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JOHANNESBURG, Jan 10 2009 (IPS) - The latest UNAIDS Report estimated that 33 million people around the globe are living with HIV; 22 million in Sub-Saharan Africa alone. Around 2.7 million new HIV infections occurred worldwide in 2007. However, encouraging new data suggests there have been significant gains in preventing new infections in several African countries with high prevalence rates.
According to the report, changes in sexual behaviour in Rwanda and Zimbabwe have led to a decline in the number of new HIV infections, while young people in countries such as Burkina Faso, Ethiopia, Ghana, Malawi, Uganda and Zambia are waiting longer to have sexual intercourse.
There is a new emphasis amongst AIDS campaigners on “knowing your epidemic”, that is to say analysing the local situation in terms of the specific factors driving the epidemic and knowing precisely who is infected and then seeking the best way to act on this information.
Rwanda is classified among the ten African countries most severely affected by HIV/AIDS pandemic. But, recognising the negative development impact of the disease, the government has demonstrated strong commitment to both HIV prevention and treatment.
Among its successful initiatives is an effort to involve male partners in the prevention of mother to child transmission.
“When I look back to 2004, we just had 6 percent of male partners accompanying their wives to check up clinics,” says doctor Anita Asiimwe, executive secretary of the National Aids Control Commission in Rwanda, “but today we have figures as high as 64 percent.”
“When the father knows why the woman is doing this, then they are they are able to protect them from the other members of the family or society. The man can stand in and explain that, no me and my wife have decided not to breastfeed so there are no questions.”
According to government statistics, the AIDS prevalence rate in Rwanda had fallen to three percent in 2008, down from seven percent in 2000. Almost 90 percent of children born to HIV+ mothers are virus-free; a huge gain on the less than 40 percent rate just two years ago.
The news from Kenya is not so encouraging. Two studies done on the general population indicate that HIV/AIDS is on the increase. The 2003 Kenya demographic health survey – which is the most recent survey done – showed an HIV/AIDS prevalence of 6.7 percent. The Kenya AIDS Indicator Survey released in 2008 shows the prevalence rate to have risen to 7.8 percent by end of last year.
Health experts say Kenya’s prevention strategy has failed to effectively target specific high risk groups that seem to be driving the epidemic.
“It is not good enough to just continue talking about VCTs [voluntary counselling and testing] as usual, we must now begin to look at individuals who fall into high risk groups and be able to target preventable strategies to these specific groups; people who sell sex, people who buy sex, regardless of the kind of sex they buy,” Omu Anzala, director of the Kenya AIDS Vaccine Initiative told IPS.
The focus of preventive messages is now shifting from awareness creation – over 90 percent of Kenyans are aware of HIV/AIDS – to addressing specific risk groups. For example, the current HIV/AIDS messages do not address the needs of homosexuals and drug users.
Anzala says new messaging must be combined with ensuring that those already infected and in need of treatment are put on anti-retroviral therapy (ART). Despite efforts to provide effective treatment and monitoring, the emergence of resistant strains of HIV remains a key challenge.
Some vital tests like viral load and liver function tests are very expensive, costing over 60 dollars for a single test. Yet without them, proper management of antiretroviral treatment is impossible.
“Those are the things that now must be looked at critically as we roll out and put more and more people on antiretroviral drugs. By failing to do that, we are just again brewing up a problem that is going to explode more in the near future,” warns Anzala.
In South Africa, an extremely high background prevalence of HIV increases the probability of new infections, particularly among young women aged 18-24, according to Quarraisha Abdool Karim, associate scientific director at the Centre for the Aids Programme of Research in South Africa (CAPRISA). Sexual relationships with older men often put young women in a vulnerable position in terms of demanding safer sex, or knowing their partner’s sexual history or status.
“We still have a standardised cookie cutter approach to prevention – ABC (Abstinence-Be faithful-Condom use),” says Quarraisha. “We are still not discussing protective effects of medical male circumcision. We are not targeting our intervention. We do not have adequate coverage of interventions that work, knowledge of HIV status and personal risk is low.”
By contrast, Ethiopia’s HIV prevalence stands at 2.2 percent – for men. But according to Berhane Kelkay, an Ethiopian AIDS activist, the prevalence rate for Ethiopian women is nearly 20 percent higher.
“The reason why women are more vulnerable is due to early marriages arranged by families in various regions, violence such as abduction, rape and circumcisions. The other reason is also because prostitution is rampant in most towns of the country.”
Kelkay has been living with the virus for 16 years, and is head of the National Network of Positive Women which is a network of 22 associations of positive women all over the Ethiopia.
When she officially started campaigning against the virus three years ago, she was the only woman head of an HIV/AIDS association. Now all the associations in her network are led by women.
Kelkay believes there has been some progress in the fight against AIDS, but there is much more to be done. “There is indeed an achievement from our campaign,” Berhane said. “But I am far from being satisfied. Still people are being infected with the virus. I don’t feel really satisfied until I see the last person to be caught with the virus.”
*Eunice Wanjiru in Kigali, Joyce Mulama in Nairobi, and Michael Chebsi in Addis Ababa contributed to this report.
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