ANSWER
To reach the new proposed global 95–95–95 targets set by UNAIDS, we will need to redouble our efforts to avoid the worst-case scenario of 7.7 million HIV-related deaths over the next ten years, increasing HIV infections due to HIV service disruptions during COVID-19, and the slowing public health response to HIV.
HIV remains a significant global public health issue, having claimed 40.1 million [33.6–48.6 million] lives.
In 2021, 650 000 [510 000–860 000] died from HIV-related causes, and 1.5 million [1.1–2.0 million] people acquired HIV.
There is no cure for HIV infection. However, with increasing access to effective HIV prevention, diagnosis, treatment and care, including for opportunistic infections, HIV infection has become a manageable chronic health condition, enabling people living with HIV to lead long and healthy lives.
An estimated 38.4 million [33.9–43.8 million] people were living with HIV at the end of 2021, two-thirds of whom (25.6 million) are in the WHO African Region.
Overview
The human immunodeficiency virus (HIV) targets the immune system. It weakens people’s defense against many infections and some types of cancer that people with healthy immune systems can more easily fight off. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient. CD4 cell count typically measures immune function.
The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS), which can take many years to develop if not treated, depending on the individual. The development of certain cancers, infections or other severe long-term clinical manifestations defines AIDS.
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 after illness, many are unaware of their status until the later stages. In the first few weeks after the initial infection, people may experience no symptoms or an influenza-like illness, including fever, headache, rash or sore throat.
As the infection progressively weakens the immune system, they can develop other signs and symptoms, such as swollen lymph nodes, weight loss, fever, diarrhea and cough. Without treatment, they could also develop severe illnesses such as tuberculosis (TB), cryptococcal meningitis, severe bacterial infections, and cancers such as lymphomas and Kaposi’s sarcoma.
Transmission
HIV can be transmitted via the exchange of a variety of body fluids from infected people, such as blood, breast milk, semen and vaginal secretions. HIV can also be transmitted from a mother to her child during pregnancy and delivery. Individuals cannot become infected through regular day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water.
It is important to note that people with HIV taking ART and who are virally suppressed do not transmit HIV to their sexual partners. Early access to ART and support to remain on treatment is therefore critical not only to improve the health of people with HIV but also to prevent HIV transmission.
Risk factors
Behaviors and conditions that put individuals at greater risk of contracting HIV include:
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having condomless anal or vaginal sex;
having another sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhea and bacterial vaginosis;
engaging in harmful use of alcohol and drugs in the context of sexual behavior;
sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs;
receiving unsafe injections, blood transfusions and tissue transplantation, and medical procedures that involve unsterile cutting or piercing; and
experiencing accidental needle stick injuries, including among health workers.
Diagnosis
HIV can be diagnosed through rapid diagnostic tests that provide same-day results. This dramatically facilitates early diagnosis and linkage with treatment and care. People can also use HIV self-tests to test themselves. However, no single test can provide a complete HIV positive diagnosis; confirmatory testing is required, conducted by a qualified and trained health or community worker at a community center or clinic. HIV infection can be accurately detected using WHO-prequalified tests within a nationally approved testing strategy and algorithm.
Most widely-used HIV diagnostic tests detect antibodies produced by the person as part of their immune response to fight HIV. Most people develop antibodies to HIV within 28 days of infection. During this time, people experience the so-called window period – when HIV antibodies haven’t been produced in high enough levels to be detected by standard tests and when they may have had no signs of HIV infection, but also when they may transmit HIV to others. After illness without treatment and viral suppression, an individual may send HIV transmission to a sexual or drug-sharing partner or for pregnant women to their infant during pregnancy or the breastfeeding period.
Following a positive diagnosis, people should be retested before they are enrolled in treatment and care to rule out any potential testing or reporting errors prior to starting life-long treatment. It is essential to support people with HIV to stay on treatment and provide counseling messages and services when there are concerns about the accuracy of their diagnosis or if they stop treatment and care and must be re-engaged.
