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Report From the President: Taking Stock of Successes and Challenges

By José M. Zuniga

October 2002

Jose M. Zuniga

Without question, the global battle against HIV/AIDS can be daunting and spiritually depleting. So, while it is axiomatic that we must never let up in this struggle that is in many ways a race against time, it is nonetheless necessary and appropriate to take periodic stock of what we are doing right. Such assessments serve as a reminder that our efforts are not futile, and replenish our energy in order to push forward. Moreover, by examining our successes in one area of medical treatment, public health policy, or region of the world, we gain perspective and insight into corresponding areas in which we have so much more to accomplish.

As evidenced by the experience of the world's wealthiest countries, well planned, adequately funded programs for prevention and treatment are effective at slowing infection rates and greatly prolonging and improving the lives of people living with HIV/AIDS. We saw an example of this in statistics recently released by the U.S. Centers for Disease Control and Prevention (CDC). These numbers show that, as with other resource-rich countries, the United States has enjoyed admirable success in curbing rates of incidence and in significantly reducing HIV-related morbidity and mortality over the past few years. This success hardly means HIV/AIDS has been defeated in the United States, but we must acknowledge progress that has been a long time coming, through much sweat and with much loss.

Yet, as we breathe a collective sigh of relief that our efforts have not been wasted, we must also commit to redoubling them. For, even in the midst of success, there is cause for further concern. In the United States, as in many of the other industrialized countries of the North, there remain several sub-populations that indicate rates of incidence far above national averages. For example, rates of infection among Latinos and African Americans (most notably African-American women) in the United States have not been reduced and are, in fact, often on the rise. This unacceptable state of affairs reflects coincidental rates of poverty and social and cultural marginalization that must be addressed as part of our collective and comprehensive strategy to ensure the health of total populations.

More than anything on the U.S. domestic level, however, the successes of some wealthier nations remind us how much more can be done in the less-developed countries and regions of our world. That Africans from the southern half of the continent alone account for 28.5 million of the world's 40 million HIV-infected people is relatively well known. But we cannot allow ourselves to become desensitized to such information; the danger is simply too great. The rate of infection in Botswana has reached a staggering 39 percent, for example, causing President Festus Mogae to remark of his nation's citizens, "We are threatened with extinction."

In other regions of the world, the rising number of HIV infections is at a critical stage as well. A United Nations Children's Fund (UNICEF) report released in September 2002 described the rapid movement of HIV/AIDS into Central and Eastern Europe and the former Soviet bloc states. The number of HIV-infected people in the region grew from 420,000 in 1998 to more than 1 million at the end of 2001, and the vast majority of newly infected people are younger than age 29, thus pointing to the potential for even more astronomical rates of increase in years to come. In China, there may be as many as 1 million HIV-infected people in Henan Province alone, where unsanitary conditions in government-affiliated blood banks spread the disease during the 1990s.

Indeed, our worst fears may be surpassed in coming years. A report issued earlier this month by the National Intelligence Council, a federal group that advises the U.S. Central Intelligence Agency (CIA), predicts a growth in HIV/AIDS infection higher than the most pessimistic calculations. According to the report, the five countries on which it focused could alone account for 75 million HIV-infected people by 2010, and its authors call the situation a security threat to the United States and several regions of the world. The report's authors maintain that within the next eight years China, India, Ethiopia, Nigeria, and Russia will have surpassed sub-Saharan Africa as the epicenter of the AIDS pandemic.

Faced with these terrible realities, let us remember the lessons that we can take from our successes: the spread of HIV is imminently preventable, and for those who have already been infected, treatment is highly effective if delivered within an adequate infrastructure by trained and supported healthcare professionals. Given these facts, we must continue to have the resolve to fight HIV disease, in all regions of the world, by advocating realistic and aggressive prevention methods and comprehensive HIV/AIDS care, to include antiretroviral treatment, for all, with a corresponding increase in clinical capacity necessary to prevent resistance. We know what is at stake. We have seen what we are able to accomplish. Thus, we must not settle for anything less.

José M. Zuniga is President of the International Association of Physicians in AIDS Care, and Editor-in-Chief of the IAPAC Monthly.

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