hiv and aids essay

Essay on AIDS for Students and Children

500+ words essay on aids.

Acquired Immune Deficiency Syndrome or better known as AIDS is a life-threatening disease. It is one of the most dreaded diseases of the 20 th century. AIDS is caused by HIV or Human Immunodeficiency Virus, which attacks the immune system of the human body. It has, so far, ended more than twenty-nine million lives all over the world. Since its discovery, AIDS has spread around the world like a wildfire. It is due to the continuous efforts of the Government and non-government organizations; AIDS awareness has been spread to the masses.

AIDS – Causes and Spread

The cause of AIDS is primarily HIV or the Human Immunodeficiency Virus. This virus replicates itself into the human body by inserting a copy of its DNA into the human host cells. Due to such property and capability of the virus, it is also known as a retrovirus. The host cells in which the HIV resides are the WBCs (White Blood Cells) that are the part of the Human Immune system.

HIV destroys the WBCs and weakens the human immune system. The weakening of the immune system affects an individual’s ability to fight diseases in time. For example, a cut or a wound takes much more time to heal or the blood to clot. In some cases, the wound never heals.

HIV majorly transmits in one of the three ways – Blood, Pre-natal and Sexual transmission. Transfusion of HIV through blood has been very common during the initial time of its spread. But nowadays all the developed and developing countries have stringent measures to check the blood for infection before transfusing. Usage of shared needles also transmits HIV from an infected person to a healthy individual.

As part of sexual transmission, HIV transfers through body fluids while performing sexual activity. HIV can easily be spread from an infected person to a healthy person if they perform unprotective sexual intercourse through oral, genital or rectal parts.

Pre-natal transmission implies that an HIV infected mother can easily pass the virus to her child during pregnancy, breastfeeding or even during delivery of the baby.

AIDS – Symptoms

Since HIV attacks and infects the WBCs of the human body, it lowers the overall immune system of the human body and resulting in the infected individual, vulnerable to any other disease or minor infection. The incubation period for AIDS is much longer as compared to other diseases. It takes around 0-12 years for the symptoms to appear promptly.

Few of the common symptoms of AIDS include fever , fatigue, loss of weight, dysentery, swollen nodes, yeast infection, and herpes zoster. Due to weakened immunity, the infectious person falls prey to some of the uncommon infections namely persistent fever, night sweating, skin rashes, lesions in mouth and more.

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AIDS – Treatment, and Prevention

Till date, no treatment or cure is available for curing AIDS, and as a result, it is a life-threatening disease. As a practice by medical practitioners, the best way to curb its spread is antiretroviral therapy or ART. It is a drug therapy which prevents HIV from replicating and hence slows down its progress. It is always advisable to start the treatment at the earliest to minimize the damage to the immune system. But again, it is just a measure and doesn’t guarantee the cure of AIDS.

AIDS prevention lies in the process of curbing its spread. One should regularly and routinely get tested for HIV. It is important for an individual to know his/her own and partner’s HIV status, before performing any sexual intercourse activity. One should always practice safe sex. Use of condoms by males during sexual intercourse is a must and also one should restrict oneself on the number of partners he/she is having sex with.

One should not addict himself/herself to banned substances and drugs. One should keep away from the non-sterilized needles or razors.  Multiple awareness drives by the UN, local government bodies and various nonprofit organizations have reduced the risk of spread by making the people aware of the AIDS – spread and prevention.

Life for an individual becomes hell after being tested positive for AIDS. It is not only the disease but also the social stigma and discrimination, felling of being not loved and being hated acts as a slow poison. We need to instill the belief among them, through our love and care, that the HIV positive patients can still lead a long and healthy life.

Though AIDS is a disease, which cannot be cured or eradicated from society, the only solution to AIDS lies in its prevention and awareness. We must have our regular and periodical health checkup so that we don’t fall prey to such deadly diseases. We must also encourage and educate others to do the same. With the widespread awareness about the disease, much fewer adults and children are dying of AIDS. The only way to fight the AIDS disease is through creating awareness.

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A Comprehensive Guide to HIV and AIDS

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AIDS is a disease that can develop in people who have the HIV virus. Treatment with antiretroviral drugs can typically prevent AIDS from developing in people with HIV.

What is HIV?

HIV is a virus that damages the immune system. Untreated HIV affects and kills CD4 cells, which are a type of immune cell called T cell.

Over time, as HIV kills more CD4 cells, the body is more likely to get various types of conditions and cancers.

HIV is transmitted through bodily fluids that include:

• vaginal and rectal fluids
• breast milk

The virus isn’t transferred in air or water, or through casual contact.

Because HIV inserts itself into the DNA of cells, it’s a lifelong condition and currently there’s no drug that eliminates HIV from the body, although many scientists are working to find one.

However, with medical care, including treatment called antiretroviral therapy, it’s possible to manage HIV and live with the virus for many years.

Without treatment, a person with HIV is likely to develop a serious condition called the Acquired Immunodeficiency Syndrome, known as AIDS.

At that point, the immune system is too weak to successfully respond against other diseases, infections, and conditions.

Untreated, life expectancy with end stage AIDS is about 3 years . With antiretroviral therapy, HIV can be well-managed, and life expectancy can be nearly the same as someone who has not contracted HIV.

It’s estimated that 1.2 million Americans are currently living with HIV. Of those people, 1 in 7 don’t know they have the virus.

HIV can cause changes throughout the body.

Learn about the effects of HIV on the different systems in the body.

What is AIDS?

AIDS is a disease that can develop in people with HIV. It’s the most advanced stage of HIV. But just because a person has HIV doesn’t mean AIDS will develop.

HIV kills CD4 cells. Healthy adults generally have a CD4 count of 500 to 1, 6 00 per cubic millimeter. A person with HIV whose CD4 count falls below 200 per cubic millimeter will be diagnosed with AIDS.

A person can also be diagnosed with AIDS if they have HIV and develop an opportunistic infection or cancer that’s rare in people who don’t have HIV.

An opportunistic infection such as Pneumocystis jiroveci pneumonia is one that only occurs in a severely immunocompromised person, such as someone with advanced HIV infection (AIDS).

Untreated, HIV can progress to AIDS within a decade. There’s currently no cure for AIDS, and without treatment, life expectancy after diagnosis is about 3 years .

This may be shorter if the person develops a severe opportunistic illness. However, treatment with antiretroviral drugs can prevent AIDS from developing.

If AIDS does develop, it means that the immune system is severely compromised, that is, weakened to the point where it can no longer successfully respond against most diseases and infections.

That makes the person living with AIDS vulnerable to a wide range of illnesses, including:

• tuberculosis
• oral thrush , a fungal condition in the mouth or throat
• cytomegalovirus (CMV), a type of herpes virus
• cryptococcal meningitis , a fungal condition in the brain
• toxoplasmosis , a brain condition caused by a parasite
• cryptosporidiosis , a condition caused by an intestinal parasite
• cancer, including Kaposi sarcoma (KS) and lymphoma

The shortened life expectancy linked with untreated AIDS isn’t a direct result of the syndrome itself. Rather, it’s a result of the diseases and complications that arise from having an immune system weakened by AIDS.

Learn more about possible complications that can arise from HIV and AIDS.

Early symptoms of HIV

The first few weeks after someone contracts HIV is called the acute infection stage .

During this time, the virus reproduces rapidly. The person’s immune system responds by producing HIV antibodies, which are proteins that take measures to respond against infection.

During this stage, some people have no symptoms at first. However, many people experience symptoms in the first month or so after contracting the virus, but they often don’t realize HIV causes those symptoms.

This is because symptoms of the acute stage can be very similar to those of the flu or other seasonal viruses, such as:

• they may be mild to severe
• they may come and go
• they may last anywhere from a few days to several weeks

Early symptoms of HIV can include:

• swollen lymph nodes
• general aches and pains
• sore throat
• upset stomach

Because these symptoms are similar to common illnesses like the flu, the person who has them might not think they need to see a healthcare provider.

And even if they do, their healthcare provider might suspect the flu or mononucleosis and might not even consider HIV.

Whether a person has symptoms or not, during this period their viral load is very high. The viral load is the amount of HIV found in the bloodstream.

A high viral load means that HIV can be easily transmitted to someone else during this time.

Initial HIV symptoms usually resolve within a few months as the person enters the chronic, or clinical latency, stage of HIV. This stage can last many years or even decades with treatment.

HIV symptoms can vary from person to person.

Learn more about the early symptoms of HIV.

What are the symptoms of HIV?

After the first month or so, HIV enters the clinical latency stage. This stage can last from a few years to a few decades.

Some people don’t have any symptoms during this time, while others may have minimal or nonspecific symptoms. A nonspecific symptom is a symptom that doesn’t pertain to one specific disease or condition.

These nonspecific symptoms may include:

• headaches and other aches and pains
• recurrent fevers
• night sweats
• weight loss
• skin rashes
• recurrent oral or vaginal yeast infections

As with the early stage, HIV is still transferable during this time even without symptoms and can be transmitted to another person.

However, a person won’t know they have HIV unless they get tested. If someone has these symptoms and thinks they may have been exposed to HIV, it’s important that they get tested.

HIV symptoms at this stage may come and go, or they may progress rapidly. This progression can be slowed substantially with treatment.

With the consistent use of this antiretroviral therapy, chronic HIV can last for decades and will likely not develop into AIDS, if treatment was started early enough.

Learn more about how HIV symptoms can progress over time.

Is rash a symptom of HIV?

Many people with HIV experience changes to their skin. Rash is often one of the first symptoms of an HIV infection. Generally, an HIV rash appears as multiple small red lesions that are flat and raised.

Rash related to HIV

HIV makes someone more susceptible to skin problems because the virus destroys immune system cells that take measures against infection. Co-infections that can cause rash include:

• molluscum contagiosum
• herpes simplex

The cause of the rash determines:

• how it looks
• how long it lasts
• how it can be treated depends on the cause

Rash related to medication

While rash can be caused by HIV co-infections, it can also be caused by medication. Some drugs used to treat HIV or other conditions can cause a rash.

This type of rash usually appears within a week or 2 weeks of starting a new medication. Sometimes the rash will clear up on its own. If it doesn’t, a change in medications may be needed.

Rash due to an allergic reaction to medication can be serious.

Other symptoms of an allergic reaction include:

• trouble breathing or swallowing

Stevens-Johnson syndrome (SJS) is a rare allergic reaction to HIV medication. Symptoms include fever and swelling of the face and tongue. A blistering rash, which can involve the skin and mucous membranes, appears and spreads quickly.

When 30 percent of the skin is affected, it’s called toxic epidermal necrolysis, which is a life threatening condition. If this develops, emergency medical care is needed.

While rash can be linked with HIV or HIV medications, it’s important to keep in mind that rashes are common and can have many other causes.

Learn more about HIV rash.

HIV symptoms in men: Is there a difference?

Symptoms of HIV vary from person to person, but they’re similar in men and women. These symptoms can come and go or get progressively worse.

If a person has been exposed to HIV, they may also have been exposed to other sexually transmitted infections (STIs). These include:

• trichomoniasis

Men, and those with a penis, may be more likely than women to notice symptoms of STIs such as sores on their genitals. However, men typically don’t seek medical care as often as women.

Learn more about HIV symptoms in men.

HIV symptoms in women: Is there a difference?

For the most part, symptoms of HIV are similar in men and women. However, symptoms they experience overall may differ based on the different risks men and women face if they have HIV.

Both men and women with HIV are at increased risk for STIs. However, women, and those with a vagina, may be less likely than men to notice small spots or other changes to their genitals.

In addition, women with HIV are at increased risk for:

• recurrent vaginal yeast infections
• other vaginal infections, including bacterial vaginosis
• pelvic inflammatory disease (PID)
• menstrual cycle changes
• human papillomavirus (HPV) , which can cause genital warts and lead to cervical cancer

While not related to HIV symptoms, another risk for women with HIV is that the virus can be transmitted to a baby during pregnancy. However, antiretroviral therapy is considered safe during pregnancy.

Women who are treated with antiretroviral therapy are at very low risk for transmitting HIV to their baby during pregnancy and delivery. Breastfeeding is also affected in women with HIV. The virus can be transferred to a baby through breast milk.

In the United States and other settings where formula is accessible and safe, it’s recommended that women with HIV not breastfeed their babies. For these women, use of formula is encouraged.

Options besides formula include pasteurized banked human milk .

For women who may have been exposed to HIV, it’s important to know what symptoms to look for.

Learn more about HIV symptoms in women.

What are the symptoms of AIDS?

AIDS refers to acquired immunodeficiency syndrome. With this condition, the immune system is weakened due to HIV that’s typically gone untreated for many years.

If HIV is found and treated early with antiretroviral therapy, a person will usually not develop AIDS.

People with HIV may develop AIDS if their HIV is not diagnosed until late or if they know they have HIV but don’t consistently take their antiretroviral therapy.

They may also develop AIDS if they have a type of HIV that’s resistant to (doesn’t respond to) the antiretroviral treatment.

Without proper and consistent treatment, people living with HIV can develop AIDS sooner. By that time, the immune system is quite damaged and has a harder time generating a response to infection and disease.

With the use of antiretroviral therapy, a person can maintain a chronic HIV diagnosis without developing AIDS for decades.

Symptoms of AIDS can include:

• recurrent fever
• chronic swollen lymph glands, especially of the armpits, neck, and groin
• chronic fatigue
• dark splotches under the skin or inside the mouth, nose, or eyelids
• sores, spots, or lesions of the mouth and tongue, genitals, or anus
• bumps, lesions, or rashes of the skin
• recurrent or chronic diarrhea
• rapid weight loss
• neurologic problems such as trouble concentrating, memory loss, and confusion
• anxiety and depression

Antiretroviral therapy controls the virus and usually prevents progression to AIDS. Other infections and complications of AIDS can also be treated. That treatment must be tailored to the individual needs of the person.

HIV transmission facts

Anyone can contract HIV. The virus is transmitted in bodily fluids that include:

Some of the ways HIV is transferred from person to person include:

• through vaginal or anal sex — the most common route of transmission
• by sharing needles, syringes, and other items for injection drug use
• by sharing tattoo equipment without sterilizing it between uses
• during pregnancy, labor, or delivery from a pregnant person to their baby
• during breastfeeding
• through “premastication,” or chewing a baby’s food before feeding it to them
• through exposure to the blood, semen, vaginal and rectal fluids, and breast milk of someone living with HIV, such as through a needle stick

The virus can also be transmitted through a blood transfusion or organ and tissue transplant. However, rigorous testing for HIV among blood, organ, and tissue donors ensures that this is very rare in the United States.

It’s theoretically possible, but considered extremely rare, for HIV to be transmitted through:

• oral sex (only if there are bleeding gums or open sores in the person’s mouth)
• being bitten by a person with HIV (only if the saliva is bloody or there are open sores in the person’s mouth)
• contact between broken skin, wounds, or mucous membranes and the blood of someone living with HIV

HIV does NOT transfer through:

• skin-to-skin contact
• hugging, shaking hands, or kissing
• air or water
• sharing food or drinks, including drinking fountains
• saliva, tears, or sweat (unless mixed with the blood of a person with HIV)
• sharing a toilet, towels, or bedding
• mosquitoes or other insects

It’s important to note that if a person living with HIV is being treated and has a persistently undetectable viral load, it’s virtually impossible to transmit the virus to another person.

Learn more about HIV transmission.

Causes of HIV

HIV is a variation of a virus that can be transmitted to African chimpanzees. Scientists suspect the simian immunodeficiency virus (SIV) jumped from chimps to humans when people consumed chimpanzee meat containing the virus.

Once inside the human population, the virus mutated into what we now know as HIV. This likely occurred as long ago as the 1920s.

HIV spread from person to person throughout Africa over the course of several decades. Eventually, the virus migrated to other parts of the world. Scientists first discovered HIV in a human blood sample in 1959.

It’s thought that HIV has existed in the United States since the 1970s, but it didn’t start to hit public consciousness until the 1980s.

Learn more about the history of HIV and AIDS in the United States.

Treatment options for HIV

Treatment should begin as soon as possible after a diagnosis of HIV, regardless of viral load.

The main treatment for HIV is antiretroviral therapy, a combination of daily medications that stop the virus from reproducing. This helps protect CD4 cells, keeping the immune system strong enough to take measures against disease.

Antiretroviral therapy helps keep HIV from progressing to AIDS. It also helps reduce the risk of transmitting HIV to others.

When treatment is effective, the viral load will be “undetectable.” The person still has HIV, but the virus is not visible in test results.

However, the virus is still in the body. And if that person stops taking antiretroviral therapy, the viral load will increase again, and the HIV can again start attacking CD4 cells.

Learn more about how HIV treatments work.

HIV medications

Many antiretroviral therapy medications are approved to treat HIV . They work to prevent HIV from reproducing and destroying CD4 cells, which help the immune system generate a response to infection.

This helps reduce the risk of developing complications related to HIV, as well as transmitting the virus to others.

These antiretroviral medications are grouped into seven classes:

• nucleoside reverse transcriptase inhibitors (NRTIs)
• non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• protease inhibitors
• fusion inhibitors
• CCR5 antagonists, also known as entry inhibitors
• integrase strand transfer inhibitors
• attachment inhibitors

Treatment regimens

The U.S. Department of Health and Human Services (HHS) generally recommends a starting regimen of three HIV medications from at least two of these drug classes.

This combination helps prevent HIV from forming resistance to medications. (Resistance means the drug no longer works to treat the virus.)

Many of the antiretroviral medications are combined with others so that a person with HIV typically takes only one or two pills a day.

A healthcare provider will help a person with HIV choose a regimen based on their overall health and personal circumstances.

These medications must be taken every day, exactly as prescribed. If they’re not taken appropriately, viral resistance can develop, and a new regimen may be needed.

Blood testing will help determine if the regimen is working to keep the viral load down and the CD4 count up. If an antiretroviral therapy regimen isn’t working, the person’s healthcare provider will switch them to a different regimen that’s more effective.

Side effects and costs

Side effects of antiretroviral therapy vary and may include nausea, headache, and dizziness. These symptoms are often temporary and disappear with time.

Serious side effects can include swelling of the mouth and tongue and liver or kidney damage. If side effects are severe, the medications can be adjusted.

Costs for antiretroviral therapy vary according to geographic location and type of insurance coverage. Some pharmaceutical companies have assistance programs to help lower the cost.

Learn more about the drugs used to treat HIV.

HIV and AIDS: What’s the connection?

To develop AIDS, a person has to have contracted HIV. But having HIV doesn’t necessarily mean that someone will develop AIDS.

Cases of HIV progress through three stages:

• stage 1: acute stage , the first few weeks after transmission
• stage 2: clinical latency, or chronic stage
• stage 3: AIDS

As HIV lowers the CD4 cell count, the immune system weakens. A typical adult’s CD4 count is 500 to 1,500 per cubic millimeter. A person with a count below 200 is considered to have AIDS.

How quickly a case of HIV progresses through the chronic stage varies significantly from person to person. Without treatment, it can last up to a decade before advancing to AIDS. With treatment, it can last indefinitely.

There’s currently no cure for HIV, but it can be managed. People with HIV often have a near-normal lifespan with early treatment with antiretroviral therapy.

Along those same lines, there’s technically no cure for AIDS currently. However, treatment can increase a person’s CD4 count to the point where they’re considered to no longer have AIDS. (This point is a count of 200 or higher.)

Also, treatment can typically help manage opportunistic infections.

HIV and AIDS are related, but they’re not the same thing.

Learn more about the difference between HIV and AIDS.

Causes of AIDS

AIDS is caused by HIV. A person can’t get AIDS if they haven’t contracted HIV.

Healthy individuals have a CD4 count of 500 to 1,500 per cubic millimeter. Without treatment, HIV continues to multiply and destroy CD4 cells. If a person’s CD4 count falls below 200, they have AIDS.

Also, if someone with HIV develops an opportunistic infection associated with HIV, they can still be diagnosed with AIDS, even if their CD4 count is above 200.

What tests are used to diagnose HIV?

Several different tests can be used to diagnose HIV. Healthcare providers determine which test is best for each person.

Antibody/antigen tests

Antibody/antigen tests are the most commonly used tests. They can show positive results typically within 18–45 days after someone initially contracts HIV.

These tests check the blood for antibodies and antigens. An antibody is a type of protein the body makes to respond to an infection. An antigen, on the other hand, is the part of the virus that activates the immune system.

Antibody tests

These tests check the blood solely for antibodies. Between 23 and 90 days after transmission, most people will develop detectable HIV antibodies, which can be found in the blood or saliva.

These tests are done using blood tests or mouth swabs, and there’s no preparation necessary. Some tests provide results in 30 minutes or less and can be performed in a healthcare provider’s office or clinic.

Other antibody tests can be done at home:

• OraQuick HIV Test. An oral swab provides results in as little as 20 minutes.
• Home Access HIV-1 Test System. After the person pricks their finger, they send a blood sample to a licensed laboratory. They can remain anonymous and call for results the next business day.

If someone suspects they’ve been exposed to HIV but tested negative in a home test, they should repeat the test in 3 months. If they have a positive result, they should follow up with their healthcare provider to confirm.

Nucleic acid test (NAT)

This expensive test isn’t used for general screening. It’s for people who have early symptoms of HIV or have a known risk factor. This test doesn’t look for antibodies; it looks for the virus itself.

It takes from 5 to 21 days for HIV to be detectable in the blood. This test is usually accompanied or confirmed by an antibody test.

Today, it’s easier than ever to get tested for HIV.

Learn more about HIV home testing options.

What’s the HIV window period?

As soon as someone contracts HIV, it starts to reproduce in their body. The person’s immune system reacts to the antigens (parts of the virus) by producing antibodies (cells that take countermeasures against the virus).

The time between exposure to HIV and when it becomes detectable in the blood is called the HIV window period. Most people develop detectable HIV antibodies within 23 to 90 days after transmission.

If a person takes an HIV test during the window period, it’s likely they’ll receive a negative result. However, they can still transmit the virus to others during this time.

If someone thinks they may have been exposed to HIV but tested negative during this time, they should repeat the test in a few months to confirm (the timing depends on the test used). And during that time, they need to use condoms or other barrier methods to prevent possibly spreading HIV.

Someone who tests negative during the window might benefit from post-exposure prophylaxis (PEP) . This is medication taken after an exposure to prevent getting HIV.

PEP needs to be taken as soon as possible after the exposure; it should be taken no later than 72 hours after exposure but ideally before then.

Another way to prevent getting HIV is pre-exposure prophylaxis (PrEP). A combination of HIV drugs taken before potential exposure to HIV, PrEP can lower the risk of contracting or transmitting HIV when taken consistently.

Timing is important when testing for HIV.

Learn more about how timing affects HIV test results.

HIV prevention

Although many researchers are working to develop one, there’s currently no vaccine available to prevent the transmission of HIV. However, taking certain steps can help prevent the transmission of HIV.

The most common way for HIV to be transferred is through anal or vaginal sex without a condom or other barrier method. This risk can’t be completely eliminated unless sex is avoided entirely, but the risk can be lowered considerably by taking a few precautions.

A person concerned about their risk for HIV should:

• Get tested for HIV. It’s important they learn their status and that of their partner.
• Get tested for other sexually transmitted infections (STIs). If they test positive for one, they should get it treated, because having an STI increases the risk of contracting HIV.
• Use condoms. They should learn the correct way to use condoms and use them every time they have sex, whether it’s through vaginal or anal intercourse. It’s important to keep in mind that pre-seminal fluids (which come out before male ejaculation) can contain HIV.
• Take their medications as directed if they have HIV. This lowers the risk of transmitting the virus to their sexual partner.

Shop for condoms online.

Other prevention methods

Other steps to help prevent the spread of HIV include:

• Avoid sharing needles or other paraphernalia. HIV is transmitted through blood and can be contracted by using materials that have come in contact with the blood of someone who has HIV.
• Consider PEP. A person who has been exposed to HIV should contact their healthcare provider about obtaining post-exposure prophylaxis (PEP). PEP can reduce the risk of contracting HIV. It consists of three antiretroviral medications given for 28 days. PEP should be started as soon as possible after exposure but before 36 to 72 hours have passed.
• Consider PrEP. A person has a higher chance of contracting HIV should talk to their healthcare provider about pre-exposure prophylaxis (PrEP) . If taken consistently, it can lower the risk of acquiring HIV. PrEP is a combination of two drugs available in pill form.

Healthcare providers can offer more information on these and other ways to prevent the spread of HIV.

Check here for more information on STI prevention.

Living with HIV: What to expect and tips for coping

More than 1. 2 million people in the United States are living with HIV. It’s different for everybody, but with treatment, many can expect to live a long, productive life.

The most important thing is to start antiretroviral treatment as soon as possible. By taking medications exactly as prescribed, people living with HIV can keep their viral load low and their immune system strong.

It’s also important to follow up with a healthcare provider regularly.

Other ways people living with HIV can improve their health include:

• fueling their body with a well-balanced diet
• exercising regularly
• getting plenty of rest
• avoiding tobacco and other drugs
• reporting any new symptoms to their healthcare provider right away
• Focus on their mental health. They could consider seeing a licensed therapist who is experienced in treating people with HIV.
• Use safer sex practices. Talk to their sexual partner(s). Get tested for other STIs. And use condoms and other barrier methods every time they have vaginal or anal sex.
• Talk to their healthcare provider about PrEP and PEP. When used consistently by a person without HIV, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) can lower the chances of transmission. PrEP is most often recommended for people without HIV in relationships with people with HIV, but it can be used in other situations as well. Online sources for finding a PrEP provider include PrEP Locator and PleasePrEPMe .
• Surround themselves with loved ones. When first telling people about their diagnosis, they can start slow by telling someone who can maintain their confidence. They may want to choose someone who won’t judge them and who will support them in caring for their health.
• Get support. They can join an HIV support group, either in person or online, so they can meet with others who face the same concerns they have. Their healthcare provider can also steer them toward a variety of resources in their area.

There are many ways to get the most out of life when living with HIV.

Hear some real stories of people living with HIV.

HIV life expectancy: Know the facts

In the 1990s, a 20-year-old person with HIV had a 19-year life expectancy . By 2011, a 20-year-old person with HIV could expect to live another 53 years.

