Alternative, complementary and traditional medicine and HIV

Alternative and complementary medicine is quite popular among people living with HIV. For example, around a half of HIV positive Americans report recent use.¹ Many HIV positive people say they feel better after using alternative and complementary medicine, and it is likely that some of these treatments are indeed beneficial, although unproven according to conventional Western medicine.

What are alternative and complementary medicines?

Alternative and complementary medicine is the name generally given to those medical and health care systems, practices, and products that are not presently considered to be part of conventional Western medicine. Well known examples include herbal and other nutritional supplements, acupuncture, aromatherapy and homeopathy.

• Alternative medicine is used in place of conventional medicine
• Complementary medicine is used together with conventional medicine.

The more ancient forms of complementary and alternative medicine are also known as traditional medicine.

AIDS: Fear and Anxiety

This page is designed to help those who feel anxious about HIV and AIDS. It could be a fear that they are infected with HIV, or it could be a fear of being at risk of HIV infection.
If the first section does not answer your worries then the idea is to keep on reading.

Are you anxious or worried because you have been diagnosed HIV positive?

Being diagnosed HIV positive can be devastating to have to deal with but it is not necessarily a death sentence, nor something you need to cope with on your own. Being anxious or fearful of having HIV and all that it entails is perfectly natural. Fear and anxiety are just a couple of many emotions you will inevitably feel, and both you will have to manage. How you respond to the feelings you will experience is a personal thing but it is not something that has to be done alone.
There are many sources of help and advice available to people diagnosed with HIV and a good place to start would be looking at AVERT's pages on learning you are HIV positive.

Criminal transmission of HIV

For the vast majority of people living with HIV, preventing others from becoming infected with the virus that they carry is a primary concern. HIV positive individuals are, after all, only too aware of just how difficult it can be to live with the illness, and few would wish it on anybody else.
This said, not all HIV positive people take the precautions that they perhaps should. Scare stories of people 'deliberately' or 'recklessly' transmitting HIV to others have appeared in the media since the epidemic first began, and some of the individuals concerned have even been criminally charged and imprisoned for their actions. But while at first it might seem obvious to prosecute someone for recklessly or intentionally infecting another with an ultimately fatal virus, this assumption, and its consequences, can present numerous problems.
So what are the issues that must be addressed when prosecuting someone for transmitting HIV? Is it right to try and criminalise HIV positive people in this way? And what can past cases teach us?

Intentional, reckless or accidental?

Before looking at the complexities of prosecuting people for infecting others with HIV, it is first necessary to understand the different types of transmission that can take place. The definitions below are based on general categories and are not specific to any particular country or legal system.

HIV & AIDS symptoms

What are the symptoms of HIV and AIDS?

It is not possible to reliably diagnose HIV infection or AIDS based on symptoms alone. HIV symptoms are very similar to the symptoms of other illnesses. So the only way to know for sure whether a person is infected with HIV is for them to have an HIV test.
People living with HIV may feel and look completely well but their immune systems may nevertheless be damaged. It is important to remember that once someone is infected with HIV they can pass the virus on immediately, even if they feel healthy.
HIV is the virus that causes AIDS. If a person infected with HIV does not take effective antiretroviral treatment, over time HIV will weaken their immune system, which will make them much more vulnerable to opportunistic infections.

AIDS vaccine

Is there an AIDS vaccine?

An AIDS vaccine does not yet exist, but efforts to develop a vaccine against HIV and AIDS have been underway for many years. Since 1987, more than 30 vaccine candidates have been tested.¹
An AIDS vaccine is not the same thing as a cure for AIDS.

Why do we need an AIDS vaccine?

Even a partially effective AIDS vaccine could save millions of lives. Experts have calculated that an AIDS vaccine that is 50% effective, given to just 30% of the population could reduce the number of HIV infections in the developing world by more than half over 15 years. An AIDS vaccine that was more than 50% effective could cut the infection rate by more than 80%.²
An AIDS vaccine would have a number of key advantages over today’s HIV prevention options. In particular, the protection offered by a vaccine during sex would not depend on the consent of both partners (unlike condom use), and would not require behaviour change (unlike abstinence). An AIDS and HIV vaccine would also be invaluable for couples wishing to conceive a child while minimising the risk of HIV transmission.
Children could be given an HIV and AIDS vaccine before ever being exposed to the HIV virus, and ideally this would subsequently protect them from all routes of HIV transmission. Vaccinating large numbers of people would probably require relatively little equipment and expertise, and would be much simpler and cheaper than providing antiretroviral treatment for those already infected.

How might an AIDS vaccine work?

This image shows an antibody (green) in contact with an HIV protein (yellow & red), which is a possible target for AIDS vaccine developers.

President's Emergency Plan for AIDS Relief

What is PEPFAR?

