This on-going project intends to visualize the impact of the HIV/Aids epidemic on humanity after 30 years since its inception. Globally, many are acting as though HIV and AIDS are no longer the threat they were when the HIV virus was first discovered.
Many young people and teenagers perceive HIV/Aids as a chronic disease, thus considering it something that they don’t have to worry about anymore. Because of reckless economic and monetary policies that have led to the actual crisis, most Governments are not honoring their commitments to provide an effective response to the epidemic, including failure to safeguarding human rights, demanding fair drug prices and lowering barriers to obtaining low-cost drugs and commodities in the current TRIPS agreement. Besides, what is even more worrisome is that efforts to discover newer, less toxic medicines are waning as pharmaceutical companies seek other more lucrative markets.
While teenagers are the most uninformed, women are still the most vulnerable. Growing evidence links gender-based violence and discrimination with the spread of HIV, underscoring the importance of reaching adolescents through comprehensive prevention programs.
01 Dr. Nelson Tembe shows some scanned results of the TaMoVac program at the immunology lab of Maputo's Central Hospital. The trial, after the laboratory tests in vitro and having proved to be safe and effective in animals, has now proceeded to the first phase of evaluation in humans. The TaMoVac I program is a HIV vaccine trial jointedly run by Mozambique and Tanzania in collaboration with Sweden, Germany and the UK.
02 A group of young kids, dressed up for a party, pass by a construction site in downtown Bangkok,Thailand. Changes in Thai society in the midst of socio-economic challenges and lowered budgets on prevention have led to an 85% of Thai youth who don’t see HIV as something that they should be concerned about.
03 An employee of LAFEPE, the reference laboratory of the State of Pernambuco in Brazil, is seen while working at the machine that mixes raw materials and excipients to produce ARV tablets. LAFEPE was the first official laboratory in Brazil to produce, back in 1994, antiretrovirals.
04 The Manga Chingusura's pharmacy, a Centro de Saude in the outskirts of Beira in Mozambique, is packed with patients receiving their ARV therapy. Thanks to theDREAM project, a program implemented by the Sant'Egidio Community, the majority of mothers and children are now being offered a holistic package of very crucial PMTCT services free of charge.
05 Tay, 38, shows the pills of ARV she has to take everyday, morning and evening time, for her therapy. She contracted Hiv from her ex husband four years ago. Now she lives with her new boyfriend at Wat Prabat Nanpu Temple, near LopBuri in Thailand, a hospice for people living with HIV and for those who are dying of Aids and have no one who can take care of them.
06 Yulia, 33, is a drug user and a volunteer of "TheWay Home" Charity in Odessa, Ukraine. Yulia started using drugs when she was 16 and she still injects opium three times a day. She is HIV+ and on ARV therapy. She’s pregnant for the second time and makes her living out of her grandmother's annuity and has a partner who pays for her drugs.
07 Pedro (fantasy name), 50,has been HIV positive since 1990. He used to be a helicopter pilot in the Brazilian Army but had to quit to keep his status undisclosed to avoid stigma and discrimination, in particular among soldiers. Thanks to the National Aids Program run by the government, Pedro has been able to recover from his AIDS related diseases, such as Kaposi’s sarcoma and facial atrophy.
08 MedPack's is the biggest factory producing condoms in Ukraine. The factory, established in 2010, has a production capacity of 300 millions condoms a year. Ukraine has one of the fastest growing HIV/Aids epidemic in the world. After its appearance, when the Soviet Union collapsed, the epidemic grew rapidly, especially among injecting drugs users. Today the situation has changed and 50% of new infections occur through sexual transmission.
09 Kyuw Cho of Raksthai Foundation shows to a group of Burmese immigrant women how to use a condom during a meeting of the Maharchai Migrant Outreach Program in the Sai Pla community, south of Bangkok, Thailand. Burmese immigrants are often arriving in Thailand from difficult living conditions and many of them had no access to information at all.
10 A thai prostitute and her foreign client are seen in a street of Pat Pong redlights district in Bangkok, Thailand. The country is considered the destination par excellence for sex tourism around the world but there is also a large number of injecting drugs users that are still becoming HIV+ through needle sharing.
11 Pregnant women are seen while waiting to be taken care of at the maternity ward of the Centro de Saude Matola II near Maputo, Mozambique. An estimated 57% of the adults living with HIV and AIDS are women who, generally, are infected at much earlier ages than men. This gendered pattern of HIV infection is related to the low educational level and exceedingly high illiteracy rates among women, as well as to women’s subordinate economic, social and political position.
