LIFE - AIDS - UNITED KINGDOM

10 steps to an Aids-free generation

 

The 19th international Aids conference opens this evening

Elton John and the executive director of UNAids, Michel Sidibé, join forces on the first day of the world's largest Aids assembly, saying: "We mark the rapidly approaching reality of a world with zero new HIV infections, zero Aids-related deaths, and zero discrimination due to stigma. In short, an Aids-free generation."

When more than 20,000 people, including Bill Gates, Whoopi Goldberg, Bill Clinton and Laura Bush, gather in Washington this week for the 19th International Aids Conference, they will discuss new ways to tackle what has been one of the world's deadliest epidemics for more than three decades.
Sir Elton and Mr Sidibé believe there is good reason to be hopeful. More than eight million people worldwide now have access to HIV treatment – more than 50 per cent of those who need it – and over the past decade, new infections among young people have dropped by 20 per cent. While "serious challenges remain in the Aids response", the pair added: "Through daily acts of creativity, compassion and courage, we can begin to end the epidemic."

As the conference kicks off, The Independent on Sunday investigates some of the obstacles still facing the world in the battle against Aids.

1. Targeting the gay and bisexual community
The epidemic continues to grow in one population in all countries: men who have sex with men. Some countries, including the US, Spain, Chile, Thailand, Malaysia, South Africa and some African and Caribbean nations, record HIV prevalence in this group at 15 per cent or higher. Worldwide, gay black men are 15 times more likely to become infected with HIV than the rest of the population; in the UK they are 111 times more likely. Gay men remain most at risk of contracting HIV in the UK with one in 20 testing positive, compared with one in 900 of the population as a whole. Campaigners have called for an increase in targeted face-to-face work with the most at-risk men.


2. Reducing mother-to-child transmission
Every minute around the world, a young woman acquires an HIV infection, but the burden falls disproportionately in sub-Saharan Africa, where women make up 60 per cent of people with the virus. Because of advances in the UK's antenatal programme, only one in 1,000 babies contract the virus from their mothers. Of the estimated 1.5 million women living with HIV in low- and middle-income countries, over 40 per cent do not receive effective antiretroviral drugs.


3. Reaching drug users
Injection-driven HIV infections are among the fastest-growing in the world, with one in 10 new HIV infections occurring in injecting drug users. The UK has one of the lowest HIV rates for this group (2.5 per cent of HIV-positive people) because of harm-reduction programmes such as needle exchange. In countries with no or few such initiatives, such as Russia, nearly half of all people living with the virus contract it from injecting drugs.


4. Getting more people tested
HIV testing has advanced to the stage where diagnosis can be made in 30 minutes with a finger prick or with a swab of saliva. The weakest level of reported testing exists for men who have sex with men. Less than 10 per cent of countries have 80 per cent coverage for this demographic. The first self-testing kit in the US has just been approved, and campaigners are now pushing for kits to be legalised in Britain. More than half of the HIV population in the UK is still being diagnosed later than it should be, with one in four infected people unaware they have the disease.


5. Increasing drug coverage
More people are receiving treatment today than ever before, but access to antiretroviral drugs remains one of the most pressing issues. More than eight million people living with HIV in low-and middle-income countries are receiving treatment, up from 6.6 million in 2010. Yet while world coverage rates rest at about 54 per cent, there are massive geographical variations. Treatment coverage is lowest in Asia, Eastern Europe, Central Asia and North Africa and especially the Middle East, where only 13 per cent of those in need receive care.


6. Finding a cure
Scientists have promised a future vaccine or cure for HIV for decades, but with 34 million people living with the virus, and 2.5 million new infections last year, experts have coined a new phrase, "treatment by prevention", highlighting the importance of an immediate response and uninterrupted treatment following diagnosis. The US has just approved Truvada, the first HIV prevention pill, which can be used by those at high risk of infection, and anyone who might engage in sexual activity with infected partners. Studies show the drug reduced the risk of contracting HIV by up to 73 per cent.

