Whether you are some one who would like to get involved in the field or whether you, a family member or a frined have been diagnosed as HIV positive - 'knowledge is power'. Sound scientific knowledge and information can help you to make better choices.
HIV/AIDS is the deadliest pandemic in recent history: it has killed twice as many people as the first World War. But the progress made in a mere 30 years against the disease has been spectacular. Today, someone who takes antiretroviral drugs every day has a very low risk of developing AIDS and can live a long and fulfilling life.
if you’re unlucky enough to live in a place with poor access to lifesaving ARV. Over 75% of the people living with HIV in West and Central Africa - 5 million people - are not on ARV treatment and therefore condemned to a slow, painful and unnecessary death. The situation is even worse for the 730,000 HIV-infected children in the region: 90% don’t have access to ARVs. Urgent action is needed to change this situation.
It may be the case in Western countries, but not worldwide. In fact, the face of HIV globally today is a young woman. 59% of people living with HIV in Sub-Saharan Africa are women. In South Africa, girls age 15-19 are as much as eight times more at risk of HIV infection than their male counterparts.
IT’S TRUE that men who have sex with men are disproportionally affected by the pandemic. It’s also the case for sex workers or injectable drug users. This is the reason why the United Nations’ plan to combat HIV/AIDS puts a lot of emphasis on these most-at-risk groups. But still, 45% of all children who are born with the virus come from West and Central Africa. Why? Because their mothers did not have access to treatment
A pregnant HIV+ woman on optimal ARV treatment has less than 2% risk of transmitting the virus to her baby. This is fantastic news: thanks to ARVs, the number of children born with the virus worldwide has been cut by 60% since 2000 and last year Cuba became the first country to declare that it had completely eliminated mother-to-child HIV transmission.
But again, this victory depends on the availability of ARV treatment. In West and Central Africa, only 39% of HIV positive pregnant women are on treatment. This is why the number of children born with the virus in this region is so disproportionately high: whereas West and Central Africa accounts for 17.9% of the total number of people living with HIV in the world, it records close to half of the births of HIV-infected children.
Those babies are born with a disease that could have been prevented. And it’s all the more dramatic that 90% of the HIV positive babies in this region do not have access to pediatric HIV treatment either. Without treatment, about one-third of children living with HIV will not survive past their first birthday; half of them will not celebrate their second birthday and only one in five of these children will celebrate a fifth birthday.
For sure, using condoms is very effective in preventing HIV infection. But it’s not the only way.
Studies have shown that optimal treatment on ARV reduces the risk of transmitting the virus by 96% in couples in which one is HIV-positive. New drugs even allow HIV negative people to be protected against infection.
Promoting the use of condoms is an important tool against HIV, but people need a combination of prevention tools to choose from, to fit best with their situation. Offering ARV treatment for all is a key component to put the HIV/AIDS pandemic under control, and therefore, it’s a huge problem that so few people – less than 1 in 4 – have access to treatment in West and Central Africa. Without treatment for all who need it, everywhere, the chances of bringing the global pandemic under control are very slim. This is why MSF is calling for an urgent, ambitious catch up plan for countries with low coverage of ARVs.
South Africa has, by far, the largest number of people living with HIV (6.8 million), and AIDS still takes a staggering toll in the country with 14,000 deaths a year. But as staggering as it is, this number remains below Nigeria’s, which has half the number of HIV+ people. Can you guess why? Again, it’s simple: Nigerians have far less access to ARVs than South Africans (22% versus 45% coverage of ARV).
Similarly, Guinea recorded roughly the same number of AIDS-related deaths in 2014 (3,800) as Swaziland (3,500). But Swaziland has twice the number of people living with the virus (210,000 versus 120,000) and the highest proportion of adults living with HIV worldwide (27.7%).
In short, in places where antiretroviral treatment is not widely accessible, people suffer and die proportionally more from HIV/AIDS.
Logic suggests that the Democratic Republic of Congo (DRC), where ‘only’ 1.2% of its population is living with HIV, would be better able to provide ARV daily treatment than Malawi. After all, both countries are relatively comparable on paper in terms of GDP per capita or human development index. Yet Malawi has managed to put 50% of its HIV-infected population on ARVs. The DRC, less than 25%.
