Acquired Immune Deficiency Syndrome (AIDS) is the most advanced stage of Human Immuno-deficiency Virus (HIV) infection. But just because a person has HIV doesn’t mean they’ll develop AIDS. Human immunodeficiency virus or HIV kills CD4 (cluster of differentiation 4) cells. Healthy adults generally have a CD4 count of 500 to 1,500 per cubic millimetre. A person with HIV whose CD4 count falls below 200 per cubic millimetre will be diagnosed with AIDS.
A person can also be diagnosed with AIDS if they have HIV and develop an opportunistic infection such as pneumonia, which is one that takes advantage of a unique situation, such as HIV.
Untreated, HIV can progress to AIDS within a decade. There’s no cure for AIDS, and without treatment, life expectancy after diagnosis is about three years. This may be shorter if the person develops a severe opportunistic illness. However, treatment with antiretroviral drugs can prevent AIDS from developing. Once HIV infection develops into AIDS, infections pose a greater risk.
Without treatment, HIV infection is likely to develop into AIDS as the immune system gradually wears down. However, advances in Antiretroviral therapy (ART) mean than an ever-decreasing number of people progress to this stage.
According to the National AIDS Control Organization (NACO) 2017 report state that new HIV infections have peaked in 1995 and then started to decline. An estimated 87.58 thousand [36.45 – 172.90] new HIV infections occurred in 2017, meaning there has been an 85% decline in annual new HIV infections since the peak of the epidemic. However, the pace of decline in new HIV infections has levelled off in recent years. Between 2010 and 2017, new HIV infections have declined by only 27%. The target is to achieve a 75% reduction in new infections by 2020, from the baseline value of 2010.
AIDS is a viral infection got chiefly by sex with a stranger. HIV is the virus that causes the infection. HIV is transmitted through semen and vaginal fluids, infected blood and blood products, infected mother to her baby before birth, during birth or through breast milk. It can be called our modern pandemic affecting both industrialized and developing countries.
Origin of HIV/AIDS
Of the many theories and myths about the origin of HIV, the most likely explanation is that HIV was introduced to humans from monkeys. A recent study identified a subspecies of chimpanzees native to west equatorial Africa as the original source of HIV-1, the virus responsible for the global AIDS pandemic. The researchers believe that the virus crossed over from monkeys to humans when hunters became exposed to infected blood. Monkeys can carry a virus similar to HIV, known as SIV (simian immunodeficiency virus), and there is strong evidence that HIV and SIV are closely related.
AIDS is caused by HIV infection and is characterized by a severe reduction in CD4+ T cells, which means an infected person develops a very weak immune system and becomes vulnerable to contracting life-threatening infections (such as Pneumocystis carinii pneumonia). AIDS occurs late in HIV disease.
Tracking of the disease in the United States began early after the discovery of the pandemic, but even to date, tracking data reveal only how many individuals have AIDS, not how many have HIV. The counted AIDS cases are like the visible part of an iceberg, while the much larger portion, HIV, is submerged out of sight. Many States are counting HIV cases now that positive results are to be gained by treating the infection in the early stages and because counting only AIDS cases is no longer sufficient for projecting trends of the pandemic. However, because HIV-infected people generally are asymptomatic for years, they might not be tested or included in the count. The Centers for Disease Control and Prevention (CDC) estimates that between 650,000 and 900,000 people in the United States currently are living with HIV.
In 1996, the number of new AIDS cases (not HIV cases) and deaths from AIDS began to decline in the United States for the first time since 1981. Deaths from AIDS have decreased since 1996 in all racial and ethnic groups and among both men and women. However, the most recent CDC data show that the decline is slowing. The decline can be attributed to advances in treating HIV with multiple medications, known as combination therapy; treatments to prevent secondary opportunistic infections, and a reduction in the HIV infection rate in the mid-1980s prior to the introduction of combination therapy. The latter can be attributed to improved services for people with HIV and access to health care. In general, those with the best access to good, ongoing HIV/AIDS care increase their chances of living longer.
