50th Agenda 

50th Session Issues

HIV/AIDS

by
Patience Monroe

In 1981, the AIDS virus was officially recognized as a disease and the HIV/AIDS pandemic began. Although the first case of HIV/AIDS is believed to have occurred in the 1940s, it was not until 1981 that a patient was diagnosed with the disease. Western Europe and North America were the first regions to recognize the epidemic. The United States alone has spent billions of dollars on treatment, research to find a cure, and on education for the prevention of HIV transmission.

Worldwide there are an estimated 33-47 million cases of HIV infection by nine major strains. Approximately 12.5 million cases of full blown AIDS are estimated, and the number is increasing by about twenty percent per year. In 1998, one person a minute, or 16,000 a day, or 5.8 million for the year contracted HIV. 13.9 million estimated AIDS deaths had occurred as of 1998.

Over the last decade, the western world has stabilized the rate at which people are infected with HIV. The discovery of antiretroviral drugs has lowered the death toll from AIDS in North America and Western Europe. Although patients' lives are now prolonged, no cure has been found. The best protection from the virus is the education of people at risk, which is virtually everyone who is sexually active (married or single).

One in every 100 sexually active people between the ages of 15 and 49 is infected with HIV and only one in ten of them know it. A common mode of transmission in the west is by injection drug users (IDUs), who share needles, contract the disease and then pass it on through sexual activity. Most frequently, transmission occurs through unprotected sex with an infected person. Transmission can also occur from mother to baby or through transfusion of infected blood products. The presence of other sexually transmitted diseases (STDs) increases the likelihood of HIV contraction. Tuberculosis is a complicating factor which increases an HIV infected person's likelihood of developing full blown AIDS.

In the beginning of the pandemic, the largest communities affected by HIV/AIDS were predominantly Caucasian men who had sex with men (MSMs) and sex workers in North America and Western Europe. Unfortunately, the disease is now concentrated in poor countries and has found its way into the lives of non-Caucasians, hetero-sexuals, young people aged 10-24, and children.

North America and Western Europe

As of June 1998, nearly 650,000 cases of HIV infection and 385,000 deaths from AIDS had been reported. According to the Provisional Report of the ___, in 1997, 84% of HIV/AID patients were male and 16% female. The reported number of new cases for 1997 was 60,634, slightly up from 1996. Of the new cases in 1997, 33% were non-Hispanic blacks, 33% were non-Hispanic whites, 21% Hispanics and 473 of the total cases were children.

African Americans are eight times as likely to contract HIV as whites. AIDS is the leading killer of African American men between the ages of 25 and 44; it is the number two killer of African American women in the same age group.

By 1996, a cumulative 247,571 persons in Canada had contracted HIV/AIDS. However, only 700 new cases were reported in 1997. In Europe, the epidemic originally occurred among MSMs. However, the percent of IDUs and heterosexuals contracting HIV has increased. In Paris, 40% of the deaths of 25-44 year olds in the mid-90s was from AIDS.

Through education about safe sex, abstinence campaigns, the treatment of STDs, and the availability of screening and treatment, North America and Western Europe have been able to stabilize their rates of infection and lower the subsequent number of deaths. There are still some bad signs with regard to behavior change. For example, despite the availability of public information in the US, 3 million people still contract STDs each year. However, in 1998, in all of North America and Western Europe combined, there were only 75,000 new reported cases of HIV infection. 1.4 million persons in these areas are currently living with HIV.

Eastern Europe and Central Asia

Until the middle of the 1990s, Eastern Europe and Central Asia had appeared unaffected by the AIDS pandemic. However, in 1998, these areas accounted for 270,000 persons living with HIV. UNAIDS and WHO report that the number of HIV infections in Russia rose from 30,000 in 1995 to over 190,000 in 1997. The Ukraine saw only 44 HIV positive persons for the period

1992-94, but by 1996 there were 12,000. In the Russian Federation, there are an estimated six infected people for every one person who tests HIV positive. The numbers are similar in Moldova and Belarus, but a bit lower in the Baltics and the Caucasus.

The recent increase in HIV infections in these regions is partly due to the growing incidence of STDs. Russia and the Ukraine have also experienced an increase in IDUs; there are over one million drug users in Russia. The port cities of Mykolayev and Odessa report most of the HIV cases in the Ukraine; they are also inlets for drug traffic. The use of heroin, cocaine and homemade opiates is also on the rise in Eastern Europe. Countries such as the Ukraine, Belarus, Kazakstan and Russia have outreach and needle exchange programs for IDUs and several countries in the region have begun implementing harm reduction projects.

A second cause of the rise in HIV infection is the increase in sex workers. Unfortunately, HIV data on sex workers in the newly independent states is nearly nonexistent. Many of the prostitutes from Eastern Europe work in Western Europe and the Middle East, adding to the spread of the disease.

