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- Things to Know - HIV Cause - Symptoms/Signs - Risks & Complications - Diagnosis - Treatment - During Pregnancy - Prognosis - Prevention - Vaccine Things to know about AIDS - AIDS stands for "acquired immunodeficiency syndrome." - AIDS is an advanced stage of infection with the human immunodeficiency virus (HIV). HIV usually spreads from person to person through contact with infected sexual secretions or blood. - People with AIDS have weakened immune systems that make them vulnerable to medical conditions and infections. - For people infected with HIV, the risk of progression to AIDS increases with the number of years the person has the infection. The risk of progression to AIDS decreases by using highly effective antiretroviral therapy (ART) regimens. - In people with AIDS, ART improves the immune system and substantially increases life expectancy. Many patients treated with ART have near-normal life expectancies. - ART is a treatment that patients must continue for life. It is not a cure. - It is possible for HIV to become resistant to some antiretroviral medications. The best way to prevent resistance is for the patient to take their ART as directed without fail. If the patient wants to stop a drug because of side effects, he or she should call the physician immediately. - If a patient with HIV exposes another person to blood or potentially infectious fluids, the exposed person can take medications to reduce the risk of getting HIV. - Research is underway to find a vaccine and cure for HIV. What does AIDS stand for? What causes AIDS? AIDS is an acronym for acquired immunodeficiency syndrome." The human immunodeficiency virus (HIV) causes AIDS and represents the most advanced stage of HIV infection. How HIV affects the immune system HIV spreads through infected blood or fluids such as sexual secretions. Over time, the virus attacks the immune system, focusing on special cells called "CD4 cells" which are important in protecting the body from infections and cancers, and the number of these cells starts to fall. Eventually, the CD4 cells fall to a critical level, and/or the immune system weakens so much that it can no longer fight off certain types of infections and cancers. AIDS is an advanced stage of HIV infection. HIV is a very small virus that contains ribonucleic acid (RNA) as its genetic material. When HIV infects animal cells, it uses a special enzyme, reverse transcriptase, to turn (transcribe) its RNA into DNA. ("Retroviruses" are viruses that use reverse transcriptase.) When HIV reproduces, it is prone to making small genetic mistakes or mutations, resulting in viruses that vary slightly from each other. This ability to create minor variations allows HIV to evade the body's immunologic defenses, essentially leading to lifelong infection, and has made it difficult to make an effective vaccine. The mutations also allow HIV to become resistant to antiretroviral medications. QUESTIONSee Answer What is the history of AIDS? Careful investigation has helped scientists determine where HIV came from. Studies have shown that HIV first arose in Africa. It spread from non-human primates to people early in the 20th century, possibly when humans came into contact with infected blood during a chimpanzee hunt. By testing stored blood samples, scientists have found direct evidence of a human being infected as long ago as 1959. Once introduced into humans, HIV spread through sexual intercourse from person to person. As infected people moved around, the virus spread from Africa to other areas of the world. In 1981, U.S. physicians noticed that a large number of young men were dying of unusual infections and cancers. Initially, U.S. victims were gay men predominately, probably because the virus inadvertently entered this population first in this country and because the virus is transmitted easily during anal intercourse. However, it is important to note that heterosexual activity and contact with infected blood or secretions also efficiently transmits the virus. In Africa, which remains the center of the AIDS pandemic, most cases are heterosexually transmitted. In 1991, the news that Magic Johnson had acquired HIV heterosexually helped the country realize that the infection was not limited to men who had sex with men. Currently in the U.S., approximately 27% of new HIV infections are a result of heterosexual transmission. Other major factors in the early days of AIDS was transmission from blood by injection drug use (IDU) with needle sharing and transfusions of blood and blood components. Before the ability to test for the virus in donated blood became available, transfusions infected numerous hemophiliacs and surgical patients. In the years