World AIDS Day is an opportunity to show support for people living with HIV and AIDS and to commemorate those we have sadly lost.

The National AIDS Trust have launched their 2023 campaign for donations to ensure people living with HIV have the health, dignity and equality they deserve.       



During the course of the AIDS epidemic unprecedented scientific advancements have been made. The first major medical breakthrough occurred in 1986 with the arrival of the antiretroviral, AZT. But eventually, AZT was found to have a limited effectiveness. More successful treatments, however, (guarding against opportunistic infections common among AIDS patients, such as pneumocystis pneumonia) were gradually developed and released. And with encouraging results.

It was the advent of combination therapy in 1996 that really began to have a visible effect on rates of death and illness amongst HIV positive people. Now there's an even better treatment available in the UK with the advent of HIV injectable antiretroviral drugs Cabotegravir and Rilpivirine. Having to take tablets every day can be physically, emotionally and socially burdensome for some people. This new treatment offers hope to thousands of people strugging with the side-effects of a daily pill regime.

As the effects of the combination drugs gradually began to kick in, the number of UK AIDS cases decreased dramatically. Since 1994, when AIDS cases hit a peak with 1,840 diagnosis, new cases of AIDS fell by 70%, dropping to 597 in 1999.
But while the instances of AIDS may have fallen, along with mortality rates (a recent report showed that AIDS death rates in Europe had fallen by 80 percent), the rates of HIV infection have continued to increase.

There are, on average, 2,500 new diagnosis of HIV in the UK every year - that's equivalent to seven cases a day. Of all new cases, 60 percent are among gay men. And studies indicate that unsafe sex is, worryingly, on the increase. Recent years have seen an explosion of STDs (UK cases of gonorrhoea rose by 30 percent last year). Another study shows that there is a general misunderstanding about HIV drugs.

A survey by the Health Education Authority found that one in six young people (16-24) believe that HIV treatments can stop the virus being transmitted. Meanwhile, a MORI poll for the Terence Higgins Trust published in April last year, showed that 20 percent of people thought there was now a cure for AIDS.

But there is no cure. And combination therapy is far from being an AIDS elixir. The regimen is rigid. It involves necking up to 15 pills a day at precise intervals.

For the treatment to be effective, patients must be 100 percent compliant. Even missing just a couple of doses a month can provide the forever varying HIV virus with a window in which to multiply and mutate.

In addition, there are various unpleasant side effects that accompany combination therapy. These range from short-term side effects (nausea, diarrhoea, fatigue, skin rashes and lypodystrophy - a misplacement of body fat) to longer-term damage (kidney and heart failure). For some, the drugs are simply too toxic to tolerate.

While for many positive people the drugs have unarguably lengthened life spans by postponing progression toward AIDS, how long that resistance against the disease can be maintained is unclear. Once the HIV virus has built up a resistance to a particular drug, that avenue of combination treatment becomes a cul-de-sac.

There has been good news in recent years. PrEP (pre-exposure prophylaxis) is medicine people at risk for HIV take to prevent getting HIV from sex or injection drug use. When taken as prescribed, PrEP is highly effective in preventing HIV and comes in two forms.

Truvada is for all people at risk through sex or injection drug use. Descovy is for people at risk through sex, except for people assigned female at birth who are at risk of getting HIV from vaginal sex. PrEP is safe but some people experience side effects like diarrhea, nausea, headache, fatigue, and stomach pain. For most people these side effects usually go away over time.

If you think you've been exposed to the virus, post-exposure prophylaxis (PEP) medicine may stop you becoming infected. PEP must be started within 72 hours of coming into contact with the virus for it to be effective. It's only recommended following higher risk exposure, particularly where the sexual partner is known to be positive. PEP involves taking HIV treatment every day for 1 month. It may cause some side effects. You should be able to get PEP from sexual health clinics or accident and emergency (A&E) departments of hospitals.

The new injectable HIV drugs are Cabotegravir (also called Vocabria and made by ViiV Healthcare) and Rilpivirine (also called Rekambys and made by Janssen) are given as two separate injections every two months, after an initial phasing-in period. The treatment is only suitable for those who have already achieved undetectable levels of virus in blood while taking tablets. It has only recently been licenced for use by the NHS, but is the most significant step forward in the fight against HIV of the past few years.



See OutUK's OutReach for a full listing of HIV and AIDS resources and advice organisations


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