Newsdesk Reinforced prevention efforts for HIV AIDS epidemic can erupt wherever significant levels of injecting drug use occur”, Dominique De Santis, a UNAIDS spokesperson told TLID. She believes that the epidemic can be reversed if HIV care and prevention programmes, particularly those targeting vulnerable groups, are scaled up in the countries in eastern Europe and Asia experiencing “newer” HIV epidemics. Also, political leadership is key to effectively fighting the epidemic, she says. “We have seen increased political [will] for HIV/AIDS control over the past year, notably in Africa where many national AIDS councils are now headed by presidents and prime ministers, but more is needed in Asia. Without political commitment from the top, stigma and discrimination surrounding HIV/AIDS will continue to run rampant, treatment programmes will not be scaled up, and AIDS awareness campaigns will not be launched nationwide”. The number of people living with HIV in high-income countries also increased significantly in 2003: around 80 000 people in these countries acquired HIV. In the UK the number of people who became infected with HIV increased to 49 500 in 2002 from 41 700
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In 2003, more than 3 million people died from AIDS and another 5 million people became infected with HIV worldwide, according to the latest UNAIDS and WHO estimates published in the AIDS epidemic update 2003 (http://www.unaids.org/ wad/2003/press/Epiupdate.html). UNAIDS’ executive director, Peter Piot, warned that although efforts directed at managing the global HIV/AIDS epidemic are greater than ever, they remain inadequate for an epidemic that is spiralling out of control. “AIDS is tightening its grip on southern Africa and threatening other regions of the world. [This] report warns regions experiencing newer HIV epidemics that they can either act now or pay later”, he warned. Southern Africa, which has less than 2% of the world’s population, accounts for nearly 30% of people living with HIV/AIDS worldwide. But a new wave of HIV epidemics threatens China, India, Indonesia, and Russia, mostly due to transmission through injecting drug use and unsafe sex, especially among young people. “Recent rapid increases in HIV infections in China, Indonesia, and Vietnam show how suddenly an
Injecting drug users risk new HIV epidemics
in 2001, according to a report published by the Health Protection Agency (HPA). Kevin Fenton of HPA points out that gays and bisexual men account for about 80% of newly diagnosed cases in the UK. Isabelle de Zoysa (Department of HIV/AIDS, WHO, Geneva) believes that prevention efforts must be “reinforced” in the UK, especially in young people and vulnerable groups whose language, culture, or immigrant status might limit their access to services. Khabir Ahmad
Drugs for HIV in South Africa The South African government has unveiled details of a major new plan to provide drugs to hundreds of thousands of HIV-infected patients. Nono Simelela, a health department official who helped draft the plan, said about 50 000 people could receive drug treatment in 2004, rising to as many as 1·4 million by 2009. The total budget will rise from US$44 million next year to $666 million in 2009. Simelela said officials were confident they could set up 50 service points around the country by the end of 2004, although she conceded the broader objective of setting up such clinics in every town and municipality would take time. Colwyn Poole (Médecins Sans Frontières Resource Centre, South Africa) sees the programme as “a massive victory for the people of South
Africa, the culmination of a long civil society-driven campaign, and a victory for democracy and promoting human rights in South Africa”. However, Poole is all too aware of the scale of the challenge: “Currently in South Africa, approximately 2000 people participate in 30 antiretroviral treatment programmes in the public sector and more than 20 000 in the private sector. However, 600 000 people are estimated to need antiretroviral treatment right now”. Brian Eley of the Red Cross Children’s Hospital in Cape Town, also sees the importance of the new programme. However, he also draws attention to the work ahead: “Specific issues in need of urgent attention include poor staff salaries, low staff morale, staff shortages, ongoing
professional education, training in all aspects of antiretroviral treatment and chronic care, regular drug supplies to clinics, and the optimal utilisation of ambulatory and inpatients facilities for individuals on antiretroviral therapy”. The new programme represents a major change of heart for the government of President Thabo Mbeki, which had long resisted the introduction of antiretroviral drugs, claiming they are too expensive, hard to take, and potentially toxic. Poole sees an essential role for the industrialised world, including support for global campaigns, such as those run by WHO and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and availability of lower-cost drugs. Cathel Kerr
THE LANCET Infectious Diseases Vol 4 January 2004
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