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Global HIV Trouble Spots: Ukraine, Greece, Israel, Asia, Indonesia Ukraine fights spreading HIV epidemic
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Nov 30 2012 By By MARIA DANILOVA, Associated Press

BUCHA, Ukraine (AP) - Andrei Mandrykin, an inmate at Prison No. 85 outside Kiev, has HIV. He looks ghostly and much older than his 35 years. But Mandrykin is better off than tens of thousands of his countrymen, because is he receiving treatment amid what the World Health Organization says is the worst AIDS epidemic in Europe.

Ahead of World AIDS Day on Saturday, international organizations have urged the Ukrainian government to increase funding for treatment and do more to prevent HIV from spreading from high-risk groups into the mainstream population, where it is even harder to manage and control.

An estimated 230,000 Ukrainians, or about 0.8 percent of people aged 15 to 49, are living with HIV, the virus that causes AIDS. Some 120,000 are in urgent need of anti-retroviral therapy, which can greatly prolong and improve the quality of their lives. But due to a lack of funds, fewer than a quarter are receiving the drugs - one of the lowest levels in the world.

Ukraine's AIDS epidemic is still concentrated among high-risk groups such as intravenous drug users, sex workers, homosexuals and prisoners. But nearly half of new cases registered last year were traced to unprotected heterosexual contact.

"Slowly but surely the epidemic is moving from the most-at-risk, vulnerable population to the general population," said Nicolas Cantau of The Global Fund to Fight AIDS, Tuberculosis and Malaria, who manages work in Eastern Europe and Central Asia. "For the moment there is not enough treatment in Ukraine."

Stigma is also a big problem for those with HIV in Ukraine. Liliya, a 65-year-old woman who would give only her first name, recently attended a class on how to tell her 9-year-old great-granddaughter that she has HIV. The girl, who contacted HIV at birth from her drug-abusing mother, has been denied a place in preschool because of her diagnosis.

"People are like wolves, they don't understand," said Liliya. "If any of the parents found out, they would eat the child alive."

While the AIDS epidemic has plateaued elsewhere in the world, it is still progressing in Eastern Europe and Central Asia, according to Cantau. Nearly 21,200 new cases were reported in Ukraine in 2011, the highest number since the former Soviet republic registered its first case in 1987, and a 3 percent increase over 2010. As a result of limited and often delayed treatment, the number of AIDS-related deaths grew 17 percent last year to about 3,800.

Two years ago, Mandrykin, the prisoner, was on the verge of becoming part of that statistic, with his level of crucial CD4 immune cells - a way to measure the strength of the immune system - dropping to 11. In a healthy person, the CD4 count is usually over 600.

"I was lying in the hospital, I was dying," said Mandrykin, who is serving seven years for robbery, his fourth stint in jail. "It's a scary disease."

After two years of treatment in a small prison clinic, his CD4 count has risen to 159 and he feels much better, although he looks exhausted and is still too weak to work in the workshop of the medium-security prison.

The Ukrainian government currently focuses on testing and treating standard cases among the general population. The anti-retroviral treatment of more than 1,000 inmates, as well as some 10,000 HIV patients across Ukraine who also require treatment for tuberculosis and other complications and all prevention and support activities, are paid for by foreign donors, mainly the Global Fund.

The Global Fund is committed to spending $640 million through 2016 to fight AIDS and tuberculosis in Ukraine and then hopes to hand over most of its programs to the Ukrainian government.

Advocacy groups charge that corruption and indifference by government officials help fuel the epidemic.

During the past two years, Ukrainian authorities have seized vital AIDS drugs at the border due to technicalities, sent prosecutors to investigate AIDS support groups sponsored by the Global Fund and harassed patients on methadone substitution therapy, prompting the Global Fund to threaten to freeze its prevention grant.

Most recently, Ukraine's parliament gave initial approval to a bill that would impose jail terms of up to five years for any positive public depiction of homosexuality. Western organizations say it would make the work of AIDS prevention organizations that distribute condoms and teach safe homosexual sex illegal and further fuel the epidemic. It is unclear when the bill will come up for a final vote.

AIDS drug procurement is another headache, with Ukrainian health authorities greatly overpaying for AIDS drugs. Advocacy groups accuse health officials of embezzling funds by purchasing drugs at inflated prices and then pocketing kickbacks.

Officials deny those allegations, saying their tender procedures are transparent.

Much also remains to be done in Ukraine to educate people about AIDS.