HIV/AIDS is still largely a disease of men who have sex with men (MSMs) and male injection drug users, but it is spreading most rapidly among women and adolescents, particularly in African American and Hispanic communities. HIV is a virus that thrives in certain ecological conditions. The following will lead to higher infection rates: a more potent virus, high viral load, high prevalence of sexually transmitted diseases (STDs), substance abuse, high HIV seroprevalence (which mean the level of a pathogen in a population, as measured in blood serum) within the community, high rate of unprotected sexual contact with multiple partners, and low access to health care. These ecological conditions exist to a large degree among urban, poor, and marginalized communities of injection drug users. Thus, MSMs and African American and Hispanic women, their children, and adolescents within these communities are at the greatest risk.
The History of HIV/AIDS in India
In India, the first cases of HIV were diagnosed among sex workers in Madras (now Chennai) in 1986. Since then, the country has evolved from a ‘low’ to ‘concentrated’ epidemic. In 2017, an estimated 2.1 million people were living with HIV. The percentage of people living with HIV among adults (15–49 years) was 0.2%. It is found that 88,000 people were newly infected with HIV and 69 000 people died from an AIDS-related illness. There has been progressing in the number of AIDS-related deaths since 2010, with a 56% decrease, from 16,000 deaths to 69,000 deaths. The number of new HIV infections has decreased, from 1,20,000 to 88,000 in the same period. Out of the 2.1 million adults living with HIV, 8,80,000 (41.9%) were women. HIV treatment was higher among women than men, with 63% of adult women living with HIV on treatment, compared to 50% of adult men. The percentage of people living with HIV and tuberculosis who were being treated for both diseases was 33.4%, down from 36.3% in 2015 (UNAIDS, 2017).
In 1987 a National AIDS Control Programme was launched to coordinate national responses. Its activities covered surveillance, blood screening, and health education. 8 By the end of 1987, out of 52,907 who had been tested, around 135 people were found to be HIV positive and 14 had AIDS. Most of these initial cases had occurred through heterosexual sex, 9 but at the end of the 1980s, a rapid spread of HIV was observed among injecting drug users in Manipur, Mizoram and Nagaland - three north-eastern states of India bordering Myanmar (Burma).
At the beginning of the 1990s, as infection rates continued to rise, responses were strengthened. In 1992 the government set up the National AIDS Control Organization (NACO), to oversee the formulation of policies, prevention work and control programmes relating to HIV and AIDS. In the same year, the government launched a Strategic Plan for HIV prevention. This plan established the administrative and technical basis for programme management and also set up State AIDS bodies in 25 states and 7 union territories. It was able to make a number of important improvements in HIV prevention such as improving blood safety.
By this stage, cases of HIV infection had been reported in every state of the country. Throughout the 1990s, it was clear that although individual states and cities had separate epidemics, HIV had spread to the general population. Increasingly, cases of infection were observed among people that had previously been seen as ‘low-risk’, such as housewives and richer members of society. In 1998, one author wrote:
“HIV infection is now common in India; exactly what the prevalence is, is not really known, but it can be stated without any fear of being wrong that infection is widespread… it is spreading rapidly into those segments that society in India does not recognize as being at risk. AIDS is coming out of the closet.”
In 2001, the government adopted the National AIDS Prevention and Control Policy. During that year, Prime Minister Atal Bihari Vajpayee addressed parliament and referred to HIV/AIDS as one of the most serious health challenges facing the country. The Prime Minister also met the chief ministers of the six high-prevalence states to plan the implementation of strategies for HIV/AIDS prevention.
HIV had now spread extensively throughout the country. In 1990 there had been tens of thousands of people living with HIV in India; by 2000 this had risen to millions.
