The fight against HIV/AIDS: new strategies and achievements

I. Epidemiological landscape: global and Russian prospects

1.1 Global HIV epidemic: key trends and regional differences

The global HIV/AIDS epidemic remains a serious public health problem, despite the significant successes achieved over the past decades. According to Yunaids, by the end of 2022 there were about 39 million people living with HIV (LZHV) in the world. New cases of infection are recorded annually, although their number has significantly decreased compared to the peak of the epidemic in the late 1990s.

Key trends in the global epidemic:

Reducing the number of new cases of infection: Global efforts to prevent HIV, such as condom spread, expansion of testing and treatment of antiretroviral therapy (ARVT), led to a significant decrease in the number of new cases of infection compared to the peak of the epidemic. However, the rate of decline has slowed down in recent years.
The growth of the life expectancy of lies: Thanks to ARVT, people living with HIV can lead a long and full life. This led to an increase in the number of falsehoods in the world and a change in the demographic structure of the epidemic.
The concentration of the epidemic in certain regions and groups of the population: The HIV epidemic is still the most acute in the African countries south of Sahara, where more than two-thirds of all lies live. In other regions, the epidemic is concentrated in certain population groups, such as injecting drugs (PIN), men who practice sex with men (MSM), and sex business workers.
The appearance of drug stability: As ARVT spreads, the risk of drug resistance to antiretroviral drugs increases. This requires constant monitoring and developing new drugs.

Regional differences in HIV epidemiology:

Africa south of Sahara: Region with the highest prevalence of HIV in the world. The main factors contributing to the spread of infection include poverty, inequality, insufficient access to health care services and the high prevalence of other sexually transmitted infections (IPPs).
Eastern Europe and Central Asia: Region with the fastest growing HIV epidemic in the world. The main path of transmission of infection is the use of injection drugs.
Asia and the Pacific region: The HIV epidemic varies in different countries of the region. In some countries, such as Thailand and Cambodia, significant successes have been achieved in the fight against HIV, while in others, such as Indonesia and Pakistan, the epidemic continues to grow.
Latin America and the Caribbean: The HIV epidemic is concentrated in certain population groups, such as MSM and sex business workers.
North America and Western Europe: In these regions, the HIV epidemic is largely controlled due to wide access to the ARW and preventive measures.

1.2 HIV epidemic in Russia: the current situation and challenges

Russia remains one of the countries with the highest prevalence of HIV in Eastern Europe and Central Asia. According to Rospotrebnadzor, by the end of 2022, more than 1.5 million cases of HIV infection were registered in Russia.

Key features of the HIV epidemic in Russia:

High incidence: Russia occupies one of the first places in the world in the number of new cases of HIV infection.
The predominance of the heterosexual transmission route: Unlike many other countries, in Russia, the main way of HIV transmission is heterosexual contact. However, in some regions, such as St. Petersburg and the Sverdlovsk region, the number of cases of infection among MSM is growing.
The involvement of young people: The HIV epidemic in Russia affects mainly young people aged 30 to 49 years.
Insufficient coverage by testing and treatment: Despite the efforts of the government, the coverage of the testing and treatment of HIV in Russia remains insufficient. Many people living with HIV do not know about their status and do not receive the necessary treatment.
Stigma and discrimination: Stigma and discrimination against lies remain a serious problem in Russia. This complicates access to health care services and negatively affects the quality of life of lies.
Insufficient prevention: HIV prevention programs in Russia often do not comply with the needs of key population groups.

Calls facing Russia in the fight against HIV:

Increased coverage by testing and treatment: It is necessary to expand access to HIV testing and provide a timely start of treatment for all lobes.
Strengthening prevention: It is necessary to develop and implement effective HIV prevention programs oriented towards key groups of the population.
The fight against stigma and discrimination: It is necessary to carry out information campaigns aimed at reducing stigma and discrimination against lies.
Ensuring sustainable financing: It is necessary to ensure sustainable financing of programs to combat HIV.
Implementation of modern approaches: It is necessary to introduce modern approaches to the prevention and treatment of HIV, such as PREP (pre -contact prevention) and self -testing.

II. New HIV prevention strategies

2.1 pre -contact prevention (PREP): mechanism of action and clinical efficiency

Prep premature prevention is the use of antiretroviral drugs by people who are not infected with HIV to reduce the risk of infection. Prep is an effective HIV prevention tool, especially for people with a high risk of infection.

PREP action mechanism:

PREP works to prevent HIV penetration into cells of the body. Antirerovirus drugs used for PREP block the enzymes necessary HIV for replication. If a person taking PREP is exposed to HIV, the drug prevents the establishment of infection.

Clinical efficiency PREP:

Numerous clinical studies have shown that Prep is a highly effective means of HIV prevention. With proper use, PREP can reduce the risk of HIV infection by more than 90%.

