HIVAIDS is an
infectious disease listed amongst the big 5 infectious disease burden in the
world. Over 35 million people have lost their lives to the global HIV epidemic
with 42 million estimated people living with this dreaded infectious disease. Developing
countries has estimated 90% of the global pandemic with sub Sahara Africa
region being the world worse affected region with already over 12 million
children already orphaned by the disease within the region and it was postulated
to increase to 18 million in 2010.
What is most
shocking is the increase in the prevalence of HIV infection globally in spite
of the huge fund that has been globally committed to the fight against the
scourge. The high income countries of the world have been able to build
feasible capacity with support from Global Partners and a combination of
political commitment to fight the scourge. The reverse is the case in the low
income countries bracket; it has become a combination of poverty, disease, political
and economic instability and weak health infrastructure which has duly hindered
remarkable progress in effort against HIV AIDS.
Despite of
increase in available resources to tackle the prevalence of this disease, most
regions such as sub-Sahara Africa, Eastern Europe, and Central Asia are still
accounting for intensifying increase in the scourge with approximately 79% of
new infections between 1998 and 2003. It is most pathetic that a greater number
of people living with HIV/AIDS are in sub-Sahara Africa with equal concern of
growing epidemic in Central Asia. A number of reasons are responsible but numerous
amongst them are:
The social
economic status of the people: This is a combination of different variables. A
poor population ravaged by HIV infection will over time be wiped away if early
intervention does not come their way and this was the case of some peculiar
regions as Africa and Asia with very high population but low per capital
income. Within the high income countries, the support from government and
global partners is robust and with the level of fund allocated to enlightenment
coupled with the improved per capita income, it looks a little better than
what’s available in the developing countries.
If you
recall, the cost of ART was exorbitantly high and was not within the reach of
the purchasing power of the infected population. It even became more complicated
when these regions had no structured health financing systems instead everyone
pays for their healthcare treatment from their pockets each time they receive
treatment at the hospitals. This was a huge burden in some regions that did not
allow for effective management of HIV infection even when detected, the
inability to continuously procure drugs and even maintain quality and healthy
meals were a great concern in developing countries where some infected cases
deteriorated to having tuberculosis alongside. This is evident in the way the
infected people look coupled with the social stigma attached to the disease,
there are virtually no one to offer help to these sets of infected patients,
they are either manage themselves as much as they could and die on the long run
predominantly without the needed care.
It was really
bad that people stop associating with you immediately they discovered you have
HIV infection, even the family members assign specific feeding plates to them,
they are confined to certain parts of the house, their meals are sneaked into
their rooms with disgust, toilets are no longer shared with them etc. These
were the challenges that fast killed the infected patients outside the virus
itself.
With the
globalization and the new information available across the world, people are
able to declare their HIV status publicly, the acceptance is quite impressive
nowadays, the drugs are more affordable now and even the prescription and
treatment outcome are quite impressive.
Sexual
behaviour: Despite the advocacy surrounding the infectious nature of the HIV/AIDS
disease, there still exist a huge belief in some of these poorer regions that
the disease called HIV/AIDS does not exist and this has encouraged a certain
proportion of the population to still take to careless sexual behaviour without
condoms, having multiple sex partners and even commercial sex workers and their
male patrons. This brings about a chain reaction from the sex workers infecting
their male partners and the male partners in turn infecting their female sexual
partners or spouses. This has created a web of challenge and difficulties in
the global efforts invested towards fighting HIV AIDS.
The concept
of globalisation which has removed the trans-border barriers is also a very
strong factor contributing to the spread of the disease. Migration through
international travel has been credited also the spread of sexually transmitted
diseases including HIV, refugee population arising in areas of conflict is not
excluded in these factors. There are currently 9.7 million worldwide refugees
according to United Nations High Commission for Refugee and these people take
refuge in different countries or cities resulting into cross border disease transmission.
Even in most
countries, there are a number of high mobility internal labour migrants who
mostly move between the urban and the rural communities, these are very
possible ways diseases also travel within a nation and between communities of
population groups.
Gender
inequality and gender bias in some regions as Africa where women are rated very
low and used as sex tools has also been an issue of concern. Studies have shown
female are more at risk of contracting HIV than their male counterparts. In
1997, women accounted for 41% of people living with HIV worldwide and in 2002,
the figure rose to almost 50%.The impact on women though less marked in Asia,
28% of those infected are women but women’s low socio-economic status renders
them more susceptible to infections. This women’s increased vulnerability to
HIV Infection was not confined to developing countries only neither was it
exclusively an issue of poverty. Between 2001 and 2003, the percentage of HIV
infected women rose from 20% to 25% in North America and in Oceania for 17% to
19%. The further buttress the point that gender inequalities is associated with
the spread of HIV.
