Essay: Acquired immunodeficiency syndrome (AIDS)

Acquired immunodeficiency syndrome (AIDS) represents the late stage of human immunodeficiency virus (HIV) infection which causes progressive depletion of a person’s defense system, therefore predisposing oneself to the complications of superimposed secondary infectionseor tumors. Since AIDS was first reported in 1980s, it has rapidly spread across the world. According to UNAIDS, approximately 35 million people were living with HIV around the world by the end of 2014.
According to the World Health Organization global health sector strategy on HIV/AIDS 2011’2015, it guides the health sector response to HIV epidemics in order to achieve universal access to HIV, diagnosis, prevention, care, treatment and support by reaffirming global targets for the health sector, identifying four strategic directions to lead international response and figuring recommended country action and who to contribute among four directions.
The strategy aims to promote a long-term, sustainable HIV response by enhancing community and health care systems as well as solving the social factors of health than spread HIV and slow down the response. Also, it strengthens collaboration between health services and HIV by improving efficiency and effectiveness.
The methadone treatment program has been serving in Hong Kong for both public health as well as public security purpose for 30 years. Nowadays, the program has opened 20 clinics over different districts in Hong Kong. There are around 10,000 registered drug users with average attendance of 7,000 (95% on maintenance) by the end of 2010. The service is operated by the Department of Health through public health and clinical service. This program has allowed Hong Kong to prevent HIV infection among drug user by an integrated set of methods focused on HIV prevention in the community and the reduction of risk-taking behavior. The former includes public education, outreaching, improved surveillance and regulated urine testing for HIV antibody. These measures also help to promote acceptance of the harm reduction strategy in Hong Kong.
The program in Hong Kong is an example of how harm reduction can be useful in practice. Although this not a perfect system, highly active antiretroviral therapy, high usage of opioid substitution therapy, needle and syringe program have synergistic effects in lowering HIV incidence among drug users by 60%. However, it is vital for Hong Kong to further improve the system. Firstly, the coverage and effectiveness are important which means the capability and flexibility to cater as many as drug users as possible in order to provide health service to them. Secondly, there should be enough dose of methadone for drug users so as to reduce the possible risk behavior. Thirdly, acceptance by the general populations and policy-makers is needed. Non-acceptance may make this program to deteriorate and finally break down. The program has performed really well and more involvement from healthcare provider; government and NGOs are needed to sustain the progress.
As for China, it is now making a promising progress in the implementation and development of HIV prevention strategies particularly after 2003. China is under a transition stage in its HIV intervention development by adopting approaches based on advancement in scientific evidence and encouraging the pilot testing of risk reduction measures such as needle exchange program (NEP).
Needle exchange program was first set up since 2003, and developed quickly in terms of the activity, needle collection and distribution. The operation models are very limited running by Center for Disease Control and Prevention during normal working hours. Other common mediums such as vending machines, mobile clinics and night services, which showed a significant efficacy in other countries, are seldom used in China and therefore account for an extremely low coverage throughout China. Target group, injecting drug users, pointed out that difficulty and distance getting to the NEP as a barrier to access the service. The flexibility of types of services and working hour are important elements of a successful NEP.
As I mentioned above, coverage is crucial in building up awareness among drug users. Injecting drug users need to be encouraged to promote the usefulness of NEP.
Making a good use of detoxification centers to educate drug users could help to achieve this goal even thought the recidivism rate is high. NEP workers and health officials should work closely with police to help promote the benefits of harm reduction. However, it is hard to increase the understanding of police under current political climate even with the support of senior government officials because police commonly regard NEP as encouraging taking drug.
On the other hand, a wage structure reform is need for peer educator. The needle turnover rate is closely related to peer educator wages and secondary exchangers always complain that they cannot get all the needles from peer educators. It is because peer educators are paid based on how many secondary exchangers they served which make the service less effective because they have to serve a huge number of individuals at the same time. Therefore, I think the health officials should employ more peer educators to meet the demand of injecting drug users and promote the use of alternative operating models to improve the satisfaction as well as coverage of NEP service in China.
One of the most significant differences between Hong Kong and China approach is that there are no needle exchange program or outreach program in Hong Kong compared to China. Secondly, the coverage rate of the approach is a lot higher in Hong Kong than in China because of the level of government support. As the methadone treatment program is implemented by the government, community acceptance is usually higher than it operates under private medical operators or NGOs for such a large-scale project. With strong support from the Hong Kong government for 30 years compared to just 10 years in China, the program’s long history has standardized the methadone treatment. Combination of both health care service and law enforcement was ensured by the structure to operate clinics and set rules. The Commissioner for Narcotics also played an important role in the introduction of the methadone treatment program. On the other hand, instead of immediately responding to the HIV epidemic when it first began, the Chinese government chose to wait few years before starting to take a real action. China tried to introduce international NGOs to assist them for HIV prevention. However, these NGOS were monitored by the Chinese government in developing policy. Some provincial government officials even planed HIV measures in advance but were always under scrutiny by the greater government power due to the political situation in China.