Causes of AIDS in India
HIV infection is not contagious in the same sense as measles, chickenpox, tuberculosis, cholera, plague or small-pox. It mainly spreads through a sexual route, blood to blood contact from mother to child during pregnancy, childbirth or breast-feeding. Here are the main causes that spread through four sources:
1. Multiple sex partners: This is the most common form of transmission of the virus. If one has unprotected sex with a person who is infected with HIV, he will get the infection as well. The risk is particularly higher during anal sex. The transmission of infection basically occurs through infected bodily fluids that include fluids from genital, rectal, or oral mucous membrane. Till some time ago, the most common form of sexual contact that led to AIDS was heterosexual. However, lately, more gay and bisexual contact has led to the occurrence of AIDS. It was estimated that about 20 lakh prostitutes distributed over 817 red-light areas in different parts of India. A large number of these prostitutes and call-girls are infected with HIV who passes on the infection to their customers. However, the married woman’s own risk to HIV was found to be extremely low, though her husband’s risk behaviour made her vulnerable.
Homosexuals are found in prisons, correctional reformatories, Rescue Homes, etc., outside these institutions also, they are found in thousands. The risk of HIV infection through homosexuality is indeed very real. Homosexuals in India are looked down upon with hostility unlike in the United States, Britain, etc., yet, it is a fact that the emerging institutions of gays like ‘Mumbai Dost’ indicate a changing attitude towards homosexuals. Though homosexuality is still an offence under the Indian Penal Code (IPC) Section 377, the long-held taboos about homosexuality are now beginning to break. However, in a historic verdict, the Supreme Court of India on September 6, 2018, decriminalized Section 377 of the IPC and allowed gay sex among consenting adults in private. The SC ruled that consensual adult gay sex is not a crime saying sexual orientation is natural and people have no control over it.
2. Infected needles: Sharing a needle or syringe puts an individual at high risk of HIV and other infectious diseases, such as hepatitis. Especially drug addicts, who take drugs by injection, carry the possibility of spreading the HIV infection through infected needles. The use of drugs is spreading rapidly among students, industrial workers, truck and auto-rickshaw drivers, and cycle-rickshaw pullers and people living in slum areas. A good number of drug-users gradually become so addicted to drugs that they start taking them by self-injection. According to data from the ministry of health, in 2014-15, India recorded 3,518 cases of HIV infections due to needles. In 2015-16, the number rose to 3,542, while in 2016-17 around 4,011 cases were recorded.
3. Infected blood: This is the second most common mode of transmission of HIV. It includes contact with infected blood through transfusion of contaminated blood, needle-sharing during drug intake or getting injected with unsterilized equipment. However, the risk of HIV through blood is getting lower in developed countries, thanks to better screening and meticulous precautions. Blood-donors to transmit the HIV infection. There are estimated to be 2,545 blood banks in our country that supply about 20 lakh bottles of blood every year. Out of which 981 are government banks and the remaining 1,564 were private banks. There are some professional blood donors also whose blood sometimes contains HIV. When their blood is transfused to patients without proper testing, HIV is transmitted. The pathological laboratories too similarly transmit HIV when they supply blood without scientific testing.
4. Infected mother to her baby before birth: It is possible for HIV to transmit from the mother to her child while she is pregnant, while she is delivering the baby or through her breast milk if she is infected. However, the risk of perinatal transmission can be significantly decreased if the mother or the child are given antiretroviral drugs. HIV-positive mothers who get treatment for the infection during pregnancy can significantly lower the risk to their babies. Undoubtedly, pregnant women who have positive HIV transmit the virus to new-born children. On one hand, about 65 per cent of the pregnant women remain anaemic and require blood transfusion and on the other hand, the prostitutes give birth to about 50 lakh children every year. They are thus doubly vulnerable to transmitting HIV.
It is also found that even the use of a blade for shaving, particularly the one used by the barbers, is also a risk factor in spreading HIV.
Impact of AIDS upon Indian Society
Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is a major public health problem in India. In general, it affects mainly young people who are at their most productive part of life. It is expected that the impact of HIV/AIDS can be felt upon Indian society. Let’s discuss how HIV/AIDS impact upon Indian society in various ways:
1. Impact on individuals and households: The impacts on individuals and households depend on their place, their households and communities where they life. The infected individual confronts in terms of
Health: Bouts of illness with increased frequency, severity and duration.
Resources: If the care is not provided free by the state, it drains away substantial amount of resources of the individual, household and communities.
