World Aids Day ,December 1 2019|Neelima MOM Fertility Center
World AIDS Day is celebrated on December 1 every year since 1988. It is dedicated to raise awareness, educate and improve the understanding of HIV as a global public health problem. It provides an opportunity to understand the interdependence between progress in ending Acquired Immunodeficiency Syndrome (AIDS) and progress towards universal health coverage and the right to health.
Everyone, regardless of who they are or where they live, has a right to health, which is also dependent on adequate sanitation and housing, nutritious food, healthy working conditions and access to justice. This year’s World AIDS Day campaign promotes the concept of “Right to health”.
World AIDS Day 2017 theme is “My health, my right”. The World Health Organization (WHO) highlights the need for all 36.7 million people living with HIV and those who are vulnerable and affected by the epidemic, to reach the goal of universal health coverage.
Universal health coverage in HIV means:
- Leaving no one behind
- Integrated care for HIV, TB, and broader health
- Access to good quality services
- Affordable and long term care for people living with HIV
- Building stronger HIV response for the stronger health system.
Remarkable progress is being made on HIV treatment. According to a report from UNAIDS (Joint United Nations Programme on HIV/AIDS) in June 2017, nearly 21 million people living with HIV are now on treatment. In 2000, just 685000 people living with HIV had access to antiretroviral therapy.
In India, 2.1 million people are living with HIV (2015 report). According to the National AIDS Control Programme, the annual AIDS-related deaths have declined by 54 percent and new HIV infections dropped by 32 percent between 2007 and 2015.
What is HIV/AIDS?
Infection caused by the Human Immunodeficiency Virus (HIV) in the human body results in a weakening of people’s immune system ( defense system) against infections and some types of cancer. This immunodeficiency results in increased susceptibility to a wide range of infections, cancers and other diseases that people with healthy immune systems can fight off.
The most advanced stage of HIV infection is called as Acquired Immunodeficiency Syndrome (AIDS). It is defined by the occurrence of any of more than 20 opportunistic infections or HIV-related cancers.
Signs and symptoms:
- The symptoms of HIV vary depending on the stage of infection. The first few weeks after initial infection, individuals may experience no symptoms or an influenza-like illness including fever, headache, rash, or sore throat.
- As the infection progresses, an individual can develop other signs and symptoms, such as swollen lymph nodes, weight loss, fever, diarrhea, and cough.
- Without treatment, they could develop severe illnesses such as tuberculosis, meningitis, severe bacterial infections, and cancers.
How is HIV transmitted?
- Sexual Contact: The most frequent mode of transmission of HIV is through sexual contact with an infected person.
- Sharing needles or syringes: HIV can be transmitted through needles and syringes contaminated with HIV infected blood.
- Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIV can result in HIV infection.
- From mother to child: A pregnant woman infected with HIV can transmit the virus to a child during pregnancy, birth, or breastfeeding.
Pregnancy, already a challenge in itself becomes further complicated when the mother is infected with HIV. However, medical advances have not only made HIV pregnancy-safe but have also reduced the chances of the baby contracting the virus
Unlike viral flu, HIV does not spread by contact, breathing the same air or through food and water. HIV can be spread in ways similar to the Hepatitis B virus
Sexual intercourse (most common)
Blood/ blood-contaminated products/other body fluid/ organ transplantation
Vertical transmission: From mother to child via the placenta or breast milk
The chance of transmission depends on the viral load, which is the number of viruses per ml of the blood. Also, during pregnancy, high levels of the hormone progesterone increase the level of virus receptors. This aids the entry of virus and increases the chance of transmission
HIV in pregnant women has symptoms depending on how low immunity is. Your doctor would check the immune status by asking for the CD4 count. CD4 is a type of blood cell that helps the body is the immune system and a low count of it is a strong indication of AIDS. Various problems that AIDS can cause are
- Infections: As the CD4 count falls, more serious and deadly infections set in, tuberculosis is the most common.
- Cancer: Various forms of cancer are common in AIDS. Women may suffer from genital tumors which may be cancerous
- STDs: Other sexually transmitted infections in addition to HIV like syphilis may add to the problem for the mother and child
Factors which increase the Risks Associated with Transmission of HIV
Viral load: The most important factor that determines the transmission is the viral load in the mother. But viral load in the blood may differ from that in the genital secretions. So, the transmission through genital secretions may occur even before it is detectable in maternal blood in some cases.
Pre-term delivery: There is a four-fold increased risk of a baby being exposed to HIV in a pre-term deliver
Breastfeeding: If you are breastfeeding your baby, there is a 30-40% chance that your baby will be infected by the virus.
Mode of transmission: The mode by which the mother acquired HIV also determines the rate of transmission. If it was a sexually transmitted infection, the rate of vertical transmission to the baby is higher
Initiation of anti-HIV treatment: The period of gestation at which the anti-HIV treatment was initiated to the mother affects the transmission to the baby
Medical intervention: Some medical producers did during delivery like forces application, artificial rupture of membranes, and invasive fetal monitoring increase the risk of transmitting the virus from the mother to the baby
Should pregnant women get tested with HIV?
It is mandatory for all pregnant women to undergo screening HIV Tests in some countries (opt-in approach) whereas in others the mother has the right to refuse after being counseled and informed about HIV (opt-in approach). pregnant women who are injectable drug users, prostitutes along with those who have HIV- infected sexual partners, multiple sexual partners or are diagnosed with an STD are recommended to repeat the test in the last trimester
Effect of HIV on the mother’s and baby’s’ health:
If the CD4 count is maintained high and the viral load is kept low it does not grossly affect the outcome of your pregnancy.
Effects on mother’s health:
The mother is at high risk of various infections that can be life-threatening various cancers, both benign and malignant are common in AIDS which may affect the course of pregnancy-related complications like preterm labor, hypertension, diabetes are common in HIV positive cases.
Effect on baby’s health:
An HIV Positive mother can also infect the baby .the infections acquired by the mother can be transmitted to the baby which can be life-threatening.it can potentially affect all the bodily functions of the baby
Does the cesarean Delivery reduce the risk of mother to child transmission of HIV?
There is only a 50% chance of the baby contracting the HIV virus if they are delivered via cesarean birth.in addition, the risk of transmission reduces by 87% when a cesarean section is combined with anti-HIV treatment.
Will my Baby need treatment after birth?
Yes, Babies born to HIV positive mothers are given HIV treatment for 4-6 weeks after birth. this reduces the HIV multiplication if any, and protects the child.
Preventing mother to child transmission of HIV & it’s Challenges
Antiretroviral therapy (ART) is the anti-HIV medicines used as a remedial measure.ART plays a major role in preventing mother to child transmission of HIV. Being HIV positive and pregnant has a lot of challenges such as social stigma non-medical hospital staff being hesitant to approach the patient. many women suffer from anxiety in revealing that they have HIV make them outcasts
Here are some preventive measures which you keep in mind if you are trying to get pregnant :
Planning pregnancy: if you are planning to get pregnant get yourself tested for HIV.if you test positive start right away with antiretroviral therapy .this will not only reduce viral load in the mother but also reduce the risk of transmission
Post-exposure prophylaxis: if you are HIV negative but your partner has been diagnosed with HIV, you need to take the ART to prevent yourself from getting HIV
Plan Delivery: planned c-section at 38 weeks is the preferred mode of delivery to minimize the risk of transmission of HIV
Avoid Breast Feeding: If good alternatives are available without compromising the baby’s nutrition, it is advised to avoid breastfeeding the baby.
With all the precautions take the risk of transmission may be reduced to less than 1%
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