AIDS Alert International: AIDS destroying hands that rock the world’s cradle
AIDS Alert International: AIDS destroying hands that rock the world’s cradle
HIV infection of women in rich nations also on rise
The latest AIDS epidemic news blaring out to the international health community as 2002 drew to a close was particularly devastating because it offered strong evidence that women increasingly are infected with HIV and are dying of AIDS, and that their proportion of the epidemic’s toll now is close to 50% worldwide.
"For the first time, half of the people living with AIDS globally are women, and in sub-Saharan Africa, 60% are women," says Peter Piot, MD, executive director of UNAIDS in Geneva, Switzerland.
In sub-Saharan Africa, the epidemic’s toll on women has exacerbated the food crisis and increased the number of orphaned children. Women work on the farm, so as greater numbers of women become sick and die, the region’s famine and drop in agriculture production will worsen, Piot explains.
The epidemic’s impact on women has made communities less resilient, Piot says. "They will be weaker when they start planting seeds again after the rains come back," Piot explains. "So we can count on a longer food crisis than the region is used to."
Women also are sub-Saharan Africa’s foundation of the family. In these societies, the women are the ones who make certain their children are educated and who are the chief caregivers for sick family members, says Bernhard Schwartlander, MD, PhD, HIV/AIDS director of the World Health Organization (WHO) in Geneva.
The trend of increasing numbers of infected women is particularly troublesome because it’s primarily women of childbearing age, and especially very young women, who are at the greatest risk of HIV infection. As more women, ages 20 to 45, join the ranks of men of this age group in becoming infected with HIV/AIDS, the situation has grown into a major humanitarian crisis, Piot says.
"A chunk of that population is disappearing, and it’s something we’ve only seen up to now after wars, and then only on the male side," Piot says. "There is a whole generation of orphans who will grow up, and that will create social instability, as well." The lack of access to HIV treatment is a major cause of the societal breakdown, Piot adds.
"What we’re seeing in Southern Africa is the first sign of the larger societywide destabilizing impact of AIDS, as was predicted some years ago, but frankly, I didn’t think it would occur this fast," Piot says.
In some African countries, about twice as many young women as men are infected with HIV, according to the December 2002 AIDS Epidemic Update by UNAIDS and WHO.
|
|
||
| Number of people living with HIV/AIDS | Total Adults Women Children under 15 years |
42
million 38.6 million 19.2 million 3.2 million |
| People newly infected with HIV in 2002 | Total Adults Women Children under 15 years |
5
million 4.2 million 2 million 800,000 |
| AIDS deaths in 2002 | Total Adults Women Children under 15 years |
3.1
million 2.5 million 1.2 million 610,000 |
An estimated 6-11% of women ages 15-24 were living with HIV/AIDS in sub-Saharan Africa in 2001, whereas for young men the estimates were 3-6% living with HIV/AIDS, the report states.
The chief reason for this trend is young women having sex with older men, who are more likely than younger men to be infected, Schwartlander says.
It’s also the case that young women are physically more vulnerable to HIV infection than are older women because of an immature cervix, and it’s long been known that HIV transmission from man to woman is much more efficient than it is from woman to man, Schwartlander explains.
In some places, the prevalence of young women who are infected with HIV when they visit a clinic to deliver babies has climbed to 30%, Schwartlander says. "These are shocking figures," he adds.
While the feminization of the AIDS epidemic is having the most devastating effect on the sub-Saharan region, it’s a trend that can be seen everywhere in the world.
While Russia’s HIV problem still is predominantly the result of young people who inject drugs, heterosexual intercourse is now the main mode of transmission in Belarus and Ukraine, the report notes.
"Heterosexual transmission is proportionately on the rise in every continent," Piot says. "The Ukraine has a more recent epidemic. Originally this was basically an epidemic among injection drug users [IDUs], and now their share of new infections has dropped to 56% and that of heterosexual transmission is close to 30%."
Statistics showing the rapid rise of HIV infections among Eastern European countries suggest that heterosexual transmission soon will play a larger role everywhere. (See chart below.)
