THE MARITAL VACCINE

Nearly a year has passed since Azerbaijan introduced mandatory medical screenings for various infections, including HIV, before marrying. Before the screenings began there were many questions of a legal character. There were even fears: would the rights of HIV-positive people be violated? Would the examinations be objective? R+ spoke with Esmira Almammadova, director of the Republic-wide Centre for the Battle Against HIV-AIDS, about the efficacy of medical screenings for couples about to marry in combatting one of our day's most dangerous infections.

- What results can you share with us based on a year of HIV tests carried out for those about to marry?

- The examinations carried out from June 1, 2015, to April 1, 2016, discovered 75 cases of Human Immunodeficiency Virus (HIV) among those about to marry. Two of the cases were among Russian citizens. Only in two cases did the couple not go through with the marriage, while the other couples did not change their minds about starting a family. Of the cases discovered, 14 were registered at our centre. They lived for a long time with their partners in common-law marriages. Some of the couples even had several children. They decided to officially register their marriages when they needed documents so that their children could begin school. In theory they knew that they were HIV-positive. One needs to remember that a total of 60,000 couples were examined. Overall approximately 770,000 HIV tests were carried out in Azerbaijan over the past year. HIV spreads because the virus has no particular clinical symptoms. According to data from the World Health Organisation, in the European region of that organization from one-half to two-thirds of HIV-positive people do not know they have been infected. Because of this, the amendments to legislation regarding HIV tests were timely and justified. Testing allows HIV-positive people who have no clinical symptoms to undergo express testing and find out if they have the virus. Measures to examine couples about to marry are intended to allow HIV-positive people to get timely treatment that will also have a preventative element, stopping them from infecting their sexual partner. Amendments to legislation do not allow us to inform the partner of the HIV-positive person about test results. It's difficult for us to say how many of the HIV-positive people told their partners that they had been infected with the virus. All of those infected were given cost-free - but far from cheap -antiretroviral treatment. Entering into their marriage, they were warned that they can only engage in sexual activity if they use protection. Those who were HIV-positive were also informed that after a certain length of treatment they would need to undergo another medical examination. When the level of the virus in the blood is minimal, they will be able to safely conceive a child. The benefit of testing lies in that the diagnosis of 75 HIV-positive people means preventing the potential infection of another 75 people. The Ministry of Health is constantly working on prevention, including efforts to raise awareness: each person is told about the necessity of free and anonymous HIV-testing and given the chance to undergo it. Along with testing the person is told how they can prevent infection of their partner and how to safely give birth to a child. 

The decision taken by the government to examine those about to marry is an excellent addition to the measures taken to prevent sexual transmission of the virus. Today sexual activity is one of the major means of transmission: throughout East Asia and Central Asia it is the most common. The centre's dedicated work to diagnose cases of HIV has on average discovered one positive result for every thousand tests. 

- If there are no problems with testing for soon-to-be-married couples, how are things with other demographic categories?

- To promote HIV prevention among the population, including teenagers and young adults, our centre conducts testing and consultation drives, during which a large number of people undergo free testing and find out their HIV status. People used to be afraid to get tested; there were unpleasant feelings about it. People associated the virus with drug addicts and sex workers. 

That's why people who had at-risk sex were afraid to get tested at an HIV-prevention centre - they were afraid of being judged by their friends. Now things have completely changed - in addition to our centre, the Ministry of Health has opened HIV-testing and consultation centres in various facilities in every region of the country. As part of various international initiatives we carry out mass testing in universities and secondary schools, at places of business, in shopping malls, bus stations, etc. Often the invitation to undergo testing comes from the management of businesses and other establishments. When we hold these drives, we also try to destroy stereotypes and misconceptions about HIV. The thing of it is, HIV is no longer a lethal illness. That is an outdated conception. Now HIV is a serious chronic disease. Early diagnosis gives very good results in providing a normal life to people living with HIV. The most important thing is dedication to treatment, which is, for the time being, a life-long course. It needs to be said that the government provides regular treatment and follow-up examination with cutting-edge medications. The government is doing everything possible for quality treatment, support, and care for people living with HIV. The patient is required only to come to a centre and receive free treatment. We have the most progressive legislation on the prevention of stigma and discrimination and the protection of the rights of people living with HIV. Even now we encounter cases of discrimination against people living with HIV, but those are isolated cases. When compared to the attitudes society had to HIV-positive people ten years ago, the situation today is much better. 

