The Magnitude of the Problem: Human Immunodeficiency Virus - Essay Example

The magnitude of the problem: an overview HIV (Human immune deficiency virus) is the virus that leads to AIDS (Acquired Immune Deficiency Syndrome). But these medical terms can’t envelope all the symptoms and stretches of this disease. For, one, it is a sure death disease, with no known cure. The treatment available simply aims at slowing down the growth of the Virus, but can not eliminate it. It never hurts anybody individually. It comes from the community and spreads into community. Still, it is unlike most of the other common epidemics. Furthermore, HIV is transmitted vertically as well. The nature of the causative agent, the Virus, makes the AIDS epidemic uniquely difficult to control. The virus attacks and resides in the immune system and hides in cellular sanctuaries. It has an extreme ability to mutate to avoid immune control and to develop resistance to anti-retroviral drugs. As if it is not enough, it has several social, psychological, behavioral, political and economic coats. That too, both at micro and macro levels. For example, It is a sexually transmitted disease, besides scores of other routes of transmission. And sexually transmitted infections are notoriously difficult to control. Syphilis is still rampant in many parts of the world after 500 years and in spite of efficient and low-priced treatment since long. On the other hand, at macro level, as the governments and societies are bound to act on it, and that carries devastating social and economic consequences. In many societies, it preys on the bread winners, leading to similar devastating social and economic consequence at the micro level. It has become a geopolitical threat of prime importance. It has been placed on the agenda of the UN Security Council and the General Assembly. According to the Millennium Goal further spread of HIV should be stopped by 2015. Primarily it was deemed as the African problem, but now no region is free from it. In 2004 about 35,000 new HIV infections occurred in Western Europe and 45,000 occurred in North America. That is in spite of the wide use of propaganda for prevention. The pandemic is continuing unabated with some five million new infections and three million fatal cases per year. Forty million are currently living with HIV/AIDS in the world and 30 million have already died. Another 45 million is predicted to be HIV infected within the next ten years.1 The available anti-retroviral treatment is not adequate. Prevention is the only thing human kind can do as of now. Medical research communities all over the world are trying best to develop some kind of an effective vaccine, and we are still hoping for one. Even if such a vaccine is developed, it is bound to be mired in the issues of pricing, patents, IPRs and availability. The law, and crime in Europe On 4th August, 2006, a gay man was sentenced for "recklessly" transmitting HIV to a sexual partner in UK. Prior to that, since 2003 seven more people were convicted in England and Wales, they were heterosexuals, and each of them received a substantial sentence. In recent years, there has been substantial and clear indication that prosecutions for HIV transmission have been on the increase across Europe - most noticeably in a series of cases in Finland, the Netherlands, Sweden, and the UK. During this same period, HIV incidence and prevalence has increased. Although no law to this effect was enacted in UK, but the courts have turned to 19th-century law to put people behind bars. Besides infringement of the human rights of people living with HIV or AIDS, such punitive actions may be increasingly seen within the new legal framework of an enlarged European Union. It is found that in 41 EU countries, at least 130 people have been convicted for transmitting or exposing another person to HIV infection. 2 The point is, what purpose will it be serving, and, more importantly how does the society reflect on it? Here comes the question of stigma. Throwing people into prison for HIV transmission can make the situation even worse. Not only inside the prisons, but more significantly, outside. Failure to reveal to sexual partner about one’s HIV positive status may have little to do with the malicious designs, but more with the stigma attached to the infection and the consequent discrimination. Scared people might be feeling safer in denial, they may be poorly equipped to discuss their infection. But above all, there is the hounding apprehension that the revelation of the status can reach among friends, neighbours, church, community and office. There may be a real fear of domestic violence, assault, eviction, and separation from children. Although there has been limited studies on the levels