UNAIDS^[1] reports a 52% reduction in new HIV infections among children and a combined 33% reduction among adults and children since 2001.

This is fantastic! All of us involved in AIDSLink International are thrilled. However, the temptation is to take our foot off the gas - in reality this is a crucial time - if we want to see these gains continue, there is absolutely no room for complacency. We must continue to TRANSMIT HOPE!

It was a thrill to read a report from the AIDSLink team at Lake Tanganyika. They have just started an HIV counseling and testing programme in very remote villages where neither HIV testing or treatment were previously available.

They test people for HIV and if they are found positive immediately test their CD4^[2] count and if needed put them on treatment right away. In one village of 67 people tested, 6 were positive and 5 of those were able to start treatment within 30 minutes of diagnosis. One person said that they had been unwell for 8 years - no one had been able to tell them why or offer help.

Not so long ago an HIV diagnosis would have been a death sentence, but now we can put people on treatment, which when adhered to correctly, will enable them to live a healthy life.  And, because it keeps the virus under control, they are less likely to transmit HIV to others.

In the light of the progress made, we need to notch up our response to HIV and AIDS. Some areas where we specifically need to scale up our response are: Eastern Europe and Central Asia (250% growth in new HIV infections).

This is the only region where HIV prevalence clearly remains on the rise. The number of people living with HIV has almost tripled since 2000.

In Russia, 15% of people who inject drugs are HIV positive.

The number of people dying from AIDS related causes in the region has grown by 21%. The life saving therapy that is saving so many is only available to 25% of those who need it.

This is why we have been working hard to be able to present our Channels of Hope Facilitators Training in Russian (coming soon: August 2014).

Africa

In the face of tremendous progress (nearly 6.2 million people on treatment and a 25% decline in new infections) East and Southern Africa remains the areas most heavily affected by the HIV pandemic.

Out of the total number of people living with HIV worldwide 67% reside in Sub-Saharan Africa.

Over the last year two new HIV ministries have started, that means we now have ministries in three fields. We need to do more at this, the epicenter of the pandemic.

Middle East & North Africa (MENA):

Reliable data on HIV in Middle East and North Africa remain in short supply. Nonetheless, according to available evidence, the number of new HIV infections in the region increased by more than 35%.

ART coverage is at just 15% and only 7% of HIV positive pregnant women received medication to avoid passing the HI virus on to their baby. In fact the MENA area is the only area in the world where there has been no reduction in the number of children born with HIV.

There is also terribly unjust treatment for migrant workers who are subjected to mandatory HIV tests and if found positive are denied health care and deported.

Key populations

The term ‘key populations’ refers to those most likely to be exposed to HIV or to transmit it.  Key populations are found in every nation. In most settings it refers to, men who have sex with men, transgender persons, people who inject drugs, sex workers and their clients.

People who inject drugs (PWID):

Although PWID account for only 0.2–0.5% of the world’s population, they make up 5–10% of all people living with HIV^[3].

In Thailand, Pakistan and Cambodia around 25% of injecting drug users are living with HIV. The country with the highest prevalence of HIV amongst PWID is in Estonia (over 52%).

Faith-based rehabilitation of drug users has a consistently higher success rate than government run programmes. We need to get involved. Even if we are not able to run rehabilitation centers ourselves there are others with whom we could partner. Bringing an HIV focus is something that we could do to add value to their ministry.

Sex-workers and women trafficked for sex-work

HIV prevalence among female sex-workers is estimated to be 12%, increasing to 30% in countries with a higher HIV prevalence.  They are 14 times more likely to contract HIV than women in the general population^[4].

In some places, sex workers commonly use drugs and share needles. The overlap between sex work and injecting drug use is linked to the growing HIV epidemics in Eastern Europe and Asia^[5]. 

Women who have been trafficked into sex work are at a higher risk still as they are subject to higher levels of violence and have less say in the use of condoms.

In India, nearly one quarter (22.9%) of women trafficked into sex work tested positive for HIV^[6]. In a study among 287 repatriated Nepalese sex-trafficked girls and women 38.0% tested positive for HIV.^[7] This is much higher than the HIV rate amongst non-trafficked sex-workers.

The clients of sex-workers are often a 'bridge' between the sex-worker and the general population. This is particularly true for wives of migrant workers. Their husbands travel long distances and spend extended periods of time away from home.

Although they are less in number, the risk of HIV infection is further increased for male-sex workers.

It is very encouraging to see our response to women in the sex-industry growing. HIV is a major risk factor and we need to further integrate HIV awareness into our response. It is good to see this happening in the Freedom Climb[8] team in Africa.

Men who have sex with men (MSM) and transgender people:

In the USA, just over half of all HIV infection is amongst MSM (57%). A study in Thailand showed that over the course of 60 months, 31% of MSM ages 18-21 became infected with HIV^[9].

Transgender women are 49 times more likely to be living with HIV than women overall, with an HIV prevalence of 19%.

Gender Based Violence (GBV)

In Asia, a study focusing on men’s use of violence against women found that more than half of the 10,000 men interviewed reported using physical or sexual violence against a female partner. Nearly a quarter of the men interviewed reported perpetrating rape against a woman or girl.

Two recent studies found that women who had experienced intimate partner violence were 50% more likely to have acquired HIV than women who had not^[10].

Thursday’s In Black is a South African driven international campaign to raise awareness around this issue^[11]. I encourage you to get involved.