In Indian family coping with infected AIDS that people or households cuts down the spending on necessities. HIV/AIDS places the households at increased economic and social risk and increase existing gender disparities. HIV households are likely to report loss of income, increased expenditure, lower savings and increased borrowing and liquidation of assets.
2. Demographic impact in India: At its current level AIDS is the 3rd largest cause of mortality in the world from 15-49 year olds, 2017. In 2017, National AIDS Control Organization (NACO) stated that India had around 21.4 lakh people living with HIV (PLHIV), 8,75,800 new patients were added to the existing pool in 2017, with 40 per cent of these new infections are women. So far 69,000 HIV-infected persons are estimated to have died in 2016. Apart from this, 22,675 pregnant mothers who were infected with HIV, needed Antiretroviral Therapy (ART) for the prevention of mother-to-child transmission of HIV.
HIV’s impact on adult mortality is greatest on people in their 20’s and 30’s and is proportionately larger for women than men. HIV/AIDS affect population growth and its structure in the following ways:
a. Fewer births
b. Women mortality
c. The reduction in fertility due to HIV injection
d. Worsening of Dependency ratio of children
e. Increase in No. of widows and orphans.
So far twenty-five million people have so far died of AIDS and 40 million are people living with AIDS in the world and the number of deaths is certain to rise.
3. The Impact on Employment and Income: The impact on employment and income due to HIV varied with the number and stage of infections of people. The per capita income levels are not affected due to the small average size of HIV households. The combined impact of lower-income and increased expenditure especially on medical care has an impact on savings of the households. To cover the medical expenses, Health and Human Services (HHS) report to borrowings liquidation of fixed assets (land, house) which implies a loss of Wealth and reduced saving. For the economy, reduced savings could result in lower investments and lower economic growth. The prevalence of HIV is higher among working people than those who are unemployed. For HIV household it results in a high prevalence of child labour as compared to non-HIV household.
4. Impact of HIV and AIDS on the education of children: Another impact is that AIDS reduces the numbers of children who enrol and stay in school and widens the gender gap between male and female enrolment. Orphans are part of a wider group of vulnerable children who do not have access to education. Mothers who died young with HIV leave their offspring nonattendance and later suffered stigma and discrimination, teasing, ostracism, and insensitivity. Gradually these children’s suffers from fears and grief, which can lead to confusion, anxiety, learning, difficulties, behavioural changes, loneliness and isolation.
5. Impact on health: The impact of HIV/AIDS at the household’s level is studied by the expenses borne on medical treatment. The financial burden of non-hospitalized as well as hospitalized illnesses is heavy on HIV households as compared to non-HIV households. For people living with HIV/AIDS (PLWHA), the prevalence rates of both hospitalized and non-hospitalized increases with the advance in stage A infection. In the earlier stages (stage I and II) the expense of hospitalization is low but gradually the expenses shoot up at stage III and IV. At stage IV of infection, 80% of PLWHA need hospitalization. The percentage of reported hospitalization is much higher for men as compared to women.
PLWHA mostly depend on health facility provided by the government and the NGOs. Health and Human Services (HHS) with higher income only resort to treatment from a private institution. In short, there is a heavy burden of disease on the HIV HHS and the burden increases as the stage of an infection increase.
6. Impact on gender: Women in India have a low economic and social status and these gender inequalities get reflected in the sexual relations between husband and wife. First, in the Indian context women do not have control over their own body and they do not have the right to decide when to have sex. As a result, women cannot negotiate safe sex and ask the men to use a condom. There is also a lack of availability of women controlled HIV prevention methods. Secondly, the cultural norms and attitude of society towards men of condoning multiple partnerships or pre-marital or extra-marital sexual affairs of men increases women’s risk of getting infected with the virus.
As a result of the low socio-economic status and limited educational opportunities, women and girls often lack basic information about HIV and AIDS. In addition, cultural taboos like speaking about sex or showing interest in or knowledge about sexual matters act as a barrier to girls receiving HIV related information from the elders or for that matter even from their peers. The economic dependency on men is also one of the factors contributing to the spread of HIV among women. Discriminatory inheritance rights, lack of access to and control over the property and unequal access to education, healthcare and income-earning activities further weaken their position. In addition, the various forms of violence against women further increases the risk of contracting HIV as sex is often forced on them.