It’s a dramatic improvement, due in large part to antiretroviral therapy. With proper treatment, many people with HIV can expect a normal or near- normal lifespan.

Of course, many things affect life expectancy for a person with HIV. Among them are:

• CD4 cell count
• serious HIV-related illnesses, including hepatitis
• misusing drugs
• access, adherence, and response to treatment
• other health conditions

Where a person lives also matters. People in the United States and other developed countries may be more likely to have access to antiretroviral therapy.

Consistent use of these drugs helps prevent HIV from progressing to AIDS. When HIV advances to AIDS, life expectancy without treatment is about 3 years .

In 2017, about 20.9 million people living with HIV were using antiretroviral therapy.

Life expectancy statistics are just general guidelines. People living with HIV should talk to their healthcare provider to learn more about what they can expect.

Learn more about life expectancy and long-term outlook with HIV.

Is there a vaccine for HIV?

Currently, there are no vaccines to prevent or treat HIV. Research and testing on experimental vaccines are ongoing, but none are close to being approved for general use.

HIV is a complicated virus. It mutates (changes) rapidly and is often able to fend off immune system responses. Only a small number of people who have HIV develop broadly neutralizing antibodies, the kind of antibodies that can respond to a range of HIV strains.

The first HIV vaccine efficacy study in 7 years was underway in South Africa in 2016. The experimental vaccine is an updated version of one used in a 2009 trial that took place in Thailand.

A 3.5-year follow-up after vaccination showed the vaccine was 31.2 percent effective in preventing HIV transmission.

The study involves 5,400 men and women from South Africa. In 2016 in South Africa, about 270,000 people contracted HIV. The results of the study are expected in 2021 .

Other late-stage, multinational vaccine clinical trials are also currently underway .

Other research into an HIV vaccine is also ongoing.

While there’s still no vaccine to prevent HIV, people with HIV can benefit from other vaccines to prevent HIV-related illnesses. Here are the CDC recommendations:

• pneumonia: recommended for all children younger than 2 and all adults 65 and older
• influenza: recommended for all people over 6 months old annually with rare exceptions
• hepatitis A and B: ask your doctor if you should get vaccinated for hepatitis A and B, especially if you are in a higher risk group
• meningitis: the meningococcal conjugate vaccination is recommended for all preteens and teens at 11 to 12 years old with a booster dose at 16, or anyone at risk. The serogroup B meningococcal vaccination is recommended for anyone 10 years or older with increased risk.
• shingles: recommended for those ages 50 or older

Learn why an HIV vaccine is so difficult to develop.

HIV statistics

Here are today’s HIV numbers:

• In 2019, about 38 million people worldwide were living with HIV. Of those, 1.8 million were children below the age 15 years.
• At the end of 2019, 25.4 million people living with HIV were using antiretroviral therapy.
• Since the pandemic began, 75.7 million people have contracted HIV, and AIDS-related complications have claimed 32.7 million lives.
• In 2019, 690,000 people died from AIDS-related diseases. This is a decline from 1.9 million in 2005.
• Eastern and Southern Africa are the hardest hit. In 2019, 20.7 million people in these areas were living with HIV, and 730,000 more contracted the virus. The region has more than half of all people living with HIV worldwide.
• Adult and adolescent women accounted for 19 percent of new HIV diagnoses in the United States in 2018. Almost half of all new cases occur in African Americans.
• Left untreated, a woman with HIV has a 15–45 percent chance of passing HIV to her baby during pregnancy or breastfeeding. With antiretroviral therapy throughout pregnancy and avoidance of breastfeeding, the risk is less than 5 percent .
• In the 1990s, a 20-year-old person with HIV had a life expectancy of 19 years. By 2011, it had improved to 53 years. Today, life expectancy is near normal if antiretroviral therapy is started soon after contracting HIV.

As access to antiretroviral therapy continues to improve around the world, these statistics will hopefully keep changing.

Learn more statistics about HIV.

How we reviewed this article:

• 10 ways STDs impact women differently from men [Fact sheet]. (2011). https://www.cdc.gov/std/health-disparities/stds-women-042011.pdf
• About HIV/AIDS. (2020). http://www.cdc.gov/hiv/basics/whatishiv.html
• CD4 count (or T-cell count). (n.d.). https://www.hiv.va.gov/patient/diagnosis/labs-CD4-count.asp
• Cresswell FV, et al. (2018). A systemic review of risk of HIV transmission through biting or spitting: Implications for policy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6120498/
• Deshpande AK, et al. (2011). Possible transmission of HIV Infection due to human bite. DOI: https://doi.org/10.1186/1742-6405-8-16
• Get the new Shingrix vaccine if you are 50 or older. (2020). https://www.cdc.gov/shingles/multimedia/shringrix-50-older.html
• Facts about HIV/AIDS. (n.d.). http://www.idph.state.il.us/about/womenshealth/factsheets/aid.htm
• FDA-approved HIV medicines. (2020). https://hivinfo.nih.gov/understanding-hiv/fact-sheets/fda-approved-hiv-medicines
• Fonner VA, et al. (2016). Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. DOI: https://doi.org/10.1097/QAD.0000000000001145
• HIV and pregnant women, infants, and children. (2020). https://www.cdc.gov/hiv/group/gender/pregnantwomen/index.html
• HIV and women. (2020). https://www.cdc.gov/hiv/group/gender/women/index.html
• HIV basics: Testing. (2020). http://www.cdc.gov/hiv/basics/testing.html
• HIV country profile: South Africa. (2016). https://www.who.int/hiv/data/Country_profile_South_Africa.pdf
• HIV treatment overview. (2019). https://www.aids.gov/hiv-aids-basics/just-diagnosed-with-hiv-aids/treatment-options/overview-of-hiv-treatments/
• HIV vaccines. (2020). https://www.hiv.gov/hiv-basics/hiv-prevention/potential-future-options/hiv-vaccines
• How is HIV transmitted? (2019). https://www.aids.gov/hiv-aids-basics/hiv-aids-101/how-you-get-hiv-aids/
• Human immunodeficiency virus (HIV). (n.d.). https://www.hhs.gov/opa/reproductive-health/sexually-transmitted-infections/hiv/index.html
• Human Milk Banking Association of North America. (n.d.). https://www.hmbana.org/
• Ivy W, et al. (2012). Premastication as a route of pediatric HIV transmission: Case-control and cross-sectional investigations. DOI: https://doi.org/10.1097/QAI.0b013e31823b4554
• Marcus J, et al. (2016). Narrowing the gap in life expectancy for HIV-infected and HIV-uninfected individuals with access to care. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427712
• Meningococcal vaccination. (2019). https://www.cdc.gov/vaccines/vpd/mening/index.html
• NIH/National Institute of Allergy and Infectious Diseases. (2016). First new HIV vaccine efficacy study in 7 years has begun [Press release]. https://www.eurekalert.org/pub_releases/2016-11/nioa-fnh112316.php
• Pivotal Phase 2b/3 ALVAC/Bivalent gp120/MF59 HIV Vaccine Prevention Safety and Efficacy Study in South Africa (HVTN702). (n.d.). https://clinicaltrials.gov/ct2/show/NCT02968849
• Pneumococcal vaccination: What everyone should know. (2020). https://www.cdc.gov/vaccines/vpd/pneumo/public/index.html
• Protect yourself – get vaccinated against hepatitis A and hepatitis B. (2020). https://www.cdc.gov/hepatitis/populations/MSM-Vaccination.htm
• Sharp PM, et al. (2010). The evolution of HIV-1 and the origin of AIDS. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935100/
• South Africa. (2018). http://www.unaids.org/en/regionscountries/countries/southafrica
• Statistics: Women and HIV/AIDS. (2020). https://www.amfar.org/about-hiv-and-aids/facts-and-stats/statistics--women-and-hiv-aids
• Statistics: Worldwide. (2020). http://www.amfar.org/worldwide-aids-stats/
• Symptoms of HIV. (2020). https://www.aids.gov/hiv-aids-basics/hiv-aids-101/signs-and-symptoms/
• The Antiretroviral Therapy Cohort Collaboration. (2017). Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: A collaborative analysis of cohort studies. DOI: https://doi.org/10.1016/S2352-3018(17)30066-8
• What to expect at your first HIV care visit. (2017). https://www.hiv.gov/hiv-basics/starting-hiv-care/getting-ready-for-your-first-visit/what-to-expect-at-your-first-hiv-care-visit
• Who needs a flu vaccine and when. (2020). https://www.cdc.gov/flu/prevent/vaccinations.htm
• World Health Organization. (2014). Evidence and recommendations on Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis. https://www.ncbi.nlm.nih.gov/books/NBK305397/

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What Is HIV?

HIV ( human immunodeficiency virus ) is a virus that attacks cells that help the body fight infection, making a person more vulnerable to other infections and diseases. It is spread by contact with certain bodily fluids of a person with HIV, most commonly during unprotected sex (sex without a condom or HIV medicine to prevent or treat HIV), or through sharing injection drug equipment.

If left untreated, HIV can lead to the disease AIDS ( acquired immunodeficiency syndrome ).

The human body can’t get rid of HIV and no effective HIV cure exists. So, once you have HIV, you have it for life. Luckily, however, effective treatment with HIV medicine (called antiretroviral therapy or ART) is available. If taken as prescribed, HIV medicine can reduce the amount of HIV in the blood (also called the viral load) to a very low level. This is called viral suppression. If a person’s viral load is so low that a standard lab can’t detect it, this is called having an undetectable viral load. People with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load can live long and healthy lives and will not transmit HIV to their HIV-negative partners through sex .

In addition, there are effective methods to prevent getting HIV through sex or drug use, including pre-exposure prophylaxis (PrEP) , medicine people at risk for HIV take to prevent getting HIV from sex or injection drug use, and post-exposure prophylaxis (PEP) , HIV medicine taken within 72 hours after a possible exposure to prevent the virus from taking hold. Learn about other ways to prevent getting or transmitting HIV .

What Is AIDS?

AIDS is the late stage of HIV infection that occurs when the body’s immune system is badly damaged because of the virus.

In the U.S., most people with HIV do not develop AIDS because taking HIV medicine as prescribed stops the progression of the disease.

A person with HIV is considered to have progressed to AIDS when:

• the number of their CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3). (In someone with a healthy immune system, CD4 counts are between 500 and 1,600 cells/mm3.) OR
• they develop one or more opportunistic infections regardless of their CD4 count.

Without HIV medicine, people with AIDS typically survive about 3 years. Once someone has a dangerous opportunistic illness, life expectancy without treatment falls to about 1 year. HIV medicine can still help people at this stage of HIV infection, and it can even be lifesaving. But people who start HIV medicine soon after they get HIV experience more benefits—that’s why HIV testing is so important.

How Do I Know If I Have HIV?

The only way to know for sure if you have HIV is to get tested . Testing is relatively simple. You can ask your health care provider for an HIV test. Many medical clinics, substance abuse programs, community health centers, and hospitals offer them too. If you test positive, you can be connected to HIV care to start treatment as soon as possible. If you test negative, you have the information you need to take steps to prevent getting HIV in the future.

To find an HIV testing location near you, use the HIV Services Locator .

HIV self-testing is also an option. Self-testing allows people to take an HIV test and find out their result in their own home or other private location. With an HIV self-test, you can get your test results within 20 minutes. You can buy an HIV self-test kit at a pharmacy or online. Some health departments or community-based organizations also provide HIV self-test kits for a reduced cost or for free. You can call your local health department or use the HIV Testing and Care Services Locator to find organizations that offer HIV self-test kits near you. (Contact the organization for eligibility requirements.)

Note: State laws regarding self-testing vary and may limit availability. Check with a health care provider or health department Exit Disclaimer for additional testing options.

Learn more about HIV self-testing and which test might be right for you .

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Human immunodeficiency virus (HIV) is an infection that attacks the body’s immune system, specifically the white blood cells called CD4 cells. HIV destroys these CD4 cells, weakening a person’s immunity against opportunistic infections, such as tuberculosis and fungal infections, severe bacterial infections and some cancers.

WHO recommends that every person who may be at risk of HIV should access testing. People at increased risk of acquiring HIV should seek comprehensive and effective HIV prevention, testing and treatment services.  HIV infection can be diagnosed using simple and affordable rapid diagnostic tests, as well as self-tests. It is important that HIV testing services follow the 5Cs: consent, confidentiality, counselling, correct results and connection with treatment and other services. 

People diagnosed with HIV should be offered and linked to antiretroviral treatment (ART) as soon as possible following diagnosis and periodically monitored using clinical and laboratory parameters, including the test to measure virus in the blood (viral load). If ART is taken consistently, this treatment also prevents HIV transmission to others.

At diagnosis or soon after starting ART, a CD4 cell count should be checked to assess a person’s immune status. The CD4 cell count is a blood test used to assess progression of HIV disease, including risk for developing opportunistic infections and guides the use of preventive treatment. The normal range of CD4 count is from 500 to 1500 cells/mm3 of blood, and it progressively decreases over time in persons who are not receiving or not responding well to ART. If the person’s CD4 cell count falls below 200, their immunity is severely compromised, leaving them susceptible to infections and death. Someone with a CD4 count below 200 is described as having an advanced HIV disease (AHD) .

HIV viral load measures the amount of virus in the blood. This test is used to monitor the level of viral replication and effectiveness of ART. The treatment goal is to reduce the viral load in the blood to undetectable levels (less than 50 copies/ml), and the persistent presence of detectable viral load (greater than 1000 copies/ml) in people living with HIV on ART is an indicator of inadequate treatment response and the need to change or adjust the treatment regimen. 

WHO’s 2022–2030 global health sector strategy on HIV  aims to reduce HIV infections from 1.5 million in 2020 to 335 000 by 2030, and deaths from 680 000 in 2020 to under 240 000 in 2030.

Many people do not feel symptoms of HIV in the first few months after infection and may not know that they are infected. Others may experience influenza-like symptoms, including fever, headache, rash and sore throat. However, these first few months are when the virus is most infectious.

As the disease progresses, symptoms will be expanded and more pronounced. These can include swollen lymph nodes, weight loss, fever, diarrhoea and cough. HIV weakens the body’s ability to fight other infections, and without treatment people will become more susceptible to other severe illnesses such as tuberculosis , cryptococcal meningitis, bacterial infections and some cancers including lymphomas and Kaposi’s sarcoma.

Diagnosis of HIV uses rapid tests that provide same-day results and can  be done at home, although a laboratory test is required to confirm the infection. This early identification greatly improves treatment options and reduces the risk of transmission to other people including sexual or drug-sharing partners.

HIV is fully preventable. Effective antiretroviral treatment (ART) prevents HIV transmission from mother to child during pregnancy, delivery and breastfeeding. Someone who is on antiretroviral therapy and virally suppressed will not pass HIV to their sexual partners.

Condoms prevent HIV and other sexually transmitted infections, and prophylaxis use antiretroviral medicines to prevent HIV. Male circumcision is recommended in high-burden countries in eastern and southern Africa. Harm reduction (needle syringe programmes and opioid substitution therapy) prevents HIV and other blood-borne infections for people who inject drugs .

HIV is treated with antiretroviral therapy consisting of one or more medicines. ART does not cure HIV but reduces its replication in the blood, thereby reducing the viral load to an undetectable level.

ART enables people living with HIV to lead healthy, productive lives. It also works as an effective prevention, reducing the risk of onward transmission by 96% .

ART should be taken every day throughout the person’s life. People can continue with safe and effective ART if they adhere to their treatment. In cases when ART becomes ineffective - HIV drug resistance - due to reasons such as lost contact with health care providers and drug stockouts, people will need to switch to other medicines to protect their health.

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HIV and AIDS Essay

HIV is the human immunodeficiency virus that causes AIDS. A member of a group of viruses called retroviruses, HIV infects human cells and uses the energy and nutrients provided by those cells to grow and reproduce. AIDS (acquired immunodeficiency syndrome) is a disease in which the body's immune system breaks down and is unable to fight off certain infections, known as "opportunistic infections," and other illnesses that take advantage of a weakened immune system . When a person is infected with HIV , the virus enters the body and lives and multiplies primarily in the white blood cells. These are the immune cells that normally protect us from disease. The hallmark of HIV infection is the progressive loss of a specific …show more content…

Most of them do not know they carry HIV and may be spreading the virus to others. Here in the U.S., nearly one million people have HIV infection or AIDS , or roughly one out of every 250 people. At least 40,000 Americans become newly infected with HIV each year, and it is estimated that half of all people with HIV in the U.S. have not been tested and do not know they are carrying the virus. Since the beginning of the epidemic, AIDS has killed more than 30 million people worldwide, including more than 500,000 Americans. AIDS has replaced malaria and tuberculosis as the world's deadliest infectious disease among adults and is the fourth leading cause of death worldwide. Over 13 million children have been orphaned by the epidemic. A person who is HIV-infected carries the virus in certain body fluids, including blood, semen, vaginal secretions, and breast milk. The virus can be transmitted only if such HIV-infected fluids enter the bloodstream of another person. This kind of direct entry can occur (1) through the linings of the vagina, rectum, mouth, and the opening at the tip of the penis; (2) through intravenous injection with a syringe; or (3) through a break in the skin, such as a cut or sore. Usually, HIV is transmitted through: Unprotected sexual intercourse (either vaginal or anal) with someone who is HIV infected. Women are at greater risk of HIV infection through vaginal sex than men, although

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HIV which stands for human immunodeficiency virus is a virus that attacks the human infection fighting CD4 cells of the immune system. AIDS which stands for acquired immunodeficiency syndrome, is the most advanced stage of the HIV infection. If HIV is left untreated it leads up to AIDS, and that is when the immune system is too weak to fight off infections or even certain cancers. HIV is spread through certain body fluids such as blood, semen, pre-seminal fluid, vaginal fluids, rectal fluids, and breast milk. In the United States HIV is commonly spread by having sex with someone who is infected or by sharing drug injection needles. HIV is not airborne so you cannot get infected by a simple

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Human immunodeficiency virus (HIV)/AIDS is a pandemic problem affecting global health. At the end of 2015, 36.7 million people were living with HIV/AIDS globally. The rate of incidence is more prevalent in Sub-Saharan Africa with almost 1 in every 24 adults living with HIV/AIDS. In the united states, HIV/AIDS is a diversified health problem affecting all sexes, ages and races and involving the transmission of multiple risk behavior. However, with the introduction of various prevention programs and antiretroviral drugs, the incidence of HIV/AIDS has reduced.

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Most people in America are not aware of people with AIDS. There are a lot of people in America with AIDS that most people do not know of. “Since then, more than half of a million Americans have died of AIDS, and 1.1 million people are currently living with HIV in the United

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Human Immunodeficiency Virus is HIV that develops into AIDS, which is Acquired immunodeficiency syndrome. This virus starts to break down white blood cells, as a result the immune system starts to deteriorate and our greatest shield cannot fight any longer (Mayo Clinic, 2016). The CDC (2015) states, that over 1.2 million people live with HIV in the United States and most who are infected are oblivious of their disease. Healthy people 2020 has declared HIV a public health crisis in the United States, and continues to sweep the nation with more than 500,000 new cases each year (HealthyPeople2020,2016).

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HIV or the Human Deficiency virus is like other viruses including the flu, but the one thing that makes this virus so different than any other is that the body is unable to clear this one out completely. Once someone is infected, there is no cure. Over time, HIV can also hide or mask itself in the body's cells. The cells within a person's body that fight off infection are called CD4 cells or T cells. HIV attacks these cells and copies or replicates itself inside these cells, then destroys them. HIV over time will destroy so many of these cells that the body is unable to fight off infection anymore. When this starts happening, AIDS or Acquired Immunodeficiency Syndrome happens which is the final stage

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Today, the number of cases of HIV and AIDS have dropped since the epidemic in 1981. However they are both still terrible diseases and still affect people. According to unicef.com,” …nearly 37 million people worldwide are living with HIV. According to the 2015 Statistical Update on HIV and AIDS among Children, HIV/AIDS is the second leading cause of death for teens

Hiv/Aids in Africa Essay

Sub-Saharan Africa is the region of the world that is most affected by HIV/AIDS. The United Nations reports that an estimated 25.4 million people are living with HIV and that approximately 3.1 million new infections occurred in 2004. To put these figures in context, more than 60 percent of the people living with the infection reside in Africa. Even these staggering figures do not quite capture the true extent and impact that this disease causes on the continent. In 1998, about 200,000 Africans died as a result of various wars taking place on the continent. In that same year, more than 2 million succumbed to HIV/AIDS (Botchwey, 2000).

HIV and AIDS: The Epidemic Essay example

HIV and AIDS have affected millions of people throughout the world. Since 1981, there have been 25 million deaths due to AIDS involving men, women, and children. Presently there are 40 million people living with HIV and AIDS around the world and two million die each year from AIDS related illnesses. The Center for Disease Control estimates that one-third of the one million Americans living with HIV are not aware that they have it. The earliest known case of HIV was in 1959. It was discovered in a blood sample from a man in Kinshasa, Democratic Republic of the Congo. Looking further into the genetics of this blood sample researchers suggested that it had originated from a virus going back to the late 1940’s or early 1950’s. In 1999,

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What is HIV/AIDS? HIV is an acronym for Human Immunodeficiency Virus. This virus can only attack humans, hence the name, and reproduces by taking over the T-cells (or CD4-cells which help fight off infections) and uses them to make copies of itself (U.S. Department of Health & Human Services). Unlike most viruses the human body cannot seem to shake HIV, which means once you have HIV you have it for life. HIV is transmitted through certain bodily fluids and they are blood, semen (including pre-seminal), vaginal secretions, breast milk, and rectal fluids. AIDS, which stands for Acquired Immunodeficiency Syndrome, is the last stage of HIV, but it is important to note that not everyone with HIV will succumb to having AIDS. According to the U.S. Department of Health & Human Services (2014) people who acquire AIDS have immune systems that have been severely deteriorated which

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HIV is global pandemic stands for Human Immunodeficiency Virus, weakens the immune system by destroying the important cells in our body that fights against disease and infection. Our immune system is able to clear out most of the viruses from our body, but once you have HIV , you have it for lifelong. HIV can hide in our body cells for long time and it can attack the T cells and CD4 cells, a key part of our immune system to fight infections and diseases. Overtime, the HIV may attack so many of CD4 cells and our body is no more able to fight against infections. When this happens, HIV can lead to AIDS, the final stage of HIV infection. HIV can be transmitted through sexual contact, injection or drug use, pregnancy, breast feeding, occupational exposure, and rarely through blood transfusion and organ

AIDS and HIV Essay

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HIV is a virus that is spread almost all over the world. Although in some places health care isn’t as developed and therefore it spreads more in those regions. Sub-Saharan Africa holds more than 70%, 25 million, of all HIV positive people in the world. Second highest is Eastern Europe together with Central Asia with 1.3 million. It is spread over most of the world, including Asia and the Pacific, the Caribbean, Central and South America, North Africa and the Middle East and Western and Central Europe (“The Regional Picture”).

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HIV Prevention

The basics of hiv prevention.

• Protect yourself during sex: To reduce your risk of getting HIV, use  condoms  correctly every time you have sex.
• Protect yourself if you inject drugs: Do not inject drugs . If you do, use only sterile injection equipment and water, and never share your equipment with others.
• Protect yourself by taking PrEP: If you do not have HIV but are at risk of getting HIV, talk to your health care provider about  pre-exposure prophylaxis (PrEP) . PrEP involves taking a specific HIV medicine every day or an injectable HIV medicine every two months to reduce the risk of getting HIV through sex or injection drug use.
• Protect others if you have HIV: Take HIV medicine (called antiretroviral therapy or ART) as prescribed by your doctor. ART can reduce the amount of HIV in the blood (called viral load) to the point where a test cannot detect it (called an undetectable viral load). If you have an undetectable viral load, you will not transmit HIV to your partner through sex.
• Prevent perinatal transmission: If you have HIV and take HIV medicine as prescribed by your doctor throughout pregnancy and childbirth, the chances of transmitting HIV to your baby are less than 1%. If you have a partner with HIV and are considering getting pregnant, talk to your doctor about PrEP to help protect you and your baby from getting HIV while you try to get pregnant, during pregnancy, or while breastfeeding.

How is HIV transmitted?

The person-to-person spread of human immunodeficiency virus (HIV) is called HIV  transmission . People can get or transmit HIV only through specific activities, such as sex or injection drug use. HIV can be transmitted only in certain body fluids from a person who has HIV. Bodily fluids that can transmit HIV include blood, semen (“cum”), pre-seminal fluids (“pre-cum”), rectal fluids, vaginal fluids, and breast milk.

HIV transmission is only possible if these fluids come in contact with a mucous membrane, open cuts or sores, or are directly injected into the bloodstream (from a contaminated needle or syringe). Mucous membranes are found inside the rectum, the vagina, the opening of the penis, and the mouth.

In the United States, HIV is transmitted mainly by:

• Having anal or vaginal sex with someone who has HIV without using a  condom  or who is not taking medicines to prevent or treat HIV.
• Sharing injection drug equipment (“works”), such as needles or syringes, with someone who has HIV.

HIV can also be transmitted from a birthing parent with HIV to their child during pregnancy, childbirth (also called labor and delivery), or breastfeeding. This is called  perinatal transmission of HIV. Perinatal transmission of HIV is also called mother-to-child transmission of HIV.

How is HIV not transmitted?

You cannot get HIV from:

• Casual contact with a person who has HIV, such as a handshake, a hug, or a closed-mouth kiss (“social” kissing).
• Contact with objects, such as toilet seats, doorknobs, or dishes used by a person who has HIV.
• Mosquitoes, ticks, or other biting insects.
• Other sexual activities that do not involve the exchange of body fluids (for example, touching).
• Donating blood or receiving a blood transfusion.

Use the  You Can Safely Share…With Someone With HIV  infographic from HIVinfo to spread this message.

How can I reduce the risk of getting HIV?

Anyone can get HIV, but you can take steps to protect yourself from HIV.

