In addition to the individual suffering and deaths, HIV/AIDS is a huge drain on the world’s health care and other resources. According to one study, the AIDS epidemic in India, if it continues at its present rate, threatens to pull down the gross domestic product of that country by at least one percentage point.
Countries, as well as individuals, frequently take a moralistic approach: outlaw homosexuality, outlaw prostitution and prohibit adolescent sex and sex outside of legally sanctioned relationships. In reality, behaviors are difficult to change. Prohibition–no matter how stern–has an inhibiting effect mainly on those who have little or no risk anyway.
African nations such as Kenya, Uganda and Zimbabwe and many Caribbean nations have been successful recently in curbing the prevalence of AIDS. Togo, a small West African state, reported that it nearly halved its HIV/AIDS infection rate during the past year–from six percent of adults to 3.2.
Of the 18,000 AIDS patients in Togo needing antiretroviral treatment, however, only 5,400 are getting it. The lower infection rate may be due in part to increased deaths of AIDS patients.
Other African countries are witnessing dramatic increases, with the HIV/AIDS infection rate approaching 40 percent of the population in some countries. Eastern Europe and central Asia are also experiencing sharp increases in infections.
Spread Is Swift
HIV typically hits first and hardest at those in high-risk situations–commercial sex workers, men who have sex with men, intravenous drug users and prisoners. When these segments of the population are ignored, the disease branches out quickly to the population at large.
Uganda is often used as an example of a government that responded effectively with harm reduction and risk reduction strategies when AIDS was spreading rapidly through its population in the late 1980s.
A national media campaign included the use of posters, radio messages and rallies. Teachers, churches and community leaders were mobilized to reduce the stigma and encourage discussion about HIV and AIDS. Efforts were made to improve the status of women, so they are less likely to be intimidated into making unsafe sexual decisions, and to provide better testing and treatment facilities for all sexually transmitted diseases (STDs).
Botswana achieved public awareness with the slogan, used on billboards throughout the country: “Avoiding AIDS is as easy as ABC: Abstain, Be faithful, Condomise.” In practical terms, that means teaching youth to abstain or delay first sex; be faithful to one’s sex partner or reduce the number of partners; and use male or female condoms consistently and correctly.
As with delaying first sex and being faithful to one’s sex partner, consistent use of condoms is easier said than done. Young people–and old–need to be taught strategies for countering resistance and be sure that a condom is available when things get steamy. Discussion about condoms–and about HIV status–should begin before entering the bed room.
Latex condoms are generally more reliable (as well as less expensive) but should only be used with water based lubricants rather than Vaseline or cold cream.
It was once believed that the spermicide Nonoxynol 9 protected against HIV and other STDs, but studies have shown it to be ineffective. Nonoxynol 9 may even increase the risk of transmission somewhat by causing an allergic reaction. It should definitely not be used for anal sex.
HIV is passed through blood as well as sexual exchanges, so a safe blood supply is crucial in any community. That is generally not a problem in the United States.
Intravenous drug users must be taught about the dangers of sharing needles, syringes and other equipment. As with sexual behavior, change is never easy, but methadone and other drug treatment programs can help. In addition to distributing clean needles and safely disposing of used ones, needle exchange programs usually offer other preventive services such as counseling and referral to drug treatment and HIV screening programs.
Individuals who have had other STDs are at increased risk of HIV infection, so sexually active individuals should have ready access to discreet, non-threatening screening for STDs. One doctor routinely asks patients, “Is there any reason I should test you for STDs?” Once HIV is detected, a person requires counseling about treatment options and ways to avoid passing the infection to others.
The good news is that HIV is no longer a virtual death sentence. With antiretroviral therapy, hospitalizations for HIV-related illnesses are steadily declining–reaching a record low of 70,000 in 2005. In one study of 1504 men and 461 women monitored after an AIDS diagnosis, 50 percent survived more than 16 years.
The bad news is that the success of therapy is leading many individuals to increase their high-risk behaviors. In 2000, only 11 percent of gay males with AIDS in Los Angeles reported not using a condom; in 2003, that number had ballooned to 26 percent. The rate of unprotected anal sex among males in San Francisco increased from 42 percent in 1997 to 67 percent in 2003.
An increasingly popular practice involves partnering–and unprotected sex–among HIV-positive persons. The danger is that new, resistant strains of the virus will develop.
UNAIDS, the United Nations agency coordinating the battle against AIDS, is beginning to see signs of success. One major obstacle is having the money to get antiretroviral treatment to millions of patients worldwide. The other is convincing those who are getting effective treatment that this is not the time to get complacent.
