For the first time, doctors met with AIDS patients in 1980 in Atlanta (USA), when five young men (29-36 years old) were in the hospital with a diagnosis of pneumonia. The patients had relationships with men (MSM) and related to injecting drug users (IDUs). By the end of 1981, the presence of AIDS in the World Health Organization (WHO) was reported by 20 countries, since 1983 they began to talk about the epidemic, and then about the AIDS pandemic. 1981 is considered the year of the official announcement of the new infectious disease “AIDS”.
On the question of the time of the appearance of the disease, the opinions of scientists differed. Some believe that the AIDS appeared a long time ago, and it “sits” in our cells, and the disease was not diagnosed until recently, others – recently.
So, the researchers L. Montagnier and R. Gallo (1983) were the discoverers of the causative agent of AIDS. In their opinion, the virus could have existed for tens or hundreds of years in isolated populations of people, and, due to small contacts of people during that period, it did not spread widely. Changes in people's living conditions, their intensive migration, the “sexual revolution”, drug addiction have created conditions for the widespread spread of the virus.
According to modern researchers, AIDS as a disease could have appeared in the 1950s and 1970s, i.e. this disease is new to humans, which has already arisen in our time. These data are based on the results of the medical documentation of the US Centers for Disease Control for the period from 1950-1986.
The place of appearance of the AIDS virus is also undetermined and is controversial. One group of scientists believes that the virus could have formed in Central Africa, another in the United States, and a third on the island of Haiti.
B. M. Zhdanov is a Russian virologist, supports the African origin of AIDS, but clarifies that the disease existed in the ancient historical times. The first appearance of the disease, in his opinion, took place during the slave trade. Most researchers believe that the question of the origin of the AIDS virus has not yet been resolved. There are several versions on this issue. Some researchers are convinced that the virus was acquired by humans from monkeys – African green monkeys, in whom it does not manifest clinically, and with whom a person had contact by eating them. When cutting up the carcasses of monkeys, the hunter could injure his hand, and through this wound bring the virus into the body. Then he could infect everyone who came into sexual contact with him, and the pathogen began to circulate in human society.
However, Japanese scientists deny this version, based on the fact that the virus that causes AIDS in humans and the virus detected in monkeys belong to different families.
Some believe that the AIDS virus is the result of genetic hybridization between animal lentiviruses and oncogenic viruses.


  There are three ways of HIV transmission:

• sexual — with heterosexual and homosexual contacts
• parenteral — with blood and its components in violation of the integrity of the skin, mucous membranes
• from mother to child — before, during and shortly after childbirth and during breastfeeding

          Every sexual act without protection (i.e. without a condom) exposes an uninfected partner to the risk of infection. The degree of risk depends on a number of factors, including the presence of other sexually transmitted infections (STIs), the sex and age of the uninfected partner, the method of sexual intercourse, the stage of the disease of the infected partner. Studies in Europe of 563 heterosexual couples in which only one partner was initially infected allowed to suggest that transmission from a man to a woman is about twice as likely as from a woman to a man. Usually, women are more vulnerable to HIV infection because of the more extensive exposed surface (vagina and cervix). Moreover, the concentration of HIV in semen is much higher than in the liquid secretions of the vagina and cervix. In the case of anal sex, there is a higher risk of HIV transmission compared to vaginal, due to the greater likelihood of tissue damage to the receiving partner. And in this case, the passive partner is at greater risk than the active partner. Since both semen and vaginal discharge contain HIV, there is theoretically a risk of transmission during oral sex. In all forms of sex, the risk of transmission is higher if there are scratches or abrasions on the skin or mucous membrane. With oral and vaginal sex, the risk is higher if a woman has a menstrual cycle.

 
          Implemented when the integrity of the skin is breached by a cutting instrument if the instrument contains the blood of an HIV-infected person. This can happen when using needles, syringes, razors and tattooing tools. Any pricking instruments that have not been sterilized can be a means of transmission of infection. This path of infection is the leading one for people who inject drugs (IDU) at least once with a “dirty” infected syringe. Injecting drug users also lead a promiscuous sex life, many girls who take intravenous drugs are commercial sex workers (SW). In addition, injecting drug users have a negative attitude to protective equipment – condoms. All this increases the possibility of HIV infection and exacerbates the spread of HIV infection among other segments of the population.         Transmission of the virus can occur between a mother and a child during pregnancy, childbirth (infection through the mother’s blood) and breastfeeding (both from an infected mother to a healthy child through breast milk, and from an infected child to a healthy mother through biting the breast during feeding).
Mostly pregnant women become infected after drug injection, less often sexually, even more often there may be infection before pregnancy.

