Home' Trinidad and Tobago Guardian : November 19th 2013 Contents B7
Tuesday, November 19, 2013 www.guardian.co.tt Guardian
HIV epidemics are becoming more con-
centrated in marginalised groups such as
sex workers, drug users and gay men, and
could defy global attempts to combat Aids
without a change in attitudes, according to
a UN special envoy.
Michel Kazatchkine, UN Special Envoy for
HIV/Aids in Eastern Europe, says he would
like to be able to celebrate without reservation
vast global progress made in the past decade,
but stubborn infection rates and alarming
growth of outbreaks in hard-to-reach pop-
ulations make that difficult.
The risk, he says, is that as the world turns
the tide of the generalised global Aids epidemic,
the virus will return to being a disease that
plagues only certain groups, and the political
will to overcome it there may fade.
"If we do not address the roots of the prob-
lem, if we do not address stigma, discrim-
ination and inappropriate legislation, if we
don t look at these people from a public health
perspective, rather than from a delinquent,
criminal perspective as we do now, then the
trend will only go on," he said in an inter-
"Then the Aids epidemic will become more
and more a sum of these concentrated epi-
Some 35.3 million people worldwide are
infected with the human immunodeficiency
virus (HIV) that causes Aids, but the rising
number of patients reflects great strides in
recent years in developing sophisticated HIV
tests and combination Aids drugs and getting
them to many of those who need them to
The annual Aids death toll is falling, drop-
ping to 1.6 million people in 2012, down from
a peak of 2.3 million in 2005, and there are
also steadily declining rates of new HIV infec-
tions: a third fewer in 2013 than in 2011.
The progress has generated much hope---
and many headlines---about the possible end
of Aids, or a potential world without HIV, or
the chance of an Aids-free generation, in our lifetimes.
Kazatchkine refers to this---both the progress and
the hope---as "extraordinary".
"I m really concerned about the future of the Aids
epidemic, especially at a time when we are perhaps a
little too optimistic because of the huge progress we
are making from a technological and scientific per-
spective," he said.
"As we celebrate the extraordinary progress, we should
also be conscious that we will not stop HIV and Aids
by just having more sophisticated drugs and only
focussing on the generalised epidemic and not focussing
enough on the complexities of the concentrated epi-
The worrisome groups are fairly clearly defined:
Injecting drug users, who can pass the Aids virus to
each other by sharing nee-
dles and syringes, prosti-
tutes and sex workers,
who are often criminalised
and have little access to
health service, and gay and
bisexual men---the popu-
lation in which the HIV
epidemic first started.
To illustrate how little
has changed in the battle
against HIV among drugs
regions such as Eastern
Europe and central Asia---
Kazatchkine tells the sto-
ries of two women.
The first is Andrée, a
drug user he met in Paris in 1986 who had no hope
of effective HIV treatment, since there was none yet
developed, and who ultimately died a lonely death. The
second was Larissa from Yekaterinburg in Russia, a
drug addict repeatedly arrested and locked up, deprived
of medications for years and at one time sentenced to
five years in a labour camp.
"These stories are remarkably similar," he said. "But
Larissa s is not from 1986, it s from this year. Some 25
years passed between my meeting these two women,
but their predicament was depressingly, tragically, the
Among gay men, Kazatchkine said, the situation is
In poor and middle-income countries, men who
have sex with men and female sex workers are 19 and
13 times more likely to have HIV, respectively, than the
rest of the population.
Even in wealthy regions like western Europe and
North America, HIV rates among gay men---or men
who have sex with men (MSM) as Kazatchkine refers
to them---stubbornly refuse to shift.
"In MSM populations, there is no sign it has
decreased," he said. "It has either been a stable number
of new infections every year for ten years, or it is an
increasing trend. And this, in western Europe at least,
is in the context of basically free and easy access to
therapy and services."
Elsewhere, in China, for example, gay men alone
account for more than 33 per cent of new HIV infections,
and projections indicate that gay men may account for
half or more of all new infections in Asia by 2020.
Kazatchkine admits that he is as frustrated and
worried now, faced with these smaller but relentless
HIV epidemics, as he was more than a decade ago
when the vast generalised HIV and Aids outbreak in
Africa looked too overwhelming to begin to tackle.
"We are a bit in disarray. We don t know quite what
it is that we should do. Here we are, we have all the
technology, we have extraordinary scientific progress,
and we just cannot translate that into making a difference
in these populations."
Yet if nothing changes, the Aids virus may never be
Kazatchkine called for a "shift in the collective mind-
set" to put equity and human rights at the centre of
the battle against HIV in these groups: "If we do not
deliver the right response, we will fail to deliver an end
to Aids," he said. (Reuters)
Could concentrated HIV epidemics make Aids unbeatable?
"As we celebrate the
progress, we should
also be conscious
that we will not stop
HIV and AIDS by just
and only focussing
on the generalised
epidemic and not
focussing enough on
the complexities of
Links Archive November 18th 2013 November 20th 2013 Navigation Previous Page Next Page