俄羅斯愛滋病毒之流行正在迅速蔓延
資料來源：剌胳針醫學期刊；www.thelancet.com Vol 393 February 16, 2019
當西歐的一些國家正慶祝愛滋病之治療和控制方面相對的成功時，在該地區東部一個迅速發展的流行卻對進步構成了持續之威脅。
2月4日一份來自歐洲疾病預防和控制中心所發布的的報告，強調了在歐洲和中亞地區對愛滋病毒感染者之治療和照護上的不平等待遇。
報告指出在整個的這些地區中，每五個愛滋病毒感染者當中就有一個，並不知道他們自己感染的狀態，亦只有43％的愛滋病毒感染者其病毒載量低到足以去預防傳播 – 大大地遠低於聯合國愛滋病規劃署73％的目標。未能達到目標主要歸因於世衛組織歐洲區署下之中部和東部次區域中，來自各國所通報低的病毒抑制率。具體來說，在俄羅斯，通報之愛滋病毒感染者的數量為998,525，卻只有26％達到病毒抑制，在烏克蘭，這個數字是244,000，只有23％達到病毒抑制。然而俄羅斯的情況值得仔細研究，因為該報告中的調查結果是基於由國家衛生部，於2017年，首次向聯合國愛滋病規劃署所提供涵蓋截至2016年度的數據，並由所提供的數據估計而得。
我們直接自該部取得涵蓋截止至2017年度底的最新資訊，則報告了新登記的愛滋病毒感染者人數增加了105,844。顯然，這並非是發生率一個精確的測量方法，但它所給出了的數字指示了持續的上升毫不衰減。俄羅斯在進展上缺席的原因很多，包括清潔的注射設施之取得不足，無法獲得阿片類藥物之替代療法，以及缺乏在最需要的人群中去進行治療，亦即那些靜脈注射藥癮者及其伴侶、性工作者以及男男間性行為者。
俄羅斯愛滋病毒數據的釋出值得讚許。但如果要在疫情方面取得重大進展，那麼現在必須轉向於關注那些感染者當中關鍵、邊緣化人群之治療。
Russia’s burgeoning HIV epidemic
While some countries in western Europe celebrate relative successes in the treatment and control of HIV,
a burgeoning epidemic in the eastern part of the region poses a continued threat to progress.
A report, published Feb 4, from the European Centre for Disease Prevention and Control underlines the
inequality of treatment and care for people living with HIV in Europe and central Asia. The report states
that in these regions overall, one of five people living with HIV (PLHIV) is unaware of their status and only
43% of PLHIV have viral loads low enough to prevent transmission—substantially than the UNAIDS goal of
73%. The failure to reach the target is largely due to low rates of viral suppression reported from countries in the central and eastern subregions of the WHO European Region. Specifically, in Russia, the number of PLHIV is reported as 998 525, with only 26% achieving viral suppression and in Ukraine, the number is 244 000, with 23% achieving viral suppression. However, the situation in Russia is worthy of closer examination
because the findings in the report are based on estimates from data provided for the first time by the
country’s Ministry of Health to UNAIDS, in 2017, and covering the year ending 2016.
The latest information, obtained directly by us from the Ministry, covers the year ending 2017, and reports the number of newly registered PLHIV has increased by 105 844. Clearly, this is not an exact measure of incidence, but it gives an indication that numbers continue to rise unabated. Reasons for the absence of progress in Russia are numerous and include insufficient access to sterile injecting equipment, unavailability of opioid substitution therapy, and a shortage of treatment in populations where it is most needed, namely people who inject drugs and their partners, sex workers, and men who have sex with men.
The release of HIV data by Russia is to be applauded. But if serious inroads are to be made into the epidemic, then attention must now turn to treatment of key, marginalised populations of PLHIV. The Lancet