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AIDS (acquired immune deficiency syndrome) is caused by a retrovirus, the human immunodeficiency virus (HIV), identified in 1984. It is currently estimated that over 35 million people are living with HIV, the vast majority living in low- to middle-income countries. HIV/AIDS is not evenly distributed and prevalence rates range from 1 percent to 25 percent in the adult population. While some countries, such as those in northern Europe, have ”concentrated” epidemics mainly confined to gay men, others such as those in southern Africa, are experiencing ”generalized” epidemics where the entire sexually active population is affected. Others such as Russia are experiencing an accelerating epidemic, initially confined to transmission among injecting drug users but now becoming generalized. The USA and countries in South America and in the Asia-Pacific region are experiencing multiple epidemics – among people who inject drugs, among gay men, and increasingly among the poor. While the global incidence rate and incidence itself appears to have peaked in the late 1990s, the estimated annual number of new infections over the last few years appears to have stabilized at the alarmingly high rate of 2 to 4 million per year and there continue to be more new HIV infections each year than there are AIDS-related deaths. The world is facing a global pandemic: a pandemic marked by inequalities of gender, race, class, and sexual orientation.
Although there is no cure for HIV, effective treatment, in the form of anti-retroviral therapies, has slowed the progression from HIV to AIDS to death in almost all who have treatment access. While in the income-rich world there has been an 80 percent fall in AIDS-related deaths, in low-income countries only a very small proportion of those in need of treatment are currently receiving effective therapy. Prospects for treatment access continue to be thwarted by poverty and global inequalities, as well as pharmaceutical patent rights. The number of new cases still outpaces the expansion of treatment access and the demand for treatment will continue to grow as people continue to become infected.
As a blood borne virus, HIV is most commonly transmitted by sexual intercourse (vaginal and anal) with an HIV infected person. It is also transmitted by the sharing of HIV-contaminated needles and syringes, from an HIV-positive mother to child during birth and breast feeding, and via the use of contaminated blood products. There is at present no effective prophylactic vaccine. Consistent condom use for sex and the use of clean needles and syringes for drug injection are the most efficacious prevention strategies currently available. Abstinence from both sex and drug use has not been shown to be an effective strategy and there continues to be debate about the effectiveness of sexual monogamy. Male circumcision has been shown to reduce the likelihood of sexual transmission from women to men, but male circumcision alone is unlikely to curb the epidemic. Clinical trials continue the search for other efficacious prevention tools, for example, microbicides.
More than efficacious prevention technologies -even when combined – are needed. Changes in social relations are also necessary. Gender inequality is one of the key social drivers of HIV-transmission and the gendered patterns of social and economic dependency which result in women having little access to education and other resources need to be changed. Human rights are central to an effective response. All people have the right to HIV-prevention information and HIV-prevention technologies, and people living with HIV have the right to effective treatment as well as the right to equality before the law, privacy, liberty of movement, work, equal access to education, housing, health care, social security, assistance, and welfare. Stigma and discrimination undermine an effective response.
Social transformation is necessary. Evidence indicates that HIV transmission rates fall in countries where governments acknowledge that HIV is a virus that affects everyone, fund prevention and health promotion including education programs, promote condom use and needle and syringe programs, support social movements by funding at-risk communities to combat HIV-transmission, and provide treatment, care and support to all those living with HIV/AIDS. In the absence of these factors and in the presence of moral agendas that thwart the promotion of effective technologies, such as condoms, prevention efforts falter.
HIV/AIDS is an issue of global governance. The policies and practices of AIDS prevention, treatment and support not only affect health care systems, they also affect the nature of social relations and the values and ideologies that underpin them. The challenge is to address the social, cultural and economic dimensions of health, to address issues of power, and to fight discrimination.
- Barnett, A. & Whiteside, A. (2006) AIDS in the Twenty-First Century: Disease and Globalization, 2nd edn. Palgrave, New York.
- Epstein, Helen (2007) The Invisible Cure: Africa, the West, and the Fight against AIDS. Farrar, Straus and Giroux, New York.