In his typical style, Hancock posted a video talking about the recent data from Public Health England that shows HIV transmissions have been on the decline in England – particularly amongst gay and bisexual men (GBM).

Indeed, without a shred of irony, Hancock stated that an ‘injustice’ was being reversed through the government’s efforts of reducing HIV transmissions by 73%.

Of course, without context, this figure sounds commendable, if not outright positive. The reduction in transmission rates comes from the rise in use of PrEP – a drug which is readily available in Scotland and has been attributed to reducing the risk of transmitting HIV by over 90%. Out of 2,000 people in Scotland, less than 0.25% contracted HIV after taking PrEP. Some experts say it’s 100% effective at stopping HIV transmission.

However, NHS England only started supplying PrEP in limited quantities through clinical trial sites – which now have major waiting lists – in 2017. And this was only after NHS England lost a high court battle regarding the commissioning of PrEP services.

The reason for NHS England’s complacency has been funding. Against my better judgement, I took a look at some of the opinions of Twitter users and regrettably found pockets of people who think that funding a proven HIV drug is somehow morally irresponsible.

It’s easy to see where these comments on social media are borne from. Take a look at the media coverage for topics relating to HIV and you’ll see hordes of articles talking about its impact on the LGBT+ community without any mention of its heterosexual impact.

For instance, many have argued that funding PrEP will reduce the rates of condom use amongst GBM communities. A valid concern, though it must be said that condom use is actually higher for gay and bisexual men compared to heterosexual males.

Sustaining condom use is of course important, but an awareness scheme that educates people about the need to use a condom alongside PrEP usage could be one answer to stemming any worries people have.

And it’s not like heterosexual communities wouldn’t benefit from a fully funded PrEP service. The report states how late stage HIV diagnoses are particularly bad amongst heterosexual men – perhaps the stigma of the disease stops this section of society from getting tested. 

Don’t get me wrong, it’s brilliant that less and less people are getting HIV, but when a clear and proven alternative is readily available, it seems hypocritical of the government to claim they’re doing all they can to stop the disease. In fact, read Hancock’s statement in the media and you’ll be forgiven for thinking that he’s solely responsible for helping tackle the rise in HIV.

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In more than 30 states, it is illegal for someone with HIV to have sex without first disclosing their status. Some are now pushing to change that, arguing that the laws are actually endangering public health.

More than 1 million people in the U.S. are living with HIV, and their HIV status could conceivably put them behind bars. That’s what happened to Michael Holder.

“I served 8 1/2 years in prison and three years after on parole,” Holder says.

Back in 2000, Holder’s ex-girlfriend testified that he didn’t disclose his HIV status before they had sex. That’s a crime in Michigan and in most states in the country.

He says the day after she said that, she came in and recanted.

“She testified the truth and said that she had lied and said that she was jealous, and she loved me and that I had told her just like I had testified and said I’d told her,” Holder says. “And she told the truth, but it was too late.”

Holder couldn’t prove that he told her. Public health experts say that’s one of many problems with HIV criminalization laws. Ohio, Tennessee and Florida are the top prosecutors, charging more than 120 people in the last decade.

“Would you want to have to disclose your sexual practices and your personal health in front of a medical professional and your partner?” asks Daphne Kackloudis, of the Ohio Health Modernization Movement. “I don’t think anyone wants to have that difficult conversation in front of a third party in order to prove that they’ve had the conversation.”

She’s part of a group of public health experts pushing to change Ohio’s 1999 statute.

“A lot has happened since 1999, and lawmakers don’t necessarily know that,” she says. “And let’s be honest. A lot of citizens, you know, who aren’t lawmakers don’t know the advances that have been made in science and the reasons that we believe this law should be modernized.”

Medical advancements have helped turn HIV from a fatal infection into a manageable chronic condition.

The Centers For Disease Control and Prevention recently announced that if people take antiretroviral drugs as prescribed, the amount of HIV in their blood can become undetectable. If it stays undetectable, they have little risk of passing the virus to a partner through sex, and can live long, healthy lives.

This past June, the American Medical Association called for the total repeal of HIV criminalization. That sparked action for reforms in Washington, Missouri, Georgia, Indiana, Tennessee and Florida.

“The data doesn’t support that any of these laws that criminalize HIV actually decrease transmission rates,” says Jada Hicks, with the New York-based Center for HIV Law and Policy.

In some places, the public health push has worked. California, Iowa and Michigan recently reformed their laws.

Ohio’s statute has been challenged multiple times since it was introduced. In a 2017 Ohio Supreme Court case, lawyer Samuel Peterson defended the law on behalf of the state.

“When you have sexual conduct, there are two parties to that conduct,” Peterson said in archival footage. “And the other person has a right to know and has a right to be party to the decision to engage in the sexual conduct.

Daphne Kackloudis says she understands that argument, but that’s only one part of the legal puzzle.

“We would never want someone who intentionally transmits HIV to not be able to be prosecuted under the statute. We think that’s not right,” she explains.

But she says, as it’s written, the law puts the burden on people like Michael Holder to prove that they disclosed.

She fears these laws, which intended to stop the spread of HIV, may actually be doing just the opposite, disincentivizing people to know their status in the first place.

“If they didn’t have the law, more people would come in and get tested, you know,” Holder says. “Because they wouldn’t have to risk having done to them what was done to me.”

According to the CDC, 1 in 7 people with HIV don’t even know they have the virus.

