World AIDS Day: History, importance and facts about AIDS in 2019

World AIDS Day observed on 1st December each year. It is an opportunity for people worldwide to unite in the fight against HIV, to show support for people living with HIV, and to commemorate those who have died from an AIDS-related illness. Founded in 1988, World AIDS Day was the first ever global health day.

On World AIDS Day 2019, WHO is highlighting the difference these communities are making to end the HIV epidemic while drawing global attention to the need for their broader engagement in strengthening primary health care. Of the 37.9 million people living with HIV at the end of 2018, 79% received testing, 62% received treatment, and 53% had achieved suppression of the HIV virus with reduced risk of infecting others.

Thousands of community health workers and members of the HIV and key population networks – many of whom are living with HIV or affected by the epidemic – contributed to this success.

Key facts about HIV AIDS:

HIV continues to be a major global public health issue, having claimed more than 32 million lives so far. However, with increasing access to effective HIV prevention, diagnosis, treatment and care, including for opportunistic infections, HIV infection has become a manageable chronic health condition, enabling people living with HIV to lead long and healthy lives.

As a result of concerted international efforts to respond to HIV, coverage of services has been steadily increasing. In 2018, 62% of adults and 54% of children living with HIV in low- and middle-income countries were receiving lifelong antiretroviral therapy (ART).

A great majority (82%) of pregnant and breastfeeding women living with HIV also received ART, which not only protects their health, but also ensures prevention of HIV transmission to their newborns.

Between 2000 and 2018, new HIV infections fell by 37% and HIV-related deaths fell by 45%, with 13.6 million lives saved due to ART. This achievement was the result of great efforts by national HIV programmes supported by civil society and international development partners.

There is no cure for HIV infection. However, effective antiretroviral drugs (ARVs) can control the virus and help prevent onward transmission to other people.

History of World AIDS Day:

World AIDS Day was first conceived in August 1987 by James W Bunn and Thomas Netter, two public information officers for the Global Programme on AIDS at the World Health Organization in Geneva, Switzerland. Bunn and Netter took their idea to Dr Jonathan Mann, Director of the Global Programme on AIDS (now known as UNAIDS). Dr Mann approved it and agreed with the recommendation that the first observance of World AIDS Day should be on 1 December 1988.

Theme for World AIDS Day 2019:

The theme for the 2019 observance is “Ending the HIV/AIDS Epidemic: Community by Community”.

What is AIDS?

The full form of AIDS is Acquired Immunodeficiency Syndrome. It is a chronic and life-threatening condition caused by HIV (Human Immunodeficiency Virus). It damages the immune system of the human being and the ability of the body to fight against disease hampered.

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. Individuals cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water.

Importance of World AIDS Day 2019:

1.  Today 4 in 5 people with HIV get tested and 2 in 3 get treatment: communities played a major role in achieving this success. Of the estimated 37.9 million people living with HIV at the end of 2018, 79% were diagnosed, 62% received treatment, and 53% had achieved suppression of the HIV virus with low risk of infecting others.One of the key contributors to this success in all countries has been the thousands of members of HIV and “key population” community networks and community health workers, many of whom are living with or affected by HIV.  
2. WHO recommends countries to adopt community-based HIV testing, prevention, treatment and care as a core strategy. WHO recommends a strategic mix of approaches for testing, including community-based testing, self-testing and provider-assisted referral to reach people at highest risk of HIV. Countries like South Africa and Rwanda have shown how trained peers or community health workers have delivered rapid diagnostic tests with same-day results, enabling more people to know their HIV status. WHO recommends increased rapid testing in community settings for key populations in Europe, Asia and the Americas to replace laborious approaches causing weeks of delays in test results and treatment initiation. WHO is also adding new recommendations to mobilize community-based social networks for increasing demand for HIV testing, including self-testing and to promote dual HIV/syphilis rapid tests and new digital tools.
3. Community-based HIV treatment and monitoring saves money and reduces workloads for doctors, nurses and other health care professionals. WHO recommends countries train and mobilize community health workers, including people living with HIV, to provide decentralized and differentiated HIV treatment and care.Evidence shows more people continue with HIV treatment when peer educators counsel and support each other.WHO also recommends that community health workers support monitoring and data collection.  
4. Expanding the role of communities and community-based health care will help countries meet global HIV and UHC targets.Health services are struggling to provide all people with HIV services they need.  Global fast-track targets for HIV for 2020 are unlikely to be met unless more support becomes available.The most glaring gap is seen in prevention. In 2018, 1.7 million people were newly infected with HIV – this number must reduce by three-fold to meet the 2020 target of 500 000.Testing and treatment coverage is off track too – especially for key populations and children. For example, more than half of all new infections are among key populations and their partners; only half of the children in need are receiving ART, of which only half achieved viral suppression due to the use of suboptimal medicines.  
5. Community and civil society engagement must remain a key strategy to boost primary health care.Activism and civil society action have been key resources in the HIV response from the early days, inspiring the global health community to galvanize efforts for increased equity, respect for health and human rights, and scientific innovation.In September 2019, global leaders signed the first-ever UN declaration on UHC with a central focus on primary health care, tailored for and built through empowered and engaged communities.Today, people-centred care, community and civil society engagement are included in three Sustainable Development Goal targets.World AIDS Day 2019 provides an opportunity to translate our commitments into action, to ensure the role of communities for HIV and health progress are both celebrated and accelerated.  