- Recently WHO stated that Thailand, Belarus, Moldova, and Armenia had completely eliminated the transmission of HIV from mother to child…

- Yes, there really was a recent WHO/UNAIDS press release that stated these countries had eliminated the vertical means of HIV transmission - in other words, the infection of a child by his mother. Here we need to recognize that not every pregnant woman infects her child with HIV. It happens in 25 to 40 per cent of cases. If the pregnant woman is diagnosed with HIV in time, she begins treatment, and the new-born is given preventive care, then the risk of infection goes down to one or two per cent. Not breastfeeding is very important. In such cases the state provides the child with free formula. That's why it's so important that pregnant women go to gynaecological consultations where they will be given HIV examinations. But even if for some reason the pregnant woman had not previously been registered at the hospital, when she comes into deliver the child she will be offered express-testing. Even in this case undergoing treatment significantly increases the chances of giving birth to a healthy child. I want to point out that in Azerbaijan there has not been a single recorded case of HIV-transmission from mother to child in a woman who has received antiretroviral treatment. It's very distressing that, even with these opportunities, sometimes we see cases where pregnant women do not undergo testing, and only once the child turns three or four is it discovered that he has been infected. In December 2015 the countries of Eastern Europe and Central Asia stated their willingness to join WHO's initiative to eliminate the transmission of HIV and congenital syphilis from mother to child. To accomplish this goal the countries must, first of all, undergo certain WHO procedures. Azerbaijan, like the other countries in the European region, has stated its willingness to eliminate transmission of the disease from mother to child. Even with Azerbaijan's high fertility rate - approximately 200,000 births a year - cases of vertical transmission are extremely rare, even lower than the WHO criteria. Reaching the goal of total elimination is not a problem. You could say that we are on the threshold of eliminating that method of transmission entirely.

- Since 2012 Azerbaijan has hosted major international events that have drawn an enormous number of foreign guests. These events include Eurovision, football tournaments, the European Games, and the Formula One European Gran Prix. Since the Seoul Olympics in 1988 international organisations such as the International Olympic Committee, FIFA, and others have taken measures to prevent the spread of HIV during competitions…

- The large influx of tourists during these events has not had any noticeable effect on the epidemiological situation with HIV. Holding events like these has not had any effect on the overall number of infections.

- In 2014 Russian scientists announced that they were conducting intensive work on an HIV-AIDS virus. What do you think - when will this most effective instrument against the infection be ready?

- Talk of HIV vaccinations periodically makes its way into the media. Unfortunately, there is not yet any such thing. The issue is that the creation of a vaccination is difficult because of the structure of the HIV virus. However, this year at the Fifth International Conference on HIV-AIDS Issues in Eastern Europe and Central Asia, Russian Academy of Sciences member V. Pokrovsky said that Russian scientists are already on their way to creating a radically new antiretroviral treatment - an injection that would be given to a patient only once a month. I'll give an example. Let's say that for the flu the doctor has prescribed a patient pills that need to be taken for seven days. What actually happens? In three days, when the patient's condition improves, he believes that he has already recovered completely, so he stops taking the pills or takes them less often. That's the typical, statistically average patient. And now imagine a person living with HIV has to take medicine for the rest of his life. Naturally, with time his dedication to taking his medicine decreases. That's why we constantly work on convincing the HIV-positive patient to continue his treatment. 

The appearance of a medication that can be administered to the patient once a month will aid successful HIV treatment.

- UNAIDS (the Joint UN Programme on HIV and AIDS) has an inspiring goal - to beat AIDS worldwide by 2030. Can we hope that by 2030 the world, and Azerbaijan in particular, will have stopped the HIV epidemic?

- It is a very difficult and arduous path. The current goal is to diagnose 90 per cent of HIV-positive people, out of that 90 per cent give 90 per cent treatment, and get a 90 per cent success rate for those treated. It will only be possible to beat HIV by 2030 if we reach that goal by 2020. This means we have to carry out those tasks in the next five years. Azerbaijan has a national programme to combat HIV that allows us to reach these goals. It is essential that we solve the problems HIV diagnosis. In this area the media plays a very important role. The mass media should create an awareness in society of the importance of caring for one's health, a civic-minded approach to protecting one's own health and the health of those around one. In the battle with HIV it is crucial that the media sets itself the mission of informing the people. We need to promote the simple - and at the same thing extremely important - decision of every person to undergo HIV testing.

Lately more publications and online media have been discussing the topic of HIV, but it's not enough. According to the research of European experts, there is a direct correlation: the less the media talks about HIV, the more infections there are. That means that the more the media educates people, the less likely they are to get infected. That's because informed people are more careful and more responsible.