 
 
 
 
How is HIV not transmitted?

• when shaking hands
• when coughing, sneezing
• when visiting the swimming pool, sauna, toilets
• with insect bites
• with friendly kisses
• through dishes, clothes, underwear
• in contact with pets
• through food

          To date, the prevention of HIV infection is one of the most effective ways to combat a dangerous disease. Scientists around the world are doing everything possible to develop an effective remedy for HIV in the near future. And although there are some successes in this area, a vaccine against infection has not yet been invented. Therefore, HIV prevention is a reliable and guaranteed way to protect against infection, and its results depend on the behaviour of each person.
One of the most important areas of HIV prevention can be considered the prevention of vertical transmission of HIV infection, that is, the passage of a preventive course of treatment for pregnant women who are carriers of the human immunodeficiency virus (HIV). This therapy is aimed at minimizing the risk of infection of the child in utero. Caesarean operation replacing natural childbirth, artificial feeding of a baby born from an infected mother are also ways to prevent HIV.



 
 
 

• The state of the mother’s health. The higher the level of the virus in the mother's blood or vaginal secretions and the lower her immune status, the higher the risk of transmitting the virus to the child. If the mother has painful symptoms, the risk is higher.
• The mother’s living conditions: nutrition, rest, vitamins and others are a very important factor. It is characteristic that the average risk of having a child with HIV in the industrialized countries of Europe and the United States is about half as low as in the third world countries.
• The presence of previous pregnancies: the more of them, the higher the risk.
• Full-term pregnancy of the child: both premature and transferred babies are more likely to be infected.
• Duration of the second stage of labour: the risk is less, the shorter the period of time before the baby is born.
• Inflammation or premature rupture of amniotic membranes: increased risk of HIV transmission to the new-born.
• Caesarean section/operation: Many studies have shown that with a caesarean section, especially if it is performed before the rupture of the amniotic membranes, the risk of having a child with HIV is reduced.
• Ulcers and cracks in the vaginal mucosa (usually they occur as a result of infections) increase the risk of having a child with HIV.
• Breastfeeding: Mothers with HIV are not recommended to breastfeed their children, as this increases the risk of HIV transmission.

        Studies show that the foetus can be infected with HIV as early as 8-12 weeks of pregnancy. However, in most cases, infection of infants occurs during childbirth.
In order to identify HIV-infected pregnant women in a timely manner and take preventive measures to prevent infection of the child, mandatory HIV testing has been introduced for them upon registration and within 28-30 weeks, as well as those who have been admitted to maternity hospitals without the results of a 2-fold HIV infection examination or examined once for more than 3 weeks before going into labour.
 
 
 
         Injecting drug users (IDU) must be given a choice: either stop consuming, or switch to safe forms (smoking, sniffing, swallowing), or inject with sterile instruments. This is called the strategy of “reducing the risk of drug use” or “reducing the harm caused by drugs”. The main principles of effective prevention of HIV infection among IDU are the following:

• Information and educational work on HIV infection prevention
• Ensuring the availability of social and health services
• Active work among injecting drug users
• Providing access to needle and syringe exchange programs
• Ensuring access to antiretroviral and substitution therapy

Prevention of sexual infection is of particular importance. According to the World Health Organization, untreated sexually transmitted diseases (STDs) increase the risk of HIV infection by 5-10 times.
Worldwide, about half of all infections with HIV and other STDs occur among young people aged 10 to 25 years. In this regard, it is especially important to teach young people responsible and safe sexual behaviour.
In fact, sex education is aimed at forming the ability of a growing person to make sound decisions, to develop psychological "immunity" in the face of a huge variety of risk factors, including the adolescent need to experiment, self-affirmation, peer pressure, the activity of drug dealers. Since modern youth face a wide range of diverse and interrelated problems, sex education and the promotion of safe behaviour should become part of the overall complex of life skills training in the modern world.
In a survey conducted in the United States, it was found that teenagers with whom their mothers talked about condoms at least a year before the teenager started having sex are significantly more likely to use condoms during the first sexual contact. In addition, those who used a condom at the first contact are 20 times more likely to continue to use a condom constantly afterwards.
Today, HIV prevention consists in carrying out information work with young people, explaining the importance of using a condom to protect against possible infection. The younger generation should know everything about the ways of transmission of the disease and how to safely avoid HIV infection.