7. Impact on governance and public services: In countries heavily affected by HIV, the epidemic affects governance and public service in three main ways:
a. The country loses hard-to-replace political leaders and civil servants
b. revenues decline and costs rise
c. demand social services increases
Taken together, these factors exert significant pressure on the governments of less developed countries. At the highest levels, AIDS is taking the lives of national leaders including ministers, parliamentarians, and cabinet members although most of these are not classified as AIDS deaths because the families fear stigmatization. Nations are losing their leaders and their years of political experience, undermining future national stability and security. The ranks of civil servants are also being depleted, deaths among skilled civil servants are especially difficult to absorb in countries with low levels of literacy and education. Many of these countries rely on a small pool of staff members to develop and administer services. Declining revenues and rising costs compound the loss of civil servants. In heavily affected countries, AIDS is reducing productivity and earnings.
India has been working tremendously hard to eradicate HIV/AIDS which poses serious health challenges to a large population living in the country. Efforts are now being made to reduce the number of HIV cases to zero and the nation has already achieved a breakthrough to stop HIV prevalence in the last few years. However, there is a long way to go for an “AIDS-Free India” as the country still has about 2.5 million people, aged between 15 and 49, estimated to be living with HIV/AIDS, the third-largest in the world.
Latest estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS) show that the world continues to close in on the goal of ending the AIDS epidemic by stopping HIV transmission and halting AIDS-related deaths. Remarkable progress has been made over the last decade-yet significant challenges remain.
Prevention of AIDS
Acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). There’s no vaccine to prevent HIV infection and no cure for AIDS. But you can protect yourself and others from infection. However, there are some easy ways that can help to prevent HIV from infecting you.
The first and the most vital aspect in the prevention of this disease is awareness. If you know about the possible sources of the infection and its transmission, there are high chances that you will not contract the infection. To help prevent the spread of HIV, let us discuss the following below:
1. Safe sexual contact: There are multiple facets to safe sexual contact. They include the following:
i. Using condoms every time you have sex and using a new one for every new session is of utmost importance.
ii. A lot of people skip condoms when they are having oral or anal sex because these two forms of sexual contact do not lead to pregnancy. However, one must know that the chances of contracting the infection from an HIV-positive person through these two kinds of sexual contact are very high.
iii. You must always disclose to your sexual partner if you are HIV positive. Similarly, your partner should also never hold this information from you. If you have a doubt, never hesitate to get yourself and your partner screened.
2. Tell your sexual partners if you have HIV: It’s important to tell all your current and past sexual partners that you’re HIV-positive. They’ll need to be tested.
3. Consider the drug Truvada: The drug emtricitabine-tenofovir (Truvada) can reduce the risk of sexually transmitted HIV infection in people at very high risk. This drug is an effective measure to prevent contracting HIV if you are at a high-risk position. However, it should only be taken if your doctor recommends it to you and the dosage should be as per his recommendations. It should be noted that though this medicine is also administered for HIV treatment, that is only done along with other medications. When taken in isolation, it is only a preventive medicine and will not help if you already have the infection. Your doctor will get you screened for HIV, hepatitis B and kidney function before he prescribes this combination drug to you.
4. Always use clean needles for drugs: If you are on any drugs that need to be injected into your body, you must make sure that they are sterile, clean and unused. You must never share needles with anyone. This is because intravenous drug use is a very common factor that causes HIV transmission.
5. Avoid exposure to infected blood: This largely applies to healthcare workers who have to deal with HIV-positive patients on a day-to-day basis. They must wear proper paraphernalia which includes gloves, eyewear, masks, gowns and shields to prevent exposure to infected blood. However, if your skin gets exposed to infected blood, besides consulting a doctor, you must wash it thoroughly and frequently. It should reduce the risk factor significantly.
6. If you are pregnant or are planning a pregnancy, get yourself screened immediately: The news of pregnancy must follow a thorough body check-up. In fact, the decision to have a baby needs to be followed by a check-up for HIV. This will reduce the risk factor for your baby significantly. Even if you are tested positive for HIV after you got pregnant, proper treatment and medication can reduce the risk of your baby contracting the infection by 92 to 99 per cent.
