AIDS - A tale of two epidemics18th June 2006
June 2006 saw the 25th anniversary of the beginnings of the HIV/AIDS pandemic. Who could have predicted the devastation this disease would have on communities around the world, as those first few cases in homosexual men in the US were diagnosed in June 1981?
In the past 25 years more than 65 million people have been infected with HIV and 25 million have died. Worldwide, 13,000 are newly infected each day, more than 40% of these new infections in adults are in those aged between 15 and 24years.
In the early years of the pandemic rapid progress was made into understanding the virus, how it spread and how to treat it. Progress in the last 5 years has been less dramatic, characterised only perhaps by a widening of the gap between the haves and the have nots.
In effect, this same virus is the cause of two different epidemics. Ninety five percent of infections and deaths have occurred in developing countries. Sub-Saharan Africa is home to 64% of the 38.6 million living with HIV/AIDS today. Here women represent 60% of those currently infected and 77% of newly infected 15 to 25 year olds. This disease is stretching to breaking point already scarce resources and affecting those most able to ensure economic stability of families and communities.
In the West, HIV is a chronic disease, comparable with diabetes, characterised by concerns over long-term adverse reactions to therapy and the development of resistance to medication. However in developing countries only 1 in 5 requiring antiretroviral therapy are receiving it, prevention services reach less than 10% of people and access to testing is only available to 1 in 10 people at risk.
We can only hope that in the next 25 years, we see the not only the development of safer drugs, an effective vaccine and cheap and effective prevention strategies, but intensified efforts by world leaders and policy makers to narrow the gap between these two epidemics.
Based on 2 editorials in New England Journal of Medicine
NEJM 2006;354:2411-2414, NEJM 2006;354:2414-2417
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