Scope of HIV / AIDS

An estimated 42 million people are HIV-infected worldwide. 20 million people have already died of AIDS over the past decade(1). To put things in perspective: the recent SARS epidemic caused a global panic. In total there were 8,427 probable cases of SARS between November 1, 2002 and July 11, 2003, and 813 people died of SARS. By contrast, 14,000 people across the globe become newly infected with HIV every day(2).

Routes of Transmission

HIV transmission can occur when blood, semen, vaginal fluid, or breast milk from an infected person enters the body of an uninfected person. The most common ways that HIV is transmitted from one person to another are:

1. by having sexual intercourse with an infected person (vaginal, anal, oral).
2. through unsafe medical practices including: blood transfusions of infected blood or blood clotting factors, re-usage of needles during vaccination drives, needle stick accidents.
3. by sharing needles or injection equipment with an infected person.
4. through breast feeding or from the blood of an HIV-infected women passing the virus to her baby before or during birth.

While most infections occur through sexual intercourse, recent studies highlight the problem of transmission caused by unsafe medical practices. A recent study conducted by the WHO concluded that up to 75% of all injections administered in developing and transitional countries are done re-using equipment and in the absence of sterilization(3). While the jury is still out on the exact percentage, some studies estimate that up to 30% of HIV infections could be prevented if unsafe medical practices were corrected(4,5). 

Barrier to Treatment, Care and Prevention: a lack of trained healthcare providers

In the US, there are 276 physicians for every 100,000 people (HIV prevalence rate: 0.6%). The picture is quite different in developing countries. Zimbabwe has 14 physicians/100,000 people (HIV prevalence rate: 33.7%); Zambia: 7/100,000 (HIV prevalence rate: 21.5%), Burundi: 1/100,000 (HIV prevalence rate: 8.3%)(6,7).

As medication becomes available and prices drop, the lack of local trained healthcare professionals has become one of the biggest barriers to treatment and effective HIV prevention in developing countries. In some cases, medication and funding are readily available, but remain unused because local healthcare providers lack the clinical expertise to treat HIV-infected patients and administer the medication. Not only does the lack of clinical expertise reflect itself in a lack of care, it also hampers effective transmission prevention messages being communicated to the HIV-infected patients and their families. Operational systems that are necessary to provide good patient care are also lacking in many developing country settings, including systems to maintain patient monitoring and confidentiality, to ensure drug distribution and accountability, to ensure the use of clean needles, etc.

Not only are few healthcare providers in developing countries trained to deal with HIV/AIDS, they also often employ unsafe medical practices that put patients at a great risk of contracting the virus – as mentioned above. Obviously, this is a major contributor of the transmission of infectious diseases, yet one that so easily can be rectified.

Global Distribution of Cases and Rate of Spread
Anti-retroviral Medication: a life-saving option

1. UNAIDS/WHO: AIDS Epidemic Update.  December 2002.  http://www.unaids.org
2. CDC: Global AIDS Program: 'Epidemic growth'. http://www.cdc.gov
3. Hutin YJF, Hauri AM, Armstrong GL.  'Use of injections in healthcare settings worldwide, 2000: literature review and regional estimates.' British Medical Journal, V. 327,8 November 2003.  www.bmj.com
4. Gisselquist D, Rothenberg R, Potterat J, Drucker E. 'HIV infections in Sub-Sahara Africa not explained by sexual or vertical transmission' International Journal of STD AIDS 2002; 13: 657-666.
5. Berkley S. 'Parenteral transmission of HIV in Africa.' AIDS 1991: 5 (suppl) S87-92.
6. AIDS Epidemic Update 2002, UNAIDS, www.unaids.org.
7. Human Development Report 2003, pg. 254-257, UNDP, www.undp.org/hdr2003

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