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HIV in Africa & Caribbean
  Zim HIV infection rate declines: UN
Herald Reporter
ZIMBABWE has become the first Southern African country to record a decrease in the rate of HIV infection in the period between 2002 and 2004, the United Nations Programme on HIV and Aids Prevention (UNAIDS) revealed this week.
According to a report presented by the UN agency in New Delhi, India, on Monday, Zimbabwe had a five percent decrease while Kenya, the second country in the Sub-Saharan region to record a drop in the HIV infection rate, saw a decline of three percent.
The report, compiled by UNAIDS in collaboration the World Health Organisation (WHO), attributed the decrease to sexual behavioural changes - including increased condom use, abstinence and having fewer sexual partners - and access to HIV information and people availing themselves to voluntary testing.
This is the second time a decrease in HIV infection rates has been recorded in Africa following the dramatic reversal of transmission achieved by Uganda 10 years ago through a sustained public Aids awareness programme taking in all age groups.
Besides Zimbabwe and Kenya, HIV infection rates have also gone down in Brazil, Thailand and the Caribbean.
Of the five Caribbean islands, Haiti, once the worst affected, has seen the transmission rate scaling down to 3,7 percent from nine percent in 2004.
Despite these welcome changes in Africa and other regions, the report noted that from overall trends HIV transmission was still increasing and that far greater HIV prevention efforts were needed to slow the epidemic.
Most affected parts are Eastern Europe, Central and East Asia, where increases of about 25 percent (translating into 1,6 million new infections) were recorded in the last 10 years.
According to the report, unlike in Tanzania, Kenya, Zimbabwe, Uganda, Thailand and India where intensive and sustained prevention programmes yielded positive results, this was not working in Europe and Asia because of the prevalence of prostitution and abuse of injectable drugs.
The report noted that in 2005 the number of infected people worldwide had risen to 40,3 million - half of them women - with 64 percent of them living in Sub-Saharan Africa.
This means there were five million new cases of HIV infection, upward from about 37,5 million people that had the virus in 2003 and over half of these are between 15 and 24 years of age
Revealingly, two-thirds of these infections were in Sub-Saharan Africa where knowledge of safe sex in countries such as Nigeria, Senegal, Cameroon and Cote d'Ivoire was lacking.
It was also observed that HIV surveillance in several regions - including some countries in Latin America, the Middle East and North Africa - was hampering prevention efforts reaching sex workers and drug users.
Globally, about three million people have so far died of Aids-related illnesses, 500 000 of them being children.
The report, however, recognised that access to HIV treatment had improved considerably over the past two years with more than a million people in low and middle-income countries now undergoing anti-retroviral therapy thereby preventing a possible 350 000 deaths.
WHO director-general Dr Lee Jong-wook said during the launch of the report that there was need to integrate prevention and treatment.
"We can now see the clear benefit of scaling up HIV treatment and prevention together and not as isolated interventions.
"Treatment availability provides a powerful incentive for governments to support and individuals to seek out HIV prevention information and voluntary counselling and testing.
"Effective prevention can also help reduce the number of individuals who will ultimately require care, making broad access to treatment more achievable and sustainable," he explained.
UNAIDS executive director Dr Peter Piot said despite the progress made in some parts of the world, HIV was still difficult to control.
"We are encouraged by the gains that have been made in some countries and by the fact that sustained HIV prevention programmes have played a key part in bringing down infections.
"But the reality is that the Aids epidemic continues to outstrip global and national efforts to contain it," Dr Piot said.
Caribbean HIV rate levels off
HIV/AIDS continues to spread in the developing world, but the number of those living with the disease in the Caribbean has steadied, a new report has found.

Miami Herald
Wed, Nov. 23, 2005
An otherwise bleak new report on the global AIDS epidemic delivers this encouraging news: The spread of the disease may have plateaued in the Caribbean.
The number of people living with HIV and the number of people dying from AIDS is holding steady in the region, even as caseloads increase in every other part of the developing world. The news is particularly heartening because the Caribbean has long had the highest rate of HIV and AIDS outside sub-Saharan Africa.
Perhaps most encouraging are long-term declines in Haiti, the hemisphere's hardest-hit country.
"This is tremendous," said Dr. Jean William Pape, who has treated AIDS in Haiti for more than 20 years. "We have everything - bad political situation, terrible economic conditions, high risk of sexually transmitted disease... If you put it all together, the fact that this was reversed is remarkable."
HIV cases and AIDS deaths increased in Latin America, though rates there remained far lower than in the Caribbean.
Several factors have driven the decline in Haiti, including widespread education programs, new clinics, an infusion of international aid, and an early recognition that a commercial blood bank was distributing tainted blood.
The nation's infection rate remains high - about 3 percent of the adult population has HIV, five times the rate in the United States. But that is down from roughly 5 percent in the 1990s, according to an estimate by Eric Gaillard, a Port-au-Prince researcher funded by USAID.
AIDS remains the leading killer of young adults in the Caribbean. The region's overall infection rate is 1.6 percent, but rates vary widely from country to country.
The new report, released Monday by the United Nations and the World Health Organization, does not give a full country-by-country breakdown. But it does say HIV rates are over 1 percent in Barbados, the Dominican Republic and Jamaica, and over 2 percent in the Bahamas, Guyana, and Trinidad and Tobago.
