HIV/AIDS in South Sudan
The Republic of South Sudan is located in Eastern Africa. Many know it for its newly-gained independence from Sudan and its status of being the youngest nation in the world. However, South Sudan is also one of the poorest nations in the world and is listed as 185 out of 189 countries on the Human Development Index (HDI). Due to ongoing conflict in the region, such as the recent civil wars, South Sudan has seen a spike in issues related to the country’s health system and many of its citizens are impacted by HIV/AIDS. Nevertheless, international and domestic institutions are taking major steps in combating the prevalence of HIV/AIDS in the region.

The Reality of HIV/Aids in South Sudan

One can characterize the issue of HIV/AIDS in South Sudan as being more concentrated in certain social groups and geographical areas. For example, HIV and AIDS are more prevalent in the southern regions of the nation and even more prevalent among female sex workers within those regions.

The transmission of HIV is a topic that is studied at length to combat the spread of the virus. According to the South Sudan Mode of Transmission Report (MoT), a study that occurred in 2014 regarding forms of transmitting HIV, the majority of the newest cases came from heterosexual sexual relations and mothers transmitting to their newborn children. Mother-to-child transmission often happened in cases of birthing, breastfeeding and pregnancy.

Another statistic that researchers often analyze when discerning the severity of the issue within a certain region is the percentage of the general population that has the virus. The U.N. Progress Report for monitoring HIV/AIDS in South Sudan states that around 2.5% of adults (ages 15-49) are living with HIV. This number, however, is improving due to help from institutions such as the Ministry of Health (MoH) and the U.N. These institutions are working on new ways of preventing the spread of HIV and treating those who have already been affected.

Something else that institutions take into consideration when attempting to combat viruses such as HIV is the general public’s knowledge of that virus. According to a survey on the attitudes and knowledge of HIV in Nimule, most adolescents had “fair” knowledge of HIV with 82% of the surveyed youth being aware that HIV can spread through sexual intercourse and 98% being aware that it can spread through blood. While the researchers concluded that there were some misconceptions surrounding the virus, it is commendable that most adolescents in the survey had a basic knowledge of the subject.

How Institutions are Battling HIV/AIDS in the Region

According to an article that the U.N. published, the prevalence of HIV/AIDS in South Sudan – and Africa as a whole –  is declining rather quickly. This is due to international institutions such as UNAIDS and the governments of Africa funneling money into their health programs. However, this article also stresses the need for continued monetary support to help these countries become healthier and safer.

One way that UNAIDS and African governments are helping combat this virus is through HIV testing. According to the MoH, there were around 32 facilities in South Sudan that provided HIV-related assistance, like testing. The South Sudanese government has also made it its mission to “Test and Treat all.” These testing efforts have made it a lot easier for institutions to pinpoint certain concentrations of affected individuals and allocate their resources accordingly. These measures to “test all” have been successful. The total number of people receiving antiretroviral treatment increased by around 20,300 between March 2013 and March 2018.

Another way in which institutions are helping the cause is by amping up anti-retroviral therapy (ART). This is an HIV treatment that helps to contain HIV replication. This therapy greatly reduces the mortality rate of HIV and even allows some patients to live completely normal lives. The “test all treat all” initiative has certain guidelines, one of which includes a minimum amount of time one can wait to receive treatment after testing positive for HIV (one week). Guidelines like these make it easier for governments and other institutions to manage the spread and treatment of the virus.

The Road Ahead

Although HIV/AIDS in South Sudan continues to be an issue, it is critical to note that governments and organizations are working to combat it. With the help of both international and domestic institutions, the cases of HIV continue to decrease year after year. However, it is still crucial to take into account that the issue has not reached its end, and continued support for South Sudan is of utmost importance.

– Tim Ginter
Photo: Wikipedia Commons

HIV/AIDS in Ghana
According to the Ghana AIDS Commission, more than 346,000 people are currently living with HIV/AIDS in Ghana. There are several important facts to know about the impact of HIV/AIDS in Ghana and the solutions in place to address the issue.

HIV/AIDS in Ghana

In sub-Saharan Africa in general, the majority of HIV/AIDs infections are concentrated among those living in poverty. According to a 2018 World Bank article, in 2015, sub-Saharan Africa accounted for more than 50% of the world’s extremely impoverished people. Predictions indicate that by 2030, 90% of the world’s extreme poor will reside in sub-Saharan Africa.

A 2007 research article by Noel Dzimnenani Mbirimtengerenji indicates that “HIV is an important outcome of poverty, with sexual trade, migration, polygamy and teenage marriages as its predictors in the sub-Saharan region.”