since people first identified the virus, HIV has spread to every corner of the globe and is one of the leading causes of infectious death worldwide. Statistics from the World Health Organization show that approximately 1.5 million people die each year from AIDS, and 240,000 of these are children. Worldwide, half of HIV-infected people are women. Two-thirds of current cases are in sub-Saharan Africa. In the U.S., more than 1 million people have HIV infections, and approximately 40,000 are newly infected each year. Over the years, more than 600,000 people in the U.S. have died from AIDS, many of them during what should have been their most productive years of life. What are AIDS symptoms and signs? AIDS is an advanced stage of HIV infection. People with AIDS often develop symptoms and signs of unusual infections or cancers largely due to the destruction of the CD4 cells in the immune system. When a person with HIV infection gets one of these infections or cancers, medical professionals refer to this as an "AIDS-defining condition." Significant, unexplained weight loss also is an AIDS-defining condition. Because common conditions like cancer or other viral conditions like infectious mononucleosis also can cause weight loss and fatigue, it is sometimes easy for a physician to overlook the possibility of HIV/AIDS. It is possible for people without AIDS to get some of these conditions, especially the more common infections like tuberculosis. People with AIDS may develop symptoms of pneumonia due to Pneumocystis jiroveci, which rarely appears in people with normal immune systems. They also are more likely to get pneumonia due to common bacteria. Globally, tuberculosis is one of the most common infections associated with AIDS. In addition, people with AIDS may develop seizures, weakness, or mental changes due to toxoplasmosis, a parasite that infects the brain. Neurological signs also may be due to meningitis caused by the fungus Cryptococcus. A yeast infection of the esophagus called candidiasis may cause complaints of painful swallowing. Because these infections take advantage of the weakened immune system, health care providers refer to them as "opportunistic infections." The weakening of the immune system associated with HIV infection can lead to unusual cancers like Kaposi's sarcoma. Kaposi's sarcoma develops as raised patches on the skin that are red, brown, or purple. Kaposi's sarcoma can also be present in the mouth, intestine, or respiratory tract. AIDS also may be associated with lymphoma (a type of cancer involving white blood cells). In people with AIDS, HIV itself may cause symptoms. Some people experience relentless fatigue and weight loss, known as "wasting syndrome." Others may develop confusion or sleepiness due to infection of the brain with HIV, known as HIV encephalopathy. Both wasting syndrome and HIV encephalopathy are AIDS-defining illnesses. SLIDESHOWSee Slideshow What are risk factors for developing AIDS? Developing AIDS requires that the person acquire HIV infection. Risks for acquiring HIV infection include behaviors that result in contact with infected blood or sexual secretions, which pose the main risk of HIV transmission. These behaviors include sexual intercourse and injection drug use. The presence of sores in the genital area, like those caused by herpes, makes it easier for the virus to pass from person to person during intercourse. HIV also has been spread to health care workers through accidental sticks with needles contaminated with blood from HIV-infected people, or when broken skin contacted infected blood or secretions. Blood products used for transfusions or injections also may spread infection, although this has become extremely rare (less than one in 2 million transfusions in the U.S.) due to testing of blood donors and blood supplies for HIV. Finally, infants may acquire HIV from an infected mother either while they are in the womb, during birth, or by breastfeeding after birth. The risk that HIV infection will progress to AIDS increases with the number of years since a person acquired the infection. If the HIV infection is untreated, 50% of people will develop AIDS within 10 years, but some people progress in the first year or two and others remain completely asymptomatic with normal immune systems for decades after infection. The risk of developing one of the complications that define AIDS is associated with declining CD4 cells, particularly to below 200 cells/ul. Antiretroviral treatment substantially reduces the risk that HIV will progress to AIDS. In developed countries, the use of ART has turned HIV into a chronic disease that may never progress to AIDS. Conversely, if infected people are not able to take their medications or have a virus that has