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In 2016, 36.7 million people lived with the Human Immunodeficiency Virus (HIV) and, the same year, one million people died from HIV-related causes globally. It makes of the AIDS one of the main concerns for the public health.

Sex, drugs and spread
Elizabeth Pisani is the director of Ternyata Ltd, a public heath consultancy company and as an epidemiologist she has spent over a decade working on the defining pandemic of our age : the HIV. In her book, the wisdom of whores, she explains the main factors of the AIDS spread. They are on the one hand sharing needles by injecting drug users and on the other hand unprotect sex with a positive person. She also criticizes actions taken by gouvernements all around the world and offers some concrete solutions on what to do about this problem.

The case of injecting drug users (IDU)
In three cities in Indonesia (Bandung, Surabaya and Jakarta), the national Ministry of Health and University conducted a study on 600 injecting drug users under the shape of individual conversation. It was asked them four questions. The first one was : ‘Did you know that shared needles spread HIV?’, the second one was : ‘Do you know where you can get new needles and for wich price?’, the third one was : ‘Do you have your own needle?’ and the last one was : ‘Do you declare that you never share your needle?’.

The results were surprising, actually there was no problem with the information and the prevention made by the gouvernement as we can see it in the 99 % of positive answers at the two first questions. The issue comes from the application of public health advices, indeed only 17 % of the injecting drug users carries his own needle, the others borrow one from someone else. Moreover, only 7 % of interviewed people report that they never share their needle. But why people who know the danger don’t avoid it ? It’s probably because they can go to jail just for carraying a needle and peoples prefer to take the risk to being sick. The result is that 55 % of indonesian heroin addicts are infected by the virus. This study is one example among other of absurd politics, we can find plenty other studies including severals on western countries population. Indonesia is not an isolate case.

The main cause of contamination in the USA (and other western contries)
Even if sharing nedlees generate an important number of new HIV diagnoses, the first cause in our western countries is still the sexual transmission.

How we can see on the graphic, 89 % of the new HIV diagnoses are from men who have sex with men (MWM) and heterosexual contact (HSC). However, a person is contagious only if he’s on a viral load peak.

So infection is rare, the exemple shows that there’re only four periods of a HIV-positive person life when he’s contageous. The risk is for those who have many partners in a short period of time such as protitutes and their regular partners, gay men on party scene (in L.A. 25 % of gay men are HIV-positive) and heterosexual people from a contry that have tradition of polygamy (in east Africa, one-third of adults are HIV-positive).

Final statement
On the whole, the two main causes of the HIV infection are the share of needles and have unprotect sex with a contagious person. The third cause definied by OMS is the mother-to-child transmission through placenta. We didn’t talk about this one because this one is really rare : under treatment, in 99 % of cases, there are no transmission and globally 7 on 10 pregnant women are treated.
Nowaday we’re in a blurred period, firstly we can observe an increase of the incidence in the world but WHO plannified the end of the AIDS for 2030. To accomplish this challenge, public health have to reinvent itself and gives messages nearler of populations. To be efficient, people way of life and legislation in general have to be taken in account. The fight against epidemics is led by governements but it requires the engagement of everyone to live in a better world.

Ghali Samuel