Recurring Pest with Four Letters

 

Photo credit: globochem3x1minus1 (CC BY)

By Katharina Michael

The zero is most conspicuous. In iridescent colours the number flaunts from the fresh-off-the- press-brochure of the United Nations organization. Zero New Infection. Zero discrimination. Zero related-deaths.  By 2015.

The illness in question? It is not Tuberculosis, not the plague. It is the Acquired Immune Deficiency Syndrome, short AIDS. The message? AIDS is coming to an end.

This year AIDS celebrates his sad 30th birthday. It was in 1981 when the illness that already cost hundreds of lives finally got a name. Since  as early as 1940 AIDS raged throughout the planet. No country on earth was spared. 25 million lives later, AIDS could be halted. Or so they say.

2015 is the year of the millennium goals of the United Nations.  In this year boys and girls all over the world shall be able to complete a full course of primary schooling, extreme poverty shall be ended. And the spread of HIV shall be halted and be beginning to reverse. This is written in the report of the 2000 UN millennium summit.

The UNaids organization now went even a step further, announcing the goal of working “Towards zero new infections. Zero discrimination. Zero AIDS- related deaths.” The AIDS- free generation is due in 2015. It is my generation, the people between 15 and 25 now, that will give birth then.

And, indeed, there is data that raise the hope of our children no longer being tightened in the grip of an illness that was once hysterically labelled as the scourge of mankind. The number of people newly infected with HIV declined by 19% in the last decade, according to the 2011 UNaids report. In 33 countries the rates dropped by at least 25%, among them some countries like Namibia in Sub-Saharan Africa, which are most affected. In December 2010 more than six million people were estimated to be receiving antiretroviral therapy in low- and middle-income countries.  The global prevention of mother-child transmission of HIV has exceeded 50%. Funding for HIV programmes increased.

A study by the National Institute of Allergy and Infectious Diseases (NIAID) from the United States came in 2011 to further news: Men and women infected with HIV reduce the risk of transmitting the virus to their sexual partners by taking oral antiretroviral medicines.

Also doctors discover that some people have inherent antibodies, their immune system prevents an outbreak of the illness naturally. This raises hopes for a vaccine in the nearer future.

„It is paramount that new HIV infections be stopped. We need to achieve a transition that will see fewer people newly infected than are newly placed on treatment. Doing so will require decisive action guided by a groundbreaking vision: zero new HIV infections, zero discrimination, zero AIDS-related deaths“ explains Saira Stewart from UNaids.

‘Are you the aids- free generation?’ The campaign advertisement on the UNaids website asks. Are you? Are we? Your kids, our kids, the worlds kids of 2015?

We were too young to experience the big AIDS scare of the late 1980s and 90s. The campaigns, at least in Western Europe, were always present, on billboards, in brochures and in class. “Don’t die of ignorance” the TV spots said in the UK, “Use a condom”, we were told in Germany, before we even thought of sex. Do not touch needles lying around the school.  “Your first love could be your last. Don’t forget HIV”, says the slogan on the billboard next to my former school now. The picture shows a couple in the autopsy room. Why do we need this reminder?

When we grew up in the beginning of the new century, when we got interested in sex, AIDS rates were stable at around 0,2% among 15-49 year-olds, spreading mostly among men sleeping with men. AIDS drugs assured the infected an almost normal life, research was on its way.

We saw the warnings, we read the brochures, we listened to the experts at the family centre, and still we believed HIV was someone else’s problem.

With the epidemic now more than 25 years in, there is beginning to be a phenomenon called “AIDS fatigue”, meaning that people are tired of hearing about the epidemic and this can lead to apathy or a lack of leadership to adequately respond.

Today nearly half of all new HIV infections occur among young people between the ages of 15 and 24. The majorities of these occur in low- and middle-income countries with limited access to HIV-prevention information and care. But also in modern countries, AIDS seems to be on the rise again among the young.

For Northern America and western and central Europe AIDS rates grew from an estimated 1.8 million in 2001 to 2.3 million in 2009—an increase of 30% according to the UN report 2010. The new infection rose from 97,000 in 2001 to 100,000 in 2009.

“Every hour, two young people between 13 and 29 in the United States alone become infected,” says Dr. Blumenthal from AMFAR Aids Institute in the United States. This number is higher than in any other age group. And that is only the reported cases.

Among the more than one million people living with HIV/AIDS in the U.S., an estimated 21% do not even know they are infected, because they do not get tested. “The fear of HIV is dwindling”, says Stefanie Holm, board member of the association of doctors dealing with the medical care of HIV infected. “For many people, AIDS is an epidemic plague in continents far away”.

Zero discrimination

Birgit Kust[1] lives with AIDS. Not in Africa, but in a German village. It has been 4 years now since she has been diagnosed HIV positive, rather coincidentally,  two years since the breakout of the illness.  Still, she is struggling to speak about it, not even her friends know.