Doesn’t make sense? Well there are some explanations. If, as in the DRC, HIV is less visible in society, media and political agenda’s, it gets lost among many other health priorities. This is understandable. What is less understandable is the constant neglect by international actors of countries with low HIV prevalence like those in West and Central Africa.
This seems to make logical sense; after all, even health systems in rich countries are already under strain to provide treatment for growing number of people with chronic conditions: diabetes, obesity… So imagine the situation in a country like Malawi that needs to provide daily HIV treatment for 10% of its adult population, even though it has six times less health workers than the bare minimum recommended by WHO.
In fact, the most noteworthy progress against HIV/AIDS have been achieved in resource-poor countries. In fact, the introduction of ARVs in the 2000s was the single most important factor to increase life expectancy in Southern Africa.
MSF has even built experience over the years as to how to provide HIV care in conflict settings, for example in Yemen or CAR, to avoid making people double victims of both war and their HIV+ status. Continuing care is imperative even in the most challenging, unstable areas.
Just because a country has limited resources or a context is complicated or unstable doesn’t have to mean that people living with HIV cannot be provided with ARV treatment.
It is essential that none of us, anywhere, forget the most neglected victims of HIV/AIDS. For this reason, MSF is calling calls on donors, affected governments and UN agencies to develop and implement a fast-track plan to scale-up life-saving antiretroviral treatment in countries where ART coverage reaches less than one-third of the population, particularly in West and Central Africa.
The time is now.
Published at Kaiser Family Foundation
On June 5, 1981, the U.S. Centers for Disease Control and Prevention (CDC) issued its first warning about a relatively rare form of pneumonia among a small group of young gay men in Los Angeles, which was later determined to be AIDS-related. While scientists believe that HIV was present years before the first case was brought to public attention, 1981 is generally referred to as the beginning of the HIV/AIDS epidemic. Since that time, tens of millions of people have been infected with HIV worldwide. The Global HIV/AIDS Timeline is designed to serve as an ongoing reference tool for the many political, scientific, cultural, and community developments that have occurred over the history of the epidemic.
HIV infection has a well-documented progression. If you are infected with HIV and don’t get treatment, HIV will eventually overwhelm your immune system. This will lead to your being diagnosed with Acquired Immune Deficiency Syndrome (AIDS).
However, there’s good news: when used consistently, antiretroviral therapy (ART) prevents the HIV virus from multiplying and from destroying your immune system. This helps keep your body strong and healthy by helping you fight off life-threatening infections and preventing HIV from progressing to AIDS. In addition, research has shown that taking ART can help prevent the spread of HIV to others. (Read more about HIV treatment.)
Below are the stages of HIV infection. People may progress through these stages at different rates, depending on a variety of factors.
Within 2-4 weeks after HIV infection, many, but not all, people develop flu-like symptoms, often described as “the worst flu ever.” Symptoms can include fever, swollen glands, sore throat, rash, muscle and joint aches and pains, fatigue, and headache. This is called “acute retroviral syndrome” (ARS) or “primary HIV infection,” and it’s the body’s natural response to the HIV infection.
During this early period of infection, large amounts of virus are being produced in your body. The virus uses CD4 cells to replicate and destroys them in the process. Because of this, your CD4 count can fall rapidly. Eventually your immune response will begin to bring the level of virus in your body back down to a level called a viral set point, which is a relatively stable level of virus in your body. At this point, your CD4 count begins to increase, but it may not return to pre-infection levels. It may be particularly beneficial to your health to begin ART during this stage.
It is important to be aware that you are at particularly high risk of transmitting HIV to your sexual or drug using partners during this stage because the levels of HIV in your blood stream are very high. For this reason, it is very important to take steps to reduce your risk of transmission.
For more information, see NIH’s Guidelines for the Use of ART in HIV-1-Infected Adults and Adolescents: Acute and Recent (Early) HIV infection.
After the acute stage of HIV infection, the disease moves into a stage called the “clinical latency” stage. “Latency” means a period where a virus is living or developing in a person without producing symptoms. During the clinical latency stage, people who are infected with HIV experience no HIV-related symptoms, or only mild ones. (This stage is sometimes called “asymptomatic HIV infection” or “chronic HIV infection.”)