The President's Emergency Plan for AIDS Relief, also known as PEPFAR, is America's initiative to combat the global HIV/AIDS epidemic.

When did PEPFAR start?

President George W. Bush signs the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003

In his State of the Union Address in January 2003, President George W. Bush made a commitment to substantially increase US support for addressing HIV/AIDS worldwide.¹

"I ask the Congress to commit $15 billion over the next five years, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean" President George W. Bush

AIDS & prostitution

For years, ‘prostitution’ has been a major theme in discussions about the global AIDS and HIV epidemic. The media often run stories about HIV that focus on individuals who sell sex, and both governments and HIV related organisations frequently talk about prostitutes and prostitution in the context of AIDS.

Why is ‘AIDS and prostitution’ an issue?

This topic is significant for several reasons:

• High rates of HIV have been found amongst individuals who sell sex in many different and diverse countries. Even where HIV prevalence is low amongst this group, it is usually higher than the rate found amongst the general adult population.
• Sex workers usually have a high number of sexual partners. This means that if they do become infected with HIV, they can potentially pass it on to multiple clients.
• Preventing HIV infections amongst those involved in the sex trade has been proven to be an instrumental part of many countries’ fight against AIDS. We discuss this issue in our HIV prevention and sex workers page.

AIDS education and young people

Why is AIDS education for young people important?

AIDS education for young people plays a vital role in global efforts to end the AIDS epidemic. Despite the fact that HIV transmission can be prevented, each year millions of people become infected with the virus; in 2008 alone, there were 2.7 million new HIV infections. Almost 1-in-6 of these new infections were among people under 15 years old.¹

“In 2008 alone, there were 2.7 million new HIV infections. Almost 1-in-6 of these new infections were among people under 15 years old.”

Providing young people with basic AIDS education enables them to protect themselves from becoming infected. Young people are often particularly vulnerable to sexually transmitted HIV, and to HIV infection as a result of drug-use. Acquiring knowledge and skills encourages young people to avoid or reduce behaviours that carry a risk of HIV infection.^2 3 4 Even for young people who are not yet engaging in risky behaviours, AIDS education is important for ensuring that they are prepared for situations that will put them at risk as they grow older.⁵
AIDS education also helps to reduce stigma and discrimination, by dispelling false information that can lead to fear and blame. This is crucial for prevention, as stigma often makes people reluctant to be tested for HIV.  Somebody who is not aware of their HIV infection is more likely to pass the virus on to others. AIDS education can help to prevent this, halting stigma and discrimination before they have an opportunity to grow.⁶

HIV & AIDS treatment for children

HIV develops very rapidly among infants and children, and, without treatment, a third of children with HIV will die of AIDS before their first birthday, with half dying before they are two.¹ In 2008, there were 280,000 deaths attributed to HIV in under-15s, most of which could have been prevented through early diagnosis and effective treatment.² Though the number of children receiving antiretroviral therapy (ART) has increased significantly in recent years, at the end of 2008 less than 40% of the 730,000 children needing ART in lower- and middle-income countries were receiving it.³

How effective is antiretroviral treatment for children with HIV?

The most effective treatment for children with HIV is antiretroviral therapy. This requires several antiretroviral drugs (ARVs) be taken every day.
Antiretroviral treatment reduces illness and mortality among children living with HIV in much the same way that it does among adults. In one study in Brazil, three-quarters of HIV-positive children receiving ART were alive after a four-year follow-up period.⁴ Positive outcomes were also seen in paediatric ART programmes in Thailand and Kenya.^{5 6} A study released in 2007, which monitored 586 HIV-positive children receiving antiretroviral treatment in 14 countries in Africa and Asia, found that 82% were still alive after two years.⁷
Some of the most compelling evidence that treatment works in children does not come from studies or statistics, but rather the stories of those who have witnessed HIV-positive children returning to health after starting treatment:

"You see scrawny, rashy, tired, lethargic kids come in, you start them on treatment and within weeks you’ve got bounding, podgy, gorgeous growing children. People often don’t believe, they’re often quite sceptical of the medications, and then you see this transformation and parents are like ‘The child’s got so much energy!’”Julie, UK nurse working with children living with HIV⁸

Continuing HIV treatment

ARV treatment should stop a person from becoming ill for many years. For many people the therapy works without any major problems. However, sometimes there can be difficulties related to drug resistance, drug interactions, side effects and adherence.
This page provides information about the issues that a person may face when continuing their antiretroviral treatment.
The following information continues from the pages introduction to HIV & AIDS treatment and starting HIV & AIDS treatment.

Monitoring treatment success

The viral load test

Once ARV treatment has been started, it is important to track how well it is working. This is the purpose of the viral load test.