• Get tested for HIV.  Talk to your partner about HIV testing and get tested before you have sex. Use the GetTested locator from the Centers for Disease Control and Prevention (CDC) to find an HIV testing location near you.
• Choose less risky sexual behaviors.  HIV is mainly transmitted by having anal or vaginal sex without a condom or without taking medicines to prevent or treat HIV.
• Use condoms every time you have sex.  Read this fact sheet from CDC on  how to use condoms correctly .
• Limit your number of sexual partners.  The more partners you have, the more likely you are to have a partner with poorly controlled HIV or to have a partner with a  sexually transmitted infection (STI) . Both factors can increase the risk of HIV transmission.
• Get tested and treated for STDs.  Insist that your partners get tested and treated, too. Having an STD can increase your risk of getting HIV or transmitting it to others.
• Talk to your health care provider about pre-exposure prophylaxis (PrEP).  PrEP is an HIV prevention option for people who do not have HIV but who are at risk of getting HIV (for example, if your partner has HIV or if you inject drugs). PrEP involves taking a specific HIV medicine to reduce the risk of getting HIV through sex or injection drug use. PrEP medications can be given in the form of pills (taken daily) or injections (every other month). It is important to take PrEP as directed by your doctor to effectively protect you against HIV. For more information, read the HIVinfo fact sheet on Pre-Exposure Prophylaxis (PrEP) .
• Do not inject drugs.  But if you do, use only sterile drug injection equipment and water, and never share your equipment with others.

How can I prevent passing HIV to others if I have HIV?

Take HIV medicines as directed by your doctor. Treatment with HIV medicines (called  antiretroviral therapy or ART ) helps people with HIV live long, healthy lives. ART cannot cure HIV, but it can reduce the amount of HIV in the body (called the  viral load ). One of the main goals of ART is to reduce a person's viral load to an undetectable level.

An  undetectable viral load  means that the level of HIV in the blood is too low to be detected by a viral load test . People with HIV who maintain an undetectable viral load by taking ART consistently as prescribed have effectively no risk of transmitting HIV to an HIV-negative partner through sex.

Remember, taking HIV medicines does not prevent transmission of other STIs.

In addition to maintaining an undetectable viral load, here are some other steps you can take to make sure you prevent HIV transmission to others:

• Use condoms correctly every time you have sex.
• Talk to your partner about taking PrEP.
• If you inject drugs, do not share your needles, syringes, or other drug equipment with other people.

Are HIV medicines used at other times to prevent HIV transmission?

Yes, HIV medicines are also used for post-exposure prophylaxis (PEP) and to prevent perinatal transmission of HIV.

• Post-exposure prophylaxis (PEP)  PEP means taking HIV medicines within 72 hours after a possible exposure to HIV to prevent HIV infection. PEP should be used only in emergency situations. It is not meant for regular use by people who may be exposed to HIV frequently. For more information, read the HIVinfo fact sheet on  Post-Exposure Prophylaxis (PEP) .   
• Prevention of perinatal transmission of HIV  Pregnant people with HIV take HIV medicines for their own health and to prevent perinatal transmission of HIV (HIV can be passed from a person with HIV to their child during pregnancy, childbirth, or breastfeeding). After birth, babies born to people with HIV receive HIV medicine to protect them from infection with any HIV that may have passed from mother to child during childbirth. For more information, read the HIVinfo fact sheet on  Preventing Perinatal Transmission of HIV .

This fact sheet is based on information from the following sources:

• How HIV Spreads
• Preventing HIV
• Preventing HIV With PrEP
• Preventing HIV With PEP

From the NIH Office of AIDS Research:

• Antepartum Care for Individuals With HIV:  Overview  
• Management of Infants Born to People with HIV Infection:  Antiretroviral Management of Newborns with Perinatal HIV Exposure or HIV Infection

Also see the  HIV Source  collection of HIV links and resources.

Introduction to HIV/AIDS

AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is a serious condition that weakens the body's immune system, leaving it unable to fight off illness.

AIDS is the last stage in a progression of diseases resulting from a viral infection known as the Human Immunodeficiency Virus (HIV or AIDS virus). The diseases include a number of unusual and severe infections, cancers and debilitating illnesses, resulting in severe weight loss or wasting away, and diseases affecting the brain and central nervous system.

There is no cure for HIV infection or AIDS nor is there a vaccine to prevent HIV infection. However, new medications not only can slow the progression of the infection, but can also markedly suppress the virus, thereby restoring the body’s immune function and permitting many HIV-infected individuals to lead a normal, disease-free life.

How HIV/AIDS Affects The Body

The immune system is a network of cells, organs and proteins that work together to defend and protect the body from potentially harmful, infectious microorganisms (microscopic life-forms), such as bacteria, viruses, parasites and fungi. The immune system also plays a critical role in preventing the development and spread of many types of cancer .

When the immune system is missing one or more of its components, the result is an immunodeficiency disorder. AIDS is an immunodeficiency disorder.

Lymphocytes (white blood cells) are one of the main types of immune cells that make up the immune system. There are two types of lymphocytes: B cells and T cells. (T cells are also called CD4 cells, CD4 T cells, or CD4 cell lymphocytes). B cells secrete antibodies (proteins) into the body's fluids to ambush and attack antigens (foreign proteins such as bacteria, viruses or fungi). T cells directly attack and destroy infected or malignant cells in the body.

There are two types of T cells: helper T cells and killer T cells. Helper T cells recognize the antigen and activate the killer T cells. Killer T cells then destroy the antigen.

When HIV is introduced into the body, this virus is too strong for the helper T cells and killer T cells. The virus then invades these cells and starts to reproduce itself, thereby not only killing the CD4 T cells, but also spreading to infect otherwise healthy cells.

The HIV virus cannot be destroyed and lives in the body undetected for months or years before any sign of illness appears. Gradually, over many years or even decades, as the T cells become progressively destroyed or inactivated, other viruses, parasites or cancer cells (called "opportunistic diseases") which would not have been able to get past a healthy body's defense, can multiply within the body without fear of destruction. Commonly seen opportunistic diseases in persons with HIV infection include: pneumocystis carinii pneumonia , tuberculosis, candida (yeast) infection of the mouth, throat or vagina, shingles , cytomegalovirus retinitis and Kaposi's sarcoma.

AIDS is transmitted via three main routes:

The most common mode of transmission is the transfer of body secretions through sexual contact. This is accomplished through exposure of mucous membranes of the rectum, vagina or mouth to blood, semen or vaginal secretions containing the HIV virus.

Blood or blood products can transmit the virus, most often through the sharing of contaminated syringes and needles.

HIV can be spread during pregnancy from mother to fetus.

You cannot get AIDS/HIV from touching someone or sharing items, such as cups or pencils, or through coughing and sneezing. Additionally, HIV is not spread through routine contact in restaurants, the workplace or school. However, sharing a razor does pose a small risk in that blood from a minor nick can be transmitted from one person to another.

Immediately following infection with HIV, most individuals develop a brief, nonspecific “viral illness” consisting of low grade fever, rash, muscle aches, headache and/or fatigue. Like any other viral illness, these symptoms resolve over a period of five to 10 days. Then for a period of several years (sometimes as long as several decades), people infected with HIV are asymptomatic (no symptoms). However, their immune system is gradually being destroyed by the virus. When this destruction has progressed to a critical point, symptoms of AIDS appear. These symptoms are as follows:

extreme fatigue

rapid weight loss from an unknown cause (more than 10 lbs. in two months for no reason)

appearance of swollen or tender glands in the neck, armpits or groin, for no apparent reason, lasting for more than four weeks

unexplained shortness of breath, frequently accompanied by a dry cough, not due to allergies or smoking

persistent diarrhea

intermittent high fever or soaking night sweats of unknown origin

a marked change in an illness pattern, either in frequency, severity, or length of sickness

appearance of one or more purple spots on the surface of the skin, inside the mouth, anus or nasal passages

whitish coating on the tongue, throat or vagina

forgetfulness, confusion and other signs of mental deterioration

It can take as short as a year to as long as 10 to 15 years to go from being infected with HIV to "full-blown" AIDS.

According to the Center for Disease Control and Prevention, a person is considered to have AIDS when they have a T cell count (also called CD4 cell count) of 200 or less (healthy T cell levels range from 500 to 1500) or they have an AIDS-defining condition. The AIDS-defining conditions are:

· Candidiasis

· Cervical cancer (invasive)

· Coccidioidomycosis, Cryptococcosis, Cryptosporidiosis

· Cytomegalovirus disease

· Encephalopathy (HIV-related)

· Herpes simplex (severe infection)

· Histoplasmosis

· Isosporiasis

· Kaposi's sarcoma

· Lymphoma (certain types)

· Mycobacterium avium complex

· Pneumocystis carinii pneumonia

· Pneumonia (recurrent)

· Progressive multifocal leukoencephalopathy

· Salmonella septicemia (recurrent)

· Toxoplasmosis of the brain

· Tuberculosis

· Wasting syndrome

People who are not infected with HIV may also develop these diseases; the presence of any one of these conditions does not mean the person has AIDS. To be diagnosed with AIDS, a person must be infected with HIV.

Some people infected with HIV may develop a disease that is less serious than AIDS, referred to as AIDS Related Complex (ARC). ARC is a condition caused by the AIDS virus in which the patient tests positive for AIDS infection and has a specific set of clinical symptoms. However, ARC patients' symptoms are often less severe than those with classic AIDS because the degree of destruction of the immune system has not progressed as far as it has in patients with classic AIDS.

Symptoms of ARC may include loss of appetite, weight loss, fever, night sweats, skin rashes, diarrhea, tiredness, lack of resistance to infection or swollen lymph nodes .

Note: Not everyone who has been infected with HIV develops AIDS. Very rarely, some individuals can be infected with HIV yet maintain normal immune function and general good health even after 20 years of infection.

Screening for HIV infection is most commonly done by testing blood for HIV antibodies. A newer test, the Orasure test, involves collecting secretions between the cheek and gum and evaluating them for HIV antibodies. Orasure is essentially as accurate as a blood test, and, because it doesn't involve a needle stick, it is favored by many individuals. Orasure is available through physicians’ offices and many public health clinics. Finally, a new urine test available for screening, although if the test is positive, blood tests need to be performed for confirmation of the presence of HIV.

In 1996, a home HIV blood test (called Home Access) became available to the public. These home kits are available in pharmacies and by mail. The kit contains a few sharp tools called lancets, a piece of blotting paper marked with a unique identification number and a prepaid return envelope with a protective pouch. After pricking the finger with the lancet, a few drops of blood are blotted onto the paper, sealed into the envelope and sent to the address on the envelope. In about a week, the person calls a toll-free number to get the results of the test.

Anti-HIV (also called antiretroviral) medications are used to control the reproduction of the virus and to slow or halt the progression of HIV-related disease. When used in combinations, these medications are termed Highly Active Antiretroviral Therapy (HAART). HAART combines three or more anti-HIV medications in a daily regimen, sometimes referred to as a "cocktail". Anti-HIV medications do not cure HIV infection and individuals taking these medications can still transmit HIV to others. Anti-HIV medications approved by the U.S. Food and Drug Administration (FDA) fall into four classes:

1 . Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs), such as nevirappine (Viramune) and efavirenz (Sustiva), bind to and block the action of reverse transcriptase, a protein that HIV needs to reproduce.

2 . Nucleoside Reverse Transcriptase Inhibitors (NRTIs), such as zidovudine (Retrovir), tenofovir DF (Viread), and stavudine (Zerit), are faulty versions of building blocks that HIV needs to make more copies of itself. When HIV uses an NRTI instead of a normal building block, reproduction of the virus is stalled.

3 . Protease Inhibitors (PIs), such as lopinavir/ritonavir (Kaletra), disable protease, a protein that HIV needs reproduce itself.

4 . Fusion Inhibitors, such as enfuvirtide (Fuzeon ), are newer treatments that work by blocking HIV entry into cells.

(View more complete list of HIV drugs).

How many pills you will need to take and how often you will take them depends on what medications you and your doctor choose.

There is no one "best" regimen. You and your doctor will decide which medications are right for you. For people taking HAART for the first time, the recommended regimens are:

Sustiva + Truvada, Sustiva + Epzicom, or Atripla

Kaletra + Truvada, Kaletra + Epzicom, or Kaletra + Combivir

In general, taking only one or two drugs is not recommended because any decrease in viral load is almost always temporary without three or more drugs. The exception is the recommendation for pregnant women, who may take Combivir plus nevirapine to reduce the risk of passing HIV to their infants. If you are pregnant or considering becoming pregnant, there are additional treatment considerations. Recently, a number of drugs have been developed that combine two or even three separate medications in a single pill. Some of these, such as Truvada (emtricitabine + tenofovir) and Epzicom (abacavir + lamivudine) need be taken only once daily. Atripla (emtricitabine + tenofovir + efavirenz) combines three drugs in one pill and needs to be taken only once daily, thereby providing a complete HAART regimen with one pill once daily.

The treatment of HIV infection and AIDS is in a highly dynamic state. Individuals with this condition are advised to seek out experts in their local community who are current with the latest modes of therapy and ongoing clinical trials for evaluating newer therapies.

HIV/AIDS Medications

The following is a partial list of drugs approved for the treatment of HIV infection.

Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)

Delavirdine (Rescriptor, DLV) Pfizer

Efavirenz (Sustiva, EFV) Bristol-Myers Squibb

Nevirapine (Viramune, NVP) Boehringer Ingelheim

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Abacavir (Ziagen, ABC) GlaxoSmithKline

Abacavir,Lamivudine, Zidovudine (Trizivir) GlaxoSmithKline

Didanosine (Videx, ddI, Videx EC) Bristol-Myers Squibb

Emtricitabine (Emtriva, FTC, Coviracil) Gilead Sciences

Lamivudine (Epivir, 3TC) GlaxoSmithKline

Lamivudine, Zidovudine (Combivir) GlaxoSmithKline

Stavudine ( Zerit, d4T) Bristol-Myers Squibb

Tenofovir DF (Viread, TDF) Gilead Sciences

Zalcitabine (Hivid, ddC) Hoffmann-La Roche

Atripla (tenofovir, emtricitabine, efavirenz) Gilead Sciences

Zidovudine (Retrovir, AZT, ZDV) GlaxoSmithKline

Protease Inhibitors (PIs)

Amprenavir (Agenerase, APV) GlaxoSmithKline, Vertex Pharmaceuticals

Atazanavir (Reyataz, ATV) Bristol-Myers Squibb

Fosamprenavir (Lexiva, FPV) GlaxoSmithKline, Vertex Pharmaceuticals

Indinavir (Crixivan, IDV) Merck

Lopinavir, Ritonavir (Kaletra, LPV/r) Abbott Laboratories

Nelfinavir (Viracept, NFV) Agouron Pharmaceuticals

Ritonavir (Norvir, RTV) Abbott Laboratories

Saquinavir (Fortovase, SQV) Invirase Hoffmann-La Roche

Tipranavir (Aptivus) Boehringer-Ingelheim

Darunavir (Prezista) Tibotec Therapeutics

Fusion Inhibitors

Enfuvirtide (Fuzeon, T-20) Hoffmann-La Roche, Trimeris

Risk Prevention

The only way to protect from contracting AIDS sexually is to abstain from sex outside of a mutually faithful relationship with a partner whom the person knows is not infected with the AIDS virus. Otherwise, risks can be minimized if they:

Don't have sexual contact with anyone who has symptoms of AIDS or who is a member of a high risk group for AIDS.

Avoid sexual contact with anyone who has had sex with people at risk of getting AIDS.

Don't have sex with prostitutes.

Avoid having sex with anyone who has multiple and/or anonymous sexual partners.

Avoid oral, genital and anal contact with partner's blood, semen, vaginal secretions, feces or urine. Unless they know with absolute certainty that their partner is not infected, a latex condom should be used during each sexual act, from start to finish. The use of a spermicidal agent may provide additional protection.

Avoid anal intercourse altogether.

Don't share toothbrushes, razors or other implements that could become contaminated with the blood of anyone who is or might be infected with the AIDS virus.

Exercise caution regarding procedures, such as acupuncture, tattooing, ear piercing, etc., in which needles or other nonsterile instruments may be used repeatedly to pierce the skin and/or mucous membranes.

Such procedures are safe if proper sterilization methods are employed or disposable needles are used. Ask what precautions are taken before undergoing such procedures.

If an individual is scheduling surgery in the near future, and is able, they could consider donating blood for their own use. This will eliminate completely the already very small risk of contracting AIDS through a blood transfusion. It will also eliminate the risk of contracting other bloodborne diseases (such as hepatitis) from a transfusion.

If a person is an IV drug user, adhere to the prevention tips mentioned earlier, as well as:

Get professional help for terminating the drug habit.

Do not share needles or syringes. Be aware that some street sellers are resealing previously used needles and selling them as new.

Clean the needle before using.

Some people apparently remain well after infection of the AIDS virus. They may have no physically apparent symptoms of illness. However, if proper precautions are not used with sexual contacts and/or intravenous drug use, these infected individuals can spread the virus to others .

Anyone who thinks he or she is infected, or who is involved in high-risk behaviors, should not donate his/her blood, organs, tissues, or sperm as they may now contain the AIDS virus.

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Prevention and Treatment of HIV/AIDS Expository Essay

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Introduction

The role of other organizations, recommendation.

HIV/AIDS has become a concern to everybody in the world. Many countries and individuals have found it very hard to deal with it because of the lack of funds. Therefore, organizations have come up to help them handle this problem. Notable organizations that have offered their support include WHO, PEPFAR, the Clinton’s AIDS Initiative, the Gates Foundation and the Global Fund.

WHO HIV/AIDS Treatment and Prevention Program Policy

The World Health Organization Department of HIV/AIDS provides normative and policy support to its members basing on enough evidence ( WHO | Guidelines, 2014). The purpose of this support is to improve the treatment, care provision and prevention services ( WHO | Guidelines, 2014).

The global vision of WHO is to eradicate HIV infections, deaths and discrimination against infected people. It aims at attaining universal and comprehensive HIV prevention, treatment and care. It also aims at combating HIV/AIDS, malaria and other diseases ( WHO | Guidelines, 2014). WHO developed strategic directions that health units should adopt in achieving its goals. They are:

• Optimizing the prevention, diagnosis and provision of care for HIV victims ( WHO | Guidelines, 2014)
• Leveraging wider outcomes in health through appropriate response to HIV ( WHO | Guidelines, 2014)
• Reducing susceptibility and getting rid of barriers to accessing services ( WHO | Guidelines, 2014)

The World Health Organization also proposes treatment and preventive methods that are specific to the needs of individual countries. Among the methods it proposes for the countries include the use of male and female condoms, male circumcision, antiretroviral therapy, prophylaxis and behavior change counseling ( WHO | Guidelines, 2014).

WHO also volunteered to expand HIV prevention methods in every country ( WHO | Guidelines, 2014). Currently, it has plans to develop a HIV prevention strategy based on national evidence and push for the creation of better prevention methods and interventions.

Global Fund

The Global Fund partners with governments, civil societies, the private sector and victims of AIDS, Tuberculosis, and malaria in 140 countries worldwide ( HIV/AIDS-The Global Fund, 2014). It spends over $4 billion every year on these partnerships. This support has greatly accelerated the rate at which the prevalence of AIDS reduces.

The fund was developed with the purpose of giving HIV victims financial support to reduce the rate of infections ( HIV/AIDS-The Global Fund, 2014). In addition, the Global Fund ensures that all infected people in the world can access antiretroviral therapy. By last year, the fund had helped 6 million victims of HIV get access to ARV ( HIV/AIDS-The Global Fund, 2014).

Its efforts have largely depended on the realization that ARV reduces the chances of HIV transmission by close to 90%. The Global Fund concentrates its services and support in areas where the effects of HIV/AIDS are more prevalent. It looks for geographic and demographic information, making it easier to focus on certain countries and populations around the world. It mostly focuses on stigmatized groups such as women, girls, drug users, migrant workers and inmates.

Gates Foundation

The main objective of the Gates Foundation is “to reduce the incidence of HIV infection and extend the lives of people living with HIV” ( HIV, 2014, par. 4). The organization offers support to all the efforts of reducing worldwide transmission of HIV. It also helps the victims of the virus live long and healthy lives.

The organization mainly focuses on populations living in Sub-Saharan regions of Africa. HIV has greatly affected the population in these regions ( HIV, 2014). These regions are very poor and cannot afford HIV medication without support. The foundation gives grants to organizations that fight HIV. It also offers financial support to the Global Fund.

So far, it has given approximately $2.5 billion to organizations in all countries and $1.4 billion to the Global Fund ( HIV, 2014). The foundation also advocates sustainability and increase in funding programs that aim at reducing HIV/AIDS prevalence.

The fund also supports the search for a HIV vaccine. It invests in research that aims at coming up with the vaccine. It partners with private institutions, individual researchers and governments in researching on several types of possible vaccines. It also provides antiretroviral therapy and other products such as vaginal rings and injections to the victims.

In addition to other activities, the foundation provides tools for carrying out voluntary male circumcision in 14 Sub-Saharan countries ( HIV, 2014). It also supports efforts by governments and other private institutions to diagnose and measure the prevalence of HIV.

Clinton’s AIDS Initiative

The Clinton Health Access Initiative was established with the purpose of helping all victims of HIV get access to medication and reduce its cost ( HIV/AIDS , 2014). Since its inception, the number of people accessing HIV medication has risen from 200, 000 in 2002 to over 8 million today ( HIV/AIDS , 2014).

In addition, the cost of the treatment has fallen from $ 10, 000 to approximately $100. The initiative has partnered with many countries around the world in formulating programs aimed at fighting HIV/AIDS ( HIV/AIDS , 2014). The best example of such partnerships includes the partnership with Ukraine.

This partnership aimed at increasing the access to HIV/AIDS treatment. President Clinton and Preval’s agreement to expand HIV/AIDS services and strengthen health systems in Haiti and the partnership with UNITAID that focused on reducing the prices of important AIDS medicine were also part of this initiative ( HIV/AIDS , 2014).

The main goal of PEPFAR is to save many lives through upgrading existing strategies and supporting efforts by different countries to improve their people’s health ( The U.S. President’s Emergency Plan for AIDS Relief, 2014). In 2008, the president of America signed an act that authorized the use of $ 48 billion in the fight against HIV, malaria and TB.

PEPFAR also aims at promoting sustainable AIDS eradication programs ( The U.S. President’s Emergency Plan for AIDS Relief, 2014). This initiative also supports countries in responding to HIV because of the belief that fighting AIDS is more effective when countries take charge of their affairs ( The U.S. President’s Emergency Plan for AIDS Relief, 2014). PEPFAR also focuses on other challenges that come with HIV/AIDS such as stigma and opportunistic diseases.

The organizations should provide more material support compared to money since most countries misuse the funds they receive.

Many countries in the Sub-Saharan Africa are too poor to provide good preventive and treatment methods of HIV/AIDS to their citizens. Close to 18% of their population is infected with the virus.

This situation has prompted many private and international organizations to come to their rescue. WHO, PEPFAR, the Clinton’s Organization and the Gates Foundation have provided support in these regions for a long time.

Private and International organizations have been very supportive in the fight against HIV/AIDS. Many countries and individuals could not afford the HIV/AIDS prevention and treatment without the support of PEPFAR, WHO, Clinton’s AIDS Initiative, Gates Foundation and other organizations. These organizations have invested lots of money and material support in regions with the most prevalent cases of HIV/AIDS.

HIV/AIDS (2014). Web.

HIV/AIDS – The Global Fund to Fight AIDS, Tuberculosis and Malaria (2014). Web.

HIV – Bill & Melinda Gates Foundation (2014). Web.

The U.S. President’s Emergency Plan for AIDS Relief: Five-Year Strategy (2014). Web.

WHO | Guidelines: HIV (2014). Web.

• Epidemiology
• Dengue Disease in Africa
• Key Drivers of HIV and AIDS in Sub-Saharan Africa and in San Francisco and Church’s Response to the AIDS Pandemic
• Malaria and Poor Quality Drugs in Africa
• Human Diseases: Exploring Malaria
• Duties of Health Care Professionals During Pandemic of Highly Contagious Diseases
• Prevention and Treatment of Tuberculosis
• Epidemiology: Genetics-Related Programs
• Leishmaniasis: Causes & Treatment
• HIV and AIDS Prevention Among the Youth in Asia
• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2019, June 22). Prevention and Treatment of HIV/AIDS. https://ivypanda.com/essays/prevention-and-treatment-of-hiv-aids/

"Prevention and Treatment of HIV/AIDS." IvyPanda , 22 June 2019, ivypanda.com/essays/prevention-and-treatment-of-hiv-aids/.

IvyPanda . (2019) 'Prevention and Treatment of HIV/AIDS'. 22 June.

IvyPanda . 2019. "Prevention and Treatment of HIV/AIDS." June 22, 2019. https://ivypanda.com/essays/prevention-and-treatment-of-hiv-aids/.

1. IvyPanda . "Prevention and Treatment of HIV/AIDS." June 22, 2019. https://ivypanda.com/essays/prevention-and-treatment-of-hiv-aids/.

Bibliography

IvyPanda . "Prevention and Treatment of HIV/AIDS." June 22, 2019. https://ivypanda.com/essays/prevention-and-treatment-of-hiv-aids/.

• Patient Care & Health Information
• Diseases & Conditions

HIV can be diagnosed through blood or saliva testing. Tests include:

Antigen-antibody tests. These tests most often use blood from a vein. Antigens are substances on the HIV virus itself. They most often show up in the blood within a few weeks after being exposed to HIV .

The immune system makes antibodies when it's exposed to HIV . It can take weeks to months for antibodies to show up in blood. You may not show a positive result on an antigen-antibody test until 2 to 6 weeks after exposure to HIV .

• Antibody tests. These tests look for antibodies to HIV in blood or saliva. Most rapid HIV tests are antibody tests. This includes self-tests done at home. You may not show a positive result on an antibody test until 3 to 12 weeks after you've been exposed to HIV .

Nucleic acid tests (NATs). These tests look for the virus in your blood, called viral load. They use blood from a vein.

If you might have been exposed to HIV within the past few weeks, your healthcare professional may suggest NAT . NAT is the first test to become positive after exposure to HIV .

Talk with your healthcare professional about which HIV test is right for you. If any of these tests are negative, you may need a follow-up test weeks to months later to confirm the results.

