^{Global HIV/AIDS Congress} August 20-21, 2018 Prague, Czech Republic

HIV infection progresses mainly in three different stages, Acute HIV infection, Chronic HIV infection and AIDS. Acute HIV infection or Acute Primary Infection refers to the earlier stages of HIV infection where it generally develops within 2 to 4 weeks of a person being affected with HIV. Some people experiences fever, headache and rash. During the acute stage of infection the virus spreads rapidly in its host’s body destroying the CD4 cells, thereby weakening the immune system. During the second stage of HIV infection i.e. the chronic HIV infection or The Asymptomatic Stage, HIV continuous to multiply very slowly. During chronic HIV infection people may not experience any HIV related symptoms but they can still spread HIV to others. If left untreated, Chronic HIV infection leads to AIDS or Symptomatic HIV Infection, the third and the final stage of HIV infection. This is also the most severe stage of HIV infection. The immune system is severely damaged and the body can’t fight off the opportunistic infections and infection related cancers.

The best defence for human body against any type of disease or infection is its own immune system. HIV is stopped by the elemental defences of our body. HIV can’t penetrate unbroken skin. It can only transmit through the exchange of body fluids. Sexual intercourse is the most common mode of HIV transmission. Blood transfusion can also cause HIV infection. HIV can also transmit from the mother to her child in the time of pregnancy or birth or during breastfeeding. HIV is a member of the retrovirus family. HIV attacks the CD4 cells and T cells, eventually destroying these cells and increasing Virus replication. As a result of the destruction of memory cells the immune system is unable to defend itself thus leaving the body vulnerable to opportunistic infections.

HIV/AIDS still remains one of the most critical health challenges in the face of the world. According to reports around 36.7 million people are living with HIV and an estimated 1.8 million new infections are recorded in year 2016. Million lives are lost annually due to AIDS related illness. Although there is still no cure for AIDS necessary steps can be taken to prevent HIV infection. There are certain treatments which can effectively slow down the growth of HIV virus in human body leading to a normal life expectancy. There are some certain ways through which HIV can spread from one person to another such as blood, semen, pre-seminal fluids, rectal fluids, vaginal fluids and breast milk. HIV transmission is only possible if these fluids come in contact with the mucous membrane or damaged tissue or are directly injected into the bloodstream. HIV can also transmit from a mother to her child during the time of pregnancy, childbirth or breastfeeding. Earlier, there were some cases of HIV transmission during organ or tissue transplant from a HIV infected person. HIV treatment involves taking medicines that are called antiretrovirals also known as ARV. These are always given in combination with other antiretrovirals. The therapy involved is called antiretroviral therapy also named as ART. Using ART drugs has significantly reduced the number of deaths related to AIDS.

Earlier patients diagnosed with HIV/AIDS were expected to live for only 1-2 years. But with the introduction of modern scientific equipment and treatments such as antiretroviral therapy, people diagnosed with HIV in the earlier stages of their infection can keep the HIV virus suppressed and live a near about normal life. But there are also complications to be seen in patients living longer with HIV. Multiple chronic diseases, use of multiple medications, changes in structural and metal abilities and increased susceptibility to stressors are just a few examples of the long term effects of HIV on human body. Although the introduction of effective HIV treatments have decreased the chances of AIDS defining diseases among people, long standing HIV infected people are being affected with cardiovascular diseases, lung diseases, certain types of cancers, HIV-Associated Neurocognitive Disorders, and liver disease such as Hepatitis B and Hepatitis C. Chronic Inflammation can also be found in patients with long term HIV infection.

Pediatric HIV infections were first reported in year 1983. Since then, the number of infected children with HIV has grown dramatically over the years in developing countries due to the increased number of HIV-infected women of childbearing age. As of 2015, 1.8 million children affected with HIV are below 15 years. Further, 400 children are getting affected every day. HIV can be transmitted sexually, vertically, through contaminated blood samples or drug abuses. Paediatric HIV infection can occur during pregnancy, birth or breastfeeding. Symptoms of pediatric HIV infection involve pneumonia, otitis media, fungal infections such as candidiasis, usually severe viral infections such as cytomegalovirus retinitis, growth failure, etc. Diagnosis of infants younger than 18 months requires virologic assays that directly detect HIV due to the persistence of maternal HIV antibody. An enzyme-linked immunosorbent assay also known as ELISA is used to detect HIV antibody in older children followed by a confirmatory Western blot. Rapid HIV tests, with sensitivity as high as 100 percent simplify and expand the availability of HIV tests by providing results within minutes. In addition to antiretroviral drugs, other types of medication are also sometimes required for specific infections. P jiroveci pneumonia prophylaxis is recommended in HIV infected patients younger than 1 year and in older children based on CD4 cell counts.