7. Helping the over-fifties
Because of effective HIV treatment, more people than ever are living to an older age with HIV. An estimated three million over-fifties live with HIV in sub-Saharan Africa, more than 14 per cent of those living with the virus. There are now more than 14,000 people aged over 50 living with HIV in the UK, which is more than 20 per cent of everyone with HIV. But living longer can also mean coping with a range of additional problems, from poor health to social isolation and a lack of savings

.
8. Overcoming stigma
HIV continues to be one of the most stigmatised medical conditions. Twenty per cent of HIV-positive people surveyed in Rwanda and 25 per cent of their peers in Colombia have experienced physical violence because of their status. In Pakistan, 26 per cent of people say they have been excluded from family activities, and more than 10 per cent of people in Belarus, Burma and Paraguay have been denied healthcare.


9. Changing the law
In more than 60 countries around the world, exposing another person to HIV or passing on the disease through sex is a criminal act, despite arguments that such punitive laws deter people from getting tested or treated and increase the risk of the disease spreading. The US has one of the worst records around criminalisation of HIV transmission. There and elsewhere, people have been given 20 years in prison for spitting or doing other things that won't transmit HIV.


10. Reducing cost of drugs
A year's supply of first-line antiretroviral drugs plummeted in cost from $10,000 in 2000 to less than $100 in 2011. However, costs can vary greatly between countries and even within a country. If countries in Latin America and the Caribbean were all able to access the most affordable generic drugs in the region, between 1.2 and 3.8 times more people could receive treatment.

CHILD / HOPE - CHINA

'Lost' generation given hope

Updated: 2012-06-28 07:58

By Yang Wanli (China Daily)

Shelters offer care to those living rough on the streets, Yang Wanli reports in Beijing.

Xiaoya (left) plays the recorder along with fellow students at the Beijing Juvenile Rescue and Protection Center. The 12-year-old, who has malformed legs, was abandoned by her grandmother at an early age. Photos by Zhang Wei / China Daily

Wang Ming has visited three provinces in China since the beginning of 2011. That's not bad going for a 12-year-old. Without a guidebook or a change of clothes, the boy took nothing but 200 to 300 yuan ($31 to $47) for each trip. Sharing a passion for globetrotting with his hero Bear Grylls in the TV program Man vs Wild, he has attempted to realize his dreams by becoming a runaway.
At a juvenile center in Beijing, Wang is among 40 children brought in off the streets. Some ran away from home, others were abandoned. Since it opened in 2003, the center has helped more than 5,000 "lost" children.
It's difficult to gauge how many children are living rough on China's streets, but on June 1 the Ministry of Civil Affairs revealed that more than 10,000 juveniles nationwide had been rescued or were being given shelter and protection in government-run centers from January to April this year.
A 2007 survey conducted in nine cities, including Beijing, Hangzhou and Shanghai, by the National Working Committee on Children and Women under the State Council, estimated the number to be between 1 million and 1.5 million.
Situated close to Beijing's East 5th Ring Road, the pink roofs of the center's six bungalows are bright and vivid in a sea of gray or white buildings. Youngsters aged 3 to 18 - mostly from rural areas in provinces such as Hebei, Henan, and Sichuan and the Ningxia Hui autonomous region - make up the bulk of the inhabitants.
"The children sent here are those who can't remember where they're from or who haven't contacted their relatives for many years," said Xu Dong, director of the center, who explained that domestic abuse, difficult relations with parents or a cripplingly low standard of living are the reasons usually cited when the children are asked why they ran away.
Wang's story is slightly different. His parents are divorced and Wang and his older sister have been living with their father in a village in Jiangsu province in East China. Wang's father works in construction and rarely has time to devote to his children or their education. Wang found himself at a loose end. "I don't like school or the village. They're so boring," he said, his dark eyes twinkling mischievously.
Xu said that many of the children give false names and lie about their backgrounds when they are first admitted to the center to avoid being sent home, but they usually end up admitting the truth once they learn to trust the staff. That was the case with Wang, who was persuaded to reveal his real address and contact details for his father. "I don't want to stay here, even though it's nice to have clean clothes and sleep in a comfortable bed," he said.
He ran away from home earlier this month and sneaked onto a Beijing-bound train. This latest escapade followed two previous attempts to break free when he traveled to the provinces of Guangdong and Yunnan "to see those beautiful sites", he admitted, as he described the bridges and mountains he'd seen. With little money in his pocket, he ate food provided by locals until the police sent him to the juvenile center.
According to Xu, this type of "free traveling" is quite normal for runaway kids. They can easily avoid detection and the ticket checks on trains, although Wang occasionally bought a ticket using an ID card he found in the street and the money he had "borrowed" from home.

