The HIV epidemic in Asia and Africa among men who have sex with men is similar to the epidemic in the 1980s in the US and Europe, said Peter Piot, retiring director of UNAIDS, at the satellite meeting on gay men/MSM preceding the 2008 World AIDS Conference in Mexico City.
A two-day pre-conference satellite meeting, ‘The Invisible Men: Gay Men and other MSM in the Global HIV Epidemic’ focused on the epidemic amongst men who have sex with men in resource-limited settings.
Delegates heard that HIV prevalence amongst men who have sex with men in Africa, Asia and the Americas is between four and 33 times higher than that seen in the general population. Peter Piot, retiring director of UNAIDS, said these epidemics reminded him of those in North America and Europe in the 1980s.
Figures from Malawi show that 21% of men who have sex with men are HIV-positive. That’s nearly twice the 12% prevalence seen amongst the general population. Levels of condom use were low and, even when they were used, two-thirds of men reported using an oil-based lubricant that can weaken condoms, making them more likely to split. Sex between men is illegal in Malawi, and stigma and discrimination appear to be driving the country’s epidemic with many of the men in the study reporting that they had been frightened to seek medical treatment because of their sexuality.
From the US, new figures based on more reliable testing technology that can distinguish recent from long-standing HIV infections, show that there are many more new HIV infections in the country than previously thought. Authorities in the US now think that there were over 56,000 new HIV infections in 2006 - about 40% higher than the previous estimate.
A research study of microfinance and training for South African women found that it reduced HIV risk behaviour and partner violence. Participants who received microfinance assistance and training sessions on HIV, sexual violence, gender inequality and communication skills were compared with a control group of women who did not receive the intervention. A follow-up analysis found improvements in economic well-being, confidence in communication with household members (but not the partner), a a 55% reduction in intimate partner violence, a 24% reduction in unprotected sex with a non-spousal partner but no overall decline in HIV incidence during the study period.
One patient two diseases
Another satellite session was devoted to tuberculosis (TB) and HIV/AIDS. ‘Universal Access to TB services to PLWHA’ made it clear that TB is the leading cause of death in people with HIV (PLWHA) in Africa. At least one-third of the 33 million PLWHA are also infected with TB, according to estimates, but less than 1 per cent was screened for TB.
There are 500,000 cases of multi-drug resistant TB and 30,000 “extremely drug-resistant” (XDR) cases annually. Almost 70 per cent of HIV-positive persons in need of TB treatment worldwide have not received it. Lack of access to HIV/TB treatment leads to a high death toll among Pakistani injecting drug users.
Nobel Peace Laureate Desmond Tutu reflected on TB, poverty and death, urging governments to live up to their promises and commitments on providing decent health care. Anand Grover, UN Special Rapporteur on the Right to Health, felt encouraged by the development of new leadership for HIV and AIDS, and the Joint Learning Initiative on Children and HIV/AIDS says the issue of HIV and children has to be addressed within the family context to be successful.
Source: Panoscope www.panosaids.org
InfoChange News & Features, August 2008