The recent data shows that the highest number of HIV diagnoses reported to be in men who have sex with men (MSM). Even as different sections have seen a decrease in their HIV infection rates over the years, the rate of new HIV infections has remained surprisingly stable in case of MSM. As per records, there were 26,376 HIV infections reports resulting from male-male sexual contact in 2015. In 2010, it was 26,338. Intervening years also witnessed about 26,000 HIV infections each year. According to the recent reports, most HIV infections in men are transmitted through Sexual contacts. The presence of some STIs highly increases the chances of acquiring or transmitting HIV. Higher rates of gonorrhea and syphilis have been found among black men than among white or Hispanic/Latino men. Also the rates of syphilis have increased in recent years among MSM. Use of drugs through injection or other substances may enhance the risk of HIV infection through sharing injection equipment infected with HIV. Engaging in high-risk behaviours, such as unprotected sex, when under the influence of drugs or alcohol also increases the risk of HIV transmission. As per reports from CDC, around 1.1 million people in U.S have HIV, and it is evident that the prevalence of transmission among men is on the rise. The reports also indicated that in 2016, 81% of the HIV diagnoses were among men ages 13 and older. Since the issue of PrEP in 2012, its uptake has been highest among MSM. These reports do tell us one important thing though, i.e. lack of awareness and responsibility among people of such group leading to staggering rates of HIV infections. Several campaigns initiated by government organisations such as MSM Testing Initiative, National HIV Behavioural Surveillance System, Act Against AIDS campaign, The Reasons/ Razones testing campaign, Testing Makes Us Stronger campaign and Let’s Stop HIV Together are the examples of a few sharing the same goal of extending the support to people thereby educating and encouraging them to come out and contribute to the fight against HIV.

It is evident that, the conventional concept about HIV/AIDS being a male specific disease in its earlier days has changed now. The recent data shows that one-third of all new HIV cases occur in women. According to the reports of CDC, 19% of the new HIV diagnoses were women in 2014. According to reports 87% of these new cases were due to heterosexual sex and the rest of the 13% were due to intravenous drug use. Although HIV cases in women have significantly dropped over the years a vast majority of new HIV diagnosed women are found to be African American. HIV symptoms that can be seen in women after 2 to 4 weeks are often mistaken as common cold or flu rather than HIV. Even though it can take years for symptoms to appear in some cases, approximately 80% of individuals affected with acute HIV infection will experience flu-like symptoms.

Bone damage is normally associated with individuals based on their age, gender, race, family history, diet, physical inactivity, smoking and drinking habits. Osteoporosis is the term associated with bone loss which indicates a serious loss of bone mass resulting it to break. Osteoporosis can bring on a lot of anxiety in affected individuals. Researchers have found that individuals infected with HIV are suffering from osteoporosis more than non-HIV infected individuals. The increased rates of osteoporosis among HIV infected people is a concern but it is noteworthy that the disease differs from young and middle aged HIV infected individuals to the older ones. Osteoporosis is less common in men as compared to women. This is due to a couple of reasons. First, men have larger skeletons compared to women leading to longer bone life and stronger bones. Second, bone loss in men tends to start later in life and progresses slower than women. Third, women are affected with rapid bone loss when their estrogen production drops as a result of menopause. Osteoporosis divided into two types, primary and secondary. Primary osteoporosis can occur in both men and women at any age. On the other hand, Secondary osteoporosis can occur in individuals who either take medications or suffer from disease that can decrease bone density. Bone Mineral Density tests are the only medical procedure to detect osteoporosis. In addition to being painless and noninvasive these tests are very helpful in measuring bone strength. Central machines, peripheral machines are examples of BMD tests. Dual Energy X-ray Absorptiometry also known as DEXA is the most widely used BMD test. Using radiation it measures BMD of spine, hip, or total body. Results of the BMD tests are usually termed as T-score which gives a measurement of difference between the tested bone density and the bone density of a young healthy individual.