Tests to stage disease and treatment

If you've been diagnosed with HIV , find a specialist trained in diagnosing and treating HIV to help you:

• Decide whether you need other tests.
• Find which HIV antiretroviral therapy, also called ART, is best for you.
• Watch your progress and work with you to manage your health.

If you get a diagnosis of HIV / AIDS , tests can help your healthcare professional learn the stage of your disease and the best treatment, including:

• CD4 T cell count. CD4 T cells are white blood cells that HIV targets and destroys. Even if you have no symptoms, HIV infection becomes AIDS when your CD4 T cell count dips below 200.
• Viral load, also called HIV RNA. This test measures the amount of virus in your blood. After starting HIV treatment, the goal is to have a viral load so low that it doesn't show up on the test, called undetectable. This greatly reduces your chances of opportunistic infection and other HIV -related complications.
• Medicine resistance. Some strains of HIV are resistant to medicines. This test helps your healthcare professional know if your form of the virus has resistance. This guides treatment decisions.

Tests for complications

Your healthcare professional also might order lab tests to check for other infections or complications, including:

• Tuberculosis.
• Hepatitis B or hepatitis C virus infection.
• Liver or kidney damage.
• Urinary tract infection.
• Cervical and anal cancer.
• Cytomegalovirus.
• Toxoplasmosis.

More Information

• Liver function tests

There's no cure for HIV / AIDS . Once you have the infection, your body can't get rid of it. But there are medicines that can control HIV and prevent complications.

Everyone diagnosed with HIV should take antiretroviral therapy medicines, also called ART. This is true no matter what stage the disease is in or what the complications are.

ART is usually a mix of two or more medicines from several classes. This approach has the best chance of lowering the amount of HIV in the blood. There are many ART options that mix more than one HIV medicine into a single pill, taken once daily.

Each class of medicines blocks the virus in different ways. Treatment involves mixing medicines from different classes to:

• Account for medicine resistance, called viral genotype.
• Keep from creating new medicine-resistant strains of HIV .
• Suppress the virus in the blood as much as possible.

Two medicines from one class, plus a third medicine from another class, are most often used.

The classes of anti- HIV medicines include the following:

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off a protein needed by HIV to make copies of itself.

Examples include efavirenz, rilpivirine (Edurant) and doravirine (Pifeltro).

Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are faulty versions of the building blocks that HIV needs to make copies of itself.

Examples include abacavir (Ziagen), tenofovir disoproxil fumarate (Viread), emtricitabine (Emtriva), lamivudine (Epivir) and zidovudine (Retrovir). Retrovir is no longer suggested for routine use in the U.S. because of high rates of toxic effects.

Mixes of medicines also are available, such as emtricitabine-tenofovir disoproxil fumarate (Truvada) and emtricitabine-tenofovir alafenamide fumarate (Descovy).

Protease inhibitors (PIs) make HIV protease inactive. HIV protease is another protein that HIV needs to make copies of itself.

Examples include atazanavir (Reyataz), darunavir (Prezista) and lopinavir-ritonavir (Kaletra).

Integrase inhibitors stop the action of a protein called integrase. HIV uses integrase to put its genetic material into CD4 T cells.

Examples include bictegravir sodium-emtricitabine-tenofovir alafenamide fumarate (Biktarvy), raltegravir (Isentress), dolutegravir (Tivicay) and cabotegravir (Vocabria).

Entry or fusion inhibitors block HIV's entry into CD4 T cells.

Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry). Newer medicines include ibalizumab-uiyk (Trogarzo) and fostemsavir (Rukobia).

Starting and staying on treatment

Everyone with HIV infection, no matter what the CD4 T cell count or symptoms are, should be offered antiviral medicine.

Staying on ART that keeps your HIV viral load in the blood from being detected is the best way for you to stay healthy.

For ART to work, you must take the medicines as prescribed. Don't miss or skip doses. Staying on ART with an undetectable viral load helps:

• Keep your immune system strong.
• Lower your chances of getting an infection.
• Lower your chances of getting treatment-resistant HIV .
• Lower your chances of giving HIV to other people.

Staying on HIV therapy can be hard. Talk to your healthcare professional about possible side effects, trouble you have taking medicines, and any mental health or substance use issues that may make it hard for you to stay on ART .

Have regular follow-up appointments with your health professional to check your health and response to treatment. Let your health professional know right away if you have problems with HIV therapy. Then you can work together to find ways to deal with those issues.

Treatment side effects

Treatment side effects can include:

• Nausea, vomiting or diarrhea.
• Heart disease.
• Kidney and liver damage.
• Weakened bones or bone loss.
• Cholesterol levels that are not typical.
• Higher blood sugar.
• Problems with thinking, emotions and sleep.

Treatment for age-related diseases

Some health issues that are a part of aging may be harder to manage if you have HIV . Some medicines that are common for age-related heart, bone or metabolic conditions, for example, may not mix well with anti- HIV medicines. Talk with your healthcare professional about your other health conditions and the medicines you take for them.

If another health professional prescribes a medicine for another condition, let that health professional know about your HIV therapy. Then the health professional can make sure there are no problems with taking the medicines together.

Treatment response

Your healthcare professional will watch your viral load and CD4 T cell counts to see your response to HIV treatment. The first check is at 4 to 6 weeks. After that, you see your health professional every 3 to 6 months.

Treatment should lower your viral load so that can't be found in the blood. That doesn't mean your HIV is gone. Even if it can't be found in the blood, HIV is still in your body.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

Besides getting medical treatment, you need to take an active role in your own care. The following may help you stay healthy longer:

• Eat healthy foods. Fresh fruits and vegetables, whole grains, and lean protein help keep you strong, give you more energy and support your immune system. Eat enough calories to keep your weight stable.
• Avoid raw meat, eggs and more. Foodborne illnesses can be severe in people who are infected with HIV . Cook meat until it's well done. Don't use dairy products that aren't treated for bacteria, called pasteurized. Don't eat raw eggs and raw seafood such as oysters, sushi or sashimi. Don't drink water you don't know is safe.
• Get the right vaccinations. These may prevent common infections such as pneumonia, influenza, COVID-19 and mpox. Your healthcare professional also may suggest other vaccinations, including those for HPV , hepatitis A and hepatitis B. Vaccines that don't have live viruses mostly are safe. But most vaccines with live viruses are not safe because of your weakened immune system.
• Take care with pets. Some animals may carry parasites that can cause infections in people who are HIV positive. Cat stool can cause toxoplasmosis, reptiles can carry salmonella, and birds can carry cryptococcus or histoplasmosis. Wash hands thoroughly after handling pets or emptying litter boxes.

Alternative medicine

People who are infected with HIV sometimes try dietary supplements that claim to boost the immune system or help with side effects of anti- HIV medicines. But there are no studies that show these claims are true. And many supplements can get in the way of other medicines you take.

Always check with your healthcare professional before taking any supplements or alternative therapies to make sure they won't affect the way your medicines work.

Supplements that may be helpful

There's little evidence to show that any supplements for HIV work. Some examples with limited research include:

• Acetyl-L-carnitine. Researchers have used acetyl-L-carnitine to treat nerve pain, numbness or weakness, called neuropathy, in people with diabetes. It may also ease neuropathy linked to HIV for people who don't have enough acetyl-L-carnitine in their bodies.
• Whey protein and certain amino acids. Early evidence suggests that whey protein, a cheese byproduct, can help some people with HIV gain weight. The amino acids L-glutamine, L-arginine and hydroxymethylbutyrate (HMB), also may help with weight gain.
• Probiotics. There is some evidence that the probiotic Saccharomyces boulardii may help with HIV -related diarrhea. Use only as your healthcare professional directs. Bovine colostrum also is being studied for treating diarrhea. But more research is needed.
• Vitamins and minerals. Vitamins A, D, E, C and B and the minerals zinc, iron and selenium may help if you have low levels of them. Talk to your health professional before taking them. Too much of some vitamins and minerals can be harmful.

Supplements that may be dangerous

• St. John's wort. Often used for depression, St. John's wort can reduce how well several types of anti- HIV medicines work by more than half.
• Garlic supplements. Garlic itself may help strengthen the immune system. But garlic supplements can reduce how well some anti- HIV medicines work. Eating some garlic in food seems to be safe.
• Red yeast rice extract. Some people use this to lower cholesterol. Don't take it if you take a protease inhibitor or a statin.

Mind-body practices

Practices such as yoga, meditation and massage have been shown to reduce stress as well as provide relaxation and improve quality of life. While they need more study, these practices may be helpful if you're living with HIV / AIDS .

Coping and support

Getting a diagnosis of any life-threatening illness can cause distress. The emotional, social and financial effects of HIV / AIDS can make coping with this illness very hard for you and for those close to you.

But there are many services and resources for people with HIV . Most HIV / AIDS clinics have social workers, counselors or nurses who can help you or put you in touch with people who can help you.

They may be able to:

• Arrange transportation to and from medical appointments.
• Help with housing and child care.
• Assist with employment and legal issues.
• Provide support during financial crises.

It's important to have a support system. Many people with HIV / AIDS find that talking with someone who knows about their disease gives them comfort.

Preparing for your appointment

If you think you might have an HIV infection, you're likely to start by seeing your family healthcare professional. You may be sent to an infectious disease specialist who focuses on treating HIV / AIDS .

What you can do

Before your appointment, think about the answers to these questions and take them to your appointment:

• How do you think you were exposed to HIV ?
• What are your symptoms?
• Do you have risk factors, such as having sex without protection or shooting illicit drugs?
• What medicines or supplements do you take?

What to expect from your doctor

Your healthcare professional asks you questions about your health and lifestyle and does a physical exam, checking you for:

• Swollen lymph nodes.
• Sores on your skin or in your mouth.
• Problems with your nervous system.
• Unusual sounds in your lungs.
• Swollen organs in your belly.

What you can do in the meantime

If you think you might have an HIV infection, protect yourself and others before your appointment. Don't have sex without using protection. If you shoot illicit drugs, always use a fresh, clean needle. Don't share needles with others.

• About HIV and AIDS . HIV.gov. https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids. Accessed Oct. 18, 2023.
• Sax PE. Acute and early HIV infection: Clinical manifestations and diagnosis. https://www.uptodate.com/contents/search. Accessed Oct. 18, 2023.
• Ferri FF. Human immunodeficiency virus. In: Ferri's Clinical Advisor 2024. Elsevier; 2024. https://www.clinicalkey.com. Accessed Oct. 18, 2023.
• Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV . HIV.gov. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/immunizations. Accessed Oct. 18, 2023.
• AskMayoExpert. Human immunodeficiency virus (HIV) infection. Mayo Clinic; 2023.
• Elsevier Point of Care. Clinical Overview: HIV infection and AIDS in adults. https://www.clinicalkey.com. Accessed Oct. 18, 2023.
• Male circumcision for HIV prevention fact sheet. Centers for Disease Control and Prevention. https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/male-circumcision-HIV-prevention-factsheet.html. Accessed Oct. 19, 2023.
• Acetyl-L-carnitine. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed. Oct. 19, 2023.
• Whey protein. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed. Oct. 19, 2023.
• Saccharomyces boulardii. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Oct. 19, 2023.
• Vitamin A. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Oct. 19, 2023.
• Red yeast rice. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Oct. 19, 2023.
• Early HIV symptoms: What are they?

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Cause and Effect Essay of AIDS/HIV

Hiv infection, causes of hiv/aids, effects of hiv/aids.

AIDS stands for “acquired immunodeficiency syndrome” which is an advanced stage of the human immunodeficiency virus (HIV) infection. AIDS is a chronic, life-threatening condition that results from HIV (Abraham, 2019). HIV interferes with the immune system by hindering the body’s ability to fight diseases and infections by destroying helper T cells which are responsible for keeping the human body immune from illnesses (K-12 Foundation 1). Medical practitioners say that AIDS is identified in a person when the CD4 count is below 200 cells per cubic millimeter (Abraham, 2019). After penetrating helper T cells, the virus copies itself in the host and destroys or infects the cell and other helper T cells throughout the body.

Figure 2 above illustrates the various ways that increase the chances of a person contracting the HIV virus. They comprise getting in contact with vaginal fluids, semen, and the blood of an infected person (Abraham, 2019). Moreover, the virus can be contracted by engaging in unprotected sexual activity with persons infected with the virus (Abraham 37). Another way a person can contract the virus is by sharing piercing instruments with infected persons. The virus also can pass from a mother to child while breastfeeding, during birth, or during pregnancy (Abraham, 2019). Without receiving suitable medication, it might take years before HIV makes the immune system weak to the point of developing AIDS (Abraham 25). These are some of the ways that the HIV virus can pass from an infected to a healthy person.

HIV/AIDS will have various effects on the body of a patient. For instance, HIV will destroy the CD4 cell count in the body of a patient which is vital for immunity from diseases and infections (Abraham, 2019). During the first several weeks, the body’s immune system tries to fight the virus. As evident in Figure 3 above, the human body’s response leads to a temporary reduction in the number of virus copies or the multiplication process. However, rapid reproduction makes it difficult for the immune system to completely destroy the pathological virus. Continued multiplication of the virus over the next several years results in further decline in helper T cells, consequently weakening the immune system further (K-12 Foundation 2. This compromise exposes the body to frequent infections.

Furthermore, a lack of appropriate medication will create a high risk of developing opportunistic diseases such as pneumonia, influenza, colds, breathing problems, fever, cough, pulmonary arterial hypertension (PAH), and cancer (Brady et al., 2019). Other consequences include loss of appetite, weight, and death.

Abraham, Thomas. “HIV and AIDS: The Causes and Effects.” HEKAMTHO (2019). Web.

Brady, Michael T., et al. “Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children.” Vaccine, 2019. Web.

Wilkin, Doughlas and Jean Brainard. “HIV and AIDS – Advanced.” K-12 Foundation, 2020. Web.

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Institute of Medicine (US) Committee to Study HIV Transmission Through Blood and Blood Products; Leveton LB, Sox HC Jr., Stoto MA, editors. HIV And The Blood Supply: An Analysis Of Crisis Decisionmaking. Washington (DC): National Academies Press (US); 1995.

HIV And The Blood Supply: An Analysis Of Crisis Decisionmaking.

• Hardcopy Version at National Academies Press

8 Conclusions and Recommendations

The HIV epidemic has taught scientists, clinicians, public health officials, and the public that new infectious agents can still emerge. The nation must be prepared to deal with a fatal illness whose cause is initially unknown but whose epidemiology suggests it is an infectious disease. The AIDS epidemic has also taught us another powerful and tragic lesson: that the nation's blood supply—because it is derived from humans—is highly vulnerable to contamination with an infectious agent. A nation's blood supply is a unique, essential, life-giving resource. Whole blood and many blood products are lifesaving for many people. As a whole, our nation's system works effectively to supply the nation with necessary blood and blood products and its quality control mechanisms check most human safety threats. The events of the early 1980s, however, revealed an important weakness in the system—in its ability to deal with a new threat that was characterized by substantial uncertainty. The potential for recurring threats to the blood supply led this Committee to reappraise the processes, policies, and resources through which our society attempts to preserve its supply of safe blood and blood products.

• General Conclusions

The events and decisions that the Committee has analyzed underscore the difficulty of decisionmaking when the stakes are high, when decisionmakers may have personal or institutional biases, and when knowledge is imprecise and incomplete. The Committee attempted to understand the complexities of the decisionmaking process during the period analyzed in this report and develop lessons to protect the blood supply in the future. In retrospect, the system was not dealing well with contemporaneous blood safety issues such as hepatitis, and was not prepared to deal with the far greater challenge of AIDS.

By January 1983, the Centers for Disease Control (CDC) had accumulated enough epidemiological evidence to conclude that the agent causing AIDS was almost certainly transmitted through blood and blood products and could be sexually transmitted to sexual partners. The conclusion that the AIDS agent was blood-borne rested on two findings. First, AIDS was occurring in transfusion recipients and individuals with hemophilia who had received AHF concentrate; these AIDS patients did not belong to any other known high-risk group for contracting AIDS. Second, the epidemiologic pattern of AIDS was similar to hepatitis B, another blood-borne disease. However, the magnitude and consequences of the risk for transfusion and blood product recipients was not known at this time. Furthermore, the epidemiological pattern of the new disease was difficult to interpret because, unlike most infectious diseases, there seemed to be several years between exposure leading to infection and the development of symptoms. As a result, physicians and public health officials underestimated the large number of infectious people who had no symptoms of AIDS but could transmit the disease to others and therefore substantially understated the risk of infection.

Compared to the pace of many regulatory and public health decision processes, the federal government responded relatively swiftly to the early warnings that AIDS might be transmitted through blood and blood products. Public and private sector officials considered a range of clinical and public health interventions for reducing the risk of AIDS transmission through blood and blood products. This period, however, was characterized by a great deal of scientific uncertainty about the risks of HIV infection through blood and blood products and about the costs and benefits of the available options. The result, the Committee found, was a pattern of responses which, while not in conflict with the available scientific information, was very cautious and exposed the decisionmakers and their organizations to a minimum of criticism. This limited response can be seen in the refusal of blood banks in 1983 and 1984 to screen for and defer homosexuals or use surrogate tests ( Chapter 5 ), in the Food and Drug Administration's (FDA) cautious and inadequate regulatory approach to the recall of potentially contaminated AHF concentrate ( Chapter 6 ), and in the failure of physicians and the National Hemophilia Foundation to disclose completely the risks of using AHF concentrate and the alternatives to its use ( Chapter 7 ).

Blood safety is a shared responsibility of many diverse organizations. They include U.S. Public Health Service agencies such as the CDC, the FDA, and the National Institutes of Health (NIH), and private-sector organizations such as community blood banks and the American Red Cross, blood and plasma collection agencies, blood product manufacturers, groups such as the National Hemophilia Foundation (NHF), and others. The problems the Committee found were inadequate leadership and inadequate institutional decisionmaking processes in 1983 and 1984. No person or agency was able to coordinate all of the organizations sharing the public health responsibility for achieving a safe blood supply.

Decisionmaking Under Uncertainty

The management of a public health risk requires an evolving process of decisionmaking under uncertainty. It includes interpretive judgment in the presence of scientific uncertainty and disagreement about values. Public health officials must characterize and estimate the magnitude of the risk, which involves considering both the likelihood that infection might occur in various circumstances, and the costs and benefits associated with each of the possible uncertain outcomes. They must also develop and test public health and clinical care strategies, and communicate with the public about the risk and strategies for reducing it. When confronted with a poorly understood and anomalous public health threat, inertia often influences decisions. It is often easier to maintain the status quo than to make a change. In fact, regulatory policymakers, health scientists, and medical experts often require substantial scientific evidence before informing the public and adopting remedial action. Lack of scientific consensus becomes a kind of amplifier for the usual discord and conflict that can be expected whenever an important science-based public policy decision—one profoundly affecting lives and economic interests—must be made. First, uncertainty creates opportunities for advocates of self-interested and ideological viewpoints to advance plausible arguments that favor their desired outcome. Second, uncertainty intensifies bureaucrat cautiousness.

In the course of its investigations, the Committee learned several lessons about decisionmaking under uncertainty. These are set out here both as general lessons and to provide a framework for the recommendations that follow.

Risk Perception

Risk perception is shaped by social tensions, and cultural, political, and economic biases (Douglas 1985). It is important to understand the different contexts in which risk is perceived and the complex system of beliefs, values, and ideals that shape risk perception (Nelkin 1989). There are several other factors that influence risk perception, including locus of control, the type of risk posed by the threat, and the time interval involved in evaluating the risk. For example, people tend to underestimate risks that they perceive to be under their control, risks associated with a familiar situation, and low probability events (Douglas 1985). People have difficulty accepting estimates of a risk that is involuntary, uncertain, unfamiliar, and potentially catastrophic (Fischoff 1987). The epidemic caused by HIV in the blood supply illustrates these patterns of perception and behavior with respect to risk.

Risk Assessment Versus Risk Management

A central precept of risk management is to separate the assessment of risk from the management of its consequences (NRC 1983). Otherwise, risk managers tend to bias their estimates of the magnitude of the risk in favor of their preconceived notions about appropriate or desirable policy choices. The events that the Committee studied provide examples of what can happen when this precept is not followed. When there is uncertainty, it may be necessary to assess risk by making subjective estimates rather than by obtaining objective measures. Such was the case in 1983 when, as part of implicit risk-benefit calculations about donor screening and deferral, blood banks and blood product manufacturers had to make judgments about the risk that their products could transmit AIDS (see Chapter 5 ). Anticipating the consequences of taking action, which is in the domain of risk management, may bias risk estimates toward values that support risk-averse action. When blood bank officials estimated the risk of transmitting AIDS as ''one per million" transfusions, they chose a rate that was low enough to justify their reluctance to take further action. Despite mounting evidence that the risk was much higher, they maintained their original estimate throughout 1983. If the CDC had made numeric estimates of the risk, and the blood banks, blood product manufacturers, or the FDA had used these estimates in a formal analysis of the decision problem, they might have reached different conclusions about, for example, surrogate testing for AIDS.

Consider the Full Range of Possibilities

When there is uncertainty about the facts that will determine the consequences of a decision, a systematic approach is usually best (NRC 1994). One important principle is to consider the full range of assumptions and alternative actions, not only worst-case scenarios. In the events studied by the Committee, systematic denial of worst-case scenarios was a recurring theme, as can be seen in the way that the NHF and the FDA discussed the CDC's warnings in 1982 and early 1983. The plasma fractionators introduced a worst case scenario of their own at the July 1983 Blood Products Advisory Committee (BPAC) meeting, when they estimated that three or four suspect donors and an automatic recall policy could lead to recall of all of the nation's supply of AHF concentrate ( Chapter 6 ). A closely related principle is to scrutinize the evidence to ascertain what is based on fact, what is a "best-guess" estimate, and what is simply untested conventional wisdom.

One approach to such an analysis would be to use a formal group process to systematically sample expert opinion on relevant factors such as the probability of infection and the economic and noneconomic costs and benefits of each of the possible outcomes. Often these officials should use decision analysis, which takes into account the likelihood of events and the magnitude of their outcomes, as a tool to compare the expected value of the outcome of the policy alternatives under consideration. Two somewhat analogous models to consider include those used in Institute of Medicine studies to establish priorities for the development of new vaccines (IOM 1985) and to evaluate the artificial heart program of the National Heart, Lung, and Blood Institute (IOM 1991). The book Acceptable Risk (Fischoff, et al. 1981) also offers sensible approaches to dealing with this kind of situation.

Risk Reduction Versus Zero Risk

Decisionmakers tend to seek zero-risk solutions even when they are unattainable or unrealistically costly (NRC 1994). In doing so, they may run the risk of failing to implement solutions that are less effective but are certain to reduce illness. The failure to adopt risk-reduction strategies can be seen in the resistance of blood banks to screening for homosexual activity or using surrogate tests for AIDS ( Chapter 5 ) and in FDA's limited approach to product recall decisions ( Chapter 6 ). Chapter 7 also points out that many risk-reduction strategies for individuals with hemophilia were available but not fully disclosed or recommended. The perfect should not be the enemy of the good.

Risk Communication

Risk communication is a sensitive area because of its influence on the perceptions and behaviors of health professionals and consumers, regulatory policies, and public decisionmaking (Nelkin 1989). Many public health officials and physicians wish to appear in command and infallible. When uncertain, they remain silent rather than disclose their ambivalence (NRC 1989). In the Committee's view, however, the greater the uncertainty, the greater the need for communication. The Committee's analysis of physician–patient communications at the beginning of the AIDS era illustrates the tragedies that can accompany silence about risks ( Chapter 7 ). Risk-communication skills are equally important when presenting information to the general public. The blood banks' reluctance to acknowledge the risk of transfusion-associated AIDS ( Chapter 5 ) seems to have been due in part to the difficulties that they foresaw in presenting this information to potential donors and recipients.

Other important principles of risk communication are that the source of the information must be credible, the process should be open and two-way, and the message should be balanced and accurate (NRC 1989). When there was no other sources of information for physicians treating people with hemophilia and for their patients, the NHF and its Medical and Scientific Advisory Council (MASAC) took on an important risk-communication role—providing what would now be called "clinical practice guidelines." The NHF's credibility in this area was eventually seriously compromised by its financial connections to the plasma fractionation industry.

Bureaucratic Management of Potential Crises

Federal agencies had the primary responsibility for dealing with the national emergency posed by the AIDS epidemic. The Committee scrutinized bureaucratic function closely, and came to the following conclusions about the management of potential crises.

Coordination and Leadership

A crisis calls for extraordinary leadership. Legal and competitive concerns may inhibit effective action by agencies of the federal government. Similarly, when policymaking occurs against a backdrop of a great deal of scientific uncertainty, bureaucratic standard operating procedures designed for routine circumstances seem to take over unless there is a clear-cut decisionmaking hierarchy. An effective leader will insist upon coordinated planning and execution. Focusing efforts and responsibilities, setting timetables and agendas, and assuming accountability for expeditious action cannot be left to ordinary standard operating procedures. These actions are the responsibilities of the highest levels of the public health establishment.

The Public Health Service failed to bring these leadership functions to bear when CDC scientists raised concerns about the blood supply at the January 4, 1983 meeting but received no public support from the director of the CDC or the office of the Assistant Secretary for Health. Similarly, the record does not indicate that the highest levels of the FDA or the PHS were involved in responding to advice from the BPAC regarding donor deferral or product recall. Part of this leadership problem may stem from major changes in the PHS leadership that took place during this period: the leadership of the FDA, the CDC, and the NIH, and the person serving as the Assistant Secretary for Health all changed between 1982 and 1984.

Advisory Mechanisms

In the early 1980s, the FDA and other agencies did not have a systematic approach to conducting advisory committee proceedings. Such an approach requires that agencies tell their advisory committees what is expected of them, keep attention focused on high-priority topics, and independently evaluate the advice offered. No regulatory process should have its information base effectively controlled by an advisory panel. Public agencies must be able to generate and analyze the information that they need to assure that decisions serve the needs of the public. The FDA failed to observe this principle when it allowed statements and recommendations of the BPAC to go unchallenged, apparently because it could not independently analyze the information ( Chapter 6 ).

