World AIDS Day and HIV in Vietnam

Hoi An Guide | Healthcare in Vietnam

World AIDS Day is celebrated every 1st of December, and one way to celebrate it is to give awareness to people regarding HIV transmission, prevention and treatment as well.

Let’s start first with some important and updated key facts:

  • There were approximately 37.9 million people living with HIV at the end of 2018.
  • At the end of 2018, 1,700,000 people were newly infected with HIV.
  • In June 2019, 24.5 million people were accessing antiretroviral therapy (ART).
  • 53% had achieved suppression of the HIV virus with no risk of infecting others.
  • Due to gaps in HIV services, 770,000 people died from HIV-related causes in 2018.

It is a well-known fact that HIV continues to be a major global public health issue. It has claimed more than 32 million lives to date. With increasing access to effective HIV prevention, diagnosis and treatment, HIV infection has become a manageable chronic health condition.

The human immunodeficiency virus (HIV) targets the immune system and weakens the immune system against infections and some types of cancer. The most advanced stage of HIV infection is Acquired Immunodeficiency Syndrome (AIDS), which can take 2–15 years to develop if NOT treated.

Signs and Symptoms

The symptoms are very non-specific and vary depending on the stage of infection. For the first few weeks after the initial infection, they might be asymptomatic or may experience flu-like symptoms such as fever, headache, rash or a sore throat. As the individual’s immune system progressively weakens, they could have swollen lymph nodes, weight loss, fatigue, persistent fever, diarrhea or a cough that does not go away for a long time. As the disease progresses, the infected person might develop severe illnesses such as tuberculosis (TB), cryptococal meningitis or other severe opportunistic infections and cancers such as lymphoma and Kaposi’s sacroma.

Transmission is through the exchange of a variety of body fluids from infected people such as blood, semen, vaginal secretions and breast milk. It can also be transmitted by an infected mother to her baby through pregnancy and delivery.

Individuals cannot become infected through ordinary contact such as shaking hands, sharing personal objects or even hugging and kissing.

Transmission

Transmission is through the exchange of a variety of body fluids from infected people such as blood, semen, vaginal secretions and breast milk. It can also be transmitted by an infected mother to her baby through pregnancy and delivery.

Individuals cannot become infected through ordinary contact such as shaking hands, sharing personal objects or even hugging and kissing.

Risk Factors

Key populations include:

  • Men who have sex with men (MSM)
  • People who inject drugs
  • Prisoners and other people in closed settings
  • Sex workers and their clients
  • Transgender people

Behaviours and conditions that put individuals at greater risk of contracting HIV:

  • Unprotected vaginal or anal sex.
  • Having another sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhea and bacterial vaginosis.
  • Sharing contaminated needles and drug solutions when injecting drugs.
  • Receiving unsafe injections, blood transfusions and tissue transplantation.
  • Medical procedures that involve unsterile cutting or piercing.
  • Accidental needle stick injuries.

Diagnosis

HIV can be diagnosed through rapid tests capable of providing same-day results, facilitating early diagnosis and allowing early treatment and care. This is done through HIV quick testing—a screening test to detect antibodies produced by the person as part of their immune response to fight HIV. This test is readily available at Family Medical Practice Clinics throughout Vietnam.

Most widely used HIV diagnostic tests detect antibodies produced by the person as part of their immune system’s response to fight HIV. Many who have the infection develop these antibodies within 28 days, and it is before this time that people experience the so-called “window” period where HIV antibodies have not been produced and when they may not yet have any signs or symptoms of the infection. It should be emphasized that after infection, an individual can still transmit HIV to a sexual or drug-sharing partner.

Up to this day, there is no single test that can provide a full HIV diagnosis. A confirmatory test is required, which is done by a qualified and validated health professional from an accredited clinic or hospital.

Any person tested positive should undergo retesting before they are enrolled for treatment and care, to rule out any potential testing or reporting error. Notably, if someone is diagnosed with HIV and has started treatment, they should NOT be retested.

Once a person has tested positive for the HIV quick test, he or she would be referred to one of the HIV-AIDS control and prevention centers strategically located throughout Vietnam. These are the only accredited centers to perform the confirmation test via trained health care providers who also provide counseling and medication prescription (ARV treatment)—and this is given for free.

Prevention

The risk of HIV infection can be reduced by avoiding or limiting exposure to risk factors. The WHO has listed some key approaches for HIV prevention:

Male and female condom use

Consistent and correct use of condoms for male and female alike during vaginal or anal sex has been proven to protect against the spread of sexually transmitted infections (STIs), including HIV.

Testing and counselling for HIV and STIs

It is strongly recommended that testing for HIV and other STIs be done on all people who are exposed to ANY risk factors. This enables them to know their HIV status and access necessary prevention and treatment services at the soonest possible time. Testing for partners or couples are also advised.

Use of antiretrovirals (ARVs) for prevention

An evidence-based study showed that if an HIV positive person adheres to an effective antiretroviral treatment (ART), the risk of transmitting the virus to their uninfected partner is significantly reduced by 96%. With this finding, the WHO recommends that all people living with HIV should be offered ART with the aim of saving lives and greatly reducing HIV transmission.

This has been proven by several randomized control trials (RCT’s) that show the use of oral Pre-exposure prophylaxis (PrEP) with daily use of ARVs among HIV negative partners have effectively reduced HIV transmission. The WHO recommends PrEP as the prevention of choice for people at substantial risk of getting infected with HIV.

Post-exposure prophylaxis (PEP) is the use of ARVs within 72 hours of exposure to HIV to prevent infection. PEP is the administration of a 28-day course of ARV drugs coupled with counseling, first aid care, HIV testing and follow-up care.

Harm reduction for people who use injectable drugs 

Using sterile injecting equipment (needles and syringes, preferably disposable ones) for each injection; not sharing drug-using equipment and drug solutions are highly advised among drug users.

Treatment

In 2018, there were 23.3 million people living with HIV all over the world who received antiretroviral treatment (ART). However, more efforts are needed to reach out—particularly to children and adolescents diagnosed with HIV.

  • The HIV treatment guidelines include new alternative ARV options with better tolerability, higher efficacy and lower rates of treatment failure.
  • Combination antiretroviral treatment (ART) consisting of three or more antiretroviral drugs. These drugs (ARVs) suppresses viral replication and strengthen one’s immune system to regain the capacity to fight off serious infections.
  • These drugs do NOT cure an HIV infection.

The WHO is expanding access to treatment and sets this at the heart of a set of targets for 2020. This is a big step to bring the world back on track to end the AIDS epidemic by 2030.

See Medical for more on health issues in Vietnam. 

A graduate of the Far Eastern University-Nicanor Reyes Medical Foundation (FEU-NRMF) in the Philippines, Dr. Hazel Gallardo-Paez’s medical expertise addresses a diversity of challenges and treatments based on her extensive pediatrics training and her experiences in handling patients under a variety of healthcare frameworks.

Written By
Stuart Neal

Former publisher at ABC Books and Consultant Publisher at Allen & Unwin in Australia, Stuart Neal is co-founder of the travel website, Hoi An Now.

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