2.2 post -contact prophylaxis (PEP): Terms of application and treatment protocols

Post -contact prevention (PEP) is the use of antiretroviral drugs after possible contact with HIV to prevent infection. PEP should begin as soon as possible after contact, preferably within 72 hours.

PEP treatment protocols:

PEP usually includes taking antiretroviral drugs for 28 days. The treatment protocol may vary depending on the risk of infection and available drugs. It is important to consult a doctor as soon as possible after possible contact with HIV in order to determine the most suitable PEP protocol.

2.3 HIV testing: access expansion and new methods

Expansion of access to HIV testing is a key component of the strategy of combating the epidemic. It is important that people know their HIV status so that they can get the necessary treatment and take measures to prevent the further spread of infection.

New HIV testing methods:

Self -testing for HIV: Self -testing allows people to independently conduct HIV testing at home. This can increase coverage by testing, especially among people who do not want to contact medical institutions.
Express tests for HIV: Express tests give results within a few minutes, which allows testing in places where there is no access to laboratory services.

2.4 Programs for reducing harm: syringe exchange and replacement therapy

Damage reduction programs are aimed at reducing the negative consequences of drug use, such as the spread of HIV and hepatitis C.

The main components of the harm reduction programs:

Spring exchange: Providing pure syringes and needles to consumers of injection drugs (PIN) to prevent the spread of HIV and hepatitis C.
Replacement therapy: The appointment of replacement drugs, such as methadone or buffacinin, people with opioid dependence. Replacing therapy helps to reduce traction to drugs and prevent relapses.

2.5 Innovative approaches to prevention: vaccines and microbicides

The development of an effective vaccine against HIV and microbicides (gels or vaginal rings containing antiretroviral drugs) is a priority in the fight against the epidemic.

HIV vaccines: Despite decades of research, an effective vaccine against HIV still does not exist. However, active research continues in this area, and there is hope that in the future the vaccine will be developed.
Microbicides: Microbicides are gels or vaginal rings containing antiretroviral drugs that can be used to prevent HIV. Several microbicides showed effectiveness in clinical studies.

III. Achievements in HIV treatment

3.1 antiretroviral therapy (ARVT): mechanism of action and modern schemes

Antirerovirus therapy (ARVT) is the use of antiretroviral drugs to suppress HIV replication in the body. ARVT does not heal HIV, but allows people living with HIV to lead a long and full life.

ARVT action mechanism:

Antirerovirus drugs block the various stages of the HIV life cycle, such as attaching the virus to the cell, the penetration of the virus into the cell, reverse transcription, integration, assembly and release of new viral particles.

Modern ARVT schemes:

Modern ARVT schemes usually include taking one or more antiretroviral drugs in one tablet once a day. These schemes are more effective and less toxic than the old ARVT schemes.

3.2 “not determined = not transmitted” (u = u): scientific evidence and significance for public health

“It is not determined = not transmitted” (u = u) – this is a scientific consensus based on numerous studies, which states that people living with HIV who accept the ARVT and have an indefinite viral load (less than 200 copies of HIV to a milliliter of blood) cannot transfer HIV sexually.

The value of u = u for public health:

Stygma decrease: U = U helps to reduce the stigma in relation to lies, showing that they can lead a full -fledged sex life, without risking to infect their partners.
Increase in treatment coverage: U = U motivates people living with HIV, to start and adhere to ARVT.
HIV prevention: U = U is an effective means of HIV prevention.

3.3 Treatment of co -infections: hepatitis and tuberculosis

People living with HIV often have co -infection, such as hepatitis B and C and tuberculosis. Treatment of these co -infections is an important component of license to leaving.

Hepatitis B and C: Hepatitis B and C can accelerate the progression of HIV infection and increase the risk of developing liver cirrhosis and liver cancer. Treatment of hepatitis B and C U lzhvs can improve their state of health and prolong life.
Tuberculosis: Tuberculosis is the main cause of the death of lies. The treatment of tuberculosis in lobes is vital.

3.4 Side effects ARVT: Monitoring and supporting therapy

Antirerovirus drugs can cause side effects. It is important to carry out regular monitoring of the health status of LZHV in order to identify and treat side effects of ARVT.

Supporting therapy:

Supporting therapy can help facilitate the side effects of ARVT. Supporting therapy may include a change in diet, physical exercises, psychotherapy and medication.

3.5 Innovative approaches to treatment: long -acting drugs and functional cure

The development of long -term antiretroviral drugs and functional cure strategies is a priority in the study of HIV.

Long -acting drugs: For a long time acting antiretroviral drugs can be administered once a month or once every several months. This can improve the commitment and simplify the care of lies.
Functional cure: Functional cure is a condition in which HIV is present in the body, but is under the control of the immune system and does not require ARVT. Researchers are working on the development of strategies that can lead to the functional cure of HIV.

