Several places are still far far away
from ending their epidemics
and in fact are seeing their epidemics increase
and that's what I'm focusing on.
Asking the question why and who's there
on the ground trying to fix things.
My name is John Cohen.
I'm a staff writer with Science magazine.
the Pulitzer Center funded travel for this project
which also involved a collaboration
with the PBS Newshour.
I’ve been covering the epidemic around the world now
for nearly 30 years.
When I began doing this I’d go on trips
to other countries and see warehouses
full of people dying.
I don't see that now but I do see places that
are struggling to use the very powerful tools that exist
both to help keep people alive and to stop them
from spreading the virus to other people.
About one out of four mother to child
transmissions in the world happen in Nigeria.
And Nigeria has had billions of dollars
of foreign aid poured into the country
to help solve the problem.
So what's wrong?
The big problem is so many pregnant women
never intersect with healthcare.
They either give birth at home or they have a traditional
birth attendant but she's not necessarily
a trained health care professional
who's gonna do HIV testing.
So one of the creative things that Nigeria has
going right now is a project working with
traditional birth attendants.
I met with a traditional birth attendant
Mama Metta and they have trained Mama Metta
to encourage women to come to her clinic
on a day when an HIV testing group shows up
and she also knows that if a woman does test positive
that she should transfer her to a hospital or a
regular clinic for care.
So that's one of the progressive things that's happening
in Nigeria to try to really isolate a problem.
About 90% of Nigerians go to services on the weekends
whether they're Christian or Muslim and the country's
about 50/50 so a project has begun
called baby shower where they go to the churches
and they have the priests say all pregnant women
And their partners come to the front for
a special blessing.
And then the priest says
after the service we're gonna have health testing here
we're gonna check you for sickle-cell anemia
and we're gonna check you for hepatitis B
and we're gonna check you for HIV.
HIV is just wrapped up into this because
there's so much stigma and discrimination
people might not come for
an HIV test but for a health test
with all these things they'll show up.
And they get a gift for their baby
and for their birthing and then
if a woman tests positive there—they link the woman
to care and they make sure that she gets on
antiretroviral drugs, her baby receives
the treatment to stop transmission.
It's a full package to try to address the problem.
With baby shower it’s producing some amazing results.
It's spray is like perfume.
You can spray it here and somebody else somewhere
hmm so what is that and comes looking
for what it is.
Once they get into the village you see all that running
and coming oh the baby shower, I saw you today,
this, that, dah, dah.
The perfume is spreading,
the fragrance is going everywhere.
Russia accounts for 80% of all the new infections
over the past five years in Eastern Europe
and Central Asia.
And it has about 10% new infections a year.
Something's really wrong.
Well what?
What's broken?
Well, Russia only has antiretroviral drugs reaching
about one third of the infected people.
That's a big problem.
They do not promote needle exchange programs.
They barely allow them.
So the Russian epidemic has just been growing
at a time when it's dropping everywhere else in Europe.
In that harsh political environment,
HIV infected people and advocates
have created a pharmacy—sort of an
underground pharmacy to supply
infected people with drugs when the government
runs out of drugs.
So they collect these antiretroviral drugs
and redistribute them to people in need.
This is for free.
Just help each other.
When I did a just a completely unbiased look at the data,
what's happening in the United States—
Miami has more new infections than any city in the country.
That shocked me and then when I looked at
the top 10 cities in the country—four of them
were in Florida for the new infection rate.
Florida has basically every driver of the epidemic
that we know of in the United States.
High rate of infection in men who have sex with men,
it has people who inject drugs,
public transportation isn't really what it should be,
and then our rural areas are even more challenged.
Homelessness, mental health, ethnic disparities
all get in the way of us dealing with the epidemic here.
it's a challenge under the best of circumstances
to get appropriate messaging to get people into care.
The Haitian community for example, a lot of
people don't speak English—they speak Creole.
So, to reach the Haitian community
a radio program has a health section
that just goes after that Creole population.
A way to specifically get them HIV tested.
Here's a clinic in Little Haiti.
It has people speaking Creole.
They'll pick you up at your home
and take you back and forth.
We know if you are treated with antiretroviral drugs
and you drive your virus in your body down to levels
that are undetectable your odds of transmitting
that virus to someone else are exceedingly low.
Myself, I take my meds all the time
so I have become undetectable.
That's at the heart of all these efforts
is get everyone tested get everyone
who's positive on treatment and getting everyone
who's at high risk to lower their risk.
To do something like needle
and syringe exchange programs
or pre-exposure prophylaxis which is a pill
usually used to treat HIV that can prevent HIV.
That's what's needed to really break
the back of the epidemic.
And there's a whole lot we can today.