Increasing spread of HIV/AIDS: The prospects and challenges in combating it

Introduction

Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome(HIV/AIDS) is a spectrum of condition caused by infection with the Human Immunodeficiency Virus (HIV) following initial infection, a person may experience a brief period of influenza like illness. This is typically followed by prolonged period without symptoms as the infection progresses, it interferes more and more with the immune system, making the person much more susceptible to common infections like tuberculosis as well as opportunistic infections(OIs)and tumors that do not usually affect people who have working immune system (Sepkowitz, 2001; Wilhelm, 2008; Klaus, 2010).

HIV is transmitted primarily via full unprotected sexual intercourse(including anal and oral sex),contaminated blood transfusion, hypodermic needles and from mother to child during pregnancy, delivery or breastfeeding, some bodily fluid such as saliva and tears do not transmit HIV (Will, 2007). The Human Immune Deficiency Virus(HIV) and Acquired Immune Deficiency syndrome(AIDS) is a major public health problem worldwide affecting both social and economic developments and also a cause for great concern all over the world. Attentions are more focused on the issue because of high morbidity associated with HIV/AIDS. This global health epidemics has created terrible burdens and health threat for millions of individual, families and community(WEBMED).

As at 2010, there are over 75% living with HIV/AIDS(PLWHAS) in the Sub-Saharan African. According to the Joint United Nation Programme on AIDS (UNAIDS) estimate as December 1991 that 5.4 million of people are newly infected with HIV.

Approximately 32.4 million are adult, 14.8 million women .And 1.2 million are children under fifteen Years. Also 2.6 million AIDS death. 2.1 million adult, 1.1 million women ,and 470,000 children. Total number of AIDS death since the beginning of the epidemic was about 12.5 million(2.7 million adult, 6.2 million women, 3.6 million children).HIV is a global pandemic. As of 2012, approximately 35.3 million people have HIV Worldwide with the number of new infections that year being about 2.3 million.

As of 2012, in Nigeria, the HIV prevalence rate among adult age 15-49 was 3.1 percent. Nigeria has the second largest number of people living with HIV. HIV epidemic in Nigeria is complex and varies widely by region. HIV/AIDS is a global pandemic as of 2014, approximately 37 million people have HIV world with the number of new infections that year being about 2 million. This is down from 3.1 million new infections in 2001. Of these 37 million more than half are women and 2.6 million are less than 15 years old. It resulted in about 1.2 million deaths in 2014, down from a peak of 2.2 million in 2005 (Cohen & Hellmann, 2015).

Overview of HIV/AIDS

HIV was discovered to be the cause of AIDS in 1983. It is said to have being originated in monkey and have first infected humans in the mid 20th century. HIV have caused several and ultimately fatal failure of the immune system to protect the body against many kinds of infection, resulting in health complications that are collectively referred to as AIDS.

According to Leleji(2004), opined that HIV/AIDS pandemic has devastated lives of individual, families and community in nearly every country on earth. HIV/AIDS has being causing great suffering and death to individual and families.

He then further explains vividly the term HIV/AIDS as follows:

H: Human: The virus is only found in the human system and not on animals, insects or non living things. This virus can be spread from one infected person to another .the virus breaks down the body immune system i.e. the body defense against infections and diseases, rendering the body vulnerable to other infections.

I: Immunodeficiency: This is the weakening of the body ability to fight against infections. This weakness brings about the group of illness called AIDS.

V: Virus: This is a tiny microorganism that cannot be seen with our naked eyes but by the aid of a microscope. It is only through blood test or serum test, that one can determine whether the virus is present or not. It is usually described as sero-negative or sero-positive.

The virus act the T-lymphocytes of the white blood cell which constitutes the body defense cell(immune system) and multiply in the cell eventually destroying them.

A:Acquired:(Not inherited) getting the virus from somebody else who is HIV/AIDS positive or who is already infected with the virus. This refer to the fact that the virus that causes AIDS is something people .ca obtain or get through sexual contact or other possible means like; blood contact ,serum contact or transplacenta which is from infected mother to her unborn child through the placental.

I: Immune: Immune here refers to immunity of the defense cell or immune system that is the ability to resist infections or fight against disease. Immunity means protection against specific diseases. The immune system is the system in the body that fight and disease .It’s functions is to stop any virus or foreign body from entering the body .It does this by producing antibodies that fight or eliminate the virus or foreign body from the person body attacked.