IV. Social and behavioral factors affecting the fight against HIV

4.1 Stigma and discrimination: influence on access to services and quality of life

Stigma and discrimination against lies remain a serious problem around the world. Stigma and discrimination can make it difficult to access the services of healthcare, negatively affect the quality of life of LZHV and impede HIV prevention efforts.

The influence of stigma and discrimination:

Limited access to health services: People who are afraid of stigma and discrimination can avoid testing for HIV and medical help.
Poor quality of life: Stigma and discrimination can lead to depression, anxiety and social isolation.
Obstacles for HIV prevention: Stigma and discrimination may difficult to disseminate HIV information and promoting preventive measures.

4.2 gender inequalities: vulnerability of women and girls

Gender inequalities make women and girls more vulnerable to HIV. Women often face economic and social inequality, which can limit their ability to protect themselves from HIV.

Factors that increase the vulnerability of women and girls:

Economic dependence: Women economically dependent on men may not be able to abandon unsafe sex.
Gender violence: Gender violence, such as rape, increases the risk of HIV infection.
Unequal access to education and information: Women and girls with a low level of education and limited access to information can be less aware of HIV and methods of its prevention.

4.3 Socio-economic factors: poverty and inequality

Poverty and inequality are important factors that contribute to the spread of HIV. People living in poverty often have limited access to healthcare services, education and information.

The influence of socio-economic factors:

Limited access to health services: People living in poverty may not be able to pay for HIV testing and treatment.
Insufficient education and information: People with a low level of education can be less aware of HIV and methods of its prevention.
Unsafe working conditions: People working in unsafe conditions, such as mines and construction sites, can be more at risk of HIV infection.

4.4 behavioral factors: risky sexual behavior and drug use

Risky sexual behavior, such as unprotected sex and the presence of several sexual partners, increases the risk of HIV infection. The use of injection drugs is also an important factor that contributes to the spread of HIV.

Programs aimed at changing behavior:

Educational programs: Educational programs can increase awareness of HIV and methods of its prevention.
Safe sex promotion programs: Programs for promoting safe sex can teach people safe sex skills and increase condoms.
Damage reducing programs: Damage to reduce harm, such as syringes and replacement therapy, can reduce the risk of HIV infection among PIN.

4.5 Role of community: participation

The participation of lves and key groups of the population is important for the effective fight against HIV. LZHV and key population groups can help develop and implement programs that meet their needs.

Advantages of community participation:

Improving access to services: LZHV and key groups of the population can help improve access to health care services for other LZHVs and members of their communities.
Decrease in stigma and discrimination: LZHV and key groups of the population can help reduce the stigma and discrimination against lies.
Improving the efficiency of programs: LZHV and key population groups can help increase the effectiveness of programs for the prevention and treatment of HIV.

V. Organizational and political aspects of the fight against HIV

5.1 Role of the Government: National Strategies and Financing

The government plays a key role in the fight against HIV. The government should develop and implement national HIV strategies, as well as ensure sufficient financing for these strategies.

Government tasks:

Development of the National Strategy for Combating HIV: The national strategy should determine the priorities and goals of the fight against HIV, as well as determine specific measures to achieve these goals.
Ensuring financing: The government must ensure sufficient funding to implement the National Strategy for Combating HIV.
Improving access to health services: The government should provide access to health care services for all lobes, including HIV testing, treatment and prevention.
The fight against stigma and discrimination: The government must conduct information campaigns aimed at reducing stigma and discrimination against lies.
Research support: The government must support HIV research in order to develop new methods of prevention and treatment.

5.2 The role of international organizations: Yunads and the Global Fund

International organizations, such as Yunades and the Global Fund, play an important role in the fight against HIV. They provide technical and financial support to countries that are fighting the HIV epidemic.

Tasks of international organizations:

Provision of technical assistance: Yunads and other international organizations provide technical assistance to countries that are fighting the HIV epidemic.
Providing financial assistance: The global fund and other donors provide financial assistance to countries that are fighting the HIV epidemic.
Coordination of efforts: Yunads and other international organizations coordinate the efforts of various interested parties in the fight against HIV.
Data collection and monitoring: Yunads and other international organizations collect data on the HIV epidemic and monitor progress in the fight against the epidemic.

5.3 The role of non -governmental organizations (NGOs): lawying and provision of services

Non -governmental organizations (NGOs) play an important role in the fight against HIV. They are engaged in advice, provide services and conduct information campaigns.

NGO tasks:

Lawyer: NGOs are in defense of the rights of LZHV and other vulnerable groups of the population.
Providing services: NGOs provide a wide range of services for lies, including HIV testing, counseling, treatment and support.
Conducting information campaigns: NGOs conduct information campaigns aimed at increasing the awareness of HIV and methods of its prevention.
Community mobilization: NGOs mobilize communities to participate in the fight against HIV.