STDs can be spread with any type of sexual activity. Viruses and bacteria are often the cause of STDs. In addition to that, there are other infections that may be transmitted on occasion through sexual activities but are not typically considered as STDs by many researchers. The main difference between the two categories of STDs is the agent responsible for that disease. Bacteria leads to Bacterial STDs and viral STDs are caused by viruses. As the diseases are caused by different microorganisms, bacterial STDs and viral STDs vary in their mode of treatment. Gonorrhea, syphilis, and chlamydia, are the types of Bacterial STDs often cured with antibiotics. Nevertheless, viral STDs such as HIV, HPV, herpes, and hepatitis have no cure, but their manifestation can be eased with the help of treatment. STDs can also be caused by protozoa also known as trichomoniasis and other organisms such as crabs, pubic lice and scabies. These kinds of STDs can be cured with antibiotics or topical ointments. Usually STDs do not exhibit any kind of symptoms. So it’s important to go for periodic check-ups. STDs need to be diagnosed correctly and fully treated as soon as possible to avoid complications that could be serious and in some cases may be permanent.

STDs differ in case of men and women and so does their symptoms. Men usually experience bumps or rashes on the genitals, discharge, discomfort or itching in the penis or testicles or pain while urinating or ejaculation. But there are cases where no symptoms can be seen of any kind and it is not the reliable measure of whether an STD is present or absent in the body. In case of men, STD symptoms take a few days to develop but it can take up to weeks. If left untreated, STD infection can have long-lasting or in some cases irreversible effects. In case of women, they are more likely to suffer symptoms such as bumps, itching or burning urination due to STDs, especially in the genital region. Symptoms typically appears within days or week of exposure to an STD. Even in case of women, STDs can go unnoticed and may not show any kind of symptoms.

Increasing infectious diseases pose a grave threat based on their impact on global health, agriculture and on the economy. Emerging infections in animals can be reduced by using the advanced HIV vaccines that can effectively safeguard animal health and stop the transmission of zoonotic diseases to human beings. The HIV vaccine market is expected to reach $57,885.4 million by 2019. Major factors behind the growth of vaccine technology market include increasing enthusiasm in the government to expand immunization across the globe thereby increasing investments from respective companies in vaccine development, and increasing initiatives by the non-government organizations towards HIV/AIDS. The HIV/STD surveillance system in Texas presently uses the HIV/AIDS Reporting System also known as HARS in order to monitor the epidemic in Texas and then report the required data to CDC in order to monitor the epidemic nationally. eHARS provides significant advantage over HARS in terms of storing and processing information. The current HIV testing includes antibody test and HIV diagnosis. Over the past decade, EIA tests have seen major improvements in performance and accuracy and also there is introduction of rapid tests. With the expansion in specimen types options for testing programs have also increased.

With the emerging study of STDs advanced diagnosis techniques such as molecular techniques have been developed. By including molecular amplification, the sensitivity for distinguishing sexually transmitted infections has greatly increased, and organisms that were laborious or sometimes futile to cultivate, such as human papillomavirus (HPV) or Treponema pallidum can now be recognised and surveyed. Nonetheless, with emerging new technologies, new complications and obstacles have also arisen such as the risk of sample contamination and the presence of inhibitors both resulting in false-negative results.

Neuro-Infectious Diseases are infections affecting areas of the brain thereby affecting the nervous system, from the brain and spinal cord to muscles and nerves. Diseases such as neuro-AIDS, neuro-HIV, neurosyphillis, and meningitis come under the category of Neuro-Infectious Diseases. Treatments such as antiviral, antibacterial, anti-inflammatory or anticonvulsive medicines, among other approaches are considered for Neuro-Infectious Diseases. Multiple sclerosis is considered as the most common neuroimmune disorder and HIV is considered as the most common viral infection of the nervous system. In both disorders, individuals experience progressive loss of neurons, resulting in significant cognitive and motor dysfunction.

Although there are no medicines currently available to prevent or cure HIV/AIDS, people are having access to HIV treatments such as Antiretroviral Therapy or ART which is beneficial to their health. People living with HIV achieve and maintain viral suppression by taking medication as prescribed. By doing so, they are staying healthy for many years and also at the same time greatly reducing their chances of transmitting HIV to their partners. In addition to that people having high risk for HIV infection may have access to pre-exposure prophylaxis. Microbicides is an emerging study in the field of HIV/AIDS and STDs/STIs prevention.

