AIDS in Europe: New Challenges for the Social Sciences

AIDS in Europe: New Challenges for the Social Sciences

AIDS in Europe: New Challenges for the Social Sciences

AIDS in Europe: New Challenges for the Social Sciences

Synopsis

Major changes in the nature and dynamics of the AIDS epidemic over the last few years are reflected in changing epidemiological trends as well as in the progress made in biochemical research and treatment.

Excerpt

Jean-Paul Moatti, Yves Souteyrand, Annick Prieur, Theo Sandfort, Peter Aggleton

The epidemiological profile of HIV infection in Europe has changed dramatically in the course of the last few years. For the first time since the beginning of the epidemic, and in three consecutive years between 1996 and 1998, the incidence of new AIDS cases decreased in Western Europe. This positive trend is associated with progress in prevention, most especially with respect to sexual transmission and transmission through injecting drug use. But it is also related to recent advances in our understanding of the natural history of HIV disease and, above all, the diagnostic and therapeutic means available for treating infection. Quantitative viral load measurement has offered a new and powerful biological marker for prognosis and for monitoring the impact of treatment. Furthermore, with the advent of highly active antiretroviral therapy (HAART), the course of HIV infection has been greatly modified. This more aggressive therapy has shown clear success in bringing about substantial and sustained suppression of HIV viral replication and in reducing the incidence of opportunistic disease among HIV-infected individuals in short-term studies at least. It has also provided a rationale for the earlier initiation of antiretroviral treatment.

However, these therapeutic advances are not the ‘magic bullets’ that can solve all the questions raised by the AIDS epidemic. In spite of medical progress, HIV is still spreading rapidly among marginalised and socially deprived groups in the richer Western European countries. A dramatic growth in the epidemic can also be observed in the Eastern part of Europe where higher rates of HIV infection seem to be part of the price to be paid for the liberalisation that has accompanied the end of the communist era.

Such clinical changes are creating new space for dialogue between social scientists, biomedical scientists, public health authorities and community organisations in the field of AIDS. However, interdisciplinary debate is not restricted to controversial issues associated with geographical and social inequities of access to therapy. It also links to divergent interpretations about the intrinsic nature of this advance itself, as well as to its sometimes negative consequences. Major uncertainties remain about the long-term consequences of currently available antiretroviral regimens and their impact on prevention, care and other features of the epidemic. The fact that

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