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Injection drug use responsible for rapid spread of HIV/AIDS: UNAIDS report

A new UNAIDS/WHO report expresses concern about the spread of HIV/AIDS in China, Indonesia, Papua New Guinea, Vietnam, several central Asian republics, the Baltic states and north Africa.

‘AIDS Epidemic Update 2003’, a report released on November 25 by UNAIDS and the World Health Organisation (WHO), highlights the urgent need to improve access to AIDS treatment. The report states that in 2003, five million people were infected by HIV worldwide; 3 million people died.

The rapid spread of HIV in a number of regions has been driven by injection drug use, the reason behind recent epidemic-like situations in China, Indonesia, Papua New Guinea, Vietnam, several central Asian republics, the Baltic States and north Africa. Sex work and low condom usage among sex workers and other vulnerable groups, such as men who have sex with men, are further spreading the infection, the report says.

In parts of China, high rates of HIV prevalence have been found among injecting drug users -- 35-80% in Xinjiang and 20% in Guangdong. A major HIV epidemic has affected communities where unsafe blood-collection practices occurred in the 1990s. In Manipur, India, HIV prevalence among injecting drug users ranges between 60% and 75%. In the most recent surveillance round, upto 4% of injecting drug users in central Bangladesh were found to be HIV-positive -- up from around 1% in surveillance rounds in previous years.

The few HIV surveillance studies available for Pakistan suggest that HIV prevalence among injecting drug users and sex workers is low, ranging from 0% to 11.5%. However, a growing number of the estimated 3 million heroin users in Pakistan have begun injecting since the late 1990s.

In Cambodia, Myanmar and Thailand, HIV/AIDS has reached almost epidemic proportions. Yet, the initiatives taken by the government of these countries has helped fight back the disease. Thailand’s notable 100% condom use programme brought the epidemic to heel in the 1990s, with national HIV prevalence figures around 2% in 2002.

Sixty-five per cent of Vietnam’s HIV infections occur among drug users, due to the use of contaminated needles. Sentinel surveillance in 2002 found that more than 20% of injecting drug users in most provinces were HIV-positive.

‘ AIDS Epidemic Update 2003’ also notes that close to 40% of countries that have reported progress 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.

Fear of discrimination is preventing people from seeking treatment for AIDS. Some 70% of people living with HIV/AIDS in India said they faced discrimination, mostly within their families and in healthcare settings, according to recent International Labour Organisation (ILO) research.

The study cites the example of Kerala where two HIV-positive orphan children were banished from their school and then refused admission to other schools. The President of India, the Indian health minister and AIDS activists have all been appealing to, and working with, the community to dispel the fears and misconceptions surrounding HIV/AIDS. Yet, by the end of 2003, almost six months after the debacle began, the children are still forced to take their lessons and write their examinations at home.

The report finds a shortfall in the implementation of even the most basic cost-effective HIV-prevention efforts. In many of the hardest-hit countries, prevention of mother-to-child HIV transmission is virtually non-existent.

According to the 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.

Over 1 million people in Asia and the Pacific acquired HIV in 2003, bringing the number of people now living with the virus to an estimated 7.4 million. A further 500,000 people are estimated to have died from AIDS in 2003.

Sub-Saharan Africa, the most severely affected region in the world, accounted for over 3 million of new infections worldwide and 2.3 million AIDS deaths.

Citing statistics from the National AIDS Control Organisation (NACO), the report says that the number of people infected with HIV/AIDS was between 3.82 and 4.58 million by the end of 2002. In Andhra Pradesh, Karnataka, Maharashtra, Manipur and Nagaland, HIV prevalence rates among pregnant women crossed the 1% threshold. According to NACO, HIV/AIDS is not confined to vulnerable groups or to urban areas but is gradually spreading into rural areas and the wider population.

While commending the efforts of Maharashtra and Tamil Nadu in helping prevent AIDS, the report maintains that there is no persuasive evidence that the epidemic is being curbed in individual states. A majority of the three lakh people possibly infected in the past year are accounted for in states like Maharashtra and Tamil Nadu, where HIV prevalence of over 50% has been found among sex workers in some cities. The report blames surveillance in the north Indian states for providing an incomplete picture of the disease.

In neighbouring Bangladesh and Nepal, national HIV prevalence has remained under 1%, but the report presents a frightening picture of the sexual behaviour of a part of the population and general awareness levels in the country.

Only about 65% of young people, fewer than 20% of married women and 33% of married men have heard of AIDS. In central Bangladesh, more than 90% of sex workers do not use condoms; elsewhere in the country, virtually all surveyed sex workers reported at least occasionally having sex without a condom.

“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,” says Dr Peter Piot, executive director of UNAIDS.

‘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 the improvements are still far too few and slow in coming to adequately respond to the growing global epidemic.

The report calls for a rapid scale-up of treatment access to help avoid the devastating effects of millions of anticipated illnesses and deaths. In an effort to scale-up treatment, the World Health Organisation, the convening agency for HIV care in UNAIDS, and its partners are developing a comprehensive global strategy to bring anti-retroviral treatment to 3 million people by 2005, known as the ‘3 by 5’ initiative. The new strategy will be unveiled this week, to coincide with World AIDS Day (December 1), says Dr Lee Jong-Wook director-general of the World Health Organisation.

InfoChange News and Features, December 2003