HIV Global

What's the Problem?

At the end of 2007, approximately 33 million people were living with HIV infection. Sub-Saharan Africa remains the region most heavily affected by HIV, accounting for 67% of all people living with HIV and for 75% of AIDS deaths in 2007. Women account for half of all people living with HIV worldwide, and for nearly 60% of HIV infections in sub-Saharan Africa. In 2007 there were 2.7 million new HIV infections and 2 million HIV-related deaths. Globally, 2 million children younger than 15 years were living with HIV in 2007 (1). In addition, more than 14 million children have lost one or both parents to HIV/AIDS (2).

HIV is a virus that suppresses the immune system of an infected person. It targets and destroys particular white blood cells (CD4 cells, a type of T cell) that the immune system must have to fight disease. The virus is transmitted from person to person through contact with HIV-infected blood or other infected bodily fluids such as semen.

HIV can remain in the body for 10 or more years without causing outward signs of illness. However, as HIV-related immune destruction progresses, symptoms may include enlarged lymph glands, depression, fatigue, fever, yeast infections of the mouth and vagina, night sweats, diarrhea, loss of appetite, loss of memory, and weight loss. The HIV-infected person also is more susceptible to illnesses that usually do not affect healthy people. These are called opportunistic infections, meaning that they take advantage of a weakened immune system. Several characteristic opportunistic infections are PCP (Pneumocystis carinii pneumonia), yeast infections of the esophagus, TB (tuberculosis), Kaposi's sarcoma, and CMV (cytomegalovirus). An HIV-infected person is considered to have AIDS when their CD4 cell count falls below 200/mL. AIDS is also characterized by the appearance of opportunistic infections. In the majority of cases, the absence of treatment once AIDS is acquired leads to death.

Who's at Risk?

The HIV virus spreads through blood and bodily fluids, so anyone engaging in unprotected sex (anal, vaginal, or oral) can become infected. Individuals with multiple sex partners, including commercial sex workers, and injection drug users are also at increased risk. In many developing countries, women and children are particularly vulnerable due to cultural norms related to age and sex, which makes them less empowered to negotiate safe sex (e.g., sex with condoms, which block the HIV virus). Groups with high levels of mobility, whether voluntarily, as for migrant workers, or forced, as for refugees and internationally displaced persons, have increased susceptibility to HIV transmission (3). Isolation from families and communities has been associated with increased risky behaviors (4).

A pregnant woman who is infected with HIV can also transmit the virus to her child during her pregnancy, as well as during childbirth and while breastfeeding.

It is important to know that HIV cannot be transmitted through casual contact such as shaking hands, or from objects such as toilet seats.

Can It Be Prevented?

Yes, there are many ways to prevent HIV transmission. These include abstaining from sex, having sex with only one—also monogamous and uninfected—partner, and using a condom while having sex. Individuals should also avoid sharing injection drug needles. Drug regimens and microbicides are under review as to their effectiveness in preventing HIV transmission. Additionally, properly performed medical male circumcision has been shown to reduce the chance of heterosexual HIV infection in men by 60% (5).

However, there are barriers to reducing risky behaviors, including social stigma, lack of awareness of testing facilities, false perception of risk, perceived lack of support systems, and fear of partner abuse or rejection if asked to wear a condom or get tested for HIV.

For a person living with HIV, treatment with a regimen of antiretroviral drugs (ARVs) can significantly delay the onset of AIDS. Rates of HIV transmission during pregnancy can be reduced significantly when antiretroviral therapy is initiated and adhered to during pregnancy. Other preventive measures for expectant mothers include getting appropriate medicine as they go into labor, delivering via cesarean, not breastfeeding the baby, and giving the infant appropriate ARVs.

The Bottom Line

HIV is a deadly disease that is transmitted from person to person through bodily fluids, such as blood or semen. HIV can be transmitted through sexual contact, or through contact with HIV-infected blood (such as through shared needles). HIV cannot be transmitted through casual contact such as shaking hands. HIV can be prevented but as of now cannot be cured. However, it can be managed by treatment with ARVs that can delay the onset of AIDS. Social consequences of HIV infection are stigma and discrimination because AIDS is associated with marginalized groups, sexual promiscuity, and death.

Case Examples

1. Bakari's wife, Ayana, is pregnant with their first child when they learn that she is HIV-positive during a clinic visit. Ayana says she has never been with another man and suggests that perhaps she may have gotten it from shaking hands with a neighbor who has AIDS. Nevertheless, Bakari throws his wife out of the house. Relatives talk with him and persuade him to get tested for HIV. As it turns out, he is also HIV-positive. He remembers that he had several relationships with commercial sex workers a few years earlier when he was working at the gold mine away from home and may have gotten it then. He takes his wife back and they both began treatment with antiretroviral drugs. Ayana delivers a healthy baby boy who will carry the family name.
2. Ester is an 11-year-old girl from Namibia. She lost her mother five years ago and her father two years later. She is now living with her aunt and uncle, and for the past six months has refused to go to school because her skin rashes have grown bigger and will not heal. She has known for a while that she is HIV- positive because her mother told her before she died. Ester has been taking antiretroviral drugs ever since. She says that she is no longer shocked she contracted it from her parents. She will continue to take the drugs as prescribed and live with the disease (6).