Information about HIV/AIDS (for educational purpose)

Introduction:

 

 

HIV/AIDS is a serious and fatal infection that destroys the immune system of the human body. HIV stands for: Human Immunodeficiency Virus and it is this virus that causes AIDS which is an abbreviation for: Acquired Immune Deficiency Syndrome.

 

When a person gets infected with HIV, the virus cannot be instantly detected in the blood. It takes at least about three to three and half months for the HIV antibodies to be seen in the blood. This dormant stage is known as Window Period. During the Window Period, the virus chiefly engages in getting multiplied and no difference will be noticed in the human system. When the Window Period ends, the HIV viruses and antibodies exist side by side fighting against each other for about 6 to 7 years. This stage is known as Honeymoon Period. Then as this stage ends, the antibodies will start losing the battle and the person develops AIDS (Acquired Immune Deficiency Syndrome). The two most significant symptoms of AIDS are: sharp loss in body weight and late recovery from common illnesses due to weak immune system in the body. Gradually, the person loses his entire immunity and becomes easily vulnerable to any kind of disease. Most of AIDS patients usually die of tuberculosis, pneumonia, common cold and diarrhea. However today, AIDS patients are treated with ARV which stands for: Anti-retroviral drug. This drug does not completely cure the disease but it at least helps the person live comparatively longer. Since the drug is very expensive, Bhutan Government has set only two criteria for getting the treatment. Firstly, only the pregnant women can receive the drug since it has been found that at least the unborn child is being saved from the infection. The second criterion is that only those patients whose WBC level drops less than 200 in the laboratory can get the drug. Others are not given the drug as of now in the country.

 

 

History:

 

The history of HIV is filled with triumphs and failures, living and death. The HIV Timeline stretches before us, marking our past and reaching toward our future. But where will that future lead? This HIV timeline began in 1981. In July of that year, the New York Times reported an outbreak of a rare form of cancer among gay men in New York and California. This “gay Cancer” as it was called at the time was later identified as Kaposi ’s sarcoma which later became the face of AIDS. At the same time, the emergency rooms in New York City began to see a rush of seemingly healthy young men with fevers, flu-like symptoms, and a rare pneumonia called Pneumocystis. This was officially the beginning of what has become the biggest health care concern in the modern history. Although in the beginning the Centre for Disease Control named the disease as “GRID” (gay related immune deficiency), the infection soon started to be seen in heterosexual, drug addicts, and people who received blood transfusion as well. In 1983, the Pasteur Institute in France discovered the virus causing the disease. The virus was then named “Pasteur retrovirus.” The controversy however arose in 1984 when an American scientist Dr. Robert Gallo discovered HTLV III which he claimed to be responsible for the infection. In 1985, it was however confirmed that both the discoveries were of the same virus although Gallo was given the credit of AIDS discovery. In the same year, the international committee of scientists renamed the virus as HIV.

 

By 1983 itself, 33 countries around the world had confirmed the cases of the disease that was once limited to New York and California. In 1984, Thailand reported the first HIV case followed by India in 1986. Bhutan became the last country in South Asia to report the first case in 1993.

  

 

Global summary of HIV AIDS epidemic as of December 2006:

 

As of December 2006, the world’s total population living with HIV/AIDS was 39.5 million out of which 37.2 million included adults, 17.7 million women, and 2.3 million children under the age of 15. People infected with HIV in 2006 alone were 4.3 million out of which 3.8 million included adults and 530.000 children under the age of 15. Total deaths in 2006 due to AIDS were 2.9 million out of which 2.6 included adults and 380.000 included children below 15. Finally, the total number of orphans in the world due to HIV/AIDS was 16.1 million.

 

The following table shows the region-wise distribution of people living with HIV/AIDS as of December 2006:

 

Sl.no

Region

Number of people with HIV/AIDS

1

Eastern Europe and Central Asia

1.7 million

2

East Asia

750.000

3

South and South-east Asia

7.8 million

4

Western and Central Europe

740.000

5

Middle-east and North Africa

460.000

6

Sub-Saharan Africa

24.7 million

7

North America

1.4 million

8

Caribbean

250.000

9

Latin America

1.7 million

10

Oceania

81.000

 

 

 

 

 

The table below shows HIV/AIDS trend in Bhutan from 1993 till March 2007:

 

Sl.no

Year

Number of HIV cases detected

1

1993

2

2

1994

1

3

1995

0

4

1996

4

5

1997

2

6

1998

0

7

1999

0

8

2000

9

9

2001

7

10

2002

15

11

2003

5

12

2004

23

13

2005

9

14

2006

24

15

2007

4

 

Therefore, the total victims come to 105 (till March 2007)

 

 

Age-wise distribution of people with HIV/AIDS in Bhutan:

 

Sl.no

Age

Male

Female

Total

1

Less than 5

1

8

9

2

5-14

1

1

2

3

15-19

0

5

5

4

20-24

3

14

17

5

25-29

22

10

32

6

30-39

20

7

27

7

40-49

8

5

13

8

50+

0

0

0

9

Total

55

50

105

 

 

 

 

Ways of transmission:

 

There are four main ways in which the disease is transmitted:

 

  1. Unsafe sexual practice with multi-partners: (without using condoms)
  2. Exchange of sringes within the group in case of drug users
  3. Blood transfusion from the infected donors and
  4. Vertical transmission: (directly from the mother to her child.

