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Acquired Immunodeficiency Syndrome
The acquired immunodeficiency syndrome, better known by its acronym AIDS or AIDS, is the name of a set of symptoms resulting from the destruction of several cells of the immune system by a retrovirus. AIDS is the late stage of infection with the virus and eventually death of the organism infected as a result of opportunistic infections.
There are several officials of the AIDS retrovirus, each infecting a particular species. The best known of these is the human immunodeficiency virus (HIV) infecting humans. Other viruses are, among others, VIS infecting monkeys and the VIF for the cat.
Since the beginning of the pandemic, three modes of transmission have been observed:
* Through sexual contact: which is the primary and which is the best protection condoms
* Through blood: Concerning particularly intravenous drug users, hemophiliacs, transfusion and health professionals
* From mother to child, which may occur in utero in the last weeks of pregnancy, delivery and lactation
There is no vaccine to eradicate the virus and antiviral treatments currently available, although some efficiency, make no cure at the present time. Only the spread of HIV in the body is slowed, thus delaying the arrival of the stage "AIDS".
This privileged access to treatment relates only to the developed countries that can provide financial coverage of these therapies. In developing countries, more than 95% of patients do not benefit from any effective treatment. It is for this reason that the United Nations through its programme UNAIDS has made the fight against AIDS a priority.
History
HIV is closely related to viruses causing diseases like AIDS among primates, the Simian Immunodeficiency Virus (SIV). There are several theories about the origin of AIDS, but it is commonly accepted that HIV-1 is a mutation of SIV. It infects including Pan troglodytes chimpanzees, which are carriers of the SIVcpz. The transmission in humans has been made possible by a mutation of the virus.
Scientific studies have suggested that the virus would be published initially in West Africa, but it is possible that there were several distinct original sources. The first sample of HIV was identified in 1959 gathered in Leopoldville (now Kinshasa), in what is now the Democratic Republic of Congo. Among the first samples collected also include the case of a gay American in 1969 and a heterosexual Norwegian sailor in 1976.
At the beginning of the epidemic, research has been undertaken to determine the patient zero, which would have spread the virus to the United States. For a while suspicion fell on Gaetan Dugas, a Canadian gay steward who died on March 30, 1984. A study led by Michael Worobey and published in Proceedings of the National Academy of Sciences on October 29, 2007 back the entry of HIV in the United States around 1969, by a Haitian immigrant single.
The first signs of the epidemic back in the late 1970's, when doctors in New York and San Francisco are finding that many of their gay patients suffering from asthenia, weight loss and sometimes even rare form and Atypical cancer (such as Kaposi's sarcoma, which attacks the leukocytes). The existence of a health problem is found in July 1981 when the Center for Disease Control and Prevention (CDC) in Atlanta noted an unusually high incidence of Kaposi sarcoma, particularly in patients homosexuals. The emergence of a new virus is mentioned as far back as 1982.
In 1983, the team of Professor Jean-Claude Chermann of the Pasteur Institute, led by Luc Montagnier discovers and isolates HIV.
The viral origin is not mentioned at the outset and the possibility of poisoning by products like the poppers (sexual stimulant containing amyl nitrite) has been issued at the beginning, because the first six were sick all been major consumers. Likewise, the identification of the virus responsible has been difficult, many scientists speaking with HTLV as the cause of the epidemic. Borrowing the discovery, the press began by designating the virus by périphrase "gay cancer" before returning to this prejudice. It was at the same time that many transfusions are contaminated with lots of blood containing HIV. Within a few years, the virus will spread and eventually reach all segments of the population.
Only information campaigns on risk behaviour, methods of spreading the disease and especially the means of protection will allow developed countries to halt the advance (but may not block). The general awareness of the populations must homosexual its rapid deployment, because many movements, such as that of Act Up, and international stars have forced the visibility, encouraging political leaders to engage in real scientific research.
From the beginning of the twenty-first century, AIDS turns into a pandemic. There were 1981 to 2006 about 25 million deaths due to diseases related to AIDS. In 2007, the epidemic seems to have stalled, the number of people infected with significantly decreased from 38.6 million in 2006 to 33.2 million people with HIV. UNAIDS, however, indicates that this reduction comes from better use of statistical tools, and warned against excessive optimism.
