AIDS stands for "Acquired Immune Deficiency Syndrome" or "acquired immunodeficiency syndrome" and denotes a condition, which results from the damage done by HIV (human immunodeficiency virus) to the immune system. The condition was first identified in 1981 and the name "AIDS" was first introduced on July 27, 1982. It has been estimated that around 33 million people around the world have been infected with HIV and that around two million people die from AIDS related conditions each year. On October 27, 1988, the UN General Assembly officially recognized that the World Health Organization declared December 1, 1988, to be World AIDS Day. World AIDS Day has also been observed on this date each year since then. World AIDS Day On World AIDS Day, many community, national and international leaders issue proclamations on supporting and treating people living with HIV and AIDS and stimulating research into the treatment of these conditions. Theme of World AIDS Day A simple red ribbon is one of the most widely recognized symbols of HIV and AIDS and the people who live with these conditions. The symbol was presented by the Visual AIDS Artists Caucus in 1991. The red ribbon was originally intended to be worn as a badge, but is now used in a wide variety of ways. The symbol of the World AIDS Campaign consists of a sketched image of a red ribbon and the words "world aids campaign". The words "world" and "campaign" are in black and the word "aids" is in red. The ends of the ribbon merge into splashes of green, blue, purple and orange. The splashes of color can be interpreted in a variety of ways, but are often taken to indicate the diversity of people living with HIV and AIDS. AIDS AIDS stands for: Acquired Immune Deficiency Syndrome AIDS is a medical condition. A person is diagnosed with AIDS when their immune system is too weak to fight off infections. Since AIDS was first identified in the early 1980s, an unprecedented number of people have been affected by the global AIDS epidemic. Today, there are an estimated 33.3 million people living with HIV and AIDS worldwide. Causes AIDS is caused by HIV.HIV is a virus that gradually attacks immune system cells. As HIV progressively damages these cells, the body becomes more vulnerable to infections, which it will have difficulty in fighting off. It is at the point of very advanced HIV infection that a person is said to have AIDS. It can be years before HIV has damaged the immune system enough for AIDS to develop. Symptoms AIDS begins with HIV infection. People infected with HIV may have no symptoms for 10 years or longer, but they can still transmit the infection to others during this symptom-free period. If the infection is not detected and treated, the immune system gradually weakens and AIDS develops. Almost all people infected with HIV, if not treated, will develop AIDS. There is a small group of patients who develop AIDS very slowly, or never at all. These patients are called non progressors, and many seem to have a genetic difference that prevents the virus from damaging their immune system. The symptoms of AIDS are primarily the result of infections that do not normally develop in individuals with healthy immune systems. These are called opportunistic infections. People with AIDS have had their immune system damaged by HIV and are very susceptible to these opportunistic infections. Common symptoms are: · Chills · Fevers · Sweats (particularly at night) · Swollen lymph glands · Weakness · Weight loss TRANSMITION Human immunodeficiency virus (HIV) causes AIDS. The virus attacks the immune system and leaves the body vulnerable to a variety of life-threatening infections and cancers. Common bacteria, yeast, parasites, and viruses that ordinarily do not cause serious disease in people with healthy immune systems can cause fatal illnesses in people with AIDS. HIV IS FOUND HIV has been found in · Saliva, · Tears, · Nervous system tissue and spinal fluid, · Blood, semen (including pre-seminal fluid, which is the liquid that comes out before ejaculation), · Vaginal fluid, · Breast milk. However, only blood, semen, vaginal secretions, and breast milk generally transmits infection to others. The virus can be spread (transmitted): · Other methods- of spreading the virus are rare and include 1. Accidental needle injury. 2. Artificial insemination with infected donated semen. 3. Organ transplantation with infected organs. HIV infection is NOT spread by: AIDS and blood or organ donation: · AIDS is NOT transmitted to a person who DONATES blood or organs. · HIV can be transmitted to a person RECEIVING blood or organs from an infected donor. · To reduce this risk, blood banks and organ donor programs screen donors, blood, and tissues thoroughly. People at highest risk for getting HIV HIV-positive, or have AIDS Safe sex Safe sex to reduce the chance of acquiring or spreading HIV, and other sexually transmitted diseases. Needle sharing Do not use illicit drugs and do not share needles or syringes. Contact with blood Avoid contact with another person's blood. Protective clothing, masks, and goggles may be appropriate when caring for people who are injured. HIV-POSITIVE Anyone who tests positive for HIV can pass the disease to others and should not donate blood, plasma, body organs, or sperm. Infected people should tell any sexual partner about their HIV-positive status. They should not exchange body fluids during sexual activity, and should use whatever preventive measures (such as condoms) will give their partner the most protection. HIV-POSITIVE WOMEN HIV-positive women who wish to become pregnant should seek counseling about the risk to their unborn children, and methods to help prevent their baby from becoming infected. The use of certain medications dramatically reduces the chances that the baby will become infected during pregnancy. Breast-Feeding It recommends that HIV-infected women avoid breast-feeding to prevent transmitting HIV to their infants through breast milk. SAFE-SEX PRACTICES Safe-sex practices, such as latex condoms, are highly effective in preventing HIV transmission. HOWEVER, there remains a risk of acquiring the infection even with the use of condoms. Abstinence is the only sure way to prevent sexual transmission of HIV. SEXUAL BEHAVIOR The riskiest sexual behavior is unprotected receptive anal intercourse. The least risky sexual behavior is receiving oral sex. Performing oral sex on a man is associated with some risk of HIV transmission, but this is less risky than unprotected vaginal intercourse. Female-to-male transmission of the virus is much less likely than male-to-female transmission. Performing oral sex on a woman who does not have her period has a low risk of transmission. Antiretroviral Medications HIV-positive patients who are taking antiretroviral medications are less likely to transmit the virus. For example, pregnant women who are on effective treatment at the time of delivery, and who have undetectable viral loads, give HIV to their baby less than 1% of the time, compared with about 20% of the time if medications are not used. HIV IN PAKISTAN. HIV is not currently a dominant epidemic in Pakistan. However, the number of cases is growing. Moderately high drug use and lack of acceptance that non-marital sex is common in the society have allowed the AIDS epidemic to take hold in Pakistan, mainly among injection drug users, some male sex workers and repatriated migrant workers. AIDS may yet become a major health issue. The National AIDS Programme's latest figures show that over 4,000 HIV cases have so far been reported since 1986, but UN and government estimates put the number of HIV/AIDS cases around 97,000 ranging from lowest estimate 46,000 to highest estimate-210,000 . More realistic estimates that are based on actual surveillance figures, however, suggest that this number may be closer to 40,000 - 45,000. The over all prevalence of HIV infection in adults aged 15 to 49 is 0.1%. (0.05% if one accepts the lower estimates). Officials say that the majority of cases go unreported due to social taboos about sex and victims' fears of discrimination. On the other hand, more detailed and recent data suggest that this may be overestimate. Evolving phases of HIV epidemic HIV epidemic evolves in three phases. First phase- is low prevalence, when prevalence of the disease is less than 5% in any high risk group of the country. Second phase- is concentrated epidemic when proportion of infected people in any high risk group rises more than 5% Third and last phase -of epidemic is generalized epidemic when prevalence of HIV infection rises over 1% among blood donor or pregnant women. Current data suggest that Pakistan has a concentrated epidemic among injection drug users in most cities and among male sex workers in a few cities. The role of therapeutic injections A major factor that must be accounted for in the overall HIV transmission scenario is the rampant use of therapeutic injections, often with non-sterile injection equipment. There are an estimated 800 million therapeutic injections given annually in Pakistan or approximately 4.5 per capita. This is among the highest in the World. A small but significant proportion of these are reused. This has led to the prevalence of Hepatitis C infection (which is nearly exclusively transmitted via blood exposures) to become >5% nationwide, although this seems to have stabilized at a national level. Conservatively this suggests around 150,000 new HCV infections annually, leading to the conclusion that HIV can also potentially spread via this route as well. Indeed recent community based outbreaks in Punjab suggest that the process may have already started. Preventing HIV/AIDS in Pakistan Pakistan still has a window of opportunity to act decisively to prevent the spread of HIV/AIDS. Although the estimated HIV/AIDS burden is still low—around 0.1 percent of the adult population - there has been an outbreak of HIV among injecting drug users in Sindh. Without vigorous and sustained action, Pakistan runs the risk of experiencing the rapid increase in HIV/AIDS among vulnerable groups seen elsewhere STATE OF THE EPIDEMIC According to UNAIDS estimates, some 70,000 to 80,000 persons, or 0.1 percent of the adult population in Pakistan, are infected with HIV. As in many countries, underreporting is due mainly to the social stigma attached to the infection, limited surveillance and voluntary counseling and testing systems, as well as the lack of knowledge among the general population and health practitioners. Until recently, Pakistan was classified as a low-prevalence country with many risk factors that could lead to the rapid development of an epidemic. However, recent evidence indicates that the situation is changing rapidly. In recent years a concentrated outbreak of HIV was found among Injecting Drug Users (IDUs) in Karachi, where over 20 percent of those tested were found to be infected. High levels