Pratiti Shirin writes for DOT : On 1. December 2018, World AIDS Day has been commemorated with the slogan: Know Your Status. This year also marked the 30th anniversary of World AIDS Day. The pioneering global health campaign was first initiated by WHO in 1988. WHO aims to achieve the following through this year’s World AIDS Day: 1) Urge people know their HIV infection status through testing, and to access HIV prevention, treatment and care services. 2) Urge policy-makers to promote a ‘health for all’ agenda for HIV and related health services, such as tuberculosis (TB), hepatitis and non-communicable diseases. The first stage of AIDS is acquiring HIV or Human Immunodeficiency Virus which can take years to manifest itself into the deadly disease. The most common ways of getting infected is by coming into contact with a variety of bodily fluids from infected people such as semen, vaginal fluid, blood and breast milk. Ways of spreading the virus include having unprotected vaginal and anal intercourse with a HIV-infected person; sharing contaminated needles and accidental needle stick injuries. The virus does not spread through hugging, normal kissing; handshake; sharing personal objects; food and water. Key populations at increased risk of HIV include men who have sex with men, transgenders; sex workers and their clients; people in prisons and other closed settings; people who inject drugs and people who have a previous sexually transmitted disease (STD) such as syphilis, gonorrhea, chlamydia, herpes and bacterial vaginosis. The symptoms of HIV vary depending on the stage of infection. People tend to be most infectious in the first few months but there is often no awareness until the later stages. Therefore, the WHO aptly adopts this year’s theme of knowing one’s HIV status. In the first few weeks of infection, there may be no symptoms or just a common cold. As the infection progresses, there may be swollen lymph nodes, weight loss, fever, diarrhea, headache etc. Without treatment, the HIV progresses into Acquired Immunodeficiency Syndrome which includes experiencing meningitis, severe bacterial infections and cancers such as lymphomas and Kaposi’s sarcoma among others. Prevention includes using male and female condoms, testing and counselling for HIV and STDs; testing and counseling for TB; voluntary medical male circumcision which can reduce the risk of heterosexually acquiring HIV in men by 60 per cent and antiretroviral drug use for prevention. A 2011 study has confirmed that adhering to a strict antiretroviral therapy (ART) regimen can reduce the risk of transmitting HIV to a partner by 96 per cent. Moreover, WHO recommends administering oral PrEP to HIV negative people (but who are at risk) to prevent acquiring HIV, as part of a combination of prevention approaches. PEP can be administered within 72-hours of exposure to HIV to prevent infection. Mother-to child transmission can be nearly fully prevented if ART is administered to both mother and child during the very early stages of pregnancy and the period of breastfeeding. Again, the key is early detection of status. Also, harm reduction for people who use and inject drugs remains a key strategy for preventing the spread of HIV.
HIV continues to be a major global public health issue having claimed more than 35 million lives so far and around 37million people live with the infection out of whom 22 million people are receiving treatment. There is no cure for HIV but the key is early diagnosis. Knowing your HIV status enables you to live a long, productive and fairly normal life as well as control the spread of HIV with the intervention of ART. In 2017, 940000 people died globally form HIV related issues. 59 per cent of adults and 52 per cent of children were receiving lifelong ART in 2017. The global ART coverage for pregnant and breastfeeding women is as high as 80 per cent. The WHO African Region is the most affected region, with 25.7 million people living with HIV in 2017. The African region also accounts for over two-thirds of the global total of new HIV infections. It is estimated that currently only 75 per cent people know their HIV status. In 2017, 21.7 million people were receiving ART globally. Between 2000 and 2017, new infections fell by 36 per cent. HIV related deaths fell by 38 per cent with 11.4 million lives saved between the same period. This achievement was the result of great efforts by various national HIV prevention and control programmes supported by civil society and a range of development partners.
Despite unprecedented medical breakthroughs in the field of HIV in the last 30 years, HIV remains an epidemic which the WHO believes, is not being fought against fast enough, mainly due to social stigma. The taboo against HIV infected people remains strong and this facilitates the non-detection, late detection and spread of HIV. The key is to break the silence: create national government and media campaigns for the detection of HIV through rallies, advertisements and websites for seeking counselling and treatment for HIV, not to mention the government-run and various private clinics established for controlling the spread of HIV through detection and administration of ART.
In 2014, the 90-90-90 campaign was launched by WHO against AIDS. This meant that by 2020, 90 per cent of all infected people will know their HIV status; 90 per cent of all infected people will receive sustained ART and 90 per cent of all people receiving ART will have achieved viral suppression. The WHO is working tirelessly for the fulfillment of the 90-90-90 goal so that AIDS and HIV end as an epidemic by 2030.
The writer is an Assistant Professor, Department of English, University of Dhaka, Dhaka, Bangladesh.
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