One Geek

Been skim reading the UN AIDS 2008 Report on the Global AIDS Epidemic and thought I’d highlight some of the more interesting things I read in it.

In the countries most heavily affected, HIV has reduced life expectancy by more than 20 years, slowed economic growth, and deepened household poverty. In sub-Saharan Africa alone, the epidemic has orphaned nearly 12 million children aged under 18 years. The natural age distribution in many national populations in sub-Saharan Africa has been dramatically skewed by HIV, with potentially perilous consequences for the transfer of knowledge and values from one generation to the next.
In Asia, where infection rates are much lower than in Africa, HIV causes a greater loss of productivity than any other disease, and is likely to push an additional 6 million households into poverty by 2015 unless national responses are strengthened (Commission on AIDS in Asia, 2008). According to the United Nations Development Programme (UNDP), HIV has inflicted the “single greatest reversal in human development” in modern history (UNDP, 2005).

p15

A recent study in rural South Africa found that each additional year of educational attainment reduced the risk of HIV infection by 7% (Bärnighausen et al., 2007). In particular, schooling offers an excellent means of reducing girls’ HIV risk and vulnerability.

Girls who complete primary education are more than twice as likely to use condoms, while girls who finish secondary education are between four and seven times more likely to use condoms, and are less likely to be infected with HIV (Hargreaves & Boler, 2006).

p69,70

Globally, between 100 million and 140 million girls and women have undergone partial
or total removal of the external female genitalia, or other injury to the female genital
organs for non-medical reasons. An additional 3 million girls are affected each year by
such practices (UNAIDS et al., 2008). In addition to reflecting and reinforcing women’s
subordinate status, female genital mutilation also exposes women to considerable
health risks.

p74

After declining sharply in the 1990s, new HIV diagnoses in Australia have increased, from the 763 reported in 2000 to 998 reported in 2006 (Figure 2.23). There is evidence that the prevalence of unprotected sex between men has increased or remained at high levels in recent years in several cities including Adelaide, Brisbane, Canberra, Perth (National Centre in HIV Epidemiology and Clinical Research, 2007b), and Sydney (Prestage et al., 2006). Unprotected sex between men also could be a factor in Papua New Guinea’s epidemic. When surveyed, more than one in ten (12%) young men said they had had sex with men, and condom use was rare (Maibani-Michie & Yeka, 2005).

p64

“I’m not like other schoolgirls”, says Stephanie, an Australian
teenager living with HIV. “Well, I am… but I also have to deal with
secrecy, discrimination, uneducated attitudes at school, what to tell
my negative friends, and the constant fear of being found out…”

p95

• Young people aged 15–24 account for 45% of all new HIV infections in adults, and many young
  people still lack accurate, complete information on how to avoid exposure to the virus.
• In the last two years, major progress has been made to expand access to services to prevent
  mother-to-child transmission. This progress suggests that in future sufficient financing, commitment,
  and strategic action could render this mode of HIV transmission rare.

p96

• The number of people receiving antiretroviral drugs in low- and middle-income countries has
  increased 10-fold in only six years, reaching almost 3 million people by the end of 2007.
• The rapid expansion of treatment access in resource-limited settings is saving lives, improving quality of life, and contributing to the rejuvenation of households, communities, and entire societies.
• Intensified action is needed to ensure timely delivery of HIV treatment to children, who are
  significantly less likely than adults to receive antiretroviral drugs.
• Globally, coverage of antiretroviral treatment for women is higher than or equal to that of men.
• The populations most at risk of HIV exposure, such as injecting drug users, face considerable barriers to HIV treatment access, often as a result of institutionalized discrimination.
• Low testing rates reduce the impact of HIV treatment, because individuals who are diagnosed late in the course of infection have a poorer prognosis. A number of countries, however, are successfully
  using a range of approaches to increase knowledge of HIV serostatus.
• Despite the existence of affordable medications, too few people living with both HIV and tuberculosis are receiving treatment for both conditions. This situation contributes to substantial, avoidable morbidity and mortality.
• Weaknesses in health-care systems are slowing the scale-up of HIV treatment programmes,
  underscoring the need for intensified action to strengthen these systems. Antiretroviral therapy
  scale-up is helping to drive significant improvements in health-care infrastructure in resource-limited
  settings.
• Among the developments needed to ensure the sustainability of HIV treatment are more affordable second- and third-line therapies, as well as greater success in preventing new HIV infections.

p130

Monitoring for side-effects
Up to half of patients on antiretroviral therapy may experience adverse effects of the
medications (Fellay et al., 2001). Common side-effects vary depending on the drug
regimen, but can include hypersensitivity, lactic acidosis, increases in blood lipids,
bleeding events, anaemia, neuropathy, lipodystrophy, and pancreatitis (NIH, 2008). While
most side-effects diminish over time, some can be life-threatening, underscoring the
importance of careful patient monitoring (NIH, 2008).
As a leading HIV clinician has advised, “The success of [antiretrovirals] comes at a price”
(Lange, 2006). That price is paid by the person taking the drugs. The unpleasant, often
painful, and potentially disfiguring side-effects sometimes associated with the drugs
may have a significant negative impact on quality of life and on an individual’s ability or
willingness to adhere to the prescribed regimen.
Management of side-effects constitutes an essential component of antiretroviral drug
administration. After more than a decade of clinical experience in administration
of antiretroviral drugs, more is known about the side-effect profiles of different
antiretroviral drugs. Improvements in the evidence base have made it easier for clinicians
to prescribe regimens with a greater likelihood of long-term treatment success and to
refine regimens when side-effects emerge. However, management of side-effects can be
more difficult in resource-limited settings, where drug substitution may not always be
feasible due to limited access to the full array of antiretroviral drugs licensed for use in
high-income countries.

p143

About stuff