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1 December, 2017 00:00 00 AM
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World AIDS Day

A person living with HIV who starts antiretroviral therapy today will have the same life expectancy as an HIV-negative person of the same age
Dr. Mohammed Abul Kalam
World AIDS Day

This year’s World AIDS Day campaign will focus on the right to health. In the lead-up to 1 December, the #my right to health campaign will explore the challenges people around the world face in exercising their right to health. The “#my right to health campaign will provide information about the right to health and what impact it has on people’s lives. It will also aim to increase the visibility around the need to

achieve the full realization of the right to health by everyone, everywhere. Almost all of the Sustainable Development Goals are linked in some way to health, so achieving the Sustainable Development Goals, which include ending the AIDS epidemic, will depend heavily on ensuring the right to health (UNAIDS 2017).

The right to health is the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, as enshrined in the 1966 International Covenant on Economic, Social and Cultural Rights. This includes the right of everyone including people living with and affected by HIV, to the prevention and treatment of ill health, to make decisions about one’s own health and to be treated with respect and dignity and without discrimination. Everyone, regardless of who they are or where they live, has a right to health, which is also dependent on adequate sanitation and housing, nutritious food, healthy working conditions and access to justice. The right to health is supported by, and linked to, a wider set of rights. Without the conditions to ensure access to justice, the right to a clean environment, the right to be free from violence or the right to education, for example, we cannot fulfill our right to health. Ending AIDS as a public health threat can only happen if these rights are placed at the centre of global health, so that quality health care is available and accessible for everyone and leaves no one behind.

Bangladesh continues to be a low prevalence country, albeit one with very high vulnerability. Levels of risk behavior, in terms of high levels of unprotected sex with commercial partners, and unsafe injecting practices, make the country very vulnerable. Condom use is in Bangladesh is reportedly lowest in Asia, although the figures have been rising, due to NGO interventions. The porous borders with India and Myanmar, which are experiencing concentrated epidemics and high migration both within the country and across the borders, increase the vulnerability. Now in Bangladesh, the number of HIV infected persons are 12000 and the number of injecting drug users are 33066. The sero-surveillance of 2016 reported that the prevalence was increased from 3 percent to 22 percent among the intravenous drug users (IDUs) in last five years in old Dhaka (UNAIDS/July 2017). IDUs are not isolated population, they have considerably complicated sexual networks through their marriage, and high number of commercial or casual sexual contacts and the endemic can spiral out.

IDUs in old Dhaka – the one pocket of a particular sub-population, though the infection was at epidemic levels (“Epidemic” in a low-prevalence country is defined at more than 5% in high population; the rate in this particular pocket of that specific group was more than 4 times higher). This was enormously valuable data, as it allowed for a targeted response to the infection. One question remained, though. Why was the rate of infection so high in that particular area (especially among males), but not elsewhere of the country? One hypothesis is that the area is close to big hospital (Dhaka Medical College & Hospital) and a high concentration of pharmacies serving the hospital patients. It seems possible that the ready access of hypodermic needles and pethidine, a drug similar to morphine and heroin, led to an unusual rate of addiction in the area.

The 2030 Agenda for Sustainable Development reflects the interdependence and complexity of a changing world and the imperative for global collective action. In shifting from so-called development for the poorest countries to sustainable development for all, the global agenda has expanded in scope and complexity. As a set of indivisible goals, the SDGs give all stakeholders a mandate for integration of efforts. The AIDS response is no exception: the epidemic cannot be ended without addressing the determinants of health and vulnerability, and the holistic needs of people at risk of and living with HIV. People living with HIV often live in fragile communities, and are most affected by discrimination, inequality and instability. Their concerns must be at the forefront of sustainable development efforts.

By extension, lessons learned from the multisectoral, multi-stakeholder AIDS response are key to progress across the SDGs. The AIDS response has advanced such issues as the right to health, gender equality, health information systems, service delivery platforms, commodity access and security and social protection. The response has garnered substantial experience in addressing entrenched social norms, social exclusion and legal barriers that undermine health and development outcomes, and its investment approach is increasingly being adopted to accelerate gains across global health and development. The AIDS response can be a leader in leveraging strategic intersections with the Sustainable Development Goals (SDGs), while disseminating lessons learned from three decades of unprecedented progress.

