The end of the HIV / AIDS epidemic is near? Deceit her - and it could be worse
The conference on HIV / AIDS held in Durban shocked the world into action. Now a new amorphous crisis, fed by drug resistance, expensive treatments and the lack of power many women have multiplied difficulties because they can not impose unprotected sex.
Sixteen years ago, a boy of 11 years and a judge warned the planet, he was shocked by the sad reality of AIDS on the African continent, where hospitals were overcrowded people between life and death and the endless list of children, abruptly, orphaned.
Hope for the "end of AIDS" exists. But is fading, warn experts
The International Conference on AIDS held in Durban in 2000, KwaZulu-Natal - one of the most plagued regions by AIDS in the world - initially imagined as a scientific meeting has become a long vibrant and passionate demonstration, with singing, dancing and thunderous march of activists from all over the world! Scientific neutrality disappeared and researchers have also become activists and advocates of "cause."
The outcry was the universal distribution of medicines to save human lives. It was unfortunately too late for the eleven-year-old Nkosi Johnson, the man who had spoken at the opening ceremony. He died the following year. Judge Edwin Cameron left everyone stunned in South Africa by declaring gay and HIV positive, and said it was unfair that he could buy their own medication, importing it from Europe or the US to save his own life while his countrymen and women were dying by the thousands, perhaps tens of thousands and Nelson Mandela urged the world to act.
Their call was heard! Activists, together with generic drug manufacturers overthrew the price of the three-drug cocktail to suppress the virus and keep people in good health, the cost of immersion in the treatment began to be funded from $ 10.000 per year to US $ 100 (£ 76) these days, almost two decades later. Last week the conference returned to Durban with 17 million people on Antiretroviral Therapy. But it is not what we'll talk. Far from it.
There is a real possibility that AIDS may once again emerge as a mass murderer, as indeed it was the turn of the century.
It's a total crisis. The conference message is that there is all this hope - and that is not sustainable, said Deenan Pillay, a virologist.
There are about 38 million people with HIV, and more than twenty million others who are not yet on treatment. About 2 million others are harvested by the pandemic every year. Editor's note: And some say that does not die over AIDS and just take a comprimidinho ... (...) ... and also states that the health of the person who contracts HIV turns out to be better than before, the bossais ...
Antiretroviral drugs can not "only" keep people well, but also prevent them from infectious. The World Health Organization now recommends that anyone diagnosed HIV positive should start treatment as soon as possible, not just when your health will unravel, but to also protect their sexual partners. In September, South Africa introduced the test and treat.
However, this year's conference heard disquieting news researchers Wellcome- Financed by African Health Centre in KwaZulu-Natal, which has been the trial and treatment in a population where a rate of about one in three people HIV door.
They found that while most people agreed to be tested by health workers, visiting their homes, only half of the people who were diagnosed seropositive for HIV were then to a clinic to receive treatment to prevent infection its partners.
Test and treat
A sugarcane farmer tested for HIV by a health worker in Gwegwe MSF around Eshowe, 2014.
Eshowe, a city of 14.000 people, located between hills and sugarcane plantations, Doctors Without Borders were pioneers in testing among with health professionals who will
from door to door. MSF also opened booths tests next to the butcher and Taxi Stand where working men spend the day of payment. They found the same thing that researchers in KwaZulu-Natal. They can get the high proportion of people tested - but that does not determine immediate visit to the clinic for treatment.
"We give them referral cards to the clinic. Then we find out they were not, "says Babongile Luhlongwane, walking endless miles every day, on the rough tracks with your kit in a backpack to reach those living in this rural community. "Last Monday I had three men were positive. Two were the clinic. The other said he had no time. "
Dr. Carlos Arias takes MSF's initiative to set up monthly clinics in sugarcane plantations, test workers for HIV and the medication supply.
Village girls fight the scourge of 'healers' whose gifts ruined their lives.
South African guidelines say that people should be treated when their CD4 count - a measure of the strength of your immune system - dropped below 500. "We saw CD4 counts less than 100 CD4s cells, about five or six," he says. Two years later, he was tested again and had a CD4 cell count at eight. This means that the presence and viral replication in his body was 'rampant' and he was alarmingly infection to a sexual partner. "Here the prevalence of HIV is enormous," he says. "In KwaZulu-Natal, among women aged 15 29 to is 56,8%."
The study center in Africa, north of KwaZulu-Natal, compared to what happened in 22 groupings of 1 thousand people: half off randomly chosen to test and treat, half said these would be given ART drugs when their CD4 count fell below of 350 (500 when the guidelines later changed government). If immediate treatment led to a drop in the numbers infected. The answer, to his chagrin, was not.
"Unfortunately, we found no difference in the number of new infections between these two random sets of clusters," says Deenan Pillay, director of central Africa and virology professor at University College London.
Sex in the cities was a problem. People were traveling away from home in Durban and Johannesburg much more than expected and sex. But more problematic are the social and cultural customs and long afflict HIV response in Africa. Much less men went to clinics for treatment than women. "
It is a hierarchical society. It's about what you say about being HIV positive. There is stigma associated with it, "says Pillay.
He has been working with this community for over ten years, he says, and saw the huge change when people stopped dying. "Treatment was first used for people who were very sick and dying - and living. Now let's talk about people who appear well and look good and you are asking themselves if-medicate, to go to this government clinic where you have to stand in line all day and see other people you also know there ... " (...).
Pillay thinks more should be done to the target "paizões or healers" - older men who give gifts and money for teenagers, poor and even for smaller pubescent, in exchange for sex. About 60% of new cases are women.
