World AIDS Day 2011: Getting to Zero HIV

The first day of the twelve month of the calendar year was adopted as ‘World AIDS Day’ on the recommendation of Dr. Jonathan Mann, a former Director of the Global Programme on AIDS at the World Health Organisation (WHO). The notion of World AIDS Day was conceived by James W. Bunn and Thomas Netter who were, at the time, public information officers at the Global Programme on AIDS.

The concept appealed to Dr Mann and he agreed with the recommendation that 1 December 1988 would be the first ever World AIDS Day. The Global Programme on AIDS became the Joint United Nations Programme on HIV/AIDS (UNAIDS) in 1996. Dr Mann and his wife, Mary Lou Clements-Mann, a world leading researcher on HIV/ AIDS died in a plane crash (Swissair Flight 111) in 1998.

World AIDS Day is dedicated to raising awareness about HIV/AIDS and demonstrating international solidarity. The day is an opportunity for public and private partners to spread awareness about the status of the pandemic and encourage progress in HIV/AIDS prevention, treatment and care in high prevalence countries. The theme of World AIDS Day between 2011-2015, will be “Getting to Zero: Zero new HIV infections. Zero discrimination. Zero AIDS related deaths”. This is a very ambitious aspiration.

The UNAIDS World AIDS Day Report (2011)  shows that by the end of 2010 there were about 34 million people living with HIV globally. This was an increase of about 17%  to the number of people living with HIV in 2001. There were 2.7 million new HIV infections in 2010, a reduction of about 15% in comparison to the number of new infections in 2001. 70% of all the new HIV infections in 2010 were in Sub-Saharan Africa. The annual numbers of new HIV infections continue to fall more rapidly in some countries than others. New HIV infections have fallen significantly in 33 countries, 22 of which are in Sub-Saharan Africa. In geography, I am told, the term Sub-Saharan Africa refers to the African countries south of the Sahara desert.

Although the population of Sub-Saharan Africa is about 12% of the global population,  it has a relatively high number of people living with HIV. Every year AIDS has claimed at least one million lives in Sub-Saharan Africa since 1998. About  21 million men, women and children were living with HIV by the end of 2010 in Sub-Saharan Africa; about 68% of all the people living with HIV in the world. There were about 2 million people newly infected with HIV in 2010. Almost half of the deaths associated with HIV-related illnesses in 2010 occurred in southern Africa. There are about 6 million people living with HIV in the Republic of South Africa, the highest number in the world. With about 25% of its adult population living with HIV the Kingdom of Swaziland has the highest adult HIV prevalence in the world. The number of people living with HIV in the Republic of South Sudan is unknown and HIV prevalence is expected to increase, particularly in the national and state capitals, until a fully functional health care system is introduced to provide access to HIV treatment, management and care.

HIV is mainly transmitted by unprotected sexual intercourse (UPSI). It may also be transmitted from mother to child in pregnancy, at birth or breast milk; the use of unsterilised injections by drug users; the transfusion of blood products and organ transplantation from HIV infected people. It is thought that the main route of transmission in the high HIV prevalence countries in Sub-Saharan Africa is UPSI. Safer sex methods and a reduced number of sexual partners can protect people from the risk of exposure to HIV, suffering the consequences of AIDS-related illnesses and premature death.

The concept of multiple sexual partners includes the cultural prac of polygamy, inheritance of the wives of dead relatives and extra-marital sexual partners. When a married woman in a polygamous family has an extra-marital affair with an HIV positive man, the infection would be passed on to her husband and his other wives. A man who inherits the wife of an HIV-infected dead uncle might pass on the virus to his other wife or wives. Similarly, a man who expresses his masculinity by serial extra-marital relationships (aka random sampling), would be at increased vulnerability to HIV infection, ill-health and premature death.

Increased sexual activity in men is inextricably linked with the indiscriminate abuse of alcohol or drugs or peer pressure. Alcohol, drugs and peer pressure frequently lead to increased sexual activity and tragic consequences. Increased sexual activity in women would also raise the potential for unplanned pregnancy, lone parenthood, social exclusion and poor mental health. This argument is in agreement with the Christian value of ‘security in marriage’

HIV/AIDS is almost always linked with the proliferation of brothels in South Sudan. Sex workers from neighbouring Uganda are allegedly responsible for the surge in the number of people living with HIV or dying of HIV-related causes. The anecdotal evidence quoted  is based on premise that the majority of sex workers speak either ‘Kiswahili’ or ‘English’. A close examination of the issue shows that some of the active sex workers are of South Sudanese origin. Many of the ‘returnee’ sex workers are unfortunate South Sudanese who were born in exile and to whom Kiswahili is the first language. Therefore, the ‘returnee’ sex workers are our own daughters and sisters orphaned or widowed by the war of liberation in which they were cruelly deprived of their parents and the opportunity for education and a better life. Some of the unfortunate women are the offspring of liberation war heroes who paid the ultimate price in the struggle for freedom and independence!

The ludicrous idea that the spread of HIV can be halted by the violent deportation of Ugandan women will not resolve our predicament. It would be tantamount to a crime against humanity. We can improve the situation by adopting a more responsible attitude in the allocation of national resources. In the United Kingdom, 40 per cent of the national budget is allocated to the National Health Service (ministry for health), thirty percent is allocated to education and the rest of the ministries share the balance. This trend is replicated across the developed world. We need more investment in education, health and social services.

There will be no significant change in South Sudan until we learn to be accountable for our actions and decisions. We should demonstrate humility in public office and in the service of the silent majority. We must reduce the burden of government bureaucracy to a manageable structure. We must also learn from the experiences of countries like Greece and Italy that ignored the participation of technocrats in government to their peril. We need to engage with and involve the vast array of South Sudanese technocrats in the international organisations, developed and developing countries so that they can return to serve in our home country. We need to act now to prevent the scourge of HIV/AIDS spiralling out of control, increasing infant and adult mortality and morbidity, reducing our capacity for economic development and growth, creating political instability and insecurity.

HIV has no friend irrespective of your age, disability, ethnicity, faith, gender or social status.I  would urge each and every one of us to be screened for HIV and other life threatening STIs.

I wish you all the best on World AIDS Day.

Hakeem Legge

Interim Head of Health Improvement

NHS North of England

Blenheim House

Leeds, United Kingdom