June 5 th 1981 is an important date in the annals of HIV ( human immunodeficiency virus) disease. On that day an outbreak of an unusual form of pneumonia was reported in Los Angeles in the United States which later turned out to be the manifestation of AIDS, the life-threatening complication brought on by HIV. Since then about 25 million people have died of AIDS and about 34 million are infected by the virus. This is the 30 th anniversary of the disease’s discovery, and there is no question that despite the absence of a vaccine to prevent the illness, the treatment of the disease has come a long way. In a sense in many parts of the world including the developing world, by effectively treating patients with this disease, the transmission of this virus to newer patients has been inhibited.
There was a time when being infected by HIV was a death sentence. This is no longer true especially in the western world. Eight or ten years ago sitting down and writing out your will was a common practice when infected with HIV.Now patientscan have their disease under control but may not be actually cured of the virus. This transformation has been due largely to anti retroviral therapy ( ART) group of drugs. HIV infectionnow is another chronic illness like diabetes, coronary artery disease, or rheumatoid arthritis which may require not only continual effective drug therapy, but also periodic laboratory tests and knowledgeable supervision on a long term basis.
As is true about many things in life, affluent nations are more readily able to afford ART and long term care. In Nepal for instance, of those patients with HIV that require ART, some estimates suggest that only 10 to 15 % have access to free ART. The Global Fund to Fight Aids and other INGOS and NGOs provide grants to supply free ART drugs in Nepal. “Rack” prices for these drugs are easily thousands of rupees per month which most Nepalis will be unable to pay for.
Evidence is mounting in favour of early initiation of ART to decrease the rates of death from HIV. Death results from HIV when the disease progresses to a full fledgedversion, that is manifestations of AIDS such as concomitant fungal or bacterial infections in a HIV patient. Starting ART drugs in a HIV infected patient is dependent on sophisticated laboratory tests ( CD4 count, for example) which are available in only a few centres in Nepal.
So, especially in a resource poor country this is a disease all too difficult to treat. The focus has to continue to be on prevention. The good news is that myriads of INGOS and NGOs are working on preventing this illness. In fact many care givers working with other common illnesses ( chronic lung disease, typhoid, chronic renal disease ) that plague this part of the world feel that HIV steals all the limelight (and the funds).
Some report the incidence of HIV in Nepal to be less than 1 % of the adult population, butlet us remind ourselves never to be complacent regarding this killer disease. Finally it is indeed heartening that this disease which was thought by some religious people to be punishment that was handed down by God for man’ s sins has been stopped in its track thirty years down the line.