HIV/AIDS

Introduction: Prior to 1970s, this illness was not widely known. Since then the global AIDS epidemic has become one of the greatest threats to human health and development. At the same time, much has been learnt about the disease process, as well as how to prevent and treat the disease. Statistics show that by end of 2009 there are around 33.3 million people are living with HIV( the virus that causes AIDS). Each year around 2.6 million more people become infected with HIV and 1.8 million die of AIDS. Over 7000 new HIV infections a day in 2009: 97% of them are from low and middle income countries. ~1/7 are from are children under the age of 15 About 6/7 are adults aged 15 and older, among whom: 51% among women 41% among young people (age 15-24) What are HIV and AIDS? The human immunodeficiency virus (HIV) is a retrovirus that infects cells of the immune system, destroying or impairing their function. As the infection progresses, the immune system becomes weaker, and the person becomes more susceptible to infections. The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS). AIDS can be defined by the occurrence of any of more than 20 opportunistic infections or HIV-related cancers. Risk Groups: HIV can be transmitted through unprotected sexual intercourse (vaginal or anal), and oral sex with an infected person; transfusion of contaminated blood; and the sharing of contaminated needles, sharing sex toys, syringes or other sharp instruments. It may also be transmitted between a mother and her infant during pregnancy, childbirth and breastfeeding. Snapshot of HIV/AIDS in developing countries The worst affected region is sub-Saharan Africa, where in a few countries more than one in five adults is infected with HIV. The epidemic is spreading most rapidly in Eastern Europe and Central Asia, where the number of people living with HIV increased by 54.2% between 2001 and 2009. In some African countries, life expectancies have fallen below 40 years, whereas they would have been above 60 without AIDS. 1) Sub-Saharan Africa:

Sub-Saharan Africas epidemics vary significantly from country to countrywith often at very high levels, particularly in southern Africa. While the rate of new HIV infections in the region has slowly declined, the number of people living with HIV slightly increased in 2008. Key regional issues discovered are Sex work, unprotected sex between men, homosexual behaviour (although highly stigmatized in the regions and injecting drug users. HIV prevention strategies such as safe sex behaviours and increased access to antiviral drugs have shown positive effect. In Africa, it is made harder by poverty, lack of resources and weak infrastructure. Misconceptions about transmission routes are widespread, and access to condoms is very low. At present, most African women are not even tested for HIV, let alone offered the drugs, counseling and infant formula that would help protect their babies. African countries have facilities for screening blood for HIV but most cannot guarantee the degree of safety found in the developed world. Because voluntary donors are rare, blood is often collected from family members and paid donors, which increases the risk of transmitting HIV. Use of poor quality test kits, unreliable supplies of equipment, and lack of trained staff can all compound in increasing this risk. 2) Asia: India accounts for roughly half of Asias HIV prevalence. While the regional epidemic appears to be stable overall, HIV prevalence is increasing in some parts of the region, such as Bangladesh and Pakistan. There is a need to improve HIV testing services. In China, fewer than one in three people living with HIV have been diagnosed. Asias epidemic is concentrated it specific population such as sex workers, MSM, Injection of drugs. Nowadays, it has been steadily expanding into lower risk population. In China, heterosexual transmission has now become the main mode of HIV transmission. In many Asian countries, men and women sex workers are at high risk of infection. More than 4.5 million Asians inject drugs. Harm reduction programs have been implemented to target drug users in countries like china and India. 3) Latin America (Peru, Mexico, Al Salvador, Argentina, Guatemala): Latin America is primarily home to low-level and concentrated epidemics. Men who have sex with men account for the largest share of HIV infections in Latin America. They have a one in three chance of becoming infected with HIV. Epidemics among injecting drug users in the region seem to be concentrated in the Southern Cone of South America and in the northern part of Mexico. As epidemics mature, the extent of heterosexual HIV transmission often increases. The HIV incidence appears to be growing among women in Central America and among indigenous populations. 4) Middle East and North Africa (Djibouti, Oman, Southern Sudan, Morocco, Egypt, Turkey, Lebanon, Yemen): There has been a shortage of timely and reliable epidemiological and behavioural data in this region. Throughout the region, HIV prevalence remains low. Although, studies show that there an increasing

