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- WHAT CAN WE DO?
How much do you really know about HIV/AIDS? How big of a consequence do you think it causes to the human body? 1 in 7 people living with HIV are unaware of their infection (HIV.gov, 2019). The first ever case of acquired immunodeficiency syndrome (AIDS) was announced in 1981, while the human immunodeficiency virus (HIV), the virus that causes AIDS, was isolated in 1983. However, since the first case of HIV/AIDS, infection with HIV has grown to pandemic proportions, resulting in an estimated 36.2 million affected in 2018 (Piot, Bartos, D.Ghys, Walker, Schwartlander et al. 2001). Generally, virulence is defined as the severity of a disease, however, in relation to HIV/AIDS, virulence is interpreted as the rate of progression to AIDS in untreated infections. The HIV/AIDS outbreak have significantly impacted on households, communities and the development and economic growth of nations, especially South African Nations. Although the US government has invested approximately $26 billion every year to research, treatment and services on HIV/AIDS, it still remains to be one of the deadliest infectious disease in the world. Therefore, it is essential that we prevent further transmission of HIV by increasing public health and awareness through campaigns, education systems, hosting educational events and such, to educate everyone just how deadly the virus is.
The drivers of most emergence of pandemic diseases, including HIV/AIDS, Ebola, SARS and pandemic influenza are associated with ecological, behavioural or socioeconomic changes (Morse et al. 2012). Even though the first pandemic event of HIV/AIDS occurred in 2006, it still remains as a global epidemic. As of 2018, more than 75 million people have acquired the infection, approximately 32 million have died and 37.9 million people currently infected globally (World Health Organisation, 2018). The vast majority of people infected by HIV are evidently living in low- and middle-income countries, which is mainly connected not only to social and economic conditions, but also environmental and ecologic factors. Many infectious diseases have merged/re-emerged in Africa in the 21st century, including HIV/AIDS, Ebola virus, Zika virus, Chikungunya virus, malaria and more (Fenolla & Mediannikov et al. 2018). Factors such as its tropical climate and environmental change contributes to the basis of Africa holding most of the poorest countries. Tropical weather creates a breeding ground for emerging pathogens, whereas environmental changes, such as global warming/destruction of rainforests, sets an environment for microbes to thrive (Laino et al. 1999). This thus, inevitably led to high rates of individuals diagnosed with different kinds of diseases. Furthermore, Africa is one of the continents that still manage to retain indigenous tribes who maintain their cultures, and because of this many continues to hunt animals in the wild to survive. In consequence, this eventually led to the emergence of HIV/AIDS.
The disclosure of HIV/AIDS, was due to consuming a particular type of chimpanzee in the West African region. It was resolved that the simian immunodeficiency virus (SIV), the chimpanzee version of HIV, was most likely transmitted to humans and mutated into HIV when humans hunted these animals for meat and came into contact with their infected blood (AIDS Institute Inc. 2011). Considering this, the infection not only affects the health of the individuals, but also the households, communities and its development, and economic growth of nations. Additionally, many of the low- and middle-countries, hardest hit by HIV, also further suffer from other infectious diseases, food insecurity and other serious problems. Gradual increase of the human population and frequent international travel further exacerbate the issue by promoting the transmission of HIV/AIDS.
HIV is spread in many ways including having anal or vaginal sex with someone who has HIV without using a condom, sharing injection drug equipment, such as needles or a mother with HIV passing it to her child during pregnancy and more. HIV/AIDS spreads widely and rapidly without knowing, which is especially dangerous to those who aren’t affected yet. The HIV virus stays in the body for life after accommodating the immune system and taken hold of it (Cherney et al. 2018). The immune system becomes weaker, making it harder for the body to fight off infections. Individuals who are infected do not actually know that they are infected as symptoms may not appear for a long period (HIV.gov, 2019). Without treatment, it takes an average of 10 years for someone who gets HIV to develop AIDS, however in saying that, some starts to show symptoms earlier than others.
Within high-income countries, the population most affected by HIV are the gay and bisexuals. At the beginning of the HIV epidemic, gay and bisexual men were frequently blamed as they were seen to be responsible for the transmission of HIV. As a consequence, LGBT people tackles specific challenges and barriers that involves violence, human right violations, stigma and discrimination in their daily life. This negative attitudes about homosexuality discourages gay and bisexual men to find health care to prevent and treat HIV. Jonathan Mann, the former head of the WHO’s global AIDS programme, highlighted what he termed the ‘third epidemic’, which he described as ‘the social, cultural, economic and political reaction to AIDS is as central to the global challenge as AIDS itself’ (Gilbert et al. 2016). Researches have noted that the stigma associated with HIV is a barrier to prevention and treatment efforts, and despite the worldwide attention, it continues to be a hurdle in HIV programmes (Gilbert et al. 2016). From a public health perspective, HIV-related stigma increases risk of developing new diseases because its deters people from getting tested (Kalichman, Simbayi, Jooste Toefy, Cain, Cherry, et al. 2005), making them less likely to acknowledge their risk of infection and discourage those who are HIV-positive from discussing their HIV status with their sexual partners and others (Gilbert et al. 2016).
