American Journal of Public Health Examines International AIDS Crisis
This month's American Journal of Public Health examines the international AIDS epidemic, particularly in the regions of sub-Saharan Africa, Eastern Europe and Central Asia. Summaries of three articles appear below:
- "The U.N. General Assembly Special Session on HIV/AIDS: Were Some Lessons of the Last 20 Years Ignored?": Sofia Gruskin of the Program on International Health and Human Rights at Harvard University in an editorial hails last June's U.N. conference as a "watershed event," but writes that the Declaration of Commitment endorsed at the end of the conference represents a "step backward" for individuals with HIV/AIDS because it treats human rights as a separate issue from health care and does not "fully integrate" human rights as a component of any HIV/AIDS response. She notes that many nations objected to references to men who have sex with men and commercial sex workers as vulnerable groups and says it is "unfortunate that political alliances and political blocks were able to shift the UNGASS consensus" away from placing more emphasis on such groups (Gruskin, American Journal of Public Health, 3/1).
- "The Global HIV/AIDS Pandemic, Structural Inequalities and the Politics of International Health": Richard Parker of the Mailman School of Public Health at Columbia University in a commentary examines the waning sense of urgency surrounding HIV/AIDS. He notes that in the developed world AIDS drugs have lowered mortality rates, and the "worst types of discrimination" against people with HIV/AIDS evident during the early years of the epidemic "seem to have declined as well." However, the "picture is considerably worse" in the developing world. He says that the "global distribution of infection has been anything but equal," noting that 25.3 million of the world's 36.1 million infections are found in sub-Saharan Africa. Some steps, such as the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria, have been taken to address this inequity, but plans for the fund are "still being finalized" and more needs to be done, Parker writes. He also notes that the Unites States' new emphasis on terrorism may further impede HIV/AIDS efforts by drawing funding and interest away from AIDS. He concludes that one "can only hope" that officials will begin to examine the "ways in which such inequities have contributed to the terrible new forms of risk and insecurity that confront us today in a world that often seems to be spinning out of control" (Parker, American Journal of Public Health, 3/1).
- "Ensuring A Public Health Impact of Programs to Reduce HIV Transmission From Mothers to Infants: The Place of Voluntary Counseling and Testing": In another commentary piece, Mary Travis Bassett of the Rockefeller Foundation examines the role of counseling and voluntary HIV testing in reducing vertical HIV transmission in Africa. Although several African governments have begun programs to tackle vertical transmission, the "challenge ahead is enormous," she states, noting that the UNGASS declaration called for offering counseling and testing to 80% of African women who receive prenatal care -- about 10 million women. She states that "[c]ommunity education to promote voluntary counseling and testing, which involves men, is the long-term solution" but calls for several short-term interventions during the process. A lack of counselors and delays in testing hamper voluntary testing systems, and many people have suggested universal testing or mass treatment as solutions for lowering vertical transmission rates until systems can be improved. She states, "It is best that a woman knows and accepts her HIV status, but achieving this aim is not the immediate goal of programs to reduce mother-to-child transmission of HIV. ... It is not appropriate to hold hostage a woman's ability to protect her infant to her ability to learn and accept her HIV status. I am confident that, over time, willingness to enter voluntary counseling and testing will increase, but we need to act now. Reducing the risk of mother-to-child transmission is the right thing to do." However, she concludes, "There may be no single right way to do it" (Bassett, American Journal of Public Health, 3/1).