HIV/AIDS

Acquired immunodeficiency syndrome (AIDS) is the late clinical stage of human immunodeficiency virus (HIV) infection, and is defined as an illness characterized by one or more indicator diseases. Populations at greatest risk include female sex workers. Lack of knowledge about HIV, and barriers to seeking services due to stigma and discrimination contribute to underdiagnosis.

Symptoms

Presentation may include, but is not limited to, persistent generalized lymphadenopathy, unexplained weight loss, persistent diarrhea, recurrent oral ulceration, recurrent respiratory tract infections or herpes zoster.

Infectious agents

The infections agents are HIV-1 and HIV-2, which have similar epidemiological characteristics.

Mode of Transmission

HIV is transmitted:

by sexual intercourse (vaginal or anal) with an infected partner, especially in the presence of a concurrent ulcerative or non-ulcerative sexually transmitted infection (STI)
from an infected mother to her child during pregnancy, labour and delivery; or through breastfeeding (mother-to-child transmission)
by transfusion of infected blood or blood products
by contaminated needles or syringes through accidental injury of patients or service providers in occupational health, or those who are injecting drug users (IDUs).

Prevention

Universal precautions

Universal precautions against transmission of HIV include:

washing hands thoroughly with soap and water, and using protective gloves and clothing when there is risk of contact with blood or body fluids
using single-use needles and syringes
ensuring safe handling and disposal of waste material, needles and other sharp instruments;
using correct procedures for cleaning and disinfecting medical instruments between patients.

Blood transfusion safety:

In an acute emergency, available resources for HIV testing should be devoted to ensuring a safe blood supply for transfusions.

Reduce sexual transmission:

Sexual transmission can be reduced by providing high-quality condoms, accom- panied by culturally sensitive promotion. The recent Behaviour Surveillance Survey in Sri Lanka found that condom use and knowledge about HIV risks among the groups most at risk is generally low (except among some subgroups of female sex workers).

Sexually transmitted infection management:

STI management must include sex workers. The syndromic STI management approach requires partner notification and promotion of safer sex. Annual esti- mates of detected STI cases in Sri Lanka vary from about 60 000 to 200 000; however, only 10–15% of these are reported to government clinics (4).

Clinical management of rape:

Clinical management in cases of rape requires a combination of;

emergency contraception (if the person who has been raped presents within 5 days)
presumptive treatment of STIs
post-exposure prophylaxis (PEP) for HIV (for those presenting within 3 days)
appropriate counselling and follow-up care

Awareness and life skills education

Awareness and life skills education, especially for young people, helps to promote understanding of what does and does not constitute a mode of transmission. It also provides information on how and where to acquire condoms, how to acquire medical attention if necessary, and what is involved in basic hygiene.

Reduction of mother-to-child transmission of HIV

Mother-to-child (i.e. vertical) transmission of HIV can be reduced through primary prevention of HIV infection and prevention of unintended pregnancies, and where indicated, ART and lower risk infant feeding practices. A cumulative total of 33 infants have been infected through vertical transmission in Sri Lanka (3). The estimated number of HIV-infected women of child-bearing age in the country is less than 1000 (2).

Post-exposure prophylaxis in the health-care setting

PEP in the health-care setting includes administration of ART within 72 hours of exposure.

Prevention among injecting drug users

To prevent HIV transmission among IDUs requires ready access to, and safe dis- posal of, sterile needles, syringes and other injection equipment; education and counselling on risk-reduction techniques; provision of drug-dependence services; and easy access to STI and HIV/AIDS treatment. Current estimates of opiate users in Sri Lanka range from 30 000–240 000, of whom 2% are IDUs (3).

Physical protection of affected populations

Affected populations, especially women and children, should be protected from violence and abuse. This is an important principle of human rights, and is essen- tial for reducing the risk of HIV infection.

References

WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Geneva, World Health Organization, 2006 (WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children).

HIV/AIDS country information. Geneva, WHO (HIV/AIDS (who.int)).