Because mistakes will always be made and opportunities sometimes missed, regulatory structures must be organized and managed to assure both the reality and the continuous appearance of propriety. The prominence of representatives from blood banks and blood product manufacturers on the BPAC, with no balancing influence from consumers and no process within the FDA to evaluate its recommendations ( Chapter 6 ), is a failure of advisory committee management. Perhaps advisory committees should contain fewer topical experts and more members with expertise in principles of good decisionmaking and the evaluation of evidence. A committee so constituted might run a reduced risk of standing accused of having conflicts of interest.

Analytic Capability and Long-Range Vision

Leadership passes to the organization that has access to information and the ability to analyze it. Federal agencies should avoid exclusive reliance upon the entities which they regulate for analysis of data and modeling of decision problems. The FDA should have had some independent capacity to analyze the information presented at the July 1983 BPAC meeting that suggested that with only three or four suspect donors, an automatic recall policy would completely deplete the nation's supply of AHF concentrate ( Chapter 6 ). In addition, there did not seem to be any focus within the Public Health Service prepared to, or charged to, analyze the options, costs, and benefits of the options for protecting the blood supply that were discussed at the January 4, 1983, meeting convened by CDC.

In addition, agencies need to monitor more systematically the long-term outcomes of blood transfusion and blood product infusion and to think far ahead to anticipate both new technologies and new threats to the safety of the blood supply. Because new pathogens can enter the blood supply and be propagated very rapidly through it, a low level of suspicion about a threat should trigger high-level consideration of how to manage and monitor the problem.

Through its fact-finding interviews and through written documents, the Committee found little evidence that the PHS agency heads and the Assistant Secretary for Health were involved in making decisions about protecting the blood supply in 1983 and 1984 when HIV was becoming increasing apparent as a threat. Most decisions and interagency communication seems to have occurred several levels below the top.

Presumptive Regulatory and Public Health Triggers

The Committee believes that the Public Health Service should prepare for future threats to the blood supply by specifying in advance the types of actions that should occur once the level of concern passes a threshold. In the face of scientific uncertainty, the PHS needs a series of criteria or triggers for taking regulatory or other public health actions to protect the safety of blood and blood products. The Committee favors a series of triggers in which the response is proportional to the magnitude of the risk and the quality of the information on which the risk estimate is based. Not all triggers should lead to drastic or irrevocable actions; some merely require careful consideration of the options or developing new information. This general principle is detailed by examples in each of the Committee's four areas of inquiry. Table 8.1 summarizes these triggers and corresponding actions.

Triggers for Taking Actions in Response to Uncertain.

Product Treatment

Whenever they propose new methods of protecting the safety of the blood supply, blood regulatory agencies must perform cost-utility or cost-benefit analyses to evaluate whether the intervention will advance the public health at reasonable costs. If manufacturers do not have market incentives, resources, or access to data to test promising methods, public agencies should create incentives or provide resources or access to data. In this case, the trigger is a new proposal to increase safety, and the action is for the public sector to assume responsibility for thorough analysis and development, or to create incentives for industry to do so.

When performing a cost-effectiveness analysis of new treatments for blood products, the potential to protect against other threats should always be a part of the analysis. Here, the trigger is the initiation of a cost-effectiveness analysis, and the action is to ensure that the analysis takes into account secondary benefits.

Donor Screening

Whenever epidemiologists identify a high-risk donor group, the FDA should immediately tell blood banks to create a way to defer that group and tell collection agencies to segregate and separately treat supplies obtained from those populations. Concerns about stigmatizing subpopulations and maintaining the supply of blood products should influence the means of taking actions, not whether to take action. In this case, the trigger to action is the identification of a high-risk population, and the action is deferral and segregation of lots.

Whenever any segment of the industry institutes a donor screening program, the FDA should require all segments of the industry to follow suit with actions that they believe will be at least as effective in promoting safety. Public regulators have a responsibility to monitor these efforts and to forge consensus or to impose the most effective methods as information concerning efficacy becomes available. Here, the trigger is one company's action to take an additional safety measure, and the response is for all companies to follow suit, or to be held accountable when they do not.

Blood banks should use a partially effective intervention that has little or no risk unless they can show that a better method will rapidly supersede it. In this case the trigger is the availability of an inherently risk-free, partially effective intervention, and the response to use that test/intervention unless it is certain to become redundant prior to realizing its full benefits.

When a test or treatment makes a product safer, manufacturers should withdraw all stocks of untested or untreated product as quickly as possible. Where immediate complete withdrawal might injure the public health, withdrawals should be partial or staged. Here, the trigger is the implementation of a new test or treatment process, and the action is to recall untested or untreated products as expeditiously as possible, given other considerations of public health.

A limited, staged, or selective recall places responsibility on public regulatory agencies to establish criteria for selecting lots for recall, to provide processes to permit effective implementation of the recall by industry, and to monitor the recall to assure that removal of the products occurs in the prescribed manner. In this case the trigger is the initiation of a recall action, and the response is to provide clear guidance and monitoring.

Communication to Patients and Providers

Whenever new information triggers inquiry into a possible threat to the blood supply, both patients and their physicians should have access to the information. Public officials should presume that candid statements and rigorous actions will enhance rather than erode public confidence and that persons using blood or blood products have the right to understand fully the risks and benefits of using these products. In this case, the trigger is new information relevant to the public health, and the action is to tell affected individuals what they need to make an informed choice: the facts, the gaps in knowledge, and the implications thereof.

• Recommendations

The Committee's charge was to learn from the events of the early 1980s the lessons that would help the nation prepare for future threats to the blood supply. The Committee identified potential problems with the system in place at that time (as summarized earlier in this chapter) and proposes changes that, if implemented in the early 1980s, might have moderated some of the effects of the AIDS epidemic on recipients of blood and blood products. This analysis has led the Committee to the following recommendations for Public Health Service agencies, for the blood and plasma fractionation industry, and for health care providers and the public. These recommendations address both public health options and individual clinical options.

The Committee is mindful of several caveats. First, the Committee is acutely aware of the difficulties of retrospective analysis, as described in Chapter 1 . Second, the Committee has not considered its recommendations from perspectives other than blood safety. Finally, the Committee tried to identify opportunities for institutional change that would respond to the problems that the Committee diagnosed. The Committee based its recommendations on the institutions as they functioned in the early 1980s, not as they exist now. The organizations responsible for blood safety and public health will have to evaluate their current policies and procedures to see if they fully address the issues raised by our recommendations.

The Public Health Service

Several federal agencies necessarily play important, often different roles in managing a public health crisis such as the contamination of blood and blood products by the AIDS virus. The National Blood Policy of 1973 charged the Public Health Service (including the CDC, the FDA, and the NIH) with responsibility for protecting the nation's blood supply.

The Committee has come to believe that a failure of leadership contributed to delay in taking effective action, at least during the period from 1982 to 1984. This failure led to incomplete donor screening policies, weak regulatory actions, and insufficient communication to patients about the risks of AIDS.

In the event of a threat to the blood supply, the PHS must, as in any public health crisis, insist upon coordinated action. The Secretary of Health and Human Services is responsible for all the agencies of the Public Health Service, 1 and therefore the Committee makes

Recommendation 1: The Secretary of Health and Human Services should designate a Blood Safety Director, at the level of a deputy assistant secretary or higher, to be responsible for the federal government's efforts to maintain the safety of the nation's blood supply.

Choosing a "lead person" is important because it is in the nature of federal agencies and their leaders to be at once competitive and protective. This condition is healthy in reasonable measure and in normal times. However, a serious threat to public health requires that agencies communicate, cooperate, and learn to view the world through each other's lenses. Once there is an action plan, the Secretary of Health and Human Services must hold the agency leaders accountable for enforcing cooperation in implementing the plan.

To be effective in coordinating the various agencies of the PHS, the Blood Safety Director should be at the level of a deputy assistant secretary or higher, and should not be a representative of any single PHS agency. When a threat does arise, the Blood Safety Director should create a crisis management team.

One such action was to establish, in July 1982, the Committee on Opportunistic Infections in Hemophiliacs (see Chapter 3 ). This group seems to have been organized by the CDC, but there is no record of its operations after August of that year.

Blood Safety Council

The AIDS crisis revealed that the institutions in place to ensure blood safety, both public and private, were unable to work cooperatively toward a common goal of a safe blood supply. The institutions were not accountable to anyone but themselves, and they failed to cooperate, to coordinate their activities, and to communicate effectively with physicians and the public. The Committee has become convinced that the nation needs a far more responsive and integrated process to detect, evaluate, and respond to emerging threats to the blood supply. To this end the Committee makes

Recommendation 2: The PHS should establish a Blood Safety Council to assess current and potential future threats to the blood supply, to propose strategies for overcoming these threats, to evaluate the response of the PHS to these proposals, and to monitor the implementation of these strategies. The Council should report to the Blood Safety Director (see Recommendation 1). The Council should also serve to alert scientists about the needs and opportunities for research to maximize the safety of blood and blood products. The Blood Safety Council should take the lead to ensure the education of public health officials, clinicians, and the public about the nature of threats to our nation's blood supply and the public health strategies for dealing with these threats.

Supplying safe blood and blood products to the nation—a public good—requires the cooperation of public and private institutions. The Blood Safety Council would give voice to the public's interest in having these institutions cooperate and would provide opportunities for them to do so.

The lessons of HIV transmission through blood and blood products show the need for an advisory council with a significantly greater level of diversity, responsibility, and authority than the current Blood Products Advisory Committee of the FDA. The BPAC is limited by the regulatory mission of the FDA which it advises, and there is no other body primarily concerned with blood safety as a whole. Representatives from governmental agencies, academia, the blood bank community, industry, and the public all have relevant expertise and perspectives and should be involved in the Blood Safety Council. A broad-based range of expertise in areas of hematology, infectious diseases, epidemiology, blood product manufacturing, blood collection and delivery, risk assessment, consumer advocacy, and cost-benefit analysis is essential.

The proposed Blood Safety Council would facilitate the timely transmission of information, assessment of risk, and initiation of appropriate action both during times of stability and during a crisis. The Council should report to the Blood Safety Director (see Recommendation 1). The Council would not replace the PHS agencies responsible for blood safety but would complement them by providing a forum for them to work together and with private organizations. The PHS agencies would be represented on the Council (see below and Figure 8.1 ). The Council would not have its own surveillance capability, but would work with CDC and FDA to interpret the information that those organizations can provide. It would not carry out or fund research itself, but would work with those at NIH and in the private sector to identify priorities for blood safety research. The Council would not have regulatory power, but would inform FDA actions from a blood safety rather than a product-specific perspective.

Figure 8.1.

Blood Safety Council relationships.

The organizations and groups that should be included in the Blood Safety Council, and the reasons for including them, are as follows:

• The FDA can provide a direct link between itself, the essential regulatory agency responsible for the safety of blood and blood products, and important sources of information, scientific support, and disease surveillance findings.
• The CDC can provide expertise in epidemiology, infectious diseases, and immunology as well as communicate the results of ongoing disease surveillance studies. The CDC's newly established emerging infectious disease program would also provide valuable information.
• The NIH can provide scientific expertise and the means to communicate information about essential research needs to the appropriate institutes for support of research.
• Representatives from academia can bring independent scientific and medical expertise, especially in hematology, infectious diseases, epidemiology, risk assessment, and cost-effectiveness analysis.
• Representatives from the volunteer blood collection community can bring experience with blood safety concerns and the knowledge of blood bank operations that is necessary to evaluate proposed change.
• Representatives from the private-sector blood product manufacturers and biotechnology companies can bring both experience with blood safety concerns and knowledge of plasma fractionation operations.
• Representatives of the general public (who may in the future require blood transfusions) and individuals who currently require frequent use of blood products, such as hemophilia patients, bring important perspectives on the trade-offs that must be considered in evaluating response options.

The Blood Safety Council should consider the following activities and issues:

Surveillance. Although the FDA and the CDC keep track of events in blood and blood product recipients, their surveillance systems are passive and incomplete. The Blood Safety Council should work with the CDC to design a system of active surveillance for adverse reactions in blood recipients, as described in Recommendation 5 below. If such a system is established, the Council would benefit from its results and should participate in its governance.

Expert Panel on Best Practices . Drawing on its members' knowledge about blood and blood product safety concerns, and about clinical alternatives, the Blood Safety Council could establish a panel of experts to provide the public and providers of care with information about risks and benefits, alternatives to using blood products, and recommended best practices, as described in more detail in Recommendation 13 below.

Investigate Methods to Make Blood Products Safer. The Council should evaluate new methods to make blood and blood products safer. One promising approach is double inactivation in the preparation of blood products, which minimizes the risk of transmission of infectious pathogens in the blood of the donor pool. At present, the FDA requires only a single inactivation process (usually solvent detergent or heat treatment) for most blood products manufactured in the United States. With the goal of maximizing the safety of the blood supply at minimal added cost, the Blood Safety Council should encourage the FDA to evaluate double inactivation methods and expeditiously relicense products manufactured by the improved technologies, if appropriate. The Blood Safety Council should also consider, at least yearly, in a public forum, opportunities to maximize the safety of the blood supply.

Another promising approach is to reconsider minimum pool size requirements in plasma product manufacturing. The FDA currently requires a large number of donors to be included in plasma pools used in the manufacture of plasma products in order to ensure a wide range of antibodies in preparations of intravenous gamma globulin. Pooling of plasma obtained from numerous donors, although permitting some economy of scale, also increases the risk that a large fraction of manufactured blood products will be contaminated by a single infected donor. The Blood Safety Council should consider this issue and address the safety and efficiency trade-offs in changing the minimum pool size.

The Blood Safety Council would provide information relevant to the decisions that individuals as well as public and private decisionmakers need to make. The forum would not have direct regulatory or other authority, but would function as a forum for holding the organizations with authority responsible for blood safety. In short, the Blood Safety Council could advocate the public's need for a responsible process for decisionmaking about public health policy. The following examples illustrate how regular public discussions of blood safety issues, in the presence of representatives from the relevant organizations' perspectives, could provide an opportunity to hold the organizations with authority accountable for blood safety.

If it had existed in the 1970s, for instance, the Blood Safety Council might have called for the development of heat-treated AHF concentrate to reduce the risk of hepatitis, which would have also reduced the risk of HIV transmission. It would have been able to do so if the NIH and blood products industry representatives on the Council had been called upon to make periodic reports to the Council during the 1970s about their efforts to deal with the hepatitis problem. These representatives would have fed the discussions of the Council back into their own organizations' decisionmaking.

In 1983, the Council could have provided a forum for CDC to present its concerns about HIV in the blood supply and held the FDA, the NHF, and the blood banks and fractionators accountable for responding constructively. CDC created a forum on its own by convening the January 4, 1983, meeting in Atlanta, but as the Committee's analysis indicates, the follow-up on this meeting was insufficient. If a standing Blood Safety Council had existed, the CDC scientists who had concerns about the safety of blood and blood products would have had an opportunity to hold blood collection organizations accountable for their decisions regarding donor deferral and surrogate testing. It would also provide an opportunity to hold plasma fractionators and the FDA accountable for its decisions with regard to heat-treated AHF.

Later that year, the Council could have provided a mechanism to evaluate the claims that automatic recall of AHF would have virtually eliminated the supply of AHF. As the analysis in Chapter 6 indicates, neither the BPAC nor the FDA staff had the capacity to analyze claims that a automatic recall would have such an effect. The Blood Safety Council could have insisted that the FDA commission a formal decision analysis of the options for surrogate testing, or the Council might have performed such an analysis itself. The FDA would retain its regulatory authority, and continue to get advice from the BPAC, but the Council would have provided critical information relevant to the agency's decision.

Finally, if the Council had established an expert panel on best practices as described above and in Recommendation 13, hemophilia patients and their physicians would have had a more credible source of information about the risks of HIV infection and their clinical options than the NHF was able to provide. The operations of such a panel are described below under Recommendation 13.

Compensation Policy

When a product or service provided for the public good has inherent risks, the common law tort system fails to protect the rightful interests of patients who suffer harm resulting from the use of those products or services. Each claim requires extended, costly, and complex adjudicative procedures to establish liability. The results are erratic and unpredictable, and therefore inequitable (IOM 1985).

The doctrine of strict liability holds manufacturers accountable for injuries that are incurred from products that are inherently dangerous because diligence cannot fully eliminate their risks. The public health imperative of assuring enough vaccine for widespread use argues for limits on the strict liability doctrine for vaccine-related injuries. The chief concern is that fear of liability will discourage manufacturers from producing a vital public good. To vitate this concern, a federal compensation system has removed vaccine-related injuries from the scope of strict liability laws (Mariner 1992). The federal government established a mechanism for compensating individuals suffering harm from vaccine-related complications. Its rationale is that consent to undergo vaccination confers benefits to the entire community.

Blood-product-related injuries have also been removed from the scope of strict liability law by blood shield laws, which are in force in most states, and which protect society's interests in having an adequate blood supply. The blood shield laws serve to protect providers and manufacturers of blood and blood products from liability claims in instances where they take all due care to ensure the safety of the product. These laws, however, are unique in the manner in which they limit liability. The shield laws have made it difficult, and often impossible, to obtain compensation for HIV infection acquired from blood or blood products. To address this asymmetry between the protection that blood shield laws offer for manufacturers and adequate protection of individual rights, the Committee makes

Recommendation 3: The federal government should consider establishing a no-fault compensation system for individuals who suffer adverse consequences from the use of blood or blood products. 2

An effective no-fault system requires prospective standards and procedures to guide its operations. In a no-fault system, individual plaintiffs would not have to prove that their adverse outcome was a result of negligence related to manufacture of a blood product. Therefore, there needs to be an objective, science-based process to establish which categories of adverse outcomes are caused by blood-borne pathogens and which individual cases deserve compensation. As with vaccines, a tax or fee paid by all manufacturers or by the recipients of blood products could finance a compensation system. Rather than attempt to allocate blame for HIV infections through blood and blood products, some countries have established such no-fault compensation programs for individuals infected with HIV as a result of their use of blood and blood products. Countries fund these programs in a variety of ways, including direct government support and joint public/private resources.

Making recommendations about compensating affected individuals for damages incurred in the past is outside the Committee's mandate. However, had there been a no-fault compensation system in the early 1980s, it could have relieved much financial hardship suffered by many who became infected with HIV through blood and blood products in the United States. The no-fault principles outlined in this recommendation might serve to guide policymakers as they consider whether to implement a compensation system for those infected in the 1980s.

The Centers for Disease Control and Prevention

The CDC has an indispensable role to play in protecting our nation's health: to detect potential public health risks and sound the alert. Because of its expertise in detecting and evaluating possible infectious disease outbreaks, the Committee believes that the CDC should take responsibility for a surveillance system to detect adverse outcomes from blood and blood products. The following two recommendations embody an important principle: separating the assessment of risk from the management of the consequences of risk. The FDA, in its role as guarantor of the safety of the blood supply, has the responsibility for managing threats to the blood supply. The CDC should detect potential threats and assess the magnitude of the danger.

Early Warning Systems

A nation needs individuals and organizations that identify problems and raise concerns that may be difficult to confront. The CDC plays this role in the Public Health Service. The CDC appears to have been prescient in raising the possibility that the blood supply was contaminated early in the AIDS epidemic, but it was relatively ineffective in convincing other agencies of the potential gravity of the situation. In order to improve CDC's efficacy in this critical role, the Committee makes

Recommendation 4: Other federal agencies must understand, support, and respond to the CDC's responsibility to serve as the nation's early warning system for threats to the health of the public.

Officials in the government, scientists, and physicians in the private sector seem to have discounted the CDC warnings about the transmissibility of AIDS through blood and blood products because the swine flu episode in the 1970s had cost the agency considerable credibility. If, in 1983, the involved public and private organizations had the attitude called for in this recommendation, CDC's recommendations regarding donor screening and surrogate testing might have led to earlier, more effective screening and donor deferral policies.

Consistent with the precept of separating risk assessment and risk management as described above, CDC's role is to characterize and assess risks, and communicate this to others. The FDA and other organizations have the responsibility to manage the risks through regulation, clinical practice guidelines, and other means. The Committee believes that CDC should be able to play its designated role without fearing loss of credibility if it sometimes proves to be wrong. Implementing this recommendation may be difficult. As a start, the Secretary of Health and Human Services should insist that an agency that wishes to disregard a CDC alert should support its position with evidence that meets the same standard as that used by the CDC in raising the alert.

Surveillance

In order to carry out its early warning responsibility effectively, the CDC needs good surveillance systems. Because blood products are derived from human beings and may contain harmful biologic agents that were present in the blood of a donor, blood products are inherently risky, a principle long recognized by blood shield laws. The Committee, believing that the degree of surveillance should be proportional to the level of risk, makes

Recommendation 5: The PHS should establish a surveillance system, lodged in the CDC, that will detect, monitor, and warn of adverse effects in the recipients of blood and blood products.

If such a system had existed in 1982, data about the risks of HIV transmission through blood and blood products might have been available sooner and might have been more definitive. In dealing with newly approved pharmaceuticals, the FDA increasingly demands careful post-approval study of potential adverse effects (the so-called ''Phase IV Trial"). Two existing systems for vaccine adverse events—the CDC/FDA Vaccine Adverse Event Reporting System (VAERS) and the CDC's Large-Linked Database (LLDB)—might be useful models (Institute of Medicine 1994).

The Food and Drug Administration

The FDA has legal authority to protect the safety of the nation's blood supply. Accordingly, it is the lead federal agency in regulating blood-banking practice, the handling of source plasma, and the manufacture of blood products from plasma. The Committee found cause for concern when it evaluated the FDA's actions in protecting the public from HIV in the nation's blood supply during the 1980s. The record reveals many opportunities to improve the agency's capacity to deal with crises involving the blood supply, most notably with respect to the safety of AHF concentrate. In responding to these opportunities, the Committee's recommendations focus on decisionmaking and the role of advisory committees in formulating the FDA's response to crises.

Risk Reduction

In a crisis, decisionmakers may become so preoccupied with seeking solutions that will dramatically reduce danger that they will fail to implement solutions that are less effective but are likely to improve public safety to some degree. Partially effective risk-reducing improvements, as described herein, can save lives, pending the development of more efficacious safety measures. In order that the perfect not be the enemy of the good, the Committee makes

Recommendation 6: Where uncertainties or countervailing public health concerns preclude completely eliminating potential risks, the FDA should encourage, and where necessary require, the blood industry to implement partial solutions that have little risk of causing harm.

In the event of a future threat to the blood supply, the FDA should encourage small, low-risk solutions to large, difficult problems. The FDA's actions during the early 1980s are evidence that the agency should change its attitude toward regulation in order to adopt this proactive approach. Some examples from Chapter 6 illustrate how the FDA might have encouraged practices that would have reduced the risk faced by recipients of blood or a blood product.

Example: Destroy Unscreened Blood When Possible . When hospital blood banks first started to screen donors by questioning them for risk factors, there was a period of transition during which its stocks contained two classes of blood or plasma: blood from screened donors, which was relatively safe; and blood from unscreened donors, which had a higher probability of containing HIV. Within a few weeks of starting to screen donors, blood from unscreened donors would have been either used or discarded. In the instructions contained in its letter of March 24, 1983, the FDA could have recommended that blood banks adopt a policy of using blood from screened donors whenever possible during the transition period, a policy that some blood banks may have adopted on their own. Requiring all blood banks to adopt this policy would not have compromised the nation's blood supply, and it would have prevented at least a few instances in which a patient received an infected unit of blood.

Example: Destruction of Potentially Contaminated Cryoprecipitate. Blood banks store cryoprecipitate from a single unit of donated blood in the frozen state for up to one year. The FDA could have issued a directive that required the blood banks to check their inventory of frozen cryoprecipitate and destroy possibly contaminated units whenever they learned of a previous donor who had AIDS or was strongly suspected of having AIDS.

Example: Phased Recall. In July 1983, there was considerable reluctance to recall untreated Factor VIII concentrate at a time when much of the supply was almost certainly contaminated with HIV. The FDA apparently feared that the ensuing shortage of Factor VIII would have caused more harm than the HIV virus. A phased withdrawal would have been a compromise between no withdrawal and immediate total withdrawal. This middle path might have avoided a factor concentrate shortage and still reduced the number of hemophiliacs who became infected.

Example: Lookback. The FDA formally instituted a "lookback" policy in 1991, years after it was clear that AIDS had a long incubation period during which a patient could transmit HIV through sexual contact or contact with blood. Lookback required blood banks to contact recipients of blood from infected donors and notify them that they might be a HIV carrier and should be tested for HIV antibodies. Earlier action on lookback might have reduced secondary transmission of HIV.

Decision Processes

In all fields, decisionmaking under uncertainty requires an iterative process. As the knowledge base for a decision changes, the responsible agency should reexamine the facts and be prepared to change its decision. The agency should also assign specific responsibility for monitoring conditions and identifying opportunities for change. In order to implement these principles at the FDA, the Committee makes

Recommendation 7: The FDA should periodically review important decisions that it made when it was uncertain about the value of key decision variables.

An example illustrates the principle of iterative decisionmaking. During 1983, most blood bank officials opposed asking prospective male donors if they had ever had sex with a man. They were worried that regular donors might take offense and stop donating blood. They were also concerned about some gays would lie about their homosexuality and donate blood in reprisal for being singled out as the target of the questioning. Eventually, some blood collection centers began to ask questions about sexual preference. If the FDA had carefully monitored these experiments, it would have soon learned that the blood bank officials' fears were groundless. The FDA might then have revised its requirements for donor screening to include direct questions about high-risk sexual practices.

Regulatory Efforts

Although the FDA has a great deal of regulatory power over the blood products industry, the agency appears to regulate by expressing its will in subtle, understated directives. This informal approach to regulation is often necessary to permit a timely response and to preserve needed flexibility. The FDA used this approach, for example, in July 1983 when it issued recommendations to withdraw lots of AHF concentrate that plasma fractionators had identified as containing material from a donor that had AIDS. The language in the July 1983 communication failed to specify, however, whether the agency considered the recommendations to be binding on industry. While most regulated industries might have interpreted these letters as mandatory, that question should not have been left to the judgment of individual entities. Taking this into account, the Committee makes

Recommendation 8: Because regulators must rely heavily on the performance of the industry to accomplish blood safety goals, the FDA must articulate its requests or requirements in forms that are understandable and implementable by regulated entities. In particular, when issuing instructions to regulated entities, the FDA should specify clearly whether it is demanding specific compliance with legal requirements or is merely providing advice for careful consideration.

