Issues on the prevalence of global AIDS – Part 2: Beyond ARVs: Examining other causes and solutions to HIV/AIDS

In a previous post, I briefly looked at production of low-cost ARVs in India and its role in facilitating access to ARVs in developing countries. However, there are many other factors which need to be considered in formulating strategies to reduce the prevalence of HIV/AIDS globally.

Heterosexual transmission of the disease is largely regarded as being the main cause of new adult HIV infections. There has been some degree of consensus on this source as the dominant source of HIV transmission, leading some to assert that in some areas that “unsafe medical injections can be confidently excluded as a major source of HIV infection”. However, the dominant cause may not be as apparent as suggested, as the sources of transmission can differ between regions, countries, and even within countries. Even though heterosexual transmission is a major cause of HIV infections globally, other causes such as drug-injections, unsafe medical care and parent-child transmission for example also need to be identified to see the impact they exert in particular communities.

Inasmuch as it is useful to encourage the use of condoms alongside sex education to reduce the likelihood of spreading HIV through sexual transmission, recognising that other methods of transmission may contribute more to the spread of HIV infections in different areas could help policymakers devise more appropriate strategies to addressing the issue. The identification of the dominant source of transmission could then lead to the implementation of interventions which are more beneficial in stemming the spread of HIV infections.

Proper diagnoses of HIV/AIDS are also imperative so that affected individuals can get the necessary treatment. However, one of the issues with some of the existing recommended case definitions is that they conflate AIDS with other diseases. For example, the one of the recommended case definitions for AIDS surveillance when diagnostic resources are limited state that individuals older than 12 years of age would be considered to have AIDS, for example, if they exhibit signs like weight loss of at least 10% of their body weight and chronic diarrhoea for more than a month accompanied by a persistent cough lasting more than a month, and if these signs are not known to be related to a  condition other than HIV infection. However, according to an article by Charles Gilks in the BMJ, “persistent diarrhoea with weight loss can be associated with opportunistic as well as ordinary enteric parasites and bacteria,” and in “those countries where the incidence of tuberculosis is high and which are using the unmodified clinical case definition for surveillance substantial numbers of people reported as having AIDS may in fact not have AIDS.”

More studies may be required to establish the prevalence of HIV/AIDS globally such that deaths which could be attributed to other diseases which are curable, like tuberculosis and malaria, can be more accurately classified as such. By establishing the main sources of HIV transmission in various regions and countries and identifying the diseases which most affect local communities, appropriate treatment methods could be devised to counter a seemingly insurmountable health crisis.