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HIV/acquired immunodeficiency syndrome 

HIV/acquired immunodeficiency syndrome
Chapter:
HIV/acquired immunodeficiency syndrome
Author(s):

Sten H. Vermund

and Suniti Solomon

DOI:
10.1093/med/9780199661756.003.0213
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date: 17 September 2019

HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) was first recognized as a disease in 1981 and has represented the worst acute health crisis in the history of many countries, most notably those in sub-Saharan Africa. In countries of highest HIV prevalence, the mortality associated with HIV has reversed decades of progress in both life expectancy and in reduction in child mortality. Yet major strides have been made in our understanding of the population dynamics of viral transmission, particular prevention strategies to deploy in specific populations with varying primary mechanisms of viral spread, and the promise of combined approaches to achieve synergies in transmission control. Proven prevention tools include antiretroviral therapy to reduce infectiousness, medical male circumcision and control of sexually transmitted infections to reduce susceptibility, viral blocking strategies that may be physical (e.g., condoms), immunological (e.g., vaccines (only marginally effective to date)), or chemical (microbicides or oral antiretroviral drugs used by at-risk uninfected persons (pre-exposure prophylaxis)), modern blood banking and use of sterile injection equipment, and changing human behaviour to reduce risk. Sterile needle and syringe exchange programmes have helped reduce incidence among people who inject drugs, alongside effective treatment programmes for opiate addiction. Prevention of mother-to-child HIV transmission has been highly successful based on treating infected mothers and prophylaxis in HIV-exposed children with antiretroviral drugs. All the biological prevention strategies depend on behavioural adherence to the given prevention tool, and can be undermined by human rights violations and gender-power imbalances that conspire to reduce access to prevention services. Both changing human behaviour and instituting structural changes in society to help reduce risk are urgent, ongoing challenges.

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