“When I go shopping and meet a neighbour, it’s always the same: ‘Hi, nice to see you, I heard you were sick, what was wrong?´ What do I say then? Should I say I am HIV positive? They would drop me in a second. For them, this illness does not exist.”

Birgit Kust is silent in order to protect her son and daughter from being teased. The few people she has told so far, did not react very encouragingly. „If I would have said, I have Leukemia or cancer, then everybody would have been there to be by my side”, she sighs, “but AIDS? They say I could have been more careful. Could have been. Yes, but are you always? Do you always do an HIV test when meeting someone?”

The woman in her forties has her own version of why AIDS is spreading again: “People do not like to talk about AIDS, they like to donate a bit of money and that’s it, keep it far away, as it is not their problem. But in my opinion, if all HIV positive people would run around with a blue dot on the forehead, we would all be blue. The people do not know they have it!”

Part of this unawareness is due to media coverage. Bernd Schmidt is member of AIDS organisation that each year awards journalists for outstanding German media pieces about HIV.  In the last years, he says, this is getting harder and harder. “Less articles, less quality”. Asked to comment on the media reaction to the “zero new infection” campaign by UNaids, he takes a moment to think, before he answers: “The most dangerous thing is to belittle AIDS. In any form.”

Is it possible that this lack of awareness put an end to the goal of zero- new infections, of an AIDS-free generation?

Less tests, less new infections

The country with the highest number of performed HIV tests in Europe is France. Five million citizens get tested every year. The prevalence rate of HIV in the population is among the highest on the continent, with 0.4% infected. For the young people the rate is 0,2%. That is 15,270 persons infected before their 25th birthday.

“We are trying to raise awareness, especially in lower-income areas and among gay men and immigrants”, says Gabrielle Issaverdens from the French National Institute for Public Health Surveillance. “It is important to get as many people tested as possible, only if you know, you can get help and protect others”.

In Germany the data how many people were tested only exists for the year 2002. Over two million got a test, if that included people being tested before blood donations XY from the Robert- Koch Institute can not say. “We only get reported new- infections, not how many people are actually tested”.

What is frequently reported in surveys is the number of people admitting having had unprotected sex. “Condom nations” is the title of the study by Miguel Fontes and Peter Roach, published in 2007. The results were surprising: the richer the country the more sexual partners people had and the greater the likelihood of having unprotected sex.

In Norway more than 70 percent admitted having unprotected sex without knowing the partner’s history. Even in South-Africa, a country with an estimated AIDS rate of almost 20 percent, more than 60 percent had unprotected sex. This sets a difficult task  for a nation in which an AIDS- struck generation instead of an AIDS- free one seems to be on the move.

Zero AIDS- related deaths

In the Mankweng hospital in the South-African district of Limpopo time is tight. Too few doctors, too few resources, too many sick people, too little time. It is hard to get Juliane Albrecht on the phone for more than three minutes. The young doctor is committed to her work. With the limited resources, she is trying her best. “HIV is always a part of our work, every day you have to be careful”, says Juliane Albrecht, “zero new infection? Zero AIDS-related deaths? We here are far, far from that”.

Mother-child transmission remains one of the toughest challenges. “To reduce the new infections it would mean, stop all the infected women now from giving birth. In Europe an infected woman, who has a caesarean and does not breastfeed has a good chance of having a healthy kid. But here it is more difficult. We hardly do caesareans, the risk is too high to kill both, mother and child.”

When asked about the possibility of taking AIDS drugs prophylactic, like the doctors of the NIAID suggested, it takes her some time to answer. “It has been discussed here, to give it to 15 to 21 year old girls, a group of high risk to reduce this time of special danger, but many disagree”. The reasons for the doubts are various. “Some doctors argue that the effect could not be proved yet, others doubt the reliability of the participants since such drugs are very expensive and worth quite a bit on the black market”.

The „zero new infection“ campaign is already the third major UN initiative about AIDS in the last eleven years. Former goals included „Three by five“, three million people getting treatment by 2005 and „Universal Access“, AIDS drugs for everybody by 2010.

In 2010, 10 million still awaited treatments, in 2015, when the UN claims „Zero new-infection, zero discrimination and zero aids-related deaths“ it will be 13 million people. In the Philippines alone, the AIDS rate will be rising by 500%, predicts Ofelia Monzon from UNaids Philippines. “And that is only based on the reported cases”.

The zero is an aim we are working towards“, says Saira Stewart from UNaids about the campaign „we need to set the goal. AIDS is declining universally. We are raising awareness“.

Birgit Kust is aware of the campaign. She saw an information-stand by activists at the town square. She passed by without looking twice. She was afraid somebody might think she has anything to do with Aids.


[1] Name changed

While the end of AIDS is proclaimed the disease is on the rise again among the young

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