Monday September 17, 2001

HIV Surveillance Poor in Many Countries: Report



NEW YORK (Reuters Health) - Surveillance systems set up to track the HIV/AIDS epidemic are ``poorly functioning'' or even ''non-existent'' in some 40% of the world's nations, according to an article in a recent issue of the journal AIDS.

However, there is also ``encouraging evidence that many of the countries worst affected by HIV have sound and functioning surveillance systems that can be gradually expanded,'' reports an international team led by Dr. Neff Walker of UNAIDS in Geneva, Switzerland.

The investigators examined the quality of HIV surveillance systems worldwide while compiling HIV/AIDS statistics at the end of 1999. They examined data collected from the US and Europe, as well as surveillance reports provided to the World Health Organization or UNAIDS for this period. In all, the team studied 167 surveillance systems.

Only 47 of the 167 systems were judged to be ``fully implemented.'' Another 51 had ``good'' systems, while 69 had surveillance systems categorized as ``poor'' or ``non-existent.''

Of the countries studied, 55 currently have HIV epidemics in the general population, 46 have ``concentrated'' epidemics in certain population groups and 53 have what are known as low-level epidemics.

Fortunately, the authors report, many of the countries most affected by AIDS appeared to have the best surveillance systems. The US, for its part, has a concentrated HIV epidemic and a fully implemented surveillance system.

Overall, estimates of the global burden of HIV/AIDS are based primarily on ``data of fairly high quality,'' Walker's team concludes.

Still, they identified three general weaknesses that were apparent in a number of the low-ranking surveillance systems. These included a lack of surveillance among gay and bisexual men, poor coverage of rural populations and inconsistency in surveillance data over time.

Most of the countries in the Middle East and Northern Africa that were studied had poor or non-functioning systems, as did several in Eastern Europe, Central Asia and Latin America.

Addressing system weaknesses and strengthening surveillance ''is an urgent priority,'' Walker and colleagues stress. ``More must be done to establish the basics of a functional surveillance system'' in countries currently lacking one, they urge.