The epidemic levels off - Special HIV/AIDS edition
published:
Wednesday | December 3, 2008
Eulalee Thompson - BE WELL
About 68 per cent of the people living with HIV are in sub-Saharan Africa, making this the most severely affected region. This 68 per cent of the global HIV total means that this region in Africa has about 22.5 million of the 33.2 million people living with HIV in 2007.
Yet, in spite of cultural and socio-economic barriers in effecting sex-related behaviour change in Africa and Jamaica, the HIV/AIDS news has not been all gloom and doom. In sub-Saharan Africa, for example, the World Health Organisation reports that there were an estimated 1.7 million new HIV infections in sub-Saharan Africa in 2007, but this was a significant reduction since 2001. The experts are seeing a trending down in these figures; they are in fact reporting a levelling off in global HIV prevalence.
The local HIV figures released last week by the health ministry also indicate some positive changes. See the figures for the last five years extracted from the Ministry of Health's chart on reported AIDS cases and death (1982 to 2007).
Fewer cases reported
Certainly, fewer cases of AIDS were reported between 2006 and 2007 (the health ministry is reporting a 30 per cent decline in AIDS cases) and there has been a trending down in the number of people dying from the disease, perhaps as a result of the aggressive heavily subsidised antiretroviral treatment programme.
In fact, elsewhere in the report, the health ministry reported a 'decrease in AIDS deaths and cases is attributed to the introduction of public access to antiretroviral treatment in 2004, prophylaxis against opportunistic infections and improved laboratory capacity to conduct investigations such as CD4 counts, viral load and PCRs. These factors have resulted in a general improved quality of care'.
See below another interesting extrapolation from a health ministry chart titled, Annual AIDS case rate in Jamaica, St James and Kingston and St Andrew (rate per 100,000, 1982 to 2007).
Multiple partnerships
For the five years in the chart, the AIDS case rate (the number of cases per 100,000 of population) is highest in the parish of St James, soaring above the national case rate and that for Kingston and St Andrew but even these rates have been trending down except for a spike in 2005.
The real troubling issues in this latest HIV/AIDS report appears to be the propensity in the population for multiple partnerships and unstable sexual relations, the high rate of transactional sex (that is, sex in exchange for gifts and money) and the fact that so many teenagers and young people in their early 20s are having sex with much older partners, thus limiting their ability to negotiate the terms of the relationships.
On the issue of multiple partnership, 47 per centof people in the 15 to 24 year old age group report multiple partnerships and in the 25 to 49 year old age group 33 per cent reported multiple partnerships. In the total population, 61.5 per cent of men reported multiple partnerships compared to 16.8 per cent of women.A significant percentage of men who have sex with men are also having sex with women. Men on average had 5.68 partners while women had 2.91 partners (data from the KABP Survey, 2008). The picture painted here is of a population having a lot of indiscriminate sex all over the place,cutting across age and socio-economic groups.
Multiple partnerships, the latest HIV/AIDS report indicates, continue to drive the epidemic. Other factors also contribute to spread: early initiation of sexual activity here in Jamaica; limited life skills and sex education; insufficient condom use; stigma and discrimination; commercial and transactional sex; substance abuse; men who have sex with men and homophobia and gender inequity and gender roles.
Other facts to note:
About 73 per cent of all AIDS cases reported in 2007 are in the 20-49 year old age group.
87 per cent of all reported AIDS cases are between 20 and 60 years old. This is similar to the breakdown for all AIDS cases reported since 1982, of which 74 per cent are in the 20 ‹ 49 year old.
Eulalee Thompson is health editor and a professional counsellor; email: eulalee.thompson@gleanerjm.com.