In 2018, 69% of all people living with HIV/AIDS resided in sub-Saharan Africa. Ghana does not have as high a risk of HIV/AIDS cases compared to other parts of sub-Saharan Africa. For the period of 2018 to 2020, the Joint United Nations Programme on HIV/AIDS, UNAIDS, categorized Ghana as “having a low-level generalized HIV epidemic.”

The prevalence of HIV/AIDS cases in Ghana has decreased over the years. In 2017, the country’s HIV rate stood at 2.1% compared to the 2016 rate of 2.4%. Women account for a significant portion of these cases.

Women are at greater risk of contracting HIV/AIDS in Ghana, but also globally. UNAIDS estimated in 2012 that “a young woman gets infected with HIV every minute.” In 2018, in Ghana,  females accounted for 65% of the 334,713 people living with HIV/AIDS in comparison to 35% of men. Women are at a greater risk of engaging in poverty-driven sex work, which increases their risk of contracting HIV. In 2014, female sex workers made up 11.1% of those with HIV in Ghana.

Greater Accra, Eastern, Ashanti and Western Region are the areas in Ghana with the highest rates of HIV. The four regions hold 75% of cases but only 58% of the population. The most at-risk populations are men who have sex with men, prisoners and female sex workers.

Solutions

The Ghana AIDS Commission, established in 2016, is a body that aims to “formulate policy on the HIV and AIDS epidemic and to direct and coordinate activities in response to HIV and AIDS.” The commission’s objectives include:

  • Advocating for HIV/AIDS prevention and control in Ghana.
  • Leading “national planning, supervision, and support of the HIV and AIDS program.”
  • Monitoring and assessing the effectiveness of the country’s HIV/AIDS programs.
  • Disseminating HIV/AIDS education across the country.
  • Ensuring proper data collection on persons living with HIV in Ghana.

Free to Shine, which the Organisation of African First Ladies Against HIV/AIDS (OAFLA) and the African Union launched in January 2018, aims to reduce mother-to-child transmission of HIV and lower the risk of pediatric HIV. The First Lady of Ghana, Rebecca Akufo-Addo, gave a speech explaining that there is an urgency for increased testing and treatment efforts among women of childbearing age in order to prevent mother-to-child transmission.

Looking Ahead

Overall, HIV/AIDS in Ghana affects women and those in poverty at a much greater rate. Through the resources that programs and organizations have provided, as well as more testing and accurate data, HIV-infected people can receive support and the spread of HIV can reduce.

– Ann Shick
Photo: Flickr

Tanzania’s Investment in Secondary Schools
HIV prevalence in Tanzania accounted for 4.8% among people aged 15-49 in 2019. HIV/AIDS’s consequences in a developing country can be devastating, leading to more deaths, slowed economic growth and further misery. HIV and poverty share a critical connection, both acting as the cause and the outcome of one another. The virus poses a more lethal and dangerous threat to the economically vulnerable part of the population that might not always have access to food, medicines and proper health care services. Tanzania has invested in an initiative called Education Plus to eliminate HIV in the country. Tanzania’s investment in secondary schools should fight HIV by ensuring education for girls and young women.

HIV and Education

Sub-Saharan Africa is considered the epicenter of the disease, with 69% of the HIV-positive world’s population living in the region. Another critical characteristic of the epidemic is its relationship with education, where less educated groups tend to be more vulnerable to contracting the disease.

Tanzania’s investment in secondary schools to fight HIV is a plan that will further develop through the country’s commitment to Education Plus. The initiative is the result of the combined efforts of UNAIDS, UNESCO, UNICEF, U.N. Women and others to fight and prevent HIV through the empowerment of adolescent girls and women in sub-Saharan African countries. Their strategy aims to achieve gender equality with secondary education as a central focus. Tanzania became the 13th African country to join Education Plus.

The Background

In Tanzania, over the last 12 years, the number of HIV infections dropped by almost half and the number of deaths decreased from 52,000 to 27,000 in 2019. Nevertheless, in 2019 the country has seen the number of HIV-positive individuals amount to 1.7 million. Evidence shows a considerable vulnerability in women to develop the infection.

Younger groups between the age of 15 and 24 represent one of the most prominent groups of new infections, making up 30% of the newly infected population, UNAIDS reported. According to UNICEF, the disease does not exist equally across the country, with a prevalence mainly in the southern areas.

The mainly affected population are people injecting drugs, men who entertain sexual relationships with other men, female sex workers, transgender individuals and prisoners. Studies show that crucial contributors to virus transmission are younger age, lack of education, alcohol use and the number of sexual partners.