developed resistance to several medications, they are at increased risk for progression to AIDS. How do health care professionals diagnose AIDS? To diagnose AIDS, the doctor will need (1) a confirmed, positive test for HIV ("HIV positive" test) and (2) evidence of an AIDS-defining condition or severely depleted CD4 cells. Testing for HIV is a two-step process involving a screening test and a confirmatory test. Current guidelines recommend that the first step is a screening test that looks for a component of the virus, called p24 antigen, as well as antibodies against HIV. Specimens for testing come from blood obtained from a vein or a finger stick, an oral swab, or a urine sample. Results can come back in minutes (rapid tests) or can take several days, depending on the method that is used. If the screening HIV test is positive, a different test that looks for antibodies to either HIV-1, the most common form of this virus, or to HIV-2, a strain more common in select parts of the World, such as Western Africa, will confirm the results. If one of these tests is positive, it confirms infection with that particular type of HIV. If both tests are negative, then medical professionals perform a test looking for the virus to see if the initial screening assay detected the viral protein at a time when infection was new and antibodies had yet to develop. Merely having HIV does not mean a person has AIDS. AIDS is an advanced stage of HIV infection and requires that the person have evidence of a damaged immune system. That evidence comes from at least one of the following: - The presence of an AIDS-defining condition - Measuring the CD4 cells in the body and showing that there are fewer than 200 cells per milliliter of blood - A laboratory result showing that fewer than 14% of lymphocytes are CD4 cells It is important to remember, however, that any diagnosis of AIDS requires a confirmed, positive test for HIV. What is the treatment for HIV/AIDS? Antiretroviral medications are medications that fight HIV. Different antiretroviral medications target the virus in different ways. When used in combination with each other, they are very effective at suppressing the virus. It is important to note that there is no cure for HIV. ART only suppresses the reproduction of the virus and stops or delays the disease from progressing to AIDS. Most guidelines currently recommend that all HIV-infected people who are willing to take medications should have them initiated shortly after their HIV diagnosis. This delays or prevents disease progression, improve the overall health of an infected person, and makes it less likely that they will transmit the virus to their partners. There are currently seven major classes of antiretroviral medications: - nucleoside reverse transcriptase inhibitors (NRTIs), - non-nucleoside reverse transcriptase inhibitors (NNRTIs), - protease inhibitors (PIs), - fusion inhibitors, - integrase inhibitors, - CCR5 antagonists, and - entry inhibitor. People use these drugs in different combinations according to their needs and depending on whether the virus has become resistant to a specific drug or class of drugs. Treatment regimens usually consist of three to four medications at the same time. Combination treatment is essential because using only one class of medication by itself allows the virus to become resistant to the medication. There are now pills that contain multiple drugs in a single pill, making it possible to treat many people with a single pill per day. Before starting ART, medical professionals usually perform blood tests to make sure the virus is not already resistant to the chosen medications. Health care providers may repeat these resistance tests if it appears the drug regimen is not working or stops working. Physicians instruct patients about the importance of taking all of their medications as directed and are told what side effects to watch for. Noncompliance with medications is the most common cause of treatment failure and can cause the virus to develop resistance to the medication. Because successful therapy often depends on taking several pills, it is important for the patient to understand that this is an "all or nothing" regimen. If the person cannot tolerate one of the pills, then he or she should call their physician, ideally prior to stopping any medication. Taking just one or two of the recommended medications is strongly discouraged because it allows the virus to mutate and become resistant. It is best to inform the HIV health care provider immediately about any problems so they can prescribe a better-tolerated combination. What is the treatment for HIV during pregnancy? There are two goals of treatment for pregnant women with HIV infection: - to treat maternal