World AIDS Day 2022 – Equalize

Dr Paul John, Port Harcourt ,mazipauljohn@gmail.com, 08083658038

Equalize is the theme for this year’s World AIDS day. Progress in prevention and treatment is faltering around the world, putting millions of people in grave danger. Eastern Europe and central Asia, Latin America, and the Middle East and North Africa have all seen increases in annual HIV infections over several years. In Asia and the Pacific, UNAIDS data now show new HIV infections are rising where they had been falling. Action to tackle the inequalities driving AIDS is urgently required to prevent millions of new HIV infections this decade and to end the AIDS pandemic


The first world AIDS day was held about 34  years ago( 1988) after health ministers from around the world met in London and agreed to such a day as a way of highlighting the enormity of the AIDS pandemic and nation’s responsibility to ensure universal treatment, care and support for people living with HIV and AIDS.  The idea was conceived in 1987 by two public information officers, James Bunn and Thomas Netter, who were workers of the WHO’s global programme on AIDS but the final approval was given by Dr Jonathan Mann ,former head of the Global programme on AIDS but now known as UNAIDS . It is observed annually on the first day of December. It is recognized by UNO and all her affiliate international organisations and member countries.


BRIEF HISTORY AND DESCRIPTION
In 1981, medical practitioners in USA discovered a strange illness among a small number of gay men. The illness was given several names until it was finally called HIV AIDS. It is one of the leading causes of death globally. HIV progressively infects cells of the immune system(especially CD4 cells of the white blood cells), breaking down the body’s ability to fend off some infections and other diseases .AIDS is the most advanced stage of HIV infection, defined by the occurrence of any of the more than 20 opportunistic infections or related cancers.


MODES OF TRANSMISSION
HIV can be transmitted through: transfusion of contaminated blood and blood products; unprotected vaginal or anal sexual intercourse ; oral sex with an infected person; transmission between an infected mother and her baby during pregnancy,  childbirth and breastfeeding ; sharing of contaminated sharp instruments and the use of contaminated and unsterilized hospital equipment such as needles and syringes.
KEY FACTS

  • To reach the new proposed global 95–95–95 targets set by UNAIDS, we will need to redouble our efforts to avoid the worst-case scenario of 7.7 million HIV-related deaths over the next 10 years, increasing HIV infections due to HIV service disruptions during COVID-19, and the slowing public health response to HIV.
  • HIV continues to be a major global public health issue, having claimed 40.1 million [33.6–48.6 million] lives so far.
  • In 2021, 650 000 [510 000–860 000] people died from HIV-related causes and 1.5 million [1.1–2.0 million] people acquired HIV.
  • There is no cure for HIV infection. However, with increasing access to effective HIV prevention, diagnosis, treatment and care, including for opportunistic infections, HIV infection has become a manageable chronic health condition, enabling people living with HIV to lead long and healthy lives.
  • There were an estimated 38.4 million [33.9–43.8 million] people living with HIV at the end of 2021, two thirds of whom (25.6 million) are in the WHO African Region.

Overview

The human immunodeficiency virus (HIV) targets the immune system and weakens people’s defense against many infections and some types of cancer that people with healthy immune systems can more easily fight off. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient. Immune function is typically measured by CD4 cell count.

The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS), which can take many years to develop if not treated, depending on the individual. AIDS is defined by the development of certain cancers, infections or other severe long-term clinical manifestations.

NIGERIAN DATA

The Director-General of Nigeria’s National Agency for the Control of AIDS (NACA), Gambo Aliyu, on Thursday said available data confirmed a decline in new HIV infections in the country.

Mr Aliyu, while speaking at a press conference ahead of the 2022 World AIDS Day (WAD), said new HIV infections gradually declined from 103,404 in 2019 to 92,323 in 2021.

He said this is an indication that Nigeria will meet the United Nations’ target of ending HIV/AIDS by 2030.


