World AIDS Day, designated on 1 December every year since 1988, is an international day dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection and mourning those who have died of the disease. The Acquired Immunodeficiency Syndrome (AIDS) is a life-threatening condition caused by the Human Immunodeficiency Virus (HIV).
Of concern in The Gambia is a recent trend toward infection with the more aggressive, deadly human immunodeficiency virus type 1 (HIV-1). In 1990, HIV-2 infections among commercial sex workers outnumbered HIV-1 by a ratio of nine to one. According to the most recent data, however, HIV-1 was present in 42% of acquired immunodeficiency syndrome (AIDS) patients; 60% of AIDS cases were attributable to HIV-2 and 4% involved infection with both HIV-1 and HIV-2. About 2.2% of Gambia’s 1 million residents are estimated to be HIV carriers, compared to 1.7% in 1986. The emergence of HIV-1 in the Gambia is attributed to foreign visitors, nationals living abroad, and contact between prostitutes and tourists and cross-border traders. According to public health officials, Gambia is in the early stages of the AIDS epidemic: despite awareness of the facts about AIDS, most Gambians are not motivated to change their behaviours. High-risk practices of particular concern include circumcision rites involving multi-partner sex, prostitution on the part of young rural wives to supplement the family income, and men having sex with their dead brothers’ wives in keeping with the tradition of wife inheritance.
About 2.2% of Gambia’s 1 million residents are estimated to be HIV carriers, compared to 1.7% in 1986. The emergence of HIV-1 in the Gambia is attributed to foreign visitors, nationals living abroad, and contact between prostitutes and tourists and cross-border traders.
Statistics, fortunately, show that HIV/AIDS has not hit as hard in The Gambia as in other parts of Africa after the first case was diagnosed in the country in 1986.
The HIV/AIDS prevalence among adults aged (15 to 49) in The Gambia is 1.8% [1.5% – 2.2%] (2015 est. unaids.org). Results from the sentinel studies have firmly established that HIV1 is now the main virus driving the epidemic in The Gambia; whilst HIV2 seems to be on the decline. Like in most of sub-Saharan Africa heterosexual intercourse is the main mode of HIV transmission.
The first round of the National Sentinel Surveillance for HIV among antenatal women was conducted between May 2000 and August 2001[pdf] in four health facilities, namely Serrekunda, Sibanor, Farafenni and Basse. The number of sentinel sites was later increased to six in 2002 (adding Brikama and Kuntaur) and eight in 2005 (adding Essau and Soma).
The 2004 sentinel surveillance data indicated that HIV1 prevalence amongst 15- to 49-year-old pregnant women has increased at most sites. There is limited data on prevalence among high-risk groups, including sex workers who had a prevalence of 14% for HIV1 in 1993 and 28% in 1993. Furthermore, lack of data on the prevalence of HIV in other key groups such as uniformed personnel, long-distance truck drivers, fishermen, etc. may mask the true extent of HIV infection rates in The Gambia.
The UNDP has worked in partnership with the Gambia Government to combat HIV/AIDS for over 10 years and it helped to put awareness of the disease on the national agenda through the National AIDS Control Programme (NACP). The main aim of the project is to assist policy development and reinforce partnerships and national capacities in a sustainable way that alleviates not just HIV but also poverty. A National AIDS Secretariat was established, and being supported by the World Bank.
The aids awareness campaign involves billboards, aids prevention messages during strategic TV programmes, workshops, seminars and the production of educational materials targeted at all sections of Gambian society.
Today between 35-50 youth and women’s groups are supported through the campaign.
Because of the engagement of local musicians and NGOs in the project’s execution, there is a higher level of awareness in the public at large and particularly among youth groups about the causes and consequences of HIV/AIDS and STDS.
What is HIV
Human immunodeficiency virus (HIV) is an infection that attacks the body’s immune system, specifically the white blood cells called CD4 cells. HIV destroys these CD4 cells, weakening a person’s immunity against opportunistic infections, such as tuberculosis and fungal infections, severe bacterial infections and some cancers.
WHO recommends that every person who may be at risk of HIV should access testing. HIV infection can be diagnosed using simple and affordable rapid diagnostic tests, as well as self-tests. It is important that HIV testing services follow the 5Cs: consent, confidentiality, counselling, correct results and connection with treatment and other services.
People diagnosed with HIV should be offered and linked to antiretroviral treatment (ART) as soon as possible following diagnosis and periodically monitored using clinical and laboratory parameters, including the test to measure virus in the blood (viral load). If ART is taken consistently, this treatment also prevents HIV transmission to others.
At diagnosis or soon after starting ART, a CD4 cell count should be checked to assess a person’s immune status. The CD4 cell count is a blood test used to assess the progression of HIV disease, including the risk for developing opportunistic infections and guides the use of preventive treatment. The normal range of CD4 count is from 500 to 1500 cells/mm3 of blood, and it progressively decreases over time in persons who are not receiving or not responding well to ART. If the person’s CD4 cell count falls below 200, their immunity is severely compromised, leaving them susceptible to infections and death. Someone with a CD4 count below 200 is described as having an advanced HIV disease (AHD).
HIV viral load measures the amount of virus in the blood. This test is used to monitor the level of viral replication and effectiveness of ART. The treatment goal is to reduce the viral load in the blood to undetectable levels (less than 50 copies/ml), and the persistent presence of detectable viral load (greater than 1000 copies/ml) in people living with HIV on ART is an indicator of inadequate treatment response and the need to change or adjust the treatment regimen.
Signs and symptoms
The symptoms of HIV vary depending on the stage of infection. Though people living with HIV tend to be most infectious in the first few months after being infected, many are unaware of their status until the later stages. In the first few weeks after initial infection people may experience no symptoms or an influenza-like illness including fever, headache, rash or sore throat.
As the infection progressively weakens the immune system, they can develop other signs and symptoms, such as swollen lymph nodes, weight loss, fever, diarrhoea and cough. Without treatment, they could also develop severe illnesses such as tuberculosis (TB), cryptococcal meningitis, severe bacterial infections, and cancers such as lymphomas and Kaposi’s sarcoma.
HIV can be transmitted via the exchange of a variety of body fluids from infected people, such as blood, breast milk, semen and vaginal secretions. HIV can also be transmitted from a mother to her child during pregnancy and delivery. Individuals cannot become infected through ordinary day-to-day contacts such as kissing, hugging, shaking hands, or sharing personal objects, food or water.
It is important to note that people with HIV who are taking ART and are virally suppressed do not transmit HIV to their sexual partners. Early access to ART and support to remain on treatment is therefore critical not only to improve the health of people with HIV but also to prevent HIV transmission.
For further information, email [email protected], send text messages only to Dr Azadeh WhatsApp on 002207774469 from 3 to 6 pm.
Dr Hassan Azadeh, senior lecturer at the University of The Gambia, clinical director at the Medicare Health Sevices.