During the clinical latency stage, the HIV virus continues to reproduce at very low levels, although it is still active. If you take ART, you may live with clinical latency for several decades because treatment helps keep the virus in check. (Read more about HIV treatment.) For people who are not on ART, the clinical latency stage lasts an average of 10 years, but some people may progress through this stage faster.
It is important to remember that people in this symptom-free stage are still able to transmit HIV to others, even if they are on ART, although ART greatly reduces the risk of transmission.
If you have HIV and you are not on ART, then eventually your viral load will begin to rise and your CD4 count will begin to decline. As this happens, you may begin to have constitutional symptoms of HIV as the virus levels increase in your body.
This is the stage of HIV infection that occurs when your immune system is badly damaged and you become vulnerable to infections and infection-related cancers called opportunistic infections. When the number of your CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3), you are considered to have progressed to AIDS. (In someone with a healthy immune system, CD4 counts are between 500 and 1,600 cells/mm3.) You are also considered to have progressed to AIDS if you develop one or more opportunistic illnesses, regardless of your CD4 count.
Without treatment, people who progress to AIDS typically survive about 3 years. Once you have a dangerous opportunistic illness, life-expectancy without treatment falls to about 1 year. However, if you are taking ART and maintain a low viral load, then you may enjoy a near normal life span. You will most likely never progress to AIDS.
People living with HIV may progress through these stages at different rates, depending on a variety of factors, including their genetic makeup, how healthy they were before they were infected, how soon after infection they are diagnosed and linked to care and treatment, whether they see their healthcare provider regularly and take their HIV medications as directed, and different health-related choices they make, such as decisions to eat a healthful diet, exercise, and not smoke.
Factors that may shorten the time between HIV and AIDS:
Factors that may delay the time between HIV and AIDS:
By making healthy choices, you have some control over the progression of HIV infection.
To learn more, see CDC’s Living with HIV.
As noted above, when used consistently, ART prevents the HIV virus from multiplying and from destroying your immune system. And there are other treatments that can prevent or cure some of the illnesses associated with AIDS, though the treatments do not cure HIV itself. The earlier you detect your HIV infection and start treatment, the better.
But not everyone is diagnosed early. Some people are diagnosed with HIV and AIDS concurrently, meaning that they have been living with HIV for a long time and the virus has already done damage to their body by the time they find out they are infected. These individuals need to seek a healthcare provider immediately and be linked to care so that they can stay as healthy as possible, as long as possible. Use the HIV Testing and Services Locator to find an HIV provider near you.
The website of The Body is an excellent source of information about all aspects of the virus and Aids.
This FAQ from the American Foundation for AIDS Research reviews some of the most common questions people have about how HIV is transmitted, who is most at risk, and what HIV testing is all about. It's a particularly helpful resource for HIV-negative people in need of a quick education on what steps they do - and don't - need to take to protect themselves from HIV.
HIV Treatment Primer. (ACRIA) The world of HIV treatment can be intimidating: dozens of meds, lab tests, medical terms and differing opinions.Whether you’ve just been diagnosed with HIV, have known for a while, or are helping a friend with HIV, the good news is that you can learn enough to make informed decisions without becoming an infectious disease specialist. Download (972KB)
TAC's Treatment Literacy Materials as well as useful materials from other organisations.
More detailed information and resources about treatment are available here.
Published by POZ
A look at some science-based facts about HIV that may surprise you as we mark the 35anniversary of the official start of the AIDS epidemic.
June 5, 1981. The Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR) detailed five recent cases of homosexual men in Los Angeles diagnosed withPneumocystis carinii pneumonia (PCP), two of whom had died. All five men had also experienced cytomegalovirus (CMV) and candidal mucosal infections.
July 3, 1981. The New York Times published a short article titled “Rare Cancer Seen in 41 Homosexuals,” reporting on a subsequent MMWR that focused on gay men, largely in New York City and the San Francisco area, who developed often swiftly fatal cases of Kaposi’s sarcoma (KS).
HIV, which had been slowly and silently spreading throughout the 20th century from its origins in Western Africa, had finally begun to rear its ugly head on a grand scale.
