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AIDS in Eastern Europe and Central Asia
“We all deserve a quality life with HIV and without it,” declared Russian activist Maria Godlevskaya at the International AIDS Conference. Godlevskaya is a loving mother and dedicated peer counselor who has been living with HIV for 18 years. Advances in the prevention and treatment of HIV mean that the number of new HIV infections is decreasing globally. Only two regions lag behind; in Eastern Europe and Central Asia, new cases of HIV are on the rise.

The State of the AIDS Crisis

To combat the global epidemic, UNAIDS has issued “90-90-90 targets” to be reached globally by 2020. The goal is that of all of the people living with HIV, 90 percent should be aware of their status. Of these people, 90 percent should receive treatment. And of those receiving treatment, 90 percent should achieve viral suppression.

Eastern Europe and Central Asia are currently the furthest from reaching this goal. In these regions, 73 percent of people infected with HIV are aware of their status, 36 percent of those people are receiving treatment and 26 percent have achieved viral suppression.

There is no indication that the epidemic of HIV/AIDS in Eastern Europe and Central Asia has even reached its peak. There is, however, hope. By understanding the key populations affected by the epidemic and funding prevention, testing and treatment methods, transmission can be slowed and even stopped altogether.

Advances Against AIDS in Eastern Europe and Central Asia

Currently, only about three percent of HIV/AIDS funding in the region is targeted toward key vulnerable populations, including men who have sex with men, transgender people, sex workers, and people who use intravenous drugs. The stigma against these populations often makes them invisible to the government and to the healthcare system.

About one-third of new HIV infections in Eastern Europe and Central Asia are in people who use intravenous drugs. Fortunately, strategies to reduce the risk of spreading the disease have been helping. Needle-syringe programs are an example of effective harm reduction strategies. They distribute free, sterile needles to drug users.

Additionally, opioid substitution therapy allows drug users to stay away from needle use. The therapy provides methadone, which is taken orally and eases drug withdrawal symptoms. Belarus, Kazakhstan, the Republic of Moldova, and Ukraine have significantly ramped up such harm-reduction programs; as a result, they have seen a decrease in HIV infections among people using intravenous drugs.

Mother-to-child transmission of HIV  has accounted for only one percent of all incidences in 2017. In 2016, the World Health Organization (WHO) declared that mother-to-child transmission was stopped altogether in Armenia and Belarus.

In the fight against AIDS in Eastern Europe and Central Asia, Saint Petersburg has become a model city. As a result of increased funding for prevention initiatives and harm-reduction programs for drug users, the number of new HIV infections has decreased. On a national level, however, the Russian Federation has neglected to fund effective prevention and treatment services.

Grassroots Nonprofits Helping Their Communities

When the government turns a blind eye, ordinary people step up. Maria Godlevskaya founded E.V.A, a nonprofit that advocates for women affected by HIV. From providing peer counseling to helping women communicate with medical officials, E.V.A gives marginalized women hope. The organization is about building bridges from woman to woman and from this network of women to their government.

The fight against HIV/AIDS knows no gender, no race and no age. Adolescents are coming together to fight HIV/AIDS in Eastern Europe and Central Asia. Across the region, 80 adolescents are part of a nonprofit called Teenergizer. They visit local HIV clinics and record any roadblocks to testing they experience. The teenagers then use this information to create an interactive map of testing and treatment facilities for other youth in their region. Teenergizer reduces stigma and empowers youth to take their health into their own hands: as a result of the initiative, nearly two thousand adolescents from Eastern Europe and Central Asia have been tested for HIV.

The crisis of AIDS in Eastern Europe and Central Asia has been bleak, and the future is uncertain. But, the leadership of several countries, nonprofit organizations and dedicated citizens has the potential to crush social stigmas and the associated legislative obstacles to funding prevention and treatment. Armen Agadjanov of Teenergizer affirms that a brighter future is on the horizon. “I’m convinced that the future is in the hands of adolescents—they are the people who will change and build a new world.”

– Ivana Bozic
Photo: Flickr

UNAIDS: Efforts to End HIV/AIDS in East and Southern Africa
UNAIDS is the international movement working to end the HIV/AIDS epidemic worldwide by 2030, which aligns with the U.N.’s Sustainable Development Goals. Its fight against HIV/AIDS in East and Southern Africa has seen encouraging results.

