HIV/AIDS is still an epidemic

Dr Mattias Larsson. Photo courtesy of Family Medical Practice

Dr Mattias Larsson*

December 1 is International HIV Day, a time to reflect on progress and challenges in addressing the epidemic. My work has focused extensively on HIV/AIDS. In 2001, during the height of the epidemic, I taught in the Global Health Course in Tanzania, where the disease's prevalence in the general population was 15 per cent, and nearly one million children were orphaned due to HIV.

At Muhimbili Hospital in Dar es Salaam, 70 per cent of inpatients had HIV and opportunistic infections. There were no antiretroviral treatments, with limited medicines for opportunistic infections and insufficient oxygen to support those with tuberculosis or pneumocystis pneumonia. Doctors faced the heartbreaking task of prioritising who might survive another day, stating that they felt like butchers. When I went back years later, in 2008 -- thanks to the Global Fund and PEPFAR -- the hospital's wards once filled with HIV patients were nearly empty, as most were able to access antiretroviral therapy through outpatient clinics, enabling them to lead normal lives.

HIV is a viral infection that gradually weakens the immune system. On average, after eight years of infection, immunity becomes so compromised that it fails to protect against common bacteria and viruses, leading to opportunistic infections like tuberculosis and cryptococcal meningitis. HIV is transmitted through blood, most commonly via small wounds during sexual intercourse, shared needles, or from mother to child during pregnancy, childbirth or breastfeeding. However, with antiretroviral therapy (ART), HIV has transformed into a manageable chronic condition, like (for example) diabetes. When adherence to daily medication is maintained, life expectancy can be nearly normal. Globally, 39 million people live with HIV, including 1.5 million children. In Việt Nam, approximately 250,000 people live with HIV, including 3,800 children and adolescents.

In 2006, we initiated a project in Quảng Ninh, a province with an HIV prevalence of 1-2 per cent. Việt Nam had recently joined the Global Fund and PEPFAR programmes. ART is most effective when patients adhere strictly to the regimen, taking medication daily at the correct times. To support this, our project introduced peer support: individuals living with HIV, who demonstrated good adherence and were trusted by healthcare providers, guided and encouraged other patients. As one of the first projects we implemented viral load testing to detect HIV in the blood, which helps identify poor adherence or resistance to treatment. Monthly meetings and community visits by peer supporters created a robust network of care. At the time, stigma in the community was severe—families affected by HIV often faced social exclusion. In one instance, an HIV-positive girl was denied schooling as parents of other children were afraid of transmission. Her mother had died, then her father developed tuberculosis in the spine and passed away. The project showed that peer support could improve the quality of life among people living with HIV.

We also established group peer support programmes for children and adolescents in Hà Nội, HCM City, Hải Phòng and Quảng Ninh involving over 600 participants. Young adult supporters organised meetings with children, adolescents and their families. Children living with HIV rely on their parents or guardians for care and treatment, who are also HIV-positive and face social or financial hardships. In many cases, grandparents became caregivers after the parents passed away. Adolescence, with its rapid physiological and psychological changes, is particularly challenging. It is during this time that many adolescents learn their HIV status and must navigate the complexities of managing the disease, sexual health and the stigma they face in society.

The HIV care and treatment programme in Việt Nam has been a success. Patients, including vulnerable groups like adolescents, are well supported, and treatment failure rates remain low. At FMP, we offer post-exposure counselling and testing and provide referrals for HIV care and treatment when necessary. Family Medical Practice

*Dr Mattias Larsson is a pediatric doctor at FMP Hanoi and associate professor at Karolinska Institutet and has a long experience in research on infectious diseases. He has worked with the Oxford University Clinical Research Unit and the Ministry of Health of Việt Nam. He is fluent in English, Swedish, Vietnamese, German and some Spanish.