MEDICAL MATTERS: Yesterday was World AIDS Day and the latest figures show that 60 million people throughout the world have been infected with HIV since 1980. Some 20 million have died from AIDS - 18 million of whom lived in Africa. Despite these grim statistics, it is sobering to realise that we are still in the early stages of a global AIDS epidemic, writes Dr Muiris Houston.
The full name for AIDS is Acquired Immunodeficiency Syndrome. It is an incurable but preventable disease carried by the Human Immunodeficiency Virus (HIV). AIDS is the late stage of HIV infection; as the immune system becomes overwhelmed, the body loses its ability to fight off opportunistic infections. Untreated, AIDS develops five to 10 years after infection with HIV. AIDS is not curable, but by taking the latest antiviral drugs it can become a chronic rather than a fatal condition.
Statistics just released by the National Disease Surveillance Centre (NDSC) have confirmed 157 new cases of HIV infection here in the first six months of 2002. Two people in the State have died from AIDS during the same period. Further analysis of these figures found that 73 per cent of heterosexuals diagnosed with HIV infection here were born in sub-Saharan Africa. In a statement emphasising how widespread the disease is in developing countries, the NDSC said: "It is important to remember that people from sub-Saharan Africa . . . include students, immigrant workers, refugees, economic immigrants and asylum seekers."
No matter what aspect of AIDS/HIV you consider, the developed versus developing countries axis comes sharply into focus. The West has transformed AIDS into a chronic disease through intense research into novel treatments. The cost of these drugs is not an issue, nor are the extensive facilities and health care teams required to look after AIDS patients and their families. Prevention and health education are well funded.
The most recent edition of AIDS, the official journal of the International AIDS Society, shows just how much HIV prevention efforts have curbed the US AIDS epidemic. Researchers from the Centre for AIDS Research at Emory University posed two fundamental questions. Roughly how many lives have been saved because of investment in prevention and have these HIV prevention efforts resulted in cost savings? Using complex statistical modelling, Dr David Holtgrave and his team came up with a number of routes the AIDS epidemic might have taken had there been no prevention efforts.
Their findings are quite explicit: between 204,000 and 1,585,000 HIV infections have been averted over a 20-year period, saving the US health system between $56,000 and $195,000 per infection.
THE fact that the US can afford the cost of this type of analytical research emphasises the huge gulf between it and those states in Africa hit by the AIDS epidemic.We in the West can afford the luxury of adopting a consensual and human rights approach to HIV infection. Africa is still crying out for an effective public health response to a problem that threatens the very existence of sub-Saharan states. Teachers are dying at a faster rate than they can be trained, industrial efficiency is declining and family incomes have been severely hit. The UN estimates that six out of every 10 adolescents will be infected with HIV in countries such as Zambia and South Africa. 12 million children in Africa have been orphaned by AIDS.
But some good news is beginning to filter though. The prevalence of AIDS in Uganda has dropped from 14 per cent of the population in the 1990s to just over 6 per cent this year following early and sustained action against HIV. According to Dr Vincent O'Neill, lead adviser at Ireland Aid at the Department of Foreign Affairs, the price of a course of AIDS treatment has dropped from US$18,000 to US$600 in developing countries. This follows world trade negotiations and other initiatives aimed at making pharmaceutical products more readily available in poorer states. And in fairness to a Government under criticism for its "slash and burn" approach to public spending, the Taoiseach yesterday reiterated a commitment to allocate €30 million to help fight AIDS in poorer nations. As part of World AIDS Day, he launched a booklet outlining the Government response to HIV/AIDS in the developing world.This money helps support AIDS vaccine research and covers contributions to a new global fund for AIDS, TB and malaria.
The international community has finally woken up to AIDS, with a five-fold increase in funding for HIV projects compared with three years ago. But just as progress is being made in Africa, there is growing concern that AIDS is spreading rapidly in China, Russia and Eastern Europe. In the case of Russia the spread is fuelled by a growth of HIV in the prison population and the collapse of the health system since the break-up of the USSR.
Finally, I cannot write about HIV/AIDS without paying tribute to my friend and colleague, Dr Fiona Bradley, who died last Monday. One of the Republic's best medical educators and foremost primary care researchers, she gained an international reputation in the study of HIV among prisoners. She will be sorely missed.
Dr Houston can be contacted at mhouston@irish-times.ie. He regrets he cannot answer individual queries.