Since 1981 when HIV and Aids were first discovered, the world has made drastic strides in tackling disease prevention, treatment and management but how much work is still needed before we can prevent Aids altogether?
These days, the phrase "HIV is no longer a death sentence" is frequently used in the media. Medications are now more accessible than they have been in the past as a result of the successful implementation of HIV programmes across the globe.
South Africa has the biggest antiretroviral programme in the world, spending around $1 billion each year, AVERT explains.
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As a result, more and more South Africans living with HIV or Aids are receiving antiretroviral treatment (ART). Between 2009 and 2011, South Africa achieved a 75% increase in access to antiretroviral treatment.
The efficacy of ART means that the life expectancy for those who adhere to their treatment regimens is only 20% lower than that of the average, healthy South African.
As a result, the Aids mortality rate has dropped by 25%, an article published in The South African Medical Journal explains.
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Is the end of Aids in sight?
All these positive statistics have contributed to the idea that the end of Aids is approaching.
UNAIDS has set an ambitious target, 90-90-90, aimed at bringing Aids to an end by 2015. The goal is for 90% of people living with HIV to know their status, with 90% of people with HIV on continuous antiretroviral treatment. Of those on ART, 90% should have viral suppression.
With 2020 just over four years away, there is much work to be done before we witness the end of Aids.
There are currently 6.19 million people living with HIV in South Africa, according to Statistics South Africa. This means that more than one in every 10 citizens are infected with the virus.
In 2013, over 300 000 South Africans became infected with HIV, and there were around 200 000 Aids-related deaths.
In 2012, South Africa’s ART programme had reached around 2 million people – a figure that means South Africa had achieved the World Health Organisation’s target of 80%.
However, in 2013, the treatment guidelines were changed to require treatment for all people with CD4 counts below 500, instead of only those with a count below 350.
This means that South Africa’s ART coverage has fallen to 42%.
The average South African with HIV has a CD4 count of only 87 when they begin antiretroviral therapy. A CD4 count below 200 is one of the factors used to determine whether a person living with HIV has progressed to having Aids, AIDS.gov explains.
This means that many South Africans already have Aids, significantly compromised immunity and are at high risk of opportunistic infections before receiving ART.
Furthermore, of those newly-diagnosed patients with CD4 counts below 200, only 42% began treatment within 12 months.
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Challenges to the 90-90-90 target
In order to eliminate Aids, people need to begin ART as soon as possible after being diagnosed with HIV, in line with the most recent World Health Organisation’s guidelines. For this to be possible, South Africans, especially at-risk population groups, need greater access to regular testing.
South African National Aids Council HCT Advisor Rev Zwoitwaho Nevhutalu recently urged the government to promote HIV self-testing for earlier identification of HIV.
Two new HIV vaccines are currently being trialled in South Africa and, should they prove successful, will assist in drastically reducing the rate of infection.
Consistent treatment remains another challenge. HIV patients need to adhere to their treatment to prevent the disease from progressing.
In the US, it is estimated that only 28% of people living with HIV stay in care and adhere to their treatment.
In sub-Saharan Africa, where accessibility is even more difficult and drug shortages are frequent, adherence remains a significant challenge.
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What would it mean to have a world without Aids?
If the world could achieve the 90-90-90 goal and eradicate Aids, healthcare providers would be able to focus on managing HIV as a chronic illness and addressing new HIV-related complications that have emerged, an article published in The Lancet explains.
Antiretroviral treatment does not fully repair damage to the immune system. While people with HIV are living longer than they have in the past, they also face a greater risk of related-complications such as cancer, liver disease, osteoporosis and cardiovascular disease.
These HIV-associated diseases are linked to accelerated ageing, with patients at greater risk of frailty including reduced mobility, muscle weakness, fatigue, weight loss and lower levels of physical activity.
These new HIV-associated medical conditions will require a drastic change in healthcare services, including retraining of medical staff on the management of the condition. Government would be required to reallocate resources in order to adequately provide an ageing population with quality chronic healthcare services.
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