Locked Doors: The Human Rights of People Living with HIV/AIDS in China, Human Rights Watch, 3Sept03
SARS and AIDS: What the people don't know: Christopher Horton, 24 APR03, Asia Times
April 25, 2003
SARS: FACING THE CHALLENGE OF HIV/AIDS
Today, emerging infectious diseases challenge the entire global landscape. As the SARS epidemic continues to expand, one of the factors under discussion is the threat of infection among individuals with HIV/AIDS (http://www.humanitarian.net/biodefense/sars_superspreaders.html). The bottom line perspective is that if outbreaks occur in geographic areas with significant HIV/AIDS infections, these populations will (1) be decimated and (2) have the potential to amplify infection, viremia and spread of the contagion.
WHY ARE WE IN THIS PREDICAMENT?
The simple answer is that fundamental public health principles of containment and control were never followed during the course of the AIDS pandemic. A 10-15 year incubation period meant that no immediate deaths and therefore no imminent public health emergency existed, allowing the virus to spread unchecked across the globe.
According to estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), 38.6 million adults and 3.2 million children were living with HIV at the end of 2002. During 2002, some 5 million people became infected with the human immunodeficiency virus (HIV), which causes AIDS. The year also saw 3.1 million deaths from HIV/AIDS - a higher global total than in any year since the beginning of the epidemic, despite antiretroviral therapy which reduced AIDS and AIDS deaths in the richer countries (Statistics: http://www.avert.org/worlstatinfo.htm).
In conjunction with the United States Conference on AIDS in 2000, Sandra Thurman, director of the White House Office of National AIDS Policy, shared with a group of high school students that since 1996, an estimated 80,000 teens and young adults have become infected with HIV in the United States.
According to the Youth and HIV/AIDS 2000 Report (http://www.thebody.com/whitehouse/youthreport/director.html), out of 40,000 new HIV infections every year, government officials estimate that 50% of the cases occur in young people between the ages of 13 to 24. Although high-risk sexual behaviors have dropped and the use of condoms has risen, the number of new HIV infections has remained steady since 1996. The report also emphasized the distressing reality that the vast majority of HIV-infected youth do not receive adequate medical care.
WHAT COULD HAVE BEEN DONE?
The simple answer is (1) defining those who are infected with the virus, this should have taken place immediately after a test was available, (2) contact tracing of all at risk contacts (3) minimizing spread via the application of universal precautions regarding blood or body fluids that carry the virus, (4) low cost access to HIV/AIDS therapeutics.
As these fundamental public health principles were overlooked, the infection spread worldwide and now challenges the capacity of the international community to handle new emerging infectious disease threats, that include bioterrorism.
The discussion of acquired immunodeficiencies (http://www.humanitarian.net/biodefense/smallpox31403.html) and comparative risk analysis in the context of bioterrorism has recently focused on (1) severity of a smallpox infection in the patient with Congenital or Acquired Immunodeficiencies, HIV causing an intensification of infection, (2) vaccination risk in patients with a CD4 count <50 cells/mm3.
20 YEARS INTO THE AIDS PANDEMIC, WHAT NEEDS TO BE DONE?
The size and scope of the present crisis responsive scenario demands we go back to the basics. Individuals infected with the HIV must be identified, universal precautions applied and as articulated by Dr. Luc Montagnier, head of the World Foundation for AIDS Research and Prevention:
"the only treatment for the potentially deadly pneumonia is to boost the natural resistance of the carrier." - iafrica.com, SARS will hit HIV sufferers - expert, Mon, 21 Apr 2003.
This would require an international public health response that includes low cost access to the full range of HIV/AIDS therapeutics (U.S. Food and Drug Administration: http://www.fda.gov/oashi/aids/status.html) to increase longevity, quality of life and immunocompetence of infected persons.
The construction of business models that thrive on epidemic disease can no longer be considered viable.
INTERNATIONAL LAW AND EMERGING INFECTIOUS DISEASES
As outlined in the article "SARS: Hong Kong Health System at brink of collapse" on the United Nations Department of Public Information NGO site (http://www.undpi.org/modules.php?op=modload&name=News&file=article&sid=98):
"The HIV/AIDs crisis dramatically illustrated the weaknesses of the health regulations. Since AIDs was not originally (or subsequently) made subject to the regulations, states had, and continue to have, no notification requirements in connection with this new disease. Further, as HIV/AIDs spread globally, many states adopted exclusionary policies that, according to experts, violated provisions of the health regulations. In relation to one of the biggest disease crises of this century, parts of the International Health Regulations were irrelevant, and other parts were openly violated."
"The International Health Regulations administered by WHO represent the most important set of international legal rules relating to infectious disease control, but the regulations only apply to plague, yellow fever, and cholera. The importance of health is mentioned in international declarations (for example, see the Universal Declaration of Human Rights, art. 25 ) and treaties (for example, see the International Covenant on Economic, Social and Cultural Rights, art. 12), leading some legal scholars to argue that international law creates a “right to health” (24); but this “right” does not directly address the control of infectious diseases."
According to the World Health
Organization: " The Sars disease poses one of the most serious global health
threats since Aids because of its infectiousness and potential to spread
through air travel" (Financial Times, April 11 2003). As for the future,
we need only look as far as viral incursions such as SARS crossing human
and animal populations (Facing Concurrent Outbreaks of SARS and HPAI: http://www.humanitarian.net/biodefense/eid_nppc.html),
facilitating the evolution of new recombinant strains that will challenge
populations without immunity.
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