X HIV/AIDS Prevention and Care in Resource-Constrained Settings

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years combined. HIV prevalencevaries from fewer than two percentof IDUs registered officially inRussia, to about 30 percent in sentinelsurveys in Ukraine andRussia, and more than 60 percentin Svetlogorsk in Belarus and indrug-injecting CSWs inKaliningrad. HIV prevalenceamong other population groupsseems to have remained low so far.While about 130,000 Russiansare believed already to be livingwith HIV, the Russian Ministry ofHealth estimates the number ofIDUs in Russia at about threemillion—two percent of the totalpopulation—providing a largepool of highly vulnerable but notyet infected persons. Although notconfirmed in scientific studies,similarly high estimates also havebeen made for Ukraine and otherNewly Independent States. Withthe deteriorating economic situationof women, the number ofwomen engaging in sex work andpotentially at high risk of infection is believed to haveincreased considerably.At the same time, large epidemics of syphilis andother STDs have been reported from these countries.In Russia alone, between 200,000 and 400,000 newcases of syphilis have been reported annually in thepast few years. This may be only the tip of the iceberg,as under-reporting is believed to be high. Althoughmajor spread of HIV via heterosexual transmission inthe population at large has not yet been confirmed,the massive increase in STDs in the populations ofEastern European countries proves the potential formore widespread HIV/AIDS epidemics.F igure 8Annual Number of Newly Registered HIVInfections, Russia, 1993–1999161412106420Number of HIV infections (thousands)93 94 95 96 97 98 99Year of registrationSource: Russian Federal AIDS Centre, Moscow.■■■The epidemics in this region feature:An estimated 420,000 adults and children livingwith HIV in Eastern Europe and in the countriesof the former Soviet Union by the end of 1999.Only a year later that number was estimated to bemore than 700,000, with the Russian Federation,Ukraine, Belarus, Kazakhstan and Moldova themost severely affected.Most HIV infections in this region are due toIDU, with HIV prevalence rates greater than 60percent in some cities, including Odessa andNikolaev in the Ukraine, Svetlogorsk in Belarusand Kaliningrad in the Russian Federation.Men account for three-quarters of all HIV infectionsregistered in the region, with as many as 60percent of infected persons between the ages of 15and 24.HIV/AIDS Prevention and Care in Resource-Constrained Settings XV
F igure 9Life Expectancy With and WithoutThe AIDS Epidemic in 2000BotswanaZimbabweSouth AfricaNamibiaKenyaTanzaniaLesothoCameroonTogoGhanaZambiaCARCôte d’IvoireSwazilandCongo (Brazzaville)NigeriaBurundiEthiopiaBurkina FasoGabonCongo (Kinshasa)UgandaMalawiRwandaBeninMozambiqueBahamasHondurasBrazilGuyanaHaitiThailandCambodiaWith AIDSWithout AIDSIMPACT OFTHE EPIDEMICSThe pandemic has not only affected the health sector,but it cuts across societies and affects every aspectof human development. There are significant differencesin the impact of AIDS throughout the worlddepending upon the stage of the epidemic within acountry and the level of society under examination.The magnitude, severity and timeframe in whichchange is seen vary according to the type of analysis—whether the effects are examined at the householdlevel, in specific labor sectors, at the level of populationdemographics or a country’s macroeconomic status.H EALTHWithout access to the combination antiretroviraldrug (ARV) therapies now used in the United Statesand other industrialized countries, essentially allnewly infected adults will sicken and die of HIVrelateddisease within three to eight years of becominginfected—many without ever truly knowing theirHIV status. The impact will be especially severe forwomen who are not only biologically more vulnerableto infection but also bear the burden of care for thesick. HIV/AIDS will undoubtedly be a major cause ofmortality in both adults and children for many moreyears to come. AIDS in sub-Saharan Africa alreadyimposes a huge burden on the health infrastructure:More than 60 percent of hospital beds are occupiedby persons with HIV- related disease. One disturbingeffect of the growing burden of HIV disease is anincreasing rate of inpatient mortality in HIV-negativepatients. This is the result of losing key health carestaff, a steady deterioration of health service deliverysystems and overcrowding of hospitals with AIDSpatients that forces HIV-negative patients to waitlonger before being admitted—often in more severe,if not terminal, condition. And because tuberculosis(TB) is so common in HIV-infected persons—and isthe leading cause of death in AIDS patients—the TBepidemic in areas of sub-Saharan Africa has increasedby more than 400 percent.Burma0 10 20 30 40 50 60 70 80 90Life expectancy at birth (years)Source: U.S. Census Bureau, International Data Base and unpublished tables.XVI HIV/AIDS Prevention and Care in Resource-Constrained Settings
Page 1 and 2: Edited byPeter R. Lamptey, MD, DrPH
Page 3 and 4: © 2001 Family Health International
Page 5 and 6: SECTION II:Chapter 6PAGE 137Chapter
Page 7 and 8: Chapter 21PAGE 501Chapter 22PAGE 51
Page 9 and 10: I N T R O D U C T I O NPAUL R. DE L
Page 11 and 12: F igure 1Factors That InfluenceThe
Page 13 and 14: F igure 3HIV Seroprevalence for Pre
Page 15 and 16: F igure 5HIV Seroprevalence for Com
Page 17: F igure 7HIV Seroprevalence for Pre
Page 21 and 22: F igure 11Population of Zimbabwe,Wi
Page 23 and 24: invest; and feedback further amplif
Page 25 and 26: R EDUCING MOTHER-TO-CHILDTRANSMISSI
Page 27 and 28: F igure 13HIV Seroprevalence in Adu
Page 29 and 30: ACKNOWLEDGEMENTSWe wish to express
Page 32 and 33: SOFIA GRUSKIN, JD, MIAAssistant Pro
Page 34 and 35: THOMAS M. PAINTER, PHDBehavioral Sc
Page 36 and 37: glossary of A C R O N Y M SACTG AID

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