HIV/AIDS

What is HIV?

'HIV' stands for Human Immunodeficiency Virus.

HIV attacks the body's immune system, reducing its ability to fight off infections.

It does this by infecting white blood cells (CD4 cells), which are responsible for engaging the immune system when infections enter the body.

What is AIDS?

One of the effects that HIV causes is Acquired Immune Deficiency Syndrome (AIDS). Although people with HIV can live for many years without major negative health effects, their weakened immune system leaves them very vulnerable to infections. When someone with HIV succumbs to another infection, the onset of AIDS is said to have occurred.

However, the term 'AIDS' is no longer widely used, according to the Terrence Higgins Trust. It is perhaps more commonly referred to, in medical circles at least, as 'late stage' or 'advanced HIV infection'.

Background

HIV became an issue of serious concern in the UK when it was first identified in the early 1980s.

The infection was particularly stigmatised when it was first discovered because the public didn't know how the disease was caught and what its consequences were. HIV/AIDS was initially thought to only infect homosexual men and drug users, complicating impartial debate, and a small minority claimed, and still claim, that the condition was a form of 'divine retribution'.

Since the disease was discovered, successive governments have funded public awareness and education campaigns to raise the profile and improve understanding of the illness. The HIV/AIDS campaigns of the 1980s led to a growth in public awareness of the importance of avoiding unsafe sex and to a lesser extent the use of 'dirty needles' – two of the principal means of transmission.

Safe sex and the development of antiretroviral therapies, which delay the onset of AIDS, have resulted in substantial reductions in AIDS incidence and deaths in the UK.

Controversies

In the developed world, HIV/AIDS is increasingly understood, avoidable and treatable – although it cannot yet be cured. The stigma once associated with the condition has also reduced considerably.

However, some parts of the developing world are experiencing an HIV/AIDS epidemic of horrifying proportions. Sub-Saharan Africa and, to a lesser but growing extent, parts of southern Asia have large proportions of their populations that are HIV positive.

These communities are some of the poorest in the world and many of those infected do not have access to effective HIV treatments. Some people argue that access to effective treatments is being hindered by some pharmaceutical companies demanding high prices for their treatments and preventing the reproduction of their drugs, under threat of legal action.

However, pharmaceutical companies say they are making their treatments available cheaply to the developing world. For example, five manufacturers of antiretroviral therapies and five manufacturers of HIV/AIDS diagnostic tests announced in April 2004 that they had agreed to make their products available to developing countries at the lowest prices, in many cases for more than fifty per cent less.

The HIV/AIDS problem in the developing world is exacerbated by low public awareness and standards of public health, religious injunctions against contraception in many areas and considerable levels of prejudice and stigma.

The United Nations Millennium Declaration adopted by world leaders in September 2000 and endorsed by 189 countries set out eight Millennium Development Goals (MDGs) to be met by 2015. MDG 6 aims to achieve by 2010 universal access to treatment for HIV/AIDS for all those who need it and to have halted, and begun to reverse, the spread of HIV/AIDS by 2015.

Latest Updates

The findings of a three year study undertaken by the World Bank, DFID and the UK Consortium on AIDS and International Development, looking at the impact of the response of communities to HIV and AIDS, were published in February 2012. The study concluded that overall "community engagement produces positive results in most instances."

A total of 11 studies were carried out in eight countries (Burkina Faso, India, Kenya, Nigeria, Lesotho, Senegal, South Africa and Zimbabwe), selected for their diversity of epidemic status (generalised vs. concentrated), HIV prevalence (from high to low) and regional location.

The evaluation found "strong evidence" that community response can: Help mobilize substantial local resources; improve knowledge and behaviour; increase the use of services; affect social processes outcomes; and impact HIV incidence and other health outcomes.

In April 2012, the UK's Health Protection Agency recommended that routine HIV testing should be commissioned "as a priority" for all general medical admissions in high prevalence areas and that HIV testing by general practitioners should be widely promoted, especially in high prevalence areas, although, they suggested, further consideration should be given to the best model of expanding testing in primary care.

