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AIDS: What you need to know

By Doris Obinna
On December 1, the global community once again marked the World AIDS Day, as is the case every year. The event is usually a time to remember and  honour those who have lost their lives to AIDS and also a renewal of commitment to assist those who are living with or at risk of Human Immunodeficiency Virus (HIV). Also the event serves to celebrate caregivers, families, friends, and communities that support people living with HIV/AIDS.
HIV is a virus spread through certain body fluids that attack the body’s immune system, specifically the cluster of differentiation 4 (CD4 cells), often called T cells. Over time, HIV can destroy so many of these cells and makes it impossible for the body to fight off infections and diseases. When this happens, opportunistic infections or cancers take advantage of the weak immune system and wreak havoc in the body.
The theme for World AIDS Day 2017, “Increasing Impact through Transparency, Accountability and Partnerships,” reflects the U.S. government’s longstanding leadership in addressing global HIV/AIDS, increasing our impact to move epidemics from crisis toward control.
It also highlights the historic opportunity to accelerate progress toward controlling, and ultimately ending, the HIV/AIDS epidemic as a public health threat in countries around the world.  It emphasises the critical role of transparency, accountability, and partnerships in reaching these goals.
According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), Nigeria has the second largest HIV epidemic in the world and has one of the highest new infection rates in sub-Saharan Africa. Incidentally, many people living with HIV in Nigeria are unaware of their status due to insufficient recommended number of HIV testing and counselling centers.
On the other hand, though an estimated 1.1 million people are living with HIV in the United States, with better treatments, these people are now living longer and with a better quality of life than ever before.
It is pertinent to note that HIV is not a death sentence. People living with HIV could still live long. However, it is important that they make choices that keep them healthy and protect others.

Reducing the risk to others
HIV is spread through certain body fluids from HIV-infected persons: blood, semen (cum), pre-seminal fluid (pre-cum), rectal fluids, vaginal fluids, and breast milk. HIV is most often transmitted by having unprotected anal or vaginal sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV. In addition, a mother can pass HIV to her baby during pregnancy, during labour, through breastfeeding, or by pre-chewing her baby’s food.
The higher your viral load, the more likely you are to transmit HIV to others. When your viral load is low (called viral suppression, with less than 200 copies per milliliter of blood) or undetectable (about 40 copies per milliliter of blood), your chance of transmitting HIV is greatly reduced. However, this is true only if you can stay virally suppressed. One thing that can increase viral load is not taking HIV medicines the right way, every day.

HIV may not cause symptoms early. However, people who do have symptoms may mistake them for flu or mono. Early symptoms of HIV are called acute retroviral syndrome, which may include: belly cramps, nausea, or vomiting. Other signs are diarrhea, enlarged lymph nodes in the neck, armpits, and groin, fever, headache, muscle aches and joint pain, skin rash, sore throat and weight loss.
These first symptoms can range from mild to severe and usually disappear on their own after 2 to 3 weeks. But many people don’t have symptoms or they have such mild symptoms that they don’t notice them at this stage.
After the early symptoms go away, an infected person may not have symptoms again for many years. However, after a certain point, symptoms reappear and then remain.
Untreated HIV infection progresses in stages. These stages are dependent on your symptoms and the amount of the virus in the blood.

Stages of HIV
When people get HIV and don’t receive treatment, they will typically progress through the three stages of the disease. Medicine to treat HIV, known as antiretroviral therapy (ART), helps at all stages of the disease if taken the right way. Treatment can slow or prevent progression from one stage to the next. It can also dramatically reduce the chance of transmitting HIV to someone else.

Stage 1: Acute HIV infection: This occurs within 2 to 4 weeks after infection with HIV. At this stage, people may experience a flu-like illness, which may last for a few weeks. This is the body’s natural response to infection. When people have acute HIV infection, they have a large amount of virus in their blood and are very contagious. But people with acute infection are often unaware that they are infected because they may not feel sick right away or at all.
To know whether someone has acute infection, either a fourth-generation antibody/antigen test or a nucleic acid (NAT) test is necessary. If you think you have been exposed to HIV through sex or drug use and you have flu-like symptoms, seek medical care and ask for a test to diagnose acute infection.

Stage 2: Clinical latency (HIV inactivity or dormancy): This period is sometimes called asymptomatic HIV infection or chronic HIV infection. During this phase, HIV is still active but reproduces at very low levels. People may not have any symptoms or get sick during this time. For people who are not taking medicine to treat HIV, this period can last a decade or longer, but some may progress through this phase faster.
People who are taking medicine to treat HIV (ART) the right way, may be in this stage for several decades. It’s important to remember that people can still transmit HIV to others during this phase, although people who are on ART and stay virally suppressed (having a very low level of virus in their blood) are much less likely to transmit HIV than those who are not virally suppressed. At the end of this phase, a person’s viral load starts to go up and the CD4 cell count begins to go down. As this happens, the person may begin to have symptoms as the virus levels increase in the body, and the person moves into Stage 3.