There are two distinctive categories of HIV epidemics. One is the concentrated epidemic and another is the generalized epidemic. In case of concentrated epidemics, transmission of HIV occurs mostly in defined exposed groups such as sex workers, transgender people, men who have sex with men. Use of injection drugs by the drug addicts also comes under the category of concentrated epidemic. In case of generalized epidemics, transmission of HIV occurs by sexual activities in the general population and it will persist despite effective programs for exposed groups. Since the beginning, more than 70 million people have been affected with HIV and about 35 million people have already died of HIV/AIDS. At the end of the year 2016, it was estimated that about 36.7 million people were living with HIV. Sub-Saharan Africa is the most affected region with HIV accounting for nearly two-thirds of the people living with HIV worldwide.

It is widely believed that the origin of HIV was in Kinshasa around 1920. Up until 1980, there was no data of people being affected with HIV or developed AIDS. According to available data, it has been suggested that the current epidemic started in the mid to late 1970s and by 1980 HIV may have already spread to five continents thereby infecting 100,000 to 300,000 people. In 1981, cases of Pneumocystis carinii pneumonia, a rare lung infection and Kaposi’s sarcoma, an unusually aggressive cancer were found in people from Los Angeles, New York and California respectively. In 1983, AIDS was reported among the female partners of men suggesting the cause to be heterosexual intercourse. Later that year, it was also found that children can also get the virus from their mother before, during or shortly after birth. In 2006, male circumcision was introduced to reduce the risk of female to male HIV transmission. In 2010, the CAPRISA 004 microbicide trial was declared as a success in reducing HIV infection in women. In 2011, introduction of antiretroviral treatment reduced the risk of HIV infection to 96% among the serodiscordant couples. In 2012, the FDA approved PrEP for HIV-negative people in order to prevent the sexual transmission of HIV. In 2013, AIDS related deaths had fallen 30% since their peak in 2005. In 2016, the number of HIV infected people living in Russia reached 1 million with 64% of all new HIV diagnoses in Europe occurred in Russia.

Individuals with HIV/AIDS infection require special attention towards them, in home and also in hospitals. Their treatment involves specific medical procedures that must be completed by trained medical professionals. With the introduction of antiretroviral treatment and opportunistic pathogens, HIV infection rate has decreased marginally. But there are individuals with HIV/AIDS infection who require specific medical attention that cannot be provided at home.  These individuals must be admitted to the hospitals for their medical treatments. Nursing care is an essential component of comprehensive patient care associated with the HIV/AIDS infected individuals. In fact, patients diagnosed with AIDS require more nursing care than non-AIDS patients. HIV/AIDS Nurses are trained to administer care for HIV/AIDS infected patients. They help the HIV/AIDS infected patients to cope with the different mental and physical challenges that come with the disease. HIV/AIDS Nurses work in communities, educating exposed groups about safe sex and the dangers associated with sharing needles.

Stigma and discrimination refers to the injustice, negative attitudes and the misdeeds done to the HIV/AIDS infected people. People subjected to stigma and discrimination based on their age, health status, social and economic status, gender, race, sexual orientation or other grounds are exposed to HIV. Stigma and discrimination reveals itself in different ways. Discrimination and other human rights violations may seem to appear in health care departments, preventing people from getting health services or appreciating quality health care. In some cases, people affected with HIV and other key affected populations are despised by family, friends and the wider community, while in some other cases, people face poor treatment in educational and work environments, denial of their rights, and psychological traumas. These all result into difficulties in HIV testing, treatment and other HIV services.

Getting affected from HIV can change a person’s life for good. It changes the social aspects of people’s lives as well as their psychological and physical aspects which in turn lead to change in their behaviour. None the less, people start showing mixed attitudes towards the HIV infected individuals. Regardless of the difficulties and the atrocities, HIV doesn’t have to stop people living a long, happy and fulfilled life. With the appropriate medical treatment and support, it is possible for a HIV infected individuals to live their lives similar to that of an average human being. There are a lot of mixed views and misconceptions associated with people living with HIV/AIDS. Each individual is living a different life than others– how he copes with his diagnosis and goes forward in his life will be unique to that individual. It is a principle, which supports the active and meaningful cooperation of individuals living with HIV/AIDS in the design, research and development, implementation, monitoring and evaluation of all policies and programmes that may affect their lives.