The AIDS epidemic had officially begun.
To say that much has changed since those early terrifying days of the epidemic is a categorical understatement. AIDS would bring out the best and the worst of society, exposing and fueling deep-seated, often institutionalized hatred toward gays and other disenfranchised demographics, while bringing to their feet a heroic new order of activists and scientists.
Often at fierce odds with one another, these two latter forces would eventually come to work more symbiotically as they fought for a common goal: to combat a plague that threatened to annihilate vast swaths of the human race.
Today, 35 years into the epidemic, an estimated 36.9 million people are living with HIV worldwide. About 17 million of them are on antiretroviral (ARV) treatment as of 2015. Twenty-nine individual ARVs have been approved since Retrovir (zidovudine, or AZT) was approved in 1987. And scientists are fast at work developing potential vaccines and cures for the virus.
To mark this milestone, POZ has culled together 35 science-based facts about the HIV epidemic, many of which may surprise you. Click on any of the hyperlinks for more information.
HIV Care & Treatment:
Hepatitis C Virus (HCV):
The State of the Epidemic:
World Council of Churches
A basic manual for health care workers to learn about AIDS.
Any parts of this book, including the illustrations may be copied, reproduced, or adapted to meet local needs, without permission from the author or publisher, provided the parts reproduced are distributed free or at cost – not for profit.
Whether you are some one who would like to get involved in the field or whether you, a family member or a frined have been diagnosed as HIV positive - 'knowledge is power'. Sound scientific knowledge and information can help you to make better choices.
THIS DOCUMENT IS PART OF THE CABSA/WORLD VISION TRAINING MANUAL
History of the controversy: The argument that HIV does not cause AIDS first attracted broad public attention in an article, published in Cancer Research in 1987, written by Professor Peter Duesberg of the University of California in Berkeley. Duesberg's contentions were rejected by scientists, but attracted attention in the mainstream press and also with specific groups outside the scientific community. For example, his attacks on the “AIDS establishment”, whom he accused of perpetuating the myth of AIDS for their own ends, were appealing to a public who already had a growing sense of disenchantment with the broad medical community. Similarly, his attribution of AIDS to specific lifestyle choices found favour with parts of society, especially those critical of the gay movement.
At the time that the controversy started, there were still some questions unanswered on the precise mechanisms of HIV disease. Ten years later there is a more complete understanding of how HIV causes AIDS.
As the total fertility rate is already declining in South Africa on account of urbanisation and rising affluence, the epidemic and the programmes to fight it could cause the rate of decline to be steeper still.
Given the complexity in implementing a vaccine development programme, it is essential that all countries affected actively participate in this process. Scientists around the world are working to understand the kind of immunity a vaccine would have to induce in order to protect someone against HIV infection. They are also looking into the genetic variability of the virus, which might affect the protection a vaccine could offer. The information that scientists generate is in turn being used by the pharmaceutical and biotechnology industry to develop "candidate vaccines" to be tested in HIV-negative human volunteers.
Most likely, the initial HIV vaccines will not be 100% effective (but then, few vaccines are) and they will have to be delivered as part of a comprehensive prevention package. What is important now is to ensure that countries where there is an urgent need for HIV vaccines participate in the global effort to ensure that a vaccine appropriate for their use is developed. Likewise, it is not too early to start planning now to ensure that a future vaccine is made available in the areas of the world where it is most needed.
In the long term, a safe, effective and affordable preventive vaccine against HIV is our best hope of bringing the global epidemic under control. However, it would be a mistake to think that the development of such a vaccine will be quick or easy or to expect that once a vaccine is available it will replace other preventive measures.
The first large-scale HIV vaccine trials, designed to show whether the candidate vaccines actually protect against HIV infection or disease, were launched in 1998 in the United States and in 1999 in Thailand. The trials involve 8000 healthy volunteers who are given one of two different versions of gp120, a protein located on the outside of the virus, depending on the virus strains prevalent in the two countries. The initial results from these trials may be available within the next two years. Parallel to this, other candidate HIV vaccines are being developed through different experimental approaches. Some are based on the HIV strains prevalent in developing countries. Most of these newer candidate vaccines will be tested in small-scale trials in human volunteers, and the best will proceed to large-scale evaluation for efficacy.