Street child Wang Ming (right) has dinner at a juvenile center in Beijing. Zhang Wei / China Daily

Wanderlust
The mini-adventurer is driven by wanderlust. "I saw people traveling to famous places on TV, and I wanted to be just like them," he said. In the early days of his trip to Beijing, his love of TV prompted him to visit the Military Museum of the Chinese People's Revolution. "I knew the museum from a TV program. It's a place I dreamed about," he said.
Like Wang, who is moving from childhood to a sense of self engendered by adolescence and beginning to pursue his own choices, most of the children at the center are 11 to 16 years old but few have close connections with their immediate family.
However, their lifestyles have provided them with strong survival skills. Roaming the bar areas of the North 2nd Ring Road, Wang spent most of his days in electronic games arcades, picking up dropped coins to feed the machines, and slept on park benches at night. A number of residents provided food, including an African man who piqued the boy's curiosity. "I took a bus to the international airport and asked the service people how I could get to Africa. I even showed them the ID card," he said. "But, they refused to let me travel, saying that I could only go there with my parents."
After a few days on the streets of the capital, the police sent Wang to the rescue center. Once the boy revealed his real address, Xu contacted Wang's father, who refused to take his son back, reasoning that he will almost definitely run away again. "If the local government in his hometown can't send someone to collect him, we will have to send him back alone," said Xu.
Basic education is provided for long-term residents and the center is supplied with books covering the entire nine-year school curriculum. Although there are only about 40 students in the class, far fewer than in ordinary primary schools, teaching is not an easy task. Every 60-minute lesson is split into three, 20 minutes allocated for each group, with students taught according to their ability and previous educational background.
"Teaching those students really takes a great deal of patience and advanced skills," said Feng Guixia, a 59-year-old who teaches Chinese and mathematics. She has been working at the center, earning 1,500 yuan ($236) a month, since retiring from her job as a teacher at a nearby school five years ago.

Li Shengli, who arrived at the center in 2005, makes his bed. Born with just vestigial digits and not fully formed fingers, the 15-year-old was abandoned on a train by his parents.

Just like a family
"The bonds that connect the kids are very touching," she said. "Unlike a lot of children nowadays, the kids here always share what they have, whether it's delicious food, new toys or other things. The youngest child is always treated well, just like in a family," she said.
Roughly 90 percent of the children sent to the center are eventually reunited with their families, but the others, those that have been abandoned, are destined to live there until they are 18. Li Shengli, 15, who arrived at the center in 2005, was abandoned on a train. "I was traveling with my parents and fell asleep. When I woke up, they had gone," he said, avoiding eye contact and rubbing his left hand on his clothes. His hand looks unusual because he was born with just vestigial digits and not fully formed fingers. He doesn't know if that is the reason he was abandoned.
Li said he can't remember anything about his birthplace and little about his family, but he knows that he has an older sister and a brother. When asked if he wanted to find his family, he looked down at the floor and shook his head.
He perked up momentarily only when he spoke of the things he's seen and done. "I love the Great Wall. It's so long and so beautiful. We climbed for hours until our legs were tired and we could hardly take another step. We went to the highest part and saw the lovely scenery, colorful trees, blue sky and birds," Li smiled. "I know where Beijing is. It's on the neck of the cockerel (to many people, the depiction of China on the map makes the country look like a crowing cockerel)."
But his interest evaporated when he spoke of life outside the center, a life with which he's unfamiliar and a frightening prospect: "I dare not explore the outside world. If I leave here, I will just be homeless again," he said.
Contact the reporter at yangwanli@chinadaily.com.cn
Tang Yue and Wu Wencong contributed to this story.