There is a lot of loose talk and sloppy thinking about HIV rates and AIDS rates in the country lately. Perhaps World AIDS Day has something to do with it.
Incidence is the number of new infections per unit of time. It is a measure of how many new people are becoming infected. Incidence of HIV in Myanmar has almost certainly been falling since early in the millennium. So the number of new cases is decreasing. This has been demonstrated scientifically http://www.hivinfo4mm.org/blog/_archives/2007/8/22/3173910.html. And we have known this scientific fact for over two years. Incidence naturally declines as most epidemics mature so most people who can be infected have become infected. And prevention programmes in the country beginning at the turn of the century were effective.
Prevalence is the number of people living with HIV expressed as a percentage. Some people call this the HIV rate or the rate of HIV. If incidence decreases, prevalence will decrease about five years later. If many people die, prevalence also decreases. Both of these decreases happen naturally in HIV epidemics. If many people begin treatment, prevalence will not decrease as quickly. So as the number of people taking ART increases, prevalence loses its value to tell us much about the epidemic. The [him] moderator is not as interested in prevalence as he is in incidence.
Long live the decrease in incidence and long live people with HIV.
[him] moderator
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Burma Marks World AIDS Day with Hope for More Aid
Wai Moe
Irrawaddy
Tuesday, December 1, 2009
To mark the occasion of World AIDS Day, Burma's state-run media today lauded the country's ruling regime for its efforts to combat the killer disease, and in the process inadvertantly highlighted the junta's woefully inadequate role in containing a scourge that is claiming countless lives.
“The government is fighting AIDS with the use of manpower and financial power,” read a brief commentary in today's edition of The New Light of Myanmar. “It spent 191.4 million kyat in 2007 in fighting the disease. UNAIDS officially announced that AIDS cases in Myanmar [Burma] dropped from 0.94 percent in 2000 to 0.67 percent in 2007.”
If the rate of HIV/AIDS is decreasing in Burma, it is difficult to see how the regime can take much credit for that success. Spending 191.4 million kyat—around US $200,000—certainly isn't going to make much of a difference in a country where there are an estimated 240,000 people living with HIV.
But like governments all over the world, the generals who rule Burma held a ceremony in their capital of Naypyidaw to show officials from international organizations that they mean business.
Ahead of World AIDS Day, the Joint UN Program on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) claimed on Nov. 24 that new HIV infections have been reduced worldwide by 17 percent over the past eight years and the number of AIDS-related deaths has dropped by more than 10 percent over the past five years.
What about the situation in Burma, one of the world's worst-hit countries? As the New Light of Myanmar noted, quoting UNAIDS, the prevalence of HIV/AIDS has also fallen in Burma. What the commentary does not mention, however, is that the infection rate in 2006 was 1.2 percent of the population—making the decline the following year all the more dramatic.
Is this a result of tampering with the numbers to create a false impression of success? Not according to one Burmese AIDS expert who spoke to The Irrawaddy on condition of anonymity.
“Most WHO and UNAIDS experts agreed that it's not a politically biased underestimate,” he said.
There are many reasons for the falling number of AIDS cases in Burma, he said, not the least of which is the fact that many of those who have contracted the disease have simply died due to a lack of treatment.
According to international relief organization Medecins Sans Frontieres, 25,000 people died of AIDS-related illnesses in Burma in 2007.
The Burmese AIDS expert also cited changes in the way infection rates are estimated as another possible reason for the decline. And to a lesser extent, there is some evidence that prevention programs and “the diffusion of information, knowledge and safe practices [is] having some protection effect.”
However, other health workers in the fight against HIV/AIDS in Burma expressed skepticism about the decreasing number of HIV-infected people in the country.
“It is too early to say that HIV infections have dropped in Burma as many people living with HIV have not yet been documented,” said Phyu Phyu Thin, a leading AIDS activist with the opposition National League for Democracy.
“The capacity of the Ministry of Health, international NGOs and UN agencies in responding to the epidemic is quite limited by budget, public health education as well as because of restriction by the authorities,” she added.
Other experts agree with this assessment.
