Researchers and HIV Santuaries Need Smart Innovations For AIDS Eradication

HIV/AIDS has had a devastating impact on the socio-economic growth of the world in the last three decades, leading to the loss of life, increase in the number of orphans all over the world, the increase in the number of child-headed families, reduced labour supply, reduced labour productivity etc., though quantifying the impact may not be so easy, but it has had gross implications on the socio-economic and political set of many nations especially the developing ones. The macroeconomic effects of HIV/AIDS in the world but most especially in Africa are substantial, and policies for dealing with them may be controversial - one is whether expensive antiretroviral drugs should be targeted at economically productive groups of people. Four million
people died from AIDS in 2014, making it the world's fourth biggest cause of death, after heart disease, stroke, and acute lower respiratory infection. Over 70% of the world's 40 million people living with HIV/AIDS are in Africa. Besides the human cost, HIV/AIDS is having profound effects on Africa's socio-economic and political development and hence its ability to cope with the pandemic. While the impact of HIV/AIDS on people may be well documented, it has been much more difficult to observe the pandemic's effects on the African political economy as a whole or to assess how it might affect Africa's future development. Nevertheless scientists, researchers and medical professionals have dedicated a lot of time and money on various inventions, innovations and research experiments to understand these broader causes and effects of the HIV/AIDS pandemic in order to form effective policy responses aimed at eradicating it. But what went wrong?

A goal-directed research sanctioned by the Global Healthcare & Education Initiative-Uganda Chapter (GHEI-Uganda) focusing on the progress of HIV/AIDS prevention, control, treatment and positive living, found out that with or without treatment, prevention must remain a priority for most developing countries, emphasizing the need to address gaps in HIV prevention and implement interventions which have the highest impact, such as making condoms available, ensuring injections and blood safety, behavioral change campaigns to address risky sexual behaviors and stigma. According to Mr. Kasozi Dickson of GHEI-Uganda, "to reduce new HIV infections, adolescent girls, young mothers and key populations must be placed at the centre of the response. Intensive focus is needed to improve their access to sexual and reproductive health services. Antiretroviral therapy and voluntary male medical circumcision need to be scaled up, along with powerful prevention strategies such as pre-exposure prophylaxis for high risk populations. For testing HIV, we need to explore new ways of delivering HIV testing services including the potential of self-testing". The same report of GHEI-Uganda indicates that the success we have achieved so far gives us hope for the future, but as we look ahead, we must remember not to be complacent. AIDS is not over but it can be.

Fundamental political, financial and implementation challenges remain, but we should not stop now. It is time to move forward to ensure that all children start their lives free from HIV, that young people and adults grow up and stay free from HIV and that treatment becomes more accessible so that everyone stays AIDS-free. Henceforth, we all share the challenge to ensure that those who are identified to be HIV positive are initiated on treatment. The full benefits of HIV interventions and services are not being realized in many areas of Africa. There are many people living with HIV who are unaware of their HIV status. In addition, there are so many people living with HIV who are not accessing antiretroviral therapy. Discrimination, Stigma, gender inequality and gender base violence continue to hinder their access to health services particularly for children, adolescents, young women and key populations most at risk". Therefore, the responsibility to end HIV and AIDS rests on each of us. We need to scale up social behavioral change communication programmes, through the use of multiple communication channels that include print media, social media and interpersonal communication initiatives.

Optimism has never run higher that the AIDS epidemic can be defeated. Effective medications have reached millions of people worldwide over the past decade, and new research also suggests that even more investment in distributing HIV drugs might help slow the disease's spread. More success has been realized in countries like South Africa, Botswana, Malawi, Uganda and Ghana. We should all aim at putting an AIDS-free generation on the horizon.

But for those living in the hardest-hit parts of Africa, there are risks in the policy shifts underway in Washington and other Western capitals. The rising enthusiasm for providing more medicines threatens to come at the expense of promising initiatives for preventing HIV infections in the first place - initiatives that could save many lives, with less money. Ambitious treatment efforts and smart prevention programs are, of course, not inherently at odds. But especially in an era of fiscal constraint, these two goals could come into conflict. The result, wasteful in dollars spent and lives diminished, would represent only the latest misjudgment by powerful donor nations such as the United States, which still struggle to understand the root causes of an epidemic that has spread most widely in weaker, poorer nations.

In Africa, the most important cause of the epidemic is sexual cultures in which it's not unusual for people to have more than one partner in the same week or month. Sound strategies for stemming the spread of HIV would pay particular attention to those places where Africans themselves - in nations such as Uganda, South Africa, Botswana and Zimbabwe-have reversed the epidemic and saved millions of lives by changing sexual behavior.

The growth of sex work is often cited as the key element of the epidemic. But even more consequential was a shift away from traditional polygamy - common across much of Africa but scorned by Christian missionaries - toward more informal relationships. In these, men often had one wife but maintained secretive and less permanent relationships with other women. And with their husbands often spending months at a time working at far-off mines, plantations or factories, wives increasingly took sex partners outside of marriage.

