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HIV: still more work to do

During her August 2-3 visit to Uganda, US Secretary of State Hillary Rodham Clinton called attention to a new survey that shows HIV prevalence in Uganda has increased to 7.3% in 2012 from 6.7% in 2011 and 6.4% in 2005. The survey suggests that behavior is largely driving the increase.  While the Infectious Diseases Institute (IDI) focuses on biomedical prevention and treatment of HIV, psychosocial factors are recognized as critically important to the success of biomedical approaches and IDI employs a large team of experienced counselors to work with clients.  One of the issues the counselors frequently report to be driving behavior is the stigma associated with HIV. The Oxford English Dictionary defines stigma as 1) a mark of disgrace associated with a particular circumstance, quality, or person or 2) a visible sign or characteristic of a disease. Unfortunately there is still a stigma in the first sense associated with HIV infection, even though many people become infected through no fault of their own.  There are not only serious medical implications of the disease, but there can be devastating social consequences when others learn that a person is HIV positive – domestic violence, break-up of families and loss of employment. It’s not surprising that many HIV positive people choose to keep their sero-status a secret, and don’t disclose it even to close family; but it’s tough to live with HIV without the support of family and friends. For people living with HIV there are also a number of telltale visible signs of the disease, stigma in the second sense of the word, that can be difficult to hide.  Kaposi’s sarcoma is the most common cancer in sub-Saharan Africa and occurs even more frequently in immune-suppressed people; this cancer produces visible lesions on the skin and face.  Some anti-retroviral drugs can produce a distressing side-effect called lipodystrophy that redistributes body fat away from the face and limbs to the torso. HIV patients must take their antiretroviral drugs regularly, twice a day, and for some it’s hard to hide this routine from their employers, as well as to take time off work to attend periodic clinic visits.  The virus can be transmitted via breast milk. HIV positive mothers are advised either to formula-feed their babies or, if either mother or baby is taking anti-retrovirals, to exclusively breast feed for at least 6 months to minimize the risk of HIV transmission to the baby.  As a result, any mother choosing to formula-feed is instantly suspected by others of being HIV positive. What can be done to overcome the stigma of HIV?  Of course, prevention of transmission is vitally important, but for those people already infected, encouragement and peer support can help them focus on adhering to treatment and living long, healthy and productive lives.

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