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A bleak picture

30 November 2005 Healthe News Service

South Africa’s Aids epidemic, one of the largest in the world, shows no sign of relenting, while infection levels continue to drop in Uganda and now also in parts of Kenya and Zimbabwe, according the UNAIDS Aids Epidemic Update.

By Anso Thom (Healthe News Service)

The total number of people living with HIV worldwide reached its highest level – an estimated 40,3 million people are now living with HIV while close to five million were newly infected with the virus this year.

Sub-Saharan Africa remains hardest hit, and is home to 25,8 million people living with HIV, almost one million more than in 2003. Two thirds of all people living with HIV are in sub-Saharan Africa, as are 77% of all women with HIV.

A staggering 2,4 million people died of HIV-related illnesses in this region in 2005, while a further 3,2 million became infected with HIV.

The report said that in the cases of Uganda and Kenya behavioural changes probably contributed to these trends, but cautioned that they remained exceptional cases.

Access to antiretroviral treatment had improved markedly in some areas with over one million people in low- and middle-income countries now living longer and better lives because they are on treatment.

The report pointed out that because of the treatment scale-up since the end of 2003, between 250 000 and 350 000 deaths were averted in 2005, but that the full effects of the dramatic increase in access during 2005 would only be seen next year.

But the battle is far from won with only one in ten Africans and one in seven Asians in need of this treatment receiving it in mid-2005.

One of the more interesting revelations in the report was the new evidence which showed a declining trend in national adult HIV prevalence in South Africa’s embattled northern neighbour, Zimbabwe.

Recent data from the national surveillance system revealed a decline in HIV prevalence among pregnant women from 26 percent in 2002 to 21 percent in 2004.

Other data indicated that the decline had already started in 2000 with findings from local studies reinforcing the national evidence.

In the capital Harare, HIV prevalence in women attending antenatal or postnatal clinics fell from 35% in 1999 to 21% in 2004.

In rural eastern Zimbabwe, declines in HIV prevalence in pregnant women were also reflected in declines among both men and women in the general population.

A significant decline in HIV prevalence among pregnant young women (15-24 years) – which fell from 29% to 20% in five years, suggested that the rate of new infections could be slowing too.

The report revealed that condom use within casual partnerships among Zimbabweans had reached high levels (86% among men and 83% among women) and data from recent national and local surveys indicated that there could have been a reduction in the reported number of sexual partners in recent years.

Mortality rates have also leveled off in some parts of the country, which according to the report, further supported the view that declines in HIV incidence accelerated by changes in sexual behaviour were driving the apparent decline in prevalence.

Turning to South Africa, the report said that the latest data from the country underlined an outstanding feature of South Africa’s epidemic: the astonishing speed at which it has evolved.

“Having lagged behind most other epidemics in the subregion, Aids in South Africa is now taking a devastating toll on human lives,” the report said.

UNAIDS acknowledged cautioned that to get ahead of the epidemic, there was growing recognition that HIV prevention efforts must be scaled up and intensified as part of a comprehensive response that simultaneously expands access to treatment and care.

Evidence and experience show that rapidly increasing the availability of antiretroviral therapy leads to greater uptake of HIV testing.

Kenya has seen a dramatic increase in testing and counselling uptake between 2000 and 2004, while in Brazil uptake increased more than threefold in between 2001 and 2003.

Uganda has had similar experiences. After being forced to close due to a lack of clients, a counselling and testing clinic in Masaka, Uganda, reopened in 2002 when an antiretroviral treatment programme began at the same hospital.

Within a few months, more than 5 000 people had sought and received voluntary counselling and testing, a seventeen-fold increase over the figure for the year 2000. This provided health workers with opportunities to educate people about HIV prevention, tailored to their HIV test results.

Finally the report points out that slowing and stopping the spread of this global epidemic urgently required universal access to prevention, treatment and care together. “If the world mobilises in this way to simultaneously and aggressively expand HIV prevention, treatment and care, we could achieve a truly comprehensive approach to AIDS that could contain and reverse the epidemic.”

Generally, estimates based on antenatal clinic data are a useful gauge of HIV infections trends among 15 to 49 year-olds. National household surveys, on the other hand, can reveal important information about the national prevalence level and about the spread of HIV, particularly among young people, men and residents in rural areas.

Considered together, the various data can yield more accurate estimates of HIV infection levels and rates. However, UNAIDS cautions that HIV and AIDS estimates (whether derived from household surveys or sentinel surveillance data) need to be assessed carefully, and the data and assumptions reviewed continually.

The regional estimates presented in the UNAIDS report have incorporated both sources of information.

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