Editorial: Better news on the HIV front

Published in The Hindu on the September 28, 2010

Although nearly 7,500 new cases of HIV infection are reported every day globally, the good news is that incidence rates are steadily declining in most parts of the world. HIV incidence has fallen by more than 17 per cent globally over the past nine years. But what is of greater significance is that it is happening in many African countries, the core of the epidemic and which for years had a disproportionately high number of new cases. According to the latest UNAIDS report, the incidence rate has dropped by more than 25 per cent in 22 sub-Saharan African countries, and many of them are well on the way to achieving the U.N. target of reducing HIV rates among the young this year. They include Ethiopia, Nigeria, South Africa, Zambia, and Zimbabwe — some of the countries with the largest HIV epidemics in the world. Better awareness of the risks and education on the different modes of transmission has been identified as the key factor that made it possible. A study published in the International Journal of Epidemiology in April this year attributes the decline in Zimbabwe to changes in sexual behaviour, particularly the use of condoms in non-regular partnerships. A dramatic reduction was also seen in the case of women in the 15-24 age group in South Africa. Despite the group reporting the highest incidence rate, the drop has been nearly 60 per cent between 2005 and 2008.

In a striking contrast to the picture emerging from sub-Saharan Africa, HIV incidence in Eastern Europe and Central Asia is showing an upward trend. Russia has the largest AIDS epidemic in Eastern Europe and Eurasia. Injection drug use is the main mode of transmission across Eastern Europe and Central Asia. Similarly, once praised for drastically cutting down the prevalence rate from 30 per cent in the late 1980s to six per cent by late 1990s, HIV prevalence in Uganda is on the rise once again. Widespread use of anti-retroviral treatment and the resultant reduction in mortality has led to the increase. But the availability of drugs has also meant greater indulgence in risky behaviour. This, combined with the scaling down of prevention programmes due to complacency, has played a major role in pushing up the incidence rate. Uganda offers a good case study for India. The prevalence rate in India is low at approximately 0.36 per cent. The lesson in this for India is that there should be no let up in the drive to increase awareness and risk avoidance in the campaigns for AIDS prevention. There is absolutely no room for complacency on this vital front.