World AIDS Day is celebrated on 1st December each year. This year, the theme is ‘Communities make the difference’.
The human immunodeficiency virus (HIV) targets the immune system and weakens people’s defence systems against infections and some types of cancer. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient. Immune function is typically measured by CD4 cell count.
Immunodeficiency results in increased susceptibility to a wide range of infections, cancers and other diseases that people with healthy immune systems can fight off.
The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS), which can take from 2 to 15 years to develop if not treated, depending on the individual. AIDS is defined by the development of certain cancers, infections or other severe clinical manifestations.
HIV can be transmitted via the exchange of a variety of body fluids from infected people, such as blood, breast milk, semen and vaginal secretions. HIV can also be transmitted from a mother to her child during pregnancy and delivery. Individuals cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water.
Key populations include:
- men who have sex with men;
- people who inject drugs;
- people in prisons and other closed settings;
- sex workers and their clients; and
- transgender people.
In addition, given their life circumstances, a range of other populations may be particularly vulnerable, and at increased risk of HIV infection, such as adolescent girls and young women in southern and eastern Africa and indigenous peoples in some communities.
Behaviours and conditions that put individuals at greater risk of contracting HIV include:
- having unprotected anal or vaginal sex;
- having another sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhoea and bacterial vaginosis;
- sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs;
- receiving unsafe injections, blood transfusions and tissue transplantation, and medical procedures that involve unsterile cutting or piercing; and
- experiencing accidental needle stick injuries, including among health workers
HIV can be diagnosed through rapid diagnostic tests that can provide same-day results. This greatly facilitates diagnosis and linkage with treatment and care.
There is no cure for HIV infection. However, effective antiretroviral drugs (ARVs) can control the virus and help prevent onward transmission to other people.
HIV continues to be a major global public health issue, having claimed more than 32 million lives so far. However, with increasing access to effective HIV prevention, diagnosis, treatment and care, including for opportunistic infections, HIV infection has become a manageable chronic health condition, enabling people living with HIV to lead long and healthy lives.
There were approximately 37.9 million people living with HIV at the end of 2018.
In 2018, for the first time, individuals from key population groups and their sexual partners accounted for over half of all new HIV infections globally (an estimated 54%) in 2018. For eastern European, central Asian, Middle Eastern and north African regions, these groups accounted for around 95% of new HIV infections.
Over two thirds of all people living with HIV live in the WHO African Region (25.7 million). While HIV is prevalent among the general population in this region, an increasing number of new infections occur among key population groups.
Due to gaps in HIV services, 770 000 people died from HIV-related causes in 2018 and 1.7 million people were newly infected.
Today 4 in 5 people with HIV get tested and 2 in 3 get treatment: communities played a major role in achieving this success.
- Of the estimated 37.9 million people living with HIV at the end of 2018, 79% were diagnosed, 62% received treatment, and 53% had achieved suppression of the HIV virus with low risk of infecting others.
- One of the key contributors to this success in all countries has been the thousands of members of HIV and “key population” community networks and community health workers, many of whom are living with or affected by HIV.
Community-based HIV treatment and monitoring saves money and reduces workloads for doctors, nurses and other health care professionals.
- WHO recommends countries train and mobilize community health workers, including people living with HIV, to provide decentralized and differentiated HIV treatment and care.
- Evidence shows more people continue with HIV treatment when peer educators counsel and support each other.
- WHO also recommends that community health workers support monitoring and data collection.
Expanding the role of communities and community-based health care will help countries meet global HIV and UHC targets.
- Health services are struggling to provide all people with HIV services they need. Global fast-track targets for HIV for 2020 are unlikely to be met unless more support becomes available.
- The most glaring gap is seen in prevention. In 2018, 1.7 million people were newly infected with HIV – this number must reduce by three-fold to meet the 2020 target of 500 000.
- Testing and treatment coverage is off track too – especially for key populations and children. For example, more than half of all new infections are among key populations and their partners; only half of the children in need are receiving ART, of which only half achieved viral suppression due to the use of sub-optimal medicines.
Community and civil society engagement must remain a key strategy to boost primary health care.
- Activism and civil society action have been key resources in the HIV response from the early days, inspiring the global health community to galvanize efforts for increased equity, respect for health and human rights, and scientific innovation.
- In September 2019, global leaders signed the first-ever UN declaration on UHC with a central focus on primary health care, tailored for and built through empowered and engaged communities.
- Today, people-centred care, community and civil society engagement are included in three Sustainable Development Goal targets.
- World AIDS Day 2019 provides an opportunity to translate our commitments into action, to ensure the role of communities for HIV and health progress are both celebrated and accelerated.
WHO recommends countries to adopt community-based HIV testing, prevention, treatment and care as a core strategy.
- WHO recommends a strategic mix of approaches for testing, including community-based testing, self-testing and provider-assisted referral to reach people at highest risk of HIV.
- Countries like South Africa and Rwanda have shown how trained peers or community health workers have delivered rapid diagnostic tests with same-day results, enabling more people to know their HIV status.
- WHO recommends increased rapid testing in community settings for key populations in Europe, Asia and the Americas to replace laborious approaches causing weeks of delays in test results and treatment initiation.
- WHO is also adding new recommendations to mobilize community-based social networks for increasing demand for HIV testing, including self-testing and to promote dual HIV/syphilis rapid tests and new digital tools.
Link to the World AIDS Day 2019 web site:
Link to the updated WHO fact sheet on HIV/AIDS (15 November 2019):