The main victims are currently people in developing countries. The reasons are many and vary from one country to another: sex tourism for South-East Asia, a lack of awareness about the risk factors for transmission (especially in Black Africa), religious beliefs forbidding the use of protection such as condoms, refusal to abstinence or relationships outside marriage, lack of capacity or willingness to make the prevention and inform people (mainly in Africa and Asia), or refusal of admit the facts.
Modes of transmission
The three modes of HIV transmission, each with its own unique:
Sexual transmission
The majority of HIV infections have been or are being acquired on the occasion of unprotected sex. Sexual transmission is through contact between sexual secretions (or blood contaminated by the virus) and genital mucosa, rectal or oral. The likelihood of transmission varies depending on the type of sexual intercourse with an infected person between 0005 and 0.00005 per sexual act, 0.0067 for sharing syringes with an HIV-positive drug addict and 0.9 for blood transfusion with contaminated blood. The best means of protection against HIV in the mode of transmission is a condom. Following the synthesis of several studies, it was shown that the use of condoms during each report and adequately reduces the risk of infection by 85%.
The transmission through blood
This mode of contamination is especially injecting drug users, hemophiliacs and transfusion recipients. Health professionals (nursing, laboratories) are also concerned, although less frequently. We must not overlook the potential for contamination by dirty needles and may or may not be disinfected (tattoos).
The transmission from mother to child during pregnancy
The mother to child transmission of the virus may occur in utero in the last weeks of pregnancy and at delivery. Note a tendency to false seropositivity among multiparous . Without treatment, the rate of transmission between mother and fetus, is almost 20%. Breastfeeding also presents a risk of contamination of the baby, in the order of 5%, which is why it is inadvisable for infections of the mother. However, three recent studies, one conducted by PJ. Illif & al. Zimbabwe and the other by H. Coovadia in South Africa, the last one by Mr. Sinkala et al. Zambia, demonstrate that exclusive breastfeeding early reduces the overall risk of postnatal transmission at 4% and increases child survival. Currently available treatments allies to a cesarean have reduced this rate to 1%. The results are more mixed in developing countries, the risk of transmission through postnatal reducing the use of Nevirapine to 13% depending HIVNET012, 18% according Quaghebeur et al.
Infection with HIV
HIV disrupts the immune system by infecting the CD4 + T lymphocytes. These cells are the "coordinators" of the immune response: they play an absolutely central. The death of the infected cells is the result of the diversion of machinery lymphocytes, which can no longer make their own molecules, as well as the destruction of membrane integrity at the time of discharge viruses neo-trained. In addition, infected cells display on their surface membrane of viral proteins (Env complex). These proteins are recognized by immune cells attach to the healthy and infected cell. Then a process of "kiss of death" (kiss of death) by which the cell is destroyed by activating the process of apoptosis. In this sense, Luc Montagnier recalled at a symposium (Brussels, December 2003): "The mass death of T4 lymphocytes is not due to direct infection of cells by the virus, which is then cytopathic little, but to indirect mechanisms affecting CD4 cells are not infected. One of the mediators of apoptosis that is the existence of a strong oxidative stress characterised by a prevalence of oxidizing molecules (free radicals) on antioxidant defenses of the body.
Without treatment, nearly all the patients infected with HIV develops into AIDS, final stage of the disease. The duration of progression to AIDS appeared to be two or three years at the beginning of the pandemic, is closer to 10 years, as demonstrated by studies carried out in Uganda. The reasons for the latency of the onset of the disease remains unexplained satisfactorily.
There are two classifications to describe the progression of HIV infection, based on the clinical signs and laboratory abnormalities.
Classification in clinical stages suggested by the WHO
Clinical stage 1
* Patient asymptomatic.
* Adénopathies persistent widespread.
Clinical Stage 2
* Weight loss less than 10% of body weight.
* Events cutanéomuqueuses minor (seborrheic dermatitis, recurrent mouth ulcers).
* Zona in the past 5 years.
* Recurrent infections of the upper respiratory tract.
Clinical Stage 3
* Weight loss greater than 10% of body weight.
* Unexplained chronic diarrhea for more than a month.
* Unexplained prolonged fever for more than a month.
* Candidiasis (thrush).
* Leukoplakia hairy mouth.
* Pulmonary tuberculosis in the previous year.
* Severe bacterial infections (pneumonia, for example).
Clinical Stage 4
* Pneumocystose.
* Cerebral toxoplasmosis.
* Kaposi's Disease.
* Lymphoma.
