Human Immunodeficiency Virus (HIV) and acquired immunodeficiency syndrome (AIDS) remain significant global health issues. This article provides an updated and comprehensive guide to understanding HIV/AIDS, including its origins, transmission, testing, prevention, new treatments, and prognosis.
Origin of HIV/AIDS: Current Understanding in 2024
It is still widely believed that HIV originated in Central and Western Africa, with the first transmission from chimpanzees to humans occurring around the 1920s. This theory is supported by the fact that HIV-1, the most prevalent strain of the virus, is closely related to the Simian Immunodeficiency Virus (SIV) found in chimpanzees in this region.
The crossover to humans is thought to have happened when hunters came into contact with the blood of infected chimpanzees. This zoonotic transmission likely occurred through the handling and consumption of bushmeat. Once in humans, the virus began to spread locally, initially through parenteral transmission, which includes non-sexual routes such as contaminated needles used in medical treatments and vaccinations for tropical diseases like sleeping sickness.
Over time, as urbanisation and mobility increased, the virus spread more widely. Key locations like Léopoldville (now Kinshasa) in the Democratic Republic of Congo became significant epicentres from which HIV disseminated both within Africa and to other continents. The exponential rise in infections was further driven by social changes and movements, including post-colonial migrations and increased commercial sex work.
In the early 1980s, HIV was officially recognised as a new health condition after cases of rare diseases, such as Kaposi’s sarcoma and Pneumocystis pneumonia, were found among gay men in the United States. These observations led to the identification and isolation of the virus, marking the beginning of modern HIV/AIDS research and public health response.
This understanding of the origins and spread of HIV highlights the importance of continuous research and public health efforts to combat the virus effectively.
What is HIV/AIDS?
HIV is a virus that attacks the body’s immune system, specifically the CD4 cells (T cells), which can lead to AIDS if not treated. AIDS is the final stage of HIV infection, where the immune system is severely compromised, making the body vulnerable to opportunistic infections.
What are Opportunistic Infections?
Opportunistic infections are infections that occur more frequently and are more severe in individuals with weakened immune systems, such as those living with HIV/AIDS. These infections take advantage of the body’s weakened defences and can cause significant health problems. Some common opportunistic infections include:
- Pneumocystis Pneumonia (PCP): A type of pneumonia caused by the fungus Pneumocystis jirovecii, which primarily affects the lungs.
- Tuberculosis (TB): A bacterial infection that affects the lungs and can spread to other parts of the body.
- Cytomegalovirus (CMV): A viral infection that can affect the eyes, digestive tract, lungs, and other organs.
How does one Contract HIV?
HIV is transmitted through contact with certain body fluids from a person who has HIV. These fluids include blood, semen, vaginal fluids, rectal fluids, and breast milk. Common methods of transmission include unprotected sexual contact, sharing needles, and from mother to child during childbirth or breastfeeding.
HIV Strains and Global Impact
There are two strains of HIV: HIV-1 and HIV-2. HIV-1 is more easily transmitted and is the cause of most of the 38 million infections worldwide. Currently, Sub-Saharan Africa has the highest number of infected people.
The Four Stages of HIV
- Seroconversion Illness: Shortly after infection, some people may experience mild flu-like symptoms. During this stage, the newly infected person is most infectious.
- Asymptomatic HIV: Despite the virus actively damaging the immune system, the person may remain healthy and show no symptoms.
- Symptomatic HIV: Without treatment, the person becomes increasingly vulnerable to opportunistic infections, leading to illness.
- Late-Stage HIV (AIDS): The immune system is severely damaged, leading to serious opportunistic infections and AIDS-defining illnesses such as cancer, tuberculosis, and pneumonia. Without treatment, HIV will eventually progress to AIDS and result in death.
Who Does HIV/AIDS Affect Most?
While anyone can be infected by HIV, certain populations are more vulnerable due to socio-economic circumstances and limited access to healthcare services. Women are disproportionately affected, largely due to gender inequalities, sexual violence, and sexual exploitation. Biologically, women, particularly younger women, are more susceptible to HIV than men. Other vulnerable groups include those aged 15-24 years, transgender people, prisoners, men who have sex with men, people who inject drugs, and sex workers.
