Until 30 September 2010, the cumulative number of AIDS cases recorded 22, 726 cases in 32 provinces scattered in 300 district (kabupaten) / cities (kota). Out of that amount, still it is highly dominated by the productive age group (20-29) 47.8%, age group (30-39) 30.9%, and age group (40-49) as much as 9.1%. Most cases occurred in the 10 provinces namely Jakarta, West Java, Central Java, East Java, Papua, Bali, West Kalimantan, South Sulawesi, North Sumatra and Riau. While the modes of transmission occur through heterosexual contact (51.3 percent), injecting drug users (39.6 percent), male-male sex (3.1 percent) and mother to her baby carriers (2.6 percent).
Acquired Immune Deficiency Syndrome (or AIDS) is a collection of symptoms and syndrome arising due to damage to the human immune system due to HIV infection or infection by other viruses. From its name, Human Immunodeficiency Virus (or HIV) is a virus that weakens the immunity in the human body. People affected by this virus will become vulnerable to opportunistic infections or tumors susceptible. Although the existing handling can slow the rate of virus growth, but the disease is not completely curable.
Researchers generally believe that HIV originated in sub-Saharan Africa. It is estimated that AIDS has infected 38.6 million people around the world. In January 2006, UNAIDS in collaboration with the WHO estimate that AIDS has caused the deaths of more than 25 million people since it was first recognized on June 5, 1981. Thus, this disease is one of the deadliest diseases in history. AIDS claimed to cause death as much as 2.4 to 3.3 million people in 2005 alone, and more than 570,000 people of whom are children. One-third of these deaths occurs in Sub-Saharan Africa, retarding the growth of economy and destroys the power of human resources there.
Causes:
HIV virus is a retrovirus that usually attacks the vital organs of the human immune system, such as CD4+ T cells (a type of T cells), macrophages, and dendritic cells. HIV damages the CD4+ T cells directly and indirectly, whereas CD4+ T cells needed for immune system to function properly. When HIV has killed CD4+ T cells to the number shrank to less than 200 per microliter (mL) of blood, then the immunity at the cellular level will be lost, and the result is a condition known as AIDS. Acute infection with HIV will progress to clinically latent infectionà early symptoms of HIV infectionà eventually AIDS, which are identified by examining the number of CD4+ T cells in the blood and the presence of certain infections.
Clinical Manifestations:
The various symptoms of AIDS usually will not occur in people who have good immune system. Most of these conditions occur due to infection by bacteria, viruses, fungi and parasites, which are usually, controlled by elements of the immune system that HIV damages. HIV affects nearly every organ system. People with AIDS are also at greater risk of suffering from cancers such as Kaposi's sarcoma, cervical cancer, and immune system cancers known as lymphomas.
More over, people with AIDS often have systemic 
symptoms of infection, such as fever, sweating (especially at night), swollen glands, chills, weakness, and weight loss.
However, the rate of development of this disease can be varies from 2 weeks to 20 years. Many factors influence it; (1) the strength of the body to defend against HIV (such as immune function) from an infected person. (2) Older people generally have a weaker immunity than younger people, so more at risk of rapid disease progression. (3) Less access to health care and other infections such as tuberculosis can also accelerate the development of this disease. (4) The genetic legacy of an infected person also plays an important role. Some people are naturally resistant to some HIV variants. HIV has some genetic variation and a variety of different forms, which will cause the rate of development of clinical disease are different also.
Route of transmission:
Three main routes of entry of HIV virus into the body is through sexual contact, contiguity (exposure) with a fluid (include blood) or tissue of infected, as well as from mother to fetus or infant during the period around birth (perinatal period) and also through breastfeeding. Although HIV can be found in saliva, tears and urine of infected people, but there is no record of cases of infection caused by these fluids, thus the risk of infection can generally be ignored.
Prevention:
“Knowing your epidemic in a particular region or country is the first, essential step in identifying, selecting and funding the most appropriate and effective HIV prevention measures for that country or region." - UNAIDS guidelines for HIV prevention.