D: Deficiency: It means inefficient or shortage. In discussing AIDS, the word deficiency goes with immune deficient or lacking immunity (ability to resist infections) this means that the immune system has been weakened, and so it is not working as it should, protect infected individual against other infections and diseases.

S:Syndrome: This refer to a variety of different symptoms and diseases the grouping of the illness connected with AIDS, makes AIDS a syndrome as at present, HIV/AIDS has no cure.

Mode of transmission of HIV

HIV can only be transmitted from an infected person to another through direct contact of body fluids such as ;

Blood (including menstrual blood).
Semen/Cum/precum/ejaculate.
Vaginal secretions.
Breast milk.

The World Health Organization(WHO) Identify three main routes of HIV transmission among the general population.

The first one is though unprotected sexual intercourse may result in the transmission and constitute the single most important HIV transmission route. Given the predominate role that heterosexual transmission plays in the HIV epidemic in Africa. It is not surprising that this epidemic (Panda, 1988). Larso(1989) has also described the role that organization of the commercial sex industry and the availability of casual sex partner can play in the spread of HIV in the Country.

Exposure to blood mainly through transfusion and needle sharing is the second most common route of transmission. HIV sero-prevalence data from blood many countries, especially in Nigeria, represent readily accessible sample for in monitoring changes in HIV infection among population samples in several areas raises question regarding the representativeness of the blood donor sample (Torry & Way,1990).

The prenatal or substantial vertical (mother to child) transmission constitutes the third main or major routes of HIV transmission. As of 1992, WHO estimated that along 6.5 million adults infections 750,000 HIV infected infants had been born in Africa (WHO,1992).Pregnant women do transmit the virus(HIV) to their babies during pregnancy or birth and also through breast milk .Nevertheless ,in Nigeria, data on pregnant women provide the most representatives picture of HIV infection in the general population(LUTH Unpublished).

Early case histories were separated out into risk group base on the social behaviors and medical needs. therefore, we can classify the following sub group demonstrated to be at risk for HIV infection .They are homosexuals and bisexual, multiple heterosexual contact, intravenous drugs users, blood product transfusion recipients and children those parents are at risk.

According to Center for Disease Control and Prevention (CDC 2001). The most common ways teenagers get HIV/AIDS is having unprotected casual sex with infected person. Some teenagers becomes infected from sharing needles and syringes with someone who have HIV, also through blood transfusion but this is now rare due to proper screening of blood.

The above sources has also revealed that nearly half of all HIV positive teenager female are infected through sex with men This source of transmission among the teenagers is very high because teenagers use sexual behaviour to meet need of friendship, intimacy and peer approval Stages of HIV/AIDS

According to NIHAIDS info-stages of HIV Infection,

Without treatment, HIV advances in stages, overwhelming your immune system and getting worse over time. There are three (3) stages of HIV infection, which are;

(1) Acute HIV infection (2) Clinical latency (3) AIDS (Acquired immunodeficiency syndrome).

However there is good news by using HIV medicines (called antiretroviral therapy or ART) Consistently, you can prevent HIV from progressing to AIDS.

Acute HIV infection stages

Within 2-4 weeks after HIV infection, many but not all people develop flu-like symptoms often described as the worst flu ever. Symptoms can include fever, swollen glands, this is called Acute Retroviral syndrome(ARS) or primary HIV infection, and it is the body natural response to the HIV infection.

During this early period of infection, large amount of virus are being produced in the body .The virus uses CD4 count to replicate and destroy them in the process. Because of this, your CD4 Cells can fall rapidly. Eventually your immune response will be to bring the level of the virus in your body back down to a level called a viral set point which is relatively stable level of virus in the body. At this point, the CD4 count begin to increase, but may not return to reinjection levels, it may be particularly beneficial to health to begin ARVs during the stage.

During the acute HIV infection stage, you are at high risk of transmitting HIV to your sexual or drugs using partners because the levels of HIV in the bloodstream are very high. For this reason, it is very important to take steps to reduce the risk of transmission.