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In many countries with a high HIV prevalence, at least 95 per cent of children born to mothers living with HIV remain HIV-uninfected. This is due to the success of wide-scale provision of antiretroviral therapy to mothers with HIV to prevent transmission to their children during pregnancy, labour or breastfeeding.

Children born to mothers with HIV are known as HIV-exposed. While many children who are HIV-exposed and also HIV-uninfected are growing and developing well, some face greater risks.

They are more likely to be hospitalised with severe infections when they are infants. They are also at higher risk of dying before their second birthday. And the risks are even higher when babies who are HIV-exposed and uninfected are born early, with low weight at birth, or to mothers with severe HIV disease.

This is why it’s important to know as much as possible about this population of children, how many there are and where they are in the world.

Every year the United Nations provides key estimates related to the HIV epidemic. These usually include the number of people living with HIV, the number of new infections and the number of people receiving treatment. In 2018 for the first time, estimates for children aged 0-14 years who were HIV-exposed and uninfected were included.

We used the most recent UNAIDS estimates, published in July 2019, to calculate the share of each country in the global total of children who are HIV-exposed and uninfected. These estimates allow us to report on changes in the size of this population and trends over time, between 2000 and 2018. And we calculated the percentage of children who are HIV-exposed uninfected in countries with the highest HIV burden.

What we found

In 2018 there were 14.8 million children who were HIV-exposed and uninfected around the world. This population has more than doubled from 6.7 million in 2000.

Ninety per cent of all these children are from sub-Saharan Africa. Strikingly, half of all children who are HIV-exposed and uninfected come from just five countries — South Africa, Uganda, Mozambique, Tanzania and Nigeria.

South Africa alone accounts for 3.5 million or 24 per cent of all children who are HIV-exposed and uninfected.

Equally alarming is that in four southern African countries more than 20 per cent, or at least one in every five children, is HIV-exposed and uninfected — Eswatini (32 per cent), Botswana (27 per cent), South Africa (22 per cent) and Lesotho (21 per cent).

The substantial global population of children who are HIV-exposed and HIV-uninfected needs a coordinated strategy to reduce HIV exposure in children and to ensure their optimal health and wellbeing. Informed by these estimates, we propose a coordinated global strategy for improving their health outcomes.

This strategy requires collaboration from governments and their partners, including multilateral organisations, researchers and funders. It must be built on a strong foundation of dialogue with families and communities affected by HIV, who have seldom been consulted on the wellbeing of their children when they are HIV-uninfected.

Our proposed strategy has three pillars:

First, to reduce the number of adolescent girls and women newly infected with HIV and to reduce unintended pregnancies in adolescent girls and women living with HIV. The number of children who are HIV-exposed is determined by the number of pregnant women living with HIV, which has remained unchanged at 1.3 million globally every year since 2000.

Second, to keep mothers with HIV on lifelong antiretroviral therapy to ensure they stay well and don’t transmit HIV during pregnancy and breastfeeding. Countries with a high burden of HIV also need systems to continually evaluate the safety of this therapy.

Third, to ensure that research covers the geographical regions that are most affected. Exposure to HIV and to antiretroviral drugs during pregnancy has been well researched in high-income countries. But their HIV prevalence is low and other factors very different from the low- and middle-income countries where most of the children exposed to HIV are found. For instance, child mortality, preterm birth, infectious diseases and malnutrition occur far more often in low- and middle-income countries.

There are large numbers of children who are HIV-exposed and HIV-uninfected in southern Africa – and they are not surviving and thriving as well as children born to women without HIV. There is an urgent need in this region to find solutions enabling all children to reach their developmental potential and contribute fully to their communities.

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In an interview with the Trinidad and Tobago Newsday in mid-December, 2019, Trinidad and Tobago Minister of Health Terrence Deyalsingh made a controversial statement, suggesting that even if the HIV-preventative drug known as PrEP (Pre-Exposure Prophylaxis) were readily available, it would encourage promiscuity.

Minister Deyalsingh had made similar remarks at the 2016 Joint United Nations Programme on HIV and AIDS signing ceremony, aimed at eliminating the spread of HIV by 2030, at which he made it clear that the government would not allow access to PrEP via the local public health care system.

Deyalsingh’s attitude toward HIV/AIDS prevention highlights Trinidad and Tobago’s ongoing struggle with HIV stigma and a lack of sex education.

While PrEP has been proven to reduce the chances of contracting the HIV virus, Deyalsingh maintained that the government will not subsidise the PrEP medication because the thrust of his ministry’s HIV/AIDS awareness campaign is post-exposure care, not prevention. If people want the drug, he said, it is available in the private health care sector.

While Deyalsingh offered exceptions to the rule, many citizens felt that his remarks exacerbate the heavy stigma of HIV/AIDS.

In the interview with Newsday, Deyalsingh explained that should a health care worker accidentally get stuck with a needle, for instance, or in cases of sexual assault, those involved would be given the treatment if there is a chance they might contract the virus. While the World Health Organisation classifies PrEP as an “essential medicine,” the minister rationalised his position this way:

PrEP is to give […] to people before exposure or with no exposure to HIV…It means that knowingly you are going to engage in some sort of behaviour that would cause you to be at a higher risk of getting HIV and you want to take a drug to prevent yourself from getting HIV. […]

That is not government policy […] It’s a simple as that.