1) Sexual transmission:
Someone can eliminate or reduce their risk of becoming infected with HIV during sex by choosing to:
- Abstain from sex or delay first sex
- Be faithful to one partner or have fewer partners
- Condomise, which means using male or female condoms consistently and correctly (pic: condom machine)
There is now very strong evidence that male circumcision reduces the risk of HIV transmission from women to men by around 50%, which is enough to justify its promotion as an HIV prevention measure in some high-prevalence areas. However, studies of circumcision and HIV suggest that the procedure does not reduce the likelihood of male-to-female transmission, and the effect on male-to-male transmission is unknown.
2) Blood transmission:
People who share equipment to inject recreational drugs are high risk becoming infected with HIV from other drug users who have HIV. Methadone maintenance and other drug treatment programs are effective ways to help people eliminate this but, there will always be some injecting drug users who are unwilling or unable to end their habit, and these people should be encouraged to minimize the risk of infection by not sharing equipment.
- Needle exchange programs have been shown to reduce the number of new HIV infections These programs distribute clean needles and safely dispose of used ones, and also offer related services such as referrals to drug treatment centres and HIV counseling and testing. Needle exchanges are a necessary part of HIV prevention in any community that contains injecting drug users.
- Small group counseling, community outreach and other activities are also important for injecting drug users to encourage safer behaviour and access to available prevention options.
- Transfusion of infected blood or blood products is the most efficient of all ways to transmit HIV. However, the chances of this happening can be greatly reduced by screening all blood supplies for the virus, and by heat-treating blood products where possible. In addition, because screening is not quite 100% accurate, it is sensible to place some restrictions on who is eligible to donate, provided that these are justified by epidemiological evidence, and don’t unnecessarily limit supply or fuel prejudice. Reducing the number of unnecessary transfusions also helps to minimize risk.
- Health care workers run a risk of HIV infection through contact with infected blood. The most effective way for staff to limit this risk is to practise universal precautions, which means acting as though every patient is potentially infected. Universal precautions include washing hands and using protective barriers for direct contact with blood and other body fluids.
3) From mother-to-child transmission:
The first step towards reducing the number of babies infected in this way is to prevent HIV infection in women, and to prevent unwanted pregnancies.
- A course of antiretroviral drugs given to her during pregnancy and labour as well as to her newborn baby can greatly reduce the chances of the child becoming infected. Although the most effective treatment involves a combination of drugs taken over a long period, even a single dose of treatment can cut the transmission rate by half.
- A caesarean section is an operation to deliver a baby through its mother’s abdominal wall, which reduces the baby’s exposure to its mother’s body fluids. This procedure lowers the risk of HIV transmission, but is likely to be recommended only if the mother has a high level of HIV in her blood, and if the benefit to her baby outweighs the risk of the intervention.
Antiretroviral drug treatment:
This is the main type of treatment for HIV and AIDS. It is not a cure, but it can stop people from becoming ill for many years. The treatment consists of drugs that have to be taken every day for the rest of a person’s life.
The aim of antiretroviral treatment is to keep the amount of HIV in the body at a low level. This stops any weakening of the immune system and allows it to recover from any damage that HIV might have caused already.
Taking two or more antiretroviral drugs at a time is called combination therapy. Taking a combination of three or more anti-HIV drugs is sometimes referred to as Highly Active Antiretroviral Therapy (HAART).
| Antiretroviral drug class | Abbreviations | First approved to treat HIV | How they attack HIV |
| Nucleoside/ Nucleotide Reverse Transcriptase Inhibitors | NRTIs, | 1987 | NRTIs interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself.. |
| Non-Nucleoside Reverse Transcriptase Inhibitors | NNRTIs, | 1997 | NNRTIs also stop HIV from replicating within cells by inhibiting the reverse transcriptase protein. |
| Protease Inhibitors | PIs | 1995 | PIs inhibit protease, which is another protein involved in the HIV replication process. |
| Fusion or Entry Inhibitors |
| 2003 | Fusion or entry inhibitors prevent HIV from binding to or entering human immune cells |
| Integrase Inhibitors |
| 2007 | Integrase inhibitors interfere with the integrase enzyme, which HIV needs to insert its genetic material into human cells. |
Until now, it is very limited data used for understanding the local epidemic, for planning the response and also its quality still remain crucial issues. I believe, by strengthening the strategic information in Indonesia will also promoting the right response for controlling the diverse HIV epidemic in Indonesia.
Resources:
1) Wikipedia-AIDS
2) AVERT
3) AIDS-ina
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