In light of all the challenges of the last decades regarding HIV, let's take a look at the bigger picture here. When it comes to HIV transmission routes, the first thing that comes to the mind is sex and drugs. For example, in most countries (Islamic countries, in particular), both homosexual and heterosexual contacts are highly sensitive topics. Extra-marital sex, multi-partnership, male/female sex-work, injection drug use, and many other surrounding issues related to HIV are of serious concern not only for health-policy makers but also for experts from different disciplines such as sociology, medicine, law, economy, religion, and politics. On the other hand the legal status of sex work varies from country to country, from being considered a form of abuse (e.g. Norway, Iceland, and Sweden), to be a legal occupation (Netherlands, Germany), or classified as a crime deserving punishments (many Muslims countries).[2
] The latter could even make taking serious actions globally, even harder.
On top of sex-related concepts, a major complicated public health issue is yet to be tackled among drug users and particularly injecting drug users (IDUs). They are another core group with completely different characteristics. Similar to the previous sub-groups, IDUs are a hidden and marginalized population, scattered in every corner of every country. They may not have proper and easy access to most services. In many cases, even with an active approach, the systems cannot reach them and respond to their needs effectively. To be honest, it is the way beyond passing clean syringes. Do you really think that clean syringes are the most important thing they are in need of?! The answer is clear; most of them are homeless and need strong psycho-social supports as well as social security and at least a half-decent job.
By the way, we wish it was only sex workers and drug abusers. Consider other vulnerable populations such as street-children, prisoners, babies, and partners of high-risk groups. Providing a complete protection to these populations is so difficult, if not impossible. In fact, almost next to nothing can be done without a firm and effective collaboration of different role-players, including policy makers, universities, and research organizations accompanied by a strong commitment from governments all around the globe.
Let's think for a minute about HIV positives and their situation at present. Detecting positives, following them up efficiently, and making sure they are minimizing their risky behaviors and receiving proper medical care and treatment is such a tough task to be achieved. There are number of countries out there who are having a really hard time providing sufficient funding resources for these services.
On top of the above-mentioned struggles and making the pandemic even worse is the fact that HIV along with tuberculosis and other horrible infections make a deadly combination. Globally, the most common cause of death among AIDS patients which kills one of every three patients is tuberculosis.[3
] Although HIV-related tuberculosis is both curable and avoidable, incidence rates continue to rise in developing nations where HIV infection and tuberculosis are endemic and resources are limited. In some areas of sub-Saharan Africa, the rates of co-infection exceed 1000 per 100,000 populations.[4
Now that we have reviewed some of the barriers we are facing regarding disarming this deadly virus, let's talk about the excuse given to us to write this editorial article. The “World AIDS Day” on December 1st brings people from all over the globe together, to raise awareness about HIV/AIDS and demonstrate international solidarity in the face of the pandemic. The day is an opportunity for all the related sectors to talk about the pandemic's status and promote HIV/AIDS prevention, treatment and care around the globe. Between 2011 and 2015, World AIDS Days are held under the theme of “Getting to Zero: Zero New HIV Infections, Zero Discrimination, and Zero AIDS-Related Deaths.” In this context, a global vision was developed for all countries; working together toward zeros, but a big question is how we can approach these ambitious targets? They are fantastic and attractive phrases that motivate all stakeholders to contribute and work together more effectively, and the world deserves no less than such a future; however, they are not easily reachable, in reality.