Kathmandu: According to a report of the National Centre for AIDS and STD Control, Teku, there are an estimated 39,397 people living with HIV as of December 2015 with new infections in four people per day on an average. It reveals that 28,865 cases have been reported, with HIV infection in 17,949 males, 10,824 females and 92 transgenders as of July 15 this year. Among these estimated and reported cases, there are 12,446 people living with HIV with the help of Antiretroviral Therapy (ART), adds the data.

“There is a huge gap between the estimated number of HIV-positive cases, reported number of patients and the number of patients taking ART in the country,” points out Dr Anup Bastola, Consultant Tropical Medicine Physician at Sukraraj Tropical and Infectious Disease Hospital, Teku adding, “This is because patients come to the hospital in a very late stage. And this means people do not know about their status.”

People become aware of their HIV-positive status only after they suffer from opportunist infections, he says. With HIV infection, CD4 cells — white blood cells that play an important role in the immune system — start to decrease and “there are high chances for one to suffer from opportunist infections. If people are only a little aware about this infection and get tested on time, there are chances for them to live a healthy life for a long time”.

He reveals, “HIV infection is revealed when one is diagnosed with opportunist infections like of tuberculosis, cryptococcal meningitis, herpes zoster, cervical cancer, brain lymphoma, and leukaemia among others.”

When one is infected with HIV, one is likely to show symptoms of viral fever in the third week of infection, Dr Bastola points out along with candidiasis oral oesophageal infection and acute retroviral syndrome such as swollen glands, sore throat, muscle and joint pain and headaches which usually get ignored.

Despite such symptoms, a patient does not visit a doctor immediately but only when the situation is at the worst. “They visit the clinicians only then when s/he loses weight by 10 per cent, suffers from persisting diarrhoea for a month or more, or after one month of fever,” he adds.

In not knowing about one’s HIV-positive status and its symptoms and treatment, awareness, education, social stigma and financial status play a vital role.

“People do not know their status as they do not have enough information on HIV. Even educated people, who are at risk, do not go for HIV test. There is a fear of stigma and discrimination,” Dr Bastola highlights.

When it comes to treatment of HIV, financial problems, social stigma, discrimination and the drug itself are some of the barriers. As per him, “ART is a lifelong drug and it is hard to adhere patients to the treatment due to financial reasons. Drug failure, lack of good clinical follow-up, lack of motivated health staff around the country are other problems.”

MORE IN YOUTH

The most infected age group of total HIV cases according to the data is 25-49 years with 72.8 per cent. As such adults (15+) who are taking ART is 92.4 per cent, while it is 7.6 per cent in children.

“Indulgence in drugs (through needle sharing) is one of the causes for HIV transmission in youth,” informs Dr Bastola on the mode of transmission.

Despite being educated and aware of the infection, they are careless. “They drink and have unprotected sex. They know they should use condom but they don’t. They also don’t undergo HIV Test,” the doctor adds. They are diagnosed only during mandatory health check-ups, or during pregnancy in case of women.

The doctor adds, “Several youth from the Far Western Development Region go to India as migrant labour workers. When they come back, they bring the infection too. They don’t undergo HIV test and transmit it to their spouses as they don’t know their status. Their wives might get pregnant with possible transmission to the children too.”

On the other hand, women in absence of their husbands or for other reasons “people have multiple sex partners including sex workers or those with HIV infection resulting in transmission of the infection”.

So, Dr Bastola suggests awareness about HIV and AIDS is vital, that parents must be aware about their children regarding indulgence in drugs, while he insists that youth indulging in risky behaviour (multiple sex partners, needle sharing) undergo an HIV test immediately.

WHAT SHOULD YOU KNOW ABOUT HIV

• The Human Immunodeficiency Virus (HIV) targets the immune system and weakens people’s defence system against infections and some types of cancer, as per WHO. The virus destroys and impairs the function of immune cells, infecting individuals gradually making immunodeficient.
• Immune function is typically measured by CD4 cell count. Immunodeficiency results in increased susceptibility to a wide range of infections, and diseases that people with healthy immune systems can fight off. The advanced stage of HIV infection is Acquired Immunodeficiency Syndrome (AIDS), which can take from two to 15 years to develop. AIDS is defined by development of certain cancers, or infections or other severe clinical manifestations.
• HIV can be suppressed by a combination ART consisting of three or more ARV drugs. ART does not cure HIV infection but controls viral replication within a person’s body and allows an individual’s immune system to strengthen and regain the capacity to fight off infections.
• It doesn’t transmit from kissing, shaking hands, or sharing food or water and from insect bites.