Socio-economic Backgrounds

Tanzania’s poverty rate was 26.4% in 2018 and HIV is a disease that tends largely affects those coming from lower socio-economic backgrounds.

According to a report from the National Education Profile in 2018, 61% of females aged 14-19 in Tanzania were out of school compared to 51% of males from the same age group. According to UNAIDS, sub-Saharan Africa has the highest rate of child marriage and teenage pregnancy. Such aspects are definitive in keeping young women out of education and about 27% of girls aged between 15 and 19 in Tanzania are either pregnant or already have a child. As of 2019, adolescents and young women constituted 24% of new cases worldwide in sub-Saharan Africa.

Before joining the UNAIDS initiative, Tanzania was already making progress in tackling the issue with the revision of the HIV and AIDS Act, which now permits self-made HIV testing and has lowered the age of consent to take the test.

Education Plus

Research shows that secondary education has a significant role in the reduction of the risk of HIV/AIDS infection. Access to education leads young women to pay more attention to matters of sexual and reproductive health and it allows them to become economically independent later in life and ensure higher incomes for the future. It also decreases the risk of them becoming child brides and teenage mothers.

The initiative Education Plus began with the focus of helping achieve gender equality, ensuring free and good secondary education for all women by 2025 in sub-Saharan African countries. The plan consists of encouraging decision-makers to raise and expand investments and efforts on instructions and teachings for girls and young women. Such measures aim to prevent HIV and offer major social and economic benefits, including to those who already have contracted the virus, UNAIDS reported on its website.

Not only does the initiative give young women the opportunity to complete secondary education, but it also offers “universal access to comprehensive sexuality education, fulfillment of sexual and reproductive health and rights, freedom from gender-based and sexual violence, school-to-work transition and economic security and empowerment,” according to UNAIDS website.

The project relies on the help of influential U.N. leaders and partners and their role as advocates for the education of young girls to encourage further action and investment in the cause. Education Plus is the ideal approach to facilitate Tanzania’s investment in secondary schools to fight HIV.

The country’s high secondary school dropout rate is a risk factor in the development and spread of an epidemic that needs significant attention and intervention.

The Relationship Between Poverty and HIV

The socioeconomic status of people infected with HIV has a significant role in their living conditions. Many of the situations associated with the risk of contracting the virus are the consequences of coming from a disadvantaged background, such as a lack of access to decent food, housing, safety and the need to exchange sex for basic necessities.

HIV also has a negative impact on the socioeconomic state of a population. Poor health conditions can impact an individual’s ability to work and function independently, and according to research, the unemployment rate of those living with HIV/AIDS goes from 45% to 65%, according to the American Psychological Association (APA).

Looking Ahead

Despite the country still being a lower-middle income economy, Tanzania’s financial status is growing and has been so for the last decade. One of the key battles to win in order to ensure the economic reprise of Tanzania is through a strategy that allows for its population to have good health and work at their full potential.

Tanzania’s investment in secondary schools to fight HIV is not only an investment to fight and defeat a fatal disease responsible for 32,000 deaths in 2020, but also to build a country characterized where gender equality and strong economic performance are a reality.

– Caterina Rossi
Photo: Flickr

HIV/AIDS in Uganda
Uganda is among the largest countries in Africa and is home to around 46 million people. Many have recognized Uganda for its significant efforts to mitigate HIV/AIDS among its population in the last couple of years. Nonetheless, HIV/AIDS in Uganda continues to present disproportionate ramifications among women. This is why government partnerships with several foreign agencies are key to facilitating effective treatments for HIV-infected women of all ages and addressing the gender gap in treatment.

History of HIV/AIDS in Uganda

The HIV virus ranks among the most dangerous health diseases in many Sub-Saharan African countries. In Uganda specifically, the disease has been following an exponential upward trend since the start of the 1980s. Among female adults (>15 years), HIV-recorded cases ranged from 1.7% for those between the ages of 15 and 19 to 13.6% for those 50-54 years of age. HIV also underpins gender inequality, as 12.4% of females between the ages of 30 and 34 had HIV while only 4.8% of males in that same age group had HIV. In Kampala in 1985, estimates indicated that 11% of pregnant women had HIV, which likely only increased up to the early 90s since by 1992, 18% of Uganda’s overall population had HIV.