|
Regional
HIV/AIDS Statistics and Features, End of 2002
|
||||||
|
Epidemic
started
|
Adults
& children living with HIV
|
Adults
& children newly infected with HIV
|
Adult
prevalence rate
|
%
of HIV-positive adults who are women
|
Main
mode(s) of transmission for those living with HIV/AIDS
|
|
|
Sub-Saharan
Africa
|
late
'70s
early '80s |
28.4
million
|
3.5
million
|
8.8%
|
58%
|
Hetero
|
|
North
Africa & Middle East
|
late
'80s
|
550,000
|
83,000
|
0.3%
|
55%
|
Hetero,
IDU
|
|
South
& Southeast Asia
|
late
'80s
|
6.0
million
|
700,000
|
0.6%
|
36%
|
Hetero,
IDU
|
|
East
Asia & Pacific
|
late
'80s
|
1.2
million
|
270,000
|
0.1%
|
24%
|
IDU,
Hetero, MSM
|
|
Latin
America
|
late
'70s
early '80s |
1.5
million
|
150,000
|
0.6%
|
30%
|
MSM,
IDU, Hetero
|
|
Caribbean
|
late
'70s
early '80s |
440,000
|
60,000
|
2.4%
|
50%
|
Hetero,
MSM
|
|
Eastern
Europe & Central Asia
|
early
90s
|
1.2
million
|
250,000
|
0.6%
|
27%
|
IDU
|
|
Western
Europe
|
late
'70s
early '80s |
570,000
|
50,000
|
0.3%
|
25%
|
MSM,
IDU
|
|
North
America
|
late
'70s
early '80s |
980,000
|
45,000
|
0.6%
|
20%
|
MSM,
IDU, Hetero
|
|
Australia
& New Zealand
|
late
'70s
early '80s |
15,000
|
500
|
0.1%
|
7%
|
MSM
|
|
TOTAL
|
42
million
|
5
million
|
1.2%
|
50%
|
||
| Source: World Health Organization, AIDS Epidemic Update. Geneva, Switzerland, December 2002 | ||||||
The 2002 UNAIDS/WHO report notes that there is evidence that young people in several of these countries are becoming sexually active at an earlier age and that premarital sex is on the rise. At the same time, young people remain ignorant about HIV and AIDS and how the virus is transmitted.
Even in Western Europe and in other high-income countries, including the United States, the proportion of women becoming infected with HIV is on the rise. Ten years ago, the chief mode of HIV transmission in Western Europe involved men who have sex with men (MSM) and IDUs. Now, heterosexual transmission is the main mode of transmission, Piot says.
Heterosexual transmission now accounts for 59% of the new HIV diagnoses in several Western European countries. In the United Kingdom, more than half of the 4,279 new HIV infections diagnosed in 2001 were the result of heterosexual sex, compared with 33% of new infections attributed to heterosexual sex in 1998, the UNAIDS/WHO report states.
In some Western European countries, a major portion of the people infected with HIV through heterosexual sex are people who have immigrated from or have lived in areas where HIV prevalence is high, the report says.
It’s not surprising that the transmission of HIV through heterosexual sex is becoming a major factor in the epidemic, because while MSMs and IDUs may spread HIV more efficiently, their total numbers are small when compared to the heterosexual population, Piot says.
However, because people in the wealthier nations have access to antiretroviral therapy, there is a steadily growing number of people living with AIDS. This group still reflects the traditional risk groups of IDUs and MSM, but that likely will change in the future as the number of infected women increases, Piot says.
Another trend that is especially noticeable in the United States, but also can be found in other high-income nations, is the preponderance of HIV infection among poor, minority, and marginalized groups, Piot says.
"African-Americans are disproportionately infected by HIV/AIDS in the United States," Piot says. "Half of the new infections are in that group that is only 13% of the U.S. population."
In some ways this trend is the result of the highly successful antiretroviral therapies that have focused attention and resources on treatment and away from prevention, Schwartlander says.
"Going back in history, you had successful programs at preventing infection among gay men and IDUs and other groups," Schwartlander explains. "But with the introduction of effective treatments to delay disease and death, there is a complete shift to care and giving drugs to people who are sick, and the elements of prevention have been almost forgotten."
So in all parts of society, there are increases in risk behaviors, increases in new infections, and increases of HIV and AIDS among women, minorities, and heterosexuals. The only sensible solution is to increase prevention efforts and spending, Schwartlander and Piot say.
"Far more explicit education and prevention programs should be organized," Piot says.
Western countries and societies need to be smarter in how they teach prevention, says Schwartlander.
"We need to talk the right language, the language of young people and of disadvantaged minorities," Schwartlander adds. "A lot can be done to improve the language and provide prevention to those who need it most, and we haven’t done enough of that."
Until prevention efforts are overhauled and improved, the epidemic will continue to increase among women, the disadvantaged, and heterosexuals. "Every new infection that happens in a situation where we have all the resources available is one infection too many," Schwartlander says.
The latest AIDS epidemic news blaring out to the international health community as 2002 drew to a close was particularly devastating because it offered strong evidence that women increasingly are infected with HIV and are dying of AIDS, and that their proportion of the epidemics toll now is close to 50% worldwide.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.