By GELINDE NAREKINE
FIRST reported in 1981, HIV/Aids infection reached its height as a health crisis by the end of that decade and the beginning of the 1990s.
It ultimately became the most important global epidemic of the 21st century, basically, due to a number of fundamental reasons.
Firstly, the origin and therefore, the transmission of the Human Immunodeficiency Virus is strongly associated with our sexuality – our sexual practices, preferences, and orientation – serve as its lifeline and driving force. Whilst the ways in which we view and address issues concerning sex and gender inequalities give it fertile soil.
Secondly, HIV primarily attacks and destroys the hierarchy of our body’s defence – the immune system. The very immune cell – CD4 T cell – that plays the most significant central role of signaling respective immune cells to execute target-specific responses against various infectious agents, serves as the primary target for HIV to enter host cells. Upon destruction of that very important cell, the body is left vulnerable to opportunistic infections.
The strength of the immune system slowly but progressively declines to a point where the Acquired Immune Deficiency Syndrome crops up as end-stage disease.
In addition, HIV evolves at one of the highest recorded biological mutation rates known to science. These rapid changes in the viral genetic makeup is a major contributing factor in the failure of the immune system to eradicate the virus. The combination of the infection process, involving about 60 dominant strains and multiple recombinant variants, as well its rapid rate of mutation makes finding a cure for HIV, exceedingly difﬁcult.
A never ending quest
For the past 40 years, it has been a never-ending quest. Global efforts have been marked by numerous setbacks. Each apparent breakthrough is usually presented with even more challenging obstacles to overcome. It has been a daunting task and a challenging endeavor for the global health community, as well as governments the world over.
Unlike many other diseases, it has no vaccine, nor a cure, and not even an agreement as to how the virus hijacks our cellular mechanism and the immune system to its own advantage.
It subsequently results in an extreme compromised immune status, making Aids one of the most extraordinary medical conditions in all of human history. Obviously, HIV/Aids infection has become a medical dilemma.
In June 2001, the world governments met at the United Nations headquarters in Geneva and made a solemn promise to reverse the HIV/Aids epidemic. Under UNAIDS – joint United Nations programme on HIV/Aids – ‘Declaration of Commitment’, a detailed plan was committed to prevent spread of HIV. Since then, its core message has been voiced every single year as reminder, over and over again.
In a nutshell, the ‘declaration of commitment’ is, in effect a blueprint for action. It includes not hypothetical goals but concrete benchmarks to measure progress on prevention, reducing stigma, building health infrastructure, ensuring treatment, and providing much-needed leadership and resources. While many countries have made their own commitments to ﬁght Aids, the Declaration was the ﬁrst recognition of Aids as a global crisis requiring a collective effort and therefore, a lasting solution.
How well have governments, international agencies, and national institutions performed in ﬁghting the HIV/Aids epidemic? Have they kept their promises to provide increased funding and better programs to treat those infected and also to prevent spread of the virus? Has the world made any progress in preventing spread of HIV? These are among the questions one may ask.
Governments, organisations, and private individuals have spent billions after billions of dollars on efforts to find answers against the epidemic – effective treatments, vaccines, and a cure for HIV/Aids – for the last 40 years. Despite the hope of reaching an end to infection by bringing the virus fully under control still remaining elusive, the world has indeed made enormous progress against HIV/Aids amidst persistent challenges. Humanity has gained greater insight into the complex dynamics of HIV/Aids infection, and therefore, there is much hope for the future.
At the height of the crisis, it was hard to imagine ending the epidemic. However, the UNAids has good news about progress in ﬁghting the global HIV/Aids epidemic.
Four decades into the seemingly intractable epidemic, it has been reported that the world has halted the spread of HIV and begun reversing transmission. Although the number of people living with the virus remains high due to effective antiretroviral treatment and therefore, less number of people dying, fewer people are becoming infected.
