Today, I’d like to share a few updates on HIV/AIDS. Uganda has backslid against the epidemic, according to advocacy organizations in the country. A review published in the British Medical Journal finds that methadone therapy for injecting drug users more than halves the risk of HIV transmission. And we are about to face a new challenge: an aging population of people living with the virus.
Advocacy organizations in Uganda have published a report calling for a more aggressive plan on HIV/AIDS in the country, according to Ugandan daily New Vision. The organizations found that HIV prevalence in Uganda has risen about about one percent since 2006, while other countries receiving United States PEPFAR funding have seen declines. Access is still a major issue–43 percent of Ugandans in need of antiretroviral therapy (ART) have not, or cannot, access the required drugs. Furthermore, public policy has had a negative effect on the epidemic. Marginalized populations, including sex workers and men who have sex with men (MSM) are not receiving adequate support to prevent, diagnose, and treat HIV. Homosexuality is a particularly volatile issue in Uganda. A law that would allow people to sue others for transmitting the virus to them–which puts women, who are more routinely tested during ante-natal visits, for example–at a disadvantage. The ten-point plan calls for more support to marginalized populations, shoring up the health system (including linkages between clinics and home care and better follow up procedures), changes to public policy and legislation, and expanding male circumcision.
According to a review published in BMJ, opioid substitution treatment (or methadone treatment) among injecting drug users offers a major risk reduction in HIV transmission – estimated at 54 percent. With prevalence among injecting drug users as high as 40 percent, this is an important finding. Methadone treatment leads to lower rates of injection and sharing of needles, as well as better adherence to ART, all of which reduce the risk of infection. However, many countries do not offer or have outlawed methadone as a treatment for drug users (such as Russia, which has a major HIV epidemic), and only 6-12 percent of users are receiving it.
The Agence-France-Presse reported this week that sub-Saharan Africa will face a 200 percent increase in the number of older people with HIV in the next 30 years, from three million to more than nine. ART has made life expectancy much longer for people with the virus. This aging cohort presents new challenges. Older people are less likely to have extensive knowledge of HIV prevention, since most public health campaigns have mostly focused on people under the age of 50. Since they are not a focus, there is not much data to give a clear picture of the current prevalence of HIV and the needs of older people. There’s no doubt that this will emerge as a significant issue in the years to come, as access to drugs, with hope, increases.
Photo credit: Jayel Aheram, via Flickr, CC BY 2.0.