His comment was met with a lot of criticism, especially from Trinidad and Tobago’s estimated 29,000 citizens living with the virus — a reduced number, thanks in part to the efforts of both government agencies and non-governmental organisations dedicated to education, prevention and stigma reduction on HIV/AIDS.

HIV stigma

HIV-positive patients often face discrimination because of their health status, and many cannot afford the required drugs through the private health care system.

The Family Planning Association of Trinidad and Tobago (FPATT) has insisted that the government must make the drug available, saying that citizens have the right to access medication in the public health sector.

Calling the minister’s statement “myopic,” executive director of FPATT, Donna Da Costa Martinez, chastised Deyalsingh for contributing to the narrative that the drug encourages promiscuity, rather than educating people about its actual purpose: being “a useful tool to prevent HIV”:

The statement is not only short-sighted but harmful, as the deciding factor then becomes grounded in a moral debate about human sexuality, an integral part of who we are and what we do.

A lack of sex education

The Family Planning Association, Minister of Sports and Youth Affairs, Shamfa Cudjoe, and Minister Deyalsingh, representing the health ministry, have all said that the country needs massive reforms in sex education, but little to nothing has been done by the Ministry of Education.

Deyalsingh is pro-sex education and admits that its absence contributes misinformation among young people:

Let’s not try to put our heads in the ground. Let’s just open our eyes, face the realities and make sure that we introduce sexual education adequate for the age of the students in schools.

Yet, several of the country’s religious bodies condemn the concept of sexual education, most notably the Trinidad and Tobago Council of Evangelical Churches.

Despite the state’s mandate to retain a secular view when it comes to laws and policies, government officials, often in the health and education ministries, often pander to the interests of the country’s diverse religious population, using religion as their rationale for not developing a well-rounded sex education curriculum.

As a result, successive governments have had a “hands-off” policy when it comes to sex education, with many schools opting for an abstinence-only approach, mainly due to the fact that a majority of the country’s schools have religious affiliations.

Currently, the ministry has a Primary Health and Family Life Education (HFLE) curriculum aimed at teaching children about sex, sexuality and STIs.  The programme, however, is not mandatory for teachers if they feel uncomfortable teaching it. Since the ministry does not have many specialised teachers to teach the subject, they rely “on the goodwill of the teachers”:

Connected with this lack of sex education are many unplanned pregnancies and a lack of knowledge about how sexually transmitted infections and be contracted and prevented.

Dr. Kale Ferguson, Chairman of the Tobago AIDS Coordinating Committee, said in a speech earlier this year that youth education is key to HIV prevention, as well as reducing stigma. Trinidad and Tobago’s “most at risk” group for HIV is females, aged 15-24.

‘Moral hypocrisy’

Meanwhile, Colin Robinson of the Coalition Advocating for Inclusion of Sexual Orientation (CAISO), which has been advocating the use of PrEP as a preventative measure, has accused Minister Deyalsingh of “moral hypocrisy.”

By refusing to implement a policy to allow access to PrEP, Robinson said, the ministry is standing in the way of protection. He explained that the decision to make the drug available in public health care facilities lies solely with the minister, but lamented the ministry’s stance, stating: “We are not really empowering communities to stop HIV.”

Other Caribbean territories, including Guyana, have already implemented the use of the drug in order to prevent HIV and save lives.

Thus far, Minister Deyalsingh has not responded to any of the outcry surrounding his statement.

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A new peer-reviewed commentary published in the January issue of the American Journal of Public Health argues for new metrics to evaluate the public health response to HIV in the United States. The U.S. Department of Health and Human Services (HHS) has announced plans to reduce the number of new HIV infections by 75 percent in the next five years and 90 percent in the next 10 years. “Ending the HIV Epidemic” (EtHE) efforts will focus initially on 48 high burden counties; Washington, DC; San Juan, Puerto Rico; and seven states with substantial rural HIV burdens, before moving on to all U.S. counties.

Dr. Denis Nash, Distinguished Professor of Epidemiology at the CUNY Graduate School of Public Health and Executive Director of the CUNY Institute for Implementation Science in Population Health, notes that because ending the public health threat of HIV requires intensification and more focused targeting of implementation, there is a need for new metrics to inform and evaluate EtHE initiatives. Nash argues that newer metrics should complement the current metrics that focus on new HIV infections, individuals successfully being treated for HIV, and coverage of pre-Exposure Prophylaxis (PrEP), a drug which can prevent HIV infection.

The HHS plan should develop metrics that track the deployment and uptake of specific intervention delivery strategies, which would provide data regarding plan goals. Nash contends that HIV-related health disparities in both implementation outcomes and health outcomes require special attention.

Finally, Nash underscores the need for HHS to develop a public facing web-based dashboard system that more rapidly disseminates actionable information based on the new metrics needed to inform the implementation of the HHS plan.

“We have made substantial strides in getting useful data into the hands of those that are in a position to act in support of New York’s Ending the Epidemic initiative,” he said, referring to New York’s Ending the Epidemic Dashboard system. “The national EtHE Plan needs a timely dissemination system like the one we have here in New York in order to accelerate impact and share lessons learned within and across those jurisdictions aiming to end HIV as a local public health threat.”

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Many African countries are struggling against the human immunodeficiency virus (HIV) infection, which results in contraction of the acquired immune deficiency syndrome (AIDS).

