AIDS creates complex challenges at many levels in society. The most obvious challenge may be the medical challenge of a rapidly spreading and incurable virus. A less obvious challenge but of equal consequence are the attitudes and beliefs which alienate and stigmatize people living with AIDS. The context of poverty itself both promotes disease and hinders effective response. Therefore, Compassion's strategies to respond to AIDS must address the diverse aspects of the disease – from education, to prevention, to treatment, to counseling, to income generation activities to orphan care.
Acquired (because you "catch" it as opposed to being born with it), ImmunoDeficiency (because it makes your immune system deficient) Syndrome (because it creates a collection of symptoms).
Human Immunodeficiency Virus. The virus that causes AIDS. AIDS is the disease caused by infection with the virus, HIV, but it often takes years for the infection to progress to the point of AIDS.
A person infected with HIV but the infection may or may not have progressed to AIDS. Being "positive" is typically known by a simple blood test. Saliva tests are also available but are less common. Many people are "positive" (infected) but do not know it. Until recently there has been little incentive for people to want to know their HIV status.
There are many types of viruses and they are classified according to their characteristics (just as there are different types of animals but biology classifies different species of animals). HIV is classified as a "retrovirus" because, in a weird way, it goes backwards.
ART and ARV
Drugs have been created that block the ability of HIV to replicate (make copies of itself and reproduce) in the body. These drugs are called Antiretroviral (ARV) drugs. When these drugs are administered to a person with AIDS, the person is on Antiretroviral Therapy (ART). The terms ARV and ART are sometimes used interchangeably, but technically they mean different things. Antiretroviral drugs do not cure HIV or AIDS, but they keep the virus in check and allow the immune system a chance to recover. In a way, they force HIV to go dormant. A person on successful ART will experience a nearly normal quality of life. Generally, there is no way to distinguish a child on ART by appearance or activity. However, life spans on ART are not known with certainty.
Unfortunately, even after years of treatment with ARV drugs, if the amount of the medicine in the body is reduced below its effective level then HIV will "wake up" and AIDS will return. Worse, the returning strain of HIV will probably be resistant to the same drugs which previously held it in check so it becomes far more difficult to treat. This happens because each time the virus makes a copy of itself it makes a few mistakes (called mutations). These mistakes, or changes, sometimes produce a defective virus, sometimes have no effect and sometimes result in changes in the very systems which are targeted by ARV drugs. Because the virus is making billions of copies of itself it is just a matter of probability that some changes will enable certain changed (mutated) versions of HIV to continue replicating even in the presence of the ARV drugs. In a sense, the virus has discovered a way to resist the effects of certain drugs. If that happens then a new set of drugs must be used to treat the patient. The really, really big problem here is when the multidrug-resistant strain of HIV spreads in society. Such an event is prelude to a future where AIDS cannot be treated and the ravaging effects of the pandemic will be unstoppable even in developed countries.
This simply means taking the medicine as prescribed. If your antibiotic prescription says to take twice daily for seven days then adherence means you take it twice daily of seven days. If you fail to take it for seven days, skip a day or miss a dose then that is called non-adherence. For many conditions non-adherence does not carry serious consequences but adherence to ART is different. Because ART often involves multiple drugs taken at different times of day and taken daily for life it is particularly difficult to encourage people to take their medicines as prescribed. Unfortunately, non-adherence to ART will often result in the emergence of drug-resistant strains of HIV. That not only complicates further treatment for that individual but raises the ominous risk of a new drug-resistant strain of HIV spreading in the general population. Therefore strategies to promote adherence should be given extremely high priority. This is especially challenging with reference to treating children.
Your immune system is made up of different kinds of cells. Some patrol your body, some stay put in the lymph nodes, some are stationed at common sites of invasion (mucosal surfaces). One particular kind of cell serves as the officer of this army. It is called the helper T cell. There are also "killer T cells" but those are more like front line infantry. The helper T cells coordinate your body's defenses to a wide range of infectious diseases. HIV kills the helper T cells and that is part of how HIV makes the body vulnerable to infection by other diseases.
The helper T cells produce a unique protein called CD4. Because most other cells do not make CD4 it is a useful way to distinguish helper T cells from other cells. Because HIV kills helper T cells it reduces the level of helper T cells in the blood. A teaspoon full of normal blood would have about 1000 helper T cells but in people with AIDS that number is often 200 or less. So, when people refer to a "CD4 count" they are not really talking about counting CD4 (a protein) but rather they are counting the number of cells that have CD4 (the helper T cells) and this is an extremely important measure of the progression of the disease. The sophisticated equipment used for CD4 counts is not widely available in the resource limited setting.
When to Start ART
This is a complex subject. In short, WHO guidelines, which most governments follow, indicate that ART should be initiated in patients whose CD4 count is below 200 or who exhibit certain indicator symptoms which are definitive of AIDS. Compassion follows those guidelines while seeking evidence of their appropriateness for children in the resource limited setting.
AIDS is a preventable disease. Either directly or indirectly HIV infection is the result of people's choices. AIDS is also incurable. That means the only "cure" is to prevent infection and the only chance of victory against the pandemic is found in reducing the rates of new infection. Educating and "raising awareness" are futile exercises unless they influence the choices people make. Therefore, prevention strategies must influence the root issues behind those decisions.
Those root issues are complex. Poverty itself is often the driving cause of high-risk choices in an effort to survive. Lack of female empowerment can undermine a girl's capacity to resist coercive efforts of older men. The same forces of adolescent sexuality faced by teenagers world-wide are no different, no more or less easily tempered, in places with high HIV prevalence. Prevention strategies must address these complex root issues in a meaningful and effective manner.
During your visit to Uganda Compassion will be piloting a new strategy for influencing the attitudes and choices among youth. This strategy combines two "best practices," peer to peer education and training the trainers, with an opportunity for Leadership Development students to utilize their leadership ability.
Other Common Acronyms in HIV/AIDS Ministry
PLWHAs – People Living With HIV/AIDS
CLWHAs – Children Living With HIV/AIDS
PMTCT – Prevention of Mother to Child Transmission
MTCT – Mother to Child Transmission
BCC – Behavioral Change Communication
VBBC – Value Based Behavioral Change
IEC – Information Education Communication
FBO – Faith Based Organization
CBO – Community Based Organization
HAART – Highly Active Anti-Retroviral Therapy
HBC – Home Based Care
IGAs – Income Generating Activities
OIs – Opportunistic Infections
TB – Tuberculosis
OVC – Orphans and Vulnerable Children
S &D – Stigma and Discrimination
STIs – Sexually Transmitted Infections
VCT – Voluntary Counseling and Testing
VCCT – Voluntary Confidential Counseling and Testing