number of people who are becoming infected with HIV while living abroad and exposing their sexual partners to infection on their return to their home country. A large number of South Asian men who are guest workers in the Middle East and North Africa risk becoming infected through contact with sex workers in the region. Coverage of antiretroviral therapy remains low throughout the region. There is is need for more health promotion strategies done of HIV screening. Epidemics in the Middle East and North Africa are largely concentrated among injecting drug users, men who have sex with men and sex workers and their clients. 5) Oceania: Papua New Guinea accounted for more than 99% of reported HIV cases in the region in 2007. Outside of Papua New Guinea, the island nations of New Caledonia, Fiji, French Polynesia and Guam account for the vast majority of HIV infections in the region. While most epidemics in the region appear to be stable, new infections in Papua New Guinea are on the rise. HIV infections are also increasing in Fiji. Heterosexual transmission accounts for 95% of HIV infections in Papua New Guinea, and 88% in Fiji. According to surveys conducted in the region, the level of HIV knowledge among young people is below the global average. What are the issues surrounding it? Stigma: The consequences of stigma and discrimination are wide-ranging: being shunned by family, peers and the wider community, poor treatment in healthcare and education settings, an erosion of rights, psychological damage, and a negative effect on the success of HIV testing and treatment. Factors that contribute to HIV/AIDS-related stigma include: HIV/AIDS is a life-threatening disease, and therefore people react to it in strong ways. HIV infection is associated with behaviors (such as homosexuality, drug addiction, prostitution or promiscuity) that are already stigmatized in many societies. Most people become infected with HIV through sex which often carries moral baggage. There is a lot of inaccurate information about how HIV is transmitted, creating irrational behavior and misperceptions of personal risk. HIV infection is often thought to be the result of personal irresponsibility. Religious or moral beliefs lead some people to believe that being infected with HIV is the result of moral fault (such as promiscuity or 'deviant sex') that deserves to be punished. What needs to be done? Certain extent of positive result can be achieved by change of laws. However, discrimination is sometimes deeply embedded in societys values. In this case, education is needed so they are able to challenge the discrimination, stigma and denial that they encounter. Institutional and other monitoring mechanisms can enforce the rights of people with HIV and provide powerful means of mitigating the worst effects of discrimination and stigma. Sex workers and AIDS epidemic:

While HIV prevalence is high amongst sex workers in some areas, in others it is relatively low, and they seem to play a fairly minor role in the spread of HIV. In most parts of Western Europe and North America, HIV transmission through paid sex is not considered to be a major issue. However, most parts of Asia, large numbers of sex workers are living with HIV, and this is influencing the overall pattern of the AIDS epidemic. The factors that put sex workers at risk vary between countries. In some places, sex workers commonly use drugs and share needles. The overlap between sex work and injecting drug use is linked to growing HIV epidemics in a number of countries throughout Eastern Europe and Asia. This issue is further compounded by a general lack of information on this group. Sex workers are a marginalized and often criminalized population, and are therefore very difficult to track and monitor. They can therefore be hard to reach with HIV prevention programs. The clients of sex workers are often referred to as a 'bridge' population for the transmission of HIV, meaning that they act as a link between high risk groups and the general population Treatments: Antivirals (cocktail of drugs) used to suppress viral replication and disrupt the action of virus. HIV prevention: Use male or female condoms correctly each time you have sex. Practice only non-penetrative sex. Remain faithful in a relationship with an uninfected equally faithful partner with no other risk behaviour. Abstain from sex. There is no cure for HIV. But with good and continued adherence to antiretroviral treatment, the progression of HIV in the body can be slowed to a near halt. Nurses role in HIV/AIDS pandemic: Nurses in this field educate individuals on how to prevent the spread of HIV, and help those infected cope with the physical, social, and psychological aspects of their disease, and to minimize pain and maximize independence. They also educate and support loved ones and family members of those infected with the disease. References: http://www.avert.org/ http://www.virologyj.com/content/8/1/401 http://www.who.int/topics/hiv_aids/en/ http://www.discovernursing.com/jnj-specialtyID_216-dsc-specialty_detail.aspx http://www.unaids.org/en/ http://www.nsna.org/Portals/0/Skins/NSNA/pdf/Imprint_AprMay07_Feat_HIV.pdf http://www.phac-aspc.gc.ca/aids-sida/info/index-eng.php