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There are many countries around the world that are affected by the HIV epidemic. Two countries in particular are Africa and Russia. There is no other place in the world that was devastated by the HIV/AIDS epidemic than the continent of Africa. For example, in South Africa, a long history of government denial of the disease fueled an epidemic that had reached disastrous amounts by the early 2000s. Even today, despite decreased rates of death and better leadership regarding HIV and AIDS, new HIV infections continue to rise year on year and many continue to die from AIDS. As a result of this, South Africa still today is the country with the largest population of HIV positive people in the world. For the history of HIV in Africa it is strongly believed that HIV originated in Kinshasa, in the Democratic Republic of Congo around the year 1920 when HIV crossed species from chimpanzees to humans. Up until the 1980s, it is not known how many people were infected with HIV or had developed AIDS since the HIV infection wasn’t publically known and transmission was not followed by any noticeable symptoms. While there were random cases of AIDS documented before 1970, existing information suggested that the HIV epidemic probably started in the mid to late 1970s. By 1980, HIV may have already spread to South America, North America, Africa, Europe, and Australia. At this point between 100,000 and 300,000 people could have already been infected with the HIV virus. It wasn’t until 1983, doctors started reporting cases of a new, deadly, deteriorating disease locally known as “slim” in Uganda. However, as the country was in the midst of this all, the HIV virus was for the most part largely ignored. While political trouble dominated the media, HIV was largely ignored while it was becoming a public health disaster. It wasn’t until in the 1990s that President Nelson Mandela recognized his countries devastation to this disaster, but by this time it was too late and South Africa had already become the largest continent affected with HIV in the world. Fast forward now 10 years, the Department of Health outlined a five-year HIV and AIDS plan, but received practically no support from the South African President Thabo Mbeki in 2000. President Thabo Mbeki rejected concrete HIV evidence and instead blamed the growing HIV epidemic on poverty, colonialism, and business greed. The five-year plan did not get off the ground as quickly as many would have liked, with very few showing up to receive free antiretroviral medication because of little government support. While this is all taking place, a growing problem is HIV among pregnant South African women with percentages over 30% by 2000. In 2008 President Thabo Mbeki was removed from office and this is when the government stepped up to tackle this health catastrophe, pushing for what is now known today as the biggest HIV drug programs in the world. With HIV and AIDS activists wanting to advocate for this disease it has been difficult because of a deteriorating public health structure, and the diminishing of the South African currency under newly elected President Jacob Zuma. To date, less than 30% of people with HIV are on medication in South Africa, while the HIV virus rates among young adults continue to rise. South Africa consists of 7.2 million people living with HIV as of 2017 making it first place against the HIV epidemic. HIV is at a high percentage among the general population of people at 18.9%. There are certain groups who have the highest rates of HIV in Africa including homosexual relations, transgender women, sex workers and people who inject drugs in South Africa. Since the enormous rates of HIV in South Africa, the country has worked hard to make huge improvements in getting people to test themselves for HIV in recent years with 86% of people aware of their HIV status. Now, Africa has the largest Antiretroviral Treatment program in the world, which has benefited the country a lot in recent years and has also emerged itself into both the gay community and the black population. By mid 1990s, HIV rates had increased by 60%, but the government remained with the “test and treat” guidelines. South Africa was the first country in sub-Saharan Africa to fully approve the Pre-Exposure Prophylaxis also known as PrEP program, that’s made available to people who are highly susceptible to HIV. Nationally, HIV infection among sex workers is estimated at 57.7%, although this depends between areas. Certain factors increase the risk for HIV in South African sex workers, including their poverty status, lack of different career opportunities, etc. The injection of drugs is also common among sex workers, possibly exposing them to the HIV virus even more. HIV infection among men who have sex with men in South Africa is now estimated at 26.8%, but this also varies geographically. In Sub-Saharan Africa, transgender women are twice as likely to have HIV as men who are in homosexual relationships because of risky behavior. In 2016, an estimation of 17% of people who are IV drug users in South Africa were living with HIV. However, IV drug users only sum up for 1.3% of new HIV infections in South Africa. Another shocking discovery is that new studies have found that only 59% of teenagers in South Africa have sufficient knowledge of ways to prevent themselves from HIV. Considering only 5% of schools were providing sex education in South Africa in 2016, but over the next five years the government has committed to increasing the 5% to 50% in areas with high rates of HIV infection. In 2018, The Joint United Nations Programme on HIV and AIDS reported that 4.4 million people were receiving treatment for their HIV infection in South Africa. The 4.4 million amounts to 61% of the people living with HIV in the country. The youth of Africa ranging from the ages of 15 to 24 also increased condom usage, took part in testing services and male circumcision. Though the knowledge of safe breastfeeding among HIV positive pregnant mothers still remains low.