Africa

Sixty-three percent of all those who are HIV-infected are in Africa, although that is down from 70% in 1993. In Uganda, 2 million of a population of 17 million are reported to be HIV positive. Other reports of HIV infection rates include: Botswana, 25-33% of the adult population; Zimbabwe, 22%; Namibia, 20%. 293,000 of one million in Swaziland are infected, where AIDS has already orphaned 22% of children under the age of 15 22. In Uganda, 1,000 children per week lose a parent to AIDS. Three to six million children under the age of 15 in 10 African nations could lose both of their parents to AIDS; 9 million have already lost their mothers.

"The UN's 1999 Human Development Report concludes that HIV/AIDS will lower life expectancy by 17 years in nine countries (Botswana, Kenya, Malawi, Mozambique, Namibia, Rwanda, South Africa, Zambia and Zimbabwe) by 2010." Life expectancies have already dropped dramatically in many countries: from 59 years to 32 in Uganda; from 63 years to 40 in South Africa; from 65 to 39 in Zimbabwe; to 39 in Swaziland, 37 in Zambia; from 51 years in 1998 to 37 years in 1999 in Malawi.

Asia

Asia is the region with the fastest growing rates of HIV infection. At the end of 1998, there were 7 million Asians infected.

"While HIV infection remains relatively low in the Philippines, Japan and South Korea, it has risen in Cambodia, where 3% of the population is estimated to be infected...." Thailand, Myanmar and India are also seriously affected. By 2000, it is predicted that as many as 100 million in India may be HIV infected. India's rural areas were once believed to have been spared by the HIV pandemic, but today HIV is familiar both in villages and in the cities. In fact, India has more HIV positive people than any other country in the world. All STDs are becoming widespread there. In a survey of the Tamil Nadu area, 10 percent of 25 million people had gonorrhea, syphilis or another STD.

In many Asian countries, it is considered proper for a woman only to have sex with her husband, and only after marriage. In a survey of 400 Asian women, 91 percent had never had sex with anyone but their spouse. Every one of these women was infected with an STD, and 13.6 percent of them were HIV positive.

The most frequent mode of transmission in this region is through heterosexual behavior. Men who travel away from home to work often get lonely and have sex with prostitutes, then frequently carry diseases home to their wives. To make matters worse, these wives are often unable to seek care for their diseases for fear of being accused of poor morals and sexual encounters outside of marriage.

Latin America

By the end of 1998, 1.4 million Latin Americans were living with HIV/AIDS. The most common modes of transmission in this area are: men having sex with men; injection drug use; and heterosexual behavior. 1998 saw 160,000 new transmissions of HIV in all of Latin America. Many workers from this region migrate to areas such as the United States, often illegally.

They may turn to drugs or prostitutes and are not able to seek care for STDs or HIV due to lack of accessibility to health care or fear of being deported.

Young People (10-24)

On December 1, 1988 the World Health Organization established World AIDS Day, which was endorsed by General Assembly Resolution A/43/15.

In 1998, the World AIDS Campaign was named, "A Force for Change" and it focused on young people. The campaign had five objectives:

1. To promote young people's genuine participation;
2. To promote policies and actions for young people's health and development, using a human rights framework;
3. To increase awareness of the impact of HIV/AIDS on young people and young people's impact on the course of the epidemic;
4. To mobilize the social and private sectors to work in partnership on young people's health and development;
5. To monitor the campaign.

UNAIDS and its co-sponsors and partners decided the campaign would emphasize young people between the ages of 10 and 24 because over 50 percent of new HIV infections occur among this group. In 1998, there were 30 million newly infected young people; that equals ten per day.

Thirty percent of the population in developing countries, where the HIV/AIDS epidemic is most serious, consists of young people. Young people are at such a high risk due to adolescent explorations of new behavior and relationships. Young people are also often fearful of seeking information or treatment. Moreover, education and treatment are not always available to them.

Unprotected sex among young people is common due to lack of knowledge or the fear of embarrassment. Unprotected sex increases the risk of STDs, which increases the risk of HIV/AIDS. Each year there are over 33 million new STD cases and young people account for more than half of these. Many young people do not receive immediate care for STDs, which increases the likelihood of contracting HIV. Young people are also often misled by myths and misinformation. One of the myths in Africa is that when a young woman is injected with sperm, her likelihood of becoming beautiful increases. Drugs and alcohol also increase the risk for HIV/AIDS contraction. They affect judgement and often lead to increased sexual activity and decreased incidence of precautions.

Young people claim that if information on safe sex, HIV/AIDS and STDs were available to them, then they would protect themselves and seek treatment when necessary. One study found that in Chile the group with the highest rate of condom use was the 15 to 18 year olds. Similar statistics have been recorded in Mexico and Brazil, where an effort has been made to educate young people. In Lusaka, Zambia, a group of NGOs created a program designed to involve young people as peer counselors in health clinics. Fifty-two young people were trained in counseling on pregnancy, STDs, substance abuse, communication with partners and financial matters. This program has been successful, creating stronger links within the community and increasing the number of young people seeking help and information about sex.

Women and Children

According to WHO, "500 women and 1,000 children die each day from AIDS."

