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HIV & AIDS: If you’re not infected, you’re affected

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By Sola Ogundipe &  Chioma Obinna

If mankind was asked to name the most troubling viral disorder of all time, the acronym “HIV & AIDS” is most likely to be repeatedly mentioned. HIV (Human Immunodeficiency Virus) is the name of the virus that results in AIDS  (Acquired Immune Deficiency Syndrome) which describes the collection of symptoms caused by HIV after it destroys a person’s immune system.

The HIV & AIDS epidemic was once described as man’s nemesis because of its long “dormant” period that allows hosts to infect others with the virus without being immediately detected by either person. This factor alone makes this disorder nearly impossible to control.

HIV is spread through sexual contact and blood. As a result, people can pass on HIV long before they notice symptoms, which is why AIDS remains a pervasive disease around the world.

AIDS may not be the most deadly of disorders man has encountered, however, the level of decimation, deprivation and despair that comes with the disorder is almost beyond measure.
Although preventable, AIDS is incurable.

No one is safe from its onslaught. If one is not infected, one could be affected. A person can be infected with HIV, but not have AIDS. The virus typically takes around 10 years to destroy the immune system. Afterwards, people die from AIDS, usually a mild infection that turns deadly.

Unfortunately, the virus load (the amount of infectious HIV active in the system) is highest early on, when the patient is symptom free.

To make matters worse, conspiracy theories claiming the virus is an engineered attempt to inflict genocide upon Africans, has led some leaders on the continent to claim AIDS as myth. As a result, the general population distrusts western healthcare providers and avoids medications that could slow its spread. In the end, widespread ignorance and fear can prescribe all kinds of bizarre treatments and lead to the continued spread of HIV.

Unfortunately for Nigeria and most of Africa, virgin cures and other misconceptions (like the “not me” syndrome) contribute to the newly diagnosed cases of HIV infection reported each day.
When first identified as a disease, it was known as GRID (Gay-Related Immune Deficiency).  This term described the mysterious cluster of symptoms first identified in gay men in 1981.

Today in Nigeria, many people still believe that if HIV doesn’t kill them, then HIV-related complications will. But this is not true. Managing complications from HIV is a far cry from what it was in the past.

However, scientists say the immune system may never fully recover from damage after HIV infection. This becomes more apparent as people with HIV reach their 50s. Severe weakening of the immune system can also lead to opportunistic infections.

HIV – a retrovirus

HIV belongs to a class of viruses called retroviruses . Retroviruses are RNA (ribonucleic acid) viruses, and in order to replicate (duplicate). they must make a DNA (deoxyribonucleic acid) copy of their RNA. It is the DNA genes that allow the virus to replicate. Like all viruses, HIV can replicate only inside cells, commandeering the cell’s machinery to reproduce.

Only HIV and other retroviruses, however, once inside a cell, use an enzyme called reverse transcriptase to convert their RNA into DNA, which can be incorporated into the host cell’s genes.

HIV belongs to a subgroup of retroviruses known as lentiviruses , or “slow” viruses. The course of infection with these viruses is characterised by a long interval between initial infection and the onset of serious symptoms.

Who has HIV?
More Nigerians getting HIV test, most never tested, Studies say 98 per cent in Nigeria don’t know.

If you’ve been diagnosed with HIV (human immunodeficiency virus), or know someone who has, the need for support and compassion couldn’t be greater. But all too often HIV-positive people become targets of discrimination and stigma. In addition to handling new health challenges, they sometimes face rejection by family and friends. They may be forced out of homes, lose jobs, or even become victims of violence.

Discrimination and stigma

It means you are treated differently than other people simply because you are infected with HIV.
If you’re newly diagnosed with HIV or about to start HIV treatment, you may still be haunted by the old spectre of gaunt AIDS patients and few treatment options. AIDS is still here and it is still a serious disorder. But the picture today is very different than it 15, 10, or even five years ago.

Life expectancy has improved dramatically. For many patients, it can be close to that of uninfected persons.
Factors that often lead to AIDS discrimination and stigma include:

* HIV is a deadly disease that many people fear.
* Some adults still wrongly believe that they can catch HIV through casual contact, such as sharing a drinking glass or touching a toilet seat. This greatly increases their fear about being near people who are infected.