The disease, which damages human immune system, has left an estimated 74.9 million affected worldwide, according to figures collected by the Avert website, a U.K.-based charity providing information about HIV and sexual health. Currently an estimated 37.9 million people across the world are living with the HIV that includes 1.7 million children.

According to the website, 770,000 people died due to AIDS-related illnesses in 2018.

The numbers have reduced by 55%, if compared to deaths in 2004 (1.7 million) and in 2010 (1.4 million).

In Africa, according to a count taken in 2018, around one in every 25 adults is infected with the HIV/AIDS.

The continent hosts 25.7 million HIV/AIDS affected population, as per the World Health Organization (WHO).

As many as 16.3 million people have received antiretroviral therapy (ART) in 2018.

Eastern and Southern Africa regions inhabit world’s highest number of people infected with the HIV/AIDS.

Kenya, located in eastern Africa, like many African countries, is battling HIV/AIDS. Officials warn that although government is providing free drugs, patients are not serious about their medication.

According to UNAIDS, 1.6 million people were living with HIV in Kenya. While 89% of them knew their status, 68% were on treatment. As many as 270,000 of them were young men.

In Uganda, 1.4 million people were reported living with HIV/AIDS in 2018, according to UNAIDS.

While 23,000 people died from an AIDS-related illness in 2018, another 53,000 people had contracted the virus.

In Somalia, 11,000 adults and children were living with infection, while 1000 people died of the disease.

South Africa has the highest number of HIV cases in sub-Saharan Africa. Some 7.7 million people are living with the virus. The number of newly infected people has been put at 240,000 by the UNAIDS. In 2018, some 71,000 people died from the disease.

Southern and Eastern Africa is also infamous for hosting the greatest number of infected children.

According to the UNICEF, 1.85 million children aged 0–19 are living with HIV/AIDS in the region.

Out of them, 51,000 contracted infection after birth.

There are also 11 million AIDS-affected orphans in Sub-Saharan Africa.

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People with obesity, high blood sugar, high blood pressure or high cholesterol are often advised to eat less and move more, but our new research suggests there is now another simple tool to fight off these diseases: restricting your eating time to a daily 10-hour window.

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We seem to have hit a wall when it comes to slowing the rate of new HIV infections, according to the US Centers for Disease Control and Prevention (CDC). “Since 2013, progress in reducing the number of new human immunodeficiency virus (HIV) infections has stalled at approximately 38,000 new infections occurring each year,” CDC investigators say in a study out this week in the agency’s Morbidity and Mortality Weekly Report.Using data from theNational HIV Surveillance System (NHSS), the CDC measured rates of new HIV infections from 2013 to 2017.

The CDC wants to practically eliminate the occurrence new HIV infections by 2030. “Accelerated efforts to diagnose, treat, and prevent HIV infection are needed to achieve the US goal of at least 90% reduction in the number of new HIV infections by 2030,” the study states. 

Reaching this goal will mean getting at least 95% of people with HIV diagnosed, getting 95% of those diagnosed to viral suppression, and getting 50% of those at increased risk for acquiring HIV on pre-exposure prophylaxis (PrEP), the daily pill that prevents HIV. 

Jonathan Mermin, MD, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, and STD Prevention, said in a statement that “the number of people who acquire HIV each year is unacceptably high. Ending this epidemic would be one of the greatest public health triumphs in our nation’s history.”

In 2017, about 154,000 people with HIV (14%) did not know that they had it and so couldn’t take advantage of HIV treatment. The CDC says that people ages 13 to 24 are less likely to know their HIV status than people 25 years or older. About two-thirds (63%) of those who knew that they had HIV were receiving effective treatment for it. 

In 2018, according to CDC data, 219,700 of the 1.2 million people who could benefit from PrEP had gotten a prescription from a retail pharmacy for the medication. PrEP coverage was likely higher than that, however, because CDC’s data did not include prescriptions from the military or managed care organizations. “Coverage was especially low among young people, African Americans, and Latinos who could benefit from PrEP,” the CDC states. 

In addition to looking at the number of new infections from 2013 to 2017, the CDC used 2017 data to determine the percentage of people with diagnosed HIV infection with viral load suppression. The agency also looked at surveillance and pharmacy data to estimate PrEP coverage—the number of people prescribed PrEP divided by number of people who should be taking it.  

The CDC has recommended since 2012 that prompt treatment with antiretroviral therapy be initiated for people diagnosed with HIV, yet only 61.5% of people diagnosed in 2017 had a suppressed viral load 6 months after diagnosis. 

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Yet it remains an enduring problem: a disease rooted in poverty and inequality, it’s an epidemic that disproportionately affects women and young girls, health workers say. 

Last year, 1.7 million people were newly infected with HIV, according to the Joint United Nations Programme on HIV/AIDS, known as UNAIDS.

But the prevalence is twice as high among young women aged 15 to 24 compared to men of the same age group.

In Gambia, South Africa, the Congo, and Gabon, HIV prevalence is three times higher among young women. In Angola, it is four times. And in eSwatini, a country with one of the highest prevalence rates in the world, young girls and women are five times more likely to be living with HIV compared to boys and young men.

There is concern that the HIV epidemic is falling from global public health agendas and, with it, financial investment.

Between 2017 and 2018, there was a $900 million decrease in HIV funding in low- and middle-income countries.

Jose Izazola, UNAIDS special adviser on resource tracking and finances, told The New Humanitarian this was driven primarily by: reduced disbursements from The Global Fund, a multilateral non-profit; reductions in contributions from donor governments such as the UK; and a stagnation in funding from the world’s largest donor – the United States.