infection and - to reduce the risk of HIV transmission from mother to child. Women can pass HIV to their babies during pregnancy, during delivery, or after delivery by breastfeeding. Without treatment of the mother and without breastfeeding, the risk of transmission to the baby is about 25%. With treatment of the mother before and during birth and with the treatment of the baby after birth, the risk decreases to less than 2%. Because of this benefit, doctors recommended that all pregnant women undergo routine HIV testing as part of their prenatal care. Once diagnosed, there are several options for treatment, although women cannot use some antiretroviral medications during pregnancy and others have not been studied during pregnancy. For example, recent data suggests that dolutegravir (Tivicay) should be avoided in women who may become pregnant so that exposure at conception does not occur. Fortunately, there are treatment regimens that have been shown to be well tolerated by most pregnant women, significantly improving the outcome for mother and child. The same principles of testing for drug resistance and combining antiretrovirals used for nonpregnant patients are used for pregnant patients. All pregnant women with HIV should receive ART treatment regardless of their CD4 cell count, although the choice of drugs may differ slightly from nonpregnant women. In developed countries, women also are instructed not to breastfeed their children. Compliance with medications is important to provide the best outcome for mother and child. Even though a physician might highly recommend a medication regimen, the pregnant woman has a choice of whether or not to take the medicines. Studies have shown improved compliance when there is good communication between the woman and her doctor, with open discussions about the benefits and side effects of treatment. Compliance also improves with better social support, including friends and relatives. Patients must continue medications throughout pregnancy, labor, and delivery. Some medicines, such as zidovudine (also known as AZT), can be given intravenously during labor, particularly for those women who do not have good viral suppression at the time of delivery. Patients need to continue other medications orally during labor to try to reduce the risk of transmission to the baby during delivery. If the quantity of virus in the mother's blood (viral load) is more than 1,000 copies/mL near the time of delivery, doctors will perform a scheduled cesarean delivery at 38 weeks gestation to reduce the risk of transmitting the virus during vaginal delivery. Women with HIV should continue taking ART after delivery for their own health. If a pregnant woman with HIV infection does not take ART during pregnancy and goes into labor, medical professionals will still give her medications during labor. This reduces the risk of transmission of HIV. After delivery, health care providers will give the infant medication(s) for at least six weeks to reduce the risk of transmission of HIV. If the mother did not take ART during pregnancy or if the mother has a drug-resistant virus, medical professionals will treat infants with multiple medications. Health care providers test infants periodically in the first six months to ensure they have not acquired the virus. QUESTIONSee Answer What is the treatment for non-HIV-infected people exposed to the genital secretions or blood of someone with HIV? Blood and genital secretions from people with HIV are infectious and the utmost care should be taken in handling them. Fluids contaminated with blood also are potentially infectious. Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomit are not considered infectious unless visibly bloody. The most commonly reported occupational exposures are - an inadvertent needle stick (usually when drawing blood from someone with HIV); - a cut from a sharp object such as a scalpel that is contaminated with blood; - exposure of mucous membranes to infectious fluid (mucous membranes that may be exposed to splashes of material include the mouth, nasal passages, and eyes); - exposure of open sores or abraded/inflamed skin to infectious material. The average risk of HIV infection after a needle-stick injury is around 0.3% and after mucous-membrane exposure to blood is approximately 0.09%. For abraded skin exposure, the risk is less than mucous membrane exposure. Some factors that may affect the risk for HIV transmission such as the amount of blood from the infected source. Deep injury from a needle, visible blood in/on the needle, or a needle placed in an artery or vein are examples of higher-risk situations. The risk of transmission also depends on the number of virus particles in the blood, with higher viral loads