* Many people connect HIV and AIDS with behaviours that are already stigmatised, such as sex between men or injecting drugs.

* Some people believe that having HIV or AIDS is the person’s own fault. For example, they might think it’s the result of moral weakness and deserves to be punished.

Unfortunately, AIDS discrimination and stigma also fuel the epidemic. They prevent people from talking about their HIV status with sex partners or people with whom they share needles. Fear of rejection and worries about confidentiality also prevent many from getting tested for HIV. This means they may spread HIV to others without knowing it.

Coping with AIDS Stigma
The first step might be to seek support from people who understand the issues. Either  local HIV/AIDS support groups, or a psychologist, psychiatrist, or clinical social worker.
Discovery & diagnosis

In 1981, homosexual men with symptoms of a disease that now are considered typical of the acquired immunodeficiency syndrome (AIDS) were first described in Los Angeles and New York. The men had an unusual type of lung infection (pneumonia) called Pneumocystis carinii (now known as Pneumocystis jiroveci) pneumonia (PCP) and rare skin tumors called Kaposi’s sarcomas. The patients were noted to have a severe reduction in a type of cell in the blood that is an important part of the immune system, called CD4 cells.

These cells, often referred to as CD4 T cells, help the body fight infections. Shortly thereafter, this disease was recognized throughout the United States, Western Europe, and Africa. In 1983, researchers in the United States and France described the virus that causes AIDS, now known as the human immunodeficiency virus (HIV) and belonging to the group of viruses called retroviruses. In 1985, a blood test became available that measures antibodies to HIV that are the body’s immune response to the HIV.

This blood test remains the best method for diagnosing HIV infection. Recently, tests have become available to look for these same antibodies in blood and saliva, some providing results within 20 minutes of testing.
Transmission

HIV is present to variable degrees in the blood and genital secretions of virtually all individuals infected with HIV, regardless of whether or not they have symptoms. The spread of HIV can occur when these secretions come in contact with tissues such as those lining the vagina, anal area, mouth, or eyes (the mucus membranes), or with a break in the skin, such as from a cut or puncture by a needle.

The most common ways in which HIV is spreading throughout the world include sexual contact, sharing needles, and by transmission from infected mothers to their newborns during pregnancy, labor (the delivery process), or breastfeeding. (See the section below on treatment during pregnancy for a discussion on reducing the risk of transmission to the newborn.)

Sexual transmission of HIV has been described from men to men, men to women, women to men, and women to women through vaginal, anal, and oral sex. The best way to avoid sexual transmission is abstinence from sex until it is certain that both partners in a monogamous relationship are not HIV_infected. Because the HIV antibody test can take up to six months to turn positive after infection occurs, both partners would need to test negative six months after their last potential exposure to HIV.

If abstinence is out of the question, the next best method is the use of latex barriers. This involves placing a condom on the penis as soon as an erection is achieved in order to avoid exposure to pre_ejaculatory and ejaculatory fluids that contain infectious HIV.

The spread of HIV by exposure to infected blood usually results from sharing needles, as in those used for illicit drugs. HIV also can be spread by sharing needles for anabolic steroids to increase muscle, tattooing, and body piercing. Currently, however, because blood is tested for both antibodies to HIV and the actual virus before transfusion, the risk of acquiring HIV from a blood transfusion in Nigeria is reducing but still considered significant.

There is little evidence that HIV can be transferred by casual exposure, as might occur in a household setting. For example, unless there are open sores or blood in the mouth, kissing is generally considered not to be a risk factor for transmitting HIV. This is because saliva, in contrast to genital secretions, has been shown to contain very little HIV.

Still, theoretical risks are associated with the sharing of toothbrushes and shaving razors because they can cause bleeding, and blood can contain large amounts of HIV. Consequently, these items should not be shared with infected people. Similarly, without sexual exposure or direct contact with blood, there is little if any risk of HIV contagion in the workplace or classroom.

Treatment
The treatment that is making this era so much more hopeful is called highly active antiretroviral therapy, or HAART. HAART is a potent combination of at least three active antiretroviral medications (ARVs). HAART is popularly called the “AIDS cocktail” because of its mix of drugs.

The goal of AIDS cocktails today is to reduce the virus in the blood (viral load) so it is no longer detected. Though AIDS cocktails aren’t a cure, they are a very effective treatment. They can delay progression to AIDS, help rebuild and maintain the immune system, and reduce complications.