of stigma and discrimination in Europe (no European Union-wide organisation or forum dealing with HIV criminalisation issues so far). Yet, the issue is very pertinent. The very fact that criminalisation is singularly for HIV cases, makes it is ‘state recognised case of stigma and discrimination’. Along with the numbers and sentences, the debate is also surging. In order to assist in the development of sound public policy and law on the question of criminal law and HIV and AIDS, UNAIDS produced in 2002 Criminal Law, Public Health and HIV Transmission: A Policy Options Paper.3 The paper identified a number of public policy, public health, human rights and legal considerations that States should take into account when making decisions about the use of the criminal law in the context of HIV and AIDS. It recommended that criminal law should only be used in certain kinds of cases as a last resort after public health laws and policies have failed to achieve the desired goals. A study on criminalisation of HIV transmission in Europe was conducted by Terrence Higgins Trust and GNP Europe. Out of 41 countries responded to the study, in at least 36 countries the actual or potential transmission of HIV can constitute a criminal offence. In 21 of these countries, it was reported that at least one person has been prosecuted.4 Understanding the threat: the European risk! The fear that people in the western world still do not understand the impact of the pandemic HIV is not totally unfounded. From public perception to government policies, the notion of about "us" and "them" relating to Aids can still be found. Primarily understood as an African problem, the Western Europe is still found taking solace in higher prevalence of the disease in Eastern , particularly former Soviet parts of the continent. That is appallingly so, despite of all the data suggesting the worsening situation in entire Europe. As recently as on 23rd November, 2007 , the Health Protection Agency (HPA), the government health watchdog of UK, had warned that the UK has one of the highest rates of HIV infection in Europe. But what is even more significant the same agency, in the same breath, put the entire onus on ‘a growing epidemic of the disease in the black African community and among gay men.’ The agency even overlooked its own finding that the sexual health crisis is also worsening due to rising rates of other sexually transmitted infections (STIs) among young adults, the government health watchdog also warned. (No ‘others’identified) There were 376,508 diagnoses of new STIs in 2006 - up from 368,341 in the previous year, said the HPA, which monitors infectious diseases in the UK. 5 The findings came as a separate report found that the UK had one of the highest rates of new HIV infections in Europe last year. This is certainly the most perplexing situation. More so because, in Western Europe, the syringe sharing drug addicts are NOT the major source of spread of infection. Rather, in this part of world, it is mostly a sexually transmitted infection. 25,241 newly diagnosed HIV cases were reported in 2006 in the Western Europe, the predominant mode of transmission was heterosexual contact (10,722; 54%) . Over one third (7,410; 37%) of the newly diagnosed HIV cases were among men who have sex with men. 6 Now, with 376,508 diagnoses of new STIs cases in 2006, can even the UK be deemed safe from the epidemic situation? A much more sinister dimension is of painting Eastern and Central Europe as deeper in trouble than me. This, irrespective of data, reveals only a partial or less than partial understanding of the threat. The western region is not only prone to rising numbers of STIs, that is to say, unsafe sex, this very unsafe sex is the biggest carrier of HIV here. Can the administrators feel safe in the belief that it can not be HIV, to ‘us’. That is a very formidable flaw, flowing into several dimensions of management of the epidemic. Europe: Migration and the HIV pandemic Migration is deemed as a major factor for HIV in Europe. However, the nature of relationship between migration and HIV infection is unconvincing. In Europe there is evidence that recent increases in HIV infection in some countries occurred among those originating from other countries with higher HIV prevalence. Though evidence is lacking, it can be assumed that they became infected prior to migrating to Europe. That poses the question- why do migrants become a specific case in study of HIV incidence. Answer to it, although not backed by any significant empirical study, suggests a number of factors. These factors apply to even the mobile sections of people within a country as well e.g. truck operators. Migrants mostly travel alone. Being separated from family or regular