HIV and AIDS
Millennium Development Goal 6
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The disease and its management
Some Facts
- In 2009, there were an estimated thirty-three million people living with HIV/AIDS globally, and nearly two million deaths.
- Worldwide, the number of new cases of HIV infection peaked in 1996 and had fallen to 2.6 million in 2009.
- An estimated 2.5 million children were living with HIV/AIDS at the end of 2009, mostly in sub-Saharan Africa.
- Preventing new infections, scaling up HIV treatment, and care of people with AIDS are important issues to combat HIV/AIDS.
- The pattern of HIV/AIDS differs across the world, depending on the main local transmission routes for new infection, but marginalised and vulnerable communities carry the highest risk.
- Effective global action against HIV/AIDS has been hampered by lack of knowledge and awareness, discrimination and social stigma, cultural and faith issues with safer sex messages, and legal status of sex work, same sex relationships and drug use.
- Advocacy for human rights, gender equality, and poverty reduction are part of HIV campaigns.
The disease
Human immunodeficiency virus (HIV) is a retrovirus that infects and impairs immune system cells. If untreated, it may eventually progress to the acquired immunodeficiency syndrome (AIDS), in which certain defined infections and / or cancers occur due to low immunity.
- HIV can be transmitted sexually, through contaminated blood, or directly from mother to child during pregnancy, delivery or by breastfeeding.
- Treatment with combined antiretroviral therapy prevents the virus multiplying and therefore protects immune cells.
- Antiretroviral therapy is also used for prevention of mother to child transmission of HIV, and for post-exposure prophylaxis either following sexual exposure or exposure to infected blood.
- In low and middle income countries it is estimated that only a third of people who need antiretroviral therapy can access it, and just over half of women needing antiretroviral therapy in pregnancy receive it.
- Research is focused on microbicide gels and developing a vaccine against HIV. Unfortunately, so far no vaccine has proven to be that beneficial. HIV/AIDS has a devastating effect on individuals, families and communities through illness and deaths, and their impact on social groups and local services.
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Preventing HIV Infection
Preventing HIV infection depends on
Safer sex programmes include messages on fidelity and abstinence, and use of condoms. Male circumcision is recommended in some settings because of research evidence that it reduces male risk of acquiring HIV infection.
- reducing harm from injecting drug use
Programmes on injecting drug use include treatment, and harm reduction through needle exchange, and change to non-injected drugs.
- minimising risk against infection from blood or body parts.
Infection control measures protect against transmission in healthcare, with screening before use of blood products and body parts.
Prevention programmes need to match local need and context to be successful.
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HIV Testing
- Voluntary counselling and testing is important for HIV prevention.
- Testing should be confidential, with informed consent.
- It is important to extend access for testing as many infected people are unaware of their diagnosis.
Diagnostic testing is used when HIV is suspected, and for all patients with active tuberculosis.
Testing should routinely be offered
- in pregnancy
- in sexual health services
- to people from areas of high prevalence
- to those engaging in high risk behaviour, irrespective of whether they have symptoms or not .
Mandatory testing is required for donors of blood and body fluids, or body parts.
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HIV/AIDS Treatment
- The antiretroviral treatment currently available suppresses the infection.
- At least three antiretroviral drugs are needed to suppress HIV and reduce disease progression.
- The effect is to decrease HIV in the bloodstream and body fluids, lowering the risk of passing on the infection.
- Initiation of treatment is determined by measuring certain immune cells (CD4 count) and assessing the clinical disease stage.
- Antiretroviral therapy is also recommended for all HIV positive people with active co-infection with tuberculosis or hepatitis B.
- WHO and national policies determine preferred treatment thresholds and regimes depending on resources and emerging resistance to HIV drugs.
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HIV/AIDS, pregnancy and transmission to the baby
- Women with HIV/AIDS in pregnancy have poorer outcomes for themselves and their babies.
- Mothers with HIV may have a higher risk of disease progression and infection, particularly malaria and tuberculosis.
- Babies of mothers with HIV have a higher risk of stillbirth, perinatal and infant death, prematurity and low birth weight.
- Most children with HIV are infected during pregnancy, labour, delivery or breastfeeding by mother-to-child transmission which can be reduced by antiretroviral therapy.
- It is estimated that 15% to 25% of babies born to HIV positive mothers are infected during pregnancy and delivery, and 15% during breastfeeding.
Prevention and treatment
- Women of childbearing age need to be tested for HIV infection.
- Women who are HIV positive need (WHO recommendations)
- family planning to reduce unintended pregancies
- lifelong antiretroviral therapy where mothers need this for their own health
- short-term antiretroviral therapy for all HIV positive mothers to prevent transmission to the child
- HIV transmission can be further decreased by antiretroviral therapy for the baby from birth for 4-6 weeks and while they are breastfed.
In resource-limited settings, this risk has to be balanced against the protection breastfeeding provides against malnutrition, diarrhoeal diseases and pneumonia, depending on the availability of antiretroviral therapy and the safety of alternative feeding with infant formula or modified cows milk.
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Treatment of children with HIV/AIDS
- Babies with HIV infection often become unwell in the first year of life, and about half will die in the first 2 years without effective treatment.
- Children with HIV are particularly vulnerable to diarrhoea and respiratory infection, requiring diligence to standard prevention and treatment measures, and anti-bacterial prophylaxis.
- Early testing should lead to antiretroviral therapy for all children under 2 years, with antiretroviral therapy depending on CD4 count for children over 2 years.
- Children are more susceptible to adverse effects of treatment and WHO has recommended preferred regimes.
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Care for people living with HIV/AIDS
- People living with HIV/AIDS benefit from an active approach to illness prevention.
- Reducing infection by good hygiene, water and sanitation should be supported by preventative treatment against bacterial infection, tuberculosis, malaria, fungal infections and immunisation.
- Psychosocial support and counselling can be reinforced by community initiatives.
- A comprehensive response to HIV/AIDs includes social protection to provide basic social rights, services, and facilities to minimise the effects of HIV on individuals, families and communities.
- Social protection increases resilience, improving health and welfare of people living with HIV/AIDS, and reducing risk of HIV infection in vulnerable communities.
- Specific protection is needed for children who may be carers or become orphaned.
- Food security is required, and poor nutrition is linked to lower survival in people living with HIV/AIDS.
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HIV advice for healthcare workers and travellers
- Care should be taken for prevention of HIV infection, with particular vigilance in high prevalence countries.
- Healthcare workers should follow occupational guidelines to reduce risk through hygiene, personal protection and avoiding hazards.
- Post-exposure prophylaxis should be used where appropriate, and thought should be given to local availability or arranging access before travel.
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