“HIV does not discriminate – anyone can be infected with HIV.”
HIV/AIDS is Not Limited to Specific Populations
While HIV/AIDS initially had a significant impact on the gay community, it affects people of all sexual orientations and identities. Understanding this is crucial in reducing stigma and promoting widespread testing and prevention measures.
HIV Testing
Knowing one’s status is paramount to getting timeous treatment and care which assists in decreasing the spread of HIV/AIDS.
The Importance of Regular Testing
Regular HIV testing is vital for early detection and treatment. Early diagnosis can significantly improve the prognosis and quality of life for those living with HIV. Tests can be conducted through blood or saliva samples, with rapid tests providing results within 30 minutes.
HIV Prevention Strategies
The most effective way to combat HIV/AIDS is through prevention. Numerous strategies have been developed to decrease the spread of HIV, including:
- Behaviour Change Programmes: Promoting safer sexual practices and reducing risky behaviours.
- HIV/AIDS Education: Providing accurate information about HIV transmission and prevention.
- Sex Education: Educating individuals about safe sex practices.
- Condom Use: Encouraging the consistent and correct use of condoms.
- HIV Testing and Counselling: Facilitating early detection and providing support.
- Blood Supply Safety: Ensuring the blood supply is free from HIV.
- Prevention of Mother-to-Child Transmission (PMTCT): Reducing the risk of HIV transmission during pregnancy, childbirth, and breastfeeding.
- Harm Reduction for People Who Inject Drugs: Implementing needle exchange programs and providing clean needles.
- Male Circumcision: Reducing the risk of heterosexual men acquiring HIV.
Advanced Prevention Methods
- Pre-Exposure Prophylaxis (PrEP): A daily medication for individuals at high risk of HIV exposure. It is used alongside other prevention methods, such as for discordant couples where one partner is HIV-positive, and the other is not.
- Post-Exposure Prophylaxis (PEP): A month-long course of antiretroviral treatment given within 72 hours of potential HIV exposure, often used as a standard practice for rape survivors and healthcare workers exposed to HIV.
These prevention strategies, when combined, offer a comprehensive approach to reducing the spread of HIV and mitigating its impact on individuals and communities.
New Treatments and Prognosis
Current Treatment for HIV/AIDS: Antiretroviral Therapy (ART)
Antiretroviral therapy (ART) remains the cornerstone of HIV/AIDS treatment. ART involves the use of a combination of HIV medicines (antiretrovirals) to reduce the viral load in the body, maintain immune function, and prevent the progression to AIDS. The primary goals of ART are to achieve and maintain an undetectable viral load, which means the amount of HIV in the blood is so low that it cannot be detected by standard tests, and to improve the overall health and quality of life of individuals living with HIV.
Recent Advances and Long-Acting Options
Recent developments in ART include the introduction of long-acting injectable forms of ART, which can be administered less frequently than daily pills. For instance, cabotegravir and rilpivirine injections can be given once a month or every two months, providing a more convenient option for patients.
The Future of HIV/AIDS Treatment
Research is ongoing for an HIV vaccine and a potential cure. However, the introduction of long-acting injectable ART and advancements in gene therapy hold promise for the future of HIV treatment.
Progress in Knowledge and Treatment
Over the years, substantial progress has been made in understanding and treating HIV/AIDS. Modern treatments have transformed HIV from a fatal disease to a manageable chronic condition. Thus, enabling individuals to live long, healthy lives.
South Africa’s Response to HIV/AIDS
Despite South Africa’s challenging history in acknowledging and treating HIV, the country now boasts one of the world’s largest and most comprehensive HIV/AIDS prevention, treatment and care programmes. Additionally, South Africa has implemented a highly successful Prevention of Mother-to-Child Transmission (PMTCT) program.
Join the Fight Against HIV/AIDS
Eradicating HIV/AIDS requires a collective effort. Be part of the solution through Prevention, Treatment, Care, and Support Programmes as a counsellor. SACAP offers a range of accredited counselling courses. Graduates of SACAP’s Bachelor of Psychology Degree can register with the HPCSA as Registered Counsellors. This qualification enables you to provide selected professional counselling services and pursue further studies to become a Psychologist. For more information, enquire today.
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