30th November, 2007
Reported Improved HIV Prevalence Rates No Excuse for Complacency
The 2007 AIDS Epidemic Update released recently by the United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organisation indicates that global HIV prevalence levels have leveled off, while the number of new infections has fallen.
There are now an estimated 33.2 million people living with HIV, down from 39.5 last year, while the estimates for new infections in 2007 is 2.5 million, less than the 2.8 in 2006, and a significant reduction from the 3.2 million infected in 2001.
According to UNAIDS, the epidemic estimates presented in this year’s report reflect improvements in country data collection and analysis, as well as a better understanding of the natural history and distribution of HIV infection. UNAIDS’ explanation is that the estimates are based on the ‘best available data’, but is this ‘best available data’ good enough to produce reliable estimates?
This may all be considered reason to celebrate as the world focuses on the AIDS epidemic this week. However, the number of AIDS-related deaths has barely changed, declining only slightly in the last two years from an estimated 2.3 million to 2.1 million globally, due in part to the life-prolonging effects of antiretroviral therapy. AIDS is still among the leading causes of death globally and remains the primary cause of death in Africa.
UNAIDS Executive Director Dr Peter Piot believes that the new – and better – figures for declining HIV infections and HIV leveling indicate "a return on investment" in anti-HIV efforts. But AMREF is concerned that the new, and perhaps rather optimistic, figures will divert global focus from critical issues that are still of major concern in Africa, where 68 per cent (22.5 million) of all the people infected with the virus live. With 1.7 million new infections out of a total 2.5 million, sub-Saharan Africa is contributing more than ever to global infection levels and increased deaths as a result of the epidemic. Even with the reported reduction in prevalence, the situation remains worrying. These new figures must not be allowed to breed complacency.
Several pertinent issues still need to be addressed. Less than 50 per cent of those infected receive treatment and care. Women’s vulnerability is another major challenge, because they make up 61 per cent of the people living with HIV in sub-Saharan Africa.. This figure has risen from under 50 per cent about 5 years ago, and the number is still growing. Moreover, there is a growing concern that the marriage institution has become one of the risk factors for new HIV infections, particularly for women, and that marriage is no longer a safe haven for preventing infection. This has major implications for the HIV epidemic in Africa, where marriage is a major factor in the social as well as economic standing of community members, and particularly of women.
AMREF is concerned that the persistently weak health systems in Africa cast a heavy cloud of doubt on the reliability of data used to estimate disease prevalence and incidence. Moreover, community data is not included; most information systems use only facility-based data from hospitals and clinics. Yet in reality Africans do not just rely on the formal health system: Many, often a majority, seek care from informal and traditional health practitioners. This data is not currently collected, and so AMREF is concerned that estimates based only on formal health services cannot give an accurate picture.
AMREF believes that in order to obtain reliable data on HIV/AIDS in Africa and improve the continent’s chances of winning the war against the epidemic, proper surveillance and reporting systems must put in place. The role of community health information systems must be reevaluated in providing more accurate data on HIV/AIDS. Finally, we must redouble efforts to fully understand HIV/AIDS trends on the continent, and the cultural, social and economic factors that influence those trends.
Dr Daraus Bukenya, AMREF's director of community partnering.
Click here to read more about AMREF's work addressing HIV/AIDS