In 1983, the FDA chose a middle ground when faced with the decision to withdraw all AHF concentrate. The agency recommended that plasma fractionators withdraw individual lots of AHF concentrate when a donor was suspected of having AIDS. This decision was certainly defensible. However, the process for this "case-by-case" withdrawal was seriously compromised by the vagueness of the criteria specified for a recall. The agency failed to specify a process for deciding whether a donor may have had AIDS. The agency should have specified a process for reviewing donors who did not fully satisfy the diagnostic criteria for AIDS but who were suspected of having the disease. When deciding whether to withdraw a lot of AHF concentrate, the FDA asked plasma fractionators to take into account the time of the donation in relation to the diagnosis of AIDS and the effect of the recall on product availability. However, the FDA did not specify parameters for assessing either of these decision criteria. With greater forethought, the FDA could have avoided the potential for a seriously flawed implementation of a policy that otherwise appeared to balance benefits, risks, and harms.

Advisory Committees

The FDA made several decisions in 1983 that appear to have been influenced by the blood-industry-based (profit and nonprofit) members of the BPAC. The BPAC membership did not include individuals with expertise in the social, ethical, political, and economic aspects of the issues that BPAC was deliberating at the time. The FDA apparently did not seek independent analysis of the recommendations made by the members of the BPAC, some of whom were employed by the blood industry. In the early 1980s, the FDA appeared too reliant upon analyses provided by industry-based members of the BPAC and the BPAC. For example, see the discussion in Chapter 6 of the July 19, 1983, BPAC meeting which resulted in the decision for case-by-case rather than automatic recall of lots of AHF when one donor was suspected of having AIDs. Chapter 6 also contains a discussion of the December 15, 1983, BPAC meeting, which effectively curtailed actions on surrogate testing of blood for months. The Committee's analysis of the FDA's management of its advisory committee leads to the following three recommendations:

Recommendation 9: The FDA should ensure that the composition of the Blood Products Advisory Committee reflects a proper balance between members who are connected with the blood and blood products industry and members who are independent of industry.

The FDA should select some BPAC members because they can provide independent judgment, question the analyses provided by blood-industry-based BPAC members, and hold the FDA accountable for a high standard of public responsiveness. The BPAC should have at least one voting member who is a representative of consumer interests. BPAC members who vote to establish policy should have neither the appearance of a conflict of interest nor a true conflict of interest.

An agency that is practiced in orderly decisionmaking procedures will be able to respond to the much greater requirements of a crisis. The BPAC meetings cited before Recommendation 9 above provide examples to support this recommendation. Applying this principle to the use of advisory committees, the Committee makes

Recommendation 10: The FDA should tell its advisory committees what it expects from them and should independently evaluate their agendas and their performance.

The FDA staff and its advisory committees should structure their relationship so that they invigorate each other. The agency should hold an advisory committee accountable for its performance through periodic independent evaluation. By placing unresolved issues on future agendas, the committee can hold the FDA accountable for taking follow-up action between committee meetings. The IOM Committee to Study the Use of Advisory Committees by the Food and Drug Administration makes further recommendations to strengthen the FDA advisory committee system (IOM 1992).

Advisory committees provide scientific advice to the FDA; they do not make regulatory decisions for the agency (IOM 1992). As Chapter 6 indicates, the FDA in 1983 did not independently verify the estimates of the risk of blood-product-related HIV infection. The FDA did not analyze the public health implications of the BPAC's recommendation against automatic recall of AHF concentrate that contained plasma from donors suspected of having AIDS. The FDA's lack of independent information and its own analytic capacity meant that it had little choice but to incorporate the advice of the BPAC into its policy recommendations. To ensure the proper degree of independence between the FDA and the blood products industry, the Committee makes

Recommendation 11: The FDA should develop reliable sources of the information that it needs to make decisions about the blood supply. The FDA should have its own capacity to analyze this information and to predict the effects of regulatory decisions.

Communication to Physicians and Patients

One of the crucial elements of the system for collecting blood and distributing blood products to patients is the means by which to convey concern about the risks inherent in blood products. In today's practice of medicine, in contrast to that of the early 1980s, patients and physicians each accept a share of responsibility for making decisions. Patients' informed consent is required for risky procedures. From early 1983, it was clear that AHF concentrate was a risky product. The failure to tell hemophilia recipients of Factor VIII concentrate about the risks of this treatment and about alternative treatments seems especially serious in the light of present-day emphasis on the autonomy of patients in decisions involving their health.

Clinical Practice

One powerful lesson of the AIDS crisis is the importance of telling patients about the potential harms of the treatments that they are about to receive. The NHF dedicated itself to providing information to individuals with hemophilia and their physicians. Their strategy, however, was seriously flawed. As discussed in Chapter 7 , the NHF provided treatment advice, not the information on risks and alternatives that would enable physicians and patients to decide for themselves on a course of treatment. Hemophilia patients did not have the basis for informed choice about a difficult treatment decision.

Considerable scientific and medical uncertainties characterized the early years of the AIDS epidemic. For individuals medically dependent on the use of blood and blood products, these uncertainties created complex dilemmas about clinical options for their continued care. In instances of great uncertainty, it is crucial for patients to be fully apprised of the full range of options available to them and to become active participants in the evaluation of the relative risks and benefits of alternative treatments. As the case studies in Chapter 7 indicate, the failure to communicate adequately about these options prevented many hemophiliacs from making choices in which they accepted responsibility for balancing the risk of AIDS and the risks of bleeding. Ultimately the failure to communicate led to a powerful sense of betrayal that exacerbated the tragedy of the epidemic for many patients and their families. To encourage better communication, the Committee makes

Recommendation 12: When faced with a decision in which the options all carry risk, especially if the amount of risk is uncertain, physicians and patients should take extra care to discuss a wide range of options.

Medicine has many "gray areas" in which the correct course of action is not clear. Guidelines should identify these areas and spotlight the importance of full disclosure of risks, discussion of the broadest range of clinical options, and incorporation of the patient's preferences into an individualized recommendation. Given the inherent risks and uncertainties in all blood products, the public and the providers of care need expert, unbiased information about the blood supply. This information includes risks and benefits, alternatives to using blood products, and recommended best practices. As Chapter 7 indicates, the NHF (the only organization that stepped in to provide information to hemophiliacs and the physicians who were treating them) focused on practice recommendations rather than complete information on risks and options. In order to provide the public and providers of care with the information they need, the Committee makes

Recommendation 13: An expert panel should be created to inform the providers of care and the public about the risks associated with blood and blood products, about alternatives to using them, and about treatments that have the support of the scientific record.

One lesson of the AIDS crisis is that a well-established, orderly decisionmaking process is important for successfully managing a crisis. This applies as much to clinical decisionmaking as to the public health decision process addressed by the earlier recommendations. As the narrative indicates, there are both public health and clinical approaches to reducing the risk of blood-borne diseases. The Blood Safety Council called for in Recommendation 2 would deal primarily with risk assessment and in the public health domain, actions that would reduce the chance that blood products could be vectors of infectious agents. The primary responsibility of the expert panel on best practices called for in Recommendation 13 would be to provide the clinical information that physicians and their patients need to guide their individual health care choices. To be most effective, this panel should be lodged in the Blood Safety Council (see Recommendation 2) so that both bodies can interact and coordinate their activities in order to share information about emerging risks and clinical options.

Any organization that supplies this information must adhere to accepted norms for documenting evidence. The Committee believes that the public's interest would be best served by creating one publicly accountable source of this information. This function would build on the experience of the Agency for Health Care Policy and Research, which has an established guideline development process and issues guidelines on topics such as the management of chronic pain, screening for AIDS, and management of urinary incontinence (El-Sadr, et al. 1994; Jacox, et al. 1994).

Experience in developing practice guidelines for hemophilia treatment and blood transfusion is an important element of preparedness for future threats to the blood supply. There are now well-established processes such as those recommended by the IOM Committee to Advise the Public Health Service on Practice Guidelines (IOM 1990, 1992) and used by the Agency for Health Care Policy and Research. The U.S. Preventive Services Task Force (1989) uses another system process. Guideline developers should perform a thorough literature search, identify well-designed studies, describe fully the evidence on harms and benefits, and explain the connection between the evidence and the recommendations. They should seek critical evaluation from a wide spectrum of individuals and organizations and should periodically reexamine the recommendations in the light of changing knowledge.

Credibility

During the early 1980s, in its role as the guardian of the interests of the hemophilia patient community, the NHF was the principal source of information about using blood products. The outcome of the NHF efforts was that individuals with hemophilia and their families lost faith in the NHF as the rightful steward of their interests. The reasons discussed in Chapter 7 include the NHF's unwavering recommendation to use AHF concentrate, its dependence on funds contributed by the plasma fractionation industry, and the composition of the NHF expert panel (MASAC) that formulated treatment recommendations (e.g., the panel's lack of infectious disease experts and decision analysts).

Toward the end of providing the highest-quality, most credible information to patients and providers, the Committee makes

Recommendation 14: Voluntary organizations that make recommendations about using commercial products must avoid conflicts of interest, maintain independent judgment, and otherwise act so as to earn the confidence of the public and patients.

One of the difficulties with using experts to give advice is the interconnections that experts accumulate during their careers. Organizations that regulate an industry may get advice from the same experts who advise the industries. Organizations that give treatment advice may rely on experts whose employer relies upon support from industry. As a result, an expert may have a history of relationships that raise concerns about whether he or she can be truly impartial when advising a course of action in a complex situation. The Committee believes that the best way to avoid these risks is to choose some panelists who are not expert in the subject of the panel's assignment but have a reputation for expertise in evaluating evidence, sound clinical judgment, and impartiality.

Financial conflicts of interest influence organizations as well as individuals. As indicated in Chapter 7 and above, the financial relationships between the NHF and the blood products industry seriously compromised the NHF's credibility. The standards for acknowledging conflicts of interest are higher than they were 12 years ago. Public health officials and the medical professions must uphold this new standard. Failure to do so will threaten the fabric of trust that holds our society together.

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• Published: 02 September 2024

The impact of COVID-19 restrictions on HIV prevention and treatment services for key populations in South Africa: an interrupted time series analysis

• Danwei Yao 1 ,
• Naomi Hill 2 ,
• Ben Brown 3 ,
• Dorian Gule 4 ,
• Matshidiso Chabane 5 ,
• Mfezi Mcingana 6 ,
• Kalai Willis 1 ,
• Vusi Shiba 2 ,
• Oluwasolape Olawore 1 ,
• Dawie Nel 4 ,
• Jacqueline Pienaar 5 ,
• Johanna Theunissen 8 ,
• Katherine Rucinski 1 , 9 ,
• Katie Reichert 8 ,
• Lauren Parmley 7 ,
• J. Joseph Lawrence 7 ,
• Stefan Baral 1 &
• Amrita Rao 1  

BMC Public Health volume  24 , Article number:  2386 ( 2024 ) Cite this article

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Key populations (KP), including men who have sex with men (MSM), female sex workers (FSW), and transgender women (TGW), experience a disproportionate burden of HIV, even in generalized epidemics like South Africa. Given this disproportionate burden and unique barriers to accessing health services, sustained provision of care is particularly relevant. It is unclear how the COVID-19 pandemic and its associated restrictions may have impacted this delivery. In this study, we aimed to describe patterns of engagement in HIV prevention and treatment services among KP in South Africa and assess the impact of different COVID-19 restriction levels on service delivery.

We leveraged programmatic data collected by the US President’s Emergency Plan for AIDS Relief (PEPFAR)-supported KP partners in South Africa. We divided data into three discrete time periods based on national COVID-19 restriction periods: (i) Pre-restriction period, (ii) High-level restriction period, and (iii) After-high level restriction period. Primary outcomes included monthly total HIV tests, new HIV cases identified, new initiations of pre-exposure prophylaxis (PrEP), and new enrollments in antiretroviral therapy (ART). We conducted interrupted time series segmented regression analyses to estimate the impact of COVID-19 restrictions on HIV prevention and treatment service utilization.

Between January 2018 and June 2022, there were a total of 231,086 HIV tests, 27,051 HIV positive cases, 27,656 pre-exposure prophylaxis (PrEP) initiations, and 15,949 antiretroviral therapy initiations among MSM, FSW and TGW in PEPFAR-supported KP programs in South Africa. We recorded 90,457 total HIV tests during the ‘pre-restriction’ period, with 13,593 confirmed new HIV diagnoses; 26,134 total HIV tests with 2,771 new diagnoses during the ‘high-level restriction’ period; and 114,495 HIV tests with 10,687 new diagnoses during the after high-level restriction period. Our Poisson regression model estimates indicate an immediate and significant decrease in service engagement at the onset of COVID-19 restrictions, including declines in HIV testing, treatment, and PrEP use, which persisted. As programs adjusted to the new restrictions, there was a gradual rebound in service engagement, particularly among MSM and FSW. Towards the end of the high-level restriction period, with some aspects of daily life returning to normal but others still restricted, there was more variability. Some indicators continued to improve, while others stagnated or decreased.

Service provision rebounded from the initial shock created by pandemic-related restrictions, and HIV services were largely maintained for KP in South Africa. These results suggest that HIV service delivery among programs designed for KP was able to be flexible and resilient to the evolving restrictions. The results of this study can inform plans for future pandemics and large-scale disruptions to the delivery of HIV services.

Peer Review reports

Introduction

Coronavirus disease 2019 (COVID-19) has been one of the most significant public health challenges of the modern era, and as of 2023, the number of those infected with SARS-CoV-2 continues to rise globally [ 1 ]. COVID-19 has resulted in significant morbidity and mortality and, in many instances, disrupted the normal functioning of critical health systems [ 2 ]. To stem the spread of infection, many countries implemented policies and mitigation strategies that have altered the functioning of daily life, including but not limited to travel restrictions, school and business closures, and physical distancing [ 3 ]. The depth and breadth of these approaches have varied across countries, with varying degrees of success in reducing COVID-19 transmission at a population level [ 4 ].

In South Africa, a full national lockdown was announced in late March 2020, 23 days after the first confirmed case of COVID-19 was detected in the country [ 5 ]. This full national lockdown meant that gatherings were prohibited, and restaurants and schools were closed. “Non-essential” individuals were only allowed to leave their homes to access health and social services and pick up essential goods. While healthcare workers and pharmacy and laboratory personnel were exempt from these restrictions to provide services, most of daily life changed as a result and altered the context that health services needed to function within [ 6 , 7 ]. As an example, healthcare workers were reliant on employer issue of specific healthcare worker permits to be exempt from restrictions. Despite specific permits, police and other official authorities still restricted and limited movement of healthcare workers in certain instances, limiting capacity to provide services. The South African government defined five different COVID-19 alert levels to determine restrictions. Over the following two years, implementation of restrictions continued to vary with changing transmission levels [ 6 , 7 ].

Amidst the public health challenges created by COVID-19, South Africa also faces an ongoing HIV crisis. In South Africa, close to 1 in 5 adults are living with HIV, and more than 231,000 individuals are newly infected each year [ 8 ], necessitating the delivery of treatment to more than 7.5 million people living with HIV and prevention services to millions more [ 9 ]. HIV remains the leading cause of death in the country despite biomedical advances that have led to earlier diagnoses and lifelong effective clinical management through treatment [ 10 ].

Even with the incredibly high HIV risk among the general population in South Africa, key populations including men who have sex with men (MSM), female sex workers (FSW), and transgender women experience a disproportionate burden of HIV. HIV incidence is up to 25 times higher among MSM and up to 26 times higher among FSW compared to other adults of reproductive age [ 11 ]. Key populations face myriad individual, social, and structural factors that put them at increased risk of HIV acquisition [ 12 ]. The same stigma, discrimination, and criminalization that puts these groups at heightened risk can challenge access to HIV services [ 12 ].

Barriers to accessing HIV services in public health clinics among key populations have historically included a range of factors, including but not limited to misalignment of clinic hours or location of services with need, risk or fear of arrest due to criminalization of sex work, fear of disclosure of HIV or population membership, and violence from partners, community members, and others [ 13 ]. HIV service delivery in South Africa for key populations through the United States President’s Emergency Plan for AIDS Relief (PEPFAR)-funded programs has long attempted to address these barriers by including tailored delivery strategies to optimize quality, satisfaction, and efficiency of care. During the COVID-19 pandemic, implementing partners carefully monitored performance data to track service delivery interruptions and respond accordingly. Quantitative, analytic research approaches can help to substantiate what was being observed by those providing services and assess to what extent COVID-19 associated restrictions may have directly impacted delivery, specifically to populations with the greatest need [ 14 ].

The impact of COVID-19 on HIV services has been examined in multiple settings, including in South Africa, though less is known about the specific impact of the pandemic on HIV prevention and treatment service engagement among key populations [ 15 ]. While we now, in many settings, have access to effective vaccines to prevent infection with SARS-CoV-2 and mitigate the severity of the disease, there is a need to understand how well HIV services were sustained as part of PEPFAR-funded services for key populations to inform future emerging infectious disease or other public health crises. In this analysis, we aim to describe patterns of engagement in HIV prevention and treatment services among key populations in South Africa and assess the impact of different COVID-19 restriction levels on this engagement using an interrupted time series approach.

Study design: implementation of key population programs in South Africa

In this analysis, we utilized routine program data collected through the PEPFAR bilateral initiative in South Africa. In brief, this initiative includes a partnership with the Government of South Africa and the National and Provincial Departments of Health, which work directly to coordinate HIV service provision with implementing partners funded through both the Centers for Disease Control and Prevention (CDC) and the United States Agency for International Development (USAID) [ 16 , 17 , 18 ]. In this analysis, data were provided by both CDC- and USAID-funded implementing partners.

In September 2021, the Key Populations Investment Fund (KPIF), a globally launched investment program aiming to increase access to HIV services for key populations ended in South Africa [ 19 ]. KPIF funding was used to both directly provide testing, prevention, and treatment services and was also used to support community mobilization. The inflection point where KPIF ended, which relates to the availability of funding to support provision of services, has been noted in the figures, and we visually inspected the data in the context of KPIF closure.

Study population

Routinely collected data were available for MSM, FSW, and transgender women (TGW). MSM in these analyses included gay and other men who have sex with men receiving HIV prevention or treatment services from Aurum Institute (CDC) and Anova Health Institute and OUT/LGBT Well-Being (USAID). FSW included women 18 years and older who sell sex and received HIV services from TB HIV Care (CDC) and Wits Reproductive Health Institute (USAID). TGW included women who were assigned male sex at birth and received services from Wits Reproductive Health Institute (USAID) [ 17 , 20 , 21 ]. These implementing partners received funding for programs and service delivery through a subagreement with FHI 360.

Outcome data were derived from programmatic indicators routinely reported by implementing partners as part of standard PEPFAR program monitoring procedures. Data were abstracted as monthly counts for each population either from program files shared directly by implementing partners or from InfoLink, a database platform where routine program data are compiled from partners for reporting purposes. Data were accessible through InfoLink because of an ongoing collaboration between the study team and FHI360 [ 22 ]. The primary outcomes included 1) monthly number of individuals who received HIV testing services and received their results (HTS_TST), 2) monthly number of new HIV cases identified, or case finding (HTS_TST_Pos), 3) monthly number of new pre-exposure prophylaxis (PrEP) initiations (PrEP_NEW), and 4) monthly number of individuals who newly started/enrolled on antiretroviral therapy (ART) (TX_NEW). Based on data availability, we accessed data across different time horizons for each population.

COVID-19 restrictions

Stringency or severity of COVID-19 restrictions was assessed based on a review of publicly available information disseminated by the Government of South Africa. Restrictions by the Government were implemented using an alert level approach, which aligned with “the level of infections and rate of transmission, the capacity of health facilities, and the extent of the implementation of public health interventions and the economic and social impact of continued restrictions.” The alert system ranged from 1 through 5, where alert level 1 represented a low level of spread and a high level of health system capacity, and alert level 5 represented a high level of spread and a low level of health system capacity. A summary of the restrictions corresponding to the alert levels are reported below [ 23 ]:

Level 5: Only essential services, restricted times for public transportation, stay-home order and no inter-provincial movement of people.

Level 4: Some industries resume activity (agriculture, waste management, information technology services), public transportation allowed with restricted capacity, curfew from 8 PM – 5 AM and limited inter-provincial movement.

Level 3: Additional industries resume activity (take-away restaurants, automotive manufacturing, government services, most retail, etc.), public transportation allowed with restricted capacity, no curfew, but ongoing limited inter-provincial movement.

Level 2: All retail, construction, domestic work, manufacturing and government services resume activity, domestic air travel and car rental allowed, movement permitted between provinces at level 1 or level 2.

Level 1: All sectors resume activity, all modes of transportation resume with strict hygiene practices enforced, movement between provinces allowed with some restrictions on international travel.

For these analyses, we grouped data into three discrete periods based on the level of restrictions that were implemented. Data provided prior to March 2020, or pre-pandemic, comprised the “pre-restriction” period. The second period was classified as the “high-level restriction period” when alert levels three to five were in place (March 2020-August 2020), and corresponded to low to moderate health system readiness. Finally, the third period, including alert level two, alert level one, and lifted restrictions (September 2020-June 2022), was classified as the “after high-level restriction period,” corresponding to high health system readiness.

Statistical analysis

The number of individuals served by each program were reported for each key population, and summary statistics on the primary outcomes were described by intervention period (high-level restriction period and after high-level restriction period). We conducted interrupted time series segmented regression analyses to assess the impact of COVID-19 restrictions on our primary HIV prevention and treatment outcomes. We fit Poisson or negative-binominal regression models based on dispersion of the data for each population separately. An assumption of the Poisson distribution is that the mean is equal to the variance. In cases where the variance was larger than the mean, we utilized the negative binomial model and incorporated an additional term to account for the excess variance [ 24 ]. We fit one model per population per outcome (3 populations × 4 outcomes = 12 total models). Models included a variable to account for time since the start of the study period, two dummy variables indicating high-level and after-high-level restriction periods and their interaction terms with their restriction implementation time period, respectively. This approach takes account of different levels of restrictions and allows evaluation of the immediate effect of restrictions at different time points by centering time at that time point. The statistical model used in this paper took the following form:

where Y represents the count of the specified outcome for each calendar month, \({e}^{{\upbeta }_{0}}\) represents the level or the count of the outcome at T = 0 (start of the study period).  \({e}^{{\upbeta }_{1}}\) represents the change in the outcome associated with time during the pre-restriction period (pre-restriction trend), Time denotes the number of months since the start of study period.  \({e}^{{\upbeta }_{2}}\)  and  \({e}^{{\upbeta }_{3}}\)  represent the immediate level changes following implementation of the high-level restriction period and the after high-level restriction period relative to the pre-restriction period, respectively. \({t}_{h}\) is the number of months since high level restrictions implemented, \({t}_{l}\) represents the number of months since the start of after high-level restriction period, \({e}^{{\upbeta }_{4}}\) and \({e}^{{\upbeta }_{5}}\) represent the averaged trend change following implementation of the high-level restriction and the after high-level restriction period relative to the pre-restriction period, respectively.

From the model, we estimated the immediate impact of COVID-19 restriction implementation by looking at the coefficient of the restriction period variable ( \({e}^{{\upbeta }_{2}}\) for high and \({e}^{{\upbeta }_{3}}\) for after high). We evaluated the post-restriction period trend for each outcome by adding together the coefficients associated with time and time-restriction interaction ( \({e}^{{\upbeta }_{1}+{\upbeta }_{4}}\) for high, \({e}^{{\upbeta }_{1}+{\upbeta }_{5}}\) for after high).

Newey-West standard errors with autocorrelation up to 6 lags were used within our models to account for serial autocorrelations and heteroskedasticity [ 25 , 26 , 27 ]. We performed all analyses in R 4.0.4 (R Foundation for Statistical Computing, Vienna, Austria; appendix).

To adjust for seasonal changes in clinic activity that have a repeating pattern with fixed frequency (e.g., holiday periods), we used a combination of sine and cosine functions to model the seasonal pattern [ 28 ]. In our case, the frequency of sine and cosine functions corresponded to the length of the seasonal cycle (12 months). The coefficient of these terms determines the strength of the seasonal pattern (amplitude), while the phase of the functions determines the timing of the seasonal pattern within the cycle. Acknowledging the inherent variability in the pre-intervention period model fitting, we introduced an additional step to enhance the interpretability and realism of the level that could conceivably have been reached for some of these indicators. Recognizing that certain indicators might exhibit unrealistic trends due to this variability, we incorporated an asymptotic line. This line serves as a cap, setting the maximum realistic value for these indicators.

Programmatic adaptations to service delivery

To supplement the quantitative results of these analyses, programmatic details around adaptations to service delivery made during the COVID-19 pandemic were documented via a brief online questionnaire administered initially in October 2020. The questionnaire included questions regarding populations served, the type of HIV services provided, implementation strategies to ensure continuity of service provision. Specific adaptations such as new delivery methods and new strategies in response to COVID-19 were also recorded. These data were updated in November 2021; a spreadsheet was shared with each implementing partner to assess any further adaptations or innovations following the initial 2020 survey.

All data included in these analyses were collected for the purposes of routine program monitoring and were reported in aggregate. Analyses did not include personal identifiable information and were thus classified as non-human subjects research (JHU IRB0007442).

Data were available for MSM from June 2019 to June 2022, for FSW from January 2018 to March 2022 and for TGW from November 2018 to March 2022. A total of 231,086 HIV tests were reported among MSM, FSW, and TGW across the study period. There were 7,866 (6.8%) positive HIV tests for MSM. During this same period, there were a total of 38,981 PrEP initiations and 8,422 ART initiations. Among FSW, there were 18,049 (16.7%) positive HIV tests reported among FSW. There were 27,656 PrEP initiations and 15,949 ART initiations. Among TGW, there were 1,136 (15.9%) positive HIV tests reported from January 2019 through March 2022 among TGW. There were 2,054 PrEP initiations and 935 ART initiations.