* Mycobacterial atypical generalized, and more generally any serious occurring in a patient infected with HIV, with a significant decline in its immunity (CD4 count below 200 ³).
CDC Classification 1993
Class A
* Seropositivity for HIV antibodies in the absence of symptoms (1993)
* Persistent widespread Lymphadenopathy
* First-infection
Category B
* Manifestation in a patient infected with HIV, which are not part of the class C and who meet at least one of the following conditions:
O they are related to HIV or indicative of an immune deficiency;
O they have a clinical or therapeutic care complicated by HIV infection. (This category corresponds to the clinical stages 2 and 3 of the WHO).
Category C
* This category is the definition of AIDS in adults. The clinical criteria are the same as the clinical stage 4 of the WHO.
Prevention
The various modes of HIV transmission are now well known.
There is, so far, no effective vaccine against AIDS.
Facts
* Reports are more receptive to risk that the reports insertifs and receptive anal sex are those that involve the risk of transmission is greater. According to the Ministry of Health french, the probability of transmission per act ranges from 0.03% to 0.07% in the case of vaginal receptive report, from 0.02 to 0.05% in the case of vaginal insertif report, from 0.01% to 0185% in the case of insertif anal intercourse, and 0.5% to 3% in the case of receptive anal intercourse
* Sexually transmitted infections (STIs) favor the transmission of the HIV virus, by micro-ulcerations and inflammation they cause locally. Do to this definition, syphilis, gonorrhoea, chlamydia (CT), herpes virus (HSV), and papillomatosis trichomoniasis.
* Be already HIV positive does not protect an HIV infection by a new virus strain potentially more virulent.
* Reports oro-genital are not devoid of risks. Several cases of documented transmission of HIV during oral-genital reports, mainly by fellatio passive, but also compared oro-anal, have been reported.
* People with HIV do not suffer from any other STDs and receiving antiretroviral therapy effective, it means having a detectable viremia for at least six months, is likely to transmit HIV through sexual contact only to a negligible extent, with a risk less than 1 in 100 000.
Prevention tips
In a sexual relationship, only condoms, whether male or female, protects HIV and major sexually transmitted infections. They are to be used in every sexual penetration (whether vaginal, anal or oral) with a partner whose HIV status or the HIV status is unknown.
* The male condom: The condition for its effectiveness is that it is used correctly every report. The lubricant base oils and fats, such as petroleum jelly, ointments or creams, or even butter, should be outlawed because they weaken latex condoms and increase the risk of fracture. It is their preferred water-based lubricant. It is preferable to use non-lubricated condoms for oral sex. It is also essential to check on the cover of condoms listing of the expiry date and a recognized standard (EN-600 CE for the European Union).
* The female condom: It represents an alternative to condoms. It is polyurethane - which authorizes oil-based fats or water - with a ring external and internal. It can be placed in the vagina through a flexible ring. It can be introduced into the vagina or anus few hours before sex and need not be removed immediately after the report, unlike the male condom. The main obstacle to its distribution remains its high cost.
The use of condoms reduces the risk of infection. But some studies have provided opposite results.
Infomations campaigns promoting sexual abstinence only is an unproved effectiveness.
Prevention of HIV transmission among drug users
* The best way is obviously to avoid consumption of drugs, of any kind whatsoever. Drugs such as cocaine, heroin, cannabis, etc., are toxic foreign body. They therefore cause an immune response more or less acute, depending on the nature of the substance, its concentration and the frequency with which it is consumed. For example, the THC would especially immunosuppressive effects on macrophages, NK cells and T cells. The ecstacy has also adversely affected the CD4 cells of the immune system.
* The sharing and reuse of syringes and soiled through contaminated blood are a major risk of HIV infection, but also by hepatitis B and C. In France, risk reduction measures were put in place: unrestricted sale of syringes (since 1987), prevention kits containing the necessary equipment to perform an injection at lower risk, setting up automated distribution and skimmers syringes, provision of substitution treatment for oral.
* The risk of infection by the AIDS virus may be increased when the person responsible for the contamination is a carrier of HIV virus and one of hepatitis (A, B or C) [ref. Required]. In this very special case, superinfection simultaneous even to consider (see HIV test).
* To prevent such contamination, it is essential not to share the small injection equipment or inhalation. This includes syringes, cotton, spoons and cups, water dilution of the drug, but also straw and pipes to crack, especially if they are chipped. The injection equipment must be single use or disinfected with household bleach for Reuse.
