* How and where did HIV originate?
HIV is closely related genetically to simian (primate) immunodeficiency viruses. How, when, and where it came into the human population is not known, but it may have been around for some time, infecting only a few people. In the last two decades, HIV has become a serious epidemic and has spread throughout the world. How to prevent its spread, rather than how and where the virus originated, is the most important question facing us today.
* Why is Africa, of all the regions in the world, the hardest hit?
The World Health Organization estimates that 70% of all AIDS cases have occurred in Africa and the highest HIV rates in the world are now in southern Africa. Poverty, the high prevalence of other sexually transmitted diseases, and cultural and sexual practices and beliefs all contribute to the rapid spread of HIV in Africa.
* Why is there more AIDS in some parts of the country than in others?
Infection levels are generally higher in urban areas than in nearby rural areas, and some parts of western Kenya have the highest recorded rates in the country. HIV is still spreading in Kenya, so that many rural and urban areas that had low infection levels in the past are now experiencing higher infection rates. Many factors may contribute to these differences, such as high population density, more movement of people because of trading and migration routes, non-practice of circumcision, sexual networks within communities, and cultural practices such as wife-sharing and widow inheritance.
* Is there a cure for AIDS? Will combination therapy cure AIDS?
There is no cure for AIDS. Recently, new therapies combining three different antiretroviral drugs have proven successful in preventing or slowing the progress from HIV infection to AIDS when a person with HIV shows signs of a weakening immune system. However, these drugs are expensive and have side effects that may make them difficult to take. They are not a cure, so lifelong treatment may be necessary.
* Is there a vaccine to prevent AIDS?
Many trial HIV vaccines are under development, and some are being tested in Kenya, but the process of developing and testing drugs and vaccines is a long one. An effective vaccine is not likely to be available within the next 10 years. Therefore, efforts to prevent the spread of HIV through education are the main weapon.
* Is there more than one type of HIV? Does the virus mutate?
There are different strains of HIV. The greatest difference is between HIV-1, which is found in Kenya and most parts of the world, and HIV-2, which is found primarily in western Africa. HIV-2 does not transmit as readily as HIV-1 but still leads to eventual death. There are various strains of HIV-1 as well. Originally subtype B predominated in America and Europe, type E was in Thailand and Australia, and types A, C and D were in Africa and India. Now, however, most strains can be found almost everywhere. HIV mutates frequently, which poses a challenge to maintaining immunity or developing an effective vaccine.
* Are condoms really safe and effective if used properly? Can HIV pass through the pores of a condom?
The only 100% effective method of avoiding sexually transmitted HIV infection is abstinence. Condoms are safe and offer reliable protection against HIV infection if used properly. The main risk for condom users is from using condoms inconsistently or improperly. Latex condoms do not have pores and have a thickness of 0.03 to 0.09 mm. They are tested extensively to make sure they meet the standards set by the World Health Organization so they are safe and effective.
* Can mosquitoes transmit HIV infection?
There is no evidence of HIV being transmitted through mosquitoes. If it were, many more children and elderly people would be infected. The HIV virus in the blood is inactivated in the mosquito digestive system, just as it is in the human digestive system. When a mosquito bites it injects saliva, which may contain malaria parasites but does not contain HIV.
* Are the tests for HIV infection accurate?
Tests for HIV infection are very accurate when done properly by qualified laboratory personnel. However, a positive test should always be confirmed with a second, different HIV test, since a small percentage of tests may be falsely positive. Also a person who has become infected very recently (for a few weeks to months after exposure) may test negative before enough antibodies develop within their body to show up in a test.
* Why do some HIV-positive mothers transmit the virus to their babies while others do not?
Mothers with HIV infection in Kenya transmit the virus to their babies between 30 and 40% of the time. Many factors influence the possibility of transmission. The amount of virus that the mother has in her body and the function of her immune system are the most important factors. But malaria during pregnancy, lack of vitamin A and other nutrients, a long or difficult labour or delivery, and duration of breastfeeding may also contribute to babies becoming infected. There are now ways to prevent the transmission of mother-to-child HIV transmission—by using drugs in pregnancy, labour and after delivery; by giving good antenatal and delivery care; and by advising on appropriate feeding (see p. 35, ‘Interventions to prevent mother-to-child transmission').
* Can a married couple have different HIV results even though they have unprotected sex with each other?
HIV infection is not transmitted each time a person has sexual intercourse.
Especially if the infected person has a good immune function, few symptoms, and does not have genital ulcers, it may be several years before HIV is transmitted to the spouse. In fact, generally more couples in a community have different (discordant) results, where one is positive and the other negative, than where both are HIV infected. The best way for couples to know if they are safe is to go for voluntary counseling and testing as a couple, where they learn their HIV results together and can protect themselves if they are discordant.
* Why can't the government test everybody for HIV infection?
The government encourages people to know their HIV status, especially for couples before marriage, when planning to have children, or when certain illnesses occur. This testing should be voluntary, counseling by a trained counselor should accompany it, and there should always be a second, different test to confirm HIV-positive results. More facilities will be offering voluntary counseling and testing throughout the country.
Improved rapid HIV tests have shortened the time to results to less than an hour.
Despite education campaigns and increased condom use, HIV is still increasing. Why aren't these programmes effective?
The AIDS prevention programmes that have been implemented have had an effect in reducing the severity of the epidemic. Many people have changed their behavior to stick with one faithful partner. Many others have adopted condom use, and others are seeking treatment for other sexually transmitted diseases. One study estimated that increased condom use alone has saved hundreds of thousands of people from HIV infection in Kenya (Stover and Baltazar 1998). So these programmes have had an effect. Unfortunately, they have not been widespread or effective enough to prevent all new infections. In fact, the number of infected people is still increasing. Only a much expanded prevention programme, with participation from all sectors—government, NGOs, the private sector, religious groups, churches, professional organizations, community groups—will be successful in reducing the number of infected people in the future.
* Won't learning that I am HIV infected cause me to die sooner?
There is no scientific evidence to show that people who know their status develop AIDS or die quicker. The advantages of knowing one's status include being able to protect sexual partners and to avoid re-infection, changing one's lifestyle to prevent illness and seek early treatment, and making more informed choices in their reproductive lives.