Introduction to HIV prevention

 How can HIV transmission be prevented?

HIV can be transmitted in three main ways:

• Sexual transmission
• Transmission through blood
• Mother-to-child transmission

For each route of transmission there are things that an individual can do to reduce or eliminate risk. There are also interventions that have been proven to work at the community, local and national level.¹
Wherever there is HIV, all three routes of transmission will take place. However the number of infections resulting from each route will vary greatly between countries and population groups. The share of resources allocated to each area should reflect the nature of the local epidemic - for example, if most infections occur among men who have sex with men then this group should be a primary target for prevention efforts.

"Knowing your epidemic in a particular region or country is the first, essential step in identifying, selecting and funding the most appropriate and effective HIV prevention measures for that country or region." - UNAIDS guidelines for HIV prevention ²

HIV prevention should be comprehensive, making use of all approaches known to be effective rather than just implementing one or a few select actions in isolation. Successful HIV prevention programmes not only give information, but also build skills and provide access to essential commodities such as condoms or sterile injecting equipment. It should be remembered that many people don’t fit into only one “risk category”. For example, injecting drug users need access to condoms and safer sex counselling as well as support to reduce the risk of transmission through blood.

HIV & AIDS treatment in the UK

Since anti-HIV treatment has been available in the UK, it has had a profound impact upon the lives of those living with HIV and AIDS. The number of people dying from AIDS has dramatically decreased and HIV is now generally thought of as a chronic disease. However, despite the introduction of free antiretroviral treatment, there are still people dying from AIDS-related illnesses in the UK. Around a third of these AIDS-related deaths occur because people are being diagnosed too late, at a stage when antiretroviral treatment is less likely to work.¹ There is the additional risk that HIV may become resistant to the drugs if treatment is not adhered to.
Issues that will be discussed in this page include:

• When HAART was introduced in the UK
• How many people are receiving treatment and care for HIV in the UK
• Who is able to receive free treatment and care for HIV/AIDS in the UK
• Treatment for HIV positive pregnant women in the UK
• How to access treatment in the UK
• The cost of antiretroviral treatment in the UK
• 'Health tourism'
• Why people still die from AIDS in the UK

For more information on antiretroviral therapy see our Introduction to HIV and AIDS Treatment in our Treatment and Care section.

HIV & AIDS in the UK

The UK has a relatively small HIV and AIDS epidemic in comparison with some parts of the world, with an estimated 83,000 people – or around 0.1% of the population – currently living with HIV.¹ While the number of people living with HIV in the UK is relatively low, it has increased dramatically since the 1990s, alongside a general rise in the prevalence of sexually transmitted infections.

AIDS & HIV in the UK - the current situation

A poster which was part of the early campaign by the British government to raise awareness of AIDS

HIV and AIDS in Russia, Eastern Europe and Central Asia

Around 1.5 million people in Russia, Eastern Europe and Central Asia were living with HIV in 2008, 110,000 of whom became infected that year, with 87,000 dying of AIDS.¹ It is estimated that over two-thirds of the area’s infected people live in Russia, and combined with Ukraine, these two countries account for 90% of the region’s total infections. Both countries also have some of the highest adult prevalence rates in the region, with 1.6% of Ukrainians and 1.1% of Russians infected. Significant numbers of people with HIV live in Belarus (13,000), Kazakhstan (12,000) and Uzbekistan (16,000) among other countries, with prevalence rates in Latvia (0.8%) and Estonia (1.3%) also being some of the highest in the region.

Since 2001, HIV prevalence in Russia, Eastern Europe and Central Asia has roughly doubled, making the region home to the world’s most rapidly expanding epidemic. In contrast, over the same period, prevalence in sub-Saharan Africa fell from 5.8% to 5.2%, and stabilised in South and Southeast Asia at 0.3%.²
This page focuses on the 15 former Soviet republics that constitute the Caucasus (Georgia, Armenia and Azerbaijan), the Baltic states (Estonia, Latvia and Lithuania), Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan), as well as Ukraine, Belarus, Moldova and Russia.

East Asia, South Asia

    East Asia

China

China’s first AIDS case was reported in Beijing in 1985. Today, an estimated 700,000 people in China are living with HIV (0.1% of the adult population), but it’s feared that this number will increase dramatically in future years, as HIV spreads from the groups most at risk to the general population.¹ The most frequent modes of HIV transmission have been injecting drug use in southern and western China and unsafe practices among paid blood donors. Heterosexually transmitted HIV is occurring primarily in the eastern provinces of China, fuelled by an increasing commercial sex trade and by the large number of migrants moving to these provinces in search of labour. HIV has been identified in some urban areas among men who have sex with men but this population is stigmatized and is difficult to survey.
In 2007 an estimated 39,000 people died from AIDS in China.²

