Three epidemic trends can be observed :
- Explosive epidemics;
- Masked epidemics;
- Emerging epidemics.
Characteristics of explosive epidemics :
- Late introduction of HIV;
- Rapid growth and;
- High case-load.
High incidence in young people, including vulnerable women and geographic
mobility, are factors which fuel the epidemic.
- The objective of one intervention for vulnerable people was to provide support
for women whose male partners also had sex with other men. This included reaching-out to
the women through a variety of media (articles, newspapers, radio and television messages
- Other interventions were developed at the community level, in particular
appropriate interventions for low income vulnerable women. One programme had three
- Womens health council (include peer opinion leaders);
- Skills training workshops (over 2 weeks, aimed to build communication, self
efficacy), which the peer leaders underwent first;
- Community Activities and Events (play, carnival, health fair, videos).
Community intervention models can change risk behaviours.
Interventions have to be targeted and tailored. Collaboration is necessary for
development, implementation and continuation. Key opinion leaders can mobilise community
based HIV prevention efforts.
- Migration not only has been an important cause for starting the HIV pandemic, it
continues to fuel it. Several sessions have dealt with this vast topic. Reasons for the
enormous changes are numerous but fall under the headings of Push and
- Examples of push includes war, famine and other natural disasters.
One presentation focused on the recent events in Bosnia and Herzegovina and referred to
the very high level of sexual violence and rape. Similar evidence is emerging from other
continents including Central and Southern Africa.
- Examples of Pull included male labour migrants in India. In China,
there are one hundred and twenty million migrants seeking for better working and living
conditions every year.
- Different migrant populations present different aspects of vulnerability. Factors
operated at both individual and social levels.
At the individual level : inadequate STD treatment, lack of information and
education, lack of access to HIV screening, inadequate access to condoms, unscreened blood
transfusions, lack of sterile injection equipment, inadequate diagnostic facilities,
sexual exploitation of women refugees.
At the social level, major factors proposed as contributing to the transmission
1) deprived living conditions;
2) disruption of social support;
3) dysfunctional social organisation.
- Given the recent African experience, it is very disappointing to see the same
mistakes being made in other regions of the world.
Any research and intervention programs need to focus on the
- In the country left by the migrants;
- During the process of migration itself;
- The country of destination.
- Stable prevalence rates are a characteristic of masked epidemic but different
sub-populations may have different incidence rates. High incidence rates may be masked by
high mortality rates. In some countries, mortality rates are coming down.
- The treatment impact of combination anti-retroviral therapy or HAART is now being
reported from many countries. Apart from the fact that many under privileged groups in
industrialised countries have limited access to these treatments, current social and
economic conditions in many developing countries restrict these treatments to the
- The increased availability of anti-retroviral therapy, has highlighted the issue
of post exposure prophylaxis (PEP). As for occupational exposures, standard regimen now
include (Highly antiretroviral therapy active (HAART) or double nucleoside reverse
transcriptase inhibitors (NRTIs). The majority of those taking PEP present minor
reversible side effects but data are inconsistent regarding their contribution to the
premature cessation of treatment in many health care workers. Follow-up for exposed health
care workers is still far from optimal. PEP for non-occupational exposures is now a
reality in many countries and different protocols have been developed and implemented.
Data are still quite scarce but according to available studies having addressed mostly
process evaluation, adherence to treatment, capacity to know the HIV status of the source
of exposure and compliance to follow-up may vary according to different characteristics
such as the type of population presenting for PEP and the type of exposure (assault versus
- Key characteristics include overall low prevalence but increasing incidence rates
in sub-group or regions. There is a potential for rapid spread into other sub-groups but
the evolution of the epidemic remains uncertain.
- This requires careful monitoring of the general population and high risk groups.
We need to understand the causes of the spread of HIV in these sub-groups and how they can
be reached both for treatment and prevention. Such groups include commercial sex-workers
and their clients while much work is performed with commercial sex-workers, their clients
are often forgotten. Intervention programs can also be peer-based.
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