The changing sexual mores alarmed colonial officials, who worried about the future of the workforce as birth rates plunged from the ravages of syphilis and chlamydia. In the Belgian Congo, a levy was imposed on all single women to encourage monogamous, Christian-style marriages. Instead, a new, freewheeling sexual culture took hold, one efficient at spreading disease.

Another factor was also crucial. The ancient ritual of circumcising boys was as essential to most African societies as it was to Jews and Muslims; on most of the continent, nearly all men were circumcised. Though no one knew it at the time, the simple absence of foreskins - the parts of men's bodies that were often infected - was a powerful drag on HIV's spread. Yet some ethnic groups, mainly in southern and East Africa, did not circumcise, and others saw the tradition fade away, often under the influence of Westernization. The way could be cleared by encouraging safe medical male circumcision. Post-colonial sexual practices and low circumcision rates combined to create an explosion in the AIDS epidemic. Perhaps one out of 100 adults in colonial Congo, where men were circumcised, contracted HIV. In countries such as Zimbabwe and Botswana, where few men were circumcised, the virus would eventually infect about one in four adults.

As we remember, President George W. Bush's $15 billion commitment to fighting the epidemic overseas was a turning point in the drive to get AIDS medicine to nations that couldn't afford it. President Obama also oversaw an expansion of funding and a focus on providing drugs and other biomedical tools for fighting the epidemic. All these efforts are doing wonders in Africa up to today. Of course, AIDS drugs do not cure the disease; recent estimates suggest that even well-treated patients may have their life spans shortened by about a decade. Still, these treatment initiatives allow many people with HIV to live much longer, better lives.

On the prevention side, however, the United States and other donors have fallen short. Part of the problem has been the polarized nature of AIDS politics, with its battles over condoms vs. abstinence. Few outsiders - not the U.S. government, the United Nations, religiously based charities, or even the Bill & Melinda Gates Foundation - have made impressive gains in preventing the spread of HIV among adults, despite massive investments of money and political will. For AIDS experts and policymakers, the long-standing frustration with donor-funded prevention campaigns has fed the excitement about new science on the power of drugs to slow the spread of HIV. People treated effectively are much less likely to pass the virus to others, and healthy people given a daily, low-dose regimen of medicine are less likely to contract HIV.

These breakthroughs have raised hopes that further widening access to AIDS drugs is the key to reversing the epidemic's march. With all such endeavors in practice, can we say that it is time to consider shifting funding from AIDS programs that seek to alter sexual behavior toward those that expand access to drugs. Western policymakers call this approach "treatment as prevention," while some activists go further, saying "treatment is prevention." But the relationship between treating AIDS and preventing HIV infection is hardly so simple, and the enthusiasm inspired by "treatment as prevention" already is sapping resources and energy away from some other initiatives for fighting the disease. It's also not clear that, even with massive new investments, the drugs can reach enough people to cause meaningful declines in HIV's spread. Even in the United States, with a medical system far superior to any in Africa, most people with HIV are not in treatment or are not taking drugs consistently enough to suppress the virus to the point where the risk of transmission is significantly reduced.

When debating how to prevent HIV, liberals like to talk about condoms, while conservatives often talk about abstinence. Yet the track record for both ideas has been disappointing. Reported condom usage rates soared in many parts of Africa years ago, but HIV infection has remained high, probably because they are not consistently used in ongoing sexual relationships. Abstinence programs have prompted some teens to delay sexual activity, but only briefly, typically pushing the risk into the future by a year or less. Both sides often fail to emphasize what some Africans in the hardest-hit countries have brought up when discussing how to stop the AIDS epidemic: having fewer sexual partners. Africans know that polygamy is part of their culture; Swaziland's king, for instance, has 14 wives and counting. They also know that modern variants of polygamy, in which both men and women have a spouse and another partner or two, are even more common. The connections between such practices and the spread of sexually transmitted diseases are unavoidable.

Virtually every place in Africa that has seen a major drop in HIV infections also has seen a significant decline in the frequency of multiple sex partners. Uganda in the late 1980s had a famously effective program, called "Zero Grazing," in which cultural and political leaders urged people to not stray from their primary relationships. But there have been other successes, typically led by churches, popular singers and occasionally even politicians. The message is easy to grasp and, to many Africans, more appealing than admonitions about abstinence or condoms. Of course, many already have monogamous relationships, or in some cases none at all, because of the fear of AIDS. But if those with multiple relationships pare down their number of partners, the sexual networks that spread disease will start to break apart, and the pace of new infections will slow. Keeping sexual behavior at the center of the conversation about preventing HIV is essential to reversing the spread of the virus. Only in this way can the vision of an "AIDS-free generation" as championed by UNAIDS will someday become reality.

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