Only about two percent of global funding for HIV is earmarked specifically for key populations such as girls and women – but that is changing.

An example is the DREAMs programme, a partnership with the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Bill and Melinda Gates Foundation, among other funders, to reduce new HIV infections in adolescent girls and young women in 10 sub-Saharan African countries. 

“For the first time, we do have comprehensive programmes,” Chewe Luo, the associate director of UNICEF’s HIV/AIDS section, told TNH. “The DREAMs programme of PEPFAR is attempting to address exactly what we are talking about.”

The problem in eSwatini

There are particular reasons why the small southern African country formerly known as Swaziland, now officially the Kingdom of eSwatini, has so many women with HIV.

“The first thing to know is eSwatini is a patriarchal society. Women are considered children,” Albertina Zodwa Nyatsi, director of Swazi’s Africa Coalition on Tuberculosis chapter, told TNH on a trip around the northwestern countryside.

“Women have limited decision-making when it comes to family planning. Women cannot advocate for condom usage or they risk being viewed by their partner as a prostitute or as diseased,” said Nyatsi, who also founded Positive Women Together in Action, a support group for HIV-positive women.

“The first thing to know is eSwatini is a patriarchal society. Women are considered children.”

Swazi women cannot take steps to prevent the spread of HIV, and when they receive their diagnosis, they are often blamed, socially isolated, or face stigma and violence.

As a result of gender inequality and cultural practices, an estimated 16 percent of Swazi girls and young women were living with HIV in 2018, a reflection of the broader burden of HIV on girls and women.

Early sexual debut and child marriage – cultural practices that are normalised in many countries across sub-Saharan Africa – put girls at high risk of contracting HIV.

In some countries, it is estimated that 25 percent of adolescents are sexually active before the age of 15, and 12 million girls under the age of 18 are married each year.

“Many of those gender inequalities mean that women have less power. Girls have less power,” said Sarah Hand, CEO of Avert, a UK-based charity focused on spreading information about HIV. 

“The cultural practices often mean that young girls, very young girls, are having sex early with male partners who are often themselves then in concurrent sexual partnerships.”

Lack of opportunities

Many challenges that young girls and women face stem from a lack of education and economic opportunities.

“We realise now, in terms of challenges among girls and young women, they go through multiple vulnerabilities as they grow,” said Luo.

“For example, we know that not keeping a girl in school increases risk of HIV acquisition because she is not empowered to negotiate for safer sex.”

“They go through multiple vulnerabilities as they grow.”

In eSwatini, only about 30 percent of adult women received some secondary education between 2010 and 2017. Limited education combined with widespread poverty creates an environment where transactional sex, often with multiple concurrent partners, and intergenerational sex are commonplace.

On top of that, gender-based violence, which is linked to higher rates of HIV transmission, is common. An estimated 48 percent of Swazi women experience sexual violence in their lifetime.

Harmful cultural practices such as polygamy and wife inheritance also persist and are frequently cited as factors contributing to high HIV rates.

In KaKhoza Township, an impoverished slum-like community in Manzini, eSwatini’s second largest city, TNH met with a support group for girls and young women living with HIV. Nearly every young woman was diagnosed with HIV in her late teens or early twenties – and only after seeking health services for pregnancy.

Gender-based violence

Stories of stigma and violence reverberated around the group.

“I was diagnosed with HIV when I went to the doctor for my pregnancy,” one girl, who asked not to be named, said. “When I told my partner, he beat me and forced me out of the home.

Today, she lives with her mother and her child in a one-room hut; she makes a small living selling fruits and vegetables in her town, but said her meagre income doesn’t even cover the medication for her baby.

“When the HIV came, my husband didn’t want to associate with me,” Dudu Manana, the support group’s leader said through a translator. “He sends a bit of money each month but doesn’t come to see me.” Like many HIV-positive women, Manana lives alone, socially isolated from her family and friends.

Stigma, violence, and the cultural expectation that Swazi women receive permission from their spouse or partner to access health services can prevent young girls and women from receiving proper medical treatment and social support.

“When you are diagnosed with HIV, you are seen as useless, depleted,” Tebeguni Nxumalo, a member of the Kakhoza support group said. “It is harder to become employed and you have to leave school.”

A grim employment outlook forces many young girls into the sex industry, said Florence, an HIV-positive sex worker living in Mbanane, the capital. “And then clients pay double for sex without a condom even when they know your HIV status,” she added.

Sex workers in eSwatini have the highest prevalence rate of HIV in the world, with 60 percent of sex workers living with the disease.

In eSwatini, antiretrovirals that suppress the virus are provided free of charge, but medications and diagnostic tests for illness caused by opportunistic pathogens are not, which drives up deaths from diseases such as tuberculosis and cryptococcal meningitis.

Food insecurity has been found to lower adherence to antiretroviral therapy.

“The [HIV] medicine makes you hungry, but there is no food,” said Hobsile Malambe, a resident in Mvembili, in the far north of eSwatini. “I wish they provided food, too.”

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Obesity may trigger inflammation that damages the brain, research suggests.

Scientists from the University of São Paulo compared the brain scans of 59 obese teenagers and 61 adolescents of a healthy weight.

Among the heavier participants, they found reduced white matter in the corpus callosum, a bundle of nerves that connects the left and right side of the brain.

