Testing for clarity and treatment for longevity (On World AIDS Day)

1st December is observed as World AIDS Day  since 1988. It is a global campaign to raise awareness about HIV/AIDS, honour those who have lost their lives to the disease and stand in solidarity with people living with HIV.

Despite decades of progress in the fight against HIV, around 40 million people worldwide are living with the virus, with women and girls representing more than half of those affected.

In 2024, approximately 630,000 people worldwide died due to AIDS-related illnesses. With 1.3 million new HIV infections still occurring globally each year, HIV/AIDS is a significant global health challenge.

Sustained political will and resource mobilisation are required to end the AIDS pandemic as a public health threat by 2030. 

This is one of the UN Sustainable Development Goal 3.3. In the absence of a cure, eradication is expected by minimising new infections. The theme of this year’s World AIDS Day is “Overcoming disruption, transforming the AIDS response”.

Human immunodeficiency virus (HIV) is a lentivirus, part of the family Retroviridae. It is transmitted via blood and genital secretions, infecting immune cells expressing CD4 receptors.

Continuous HIV replication leads to both virus and immune-mediated destruction of CD4 cells. Over time, this allows opportunistic infections, which are the defining feature of Acquired Immune Deficiency Syndrome (AIDS).

Not everyone with HIV will develop AIDS if detected early and treated properly. The oldest proven HIV infection was in an adult male in Kinshasa, Democratic Republic of Congo, in 1959.

Studies have indicated that the HIV epidemic probably originated in central Africa in the 20th century, when there were multiple cross-species transmission events from primates to humans involving a simian lentivirus, most likely through hunting practices.  

AIDS was first recognised in 1981, and HIV was identified as its cause in 1983. There are two types of HIV: HIV-1 and HIV-2.

The former is more common with a worldwide presence and is more easily transmitted. It progresses rapidly as well.

HIV-2 mostly present in West Africa, is transmitted less efficiently, tends to have a longer symptomless period and is less likely to progress to AIDS.

Both are transmissible in the same ways: Sexual contact, Exposure to blood that contains the virus and Pregnancy, birth or breastfeeding.

In early stages, both types lead to similar symptoms: Fever, chills or night sweats/ Muscle aches/ Coughing/ Rash/ Sore throat/diarrhoea.

Once these symptoms disappear, people enter the chronic (quiet) phase, where no symptoms appear. The immune system is damaged slowly, and in about 8- 10 years, the body becomes vulnerable to infections that a healthy immune system would normally fight off.

The final stage of HIV infection is AIDS. The only way to know our HIV status is to get tested. It gives us clarity, enabling us to take control of our health. 

A positive result allows for early treatment to manage the infection and prevent its transmission to others, while a negative result gives us peace of mind and increases our commitment to keep it that way.

Advantages of early detection include- ability to control infection while the immune system is still strong, reduced side effects of medicines, longer survival rates, prevention of onward virus transmission and opportunity for testing for other diseases like syphilis and Hepatitis B in high-risk individuals.

There are three types of HIV tests: antibody tests, antigen/antibody tests and nucleic acid tests. The state government has Integrated Counselling and Testing Centres (ICTC), where people are counselled and tested for HIV free of cost.

One can get checked at private labs without a prescription and even test themselves in the privacy of their homes using easy-to-use kits.

Anti-Retroviral Therapy is the mainstay of HIV treatment. It is aimed at managing the viral load, helping the immune function to recover and enhancing the quality of life for individuals living with HIV.

ART regimens consist of a combination of antiretroviral drugs that work synergistically to suppress HIV replication.

High adherence to ART is crucial for viral suppression and prevention of resistance. Periodic screening for drug toxicity and side effects is essential to ensure long-term safety of ART.

Appropriate regimen selection is vital for optimising treatment outcomes. Regular monitoring of viral load and CD4 count is effective in assessing the efficacy of ART and modifying it wherever needed.

ART is continuously improving, ensuring efficacy with fewer side effects, and this has transformed HIV from a fatal diagnosis in the 1980s to a manageable chronic condition presently.

Due to its success, ART is sometimes called the Lazarus drug, referring to the biblical story about a man raised from the dead.

 The longevity provided by ART allows patients to live productive lives. On 1st April 2004, the Indian Government launched Free ART for Persons living with HIV (PLHIV).

ART centres provide medicines, treatment monitoring, counselling and diagnosis/treatment of opportunistic infections.

Assam has a low HIV prevalence compared to the national average, but the number of new infections is rising. Neighbouring states of Mizoram, Nagaland and Manipur have high HIV prevalence.

The state is vulnerable since it is the gateway of the northeastern states, shares borders with high-prevalence states, has high bridge populations like migrant workers and long-distance truckers and a large youth population.

Injectable drug use is the major driver of HIV spread in the state. Testing and treatment of HIV are ensured by an environment free from stigma.

With awareness of HIV, myths disappear, facts appear, people are empowered, fear drops, and support rises. World AIDS Day is a reminder that the fight against HIV is far from over, and we cannot look away.

People with HIV face enormous challenges socially, psychologically and financially. At the height of the AIDS epidemic, Princess Diana shaking hands without gloves with people with AIDS sent a powerful message and helped to break down the intense stigma associated with the disease.

Every HIV patient deserves care without judgment. HIV cannot spread through casual contact like shaking hands, hugging, sharing food or utensils or using the same toilet.

Absence of a vaccine or a cure may seem depressing, but the fight for a cure isn’t over. This World AIDS Day, let’s choose kindness and facts over doubts and fears and embrace humanity.

Also Read: Knowledge is power – know your risk and spread the word