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HIV/AIDS Declines in Some Regions, But is Poised to Take Off in Others
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| Chris Beyrer |
WASHINGTON, September 14, 2006 � The spread of HIV/AIDS has peaked or gone into decline in some regions, but epidemics may just be beginning in other parts of the world, said Dr. Chris Beyrer, Director of Johns Hopkins Fogarty AIDS International Training and Research Program and an associate professor of epidemiology at the Johns Hopkins University Bloomberg School of Public Health.
In a talk to IRP Fellows and SAIS students, Beyrer presented a somewhat hopeful but still mixed picture on progress made in the global fight against HIV/AIDS. Beyrer has studied the global spread of HIV/AIDS since it was first diagnosed in the early 1980s, and is the author of War in the Blood: Sex, Politics, and AIDS in Southeast Asia.
He spoke about the frustration he feels each time he sees slow policy responses to emergent epidemics. Many governments are still reluctant to apply the difficult lessons learned by other nations struggling with HIV/AIDS, Beyrer said, waiting until the disease rises to epidemic proportions among their own populations to act. "Every culture thinks that somehow it is going to be immune, but none is." He stressed that all nations and cultures must recognize their own vulnerabilities to the disease, and aggressively implement prevention strategies modeled after those with proven efficacy.
Beyrer cited Thailand's “100 percent condom campaign” as one model of success that nations confronting emerging HIV/AIDS epidemics can turn to for guidance. Thailand's HIV transmission rates dropped dramatically following the government’s enforcement of condom use in all arenas of the nation's sex industry. “Harm reduction” programs such as needle exchanges and methadone clinics have also proven to be highly effective in reducing HIV transmission rates in communities where these programs are available, he said.
Other nations have lost traction in their fight against HIV/AIDS, however, partly because they have emphasized policies with punitive approaches to high-risk behaviors. In Russia and Ukraine, for example, spikes in transmission rates have corresponded with intensified prosecution of drug users and sex workers. Beyrer said epidemiologists have traced similar correlations in regions across the globe. Heroin addicts threatened with incarceration or surveillance are driven further underground, where clean needles are scarce and support for recovery, prevention and education programs are out of reach. Prostitutes who work in fear of fines and imprisonment are less likely to carry or use condoms, and less likely to work in venues where they can protect their personal health and safety.
Beyrer, who also serves as Director of Johns Hopkins Center for Public Health and Human Rights, emphasized that access to effective HIV prevention methods is a basic human right that should not be withheld from an individual on any criteria, including criminal status. An advocate for the distribution of condoms in prisons – which are concentrated centers of HIV transmission throughout the world – Beyrer said no government yet has acted on this advice, fearing such a measure would indicate tolerance for sexual activity between inmates.
Beyrer said that even strict regulation doesn't stop both consensual and non-consensual sex from happening in prisons on a regular basis. It is unethical, he said, to deny prisoners the simple tools necessary to protect themselves against infection in this high-risk environment. As with prostitution and drug abuse, neither laws nor value judgments will ever fully eradicate illegal activities, he said, adding that the right prevention tools will mitigate the consequences those activities could have for all of society.
Beyrer also called on organizations and governments that run international HIV/AIDS treatment and prevention programs to use proven methods to prevent the spread of the disease. While he commended the Bush Administration for making an unprecedented financial commitment to combating global HIV/AIDS, he challenged the Administration's emphasis on programs that promote abstinence and monogamy rather than those that promote condom use. "What evidence do we have that promoting monogamy reduces HIV transmissions?" he asked. "None! What evidence do we have that promoting condom use reduces HIV transmissions? It's overwhelming."
Copyright © 2005 International Reporting Project. All Rights Reserved.