In simple terms, grey matter contains the bulk of our nerve cells, while white matter is made up of long filaments that transmit electrical signals between neurones. 

This damage is reportedly linked to the inflammatory hormone leptin, which is made by fat cells and helps regulate appetite.

Obesity is a growing problem, with one in three children in the UK being overweight or obese by the time they leave primary school, Public Health England statistics show.

In 2017/18, 335 16-to-24 year olds in England alone were admitted to hospital with a “primary diagnosis of obesity”, according to NHS Digital.

And in the US, one in five (20.6%) of 12-to-19 year olds are obese, data from the Centers for Disease Control and Prevention reveals.

Obesity is known to cause inflammation, which has been linked to everything from heart disease to cancer.

To learn more about how it affects the brain, the scientists analysed scans for “fractional anisotropy” (FA). A reduction in FA indicates white matter damage, they claim.

The scans show reduced FA in the obese participant’s corpus callosum, as well as their middle orbitofrontal gyrus. This is the brain’s “reward centre” and has been linked to emotional control.

Results will be presented in full at the Radiological Society of North America conference in Chicago next week.

Past research suggests obese people’s brains do not respond to leptin, which may cause them to overeat.

“Brain changes were found in obese adolescents related to regions responsible for control of appetite, emotions and cognitive functions,” study author Dr Pamela Bertolazzi said.

The study also found the overweight participants had altered levels of insulin, which helps the body use glucose for energy.

Carrying too much weight has been associated with insulin resistance. This occurs when the body stops responding to the hormone and can lead to type 2 diabetes.

“Our maps showed a positive correlation between brain changes and hormones, such as leptin and insulin,” Dr Bertolazzi said.

“In the future, we would like to repeat brain MRI in these adolescents after multi-professional treatment for weight loss to assess if the brain changes are reversible.”

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The United Nations has set targets to end the AIDS epidemic by 2030. To do this the aim is to ensure that by next year, all countries will have achieved what the UN calls 90-90-90 targets. That is that 90% of those with HIV should know their status; 90% of those who know their status should be on antiretroviral treatment; and 90% of those on treatment should be virally suppressed (meaning the levels of the virus in their blood are undetectable).

Many countries have made substantial progress towards achieving these goals. But many have not. In particular, there are important groups of people at high risk, such as adolescents, whose progress is below the national average. These populations contribute the most to the ongoing transmission of HIV.

Adolescents – aged between 10 and 19 – especially female adolescents, continue to show high infection rates. Worldwide, 25% of all new infections are in adolescent girls and young women aged between 15 and 24. And unlike most age groups, adolescent mortality is increasing, with HIV being the leading cause of adolescent death in Africa.

Adolescents are also less likely to seek HIV services, or stay on treatment. HIV treatment outcomes, including retention, are worse for this age group than for adults.

This is true for South Africa too.

The country’s HIV treatment programme is expanding and the number of adolescents receiving care is growing. But our recent study shows that many adolescents who tested for HIV and had a blood test to measure the stage of HIV disease don’t start antiretroviral therapy.

This is a missed opportunity to engage adolescents already at a facility and link them to treatment successfully. By 2016, two thirds of young South Africans living with HIV were on antiretroviral therapy. This is encouraging but it’s still far off the UN’s 90% target.

Evidence from other work suggests that current models of HIV care aren’t meeting the unique needs of this group. This shows that South Africa’s health system needs to be adapted to deliver effective HIV care to adolescents.

What we found

We used routinely collected laboratory data from South Africa’s national HIV programme to estimate the total number of children and adolescents (aged 1-19 years) entering HIV care. The key finding was a 10-fold increase in the number of adolescents aged 15-19 years on antiretroviral therapy between 2013 and 2016 compared with 2005-2008.

Despite this growth there are still large gaps in successful linkage to treatment. Only 50% of those aged 15-19 successfully initiated antiretroviral therapy through to viral load testing. This is a test that measures the effectiveness of the treatment and usually takes place at six months, one year and then annually after treatment is started.

We didn’t look at long-term retention, so our research doesn’t speak to whether they are still on treatment now or even alive. We looked specifically at uptake of antiretroviral therapy after entering into HIV care.

This is an important finding because adolescence is a critical developmental transition stage from childhood to adulthood. We suggest that there are a number of factors that contribute to the lower rates of uptake of HIV treatment at this stage of life.

The first is that adolescents with HIV can be caught between paediatric and adult services that are unable to address their special needs. These include disclosure of HIV status, stigma, discrimination, sexual health and social support and other factors that impact their ability to move successfully through the HIV care cascade. This refers to the steps that people with HIV go through from diagnosis to viral suppression. It also shows the proportion of people accessing services at each stage of care.

Another factor affecting the rate of treatment among adolescents is that they are dealing with changes in parental versus personal responsibility for maintaining their health. They may be taking more risks, relying more on their peers for support and becoming more interested in serious sexual relationships. They may drop out from treatment to avoid disclosing their activities.

Research has shown that adolescents are at increased risk of infection and have lower rates of entry into care than adults. They also have higher rates of loss from care. But, until now, no national description of the stages in the adolescent HIV care cascade has been available to guide the way resources are targeted.

Our research provides this national perspective of the early stages of the care cascade. It gives a better idea of which young people are in need and when they are at risk of dropping out of care. It’s also important to track how they move from adolescent to adult care and how to keep them in care.

Next steps

Several factors will have an impact on the numbers of adolescents accessing HIV care in the coming years.