 

Detection methods:

 

There are various methods by which an HIV case is being detected in Bhutan.  The following table shows the distribution of cases detected through different ways:

 

Sl.No

Detection method

Number of cases detected

1

Medical checkup

22

2

Blood donor

12

3

Sentinel surveillance

29

4

Voluntary testing

7

5

Contact tracing

25

6

Vertical transmission

10

7

Total

105

 

The term “Sentinel Surveillance” refers to the secret observation made by a joint team of police and health officials in such vulnerable areas as bars, hotels, restaurants, etc where commercial sex-workers can be found. “Contact tracing” is the tracing of people who have had sex with the person detected with HIV. And “Vertical transmission” is the term given to the transmission of HIV virus from a mother to her child either unborn or through breastfeeding.

 

 

 

Bhutan epidemic situation:

 

v     Prevalence of 0.02% which is low but diffuse level.

v     Risk of going into generalized population, or risk of experiencing concentrated epidemic among certain population groups.

v     Estimated at over 500 Bhutanese living with HIV.

 

Potential for HIV epidemic:

 

v     High STI prevalence.

v     Rising trend of sex work.

v     Increased mobility of Bhutanese population such as rural-urban migration.

v     Relaxed sexual moods of Bhutanese population and the system of having multi-partners.

v     Low condom usage.

v     Emerging problem of substance abuse and injecting drug users (IDU)

v     Cross-border sex-work and drug abuse: increasing number of commercial sex workers across the borders with India. And

v     High level of HIV stigma: people fear of going for HIV test whereby the infected ones go on spreading the disease. There is a high social stigma attached to the issue at present because they fear that they will be overlooked by the society if their HIV status is made known to the public.

 

 

 

Priority population for targeting prevention:

 

From the general population, the groups that need more attention at present include young people, armed forces, business people and transport-workers. However the most vulnerable groups include sex-workers and drug users because there is every chance that they can indulge in unsafe sex with multi-partners.

 

 

 

 

Impact of HIV/AIDS on life expectancy:

 

The following table shows the difference of life expectancy just before the advent of HIV/AIDS and by the year 2010:

 

 

Sl.

No.

Country

Life expectancy before HIV/AIDS

Life expectancy by 2010

1.

Botswana

74.2

26.7

2.

Lesotho

67.2

36.5

3

Malawi

69.4

36.9

4.

Swaziland

74.6

33.0

5

South Africa

68.5

36.5

 

 

Impact of HIV/AIDS on health sector:

 

  • HIV prevalence in one Tanzanian hospital was over 33%.

 

  • Hospital beds for AIDS patients to exceed the total number available in Swaziland and Namibia in 2005.

 

Issues:

 

v     Strain on health system.

 

v     Staff shortage: decline in the quality of health care.

 

 

Impact on enterprises and workplaces:

 

v     Increase in retirements: around 75% of early retirements in Botswana Diamond Company is due to HIV/AIDS.

 

v     HIV/AIDS affects the productivity of workers, depletes their skills and adds costs mainly due to heavy medical expenditures. Therefore, AIDS affects all types of enterprises such as small-scale and larger ones.

 

 

Impact on households:

 

v     Dissolution of the households: a study in Zambia has shown that 65% of the households have been dissolved due to the early death of the entire family-members because of AIDS.

v     It was also found that the households affected with HIV/AIDS could earn the income of 50% less than the average households. This shows that it affects the productivity of the families.

v     Sub-African study showed that the steep fall in income had forced about 6% of households to reduce the amount they spent on food.

Impact on education sector:

 

v     A decline in the school enrollments: for instance, in South Africa, the school enrollment declined by 20% in one of the provinces in 1998.

v     Teachers: a study in Zimbabwe showed that about 19% of male teachers and 29% of female teachers were infected with HIV/AIDS. Such a trend leads to the shortage of teachers in schools, increasing absenteeism of both students and teachers, etc that ultimately leads to a decline in educational quality and standard.

 

Current HIV impacts in Bhutan:

 

v     Orphans due to AIDS: 3

v     23 families died premature deaths due to HIV/AIDS.

v     Increase in health care and treatment costs: (around Nu.3000 per person per month.)

 

 

HIV/AIDS scenario in Bhutan:

 

A total of 105 HIV cases have been detected in Bhutan till March 2007 which includes 53 male, 41 female, and 11 children. The first case of mother-to-child transmission (vertical transmission) was detected in 2002. Today, there are 11 children infected through such a transmission. Out of 105, 23 have so far died and now there are 75 of them residing in the country out of which 17 are on ARV treatment.

 

Sector-wise HIV cases distribution:

 

Sl.

no

Sector

Number of cases detected

1.

Housewives

22

2.

Business people

17

3.

Armed forces

17

4.

Minor

10

5.

Civil servants

8

6.

Sex-workers

8

7.

Farmers

7

8

Corporate employees

7

9

Monks

5

10.

Laborers

3

11.

Unemployed

1

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