Women's reproductive tracts are more susceptible to infection with STDs and HIV than are men's. AIDS is the number one cause of death for women between the ages of 15 and 40. More than 40 percent of new HIV infections reported in 1997 were in women. It is noteworthy that women are less likely to have health care coverage or the financial resources to get tested, much less treated.

In 1998, about 600,000 children worldwide were born with HIV. Many pregnant women are unaware of their HIV status and the general lack of testing puts mothers at high risk of passing HIV on to their babies. Transmission can occur during pregnancy, through the birth process or by breast feeding. Treatment with zidovudine (ZDU) can reduce the likelihood of transmission form mother to child by 80% However, ZDU is not available worldwide and costs from $800-$900 per woman. Other, less costly means of preventing mother to child transmission are begin explored. Two experimental methods are cleansing the birth canal with chlorhexidine during birthing and administering a micronutrient supplement during pregnancy.

WHO has estimated that there will be at least 40 million AIDS orphans by the year 2020. These orphans are at high risk for: homelessness, malnutrition, lack of access to education, violence and abuse, drugs, exploitation and HIV. In Swaziland, 22 percent of the children under age 15 have already been orphaned due to AIDS. Africa now has 9 million children without mothers due to AIDS.

The Global Cost of HIV/AIDS

The cost of HIV/AIDS is high. Treatment consists of a mixture of drugs which cost between $16,000 and $20,000 per person per year. Many HIV/AIDS patients, especially in developing countries, cannot begin to afford treatment and have no or inadequate health coverage. US President Bill Clinton made finding a vaccine for the virus a national goal in 1997 and spent $150 million on research. Still, no remedy has been discovered.

Preventive precautions have so far been most effective. Poland, for example, began education and prevention programs in the early 1980s and has maintained a low number of new infections each year. Prevention, through education and awareness campaigns, is the most effective use of money to combat HIV/AIDS. Dr. Richard Feachem of the World Bank has said, "The best time to spend a dollar on HIV control is when you've got no HIV in your country." Unfortunately, less than five percent of global funding actually goes towards prevention and education; the majority of funds now being spent goes towards finding a cure.

Conclusion

By the end of 1998, 33.4 million persons in the world were reported as living with HIV. Many developing nations have no resources at all for prevention, counseling, or heath care. The HIV/AIDS pandemic continues to spread. Now its victims are most likely to be women, children and young people. New solutions to this global health problem need to be explored.

Questions

1. How can the UN and WHO better address the growing incidence of STDs and HIV/AIDS among youth and HIV/AIDS in women and children?
2. How can regional disparities be better addressed in the North-South context? How can experiences with antiviral therapies in the advanced industrialized countries be applied to developing countries?
3. How can the UN community address the enormous costs of providing anti-viral pharmaceuticals to developing countries?
4. How can the UN/WHO further "safe sex" strategies (and promote related contraception methods) and overcome cultural and political resistence - in the global environment as well as in local communities?
5. What can be done to further international research efforts and intergovernmental collaboration on the cure and treatment of HIV/AIDS?

Sources

  1. "AIDS Epidemic Update," Joint United Nations Programme on HIV/AIDS, December, 1998. http://www.unaids.org
  2. "AIDS in the Third World: A Global Disaster," The Economist, January 2, 1999.
  3. "Force for Change: 1998 World AIDS Campaign," UNAIDS, April, 1998. http://www.unaids.org/highband/events/wad/1998/force.html
  4. "HIV infectiong in Eastern Europe: 1998 World AIDS Campaign," UNAIDS, April 1998.
  5. http://www.unaids.org/highband/events/wad/1998/easteren.html
  6. Halweil Brian, "HIV/AIDS Pandemic Far from Over," State of the World, 1999, Worldwatch Institute, 1999.
  7. "HIV/AIDS Prevention: Facts About the Human Immunodeficiency Virus and Its Transmission," Centers for Disease Control and Prevention, July, 1997.
  8. "Provisional Report: The Status and Trends of the HIV/AIDS Epidemics in the World," Monitoring the AIDS Pandemic, June 26, 1998.
  9. Shay, Dr. Roshani, "AIDS in the World, the U.S. and Oregon as of April, 1999: A Compilation," April, 1999.
  10. "Surgeon General's Report to the American Public on HIV Infection and AIDS," Centers for Disease Control and Prevention, June, 1994.
  11. "Trends in the HIV and AIDS Epidemic," Centers for Disease Control and Prevention, 1998.
  12. "UN Wire," July 21, 1999 accessed at http://www.unfoundation.org
  13. "UN Wire," July 23, 1999 accessed at http://www.unfoundation.org
  14. "UN Press Release" 25 Nov 98 accessed at http://www.un.org/news/press/docs/1998/19981125.note5536.html
  15. "Selected Internet Links To HIV/AIDS Information," CDC National Prevention Information Network A Series of NCHSTP http://www.cdcnpin.org/

Web Sites:

AmFar (American Foundation for AIDS Research) http://www.amfar.org/
American Red Cross HIV/AIDS Page http://www.redcross.org/hss/HIVAIDS/
XII International Conference on AIDS http://www.aids98.ch/
AIDS Economics http://rocks.worldbank.org/aids-econ/