Today HIV medications are available with fewer short-and long-term side effects. And taking more than one drug helps prevent drug resistance. This means the drugs will keep working longer because they continue to be effective against HIV.

Patients who were previously considered untreatable because of multi-drug resistance have become treatable. That’s because people have not developed resistance to drugs in the new classes, and the drugs are stronger in overcoming resistance.

HIV & AIDS Facts
More Nigerian adults than ever before report getting at least one HIV test  — but at least 95 per cent don’t know for sure whether they carry the AIDS virus. Over  40 percent suspected to be most at risk of HIV infection have never been tested.

According to a new CDC report:
* Nearly one in three people who test positive for HIV have waited too late: They already have AIDS.
* Blacks  get more than half of new HIV infections in the U.S., yet only 60 per cent have ever been tested.
* Men who have sex with men make up more than 55 per cent of people with HIV, yet only 40 per cent of these at-risk men were tested in the past year.

* People who know they have HIV are less likely to transmit the virus than are people who are infected but don’t know it.
* Taken before AIDS develops, HIV drugs prolong life and health.
* People being treated for their HIV infection are less likely to transmit the virus to others.

* Most HIV infections come from people who don’t know they carry the virus.
*Virtually all AIDS cases are preventable, either by preventing infection or by early treatment
In 2006, the CDC recommended that all Americans get routine HIV tests. Those at high risk of infection should get tested at least once a year, if not more often.
HIV & AIDS: Myth vs Reality

Myth: HIV or AIDS can be cured
Reality: To date, there is no cure for HIV or AIDS and there are no vaccines to prevent HIV infection.
Myth: HIV/AIDS is a gay disease.

Reality: Anyone can be susceptible to HIV/AIDS, regardless of their sexual orientation. Everyone is at risk of getting HIV from blood-to-blood contact, sharing needles or unsafe sex. Worldwide, HIV is spread most often through heterosexual contact.

Myth: You can get HIV from breathing the air around an HIV-infected person or from hugging or holding hands with an HIV-infected person.

Reality: HIV cannot be transmitted through…
* toilet seats or door-knob handles.
* touching, hugging, holding hands, or cheek kissing with an HIV-infected person.
* sharing eating utensils with an HIV-infected person.
* mosquito bites.

HIV is transmitted through contact with an HIV-positive person’s infected body fluids, such as semen, pre-ejaculate fluid, vaginal fluids, blood, or breast milk. HIV can also be transmitted through needles contaminated with HIV-infected blood, including needles used for injecting drugs, tattooing or body piercing.

Myth: I can get HIV by sharing exercise equipment or playing sports with an HIV-positive person.
Reality: Contact with sweat or tears has never been shown to result in transmission of HIV.
Myth: You can get HIV by kissing an HIV-infected person.

Reality: Casual contact through closed-mouth or “social” kissing is not a risk for transmission of HIV. Because of the theoretical potential for contact with blood during “French” or open-mouthed kissing, the CDC recommends against engaging in this activity with an infected person. However, no cases of AIDS have been attributed to any kind of kissing.

Myth: You cannot get HIV if you are using birth control methods like diaphragms, cervical caps, sponges, spermicides, DepoProvera, Norplant, or the Pill.

Reality: These birth control methods do not prevent the transmission of sexually transmitted diseases (STD) such as HIV. They only aim to prevent pregnancy.

The surest way to prevent both pregnancy and an STD is through abstinence. One way people who are sexually active may prevent pregnancy and STD infection is to use a condom in combination with another form of birth control, such as a diaphragm, cervical cap, sponge, spermicide, DepoProvera, Norplant, or the Pill.

Birth control products containing the spermicide nonoxynol-9 (found in most contraceptive creams, gels, suppositories, foams, films and sponges) help to prevent pregnancy but may increase the risk of HIV.
Myth: I can’t have more than one sexually transmitted disease (STD) at a time.

Reality: A person can be infected with more than one STD. A person with an untreated STD may also be six-10 times more likely to pass on or acquire HIV during sex. Risk for infection increases 10 to 300-fold in the presence of a genital ulcer, such as occurs in syphilis or genital herpes.