12 Voznesensky Monastry Orphanage is an orphanage founded by the Russian Orthodox Church in Banchensky Svyato in Ukraine. More than 60 of the kids at the orphanage are HIV+ and live in a special building with permanent care-givers and exceptional living conditions. The orphanage's been accepting HIV+ kids since 2002. Matushka Elisabeth is the responsible of the HIV+ kids' section and according to her "praying is much more effective than medicines to cure HIV".
13 A nurse of Matola II Hospital is seen while talking to a father about his HIV+ child. In Mozambique children in general lag behind adults in terms of access to services and in 2010 only 19% of children younger than 15 living with HIV were receiving ARV therapy.
14 Ivan, 25, started using drugs when serving the army because his "mind was hard and all the company was doing it. Now we are very different from what we were before". Here he's seen while exchanging used needles with new ones at the harm-reduction center run by "The way Home" Charity in Odessa.
15 PSI's house to house voluntary testing program aims to reach people in peripheral suburbs of Mozambique's biggest cities, where it might be difficult for people to find facilities that provide such service to the population.
16 Sergey, 24, an HIV+ drug user, is seen while getting out from the trees that circle the spot where he lives with his friends in Odessa. He has been several times in jail after he left Moldova to come to Ukraine. He's been using some sort of home made drug which has affected is nervous system and made him unable to walk without his sticks. Kids like him are easily recognizable because of the way they walk which is called "the ballet".
17 The pharmacy at Edoardo de Menezes, the reference hospital for HIV/AIDS in Minas Gerais State. With the onset of the AIDS epidemic in the 80s, the HEM opened beds for patients with the disease and soon after became a reference for the treatment of AIDS and other infectious diseases. The hospital's outpatient clinic plays an important role as part of the Integration Program of Appropriate Patients with STD/HIV-AIDS of the Ministry of Health.
18 The terminally ill ward at Wat Prabat Nampu Temple, near Lop Buri in Thailand. The Temple is a hospice for people living with HIV and for those who are dying of Aids.
19 A terminally ill patient is being take care of by a nurse at Emilio Ribas Institute of Infectious Diseases in Sao Paulo, Brazil. Most Intensive Care Unit patients are carriers of HIV and AIDS. Founded in 1880, the hospital currently serves more than 30,000 patients yearly.
20 Olga, 33, is a HIV positive woman who’s been hospitalized at the Intensive Care Unit of the Kiev AIDS Center because of a serious complication concerning her lymphatic system, possibly a bad form of tuberculosis, doctors say.
I started this project at the beginning of 2011, looking forward to the 30th anniversary of the first reported cases of AIDS in the United States. After completing the first reportage on sexual health in Thailand, destination par excellence for sex tourism around the world, I decided that I needed funds - which I was eventually granted by the Department of Reproductive Health and Research of the World Health Organization - to shoot new stories in different countries facing different challenges, in order to show properly the complexity of the epidemic.
Following the outline provided by the four words that have always served as guidelines in the fight against AIDS - prevention, treatment, care and support - I've then worked investigating critical aspects of the AIDS epidemic in Mozambique, Brazil and Ukraine, approaching each country from a different perspective and focusing on specific aspects including sexual, reproductive, neonatal and children's health as well as national prevention and treatment policies or collaborations with the private sector for local production of drugs and condoms.
The project - which I'm planning to enrich with a new chapter to be shot in the US, the country where "it all started" - focuses its attention on the effects of the epidemic on women's and children's health thirty years after its inception. It also highlights the efforts made by the Governments and civil societies of these countries - including individuals, associations, NGOs and foundations - to give a strong response to the epidemic and it intends to visualize the impact of the epidemic on humanity in a positive way.
Despite the massive commitments of the United States of America through PEPFAR, of small and large donors, the domestic investments by countries and the catalytic impact of the Global Fund, today the needs still far exceed available resources and the surge has stalled. United Nations Member States have collectively pledged to provide the needed amount by 2015 but international support has not increased since 2008. In 2010 it declined for the first time in a decade while last year the Global Fund was forced to cancel its next round of grants when donors fell short of their funding commitments. Until now, the global response has hinged on the largesse of a relatively small handful of wealthy donor countries but their commitment is unpredictable and undependable in the current economic climate, yet millions of lives depend on them.
Throughout the years, tremendous progress have been done in stabilizing or reducing rates of new infections, but this success has only highlighted the rampant stigma and discrimination that still contributes to rising infection rates among higher-risk key populations and to the vulnerability of women and girls. Punitive laws, gender inequality and violence continue to inflame the epidemic and the goals of zero new infections, zero discrimination and zero AIDS related deaths, as set by UNAIDS, might receive a very unnecessary setback because of the worsening global economic conditions. After 30 years into a very complex epidemic, the gains are real but still too fragile.
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