Progression of HIV/AIDS in Uganda and Women

Over the past few decades, Uganda has significantly progressed in the fight against HIV/AIDS. Through the introduction of behavioral and educational policies, Uganda’s government reduced the prevalence of the HIV burden to 7%. Uganda’s government launched various campaigns devoted to advocacy efforts encouraging citizens to undergo testing, as well as donated condoms among different rural regions of the country. From 2011 to 2016, the country witnessed an overall 18% decline in the prevalence of HIV-recorded cases for ages 15-49. This indicates effective development in the health sector, which is especially necessary to alleviate the number of cases.

According to UNAIDS statistics, HIV continues to affect almost 570 Ugandan girls and women aged 15-24 per week. One can attribute the increased vulnerability of young girls to HIV to their reproductive systems which have not yet matured, which increases their susceptibility to contracting the virus during sexual intercourse. Data shows that in Uganda, two-thirds of all new infections of HIV occur in young girls, but only about 30% of them receive any HIV testing services.

Working Towards Equality

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program and the CDC partnered to eliminate mother-to-child transmission of HIV in Uganda. Since March 2022, the CDC supplied HIV treatment for more than 700,00 people residing in Uganda, including around 19,875 pregnant and breastfeeding women. Based on Uganda’s Ministry of Health records, there has been a considerable decline in mother-to-child transmission of HIV in 2000 from 20% to 2.8% in 2021. Considering this, it seems that Uganda is making progress in addressing the gender gap in treatment.

The AIDS Support Organization (TASO) is a non-governmental institution, which has significantly reduced the number of HIV cases in the country since its inception in 2006 by Uganda’s government. The NGO works to support infected patients through its community drug distribution point (CDDP) by providing physical and psychological aid. The CCDP reduced travel time for Antiretroviral therapy (ART) and the wait times from typical pharmacies from two to three hours to 30-45 minutes. An estimated 65% of the patients enrolled in the CDDP program are women, with the program targeting 200 female sex workers.

The battle against HIV/AIDS in Uganda has been persistent for several years. With the various external and internal forces working to reduce existing inequalities in HIV treatments in Uganda, Women may be better able to access adequate treatment. Collaborations such as those between the government of Uganda and governmental agencies from the U.S. demonstrate the importance of U.S. aid and a mutual goal in addressing the gender gap in treatment and helping the most vulnerable populations across the world.

– Andres Valencia
Photo: Unsplash

HIV/AIDS in Albania
Although Albania has a low prevalence of HIV/AIDS, cases of HIV/AIDS in Albania have risen over the years. Cases of HIV in Albania increased by more than 50% between 2008 and 2018. The most recent estimates note 1,400 HIV cases, equating to a prevalence lower than 0.05%. The highest prevalence of HIV is apparent among specific vulnerable populations: “people who inject drugs, sex workers, gay men and other men who have sex with men, ” The Global Fund reported. However, stigma and discrimination present barriers to testing and treatment. The Albanian organization Aksion Plus, a member of the IDPC (International Drug Policy Consortium) aims to reduce HIV/AIDs in Albania through education and awareness campaigns, with a special focus on the most vulnerable groups.

People Who Inject Drugs (PWID)

Data from a 2019 HIV Integrated Biological and Behavioural Study (IBBS) reported a low rate of HIV/AIDS among PWID at 1.4%. However, the study shows concerning rates of needle sharing among this group. At the time of the study, about 41% of PWID reported sharing needles with others in the last 30 days. The majority of these individuals shared needles with one person and 14% shared with up to three people. This means the PWID group is at high risk of contracting and spreading HIV/AIDS in Albania. There are also difficulties in reaching the PWID group as most of them inject drugs in isolated areas during hours when not many people are around.

Men Who Have Sex with Men

Men Who Have Sex With Men are also vulnerable to contracting HIV/AIDS. In 2019, Albania noted 93 new HIV cases, with men accounting for 66% of these cases. Sexual intercourse is the primary mode of transmission of HIV/AIDS in Albania among men who have sex with men. However, the number of HIV cases among this group is likely higher as stigma and discrimination deter individuals from revealing their sexual practices and prevent them from seeking out testing/treatment.

The 2019 IBBS study shows an HIV prevalence of 2.0% among this group. However, condom use is high. Comparing the 2011 and 2019 IBBS results, 74% of respondents in 2019 used condoms during their last sexual encounters compared to 14% in 2011.

Aksion Plus

Aksion Plus has engaged in HIV/AIDS work in Albania since 1992. The organization works to prevent the spread of HIV through advocacy and education campaigns. Aksion Plus also provides targeted support to those who inject drugs. The activities to reduce HIV among this group include needle exchanges, methadone therapy, “outreach in the drug scene” and counseling.

