Hello World : WHO ; Drug resistance for HIV

 

Overview HIV

Antiretroviral therapy (ART), which has helped tens of millions of individuals living with HIV/AIDS, has seen an unparalleled rise in use over the past ten years. Out of an estimated 37.7 million persons living with HIV, 27.5 million were receiving ART globally as of the end of 2020.

The evolution of HIV treatment resistance, whose levels have gradually risen in recent years, has coincided with growing usage of HIV medications.

HIV genetic mutations that affect a treatment's capacity to stop the virus from replicating are what lead to HIV drug resistance. Due to the advent of drug-resistant viruses, all antiretroviral medications, even those from more recent pharmacological classes, run the danger of going partially or completely inactive. HIV drug resistance puts the effectiveness of HIV medications in jeopardy if it is not prevented, leading to a rise in HIV infections and HIV-related morbidity and mortality.

Size of the issue

HIV medication resistance monitoring gives nations data they can utilize to improve patient and population-level treatment outcomes. WHO recommends that nations regularly carry out surveys on HIV drug resistance in various populations, including adults, kids, and teenagers.

The implementation of nationally representative surveys in low- and middle-income countries, as well as the formulation of national action plans to prevent, monitor, and address HIV drug resistance, have advanced significantly, according to the WHO's Report on HIV Drug Resistance 2021. As of 2021, national action plans had been created in 64% of the nations with a high prevalence of HIV. 34 nations intend to carry out HIV drug resistance surveys during the next two years. Between 2004 and 2021, 66 countries implemented surveys of HIV drug resistance using WHO-recommended standard procedures.

HIV medication resistance during pretreatment

Some individuals already exhibit drug resistance before starting treatment. This resistance may be developed during prior treatments or transmitted at the time of infection, as in the case of women who use antiretroviral medication to stop HIV from being passed from mother to child.

In order to make the best choice of first-line regimens, WHO advises monitoring HIV medication resistance in adults starting or restarting ART as well as in treatment-naive newborns starting ART.

When initiating HIV treatment, up to 10% of individuals may have medication resistance to the NNRTI drug class. People who have previously taken antiretroviral medications are up to three times more likely to develop pretreatment NNRTI resistance. Children under the age of 18 months who have just been diagnosed with HIV have a high prevalence of drug-resistant HIV. According to surveys done in ten sub-Saharan African nations between 2012 and 2020, over half of babies with newly discovered HIV already had NNRTI-resistant virus.

The urgency of accelerating the switch to the dolutegravir-based treatments advised by the WHO is highlighted by the global incidence of NNRTI resistance in both adults and newborns.

acquired medication resistance to HIV

The purpose of HIV treatment, viral load suppression, is to avoid the development of HIV medication resistance. HIV that has developed treatment resistance is less likely to spread when viral load reduction is attained and maintained. Adults using ART generally had high levels of viral load suppression in 14 nationally representative studies conducted between 2015 and 2020. For people taking first-line ART, the combined outcomes for viral load suppression in Africa were 94% (95% CI 92-96%), and for those receiving second-line ART, they were 84% (95% CI 79-88%). For individuals getting first-line ART in the Americas, the pooled results for viral load suppression were 81% (95% CI 75-87%) and for those receiving second-line ART, they were 70% (95% CI 67-72%).

Some HIV drug resistance is anticipated to develop despite therapy with powerful medications and even when adherence to treatment is encouraged. For the best choice and management of ART regimens, surveillance of acquired HIV drug resistance in people undergoing ART offers valuable information. Resistance to routinely used NNRTIs varied from 50% to 97% among populations that failed NNRTI-based ART.

The high rates of HIV medication resistance to NNRTIs among those who experience treatment failure highlight the need for expanded viral load testing, improved adherence counseling, and rapid therapy switching.

Fortunately, nations are implementing dolutegravir-containing regimens for both adults and children very quickly. It has been demonstrated that dolutegravir-based ART is associated with very high levels of viral load suppression and that patients who fail it do not develop as much acquired resistance. Global statistics on the establishment of HIV resistance to dolutegravir are currently scarce.

According to WHO, nations should regularly monitor the development of HIV medication resistance in adults, kids, and teenagers using ART using either a viral load laboratory-based method or an ART clinic-based method. Depending on the availability of deidentified demographic data and the extent of national viral load testing coverage, a particular strategy may be employed.

Pre-exposure medication for the prevention of HIV

Many people who are at high risk of being exposed to HIV take medications every day to lower their risk of contracting the illness. Oral pre-exposure prophylaxis (PrEP) is advised by the WHO as an alternative HIV preventive option.