The effectiveness of such measures, however, remains controversial: for example, some studies have shown that in Montreal, those who participate in programs "sterilized syringes" were apparently a transmission rates higher than those who do not participate in it.
Diagnosis
Today, in France, more than one in two infected ignore his condition occurs when an opportunistic infection. There is no mandatory testing in France, if not in blood, semen or organs. It is proposed at the premarital medical certificate on the occasion of a marriage. Everyone is free to ask the question of his own HIV status vis-à-vis HIV, and to have a screening test.
Screening Tests
The diagnosis of HIV infection uses detection in the blood of patients with antibodies against HIV. The French legislation now requires the use of two different kits at the serological testing, as the Elisa test, if it provides a sensitivity of 99.9% (ie not pass it to next to an infected person), can give false positive results, especially during pregnancy multiparous, when influenza illness among holders of rheumatoid factor, and so on. Two different tests are made from two different laboratories. These tests are tests to limit, ie that the HIV status is declared if the antibody levels exceeds a certain value set by the manufacturer of the test.
To eliminate the risk of false positive result, the HIV-positive will be confirmed by a second sample for confirmation by a Western blot (immunoblot). The patient is considered HIV positive if one track at a time of antibodies against the proteins making up the virus and internal proteins of the virus.
Further testing could identify patients with p24 antigen. Indeed, in case levy too early, the agency has not produced antibodies detectable quantity, and the search for Ag p24 or the measurement of HIV RNA plasma allow earlier diagnosis but must always be confirmed by a second sample.
It is also noteworthy that the tests of HIV in the developing countries are reduced mostly to a single Elisa test conducted among pregnant women, people who are easiest to detect in the hospital.
A study showed that mice can produce alloimmunes antigens GP120 and P24 created during an HIV infection, although they have not been exposed to HIV. In humans, have been found antigens GP120, P24 and P17 in some placental tissue specific (chronic villitis) in terms of women not infected.
The screening test (Elisa) may be false-positive patients with lupus (and other auto-immune disease, as was confirmed at the congress in Yokohama in 1994) but this does not generally the confirmatory tests (Western blot). During the months after influenza vaccination (2 to 5 months), screening may also be false positive in certain circumstances, including for confirmatory tests.
Measurement of plasma viral RNA
The quantification by PCR (Polymerase Chain Reaction) of the plasma viral RNA testing to monitor the intensity of the viral replication in the body infected and is called viral load. This test, coupled with the measurement of the rate of CD4 + T Lymphocytes, is used to monitor virological a patient before or after the treatment. It can be used as the sole means of diagnosis.
It considers that a change in the viral load is significant that beyond 0.5 log or variations of a factor (multiplication) of approximately 3.6 to upwards or downwards. The viral load is expressed in copies per ml.
Manifestation of primary infection
The symptoms of primary infection are not very specific. They appear between one and six weeks after infection, in the form of a pseudogrippal syndrome, or mononucléosique. Fever is almost constant, accompanied by headache, myalgia, fatigue. Signs cutanéomuqueux angina associated pseudomembranous erythematous or as in infectious mononucleosis, and maculopapular rash affecting primarily the trunk and face. Can join cutanéomuqueuses superficial ulcers, especially genital and oral.
In more than half the cases appear during the second week of multiple lymph nodes, neck, and axillary inguinal. Demonstrations in digestive type of diarrhoea with abdominal pain are present in one third of cases. The time evolution of a primary infection is on average two weeks.
Manifestation at other stages
Without early detection and treatment, therefore, both prophylactic and curative, many patients discover their HIV status at the stage AIDS, at the onset of opportunistic disease. The list is long: lung damage (pneumocystosis, tuberculosis, lymphoid interstitial pneumonia, lymphoma), gastrointestinal (diarrhea, cryptosporidiosis), neurological (cerebral toxoplasmosis, HIV dementia, meningitis), dermatological (Kaposi's sarcoma, seborrheic dermatitis), ocular (cytomegalovirus retinitis, which can cause blindness).
Salaries
There is no at the moment of treatment to cure AIDS, despite the availability of treatments such as retroviral triple therapy that can contain the virus more or less effectively; there are many died every day in particular in developing countries where these treatments are difficult to reach because of their cost. Research continues to develop a vaccine, but progress in this area is very slow.