Ninety thousand four hundred fifty-seven total HIV tests were reported during the ‘pre-restriction’ period, with 13,593 confirmed positive cases. From March 2020 to August 2020, the ‘high-level restriction’ period, 26,134 total tests, and 2,771 positive cases were reported. During the ‘after high-level restriction period,’ 114,495 HIV tests and 10,687 cases were reported.

High-level restriction period: March 2020-August 2020

As detailed below for each indicator, the segmented regression analysis substantiated a sharp drop across the HIV indicators among all key population groups at the implementation of Level 5 national COVID-19 restrictions in March 2020.

Men who have sex with men

Among MSM, a 59% decrease in the number of HIV tests was observed during the first month of high-level restrictions (Fig.  1 a, Risk Ratio (RR): 0.41, 95% Confidence Interval (CI): 0.27–0.64) compared to the pre-restriction period. Decreases were also seen for HIV case-finding (Fig.  2 a, RR: 0.31, 95% CI: 0.21–0.46), PrEP initiation (Fig.  3 a, RR: 0.57, 95% CI: 0.34–0.96), and ART initiation (Fig.  4 a, RR: 0.47, 95% CI: 0.34–0.66). Starting in May 2020, all indicators demonstrated a moderate rebound following the initial drop in service engagement (Table  1 ). For example, HIV testing showed a gradual positive trend during this period (RR: 1.12 95% CI: 0.97–1.28).

Monthly counts, trends and fitted segmented regression models of HIV total tests for Men who have sex with men ( a ), Female sex workers ( b ), and Transgender women ( c ) in South Africa

Monthly counts, trends and fitted segmented regression models of HIV positive cases for Men who have sex with men ( a ), Female sex workers ( b ), and Transgender women ( c ) in South Africa

Monthly counts, trends and fitted segmented regression models of PrEP initiations for Men who have sex with men ( a ), Female sex workers ( b ), and Transgender women ( c ) in South Africa, PrEP = pre-exposure prophylaxis

Monthly counts, trends and fitted segmented regression models of ART initiations for Men who have sex with men ( a ), Female sex workers ( b ), and Transgender women ( c ) in South Africa, ART = antiretroviral therapy

• Female sex workers

Among FSW, there was a 65% decrease in HIV testing at the start of high-level restrictions (Fig.  1 b, RR: 0.35, 95% CI: 0.17–0.69). Similarly, there were declines observed for HIV case finding (Fig.  2 b, RR:0.48, 95% CI: 0.24–0.96), PrEP initiation (Fig.  3 b, RR: 0.41, 95% CI: 0.21–0.78), and ART initiation (Fig.  4 b, RR: 0.61, 95% CI: 0.31–1.21). There was a similar rebound in outcomes as was seen among MSM during this period, with HIV testing gradually improving over time for FSW (RR: 1.08, 95% CI: 1.06–1.09).

Transgender populations

Findings were similar among TGW with a 64% (Fig.  1 c, RR: 0.36, 95% CI: 0.09–1.41) decrease in HIV testing, a 23% (Fig.  2 c, RR: 0.76: 95% CI:0.50–1.16) decrease in positive cases, a 69% (Fig.  3 c, RR: 0.31, 95%CI: 0.14–0.68) decrease in PrEP initiations, and a 72% (Fig.  4 c, RR: 0.28, 95% CI:0.12–0.63) decrease in ART initiations. Among TGW, there was a similar gradual increase in each of the indicators over time except for HIV testing, which saw a decline in the trend over time during this period.

Additional changes in the key outcomes over time are documented in Table  1 .

After high-level restriction period: September 2020-June 2022

After the high-level restriction period, we observed a decline in the level of all HIV indicators across the various key population groups. Patterns in trends varied across indicators and populations.

For MSM, a 51% decline in the number of HIV tests was detected at the start of the after-high level restriction period relative to the level during the pre-restriction period (April 2020) (Fig.  1 a, RR: 0.49, 95%CI 0.27–0.90). Similar reductions were also observed among other indicators (Table  1 ). Thereafter, the segmented analysis revealed a decrease of 2% per month (Fig.  1 a, RR: 0.98, 95%CI: 0.96–1.00) in HIV tests. Moderate declines over time were also found in HIV case finding (Fig.  2 a, RR:0.98, 95%CI: 0.96–1.00), PrEP initiation (Fig.  3 a, RR: 0.97, 95% CI: 0.95–0.99), and ART initiation (Fig.  4 a, RR: 0.97 95% CI: 0.95–0.99).

Among FSW, the level of HIV testing declined at the start of the after high-level restriction period compared with the pre-restriction period (Fig.  1 b, RR: 0.52, 95%CI: 0.35–0.76). The other primary indicators showed a similar pattern (Table  1 ). During this period, we observed HIV testing numbers gradually recovered by 3% per month (RR: 1.03, 95%CI: 1.03–1.04). Positive increases per month were also seen in other indicators: HIV case finding (Fig.  2 b, RR:1.03, 95%CI: 1.02–1.03), PrEP initiations (Fig.  3 b, RR: 1.04, 95%CI: 1.01,1.07), and ART initiations (Fig.  4 b, RR: 1.03, 95%CI: 0.99–1.06).

Among TGW, there was a significant decrease in the level of HIV testing at the start of the after high-restriction period (Fig.  1 c, RR: 0.1, 95% CI: 0.03, 0.33). Decreases were also seen in PrEP initiations and ART initiations (Table  1 ). After that, HIV testing consistently improved during this period (Fig.  1 c, RR: 1.03, 95%CI: 1.00–1.06), while other indicators stayed at a constant level with no significant increase (Table  1 ).

During this period, implementing partners enacted several modifications to HIV community outreach programs to adapt to COVID-19 restrictions. Strategies varied across partners and population groups. Some example efforts that were made to provide more virtual support included utilizing mobile online communication (WhatsApp, Facebook groups) and a bulk SMS platform to inform clients of updates and changes to clinic services, times, and locations. Concurrently, self-testing, multi-month dispensing, and home-based ART-delivery along with telemedicine appointments were introduced and offered to clients during this time. For TGW identified by service providers to have increased housing insecurity and who were forced into shelters during the pandemic, mobile HIV services were brought to these shelters to ensure sustained services. For FSW, who were unable to work and earn an income as a result of restrictions, implementing partner teams solicited and provided food parcels. Additional innovations included small group meetings with peer navigators and outreach based on where clients live rather than at centralized locations historically dictated by hotspots (bars, brothels, clubs etc.). For MSM, ambassadors from different wards hosted community advisory board meetings to identify PrEP needs and provided additional support in transferring of clients to other clinics to continue provision of care. Other peer navigation teams were formed for further home visits, HIV testing, and PrEP deliveries. Implementing partners were able to reintegrate their standard community-based activities and mobile services, as well as create small group peer meetings, form peer navigation teams, and utilize community ambassadors from different wards to host community advisory meetings to support local client needs.

In this analysis, we evaluated the impact of national-level COVID-19 restrictions on HIV prevention and treatment service utilization for key populations accessing PEFPAR-supported HIV services in South Africa utilizing an interrupted time series approach. At the onset of pandemic restrictions, we observed an immediate and pronounced decrease in service engagement, including declines in the number of individuals accessing HIV testing, treatment and PrEP that persisted for MSM, FSW, and TGW. As programs began to adjust and adapt to restrictions, there was a gradual rebound in service engagement, particularly among MSM and FSW. At the end of the high-level restriction period, with most returning to normal, but some movement and daily life still restricted, there was more variation across the different indicators. Some indicators continued to make improvements and increase, others stagnated, and still others decreased. Taken together, these findings largely highlight the flexibility and resiliency of HIV service delivery and the maintenance of HIV services for those with the greatest need during the pandemic in South Africa.

Consistent with what has been described elsewhere in sub-Saharan Africa, we found an immediate impact on the uptake of critical HIV services following the implementation of COVID-19 restrictions. A multi-country study among MSM involving 20 countries revealed that 30% of 10,654 surveyed individuals experienced interruptions to in-person HIV testing, with 55% reporting interruptions to HIV self-testing [ 4 ]. A study using routine data across populations from public sector clinics in South Africa saw similar declines in access to these same services, with HIV testing being among the most affected with considerable variation by province [ 29 ]. A cohort study in the Western Cape Province of South Africa found decreases in the number of PrEP visits among women attending antenatal care [ 30 ]. A review of studies across South Africa found reported decreases in HIV testing, positive HIV tests, and initiation of ART [ 31 ]. While delivery of HIV services remained essential during even the most stringent Level 5 restrictions, the changing context of daily life placed additional burden on programs in the early months of the pandemic. Some of these changes included suspension of certain in-person services to promote physical distancing, staff shortages due to the need for quarantine for exposed individuals and isolation for those infected with COVID-19, closure of community hotspots, including bars, brothels, and nightclubs where outreach for key populations often occurs, suspension of peer outreach, and the confluence of COVID-19 and HIV related stigma [ 14 ]. Despite these closures, the need for services remained and in some instances was likely heightened. The pandemic pushed already stigmatized and hidden hotspots and areas of congregation further underground, increasing the likelihood of violence, discrimination and harassment from clients, partners, police, and others [ 32 ].

Despite the initial declines observed associated with pandemic restrictions, a gradual rebound was seen across most indicators over time, reflecting both an easing of restrictions and efforts by partners to ensure the continuity of services. A large-scale study looking at the impact of COVID-19 lockdown on HIV care across 65 South African primary care clinics similarly found that while there were immediate declines associated with pandemic restrictions, there was a measured but ongoing observed improvement in HIV testing and ART initiations as restrictions began to ease [ 29 ]. Other studies also found that HIV services were resilient to the shocks and interruptions created by COVID-19 restrictions, especially in the months immediately after the beginning of the pandemic with easing restrictions [ 6 , 33 ].

We considered two key programmatic shifts that occurred during this period: program-driven adaptations to services to maintain delivery during the pandemic and the end of KPIF, a key funding mechanism that provided additional funds for key populations programs with a focus on capacity building of key population-led organizations and evaluated their relevance by visually inspecting the Figures. As documented in the Results section, implementing partners contributing data to these analyses made changes and adaptations to better support those accessing services during the pandemic. Further research is needed to understand which of these adaptations and implementation strategies proved most useful in sustaining provision of services, but it is clear that creative adaptations like the ones mentioned here will be critical for future pandemics or other disruptive events. KPIF was primarily intended to provide additional capacity for key populations organizations and test certain innovations. Qualitatively, we did not observe a considerable impact of the conclusion of KPIF on the primary HIV indicators, but this was not the primary analytic question of this study.

There were two key strengths of this study. First, we leveraged routinely collected program data for these analyses, which meant that we were able to elucidate patterns in HIV service engagement use and better understand fluctuations in that use at no additional cost or burden to the program or to service users. Second, these data are largely representative of key populations accessing PEPFAR-funded services in South Africa, as we did not do any sampling or selective inclusion. This is particularly important as representative data for key populations are often difficult to collect, given high levels of mobility and systemic marginalization and discrimination and associated fear and distrust.

There were several limitations of this study. First, a key assumption of the statistical models is that COVID-19 restrictions in practice changed in alignment with the official alert levels put forward by the Government. In practice, there may have been variability in when different restrictions went into place and how this impacted daily life. For the purposes of the interrupted time series, this was a simplifying assumption to establish a clear-cut point but one that we feel does broadly align with both perceived and actual changes that occurred. Second, we combined data across different implementing partners for a single population and assumed that patterns would be similar across the programs. There could be variability by implementing partner depending on the size of the program, for example based on the number of clients served or number of staff involved, or the geographic area. Thirdly, while our seasonal adjustment aims to account for known patterns such as reduced activity during holiday periods, the limited data duration may affect the precision of these adjustments. Finally, there was a significant amount of relocation with people moving out of urban centers during the pandemic, and the underlying population may have been changing over time. Though we were unable to assess changes to population characteristics, as we did not have access to individual-level demographic and behavioral data, we do not anticipate that the distribution of these characteristics was changing dramatically on average over time.

HIV service utilization among key populations in South Africa was severely impacted in the initial months of the pandemic by stringent restrictions intended to stem the spread of SARS-CoV-2. As restrictions eased, and as programs adapted to the context of changing daily life, there was a gradual rebound in the uptake of services across populations. These results highlight the resiliency and dynamicity of PEPFAR-funded implementing partners in generating creative solutions, including virtual support, multi-month dispensing and home delivery of HIV testing and ART, and amplified peer navigation, to maintain HIV services during the COVID-19 pandemic. As of the end of the study period, however, the level of uptake of most services had not yet returned to pre-pandemic levels. There is an ongoing need to come up with new strategies to get key populations in need of HIV services re-engaged in care and to evaluate existing strategies to understand which are most effective at ensuring continuity of care. Using these results and the results from future studies, we can begin to develop plans for future pandemics and large-scale disruptions to the delivery of HIV services.

Availability of data and materials

The datasets used during the current study are available from the corresponding author on reasonable request.

Abbreviations

Coronavirus disease 2019

• Transgender women

United States President’s Emergency Plan for AIDS Relief

Centers for Disease Control and Prevention

The United States Agency for International Development

Key Populations Investment Fund

Antiretroviral therapy

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Acknowledgements

We want to acknowledge Helen Savva from the U.S. Centers for Disease Control and Prevention (CDC) South Africa country office for her critical contributions to strengthening this manuscript. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), through the United States Agency for International Development (USAID), supported the preparation of this manuscript. It was prepared by Panagora Group under the USAID/Southern Africa Bilateral Health Office and the Regional Health Office (RHO) Technical Support Services (TSS) Activity, Contract Number: 72067419C00001. The findings and conclusions in this manuscript are those of the author(s) and do not necessarily represent the official position of USAID, CDC, or the United States Government.

Sources of support for this manuscript include: National Institute of Allergy and Infectious Diseases: R01AI170249 (PI: Baral), National Institute of Mental Health: K01MH129226 (PI: Rucinski), and the Panagora Group Technical Support Services Activity (Contract no: 72067419C00001).

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AR, KR, LP, JJL, and SB developed the concept for the manuscript. DY and AR developed the manuscript and drafted the initial text. OO, KW and DY collated the data, and DY conducted the interrupted time series analyses. JT, KR, and KW coordinated the study logistics. NH, BB, DG, MC, MM, VS, DN, and JP lead in the delivery of services from which the data are derived. All authors read and provided critical feedback on the final manuscript.

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Yao, D., Hill, N., Brown, B. et al. The impact of COVID-19 restrictions on HIV prevention and treatment services for key populations in South Africa: an interrupted time series analysis. BMC Public Health 24 , 2386 (2024). https://doi.org/10.1186/s12889-024-19679-0

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Motivation, responsibilities, and experiences of HIV/AIDS counselors in the Volta Region of Ghana: a descriptive phenomenological study

• Festus Dwomoh   ORCID: orcid.org/0009-0007-4561-5016 1 ,
• Mbuyiselo Douglas   ORCID: orcid.org/0000-0003-2777-8384 2 ,
• Veronica O. Charles-Unadike   ORCID: orcid.org/0009-0009-9061-4965 3 ,
• Joyce Komesuor   ORCID: orcid.org/0000-0003-4016-6948 3 &
• Emmanuel Manu   ORCID: orcid.org/0000-0002-2724-3649 3  

AIDS Research and Therapy volume  21 , Article number:  60 ( 2024 ) Cite this article

Metrics details

The provision of professional counseling services for persons living with human immunodeficiency virus (PLHIV) is crucial in the prevention and treatment continuum of the disease. However, for counselors of people infected with the human immunodeficiency virus (HIV) leading to acquired immune deficiency syndrome (AIDS) to give their best, their motivations to become counselors and the challenges they face in their line of duty need to be contextually understood and addressed. We ascertained the roles, motivations, and experiences of HIV/AIDS counselors in the Volta Region of Ghana to inform HIV/AIDS counseling decision-making in the region and the country.

A phenomenological study conducted among sixteen (16) HIV/AIDS counselors from five HIV/AIDS sentinel sites in the Volta region of Ghana, recruited through a purposive sampling approach and interviewed to ascertain their HIV/AIDS counseling-related experiences. The data were thematically analyzed using the Atlas. ti software, and sub-themes supported with verbatim quotes.

Five motives for becoming an HIV/AIDS counselor were found. These include being randomly assigned to the unit, developing interest in the job, because of the status of a relative, witnessing bad attitudes of healthcare providers, and seeing HIV- clients lacking knowledge of the condition. The study found that these counselors performed six core roles: providing nutritional counseling, educating clients on HIV, treatment, and medication provision, conducting testing and comprehensive counseling of clients, providing social support to clients, and offering financial support to clients. The experiences these counselors had were boosting clients’ health status, counseling clients back to a normal mental state, cooperation from clients, participants gaining knowledge on HIV through counseling, counseling clients to accept their status, and when a client delivered an HIV-negative baby. Their negative experiences included clients denying their HIV status, clients defaulting on their treatment, uncooperative clients, death of clients due to fear of breach of confidentiality, self-stigmatization among clients, and the myths some people hold towards HIV/AIDS.

By organizing capacity-building training programs for HIV/AIDS counselors in the Volta region and addressing the negative experiences they encounter, they could be empowered to provide effective counseling, curative, and social services to people living with HIV in the region, leading to improved health outcomes.

Introduction

Counseling plays a crucial role in the prevention and management of the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) [ 1 ]. When individuals learn about their HIV status, they often experience significant psychosocial and psychological distress associated with the fear of rejection, social stigma, disease progression, and the uncertainties about future HIV management [ 2 ]. HIV/AIDS counselors are responsible for providing the necessary time, attention, and respect to help these individuals live peacefully and resourcefully with the virus [ 3 ].

HIV/AIDS counseling seeks to address the biopsychosocial needs of persons living with HIV (PLHIV) for timely management [ 4 ]. Counselors assist in preventing HIV transmission and support those affected by the virus to improve their health outcomes [ 5 ]. They also promote behavioral changes in affected individuals and collaborate with their families to encourage treatment adherence and sustain behavior changes [ 6 ]. Furthermore, HIV/AIDS counselors provide support and education to PLHIV, which is crucial for preventing the spread of the disease [ 7 ]. They help patients and families understand their diagnosis, manage their treatment plans, and cope with the social and emotional impacts of living with a chronic illness [ 8 ]. Additionally, counselors collaborate with other healthcare professionals to coordinate care for their clients [ 9 ].

The demanding role of HIV/AIDS counselors underscores the necessity for motivated counselors, as the quality of the counseling services depends on their performance. It is crucial to have experienced, dedicated, and motivated HIV/AIDS counselors providing counseling services to PLHIV [ 10 ]. A lack of motivation among HIV/AIDS counselors can affect the care provided to PLHIV and may even lead some to leave their jobs [ 11 , 12 ].

Despite the vital role of HIV/AIDS counselors, they face many challenges, many of which are underreported. For example, often face stigma and discrimination due to the nature of their work [ 13 ]. Some people believe HIV is contracted through witchcraft and promiscuity, which undermines the efforts of HIV/AIDS counselors in combating the disease [ 14 ]. These challenges are context-specific to the African continent. In South Africa, for instance, challenges such as confidentiality, stigma, emotional responses when informing clients of their HIV status, cultural and contextual factors, situational stressors related to the work environment, and inadequate support from their work infrastructure are some of the issues HIV/AIDS counselors encounter [ 15 ]. In Nigeria, poor governance, weak institutions, poverty, and cultural norms and practices have been found to negatively affect HIV/AIDS counseling in general [ 16 ].

In Kenya, training needs, lack of in-depth understanding of the root causes of risky sexual behaviors among PLHIV, especially among men that sleep with men, and perceived intractability of clients’ issues have been reported as some of the challenges facing HIV/AIDS [ 17 ].

In Ghana, HIV/AIDs remain a significant public health issue, with an estimated prevalence of 1.8% according to the Ghana AIDS Commission [ 18 ]. As of the end of 2022, there were a total number of 354,927 people living with HIV in the country, with an estimated 16,574 new cases in 2023 [ 19 ]. The Volta region ranks seventh out of the sixteen regions in terms of HIV burden, with 16,996 HIV/AIDS cases. To reduce the transmission of the virus and improve the health outcomes of those already affected in the region, it is essential to motivate HIV/AIDs counselors and address context-specific challenges they face.

Despite the important contributions of HIV/AIDS counselors in Ghana, the literature on HIV/AIDs in the country has often overlooked their crucial role. While some studies focus solely on the experiences of HIV/AIDs counselors [ 20 , 21 , 22 , 23 ], most literature emphasizes HIV counseling and testing [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. In the Volta region, research has primarily focused on the epidemiology of the disease, its risk factors, and transmission patterns [ 36 , 37 , 38 , 39 , 40 ]. Therefore, the specific roles, motivations, and experiences of HIV/AIDS counselors have not been comprehensively documented in the country to inform policy on HIV/AIDS counseling. This study aims to contribute to the existing literature on HIV/AIDS by exploring the core roles, motivations, and experiences of HIV/AIDS counselors in the Volta region of Ghana, following the standards for reporting qualitative research (SRQR) as outlined by O’Brien et al. [ 41 ].

Study site description

The study was conducted at five HIV/AIDS sentinel sites in the Volta Region of Ghana. The region has a total of 749 health facilities, including 29 hospitals, 156 health centers, 44 clinics, 4 polyclinics, 14 maternity homes, 452 CHPS compounds, and 50 private health facilities [ 42 ]. Among these, the Volta Regional Hospital, the Ho Teaching Hospital, the Bator Catholic Hospital, the Adidome Hospital and the Torgorme Hospital serve as the HIV/AIDS sentinel sites, with certified HIV/AIDS counselors. These five facilities were specifically selected for the study. According to the 2021 population and housing census figures, the region has an estimated population of 1,659,040 [ 42 , 43 ].

Map of Ghana indicating the Volta Region

Study design

A qualitative approach, using a descriptive phenomenological design, was employed to explore the motivation, responsibilities, and experiences of HIV/AIDS counselors in the Volta Region of Ghana. Descriptive phenomenology suggests that a phenomenon should be described rather than explained or investigated for its causal relationship [ 44 ]. It examines and aims to comprehend the subjective human lived experience concerning a phenomenon as it appears in a natural context [ 45 ]. This approach enabled the participants to share a narrative about their lived experiences. Since there is a paucity of research data on the motivation, responsibilities, and experiences of HIV/AIDS counselors in the Volta Region of Ghana, descriptive phenomenology facilitated the elucidation of poorly understood aspects of this human lived experience.

Researchers’ characteristics and reflexivity

The research team consisted of an Associate Professor experienced in qualitative research (MD), three Senior Lecturers (EM, JK & VC) and a public health degree holder (FD), all with qualitative research experience. To ensure objectivity, we bracketed our biases by identifying and acknowledging our preconceptions and assumptions and setting them aside during the interview and data analysis processes in order not to misrepresent participants’ meanings and experiences, as explained by Chan and colleagues [ 46 ].

Study population

The study was conducted among HIV/AIDS counselors at the five (5) HIV/AIDS sentinel sites in the Volta region of Ghana. According to the records of the Volta Regional Health Directorate, there were a total of twenty-five (25) certified HIV/AIDS counselors across these sites at the time of the study. Of these twenty-five (25) certified counselors, eighteen (18) met the inclusion criteria of having at least three (3) years of experience working as HIV/AIDS counselors. However, two of these eligible counselors were on leave during data collection and were thus excluded from the study.

Sample size determination

The sample for the study consisted of sixteen (16) purposely selected certified HIV/AIDS counselors from the five (5) sentinel sites. Although data saturation could have been reached by the 13th interview [ 47 ], we decided to interview all the eligible participants (16) since the total available sample was small enough (16 people) to include everyone.

Sampling procedure

At each sentinel site, all potential participants who met the inclusion criteria and were on duty were purposely recruited and interviewed. Therefore, a census approach was followed in recruiting eligible participants at the various sentinel sites for the study.

Data collection tool

A semi-structured interview guide was used to moderate the interviews and gather data for this study. This approach was preferred because it provided structure, focusing on core issues while allowing flexibility for participants to express themselves and for the interviewer to probe for clarity when necessary. The guide was designed to explore four thematic areas: the socio-demographic characteristics of the participants, their motivation to become HIV counselors, their responsibilities, and their experiences as HIV/AIDS counselors.

The guide was pre-tested among two (2) HIV/AIDS counselors from the Oti region, which has similar demographic characteristics to the Volta Region. This pre-testing aimed to identify and clarify any areas of the guide that needed adjustment before the actual data collection.

Data collection procedure

In-depth individual interviews (IDIs) were conducted with participants from June 10, 2023 to July 17, 2023. IDIs were preferred because participants were scattered across the various sentinel sites in the region, making it financially burdensome to converge them at one place for focus group discussion. Additionally, participants may have felt more comfortable expressing themselves in one-on-one interviews compared to group settings, influencing the choice of IDIs [ 48 ].

The interviews were moderated by the Principal Investigator (FD), a Bachelor of Public Health Student at the time, along with an experienced team member under the supervision of the team lead (EM). Each interview lasted an average of 45 min and was conducted in English, as all participants had tertiary-level education. To ensure privacy, interviews were held in secluded rooms away from the public. Hand-written notes (with pens and notebooks) and call recorders were used to document the interviews. The notes were taken by a team member (either JK or VC) while the interviews were recorded by the Principal Investigator (FD). The use of both call recorders and handwritten notes was to ensure that interviews were not halted as a result of equipment breakdown during the interview process and also to fall back on the notes as a backup in case of data loss.The handwritten notes also helped to capture nonverbal cues of the participants.

Data analysis

Data collection and analysis were conducted concurrently. Each interview was transcribed and compiled into a Microsoft Word file, from which codes, sub-themes and themes were developed using the Atlas ti. v7.5 software. To reduce subjectivity in the analysis process, the data were analyzed by two research team members [FD and EM]. The data analysis followed the descriptive phenomenological method proposed by Colaizzi [ 49 ]. The steps employed included: (1) repeated reading of the transcripts to obtain a general sense of the whole content, (2) extracting and recording significant statements related to the phenomenon under study for each transcript, (3) formulating meanings from these significant statements, (4) sorting the formulated meanings into categories, clusters of themes, and overarching themes, (5) integrating the findings into an exhaustive description of the phenomenon under study, (6) describing the fundamental structure of the phenomenon, and (7) conducting member checking with seven of the participants to validate the descriptive results.