There are three stages to HIV infection. During stage 1, the HIV infection can be easily transmitted as there is a high level of the virus within the bloodstream (Leonard et al. 2018). Within 2 to 4 weeks of exposure, while many develop flu-like symptoms, others don’t show any symptoms as it is possible for HIV to progress without any indication that the virus is present in the body. These flu-like symptoms represent the body's natural response to an infection as it attempts to kill off the virus. Though, it is not possible to completely remove it, because the virus replicates itself using the host's own CD4 cells and spreads throughout the body (Leonard et al. 2018). During this process, the virus weakens the host’s immune system by killing off as many CD4 cells as they can.
Symptoms during stage 1, includes:
- muscle and joint aches and pains
- raised temperature
- ulcers in the mouth
- night sweats
- body rash
- sore throat
- swollen glands
Throughout the second stage, infected individuals usually still don’t show symptoms because even though the virus is active, it reproduces at a slow rate. There is still no cure for HIV/AIDS and so individuals, who decides to follow a treatment program, remains at this asymptomatic stage and reduce the viral reproduction rate to the extent that it is undetectable (Leonard et al. 2018). As a result, the body remains healthy and the virus is untransmittable, nonetheless, if viral levels are detectable, the virus can be passed on despite not expressing any symptoms. Critically speaking, by ensuring a regular monitoring of undetectable level of the virus is necessary to reduce further transmission is crucial. In order for everyone to live a long healthy life, taking appropriate precautions allows avoidance or prevention of transmission of HIV and other diseases.
Stage 3 HIV can also be referred to as AIDS, however, AIDS is a different and separate diagnosis from HIV in that it is a syndrome, whilst HIV is a virus. Those undergoing drug therapy for HIV, prevents their condition from worsening to stage 3 level because their level of immunity remains strong enough to protect them (Leonard et al. 2018). Those without treatment notably increases the viral load, and decrease CD4 cell count. This weaken immunity leaves the body susceptible to various infections and diseases, which can be life-threatening (Leonard et al. 2018). A healthy CD4 count is between 500 and 1,500 cells/mm3, but an AIDS diagnosis from HIV is said to be under 200.
During this stage, symptoms include:
- blotches under the skin or in the mouth and nose
- blurred vision
- diarrhea lasting longer than 1 week
- swollen lymph glands
- constant tiredness
- fever that keeps coming back
- memory loss
- weight loss
- mouth, anus, or genital sores
Conditions that commonly develop at this stage further include tuberculosis (TB), fungal infections of the respiratory system, hepatitis, and some types of cancer (Leonard et al. 2018).
WHAT CAN WE DO?
Whether high prevalence or low prevalence of HIV are being experienced, the spread of HIV has gotten to every nation in the world. In low-prevalence nations, in particularly, those with high risk of sexual ad injection drug use behaviours in the population, the priority is to avoid an epidemic. Whereas in high-prevalence nations, the primacy is to reduce the spread of the disease and coping with the morbidity and mortality rates (Gibney et al. 1999). The biomedical approach to preventing HIV transmission includes usage of condoms, a barrier method that stops live virus from touching the genital mucosa, development of microbicides, physical barriers, and vaccines to prevent acquisition of the virus (Gilbert et al. 1999). Behavioural approaches include implementing HIV prevention interventions before adolescents become sexually active, because it facilitates a longer-term impact on sexual behaviour and on HIV prevalence than interventions implemented after the onset of sexual activity. An additional important impediment to adopting safer behaviours is likely to be individuals’ daily encounters with the more pressing problems and challenges that poverty brings; these diminish the attention they are willing or able to pay to something that is not an actual condition but represents a potential threat to their future health (Gibney et al. 1999).
Although there is no cure currently available for HIV/AIDS, but there are treatments that can stop further progression of the disease and allow most people living with HIV the opportunity to live a long and relatively healthy life. Starting antiretroviral therapy (ART) early in the progression of the virus is crucial because this improves quality of life, extends life expectancy, and reduces the risk of transmission (Murrell et al. 2018). More effective and better-tolerated treatments have evolved that can improve general health and quality of life by taking as little as one pill per day. The treatment of HIV involves antiretroviral medications that fight the HIV infection and slows down the spread of the virus in the body (Murrell et al. 2018).
However, there are improvements signified, whereby since 1995, new infection has declined by 81% and since 2002; number of HIV cases has declined by 35.5% (Girum, Wasie, & Worku et al. 2018). ART coverage has increased by 90% among all age and tripled among pregnant women within 6 years. Nationally, 67% of people living with HIV know their status, 88% of them are on treatment and 86% of people on treatment have viral suppression. As a result, AIDS-related death declined by 77 and 79% among all age and children respectively. By 2020, 79% of people living with HIV will know their HIV status, of which 96–99% of HIV infected people will be on ART and more than 86% will have viral suppression.
Emerging infectious diseases and pandemic threats remain a major global concern. Epidemic burden that countries face is excessive when it comes to treatment of patients infected with the disease. High prevalence of HIV/AIDS that a country suffers forces them to become reconcile to the incapacitation of the entire society and reduced the nation’s productivity. Effective HIV prevention requires a combination of behavioural, biomedical, and structural intervention strategies. Carrying out actions such as consistent male- and female-condom use, reductions in concurrent and/or sequential sexual and needle-sharing partners, and treatment with antiretroviral medications will reduce the risk of transmission of HIV/AIDS. The future of HIV/AIDS is looking positive as more people are regularly checking up and taking up treatments. A significant decline of death rates shows that we should continue what we’re doing. Hence, HIV/AIDS is not something people should be ashamed of having, be brave and regularly check-up on your body. Does the information provided scare you? It’s not too late to check up now!