People using PrEP are less likely to contract HIV, especially those who take their meds as prescribed. However, medication resistance frequently develops among those who contract HIV despite using PrEP. Due to overlapping antiretroviral medication resistance profiles used for both PrEP and treatment, this may result in fewer alternatives for HIV treatment.

WHO advises that countries carry out nationally representative surveys to track the levels of HIV drug resistance among those beginning treatment, those receiving treatment, and those using PrEP who contract HIV in order to monitor the ongoing efficacy of HIV medications used for both treatment and prevention.

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Hallo World : understand the AIDS/HIV virus (The human immunodeficiency virus) with I'm World

 The human immunodeficiency virus (HIV) preys on the immune system and erodes people's resistance to a variety of illnesses and cancers that healthy immune systems are better able to combat. Infected individuals eventually lose their immunological capacity as the virus kills and damages immune cells. CD4 cell count is commonly used to assess immune function.

Depending on the individual, acquired immunodeficiency syndrome (AIDS), the most advanced stage of HIV infection, might take many years to manifest. The emergence of certain tumors, infections, or other serious long-term clinical symptoms is what defines AIDS.

Depending on the stage of infection, the symptoms of HIV change. Although those who have HIV are typically most contagious in the first few months after becoming infected, many don't become aware of their condition until much later. People may suffer no symptoms in the first several weeks following first infection or flu-like symptoms, such as fever, headache, rash, or sore throat.

They may also have other signs and symptoms like swollen lymph nodes, weight loss, fever, diarrhea, and cough as the virus gradually weakens the immune system. In addition, they run the risk of contracting life-threatening conditions such as Kaposi's sarcoma and lymphomas, as well as cryptococcal meningitis, severe bacterial infections, and tuberculosis (TB).

Blood, breast milk, semen, and vaginal secretions are just a few of the bodily fluids from infected people that can spread HIV. During pregnancy and delivery, a mother's HIV infection might pass to her kid. Normal daily interactions like kissing, hugging, shaking hands, or sharing of personal items, food, or water do not cause an infection in a person.

It is crucial to remember that HIV-positive individuals who are on ART and have their viral load lowered do not transfer the virus to their sexual partners. Therefore, early access to ART and encouragement to continue treatment are essential not just to improve the health of those living with HIV but also to stop the spread of HIV.

Risk Elements

Individuals are more likely to get HIV if they engage in the following behaviors and conditions:

sharing contaminated needles, syringes, and other injecting equipment and drug solutions when injecting drugs; engaging in condom-free anal or vaginal sex; having another STI like syphilis, herpes, chlamydia, gonorrhoea, and bacterial vaginosis; using harmful alcohol and drug use during sexual activity; receiving unsafe injections, blood transfusions, and medical procedures that involve unsterile instruments;

Diagnostic

Rapid diagnostic assays with immediate findings can be used to diagnose HIV. This makes it much easier to correlate early diagnosis with care and therapy. Self-tests for HIV are another option for people. A confirmatory test must be performed by a certified and trained health or community worker in a community center or clinic because no one test can fully diagnose HIV positivity. Using WHO prequalified assays within a nationally accepted testing strategy and methodology, HIV infection can be found with high accuracy.

The majority of commonly used HIV diagnostic tests look for antibodies that an individual produces as part of their immunological response to combat HIV. People typically produce anti-HIV antibodies within 28 days after infection. People go through a period of time known as the "window period" during which they may have no symptoms of HIV infection and no high enough levels of HIV antibodies have been developed to be detected by routine tests, but they are also at risk of spreading the virus to others. After becoming infected and going without treatment and viral suppression, a person may pass HIV to a partner with whom they engage in sexual activity or drug use, or in the case of pregnant women, to their unborn child while they are nursing.

Prior to beginning lifelong therapy after receiving a positive diagnosis, individuals should be retested to rule out any possible testing or reporting error. When there are doubts regarding the veracity of an HIV patient's diagnosis or when they discontinue medication and care and need to be re-engaged, it is crucial to encourage them in continuing their treatment and to offer counseling messages and services.

While testing for teenagers and adults has become quick and easy, this is not the situation for infants born to mothers who are HIV-positive. Rapid antibody testing is insufficient for detecting HIV infection in children under the age of 18 months; virological testing must be done as early as at birth or at 6 weeks of age. It is now possible to run this test at the point of care and have results the same day, which will hasten the proper linkage to therapy and care.

Treatment

Antiretroviral (ARV) medication combinations can be used in treatment plans to control HIV illness. Antiretroviral therapy (ART) as it is practiced now slows viral replication while allowing an individual's immune system to recover, strengthen, and restore the ability to combat opportunistic infections, some malignancies, and HIV infection.

Since 2016, WHO has advocated Treat All, which calls for all HIV-positive individuals—including children, adolescents, adults, pregnant women, and nursing mothers—to get lifelong ART, regardless of their clinical status or CD4 cell level.