In 2016, UNAIDS created the 90-90-90 targets for 2020, aiming to have 90 percent of all people with HIV know they are HIV positive, 90 percent of those who know their status receive antiretroviral therapy (ART) consistently and 90 percent of those receiving treatment show viral suppression (having no symptoms of HIV/AIDS).

HIV/AIDS in East and Southern Africa a Main Target of UNAIDS

East and Southern Africa is the region of the world most impacted by HIV/AIDS. UNAIDS estimates that 19.4 million people in that region have HIV/AIDS. However, since the creation of the 90-90-90 targets and the subsequent implementation of more rigorous prevention and treatment programs, tremendous progress has been made towards curbing the transmission of and deaths from HIV/AIDS.

These statistics show how East and Southern Africa are faring in each of the 90-90-90 categories:

  1. Knowing Status
    According to a UNAIDS Special Analysis from 2017, in 2016, 14.7 million of an estimated 19.4 million people with HIV/AIDS in East and Southern Africa knew their status. That is 76 percent, up from 72 percent the previous year.
  2. Receiving Antiretroviral Therapy
    Seven million people with HIV/AIDS in East and Southern Africa are on ART. This means that 60 percent of all people with HIV (up from 53 percent in 2015)—or 79 percent of those who know their status—are receiving treatment.
  3. Showing Viral Suppression
    Seven million people on ART in this region show suppressed viral loads. Thus, 50 percent of people with HIV in East and Southern Africa (up from 45 percent in 2015)—which is equivalent to 83 percent of those receiving ART—show viral suppression.

Both the infection rate and death rate from HIV/AIDS are improving. Infection rates peaked between 1995 and 1998, when UNAIDS estimates that 1.7 million people in East and Southern Africa were newly infected each year. The decline began in 1990 and has continued. In 2016, UNAIDS estimated that 790,000 people contracted HIV/AIDS, down from 850,000 a year before.

Deaths from HIV/AIDS in East and Southern Africa peaked about a decade later than infection rates did, with approximately one million people dying annually between 2004 and 2006. In 2010, 720,000 people died from HIV/AIDS. By 2016, that number had dropped by nearly 50 percent to 420,000 deaths. As UNAIDS notes, it is extraordinary to see a death rate cut nearly in half in just six years.

Much of this recent success must be attributed to the work of UNAIDS, which is working to make testing and treatment of HIV/AIDS available to everyone. Its programs specifically target young women, pregnant mothers-to-be and males who, because of the stigma around HIV/AIDS, are often the least likely to receive proper treatment.

Multi-Pronged Efforts Reach Most Vulnerable Populations

Efforts aimed at young females including getting comprehensive sex education into all primary and secondary schools in East and Southern Africa, encouraging girls to stay in school (and away from dangerous sex work), and providing easily accessible female and reproductive healthcare.

UNAIDS is also helping to equip maternity clinics with what they need to ensure that all pregnant women will be aware of their HIV status and are able to get the care they need to have a healthy pregnancy.

Along with working to end the stigma around HIV/AIDS and providing accessible places to receive testing and treatment, UNAIDS aims to distribute 30 male condoms to every man living in the region each year. It also offers voluntary male circumcision programs, which can help prevent female to male HIV transmission.

East and Southern Africa may be the region most affected by HIV/AIDS, but UNAIDS is doing tremendous work towards achieving its 90-90-90 goals by 2020 and its goal of ending the HIV/AIDS epidemic by 2030. Continuing to spread awareness about HIV/AIDS and making testing and treatment increasingly available will ensure that these successes continue.

– Abigail Dunn
Photo: Flickr

90-90-90: A Bold New Goal in the Fight Against AIDSWhen the U.N. met its goal to provide 15 million HIV-affected people with treatment by 2015, it did not pause to celebrate its victory. Two years prior, in 2013, the organization had already crafted a new goal in the fight against the HIV/AIDS epidemic. By 2020, UNAIDS hopes to see a world that has accomplished something miraculous: 90-90-90.

90-90-90 is a target comprised of three interconnected objectives:

  1. By 2020, 90 percent of people living with HIV will know their diagnosis.
  2. By 2020, 90 percent of all HIV-positive individuals who have been diagnosed will receive antiretroviral therapy.
  3. By 2020, 90 percent of all HIV-positive individuals undergoing treatment will achieve viral suppression.