leading to an increased risk of transmission. If an exposure occurs, the exposed person can reduce the risk of getting HIV by taking antiretroviral medications. Current recommendations suggest three antiretroviral medications. Start medications as soon as possible, preferably within hours of exposure and should be continued for four weeks, if tolerated. People who have been exposed should be tested for HIV at the time of the injury and again at six weeks, 12 weeks, and six months after exposure. It is important to document that an exposure has occurred or was likely. A needle stick from a person with HIV or a person likely to have HIV constitutes a significant exposure. Medications should be started immediately. If it is unknown whether the person who is the source of the potentially infected material has HIV, health care providers can test the source person. Medications started immediately in the exposed person can be discontinued if the source person does not turn out to carry HIV. Potentially infectious material splashed in the eye or mouth, or encountering non-intact skin, also constitutes an exposure and should prompt immediate evaluation to determine if medications should be started. Other potential exposures include vaginal and anal sexual intercourse and sharing needles during intravenous drug use. There is less evidence for the role of antiretroviral postexposure prophylaxis after these exposures. In part, this is because the exposed person usually does not know the HIV status of a sexual partner or drug user. Nevertheless, the U.S. Centers for Disease Control and Prevention (CDC) recommends treatment for people exposed through sexual activity or injectable drug use to someone who is known to carry HIV. If the HIV status of the source is not known, the decision to treat is individualized. Concerned people should see their physician for advice. If a decision to treat is made, medications should be started within 72 hours of the exposure. For every exposure, especially with blood, it is important to test for other blood-borne diseases like hepatitis B or C, which are more common among HIV-infected patients. Reporting to a supervisor, in the case of health care workers, or seeking immediate medical consultation is advisable. For sexual exposures, medical professionals should test patients for syphilis, gonorrhea, chlamydia, and other sexually transmitted diseases (STDs) because individuals with HIV are more likely to have other STDs. Patients also should be counseled about how to prevent exposure in the future. What are the complications of HIV? The complications of HIV infection result mainly from a weakened immune system. The virus also infects the brain, causing degeneration, problems with thinking, or even dementia. This makes the person more vulnerable to certain types of conditions and infections (see Table 1). Treatment with ART can prevent, reverse, or mitigate the effects of HIV infection. Some patients on ART may be at risk for developing cholesterol or blood-sugar problems. Although many effective medications are on the market, the virus can become resistant to any drug. This can be a serious complication if it means that a patient must use a less effective medicine. To reduce the risk of resistance, patients should take their medications as prescribed and call their physician immediately if they feel they need to stop one or more drugs. What is the prognosis for HIV infection? Left untreated, HIV is usually a fatal illness with half of the people dying within nine months of diagnosis of an AIDS-defining condition. The use of ART has dramatically changed this grim picture. People who are on an effective ART regimen have life expectancies that are similar to or only moderately less than the uninfected population. Unfortunately, many people with HIV deal with socioeconomic issues, substance-abuse issues, or other problems that interfere with their ability or desire to take medications. How can people prevent an HIV infection? Sexual abstinence is completely effective in eliminating sexual transmission, but educational campaigns have not been successful in promoting abstinence in at-risk populations. Monogamous sexual intercourse between two uninfected partners also eliminates the sexual transmission of the virus. Using barrier methods, such as condoms, during sexual intercourse markedly reduces the risk of HIV transmission. These measures have had some success in blunting the rate of new cases, especially in high-risk areas such as sub-Saharan Africa or Haiti. As discussed above, medications may reduce the risk of HIV infection if used within hours of exposure. There also is data that if uninfected people can take antiretroviral medications, in