2. Understanding HIV/AIDS

AIDS (Acquired Immune Deficiency Syndrome) is caused by the Human Immunodeficiency Virus (HIV) that damages a person's immune system. People become infected by HIV in three possible ways:

1. Through heterosexual or homosexual intercourse. Most infections in the developing world are transmitted heterosexually and 95% of all infections in Africa are attributed to heterosexual intercourse.
2. Directly into the bloodstream through use of contaminated blood or blood products, or sharing of intravenous drug-injecting equipment.
3. From mother to child. This may occur prior to birth across the placenta, during birth, or via breast milk.

When someone is infected with HIV, there is a latency period when the person is free of all symptoms. This may last as long as ten years, depending on the general health and nutrition status of the individual. The length of the latency period is also influenced by the number of re-infections occurring through unprotected sex with another HIV-positive person. During this time there are no signs of being HIV positive and this is why 90% of infected people are not aware of their status. The only way to find out is through testing. Often a woman may discover for the first time that she is HIV positive only when she delivers a HIV-positive baby that shows signs of illness. This may or may not be followed by a test on both mother and child. Even when the test is done, many women will not reveal their positive status to their partners or families – there are too many examples of women who have been chased from the house and blamed for the infection.

The latency period comes to an end with the onset of illnesses. AIDS itself has few symptoms, but manifests itself by a breakdown of the immune system, resulting in vulnerability to a range of common diseases and infections. These opportunistic infections include especially tuberculosis, herpes and some forms of cancer. In addition, illnesses such as diarrhoea and malaria have a much more devastating effect on the body, rapidly breaking down its immune system. The opportunistic infections can be treated with the drugs that are normally used for them, but generally a person will die after a period of about two years unless treatment with anti-retroviral drugs begins before the onset of AIDS.

A major plank in the fight against HIV/AIDS is the 3 by 5 initiative of WHO and UNAIDS. Its target is to provide anti-retroviral treatment (ART) to three million AIDS sufferers in developing and transition countries by the end of 2005. That is an intermediate target towards the eventual goal of providing universal AIDS treatment to all who need it. Progress has been significant since the target was set in 2003, but a June 2005 progress report showed just one million people then on treatment (it should have been 1.6 million), meaning that it is unlikely to reach 3 million by the end of the year. HIV transmission from mother to child can be reduced by treatment with anti-retroviral drugs around the time of birth. The trouble is that most pregnant women do not realise that they are HIV positive, so do not request ART.

The impact of HIV/AIDS on an affected country goes through phases of progressively more severe damage and disruption to society and to development goals. The phases have been described in a table developed for the UNDP Regional Project on HIV and development for Sub-Saharan Africa. Adapted and reproduced for this TOP, it also sets out the policy and programme options available to governments willing to face up to the challenges of HIV/AIDS. Not all governments are. Too many let the problems remain unseen until social and economic impacts become undeniable. By then, the spread of the epidemic brings huge costs. Countries that have proved most successful in combating AIDS are those, such as Uganda, that have broken through the wall of denial at an early stage, and made a central commitment to mobilising society.