HIV and AIDS

HIV (Human Immunodeficiency Virus) is a virus that attacks the immune system — specifically the CD4 T-cells that coordinate the body's defences. Without treatment, HIV gradually destroys these cells until the immune system can no longer defend against infections and cancers. Advanced HIV disease with severe immune damage is called AIDS (Acquired Immunodeficiency Syndrome). Nigeria has the second largest HIV burden in the world, with approximately 1.9 million people living with HIV. There is currently no cure, but antiretroviral therapy (ART) allows people living with HIV to live long, healthy, and productive lives — and prevents transmission to others.

HIV has three stages: Stage 1 — Acute HIV infection (2–4 weeks after infection): • Flu-like illness: fever, chills, night sweats, swollen lymph nodes, sore throat, rash, muscle aches, mouth ulcers • These symptoms resolve on their own within weeks and are easily mistaken for flu Stage 2 — Chronic infection (clinical latency): • HIV continues to multiply at low levels • Many people have no symptoms for years • Some have recurrent minor infections, persistent lymph node swelling, or fatigue • Without ART, this stage typically lasts 10 years on average Stage 3 — AIDS (without treatment): • CD4 count falls below 200 cells/mm³ • Severe opportunistic infections: – Tuberculosis (most common in Nigeria) – Cryptococcal meningitis – Pneumocystis pneumonia (PCP) • AIDS-defining cancers: Kaposi's sarcoma, aggressive lymphomas, invasive cervical cancer • Severe weight loss and wasting • Persistent fever and night sweats

HIV is caused by the Human Immunodeficiency Virus (types HIV-1 and HIV-2). Transmission occurs through: • Unprotected sexual intercourse (vaginal, anal, or oral) — the most common route in Nigeria • Blood-to-blood contact: sharing needles, blood transfusions, needlestick injuries, unsterile medical instruments • Mother to child: during pregnancy, labour, delivery, or breastfeeding HIV is NOT transmitted through: • Casual contact — hugging, handshakes, sharing food or drinks, coughing, sneezing • Mosquitoes or other insect bites • Toilets or swimming pools

• Unprotected sexual intercourse — particularly anal sex (highest risk), then vaginal sex • Multiple sexual partners • Having an untreated sexually transmitted infection (increases transmission risk up to 8-fold) • Injecting drug use with shared equipment • Children born to HIV-positive mothers not receiving ART • Healthcare workers (needlestick exposure) • Young women aged 15–24 (disproportionately affected due to gender inequality) • Sex workers and their clients

Without treatment: • AIDS-defining opportunistic infections (TB, cryptococcal meningitis, PCP, CMV retinitis) • AIDS-defining cancers (Kaposi's sarcoma, lymphoma, invasive cervical cancer) • Severe wasting and death — AIDS remains one of the leading causes of death among adults in Nigeria Even with treatment, long-term complications include: • Cardiovascular, kidney, and liver disease • Osteoporosis • Non-AIDS-defining cancers • Metabolic complications from ART • Depression and anxiety (extremely common) • Stigma and social isolation

Prevention: • Use condoms correctly and consistently • Know your and your partner's HIV status • PrEP (Pre-Exposure Prophylaxis) — daily ART for HIV-negative individuals at very high risk; increasingly available in Nigeria • PEP (Post-Exposure Prophylaxis) — emergency ART taken within 72 hours of a potential exposure; available at most tertiary hospitals Preventing mother-to-child transmission: • All HIV-positive pregnant women should start ART immediately • This reduces mother-to-child transmission to less than 1% Harm reduction: • Never share needles or syringes; ensure medical instruments are sterile For people living with HIV: • Start ART immediately regardless of CD4 count — "U=U" (Undetectable = Untransmittable): viral suppression on ART prevents sexual transmission • Take medication daily as prescribed; attend regular monitoring appointments