Fighting stigma | Political economics



In 2021, HIV / AIDS remains a major public health problem affecting millions of people around the world. World AIDS Day is an opportunity for public and private partners to publicize the state of the pandemic. Encouraging progress has been made in the prevention, treatment and care of HIV / AIDS around the world. It has become a key opportunity to raise awareness, to remember those who have died and to celebrate victories such as increased access to treatment and prevention services.

The theme for World AIDS Day 2021 is: Ending Inequalities to End AIDS. On December 1, WHO calls on world leaders and citizens to step up to fight the inequalities that cause AIDS and to reach people who currently lack essential HIV services.

The human immunodeficiency virus (HIV) targets the immune system and weakens people’s defenses against many infections and certain types of cancer that people with healthy immune systems can fight off. As the virus destroys and impairs the functioning of immune cells, infected individuals gradually become immunocompromised. Immune function is usually measured by the number of CD4 cells.

Symptoms of HIV vary depending on the stage of infection. The initial period is called acute HIV. People living with HIV tend to be more contagious in the first few months after infection. During the first weeks after the initial infection, people may not have any symptoms or have flu-like illness, including fever, headache, fatigue, sore throat, large tender lymph nodes, a rash on the trunk. As the infection gradually weakens the immune system, they may develop other signs and symptoms, such as weight loss, fever, diarrhea, and cough. Without treatment, they could also develop serious illnesses such as tuberculosis (TB), meningitis, serious bacterial infections, and cancers such as lymphomas and Kaposi’s sarcoma.

The first symptoms are followed by a stage called chronic HIV. Without treatment, this second stage can last from about three years to more than 20 years (on average eight years). Usually there are few or no symptoms at first. However, many people experience fever, weight loss, gastrointestinal issues, and muscle pain near the end of this stage. Between 50 and 70 percent of people also develop persistent generalized lymphadenopathy, characterized by unexplained and painless enlargement of more than one group of lymph nodes for more than three to six months.

If left untreated, an HIV infection will eventually progress to AIDS. The most advanced stage of HIV infection is Acquired Immune Deficiency Syndrome (AIDS), which can take many years to develop if left untreated. AIDS is defined as infection by HIV with a CD4 + T lymphocyte count of less than 200 cells per µL or the occurrence of specific diseases associated with HIV infection. The most common initial conditions that alert people to the presence of AIDS are pneumocystis pneumonia, cachexia in the form of HIV wasting syndrome, and esophageal candidiasis. Other common signs include recurrent respiratory tract infections.

Opportunistic infections can be caused by bacteria, viruses, fungi and parasites that are normally controlled by the immune system. These infections can affect almost any organ system.

Additionally, people with AIDS frequently experience systemic symptoms such as prolonged fevers, sweating (especially at night), swollen lymph nodes, chills, weakness, and unintentional weight loss. Diarrhea is another common symptom, present in about 90 percent of people with AIDS. They can also be affected by various psychiatric and neurological symptoms independent of opportunistic infections and cancers.

It is spread by three main routes: sexual contact with an infected person, significant exposure to infected body fluids or tissues such as blood and blood products, semen and other genital fluids, or breast milk, and from mother to child during pregnancy, childbirth or breastfeeding. HIV is frequently spread among injecting drug users who share needles or syringes. There is no risk of contracting HIV from exposure to feces, nasal secretions, saliva, sputum, sweat, tears, urine or vomit, unless you ‘they are not contaminated with blood.

HIV is not spread through coughing, sneezing, or casual contact (for example, shake hands). HIV is fragile and cannot survive for long outside the body. Therefore, the direct transfer of bodily fluids is necessary for the transmission.

HIV is not spread through coughing, sneezing, or casual contact (for example, shake hands). HIV is fragile and cannot survive for long outside the body. Therefore, the direct transfer of bodily fluids is required for transmission.

HIV can be diagnosed with rapid diagnostic tests that provide same day results. People can also use HIV self-tests to test themselves. However, no test can provide a complete diagnosis of HIV; confirmatory testing is required. The most common tests for HIV are enzyme-linked immunosorbent assay (ELISA), polymerase chain reaction (PCR) tests, which look for viral RNA and therefore allow detection of the virus after very recent exposure, and single-use diagnostic screening (FOAM). These tests are very expensive.