Country profiles - South East Asia

Cambodia

Cambodia’s HIV epidemic can be traced back to 1991. After an initial rapid increase, HIV infection levels declined after the late 1990s and by 2003 HIV prevalence was estimated at 1.2%.¹ Results published in 2009 from the first national population-based survey estimated HIV prevalence at 0.6%.² It’s believed that interventions with sex workers, carried out by the government and non-governmental organisations (NGOs), played a role in this decline. The adoption of a ‘100% condom’ policy that enforced condom use in brothels led to a substantial rise in condom use among sex workers and their clients and a drop in HIV infection levels among brothel-based sex workers. However, ongoing concerns include low levels of condom use among MSM, an increase in sex work occurring outside of brothels (making it harder to reach sex workers with interventions), and mother-to-child transmission of HIV – around one third of new infections occur through this route. HIV is mostly transmitted through heterosexual sex in Cambodia, and concerns are growing about the number of married women who are infected through their husband.³

HIV prevention and Antiretroviral treatment in Asia

HIV prevention in Asia

HIV prevention sign in Ho Chi Minh City, Vietnam

Asia has been the base for some extremely successful large-scale HIV prevention programmes. Well-funded, politically supported campaigns in Thailand and Cambodia have led to significant declines in HIV-infection levels, and HIV prevention aimed at sex workers and their clients has played a large role in these achievements. In Tamil Nadu, India, HIV prevention initiatives have had a substantial impact.

How is HIV transmitted in Asia?

 In the early to mid-1980s, while other parts of the world were beginning to deal with serious HIV and AIDS epidemics, Asia remained relatively unaffected. By the early 1990s, however, AIDS epidemics had emerged in several Asian countries, and by the end of the decade, HIV was spreading rapidly in many areas of the continent.

Activists campaigning against HIV-related discrimination in India

Today, around 4.7 million people are living with HIV in Asia.¹ Although national HIV prevalence rates in Asia appear to be relatively low, the populations of some Asian countries are so vast that these low percentages actually represent very large numbers of people living with HIV. India, for example, has an estimated HIV prevalence of 0.3%, which seems low when compared to prevalence rates in some parts of sub-Saharan Africa. However, with a population of around one billion, this actually equates to 2.5 million people living with HIV in India.²

Am I ready for sex?

Almost everyone asks themselves "am I ready to have sex?" at some point in their lives, but unfortunately not many people will be able to answer it with a definite "yes" or "no".

Having sex for the first time can be a very special experience, but it can also lead to all sorts of complications. Sex without a condom or other form of contraception can result in pregnancy, and if your partner has HIV or a sexually transmitted infection (and you might not always know they do), you can become infected too. There can also be emotional consequences to having sex with someone – it can really change a relationship, and not always for the better. Sex can be enjoyable with the right person, but it’s very easy to make mistakes and end up hurt, which is why people advise you: "don’t have sex until you’re ready!"
Of course it's all very well saying this, but how do you know when you’re ready? Legally, you aren’t allowed to have sex with anyone until you’re over the age of consent. But it takes more than just being a legal age to make you ready for sex – you need to be emotionally ready too. Here are some questions to help you work out if you're ready to have sex.

The history of HIV and AIDS in America

The history of AIDS in America began in 1981, when the United States became the first country to officially recognise a strange new illness among a small number of gay men. Today, it is generally accepted that the origin of AIDS probably lies in Africa. However, America was the first country to bring AIDS into the public consciousness and the American reaction undoubtedly contributed to the establishment of AIDS as one of the most politicised, feared and controversial diseases in the history of modern medicine - a reputation that stands today.

The history of AIDS in America in the 1980s

The Circle of Friends in the National

HIV and AIDS in the Caribbean

In 2008 an estimated 20,000 people in the Caribbean became infected with HIV, and around 12,000 died of AIDS. After sub-Saharan Africa, the Caribbean has a higher HIV prevalence than any other area of the world, with 1.0% of the adult population infected.¹

An overview of AIDS in the Caribbean

Due largely to their close geographic locations, the Caribbean is usually grouped with Latin America in discussions about HIV and AIDS, but the epidemics in these regions are very different. Even within the Caribbean, each country faces a unique situation. The diversity of the region – which is apparent in terms of politics, languages spoken, geographic location and wealth – is reflected in the significantly different ways that countries are affected.
At one extreme, the Bahamas has the highest HIV prevalence in the entire western hemisphere (3%); at the other, Cuba has one of the lowest (0.1%). Trinidad and Tobago (1.5%) and Jamaica (1.6%) are heavily affected, while Puerto Rico is the only Caribbean country apart from Cuba where it is thought that less than 1% of the population is living with HIV.² Other factors, such as AIDS mortality rates and transmission patterns, also vary across countries and areas. See our Caribbean statistics page for more data.
Before Haiti's devastating earthquake in January 2010, an estimated 2.2 percent of the population were living with HIV. Haiti's AIDS epidemic is one of the most severe in the Caribbean. Before the earthquake an estimated 126,800 people under the age of 49 were living with the virus, which included 6,800 children; and an estimated 19,000 people were receiving antiretroviral drugs (ARVs). Since the earthquake, thousands of people will still be in need of ARVs, and the priority for AIDS organisations is to get the medication to those in need. It is also critical that HIV prevention, treatment, care and support services are resumed.³

