Global Perspectives on Women, HIV, and AIDS
At the end of 1999, UNAIDS/WHO estimates that 12.2 million women and 10.1 million men age 15-49 were living with HIV in sub-Saharan Africa, as were 11 million orphans.
The Second Conference on Global Strategies for the Prevention of HIV Transmission from Mothers to Infants took place September 1-5, 1999, in Montreal. Over 500 participants heard presentations from approximately 140 experts from around the world, many from regions most affected by the HIV epidemic, such as sub-Saharan Africa and Southeast Asia. At the opening session, Alan Rock, Canadian Minister of Health, noted that until imbalances in economic resources between developed and developing nations are addressed, "tens of millions of people -- women and children prominently among them -- are condemned to death. We need to level the playing field of people on this globe."
Crispus Kiyonga of Uganda noted that the effects of HIV/AIDS in his country are wide-ranging and no longer restricted to health; rather, HIV/AIDS has become a development problem. In Uganda, 1-2 million of the 10 million residents are estimated to be infected. Although sexual transmission is the primary route of infection, perinatal HIV transmission (PHT) accounts for 15% of cases. Based on the numbers of women infected, this translates to 280,000 children. Today, there are already 1.5 million Ugandan children who have lost one or both parents to AIDS, creating an additional burden for the already ailing country in which agriculture, the mainstay of the economy, is suffering because so many workers are sick and no longer able to work.
The Minister of Health from Zambia, Nkandu Luo, reminded the audience that over 90% of people with HIV are living in developing countries, in particular sub-Saharan Africa, where 22.5 million people with HIV live and 16,000 new infections occur daily. "Whereas HIV transmission from mother to child in the Western world is 1-2% and dropping, in clinics where I come from, many populations such as women attending antenatal clinics have a seroprevalence of 20%," she said. "Western leaders must reaffirm their commitment to 'bridging the gap,' the theme of the last World AIDS Conference, by investing in developing countries, especially Africa. In the scientific arena we tend to get excited by new discoveries and forget to build on what we have already discovered. But we must implement these discoveries" with resources that have been mustered and allocated through collective global decision-making.
Geeta Rao Gupta of the International Center for Women quoted Charles Dickens, calling the present era with regard to HIV "the best of times and the worst of times." She noted that political will has been enacted and that public and private sectors have put monies into partnerships and research and development. She described a growing advocacy movement for microbicides, the establishment of successful antiretroviral strategies, and the existence now of two low-cost ways to prevent PHT. Yet the epidemic rages on in parts of the world with the greatest number of infections and where new biomedical options are not only economically but also sometimes ethically and otherwise problematic. "If something doesn't change," she said, "the benefits of new prevention technologies may not outweigh the costs. We must examine each biomedical intervention and the context in which to implement it."
Conference organizers were hopeful that the conference would enable low-resource countries to adopt prevention strategies tested and proved successful in developed countries. In North America and Europe, the rate of perinatal transmission has fallen dramatically since the early '90s and now, at the end of the century, has slowed so much that some experts have ventured that no cases of perinatal transmission need occur -- in North America and Europe, that is. With respect to the rapidly widening gulf between "high- and low-resource settings," either of two other directions would seem plausible: 1) basic scientific research continues to work to find affordable alternatives for use in low-resource countries, or 2) governments and political and business leaders roll up their sleeves and find ways to utilize the successes already attained.
Social and political factors are among the most daunting problems; at this point, with regard to global perinatal transmission, scientific problems arguably appear far less urgent. Perhaps the next Conference on Global Strategies should focus on the development of strategies to permit the implementation in low-resource countries of techniques and knowledge already available and proven useful in North America and Europe.
This article was provided by San Francisco AIDS Foundation. It is a part of the publication Bulletin of Experimental Treatments for AIDS. Visit San Francisco AIDS Foundation's Web site to find out more about their activities, publications and services.