Vaccine development is complicated not only by the range of virus subtypes circulating but by the wide variety of human populations who need protection and who differ, for example, in their genetic make-up and their routes of exposure to HIV. Inevitably, different types of candidate vaccines will have to be tested against various viral subtypes in multiple vaccine trials, conducted in both high-income and developing countries. It is vital for developing countries to build up their technical and human capability to conduct such trials with the highest ethical and scientific standards and with the full participation of the community.
Here are some sample responses women can practice and then use when a partner objects to condoms:
Use of the product is not expected to reach the high levels recorded in many countries for the male condom. Research in Zambia and Zimbabwe reveals that after a year of mass marketing, awareness of the female condom is high but use remains extremely low. Some studies show, however, that once women try the female condom, they like it. For example, among female drug users in Brazil, 75% who used the female condom reported being comfortable with it. Follow-up interviews three months later showed that 43% reported continued use, although women living in poor areas (favelas) were less likely to continue using the condom. The biggest problem is that female condoms are several times more expensive than male condoms and therefore not readily available to all. Efforts to expand access, increase global volume and further reduce the price continue. (UNAIDS global report – June 2000)
Clearly, the correlations are not straightforward. In the higher-income countries, the rates of HIV infection among men who have sex with men do not vary greatly even though the circumcision rates do: few men in Europe and Japan but four-fifths of men in the United States are circumcised. In Africa, however, circumcision seems to confer some protection. A study in Nyanza Province, Kenya, among men from the same ethnic group (the Luo), found that one-quarter of uncircumcised men were infected with HIV, compared with just under one-tenth of circumcised men. The protective effect remained even after other factors, such as sexual behaviour and sexually transmitted infections, had been taken into account. A study of over 6800 men in rural Uganda has suggested that the timing of circumcision is important: HIV infection was found in 16% of men who were circumcised after the age of 21 and in only 7% of those circumcised before puberty. A recent review of 27 published studies on the association between HIV and male circumcision in Africa found that, on average, circumcised men were half as likely to be infected with HIV as uncircumcised men.
When African men with similar socio-demographic, behavioural and other factors were compared, circumcised men were nearly 60% less likely than uncircumcised men to be infected with HIV.
Even though the weight of evidence increasingly suggests that circumcising men before they become sexually active does provide some protection against HIV, the practical implications for AIDS prevention are not obvious. Circumcision, where it is practised, usually has links to religious or ethnic identities and life-cycle ceremonies, and may customarily be done after puberty. If the same scalpel were used without sterilisation on a number of boys, this could actually contribute to the transmission of HIV. Finally, if circumcision were promoted as a way of preventing HIV infection, people might abandon other safe sexual practices, such as condom use. This risk is far from negligible – already, rumours abound in some communities that circumcision acts as a "natural condom". A sex worker interviewed in the city of Kisumu in Kenya summed up this misconception, saying: "I can sleep with circumcised men without a condom because they don’t carry a lot of dirt on their penis". While circumcision may reduce the likelihood of HIV infection, it does not eliminate it. In one study in South Africa, for example, two out of five circumcised men were infected with HIV, compared with three out of five uncircumcised men. Relying on circumcision for protection is, in these circumstances, a bit like playing Russian roulette with two bullets in the gun rather than three (UNAIDS report June 2000).
The Options Project found that 7.8% (8 out of 102) of recently infected men who had sex with men in San Francisco were probably infected through oral sex. Most of these men believed that the risk was minimal or non-existent. Nearly half (3 out of 8) of these cases reported oral problems, including occasional bleeding gums. Almost all (7 out of 8) of these men reported having had oral contact with pre-semen or semen.
The study results emphasise that any type of sexual activity with an infected person poses a risk of HIV transmission. (7th National Conference on Retroviruses and Opportunistic Infections, January 2000) Oral sex with someone who is infected with HIV is certainly not risk-free.
This is why scientists divide the risk of contracting HIV into four categories:
French Kissing (kissing with an open mouth), sharing toothbrushes and razors, etc.
Any form of unprotected sex, of which receptive anal sex has the highest risk incidence