Sunday, June 28, 2009

HIV Treatment is Necessary but not Sufficient for Eradication

The HIV in Kenya blog has covered many aspects of development in Kenya and other African countries because HIV is a symptom of underdevelopment, poor health systems, inadequate education and few, if any, social services. However, it has been primarily concerned with prevention of HIV, as opposed to treatment and care for those already infected with HIV. This is not because I consider treatment and care to be unimportant or because it is already over funded. On the contrary, treatment and care for people with HIV and Aids should be a vital part of any country's approach to reducing the spread of HIV.

If people who are HIV positive have no expectation of treatment or care, there is no reason why they should bother being tested. If people don't get tested and don't know their status, they could continue having sex with HIV negative people and thus spread HIV further. People who are found to be HIV positive can be advised on how to take precautions against spreading HIV. They can also receive antiretroviral therapy (ART), which, when they respond to it, makes them less likely to transmit HIV.

At present, many tens of thousands of people are on ART in Kenya. Most of them are able to live a healthy life, to work and provide for themselves and their families. Many of them have been provided with conditions that can reduce the probability of their transmitting HIV to their partners.

Admittedly, some treatment and care programmes are better than others. The programmes are very expensive and require a delicate balance, so treatment can be interrupted for many reasons, such as civil disturbance, financial problems, various disasters, food shortages, etc. The majority of people who are HIV positive and requiring treatment are still not receiving it, but there are also many people who would not be alive or healthy today if they were not receiving treatment.

This is good for HIV positive people, who may number as much as 1.5 million, sexually active people. In a population of around 40 million people, that's no small feat because these 1.5 million adults would have many dependents. Many millions of people are less directly affected by HIV but would be at far greater risk if they didn't have a parent, sibling or guardian to provide for them. When you add in dependents, maybe a quarter of the population of Kenya or more need ART to be rolled out to everyone who needs it.

But even if everyone who needed ART were to receive it, this would not cut the rate of HIV transmission to a level where the epidemic will eventually 'fizzle out'. Tens of thousands of people are being infected every year, more than are being put on ART every year. The epidemic may be bumping along, with prevalence lower than it was 10 years ago, when it peaked at 10%. But this is not a good situation, this is not something to celebrate. Prevalence dropped in the early 2000s because death rates were very high. Now that death rates are lower, prevalence is going up.

Treating and caring for people who are HIV positive is only one part of preventing people from becoming infected and, eventually, reducing infection to so low a level that the epidemic will cease to be the serious threat to the country that it is now and will be for the foreseeable future. At the moment, the amount of money spent on HIV prevention is estimated to be less than 25% of total spending. And much of the money being spent on HIV prevention seems to be having very little effect.

Much more money needs to be spent on researching and implementing viable prevention programmes. Treatment and care can only be a part of a country's overall HIV eradication programme. The disease won't just go away and, right now, the number of people requiring treatment, which they will need for the rest of their lives, is going up. Kenya can't afford to keep treating people at the rate that people are becoming newly infected; the world can't afford to keep treating people at the rate that people are becoming infected, globally.

HIV will not just die out unless new infections are reduced radically. Treatment and care programmes are very necessary but, on their own, are not sufficient to eradicate HIV.



Andruid said...

"This is good for HIV positive people, who may number as much as 1.5 million, sexually active people."

I suspect that figure could include a fair number of teenagers. Just a hunch

Simon said...

Hi Andruid
Do you mean teenagers who are not sexually active but were infected at birth? I'm sure you are right. I was just using ballpark figures, though many teenagers have dependents too. But the issue is not really the numbers but the process of emphasizing treatment and care at the expense of prevention. New infections must be cut to a very low level before the epidemic can start to be eradicated.