End inequalities, end AIDS

Dr Rajiv Kumar Gupta
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. 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. 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. Without treatment, they could also develop severe illnesses such as tuberculosis (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. Behaviours and conditions that put individuals at greater risk of contracting HIV include:
* Unprotected sex;
* Having another sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhoea and bacterial vaginosis;
* Engaging in harmful use of alcohol and drugs in the context of sexual behaviour
* 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.
Key approaches for HIV prevention, which are often used in combination, include:
* Male and female condom use;
* Prevention, testing and counseling for HIV and STIs;
* Voluntary medical male circumcision (VMMC);
* Use of antiretroviral drugs (ARVs) for prevention
* Harm reduction for people who inject and use drugs; and
* Elimination of mother-to-child transmission (MTCT) of HIV.
Since 2016, WHO has recommended “Treat All: that all people living with HIV be provided with lifelong ART.” By June 2022, 189 countries had already adopted this recommendation, covering 99% of all people living with HIV globally. In addition to the Treat All strategy, WHO recommends a rapid ART initiation to all people living with HIV. Globally, 28.7 million people living with HIV were receiving ART in 2021. WHO is supporting countries to implement the advanced HIV disease package of care to reduce illness and death. The 2022-2030 strategies recommend shared and disease-specific country actions supported by actions by WHO and partners. The strategies call for a precise focus to reach the people most affected and at risk for each disease that addresses inequities.
This year’s theme for World AIDS Day is “Putting Ourselves to the Test: Achieving Equity to End HIV.” It encourages people to unite globally to eliminate the disparities and inequities that create barriers to HIV testing, prevention, and access to HIV care.
The inequalities which perpetuate the AIDS pandemic are not inevitable; we can tackle them. This World AIDS Day, 1 December, UNAIDS is urging each of us to address the inequalities which are holding back progress in ending AIDS.
The “Equalize” slogan is a call to action. These include:
* Increase availability, quality and suitability of services, for HIV treatment, testing and prevention, so that everyone is well-served.
* Reform laws, policies and practices to tackle the stigma and exclusion faced by people living with HIV and by key and marginalised populations, so that everyone is shown respect and is welcomed.
* Ensure the sharing of technology to enable equal access to the best HIV science, between communities and between the Global South and North.
* Communities will be able to make use of and adapt the “Equalize” message to highlight the particular inequalities they face and to press for the actions needed to address them.
We have only eight years left before the 2030 goal of ending AIDS as a global health threat. Economic, social, cultural and legal inequalities must be addressed as a matter of urgency. In a pandemic, inequalities exacerbate the dangers for everyone.
“We can end AIDS – if we end the inequalities which perpetuate it. This World AIDS Day we need everyone to get involved in sharing the message that we will all benefit when we tackle inequalities,”
(The Professor and Head Community medicine GMC Jammu)