partners, loneliness, depression, poverty and anonymity may cause a person to take risks they would not take at home. Experiencing displacement and alienation and living in a foreign environment have also been linked to an increase in risk behaviours - both sexual and drug using. Migration and trafficking of individuals for sex work, is of particular concern. A typical European phenomenon is that this region attracts a large number of undocumented migrants, who are assumed to be more vulnerable. Such migrants are more often subject to exploitation and those who find themselves in need of money or services, may turn to selling or trading unprotected sex in order to survive. Thus the migrating community quickly becomes the ‘high risk community’, and thus a point of attraction for policy makers. There have been some seminars on this subject, and a few reports. There is a very limited study on the pertinence of migration and HIV infection. There is no doubt that the past decade has seen dramatic changes with respect to HIV and migration in Europe with changes in the populations involved, nature of the epidemic and national policies relating to immigration. In this context, and in view of the new European Public Health Programme, the European Project AIDS and Mobility conducted a evaluation study on the future challenges in HIV/AIDS and migration across Europe. 7 the study re asserted that migrants and ethnic minorities continue to experience serious inequalities in HIV/AIDS prevention, diagnosis and care. Some prior studies had ‘conformed ’the pattern of migration and HIV/AIDS on the lines of Sub-Saharan immigrants8-9 Similarly the World Bank and leading medical charities too had warned that Europe (read Western Europe) is facing a bigger AIDS crisis than had previously been thought. As a huge leap in the number of new cases, mostly in Eastern Europe, threatens to put a severe strain on the health services of the western European countries which are the preferred destinations for economic migrants within the EU.10 There may not be any empirical data to prove the link either way, but the governments in Europe have started responding to the migrants question. It is said that these governments are basically responding to the feelings of their home populations and to the nasty media. Nonetheless, In April 2004, in an effort to prevent ‘treatment tourism’, the UK Government introduced changes to regulations concerning HIV treatment for overseas visitors to the UK. The new changes effectively excluded a majority of immigrants from having access to HIV treatment without charge. However, such moves contradict the basic assumptions. If immigrants constitute the vulnerable section, denying them access to treatment, makes them further vulnerable. Economic dimension of HIV in Europe None else but President Bill Clinton has said that he would prefer the American patent laws be broken in favour of cheap Indian drugs for the HIV positive people. The Bush administration too declared that it will continue will the Clinton policy, even if the big American pharmaceutical companies complain or American. patent laws are being broken.11 In fact President Bush Supported Moratorium on Global patent Laws for HIV Drugs. This is just a reflection of the economic space occupied by the HIV Virus. The social and economic dimension of the impact of HIV/AIDS is so enormous, that it can drain the wealthiest nations and can barren the poor. Despite the political commitment of this order, the costs of providing healthcare resources for patients with HIV disease have continued to rise during the last 2 decades. Unfortunately, the outcome measures for, and the economic consequences of, differing models of HIV care are poorly documented or understood. There are a handful of European studies, but mostly confined to peep into the perils of Eastern Europe. Most published data relate only to North America, and there remains a paucity of European studies. A Review of the European Literature is done by Youle M.12, Trueman P.13; Simpson K14 the findings of their review says “… that countries with lower population density that manage to provide better health system performance, per capita support (doctors, nurses and hospital beds) with better media information (radio, phone and TV access), and not necessarily higher GNP are more likely to exhibit lower HIV/AIDS indicators. Interestingly, the “spoilers” of the widely anticipated negative relationship between HIV/AIDS prevalence and wealth of countries are the healthier of the wealthiest and the wealthier of the sickest.”15 Barnett T, Jung SH, Harland AB16 conducted survey of 27 countries in Eastern Europe and Central Asia on a number of topics, but could conclude only this much that Eastern Europe and Central