The second country impacted by the HIV epidemic is Russia. HIV first emerged as a public health issue at the end of 1986 in Russia. The first case was identified in a Russian man who was believed to have contracted the disease while in Africa. He then apparently transmitted the virus to 15 Soviet soldiers who he had sex with. Since privacy laws didn’t exist in the Soviet Republic at the time, the names of those infected were publicized by the states media, which mocked them for living so called “corrupt lifestyles” that led to their disease. The fact that homosexuality was illegal and remains illegal under the countries Russian LGBT propaganda law, only served to stigmatize the men as well as HIV itself. In the late 1980s, HIV testing was made mandatory across the Soviet Union, which was often performed without the approval or knowledge of the person that the test was being given to. Over 142 million people had been tested which none were anonymous in 1991. Positive HIV tests were dealt with aggressive efforts made to identify and often publicized, the path of infection from one person to the next. The peak of conflict politically in the Soviet Union was in the early 1990s, pushing the HIV epidemic into the dark. In Russia, foreign HIV prevention information was available, but once translated into Russian, could no longer be found in the country. Public prevention campaigns failed to exist at that time because many considered this time period to be the age of the Russian “sexual revolution.” With a rise in IV drug use throughout Russia, the HIV epidemic was left unattended to, while the disease spread like wildfire. With the rise of the newly independent Russian Federation of States, AIDS agencies were of little importance among leaders in the Russian government and receive even less funding. Poor communication among the few HIV organizations that existed resulted in poor information communicated to agencies and treaters on the ground. Unfortunately, Russia’s HIV epidemic is continuously growing, with the rate of new infections increasing year after year between 10% and 15% each year, with over 250 people becoming infected every day. What fuels the HIV epidemic to continue is the constant shift away from progressive policies towards socially conservative legislation since enforcing HIV prevention and treatment is frowned upon. Russia has the highest number of IV drug users in the region at about 1.8 million which accounts for 2.3% of the adult population. Russia’s ban on non traditional sexual relations among the youth blocks information about HIV and support services. Although mother to child transmission is one of Russia’s famous HIV success stories, with the government stating it had achieved a 98% success rate in 2016. 1.16 million people had been diagnosed with HIV in Russia by the middle of 2017. However, this does not amount to the number of people who are currently living with HIV as well as the amount of deaths due to AIDS or people who are still undiagnosed with HIV. Russia’s HIV epidemic has boiled down to certain groups. In 2016, IV drug users accounted for the largest percentage of new cases at 48.8%, followed by heterosexual sex transmission at 48.7%, homosexual sex at 1.5% and 0.8% due to mother to child transmission. Although data is limited, it is believed that around 500,000 people in Russia are not aware of their HIV positive status. HIV testing is available, but only reaching about 19.3% of the population which is around 30 million people. Now HIV testing is carried out generally, rather than discriminating against people being targeted towards certain groups that are most affected by HIV. As a result of this, less than 1% of the 24 million HIV tests that were performed in Russia in 2011 made up for certain groups. While new infections rise year after year, a strategic prevention plan is what is needed to slow this epidemic. In 2016 the Russian Prime Minister approved Russia’s 2017-2020 HIV plan, which is the first official HIV document to be drawn up since Russia’s 2002-2006 strategy which clearly didn’t go well. The plan is set out to decrease transmission rates by focusing on prevention programs and reduce the number of deaths related to AIDS in the country. Although the help of social change and support towards high affected populations is discussed, no national programs have been created. As for condoms, although they are widely available to buy in Russia, there’s no government free distribution programs while condom use is thought to be low. This is because the practice of using condoms is at issue. For example, a 2015 national public health campaign about HIV prevention focused on faithfulness rather than promoting condom use. Funding for sex education in schools is also minimal to none. Socially conservative forces push for the teaching of “moral education”, which focuses on ideas like faithfulness in heterosexual marital relationships, instead of sex education, which includes information about anatomy and reproductive health, as well as contraception, STIs, child birth, gender relations, sexuality, and gender identities information.
