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  • PMSA EDITORIAL TEAM 2020

HIV/AIDS Prevalence in the Pacific

Updated: Aug 2

Author: Jordan Alphonse Bachelor of Science in Medicinal Chemistry


Background on HIV/AIDS

According to the World Health Organization [1], “AIDS (acquired immunodeficiency syndrome) is a severe disease syndrome that represents the late clinical stage of infection with HIV (human immunodeficiency virus)”. In 1981 the disease was first realized in Central Africa before it became an epidemic and spread across the globe [1].

The WHO clinical staging system for HIV/AIDS [1] is as follow:


Clinical Stage 1:

  • Asymptomatic 

  • Persistent generalized lymphadenopathy (PGL)

  • Performance scale 1: asymptomatic, normal activity

Clinical Stage 2:

  • Weight loss, <10% of body weight

  • Minor mucocutaneous manifestations

  • Herpes Zoster within the last 5 years

  • Recurrent upper respiratory tract infections (e.g. bacterial sinusitis)

  • And/or performance scale 2: symptomatic, normal activity

Clinical Stage 3:

  • Weight loss, >10% of body weight

  • Unexplained chronic diarrhoea, >1 month

  • Unexplained prolonged fever (intermittent or constant), > 1 month

  • Oral candidiasis (thrush) Oral hairy leukoplakia

  • Pulmonary tuberculosis within the past year.

  • Severe bacterial infections (e.g. pneumonia, pyomyositis)

  • And/or Performance scale 3: bed-ridden, >50% of the day during the last month

Clinical Stage 4:

  • HIV wasting syndrome, as defined by CDC1

  • Pneumocystis carinii pneumonia

  • Toxoplasmosis of the brain

  • Cryptosporidiosis with diarrhoea, >1 month

  • Cryptococcosis, extra pulmonary

  • Cytomegalovirus (CMV) disease of an organ other than liver, spleen or lymph nodes

  • Herpes Simplex Virus (HSV) infection, mucocutaneous >1 month, or visceral any duration

  • Progressive multifocal leukoencephalopathy (PML)

  • Any disseminated endemic mycosis (e.g. histoplasmosis, coccidioidomycosis)

  • Candidiasis of the oesophagus, trachea, bronchi or lungs

  • Atypical mycobacteriosis, disseminated non-typhoid

  • Salmonella septicaemia

  • Extrapulmonary tuberculosis Lymphoma

  • Kaposi’s sarcoma (KS)HIV encephalopathy, as defined by CDC2

  • And/or Performance scale 4: bed-ridden, >50% of the day during the last month

Introduction

The Pacific region is made up of diverse cultures, traditions, languages, political systems and living conditions. According to a report from the Commission of AIDS in the Pacific [2], “It spans a third of the world’s surface and accounts for just 0.14% of the world’s population-with a similar proportion of the global burden of HIV”. Thus, in the Pacific, a few number of people living with HIV can already have drastic impact on their families and communities.


History


HIV was imported to the Pacific from foreigners who travelled in and out of the region. The first reported case of HIV in the Pacific was reported in the Northern Mariana Islands in 1984 [3]. According to the Secretariat of the Pacific Community [4], in an article on Pacific Regional Strategy on HIV/AIDS 2004-2008, “Since 2005, about 8,268 confirmed HIV infections and 1,672 AIDS cases have been subsequently reported. Over 95% of reported HIV infections have been from five Pacific Island countries and territories (PICTs): French Polynesia, Guam, New Caledonia, Fiji and Papua New Guinea” [4]. However, there are still a good number of unreported cases throughout the region.


Transmission in the Pacific


The spread of HIV can come in different forms all relating to transfer of blood and body fluids from an infected person to another person. The basic ways of transmission are through sexual transmission, injection of drugs using needles, blood transfusion, and mother-to-child transmission [1]. According to Wanyeki [5], “The two most common modes of HIV transmission identified in the 21 PICTs (excluding PNG) are unprotected heterosexual sexual contact (52%) and male to male sexual contact (27%)”. Wanyeki [5] further concluded that, “A systematic review of data from 38 low- and middle-income countries found that men who have sex with men were, on average, 19 times more likely to have HIV than the general population. A similar review of studies among female sex workers in low- and middle-income countries found that they were nearly 14 times more likely to be infected by HIV than were women of reproductive age” [5]. Figure 1 shows the combined data from the 21 PICTs revealing the primary mode of transmission contrasted with three other PICTs [5].