of HIV infection - 4 percent - were also found among men who have sex with men (MSM) in the city. The infection rate among Hijras was 2 percent. Nonetheless, HIV prevalence among other high risk groups in Karachi and all vulnerable populations in Lahore is still low - below 1 percent. The findings underline the risk of an escalating epidemic. They point to the presence of significant risk factors such as the very low use of condoms among vulnerable populations including female sex workers (FSW), MSMs, truckers, and Hijras, as well as the low use of sterile syringes among IDUs. They also reveal an alarmingly high prevalence of syphilis among Hijras - 60 percent in Karachi and 33 percent in Lahore - which increases the risk of HIV infection. RISK FACTORS There are serious risk factors that put Pakistan in danger of facing a rapid spread of the epidemic if immediate and vigorous action is not taken: Outbreaks Among Injecting Drug Users (IDUs): The number of drug dependents in Pakistan is currently estimated to be about 500,000, of whom an estimated 60,000 inject drugs. An outbreak of HIV was discovered among injecting drug users in Larkana, Sindh, where, out of 170 people tested, more than 20 were found HIV positive. In Karachi, a 2004 survey of Sexually Transmitted Infections among high risk groups found that more than one in five IDUs was infected with HIV. These represent the first documented epidemics of HIV in well-defined vulnerable populations in Pakistan. They serve as confirmation of the threat that HIV poses to Pakistan and validate the premise of the country's recent Enhanced HIV/AIDS Program. HIV Infection Among Men who have Sex with men (MSM): Lahore had an estimated 38,000 MSM in 2002. The MSM community is heterogeneous and includes Hijras (biological males who are usually fully castrated), Zenanas (transvestites who usually dress as women) and masseurs. Many sell sex and have multiple sexual partners. The 2004 STI survey found that 4 percent of MSMs in Karachi were infected with HIV, as were 2 percent of the Hijras in the city. Syphillis rates were also high with 38 percent of MSMs and 60 percent of Hijras in Karachi infected with the disease. Unsafe Practices among Commercial Sex Workers (CSW): Commercial sex is prevalent in major cities and on truck routes. Behavioral and mapping studies in three large cities found a CSW population of 100,000 with limited understanding of safe sexual practices. Furthermore, sex workers often lack the power to negotiate safe sex or seek treatment for STIs. Recent findings indicate that although HIV prevalence remains below 1 percent, female sex workers (FSWs) and their clients report low condom use. Less than half the FSWs in Lahore and about a quarter in Karachi had used condoms with their last regular client. Inadequate Blood Transfusion Screening and High Level of Professional Donors: It is estimated that 40 percent of the 1.5 million annual blood transfusions in Pakistan are not screened for HIV. In 1998, the AIDS Surveillance Center in Karachi conducted a study of professional blood donors—people who are typically very poor, often drug users, who give blood for money. The study found that 20 percent were infected with Hepatitis C, 10 percent with Hepatitis B, and 1 percent with HIV. About 20 percent of the blood transfused comes from professional donors. Large Numbers of Migrants and Refugees: Large numbers of workers leave their villages to seek work in larger cities, in the armed forces, or on industrial sites. A significant number (around 4 million) are employed overseas. Away from their homes for extended periods of time, they become exposed to unprotected sex and are at risk for HIV/AIDS. Unsafe Medical Injection Practices: Pakistan has a high rate of medical injections - around 4.5 per capita per year. Studies indicate that 94 percent of injections are administered with used injection equipment. Use of unsterilized needles at medical facilities is also widespread. According to WHO estimates, unsafe injections account for 62 percent of Hepatitis B, 84 percent of Hepatitis C, and 3 percent of new HIV cases. Low Levels of Literacy and Education: Efforts to increase awareness about HIV among the general population are hampered by low literacy levels and cultural influences. In 2001, the illiteracy rate of Pakistani women over 15 years old was 71 percent. Vulnerability Due to Social and Economic Disadvantages: Restrictions on women's and girls' mobility limits access to information and preventive and support services. Young people are vulnerable to influence by peers, unemployment frustrations, and the availability of drugs. In addition, some groups of young men are especially vulnerable due to the sexual services they provide, notably in the transport sector. Both men and women from impoverished households may be forced into the sex industry for income ISSUES AND CHALLENGES: PRIORITY AREAS Vulnerable and High-risk Groups: · Expand knowledge, access, and coverage of vulnerable populations—particularly in large cities—to a package of high impact services, through combined efforts of the government and NGOs. · Implement harm-reduction initiatives for IDUs and safe sex practices for CSWs. · Make effective and affordable STD services available for high-risk groups and the general population. General Awareness and Behavioral Change: 1) Undertake behavioral change communications with the following behavioral objectives: (i) use of condoms with non-regular sexual partners; (ii) use of STI treatment services when symptoms are present and knowledge of the link between STIs and HIV; (iii) use of sterile syringes for all injections; (iv) reduction in the number of injections received; (v) voluntary blood donation (particularly among the age group 18 to 30); (vi) use of blood for transfusion only if it has been screened for HIV; (vii) Display of tolerant and caring behaviors towards people living with HIV/AIDS and members of vulnerable populations. 