While testing for adolescents and adults has been made simple and efficient, this is not the case for babies born to HIV-positive mothers. Rapid antibody testing is insufficient for children under 18 months of age to identify HIV infection – virological testing must be provided as early as birth or at six weeks. New technologies are now available to perform this test at the point of care and enable same-day results, accelerating appropriate linkage with treatment and care.
Prevention
Individuals can reduce the risk of HIV infection by limiting exposure to risk factors. Critical approaches for HIV prevention, which are often used in combination, include:
male and female condom use;
prevention, testing and counseling for HIV and STIs;
voluntary medical male circumcision (VMMC);
use of antiretroviral drugs (ARVs) for prevention (oral PrEP and long-acting products), the dapivirine vaginal ring and injectable long-acting cabotegravir;
harm reduction for people who inject and use drugs; and
elimination of mother-to-child transmission (MTCT) of HIV.
HIV is not transmitted if a person’s sexual partner is virally suppressed on ART. Increasing access to testing and supporting linkage to ART is essential to HIV prevention.
Treatment
HIV disease can be managed by treatment regimens composed of a combination of antiretroviral (ARV) drugs. Current antiretroviral therapy (ART) does not cure HIV infection but suppresses viral replication and allows an individual’s immune system recovery to strengthen and regain the capacity to fight off opportunistic infections and some cancers.
Since 2016, WHO has recommended Treat All: that all people living with HIV be provided with lifelong ART, including children, adolescents, adults and pregnant and breastfeeding women, regardless of clinical status or CD4 cell count.
By June 2022, 189 countries had already adopted this recommendation, covering 99% of all people living with HIV globally. In addition to the Treat All strategy, WHO recommends a rapid ART initiation to all people living with HIV, including offering ART on the same day as a diagnosis among those who are ready to start treatment. By June 2022, 97 countries reported adopting this policy, and almost two-thirds said country-wide implementation.
Globally, 28.7 million people living with HIV were receiving ART in 2021. Global ART coverage was 75% [66–85%] in 2021. However, more efforts are needed to scale treatment, particularly for children and adolescents. Only 52% [42–65%] of children (0–14 years old) received ART at the end of 2021.
Advanced HIV disease remains a persistent problem in the HIV response. People continue to present or re-present for care with advanced immune suppression, putting them at a higher risk of developing opportunistic infections. WHO supports countries in implementing the advanced HIV disease care package to reduce illness and death.
WHO response
Global health sector strategies on, respectively, HIV, viral hepatitis, and sexually transmitted infections for the period 2022–2030 (GHSSs) guide the health sector in implementing strategically focused responses to achieve the goals of ending AIDS, viral hepatitis B and C and sexually transmitted infections by 2030.
The 2022–2030 strategies recommend shared and disease-specific country actions supported by actions by WHO and partners. They consider previous years’ epidemiological, technological, and contextual shifts, foster learnings across the disease areas, and create opportunities to leverage innovations and new knowledge for effective responses to HIV, viral hepatitis, and sexually transmitted infections.
The strategies call for a precise focus to reach the most affected and at risk for each disease that addresses inequities. They promote synergies under a universal health coverage and primary health care framework and contribute to achieving the 2030 Agenda for Sustainable Development goals.
The Seventy-fifth World Health Assembly requested progress reports on the implementation of the strategies in 2024, 2026, 2028 and 2031, noting that the 2026 report will provide a mid-term review based on the progress made in meeting the strategies’ 2025 targets.
The strategic directions of the GHSSs 2022–2030 are to:
deliver people-centered evidence-based services
optimize systems, sectors and partnerships for impact
generate and use data to drive decisions for action
engage empowered communities and civil society
foster innovation for accelerated movement.
As a founding cosponsor of the UNAIDS Joint Programme, WHO takes the lead on HIV testing, treatment and care, resistance to HIV medicines and HIV/TB co-infection. WHO jointly coordinates work with UNICEF on EMTCT of HIV and pediatric AIDS and works with UNFPA on integrating SRHR and HIV. With the World Bank, WHO convenes actions to drive progress towards achieving universal health coverage, including with UNICEF, through primary health care.
QUESTION
The discussion must address the topic. At least 500 words in your post, minimum of two scholarly references in APA format (7th edition) within the last 5 years published. No plagiarism please.
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