Impact of HIV/AIDS in the Pacific


The impacts of HIV/AIDS can be seen in the health, social and economic sectors in the Pacific. The WHO has done a good number of research and survey in the PICTs. These countries included American Samoa, Cook Islands, Fiji, French Polynesia, Guam, Kiribati, the Marshall Islands, the Federated States of Micronesia, Nauru, New Caledonia, Niue, the Northern Mariana Islands, Palau, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu, Vanuatu, and Wallis and Futuna [1].

Wanyeki [5] stated that, “A low-level epidemic is an epidemic where HIV prevalence has consistently not exceeded 1% in the general population nationally, nor 5% in any sub-population. Five Pacific Island countries and territories (PICTs), (Cook Islands, Nauru, Niue, Pitcairn and Tokelau) had no people living with HIV at the end of 2012. 



The estimated prevalence among adults aged between 15 and 49 years in the 16 PICTS that reported people living with HIV at the end of December 2012 was less than 0.1%. For PNG the estimated prevalence at the end of December 2010 at selected sentinel urban antenatal clinics (ANC) sites was 0.7% and 0.5% at selected rural ANC sites”[5]. The regional overview of Asia and the Pacific shows that since 2018, about 5.9 million people are living with HIV, about 0.2% adult HIV prevalence rate, 310,000 new HIV infections, 200,000 AIDS related deaths, 54% adults on ART and 78% children on ART [6].


The prevalence rate gives a clear picture on how damaging the claws of HIV/AIDS can be felt in the Pacific Island countries. PNG faces the biggest challenge in managing the highest prevalence rate in the Pacific. 

From an article by Tawfik and Kinoti [7] on the impact of HIV/AIDS on the health workforce in developing countries, “The HIV/AIDS impacts on the health workforce and health systems are an added insult to the already fragile health systems in developing countries which are characterized by poor infrastructure, insufficient numbers of service providers, lack of drugs and commodities and frequently poor management”.


The damage done by HIV/AIDS to the social and economic sectors are enormous. There are two vulnerable groups in the Pacific that is mostly affected by the disease. Firstly, the young and middle-aged adults are prone to getting infected faster. This may include single young people or young married couples [4]. Secondly, the under-privileged communities are affected drastically by the disease. HIV/AIDs contributes highly to increase in poverty, less workers in the workforce and reduction in business incomes [4].


Conclusion

HIV/AIDS is a serious health concern for all the Pacific Island countries to consider. This serious threat can only be tackled by taking a holistic approach. Effort is required for Pacific Island country governments to work with their people and also governments to work together. Primarily, Pacific Island countries must prioritize on preventative measures to reduce the spread of HIV. Measures such as doing awareness and providing more education to local communities on staying safe from HIV. Governments need to take full responsibility in making sure HIV testing is carried out all throughout their countries. As well as getting the updated total statistics of infected people living with HIV yearly. Most importantly, making sure the infected people are on Anti-retroviral treatment (ART) and keeping track of them. Finally, ensuring an up-to-date statistical data system and coming up with effective strategies to counter impacts of HIV/AIDS will help reduce the prevalence rate of HIV/AIDS in the Pacific.

Reference


  1. World Health Organization (WHO). HIV/AIDS in Asia and the Pacific Region; 2003

  2. Turning the tide: an open strategy for a response to AIDS in the Pacific: report of the Commission on AIDS in the Pacific – Suva, Fiji: UNAIDS Pacific Region; 2009.

  3. Pacific: Children and HIV/AIDS: A call to action. Bangkok, Thailand: UNICEF East Asia and Pacific Regional Office; 2006

  4. The Pacific Regional Strategy on HIV/AIDS 2004-2008. Noumea, New Caledonia: Secretariat of the Pacific Community; 2005

  5. Wanyeki I. HIV Surveillance in Pacific Island Countries & Territories: 2012 Report. Noumea, New Caledonia: Secretariat of the Pacific Community; 2013

  6. Avert. HIV and AIDS in Asia & the Pacific Regional Overview [Homepage on the internet]. c2020 [updated 2020 Feb 20; cited 2020 July 17]. Available from https://www.avert.org/professionals/hiv-around-world/asia-pacific/overview

  7. Tawfik L, Kinoti S.N. The impact of HIV/AIDS on the health workforce in developing countries. World Health Organization; 2006.

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