March 2002, Vol 92, No. 3 | American Journal of Public Health 335
© 2002 American Public Health Association
The Global Spread of HIV
Mary E. Northridge, PhD, MPH, Editor-in-Chief
This month, the Journal highlights the global HIV epidemic. By the end of 2001, 40 million people worldwide were living with HIV, the overwhelming majority of them—28.1 million—in sub-Saharan Africa, according to statistics compiled by UNAIDS and available at www.unaids.org. Nonetheless, abrupt spikes in HIV infection rates throughout Eastern Europe and Central Asia also demand global attention. Around the region, the number of infections is 15 times higher than it was 3 years ago, largely because growing numbers of young people are turning to intravenous drug use in these generally bleak economies.
Dr. Peter Piot, executive director of UNAIDS, warned recently that an even larger epidemic in the former Soviet countries "may be imminent." Ukraine is a case in point. While HIV is still spreading fastest via shared needles and sex work, there has been a clear shift to the larger population (Ian Fisher, The New York Times, January 23, 2002, p. A3). Health officials are alarmed by the inability of the cash-strapped government to rein in the spread of HIV despite relatively progressive policies, including using police officers to hand out syringes to injection drug users. The moment to act is now, as HIV bores deeper into the Ukrainian population.
In this month's lead editorial, Sofia Gruskin hails the June 2001 UN General Assembly Special Session on HIV/AIDS as a landmark event, but rightly questions whether important lessons of the last 20 years are being ignored. Richard Parker, in his thoughtful commentary on HIV/AIDS, structural inequalities, and the politics of international health, challenges us to keep alive the sense of urgency about global HIV in the face of the events of September 11 and their aftermath. Finally, Mary Bassett argues provocatively that short-term mechanisms to enhance the delivery of antiretroviral drug regimens in Africa are desperately needed. In her words, "Reducing the risk of mother-to-child transmission is the right thing to do. There may be no single right way to do it."(p 351)
This month's cover image portrays one attempt to fill that need. In La Romana, Dominican Republic, the local organization Complejo Micaeliano provides medical care and social services for many of the 8,600 legally-licensed female sex workers who work there; 7.5% of these women are HIV-infected. Another local organization, Project Compassion, provides food supplements and social services to rural communities of sugarcane workers, predominantly Haitian migrant workers with high rates of maternal death from HIV.
Since 1999, a local nurse, an obstetrician, and a health coordinator have ensured continuity of medical care for HIV-infected women and children. Visiting HIV specialists conduct clinics 4–6 times each year to review patient management strategies and train local health care providers. To date, routine medications, vitamins, prophylactic antibiotics, and dietary supplements have been provided for 95 HIV-infected women and children, and perinatal AZT prophylaxis (076 regimen) has been used for 24 HIV-infected pregnant women. The resulting mother-to-child transmission rate is 8.3%, meaning that most of the children born to these HIV-infected women, including 18-month-old Yolanda (on the cover), are living HIV-free.
Marking the importance of policy to public health, a new Journal department debuts this month: Government, Politics, and Law. John Colmers, MPH, the department editor, hopes to counter what he considers the mistaken belief that government, politics, and law have little to do with public health. With more than 20 years of experience as a public health practitioner, he aims to help restore the "public" in public health.
Copyright © 2002 by the American Public Health Association