No single prevention method or approach can stop the HIV epidemic on its own. Several methods and interventions have proved highly effective in reducing the risk of, and protecting against, HIV infection, including male and female condoms, the use of antiretroviral medicines as pre-exposure prophylaxis (PrEP), voluntary male medical circumcision (VMMC), behaviour change interventions to reduce the number of sexual partners, the use of clean needles and syringes, opiate substitution therapy (e.g. methadone) and the treatment of people living with HIV to reduce viral load and prevent onward transmission.

Despite the availability of this widening array of effective HIV prevention tools and methods and a massive scale-up of HIV treatment in recent years, new infections among adults globally have not decreased sufficiently. The 2016 United Nations Political Declaration on Ending AIDS target is to reduce new HIV infections to fewer than 500 000 by 2020, from more than 1.8 million in 2016.  

Three interconnected reasons seem to underpin the failure to implement effective programs at scale: lack of political commitment and, as a result, inadequate investments; reluctance to address sensitive issues related to young people’s sexual and reproductive needs and rights, and to key populations and harm reduction; and a lack of systematic prevention implementation, even where policy environments permit it.

Since the discovery of AIDS in 1981 and its cause, the HIV retrovirus, in 1983, dozens of new antiretroviral medicines to treat HIV have been developed. Different classes of antiretroviral medicines work against HIV in different ways and when combined are much more effective at controlling the virus and less likely to promote drug-resistance than when given singly. Combination treatment with at least three different antiretroviral medicines is now standard treatment for all people newly diagnosed with HIV. Combination antiretroviral therapy stops HIV from multiplying and can eradicate the virus from the blood. This allows a person’s immune system to recover, overcome infections and prevent the development of AIDS and other long-term effects of HIV infection.

 nCivil society activists, working closely with researchers and national regulatory authorities, promoted unprecedented investment in AIDS research and accelerated access to new medicines. This enabled new medicines and combinations to get to patients faster than ever before. Pressure from the global AIDS movement also ensured that the prices of new medicines were rapidly brought down to make them affordable to almost every country in the world.

Currently, there are 19.5 million people globally on HIV treatment. A person living with HIV who starts antiretroviral therapy today will have the same life expectancy as an HIV-negative person of the same age. Antiretroviral therapy results in better outcomes when started early after HIV infection rather than delaying treatment until symptoms develop. Antiretroviral therapy prevents HIV-related illness and disability and saves lives. AIDS-related deaths have globally declined by 43% since 2003. Antiretroviral therapy also has a prevention benefit. The risk of HIV transmission to an HIV-negative sexual partner is reduced by 96% if the partner living with HIV is taking antiretroviral therapy.

Community action translates into results. They can achieve improved health outcomes, mobilize demand for services, reach people with services difficult to reach with formal health systems, support health systems strengthening, mobilize political leadership, change social attitudes and norms, and create an enabling environment that promotes equal access.

Community responses to HIV include: (1) Advocacy and participation of civil society in decision-making, monitoring and reporting on progress made in delivering HIV responses (2) Direct participation in service delivery, including HIV-related health services, prevention, sexual and reproductive health and human rights-services (3) Participatory community-based research, and (4) Community financing.

Community responses to HIV are essential to ending the AIDS epidemic, and they are a model on how to reach Sustainable Development Goal 16 (promote peaceful and inclusive societies).

To ensure the right to health, a human rights-based health system is needed, which includes four key elements: (1) Access: health care must be affordable or free and comprehensive for everyone                 (2) Availability: there must be adequate health-care infrastructure and staff (3) Acceptability: health-care services must be respectful, non-discriminatory, culturally appropriate and treat everyone with dignity; and (4) Quality: all health care must be medically appropriate and of good quality.

States should adhere to the following basic human rights obligations: (1) Respect: refrain from interfering with a person’s ability to fulfill their right to health (2) Protect: act to prevent third parties from interfering with a person’s ability to fulfill their right to health (3) Fulfill: adopt appropriate legislative, administrative, budgetary, judicial, promotional and other measures to enable everyone to fully realize their right to health and put measures in place to actively inform and promote the fulfillment of the right to health (4) Almost all of the Sustainable Development Goals are linked some way to health                 (5) Achieving the Sustainable Development Goals, including ending AIDS as a public health threat, will depend heavily on ensuring the right to health for all; and (6) Only by placing rights at the centre of global health can quality health care be available and accessible for everyone, leaving no one behind.

The writer is former Head, Department of Medical Sociology,

Institute of Epidemiology, Disease Control & Research (IEDCR),

Dhaka, Bangladesh,

E-mail: med_sociology_iedcr@yahoo.com

 

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Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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