The human immunodeficiency virus (HIV) has claimed more than 35 million lives around the world and remains a major threat to global public health, with an estimated 1.0 million people dying from HIV-related causes in 2016 alone. Approximately 36.7 million people were living with HIV worldwide at the end of 2016, the majority of them in sub-Saharan Arica. Roughly 1.8 million people became newly infected with the virus in 2016. Only 70 per cent of people currently infected with the virus know their status.
One tenth of people living with HIV/AIDS are children under the age of 15, with over 1,000 becoming infected every day. Without treatment, half of all infants with HIV will die before their second birthday.
HIV gradually breaks down the immune system – usually over a three- to 15-year period, although 10 years is more usual – leading to acquired immunodeficiency syndrome, or AIDS. As immunodeficiency progresses, people begin to suffer from opportunistic infections. The most common opportunistic infection, which often leads to death, is tuberculosis.
For more information: WHO HIV/AIDS fact sheet
- Transmission: HIV is most commonly spread by sexual activities and the exchange of body fluids. It can also be transmitted through childbirth, breastfeeding and sharing needles.
- Signs and symptoms: Some people develop symptoms similar to flu within the first two to six weeks of contracting the virus; others may not show symptoms for many years while the virus slowly replicates.
- Diagnosis: Simple blood tests can confirm HIV status, but many people live for years without symptoms and may not know they have been infected.
- Treatment: There is no cure for HIV/AIDS, although life-long treatments are much safer and more effective than they used to be. Combinations of drugs known as antiretrovirals (ARVs) help combat the virus and enable people to live longer, healthier lives.
- Prevention and control: The primary tools for HIV prevention include condom use, voluntary medical male circumcision, the use of ARVs for prevention of mother-to-child transmission and pre- and post-exposure prophylaxis, and harm reduction programmes for injecting drug users. Continuous adherence to ARV treatment reduces HIV viral load to very low levels, reducing the risk of onward HIV transmission.
In 2000, MSF began providing ARV treatment to a small number of people living with HIV/AIDS in projects in Thailand, South Africa and Cameroon. At the time, MSF witnessed first hand the toll that HIV/AIDS was taking on communities in lower-income countries, and there was much internal debate about whether or not MSF should get involved with ARV treatment provision. At the time, treatment cost more than US$10,000 per person per year and some questioned whether treatment was too complex to be used successfully in low-income countries. Research conducted by MSF in Uganda, Kenya, South Africa, Malawi and Thailand played a historical role in demonstrating the feasibility and effectiveness of HIV treatment in resource-limited settings. Coupled with activists’ work to bring down the cost of drugs, this evidence helped drive efforts to scale up access to lifesaving ARV treatment.
MSF now provides ARV treatment to nearly 250,000 people in 18 countries, implements treatment strategies to reach more people earlier in their disease progression, and places people living with HIV at the centre of their care. MSF focuses on community models of care, which separate appointments to see a doctor or nurse for a check-up (which is only necessary once or twice a year for patients whose HIV treatment is working optimally) from picking up a supply of daily ARV drugs (which, depending on the context, can be as often as once every month).
In addition to treatment, MSF’s comprehensive HIV/AIDS programmes generally include health promotion and awareness activities, condom distribution, HIV testing, counselling, and prevention of mother-to-child transmission (PMTCT) services. PMTCT involves the administration of ARV treatment to the mother during and after pregnancy, labour and breastfeeding, and to the infant just after birth.
While progress has been made in recent years, persistent treatment gaps in many countries threaten lives and compromise globally agreed goals to curb the HIV epidemic by 2020. In most of the 25 countries of West and Central Africa, for example, fewer than one-third of those in need of ARV treatment receive it. The international community’s narrowing focus of support on high-burden countries and HIV ‘hotspots’ in sub-Saharan Africa has led to greater neglect of people in West and Central Africa. These lower-prevalence regions account for one in five new HIV infections globally, over one in four AIDS-related deaths, and nearly half of all children infected by the virus.
MSF provided first-line ARV treatment for 222,200 people and second-line ARV treatment for 10,200 people in 2016.
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