In Brazil, a young man with 15 years old has today, 80% chance of being infected, "he says. In clinics with prenatal treatment "where pregnant women are all tested for HIV ... Half are positive.
The government launched a campaign telling teenagers not to sleep with older men. But, says Pillay, "the real problem is the men who are not being tested and treated."
The cost is a huge and growing problem. If the test and treat work, would reduce bills by preventing new infections. But this hypothesis now seems premature and donor funding has fallen for the first time. A report by the Kaiser Family Foundation and UNAIDS says it gave US $ 7,5 billion last year, compared to US $ consecrated in 8.600 2014.
The invoice of medicines will increase dramatically, not only due to increased infections and the fact that everyone should have antiretroviral therapy for life, but also because the resistance is spreading to the combination of three drugs base available in Africa for as little as US $ 100,00 per year. Hospital beds are once again taken by AIDS patients whose treatment failed. Africa can not afford the latest drugs available in Europe and the United States.
MSF found resistance levels based on combination of 10% in its projects in South Africa. There was more bad news in other parts of Africa. A study covering Kenya, Malawi and Mozambique found 30% of people in second-line treatment, which costs at least $ 300 because they were resistant. The third-line treatment or treating "wild HIV" for a third line treatment with drugs in Africa is $ 1,859 person / year.
"I think we're seeing the tip of the iceberg," said Dr. Vivian Cox MSF. "Many countries are not making viral load monitoring routine for the first time. They are moving in your direction, then you can imagine what they will find. "
The focus of youth
Under the shadow of HIV are taken by 'dirty', South African children offered a refuge.
No one of this year's conference was talking about the end of AIDS, as they were just four years ago, when the conference was held in Washington DC. Bill Gates expressed real concern. If it is difficult now for the treatment and prevention of HIV infections, said Gates, demographic bulge could make things worse. "If we have to do" just "as good as we have been doing, the number of people with HIV will even beyond their previous peak," Gates said.
"We have to do an incredible amount of efforts to reduce the incidence of the number of people to infection. To start writing the story of the end of AIDS, new ways of thinking about treatment and prevention are essential. "
A vaccine is still a far way. PrEP works only for partners of people with HIV in the global north. Taking an antiretroviral drug protects against infection. But it seems very difficult to implement for young women in Africa, who barely have their own bodies and could face charges and be tried criminally for carrying HIV or be a prostitute.
There are courageous attempts to change behavior and subservience of women and adolescents. Actor Charlize Theron is funding projects to educate, help and support young people. MTV Staying Alive Foundation is trying to reach young people through its mass media campaign Shuga, sharing the sex lives of wealthy young Africans. After two series in Kenya and two in Nigeria, the fifth will be filmed in South Africa.
Charlize Theron visits the project to create youth ambassadors in KwaZulu-Natal in 2013. Research conducted in South African schools to determine the issues facing the 14 20-years before the new series offers a glimpse of the dangers they face. One-third of the girls said that a girl does not have the right to ask a guy to stop kissing her. A quarter of boys said they had "forced someone sexually." A fifth of the girls said they were sexually active and most people had been forced to sexual activity at some point.
"Appeared that 86% of sexually active girls said they were sexually forced by their boyfriends," the researchers say. "These figures ... reflect a need to understand what is happening within heterosexual relationships and experience and risk position within these relationships. It also calls for efforts to prevent HIV infection, seeking help create safety and support within relationships. "
Girls between the 3 thousand students surveyed in three provinces over two years 15% said they had gotten pregnant - equivalent to 70% of them are sexually active. Almost half of young people - 46% - said a young couple who accessed the data from your public about HIV if one of them became HIV positive would be openly tried and 4% thought they would be physically harmed.
"This indicates the fear environment full of young people in South Africa are still growing in when it comes to HIV," the report says. "Fear keeps people silent and silence feeds the risks for HIV and do not receive the care and support they need to deal with HIV infection."
Research is showing that Shuga not have an impact on the young or the behavior of these people.
"Where we see that behavior change works very well is when the public consultation on their own lives reflected in the storylines," said Georgia Arnold, Executive Director of MTV Foundation, who says she wants to get money to create a DVD to each 6 million high school students in South Africa.
behavioral changes could stop the epidemic - but do not do it in Europe or the US - and initiatives could help to improve the lives of young people. But it is difficult and slow this awareness. AIDS will be with us to go further than anyone imagined. Professor Peter Piot, the first head of UNAIDS and director of the London School of Hygiene and Tropical Medicine, says the biggest challenge is to keep people uninfected. "It's as if we were in a rowboat with a big hole and we're just trying to get the water out. We are in a major crisis with the continuation of this number of infections and that is not a matter of just making some interventions.
"We will not eradicate HIV as an epidemic only by medical means. People are not robots. Sex happens in context. It is a matter of power. Adolescent girls and young women in Southern Africa are infected by men who are much older. It's about poverty. Also it is a macho culture. There are also gay men around the world who are victims of discrimination and fear, and there is no way for you to avoid the infection if something is underground. "
He believes it was a mistake to predict the end of the epidemic a few years ago. "I do not believe the slogan" end of AIDS by 2030 "be realistic and could be counterproductive. It might suggest that all is well and good, and we can move on to something else, no ... "
AIDS is still one of the greatest mass murderers in the world.
Translated Claudio Souza Original in: Think the AIDS epidemic is over? Far from it - it Could be getting worse
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