Dr. Prakash Budathoky

An estimated 38.0 million people had been living with HIV at the end of 2019. Owing to the concerted national and international efforts response to HIV, the coverage of service has been increasing steadily lately.
In 2019, 68% of adults and 53% of children living with HIV globally were receiving lifelong antiretroviral therapy (ART). A great majority (85%) of pregnant and breastfeeding women living with HIV also received ART, which not only protects their health but also ensures the prevention of HIV transmission to their newborns.
HIV can transmit via the exchange of a variety of body fluids from infected people, such as blood, breast milk, semen and vaginal secretions and can transmit from a mother to her child during pregnancy and delivery. Individuals cannot become infected through ordinary day-to-day contacts such as kissing, hugging, shaking hands, or sharing of personal objects, food or water.

Risk factors
It is important to note that people with HIV, who are taking ART and whose infection has been suppressed, do not transmit HIV to their sexual partners. 
Early access to ART and support to remain on treatment is therefore critical not only to improve the health of people with HIV but also to prevent HIV transmission.
Behaviours and conditions that put individuals at greater risk of contracting HIV are: engaging in unprotected anal or vaginal sex, suffering from other sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhoea and bacterial vaginosis and sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs.
Similarly, receiving unsafe injections, blood transfusions and tissue transplantation, and medical procedures that involve unsterile cutting or piercing and experiencing accidental needle stick injuries are other conditions that increase risk of disease transmission.

Symptoms
In the first few weeks after initial infection, people may experience no symptoms or an influenza-like illness including fever, headache, rash or sore throat.
As the infection progressively weakens the immune system, they can develop swollen lymph nodes, weight loss, fever, diarrhoea and cough.
Without treatment, the infected will develop severe illnesses like tuberculosis (TB), cryptococcal meningitis, severe bacterial infections, and cancers such as lymphomas and Kaposi's sarcoma.
HIV testing services must follow the principles known as the “5 Cs: informed Consent, Confidentiality, Counselling, Correct test results and Connection (linkage to care, treatment and other services).
The 69th World Health Assembly endorsed a new “Global Health Sector Strategy on HIV for 2016–2021”. The strategy includes the information for focused action, interventions for impact, delivering for equity, financing for sustainability and innovation for acceleration.
However, not everyone has access to HIV testing, treatment and care. Due to gaps in HIV services, 690 000 people died from HIV-related causes in 2019 and 1.7 million people were registered as the newly infected. The increased rate of HIV vulnerability is often associated with legal and social factors, which increases exposure to risk situations and creates barriers to accessing effective, quality and affordable HIV prevention, testing and treatment services.

Test And Treatments
HIV can be diagnosed through rapid diagnostic tests that can provide same-day results. HIV self-tests are increasingly available and provide an effective and acceptable alternative way to increase access to people who are not reached for HIV testing through facility-based services. Rapid tests and self-tests have greatly facilitated diagnosis and linkage with treatment and care.
There is no cure for HIV infection. However, effective antiretroviral drugs (ARVs) can control the virus and help prevent onward transmission to other people. At the end of 2019, an estimated 81% of people living with HIV knew their status.
During the same year, about 67% were receiving antiretroviral therapy and 59% had achieved suppression of HIV with no risk of infecting others. This achievement was the result of great efforts by national HIV programmes supported by our civil society and international development partners.

Pre and Post-exposure Prophylaxis
Oral Pre-exposure Prophylaxis of HIV is the daily use of ARVs by HIV-negative people to block the acquisition of HIV like men who have had sex with men, transgender women, high-risk heterosexual couples, and people who inject drugs.
The World Health Organisation has also expanded these recommendations to the HIV-negative women who are pregnant or breastfeeding.  WHO has recommended taking two pills between two and 24 hours before having sex, taking the third pill 24 hours after taking the first two pills, and then taking the fourth pill 48 hours after the first two pills.  
Post Exposure Prophylaxis (PEP) is the use of ARVs within 72 hours of exposure to HIV to prevent the infection. PEP includes counseling, first aid care, HIV testing, and administration of a 28-day course of ARV drugs with follow-up care. WHO recommends PEP use for both occupational and non-occupational exposures, and adults and children.
At last, individuals can reduce the risk of HIV infection by limiting exposure to risk factors. The key approaches for HIV prevention, which are often followed in combination with other preventing measures.
HIV continues to be a major global public health concern and has so far claimed almost 33 million lives worldwide. However, with increasing access to effective HIV prevention, diagnosis, treatment and care, HIV infection has become a manageable chronic health condition, enabling the people living with HIV to lead a long and healthy life.

(Budathoky is Central Treasurer, Nepal Medical Association)