HIV and AIDS: A Global Health Challenge
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0HIV (Human Immunodeficiency Virus) remains a formidable global public health concern, affecting millions of lives and posing ongoing challenges. The virus, which leads to AIDS (Acquired Immunodeficiency Syndrome), has claimed approximately 40.4 million lives to date, with 39.0 million people living with HIV as of the end of 2022. This article delves into key facts, transmission methods, risk factors, diagnosis, prevention, and treatment options, emphasizing the ongoing efforts by global health organizations to combat the epidemic. Bangladesh initiated an early response to the HIV epidemic in the mid-1980s, and significant enhancements have been made since. This article reviews available data sources, including routine surveillance, general population surveys, and research studies, to understand the dynamics of the HIV epidemic in Bangladesh.
HIV has left an indelible mark on global health, causing the death of 630,000 people in 2022 alone and infecting 1.3 million new individuals. Despite these staggering figures, access to effective prevention, diagnosis, treatment, and care has transformed HIV into a manageable chronic health condition. Currently, 95% of all people living with HIV (PLHIV) should have a diagnosis, 95% of those should be taking lifesaving antiretroviral treatment (ART), and 95% of PLHIV on treatment should achieve a suppressed viral load by 2025, as part of the global effort to end the HIV epidemic by 2030.
HIV targets the body's white blood cells, specifically weakening the immune system. This increased susceptibility to infections and certain cancers characterizes the progression to AIDS, the most advanced stage of the disease. The virus is primarily transmitted through body fluids such as blood, breast milk, semen, and vaginal fluids. Contrary to misconceptions, it is not spread through casual contact like kisses, hugs, or sharing food.
Symptoms vary across the stages of infection. In the initial weeks post-infection, individuals may not exhibit symptoms or may experience flu-like symptoms, including fever, headache, rash, and sore throat. As the infection progresses, signs such as swollen lymph nodes, weight loss, fever, diarrhea, and cough may manifest. Untreated HIV can lead to severe illnesses, including tuberculosis, cryptococcal meningitis, and certain cancers, exacerbating the impact on health.
Understanding the modes of HIV transmission is crucial for prevention. The virus can be transmitted through the exchange of various body fluids, such as blood, breast milk, semen, and vaginal secretions. Mother-to-child transmission is also a significant concern. Importantly, people with HIV who are on ART with an undetectable viral load do not transmit the virus to their sexual partners. High-risk behaviors and conditions, including unprotected sex, other sexually transmitted infections (STIs), substance abuse, needle sharing, and accidental needle stick injuries, elevate the risk of contracting HIV.
Rapid diagnostic tests enable same-day HIV diagnosis, facilitating early intervention and linkage to treatment. Additionally, HIV self-tests offer a convenient option for individuals. However, confirmatory testing is essential and is typically conducted by qualified health or community workers. Prevention strategies focus on reducing the risk of HIV infection through condom use, regular testing, voluntary medical male circumcision, harm reduction for drug users, and antiretroviral drugs.
While there is no cure for HIV, ART effectively manages the virus, allowing individuals to lead full and healthy lives. ART inhibits viral replication, strengthens the immune system, and prevents the progression to AIDS. Continuous ART is required for life, and pregnant women with HIV should initiate treatment promptly to protect both maternal health and prevent transmission to the fetus or through breastfeeding.
Global health organizations, including WHO, the Global Fund, and UNAIDS, have devised strategies aligned with the Sustainable Development Goal (SDG) target of ending the HIV epidemic by 2030. These strategies emphasize diagnosis, treatment, and achieving suppressed viral loads among PLHIV. Despite progress, challenges persist, with 86% of people living with HIV knowing their status, 76% receiving ART, and 71% achieving suppressed viral loads in 2022.
While significant strides have been made, advanced HIV disease remains a concern. WHO supports countries in implementing a comprehensive advanced HIV disease care package to reduce illness and death. Innovations in HIV medicines, including injectable formulations and short-course treatments for opportunistic infections, represent promising developments for the future.
The Government of Bangladesh (GoB) established the National AIDS Committee (NAC) in 1985, preceding the first detected HIV case in 1989. The NAC, supported by the National AIDS/STD Programme (NASP), plays a crucial role in coordinating and implementing HIV-related initiatives. Comprehensive policies, National Strategic Plans (NSP), and guidelines on antiretroviral treatment, harm reduction, and voluntary counseling have been developed.
Non-Governmental Organizations (NGOs) actively collaborate on prevention, with approximately 235 NGOs linked through the STI/AIDS Network. Funding comes from various sources, including the GoB, Global Fund, World Bank, DFID, GTZ, and USAID.
Risk Behaviors and Injection Practices
Data reveal risky injection-sharing behaviors among Injecting Drug Users (IDUs). The Behavioral Surveillance Survey (BSS) in 2003–2004 highlighted high needle-sharing rates among IDUs in Dhaka. Qualitative insights showed varied beliefs about safe sharing practices. Although 48.3% of IDUs obtained needles from the NSP, 57.8% shared due to the lack of sterile needles. Sexual behavior among IDUs indicated risky practices, with 8% buying sex from sex workers.
Female IDUs
Female IDUs, a marginalized group, exhibited higher needle-sharing rates than males. A cohort study identified 16.5% with HIV, indicating vulnerability. Networking proved effective in reaching HIV-positive IDUs and their partners.
Interventions and Modeling
Modeling exercises assessed the impact of interventions among IDUs. The NSP of CARE Bangladesh in Dhaka reduced HIV incidence by 89.5%, suggesting intervention effectiveness.
Sexual Transmission and Most At-Risk Populations
Female sex workers showed low HIV prevalence (<1%) but engaged in high-risk behaviors. Risky behaviors were observed among male sex workers and Hijra. MSM (males having sex with males) exhibited high-risk behaviors, and a study explored the complexity of their relations with women.
Migration, Gender, and Stigma
Migration, especially by male workers, contributes to HIV introduction. Returnee-migrants form a vulnerable group, and studies suggest the need for effective interventions. Stigma, gender norms, and cultural barriers pose challenges in addressing HIV risks.
Challenges and Future Perspectives
While Bangladesh has made progress, challenges persist. Low condom use remains a barrier, and comprehensive strategies are needed to address cultural norms and gender issues. Ongoing research is crucial for effective interventions.
HIV and AIDS continue to impact millions of lives globally, underscoring the need for sustained efforts in prevention, diagnosis, and treatment. The progress made in transforming HIV into a manageable condition demonstrates the effectiveness of comprehensive strategies. Ongoing global initiatives, guided by organizations like WHO, strive to achieve ambitious targets to end the HIV epidemic by 2030. As the world collectively works towards this goal, it remains imperative to address challenges, reduce stigma, and ensure equitable access to prevention and treatment services. The battle against HIV and AIDS is multifaceted, requiring ongoing collaboration, innovation, and a commitment to building a healthier future for all.