Myth: There is no such thing as safer sex.
Reality: Safer sex is sexual activity without penetration, or sex with a latex condom or a latex barrier (in the case of oral sex). Although safer sex can substantially reduce the sexual transmission of an STD like HIV, sexual abstinence is the surest way to prevent the sexual transmission of an STD, including HIV.

Myth: Since I only have oral sex, I’m not at risk for HIV/AIDS.
Reality: You can get HIV by having oral sex with a man or a woman. That is why it is important to use a latex barrier during oral, vaginal, or anal sex.

Myth: I would know if a loved one or I had HIV.
Reality: A person with HIV may not show any symptoms for up to 10 years. Since HIV affects each person differently, many people with HIV can look and feel healthy for years. The only sure way to know is to get tested.

Myth: Getting tested for HIV is pointless.

Reality: Knowing if you are HIV-positive will allow you to seek early treatment that can help you stay healthy longer and enable you not to pass on the virus to someone else. Regardless of your HIV status, you can learn how to prevent further infection from HIV and other STDs through counseling offered at many HIV testing centers.

Myth: When you’re on HIV therapy you can’t transmit the virus to anyone else.
Reality: Antiretroviral drugs don’t keep you from passing the virus to others. Therapy can keep the viral load down to undetectable levels, but HIV is still present in the body and can still be transmitted to others.
AIDS Timeline

AIDS has killed more than 25 million people since 1981. That’s half as many deaths as in World War II. And it’s not over. 4.4 million Nigerians  are among the 33 million people now living with HIV, the virus that causes AIDS.

How did we get here?
1981: First cases recognised
1983: Heterosexual spread of AIDS in Africa is confirmed. Public apprehension grows. False rumors of “household spread” abound. Landlords are reported to evict AIDS patients.

1983 : Pasteur Institute researchers Luc Montagnier and Francoise Barre-Sinoussi isolate a virus from the swollen lymph gland of an AIDS patient. They called it lymphadenopathy-associated virus.
1984: National Cancer Institute (NCI) researcher Robert Gallo reports isolation of an AIDS virus he calls HTLV-III. Later, it turns out to be LAV from a sample sent by the Montagnier lab – but not before HHS Secretary Margaret Heckler gives Gallo full credit.

1985: First International AIDS Conference is held in Atlanta.
1986 : Everybody agrees to call the AIDS virus HIV: human immunodeficiency virus. First case of AIDS is reported in Nigeria

1989 :Scientists find that even before AIDS symptoms develop, HIV replicates wildly in the blood. The goal of treatment shifts to keeping HIV at low levels.
1991_1992 : The red ribbon is introduced as a symbol of AIDS solidarity.  FDA licenses the first rapid HIV test

1993: CDC launches condom ads on TV
1996_1997: A treatment breakthrough: The AIDS drug cocktail __ highly active anti_retroviral therapy or HAART __ can cut HIV viral load to undetectable levels. Hope surges when AIDS researcher David Ho suggests treatment could eliminate HIV from the body.

1998_2000: FDA approves new classes of drugs that make HIV treatment safer, easier, and more effective. But the drugs still do not cure AIDS.

2001_2002: UN Secretary General Kofi Annan proposes the Global Fund for AIDS to extend AIDS treatment __ still totally unavailable to the vast majority of people living with AIDS. Only 1 percent of the 4.1 million sub_Saharan Africans with HIV receive anti_HIV drugs.  AIDS becomes the leading cause of death worldwide for people aged 15 to 59.

2003_2005:  President Bush announces the $15 billion President’s Emergency Plan for AIDS Relief PEPFAR). The prevention portion of the plan is criticized for over_emphasis on abstinence. But the plan provides much_needed AIDS_treatment funds to 15 nations.

2006_2007: HIV treatment is shown to extend life by 24 years, at a cost of $618,900. UNAIDS recommends adult circumcision after it’s found to halve AIDS transmission from women to men in regions of high prevalence

2008: Luc Montagnier and Francoise Barre_Sinoussi awarded Nobel Prize in medicine for discovery of HIV.  Of the 33 million people now living with HIV, 3 million are getting treatment – less than a third of those who need immediate treatment. Yet for the first time, global AIDS deaths decline.

2009: UNAIDS calculates that the global spread of AIDS peaked in 1996 at 3.5 million new infections.  More than half of those who need treatment don’t get it.

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