Analysis: UN urges AIDS prevention

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UNWASHINGTON, Nov. 24 (UPI) -- Huge gains have been made in making sure that HIV treatment is getting to those who need it -- but prevention efforts lack the resources they need to slow the disease's spread.

Nearly 40 million people worldwide are living with HIV or AIDS, according to United Nations data released Tuesday, and that number continues to grow.

"Countries are not moving at the same speed as their epidemics," said Peter Piot, executive director of UNAIDS. "We need to greatly intensify life-saving prevention efforts while we expand HIV treatment programs."

In North American and Europe, new infection rates have remained flat, while in other regions they continue to grow. In some places in Eastern Europe and Central Asia the rate has skyrocketed by more than 50 percent in the last two years.

Sub-Saharan Africa remains the hardest hit. Since 2004, 65 percent of new infections occurred in the region, and life expectancy is now 47 years -- some 30 years shorter than in most high-income countries.

To combat new infections, more resources are needed, and they need to be better targeted to groups most at risk of infection like women and girls, men who have sex with men, sex workers and intravenous drug users, the report says. At the moment those groups are often overlooked or cut off from public-health resources.

"It's clearly the case -- as the data demonstrates -- that preventive services are not reaching enough people and most vulnerable groups," Maurice Middleberg, vice president of public policy at the Global Health Council, told United Press International. "Preventive services need to be expanded."

Countries lack the resources they need to provide materials and education to all those who want and need it, he said.

In a recent study of a dozen countries hard-hit by the epidemic, the council found that only one-third of young men and one-fifth of young women had correct knowledge of HIV.

"It's shocking to find at this point in the history of the pandemic we still haven't reached out to young people," Middleberg said.

Public-sector health programs had less than half the condoms they needed, and only about 40 percent of sex workers and 25 percent of men having sex with other men had access to preventive services.

"People just aren't getting the preventive services they need," he said. "Marginal populations suffer from other kinds of social discrimination, so access to the health services and information they need also suffers."

In addition to a lack of overall resources, countries need flexibility to adapt programs to their own needs, he said. "The nature of the disease and why it spreads varies from place to place."

The good news, he said, is that there are preventive strategies that have been proven to work like counseling, education, testing and treatment to prevent mother-to-child transmission during pregnancy.

In the future, advancements like cervical barriers and microbicides could be added to the arsenal of tools available to fight the disease, Middleberg added, and ultimately a vaccine may be developed.

But all of that will depend, he said, on maintaining momentum for prevention programs. "We're never going to treat our way out of the pandemic. Ultimately we have to do a better job of preventing new infections."

The U.N. report also included some success stories.

Declines in HIV prevalence among young people between 2000 and 2005 are evident in the African countries of Botswana, Burundi, Côte d'Ivoire, Kenya, Malawi, Rwanda, Tanzania and Zimbabwe.

In China, some programs for sex workers saw marked increases in condom use and decreases in rates of sexually transmitted infections, and in Portugal HIV diagnoses among drug injectors were almost one-third lower in 2005, compared with 2001, following special programs focused on HIV and drug use.

source - UPI