5.4 Politics in the field of drug support: availability and pricing

The availability and pricing of antiretroviral drugs is an important factor affecting the effectiveness of the fight against HIV. The government must take measures to ensure that antiretroviral drugs are available at an affordable price for all lobes.

Measures to ensure accessibility and pricing:

Purchase of drugs at reduced prices: The government can purchase antiretroviral drugs at reduced prices through international organizations, such as a global fund.
General production: The government can maintain the production of generic antiretroviral drugs, which are usually cheaper than original drugs.
Price regulation: The government can regulate the prices of antiretroviral drugs so that they are affordable for all lobes.
Supporting insurance coating: The government can provide insurance coating of antiretroviral drugs for all lobes.

5.5 Legal aspects: Protection of LZHV rights and criminalization of HIV transfer

Legal aspects play an important role in the fight against HIV. The government must adopt laws that protect the rights of LZHV and provide them with equal access to health care services.

Government tasks:

Adoption of laws protecting the rights of LZHV: The government must adopt laws that protect the rights of LZHV and provide them with equal access to healthcare services, education and employment.
The ban on discrimination against lies: The government should prohibit discrimination against lots in the field of healthcare, education, employment and other areas of life.
CRIMINALISE OF HIV transmission: Criminalization of HIV transmission is a controversial issue. Some believe that criminalization can help prevent the spread of HIV, while others believe that it can aggravate stigma and discrimination.

VI. The future of the fight against HIV: Prospects and tasks

6.1 goals 95-95-95: Achieving epidemiological control

Goals 95-95-95 are the global goals that have been set by Yunaids to achieve epidemiological control of HIV by 2030. These goals are to:

95% of all people living with HIV knew their HIV status.
95% of all people who know their HIV status received antiretroviral therapy.
95% of all people receiving antiretroviral therapy had a depressed viral load.

Achieving these goals will significantly reduce HIV spread and improve the quality of lifestyle of lies.

6.2 Integration of services: HIV and other diseases

The integration of HIV services with services for other diseases, such as tuberculosis, hepatitis and IPPs, can improve access to health care services and increase the efficiency of programs.

Advantages of the integration of services:

Improving access to health services: Integration of services can improve access to health care services for people living with HIV and other diseases.
Improving the efficiency of programs: Integration of services can increase the effectiveness of programs by reducing duplication of efforts and optimizing the use of resources.
Stygma decrease: Integration of services can help reduce the stigma associated with HIV.

6.3 Personalized medicine: an individual approach to treatment

Personalized medicine is an approach to treatment, which takes into account the individual characteristics of each patient, such as genetics, lifestyle and related diseases. A personalized approach to HIV treatment can improve treatment results and reduce the risk of side effects.

The principles of personalized medicine:

Genetic testing: Genetic testing can help determine which antiretroviral drugs will be most effective for a particular patient.
Monitoring of drug stability: Monitoring of drug stability can help identify resistance to antiretroviral drugs and adjust the treatment regimen.
Accounting for related diseases: Accounting for concomitant diseases can help avoid drug interaction and reduce the risk of side effects.
Individual support: Individual support can help patients adhere to treatment regimen and cope with side effects.

6.4 Artificial intelligence and big data: new opportunities for research and prevention

Artificial intelligence (AI) and big data can provide new opportunities for research and prevention of HIV. AI can be used to analyze large data arrays to identify patterns and develop new strategies for the fight against HIV.

Application of AI and big data:

Identification of risk groups: AI can be used to identify groups of the population exposed to the greatest risk of HIV infection.
Development of personalized prevention programs: AI can be used to develop personalized prevention programs, which take into account the individual characteristics of each person.
Improving diagnostics: AI can be used to improve the diagnosis of HIV and other diseases.
Development of new drugs: AI can be used to develop new antiretroviral drugs.

6.5 Global solidarity: Strengthening cooperation and support

Global solidarity is important for the effective fight against HIV. It is necessary to strengthen cooperation and support between countries, international organizations and NGOs.

The principles of global solidarity:

Separation of responsibility: All countries must be responsible for the fight against HIV.
Assistance to those in need: Countries that have resources should provide assistance to countries that need support.
Exchange of knowledge and experience: Countries should exchange knowledge and experience in the fight against HIV.
Partnership strengthening: It is necessary to strengthen partnership between countries, international organizations and NGOs.

VII. Final thoughts: stability and hope

The fight against HIV/AIDS has come a long way, marked by significant successes in the prevention, treatment and understanding of this complex disease. However, despite the successes achieved, the HIV epidemic is still a serious threat to public healthcare around the world. Further efforts are needed to achieve goals 95-95-95 and ensure that all people living with HIV have access to the necessary treatment and care. Global solidarity, innovative approaches and participation of communities are important for achieving these goals and the final termination of the HIV epidemic.