The organization runs a program, which began in 2014, to educate the younger generation about HIV/AIDS. In the program, a group of social workers gives HIV/AIDS information, life skills education and counseling to students in some of Albania’s secondary schools. Due to the success of the program, the Regional Directorate of Education is bringing similar initiatives to other high schools.

Through the work of Aksion Plus, efforts are in place to prevent, manage and control cases of HIV/AIDS in Albania. In this way, Aksion Plus contributes to the health and well-being of the country’s citizens.

– Olga Petrovska
Photo: Unsplash

HIV/AIDs in Cameroon
One of the most prominent challenges citizens in Cameroon are facing today is the prevalence of HIV/AIDs throughout the country. With the national infection rate being 3.7% in 2021, achieving epidemic control continues to be a constant battle. However, with the help of foreign aid, NGOs and the proactive efforts of the Cameroonian government, the country is making progress toward this goal. Here are the most important things to know about the history of HIV/AIDs in Cameroon and the state of the prevention effort.

History and Demographics

Like many countries in sub-Saharan Africa, there is a higher rate of individuals infected with HIV/AIDs in Cameroon than in most other parts of the world. The earliest reported case in Cameroon was in 1985 and by 1990 the country had an estimated 49,000 infected individuals. This number increased every year until it peaked at an estimated 520,000 cases in 2012. Since then, the annual rate has slowly but steadily declined to an estimated 500,000 cases in 2021.

Though many children have HIV/AIDs in Cameroon, people 15 years or older are by far the most common and represent an estimated 460,000 of the 500,000 currently infected, according to UNAIDS. Within the adult over 15 cohort, women are more than twice as likely to have HIV/AIDs than men.

Prevention and US Support

The first measure the government of Cameroon took to prevent the spread of HIV/AIDs was the establishment of the National AIDS Control Committee (NACC) in 1986. Its function was to facilitate cooperation between prevention efforts nationally. It expanded its efforts further in 2000 when it launched the first of three five-year plans to prevent the transmission of HIV/AIDs in the country.

There has also been a myriad of U.S.-backed efforts to help assist in the prevention effort. For example, in 2008 the U.S. Center for Disease Control and Prevention (CDC) partnered with Cameroon’s Ministry of Health as well as a host of NGOs to assist in the fight against HIV/AIDs. Through this collaboration the CDC aimed at “providing technical leadership on HIV epidemic control efforts within the country” but eventually expanded its operations to also include “direct clinical support” and help “scale-up access to HIV prevention and treatment services.”

Additionally, USAID has backed and helped execute a variety of HIV/AIDs prevention plans in Cameroon through the President’s Emergency Plan for AIDS Relief (PEPFAR). A few of these initiatives are The Continuum of Prevention, Care and Treatment (CoPCT) of HIV/AIDS with Most-at-Risk Populations in Cameroon (CHAMP), Reaching Impact, Saturation, and Epidemic Control (RISE) and Community-Led Monitoring (CLM).

In general, PEPFAR programs aim to mitigate the spread of HIV/AIDs in Cameroon through education, community outreach, reliable data collection and strengthening existing government and non-governmental healthcare agencies.

Looking Forward

Though it may seem like a sign of inefficacy that total infection numbers have only gone down by a small margin since 2012, it is important to remember that epidemics tend to grow exponentially and that the population of Cameroon has been increasing steadily at a high rate for the past several decades. With this in mind, a stagnated or only marginally decreased total infection figure is actually quite an accomplishment, as the government has to account for an enormous increase in population and the spread of infectious diseases is notoriously difficult to subdue.

Further, aid from countries like the U.S. was undoubtedly instrumental in achieving this feat and continued international support will be necessary as the national government continues to battle HIV/AIDs in Cameroon.

– Xander Heiple
Photo: Unsplash

African Governments Combating HIV/AIDS
The threat of the COVID-19 pandemic is still a major problem today. A variety of problems continue to affect the globe, such as poverty and HIV/AIDS, the latter of which has severely affected Africa for years. Globally, estimates indicated that HIV infected 33.9 to 43.8 million people by the end of 2021 and nearly two-thirds of those infected were Africans. However, the situation is far from hopeless as African governments are combating HIV/AIDS and some progress is occurring on that front.

The Current Situation in Africa

According to reports by the Joint United Nations Programme on HIV/AIDS (UNAIDS), new HIV infections have declined by 14% between 2010 and 2015 in Eastern and Southern Africa. Similarly, there was an 8% decline in West and Central Africa. Despite the small percentages, progress is obvious. In 2000, only 11,000 people were getting antiretroviral treatment (ARV) for HIV. Now, more than 12 million people today are receiving the treatment. African governments that are combating HIV/AIDS have also expanded prevention methods to stop the spread of HIV/AIDS. Some of the prevention methods are voluntary medical male circumcision and tests for pregnant women to see if they are HIV positive. Those who are positive receive medicine in order to prevent the transmission of HIV/AIDS to their unborn babies. Hence, there has been a decrease in infections throughout the region.