One is the success of programmes addressing prevention of mother-to-child transmission of HIV. Another is the extent to which adolescents get tested for HIV, how many go on treatment, and how many stay on it.

If these gaps were closed and antiretroviral treatment uptake increased to the 90% targets, the adolescent population on treatment in South Africa could nearly double in the next five years.

This expansion could have a powerful impact in breaking HIV transmission chains among adolescents. It also highlights why it’s important for the country’s health systems to understand and meet the needs of this group.

For example, traditional ways of getting care – having to go to a clinic or hospital to get tested and treated – don’t seem well-suited to the needs of many adolescents. They may be put off by the operating hours, poor relationships with staff, perceived stigma and loss of confidentiality.

South Africa is already trying to find more flexible ways to address some of these challenges. Adherence clubs – where HIV treatment and support is offered at times and locations convenient for specific groups of people – are one way of getting health care without having to visit a clinic. Mobile app-based technology could also offer awareness and education services that appeal to adolescents.

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The US Department of Health and Human Services on Friday announced approximately $2.27 billion in Ryan White HIV/AIDS Program grants were awarded to cities, counties, states, and local community-based organizations in fiscal year (FY) 2019.

This funding, through the Health Resources and Services Administration (HRSA), supports a comprehensive system of HIV primary medical care, medication, and essential support services to more than half a million people with HIV in the USA.

“The Ryan White HIV/AIDS Program has played a major role in the in the improved outcomes we see for Americans with HIV,” said HHS Secretary Alex Azar, explaining: “Thanks to expanded access to treatment and medical advances, HIV/AIDS has gone from being a likely death sentence to a condition that allows a nearly normal lifespan if properly treated. Ryan White HIV/AIDS Program clients, despite often very challenging circumstances, have a viral suppression rate that far exceeds the national average.”

Program cares for the needs of the whole person

He continued: “The successes of the Ryan White HIV/AIDS Program are in part thanks to how the program cares for the needs of the whole person, including non-health factors. With President Trump’s new initiative to end the HIV epidemic in America by 2030, we will build on the successes of the Ryan White HIV/AIDS Program to connect Americans, especially in the communities most at risk, to the treatment and prevention services they need.”

“For nearly three decades, HRSA’s Ryan White HIV/AIDS Program has played a critical role in the United States’ response to ending the HIV epidemic,” said HRSA acting administrator Tom Engels. “These grants will help ensure that Americans with HIV/AIDS have access to life-saving care and treatment needed to improve their health quality and medical outcomes,” he added.

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Greece was never known for the quality of its health system. But in 2009, at least among drug users, HIV was not a major threat — just 15 were diagnosed with the virus that year.

Then came the financial crisis and the harsh austerity that followed. In 2011, another 256 drug users learned they had HIV. In 2012, the number was 484. The reason for the explosion: the Greek financial crisis and the harsh austerity measures that followed.

The ballooning epidemic illustrates the importance that politics and policy plays in the fight against AIDS. Though there’s still no cure, experts say we already have the tools to eliminate HIV as a threat to human health.

The problem is not the science. It’s the political will — and the fact that the most vulnerable tend to live on the margins of society. Lingering homophobia in some countries holds back men who have sex with men from getting care. Where they’re accepted, sex workers and migrants are still at risk — and blamed for the spread of the epidemic.

“These groups are generally discriminated [against] and stigmatized,” making them less likely to seek help with prevention and treatment, said Nedret Emiroglu, the chief for communicable diseases in the World Health Organization’s European Region. HIV isn’t just a medical condition; it’s “a social disease,” she added.

Marios Atzemis was one of the Greek drug users diagnosed with HIV in 2011. He had been addicted to heroin and a regular in Athens’ open-air drug markets well before the crisis. Then in 2010, street services to help drug users stay safe lost a third of their funding. Atzemis stopped seeing the vans that used to distribute fresh syringes, even as new users were entering the scene, shooting newer, cheaper drugs.

“As a community of drug users, we didn’t have an effective means of defense,” said Atzemis, now a harm-reduction coordinator with the Association of People Living with HIV Greece (Positive Voice). “It was very easy for us to be targeted and to be scapegoats.”

The doctor refused to put him on anti-AIDS antiretrovirals medication until he got clean at a rehab clinic — even though the clinic was on the brink of being shut down for lack of funding.

For Atzemis, now 44, this was enough motivation to wean himself off the drugs. “It didn’t work the same for other people,” he said.

Whether it’s inconsistent funding for programs that are working or social stigma blocking help from getting to the people who need it most, activists and public health professionals say even relatively wealthy countries are struggling to close the remaining gaps in the fight against the epidemic. Worldwide, just four countries — Burundi, the Dominican Republic, the Democratic Republic of Congo and Portugal — are on track to meet the global goal to reduce AIDS deaths by 75 percent between 2010 and 2020, according to UNAIDS.

AIDS is in many ways a 21st century success story. The epidemic tore communities apart in the 1980s and 1990s. In 2000, only 680,000 people were on antiretroviral therapies. Today, 62 percent of people with HIV — some 23.3 million people — have access to the life-saving drugs. New infections are down 40 percent since their peak in 1997, according to UNAIDS.

Early diagnosis and speedy treatment create their own virtuous side effect. The drugs that prevent HIV from exploding into full-blown AIDS also prevent HIV-positive people from transmitting it to others.