By June 2022, 189 nations had already enacted this suggestion, providing care for 99% of all HIV-positive individuals worldwide. In addition to the Treat All plan, WHO advises a prompt ART introduction for all HIV-positive individuals, including providing ART to those who are prepared to begin treatment the same day as their diagnosis. Nearly two-thirds of the 97 nations that reported adopting this strategy by June 2022 said it had been implemented nationally.

In 2021, 28.7 million HIV-positive individuals received ART globally. In 2021, there was 75% [66-85%] global ART coverage. To scale up treatment, though, additional work is required, especially for kids and teenagers. By the end of 2021, only 52% [42-65%] of youngsters (0-14 years old) were receiving ART.

The HIV response continues to struggle with advanced HIV illness. People who have advanced immune suppression continue to seek medical attention or re-seek it, which increases their risk of contracting opportunistic infections. To lower illness and mortality, WHO is assisting nations in implementing the advanced HIV disease package of care.

Prevention

By reducing their exposure to risk factors, individuals can lower their risk of contracting HIV. The following are important HIV preventive strategies that are frequently combined:

The use of male and female condoms; 

HIV prevention, testing, and counseling; 

voluntary medical male circumcision (VMMC); 

the use of antiretroviral drugs (ARVs) for prevention (oral PrEP and long-acting products), the dapivirine vaginal ring, and injectable long-acting cabotegravir; 

harm reduction for people who inject drugs and use drugs; and the abolition of mother-to-child transmission (MTCT) of HIV.

An essential feature of HIV prevention is expanding access to testing and promoting linkage to ART because HIV cannot be transmitted if a person's sexual partner is virally suppressed on ART.

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Hallo : Sex Education in Christian Parenting with I'm World

School Sex : How To Start Sex Education At Home As (Christian Parents)

It is awkward to discuss sex. even more so when we talk to our kids about it. It won't get any less terrible by talking about it while munching on a bowl of potato chips or a cup of Haagen Dazs. Then, just as you think you've finished with the most difficult part—"the birds and the bees"—your children start pelting you with questions like fireballs.

Most parents would enquire, "Can't the conversation wait?," because they are so unwelcomed to the questions. The fact is, though, that while the world is discussing sex, our children aren't becoming any younger. Which would you like for your children to learn from—their classmates or you, the parents, in the secure environment of your home?

While the second option would undoubtedly be your response, it's crucial to take your time explaining and reacting without first laying the proper groundwork. As believers, we are aware that sex education encompasses more than simply banning minors from engaging in sex prior to marriage. It goes well beyond that, though.

Here, we've compiled a few ideas to provide your much-needed parent-child sex education session the proper biblical foundation.

1. Everything starts in Genesis.

Before the discussion on sex begins, we must take our attention back to the Creation, the very beginning of gender and sexuality. As a result, "God created man in his own image, in his own likeness; He created him male and female" (Genesis 1:27). It is important to note that although each is made in God's image, male and female have distinct characteristics.

Nobody is flawed or incorrectly designed, according to Esther Kurniawati, a Christian counselor and psychology lecturer at UPH, who noted that God created our bodies for certain reasons. He created His offspring and gave each of us—male and female—the proper identity and specific function in order to carry out his lovely purpose for us here on earth. In this manner, kids to accept them with a grateful heart and to have a clear awareness of the gender role and identity that God has made them for.

2. God made sex as a celebration.

For those of us who were raised in Eastern cultures, discussing sex is considered taboo. If you can relate to this, you will recall all too well how your parents reprimanded you for watching a kissing scene on television while keeping your eyes open. Unfortunately, the conversation around sex has turned into a cautionary tale-filled narrative in many homes.

We need to turn our attention to God by pondering why God initially created sex in order to prevent going down this road. Teach them that "God saw all he had made, and it was very good" (NIV, Genesis 1:31). Explain to kids why God did what He did Having sex serves three purposes: to procreate, to show our unity with Christ, and to firstly unite man and woman's love in a marriage bond. The third point may need to wait till the kids are old enough to understand it fully.

One lovely quote from an article in The Gospel Coalition is relevant to the Bible verse above. God created sex for our enjoyment and for our benefit, therefore we celebrate it, it read. In other words, as sex is a celebration that God made, it is sacred and lovely.

3. Timing.

Sexual urges would normally develop in youngsters as they get older. Parents should emphasize timing at this point. God not only created sex but also established rules for how to engage in it, with sex being a marriage-only activity. Parents should exercise caution while conveying the message. Explain that God wants us to reserve our time for Him rather than filling it with commands like "Don't become pregnant!" or "Pre-marital sex will wreck your future." elucidate God's desire for us to save some of ourselves for a certain someone in the future. In this way, kids will understand the profundity of sex and marriage and eventually retain their sexual integrity until they are prepared to enter the holy union of marriage with someone they love.

