Hands up for HIV prevention!

This was the theme for the 29th World AIDS Day on December 1st. Substantial progress has been made in developing and disseminating effective antiretroviral therapy (ART) for people diagnosed with HIV/AIDS. Indeed for the around 19 million people globally currently taking ART, the disease can be considered a chronic condition, albeit one that requires careful and continuous monitoring.
Huge strides have also been made in reducing transmission of infection. Concerted efforts by national programmes and development partners have promoted safe sex and condom use (though not without some controversy and pontification about the value of celibacy) with studies showing that this reduces HIV transmission by 85percent. Medical male circumcision, which reduces the risk of heterosexual men becoming infected by an estimated 60percent, is also becoming acceptable in high risk countries where performance of this operation is not the cultural norm. The efficacy of pre-exposure prophylaxis (PrEP) for subjects at a high risk of becoming infected with HIV, such as those with infected sexual partners, has been demonstrated and is advocated in many countries. Vertical transmission, formerly accounting for up to 45percent of babies acquiring the infection from their HIV positive mother, can now be prevented by prescribing ART to both mother and child during pregnancy, labour, delivery and breastfeeding. And programmes have been set up both to educate people who inject recreational drugs about the risks of HIV infection and to provide sterile injecting equipment to reduce the risk.
However an enormous obstacle blocking the goal to end the AIDS epidemic by 2030 is that according to the WHO an estimated 14 million people (around 40percent of all people with HIV) are unaware that they are infected with the virus. Not only are they not receiving ART, they are also unwittingly infecting others. Highly accurate rapid diagnostic tests or enzyme immunoassays are available, but many people are either geographically distant from such testing services or are too diffident to access them. So it is wonderful news that, according to WHO, twenty-three countries have so far approved policies for HIV self-testing, and many others are aiming to follow suit. Studies have shown that with such testing, performed in the privacy of one’s home with results available after 20 minutes, the number of people tested doubles. While there is great need to distribute kits to the most high risk areas, how many of us currently living in lower risk countries are celibate until we meet our life partner who has also been celibate prior to meeting us?