Key Facts: HIV

What is HIV?

The Human Immunodeficiency Virus (HIV) attacks the cells of the immune system that fight infection. The immune system gradually stops being able to protect the body against bacteria, viruses and germs. Without treatment this eventually leads to opportunistic infections that can be fatal.

What is AIDS?

AIDS stands for acquired immunodeficiency syndrome. A person living with HIV is diagnosed with AIDS when he or she develops at least one of about 25 different opportunistic infections. People don’t die of AIDS, they die of HIV-related or AIDS-related diseases.

How many people are affected?

• In 2007 an estimated 33 million people were living with HIV.
• There were 2.7 million new HIV infections that year, and two million AIDS-related deaths.
• Sub-Saharan Africa has two thirds of all people living with HIV worldwide.
• Two million children are living with HIV – almost 90% live in sub-Saharan Africa.

How is HIV spread?

HIV is most commonly passed on by unprotected sexual intercourse. It can also be spread through blood, usually among drug users sharing infected needles, and by transmission from mothers to their children. A small number of people are infected from contaminated blood transfusions.

Who is most at risk?

While anyone can catch HIV, a number of groups are especially vulnerable:

• Women – especially young women. In sub-Saharan Africa, more than three-quarters of young people living with HIV are female and there are 14 adult women infected for every ten adult men. Married women are also particularly at risk.
• People who are malnourished. Malnourishment puts an individual at higher risk of being infected with HIV if they have unprotected sex with an HIV-positive person.
• Indigenous communities. Lacking access to appropriate health information and to condoms, some indigenous communities face extremely high rates of infection. Indigenous communities undergoing rapid social change and experiencing a rise in contact with outsiders can be particularly hard hit, especially when made more vulnerable by government oppression or the occupation of their land. West Papua (with a high proportion of indigenous communities) has a rate of HIV at least 15 times the rate in Indonesia as a whole.
• Migrant workers. Men often migrate to new places if they cannot find work near their families. They may start having new sexual partners, and then spread the infection on their return home.
• Vulnerable young people. Being poor, homeless or orphaned can make young people vulnerable to unprotected sex or forced sex.
• Men who have sex with men. The chances of infection are higher during anal intercourse than vaginal sex.
• Sex workers and their clients. Sex workers are often unable to persuade clients to use condoms, putting them more at risk of the virus.
• People who inject drugs. People who share needles are at high risk of infection.
• Prisoners. Mostly through injecting drug use.

Many governments fail to target prevention, testing or treatment at these groups.

Which countries are most affected?

Sub-Saharan Africa has two thirds of all people living with HIV worldwide – around 22 million. Countries with the highest HIV prevalence are Swaziland (26%), Zimbabwe (24%), and Botswana (23%). Every region of the world is affected by this disease.

Are there examples of countries that have made good progress?

Decisions made by national and local governments can be critical in curbing the spread of HIV and AIDS.

Brazil took a pioneering early decision in 1996 to provide free antiretroviral treatment to all. The decision extended the lives of tens of thousands of Brazilians, and is estimated to have saved around $2.2 billion in health costs between 1996 and 2004. Brazil also put a strong emphasis on preventing the spread of HIV with huge condom campaigns to the general population and adolescents, as well as campaigns with drug users, sex workers and people in prison.

Cambodia has also reduced HIV prevalence from 3% to less than 1% over the past ten years. Much of this success has been attributed to the government's 100% condom use policy for sex workers. Between 1997 and 2002 the share of new HIV infections resulting from commercial sex plummeted from 80-90% to only 21%. However, an increase in drug use in Cambodia is a new threat to HIV progress.

Uganda saw a drop in HIV prevalence rates during the 1990s. This was attributed to Uganda's early and active government response, including a willingness to support civil society organisations and to work closely with them. Unfortunately these gains have been compromised by a greater emphasis on prevention through abstinence, at the expense of condoms, in recent years.

What are some of the key challenges for tackling the HIV epidemic?

• Poverty can mean women and girls are economically dependent on men and cannot say no to unprotected sex.
• Poverty often makes people live from day to day, taking risks as a result. For example, women involved in sex work may realise they are at greater risk of HIV in the long term, but hunger is a more immediate threat to them and their children. Desperate poverty can drive people to exchange sex for money, shelter or food.
• A culture of silence around sex can mean accurate information about HIV is very hard to get hold of, especially for young people.
• Dangerous myths continue to be spread, such as that sleeping with a virgin can cure a man of the HIV virus.
• Fear of discrimination can put people off from being tested and getting treatment.
• People may not wish to use condoms for cultural or religious reasons, or may find them hard to obtain.
• It is important to influence the attitudes and behaviour of men, but they are a difficult group to reach and are often not considered a ‘target’ group in the same way as women.
• Even when people have knowledge, they may not see themselves as at risk, or may not care because they are under the influence of alcohol or drugs.