When preventing infection through the blood, it is necessary to remember the rules of personal hygiene when using personal care items (toiletries). First of all, this applies to objects that can be cut, and on which traces of fresh blood can remain (scissors, forceps, shaving machines, etc.).
In medical institutions, the use of a sterile instrument is mandatory.
The task of prevention is to convince people to change their behaviour voluntarily and for a long time, making it safer.
  
HIV diagnosis

1. What tasks are performed by the laboratories of the AIDS Centers?
The functions of the laboratories include the following main tasks:

• Diagnosis of HIV infection
• Control (monitoring) over the efficiency of treatment provided to people living with HIV (PLHIV)
• Diagnosis of HIV drug resistance

 Diagnosis of HIV infection is a process that includes a series of laboratory tests with the mandatory use of various diagnostic test systems and methods. The need for a series of tests is primarily due to the simple fact that today there is no ideal method that guarantees absolutely accurate separation of infected patients from uninfected persons. The most reliable data is achieved by a combination of several tests (methods), some of which better identify HIV-infected patients, and others - better identify uninfected. At the first stage, laboratories use the most sensitive test systems of the latest (fourth) generation. The probability of a false negative result when using these test systems is extremely small, therefore, when receiving a negative result, AIDS Centers immediately issue a conclusion: No antibodies to HIV have been detected.

        However, a positive result is not absolutely accurate proof of the presence of HIV infection. In Kazakhstan, the overall prevalence of HIV infection is quite low (<0.05%). The probability of detecting an HIV-infected patient among the general population is less than the probability of obtaining a false positive result (the permissible limit is 2%). Therefore, a positive result requires confirmation. To do this, the laboratories of the AIDS Centers conduct additional tests that allow you to "filter out" true-positive results from false-positive ones. At the last stage, an immunoblot test is used, which guarantees maximum reliability of positive results. Based on this result, doctors can make a final conclusion about the presence of HIV infection in the patient.
        Monitoring the effectiveness of antiretroviral therapy. In Kazakhstan, people living with HIV receive free treatment in the form of antiretroviral therapy (ART). The effectiveness of ART depends very much on a number of factors: compliance with the medication regimen, the primary resistance of the virus to a particular drug, or the rate of occurrence of mutant resistant forms. Therefore, all PLHIV receiving ART undergo regular examination in the laboratories of regional and city AIDS centers for quantitative determination of HIV RNA (viral load) and quantitative determination of CD4+/CD8+ T-lymphocyte levels.
        The viral load test allows you to determine how effectively drugs suppress the reproduction of the virus. A test for CD4+/CD8+ T-lymphocytes shows the state of the patient's immunity. If the viral load is at a low level, and the number of CD4+ cells is growing, then the chosen treatment regimen is effective. If not, it is necessary to make appropriate adjustments.
 Diagnosis of HIV drug resistance. The problem of the emergence of HIV drug resistance is inevitable when implementing a large-scale treatment program for PLHIV. In the case when therapy turns out to be ineffective, and this is not related to the patient's commitment to treatment, studies are conducted on the basis of the AIDS RC to identify and genotyping mutant forms of the virus. These studies allow us to determine which drugs can no longer suppress the reproduction of the virus, and thus adjust the treatment regimen.
 
 2. What is an immunoblot and why can we trust its positive results?
        The human immunodeficiency virus consists of a number of proteins (antigens), to each of which specific antibodies are produced in an infected patient. Unlike tests performed at the first stages (ELISA, IHLA, rapid tests), the immunoblot can determine which specific HIV antigens a patient has antibodies.
According to the criteria of the World Health Organization (WHO), a positive result can be established when antibodies to at least two of the three surface proteins of the virus (gp) are detected. Therefore, the use of an immunoblot minimizes the probability of false positive results.
Fig. 1. An example of an immunoblot is gp160, gp120, gp41, p66, p24, p17 –virus proteins. The appearance of a dark transverse line on the test strip indicates the presence of antibodies to this protein in the patient’s body.
 
Example of an immunoblot

There are two types of immunoblot. The first, the so-called Western Blot, is made from proteins of real, but previously destroyed viruses grown in cell culture. The advantage of the Western blot is that all HIV proteins are present in it, and we can see the full picture of the process of generating specific antibodies in the patient's body. However, the use of an expensive culture accordingly affects the price of this test. The second type of immunoblot, a linear immune test, was developed in order to reduce the cost of confirmatory analysis. Recombinant (artificially created) proteins are used in linear immune tests. Since a number of HIV proteins are missing in tests of this type, we get a fragmentary picture. For example, in linear immune tests, gp160 protein is missing - one of the three surface proteins on the basis of which the final decision is made, which makes this test less informative. Therefore, the Western blot remains today the “gold standard” for confirming the diagnosis of HIV infection.
 