Bloomberg News

HIV Soars Among Greece's Drug Users Amid Austerity

While the extent to which Greece's economic crisis has contributed to the outbreak is unclear, austerity measures and high unemployment may fuel an acceleration in new infections in Athens and beyond the capital unless programs to provide methadone, clean needles and condoms are expanded, the Stockholm-based ECDC said in the report.

By Simeon Bennett on November 29, 2012

HIV infections among drug users in Greece jumped more than 20-fold in fewer than two years, fueled by a lack of needle exchange and methadone programs, according to the European Centre for Disease Prevention and Control.

The ECDC, the European Union's agency that monitors infectious disease, reported 314 cases of the AIDS-causing virus among injecting drug users in the first eight months of this year. That compares with 208 for all of 2011 and no more than 15 cases a year from 2001 to 2010, the agency said.

While the extent to which Greece's economic crisis has contributed to the outbreak is unclear, austerity measures and high unemployment may fuel an acceleration in new infections in Athens and beyond the capital unless programs to provide methadone, clean needles and condoms are expanded, the Stockholm-based ECDC said in the report.

"The current economic turmoil will continue to have adverse effects on HIV prevention not only in Greece, but also in other parts of Europe," the ECDC said. "The cost of prevention to avert HIV infections will be less than the provision of treatment to those who become infected."

Waiting lists for methadone programs in Athens were more than seven years long in August 2010, and about seven syringes were distributed per drug user per year, according to the report. Programs implemented by Greece's health authorities since the outbreak began have reduced the waiting list to fewer than four years and increased the number of syringes to 45 per user per year, the ECDC said. Still, that's well below the international standard of 200 needles, according to the report.

Care Capacity

"There are currently concerns that the HIV clinical care capacity in Athens has already reached a ceiling due to the increased number of HIV cases detected in 2012," the ECDC said. "The response to the HIV outbreak by public authorities and NGOs is being managed in the context of social uncertainty, with exceedingly scarce financial resources."

Greece signed a three-year agreement with the International Monetary Fund, European Commission and European Central Bank in May 2010 that stipulated the nation cut health spending to no more than 6 percent of gross domestic product from 9.7 percent.

Euro-area finance ministers this week drew up a debt-relief agreement for Greece that reduced the rates on bailout loans and suspended interest payments for a decade. The government in Athens was also given more time to repay its debt and will be able to buy back its bonds.

Even with those measures, Greece's debt load, which will peak at almost twice the size of its economy in 2014, remains unsustainable, Moody's Investors Service said yesterday. The chance of a default is "high," Moody's analysts wrote.


'Local HIV carriers rising, bucking world trends' - Israel AIDS Task Force notes that 70% of Israelis have never been tested for HIV, which raises fear numbers not accurate.

Contrary to world trends, there is continual increase in HIV carriers, the Israel AIDS Task Force reported before World AIDS Day, which is marked every year on December 1.

However, the rate of new HIV carriers has been slowed due to increased prevention in many countries, including in the most affected countries in Africa, said task force chairman Yonatan Karni said.

"Despite all efforts, it seems that in 2012 as before, the numbers of new carriers continues to grow," he added.

The worrisome statistics showed that in the last nine years, the number of new cases has risen - even though before that, there was a decline. In 2010, there were 430 new carriers reported. Data from the Central Bureau of Statistics that were made public showed there were 456 new cases - 303 men and 153 women - last year.

Between 1981 - when the AIDS virus was first officially identified - until the end of 2011, a total of 7,000 Israelis were diagnosed as HIV carriers.

Today, there are at least 5,658 carriers and AIDS patients living in Israel, with 178 of them children infected by their mothers through breastfeeding because they had not been identified in time.

Although the final 2012 figures have not been officially announced yet by the Health Ministry, Karni said he expected they would show another rise.

Karni noted that seven out of 10 Israelis have never been tested for HIV, which raises the fear that the official numbers do not reflect the true situation.

"We need significant investment by government decision makers to strengthen our activities so we can continue to inform, prevent the spread of HIV and support carriers," Karni added.

The Health Ministry will on Friday officially make public its new epidemiologial report on AIDS. It said 7,032 Israelis have been diagnosed as HIV carriers or sick with full-blown AIDS since 1981. Of these, 1,401 died or left the country, leaving 5,631 actual patients today. But the ministry estimates that there are some 2,000 more who have not yet been tested, as this is not mandatory.

There were 454 new cases diagnosed in 2011, the ministry said. These represent 58 new cases per million residents.


Indonesia and Others See 'Embarrassing' Rise in H.I.V. Infections



HONG KONG - A new United Nations report on H.I.V.-AIDS has some encouraging findings, notably dramatic reductions in new infections in southern Africa, although several countries in Asia now have infection rates 25 percent higher than they were a decade ago.