Although far from the ultimate goal of preventing any new infections and protecting the rights and well-being of those with HIV, this progress suggests that the multifaceted approach to ﬁghting the epidemic has made a difference. The international response includes a wide range of prevention efforts including, educating the public about the risks of unsafe sex, wide distribution of condoms, and encouraging sexually active people to get tested for HIV. In addition, counseling those who test positive for the virus, reducing the stigma and discrimination associated with HIV infection, and making blood supply HIV-free, continue to make major impacts.
With the availability of antiretroviral therapy for millions of people living with HIV in low income countries in recent years, HIV-related deaths have been markedly reduced. This surely has resulted in many more people living longer with HIV infection. Transmission of HIV from mother to infant has signiﬁcantly declined due to the timely administration of antiretroviral therapy for HIV-positive women and their newborn babies. And in many such cases, there is 100 per cent success rate in the baby being prevented from contracting HIV.
The world’s regions with heavy burden of HIV/Aids have seen a decline in its prevalence – total number of cases. For instance, in sub-Saharan Africa, where more than two-thirds of the world’s HIV-positive people live, there has been a significant fall in the number of adults living with HIV infection.
Again, in South, Southeast, and East Asia, as well as the Caribbean, prevalence has also dropped. In some of the world’s major AIDS-dominant countries, including Botswana, South Africa, Tanzania, and Zimbabwe, the combination of prevention and treatment efforts has contributed to signiﬁcant declines in new infections.
The decline in new infections among young people in several African countries show that more people are practicing safer sexual behavior, in what UNAids calls a “revolution in HIV prevention.” Several national surveys in high-HIV African countries indicate that teenagers are waiting longer to have sex, and that sexually active adults have fewer sexual partners and are more likely to use condoms.
These are welcome ﬁndings, because HIV prevention requires people to change sexual behaviour, which often means altering well-established patterns.
In the past decade, the international response to the HIV/Aids epidemic in less developed countries expanded to include antiretroviral therapy. These medicines do not cure the disease, but had been used successfully in wealthier countries to slow the progression of the disease and allow those with HIV to live longer and more active lives.
Although many public health experts were skeptical that this therapy could be successfully used in poor countries with limited health infrastructures, UNAids has reported that expanding access to treatment contributed significantly to decline in deaths among people living with HIV/Aids in the third-world.
Though there have been reports of increase in prevalence in other regions of the world including, Eastern Europe and Central Asia – with the incidence of new cases – the generally observed global trend is that, there has been a steady decline in the prevalence of HIV infection.
While antiretroviral drugs are not a cure, this cocktail of drugs delay the progress of HIV infection to AIDS. Essentially, antiretroviral drugs have changed what was formerly a ‘death sentence to a life sentence’. As a result, those with HIV continue to live near-normal lives, with the caution that they must take medication on a regular basis while living with uncertainty over reemergence or a flashover of viral situation.
The good news about the global progress against HIV/Aids is tempered by the magnitude of the existing problems. The epidemic has had a devastating effect on the economic and social lives of tens of millions of families worldwide.
More than 2 million more people are infected with the virus each year and about 38 million people now living with an incurable disease that is transmitted primarily through sexual contact. But the mounting evidence of successful approaches to stopping the spread of HIV, even in the poorest countries, offers much hope.
Reducing HIV infection and improving the lives of people living with HIV surely requires extensive national and international resources and political commitment. Even in the face of other emerging epidemics, such as the current Covid-19 crisis, and a time of economic downturn, these resources and commitments will need to continue in order to halt HIV/Aids epidemic.
Now more than ever, the progress requires continued commitment and boldness. This is our opportunity. We must not let it slip through the holes in our social and political fabric.
It will take all of us working together to create a future in which HIV/Aids is no longer a threat; by doing our part every day, it is highly possible to put an end to this epidemic.
Source of information:
- PRB 2010, Progress Against HIV/Aids Amidst Persistent Challenges, viewed 07 June 2022, http://www.prb.org
- Sara M. Tharakan 2019, Global Trends in HIV/AIDS, Congressional Research Service, viewed 11 June 2022, http:/www.sgp.fas.org
Gelinde Narekine is a technical officer at the School of Medicine and Health Sciences, University of Papua New Guinea