In Cuba, by contrast, the rate remains below 0.2 percent, by far the lowest in the region. A UN assessment credited the nation's long-standing treatment, education, testing and research programs. But the country has been criticized for forcing AIDS patients to leave their homes and live in isolation.
But the rate of new HIV infections in Cuba, though still low, is rising, possibly as a result of a growing sex industry, according to the report.
Elsewhere in the region, several factors appear to be slowing the spread of HIV. Among the shifts singled out in the report: better care for HIV-positive pregnant women in the Bahamas, more voluntary counseling and testing services in Barbados, and widespread condom use among prostitutes in Santo Domingo.
Dr. Michel Dodard, a Haitian-born UM physician who helps run a medical center in Cap-Haitien, said broad cultural shifts have helped fuel declines in Haiti.
"There is clearly a better educational effort that's being made, better acceptance of things like use of condoms," he said. "You can see, even when you drive in the country, advertisements for condoms, which at one time was not culturally acceptable."
The stigma of being HIV positive is also declining, Dodard said.
"The ostracism is not completely gone, but you find more and more people willing to talk about it and going for testing," he said.
Two decades ago, in the earliest days of the AIDS epidemic, the United States Centers for Disease Control and Prevention identified four groups at high risk: gay men, intravenous drug users, hemophiliacs and Haitians.
The designation "created a real blow to national pride," Pape said. But it also led to the formation of institutions to study and treat the disease.
"It created a national reaction against what appeared to be discrimination," he said.
These institutions persisted after the CDC took Haitians off the high-risk list, and they have survived the country's instability.
"For my country, the fact that we can stand up and fight against this disease has been extremely important," Pape said. "I can tell you for sure, we will control AIDS here."
In Central and South America, according to the report, the infection rate is 0.6 percent, comparable to the rate in North America.
Within the region, the epidemic is most intense in Belize, Guatemala and Honduras, all of which have infection rates of 1 percent.
In raw numbers, Brazil, Argentina, and Colombia have the largest share of the region's 1.8 million HIV cases.
In Brazil surveys suggest teenagers are having sex at earlier ages and with more partners, the report said. One survey of 15-24-year-olds found that only 62 percent knew how HIV is transmitted.
In Argentina, most new infections are coming from unprotected sex between men and women, with women bearing a growing share of the burden. In 1988, women accounted for one in 16 AIDS cases; in 2004, they accounted for one in four.
Increasing numbers of women are being infected in Colombia, as well, particularly along the Caribbean coast and Northeast.
Two-thirds of people with HIV live (Africa) in the Commonwealth
Cynthia Busuttil
A staggering 72 per cent of women living with HIV come from Commonwealth countries, a symposium on global health organised yesterday as part of the Commonwealth People's Forum, heard.
Every year AIDS claims the lives of 10 times more people than were killed in last year's Boxing Day tsunami.
In many Commonwealth countries the HIV/AIDS reality is stark: two-thirds of the odd 40 million HIV infected people in the world are Commonwealth citizens.
The epidemic is ravaging some countries. In Botswana the life expectancy is just 27 years and in Zambia whole forests have vanished so that the wood could be turned into coffins.
For many women living in developing countries marriage puts them at risk of contracting the infection, Alice Welbourn, the chairman of the board of trustees of the International Community of Women Living with HIV/AIDS said.
She said most of the ICW's members, women living in 130 countries, had no idea that they had been at risk of contracting the infection, let alone that they were actually infected. Most had no say as to whom they had sex with, when they had sex and had no option of choosing safe sex practices.
"Most acquired the virus through unsafe sex in their own marriage bed," she said.
Young women, she said, are especially vulnerable, through physical factors, through their lack of education and their poor social, legal and economic status in society.
"Many are subject to violence, abuse and exploitation, all of which increase their risk of HIV infection," she said. Dr Welbourn pointed out that 76 per cent of young people with HIV in sub-Saharan Africa are girls. Dr Welbourn was diagnosed with HIV in 1992 and can therefore associate with other female sufferers.
But she admitted that the difference between her and other HIV positive women living in developing countries was substantial.
"I am healthy because of good care, good nutrition and access to antiretroviral drugs since 2003. But many other HIV positive women in the world, many from Commonwealth countries, are living a very different reality."
She said the lack of enough food in many countries was a problem.
"Even I feel sick if I take drugs without enough food in my stomach, and I am certainly not undernourished," she said.
Richard Scheffer, the chairman of the Advocacy Committee of the UK Forum for Hospice and Palliative Care Worldwide, spoke about the importance of palliative care for all sufferers of life-threatening diseases, including HIV and AIDS.
He said the goal of palliative care - a treatment that provides symptomatic relief but not a cure - was to improve the sufferer's quality of life.
It was needed from diagnosis to death but it was not just going to happen - it needed to be included in governments' health policies.
Commonwealth Secretariat deputy Secretary General Winston Cox said although progress has been made to treat illnesses in Commonwealth countries, more funding was necessary.
He mentioned the influenza pandemic, which experts are saying could hit at any time, and spoke of the possible loss of life in Commonwealth countries, especially those affected by poor nutrition and HIV/AIDS.
With regard to the Commonwealth Heads of Government Meeting, Mr Cox said: "Malta is where Africa and Europe meet; it is a well-chosen spot for CHOGM".
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