Despite Increased Global Attention to HIV/AIDS Pandemic, More Infections, Deaths Occur, NEJM Perspective Piece Says

Although "funding, global attention and political will" aimed at the HIV/AIDS pandemic have increased, "more infections and more deaths continue to occur," and participants in the XV International AIDS Conference have the "daunting task" of examining how to reverse these trends, Dr. Robert Steinbrook, a New England Journal of Medicine editor, writes in a perspective piece published in the July 8 issue. Steinbrook says that there are "only two" approaches to combating the pandemic: preventing new HIV cases and providing antiretroviral drug treatment to HIV-positive people. He adds that to fight the disease effectively, the "public, the medical community and government officials all need better information about AIDS." In addition, many people living with HIV are unaware of their statuses and other HIV-positive people may not seek care because of stigma or discrimination, according to Steinbrook. Although the World Health Organization has launched its "ambitious" 3 by 5 Initiative to treat three million HIV-positive people with antiretrovirals by 2005, the program's "succe[ss] ... is by no means assured," Steinbrook says. There is a "large gap" between the number of people in developing countries who need antiretroviral treatment -- between four and eight million -- and the number receiving treatment -- about 400,000 at the end of 2003, Steinbrook says, adding that the treatment-coverage rates are "dismal." Steinbrook concludes that although "global control is not in sight," the International AIDS Conference will "bring new energy, attention and perhaps resources to the battle against the pandemic" (Steinbrook, New England Journal of Medicine, 7/8).

Eastern Europe
Eastern European countries, including the Russian Federation, Latvia and Estonia, are facing some of the most rapidly increasing HIV prevalence rates in the world because of obstacles to prevention efforts, Mark Field, an adjunct professor at the Harvard University School of Public Health and Harvard's Davis Center of Russian and Eurasian Studies, writes in a New England Journal of Medicine perspective piece (Field, New England Journal of Medicine, 7/8). According to the 2004 UNAIDS Report of the Global AIDS Epidemic released by UNAIDS in advance of the XV International AIDS Conference, the most affected countries in the region are Estonia, Latvia, the Russian Federation and Ukraine; however, Belarus, Kazakhstan and Moldova also are experiencing increases in numbers of HIV cases. The driving force behind the epidemic in the region is injection drug use, particularly in Russia (Kaiser Daily HIV/AIDS Report, 7/6). Field says that in most Eastern European countries, the medical community and "population at large" have little knowledge about "the nature of the disease or its transmission." In addition, although sex education was introduced in the late 1980s, conservatives have strongly opposed it, Field says, adding that on the "most obvious practical level, well-equipped facilities and relatively expensive drugs" are needed to combat the region's HIV/AIDS epidemic. However, there are also cultural barriers to overcome, Field concludes, saying, "The stigmatizing quasi-criminalization of [HIV/AIDS] must be abandoned, and affected persons must be recognized and accepted as victims with human rights rather than perpetrators who are being punished" (New England Journal of Medicine, 7/8).

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