SIGNS AND SYMPTOMS
The symptoms vary according to the stage of the disease .About 49 % of the people living with the virus are unaware .This is worsened by the fact that the disease may be  symptomless for a period of  time or may present with influenza-like illness such as fever ,headache ,rash or sore-throat.
However, as the infection progresses ,it will  affect the immune system adversely hence the person can show features such as swollen lymph nodes, diarrhoea and cough  lasting for more than  a month, unaccounted weight loss etc. When treatment is not started and the infection is allowed to progressed uncontrolled, the patient may develop opportunistic infections and other AIDS-related diseases such as Pulmonary Tuberculosis ,Cancers such as Lymphomas, Kaposi’s sarcoma etc
THE WAY FORWARD
The first requirement is for everybody to go for Voluntary Counselling and Testing (VCT) in order to ascertain one’s HIV status .When positive, the individual should leave positively and if negative, the individual should avoid being infected .For us to maintain an HIV free generation, the following must be considered and properly implemented:


ATTITUDINAL CHANGE
Nigeria and other African countries should abhor some obnoxious cultural practices that help in the spread of the virus. On May 8th 2006, a Johannesburg High court acquitted Jacob G. Zuma, the current president of South Africa and current president of the governing political party, African National Congress (ANC) , of rape charge brought against him in December 6th 2005. The accuser (the victim), a daughter of Zuma’s deceased friend was known to Zuma to be HIV positive.
President Zuma argued in court that he had shower immediately after having an unprotected sex with the known HIV patient to cut down the risk of contracting the dreaded disease .The court finally dismissed the case on the grounds that the sex was consensual but Zuma’s defence of having showers after the unprotected sex with a known HIV patient was condemned by health experts, AIDS activists and the general public.
Also, a former president in that country once said that the happiest day in his life was the day he was circumcised. Although from medical perspectives, circumcision reduces the rate of HIV transmission but the way people were circumcised in South Africa where one sharp object was used for everybody present, really helped in the spread of the virus in other country .
THE ACTIVITIES OF SOME RELIGIOUS LEADERS
I have witnessed, in the course of my medical practice, many lives that were lost due to the activities of these religious leaders. Some of them claim to  have cure for  HIV all other diseases hence anybody that is newly diagnosed with HIV will prefer wasting his/her time with these religious leaders  only to come back to the hospital when the disease has  reached an advanced stage, when the opportunistic infections and HIV related cancers must have been established. At  that stage ,medical science may have little or nothing to offer to these individuals .
SERODISCORDANT COUPLE
This situation occurs when one partner tested positive to the virus while the other  partner remains negative. The partner that is positive must be placed on ART no matter the CD 4 count in order to protect the other partner that is negative from being infected  . They should also use barrier method of contraception according to WHO standard unless when they are ready for conception . The current teaching now is both will be on the drugs as Prophylaxis for the other partner that test negative to the virus.
INCESSANT STRIKES IN THE HEALTH SECTOR
When a particular group wants to embark on any strike, the group must ensure that an alternative arrangement is  made so  that these HIV patients can  get their drugs as at when due .
OTHER WAYS:
Federal Road Safety Corps (FRSC) should make it compulsory for each vehicle to have a packet of medical  hand gloves .This is because many Nigerians are getting enlightened that one can get infected through contaminated blood  hence at times when a road accident occurred ,victims that  would have been saved had they been rushed to the nearest hospital ,normally lost their lives because people would wait for FRSC officials to arrive with safety hand  gloves. More unfortunate is the fact that it may take some time for the FRSC officials to arrive at the venue . I will certainly not blame those who refuse to help the accident victims without medical hand gloves .
Also, I think the National Agency for the Control of Aids ( NACA) should map out strategies to go to our rural settings to enlighten the masses because many people in those settings are still naive of this deadly virus . NACA can as well go to secondary schools in order to enlighten the fledgling students there and Sex education can also be included in our academic  curricula .
People should be enlightened on the ways  of transmission of the virus and how  to avoid them through safe sexual and good hospital practices , Safe antenatal and postnatal care ,Proper use  of uncontaminated sharp objects/instruments and safe disposal of contaminated objects etc .The  Government, at the federal, state and local government levels, needs to do more in ensuring that not only the ART drugs but also other tests and services should be rendered free to the  HIV  patients  .In some settings ,some of them are mandated  to pay for laboratory services hence those that don’t have the money for the tests  may not be able access full medical treatment.
If Nigeria is truly the Africa’s largest economy ,I think we don’t need to overemphasized on the need for all services and treatments  to be rendered free to the victims of HIV infections . A legislation can also  be enacted to ensure that each of these multinational companies contributes a particular percentage (even if it is  1%) of their income to the HIV campaign . All forms of discrimination against people living with the virus must be discriminated at all costs .

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