“Principal challenges include the politicized and difficult operation environment, chronic underfunding, a weak public sector and insufficient multi-sectoral engagement from non-health government departments,” according to the UNAIDS’ situation report on the country.
While the military regime spends little on the war on HIV/AIDS, the people of Burma also get little international assistance to fight the disease compared to neighboring countries due to the political situation and transparency issues. The development assistance for Burma is roughly $3-5 per person, while Cambodia, Laos and Vietnam get 10 times that amount.
“The collective capacity of the UN, NGOs and the Health Ministry has not been utilized because of the shortage in funds,” said the Burmese expert. “There are also other needs obviously—technical capacity, conducive operating environment, stronger accountability, etc. But the biggest need is financial resources.”
As the international community, particularly Washington, shows a growing willingness to engage with the Burmese regime, funds for humanitarian issues in the country could increase. Recently, the the Global Fund to Fight AIDS, Tuberculosis and Malaria decided to return to Burma for the first time since it withdrew from the country in 2005. A meeting of the Global Fund was held in Naypyidaw today, according international NGO sources.
“The return of the Global Fund will be welcomed by AIDS workers in Burma, but even with that there will still be funding gaps in both treatment and prevention activities on HIV,” said the Burmese expert.
Also adding to the momentum for an increase in aid to Burma is the position of opposition leader Aung San Suu Kyi, who in recent meetings with Western diplomats has expressed support for plans to increase the level of humanitarian assitance coming into the country
http://www.irrawaddy.org/article.php?art_id=17336
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NEWS: Report Confirms Decline in the Rate of New HIV Infections
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New HIV infections in 2008 were 30% lower than they were 12 years ago, according to data just released by UNAIDS and the World Health Organization (WHO). The findings confirm a trend first observed about two years ago.
UNAIDS and WHO state that the spread of HIV "appears to have peaked" in 1996. An estimated 2.7 million new HIV infections occurred in 2008, the same number as in 2007, but well below the 3.5 estimated new infections in 1996. Sub-Saharan Africa remains the most heavily affected region, accounting for 71% of all n
ew HIV infections in 2008. But even there, the number of new infections is 15% lower than it was in 2001.
"The good news is that we have evidence that the declines we are seeing are due, at least in part, to HIV prevention," said Michel Sidibé, Executive Director of UNAIDS. "However, the findings also show that prevention programming is often off the mark and that if we do a better job of getting resources and programmes to where they will make most impact, quicker progress can be made and more lives saved."
The number of people living with HIV continues to grow. In December 2008, an estimated 33.4 million people were living with HIV, compared to 33.0 million in 2007. The reason that this number continues to grow while new infections are declining is that HIV-positive people are living longer, due in large part to expanded antiretroviral (ARV) coverage. UNAIDS and WHO report that the percentage of those needing ARV treatment who actually receive it rose from 7% in 2003 to 42% in 2008, meaning that over half of those in need of treatment are still not receiving it.
According to UNAIDS and WHO, annual HIV-related mortality "appears to have peaked" in 2004, when 2.2 million deaths occurred. The estimated number of AIDS-related deaths in 2008 was 2.0 million.
UNAIDS and WHO say that while the epidemic appears to have stabilized in most regions, prevalence continues to increase in Eastern Europe and Central Asia. "Differences are apparent in all regions," the two organisations state, "with some national epidemics continuing to expand even as the overall regional HIV incidence stabilizes." In Eastern Europe and Central Asia, epidemics that were once characterised primarily by transmission among injecting drug users are now increasingly characterised by significant sexual transmission. In parts of Asia, the epidemic is becoming increasingly characterised by significant transmission within heterosexual couples.
UNAIDS and WHO state that AIDS continues to be a major global health priority. "Although important progress has been achieved in preventing new HIV infections and in lowering the annual number of AIDS-related deaths," the two organisations say, "the number of people living with HIV continues to increase. AIDS-related illnesses remain one of the leading causes of death globally and are projected to continue as a significant global cause of premature mortality in the coming decades."
http://www.aidspan.org/index.php?page=gfomostrecent
