Saturday, April 28, 2007
Abstract from:
HIV/AIDS: global trends, global funds and delivery bottlenecks
By: Hoosen M Coovadia and Jacqui Hadingham
URL link: http://www.globalizationandhealth.com/content/1/1/13
Trends in the global epidemic
Despite increased resources being available to address the global AIDS challenge, the infection continues to spread. HIV prevalence is intensifying in most regions, with sub-Saharan Africa, Eastern Europe and Central Asia being the worst hit, accounting for approximately 79% of new infections between 1998 and 2003. Although the greatest number of people living with HIV are in sub-Saharan Africa, of equal concern is the growing epidemic in Central Asia.
The epidemiology of the disease differs between regions. It has been suggested that, due to dissimilar patterns of sexual behaviour between Africa and Asia, the extent of the spread to the heterosexual population in Asia will be circumscribed. In most of sub-Saharan Africa, HIV spreads through an intricate web of relationships from sex workers to male clients to female spouses/partners. According to Peter Piot of UNAIDS, females in Africa generally report more sexual partners than their Asian counterparts. In most of Central Asia transmission is virtually linear, from intravenous drug users to sex workers to male clients to female spouses/partners, with women tending to monogamy. The next decade will attest to the accuracy or error of this prediction. Rising prevalence is, however, not confined to developing countries, as an increase in the number of HIV infections is evident in all other regions except South and South East Asia (where inconsistencies in data collection methods have tended to skew the figures).
Several trends shape the HIV epidemiological curve
An increasingly mobile global population exacerbates the risk of HIV transmission. The increasing volume of international travel contributes to the spread of sexually transmitted infections, including HIV. Refugee populations arising from areas of conflict, estimated by the United Nations High Commission for Refugees to number 9,7 million worldwide, are at higher risk, as are internal migrants within countries, who oscillate between rural and urban milieux. According to the International Labour Organisation, at the beginning of the 21st century, 120 million workers worldwide were migrants.
Females are more at risk of contracting HIV than males. In 1997, women accounted for 41% of people living with HIV worldwide. This figure had risen to almost 50% by 2002. This gender-bias is especially apparent in sub-Saharan Africa, where the majority of those infected are women and girls. Widespread wars and regional conflicts in Africa escalate, by orders of magnitude, the risk of rape of women and girls. The low social status of women, risky sexual practices, and endemic poverty in Africa contribute to the spread of the disease. The impact on women is less marked in Asia (where 28% of those infected are women), although women's low socio-economic status renders them more susceptible to infection. Women's increased vulnerability to HIV infection is not confined to developing countries. Between 2001 and 2003, the percentage of HIV-infected who are women increased in North America from 20% to 25%, and in Oceania from 17% to 19%, suggesting that gender inequalities underpin the transmission of HIV.
Global funds
Various global initiatives and collaborations are addressing the global HIV/AIDS challenge. For example, the United Nations Millennium Development Declaration, signed in 2000 by 189 nations, encompasses eight Millennium Development Goals (MDGs), three of which are health related: reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria and other diseases, by 2015. Many international organizations have been set up to assist in funding and implementing HIV prevention and care programmes and related health initiatives worldwide. These include the President's Emergency Plan For AIDS Relief (PEPFAR); the Global Fund to fight AIDS, Tuberculosis and Malaria; RollBack Malaria, the Global Alliance for Vaccines and Immunization; the Global Health Council; Médecins sans Frontiers; the Bill and Melinda Gates Foundation; the World Bank Multi Country HIV/AIDS Programme (MAP); the Accelerating Access Initiative and the William J. Clinton Presidential Foundation. These organizations contribute increasing amounts of money to confront AIDS and other pressing global health issues. UNAIDS reports that in 1996, approximately US$330 million was available for HIV/AIDS initiatives worldwide, a figure which had risen to US$4.7 billion by 2003. Although this represents a huge increase in funding, it is still less than half the amount of US$12 billion that is now required, and this exigency is expected to rise to US$20 billion by 2007.
Despite the large amount of aid being made available in addressing the AIDS epidemic, shortfalls in both money and numbers of people being reached are apparent. Of the estimated 6 million people in developing countries who are in need of ART, only 400,000 currently receive it. Of these, 208,000 are in Brazil alone. Even if the World Health Organization's '3 by 5' effort, which aims to provide treatment to 3 million people by the end of 2005, is successful, it will have addressed only 50% of the demand for treatment at the current level of need. The MDGs are unlikely to be met at the current rates of progress, with the worst affected countries likely to make the least headway.
Future Perfect; Environment and Health Expert
4:17 AM
