Ending AIDS? These three places show the epidemic is far from over

December 15, 2019

Several places are still far far away from ending their epidemics and in fact are seeing their epidemics increase and that’s what I’m focusing on. Asking the question why and who’s there on the ground trying to fix things. My name is John Cohen. I’m a staff writer with Science magazine. the Pulitzer Center funded travel for this project which also involved a collaboration with the PBS Newshour. I’ve been covering the epidemic around the world now for nearly 30 years. When I began doing this I’d go on trips to other countries and see warehouses full of people dying. I don’t see that now but I do see places that are struggling to use the very powerful tools that exist both to help keep people alive and to stop them from spreading the virus to other people. About one out of four mother to child transmissions in the world happen in Nigeria. And Nigeria has had billions of dollars of foreign aid poured into the country to help solve the problem. So what’s wrong? The big problem is so many pregnant women never intersect with healthcare. They either give birth at home or they have a traditional birth attendant but she’s not necessarily a trained health care professional who’s gonna do HIV testing. So one of the creative things that Nigeria has going right now is a project working with traditional birth attendants. I met with a traditional birth attendant Mama Metta and they have trained Mama Metta to encourage women to come to her clinic on a day when an HIV testing group shows up and she also knows that if a woman does test positive that she should transfer her to a hospital or a regular clinic for care. So that’s one of the progressive things that’s happening in Nigeria to try to really isolate a problem. About 90% of Nigerians go to services on the weekends whether they’re Christian or Muslim and the country’s about 50/50 so a project has begun called baby shower where they go to the churches and they have the priests say all pregnant women And their partners come to the front for a special blessing. And then the priest says after the service we’re gonna have health testing here we’re gonna check you for sickle-cell anemia and we’re gonna check you for hepatitis B and we’re gonna check you for HIV. HIV is just wrapped up into this because there’s so much stigma and discrimination people might not come for an HIV test but for a health test with all these things they’ll show up. And they get a gift for their baby and for their birthing and then if a woman tests positive there—they link the woman to care and they make sure that she gets on antiretroviral drugs, her baby receives the treatment to stop transmission. It’s a full package to try to address the problem. With baby shower it’s producing some amazing results. It’s spray is like perfume. You can spray it here and somebody else somewhere hmm so what is that and comes looking for what it is. Once they get into the village you see all that running and coming oh the baby shower, I saw you today, this, that, dah, dah. The perfume is spreading, the fragrance is going everywhere. Russia accounts for 80% of all the new infections over the past five years in Eastern Europe and Central Asia. And it has about 10% new infections a year. Something’s really wrong. Well what? What’s broken? Well, Russia only has antiretroviral drugs reaching about one third of the infected people. That’s a big problem. They do not promote needle exchange programs. They barely allow them. So the Russian epidemic has just been growing at a time when it’s dropping everywhere else in Europe. In that harsh political environment, HIV infected people and advocates have created a pharmacy—sort of an underground pharmacy to supply infected people with drugs when the government runs out of drugs. So they collect these antiretroviral drugs and redistribute them to people in need. This is for free. Just help each other. When I did a just a completely unbiased look at the data, what’s happening in the United States— Miami has more new infections than any
city in the country. That shocked me and then when I looked at the top 10 cities in the country—four of
them were in Florida for the new infection rate. Florida has basically every driver of the epidemic that we know of in the United States. High rate of infection in men who have sex with men, it has people who inject drugs, public transportation isn’t really what it should be, and then our rural areas are even more challenged. Homelessness, mental health, ethnic disparities all get in the way of us dealing with the epidemic here. it’s a challenge under the best of circumstances to get appropriate messaging to get people into care. The Haitian community for example, a lot of people don’t speak English—they speak Creole. So, to reach the Haitian community a radio program has a health section that just goes after that Creole population. A way to specifically get them HIV tested. Here’s a clinic in Little Haiti. It has people speaking Creole. They’ll pick you up at your home and take you back and forth. We know if you are treated with antiretroviral drugs and you drive your virus in your body down to levels that are undetectable your odds of transmitting that virus to someone else are exceedingly low. Myself, I take my meds all the time so I have become undetectable. That’s at the heart of all these efforts is get everyone tested get everyone who’s positive on treatment and getting everyone who’s at high risk to lower their risk. To do something like needle and syringe exchange programs or pre-exposure prophylaxis which is a pill usually used to treat HIV that can prevent HIV. That’s what’s needed to really break the back of the epidemic. And there’s a whole lot we can today.

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