The authors met regularly to discuss and verify the accuracy of the emerging themes and their meanings. In cases of disagreement, an independent coder served as an arbitrator to resolve the issues. A theme was not accepted until an agreement was reached between the two authors. Member checking was utilized to ensure the rigor of the analysis process. The themes that emerged capturing the motivations, responsibilities, and experiences of HIV/AIDS counselors in the Volta Region of Ghana were emailed to all the participants for verification and confirmation of the researchers’ interpretation of their experiences. All seven participants confirmed that the results accurately reflected what they said during the interview process. Verbatim quotes from participants were used to support the study findings.

Following Lincoln and Guba’s criteria [ 50 ], the credibility of the study findings was ensured through several measures. First, rapport was developed between the research team and HIV/AIDS counselors before the study commenced, encouraging participants to share sensitive but vital information openly. Additionally, peers with expertise in qualitative research were consulted to assist in the study design. Dependability of the study findings was guaranteed through the involvement of professional qualitative researchers on the research team and the evaluation of processes, transcripts, and findings by peers with qualitative expertise to minimize bias. Transferability of the findings was ensured by providing a detailed description of the methods, ensuring that they could be replicated in similar settings if needed. Finally, confirmability was ensured by having seven participants review the transcripts and the results for approval, thus validating the accuracy of the researcher’s interpretations and ensuring the findings were grounded in the participants’ experiences.

Socio-demographic characteristics of participants

The total number of participants in the study was sixteen (16). The majority, 10 (62.5%), were females. Additionally, half, 8 (50%), were aged between 30 and 40 years. most participants, 11 (68.8%) were Ewe. All participants, 16 (100%), were Christians and the majority, 9 (56.2%), were single. All participants had a tertiary educational background, and the majority, 9 (56.3%), had working experience between 3 and 5 years (Table  1 ).

Thematic findings

From the data, four (4) main themes, along with their accompanying sub-themes, were generated. These themes are: motivation to become HIV/AIDS counselor (random assignment, personal interest, HIV status of a relative, bad attitude of healthcare workers), responsibilities as an HIV/AIDS counselor (nutritional counseling, education, counseling on medication, comprehensive counseling and testing, provision of social support), positive experiences as an HIV/AIDS counselor (boosting client’s health status, counseling client back to a normal psychological state, client’s acceptance of their HIV/AIDS status, gaining knowledge on HIV/AIDS, and client delivering an HIV negative child) and the negative experiences as an HIV/AIDS counselor (denial of HIV status, treatment default, uncooperative clients, self-stigmatization, death of a client, myths surrounding HIV/AIDS). The themes and their corresponding sub-themes are presented in Table  2 .

Motivation to become an HIV/AIDS counsellor

About what motivated participants to become HIV/AIDS counselors, five sub-themes emerged. These include being randomly assigned to the unit, developing an interest in the job, having a relative with HIV status, witnessing the bad attitudes of healthcare providers, and seeing HIV- positive clients lacking knowledge of their condition.

Random assignment as an HIV/AIDS counselor

Some of the respondents indicated that they had no specific motivation to become HIV/AIDS counselors. Rather, they were simply assigned to the antiretroviral therapy (ART) unit and began working there as counselors before receiving formal training. This sentiment is exemplified by the following story:

“I am a practitioner in the health system who was assigned to the unit based on my profession as a nurse to work with the HIV unit or the department. The HIV/AIDS unit is part of the healthcare system. So , when I was sent here , I knew it was just a service to humanity and also to facilitate and speed up the work at the department.“- (R3, Male, 26 years).

Developed an interest in the job

Some respondents mentioned that they simply developed an interest in the job. They were intrigued by the HIV/AIDS services and wanted to learn about the disease. One of them explained:

“There is no particular thing that motivated me , I will say. I just developed an interest in the job and volunteered. I can’t point out something in particular that motivated me.”- (R14, Female, 30 years).

HIV status of a relative

Participants said they decided to become HIV/AIDS counselors as a result of a relative contracting the disease. One of them explained:

“What motivated me is that I have a family member who has been exposed to HIV and through the interactions we had , I felt that the information they passed on to the family member was not enough , and that this nearly contributed to a lot of things that nearly led to them making a certain decision which was out of context.” - (R4, Male, 42 years).

As a Result of the poor attitudes of healthcare providers towards HIV/AIDS

One of the participants said they were motivated due to the poor attitudes of healthcare providers towards HIV/AIDS clients. He had experienced a situation where a friend was mistreated by healthcare providers and decided to become a counselor himself. The quotation below summarizes what the participant had to say:

“I have a friend who has been in the hospital and was tested. So , during that time , anytime I went to the hospital , the way the healthcare providers handled the patient or talked to the patient was not nice at all , so I was touched to become a counselor who would sympathize with the client and calm them down”.-(R1 , Male , 36 years).

Primary responsibilities of an HIV/AIDS Counselor

We also identified the primary responsibilities of HIV/AIDS counselors in the Volta region of Ghana. Some of the responses that emerged include nutritional counseling, educating clients about HIV, providing treatment and medication to clients, conducting testing and comprehensive counseling, offering social support to clients, and providing financial support to clients.

Counseling clients on their nutritional needs

Most participants emphasized that their primary responsibility as an HIV/AIDS counselor was to provide nutritional counseling to clients. This is crucial because the medication the clients take increases their calorie demands, necessitating a balanced diet for effective treatment. This sentiment was expressed in narratives such as:

“When the patients arrive , you talk to them about their medication , the type of food they are supposed to eat , and what they are supposed to do and what they are not supposed to do.” -(R1 , Male , 36 years).

Educating clients about the disease (HIV/AIDS)

Some participants indicated that their primary responsibility is to educate clients about HIV/AIDS. They emphasized the importance of ensuring that clients have comprehensive information about the disease to guide them in managing their health effectively. One participant explained:

“My primary responsibilities as an HIV/AIDS counselor are to pass on relevant information about the disease condition to anybody who has come for counseling and testing. Also , I must ensure the person receives adequate information so that , regardless of the testing outcome , they can accept the result and move forward.” -(R4 , Male , 42 years).

Providing counseling to clients on medication and adherence

Participants mentioned that their primary responsibility as an HIV/AIDS counselor was to provide counseling related to clients’ treatment and medication. They emphasized the importance of guiding clients through their treatment plans and ensuring adherence to medications. This is elaborated below:

“Yes , I do play a role in their treatments and medications. We call it adherence counseling for those who are receiving treatment. So , we give them information on how the medication works , how they should take it , and the duration that they should take it”. (R4 , Male , 42 years).

Comprehensive HIV counseling and testing of clients

Participants highlighted that their primary responsibility as HIV/AIDS counselors was to provide comprehensive counseling and testing for clients. They stressed the need for conducting thorough counseling sessions to ensure clients understand their HIV status, the implications of the disease, and the necessary steps for managing their health. This is illustrated by the explanation provided by a participant:

“Okay , the first one is counseling and testing , and the other ones are educating the client on viral loads , EID (Early Infant Diagnosis) and other services , but providing enough and adequate information to the client is the major responsibility. So , for the counseling , it depends on the client you have with you”.-(R10 , Female , 29 years).

Providing social support to clients

Some participants mentioned that they offer social support to clients, particularly those who face discrimination from their families. They aim to provide a sense of community and understanding to help clients cope with these challenges. The quotation below summarizes what a participant said:

“We also provide them with social support. It is done in a way like caring for them as if they were our family members , attending to their day-to-day needs.” -(R3 , Male , 26 years).

Provision of financial support for some clients

Some participants mentioned that they provide financial support to clients. Although it is not supposed to be one of their core roles, the dire financial situation of some clients often compels counselors to help them financially. One of them explained:

“For financial support , some of them come and will be like ‘I do not have money to buy food to take the drug’ and we do our best to assist them. We also advise them to eat well because the drug that they are on needs a whole lot of balanced diet”. -(R3 , Male , 26 years).

Positive experiences of HIV/AIDS counselors

The study explored the experiences of HIV/AIDS counselors in the Volta region of Ghana. Responses that emerged under this theme include: boosting clients’ health status, counseling clients back to a normal psychological state, cooperating with clients, gaining knowledge on the disease through counseling, counseling clients to accept their HIV/AIDS status, and clients delivering HIV-negative babies.

Improving clients’ health status

When participants were asked to share their experiences as an HIV/AIDS counselor, some mentioned that they cherished the aspect of being able to restore a client’s health to normalcy through counseling. One of them mentioned:

“The experience is that I have counseled people who are and not close to me , and the outcome is that they are doing very well. Initially , when some of them come , it looks like there is no hope but with time , as they listen to us , they improve greatly.” -(R4 , Male 42 years).

Counsel clients to return to a normal psychological state

Some participants mentioned that they found fulfillment in counseling a client back to their normal psychological state after receiving the shocking results. The quote below sums up their views.

“Okay , so when it comes to the experiences , the people who are living with HIV at first , when you break the news to them , they break down and are in denial. Some even want to hurt themselves , but if you can counsel them to get back to their normal state , it is such an experience.” -(R1 , Male , 36 years).

Cooperation from clients

Few of the participants mentioned that cooperation from clients was a significant experience they often encountered, as many clients are unruly and in denial after receiving HIV- positive results. Therefore, when a client cooperates and accepts their status immediately after testing, it becomes a notable experience for them. They recounted:

“Some clients are a bit enlightened on the condition because there is some literature among them. The disease is not only for the illiterate. Some have heard of the condition , and they accept it in good faith that it has come and there is nothing they can do , and they stick to treatment , and they see improvement.” -(R14 , Female , 30 years).

Gaining knowledge of the disease through counseling

Some participants reported that their experience as an HIV/AIDS counselor involved gaining knowledge about the disease. They explained that prior to becoming counselors, they had limited knowledge about HIV/AIDS. However, their involvement in counseling and testing exposed them to a wealth of information about the disease, thereby enhancing their understanding over time. They explained:

“When I came here first , I had a different perception of HIV and how to deal with the clients , but after some time , I got used to the system and was very comfortable. I can boldly say that I have gained much knowledge of the disease.” -(R10 , Female , 29 years).

Client giving birth to an HIV-negative baby

One participant expressed that witnessing a client deliver an HIV-negative baby brings him great joy, knowing that his counseling efforts contributed to this positive outcome. He narrated:

“The experiences as an HIV/AIDS counselor are rewarding when you witness mothers who are HIV-positive , provide care for them , and by the end of the day , their babies test negative and are doing well and healthy is a significant motivation. " -(R7 , Male , 37 years).

Negative experiences of HIV/AIDS counselors

Another theme that emerged from the study was the negative experiences of HIV/AIDS counselors in the Volta region of Ghana. Again, six (6) sub-themes were identified under this theme. These include clients denying their HIV status, clients defaulting on their treatment, clients being uncooperative, the death of some clients due to fear of breach of confidentiality, self-stigmatization, and the myths surrounding HIV/AIDS.

Denial of HIV- status by clients

Three participants mentioned that one of their negative experiences as HIV/AIDS counselors was clients’ denial of their status after testing positive for HIV. This hindered effective counseling and treatment, as the clients did not accept the reality that they were infected with the virus. One of them explained:

“One of the negative experiences as an HIV/AIDS counselor is when I had a mother who initially came here saying she was coming to fight me. She was tested , took medication once , and then never returned. So , I used to call her intermittently , but one day I called her , and she got crazy on the phone saying that she does not have HIV”. -(R15 , Female , 40 years).

Client defaulting on their treatment

Additionally, a few participants mentioned that clients defaulting on treatment and medication was a negative experience they encountered as HIV/AIDS counselors. This is particularly challenging because the counselors put in a lot of effort to enroll the clients on ART to control their viral load, only for them to default on treatment and disrupt the entire treatment course. They shared:

“Clients discontinuing treatment after all the counseling and reassurance given to them is both frustrating and sad at the same time. It poses a big challenge to us because it looks like we are not doing our work very well.” -(R3 , Male. 26 years) .

Uncooperative clients

Some participants complained that uncooperative clients pose a significant challenge to HIV/AIDS counselors. Despite the efforts they put in, some clients still see them as the problem and refuse to listen, making their efforts seem in vain. A male participant summarized this, stating:

“The negative experience was when a pregnant woman who had been diagnosed with HIV. Despite the counseling and empowering I had provided , she did not cooperate or adhere to the treatment. After giving birth , the child became infected , which deeply saddened me.” - (R7 , Male , 37 years).

Self-stigmatization by clients

A few participants explained that clients sometimes stigmatize themselves (self-stigmatization), feeling worthless and becoming shy or afraid to engage with healthcare providers. One of them explained:

“There is still some form of stigmatization. The clients themselves have self –stigma , so society also plays a certain part. That’s why they still have that self-stigma because they see themselves as worthless as they are infected with some sort of extraordinary or dangerous disease , which I think is not true.” -(R14 , Female , 30 years).

Client committing suicide due to breach of confidentiality

A participant recounted that a client committed suicide due to a breach of confidentiality, which was a negative experience he faced as an HIV/AIDS counselor. He narrated that one of his clients took her own life when a nurse in the community disclosed her status to the community members, leaving a lasting impression on his mind. He explained:

“One of the negative experiences I have encountered as an HIV/AIDS counselor is that after counseling someone I know who had tested positive , later on , she passed on information to another health staff working here that because of me , she is not comfortable with it , so she wants to transfer to another facility.” - (R4 , Male , 42 years).

Myths surrounding the transmission of HIV/AIDS

Furthermore, another participant was concerned about the myths and beliefs people hold towards HIV/AIDS. For example, some clients still believe that HIV is a curse and only affects those who live promiscuous lives. Therefore, these beliefs make the counseling process difficult as people do not readily accept their status or commence treatment. She explained:

“Some people still feel that HIV/AIDS is a curse done on them , so they prefer visiting herbalists , prayer camps , and the like. So , talking to them , you get to know what they believe in some myths and superstitions , as they remain in denial.” - (R9, Female, 28 years).

This study aimed to understand the motivations, responsibilities, and experiences of HIV/AIDS counselors in the Volta Region of Ghana to guide HIV/AIDS counseling policy in the area. Four (4) main themes were generated. These themes are: motivation to become HIV/AIDS counselor, responsibilities as an HIV/AIDS counselor, positive experiences as an HIV/AIDS counselor, and the negative experiences as an HIV/AIDS counselor.

The motivation of participants to become HIV/AIDS counselors was influenced by many factors. Some were randomly assigned to the HIV counseling unit, others developed an interest in the job, some were motivated by a relative’s status with HIV, while others were driven by witnessing poor attitudes of healthcare providers towards HIV clients. Additionally, some participants were inspired to become counselors after encountering HIV clients who lacked knowledge about HIV/AIDS and wanted to help educate and support them.

The practice of randomly assigning healthcare workers as HIV/AIDS counselors is prevalent in some African countries like Eswatini [ 11 ]. The reason for such random assignment in these settings is to fill the gap left by the lack of professionally trained HIV/AIDS counselors in providing counseling services to clients [ 12 ]. In the long run, nevertheless, this could be counterproductive since the personnel were not motivated to work as HIV/AIDS counselors, which could compromise commitment and the quality of services delivered to clients [ 51 ].

Conversely, some participants were self-motivated to become HIV/AIDS counselors by developing an interest in the job. This could have been due to curiosity to get a better understanding of the nature of the disease or to make a potential impact on the lives of people living with HIV [ 52 ]. On the African continent, the interest in helping others and a desire to make a difference in the lives of HIV clients are common motivations for becoming an HIV/AIDS counselor [ 53 ]. This is because the concept of “Ubuntu” transcends the African continent [ 54 ]. Recruiting individuals with the passion and motivation to become HIV/AIDS counselors could thus help improve the quality of care given to HIV/AIDS clients in the Volta region and Ghana in general, helping curb the transmission, morbidity, and mortality associated with HIV/AIDS.

Another reason why some participants chose to become HIV/AIDS counselors was due to a family member being diagnosed with the disease. Having a close relative or friend who is living with HIV/AIDS can inspire one to pursue a career in counseling to make a difference in the lives of others affected by HIV/AIDS and gain a better understanding of the challenges they face [ 55 ]. Similar reasons have been cited by some HIV/AIDS counselors in South Africa, where the HIV status of a family member or friend motivated them to become involved in HIV/AIDS counseling [ 56 , 57 ]. In some African communities, supporting and embracing the HIV status of family members often inspires individuals to become HIV/AIDS counselors to provide quality HIV/AIDS counseling services to family members suffering from the disease [ 58 ].

Witnessing the bad attitude of some healthcare providers towards people living with HIV/AIDS also served as motivation for some participants to become HIV/AIDS counselors. Bad attitudes of healthcare providers can have a significant impact on the quality of care that patients receive [ 59 ]. In Ghana, the narrative has often been that health workers are harsh and frequently treat patients without respect, ordering them around or yelling at them [ 60 ]. While this could be the case for some healthcare workers, others who detest such behavior see it as motivation to get involved and offer quality and humane healthcare services, as found in the present study.

As HIV/AIDS counselors, participants had responsibilities that included counseling in six thematic areas: nutritional counseling, educating clients about HIV/AIDS, providing treatment and medication, testing and offering comprehensive counseling, as well as providing social and financial support to clients.

HIV/AIDS treatment goes hand in hand with nutrition. Research has shown that malnutrition is a major complication of HIV infection that accelerates disease progression, increases morbidity, and reduces survival outcomes [ 61 ]. This is often exacerbated by the fact that antiretroviral drugs place much more energy demands on patients and thus require them to eat nutritious meals [ 62 ]. Providing nutritional counseling to HIV/AIDS clients to eat healthy food in the appropriate amounts regularly can help them better tolerate HIV drugs, maintain a healthy weight, and improve their health outcomes. This is a primary focus of HIV/AIDS counseling in Ghana [ 63 ].

The provision of comprehensive knowledge on HIV/IDS is another important role of HIV/AIDS counselors in the Volta region. This aligns with the World Health Organization’s recommendation that HIV/AIDS counselors provide a range of services, including educating clients on the prevention and modes of transmission of the disease [ 64 ]. In some jurisdictions, HIV/AIDS counselors are encouraged to patiently educate clients on the disease by communicating at the client’s level of understanding to ensure they gain substantial insight and knowledge about the condition [ 1 ]. Providing accurate information about the disease, its transmission, and treatment options can help dispel myths and misconceptions, thereby reducing discrimination and promoting acceptance within communities [ 65 ].

Participants also mentioned the provision of medication/treatment, counseling, testing, and educating persons living with HIV/AIDS about the disease as their responsibilities. The practice of HIV/AIDS counselors also acting as treatment providers is common in HIV/AIDS care across Africa. In Botswana for instance, HIV counselors are responsible for treatment and medication services for persons living with HIV [ 66 ]. As previously explained, the diverse roles fulfilled by HIV/AIDS counselors on the continent stem from the insufficient number of healthcare providers. Thus, HIV/AIDS counselors in the Volta region of Ghana are responsible for monitoring persons living with HIV/IDS regarding treatment adherence and managing medication side effects [ 67 ]. Comprehensive education of clients on HIV/AIDS through counseling is essential to raising awareness about the disease, improving treatment accessibility, and reducing stigma among people living with HIV [ 68 ]. This ensures that clients receive thorough and holistic guidance and support pre- and post-testing [ 69 ]. To offer comprehensive counseling services, HIV/AIDS counselors must be empowered. In this context, empowerment involves promoting the emotional well-being of clients and educating them on managing HIV/AIDS [ 70 ].

Moreover, providing social and financial support to clients was another responsibility undertaken by the HIV/AIDS counselors in the Volta region of Ghana, according to findings. Social support involves emotional, esteem, companionship, and informational support that HIV/AIDS counselors give to clients, while financial support involves providing monetary assistance or resources to persons living with HIV/AIDS [ 71 ]. Effective HIV/AIDS care encompasses not only medication management but also addressing the psychological, social, and economic aspects of an individual’s life [ 11 ]. Similar roles have been reported among South African HIV/AIDS counselors [ 72 ]. Although it is not their mandate to provide financial support, HIV/AIDS counselors, out of empathy, share their own money with some clients as they struggle with medication costs, transportation, and access to nutritious foods. This finding was also reported as a negative experience of HIV/AIDS counselors, where PLHIV lacked financial and social support, hampering their treatment process and outcomes. Therefore, stakeholders in the fight against HIV/AIDS could consider channeling funding through HIV/AIDS counselors who readily identify clients in financial need of assistance to improve treatment adherence and outcomes. Additionally, efforts should be made to strengthen support networks for PLHIV in the Volta region of Ghana.

Participants’ experiences as HIV/AIDS counselors included both positive and negative aspects in working with persons living with HIV. Positive experiences revealed by the study include the improvement in clients’ health status, counseling clients back to a normal psychological state, cooperation from clients, gaining knowledge on HIV/AIDS, and clients delivering HIV-negative babies. One of the most significant achievements for HIV/AIDS counselors is experiencing both losses and successes, with the restoration of clients’ health to normalcy [ 14 ]. This was identified as one of the cherished experiences among participants. According to Okal et al., counselors experience both losses and successes, with the restoration of clients’ health being a major source of happiness for them [ 73 ]. The joy stems from the fact that their counseling and educational efforts resulted in positive outcomes [ 74 ].

Another positive experience mentioned by participants was gaining knowledge on the disease and being able to calm a client down after testing positive for the first time. They highlighted the importance of gaining knowledge and experience in HIV counseling, which assists counselors in calming difficult clients. It is reported that it takes at least three years of working experience for counselors to gain the expertise needed to handle clients who test positive for HIV for the first time [ 75 ]. Given that all the study participants had practiced as HIV/AIDS counselors for no less than three years, this finding is well-supported. Thus, as a form of incentive, HIV/AIDS counselors in the Volta region should be provided with ongoing capacity-building training programs to optimize their operations [ 76 ].

With regard to the negative experiences, participants recounted clients denying their HIV status, treatment default, lack of cooperation from some clients, self-stigmatization, clients committing suicide due to a breach of confidentiality, and the myths that some clients hold about HIV/AIDS. Clients defaulting on their treatment was a significant concern for most participants, as it leads to negative health outcomes. Treatment default among HIV/AIDS clients is a major global challenge. For instance, in Nigeria, clients defaulting on treatment and medication have been one of the greatest challenges faced by HIV/AIDS counselors [ 77 ]. Unfortunately, some PLHIV often stop taking medication under the mistaken belief that they have been healed or remain in denial about the disease [ 78 , 79 ]. Even long-term HIV clients on ART often misinterpret undetectable test results, leading to noncompliance with the therapeutic regimen [ 53 ]. Therefore, client education programs could be established as an effective intervention strategy to improve treatment adherence and minimize treatment default [ 80 ].

Participants also raised concerns about self-stigma among people living with HIV. They mentioned that one of their biggest challenges was counseling clients out of self-stigma. Upon receiving an HIV- positive diagnosis, clients often experience self-pity, low self-esteem and social isolation. This hinders their treatment and recovery, as they may default on treatment or not receive the support they need. This challenge is also prominent among HIV/AIDS counselors in Nigeria [ 81 ]. Persons living with HIV often face rejection and stigmatization upon disclosure of their status [ 82 ], leading them to isolate themselves from society, loved ones, and healthcare providers.

Additionally, a client committing suicide due to a breach of confidentiality was identified as a negative experience. Confidentiality in HIV/AIDS treatment is crucial for the progress and success of treatment [ 83 ]. When clients do not trust healthcare providers to keep their HIV status private, they may change health facilities, opting for ones further from where they live, which can lead to financial strain and health complications [ 84 ]. To address this, healthcare providers should assure clients that their status will not be disclosed to a third party to maintain their trust and sustain them on treatment.

Finally, participants were concerned about the myths and misconceptions that some clients hold about the disease. Some clients believe that HIV is contracted through a charm or only affects those who lead promiscuous lives. According to Agyeman and colleagues, this is a long-held perception in Ghana [ 85 ]. Similar misconceptions are found in South Africa, where some believe that HIV can be transmitted through mosquito bites [ 86 ]. These may be attributed to the lack of education on the disease in Sub-Saharan African countries [ 87 ]. HIV/AIDS-related myths and misconceptions, if not addressed, could hamper HIV prevention and treatment efforts in the Volta region and across the country. Extensive education on the disease is essential to dispel these misconceptions and promote effective HIV/AIDS care.

Strengths and limitations of the study

The robustness of the methods, such as allowing both the participants and independent qualitative research experts to thoroughly review the transcripts and results before and after data analysis, coupled with the detailed description of the methods, strengthens the scientific and credible nature of the findings. However, the study sample was female-dominated, which could have skewed the responses obtained. Therefore, interpretation of the findings should be done with caution.

In this study, we ascertained the varied motives, responsibilities, and experiences of HIV/AIDS counselors in the Volta region of Ghana. Based on our findings, we conclude that by organizing capacity-building training programs for HIV/AIDS counselors in the Volta region and addressing the negative experiences they encounter, they could be empowered to provide effective counseling, curative, and social services to PLHIV in the region, leading to improved health outcomes for PLHIV.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Acquired Immune Deficiency Syndrome

Community-Based Health Planning Services

Human Immunodeficiency Virus

In-depth Interviews

Persons Living with HIV

Standards for Reporting Qualitative Research

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Mbuyiselo Douglas

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Veronica O. Charles-Unadike, Joyce Komesuor & Emmanuel Manu

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F.D., E.M., and M.D conceptualized the study. F.D., V.C., and J.K. collected the data. F.D., and E.M. analysed the data and drafted the manuscript. All authors reviewed and approved the manuscript.

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Dwomoh, F., Douglas, M., Charles-Unadike, V.O. et al. Motivation, responsibilities, and experiences of HIV/AIDS counselors in the Volta Region of Ghana: a descriptive phenomenological study. AIDS Res Ther 21 , 60 (2024). https://doi.org/10.1186/s12981-024-00648-x

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Received : 06 February 2024

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DOI : https://doi.org/10.1186/s12981-024-00648-x

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