Asia have high social disruption …. is fertile ground for an epidemic. Very little is known about the basic epidemiology, reflecting absence of adequate surveillance systems. Less is known about the longer term social and economic impact of the epidemic. According to a newly published UNDP report “Reversing the Epidemic: Facts and Policy Options,” 17 in Eastern Europe, the Russian Federation and the Central Asian republics, there is a high prevalence of infection among young people, especially young men. 8 out of every 10 persons living with HIV in this region are under the age of 30. Among the most recently diagnosed cases, the overwhelming majority (70%) are young men, but infection rates among women are increasing. There comes the economic (besides the social & human) dimension. “This region cannot afford to see its young workers and future leaders infected and unable to contribute to society before they reach maturity”. And “ the success of the economic and social transition depends on this younger generation.” According to the report, the disease threatens to seriously affect the region’s prospects for economic growth, by putting new strains on already overburdened social protection systems. Premature morbidity could reduce annual GDP growth by one full percentage point, a tremendous impact for any country. Increased health expenditures associated with treating people living with AIDS could amount to one to three percentage points of annual GDP. UNDP conducted another study on the linkages between HIV/AIDS and Human Development in Central and Eastern Europe and the Commonwealth of Independent States. 18 Chapter 3 of this report specifically deals with the economic aspects of the epidemic. This chapter provides a brief overview of the nascent economics literature on how growth models can be used to forecast the long term effects of the epidemic. And it documents how the epidemic may pose a national security threat to the region’s premier military power, the Russian Federation. The chapter shows that the Western CIS and Northern Baltic countries that have the region’s most disturbing epidemiological profiles also have the most unfavourable demographic trends,in terms of shrinking populations and labour forces,rising mortality and morbidity trends, and declining replacement rates. This will pose major – perhaps unprecedented - challenges in the area of social policy reform. Literature selected for review The research paper on “HIV health experiences among migrant Africans in Europe: how are we doing?”, given in the appendix is selected for literary review. Introduction and rationale The scourge called HIV/ AIDS can neither be understood comprehensively in sheer medical terms, nor can be taken care by simple allocation of funds. Several dimensions of this disease can converge only one point, and that is - the response, both at micro or individual level and macro or societal levels. Media, academics, government, law, individual, researchers, doctors and even prostitutes, all are part of it. The European situation requires a radical response, i.e. a big departure from were we are today. A thin thread seems to pass through the entire gamut of European, particularly Western European, response. That is of an ecstatic tendency, of thinking along the demagogues lines. One particularly popular line is to fix the blame either on the migrants in general and migrant Africans in particular. Similarly, the horrific situation in Eastern parts is looks like taken as a yardstick to bliss away from the gathering storm in the Western Europe. It is needed to critically examine how do the intellectuals and academicians respond to this notion. About the paper This is well done research , more so because not much literature is available on the ethnocentric lines on HIV/ AIDS in Europe. The medical aspects too are picked as well as the socio-economic and legal aspects. This research was done in year 2003 and since then, a massive change in the laws on availability of ART drugs, free of cost, to migrants has taken place in UK and elsewhere. So, that aspect will have to be discounted from this review. Perception An epidemic is an epidemic is an epidemic. No matter, what we believe or wish, any epidemic will proceed according to its own programme. Some races may be more prone to a particular disease, and some may be less. But unless and until we don’t want to prove one human being as totally different to other, no one can be totally immune to the disease which inflicts other. Even if we wish to be so, we are not, and that is where a ‘a big departure’ is required. What is surprising in all this is the cumulative flapping around in reflecting on advancing danger of AIDS. It is a fundamental flaw in tackling the menace of AIDS. Data after data is indicting the ‘heterosexual contact (53%)’ as the predominant route of transmission of HIV virus, but each report, in the same breath, makes it clear that it is ‘ with a large proportion of those infected originating from countries with generalised epidemic (e.g. countries in sub-Sahara Africa).’ No such definition of ‘generalised epidemic’ is available which excludes and immunises ‘non generalised people’ from the epidemic. Still, take look at how does the media covers the case: ‘Sections of the press have been predictably fascinated with specific cases, especially when the accused were African migrants (the first three cases) or women (two cases) - cue headlines such as "Aids assassin", "Pure evil" or "HIV migrant"’19 This is no mystery that the beginning cases of AIDS were reported from Africa. But that was it. Now it hurts every continent. Still, attempt after attempt is made to pre-fix the other end of the virus back to Africa. See what the study says: “many continuing to focus on the description of so-called 'imported diseases' or comparing disease burden in migrants from different countries in order to improve understanding of disease aetiology.” “ Data from EuroHIV indicate that, where information on geographic origin was available, 12.4% of those with AIDS diagnosed between 1997 and 1999 in Western Europe were foreigners. Of these, the commonest area of origin was Sub-Saharan Africa (5.5%), followed by other western Europeans (2.5%), North Africans (1.6%) and Latin Americans (1.3%)” “HIV-positive men from sub-Saharan Africa in the Swiss cohort presented with more advanced HIV infection, though this was not observed in sub-Saharan women.” Virtues can be found in almost every study and report. The point here is not of selective picking and debating the virtues of the report. Point is, as any discrimination, any stigma actually hardens the challenge, the continued perusal into a pre-fixed line would actually add to the problem, instead of contributing to solve it. The same trend can be seen with reference to the incidence of HIV/AIDS in Eastern Europe. The World Health Organisation (WHO) Regional Office report reads “Europe has witnessed a rapid increase in new cases in recent years, driven by a rapidly expanding epidemic among injecting drug users (IDU) in Eastern Europe in the late 1990s and a steadier increase in new cases in Western Europe in migrant populations and men who have sex with men (MSM)”. This is just a standard line since several years. But once read with the news of ‘sentencing’ of guilty for "recklessly" transmitting HIV to a sexual partner, the message plainly creates a category of ‘rouge’ elements, guilty for spreading HIV in the cleaner plains. This tantamount to a systematic move for stigma and discrimination. And thus can be seen contributing to the cause of making Europe safer. The east-west divide Yes, Europe is divided by the Aids line. Rather by the slash line between HIV & AIDS. The simple difference is that HIV with resources is a differed AIDS. The Eastern Europe has got the AIDS, the Western part has got the differed AIDS. According to the report published as late as November 29, 2007, the rate of newly diagnosed HIV infection in the European Union has almost doubled since 1999, according to EuroHIV data from the European Centre for Disease Prevention and Control (ECDC). Estonia reported the highest rate of new diagnosis (504.2 per million), followed by Portugal (205 per million), the UK (148.8 per million) and Latvia (130.3 per million). The lowest rate was in Slovakia, where 27 new HIV cases (five per million people) were reported last year. Men accounted for the majority of EU diagnosis (66%) with 11% of cases in young people aged 15-24. The predominant route of transmission was heterosexual contact (53%). In 2006, over two thirds of the new HIV diagnoses in Europe were reported in the former Soviet Union countries with 59,866 new cases or 211 new diagnoses per million inhabitants). The predominant mode of HIV transmission was injecting drug use (22,185 cases) although there has been a five-fold increase in heterosexually-acquired cases since 1999. In Western Europe 25,241 new HIV diagnoses were reported in 2006 (82.5 per million inhabitants) of which 35% were female and 10% aged 15-24 years old. The predominant mode of transmission was heterosexual (10,722). 