While the plan is straightforward and succinct, UNAIDS has self-awarely deemed it a “bold new target,” which may seem impossible to achieve to some. However, many countries around the globe are well on their way to achieving the elusive 90-90-90.

Most of the nations closest to 90-90-90 are part of the developed world, including Australia, Denmark and the UK. Unfortunately, poverty and weak healthcare systems make developing regions particularly vulnerable to the transmission of HIV. In fact, HIV is the second leading cause of death in developing countries.

HIV is more prevalent in Africa than in any other continent. Since the start of the AIDS epidemic, African countries such as Zimbabwe, Uganda and Botswana have exhibited average life expectancies up to 20 years lower than the rest of the world.

Despite HIV’s lethal presence in the developing world, there are methods that can be implemented to decrease HIV transmission and facilitate treatment in all nations.

In order to increase the amount of HIV-positive people who know their status, HIV testing must become more proactive. Some individuals infected with the HIV virus may not present symptoms and, therefore, will not be tested for the disease and never learn their status. Health campaigns in Uganda have increased their coverage of HIV status by 72 percent, simply by incorporating HIV tests in routine healthcare visits.

In many countries, HIV treatment is flawed due to its reliance on CD4 cell count. CD4 T-cells are the immune cells destroyed by the HIV virus. Ordinarily, HIV treatment is only given to people whose CD4 levels are low enough to put them at risk of developing AIDS. However, without treatment, anyone with HIV can pass on the virus, regardless of CD4 levels.

In 2002, Botswana began offering antiretroviral treatment to anyone infected with HIV. Botswana is now closer to 90-90-90 than almost any other country in Africa.

HIV treatment must be sustained in order to reach viral suppression – the final objective. In the Caribbean, 66 percent of individuals receiving treatment attain viral suppression. The ability to ascertain viral suppression status is reliant on viral load testing, which analyzes the amount of the HIV virus in the blood. Unfortunately, the medical technology required for viral load testing is not easily accessible throughout the globe. Recent data shows that the ability to perform these tests will likely inhibit viral suppression in the developing world. However, the work of the Diagnostics Access Initiative, which creates sustainable medical labs, has successfully decreased the global price of viral load tests by 40 percent, which will make them more accessible in impoverished regions.

While 90-90-90 may seem like an ambitious or overly optimistic dream, the methodology of efficiently diagnosing and treating HIV has proven successful in many countries. If strategically implemented on a global scale, these methods could feasibly eradicate HIV/AIDS and eventually heal the world of this epidemic.

Mary Efird

Photo: Flickr

Eliminate AIDS

Thailand has recently launched a new national strategy, with the goal of eliminating AIDS as a public health threat by 2030. The plan, devised by the Ministry of Public Health, aims to use rigorous strategy of detecting, treating and suppressing the AIDS virus within the infected population.

The first step of the plan aims to meet the global 90-90-90 goal by 2020, where the first 90 percent of people who have AIDS are informed of their infection. This 90 percent of infected people should then have access to, and begin, treatment. Then, 90 percent of people who have received treatment are fully virally suppressed. This breakdown provides realistic goals for the plan’s execution.

This plan is targeted to the key demographics among which the HIV rate is the highest. Thailand’s government is committing full efforts to providing the citizens with prevention and outreach programs in highly infectious areas to help inform and protect the uninfected populations.

One of the further goals of this plan is to eventually include hepatitis C, tuberculosis and other infectious diseases as serious public health issues to be resolved within Thailand. The U.N. Programme on HIV/AIDS (UNAIDS) firmly believes in Thailand’s plan, as its pilot tests have resulted in an excellent effective rate. Because of this, UNAIDS would like to implement the plan in more nations dealing with similar situations.

The initial segment of the plan – encompassing 2015 to 2019 – is dedicated to the testing of new measures as well as setting up new two-way coordination frameworks for the execution of the rest of the plan. This segment includes a majority of pilot testing, where the results of the data collected would help to produce the next plan segment.

While Thailand is pioneering new widespread measures to eliminate AIDS, their groundbreaking work will be a stepping stone to the elimination of AIDS in the nation. With massive organizations, such as UNAIDS, working alongside them to study and develop solutions, there is a lot of promise in the eventual elimination of the global AIDS issue.

Rebekah

Photo: Flickr