HIV/AIDS

Introduction
HIV, which stands for Human Immunodeficiency Virus, is a virus that attacks the immune
system, specifically the CD4 cells (T-cells), weakening the ability of the body to effectively fight
infections and diseases. Over time, if left untreated, HIV can progress into a more advanced
stage known as AIDS (Acquired Immunodeficiency Syndrome), where the immune system
becomes severely compromised.
HIV is primarily transmitted through the exchange of certain body fluids, such as blood, semen,
vaginal secretions and breast milk. Unprotected sexual intercourse, sharing contaminated needles
or syringes, mother to child transmission during child birth of breast feeding and in rare cases,
through contact with contaminated blood are means of HIV transmission. It is important to note
that HIV can affect individuals of any age, gender, sexual orientation or background. It carries
significant social and psychological perspectives as well, tackling issues such as stigma,
discrimination and lack of access to healthcare services.
Efforts are underway on a global scale to combat the HIV/AIDS epidemic, including awareness
campaigns, education programs and improved access to medications and healthcare services.
Understanding and awareness of HIV, combined with prevention strategies and early detection
play a vital roles in curbing the dispersion and impact of the virus.
While there is currently no cure for HIV, substantial progress has been made in the field of
treatment and prevention. Antiretroviral therapy (ART), a combination of medications ensures
long-term management of the infection, slowing its progression and reducing the risk of
transmission. Additionally, practicing safer sex, using sterile needles, early diagnosis and regular
testing contributes to both individual well-being and controlling its spread.
HISTORICAL PERSPECTIVE:- Since the original description in 1981 of an unusual cluster
of cases of Pneumocystis carinii pneumonia and Kaposi's sarcoma in previously healthy
homosexual males, substantial advances in our understanding of the acquired immune deficiency
syndrome (AIDS) have been achieved. The identification of a cytopathic retrovirus in 1983 and
development of a diagnostic serologic test for HIV-1 in 1985 have served as the basis for
developing improvements in diagnosis.
In addition, therapy was dramatically altered with the introduction of antiretroviral drugs in 1987
and revolutionized by combination treatment, known as highly active antiretroviral therapy
(HAART), in 1996. In the three years following the introduction of HAART, mortality, AIDS,
AIDS-defining diagnoses, and hospitalizations all decreased 60 to 80 percent. The Euro SIDA
study, comparing this early HAART period to pre-HAART and later HAART (1998 to 2002)
treatment periods, found a sustained decrease in mortality and progression to AIDS with ongoing
HAART. Despite the absence of a cure, the natural history of the disease was radically changed.
Despite these advances, it is still useful to review the natural history of HIV infection without
antiretroviral therapy and the classification of disease. Although modified from the initial case
definition, the newer Centers for Disease Control and Prevention (CDC) classification system
remains the cornerstone for diagnosing HIV and AIDS.
According to the Joint United Nations Program on AIDS (UNAIDS) Gap Report 2018, globally,
there were 36.9 million people living with HIV and 21.7 million people accessing antiretroviral
therapy at the end of 2017. This number is rising as more people are living longer because of
antiretroviral therapy, alongside the number of new HIV infections—which, although declining,
is still very high. An estimated 0.8% of adults aged 15–49 years worldwide are living with HIV,
although the burden of the epidemic continues to vary considerably between regions and
countries. There are 1.8 million children younger than 15 years living with HIV.
The Eastern and Southern Africa remains the region that is most severely affected. In 2017, there
were an estimated 19.6 million people living with HIV in this region, nearly 53.1% of the global
total. Ten countries – Ethiopia, Kenya, Malawi, Mozambique, Nigeria, South Africa, Uganda,
United Republic of Tanzania, Zambia and Zimbabwe – account for 81% of all people living with
HIV in the region and half of those are in only two countries – Nigeria and South Africa. In sub-
Saharan Africa, three in four new infections are among girls aged 15–19 years and young women
aged 15–24 years are twice more likely to be living with HIV than men.
The primary contributor to the scale of the epidemic in this region is heterosexual transmission
and the increased vulnerability to and risk of HIV infection among adolescent girls and young
women. AIDS-related mortality declined by 42% from 2010 to 2017 in eastern and southern
Africa, reflecting the rapid pace of treatment scale-up in the region. A significant decline (48%)
was seen in South Africa and other countries that recorded major declines in AIDS-related deaths
include Rwanda (76%), Eritrea (67%), Ethiopia (63%), Kenya (60%), Botswana (58%), Burkina
Faso (58%), Zimbabwe (57%), Malawi (51%) and the United Republic of Tanzania (44%). This
success is directly due to the rapid increase in the number of people on antiretroviral therapy.
The region has witnessed an expansion in the coverage of HIV treatment to record numbers of
people for the past three years.
The first evidence of HIV epidemic in Ethiopia was detected in 1984. Since then, HIV/AIDS has
claimed the lives of millions and has left behind hundreds of thousands of orphans. The
government of Ethiopia took several steps in preventing further disease spread, and in increasing
accessibility to HIV care, treatment and support for persons living with HIV.
According to the Ethiopian Demographic and Health Survey 2016 (EDHS 2016), the national
HIV prevalence is 0.9%.; the urban prevalence was 2.9%, which is seven times higher than that
of the rural (0.4%). The 2016 EDHS also show that the HIV prevalence varies from region to
region ranging from less than 0.1% in Ethiopia Somali to 4.8% in Gambella. Furthermore, the
2018 spectrum HIV estimate indicate that the 2017 HIV prevalence in regions ranges from
0.16% to 4.34%.
In 2017, around 414,854 adults and 21,146 children under the age of 15 are taking ARV. Based
on the spectrum estimate, the 2017 ART need is 551,630 for adults and 62,194 for children under
15 years of age. Free ARV service was launched in January 2005 and public hospitals start
providing free ART in March 2005. Recently ART service is being available in more than 1361
health facilities of which around 909 are health centers. Based on the new spectrum estimate for
2017, ART coverage for adults (age >15) has reached 75% but the coverage remains low (34%)
for children (age <15) living with HIV.

References
 Uptodate Version 21.6
 National Comprehensive HIV Prevention, Care and Treatment Training for Healthcare
Providers, participants manual, 2021
 Ethiopian National consolidated guidelines for comprehensive HIV prevention, care and
treatment, 2018