and care, and eliminating the stigma associated with it.

The Theme:

Between 2011 to 2015, the theme for World AIDS Day is:

“Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS related deaths”.

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This theme is just a summarization of the three-pronged strategy to counter HIV:

  • reduce new infections
  • eliminate the stigma associated with the diagnosis of HIV
  • improve access to healthcare services and antiretroviral drugs, thus improving survival

This theme also highlights the responsibility of the individual nations to fulfill their commitment towards providing resources and materials for the eradication of the disease. One of the international declarations that needs mention with this regard is the Abuja Declaration.

The Abuja Declaration:

HIV AIDS has been a major public health concern globally, but perhaps, nowhere has it been more harrowing than in the African continent. Poverty, unstable economic and political environment, coupled to a lack of proper awareness regarding the disease has led to disastrous numbers in the past. To counter the threat of HIV-AIDS, in April 2001, the heads of states of the countries of the African Union pledged to allocate at least 15% of the annual budget to the healthcare sector. At the same time, 22 donor countries were urged to contribute 0.7% of their GNP (some countries used GNI as the calculator) towards the African Union nations to counter the shortage of resources.

Ten years on, in March 2011, the WHO came out with its report on the Abuja Declaration status and they found that only Tanzania had met the criteria of 15% expenses on healthcare and only 3 other countries: (Mauritius, Seychelles and Eritrea) are on track. The rest show very little progress, if at all!

The donor countries are also not honoring their commitments. Five countries were already contributing at least 0.7% of their GNP in 2001 to the AU when the declaration was signed and the unweighted mean of their contribution was around 0.4%. In 2011, following the weakening of the dollar due to the global financial crisis and drying up of funds from the donor countries, the unweighted mean has come down to 0.31%, with actually a reduction in the aid given to AU.

The theme, therefore, reiterates that the nations, developing and developed alike, need to honor their commitments to the global population, in order to combat the HIV pandemic.

Numbers Game: The UNAIDS 2012 Global Report:

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India has shown a staggering 57% reduction in the incidence of new cases in comparison to the last decade!

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In order to understand the above figure, use the key below, and also check out the global figures in the UNAIDS results 2012 report. Makes for interesting viewing.

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India Reports:

Yesterday, the Honorable Health Minister Shri Ghulam Nabi Azad released India’s numbers at New Delhi:

Some of the key findings of the released reports are summarized here:

Indicator

2007

2011

Adult (15-49 years) HIV Prevalence 0.33% 0.27%
No. of PLHIV 22,52,253 20,88,642
No. of Adult new HIV Infections 1,23,890 1,16,456
No. of annual AIDS-related deaths 2,06,671 1,47,729
State with highest adult prevalence Manipur 1.22%
New infections in children   14,500
Female Sex Worker incidence 5.06% 2.67%
Prevalence in men having sex with men 7.41% 4.43%
Prevalence in Injecting Drug Users 7.23% 7.14%

The report identifies pockets of rising incidence, although it notes and acknowledges the fact
that there has overall been a significant downwards trend on the national scale and in the high prevalence states, which alone have accounted for a reduction of 76% in comparison to the numbers from 2001. The steady state of prevalence in the injecting drug abusers possibly indicates the failure of the program in espousing Needle Share Programs and other such preventive measures targeting the IDU groups specifically. The press release does mention a spate of new initiatives in this regard though the details are not divulged.

UN: The Way Ahead: 10 Goals for 2015:

  1. Sexual transmission of HIV reduced by half, including among young people, men who have sex with men and transmission in the context of sex work;
  2. Vertical transmission of HIV eliminated and AIDS-related maternal deaths reduced by half;
  3. All new HIV infections prevented among people who use drugs;
  4. Universal access to antiretroviral therapy for people living with HIV who are eligible for treatment;
  5. TB deaths among people living with HIV reduced by half;
  6. All people living with HIV and households affected by HIV are addressed in all national social protection strategies and have access to essential care and support;
  7. Countries with punitive laws and practices around HIV transmission, sex work, drug use or homosexuality that block effective responses reduced by half;
  8. HIV-related restrictions on entry, stay and residence eliminated in half of the countries that have such restrictions;
  9. HIV-specific needs of women and girls are addressed in at least half of all national HIV responses;
  10. Zero tolerance for gender-based violence.

What Can WE Do?

One additional responsibility we need to espouse is to fight the darkness of stigma that still enshrouds the disease. We need to bring people out from behind the shadows and start them on preventive and therapeutic journeys. Whenever we meet someone with a bias against the disease, and the diseased, we need to use our position of privilege to make them understand that this is just another disease, which needs not be feared nor its patients persecuted.

We need to be aware, think aware, act aware.

We need to live, think and speak positive.

Happy World AIDS Day, folks!

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Skeptic Oslerphile, Scientist at the Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases. Interests include: Emerging Infections, Public Health, Antimicrobial Resistance, One Health and Zoonoses, Diarrheal Diseases, Medical Education, Medical History, Open Access, Healthcare Social Media and Health2.0. Opinions are my own!

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