particular, tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC or Truvada) once daily, it markedly reduces the risk of sexual transmission. Perhaps the most effective way to reduce HIV transmission is for the HIV-infected partner to be on ART with undetectable levels of virus in their blood. As noted above, a pregnant woman with HIV can reduce the risk of passing the infection to her baby by taking medications during pregnancy and labor and avoiding breastfeeding. There is now growing data that those consistently suppressed on ART pose virtually no risk of transmitting sexually to their partners. People can prevent needle-stick injuries by touching syringes with only one hand and by using more modern needles that have retractable sleeves. The use of gowns, gloves, masks, and eye protection can reduce the risk of exposure to infected secretions in high-risk settings. For intravenous-drug abusers, the use of clean needles and the elimination of needle sharing reduces the risk of transmission. SLIDESHOWSee Slideshow Is there a vaccine for HIV? To date, there is no effective vaccine for HIV. Researchers have made several attempts to create a vaccine but all have failed. This remains an active area of research. What are researchers doing to find a cure for HIV? The search for a cure for HIV began as soon as researchers identified the virus. HIV is probably one of the most studied viruses in history. Scientists have a detailed knowledge of the virus' genes, and proteins, and understand how it functions. In fact, researchers chose the combinations of drugs that make up ART therapy because they attack different parts of the virus life cycle, causing it to malfunction. However, ART is not a cure and HIV patients must take the drugs for life. Even when viral levels are low, the virus is still present in the body. One of the problems with finding a cure is that the virus can persist in cells throughout the body and potentially hide in areas that are difficult for drugs to reach, like the brain. New research is helping us understand how to treat viruses effectively in these secluded areas of the body. In addition, researchers are studying those infected cells that persist in the body to determine how they can be stimulated to produce viruses and/or be targeted for clearance from the body by novel therapies. Where can a person find information about clinical trials for HIV and AIDS? There are a large number of studies currently under way that involve HIV-infected patients. These studies are registered in a central database that can be searched at http://clinicaltrials.gov. From Resources for Staying Well Featured Centers Health Solutions From Our Sponsors Health Solutions From Our Sponsors Perinatal HIV Guidelines Working Group. "Public Health Service Task Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States." Richman, Douglas D., David M. Margolis, Martin Delaney, Warner C. Greene, Daria Hazuda, Roger J. Pomerantz. "The Challenge of Finding a Cure for HIV Infection." United States. CDC. "Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings." United States. CDC. "Subpopulation Estimates From the HIV Incidence Surveillance System - United States, 2006." United States. Centers for Disease Control and Prevention. "Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV -- United States, 2016": 1-91. United States. CDC. "Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis." United States. Department of Health and Human Services. "Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents." United States. Department of Health and Human Services. "Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States."
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काठमाडौं , पुस २ : विश्वभरका देशहरुमा जस्तै नेपालमा पनि हरेक वर्ष डिसेम्बर महिनाको १ तारिकलाई ‘एचआइभी परीक्षण गराऔँ, आफ्नो अवस्था थाहा पाऔँ’ भन्ने नाराकासाथ ३० औँ विश्व एड्स दिवस मनाइएको छ । विश्व एड्स दिवसको मूख्य उद्देश्य हरेक व्यक्तिले आफू एचआइभी संक्रमित भए–नभएको अवस्था र एचआइभी परीक्षणको महत्वबारे समुदायस्तरसम्म जनचेतना अभिवृद्धि गर्ने र परीक्षणको पहुँच पु¥याउनु पर्ने हो । एचआइभी एड्स के हो ? मानवको प्रतिरक्षा प्रणाली नष्ट गर्ने जीवाणु शरीरमा प्रवेश गरे रगतमा यसको वृद्धि विकास हुनु नै एचआइभी संंक्रमण हो । एचआइभीले मानव शरीरको रोगसँग लड्नसक्ने क्षमता कमजोर बनाउँदै लैजान्छ । प्रतिरक्षा प्रणाली कमजोर भएपछि जुनसुकै रोगले पनि आक्रमण गरी रोगी तुल्याउने अवस्थालाई एड्स भनिन्छ । एचआइभी एड्सको ऐतिहासिक पृष्ठभूमि कस्तो छ ? सर्वप्रथम सन् १९८१ तिर अमेरिकाली मुलुक हाइटीमा एचआइभी संक्रमणमा जस्तै चिन्ह र लक्षण भएका समलिंगी व्यक्तिको समूह पाइएको थियो । अनुसन्धान र परीक्षणान सन् १९८३–८४ तिर मात्र एचआइभी पहिचान भएको थियो । नेपालमा १९८८ मा पहिलो एचआइभी संक्रमित व्यक्ति पाइएको थियो । सन् २०१६ सम्म ८० लाख भन्दा बढी व्यक्ति एचआइभी एड्स परीक्षण गर्दा संक्रमित भएर उपचाररत पाइएका