Dr Binita PriyambadaDec 03, 2018 10:09:00 IST
It’s that time of the year again when wearing a red ribbon is trendy: World AIDS Day.
The ribbon is a show of support for those living with HIV, which affected 36.9 million people globally in 2017. And what the red ribbon has also done to different degrees in different countries is draw people's eyes, call attention to HIV, its causes and risks and how it can damage the immune system without proper care.
1 December 2018 marks the 30th anniversary of the World Aids Day, which all the UN member states have observed since 1988.
This year’s theme: 'Know your status' intends to promote everyone to undergo medical testing to discover if the virus exists in them and to put those diagnosed positive towards the right treatment and care.
As per data gathered by the Joint United Nations Programme on HIV/AIDS (UNAIDS) in 2018, India after South Africa, and Nigeria has the world’s third largest HIV populations – an estimated 2.1 million people.
India, however, made steady progress as the epidemic slowed its progression between 2010 and 2017. Today, India has the second largest HIV treatment program in the world. There was a steep drop of 27 percent in cases of new infections and a drop of 56 percent in AIDS-related deaths in the country during this time.
But that streak would end last year when the number of new infections rose again up from 8,000 to 88,000 a year, and HIV deaths remained roughly the same as before at 62,000.
In 2017, the country switched to a ‘Test & Treat’ strategy to deal with the challenges of HIV on the World Health Organization's recommendation. But before one is introduced to the rationale behind the strategy, it is critical to know how HIV and AIDS are connected.
A HIV (Human Immunodeficiency Virus) infection is considered serious because the virus attacks a type of immune cell, (CD4+ cells) that protect the body from all kinds of diseases.
After an individual is infected with HIV, it doesn't just destroy the infected CD4+ cells but also multiplies to infect more cells. Timely treatment can reduce the viral load in the body and thus help in preserving immunity to a great extent.
AIDS (Acquired immunodeficiency syndrome), on the other hand, is the final stage of HIV, which can today be avoided altogether with the right treatment. During this time, the resistant to fight infections is low and the risk of developing disorders becomes higher.
Whereas HIV is a virus, AIDS is a medical condition. Symptoms of an HIV positive person and an AIDS victim are significantly different, and treatments can now reduce the progression of an HIV infection to AIDS almost entirely, with the right treatment regimen.
How does HIV/AIDS spread?
HIV can affect anyone. The HIV virus can be transmitted from an infected person to another not just from sex, but also contact with blood, semen, vaginal secretions, even breast milk from an infected mother.
HIV is a sexually transmitted infection. HIV is largely transmitted through unprotected sex. Be it heterosexual or homosexual intercourse, anal or oral sex, there is a risk of transmission from an HIV-positive sexual partner that is not seeking treatment for his/her condition. Between the two, it has been understood that the rate of transmission is lower for oral than anal sex.
Therefore, sex between HIV positive and negative individuals absolutely requires protection – a physical barrier like a condom or dental dam (a piece of latex that covers the vagina), and prophylaxis (preventive medication for HIV negative people that have HIV positive sexual partners). However, this is not a widely known precaution.
India accounted for 86 percent of new infections caused by STIs in 2017 and 2018. Manipur, Mizoram, and Nagaland are the three states with the highest HIV prevalence.
HIV can be transmitted via blood. For instance, blood transfusions with infected blood person and reusing or sharing syringes for medical treatment or IV drug abuse are some obvious, high-risk examples of activities that can lead to HIV being transmitted.
HIV also spreads through perinatal infection, i.e. from a mother to a child during pregnancy, delivery of the baby and breastfeeding. Cases of this form of transmission are on the decline, with the rates having lowered to just 2 percent from 25 percent with the medical treatments on hand today.
The virus is also found in saliva, sweat, and tears. But the rate of transfer from contact with these fluids is much, much lower. There are no reported cases of anyone catching HIV from using the same toilet seats, shaking hands, even mosquito bites or sneezing.
Hugging, kissing and shaking hands are warm gestures that infected and uninfected people can continue to share without worrying about contracting or spreading HIV. The virus also doesn't survive outside the warm, energetic environment of a living person, so there is also no threat from sharing a room, clothes or a cup of coffee with HIV-positive people.
How to protect yourself from contracting an HIV infection
Since neither HIV, nor AIDS, have a known cure, it becomes imperative to take some precautions:
- Use a condom every time. When using lubricant, make sure it’s water-based instead of oil-based. Also, having fewer sexual partners can bring down the risks of contracting STDs in general, but also a life-long infection (till a cure is developed) such as HIV.
- Make sure any needles and tattoos are handled by professionals. It is important to ask and ensure your provider that they are using clean (sterile/new/just-opened seals of) needles to injecting a medication, draw blood for a test, or ink a tattoo.
- Should you ever need blood or blood components transplanted, make sure the lab/blood bank has tested it for HIV (also some other infective agents like HBV, etc.)
Why “test and treat”?
The first symptoms of an HIV infection can appear 2-12 weeks after transmission.
Some of the visible symptoms of an HIV infection – tiredness, fever, a possible headache or diarrhea– resemble the flu. Some may also experience pain in the joints, get a skin rash, night sweats or drop a few kilos in weight.
Swollen glands and yeast infections can be seen in the mouth or vagina. HIV symptoms can be difficult to differentiate from a regular flu, or other viral ailments at first.
Oddly, it is also possible that the infection comes on with little or no visible symptoms at all.
In either case, if the infection is detected early, Anti-Retroviral Treatment (ART) can help an HIV positive individual live as long and as well as an unaffected person can. Even for AIDS, though there is no cure, ART can increase a person’s immune cell count considerably, slowing down the spread of the disease considerably.
There is now also a post-exposure prophylaxis (PrOP), an emergency prevention pill, to help concerned HIV-negative sexual partners reduce their risk after sex with an HIV-positive person completely.
Both testing and treating are, therefore, oh-so-important!
What HIV risk really means, and should you get tested?
Before understanding who should get an HIV test done, getting it done anyway is important. There is no way for doctors to assess the risk from an HIV-positive individual that isn't under treatment. For sexually-active people and all their sexual partners, getting a test done periodically is the only way to know for sure and take action quickly if needed.
There is currently no shortcut or science to predict HIV risk accurately.
The Centre of Disease Control and Prevention states that anyone between the ages of 13 and 64 should once include this test as part of a routine checkup.
If any of the below describes you, you should certainly get tested on a regular basis for HIV:
- If you engage in high-risk sexual behavior
- If you are a sexually-active gay or bisexual man, or a partner of one
- If you have had unprotected sex or shared a needle with someone who's HIV status you do not know. In this case, both you and your partners should get tested within 72 hours of the incident. If one partner tests positive, the other one can be offered post-exposure prophylaxis (PrOP). PrOP needs to be started within 72 hours and taken for 28 continuous days.
- If you are pregnant or in the middle of a pregnancy
- If you share needles or syringes to inject drugs
- If you are diagnosed with, or have been treated for, hepatitis, tuberculosis or any STDs before.
Having HIV is no longer a death sentence – a straight road leading to AIDS. Today, there are plenty of treatment options for HIV-positive people, some of which are even sold by NGOs at more affordable prices to them.
The only hurdle India is still quite a distance away from crossing is the sociocultural one: we're in a country that still stigmatizes HIV and AIDS. While that could take years or decades to change, there's something else that can't be delayed: knowing for sure where we stand. Information is power in the case of an HIV infection
The author is a Senior Consultant to the Medical Team at docprime.com
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