The salaries are not usually prescribed at the beginning of the HIV status because they have side effects, and a certain toxicity. We evaluate the need for a treatment with blood tests, including the report viral load / Rate of CD4. Once the treatment started, it must be pursued with great regularity (poor adherence may make the virus resistant). Attempts to stop treatments have not as yet inconclusive evidence.
The main side effects of short-term multi usually fade quickly: fatigue, headaches, digestive disorders (nausea, diarrhea), fever or red spots on the skin. After several months of treatment, lipodystrophy (fat face disappearing to go on its belly for men and thighs for women), dyslipidemia (increase in the (cholesterol and triglycerides), and a disturbance of carbohydrate metabolism ( poor absorption of sugar) may occur. Some of these side effects can be mitigated by appropriate physical activity or an adaptation of drug treatment.
Life expectancy now under treatment in young subjects infected more than 35 years.
During a pregnancy, the risk of transmission from mother to child is 20% to 40%. This risk can be greatly reduced by using a preventive treatment. Antiretroviral treatment associated with caesarean section and artificial feeding reduces the risk of transmission to less than 1%. The short duration of work and the short period of care after the breakdown of the pocket water are protective factors against transmission maternofoetale. The latest recommendations encouraging breastfeeding complete until the age of 9 months at least come very recent studies that show that it reduces the transmission rate to 4%.
Epidemiology: current status
Since the year 2002, AIDS is considered a global pandemic.
The latest estimates provided by the UNAIDS 2007 report [39] relate to:
* 33.2 million, the number of people with HIV in the world.
* 2.5 million, the number of people newly infected with HIV in 2007.
* 2.1 million people died of AIDS in 2007.
This allows us to estimate at more than 25 million deaths since the beginning of the disease in 1981. The organization is a stabilization of infection rate (ie the number of people infected compared to the total population), which suggests that it has reached the peak of the epidemic and it stabilizes. However, the number of people infected has risen, because of the increase in population and access to triple (delaying deaths).
These estimates are obtained through the Epimodel used by UNAIDS. The evolution of the HIV prevalence is then obtained by modeling using multiple medical and demographic parameters determined on samples of the population, particularly antenatales studies.
The disease spreads rapidly in Asia (more than a million people were newly infected in the region) and is continuing its expansion in Eastern Europe. By extending to the most populous countries in the world, it can have potentially catastrophic consequences. While in the early years it affected mainly injecting drug users, gay men and sex workers and their partners, this is no longer the case where the majority of infections are heterosexual [ref. Required].
In Western countries, the HIV prevalence has declined somewhat, thanks to awareness campaigns, as well as in the central African country. For example, in Uganda rose from 30% in 1995 to 5% in 2003. However, among certain segments of the population, such as young gay, the infection rate shows slight signs of a possible return to the upside. This is a major problem for public health professionals. AIDS also remains highly problematic as regards the prostitute (s) and drug addicts. The death rate has dropped significantly, due to the use of combined therapies that have proven to be very effective, without ever reaching the cure (according to the 2004 report of UNAIDS, there are about 580000 in 2003 people with HIV in Europe West).
According to UNICEF, 530000 children under the age of 15 were infected with HIV in 2006, mainly through mother to child transmission, despite the progress made in Africa, particularly in the south and east in prevention of this type of transmission. 50% of infected babies die before age 2 unless treated. The number of infected women is higher than among men. There is still a shortage of antiretrovirals (ARVs) in Africa: 9% of pregnant women with HIV have received in 2005 in poor countries or rich medium, in order to prevent the transmission of HIV to babies, compared with 3% in 2003.
However, in developing countries (mainly in sub-Saharan Africa), the economic conditions and lack of public awareness campaigns have helped to maintain high infection rates. Some countries in Africa are currently up to 25% of the active population is HIV positive.
If these people actually reached the stage AIDS, they become unable to work and require intensive medical care. Such situations may in the future result in the collapse of some companies, the fall of governments, further increasing the distress of these countries.
For years, many of these governments have denied the existence of this problem, and are only beginning to find solutions. The lack of adequate medical care, ignorance regarding the disease and its causes, as well as the lack of financial resources to educate and care are now the leading causes of death by AIDS in developing countries.
For the most part, the rapid spread of HIV in these countries is due to HIV coinfection and the herpes virus (HSV). It promotes, during sex, HIV transmission, especially heterosexual transmission by making mucous membranes more permeable genital viruses.
