The world has made significant progress since the late 1990s, but HIV remains a major global public health issue. And like many other major health issues, it faces additional challenges during the COVID-19 pandemic.
HIV prevention, testing, treatment and care services are all being disrupted particularly in countries with fragile heath systems. The breakdown in essential HIV services due to COVID-19 is threatening lives. Any slowing down in provision of these services will leave many vulnerable populations at greater risk of HIV infection and AIDS-related deaths. Nevertheless, all over the world, health workers and community representatives are doing their utmost to keep services going, adopting innovative ways to overcome disruptions in services caused by COVID-19.
On 1 December WHO joins partners in paying tribute to all those working to provide HIV services, and in calling on global leaders and citizens to rally for “global solidarity” to maintain essential HIV services during COVID 19 and beyond. It is a call to focus on vulnerable groups who are already at risk and expand coverage to children and adolescents. And in 2020, the International Year of the Nurse and the Midwife, it is a call for more protection and support to these health workers who have long been on the frontline of HIV service delivery. We can all contribute to the effort to end AIDS and make the world a healthier place.
Human immunodeficiency virus (HIV) is an infection that attacks the body’s immune system, specifically the white blood cells called CD4 cells. HIV destroys these CD4 cells, weakening a person’s immunity against infections such as tuberculosis and some cancers. WHO recommends that every person who may be at risk of HIV should access testing. People diagnosed with HIV should be offered and linked to antiretroviral treatment as soon as possible following diagnosis. If taken consistently, this treatment also prevents HIV transmission to others.
If the person’s CD4 cell count falls below 200, their immunity is severely compromised, leaving them more susceptible to infections. Someone with a CD4 count below 200 is described as having AIDS (acquired immunodeficiency syndrome). HIV can be diagnosed using simple and affordable rapid diagnostic tests, as well as self-tests. It is important that HIV testing services follow the 5Cs: consent, confidentiality, counselling, correct results and connection with treatment and other services.
Many people do not feel symptoms of HIV in the first few months after infection and may not know that they are infected. Others may experience influenza-like symptoms, including fever, headache, rash and sore throat. However, these first few months are when the virus is most infectious..As the disease progresses, symptoms will be expanded and more pronounced. These can include swollen lymph nodes, weight loss, fever, diarrhoea and cough. HIV weakens the body’s ability to fight other infections, and without treatment people will become more susceptible to other severe illnesses such as tuberculosis, cryptococcal meningitis, bacterial infections and some cancers including lymphomas and Kaposi’s sarcoma.
Diagnosis of HIV uses rapid tests that provide same-day results and can be done at home, although a laboratory test is required to confirm the infection. This early identification greatly improves treatment options and reduces the risk of transmission to other people including sexual or drug-sharing partners. HIV is fully preventable. Effective antiretroviral treatment (ART) prevents HIV transmission from mother to child during pregnancy, delivery and breastfeeding. Someone who is on antiretroviral therapy and virally suppressed will not pass HIV to their sexual partners.
Condoms prevent HIV and other sexually transmitted infections, and prophylaxis use antiretroviral medicines to prevent HIV. Male circumcision is recommended in high-burden countries in eastern and southern Africa. Harm reduction (needle syringe programmes and opioid substitution therapy) prevents HIV and other blood-borne infections for people who inject drugs. HIV is treated with antiretroviral therapy consisting of one or more medicines. ART does not cure HIV but reduces its replication in the blood, thereby reducing the viral load to an undetectable level.
ART enables people living with HIV to lead healthy, productive lives. It also works as an effective prevention, reducing the risk of onward transmission by 96%. ART should be taken every day throughout the person’s life. People can continue with safe and effective ART if they adhere to their treatment. In cases when ART becomes ineffective due to reasons such as lost contact with health care providers and drug stockouts, people will need to switch to other medicines to protect their health.