Introduction
Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body’s ability to fight the organisms that cause disease.
Burden Of HIV
As per a recent report from World Health Organization, HIV continues to be a major global public health issue, having claimed almost 33 million lives so far. There were an estimated 38.0 million people living with HIV at the end of 2019. Due to gaps in HIV services, 690 000 people died from HIV-related causes in 2019 and 1.7 million people were newly infected.The disruptions caused in the access to basic healthcare amid Covid-19 pandemic is likely to increase the burden. Key population groups and their sexual partners accounted for over 60% of all new HIV infections globally among the age group 15-49 years (an estimated 62%) in 2019. WHO defines key populations as people in populations who are at increased HIV risk including men who have sex with men; people who inject drugs; people in prisons and other closed settings; sex workers and their clients; and transgender people. India has the third largest HIV epidemic in the world. In 2017, HIV prevalence among adults (aged 15-49) was an estimated 0.2%. This figure is small compared to most other middle-income countries but because of India’s huge population (1.35 billion people) this equates to 2.1 million people living with HIV. Overall, India’s HIV epidemic is slowing down. Between 2010 and 2017 new infections declined by 27% and AIDS-related deaths more than halved, falling by 56%. The number of new HIV infections in Jammu and Kashmir is lowest in recent years and seven times lower than the Indian national average, a government reports says, but the rate of decline is still worrying. A recent HIV estimation report published by national AIDS control society (NACO) puts J&K at the bottom of the list of Indian states in terms of adult prevalence of the life threatening viral infection. According to the J&K State AIDS Control Society (JKSACS) statistics, a total of 4,175 HIV-positive patients, including 2,437 men, 1,484 women and 248 children, have been registered with the society in the Jammu region till May 2017. In the Kashmir region, including Leh, the prevalence of HIV is quite low. The number of HIV patients there is 228, including 58 non-locals.
Signs And Symptoms
The symptoms of HIV vary depending on the stage of infection. Though people living with HIV tend to be most infectious in the first few months, many are unaware of their status until later stages. The first few weeks after initial infection, individuals may experience no symptoms or an influenza-like illness including fever, headache, rash, or sore throat. As the infection progressively weakens the immune system, an individual can develop other signs and symptoms, such as swollen lymph nodes, weight loss, fever, diarrhoea and cough. Without treatment, they could also develop severe illnesses such as tuberculosis, cryptococcal meningitis, severe bacterial infections and cancers such as lymphomas and Kaposi’s sarcoma, among others.
Modes Of Transmission
To become infected with HIV, infected blood, semen or vaginal secretions must enter your body. You can’t become infected through ordinary contact — hugging, kissing, dancing or shaking hands — with someone who has HIV or AIDS. HIV can’t be transmitted through the air, water or insect bites. You can become infected with HIV in several ways, including:
▪︎By having sex with an infected partner. You may become infected if you have sex with an infected partner whose blood, semen or vaginal secretions enter your body. The virus can enter your body through mouth sores or small tears that sometimes develop in the vagina during sexual activity.
▪︎From blood transfusions. In some cases, the virus may be transmitted through blood transfusions from infected persons.
▪︎By sharing needles. HIV can be transmitted through needles and syringes contaminated with infected blood. puts you at high risk of HIV and other infectious diseases, such as hepatitis.
▪︎During pregnancy or delivery or through breast-feeding. Infected mothers can infect their babies. But by receiving treatment for HIV infection during pregnancy, mothers significantly lower the risk to their babies.
Risk Factors
Anyone of any age, race, sex or sexual orientation can be infected. Behaviours and conditions that put individuals at greater risk of contracting HIV include:
▪︎Having unprotected anal or vaginal sex.
▪︎Having another sexually transmitted infection such as syphilis, herpes, chlamydia, gonorrhoea, and bacterial vaginosis.
▪︎Sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs.
▪︎Receiving unsafe injections, blood transfusions, tissue transplantation, medical procedures that involve unsterile cutting or piercing.
▪︎Experiencing accidental needle stick injuries, including among health workers.
▪︎Key risk populations include: men who have sex with men(MSM), people who inject drugs, people in prisons and other closed settings, sex workers and their clients, and transgender people.