“Haiti's AIDS epidemic is one of the most severe in the Caribbean”

HIV & AIDS in Latin America

At the end of 2008 there were around 2 million people living with HIV in Latin America - more than in the U.S., Canada, Japan and the UK combined.¹ While this region has often been overlooked in the past, there is now growing recognition amongst the international community that the HIV epidemics of Latin American countries demand more attention than they have received so far.
Latin American countries have been affected by HIV and AIDS in different ways, and to different extents. Responses have varied, with some countries displaying weak political leadership and others – most notably Brazil – forming strong and positive responses. Despite many differences between the epidemics of individual countries, high levels of poverty, migration, homophobia and HIV-related discrimination are apparent throughout the region, and these factors present common barriers to overcoming the crisis.²
In this page, we use the term Latin America to refer to the countries of South and Central America, excluding Suriname, Guyana, French Guyana and the Caribbean islands, which we discuss in our HIV & AIDS in the Caribbean page. AVERT.org also has an individual country page about AIDS in Brazil.

HIV & AIDS in Brazil

The first case of AIDS was recorded in Brazil in 1982, and whilst many countries have struggled to curb the spread of HIV and to care for those with AIDS, Brazil’s response has been seen as a success story. Working alongside civil society groups, the Brazilian government has made aggressive efforts to minimise the impact of the AIDS epidemic. By the end of 2007, 730,000 Brazilians were living with HIV¹ – just over half the number that estimates in the previous decade had predicted.² The AIDS mortality rate has fallen and the number of people who avoided hospital due to to effective treatment saved over US$2 billion in medical costs between 1996 and 2004.³
To understand Brazil’s achievements, the historical context in which they took place must first be acknowledged.

The history of AIDS in Brazil

Although it was first declared a republic in 1889, Brazil spent most of the following century under a series of military dictatorships. It was under the last of these dictatorships, at a time when citizen groups and non-governmental organisations (NGOs) were expanding and becoming more outspoken in their calls for change, that the country’s first AIDS case was recorded in 1982. ⁴ Although relatively few cases of HIV were recorded over the next few years, these civil society groups made sure that the government was quick to act and did not ignore the problem. As the country moved closer to democracy, they encouraged a climate of social solidarity, allowing open and frank debate about HIV and AIDS.

HIV and AIDS in America

Since the beginning of the HIV and AIDS epidemic well over half a million people have died of AIDS in America¹  – the equivalent of the entire population of Las Vegas. There are currently more than one million people living with HIV and AIDS in America and around a fifth of these are unaware of their infection,² posing a high risk of onward transmission.
America’s response to the AIDS epidemic has produced mixed results. HIV prevention efforts have not always been successful and every year approximately 56,000 Americans are infected with HIV.³ In March 2009 Washington DC reported an HIV prevalence of at least 3% among people over 12 years - similar to rates in some parts of sub-Saharan Africa.⁴
Stigma and discrimination towards HIV positive people still persist and thousands of uninsured Americans struggle to access good HIV care and antiretroviral therapy. The world’s biggest donor of AIDS-related funding is itself facing a major, ongoing AIDS epidemic, which shows little sign of abating.

Who is affected by AIDS in America?

Although HIV and AIDS can and do affect all sectors of American society, the impact has been more serious among some groups than others. In the early years of the epidemic, the most commonly identified ‘vulnerable groups’ in America were men who have sex with men, injecting drug users, haemophiliacs and Haitians. Today, AIDS continues to directly affect thousands of gay and bisexual men and injecting drug users every year, but it has also become a serious problem among Black Americans and, more recently, among the Hispanic/Latino population.

The impact of HIV & AIDS in Africa

Two-thirds of all people infected with HIV live in sub-Saharan Africa, although this region contains little more than 10% of the world’s population.¹ AIDS has caused immense human suffering in the continent. The most obvious effect of this crisis has been illness and death, but the impact of the epidemic has certainly not been confined to the health sector; households, schools, workplaces and economies have also been badly affected.
During 2008 alone, an estimated 1.4 million adults and children died as a result of AIDS in sub-Saharan Africa.² Since the beginning of the epidemic more than 15 million Africans have died from AIDS.³
Although access to antiretroviral treatment is starting to lessen the toll of AIDS, fewer than half of Africans who need treatment are receiving it.⁴ The impact of AIDS will remain severe for many years to come.

