Lisa Söderlindh
UNITED NATIONS, Apr 18 2006 (IPS) – A quarter century into the HIV/AIDS pandemic, researchers fear that a lack of preparedness for large-scale social changes, driven by factors like armed conflict and climate change, could lead to explosive new outbreaks affecting millions of people.
Since cases of a severe pneumonia affecting gay men were described for the first time in a U.S. public health report in June 1981, more than 65 million people have become infected with HIV and 25 million have died, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS), which estimates the current number of people living with HIV at 37 to 45 million.
We should not accept living with this epidemic at the level it has reached, Paul DeLay, director of monitoring and evaluation at UNAIDS, told IPS. Today, we have a much clearer understanding of the epidemic itself and what we need to do.
Pointing to the most important advances of the last 25 years, DeLay said the real breakthrough from the standpoint of science has been cheaper, simpler treatment and diagnosis, and drugs that prevent mother-to-child transmission.
While he believes that it is unrealistic to think in terms of eradicating the epidemic right now, What we instead have to do is use all of the tools we have to get it under control and reduce it as much as possible, he said. We have to fight the fight.
But according to researcher Samuel R. Friedman, We are not really looking ahead to what may be coming down the road at us.
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There has been a general lack of attention to social science and large-scale issues of any kind in the conversation around AIDS, he told IPS, adding that the focus has been on individual behavioural and medical interventions.
Friedman, director of the Social Theory Core at the Centre for Drug Use and HIV Research at the U.S.-based National Development and Research Institutes (NDRI), and researchers from Argentina, Australia, South Africa and the U.S., have identified a number of larger social factors that may affect the spread of HIV and the world s ability to respond to the changing global epidemic at the cost of derailing the progress already made.
The emerging challenges are outlined in an editorial review published in the April issue of the International AIDS Society s official journal, AIDS .
The paper outlines six major themes big events like wars, political transitions, ecological or economic disruption; large-scale HIV epidemics and their social consequences; government policies that ignore or defy available evidence; stable societies without generalised epidemics, which face distinctive challenges; emerging biomedical changes; and possible failure of previously effective therapies due to evolution of the HIV virus.
Each of the six themes provokes a number of research questions. And to answer these questions, the full armamentarium of social science and social epidemiologic research methods will be needed , notes the editorial.
There is a high probability of massive political, ecological and social changes over the next few years, the authors note. These threaten large-scale disruption of existing social and risk networks, sexual (and injection) mixing patterns, and sexual and injection behaviours that can impede or facilitate HIV transmission.
Global warming, for example, could cause mass migrations and the resultant breakdown of social norms that keep the virus in check. And the rise of religious fundamentalism can lead to government policies that ignore or defy available evidence on prevention.
The relative lack of such large-scale research has weakened the response both individual and societal to the epidemic, states the editorial. It calls for funding agencies, individual researchers and students, non-governmental and community organisations, and the general public to become better informed about the bigger picture of the pandemic.
At the time of the AIDS outbreak, We did not know enough to be able to have the conversation in intelligent terms, said Friedman. But today we certainly know enough to start such a conversation.
The most important issue in many parts of the world is preventing epidemics rather than simply preventing individuals getting infected one by one, said Friedman.
We do know that some of the biggest events in the epidemiology of AIDS in the last 15 years have came about partly because of big events, said Friedman, pointing to the huge outbreak of HIV/AIDS in Central Asia and Eastern Europe following the collapse of the former Soviet Union in the early 1990s.
UNAIDS estimates that the number of people living with HIV in those regions reached 1.6 million in 2005, an increase of almost twenty-fold in less than 10 years. The epidemic continues to grow, with Ukraine and the Russian Federation seeing the greatest number of people living with HIV in Central Asia and Eastern Europe.
With an estimated 860,000 people HIV-infected in late 2004, Russia has the largest AIDS epidemic in Europe. The situation partly stems from large-scale disruption of existing social networks and the demoralisation of youth following the transition period, which led to changed sexual, drug and injection behaviours, explained Friedman.
There is a vast range of reasons to be worried, he said. There is every reason, in my opinion, to think that there may well be additional revolutionary situations breaking out around the globe, in underdeveloped countries and possibly in some developed countries.
He cited the continued creation of urban slums with no sanitary facilities and a great deal of exposure to various parasites and malnutrition , as well as the myriad social problems caused or worsened by armed conflicts around the world, and the impact of a possible economic collapse.
If no effective interventions are carried out, We could end up with another half a million to a million people infected very quickly within five years, possibly less, he warned.
However, the authors note that such outbreaks are not inevitable. Many African wars have not increased HIV transmission, and the case of the Philippines shows that transitions need not lead to outbreaks either, they say, calling for further study of the specific social risk factors driving HIV transmission.
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