छन् । सन् २०१७ सम्ममा १८ लाख जति नयाँ एचआइभी संक्रमित पाइएका छन् भने करिब ९४ लाख जति एचआइभी सक्रमित भएपनि आफ्नो अवस्थाबारे थाहा नपाएका देखिन्छन् । एचआइभी एड्सको पछिल्लो अवस्था कस्तो छ ? सन् २०१५ सम्ममा दक्षिण पूर्वी एसियाली मुलुकमा हालसम्म प्रायः १५ देखि ४९ वर्ष उमेरका ३५ लाख जति व्यक्ति एचआइभी एड्स पीडित छन् । तीमध्ये १४ लाख जतिले औषधि सेवन गरिरहेका छन् । नयाँ एचआइभी संक्रमित व्यक्तिमध्ये सबैभन्दा बढी भारतमा ८६ हजार, नेपालमा १ हजार ३ सय र सवैभन्दा कम श्रीलङ्कामा १ हजार मात्र पाइएका छन् । एचआइभी संक्रमित भएर जीवन बिताइरहेका व्यक्तिमध्ये सबैभन्दा बढी भारतमा २१ लाख, नेपालमा ३९ हजार र भुटानमा १ हजार जति भएको तथ्याङ्क छ भने एचआइभी एड्सका कारणले मृत्यु भएका व्यक्तिमध्ये भारतमा ६८ हजार, नेपालमा २ हजार ३ सय, र श्रीलङ्कामा भने २ सयभन्दा कम रहेको प्रतिवेदनमा उल्लेख छ । सन् २०१७ को प्रतिवेदनअनुसार, नेपालमा ३१ हजारभन्दा बढी व्यक्ति एचआइभी संक्रमित भएर जीवनयापन गरेको अनुमान गरिएको छ । तीमध्ये १५ देखि ४९ वर्ष उमेरका २९ हजार भन्दा बढी व्यक्ति एचआइभी संक्रमित भएर जीवन बिताइरहेको अनुमान छ । स्वास्थ्य सेवा विभागको २०७३–७४ को प्रतिवेदनअनुसार, यौनरोगका बिरामीको संख्या (१,४१,७८५) बढ्दो छ भने जम्मा २९ प्रतिशतले मात्र यौनसम्पर्क गर्दा कण्डम प्रयोग गर्ने गरेका छन् । सन् २०१८ जुलाइसम्ममा नेपालमा १ हजार ३ सयभन्दा बढी व्यक्ति एचआइभीबाट नयाँ संक्रमित भएका छन् भने १६ हजार ४ सयभन्दा बढी (५३ प्रतिशत) एचआइभी एड्स पीडित व्यक्तिले एन्टी रेक्ट्रोभाइरल थेरापी (एआरभी) सेवन गरिरहेका छन् । एचआइभी कसरी सर्छ ? + असुरक्षित यौन सम्पर्कः एचआइभी संक्रमित व्यक्तिसँग असुरक्षित यौनसम्पर्क गरे एचआइभी सर्दछ । + असुरक्षित रगतः स्वच्छ व्यक्तिले एचआइभीबाट प्रदूषित रगत लिए एचआइभी सर्दछ । + एचआइभी संक्रमित आमाः एचआइभी संक्रमित गर्भवती आमाबाट शिशुमा एचआइभी सर्ने सम्भावना ४५ प्रतिशत रहन्छ । + लागुपदार्थ औषधि सेवनः एचआइभी संक्रमित व्यक्तिले नसाद्वारा लागुपदार्थ, औषधि सेवन गर्दा प्रयोग गरेका प्रदूषित सिरिञ्ज–सुई स्वस्थ व्यक्तिले प्रयोग गरे एचआइभी सर्दछ । एचआइभी एड्सका चिन्ह र लक्षण के के हुन् ? १. विनाकारण हरेक महिना १० प्रतिशतसम्म तौल घट्नु । २. एक महिनाभन्दा बढी पखाला लागिरहनु । ३. जुनसुकै स्वास्थ्य समस्याले आक्रमण गरिरहनु । ४. एक महिनाभन्दा बढी ज्वरो आउनुका साथै अन्य संक्रमण भइरहनु । ५. मुखभित्र ढुसी देखिनु । ६. शरीर जीर्ण हुँदै जानु । ७. अन्त्यमा मृत्युसमेत हुनु । एचआइभी एड्स तथा क्षयरोगको सह–संक्रमण के हो ? + एचआइभी एड्स व्यक्तिमा प्रतिरक्षा प्रणाली कमजोर हुँदा क्षयरोगको समेत संक्रमण बढिरहेको छ र एचआइभी एड्स, क्षयरोग सह–संक्रमणका कारणले मृत्युसमेत बढिरहेको छ । यसबाट नागरिक, परिवार, समुदायका साथै देशकै सामाजिक, आर्थिक अवस्थामा समेत नकारात्मक असर परेको छ । + एचआइभी संक्रमित नभएका व्यक्ति भन्दा संक्रमित व्यक्तिलाई क्षयरोगको संक्रमण हुने सम्भावना १० गुणासम्म बढी रहन्छ । तसर्थ समयमै परीक्षण गरी पूरा उपचार गर्नु पर्दछ । + समयमैं परीक्षण, परामर्श, नियमित पूरा उपचार, माया र हेरचाह गरेमा एचआइभी क्षयरोगको सह–संक्रमणबाट हुने मृत्युदर घटाउन सकिन्छ । एचआइभी एड्स नियन्त्रणमा चुनौति के के छन् ? + कुनै व्यक्तिलाई एचआइभी संक्रमण भएको थाहा वा शंका लाग्नासाथ सामाजिक बहिष्कार तथा भेदभाव गरिन्छ । + एचआइभी एड्स नियन्त्रणमा राजनीतिक प्रतिबद्धता र दिगो राजनीतिक शासन व्यवस्था कायम नहुँदा पनि समस्या देखिन्छ । १५ देखि ४९ वर्षका उत्पादनशील व्यक्ति नै एचआइभी एड्सबाट संक्रमित र पीडित छन् । + स्वास्थ्य सेवा प्रणालीमा एचआइभी एड्स नियन्त्रणमा तालिमप्राप्त स्वास्थ्यकर्मीको कमी, औषधि, उपकरण आपूर्तिमा कमी, आवश्यक प्रयोगशाला कमी, भएका प्रयोगशालामा पर्याप्त परीक्षण क्षमतामा कमी, सुपरिवेक्षण अनुगमनमा कमीले चुनौति देखिन्छ । + विश्वव्यापी, सामाजिक, आर्थिक समस्याले एचआइभी एड्स स्वास्थ्य क्षेत्र प्राथमिकतामा पर्न सकेको छैन । + मुलुकबाट रोजगारीका सिलसिलामा बाहिर जाने कामदारलाई एचआइभी एड्सबारे चेतनाका साथै स्वास्थ्य प्रवद्र्धन गर्न सकिएको छैन । + संयुक्त राष्ट्रसंघीय संगठनबाट प्रदान गर्दै आएको एचआइभी एड्स नियन्त्रणमा प्राप्त बजेट धेरै वर्षदेखि एड्स, क्षयरोग तथा औलो रोग नियन्त्रणमा ग्लोबल फण्डमार्फत प्राप्त बजेट एउटा अन्तर्राष्ट्रिय गैरसरकारी संस्था सेभ द चिल्ड्रेनलाई उपलब्ध गराइएको छ । तर सरकारी निकाय राष्ट्रिय एड्स तथा यौनरोग नियन्त्रण केन्द्र भने उसैको प्रस्तावमा सहीछाप गरेर बसेको छ । यसैले एचआइभी एड्स नियन्त्रणमा समुदायस्तरसम्म चेतना, परामर्श, परीक्षण र उपचार पुग्न सकेको छैन । + एचआइभी एड्स संक्रमित भएका तर जानकारी र परीक्षणको पहुँच नहुदा परामर्श परीक्षण तथा उपचारको अभावमा पिल्सदै अकालमा मृत्युको मुखमा पुग्नुपरेको छ । एचआइभी एड्सको परामर्श र परीक्षण कसरी गर्ने ? + १ सय ३६ सरकारी अस्पताल, ३९ निजी अस्पतालमा भोलुन्टरी काउन्सिलिङ तथा परीक्षण केन्द्रमा एचआइभी परामर्श तथा परीक्षण निशुल्क गरिन्छ । + एचआइभी एड्सको परामर्श र परीक्षणका फाइदा के के छन् ? + एचआइभी एड्सको परामर्श गर्दा संक्रमण नभए र संक्रमण भए गर्नुपर्ने सावधानीबारे थाहा पाउन सकिन्छ । + एचआइभी परीक्षणमा आफू एचआइभी संक्रमित भए नभएको अवस्था थाहा पाउन सकिन्छ । यसवर्षको विश्व एड्स दिवसको नारा पनि यही थियो । +एचआइभी संक्रमण नभए ढुक्क हुन पाइन्छ भने आगामी दिनमा एचआइभी संक्रमण हुनबाट सावधानी अपनाउन सघाउ पुग्छ । + संक्रमण भए परिवार, सन्तानसमेतको परीक्षण गराई औषधोपचार र स्याहारसुसार गर्न मद्दत पुग्छ भने यौनसाथीको समेत एचआइभीको अवस्था थाहा पाई आवश्यक कदम चाल्न सकिन्छ । + एचआइभी संक्रमित भए समयमै औषधि सेवन गरी स्वस्थ रहन र अरुलाई एचआइभी सर्न बचाउन सकिन्छ । + गर्भवतीले औषधि सेवन गरे गर्भको शिशुलाई एचआइभी सर्ने सम्भावना न्युन हुन्छ । एचआइभी एड्स रोकथाम कसरी गर्ने ? १.