The impact on the health sector

In all heavily affected countries the AIDS epidemic is adding additional pressure on the health sector. As the epidemic matures, the demand for care for those living with HIV rises, as does the toll of AIDS on health workers. In sub-Saharan Africa, the direct medical costs of AIDS (excluding antiretroviral therapy) have been estimated at about US$30 per year for every person infected, at a time when overall public health spending is less than US$10 per year for most African countries.⁵

The effect on hospitals

Nurses working on the HIV ward at Kisiizi Hospital in Uganda

AIDS in Africa summary

Sub-Saharan Africa is more heavily affected by HIV and AIDS than any other region of the world. An estimated 22.4 million people are living with HIV in the region - around two thirds of the global total. In 2008 around 1.4 million people died from AIDS in sub-Saharan Africa and 1.9 million people became infected with HIV. Since the beginning of the epidemic more than 14 million children have lost one or both parents to AIDS.¹

In the absence of massively expanded prevention, treatment and care efforts, it is expected that the AIDS death toll in sub-Saharan Africa will continue to rise. This means the impact of the AIDS epidemic on these societies will be felt most strongly in the course of the next ten years and beyond. Its social and economic consequences are already widely felt, not only in the health sector but also in education, industry, agriculture, transport, human resources and the economy in general. The AIDS epidemic in sub-Saharan Africa threatens to devastate whole communities, rolling back decades of development progress.
Sub-Saharan Africa faces a triple challenge:

• Providing health care, antiretroviral treatment, and support to a growing population of people with HIV-related illnesses.
• Reducing the annual toll of new HIV infections by enabling individuals to protect themselves and others.
• Coping with the impact of over 20 million AIDS deaths, on orphans and other survivors, communities, and national development.
  

The 1990s – Southern Africa and the Fight for Treatment

The beginning half of the 1990s was a bleak time in the history of AIDS in Africa. At a time when new HIV infection rates were rocketing in Southern Africa there were few new ideas of how to deal with generalised epidemics in poor countries¹. Prevention campaigns were having minimal effect and there was no visible prospect for effective treatment in Africa. The international community was yet to take efficient action and many national government programmes were corrupt or ill-equipped to deal with the escalating crisis². By the middle of the decade the seriousness of the epidemic was blatant. In 1999, the Kenyan President Daniel Arap Moi declared AIDS a national disaster.

"AIDS is not just a serious threat to our social and economic development, it is a real threat to our very existence, and every effort must be made to bring the problem under control." ³

Although HIV/AIDS prevalence continued to increase in Southern Africa in the later Nineties, glimmers of hope for the future of the epidemic began to emerge.
Prevalence rates in many East African countries that were hard hit in the 1980s were beginning to slow, stabilise or decline. Between 1992 and 1998 prevalence rates in Uganda were estimated to have dropped from 30% to 12% of adults in Kampala⁴.
In 1996, UNAIDS was established to take responsibility for coordinating international action against the epidemic^{5 6}.

AIDS in Africa has had a short but devastating history.

“It all started as a rumour…  Then we found we were dealing with a disease.  Then we realised that it was an epidemic.  And, now we have accepted it as a tragedy.” - Chief epidemiologist in Kampala, Uganda¹

Adult HIV prevalence (%) in Africa between 1988 and 2003

• 20%-30%
• 10%-20%
• 5%-10%
• 1%-5%
• 0%-1%
• data unavailable

Before the 1960s – African origins of AIDS

Introduction to the global AIDS epidemic

The start of AIDS

The history of AIDS is a short one. As recently as the 1970s, no one was aware of this deadly illness. Since then the global AIDS epidemic has become one of the greatest threats to human health and development. At the same time, much has been learnt about the science of AIDS, as well as how to prevent and treat the disease.

The global picture

Statistics for the end of 2008 indicate that around 33 million people are living with HIV, the virus that causes AIDS. Each year around 2.7 million more people become infected with HIV and 2 million die of AIDS.¹
Although HIV and AIDS are found in all parts of the world,

World AIDS Day 2009

World AIDS Day theme: Universal Access and Human Rights

The theme for World AIDS Day 2010 is 'Universal Access and Human Rights'. Global leaders have pledged to work towards universal access to HIV and AIDS treatment, prevention and care, recognising these as fundamental human rights. Valuable progress has been made in increasing access to HIV and AIDS services, yet greater commitment is needed around the world if the goal of universal access is to be achieved. Millions of people continue to be infected with HIV every year. In low- and middle-income countries, less than half of those in need of antiretroviral therapy are receiving it, and too many do not have access to adequate care services.³
The protection of human rights is fundamental to combating the global HIV and AIDS epidemic. Violations against human rights fuel the spread of HIV, putting marginalised groups, such as injecting drug users and sex workers, at a higher risk of HIV infection. By promoting individual human rights, new infections can be prevented and people who have HIV can live free from discrimination.
World AIDS Day provides an opportunity for all of us - individuals, communities and political leaders - to take action and ensure that human rights are protected and global targets for HIV/AIDS prevention, treatment and care are met.

