HIV  – the Human Immunodeficiency Virus, is the virus that causes Acquired Immune Deficiency Syndrome (AIDS) and is transmitted by blood and body fluids.

• There are an estimated 38 million people around the world who are living with HIV
• 8,45 million of them live in South Africa.
• Only 5,7 million are on ARVs in South Africa.
• Approximately 4000 new infections occur per day in South Africa. (average 1,5 million per year.)
• In 2022, approximately 630,000 people died of AIDS-related illness.

The condition that is referred to as AIDS is caused by HIV damaging the immune system cells until the immune system can no longer fight off other infections that it would usually be able to prevent.
If left untreated, it takes around ten years on average for someone with HIV to develop AIDS. However, this average is based on the person with HIV having a reasonable diet, and someone who is malnourished may well progress from HIV to AIDS more rapidly.

Allinder & Fleishman stated in 2019 in an article ”The World’s Largest HIV Epidemic in Crisis: HIV in South Africa”:

”New infections in young men and women remain alarmingly high (nearly 87 % of the total), and viral suppression rates, a key to preventing those living with the virus from passing it on, are under 50 % for those 15-24 years old.

With approximately 45 % of the population under the age of 25, the sheer numbers of those becoming infected and overall prevalence of HIV will stay alarmingly high without a massive decline in the new HIV infection rate.”

Key facts

• HIV continues to be a significant global public health issue, having claimed more than 35 million lives so far. In 2015, 1.1 (940,000–1.3 million) million people died from HIV-related causes globally.
• Sub-Saharan Africa is the most affected region, with 25.6 (23.1–28.5) million people living with HIV in 2015. Also, sub-Saharan Africa accounts for two-thirds of the global total of new HIV infections.
• HIV infection is often diagnosed through rapid diagnostic tests (RDTs), which detect the presence or absence of HIV antibodies. These tests usually provide same-day test results, essential for same-day diagnosis, early treatment, and care.
• There is no cure for HIV infection. However, 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 and productive lives.
• It is estimated that currently, only 54% of people with HIV know their status. In 2014, approximately 150 million children and adults in 129 low- and middle-income countries received HIV testing services.
• Only half of the people who tested positive for HIV are receiving antiretroviral therapy (ART) globally.
• Between 2000 and 2015, new HIV infections have fallen by 35%, and AIDS-related deaths have fallen by 28%, with some 7.8 million lives saved as a result of international efforts that led to the global achievement of the HIV targets of the Millennium Development Goals.
• Expanding ART to all people living with HIV and expanding prevention choices can help avert 21 million AIDS-related deaths and 28 million new infections by 2030.

How is HIV transmitted from one person to another?

There are various ways a person can become infected with HIV:

• Unprotected sexual intercourse with an infected person: Sexual intercourse without a condom carries the risk of HIV infection.

• Contact with an infected person’s blood: If sufficient blood from somebody who has HIV enters someone else’s body, then HIV can be passed on in the blood.

• Use of infected blood products: Many people in the past have been infected with HIV by the use of blood transfusions and blood products which were contaminated with the virus. In much of the world, this is no longer a significant risk, as blood donations are routinely tested for HIV.

• Injecting drugs: HIV can be passed on when injecting equipment that an infected person has used is then used by someone else. In many parts of the world, often because it is illegal to possess them, injecting equipment or works are shared.

• From mother to child: HIV can be transmitted from an infected woman to her baby during pregnancy, delivery and breastfeeding.

Frequent questions about HIV

Question 1: Can an HIV-positive woman have an HIV-negative baby?

Yes,  she can.

• The couple needs to go for counselling before trying to get pregnant.
• The mother and father need to be on ARVs and have an undetectable viral load in their blood before they try to fall pregnant.
• Once the mother is pregnant, she has to continue taking ARVs right through the pregnancy.
• When the baby is born, the baby will be given ARV drops for six weeks after birth and then have a blood test to make sure the baby is negative.
• The mother continues with ARVs and is encouraged to breastfeed.
• South Africa has nearly eradicated mother-to-child transmission with this regime.

Question 2: What can a patient expect within the first six months of ARV therapy?

Remember these points:

– Common symptoms include stomach and flu-like symptoms, headache, dizziness, vivid dreams, rash, and hepatitis. Symptoms may worsen over time. Talk to your healthcare provider about managing side effects so you can continue taking the drugs every day.

– If you don’t take ARVs consistently, your body can become resistant to the drug, and it won’t work as well against HIV. If side effects are life-threatening, you should switch to a different ARV medicine. There are about three types available. The newest pill, which combines three types of ARVs in one tablet, is considered to have the fewest side effects.

Question 3: Where did HIV come from?

We do not know.

”Scientists have different theories about the origin of HIV, but none have been proven. It is believed that HIV originated in Kinshasa, in the Democratic Republic of Congo, around 1920, when HIV crossed species from chimpanzees to humans. The earliest known case of HIV was from a blood sample collected in 1959 from a man in Kinshasa, Democratic Republic of Congo. (How he became infected is not known.)

Genetic analysis of this blood sample suggests that HIV-1 may have stemmed from a single virus in the late 1940s or early 1950s. We know the virus has existed in the United States since at least the mid-to late-1970s. From 1979-1981, rare types of pneumonia, cancer, and other illnesses were being reported by doctors in Los Angeles and New York among many gay male patients.

