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.
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