Preventive measures include safer sex, needle exchange programs, treatment of infected people, as well as pre- and post-exposure prophylaxis. Illness in a baby can often be prevented by giving the mother and baby antiretroviral drugs. Attempts to reduce intravenous drug use and discourage needle sharing have resulted in reduced rates of infection.

Antiretroviral therapy is an important prevention strategy. Research has indicated that pre-exposure prophylaxis, in which uninfected people take an antiretroviral pill daily, can effectively prevent infection.

Vaginal antimicrobial gels have also been studied for the prevention of HIV infection, designed to prevent binding of HIV to cells in the vagina. Regular condom use reduces the risk of transmitting HIV by about 80% in the long term.

Circumcision “reduces the acquisition of HIV by heterosexual men between 38 and 66% over 24 months”. The World Health Organization and UNAIDS recommended male circumcision in 2007 as a method of preventing female-to-male transmission of HIV in areas with high HIV rates. Comprehensive sexuality education in schools can reduce high-risk behavior.

A course of antiretrovirals given within 48 to 72 hours of exposure to HIV-positive blood or genital fluids is called post-exposure prophylaxis. PEP treatment is recommended after sexual assault when the abuser is known to be HIV positive. The duration of treatment is usually four weeks.

Currently, there is no licensed vaccine against HIV or AIDS. In 2010, scientists reported the discovery of natural antibodies that neutralize (inactivate) around 90 percent of HIV strains and therefore have considerable potential to facilitate the generation of vaccines for HIV prevention.

There is currently no cure. Treatment is highly active antiretroviral therapy (HAART), which slows the progression of the disease. Treatment also includes preventive and active treatment for opportunistic infections. Early initiation of antiretroviral therapy (within a week of diagnosis) appears to improve treatment outcomes. Once treatment has started, it is recommended to continue it without interruption.

WHO has recommended that all people living with HIV receive lifelong ART. This included children, adolescents, adults, and pregnant and lactating women, regardless of clinical condition or CD4 cell count.

The benefits of treatment include a lower risk of progression to AIDS and a lower risk of death. The treatment also improves physical and mental health. With treatment, the risk of contracting tuberculosis is reduced by 70 percent. Additional benefits include a decreased risk of transmission of the disease to sexual partners and a decrease in mother-to-child transmission. Treatment recommendations for children are somewhat different from those for adults. The World Health Organization recommends treating all children under five; children over five are treated as adults.

A generally healthy diet is recommended. High intakes of vitamin A, zinc and iron may produce unwanted effects in adults with HIV and are not recommended except in cases of documented deficiency.

For pregnant and breastfeeding women living with HIV, a multivitamin supplement improves outcomes for mothers and children. There is some evidence that vitamin A supplementation in children with HIV infection reduces mortality and improves growth.

The main causes of death from HIV / AIDS are opportunistic infections and cancer, both of which are frequently the result of progressive failure of the immune system. The rate of clinical progression of the disease varies widely from individual to individual and has been shown to be affected by a number of factors such as a person’s susceptibility and immune function; their access to care, the presence of co-infections; and the particular strain (or strains) of the virus involved.

Tuberculosis co-infection is one of the leading causes of illness and death in people with HIV / AIDS, being present in one-third of all people infected with HIV and causing 25 percent of HIV-related deaths. HIV is also one of the most important risk factors for tuberculosis. Hepatitis C is another very common co-infection where each disease increases the progression of the other. The two most common cancers associated with HIV / AIDS are Kaposi’s sarcoma and AIDS-related non-Hodgkin lymphoma.

The stigma of AIDS exists around the world in a variety of ways, including ostracism, rejection, discrimination and avoidance of those infected with HIV, including quarantining those infected with HIV. Stigma-related violence or fear of violence prevents many people from requesting an HIV test, coming back for their results, or getting treatment, potentially turning what could be a manageable chronic disease into a conviction death and perpetuating the spread of HIV.

There are many misconceptions about HIV and AIDS. Three of the most common are that AIDS can be spread by casual contact, that sex with a virgin will cure AIDS, and that HIV can only infect gay men and drug addicts. Also, that one could get HIV by sharing a drink, spitting up, using a public toilet, and coughing or sneezing.

The writer is a longtime physician

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