These were conditions not usually found in people with healthy immune systems. In 1982, public health officials began to use the term “acquired immunodeficiency syndrome,” or AIDS, to describe the occurrences of opportunistic infections, Kaposi’s sarcoma (KS), and Pneumocystis carinii pneumonia (PCP) in previously healthy men. Formal tracking (surveillance) of AIDS cases began that year in the United States.

The cause of AIDS is a virus that scientists isolated in 1983. The virus was first named HTLV-III/LAV (human T-cell lymphotropic virus-type III/ lymphadenopathy-associated virus) by an international scientific committee. This name was later changed to HIV (human immunodeficiency virus).”

Source: History of HIV and AIDS overview | Avert. https://www.avert.org/professionals/history-hiv-aids/overview

Question 4: How long does it take for HIV to cause AIDS?

Since 1992, scientists have estimated that about half of people with HIV develop AIDS within ten years after getting infected. This time varies from person to person and depends on many factors, including health and behaviour.

Today, there are medical treatments that can slow down how fast HIV weakens the immune system. Other treatments can prevent or cure some of the illnesses related to AIDS, but they do not cure AIDS itself. Just like with other diseases, finding out early offers more options for treatment and preventive health care.

Question 5: Can I get HIV from kissing on the cheek?

Since 1992, scientists have estimated that about half of people with HIV develop AIDS within ten years after getting infected. This time varies from person to person and depends on many factors, including health and behaviour.

Today, there are medical treatments that can slow down how fast HIV weakens the immune system. Other treatments can prevent or cure some of the illnesses related to AIDS, but they do not cure AIDS itself. Just like with other diseases, finding out asap offers more options for treatment and preventive health care.

Question 6: Can I get HIV from open-mouth kissing?

HIV is not easily spread, so kissing on the cheek is very safe. Your unbroken skin provides a strong barrier, even if the other person has the virus. No one has become infected through everyday social contact, such as dry kisses, hugs, and handshakes. Animals also cannot transmit the disease.

Question 7: Can I get HIV from performing oral sex?

Yes, you can become infected with HIV through performing oral sex. There have been a few cases of HIV transmission from performing oral sex on a person infected with HIV. While no one knows exactly what the degree of risk is, evidence suggests that the risk is less than that of unprotected anal or vaginal sex. Blood, semen, pre-seminal fluid, and vaginal fluid all may contain the virus. Cells in the mucous lining of the mouth may carry HIV into the lymph nodes or the bloodstream. The risk increases:

• if you have cuts or sores around or in your mouth or throat;
• if your partner ejaculates in your mouth; or ·
• if your partner has another sexually transmitted disease (STD).

Question 8: Can I get HIV from someone performing oral sex on me?

Yes. When having oral sex, use a condom on the penis or a barrier between the mouth and the vagina to reduce the risk of HIV transmission.

Question 9: Can I get infected with HIV from mosquitoes?

Since the beginning of the HIV epidemic, there has been worry about HIV being transmitted by biting and bloodsucking insects like mosquitoes. However, studies by the CDC and others have found no evidence of HIV being transmitted through mosquitoes or any other insects, even in areas with many AIDS cases and large mosquito populations. Despite intense efforts to find such cases, the absence of such outbreaks supports the conclusion that insects do not transmit HIV.

Source: The HIVE. https://hivedmonton.blogspot.com/

Question 10: Can HIV be passed on through breast milk?

HIV can be passed from a mother to her baby during pregnancy, and it can also be found in breast milk, which means that breastfeeding might lead to HIV transmission. The challenge in determining the risk of HIV transmission through breastfeeding is that it’s difficult to know if a baby is already infected at birth. The actual likelihood of HIV transmission through breast milk is not known. However, it’s believed to be more probable if a mother is newly infected, which makes her more infectious. Women with lower levels of the virus (those taking antiretroviral medications) are thought to be less likely to transmit HIV through breast milk.

For more information on pregnancy and preventing mother-to-child transmission: http://www.avert.org/fact-sheet-hiv-pregnancy.htm

HIV OVERVIEW

https://www.thebody.com/health/hiv-aids

References:

Who updated the fact sheet on HIV/AIDS (13 July 2016) | communitymedicine4all. https://communitymedicine4all.com/2016/07/15/who-updates-fact-sheet-on-hivaids-13-july-2016/

Health Days 2016 – World AIDS Day. https://www.moh.gov.sa/en/HealthAwareness/healthDay/2016/Pages/HealthDay-2016-12-01.aspx

What is HIV / AIDS – Meaning and definition – Pallipedia. https://pallipedia.org/hiv-aids/

Facts About HIV and AIDS We Need to Start Talking About. https://www.mic.com/articles/138161/facts-about-hiv-and-aids-we-need-to-start-talking-about

What is HIV? https://www.lovbyte.com/what-is-hiv

Facts About HIV and AIDS We Need to Start Talking About. https://www.mic.com/articles/138161/facts-about-hiv-and-aids-we-need-to-start-talking-about

AIDS | Discovery Series. https://discoveryseries.org/courses/aids/lessons/the-roots-of-the-crisis/