North Korea Has A Growing HIV Problem That It Didn't Want To Acknowledge
A report from U.S. and North Korean HIV researchers has outlined a big issue with the infection in North Korea that has spiraled in recent years, despite the government's best attempts to deny its existence.
The report, which has been submitted to the server, medRxiv and is due to be published this week details a problem with HIV in North Korea that Pyongyang has managed to keep quiet until now.
However, in December last year, at a World AIDS Day event, the North Korean government proudly asserted that the country had managed to keep HIV infections at net zero -- a remarkable feat given its population of 25.5 million.
Australia, with a comparable population of 24.6 million, has approximately 25,000 diagnosed cases of HIV infection.
The World Health Organisation (WHO) appeared to take North Korean officials at their word when Dr Thushara Fernando, the WHO representative for North Korea said that to the best of their knowledge, nobody in North Korea has been infected by HIV.
The UNAIDS factsheet concerning North Korea's HIV statistics from 2017 is a blank document of bracketed dots where figures should be.
During the World AIDS Day presentation, Fernando outlined the country's stringent approach to blood transfusion, as well as vast preventive programs and continuous HIV testing in front of officials from WHO, UNICEF, as well as representatives from North Korean public health organisations.
However, the new report outlines that despite these claims, North Korea has been witnessing a surging number of cases, with 8,362 individuals infected in 2018.
The first confirmed case of HIV acknowledged by Pyongyang was in 1999; the country had been apparently unscathed by the global epidemic before this time due to restricted immigration.
Zunyou Wu, chief epidemiologist at China's Center for Disease Control and Prevention in Beijing, told Science Mag that the prevalence of HIV in North Korea is "much higher" than he expected.
Since 2015, North Korea’s Centers for Disease Control has been observing a steady increase in HIV infections but a country-wide survey in September of 2018 suggested that cases were booming.
Public health officials have been communicating with international organisations, including one non-profit based in New York City in a rare display of collaboration for North Korea in order to address HIV concerns, particularly among rural populations in the country.
According to United Nations-backed research, North Koreans are particularly vulnerable to sexually-transmitted infections because condoms are scarcely available, there is very little education available, and young people rarely have stable sexual partnerships.
According to the report, approximately 3,000 North Koreans are currently on antiretroviral drug therapies but strict importation laws make it difficult for even these individuals, who have been acknowledged by health authorities, to access medication.
Blood donation, intravenous drug use and female sex work account for the majority of HIV cases, according to North Korea's National AIDS Commission.
This differs from infection patterns witnessed in other nations, where male to male sexual contact tends to account for the majority of infections.
Wu theorises that the tight immigration policies, even between the border of northern China where homosexual male sex accounts for 60 percent of HIV infections, keeps the country relatively unaffected by this form of transmission.
The authors of the paper recommend that the international community respond to these HIV infections by providing antiretroviral drugs to the region and ensuring that they reach those in need.
Besides the growing HIV problem, North Korea continues to face vast public health challenges. A UN plan published in early 2018 asserts that six million people in the country do not have access to adequate healthcare -- almost a quarter of the country go without basic sanitation.
Tuberculosis, a deadly bacterial infection of the lungs is on the rise in North Korea. In 2015 it killed around 10,700 people -- in 2017 it killed just over 16,000 people.
Australia reports approximately 1,300 cases of tuberculosis yearly and very few of these cases lead to death (approximately one percent across all cases).