20 HIV is increasing in Eastern Europe faster than anywhere else in the world. Figures from UNAIDS and the World Health Organisation show there are a million HIV positive individuals living in the former Soviet Union. Most of the results point to lack of resources in Eastern Europe, Social upheaval in the former communist block in the 1990s- leading to rapidly declining socioeconomic conditions, substance abuse, prostitution and unsafe sex.21 Russia has the largest HIV epidemic in Europe, and accounts for around two-thirds of the cases in the Eastern Europe and Central Asia region. There were an estimated 940,000 people living with HIV at the end of 2005 in Russia - up from 760,000 in 2003 - and this figure looks set to increase further. In countries like Estonia, the Ukraine, The Russian Federation and Kazakhstan, HIV has been spreading through intravenous drug use over the past five years. But HIV is now being transmitted through heterosexual sex. The fear is that HIV cases might spread in a similar way to Spain and Portugal. In central Europe HIV incidence is much lower with almost half the cases found in Poland and a third in Romania. Although Poland is a success story of efficient control. One of the authors of the report, Dr Françoise Hamers from the Insititut de Veille Sanitaire in France, said: “In view of the current levels of HIV prevalence, Eastern Europe will soon be confronted with a major AIDS epidemic.”22 The region stretching from Estonia down to Bulgaria, across to Russia, and south as far as Tajikistan, Turkmenistan and Armenia is home to around 1.6 million people living with HIV at the end of 2007. In the north of Eastern Europe: Estonia, Latvia and Lithuania, overall numbers of infections remain low, but HIV is spreading at an alarming rate here. In the three countries between the Black and Caspian Seas - Georgia, Armenia and Azerbaijan - have much lower HIV prevalence rates than Russia. Here is a chart describing the methods of spreading the HIV virus. 23 On the western side, the UK has one of the highest rates of HIV infection in Europe largely due to a growing epidemic of the disease in the black African community and among gay men. Rates of other sexually transmitted infections (STIs) among young adults are also rising. There were 376,508 diagnoses of new STIs in 2006 - up from 368,341 in the previous year. UK also had one of the highest rates of new HIV infections in Europe last year. UK HIV infection rate was more than double the European Union average. The chart displaying the incidence if new HIV case is given here: Source: http://www.eurosurveillance.org/em/v08n03/0803-221.asp Kallings L., 15th European Congress of Clinical Microbiology and Infectious Diseases Copenhagen / Denmark, April 2-5, 2005 http://www.blackwellpublishing.com/eccmid15/abstract.asp?id=36241 Criminalisation of HIV transmission in Europe, study by Terrence Higgins Trust, 5.1, Overview, http://www.gnpplus.net/criminalisation/people.shtml Elliot, R, Criminal Law, Public Health and HIV Transmission: A Policy Options Paper, UNAIDS, 2002 ibid, 4.1 Overview, http://www.gnpplus.net/criminalisation/results.shtml Reported in the Guardian. Health watchdog warns of UK sexual health crisis http://www.guardian.co.uk/aids/story/0,,2215956,00.html HIV/AIDS in Europe: epidemiological situation in 2006 and a new framework for surveillance http://www.eurosurveillance.org/ew/2007/071122.asp Future challenges in HIV/AIDS and migration across Europe: Results of an evaluation study. Gray KA, Erwin J, del Amo J, Fenton K, Broring G. http://gateway.nlm.nih.gov/MeetingAbstracts/102251647.html Del Amo J, Erwin J, Fenton K, Gray K for AIDS&Mobility. Looking to the Future. Migration and HIV/AIDS in Europe: Recent Developments and Needs for Future Action. Woerden: Netherlands Institute for Health Promotion and Disease Prevention; October 2001 http://www.aidsmobility.org/future.html. Fenton KA, Chinouya M, Davidson O, Copas A for the MAYISHA Study Team. HIV testing and high risk sexual behaviour among London's migrant African communities: a participatory research study. Sex Transm Infect 2002, 78:241-245. The Sunday Telegraph (UK, 07/04). annonc.oxfordjournals.org/cgi/reprint/12/5/577-b.pdf Royal Free Hospital, London, England Glaxo Wellcome, Uxbridge, Middlesex, England University of North Carolina, School of Public Health, Chapel Hill, North Carolina, USA Health Economics in HIV Disease: A Review of the European Literature , Youle M.; Trueman P.; Simpson K, Pub. Adis International Social and economic dimension of the impact of HIV/AIDS on human development in eastern Europe and Central Asia, Barnett T, Jung SH, Harland AB, School of Development Studies, UEA, Norwich, United Kingdom. Reversing the Epidemic: Facts and Policy Options, UNDP News, http://undp.by/en/undp/news/world/41673b06010de.html http://rbec.undp.org/hiv/files/HIV%20AIDS%20intro%202.pdf. Column by Deborah Jack, The Guardian, Thursday August 3, 2006 http://www.hiveurope2007.eu/press/HIVinEurope-General_Release.pdf http://www.avert.org/ecstatee.htm Dr Françoise Hamers, http://www.avert.org/ecstatee.htm http://www.avert.org/ecstatee.htm Read More