According to the HPA, the estimated annual cost of expanding testing into general medical services nationally in areas of high prevalence with coverage of 75% would be £1.3 million; the cost for an average high prevalence PCT would be £19,000 per 100,000 population.

In May 2012, on the first anniversary of the adoption by the World Health Assembly of the Global Health Sector Strategy (GHSS) on HIV/AIDS, 2011-2015, the World Health Organisation's HIV Department published an operational plan identifying four "flagship initiatives" as priorities for the next two years:

Guidance on the strategic use of antiretroviral drugs (ARVs)
Antiretrovirals (ARV) for preventing HIV
Elimination of mother-to-child transmission of HIV (eMTCT)
Treatment

According to the WHO, these initiatives are needed to respond to the "fast-moving and complex developments" in HIV science and country programmes and to "meet the needs of the Member states for cutting-edge normative and technical leadership on HIV diagnostics, care, treatment and support."

The WHO also issued an update in June 2012 on antiretroviral treatment as prevention (TasP) providing current perspective to countries and partners.  The Organisation is also carrying out a comprehensive revision of all guidelines related to use of antiretrovirals, including guidance on TasP, planned for release in 2013.
 

Statistics

New HIV and AIDS diagnoses and deaths in the UK in 2011:

New data – based on surveillance reports received as at end-December 2011 – indicate that a total of 5,600 people (4,050 men and 1,550 women) were diagnosed with HIV in the United Kingdom in 2011. This provisional figure is likely to rise to 6,150 after adjustment for reporting delays. The 2011 total is a slight decrease on 2010 and continues the year-on-year decline from the peak of 7,820 diagnoses reported in 2005.

For the first time since 1998, the number of new HIV diagnoses in men who have sex with men (MSM) has surpassed new diagnoses in heterosexuals. Half of those diagnosed in 2011 (48%, 3,000) probably acquired their infection through sex between men and 47% (2,890) through heterosexual contact (data adjusted for undetermined risk). The overall decline in new diagnoses is largely due to fewer reported cases among heterosexuals who probably acquired their infection abroad.

The number of new diagnoses among MSM in 2011 (2,475) is expected to reach 3,000 when all reports are received. This continues the slow but steady increase observed over the past decade. The majority of MSM diagnosed in 2011 are white (84%) and acquired their infection within the UK (84%). Analysis of data from each of the related surveillance systems strongly suggest that the continuing high annual numbers of new HIV diagnoses in MSM have been driven by an underlying high and unchanged HIV incidence.

The number of new diagnoses among those infected heterosexually within the UK has remained steady at around 1,100 per year since 2008. In contrast, the number of new diagnoses among heterosexuals infected abroad has halved since 2006, from 3,530 in 2008 to 1,850 in 2011. This is largely due to a decrease in new diagnoses among persons from sub-Saharan Africa.

Continued low numbers of HIV diagnoses were made in people who inject drugs (PWID) (140) and persons infected through other exposures (120), such as mother to child transmission and recipients of blood/tissue products. All infections acquired through receipt of blood/tissue products diagnosed since 2002 were acquired outside of the UK, including the 21 diagnosed in 2011.

A total of 375 deaths and 350 AIDS diagnoses among HIV-infected persons in 2011 were reported, and this number is likely to increase as further reports are received.

Source: Health Protection Agency – April 2012
 

Quotes

"There is a 96% reduction in chances of transmitting HIV when anti-retroviral therapy is used effectively by people who are HIV positive."

UK Consortium on Aids and International Development – 2012

"The evaluation represents groundbreaking research on the community response to HIV and AIDS and through uptake of the core findings it is hoped that the initiative will inspire the donor community and governments to increase their investment in the community response."

DFID: 'The impact of communities on the HIV/AIDS pandemic: presenting the evidence.' -2012