4. Because He loves us, God has created a standard for sex.

Christian parents today face a great problem in trying to protect their children in a time where sex has turned into a commodity and is used as entertainment on the internet and in the media. The way that sex, gender, and sexuality are taught in the world is distorted. Sex before marriage is now accepted, and homosexuality is pervasive.

Children should be reminded that everyone is a sinner and that everyone in the world is a sinner, which is why we need the Lord to restore our paths. According to 1 Corinthians 6:13 (NIV), "The body, however, is not meant for sexual immorality but for the Lord, and the Lord is the use of the body 

It's a terrific chance to reiterate God's standards for sex to them. Because He is the all-knowing Creator of the heavens and the earth, He has created this standard not to constrain His children but rather because He loves us and knows what is best for us. The way we as God's children respond to this is by carrying out His commands.

The only thing left to do after learning about the biblical basis for sex education for our kids is to start the dialogue. The recipe is rather straightforward: cultivate an atmosphere of honesty and trust with youngsters by having a constructive dialogue about sex. Do not feel embarrassed to talk about sex, gender, and sexuality in public.

Children who grow up in families where sexuality is openly discussed are not only healthier and happier, but they also postpone participation in a range of risky behaviors, including sexual activity, according to Deborah Ruffman, an expert on teen sexuality and the author of Talk to Me First: Everything You Need to Know to Become Your Kids' "Go-To" Person About Sex.

You can engage the younger children in conversation by responding to their inquiries about the distinctions between boys and girls, depending on their age. You can allay pre-teens' concerns about unsuitable TV advertisements by providing information. Always begin the dialogue while a child is a young age. Maintain the rapport you establish with your kids as it grows. When your kids repeatedly ask, It shows that they are at ease bringing up such subjects with their parents.

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Hallo : Sex Education in the school with I'm World

  An Inclusive Teenage Guide to Relationships and Sex

Sex Ed: An Inclusive Teenage Guide to Sex and Relationships was written by the School of Sexuality Education. By that time, we had been conducting sex and relationship education workshops in schools for a number of years, and we wanted to make the most of all the knowledge we had acquired. We determined that the best way to do that would be to co-write a book that students around the nation could access, regardless of who they were or where they were.

Our team, which consists of physicians, educators, activists, and academics, believed that it was crucial to include many various viewpoints and voices in the book, both in terms of expertise and the particular mixes of life experiences that make each of us individuals. As a result, it was truly a team effort, and we are proud of it, to be honest! The outcome, in our opinion, is an encouraging, useful, and powerful manual for teenagers that addresses challenging subjects in an accepting and nonjudgmental manner.

Each of the nine chapters—consent, gender, sexuality and identity, relationships, the body, what is sex?, reproductive health, sexual health, body image, and online life—concentrates on a different one of those complex subjects. We hope to address the concerns that young people—people of all ages, really—might not feel comfortable raising elsewhere.

We also included a few more sections in addition to the chapter's primary text. One of these is the "myth vs truth" boxes, which offer factual data to refute some of the widespread "myths" about sex and relationships that frequently surface in the classroom. Additionally, there are "did you know?" boxes that reveal amusing or intriguing facts, "tips and tricks" sections, and "consider" boxes that provide additional information to aid readers in seeing the "larger picture." Last but not least, each chapter also includes a variety of "unembarrassable moments" when various team members relate anecdotes about their own personal experiences to tie the knowledge to some real-life situations and demonstrate that we are truly invulnerable!

The book is crammed with information due to the variety of themes and features it covers, yet readers aren't expected to absorb everything at once. Teenagers can read the chapters in whatever order they like, or they can simply skim the different sections until they find something they're interested in. It really is for anybody and everyone, so we've included some comments in the back for teachers and parents in case they wish to use the book to initiate dialogues with the young people in their lives.

We hoped that Sex Ed could be used as a planning and teaching tool when we wrote the note for teachers, so we're thrilled that several teachers have already expressed their appreciation for its value in helping them to clarify information, spark discussion, and determine the best way to frame concepts. In response to this positive feedback, we are currently attempting to get at least one copy into each school library in the UK. This will not only benefit more teachers, but it will also provide every youngster in the nation access to the crucial knowledge the book contains, giving them the chance to comprehend themselves, their relationships, and one another better.

Given the lofty goal of having Sex Ed in every UK school, we are raising money through crowdfunding to send copies of the book to 1,000 schools by the end of 2022. Please click on this link for further details if you're interested in helping us accomplish this.

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