3. How reliable are the negative results of the immunoblot?
Due to insufficient sensitivity (compared to ELISA, ICLA or rapid tests), negative results of the immunoblot should be treated with caution. Therefore, when receiving a negative or uncertain result of the immunoblot, AIDS Centers prescribe the patient to undergo a second examination in two weeks. As a rule, this period is enough for the patient's body to develop enough antibodies to the main proteins of the virus. However, in some cases, this process may take several months, so the patient may be invited to undergo an examination several more times, up to the final establishment or exclusion of the diagnosis of HIV infection.
  
4. How is the safety of donated blood ensured?
Screening of blood donors for HIV (i.e. mandatory examination of each blood donation, each donor) is carried out not by regional AIDS, but by blood centers. At the same time, the fourth-generation IHL/ELISA methods are used, which make it possible to simultaneously detect viral antigen and antibodies to HIV. In addition, blood samples are examined using the polymerase chain reaction method (in Fig. 2 it is designated as NAT – nucleicacidamplificationtechnology), which allows detecting HIV RNA as early as 10 days after infection. Up to this point, HIV infection is not detected by any tests.
  
Fig. 2. Detection of HIV infection using tests of various forms and generations during the natural course of infection.

Detection of HIV infection using tests
Upon receiving a positive result of any of the tests, the potentially infected donor blood is destroyed, and the donor himself is removed from the opportunity to donate blood in the future. At the same time, the diagnosis of HIV infection is not made to the donor without conducting confirmatory studies. To make a final diagnosis, a blood sample of the donor is submitted to the Republican Center for the Prevention and Control of AIDS for further research according to the approved algorithm of testing for HIV infection.
 
5. How is HIV-2 diagnosed in Kazakhstan?
According to the available epidemiological data, not a single case of HIV-2 infection has been registered in the territory of CIS today. Nevertheless, all laboratories of the regional AIDS centers of Kazakhstan and blood centers use test systems capable of simultaneously detecting both HIV-1 and HIV-2 infection. In addition, the great similarity of the structure of viruses of the first and second types provides a cross-reaction in the immunoblot at the confirmation stage. If HIV-2 infection is suspected, the laboratory of Republican Center for the Prevention and Control of AIDS has an appropriate immunoblot at its disposal to detect specifically antibodies to the human immunodeficiency virus of the second type.
 
 
6. How much does an HIV test cost?
According to the rates for medical services within the guaranteed volume of free medical care approved by the order of the Ministry of Healthcare of the Republic of Kazakhstan, the cost of HIV testing is 1413.99 tenge (KZT).
 
 
7. Can private medical organizations perform HIV research?
 In order for the population to have wide access to HIV testing, medical organizations of all forms of ownership can conduct the first stage of laboratory diagnostics of HIV infection. At the same time, the Ministry of Healthcare of the Republic of Kazakhstan will provide with qualification requirements and the obligation to provide statistical reporting.
 
 

• The global number of people living with HIV in 2020 was 37.7 million [30.2 million–45.1 million] people. 
• The number of new HIV infections in 2020 amounted to 1.5 million [1.0 million–2.0 million] people.
• The number of people who died from AIDS-related diseases in 2020 was 680,000 [480,000-1.0 million] people. 
• 27.5 million [26.5 million–27.7 million] people received the antiretroviral therapy in 2020. 
• 79.3 million [55.9 million–110 million] people have been infected with HIV since the beginning of the epidemic.
• 36.3 million [27.2 million–47.8 million] people have died from AIDS-related diseases since the beginning of the epidemic.

• In 2020, the number of people living with HIV was 37.7 million [30.2 million -45.1 million] people:
  • 36.0 million [28.9 million – 43.2 million] adults.
  • 1.7 million [1.2 million - 2.2 million] children (aged 0-14 years).
  • Women and girls accounted for 53% of all people living with HIV.
• In 2020, 84% [67–>98%] of all people living with HIV knew their status.
• About 6.1 million [4.9 million–7.3 million] people did not know that they were living with HIV in 2020.

• As of the end of December 2020, 27.5 million [26.5 million–27.7 million] people were receiving antiretroviral therapy compared to 7.8 million [6.9 million—7.9 million] in 2010.
• In 2020, 73% [56-88%] of all people living with HIV had access to treatment.
  • 74% [57-90%] of adults aged 15 years and older living with HIV and 54% [37-69%] of children aged 0-14 years had access to treatment.
  • 79% [61-95%] of adult women aged 15 and older had access to treatment, while only 68% [52-83%] of adult men aged 15 and older had access.
• 85% [63– >98%] of pregnant women living with HIV had access to treatment with antiretroviral drugs in order to prevent transmission of the virus to the foetus in 2020.

