On the wane

Despite the decline in HIV/AIDS prevalence, many with HIV still don't have access to treatment

Since being first discovered in the early 1980s, HIV/AIDS has since killed around 35 million people. In 1990, it was the 33rd global cause of death and over a period of 20 years, spread so rapidly that it became sixth major global cause of death in 2010. The World Health Organisation estimated that, in 2012, there were around 35.3 million people living with HIV/AIDS, mostly adults between 15-49 years of age. There were 2.3 million new HIV infections and 1.6 million people have died of AIDS related diseases in 2012. In Nepal, the first HIV infection was seen in 1988 and since then, 48,600 people are estimated to have been infected. However, the prevalence of HIV/AIDS has been decreasing in the last five years. According to a report from the National Centre for AIDS and STD Control (NCASC), the prevalence rate was 0.2 percent in 2012, down from 0.3 in 2011, 0.33 in 2010 and 0.39 in 2009. Declining, but still a problemThe burden of the disease has decreased across the world, especially in industrialised countries, and the major credit goes to the invention and spread of antiretroviral drugs and their easy availability. The improvement has also been accelerated by progress in technology and research, effective political leadership, social reform, innovation in delivery of care, increase in resources, establishment of new developmental aids and new forms of global governance. However, the vast majority of HIV-infected people, approximately 95 percent of the total, still reside in developing countries. Africa is the most affected continent, with Sub-Saharan Africa accounting for 69 percent of people living HIV. South and South East Asia comes second, accounting for 3.9 million people. Nevertheless, factors contributing to the HIV/AIDS pandemic include growing urbanisation, development of megacities and many other societal and ecological determinants. Poverty, which is so far an underlying driver of HIV/AIDS, is no longer a major socio-economic determinant of HIV/AIDS. Evidence has shown that wealthier countries and richer individuals, especially in Sub-Saharan Africa, are at augmented risk of HIV infection. What is called poverty in developed nations cannot be conceptualised in the same way in the context of developing nations. Poverty in the context of the developing world includes individuals who cannot meet their basic needs and primarily live at a subsistence level. Ecological survey have also demonstrated that relative poverty, rather than absolute poverty, correlates with high rates of HIV infection. Additionally, social factors like stigma and discrimination pose a great threat and a major obstacle. Stigma prevents people from accessing HIV treatment while racial and gender discrimination in developing countries contributes largely to HIV infection. Social constructions along with often low socio-economic status have placed women and girls at a disadvantage when it comes to negotiating safe sex and accessing HIV prevention and services. The proportion of HIV infections among women and black people is higher, compared to males and white people respectively. Migrant labour, the destruction of family life, vast income inequalities and extreme violence are also connected with the high prevalence of HIV/AIDS in developing nations. International cooperationHowever, medical interventions in HIV/AIDS treatment have shown promise. People receiving antiretroviral therapy (ART) in low and middle-income countries reached 9.7 million in 2012, up from 30,000 in 2002. More than 7.5 million people in Africa alone had received ART by the end of 2012, which is 150 times higher than a decade earlier. As treatment has scaled up, there are now more people living with HIV than those dying of AIDS. New HIV infections have declined more than 50 percent between 2001 and 2012 in Nepal, India, Cambodia, Myanmar and Thailand and other 21 countries, according to the UN. Given the increasing trend of globalisation, national effort and policies are not enough to decrease the burden of disease. Control strategies must include a Global Public Goods (GPG) perspective. This will prepare us for the enduring challenges of health inter-dependencies in a way that benefits the whole planet. Despite the dwindling epidemiological trend of HIV/AIDS among industrialised countries, they are not spared the risk of the disease. If the disease is allowed to persist in developing countries, it will have serious consequences for economic globalisation, international peace and security and the prosperity and well-being of industrialised countries.   Health inequities, which are more among poor countries, could be best solved through international cooperation in which industrialised countries lead the way. Compared to 2001, the money spent on HIV/AIDS is 15 times more, constituting $15.3 billion in 2012. Unfortunately, due to expensive antiretroviral drugs and socio-economic impacts associated with the disease, the funds are still insufficient to meet the demands of this catastrophe. In many developing countries, HIV/AIDS services are centralised in cities and towns, so marginalised populations, stigmatised groups and even adults and children from remote regions are beyond the reach of treatment. MDG targets met and unmetThe target set by the Millennium Development Goal-6A (MDG) to halt and begin to reverse the spread of HIV/AIDS by 2015 has already met by most countries, including Nepal. However, target 6B of achieving universal access to treatment for HIV/AIDS has yet to be met, despite improved access to ART in low and middle-income countries. Only 11 countries have to date achieved universal access to ART under the understanding that at least 80 percent of the people who need it have access. Elsewhere, most developing countries are far behind. Nepal met the MDG-6A target in 2011. Although the percentage of the HIV population receiving ART has increased, data shows that it will be very difficult for Nepal to reach the MDG-6B target of universal access by 2015. However, much progress has been made. Nepal is now on the list of 26 countries where new HIV infections declined by more than 50 percent between 2001 and 2012.