In the Netherlands, around 24,000 people are infected with HIV. 94 percent of them receive treatment and no longer transmit the virus. Compared to the rest of the world, our country has a good score and, according to the AIDS fund, the end of the HIV epidemic is even in sight. But shocking figures can be seen elsewhere: the HIV epidemic is growing in 45 countries.
Inequality and discrimination
Good health care is not accessible to everyone and is a fundamental right. In several countries, for example in Russia, people are discriminated against on the basis of their sexual orientation.
“Homosexual men in Russia who go to a clinic to get tested for HIV are not being helped,” says AIDSfonds spokeswoman Anna Nijsters. There are also a large number of drug addicts in Russia who spread the HIV virus with used needles. “There is absolutely no concern for these people. The government prefers to let them die.”
Countries where HIV has increased in the last decade are: Afghanistan, Algeria, Armenia, Belize, Brazil, Chile, Congo, Costa Rica, Cuba, Dominican Republic, Egypt, El Salvador, Equatorial Guinea, Fiji, Philippines, Georgia , Greece, Guatemala, Guyana, Honduras, Ireland, Jamaica, Yemen, Cape Verde, Kazakhstan, Kyrgyzstan, Madagascar, Malaysia, Mauritania, Uzbekistan, Oman, Papua New Guinea, Paraguay, Peru, Russia, Senegal, Serbia, Sudan, Suriname, Tajikistan, Timor-Leste, Tunisia, Turkmenistan, Uruguay and South Sudan.
In the Philippines and Malaysia, a conservative Islamic government is cracking down on sex workers and drug addicts. They end up in prison with no HIV treatment.
Things are also going badly again in some African countries, including Uganda and Kenya. In the early years of HIV control, for example, things were going well in Uganda. “But since a conservative and Christian wind has blown, LGBTI people have been excluded and women have lost their rights; HIV is now on the rise again,” says Nijsters.
In Kenya, a gay relationship can be punished with a 14-year prison sentence. “If a homosexual dares to go to a clinic to ask for HIV testing, he will be kicked out or beaten up by other patients.”
HIV prevention with PrEP
In the Netherlands, the GGDs are conducting a five-year trial with the HIV prevention pill PrEP. For a small fee, 8,500 people at increased risk of contracting HIV can get PrEP pills that protect against HIV. Gays, transgender people, sex workers and drug addicts are among the groups at risk.
New data shows that PrEP pills work effectively: The number of new HIV infections is falling dramatically among men who have sex with men. The interest is therefore great: there are over 2500 people on the waiting list at the GGD.
The PrEP trial will run until 2024. It has not yet been decided how the drug will be used after 2024. Aidsfonds would like to see the range of PrEP expanded now. “Don’t limit it to the 8500-person group. Eliminate waitlists and make PrEP much more widely available. Make it available to everyone who sees it as necessary,” says Nijsters.
The queue leads to contamination
The waiting list for PrEP is long, which can have unfortunate consequences for people who would like to use the drug. For example, there are people who were infected with HIV while still on a PrEP waiting list.
Also, PrEP is not available to all primary care physicians. A large proportion of GPs choose not to make the drug available because it is not part of the patient’s deductible.
Reach people
It is estimated that there are around 1700 people in the Netherlands who do not know they have HIV. Even late HIV diagnoses still occur, especially among people over 50 and more among straight men and women than among gay men, writes Aidsfonds. Soa Aids Nederland tries to reach these groups of people.
The young should certainly not be forgotten either. Nijsters: “We are constantly working to educate young people. There are always young people who become sexually active and they need to be given adequate information on how they can prevent STIs and HIV.”
Aidsfonds stresses the importance of tracing the latest HIV infections. “HIV is easy to cure, you stay healthy, and you can’t pass it on anymore thanks to medication,” says Nijsters. For primary care physicians, the appeal is therefore: “Also actively consider using HIV testing, even for people to whom it may not be immediately obvious.”