7. Awareness: As stated above, the first step towards preventing HIV is by creating awareness about the disease. This will significantly curb risky behaviour among people.
In India, a number of international organizations are working with the National AIDS Control Organization (NACO) in addressing HIV/AIDS issue by contributing their technical expertise and financial resources. Even non-governmental organizations (NGO) has taken initial steps in raising awareness of the basic facts of HIV transmission and AIDS care, promoting condom use and empowering marginalized women to take into their own hands the struggle against HIV/AIDS should help spread knowledge on AIDS to different vulnerable groups through innovative and community-based approaches. Prevention and control of HIV/AIDS epidemic require the organisation of resources, technology and concerted effort both at the local and global level. The costs of prevention and control are high.
Trends on AIDS
In India, new HIV infections dropped from 1,20,000 in 2010 to 88,000 in 2017. AIDS-related deaths also dropped from 1,60,000 to 69,000, and people living with HIV from 23,00,000 to 21,00,000 in the same time period, noted the Joint United Nations Programme on HIV/AIDS (UNAIDS) report 2018. It surely is good news for the prevention programs and interventions functioning in the country, but they still have a long way to go. The UNAIDS report also noted that this downfall in the deaths and an improvement in the attitudes towards people living with HIV in India, just like in Vietnam, is due to the proper implementation of the program. The credit for this goes to the HIV/AIDS movement in the country.
The first HIV positive case in India was reported in Chennai in 1986, and it was found that Maharashtra, Tamil Nadu, and Manipur had the majority of AIDS cases in the country. By the end of 1999, 1.3 million women were living in India with HIV, and by 2002, 3.7 million adults and children were living with HIV in the country. The Indian government set up screening centres to diagnose the disease which was said to be dangerous enough to wipe away humanity. The government set up the National AIDS Control Program (NACP) in 1987, aiming to stop HIV from spreading. The second phase of the program was launched in 1999, aimed at providing antiretroviral treatment. The third phase, which was launched in 2007, focused on high-risk groups and control outreach programs.
In 2017, the Lok Sabha passed the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Bill, 2017. The bill, that was passed by the Rajya Sabha on March 22, 2017, makes antiretroviral therapy a legal right of HIV/AIDS patient and states that “every person in the care and custody of the state shall have right to HIV prevention, testing, treatment and counselling services.” The bill also prohibits HIV testing from being used as a pre-requisite for securing a job, accessing health care, or education and states that no person shall have to undergo HIV test or medical treatment without one’s informed consent. An HIV positive person shall have to disclose his HIV status only if required by a court order.
The bill, as a whole, does introduce a right-based approach that the movement in the country has adopted. However, the bill reflects the government’s reluctance to spend its money on public health in Section 14 (1) of the bill. The section states, “The measures to be taken by the central or state governments under section 13 shall include measures for providing, as far as possible, antiretroviral therapy and opportunistic management to people living with HIV or AIDS.” “As far as possible” in this section defeats the whole purpose of the bill and has been opposed by the community.
The government, in its annual budget for the fiscal year 2018-2019, has allocated a mere sum of Rs 52,800 crore for healthcare, and it is only 5 per cent higher than what was allocated for 2017-2018. The investment in public health of the government is hardly enough and invites the private players to invest in public health. The stock out a problem that the HIV/AIDS drugs face, for example, is due to the lack of investment by the government in public health. The public health system is the only way to ensure that medicines are more accessible. Jagat Prakash Nadda, former Union Minister of the health minister, had promised a “test and treat” policy, where all individuals who have been tested positive for HIV infection will receive antiretroviral drugs in India. This, however, as the civil society argues, has remained merely a verbal commitment.
Thus, World AIDS Day is held on 1 December each year. The Day is treated as an opportunity for people worldwide to unite in their fight against HIV, show their support for people living with HIV and to commemorate people who have died. World AIDS Day was the first-ever global health day and the first one was held in 1988.
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