Clinical latency stage

After the acute stage of HIV infection, the disease moves into a stage called the clinical latency stage. Latency means a period here a virus is living or developing in a person without producing symptoms. During the clinical latency stage, people who are infected with HIV experience no symptoms, or only mild ones(this stage is sometimes called asymptomatic HIV infection or Chronic HIV infection). During this stage, the HIV virus continues to reproduce at very low levels, although it is still active.

If someone is HIV positive and not on ART(antiretroviral therapy), then eventually the viral load will begin to rise and the CD4 count will begin to decline. As this happens, the person may begin to have constitutional symptoms of HIV as the viral level increases in the body.

AIDS

This is the stage of HIV infection that occurs when your immune system is badly damaged and you become vulnerable to opportunistic infections. When the number of the CD4 cells falls below 200 cells per cubic millimeters of blood(200cells/mm3),he/she progressed to AIDS (in someone with healthy immune system, CD4 count are between 500 and 1600 cells/mm³).

Without treatment, people who progresses to AIDS typically survive about 3 years. Once you have dangerous opportunistic infections, life expectancy without treatment falls to about 1 year. However, if you are taking your ART and maintain a low viral load, then you may enjoy a near normal life span (NIHAIDS info-stages of HIV infection).(web-U.S Department of health and human services).

Signs and symptoms of HIV/AIDS

According to Centers for Disease Control and Prevention (CDC 2004) signs and symptoms of HIV/AIDS varies depending on the phase or stage of infection.

Early signs (within the first week) when first infected with HIV, you may have no sign or symptoms at all, although you are still able to transmit the virus to another. Many people develop a brief flu-likeliness two to four weeks after becoming infected such as fever, headache, sore throat, tiredness and swollen lymph nodes in the neck, armpits or groin.

Later signs or years later, you may remain symptom free for years but as the virus continues to multiply and destroy immune cells, which the individual may develop mild or chronic symptoms such as recurring fever, profuse night sweat, profound and unexplained fatigue, swollen lymph nodes in the armpits, neck or groins, unexplained chronic diarrhoea lasting for more than one month.

Weight loss of more than 10% of body weight.
Pulmonary tuberculosis pneumonia(bacterial infection)
Oral and vaginal candidate (thrust)
Mouth ulcer.
Herpes zoster(shingles)
Kaposi sarcoma.
Memory loss, depression and other neurological disorder.

With initial HIV infection you cannot rely on these signs and symptoms to establish a diagnosis of AIDS, because these symptoms are similar to symptoms of many other illnesses, according to CDC. So screening with an enzyme linked immunosorbet assay(ELISA) is done with a confirmatory test with a more specific supplement test e.g. Western blot to diagnose the HIV/AIDS infection.

Factors responsible for the increasing spread of HIV/AIDS

Many researchers have been carried out to show the prevalence of HIV/AIDS among women. Standing and Kisekka(2012)reported that research in HIV/AIDS is increasingly recognizing the socio cultural, economic, environmental and political dimensions of the epidemic.

Another factors contributing to the high level of HIV transmission is environmental elements like sanitation, diet, unavailable health care and malnutrition. These contribute to the individual’s vulnerability to opportunistic infections(Anarfi,2010).A number of studies of HIV infection have identified risky behaviour such as non-regular multiple partnership, which may be serial or concurrent. Morris and Kretschmar (2012) identified the use or non use of condoms, use of contaminated needles and skin piercing instruments and blood transfusion as a contributing factors in the spread of the disease.

Another transmission pattern of HIV on Nigeria has been associated with the movement of soldiers, especially those that were sent on peace keeping operation, most of them returned with the virus, only to in turn infect their wives. According to Obbo(1993) barracks in Lagos state such as Ojo cantonment in Ojo, Bonny camp in Victoria Island and air force barrack in Shogunle experience high rate high of HIV infection following the arrival of military personnel dealing with unrest situation.

Prostitution is one of the oldest trades in the world, women and young girls constitute the bulk of those engage in this trade and this has constituted a major source for the spread of the HIV/AIDS among women. Apart from engaging in prostitution, some researchers have also discovered that seaports and high ways connecting big urban centers and connecting Nigeria with the outside world are powerful foci fir the spread of HIV in the 90’s due to population movement associated with the trade. Prostitute are also draw into such areas, truck drivers, fishermen and traders engaged in sexual behavior with several women, many of them contacted the virus only to return home to infect their wives.