Despite the progress, the epidemic still severely affects African countries. Poverty and the COVID-19 pandemic only further exacerbate this issue. HIV/AIDS affects the region socially and economically. There are still a large number of people who are not receiving the treatment they need and the cure has yet to emerge. Sub-Saharan Africa suffers the most as it is the world’s epicenter of HIV/AIDS, accounting for two-thirds of the global total of new HIV infections. Progress continues to be slow and multiple challenges remain.

Response and Progress to End HIV/AIDS

Currently, African governments are aiming to put an end to the HIV/AIDS epidemic worldwide by 2030. They have partnered with multiple organizations such as UNAIDS, PEPFAR and other global health organizations to realize this goal. Together, they are working tirelessly to respond and accelerate progress in the continent. Access to condoms and lubricants for men is increasing, programs encouraging changes to sexual behavior are undergoing implementation and affordable methods to prevent infections are spreading.

The United States Global AIDS Coordinator and Special Representative for Health Diplomacy, Ambassador Dr. John Nkengasong launched “Reimagining PEPFAR’s Strategic Direction, Fulfilling America’s Promise to End the HIV/AIDS Pandemic by 2030.” According to UNAIDS, it focuses on key priority areas that include addressing health equity for children, adolescent girls, young women and other key populations. It also focuses on maintaining long-term sustainability, enhancing global health security, nurturing transformative partnerships and leading with science. UNAIDS has reported considerable success in many sub-Saharan African countries. The number of deaths that HIV/AIDS has caused in Sub-Saharan Africa has declined by 35% in recent years.

The Global Mission to End HIV/AIDS

Global efforts addressing the epidemic have shown promising signs. People in resource-poor countries like Africa that are receiving HIV treatment have increased dramatically over the past decade. PEPFAR has provided HIV testing services for more than 50 million people as of 2021. Additionally, 2.8 million babies were born HIV-free from parents living with it. The battle continues as African governments combating HIV/AIDS continue to work around the clock. They are strengthening public health systems and local capacity for preparedness and response to other diseases. Progress may be slow but efforts put forth by various organizations continue to provide promising results. Research is also progressing as many around the globe work to prevent further HIV infection and find a cure someday. So long as Africa and its people continue to fight the good fight, the goal to end the pandemic by 2030 may just be achievable.

– Aaron Luangkham
Photo: Flickr

Japan is an affluent country with an industrious workforce and is one of the world’s largest consumer markets. However, with a 15.4% poverty rate, poverty does exist in the East Asian country. In addition to poverty, HIV/AIDS in Japan is a major concern. Specifically, a significant portion of HIV cases still goes undetected until they progress to AIDS. Japan is working with the United Nations Programme on HIV/AIDS (UNAIDS) to rectify that and to improve HIV/AIDS treatments.

Background on HIV/AIDS

Human immunodeficiency virus (HIV) attacks and weakens the body’s immune system by destroying CD4 cells, which leads to a higher risk of contracting other infections, viruses and diseases, such as tuberculosis and specific cancers. In 2021, 38.4 million people around the world were living with HIV, but only 75% had access to treatment therapy. Of those who were tested in 2021, 15% were unaware of having HIV or symptoms. A key problem in Japan is that the number of people unaware of their HIV status is at least double that rate.

Symptoms of HIV may not be noticeable within the first few months and could be mistaken for influenza. However, as the symptoms progress to having possibly swollen lymph nodes, weight loss, diarrhea, fever or cough, people should take a test to determine the diagnosis. HIV spreads through unprotected intercourse, the sharing of needles and blood transfusions, all due to the sharing of specific bodily fluids.

By using protection during intercourse and not sharing needles, people can prevent HIV spread. If infected people take antiretroviral treatment (ART), they can keep their viral load low and prevent transmitting HIV to others. If they do not use ART, their viral load will rise and HIV progresses to (Acquired Immunodeficiency Syndrome) AIDS. People with AIDS have extremely low immunity and are vulnerable to life-threatening infections. Mothers can take ART to prevent mother-to-child transmission through pregnancy, delivery and breastfeeding.

