インディアナ州でHIVの感染が拡大 その背景にある理由とは

インディアナ州のスコット郡を中心にHIV患者が急激に増えている。スコット郡ではかつてNPO「家族計画連盟」が運営するクリニックでHIV検査を受けることができたが、2013年にクリニックが閉鎖されて以来、HIV検査ができる施設がない。
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インディアナ州では、スコット郡を中心にHIV(エイズウイルス)感染者が急激に増えている。スコット郡ではかつて、性教育や生殖の健康促進に携わるNPO「家族計画連盟」が運営するクリニックがHIV検査を行っていたが、2013年にこのクリニックが閉鎖されて以来、HIV検査を受けられる施設がない。

このクリニック以外にも、2011年以降インディアナ州では4つの家族計画連盟の施設が閉鎖に追い込まれている。いずれもHIV検査を行っていた施設だ。閉鎖の主な理由は、州からの資金援助が削減されたために運営が立ち行かなくなったこと。当時、アメリカ国内やインディアナ州内では、中絶手術を行っているという理由で、家族計画連盟に対する抗議運動が繰り広げられていた。

ただ、閉鎖に追い込まれた5つの診療所はいずれもHIV検査は行っていたが、中絶手術は行っていなかった。現在インディアナ州は、かつてない規模でのHIVの流行に対処するために、診療所を慌てて立ち上げている。

「数週間前までスコット郡に検査施設がなかったということは、予防や検査への資金援助を打ち切ることが、深刻な公共衛生問題を引き起こすということをはっきりと示しています」と、家族計画連盟インディアナ州支部とケンタッキー州支部の副代表を務めるパティ・ストファー氏は述べている。

2011年に共和党主導のインディアナ州議会は、一部施設で中絶サービスが行われていることを理由に家族計画連盟への資金援助を止める法案を可決。この法案は後に連邦裁判所判事によって却下されたが、その後も州は家族計画連盟への財政支援を大幅に削減し続けた。

2005年は計3000万ドルあった家族計画連盟インディアナ支部への補助金は、2014年には1900万ドルにまで下がった。こうした資金援助の削減の結果、スコッツバーグ、マディソン、リッチモンド、ベッドフォード、ワルシャワの5都市にある診療所は、必要な医療技術を維持し続けるための費用をまかないきれなくなってしまったのだ。

5つの診療所が閉鎖になった一方で、家族計画連盟が行うHIV検査の件数は毎年増え続けている。インディアナ州とケンタッキー州に残る25の診療所で2014年に行われたHIV検査の数は8000件。前年に比べて1000件以上も増加している。もし、5つの診療所が閉鎖されていなかったら、もっと多くの検査が行われていただろう。

ストファー氏は、州南西部のスコッツバーグとマディソンの施設が運営を続けることができていれば、HIVの大流行を予防する重要な役割を果たしていただろう、と話す。

「現在、HIVの流行に対して、州の公衆衛生局は素晴らしい対応ができていると思います。しかし、今後インディアナ州の人々をHIVやその他の病気から守っていくために、州議会には公的健康への取り組みに適切な資金援助をして欲しいと思っています」

今回のHIVの感染拡大は静脈麻薬の使用が原因と見られており、感染拡大を受けてインディアナ州マイク・ペンス知事(共和党)は、非常事態宣言を発表した。そして感染拡大を抑えるためにこれまでは認めてこなかった「注射針交換プログラム」を一時的に実施することも決定している。

「注射針交換プログラム」とは、静脈注射で使った注射針を使い回してHIVなどの病気が感染しないよう、使用済みの針を交換してくれるプログラムだ。しかし、このプログラムは「麻薬を公認することになる」という反対の声もあり、ペンス知事は反ドラッグの立場からこの政策をこれまで認めてこなかった。

