Thursday, March 22, 2007

Millennium Challenge Series #17: Managing or Mismanaging the HIV Epidemics

Millennium Challenge Series No 17:
Managing or Mismanaging the HIV Epidemics

It has now been over 21 years since the advent of HIV Epidemics in the Northern American and European continents.

The epidemics are now raging in Africa, Asia and Russia ignoring the original two continents where it was a captivating history just 15 years ago. Today, it has turned to be a disease of ignorance and poverty more than an infectious disease or to be more exact the common sexually transmitted diseases it has become.

It is no more described as the four H conditions that is associated with hemophiliacs, homosexuals, intra-venous heroin users and haemo-dialysls and blood transfusion patients. Today, it is commonly affecting women and youth and is transmitted mainly via heterosexual contact making another H condition to the list.

Although there are many drugs available to suppress the viral replication, we cannot still cure HIV/AIDS. Yes, we can prolong the life of the infected person, even keep the viral replication under control but the mutation continues to be a serious challenge. The disease process is such that the toxic drugs and the vaccine efforts are fantasy as the rapid mutations are the inherent challenge of the disease.

Unfortunately, this reality is not appreciated both by the scientific community and the public policy makers as they tend to spend too much talent and resources on drug therapy and vaccine development. Both are noble objectives but unattainable. Most importantly they are competing for the limited window of opportunity to control and even prevent the disease from infecting the rest of the 6.5 billion people on earth. What a tragedy.

The therapeutic and vaccine development fantasies are diverting precious resources away from Prevention and Early Intervention efforts. It is a shame, and no one seems to act on this fact. The latest UN and WHO report affirms that HIV is not yet curable. What a revelation?

The only solution is prevention and early intervention. Yes, it makes good story to scavenge news from the Ugandan and South African experience. The reality is that only two measures work.

Measure One: Mandatory HIV testing and pre and post rest counseling of all sexually active populations and providing appropriate early intervention measures.

Measure Two: Aggressive health education and prevention measures that include "contact tracing of all sexual contacts of infected persons and providing appropriate counseling and standard early intervention measures.

As usual the most able minds and precious resources are wasted in vaccine and drug research. Just imagine what could have happened in the early stage of this epidemic if mandatory testing with appropriate pre and post test counseling was made available to all high risk populations with early intervention measures.

Now; like all business, HIV/AIDS is a big industry with funding to the tune of billions and no results. We have 6.5 populations and wonder how long the virus will take to infect every body.

Intelligent people are wasting time and effort on the wrong measures and I bleed for my country Ethiopia that is diverting its very limited resources to the fantasy of distributing the ever increasing number of new drugs that only populates the at risk population with even more virulent and toxic virus strains. The tragedy is that countries such as Ethiopia are being converted into an experiment for failed policies. Just imagine, what can be done with the epidemic if more preventative and early intervention strategies are made operationa. I believe the challenge of policy makers and community activists as well as the international community is to move away from failed policies of drug distribution towards aggressive prevention and early intervention campaigns where mandatory HIV testing with pre and post test counseling is complemented with early intervention strategies where even the drugs are most effective in the early stages where the immune system is still competent and can fight back the viral replication.

The Ugandan, South African and now the Afghan experience is worth mentioning here.

Afghanistan- The country that is infecting the world with heroin is now being infected back with HIV. As heroin is an industry the Afghans cherish for quick money the pharmaceutical industry is doing exactly the same thing to the HIV population. The current failed policy is literally spreading more toxic and virulent forms of the virus to unsuspecting public. Who are the cohorts? and collateral damage of this madness? The public health professionals and great foundations and the collateral damage is that all of us 6.5 billion will be at risk.

What a shame? Please read on and see at the bottom where Bill Clinton affirms the notion that Pharmaceuticals can save an AIDS patient. The facts do not support it. It merely prolongs life and ensures virulent forms of the disease are spread during the life time of the infected individual. It is sad, but it is the truth.