The absence
of relative peace due to widespread of wars and regional conflicts across
Africa also led to a number of young women and girls getting raped and sexually
violated in war torn countries as Liberia, Rwanda, Ivory Coast, Sierra Leone,
Somalia etc and these also contributed to the spread of HIV infection.
Some of the
early challenges which also posed initial problems across some developing regions
as Africa were lack of enough information and clearly defined advocacy
programs. Because of this paucity of right information, people chose to believe
whatsoever they are told about HIV even if it is utterly wrong. This brought
about different interpretations of the acronyms (AIDS) in some parts of Nigeria,
younger people trivialised it and tagged it American Invention to Discourage Sex (AIDS) and in the midst of all
these confusion and misconception, there was no strong political commitment on
the part of Government to take ownership of a strong advocacy and public
enlightenment processes, this was the case in many regions across Nigeria and
other parts of sub-Sahara Africa. The younger population in high schools and
colleges yearned for the right information which was in scarce content and were
sometimes aired in between network news on Television at 9.00pm when more than
50% of Nigerians in many regions had no access to electricity let alone
television to access such information.
Hospital and
healthcare facilities did not have the requisite capacity rather to help people
who came with honest intentions to be educated on HIV infection. It was wrongly
classified as an issue that has to do exclusively with sex and this made people
stay away from sex and continue to share sharp objects which has great
potentials to getting them infected. There were absence of HIV counseling
centres and no sexual health education in schools and communities, these led to
limitation in available information that will be of help to the population.
Even the
nurses and the entire healthcare workers did not have protection neither were
there care workers prevention guidelines so they were not also excluded from
the chain of spread of HIV infection. Do not forget most of those Nurses,
Doctors, Phlebotomists and everyone in the healthcare chain that has anything
to do with patient’s blood and other potentially infections materials were all
vulnerable and had sexual partners or spouses also.
One of such
local determinants that contributed to the challenge in developing countries is
the local belief system, use of local herbs and traditional medication. Outside
the fact that they did not open their mind to accept the existence of the
pandemic, they even believed that even if it does exist they have enough herbs
to achieve outright treatment and cure. The infection found its way in through
internal migration and yet people died with perhaps symptoms of AIDS but we
refused to agree that it was AIDS disease living with us.
If you
recall, a number of Nigerians (Medical Doctors and Herbal Doctors) came up with
the false claims that they have discovered cure for the HIV AIDS and most
people who suspected they had this infection went quietly and secretly to those
Doctors who deceived them and collected their money and left them to die.
Since the
adoption of global public goods approach, there have been tremendous milestones
in terms of achievement in finding useful solutions in addressing this issue.
Some of such
profound approaches adopted were the funds allocation to research and
development to enable researchers come up with new medicines to combat and
prevent these diseases. This made the pharmaceutical companies have access to
funds to research on relatively new areas and also to conduct trials at
different stages for possible clinical approvals.
There was
also the convention on Intellectual Property Rights (IPR), most importantly the
DOHA declaration on the TRIPS agreement. These efforts gave room for the
outcomes of research and development that has been approved to be shared and used
for the good of all instead of placing restrictions in form of patents and
copyrights that makes these research breakthroughs exclusively products or
efforts of a few people who the world must pay so much to benefit from. The
interventions made by the WTO gave room for other pharmaceutical companies
(multi partner collaborations) to use the same research to come up with other
generic brands of drugs that are more affordable and efficacious. This was a
very useful instrument in ensuring access to treatment within and between low
and middle income countries who per capital income could hitherto not grant
them access to medications. This approach has also led to treatment
simplification, it has reduced 10 pills taken 3 times a day in 1996 to 1 pill
combined in all treatment taken once or twice daily in 2006. Virtually all
hospitals and health centres have access to these drugs and it has given
respite and hope to those living with HIV infection. The introduction of the
male condom and lately the female one has also been an achievement in this
direction coupled with the fact that counseling centres now have access to new
information to help people on HIV infection.
We can see in
recent reports that over 8 million people now have access to treatment and over
60% of people needing treatment in developed countries now having access to
treatment.
References:
HIV/AIDS: Global trends, global
funds and delivery bottlenecks. A paper presented by, Hoosen M Coosvadia and
Jacqui Hadingham
UNFPA priority areas of support
and key achievements/contributions to Nigeria’s HIV/AIDS response, UNFPA
The perpetual challenge of
infectious diseases. By Anthony S. Fauci and David M. Morens
Global public goods and health:
taking the agenda forward. By Inge Kaul and Michael Faust
This comment has been removed by the author.
ReplyDeleteNice piece. Very informative
ReplyDelete