この記事はハフポストUS版に掲載されたものを翻訳しました。

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HIV/エイズに関する10の発見
1. Most Don't Have Their Infection Under Control (01 of10)
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Only one quarter of the 1.1 million people with HIV have their condition under control, where \"under control\" means the virus has been suppressed, according to a report released this summer by the Centers for Disease Control and Prevention. \n\nCORRECTION: The first sentence has been reworded to more accurately reflect the number of people with HIV. (credit:Alamy)
2. Experiments With Bone Marrow Transplants Have Been Unsuccessful To Date(02 of10)
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Even though two men were, for a time, able to go off antiretrovirals because their HIV had been reduced to undetectable levels after receiving bone marrow transplants, the HIV eventually returned in the men, according to news reports.\n\nIn 2012, the news of the men’s undetectable HIV levels made headlines. The men, who were both HIV positive and taking antiretroviral drugs, had received bone marrow transplants for Hodgkin’s lymphoma. They had received the transplants while they were also taking the antiretroviral medication. \n\nHowever, in late 2013, preliminary results showed that the HIV had returned. \n\nThis slide has been updated to note more recent developments related to the procedure. (credit:Alamy)
3. No-Cost HIV Treatment Could Cut New Infection Rates(03 of10)
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New HIV infection rates can be dramatically lowered by making antiretroviral drugs free, a study from Canadian researchers found. \n\nThe Canadian Press reported on the study, conducted by B.C. Centre for Excellence in HIV-AIDS researchers, which showed that British Columbia -- a province that offers free access to antiretroviral therapy -- had the lowest rate of new HIV infections over a more-than-10-year period, compared with Ontairio and Quebec. \n (credit:Alamy)
4. Many Young People Don't Know Their HIV Status (04 of10)
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More than half of HIV-infected young people are unaware that they have the virus, according to a Centers for Disease Control and Prevention report.\n\n\"Given everything we know about HIV and how to prevent it in 30 years of fighting the disease, it\'s just unacceptable that young people are becoming infected at such high rates,\" Reuters reported CDC Director Dr. Thomas Frieden saying. \n\nThe report also showed that for young people, 72 percent of the new HIV infections were in men who have sex with men, while almost 50 percent were in young, African-American males, Reuters reported. These figures are based on 2010 data. (credit:Alamy)
5. More People Are Living With HIV Than 10 Years Ago(05 of10)
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The number of people living with HIV has increased by 18 percent from 2001 to 2011, according to a report released this year from the United Nations Programme on AIDS. An estimated 34.2 million people around the world are living with HIV. \n\nThe report also showed that deaths from AIDS have dropped, from 2.3 million in 2005-2006 to 1.7 million in 2011, Reuters reported. \n (credit:Alamy)
6. The Cost Of HIV Drugs Is Decreasing(06 of10)
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According to the same United Nations report, costs for the cheapest UN-recommended antiretroviral therapy drugs have also decreased over the past 10 years, Reuters reported. A year\'s worth of the drugs used to cost $10,000 in 2000 for one person; now, it costs $100 a year. (credit:Alamy)
7. HIV Treatment Truvada Can Also Be Used As A Preventive Measure(07 of10)
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The Food and Drug Administration this year officially approved the drug Truvada -- which has been used since 2004 as a treatment for HIV -- to be sold as a preventive measure for people who don\'t have the infection, but are at high risk for it.\n\nThe FDA said that the pill should be considered for preventive use not only by gay or bisexual men who are at high risk for HIV, but also heterosexual men and women who may also face HIV risks, the Associated Press reported. \n\nHeterosexual men and women make up more than one-fourth of new cases of HIV, and \"that\'s not a portion of the epidemic we want to ignore,\" the CDC\'s Dr. Dawn Smith, who was the lead author of the new recommendations, told the Associated Press. \n\nThe FDA also approved a new drug this year, Stribild, to treat HIV, Reuters reported. (credit:Getty Images)
8. Engineered Stem Cells Could Play A Part In Fighting HIV(08 of10)
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In findings published this year in the journal PLoS Pathogens, scientists from the University of California, Los Angeles found that it\'s possible to genetically engineer stem cells to attack living HIV-infected cells in mice. \n\nWhile the study was only for \"proof-of-principle,\" it \"lays the groundwork for the potential use of this type of an approach in combating HIV infection in infected individuals, in hopes of eradicating the virus from the body,\" study researcher Dr. Scott G. Kitchen, an assistant professor of medicine at UCLA, said in a statement. (credit:Alamy)
9. Pretty Much Everyone Should Be Screened For HIV(09 of10)
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People should be screened for HIV even if they\'re not at high risk of contracting the infection, according to draft recommendations released just last month by the U.S. Preventive Services Task Force. The recommendations would mean that everyone between the ages of 15 and 65 should be screened for HIV, even if they\'re not at high risk for it, Reuters reported. \n\n\"The prior recommendations were for screening high-risk adults and adolescents,\" Dr. Douglas Owens, a member of the USPSTF task force and a Stanford University medical professor, told Reuters. \"The current recommendation is for screening everyone, regardless of their risk.\" (credit:Alamy)
10. People Should Be Treated With Antiretrovirals As Soon As They're Diagnosed WIth HIV (10 of10)
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All HIV patients should be treated immediately with antiretrovirals, according to new guidelines issued this year from a panel of the International Antiviral Society-USA, as reported by TIME. The recommendations are counter to previous guidelines, which said that antiretrovirals should only be used if the CD4 count -- a measure of immune cells in a person\'s body -- becomes less than 350 cells for every mm3 of blood. (credit:Alamy)

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