HIV structure and life cycle

HIV stands for Human Immunodeficiency Virus. Like all viruses, HIV cannot grow or reproduce on its own. In order to make new copies of itself it must infect the cells of a living organism.

The Structure of HIV

What does HIV look like?

In this computer generated image, the large object is a
human CD4+ white blood cell, and the spots on its surface
and the spiky blue objects in the foreground
represent HIV particles.

Outside of a human cell, HIV exists as roughly spherical particles (sometimes called virions). The surface of each particle is studded with lots of little spikes.
An HIV particle is around 100-150 billionths of a metre in diameter. That's about the same as:

• 0.1 microns
• 4 millionths of an inch
• one twentieth of the length of an E. coli bacterium
• one seventieth of the diameter of a human CD4+ white blood cell.

Origins of HIV and AIDS

The origin of AIDS and HIV has puzzled scientists ever since the illness first came to light in the early 1980s. For over twenty years it has been the subject of fierce debate and the cause of countless arguments, with everything from a promiscuous flight attendant to a suspect vaccine programme being blamed. So what is the truth? Just where did AIDS come from?

The first recognised cases of AIDS occurred in the USA in the early 1980s (more about this period can be found on our History of AIDS page). A number of gay men in New York and California suddenly began to develop rare opportunistic infections and cancers that seemed stubbornly resistant to any treatment. At this time, AIDS did not yet have a name, but it quickly became obvious that all the men were suffering from a common syndrome.
The discovery of HIV, the Human Immunodeficiency Virus, was made soon after. While some were initially resistant to acknowledge the connection (and indeed some remain so today), there is now clear evidence to prove that HIV causes AIDS. So, in order to find the source of AIDS, it is necessary to look for the origin of HIV, and find out how, when and where HIV first began to cause disease in humans.

How?

HIV testing in pregnancy

In many countries across the world, women are tested for HIV during pregnancy. There are a number of important reasons for this:

• HIV infection can be passed on to a baby during pregnancy, labour and delivery, and breastfeeding. With appropriate treatment and intervention, the chances of a child becoming infected can be reduced from around 25% to less than 2%. It is therefore vital that an HIV infection in a mother is identified during the early stages of pregnancy to allow for an opportunity to reduce the risk of transmission to the baby. AVERT.org has more information about mother-to-child transmission (MTCT), including details of a Stop AIDS in Children campaign, which is calling for better prevention of MTCT around the world.
• In areas where antiretroviral therapy is available, a pregnant woman can receive these drugs if she tests HIV positive during pregnancy. The antiretroviral drugs can suppress HIV, which will keep her healthy for longer.
• For many women, especially in resource-poor areas, pregnancy will be the only time in their young adult lives when they access healthcare services on a regular basis. It therefore presents an excellent opportunity not only to screen for HIV, but also to educate and advise about the dangers of the virus.

Routine, voluntary HIV testing

In most developed nations, HIV tests are either routinely offered as part of antenatal care or are offered to pregnant women thought to be at high risk of exposure to HIV. This has helped to reduce rates of mother-to-child transmission dramatically.¹ There are two types of routine testing: opt-out and opt-in.

HIV testing

The different types of HIV test

Using a rapid oral HIV test

HIV antibody test

HIV antibody tests are the most appropriate test for routine diagnosis of HIV among adults.  Antibody tests are inexpensive and very accurate. The ELISA antibody test (enzyme-linked immunoabsorbent) also known as EIA (enzyme immunoassay) was the first HIV test to be widely used.

How do antibody tests work?

When a person is infected with HIV, their body responds by producing special proteins that fight infection, called antibodies. An HIV antibody test looks for these antibodies in blood, saliva or urine. If antibodies to HIV are detected, it means a person has been infected with HIV. There are only two exceptions to this rule:

Effects of HIV on nutrition

Body changes

A man suffering wasting related to HIV and TB infection

AIDS is well known for causing severe weight loss known as wasting. In Africa, the illness was at first called “slim” because sufferers became like skeletons. Yet body changes are not only seen during AIDS; less dramatic changes often occur in earlier stages of HIV infection.
Whereas starving people tend to lose fat first, the weight lost during HIV infection tends to be in the form of lean tissue, such as muscle. This means there may be changes in the makeup of the body even if the overall weight stays the same.¹
In children, HIV is frequently linked to growth failure. One large European study found thatchildren with HIV were on average around 7 kg (15 lbs) lighter and 7.5 cm (3 inches) shorter than uninfected children at ten years old.²

What causes these changes?

