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HIV: Does It Continue To Be A Major Global Public Health Issue Still?

The infection, in the vast majority, is transmitted sexually. In a small percentage, it is also transmitted by blood and blood products and from an infected mother to child during delivery

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The burden of the human immunodeficiency virus globally has dominated healthcare for over four decades now, ever since it caught the attention of the medical fraternity in the seventies. It has since had the undivided attention of clinicians, researchers, activists and patients alike that seem to have a common question - how soon is a cure likely?

The infection, in the vast majority, is transmitted sexually - high-risk practices including multiple sexual partners, sharing needles and generally, exchange of body fluids that are infected with the virus. In a small percentage, it is also transmitted by blood and blood products and from an infected mother to child during delivery.

In a substantial population, there is a perceptible lack of awareness about the risk of certain lifestyles. This applies to all age groups but especially teens and younger adults. The curiosity of adolescence is sometimes cloaked in the shroud of unawareness and therefore prone towards misadventure. Other times, it is simply not having the means to get the correct information.

The pandemic of the eighties and nineties does not have its edge but it is nowhere close to being over. From being an aggressive clinical presentation, it is now detected on routine blood tests and discovered by default. The infections are lifelong and therefore so are the treatments. The burden on patients, besides other aspects, is vastly emotional.

A word to the wise about pre-exposure prophylaxis or PrEP. This is a medication that is taken in a high-risk situation of sexually active partners who are unaware of each other’s HIV status, or are aware but choose to disregard it. While the medication is effective, like any other medication it's levels may be altered by food, alcohol and other recreational substances. It does not preclude taking responsibility of choices.

The treatments that are available now are wonderful, and the good news is that they are likely to get better from here. In the newer regimens, there is evidence of protection to major organs and that augurs well for affected patients. There isn't a vaccine at this time and this is a measure of how clever the virus is, that it has eluded the collective might of the scientific community for over four decades. Inspite of that, if treatment regimens are tailored appropriately, longevity is only likely to keep increasing.

I have often felt that in patients who sadly succumb to the illness, the terminal event is a shame. The overwhelming emotional burden is surmountable with good family support, sometimes counseling and an individual’s desire to come to terms with a condition that is, simply, no limitation at all, only a distant boundary that needs to be recognized and accepted. This subset of patients make a clean breast of their situation and circumstances and quite simply, are too consumed with making their lives wholesome to give an unproductive emotion any consequence. Ultimately it is more pragmatic to be fully aware of what implications a decision to engage a sexual partner may have, ideally go through a blood test, and keep the virus at an arm’s length.

Disclaimer: The views expressed in the article above are those of the authors' and do not necessarily represent or reflect the views of this publishing house. Unless otherwise noted, the author is writing in his/her personal capacity. They are not intended and should not be thought to represent official ideas, attitudes, or policies of any agency or institution.

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Dr. Om Shrivastav

The author is the Director of Infectious Diseases at Jaslok Hospital and Research Centre.

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