2) Increase interventions among youth, police, soldiers, and migrant laborers. Blood and Blood Product Safety: · -Ensure mandatory screening of blood and blood products in the public and private sectors for all major blood-borne infections. · -Conduct education campaigns to promote voluntary blood donation · -Develop Quality Assurance Systems for public and private blood banks to ensure that all blood is properly screened for HIV and Hepatitis B. Surveillance and Research: · -Strengthen and expand the surveillance and monitoring system. · -Implement a second-generation HIV surveillance that tracks sero-prevalence and changes in HIV-related behaviors, including the spread of STIs and HIV, sexual attitudes and behaviors, and healthcare-seeking behaviors related to STIs. HIV/aids – A Social Issue The word "AIDS" evokes different feelings for different people. As Pakistani you are part of a nation that is "living with HIV/AIDS". This is forcing us to face the reality of sex, love, death and mortality. AIDS is bringing to the surface all that is strong and all that is weak in our humanity: our vulnerability and our fears as well as our strength and compassion to reach out. For many of us we feel a mixture of fear, embarrassed compassion, hostility and at times ignorant disgust. We have seen the disease shatter relationships. We have seen it bind them together. The medical profession has been both divided and united by HIV. We can no longer cope with HIV/AIDS by keeping it invisible. At the break of 2001 there is still no cure and no vaccine. In 1998 16 000 individuals were infected with HIV everyday. By the years end over 34 million people were living with HIV worldwide – although it is estimated that nine-tenths of them are unaware of their infection. Almost 20 million adults and children have already lost their lives to the disease. HIV is a social disease HIV is a social disease. It is the single greatest threat to our economic, social and human development. We can search for people to blame or we can let ourselves think that it only affects others, but AIDS is here and it is going to impact on our lives dramatically. If we're not infected ourselves, we will soon all know a family member, a neighbors, a relative, a co-worker, or a friend infected with HIV and in need of love and support. In Pakistan, most people with HIV/AIDS have no access to medication, even to relieve their pain and suffering. AIDS drug therapies are currently too expensive and drug trials are only made available to the few. An HIV+ diagnosis could mean complete hopelessness for many people as feelings of fear and despair are worsened by the underlying stigma of the epidemic. However, being HIV+ is not a death sentence. As important as it is to do all we can in the area of prevention, we need to focus on the hope that exists for those infected and affected by HIV. Stress and malnutrition can significantly push the progression of HIV to AIDS. Healthy living, with the support of others, has for many HIV+ Pakistani become the answer to a longer and fuller life. Positive attitude · Learning how to prevent the spread of HIV to others, · Talking to a trained HIV counselors or attending a support group regularly will encourage a person to live positively with the virus and see their dreams flourish. · Concerns about affordable health care and help when too sick to work can also be dealt with. · An HIV+ person's greatest need is having supportive relationships with other people. You can help an HIV+ person live a healthy normal life by being informed. · Work through your own attitudes and fears about HIV/AIDS and learn to treat infected people normally. · Be compassionate and listen. · Care for them like you would care for any of your other friends. CONCLUSION HIV and AIDs have been hugely impactful to world health for over thirty years. Nearly everyone has been touched in some way by this issue, which reached pandemic proportions at its height. Although progress is being made, HIV and AIDs remain among the most urgent humanitarian concerns of our day. Because of this, it is important to keep this issue alive in the public consciousness. Prevention depends upon proper education and awareness, funding for research, as well as equitable and affordable distribution of medical care worldwide. The theme of this year's recognition week is "human rights and universal access". In the United States alone, one in every five people living with HIV have not been diagnosed, let alone reported. We must continue to take steps to open the door to communication and access to treatment in order to eradicate this epidemic. CONTRIBUTED BYThe theme for World AIDS Day 2010 is
'Universal Access and Human Rights'.
Symbols
Important facts about the spread of AIDS include:
DR SYED FAHIM AHMED
MBBS, MPH, MBA
drsyedfahimahmed@hotmail.com
drsyedfahimahmed@yahoo.com
magnumresoursecentre@hotmail.com
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