Prevention of HIV infection in modern conditions

September 15, 2022

More than 40 years have passed since the publication of the first scientific report on pneumocystis pneumonia, which later became known as acquired immunodeficiency syndrome (AIDS), the last stage of HIV infection.

Human Immunodeficiency virus (HIV) – causes an infection that is transmitted: sexually, through contact with infected blood, semen or vaginal secretions.The virus can be transmitted by sharing needles and syringes for drugs and from mother to child.

The diagnosis of HIV and AIDS has a different meaning now than it did two decades ago. We have gone from people taking several medications with many side effects to one tablet a day, a combination of medications that is well tolerated and completely suppresses the virus.

New research is now exploring different ways of drug delivery: for example, an injection that lasts for several months, or perhaps implantable drug delivery mechanisms so that people don't have to take pills every day, increasing adherence.

In July 2022, the World Health Organization (WHO) published its recommendations on the use of long-acting injectable cabotegravir (CAB-DD) as a means of pre-contact prevention of HIV infection to persons from key populations at high risk of HIV infection.

Universal HIV screening is very important at the present stage: many people have HIV, but they do not suspect it, timely diagnosis, effective treatment with suppression of viral load can preserve health for many years and prevent transmission of the virus to others.

According to UNAIDS (Joint United Nations Programme on HIV/In 2021, of all people with HIV worldwide: 85% knew about their HIV status, 75% received ART, 68% were with viral load suppression. In Kazakhstan, these are the indicators, respectively: 81%/79%/86%. Targets by 2030, according to the strategyuNDINGS are outlined:95%/95%/95%.

Kazakhstan maintains a high standard of HIV data and implements measures in accordance with international recommendations of WHO and UNAIDS.As a result of the ongoing systemic preventive measures, the situation regarding the prevalence of HIV infection in Kazakhstan is kept in a concentrated stage (0.2% of the population with a global average of 1.1%). There is a significant decrease in the level of perinatal transmission from 8.4% in 2007 to 1.4% in 2021.

An integrated approach to HIV prevention is aimed at achieving maximum impact in terms of preventing HIV infection through a combination of behavioral, biomedical and constructive strategies based on respect for human rights and confirmed information in the framework of evidence-based medicine, in the conditions of the studied epidemic.

Behavioral interventions are mainly informational work aimed at changing the nature of behavior. To reduce the risk of STI or HIV infection, people need to understand the level of risk they are exposed to and have the knowledge, skills and abilities necessary to reduce this risk. They include a number of communication programs using various communication channels (for example, mass media, at the community level and interpersonal) to disseminate messages aimed at, for example, only sex education at school.

Biomedical interventions are those that directly affect the biological systems through which the virus is transmitted to a new host, blocking infection (for example, male and female condoms), reducing infectivity (antiretroviral therapy as prevention), or reducing the risk of infection (voluntary male medical circumcision, reproductive health programs, voluntary counseling and testing, index testing contact details, self-testing and community-level testing by workers without special education using rapid tests); prevention of HIV transmission from mother to child, pre-contact and post-contact prevention programs, prevention of sexually transmitted infections, syringe exchange points, opioid substitution therapy, for people who inject drugs; ensuring blood safety and others.

Structural interventions are focused on the most important social, legal, political and environmental factors that contribute to the spread of HIV: improving legislation, law enforcement and the justice system, decriminalization, including programs to protect intimate partner from sexual violence; strengthening partnerships with non-governmental organizations; reducing stigma and discrimination against people living with HIV and marginalized groups; gender inequality and gender-based violence; economic empowerment and other multisectoral approaches.

A comprehensive, combined approach to HIV prevention as a socially significant infection in the modern world is necessary to expand understanding and form a holistic approach to HIV not only as a single epidemic, but as a SYNDEMIA.Syndemic or synergetic epidemic is a combination of two or more simultaneous or sequential epidemics or clusters of diseases in a population with biological interactions that aggravate the prognosis of the disease.This term was developed by Merrill Singer in the early 1990s, to draw attention to the synergistic nature of medical and social problems.Unlike the syndemic approach, the biomedical approach considers the disease separately from other diseases and independent of social and other contexts.For example, it has been studied that HIV is temporarily suppressed during acute measles infection, the pain of tsutsugamushi or bush typhus, tick-borne infection in Asia and Australia, and the mechanisms are still unclear.Syndemia, as a set of related health conditions, for example: such as HIV, viral hepatitis, STIs, alcohol and substance use and mental health disorders interact unfavorably with each other, potentiating the effect. Health conditions are often closely linked to employment, stable housing, access to health care and food, and other social determinants of health, environmental ecology. Further research of the links, development of innovative interventions, as well as allocation of resources for effective response is needed. Research is needed that examines the processes and conditions of syndemia functioning in order to better understand how public health systems and communities can effectively respond to and limit the health effects of syndemias.At the same time, each community and interested party brings a unique point of view and their involvement, interaction with non-governmental organizations play a crucial role in the prevention and response to the syndrome.The fight against syndemia requires comprehensive and simultaneous efforts for prevention, screening, diagnosis and treatment, as well as the rapid application of new scientific achievements.

"Harmonious development of society is possible only if the health of the nation is ensured" - the key thesis of the Address of the Head of State Kassym-Jomart Tokayev to the people of Kazakhstan dated September 1, 2022, reflects the recognized trends of public health policy around the world. Modern realities present more and more new challenges, including the pandemic of coronavirus infection, which began in 2019, and monkey pox, which began to be registered in 2022 in non-endemic areas, mainly among individuals of a certain group.

But the statement of Dr. Stacey Rizza of the world-famous Mayo clinic seems justified in relation to:"We know that if every person on the planet who has HIV were diagnosed, associated with care and effective treatment, then HIV would disappear from this planet in one generation. We know we can do it with these measures."

 Zhannat Musina,

Epidemiologist, Head of the HIV Prevention Department of the KNCDIZ of the Ministry of Health of the Republic of Kazakhstan

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