 

• The number of new HIV infections has decreased by 52% compared to 1997, when this indicator peaked.
  • In 2020, the number of new HIV infections was about 1.5 million [1.0 million-2.0 million] people, compared with 3.0 million [2.1 million–4.2 million] people in 1997.
  • Women and girls accounted for 50% of new HIV infections in 2020.
• In 2020, the rate of new HIV infections decreased by 31% compared to 2010, from 2.1 million [1.5 million-2.9 million] to 1.5 million [1.0 million–2.0 million].
  • In 2020, the rate of new HIV infections among children decreased by 53% compared to 2010, from 320,000 [210,000-510,000] to 150,000 [100,000-240,000].

 
 
 

• The number of people who died due to AIDS-related diseases decreased by 64% compared to the peak in 2004 and by 47% compared to 2010.
  • In 2020, the global number of deaths from AIDS-related diseases was 680,000 [480,000-1 million] people. For comparison, in 2004 this figure was 1.9 million [1.3 million–2.7 million] people and 1.3 million [910,000– 1.6 million] people in 2010.
• AIDS-related deaths have decreased by 53% among women and girls and by 41% among men and boys since 2010.

• People living with HIV have more severe outcomes and have higher comorbidities from COVID-19 than people without HIV, and in mid-2021, most of them did not have access to COVID-19 vaccines.
• Studies conducted in England and South Africa have shown that the risk of death from COVID-19 among people with HIV is twice as high as in the general population.
• Two thirds (67%) of people living with HIV live in sub-Saharan Africa. But vaccines that can protect them don't appear fast enough. In July 2021, less than 3% of people in Africa received at least one dose of the COVID vaccine.
• Lockdown and other restrictive measures in connection with COVID-19 prevented HIV testing and in many countries led to a sharp decrease in the number of diagnoses and referrals for HIV treatment.
• The Global Fund to Fight AIDS, Tuberculosis and Malaria reported that, according to data collected in 502 medical institutions in 32 countries in Africa and Asia, HIV testing decreased by 41%, and the number of referrals for diagnosis and treatment decreased by 37% during the first lockdown in connection with COVID-19 in 2020 compared to the same period in 2019.

 
 
 
 

• In 2020, key risk groups (sex workers and their clients, gay men and other men who have sex with men, people who inject drugs, transgender women) and their sexual partners accounted for 65% of new HIV cases worldwide:
  • 93% of new HIV infections worldwide except in sub-Saharan Africa.
  • 39% of new HIV infections in sub-Saharan Africa.
• Risk of HIV infection:
  • 35 times higher among people who inject drugs.
  • 34 times higher among transgender women.
  • 26 times higher among female/sex workers.
  • It is 25 times higher among homosexual men and other men who have sex with men.

 
 
 
 

• About 5,000 young women aged 15-24 are infected with HIV every week.
  • In Sub-Saharan Africa, six out of seven new infections among adolescents aged 15-19 are among girls. The probability of HIV infection for young women aged 15-24 years is twice as high as for men. About 4,200 adolescent girls and young women aged 15-24 were infected with HIV every week in 2020.
• More than a third (35%) of women worldwide have at some point in their lives been physically and/or sexually assaulted by a sexual partner or sexually assaulted by a person who is not their partner.
  • In some regions, women who have been physically or sexually abused by a partner are 1.5 times more likely to become infected with HIV than women who have not been subjected to such violence.
• In Sub-Saharan Africa, women and girls accounted for about 63% of all new HIV infections

 
 
 

• In 2020, 84% [67– >98%] of people living with HIV knew their status.
• Among people who know their status, 87% [67– >98%] had access to treatment.
• And 90% of people receiving therapy, 90% [70– >98%] suppressed viral load was achieved.
• In 2020, of all people living with HIV, 84% [67—>98%] they knew their status, 73% [56-88%] had access to treatment and 66% [53-79%] achieved suppressed viral load.

 
 

• As of the end of 2020, $21.5 billion (USD) has been allocated (in constant USD dollars at 2019 prices) for the AIDS response in low and middle-income countries; about 61% came from domestic sources.

According to UNAIDS estimates, in 2025, the AIDS response will require $29 billion USD (in constant USD dollars at 2019 prices) in low and middle-income countries, including countries that were previously considered high-income countries, in order to return to the path of ending the AIDS epidemic.