By Kristen E. Porter, PhD, MS, MAc, Lac and Elizabeth Sommers, PhD, MPH, LAc
Approximately 20,000 attendees from 193 countries convened on July 18-23 for the XVIII International AIDS Conference (AIDS 2010). The week-long program featured 248 sessions covering scientific research, community and leadership.
The 2010 theme of Rights Here, Right Now placed a central focus on the human rights protections needed to succeed in fighting the global HIV/AIDS epidemic. In the opening remarks, Deputy President of South Africa Kgalema Motlanthe said "The AIDS epidemic requires a holistic response."
In the past, this bi-annual conference has had a rich undertone supporting the important role of CAM and traditional healers (TH) through the presentation of research, posters and hands-on therapies provided to attendees. At this year's conference, however, there was a dramatic lack of CAM-related content.
There were no oral presentations addressing CAM/TH. Of the hundreds of posters chosen for exhibition, only eight were CAM re-lated, although the conference does have a conference abstract track dedicated to CAM/TH. Of those accepted, only three were present at the conference:
Ethnomedicinal survey of medicinal plants used as remedy for HIV/AIDS-related infections by traditional medicinal practitioners of Bangladesh (MAH Mollik, Bangladesh)
Role of therapeutic massage in the management of HIV and AIDS patients, Mostlene's experience (J Mmayi, Kenya)
Traditional healers of Malawi: their role in HIV/AIDS prevention and treatment (S Yourmans, Malawi)
Perceptual differences between providers and people with HIV/AIDS on complementary and alternative medicine (C Jorstad, U.S.)
Of these, only the last poster was presented. I asked researcher, Connie Jorstad from HealthHIV in Washington, D.C., what prompted her to pursue the subject matter: "We know a lot of resources from the NIH go into CAM. We had not recently heard of many results and were curious about what type of information was going out to providers. We decided to tap into our provider net-work to get a sense of the perceptions," she replied.
The study was a national survey conducted in 2009. A total of 96 people living with HIV/AIDS (PLWHA) and 92 providers re-sponded. Results showed the majority (52 percent) of PLWHA used CAM, however 17 percent of PLWHA didn't know if they used CAM or not. Of those PLWHA using CAM, 72.3 percent used massage, 57.4 percent used acupuncture, 55.3 percent used meditation and 34 percent used chiropractic. Overall wellness was the main reason for use in 84.5 percent of patients with 39.7 percent seeking relief from stress and 29.3 percent using CAM to treat side effects of medication. Only 21.8 percent of patients using CAM were re-ferred by their physicians.
Of the providers surveyed, 80 percent indicated they lacked knowledge about CAM, and 5.8 percent stated CAM is not effective. Reasons physicians recommended CAM included stress (86 percent), pain (63.2 percent) and overall wellness (61.4 percent). Types of CAM recommended by physicians included massage (72.3 percent), acupuncture (57.4 percent), movement therapy/yoga (51.1 per-cent) and deep breathing exercise (57.4 percent). Based upon the conclusions of the study, as CAM providers, we can play a crucial role in providing more education to both consumers and providers.
As of 2008, 33.4 million people are estimated to be living with HIV/AIDS. Five thousand people die each day, while only 3,000 are placed on antiretroviral therapies. Seventy percent of infections are in sub-Saharan Africa, with the fastest growing region of new infections occurring in Eastern Europe and Central Asia. The HIV epidemic has stabilized globally, with annual numbers of deaths declining from 2.2 million in 2004 to 2 million in 2008, mostly due to impressive scale up of HIV treatment. However, HIV is still not under control, leading to around 2.7 million new infections each year.
Treatment equals prevention. Dr. Bernard Hirschel (Switzerland) of the Infectious Diseases Service Geneva University Hospitals said, "It is known that decreased viral load lowers the risk of HIV transmission and that effective treatment lowers viral load to unde-tectable levels. Therefore, if one could identify and treat all people living with HIV, the AIDS epidemic would wither and die away." Immune Reconstitution Inflammatory Syndrome is emerging as a risk at treatment inception for patients with low CD4 counts or a recent opportunistic infection.
The theme of this year's conference, Rights Here, Right Now echoes the demand of global activists that HIV/AIDS is a human rights issue. Until human rights are assured, no progress can be made. Criminalization of IV drug users, sex workers and men who have sex with men holds back efforts to contain HIV/AIDS. While injection drug use is recognized as a leading cause of HIV/AIDS transmission, "Twenty-five countries in the Asia-Pacific region still impose the death penalty for offences related to the possession and abuse of drugs, creating a huge stigma that means abusers often avoid treatment for fear of imprisonment," said Anand Grover, a lawyer and reporter for the U.N. Human Rights Council. The conference is promoting a global petition, The Vienna Declaration, to encour-age governments to treat addiction as an illness, not a crime.
Creating a world in which no one is born with HIV was said to be in reach but it requires broad and universal treatment along with a commitment to end stigmatization. For example, it is not uncommon for an expectant mother to refuse HIV testing even though immediate treatment could save her baby from infection. A positive HIV test comes with stigma that is still so severe a woman along with her children could be ostracized from her community, left by her husband and refused care by community members. In some Afri-can countries, a positive HIV test results in forced sterilization.
Conference protestors chanted and carried signs throughout the week to put pressure on governments to support the Global AIDS Fund. During the closing ceremony, President Barack Obama pledged to increase efforts to fight HIV and AIDS through his Global Health Initiative, despite dealing with economic hard times in the wake of a global recession.
"International governments say we face a crisis of resources, but that is simply not true. The challenge is not finding money, but changing priorities. When there is a Wall Street emergency or an energy crisis, billions upon billions of dollars are quickly mobi-lized. People's health deserves a similar financial response and much higher priority," said Dr. Julio Montaner, AIDS 2010 Co-Chair and president of the International AIDS Society.
The overall sentiment of the conference and its attendees was well-voiced when he quoted the Chinese proverb "Don't let those who say it cannot be done step on those who are doing it."
Click here for more information about Kristen E. Porter, PhD, MS, MAc, Lac.
Click here for more information about Elizabeth Sommers, PhD, MPH, LAc.
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