Also cultural and socioeconomic factors are contributory factors that increase the spread of HIV/AIDS. Poverty and HIV transmission are linked in variety of ways. Poverty also leads to prostitution, young women may be especially vulnerable due societal practices that deny them education and job opportunities. Poverty also leads to poor nutrition and a weakened immune system making poor people more susceptible to tuberculosis and STDs. (Mandell, 2014).

Several traditional practices such as child marriage, female genital mutilation, scarification, tattooing, wife inheritance and polygamy have increased the epidemic among women and girls. Caldwell, Pieris and Ichuda (1999) opined that women and girls are particularly vulnerable to contacting AIDS for social, cultural, economic and even physiological reasons. According to them, greater risk arises from practices that encourage girls to accept older men as partner to preferences to their peer. Customs such early marriage, women inheritance of a deceased brothers wife and other sexual practices etc makes the rate of infection higher in girls than in boys, there is female-male ratio 38:1 in Africa (WHO, 2004).

Also, lacks of awareness as regards to the stigma associated to people that are already infected. Because of the stigma, some people who are infected fail to confront its head on by going to do the right authorities for proper control measure and also because of the stigma that is involved, so people are even scared of going their status for the normal three month basis, and according to them, they prefer not to know and die of it than knowing that they have it. And you will agree with me that someone is infected without even knowing would definitely keep on spreading it unknowingly too even though there are some people who know they have it yet they spread it .

Measures to combat the threat of HIV/AIDS

In order to combat ignorance on the threat of HIV/AIDS, CDC (2012)

Preventive education should be put in place in order to change the cultural habit (particularly women more vulnerable to infection)
Health education programme must reach girl and woman to equipped them with information and skills that can help them protect themselves against HIV/AIDS
Preventive education must occur through all avenues of education (formal and nor-formal) for it to be effective. It should also match the various linguistic, social, cultural realities of the groups being address.

Prospects and challenges associated in combating HIV/AIDS

Challenges associated in combating the spread of HIV/AIDS are:

Most people lack information about the HIV/AIDS infection, so they don’t know how it can be contacted thereby making them feel that virus does exist. And some people still sees the virus as a spiritual sickness.
Regular HIV/AIDS screening also helps a lot in combating the spread. Most people don’t have the courage of going to the hospital to carry out the test and the stigma attached to it, they don’t want others to know they have HIV/AIDS so they won’t even want to go to the health facilities for proper management thereby resulting to full blown AIDS.
Most people don’t use barrier method (condoms) when having sexual intercourse. Some of the youth don’t use condom because they think they are saving their relationship even infect married men transfer it to innocent teenagers telling the girls they are married and cannot be a carrier of the virus
Most female are involved in commercial sex business and because of these acts the female are infected more compare to that of male.
And how it infect the new born, the expecting mothers never knows her stays because they won’t attend ante natal where proper screening will be carried out on them. They prefer going to the pharmacist to buy their routine drugs and also go to TBAs(traditional birth attendants).

References

Anarfic,J.K.(1997). Vulnerability to sexually transmitted diseases, stress children in Accra. Health Transmission Review 7, 281-306.

Caldwell,B. & Ichuda, B. (1999). Sexually regimes and sexual networking: The risk of an HIV/AIDS epidemic in Bangladesh. Social Science & medicine .

Center for disease control and prevention CDC 2001,2004.

Federal Ministry of Health ( FMOH)(HTC) ,training manual 2006,

Kisekka, S. (1989) Preventing and mitigating (social behavior) AIDS in Sub Saharan Africa.

Larso, M. (1989). Preventing and mitigating AIDS in Sub-Saharan Africa.

Mandell, G. F. (2014). Principles and practice of infectious diseases (7^th ed.). Philadelphia, PA: Churchill Livingstone.

NIHAIDS info-stages of HIVWeb-Us Department of Health and human service.

Obbo,C.(2002). HIV transmission through social and geographical network in Uganda.

Pandian,N. (1988) prostitute women & AIDS Epidemiology

PLWHAS People living with HIV/AIDS (WEB)

Septowitz, K.A. (2001) AIDS-the first 29yrs .N.England .J.Med.

Torry,M.& Way, P (2004)”Blood donor and AIDS in Africa.

UNIAIDS United Nations programs on HIV/AIDS,report on the global AIDS epidemic.