Hoje 1 de dezembro, é dia mundial contra o Sida! Sida existe! Sida mata! E cada vez mais tem ceifado vidas de guineenses. E sinto muito por aqueles que não querem acreditar, nesta realidade. O Sida é provavelmente a doença com maior facilidade de propagação entre africanos e a mais democrática do Mundo. O meu testemunho num dia como este, em que mundialmente se celebra, o dia desta Pandemia, que não escolhe raça, credo, ou condição social, vai ter um pequeno enfoque sobre um grupo de seropositivos guineenses que adorei conhecer em Bissau, alguns dados recentes de estudos de tendências feitos na Guiné e algumas informações de âmbito mundial.
Nesta minha última estada na Guiné-Bissau, tive uma oportunidade única, pois pude conhecer um pouco mais sobre esta doença, Sida, e as penetrações do vírus VIH, na sociedade guineense. Com base num convite de trabalho feito pela ONG – Enda Tiers-Monde, conheci guineenses portadores deste vírus habitualmente denominados “seropositivos” que para além de ultrapassarem as provações dos preconceitos ou o medo dos estigmas, ganharam consciência do papel que podem desempenhar para travar esta doença entre os filhos da Guiné. Não posso deixar de sublinhar que, o que mais se denota neste grupo de seropositivos era a forma como trabalhavam em equipa, tinham métodos de trabalho exemplar e extremamente dinâmico. Vi-os a desenvolverem trabalhos magníficos, extremamente importantes para o combate sem tréguas contra uma doença, de que eles próprios são vítimas.
O valor humano deste tipo de ação não tem palavras, muito menos classificação. Resta-me apenas reconhecer e admira-los. Mas o mais marcante da conversa que tive ao contactar este grupo foi, a questão do Preconceito, ou seja a falta de informação e de formação, que leva alguns guineenses a terem comportamentos preconceituosos com relação a eles. E essa barreira criada pela ignorância de alguns dos nossos conterrâneos deve ser destruída! Com urgência!
A síndrome da imunodeficiência adquirida (Sida) está cada vez mais presente na vida dos guineenses. Os dados aqui publicados foram concedidos pelo Secretariado Nacional de Luta Contra a SIDA, na Guiné-Bissau. Espero que possam fazer um pequeno “balanço da situação e traçar o perfil da epidemia…no nosso país” como diz o relatório do secretariado. Com espaçamento temporal de 2008-2010, utilizando à tendência como variável de avaliação aqui temos:
ANALISE DAS TENDENCIAS 2008-2010 (fim do primeiro trimestre)
Dr T. Vincent - 31 Julho 2010
Introdução
No quadro do relatório sobre o Acesso Universal aos cuidados VIH/SIDA no fim de 2009, foram estabelecidas tendências a partir das estatísticas disponíveis entre o quarto trimestre de 2007 e o segundo trimestre 2009.
Na perspectiva da segunda fase e da revisão dos objectivos do PEN (Plano Estratégico Nacional de Combate ao Sida) para rever numa base objectiva os quadros de performance, foram utilizadas as estatísticas do primeiro trimestre 2010 para actualizar os gráficos. Os dados dos trimestres 3 e 4 de 2009 ficam ainda a ser introduzidos.
De salientar que dados são utilizados assim que publicados pela direcção de M&E do SNLS, sem ser validados de maneira formal, nem dispor dum sistema de controlo de qualidade sistematizado. Embora, o exercício permite de fazer aparecer tendências interessantes para construir um pensamento global sobre a dinâmica da resposta nacional em termos de despistagem, prevenção e tratamento.
Despistagem
O número de pessoas despistadas aumenta de maneira significativa entre o terceiro trimestre 2009 e o primeiro trimestre 2010. Como o número de pessoas despistadas não aumentou de maneira proporcional, o progresso parece ser principalmente feito na despistagem voluntaria e ao benefício da população geral.
Ainda não é visível o impacto enorme que teve a campanha do mês de Junho, e que será visível com as estatísticas do segundo trimestre 2010.
Tratamento antiretroviral
A tendência positiva confirmou-se tanto em termos de novas pessoas em seguimento como das novas pessoas em TARV, e a uma velocidade que se reduz aproximadamente de metade ao longo do tempo:
Novo TARV | % novo TARV | Novo seguimento | % novo seguimento | |
1ro trim. 2009 / 2008 | 808 | + 72% | + 1989 | + 52% |
1ro trim. 2010 / 2009 | 781 | + 40% | + 1120 | + 19% |
Embora a despistagem cresce, os pacientes a entrar na cohorte activa se reduzem, com duas possibilidades:
- seja as capacidades de acolhimento das CTAs já estão saturadas
- seja o rendimento de despistagem se reduz, devido a uma prevalência observada reduzida.
A segunda explicação parece ser mais judiciosa, já vimos que o numero de seropositivos estava estável com um melhor numero de testes negativos.
Assim, o objectivo do PEN parece ser atingível com 55% das pessoas com necessidade de TRAV ja beneficiando do tratamento (o denominador do modelo de ONUSIDA tem que ser validado).