Question- Do we have an RFP in Afghanistan. And if so can that person or any
RFP working in the Middle East, South Asia, provide us with the current
situation on youth in Afghanistan.

Is there a high-risk youth population in Afghan that are IDU or even living
with HIV/AIDS?

[Mar 19, 2007]

Stigma and a lack of education and prevention efforts are fueling the
spread of HIV in Afghanistan, the New York Times reports. According to the
Times, there are 69 recorded cases of HIV in the country; however, some
health officials say the actual number of cases is much higher.

The World Health Organization estimates that about 1,000 to 2,000 Afghans are
HIV-positive. Nilufar Egamberdi, a World Bank consultant on HIV/AIDS, said
the WHO estimate is "not even close to reality.

" According to the Times, Afghanistan "faces the additional vulnerabilities of countries emerging from conflict -- lack of education and government services; mass movements of
people; and a sudden influx of aid money, commerce and outsiders."

In addition, Afghanistan's proximity to Russia, China and India -- which have
some of the fastest-growing HIV/AIDS epidemics worldwide -- and the
migration of its residents are fueling the spread of HIV.

The country, which produces the largest amounts of opium and heroin in the world, has about one million injection drug users, according to United Nations estimates. In
addition, about 30% of blood used for transfusions in the country's
hospitals is screened for HIV, according to a World Bank report.

According to Saifur Rehman, director of the National AIDS Control program at the
Ministry of Health, about 80% of government hospitals screen blood for HIV,
but many other institutions do not.

Rehman added that health providers in the country are not well-informed about HIV and often reuse needles. A lack of knowledge about the virus among commercial sex workers in Kabul, the country's capital, also is contributing to the spread of the virus,
according to the Times.

A 2003 survey by the German international aid organization ORA International found that one of 126 surveyed sex workers was familiar with condoms and that one had knowledge of HIV/AIDS. There are no treatment centers in the country, and one clinic in Kabul monitors
HIV/AIDS but does not provide access to antiretroviral drugs, the Times

According to the World Bank, which is providing $10 million to fight HIV/AIDS in the country, although several organizations are working to implement needle-exchange programs and to increase awareness of HIV/AIDS, a wider program is needed. Stigma is the "most difficult" challenge in fighting HIV/AIDS in Afghanistan, according the Times. Health providers in
the country say that HIV-positive people will face ostracism and possibly
death if their communities learn their HIV status.

The Ministry of Health keeps the identity of HIV-positive people confidential to prevent stigma.

The health ministry also is working with the country's Ministry of Hajj and
Religious Affairs to educate religious leaders, who often are the most
influential people in villages, to promote HIV/AIDS education and reduce
stigma surrounding the disease, the Times reports (Gall, New York Times,

Resource found at:

Below is some communication with some key players for the record!

Marco Gomes
Regional Focal Point North America
Toronto, Ontario Canada
+1-416-906-8392 (YPLWHA fight back!!)
GYCAliving positively:

”….AIDS is no longer a death sentence for those who can get the medicines. Now
it's up to the politicians to create the "comprehensive strategies" to
better treat the disease. ….”-Bill Clinton

I had circulated the South African (SA) HIV/AIDS initiative because I believe we could learn from the 'revolutionary' transformation (from denial to action) in terms of AIDS response in SA that could be exemplary to Ethiopia.

Please find, as per your request, two AIDS reports on Ethiopia (from 2000 and 2006) on the HIV/AIDS situation in Ethiopia. Kindly let me know if you need any more information
On 3/16/07, Belai FM Habte-Jesus wrote:

Tell us how Ethiopia is faring too!
Remember People to People is about Ethiopia!

BT Costantinos, PhD
Africa Avenue, PO Box 13309,
Tel. +251 (11) 551 1224, Facsimile +251 (11) 551 3851
Addis Ababa, Ethiopia.

Our mission is to advance a rights-based human security and entrepreneurial development

"Throughout history, it has been the inaction of those who could have acted; the indifference of those who should have known better; the silence of the voice of justice when it mattered most; that has made it possible for evil to triumph". Emperor Haile Selassie

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