The human immunodeficiency virus (HIV) remains a major public health issue that affects millions of people worldwide. Although the world has made significant progress in recent decades, important global targets for 2020 were not met.
Division, disparity, and disregard for human rights are among the failures that allowed HIV to become and remain a global health crisis. Now, COVID-19 is exacerbating inequities and disruptions to services, making the lives of many people living with HIV more challenging.
The theme of World AIDS Day 2021 is “End inequalities. End AIDS”. With a special focus on reaching people left behind, the World Health Organization (WHO) and its partners are highlighting the growing inequalities in access to essential HIV services.
On 1 December 2021, WHO is calling on global leaders and citizens to rally to confront the inequalities that drive AIDS and to reach people who are currently not receiving essential HIV services.
HIV continues to be a major global public health issue, having claimed 36.3 million lives so far. 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 37.7 million people living with HIV at the end of 2020, over two-thirds of whom (25.4 million) are in the WHO African Region.
In 2020, 1.5 million people acquired HIV,150,000 children aged 0-9 years were newly infected with HIV, bringing the total number of children in this age group living with HIV to 1.03 million.155,000 adolescents aged 10-19 were newly infected with HIV, bringing the total number of adolescents living with HIV to 1.75 million.120,000 adolescent girls were newly infected with HIV, compared with 35,000 adolescent boys.
In 2020, 680 000 people died from HIV-related causes, 120,000 children and adolescents died from AIDS-related causes; 86,000 aged 0-9 years and 32,000 aged 10-19.
To reach the new proposed global 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.
In Eastern and Southern Africa, annual new infections among adolescents decreased by 41 per cent since 2010, while in the Middle East and North Africa, infections increased by 4 per cent over the same period.
A Deadly Combination
AIDS and Tuberculosis (TB) are a deadly combination. TB is the world’s leading infectious disease and it accounts for one in three deaths from HIV/AIDS, according to the WHO. A total of 1.5 million people died from TB in 2020 (including 214 000 people with HIV). Worldwide, TB is the 13th leading cause of death and the second leading infectious killer after COVID-19 (above HIV/AIDS).In 2020, an estimated 10 million people fell ill with TB worldwide. 5.6 million men, 3.3 million women and 1.1 million children. TB is present in all countries and age groups. But TB is curable and preventable.
In 2020, 1.1 million children fell ill with TB globally. Child and adolescent TB is often overlooked by health providers and can be difficult to diagnose and treat.
In 2020, the 30 high TB burden countries accounted for 86% of new TB cases. Eight countries account for two thirds of the total, with India leading the count, followed by China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa.
Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. Only about one in three people with drug-resistant TB accessed treatment in 2020.
Globally, TB incidence is falling at about 2% per year and between 2015 and 2020 the cumulative reduction was 11%. This was over halfway to the End TB Strategy milestone of 20% reduction between 2015 and 2020.
An estimated 66 million lives were saved through TB diagnosis and treatment between 2000 and 2020.Globally, close to one in two TB-affected households face costs higher than 20% of their household income, according to latest national TB patient cost survey data. The world did not reach the milestone of 0% TB patients and their households facing catastrophic costs as a result of TB disease by 2020.
Ending the TB epidemic by 2030 is among the health targets of the United Nations Sustainable Development Goals .
In the developing world, TB is often the first sign a person has HIV. Together, the diseases are far worse than they are alone. Shortly after AIDS emerged, it fueled a global resurgence of TB that continues in many low- and middle-income countries. HIV infection is the strongest risk factor for progressing from latent to active TB.WHO estimates that the risk of developing TB is 16-27 times greater in people who are infected with HIV than those who are not.
Signs and Symptoms
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 fight off. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient.
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.
The symptoms of HIV vary depending on the stage of infection. Though people living with HIV tend to be most infectious in the first few months after being infected, many are unaware of their status until the later stages. In the first few weeks after initial infection people may experience no symptoms or an influenza-like illness including fever, headache, rash or sore throat.
As the infection progressively weakens the immune system, they can develop other signs and symptoms, such as swollen lymph nodes, weight loss, fever, diarrhoea and cough. Without treatment, they could also develop severe illnesses such as TB, cryptococcal meningitis, severe bacterial infections, and cancers such as lymphomas and Kaposi’s sarcoma.
HIV can be transmitted via the exchange of a variety of body fluids from infected people, such as blood, breast milk, semen and vaginal secretions. HIV can also be transmitted from a mother to her child during pregnancy and delivery. Individuals cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water.
Behaviours and conditions that put individuals at greater risk of contracting HIV include: having unprotected anal or vaginal sex; having another sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhea and bacterial vaginosis; sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs; receiving unsafe injections, blood transfusions and tissue transplantation, and medical procedures that involve unsterile cutting or piercing; and experiencing accidental needle stick injuries, including among health workers.
HIV and Injection Drug Use
Sharing needles, syringes, or other drug injection equipment—for example, cookers—puts people at risk for getting or transmitting HIV and other infections.
The risk for getting or transmitting HIV is very high if an HIV-negative person uses injection equipment that someone with HIV has used. This is because the needles, syringes, or other injection equipment may have blood in them, and blood can carry HIV. HIV can survive in a used syringe for up to 42 days, depending on temperature and other factors. Substance use disorder can also increase the risk of getting HIV through sex.
An AIDS orphan is a child who became an orphan because one or both parents died from AIDS. Children orphaned due to AIDS make up 10 per cent of all orphans worldwide.16.5 million children worldwide have lost their mother, father or both parents due to HIV / AIDS. Three-quarters of these children live in sub-Saharan Africa. But AIDS is also taking over more and more children from parents in Asia and Eastern Europe.
Individuals can reduce the risk of HIV infection by limiting exposure to risk factors. Key approaches for HIV prevention, which are often used in combination, include: male and female condom use; testing and counselling for HIV and STIs; testing and counselling for linkages to TB care; voluntary medical male circumcision; use of antiretroviral drugs for prevention; harm reduction for people who inject and use drugs; and elimination of mother-to-child transmission of HIV.