World AIDS Day 2014: Closing the gap in HIV prevention and treatment
1 December 2014

On World AIDS Day 2014 WHO will release new guidelines on providing antiretrovirals (ARVs) as an emergency prevention following HIV exposure, and on the use of the antibiotic co-trimoxazole to prevent HIV-related infections.
The guidelines provide advice on providing ARVs as post-exposure prophylaxis (“PEP”) for people who have been exposed to HIV – such as health workers, sex workers, and survivors of rape.
In 2013, WHO published consolidated guidelines on the use of antiretrovirals that promote earlier, simpler and less toxic interventions to keep people healthier for longer, and to help prevent HIV transmission. A growing number of countries with a high burden of HIV have adopted these guidelines. In 2013, a record 13 million people were able to access life-saving ARVs.
But too many people still lack access to comprehensive HIV treatment and prevention services. The 1 December supplement to the WHO consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, released in June 2013, aims to help bridge that gap
What is HIV?
The human immunodeficiency virus (HIV) infects cells of the immune system, destroying or impairing their function. Infection with the virus results in progressive deterioration of the immune system, leading to "immune deficiency." The immune system is considered deficient when it can no longer fulfil its role of fighting infection and disease. Infections associated with severe immunodeficiency are known as "opportunistic infections", because they take advantage of a weakened immune system.
What is AIDS?
Acquired immunodeficiency syndrome (AIDS) is a term which applies to the most advanced stages of HIV infection. It is defined by the occurrence of any of more than 20 opportunistic infections or HIV-related cancers.
How is HIV transmitted?
HIV can be transmitted through unprotected sexual intercourse (vaginal or anal), and oral sex with an infected person; transfusion of contaminated blood; and the sharing of contaminated needles, syringes or other sharp instruments. It may also be transmitted between a mother and her infant during pregnancy, childbirth and breastfeeding.
How many people are living with HIV?
According to estimates by WHO and UNAIDS, 35 million people were living with HIV globally at the end of 2013. That same year, some 2.1 million people became newly infected, and 1.5 million died of AIDS-related causes.
How quickly does a person infected with HIV develop AIDS?
The length of time can vary widely between individuals. Left without treatment, the majority of people infected with HIV will develop signs of HIV-related illness within 5–10 years, although this can be shorter. The time between acquiring HIV and an AIDS diagnosis is usually between 10–15 years, but sometimes longer. Antiretroviral therapy (ART) can slow the disease progression by preventing the virus replicating and therefore decreasing the amount of virus in an infected person’s blood (known as the ‘viral load’).
What is the most common life-threatening opportunistic infection affecting people living with HIV/AIDS?
Tuberculosis (TB) kills nearly 360 000 people living with HIV each year. It is the number one cause of death among HIV-infected people in Africa, and a leading cause of death in this population worldwide. There are a number of core health care strategies that are critical to prevent and manage TB infection among people living with HIV:
intensified case finding for active TB
isoniazid preventive treatment
TB infection control
early initiation of antiretroviral therapy.
How can I limit my risk of HIV transmission through sex?
Use male or female condoms correctly each time you have sex.
Practice only non-penetrative sex.
Remain faithful in a relationship with an uninfected equally faithful partner with no other risk behaviour.
Does male circumcision prevent HIV transmission?
Male circumcision reduces the risk of female-to-male sexual transmission of HIV by around 60%. Since 2007, WHO and UNAIDS have recommended voluntary medical male circumcision as an additional strategy for HIV prevention in settings with high HIV prevalence and low levels of male circumcision. Fourteen countries in eastern and southern Africa with this profile have initiated programmes to expand male circumcision.
A one-time intervention, medical male circumcision provides life-long partial protection against HIV as well as other sexually transmitted infections. It should always be considered as part of a comprehensive HIV prevention package and should never replace other known methods of prevention, such as female and male condoms.
How effective are condoms in preventing HIV?
When used properly during every sexual intercourse, condoms are a proven means of preventing HIV infection in women and men. However, apart from abstinence, no protective method is 100% effective.
What is a female condom?
The female condom is the only female-controlled contraceptive barrier method currently on the market. The female condom is a strong, soft, transparent polyurethane sheath inserted in the vagina before sexual intercourse. It entirely lines the vagina and provides protection against both pregnancy and STIs, including HIV, when used correctly in each act of intercourse.
What is the benefit of an HIV test?
Knowing your HIV status can have 2 important benefits.
If you learn that you are HIV positive, you can take steps before symptoms appear to access treatment, care and support, thereby potentially prolonging your life and preventing health complications for many years.
If you know that you are infected, you can take precautions to prevent the spread of HIV to others.
What are antiretroviral drugs?
Antiretroviral drugs are used in the treatment and prevention of HIV infection. They fight HIV by stopping or interfering with the reproduction of the virus in the body, reducing the amount of virus in the body.
What is the current status of antiretroviral treatment (ART)?
At the end of 2013, 11.7 million people in low- and middle-income countries were receiving HIV antiretroviral therapy (ART). Until 2003, the high cost of the medicines, weak or inadequate health care infrastructure, and lack of financing prevented wide use of combination ART in low- and middle-income countries. But in recent years, increased political and financial commitment has allowed dramatic expansion of access to treatment.
Is there a cure for HIV?
No, there is no cure for HIV. But with good and continued adherence to ART, the progression of HIV in the body can be slowed to a near halt. Increasingly, people living with HIV can remain well and productive for extended periods of time, even in low-income countries.
What other kinds of care do people living with HIV need?
In addition to ART, people with HIV often need counselling and psychosocial support. Access to good nutrition, safe water and basic hygiene can also help an HIV-infected person maintain a high quality of life
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