PTME
A cobertura de despistagem nas grávidas parece ser duas vezes melhor, em comparação com o ano passado. Isso representa um progresso indiscutível e muito encorajante.
Mas esta tendência na se acompanha dos mesmos ganhos para o acesso a PTME para as grávidas seropositivas: o constrangimento maior do desenvolvimento da PTME fica no abastecimento dos ARVs. Será que as roturas de produtos estão a mostrar esta limita num contexto de melhoria da despistagem?
O numero de crianças a receber TARN quase foi multiplicado por 3 em um ano passando de 50 à 150. Assim, a falta de disponibilidade dos ARVS não parece afectar do mesmo modo a população das grávidas e das crianças.
Conclusão
Este estudo rápido das tendências permite evidenciar um progresso importante tanto para a despistagem como para o acesso ao tratamento antiretroviral. O maior constrangimento fica a nível do acesso as ARV para as grávidas seropositivas.
Esta perspectiva global do programa nacional e das tendências objectivas devem permitir de relativizar o atraso dos indicadores da subvenção da sétima ronda embora seja necessário garantir o acesso a segunda fase, e determinar até que ponto as verbas disponibilizadas contribuíram a este resultado.
Completar a análise com dados dos trimestres 3 e 4 de 2009 vai permitir de saber a partir de quando as tendências começaram a mudar. E fica ainda de discutir e de atribuir os ganhos registados a factores particulares: uma análise mais fina das tendências por sítio deveria permitir de determinar os lugares onde os ganhos foram mais decisivos.
A wall mural in downtown Johannesburg shows a city skyline with an AIDS ribbon passing through workers who make a living in the town. The UN report says the global AIDS epidemic has slowed and cited a drop in new HIV infections with South Africa infection rate reduced by more than 25 percent in the past decade.
First, the good news.
After several decades of explosive growth, particularly in Africa, there are signs that the AIDS epidemic is slowing. Over the past decade, new HIV infections have decreased by 20 percent, according to UNAIDS, the United Nations AIDS agency.
Here in South Africa – the country with the world’s highest number of people living with HIV, at 5.6 million – the drop in new infections is 25 percent. What this means is that all that money spent on education about condom use, abstention from sexual behavior, and being faithful to one’s partner seems to be working.
Much of the credit for this turnaround clearly belongs to funding from donor nations, and in particular, the US President's Emergency Plan for AIDS Relief (PEPFAR), the Global Health Initiative, and private donors such as the Bill and Melinda Gates Foundation. From its inception in 2004, PEPFAR funding has grown from $2.3 billion to $6.8 billion in 2010, allowing the US government to buy up and provide free-of-charge antiretroviral treatments to some 2.4 million people worldwide.
On Monday, UN Secretary Ban Ki Moon emphasized the positive trends in a speech.
“With commitment and solidarity, this movement is helping the world turn the corner on the AIDS epidemic,” Mr. Ban said. “We have finally reached the first part of Millennium Development Goal 6 – by halting and beginning to reverse the spread of HIV. We must continue to chart a new and bold path ahead.”
But Ban also acknowledged that there was still much work to be done: “Our common goal is clear: universal access to HIV prevention, treatment, care and support. We must also work to make the AIDS response sustainable.”
Which brings us to the bad news.
There are 33 million people around the world infected with HIV. HIV spreads through sexual contact, and also through blood transfusions and intravenous drug use. Of that 33 million, more than two-thirds (22.5 million) of all HIV-positive people live in Africa, and their access to health care and to AIDS treatment remains quite low. Some 12 million of those HIV patients will require immediate care through an expensive cocktail of drugs called antiretroviral (ARV) treatments, but only 7 million of them will actually receive treatment, according to a recent study by the US Institute of Medicine. Hang in there. The news gets worse before it gets better.
Funding for AIDS research and treatment seems to have stalled, a sign of donor fatigue during the ongoing global economic slowdown. ARV treatments are costly and become even more expensive, far beyond the means of developing countries, where the AIDS epidemic is centered. Aid groups such as Doctors Without Borders warn of a growing funding gap, and a withdrawal of donor support precisely when those funds are needed the most.
"In South Africa and the whole of Africa, if we do see a decrease in funding, it will mean we go back on all of the progress made so far after six years of heavy support," says Gilles van Cutsem, medical coordinator for Doctors Without Borders in South Africa and Lesotho. "We currently have about 1 million people on ARV therapy and there are plans to expand that to 2 million by 2016. You will go back to the days when people were dying because they didn't have access to ARVs. People will have to wait much longer to get access to ARVs, and when they do come to get treatment, they will be much sicker patients."
"Even South Africa will not be spared," Dr. van Cutsem says, "but in poorer countries like Mozambique, Lesotho, Swaziland, Zimbabwe, and Malawi, this will affect people much more quickly and more severely."
Van Cutsem said in a report released in May by Doctors without Borders that poorer countries are estimated to need about $20 billion in private donations over the next three years, but only $11.7 billion has been raised so far.