One of those countries is Indonesia, the world's fourth most populous nation. The health minister, Nafsiah Mboi, called the U.N. findings "so embarrassing," especially in light of large expenditures on prevention programs in Indonesia.

"I don't know what mistakes I have made," she told reporters. "It was shocking to me."

Statistics from Indonesia's National AIDS Commission cited by The Jakarta Post show that condom use remains low, especially consistent use among sex workers. Ms. Nafsiah, 72, a pediatrician who was appointed to her post in June, has favored the distribution of free condoms to young people, an effort opposed by conservative lawmakers and religious groups in the predominantly Muslim country.

Cho Kah Sin, the country director for the Unaids agency, suggested that Indonesia's infection numbers appear higher because the epidemic reached full force there later than it did in other countries.

Another country with worrisome statistics is the Philippines.

Teresita Marie Bagasao, head of the Manila office of Unaids, told The Philippine Daily Inquirer that "while the absolute number of H.I.V. infections in the Philippines is still relatively low, the rate of increase in the number of cases is a cause for concern."

The Philippine Department of Health said there were an estimated 600 H.I.V. cases in 2001. Last year, the number of new infections was 4,600.

"The Philippines is still one of only seven countries in the world to have recorded a sharp increase in the number of H.I.V. cases," Ms. Bagasao said. "While other countries managed to stabilize their epidemics, the Philippines still needs to muster the political will to face the challenge posed by this growing epidemic."

The news site Rappler, citing a national health survey, reported that "the proliferation of social media networks and online dating sites in the Philippines have also made casual sexual encounters extremely accessible among the MSM (men who have sex with men) community."

The U.N. report, issued in conjunction with World AIDS Day this Saturday, shows nine countries with at least 25 percent increases in infection rates since 2001. Six of those countries are in Asia - Indonesia, the Philippines, Bangladesh, Sri Lanka, Kazakhstan and Kyrgyzstan - in addition to Georgia, Guinea-Bissau and Moldova.

Some 34 million people were living with H.I.V. last year, compared to 29.4 million in 2001, the report said.

"Still, 25 countries have witnessed a decline of 50 percent or more in new H.I.V. infections since 2001," according to the Web site CSR-Asia. "Among the countries with the greatest declines are Papua New Guinea, Thailand, India and Cambodia."

Myanmar, Malaysia and Nepal also registered encouraging declines.

As Donald G. McNeil Jr. reported in The Times, the annual U.N. report shows that "globally, progress is steady but slow."

"By the usual measure of whether the fight against AIDS is being won," he wrote, "it is still being lost: 2.5 million people became infected last year, while only 1.4 million received lifesaving treatment for the first time."

Donald cited comments by Michel Sidibe, the executive director of Unaids, about the successes in reducing infection rates, particularly in Africa:

The most important factor, Mr. Sidibe said, was not nationwide billboard campaigns to get people to use condoms or abstain from sex. Nor was it male circumcision, a practice becoming more common in Africa.

Rather, it was focusing treatment on high-risk groups. While saving babies is always politically popular, saving gay men, drug addicts and prostitutes is not, so presidents and religious leaders often had to be persuaded to help them. Much of Mr. Sidibe's nearly four years in his post has been spent doing just that.

Many leaders are now taking "a more targeted, pragmatic approach," he said, and are "not blocking people from services because of their status."

The Chinese health authorities last week ordered hospitals to stop refusing treatment to H.I.V. positive patients, state media reported.

The order came after social-media messages began circulating about a 25-year-old man with lung cancer who was denied surgery at a hospital in Tianjin because he was H.I.V. positive. He went to another hospital, did not reveal his infection and got the surgery, according to Xinhua, the official Chinese news agency.

Xinhua also reported Wednesday that nearly half a million Chinese are now living with H.I.V., including 68,802 new cases so far this year, according to the latest statistics from the Ministry of Health.

An excerpt from a recent report on NPR:

New infections in China have nearly quadrupled since 2007, the report found. HIV prevalence is still generally low in China compared to that in many African countries, but China had nearly 40,000 new diagnoses in 2011, and the steady incline is concerning.

"There is a significant epidemic in men having sex with men in China, which happens in almost all of the major cities," said Dr. Bernard Schwartlander, a director at Unaids. "The Chinese are very pragmatic people. They have recognized the problem, and they have started a strong and proactive program to reach these populations."

"They are completely controlling the epidemic among people who are injecting drugs," said Mr. Sidibe. Even so, the epidemic is growing among homosexual men, he said, with over 30 percent of the new infections occurring among them.

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