London serves as an example of what is possible. An estimated 95 percent of people with HIV in the British capital have been diagnosed with the virus. And of those, 97 percent of them have such low levels of the virus that it’s undetectable (and therefore not contagious).

On top of that, some antiretrovirals taken in advance of exposure, a treatment known as PrEP, can actually drastically reduce people’s chances of getting infected in the first place. Lower-tech methods like condom campaigns and needle-exchange programs help prevent HIV’s spread further. There’s justified optimism that London can end HIV transmission in the coming years.

Then there’s what happened among drug users in Greece. Backsliding threatens progress worldwide. Complacency is another major threat.

Funding to fight HIV dropped in 2018 compared with the previous year, the NGO Doctors Without Borders warned in a report published this month. This dip in donations, the first since the turn of the century, could trigger an “epidemic rebound” in some poor African countries that can’t afford to pick up the slack left by the loss of international aid.

HIV diagnoses are down in the EU as a whole; however, in a third of the bloc’s countries, the trend is moving the wrong way. Ireland, for example, saw a record high number of diagnoses in 2018. Public health officials pointed the finger at migrants, but activists argue the country needs better access to PrEP and self-testing kits.

Indeed, late diagnosis is a problem around the EU, where about half of patients don’t find out they’re HIV positive until several years after infection, according the the European Centre for Disease Prevention and Control.

Sex between men is still the top mode of transmission in the EU, but it’s also a bright spot: Diagnoses among this population are down 20 percent between 2015 and 2017. PrEP has the potential to drive further improvements, but it’s not reimbursed in many countries, and the principal developer, Gilead, has found itself in some bitter pricing disputes.

Russia represents a horrifying story of complacency, denial and discrimination. The epidemic there didn’t take off until the mid-1990s, and then mainly among people who inject drugs. But the country refused to fund harm-reduction measures, and in 2013, it outlawed targeting information to gay men. More recently, its rate of infections has been increasing by 10 to 15 percent annually, with 100,000 infected in 2017 alone, and most transmissions are between heterosexual couples.

In Greece, government officials, civil society and activists were relatively quick to acknowledge the problem. While the government faced heavy criticism from human rights advocates when it posted photos of alleged HIV-positive prostitutes, the public health community also rallied, doubling the number of needle exchanges in 2011 and cutting wait times for addiction treatment. Greece also introduced a novel system of paying drug users €5 to get tested and €3 for referring others, while connecting them with treatment and other services. That approach is now considered a model for responding quickly to outbreaks.

For better or worse, Greece shows that a country doesn’t need to fix its entire health system to deal with HIV. As a case in point, its progress on AIDS hasn’t translated into progress on correlated problems like hepatitis C. Those rates rose during the debt crisis and haven’t ebbed much; based on 2017 data, around 62 percent of drug users in Greece have tested positive for hepatitis C.

The crisis-era HIV outbreak marked “the first time that all the stakeholders — NGOs, state structures, every single one — worked together to face this epidemic,” said Atzemis. “And probably the last time.”

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For more than a decade, Northwestern professor Celeste Watkins-Hayes documented the lives of more than 100 women living with HIV/AIDS in Chicago and beyond.

Now, the stories of the obstacles they faced, and the ways in which their diagnoses transformed their lives, are featured in a new book.

It’s called “Remaking a Life: How Women Living with HIV/AIDS Confront Inequality.”

The book opens with a statement Watkins-Hayes describes as powerful – and complicated: “If it weren’t for HIV, I’d probably be dead.”

Watkins-Hayes told “Chicago Tonight” she was initially confused by the logic of that statement, told to her by one of the women featured in the book. “How can an illness responsible for the deaths of millions around the world help to save a life?” she asked.  

“And what I came to learn … is what she was explaining was that the support system that was necessary for her to move from what I call ‘dying from,’ to ‘living with,’ to ‘thriving despite’ HIV/AIDS was found within the HIV support community,” Watkins-Hayes said. “She was telling me about the significance of the social support network that constitutes our HIV/AIDS safety net and pointing to it as a lifesaving resource that helped save her life.”

Those safety nets and the HIV community were crucial to the personal and political transformations of the women profiled in the book.

Worldwide, 36 million people live with HIV/AIDS. In the United States, 1.1 million are living with it, and there are about 40,000 new infections each year.

But in the early days of the epidemic, white gay men were the face of the disease, making it difficult for cisgender and transgender women to be addressed in the HIV/AIDS response, Watkins-Hayes said.

As more women tested positive, Watkins Hayes says “it became clear that the infrastructure that was being built and the mobilization that was being mounted didn’t necessarily include the experiences of HIV positive women.”

The focus on women living with HIV/AID didn’t happen until much later, she said. Part of their struggle was “finding their voice within that existing community, thinking about HIV in the context of motherhood and not just the potential risk of HIV transmission to their children.”

Watkins-Hayes said there was a reluctance among women to be out in front of the movement because some had children. Women were worried about the stigma of the disease and whether or not the foster care system would take their children away or if they’d be able to stay in school.

Racial disparities among HIV/AIDS diagnoses have also been persistent.

Though African Americans make up about 12% of the U.S. population, the disease still disproportionately impacts them. According to “Remaking a Life,” among all women with HIV diagnoses in 2015, 61% were African American, 19% were white and 15% were Latino. In 2015, HIV/AIDS was the fourth leading cause of death among black women aged 35 to 44.

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