Africa and Russia are two countries that are severely affected by the HIV epidemic although the reasons why and how for the two is different. In Africa, the groups most affected by HIV are sex workers at 57.7%, homosexuals at 26.8%, IV drug users at 17%, followed by a small percentage of transgender women. While in Russia, the groups most affected are IV drug users at the highest percentage of 48.8%, heterosexual relations at 48.7%, followed by homosexual sex at 22% and mother to child transmission at a low percentage. In Africa, since poverty is at an all time high in many areas, people turn to sex working, where many women for example, contract HIV. The stigmatism against using a condom also doesn’t help the cycle of contracting HIV. Many homosexual relations contract HIV because many don’t get tested and aren’t aware of their status and refrain from using condoms as well. Next for IV drug users, many contract HIV by sharing dirty needles and equipment. The last group which doesn’t have a very high percentage, but is still very vulnerable to HIV is transgender women. Since many are excluded in society, they neglect to get tested for HIV. If there was more information given at home, in schools and on the media to advocate about risky sexual behavior and programs set up to give people condoms or new needles/syringes then maybe many of these percentages would be much less. Although in South Africa many efforts have been made to improve the country for example, by the approval of the PreP program for people who are at high risk of HIV and also significant increases in getting people to test themselves for HIV in recently. With all the efforts now, 61% of adults are on antiretroviral treatments as well as 58% of children on antiretroviral treatments. Now in comparison to Russia. The groups most affected by HIV are heterosexuals, IV drug users, homosexuals, and mother to child transmissions. In Russia, the group most affected is heterosexual relations. These groups are most affected because of intimate violence between partners and sexual violence which are common within the Russian society. IV drug users are at high risk for HIV because of the habit of sharing used needles as well as many people being denied access to HIV information and prevention causing them to not access available testing. Homosexuals are also vulnerable because of the lack of knowledge towards risky sexual behavior, and the Russian society which frowns upon homosexual relations causing many to not go and get tested. Lastly mother to child transmission although at a small percentage is also probable since they can actually give the HIV virus to their baby through breast feeding because there is not enough advocacy that mothers should go out and get tested. If funding, HIV research and education was better supported in Russian government and society, then these percentages would significantly decrease.
I see the future of the HIV epidemic coming to a hault. There are many strides being made around the globe, by the United States, Africa and many other countries. People all over the globe are receiving effective HIV treatments and scientists are working diligently to have more treatment options available. Now in 2018 many are aware of their HIV status and are participating in safe sex and have the proper knowledge to minimize their risk of infection. In addition to this all, in 2015, the Joint United Nations Programme launched a goal to end the AIDS epidemic by the year of 2030. No matter whether the strides being made are big or small, we’re on the track to ending this epidemic. Although a cure for HIV may be out of reach, I believe that with sufficient testing, treatment prevention strategies and funding, this is the way to end the HIV epidemic, although it’ll be a long journey.


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