The State of HIV/AIDS in Japan

The annual number of new cases of  HIV/AIDS in Japan remained relatively flat or slightly declining from 2006 to 2019 at about 1300 cases. Still, HIV/AIDS in Japan is a concern because from 1985 to 2019, physicians diagnosed 19,216 men and 2,523 women with HIV. During the same period, physicians diagnosed 9,646 people with AIDS, and they reported 720 deaths.  In 2019, 72% of the new 903 cases were men who had sex with other men. The majority of these men were 20 to 40 years old.  In the same year, heterosexual contact contributed to 11% of new male cases and 27 of 29 new female cases.

The number of cases undiagnosed as HIV and diagnosed as AIDS is a key concern for HIV/AIDS in Japan. Annually, about 30% of new cases nationwide are diagnosed through AIDS onset which means that they were not diagnosed as HIV cases before they progressed to AIDS. Further, the discrepancy between the number of rural versus urban cases of HIV that have progressed to AIDS before diagnosis has been a concern. In 2009, the discrepancy in rural areas of the Aichi region was almost double that of the region as a whole.  In Sapporo in the Hokkaido region cases diagnosed as AIDS were 27.3% in urban areas and 87.3% in rural areas where tests are less accessible. These discrepancies led the Ministry of Health, Labour and Welfare to call on local governments to implement more HIV testing programs in rural areas.

Progress to Date

In December 2020, UNAIDS launched new HIV/AIDS prevention goals. The 95-95-95 goals aim to ensure that 95% of people living with HIV know their status, 95% of them are on ART and 95% of those on ART to have viral suppression by 2025. Japan is currently working to meet UNAID’s 95-95-95 target. In fact, UNAIDS and Japan’s National Center for Global Health and Medicine (NCGHM) entered into an agreement in 2020 to promote awareness of HIV symptoms and prevention, including a campaign during the 2022 Summer Olympic and Paralympic Games. There is also health insurance and social support in Japan. Third, Japan is testing treatments to find the most effective one. One such drug is Dovato, which is an oral drug available for both adults and children over 12.

While Japan offers doctors and patients a host of the original ART, many of the newer medicines that are available in Western countries and generic ART are not available in Japan at this time. Also, mouth ulcers are one of the first signs of HIV infection, and patients with mouth ulcers have trouble swallowing pills. Pharmaceutical Technology underlined that due to the need to run clinical trials in Japan versus just accepting the results of trials run elsewhere, the Japanese market does not have enough injectable medicines available for these HIV/AIDS patients.

Looking Ahead

It is clear that there is a need to raise awareness of HIV/AIDS in Japan. Early diagnosis and treatment are key. The government’s work with UNAIDS and its treatment testing campaign should help Japan get on track with the 95-95-95 goal.

– Deanna Barratt
Photo: Flickr

HIV/AIDs in BulgariaBulgaria is a country in southeastern Europe bordered by Greece, the Aegean Sea and Turkey to the south, North Macedonia and Serbia to the West, Romania to the North and the Black Sea to the east. Though the fight against HIV/AIDs in Bulgaria has had its ups and downs, the country has made substantial progress during the past 20 years in providing accessible treatment and diagnoses to its citizens.

Demographics

The prevalence of HIV/AIDs in Bulgaria is higher among men than women and new cases are most common in people 30 to 40 years old. By far the most common mode of infection for men and women is sexual contact, representing 89% of all new cases, while the remainder is mostly drug use by a needle. The rate of new cases is also drastically more likely in urban areas, 40% of all new cases being from the capital city Sofia alone. Al Although 17.7% of Bulgaria’s population resides in Sofia, this is still a much higher per capita rate than elsewhere in the country.

History

In 2004, The Global Fund, an international organization sponsored by many private and governmental agencies, provided Bulgaria with significant financial support to expand its fight against AIDS, tuberculosis and malaria. With this money, the Bulgarian Government expanded HIV/AIDs resources through its Health Ministry as well as sponsored many NGOs dedicated to implementing wide-reaching services for HIV/AIDs treatment and diagnosis.

While the steady increase in documented AIDs cases since the Global Fund’s intervention might make it seem as if the problem is actually getting worse, this apparent setback is just a result of more widely available testing and is not necessarily indicative of an increase in HIV/AIDs cases. In fact, these measures were largely effective and continue to contribute to the relatively low rate of HIV/AIDs in Bulgaria.

However, due to the country’s success, in 2014 the Global Fund determined Bulgaria was no longer eligible for aid and by 2017 the government spent the remaining Global Fund money. Due to these changes, many NGOs dedicated to fighting HIV/AIDs have either dissolved or shrunk, Politico reported. While the government is doing well in maintaining treatment and diagnoses for its citizens, NGOs were primarily responsible for reaching marginalized and impoverished communities with on-the-ground testing and prevention efforts and the extent of inclusion of these is difficult to determine.