Prevention Of HIV
There’s no vaccine to prevent HIV infection and no cure for AIDS. But it’s possible to protect yourself and others from infection. That means educating yourself about HIV and avoiding any behaviour that allows HIV-infected fluids — blood, semen, vaginal secretions and breast milk — into your body. Also effective antiretroviral (ARV) drugs can control the virus and help prevent transmission so that people with HIV, and those at substantial risk, can enjoy healthy, long and productive lives. To help prevent the spread of HIV:
▪︎Use a protective device. If you don’t know the HIV status of your partner, use a protective device like new condom every time you have sexual intercourse .Women can use a female condom.
▪︎Consider the new drug combinations. Use of the new combination of drugs can reduce the risk of sexually transmitted HIV infection in those who are at high risk. It is also used as an HIV treatment along with other medications.
▪︎Use a clean needle. If you use a needle to inject drugs, make sure it’s sterile and don’t share it. Take advantage of needle-exchange programs in your community and consider seeking help for your drug use.
▪︎If you’re pregnant, get medical care right away. If you’re HIV-positive, you may pass the infection to your baby. But if you receive treatment during pregnancy, you can cut your baby’s risk significantly.
▪︎Consider male circumcision. There’s evidence that male circumcision can help reduce a man’s risk of acquiring HIV.
▪︎Get tested and know your partner’s HIV status. Talk to your partner about HIV testing and get tested before you have sex. Your partner need to be tested and to receive medical care if they have the virus. They also need to know their HIV status so that they don’t infect others. Use a testing locator from the Centers for Disease Control and Prevention (CDC) to find an HIV testing location near you.
▪︎Avoid multiple sexual partners. The more partners you have, the more likely you are to have a partner with HIV whose HIV is not well controlled or to have a partner with a sexually transmitted disease (STD). Both of these factors can increase the risk of HIV transmission.
▪︎Get tested and treated for STDs. Insist that your partners get tested and treated too. Having an STD can increase your risk of becoming infected with HIV or spreading it to others.
▪︎Talk to your health care provider about pre-exposure prophylaxis. Pre-exposure prophylaxis (PrEP) can help prevent HIV infection in people who don’t have HIV but who are at high risk of becoming infected with HIV.PrEP involves taking a specific HIV medicine every day. PrEP is most effective when taken consistently each day. According to the Centers for Disease Control and Prevention (CDC), by taking PrEP every day, a person can lower their risk of getting HIV from sex by more than 90% and from injection drug use by more than 70%.
Preventing Mother -To -Child Transmission Of HIV
Mother-to-child transmission of HIV is the spread of HIV from a woman with HIV to her child during pregnancy, childbirth (also called labor and delivery), or breastfeeding (through breast milk).Pregnant women with HIV receive HIV medicines during pregnancy and childbirth to prevent mother-to-child transmission of HIV. In some situations, a woman with HIV may have a scheduled cesarean delivery (sometimes called a C-section) to prevent mother-to-child transmission of HIV during delivery. Babies born to women with HIV receive HIV medicines for 4 to 6 weeks after birth. The HIV medicines reduce the risk of infection from any HIV that may have entered a baby’s body during childbirth. Because HIV can be transmitted in breast milk, women with HIV should not breastfeed their babies. Baby formula is a safe and healthy alternative to breast milk. If a woman takes HIV medicines during pregnancy and childbirth and her baby receives HIV medicines for 4 to 6 weeks after birth, the risk of transmitting HIV can be lowered to 2% or less.
Post-Exposure Prophylaxis (PEP)
Post-exposure prophylaxis (PEP) involves taking antiretroviral (ARV) medicines very soon after a possible exposure to HIV to prevent becoming infected with HIV. PEP should be started as soon as possible to be effective and always within 72 hours (3 days) after a possible exposure to HIV. If your health care provider thinks PEP is right for you, you’ll take 3 or more ARV medicines every day for 28 days.
Testing And Counseling Related To Tuberculosis Cure
Tuberculosis (TB) is the most common presenting illness and cause of death among people with HIV. It is fatal if undetected or untreated and is the leading cause of death among people with HIV, responsible for 1 of 3 HIV-associated deaths. Individuals who are diagnosed with HIV and active TB should urgently start effective TB treatment (including for multi-drug resistant TB) and ART. TB preventive therapy should be offered to all people with HIV who do not have active TB.
( The author is Chairman/Founder/Director Jammu and Kashmir Innovative Foundation For Transforming(JKIFTS) and presently works as a doctor at Narayana Hospital Jammu. Views are his own)