One factor behind HIV-related weight loss is increased energy expenditure. Though no one knows quite why, many studies have found that people with HIV tend to burn around 10% more calories while resting, compared to those who are uninfected. People with advanced infection or AIDS (particularly children) may expend far more energy.³
But faster metabolism is not the only problem. In normal circumstances, a small rise in energy expenditure may be offset by eating slightly more food⁴ or taking less exercise.⁵ There are two other important reasons why people with HIV may lose weight or suffer childhood growth failure.⁶
The first factor is decreased energy intake or, to put it simply, eating less food. Once HIV has weakened the immune system, various infections can take hold, some of which can affect appetite and ability to eat. For example, sores in the mouth or throat may cause pain when swallowing, while diarrhoea or nausea may disturb normal eating patterns. Someone who is ill may be less able to earn money, shop for food or prepare meals. Stress and psychological issues may also contribute.
Secondly, weight loss or growth failure can occur when the body is less able to absorb nutrients – particularly fat – from food, because HIV or another infection (such as cryptosporidium) has damaged the lining of the gut. Diarrhoea is a common symptom of such malabsorption.

Prevention of HIV transmission from mother to child

What is mother-to-child transmission?

Mother-to-child transmission (MTCT) is when an HIV-infected woman passes the virus to her baby. This can occur during pregnancy, labour and delivery, or breastfeeding. Without treatment, around 15-30% of babies born to HIV positive women will become infected with HIV during pregnancy and delivery. A further 5-20% will become infected through breastfeeding.¹

Is MTCT a major problem?

In 2008, around 430,000 children under 15 became infected with HIV, mainly through mother-to-child transmission. About 90% of these MTCT infections occurred in Africa where AIDS is beginning to reverse decades of steady progress in child survival.²
In high income countries MTCT has been virtually eliminated thanks to effective voluntary testing and counselling, access to antiretroviral therapy, safe delivery practices, and the widespread availability and safe use of breast-milk substitutes. If these interventions were used worldwide, they could save the lives of thousands of children each year.

How can MTCT be prevented (PMTCT)?

An HIV positive mother and her HIV positive baby in India

Effective prevention of mother-to-child transmission (PMTCT) requires a three-fold strategy.^{3 4}

• Preventing HIV infection among prospective parents - making HIV testing and other prevention interventions available in services related to sexual health such as antenatal and postpartum care.
• Avoiding unwanted pregnancies among HIV positive women - providing appropriate counseling and support to women living with HIV to enable them to make informed decisions about their reproductive lives.
• Preventing the transmission of HIV from HIV positive mothers to their infants during pregnancy, labour, delivery and breastfeeding.
• Integration of HIV care, treatment and support for women found to be positive and their families.

The last of these can be achieved by the use of antiretroviral drugs, safer infant feeding practices and other interventions.

Worldwide statistics commentary

Number of people living with HIV

According to estimates from the UNAIDS 2009 AIDS Epidemic Update, around 31.3 million adults and 2.1 million children were living with HIV at the end of 2008.

Number of people infected during 2008, and the number of deaths

During 2008, some 2.7 million people became infected with the human immunodeficiency virus (HIV), which causes AIDS.
The year also saw 2 million deaths from AIDS - a high global total, despite antiretroviral (ARV) therapy, which reduced AIDS-related deaths among those who received it. The number of deaths probably peaked around 2004, and has since declined only slightly.

How people become infected with HIV

Globally, around 11% of HIV infections are among babies who acquire the virus from their mothers; 10% result from injecting drug use; 5-10% are due to sex between men; and 5-10% occur in healthcare settings. Sex between men and women accounts for the remaining proportion – around two thirds of new infections.

HIV/AIDS Statistics - Worldwide

The latest statistics of the global HIV and AIDS were published by UNAIDS in November 2009, and refer to the end of 2008.

	Estimate	Range
People living with HIV/AIDS in 2008	33.4 million	31.1-35.8 million
Adults living with HIV/AIDS in 2008	31.3 million	29.2-33.7 million
Women living with HIV/AIDS in 2008	15.7 million	14.2-17.2 million
Children living with HIV/AIDS in 2008	2.1 million	1.2-2.9 million
People newly infected with HIV in 2008	2.7 million	2.4-3.0 million
Children newly infected with HIV in 2008	0.43 million	0.24-0.61 million
AIDS deaths in 2008	2.0 million	1.7-2.4 million
Child AIDS deaths in 2008	0.28 million	0.15-0.41 million

More than 25 million people have died of AIDS since 1981.