Signs and symptoms of HIV AIDS:

The symptoms of HIV vary depending on the stage of infection. Though people living with HIV tend to be most infectious in the first few months after being infected, many are unaware of their status until the later stages. 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 progressively weakens the immune system, they can develop other signs and symptoms, such as swollen lymph nodes, weight loss, fever, diarrhoea and cough. 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.

Prevention of AIDS:

Individuals can reduce the risk of HIV infection by limiting exposure to risk factors. Key approaches for HIV prevention, which are often used in combination, are listed below.

Male and female condom use

Correct and consistent use of male and female condoms during vaginal or anal penetration can protect against the spread of STIs, including HIV. Evidence shows that male latex condoms have an 85% or greater protective effect against HIV and other STIs.

Testing and counselling for HIV and STIs

Testing for HIV and other STIs is strongly advised for all people exposed to any of the risk factors. This enables people to learn of their own HIV status and access necessary prevention and treatment services without delay. WHO also recommends offering testing for partners or couples. Additionally, WHO recommends assisted partner notification approaches, in which people with HIV receive support to inform their partners either on their own, or with the help of health care providers.

Testing and counselling, linkages to tuberculosis (TB) care

TB is the most common illness among people living with HIV. Fatal if undetected or untreated, TB is the leading cause of death among people with HIV, responsible for nearly 1 in 3 HIV-associated deaths.

Early detection of TB and prompt linkage to TB treatment and ART can prevent these deaths. TB screening should be offered routinely at HIV care services, and routine HIV testing should be offered to all patients with presumptive and diagnosed TB. TB preventive therapy should be offered to all people living with HIV who do not have active TB. Individuals who are diagnosed with HIV and active TB should urgently start effective TB treatment (including for multidrug-resistant TB) and ART.

Voluntary medical male circumcision (VMMC)

Medical male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. Since 2007, WHO recommends VMMC as an additional prevention strategy. This is a key prevention intervention supported in 15 countries in eastern and southern Africa with high HIV prevalence and low male circumcision rates. VMMC is also regarded as a good approach to reach men and adolescent boys who do not often seek health care services. At the end of 2018, 23 million adolescent boys and men in eastern and southern Africa had been provided with a package of services, including VMMC, HIV testing, and education on safer sex and condom use.

Use of ARVs for prevention

Prevention benefits of ART

A scientific trial confirmed that if an HIV-positive person adheres to an effective ART, the risk of transmitting the virus to their uninfected sexual partner can be reduced by 96% in 2011. Following the results, WHO recommended that all people living with HIV should be offered ART with the aim of saving lives and significantly reducing HIV transmission. A 2019 study showed that HIV transmission risk through sex without condoms in serodiscordant men in same sex couples who were virally suppressed and on ART was effectively zero.

Pre-exposure prophylaxis (PrEP) for HIV-negative partner

Oral PrEP of HIV is the daily use of ARVs by HIV-negative people to block the acquisition of HIV. More than 10 randomized controlled studies have demonstrated the effectiveness of PrEP in reducing HIV transmission among a range of populations, including serodiscordant heterosexual couples (where one partner is infected and the other is not), men who have sex with men, transgender women, high-risk heterosexual couples, and people who inject drugs.

WHO recommends PrEP as a prevention choice for people at substantial risk of HIV infection as part of a combination of prevention approaches. WHO has also expanded these recommendations to HIV-negative women who are pregnant or breastfeeding.

Post-exposure prophylaxis for HIV (PEP)

PEP is the use of ARVs within 72 hours of exposure to HIV to prevent infection. PEP includes counselling, first aid care, HIV testing, and administration of a 28-day course of ARV drugs with follow-up care. WHO recommends PEP use for both occupational and non-occupational exposures, and for adults and children.

Treatment of AIDS:

HIV can be suppressed by combination ART consisting of 3 or more ARV drugs. ART does not cure HIV infection but 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 2016, WHO recommended that all people living with HIV be provided with lifelong ART, including children, adolescents and adults, and pregnant and breastfeeding women, regardless of clinical status or CD4 cell count. By mid-2019, 182 countries had already adopted this recommendation, covering 99% of all people living with HIV globally.

The HIV treatment guidelines include new alternative ARV options with better tolerability, higher efficacy, and lower rates of treatment discontinuation when compared with previous recommended medicines. WHO recommends the use of dolutegravir-based or low-dose efavirenz for first-line therapy, and raltegravir and darunavir/ritonavir for second-line therapy.