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Things are generally more positive on the global HIV front: the number of new infections is down, treatment figures are up and headway is being made in the fight to end discrimination against people living with HIV.
However, there is still work to be done and progress in the fight against the pandemic has not been even. Here is a list of five countries that could determine the future of the pandemic this year.
South Africa - The sheer size of the epidemic in South Africa means it cannot be ignored: more than one million people are on treatment - the biggest antiretroviral programme in the world - and more than five million people are living with HIV - the highest caseload globally.
The country also offers the best-case scenario in terms of HIV/Aids funding since the government is largely responsible for financing the country's Aids efforts and does not rely as heavily on external resources. The amount of the national health budget allocated to HIV/Aids has increased from R4.3 billion (US$627 million) in 2008 to an estimated R5.3 billion ($774 million) in 2010.
After years of dragging its feet, the government has introduced policies and initiatives aimed at strengthening the HIV/Aids response, including a national HIV counselling and testing campaign and the decentralisation of ARV treatment from doctors prescribing at hospitals to nurses providing the drugs at primary healthcare facilities. This year will provide an idea of how these measures are panning out.
Russia - With 37% of the country's estimated 1.8 million intravenous drug users (IDUs) believed to be living with HIV, Russia is dealing with one of Eastern Europe's largest HIV epidemics.
The country has been heavily criticised for its refusal to adopt evidence-based harm-reduction techniques recommended for treatment of drug users, preferring instead to put IDUs in prison, where clean needles are harder to find, thereby raising the HIV threat. Experts say unless the drug policy changes, HIV prevalence is likely to continue increasing.
Uganda - Once hailed as a beacon in the fight against HIV, Uganda's prevalence rate fell from 18% in 1992 to about 6.1% in 2004. The government's aggressive prevention campaigns focused on abstinence, sexual fidelity and condom use, becoming the foundation of national HIV prevention programmes across sub-Saharan Africa. Today, however, UNAIDS reports that the country's HIV prevalence is between 6.5% and 7%.
There is also evidence of apparent reversals in preventive sexual behaviour in the general population, the Uganda Aids Commission reports. The proportion of adults who say they had sex with a person who was not a permanent partner has grown since 1995, from 12% to 16% for women and from 29% to 36% for men.
With several mass media HIV prevention campaigns now targeting multiple concurrent partnerships, where the highest number of new infections is occurring, 2011 will test the government's will and capacity to effectively reduce the number of new infections.
Haiti - The 7.0 magnitude earthquake that hit the country a year ago damaged its health infrastructure extensively. While most patients who were on life-prolonging anti-retroviral drugs before the quake were traced and put back on treatment, the country's HIV programmes remain unstable.
Reports of sexual abuse and transactional sex in Port-au-Prince's tent cities raise the possibility of increased infections, while the threat of tuberculosis in the overcrowded camps is also high.
As the country continues to rebuild basic services this year, it will be important for the government, faced with multiple competing interests, to ensure that HIV/Aids receives the attention it needs.
India - More than 80% of all donor-funded antiretroviral drugs used in developing countries are Indian-manufactured generics. However, an imminent Free Trade Agreement (FTA) with the European Union could potentially see the country lose its ability to produce the cheap generic medicines so vital to healthcare in poor nations.
The EU is pushing for data exclusivity, which means Indian generics manufacturers would no longer be able to use existing drug trials to make identical generic drugs. Instead, they would be required to conduct their own clinical trials, delaying poor countries access to these drugs for several years. EU officials say data exclusivity clauses in the FTA will take into consideration the role India plays in producing generic medicines for the developing world.
So far, India has stood up well to threats against its generics industry from large western pharmaceutical companies. Earlier this month, the country rejected two separate ARV patent applications by pharmaceutical giants Bristol-Myers Squibb and Abbott on the grounds that they did not add anything to the original patent.
With increasing pressure on India and other developing nations to adhere to tighter intellectual property laws, 2011 could be critical to the future of HIV treatment in sub-Saharan Africa and other regions. - (PlusNews, February 2011)
