ABOUT 47 MILLION PEOPLE WORLDWIDE HAVE BEEN INFECTED WITH HIV SINCE 1981. HIV (human immunodeficiency virus) is a virus that causes a gradual deterioration of the immune system, resulting in infections which the human body cannot defend. People who are infected with HIV may have the virus up to ten years before displaying any symptoms. During this period, however, they can transmit the disease to other people. HIV is spread through the exchange of blood, semen and/or vaginal secretions.
Those at highest risk include people engaging in unprotected sex with multiple partners, intravenous drug users who share needles, infants born to mothers and people who received blood transfusions between 1977 and 1985. Mother to child HIV transmissions occurs predominantly during birth and less so prior to birth.
Antiretrovirals effectively used with good adherence significantly lowers the risk of Mother-to-Child Transmission (MTCT). About 10% of MTCT of HIV infections occur through breastfeeding. This mode of transmission is effectively reduced should the mother be on Antiretroviral Therapy (ART), but only if the viral load in the mother is effectively suppressed and/or is undetectable in the blood of the mother. Should the viral load still be high in the mother due to poor adherence to the ART or viral resistance to the ART used by the mother, the risk of transmission through breast milk remains substantial. Preventive ART to the baby offers additional protection.
At present the main preventive drug used in babies is Niverapine, and Zidovudine, which would offer some protection, but not complete protection, especially if the viral load in the mother is high because of the reasons mentioned above. In poor socio-economic and hygienic circumstances the recommendation is exclusive breast feeding, as the benefits of breastfeeding under those circumstances outweigh the risk of HIV transmission. With good adherence to ART by the mother and provided the viral load in the mother is effectively lowered, as well as preventive Niverapine and Zidovudine for the baby, the risk of HIV transmission through breast milk is very effectively reduced. However, should all these conditions not be followed, transmission through breast milk remains possible. Under good socio-economic and hygienic conditions formula milk feeding would still remain an option if the mother would prefer that.
ART and HAART (Highly Active ART) does not cure or eliminate the virus from the body, but if taken with good adherence and as a life- long therapy, leads to good control of the disease, with a good quality of life and significant lowered risk of opportunistic infections and malignancies. Good daily adherence to ART and regular monitoring including Viral load tests to asses effective viral suppression or emergence of resistant viral strains, is mandatory to achieve this result. Successful and effective use of ART through good adherence and a well suppressed/undetectable viral load significantly prevents transmission up to 90-95 %. Once again this is dependent on achieving a well suppressed/undetectable viral load.
For HIV negative people who are at risk of contracting HIV there is Pre Exposure Prophylaxis (PrEp). This is currently a combination of Tenofovir and Emtracitabine (Truvada) taken as one tablet daily and when taken with good adherence, with a lead in period of at least 21 days before exposure continually every day bridging all exposure periods, and for 28 days after the last exposure to close off, can offer protection of HIV acquisition up to 94%. Once again, good adherence in taking the drug on a daily basis and provided the “lead in” and “close off ” periods are followed, are all mandatory to achieve this result. Keep in mind that while PrEP helps to prevent acquiring HIV, it does not prevent pregnancy or other sexually transmitted diseases. Under circumstances where there is a relative high prevalence of resistant viruses in a community the effectivity of PrEP would also be reduced.
Recent research has demonstrated an up to 30% decrease risk of HIV infection in women when their male partners were circumcised. Additional benefits for medically circumcised males as well as for their female partners also include decreased risk of other sexually transmitted infections, as well as a decreased risk of cervical cancer in females. Voluntary male medical circumcision should therefore be strongly encouraged. DFL stands for a scientific approach to health and disease. It does not denigrate or ignore scientific/statistical findings on certain interventions. However as an organization with one of its main areas of focus being ethics, it may put forward certain recommendations
Symptoms of HIV include, but are not limited to, sore throat, mouth sores, muscular stiffness or aching, headache, diarrhea, swollen lymph glands, fever, fatigue, various rashes or frequent vaginal yeast infections. An acute HIV infection progresses over time to an asymptomatic HIV infection, into an early symptomatic HIV infection and then into AIDS. It is at this stage that the immune system is completely susceptible to a variety of life threatening diseases, cancers and infections of the blood and/or brain. Common symptoms of AIDS include, but are not limited to, fever, night sweats, swollen glands, chills, weakness and weight loss.
THERE IS NO CURE FOR AIDS. However, there are several anti viral therapies that can delay the progression of the disease. It is our belief that this insidious disease must be stopped. This begins by people taking responsibility for their behavior. Doctors for Life promotes abstinence and the principle that sex is reserved for a man and a woman in a marital relationship. We strongly oppose the myth that forced or consensual intercourse with a virgin will cure AIDS. We offer counseling for intravenous drug users (or any drug users), those that are sex workers, and those who need to talk about their illness. Please just call if you need help.
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- Syndromic Management of STD Regimen – chart for treating STD patients. [pfd download]
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