Thus, even as overall donor funding is increasing for AIDS relief, it isn’t keeping pace with the AIDS epidemic itself. According to the US Institute of Medicine panel of experts, external donor funding won’t ever be enough to provide universal treatment for AIDS.
“Because treatment will only reach a fraction of those who need it ... preventing new infections should be the central tenet of any long term response to HIV/AIDS in Africa," Dr. Thomas Quinn, co-chair of the Institute of Medicine panel that wrote the report, said at a news conference in Washington. He is also a professor at Johns Hopkins University in Baltimore and the National Institutes of Health.
Denis Farrell/AP
On World AIDS Day, infection rates are declining, but dwindling funds threaten progress
By Scott Baldauf, Staff Writer / November 30, 2010
World AIDS Day on Wednesday is a chance to assess the impact of six years of heavy US and international donor funding. Johannesburg, South Africa
This year on World AIDS Day, we’re likely to hear more of the bad news than the good. This is normal. One doesn’t call a fire department to report the 99 houses that are perfectly fine, but rather the one that is burning. Still, when it comes to the current state of the AIDS epidemic, the truth may be found in the balance between the two extremes.First, the good news.
After several decades of explosive growth, particularly in Africa, there are signs that the AIDS epidemic is slowing. Over the past decade, new HIV infections have decreased by 20 percent, according to UNAIDS, the United Nations AIDS agency.
Here in South Africa – the country with the world’s highest number of people living with HIV, at 5.6 million – the drop in new infections is 25 percent. What this means is that all that money spent on education about condom use, abstention from sexual behavior, and being faithful to one’s partner seems to be working.
Much of the credit for this turnaround clearly belongs to funding from donor nations, and in particular, the US President's Emergency Plan for AIDS Relief (PEPFAR), the Global Health Initiative, and private donors such as the Bill and Melinda Gates Foundation. From its inception in 2004, PEPFAR funding has grown from $2.3 billion to $6.8 billion in 2010, allowing the US government to buy up and provide free-of-charge antiretroviral treatments to some 2.4 million people worldwide.
On Monday, UN Secretary Ban Ki Moon emphasized the positive trends in a speech.
“With commitment and solidarity, this movement is helping the world turn the corner on the AIDS epidemic,” Mr. Ban said. “We have finally reached the first part of Millennium Development Goal 6 – by halting and beginning to reverse the spread of HIV. We must continue to chart a new and bold path ahead.”
But Ban also acknowledged that there was still much work to be done: “Our common goal is clear: universal access to HIV prevention, treatment, care and support. We must also work to make the AIDS response sustainable.”
Which brings us to the bad news.
There are 33 million people around the world infected with HIV. HIV spreads through sexual contact, and also through blood transfusions and intravenous drug use. Of that 33 million, more than two-thirds (22.5 million) of all HIV-positive people live in Africa, and their access to health care and to AIDS treatment remains quite low. Some 12 million of those HIV patients will require immediate care through an expensive cocktail of drugs called antiretroviral (ARV) treatments, but only 7 million of them will actually receive treatment, according to a recent study by the US Institute of Medicine. Hang in there. The news gets worse before it gets better.
Funding for AIDS research and treatment seems to have stalled, a sign of donor fatigue during the ongoing global economic slowdown. ARV treatments are costly and become even more expensive, far beyond the means of developing countries, where the AIDS epidemic is centered. Aid groups such as Doctors Without Borders warn of a growing funding gap, and a withdrawal of donor support precisely when those funds are needed the most.
"In South Africa and the whole of Africa, if we do see a decrease in funding, it will mean we go back on all of the progress made so far after six years of heavy support," says Gilles van Cutsem, medical coordinator for Doctors Without Borders in South Africa and Lesotho. "We currently have about 1 million people on ARV therapy and there are plans to expand that to 2 million by 2016. You will go back to the days when people were dying because they didn't have access to ARVs. People will have to wait much longer to get access to ARVs, and when they do come to get treatment, they will be much sicker patients."
"Even South Africa will not be spared," Dr. van Cutsem says, "but in poorer countries like Mozambique, Lesotho, Swaziland, Zimbabwe, and Malawi, this will affect people much more quickly and more severely."
Van Cutsem said in a report released in May by Doctors without Borders that poorer countries are estimated to need about $20 billion in private donations over the next three years, but only $11.7 billion has been raised so far.
Thus, even as overall donor funding is increasing for AIDS relief, it isn’t keeping pace with the AIDS epidemic itself. According to the US Institute of Medicine panel of experts, external donor funding won’t ever be enough to provide universal treatment for AIDS.
“Because treatment will only reach a fraction of those who need it ... preventing new infections should be the central tenet of any long term response to HIV/AIDS in Africa," Dr. Thomas Quinn, co-chair of the Institute of Medicine panel that wrote the report, said at a news conference in Washington. He is also a professor at Johns Hopkins University in Baltimore and the National Institutes of Health.