Stage 3: Acquired immunodeficiency syndrome (AIDS): AIDS is the most severe phase of HIV infection. People with AIDS have such badly damaged immune systems that they get an increasing number of severe illnesses, called opportunistic illnesses. Without treatment, people with AIDS typically survive about three years. Common symptoms of AIDS include chills, fever, sweats, swollen lymph glands, weakness, and weight loss. People are diagnosed with AIDS when their CD4 cell count drops below 200 cells/mm or if they develop certain opportunistic illnesses. People with AIDS can have a high viral load and be very infectious.

How to know you have HIV
The only way to know for sure whether you have HIV is to get tested. Knowing your status is important because it helps you make healthy decisions to prevent getting or transmitting HIV. Some people may experience a flu-like illness within 2 to 4 weeks after infection (Stage 1 HIV infection). At advanced stage, there are other symptoms, which can last anywhere from a few days to several weeks. During this time, HIV infection may not show up on an HIV test, but people who have it are highly infectious and can spread the infection to others.
If you have these symptoms, however, this do not mean you have HIV. Each of these symptoms can be caused by other illnesses. The only way to determine whether you are infected is to be tested for HIV infection.
The acting Public Affairs Officer, Public Affairs Section, U.S. Consulate General, Kevin Krapf, said Lagos State AIDS Control Agency has been conducting a state-wide aggressive campaign, counselling and HIV/AIDS testing through mobile clinic initiative. Noting, however, that it is the state’s determination to ensure a zero prevalence of HIV in the state and to align with the strategic plan of the President’s Emergency Plan for AIDs Relief (PEPFAR).
Approximately four million Nigerians have received HIV counseling and testing services in 2017. Also, HIV prevention messages and activities have reached over 300,000 people identified as most-at-risk, and approximately 50,000 pregnant women have received antiretroviral drugs to prevent mother-to-child transmission of HIV.
Krapf said: “In mid-November this year, the United States Centers for Disease Control and Prevention (CDC) Nigeria, in collaboration with its implementing partners, organised a two-day symposium to examine efforts made in HIV/AIDS and TB intervention. Through this event,  the United States Mission in Nigeria brought together relevant HIV/AIDS stakeholders in Nigeria to share innovative strategies, successes attained, lessons learnt and challenges confronting fight against HIV/AIDS epidemics during the past five-year funding cycle.”
“We are at an unprecedented moment in the global HIV/AIDS response.  For the first time in modern history, we have the opportunity to change the very course of a pandemic by controlling it without a vaccine or a cure.  Controlling the pandemic will lay the groundwork for eliminating or eradicating HIV, which we hope will be possible through the future scientific breakthroughs which lead to an effective HIV vaccine and cure.
“The latest PEPFAR data from its Population-based HIV Impact Assessments (PHIAs) show that five high-burden African countries are already approaching control of their HIV/AIDS epidemics, something that would have once seemed impossible.
“Building on this progress, at the 2017 United Nations General Assembly, U.S. Secretary of State Rex Tillerson launched the PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020). The Strategy demonstrates both the courage of our convictions and the boldness of our ambitions.  It reaffirms that the U.S. government, through PEPFAR, will continue to support HIV/AIDS efforts toward achieving epidemic control in more than 50 countries, ensuring access to HIV services by all populations, including the most vulnerable and at-risk groups.”
Indeed, the U.S. government continues to lead the way in the global HIV/AIDS response.  But no one country or entity alone can end the AIDS pandemic.
Krapf said the US was proud to partner with governments, the private sectors, philanthropics organisations, multilateral institutions, academic institutions, civil society and faith-based organisations, people living with HIV and many others in this work.
He said: “Through this collective effort, we also expect to reduce the future costs required to sustain the HIV/AIDS response. To accelerate progress toward HIV/AIDS epidemic control, PEPFAR continues to leverage the capabilities, assets, and technological know-how of the private sector, creating innovative solutions to complex problems.”
He noted that in Nigeria and around the world, the fight is closer to controlling the HIV/AIDS pandemic than ever before, binding communities, scientists, and political leaders together to envision a very different future.
Krapf said: “What once seemed impossible is now possible.  But our work is far from done. Low access of antiretroviral treatment remains an issue for people living with HIV in Nigeria, however, the new commitment of the Federal Government of Nigeria to use domestic funds to provide antiretroviral drugs to an additional 50, 000 people living with HIV each year is a welcome development.”
All said and done, the world is not sleeping in relation to HIV/AIDS. Efforts are being made globally. And the result shows. AIDS is dreaded, but its impact is reducing, as more people are aware of what to do. However, there are places it is spreading, with those infected not aware of their predicament and, therefore, go about infecting others.


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