History of HIV in Two Countries

  There are many countries around the world that are affected by the HIV epidemic. Two countries in particular are Africa and Russia. Nowhere in the world is the HIV/AIDS epidemic been more devastating than the continent of Africa. For South Africa, political chaos and a long history of government denial of the disease fueled an epidemic that had reached disastrous amounts by the late 1990s and early 2000s.Even today, despite plummeting death rates and better leadership on the HIV/AIDS war front, the rate of new HIV infections continue to rise year on year.

As a result of this, South Africa still today is the country with the largest population of HIV infected people in the world. For the history of HIV in Africa it is largely believed thatit originated in Kinshasa, in the Democratic Republic of Congo around 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. The HIV infection was unknown and transmission was not followed by any noticeable symptoms. While random cases of AIDS were documented before 1970, existing information suggests that the current epidemic started in the mid to late 1970s. By 1980, HIV may have already spread to North America, South America, Europe, Africa and Australia. By this time between 100,000 and 300,000 people could have already been infected with the HIV virus. In 1983, doctors reported cases of a new, fatal wasting disease locally known as 'slim' in Uganda. However, as the country was in the midst of this all, the HIV problem 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 was only in the 1990s that President Nelson Mandela acknowledged his government's grievance to the crisis, but by this time South Africa had already become the largest population of people with HIV in the world. By 2000, the South African Department of Health outlined a five year HIV/AIDS plan but received practically no support from the South African President Thabo Mbeki. President Thabo Mbeki rejected usual HIV science and instead blamed the growing AIDS epidemic on poverty, colonialism, and business greed. Without government support, the five year plan did not get off the ground as quickly as the country planned, with very few showing up to receive freeantiretroviral medication. In the meantime, HIV among pregnant South African women soared to over 30% by 2000. It was only with the removal of President Thabo Mbeki from office in 2008 that the government took steps to take on this health catastrophe, increasing efforts to become what is known today as the largest HIV drug programs in the world. However, increasing pressure to expand has been weakened by a deteriorating public health structure and the weakening 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 has the biggest HIV epidemic in the world, with 7.2 million people living with HIV as of 2017. HIV is at a high percentage among the general population at 18.9%. Particular groups who have the highest rates of HIV in Africa are men who have sex with men, transgender women, sex workers and people who inject drugs in South Africa. Since there is such a high rate of HIV in South Africa, the country has made huge improvements in getting people to test for HIV in recent years with 86% of people aware of their HIV status. Africa has the largest Antiretroviral Treatment program in the world, which has went through even more growth in recent years which began to emerge in 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 Pre-Exposure Prophylaxis also known as PrEP, which is now being made available to people at high risk of infection. Nationally, HIV infection amongsex workers is estimated at 57.7%, although this depends between areas. Certain factors increase HIV risk for South African sex workers, including poverty status, lack of different career opportunities, etc. Injecting drug use is also common among sex workers, increasing their risk to the HIV virus even more. HIV infection amongmen who have sex with men in South Africa is now estimated at 26.8%, but this also varies geographically. Transgender women in Sub-Saharan Africa are twice as likely to have HIV as men who are in homosexual relationships. In 2016, an estimation of 17% of people who inject drugs in South Africa were living with HIV. However, IV drug users only sum up for 1.3% of new HIV infections in South Africa. Recent studies have found that only 59% of young people in South Africa have sufficient knowledge of ways to prevent themselves from HIV.Only 5% of schools were providing widespread sexuality education in South Africa in 2016, but over the next five years the government has committed to increasing this to 50% in areas with high rates of HIV infection. The 2012 National Communication Survey on HIV/AIDS found the country's HIV communication programs were having a positive effect, particularly on young people from the ages of 15 to 24, with an increase in condom usage, testing services and male circumcision. Though knowledge around safe breastfeeding practices among pregnant mothers living with HIV still remains low. 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. This equals up to 61% of the people living with HIV in the country.

     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 tostigmatizethe men as well as HIV itself. In the late 1980s, mandatory HIV testing was started across the Soviet Union, which was often done without the approval or knowledge of the person being tested. 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 pathof infection from one person to the next. The early 1990s saw the highest point of political conflict in the Soviet Union, pushing the HIV crisis into the shadows. 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 injecting drug use throughout the country, the HIV epidemic was left unchecked, with the disease spreading like wildfire. With the rise of the newly independent Russian Federation of States, AIDS agencies commanded little importance among leaders in the Russian government and is receiving even less funding. Poor communication among the few HIV organizations that existed resulted in poor information communicated to agencies and treaters on the ground. Unlike most countries, Russia's HIV epidemic is growing, with the rate of new infections rising between 10 and 15% each year. It is estimated that in Russia over 250 people become infected with HIV every day.The continued shift away from progressive policies towards socially conservative legislation is an obstacle to enforcing HIV prevention and treatment.Russia has the highest number of people who inject drugs in the region at about 1.8 million which accounts for 2.3% of the adult population.The ban on non traditional sexual relations among minors blocks information about HIV and support services.Preventing mother to child transmission is one of Russia's HIV success stories. The government announced it had achieved a 98% success rate in 2016. By the middle of 2017, 1.16 million people had been diagnosed with HIV in Russia. However, this does not amount to the number of people currently living with HIV as well as AIDS related deaths or people who are still undiagnosed with HIV. Russia's HIV epidemic is now targeted on certain groups. In 2016, IV drug users represented the largest percentage of new diagnoses 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 estimated that around 500,000 people in Russia are unaware of their HIV positive status.HIV testing is available, but only covering about 19.3% of the population which is around 30 million people. Now HIV testing is carried out generally, rather than being targeted towards certain groups most affected by HIV. As a result of this, certain populations made up for less than 1% of the 24 million HIV tests that were carried out in Russia in 2011. With new infections rising year after year, a targeted, combination prevention strategy is needed to slow this epidemic. The Russian Prime Minister approved Russia's 2017-2020 HIV strategy in 2016, which is the first official HIV document to be drawn up since Russia's 2002-2006 strategy. The plan aims to reduce transmission rates by focusing on prevention programs and decrease the number of AIDS related deaths in the country. However, although the help of social change and support of high affected populations is discussed, no national programs are created. As for condoms, they are widely available to buy in Russia, but there's no government backed free distribution programs, and condom use is thought to be low. The practice of using condoms is also controversial. 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 advocate for the teaching of moral education, which focuses on subjects such as chastity and faithfulness in heterosexual marital relationships, as opposed to sex education, which includes accurate information about human development, anatomy and reproductive health, as well as information about contraception, childbirth, STIs, gender relations, sexuality and gender identities.

     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 improvements have been made with approving the PreP program made available to people at high risk of infection, improvements in getting people to test for HIV in recent years, with 61% of adults on antiretroviral treatments and 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. This is because gender inequality, intimate partner violence and sexual violence are common within Russian society. IV drug users are highly susceptible because of sharing used needles and many are denied access to HIV information and prevention causing them to not access testing available. 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 world are receiving effective HIV treatments and scientists are working to have more treatment options available. Many are aware of their status and are participating in safe sex and have the knowledge to reduce their risk of infection. In 2015, the Joint United Nations Programme on HIV/AIDS launched a target to end the AIDS epidemic by 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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