असुरक्षित यौनसम्पर्क गर्दा एचआइभी सर्ने जोखिम अत्यधिक बढ्ने हुनाले असुरक्षित यौनसम्पर्क गर्नु हुदैन । २. एकपटक प्रयोग गरिएका सिरिञ्ज, सुई तथा अन्य छाला छेड्ने औजार निर्मलीकरण नगरी प्रयोग गर्नु हुँदैन । ३. यौनरोग लागेको शंका लाग्नासाथ स्वास्थ्य संस्थामा निशुल्क परीक्षण तथा उपचार गर्नु पर्दछ । ४. एचआइभी संक्रमित आमाले आफू र शिशुलाई एचआइभी संक्रमणबाट बचाउन पूरा औषधि खानु पर्दछ । ५.एचआइभी संक्रमित भएको यकिन भएपछि स्वास्थ्यकर्मीको सल्लाह लिई नियमित र पूरा उपचार गर्नु पर्दछ । बीचमा औषधि कदापि छोड्नु हुँदैन । ६.परीक्षण नगरिएको र असुरक्षित रगत प्रयोग गर्नु हुँदैन । ७. शंकास्पद साथीसँग यौनसम्पर्क गर्दा सही तरीकाले कण्डम प्रयोग गर्नु पर्दछ । ८.समुदायस्तरसम्म निशुल्क एचआइभीपरीक्षण सुविधा विस्तार गर्नु पर्दछ । ९.लागुपदार्थ औषधि सेवन गर्नु हुँदैन । १०.अत्यधिक मद्यपान सेवन गर्नु हुँदैन । ११.विश्व एड्स दिवस काठमाडौंका तारे होटलमा भन्दा खुला मैदान, हरेक स्थानीय तह र स्वास्थ्य संस्थामा जनचेतनामूलक कार्यक्रमकासाथ व्यापकरुपमा मनाइनु पर्दछ । एचआइभी एड्सको उपचार तथा हेरचाह कसरी गर्ने ? एचआइभी एड्स पीडित व्यक्तिलाई विभिन्न सरकारी अस्पतालमा ७४ वटा एआरटी सेन्टर तथा ३० वटा डिस्पेन्सिङ क्लिनिकबाट निशुल्क एण्टिरेट्रोभाइरल औषधि दिइन्छ । स्वास्थ्यकर्मीको सल्लाहअनुसार समयमै नियमित औषधि सेवन गरे एचआइभी एड्स संक्रमित भए पनि सजिलोसँग जीवन बिताउन सकिन्छ । एचआइभी क्षयरोग सहसंक्रमण भए पनि दुवै समस्याका औषधि नियमित र पूरा उपचार गरेमा एचआइभी तथा क्षयरोगको समस्या समाधान गर्न सकिन्छ । एचआइभी एड्स पीडितलाई घरपरिवार अथवा समुदायस्तरसम्म निम्नानुसार हेरचाह गर्न सकिन्छः + एचआइभी एड्स पीडितलाई व्यक्तिगत सरसफाइ, स्वस्थ खानपान व्यवस्था गरिदिनुपर्छ । कुनै समस्या परे स्याहारसुसारका साथै सामाजिक तथा भावनात्मक सहयोग गर्नु पर्दछ । + आयआर्जन गर्न आर्थिक व्यवस्था तथा अन्य सरसल्लाह दिई सघाउनु पर्दछ । + जुनसुकै कारणले एचआइभी संक्रमित भए पनि निरासाको सट्टा सकारात्मक सोच लिई जिउन स्वास्थ्य प्रबद्र्धन गर्नु पर्दछ । + एचआइभी एड्स संक्रमितलाई हेरचाहका साथै एचआइभी एड्सबारे जानकारीमूलक शिक्षा दिनु पर्छ । + एचआइभी एड्ससँगै क्षयरोग संक्रमण भए दुवैथरी औषधि सँगै खानु पर्दछ । + स्तनपान गराउने एचआइभीसंक्रमित आमाले स्तनपान गराइरहनु पर्दछ । + एचआइभी एड्स संक्रमितको रगतमा एचआइभीको बोझ २०० भन्दा कममा सीमित राखे दुःख दिन पाउँदैन । त्यसैले संक्रमित व्यक्तिले ३३ केन्द्रमा पाइने निशुल्क रगतको सिडिफोर काउन्ट नियमित गराइ भाइरसको बोझ यकिन गर्नु पर्दछ । एचआइभी एड्सको औषधि एआरटीले भाइरस बोझ घटाउँछ । + एचआइभी संक्रमितलाई समुदायस्तरसम्म स्वास्थ्य सेवाको पहुँच बढाउनु पर्दछ । + स्वास्थ्यकर्मीलाई सकेसम्म एचआइभी एड्सपीडित व्यक्तिको घरमै पुगेर स्वास्थ्य सेवा दिने व्यवस्था गर्नु पर्दछ । + एचआइभी एड्स पीडितलाई परिआउने स्वास्थ्य हेरचाह तथा संक्रमण रोकथाम गर्न परिवारका सदस्य, स्वास्थ्य स्वयम्सेवक तथा एचआइभी एड्स संक्रमित समेतलाई तालिम दिइ परिचालन गर्नु पर्दछ । + एचआइभी एड्स औषधि स्वास्थ्यकर्मीको सल्लाहबमोजिम नियमित रुपमा र पूरा अवधिभरि सेवन गर्नु पर्दछ । + एड्स हेल्थ केयर फाउन्डेसनको सहयोगमा १५ वटा केन्द्रमा कर्मचारी परिचालन र १० वटाजति अस्पतालमा एआरटीबारे जानकारीमूलक होर्डिङबोर्ड राखिएको छ । यसको संख्या बढाउनु पर्दछ । एचआइभी एड्स संक्रमितलाई स्वास्थ्य प्रवद्र्धन कसरी गर्ने ? १. एचआइभी संक्रमणबाट बच्न यौन व्यवहारमा सकारात्मक परिवर्तन ल्याउनु पर्दछ । २. असुरक्षित यौन सम्पर्कका हानीबारे समुदायस्तरसम्म व्यापक चेतना जगाउनु पर्दछ । ३. यौनरोग एचआइभीसंक्रमण भए नभएको अवस्था थाहा पाउन समयमै परामर्श र परीक्षण गरी उपचार गर्नु पर्दछ । ४. एचआइभी एड्स संक्रमण भएमा पनि सकारात्मक भई स्वस्थ्य जीवन बिताउन लाग्नु पर्दछ । ५. व्यक्तिगत सरसफाइ र जीवनशैलीमा ध्यान दिनुपर्दछ । स्वास्थ्य समस्या देखिनासाथ तुरुन्तै नजिकको स्वास्थ्य संस्थामा जँचाउनु पर्दछ । ६. हरिया तरकारी, फलफूलसहित स्वस्थकर र पोषिलो खानेकुरा खानुपर्दछ । ७. यौनसम्पर्क गर्दा सही तरीकाले कण्डम प्रयोग गर्नु पर्दछ । ८.विद्यालयस्तरदेखि शैक्षिक पठनपाठनमा यौन क्रियाकलाप, यौनरोग, एचआइभी एड्सबारे जोड दिनुपर्दछ । ९.एचआइभी एड्सपीडित गर्भवती आमाले आफू र आफ्नो गर्भको शिशुलाई संक्रमणबाट बचाउन स्वास्थ्यकर्मीको सल्लाहबमोजिम नियमित र पूरा औषधि सेवन गर्नु पर्दछ । १०. हरेक जुन महिनाको २७ तारिखका दिन मनाइने एचआइभी परीक्षण दिवस नेपालका हरेक स्वेच्छिक काउन्सिलिङ तथा परीक्षण केन्द्र चलाउनुु पर्दछ भने हरेक प्राथमिक स्वास्थ्य केन्द्रस्तर वा स्थानीय तहसम्म यस्ता केन्द्रको विस्तार गरिनुपर्दछ । ११.यौनरोग एचआइभी संक्रमण भएको शंका लाग्नासाथ नजिकको स्वास्थ्य संस्थामा निशुल्क परीक्षण तथा उपचार गर्नु पर्दछ । १२. विद्यालयस्तरदेखि नै शैक्षिक पाठ्यक्रममा यौन, यौनरोग एचआइभी एड्स विषय समावेश गरिनु पर्दछ । १३. किशोरकिशोरीलाई यौन, यौनरोग एचआइभीबारे स्पष्ट जानकारी गराउनु पर्दछ । १४. विश्व एड्स दिवस काठमाडौंका तारे होटलभन्दा खुला मैदान, हरेक स्थानीयतह, शिक्षालय, स्वास्थ्य संस्था तथा टोलटोलमा व्यापक जनचेतना मूलक कार्यक्रमकासाथ मनाइनु पर्दछ । १५. सुरक्षित यौन व्यवहार परिवर्तनसम्बन्धी सूचना, शिक्षा तथा सञ्चार सामग्री व्यापक वितरण गर्नु पर्दछ । काठमाडौं , पुस २ :