On the Bright Side

The fight against HIV/AIDs in Bulgaria is largely successful even in the absence of Global Fund support. The rate of diagnoses is only 3.7 per 100,000 people as opposed to the EU average of 5.4 per 100,000 people, making it a success story among eastern European countries. Treatment of HIV/AIDs in Bulgaria is also a success with 98% of its infected population receiving antiretroviral therapy, a marked difference from the 68% world average, Radio Bulgaria reported.

Additionally, according to WHO, due to stigma as well as limited access to resources and transportation, many people simply will not or cannot access the treatment or testing they need. By using private, at-home tests, the experimenters sought to circumvent these factors and it showed many people who otherwise would not have had access utilized the at-home option. Projects like this foreground a bright future in the fight against HIV/AIDs in Bulgaria.

Lastly, after observing several similar instances of countries struggling to transition to the absence of support from the Global Fund, the organization revised its policy to account for an adjustment period. These revisions include “investing in the development of robust National Health Strategies, Disease Specific Strategic Plans… and requirements to ensure that Global Fund financed programs can be implemented through country systems.” With these changes, countries dealing with the same process in the future could be better able to maintain their fight against HIV/AIDs.

– Xander Heiple

Photo: Unsplash

HIV/AIDS in Sudan
The global epidemic of HIV/AIDS began in 1981 and continues as a severe global issue today, especially in developing countries. Citizens of developing countries are at higher risk of contracting HIV due to factors such as having a weak immune system from prior infections, lack of accessible health care and inadequate preventative education. According to a 2020 UNAIDS report, in Sudan, a developing country of 11.19 million, 0.2% of people aged 15-49 are HIV positive, based on 2019 estimates. Not only is the number significantly lower than in Sudan’s neighboring countries such as Kenya (4.2%), Malawi (8.1%), Zambia (11.1%) and South Sudan (2.3%) but the percentage of people with HIV in Sudan is lower than the global average, which stands at 0.7% as of 2021. Not only is this a significant success for HIV news but this statistic breaks stereotypes about HIV in developing countries as well as overall rates of HIV/AIDS in Sudan are generally low.

Sudan’s Culture and HIV Prevalence

Sudan’s 0.2% HIV prevalence rating gives the country a “low epidemic” classification. Within the geographical region, Sudan’s most commonly practiced religion is Muslim, with 91% of the population practicing the religion. The Muslim religion follows the ideology of the absence of sex until marriage. Islamic teachings also prohibit homosexuality, adultery and intoxicants.

A 2004 study by Peter Gray researched HIV prevalence among different religions and Islam proved to have a negative correlation with HIV prevalence. However, despite these stringent rules, HIV still has some prevalence in Muslim-dominated countries such as Sudan. Muslim leaders initially did not see HIV as an issue in their countries, believing that the rules of their culture made it a non-issue.

In some ways, the conservative attitudes of Muslim societies have created additional barriers to addressing the HIV crisis due to prejudices and stigma, leading to a lack of awareness. Fortunately, over the past decade, more Muslim-dominated countries are acknowledging the prevalence of HIV/AIDS within their borders and are taking steps to increase awareness, preventative care and treatment. This is the case regarding Sudan as well.

The Fight Against HIV/AIDS in Sudan

By the latter part of 2016, Sudan decided to adopt the World Health Organization (WHO) “treat-all policy.” According to WHO, this policy means providing each and every person enduring HIV with “lifelong [antiretroviral treatment], including children, adolescents, adults and pregnant and breastfeeding women, regardless of clinical status or CD4 cell count.” The treat-all policy focuses on treating HIV as early as possible rather than waiting for its progression. This treat-all policy is associated with decreased mortality and transmission rates.

The Correlation Between HIV and Poverty

HIV/AIDS and poverty have several links. For instance:

  • Patients with HIV may find that their condition can get in the way of keeping a steady job, thus affecting a country’s employment levels. Research shows that unemployment among individuals living with HIV/AIDS stands between 45% and 65%.
  • People from lower social classes “have delayed treatment initiation relative to more affluent patients, reducing their chances of survival,” said the American Psychological Association.
  • Those living with HIV in lower social classes face higher mortality rates.

Despite being a developing country, Sudan still has a generally low HIV rate. This not only breaks stereotypes but also shows strides in the fight against HIV/AIDS in Sudan.

– Luke Sherrill
Photo: Flickr