Having claimed more than 32 million lives worldwide to date, HIV continues to be a major global public health issue.
Strategies to increase access to effective HIV prevention, diagnosis, treatment and care, including for opportunistic infections, have transformed a once deadly condition to a manageable chronic health condition, enabling people living with HIV to lead long and healthy lives.
Global data compiled by the World Health Organisation shows that of the 37.9 million people living with HIV at the end of 2018, 79 per cent received testing, 62 per cent received treatment and 53 per cent had achieved suppression of the HIV virus with reduced risk of infecting others.
This is an advancement in the area of HIV management and the credit goes to the work of health professionals, networks of people working in the area, including NGOs, and efforts of the patients themselves.
In Malta during 2018, 70 new HIV cases were reported and an additional three cases of AIDS. In line with the UN target 90-90-90, it is estimated that 70 per cent of people living with HIV in Malta know their status, 98.6 per cent of people diagnosed with HIVin Malta are on antiretroviral therapy and 87.7 per cent of HIV positive people who are on treatment are virally suppressed.
On World AIDS Day, celebrated every year on December 1, the WHO is highlighting the impact of the work in progress to end the HIV epidemic while drawing global attention to the need for their broader engagement at all levels of care.
Key populations affected by HIV include: men who have sex with men; people who inject drugs; people in prisons and other closed settings; sex workers and their clients; and transgender people. HIV can be diagnosed through rapid diagnostic tests that can provide same-day results.
This testing is available from the GU clinic at Mater Dei Hospital. Enhanced testing facilitates diagnosis and linkage with treatment and care. Although there is no cure for HIV infection, effective antiretroviral drugs can control the virus and help prevent onward transmission to other people since effective treatment results in an undetectable viral load, meaning that the virus can no longer be transmitted to others.
There were 37.9m people living with HIV at the end of 2018, 79% received testing, 62% received treatment and 53% had achieved suppression of the HIV virus
On World Aids Day, Vytenis Andriukaitis, the European Commissioner for Health and Food Safety, highlights: “Too many people living with HIV are still not aware of their status. The sooner women and men know of their HIV status, the sooner they can be put on antiretroviral treatment and halt transmission of HIV sexually. This makes a major difference in the lives of people living with HIV and those around them.
“It is more important, therefore, for public health services to support easy access to testing and fast linkage to care, especially for those at risk of HIV, in order to bring people faster to the stage where they are no longer infectious. We must all ramp up our efforts to halt and reverse the HIV epidemic in order to achieve our sustainable development goals by 2030.”
In face of the evidence which shows that women in Europe are diagnosed late, Dr Andrea Ammon, director of ECDC, the EU agency aimed at strengthening Europe’s defences against infectious diseases, stresses that “women are generally diagnosed with HIV later than men, and the older they are, the longer they live with undiagnosed HIV”.
Enhanced strategies and systems that make HIV testing more widely available and user-friendly are required to ensure early diagnoses. The WHO consolidated guidelines on HIV self-testing and partner notification and ECDC’s evidence-based guidance on integrated testing for HIV and viral hepatitis recommend innovative approaches that include self-testing and community-based testing by lay providers as part of overall HIV testing services.
The human immunodeficiency virus (HIV), which attacks the immune system and causes a lifelong severe illness, has a long incubation period. The virus targets the immune system and weakens people’s defence systems against infections and some types of cancer. The end-stage of an untreated HIV infection, acquired immunodeficiency syndrome (AIDS), results from the destruction of the immune system. AIDS is defined by the development of certain cancers, infections or other severe clinical manifestations.
The symptoms of HIV vary depending on the stage of infection. 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 progresses, it weakens the immune system further and can result in swollen lymph nodes, weight loss, fever, diarrhoea and cough. Without treatment, typical infections such as tuberculosis (TB), cryptococcal meningitis, severe bacterial infections and cancers such as lymphomas and Kaposi’s sarcoma can develop.
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. It 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 such as syphilis, herpes, chlamydia, gonorrhoea; 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.
People can reduce the risk of HIV infection by limiting exposure to risk factors through a prevention combination approach including use of condoms, testing for HIV/ STIs, early diagnosis, preventive treatment, pre-exposure Prophylaxis and post-exposure prophylaxis, harm reduction for people who inject drugs and elimination of mother to baby transmission.
HIV treatment suppresses viral replication within a person’s body and allows an individual’s immune system to strengthen and regain the capacity to fight off infections.
In order to tackle the global public health issue posed by HIV, we must maintain and strengthen our efforts to reduce the risk, vulnerability and impact of the epidemic on the communities most at risk of HIV infection.
Prof. Charmaine Gauci is Superintendent of Public Health.