At present, for example, the overall mortality in South Africa is 567000 people per year, with a population of 46.6 million at the same time [46], a rate of 12 per thousand (compared with 13 per thousand achieved in Hungary and 9 per thousand of France).
Similarly, some official figures are disturbing. In fact, the raw data of the census of 1991 and 2001 to give Botswana an increase in the population of 2.4% per year, whereas the estimates of the U.S. Bureau of Census gives an estimate (for 2000 ) of this annual increase of 0.76% taking into account the prevalence of HIV, and 2.5% by ignoring the constraint. The figure of the population in 2004 is increasing the disorder, since the annual increase rises to 2.55%. It is as if the high prevalence of HIV had no real impact on population growth.
In response to this epidemic, which reaches more and more women and young people, UNAIDS estimates that it would raise $ 20 billion by 2007 to ensure the prevention and care of the sick in poor countries.
On 1 December has been declared World AIDS Day. The sixteenth congress was held from 13 to 18 August 2006. One hundred and thirty seven delegates from Africa have submitted an application for asylum.
Where African
It is in Africa that the pandemic knows the death rate highest. The UN estimates that by the year 2002, 2.4 million Africans died of AIDS. It is also estimated that 10 million young Africans aged 15-24 and approximately 3 million children under the age of 15 are infected with the HIV virus. In 2004, UNAIDS, the UN organization in charge of the case of AIDS, has published a report on trends in the prevalence in the world. In the 2007 update of this report, UNAIDS now indicates a steady decline in prevalence in Africa since 2000 when it stood at 5.9% to 5% return in 2007.
The case french and European
Since 2003 the number of people who discovered their HIV infection remained stable between 6000 and 7000. The number of people living with HIV is increasing (from 106000 in 1996 to 130000 in 2005), not least because of antiretroviral treatments available that have increased life expectancy to 17 months before 1994 to more than five years in 2005.
Between 1995 and 2005, the evolution of AIDS are notable on four points:
* An increase in unsafe sex among homosexuals, mainly among those with HIV, which causes problems in terms of HIV but also other sexually transmitted infections (STIs), which triggers when co-infections easily treatable
* Practice drug newly infected with HIV adhere well to risk reduction policies, which has resulted in the reduction of new infections
* An increase in the number of people in sub-Saharan Africa living in France were infected with HIV. In such cases, the infections are not only in Africa but also in France. This reflects a intricacies between the French and African populations
* A slow feminization of HIV infection
The french case is not very different from other European countries that recorded a decrease in cases of new infections (30 cases per million in 1998 and 19 cases per million in 2005) and AIDS-related deaths. Drug users, as in France, adhere well to risk reduction policies. The new cases are in part related to the increase in diagnoses among people from Africa.
While the reporting of infections is compulsory in France, it is not in Spain and Italy, which with France, the European countries most affected by HIV / AIDS [54]. On this side, France remains in time the European country at the forefront of epidemiological observation. This allows us to observe the evolution of this disease and to tailor information campaigns, screening and prevention for high-risk populations.
Assumptions alternatives and the denial of AIDS
A very small minority of the scientific community believes that there is no evidence in the responsibility of HIV in AIDS. Scientists and groups who were most involved are Peter Duesberg, Dr. Willner, David Rasnik, Kary Mullis (Nobel Prize in Chemistry), the association Act Up San Francisco (the only one in the world) and the group of Perth Australia.
This view was echoed for a time by the government of South Africa and particularly its president Thabo Mbeki. That's why he convened a conference contest between the proponents of the official position and those supporting other alternative hypotheses by asking for a reassessment. He also questioned the safety of certain antiretroviral drugs such as AZT and presented poverty as a cause of AIDS. Despite this, South Africa has been a driving force in the development of generic legal circumvention of the dominant position of large western laboratories. Despite the government's reluctance to provide drugs to HIV-positive and under pressure domestic and international funds for the fight against AIDS has steadily increased, reaching their high point in national campaigns free treatment announced 2003, but less developed since. Delays in access to care and treatment but also in the prevention are attributed to these attitudes controversial, although many other factors may legitimately be invoked to explain that South Africa is one of the countries most affected by AIDS.
Henan Province of China was heavily contaminated in the years 1990 through blood drives and blood effected as a protocol dangerous (reuse of used equipment, pooling of blood, and so on.), And has also denied the reality of AIDS To protect those responsible. Today, the evil is identified, but the salaries are not.
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