Human acquired immunodeficiency virus (HIV) has not lost its importance and leading position on the list of causes of death worldwide. Since its discovery in 1983 by French scientists Françoise Barré-Sinoussi and Luc Montagnier [1], its importance in human consciousness has diminished significantly, due to the emergence of other health threats that threatened the world (including SARS-CoV-2 causing COVID-19, as well as other pathogens), although HIV has led to the deaths of many well-known and respected people, including people from the world of music, art and film, e. g. Freddie Mercury, who was a vocalist of Queen and Liberace, famous American pianist of Polish origin. HIV infection is currently an important medical and social problem in Poland, often neglected by health care system organizers, health care professionals, but above all by patients themselves.
According to data from the National Centre for AIDS (2), as of the end of 2020, since the contractual beginning of the AIDS epidemic, which dates back to 1985, 26,486 people have been infected with HIV in Poland, of which 3,815 patients have contracted AIDS, and 1,428 of them have died because of it. At the end of March 2021, 13,605 patients received antiretroviral (ARV) treatment in Poland. There are 38 million people living with HIV or AIDS in the world. In 2019 alone, 1. 7 million people were diagnosed with HIV, and 690 thousand people died of AIDS-related diseases. This means that despite the availability of antiretroviral treatment, both AIDS cases and deaths are uncommon. Polish statistics are not isolated and reflect global trends.
People living with HIV often belong to minorities – both ethnic and sexual – which puts them in a very difficult position to achieve social acceptance, tolerance and support [3]. However, this condition should not be the reason for low interest in testing. All the more so because the diagnosis of infection leads, regardless of sexual orientation or gender identity, to an emotional crisis, which is very often conditioned by insufficient sex education or ignorance of the impact of HIV on further life and therapeutic prognosis [4].
Patients living with HIV in Polish healthcare are often left on their own. Often they are unable to count on psychological care (despite the existence of systemic opportunities to use care), they are unable to cope with the difficulties of everyday life, especially those related to the conditions of sexual life, self-acceptance, socialization. Most of the population is unaware of the existence of a nationwide network of Consultation and Diagnostic Points (PKDs) operating within the framework of the multi-year National Programme for HIV Prevention and Combating AIDS and operating in cooperation with them crisis intervention centres, psychotherapeutic support and acquired immunodeficiency counselling centres.
Stigmatization of people living with HIV
Patients living with HIV are often affected by stigma and social exclusion, which is an expression of a social misunderstanding of the nature of the infection and a lack of education about HIV and AIDS. Since HIV patients treated with antiretroviral therapy need to be fully aware of all the conditions of their health, health education, knowledge of the conditions related to treatment (including expected side effects, awareness of the need to perform regular diagnostic tests – also for co-infections, i. e. HBV, HCV, syphilis, gonorrhea, etc. ), as well as actions that the patient can take in the event of complications during treatment, e. g. related to intolerance to ARV therapy
In Poland, there is a very good system of care for patients living with HIV – the model of functioning of the counsellor for HIV has been developed. HIV. Persons with not necessarily medical education, but with thorough training and professional preparation to conduct per-test counselling and STI counselling. Advisors on HIV/AIDS is concentrated in a network of nationwide Diagnostic and Consultation Points, operating within the framework of the National Programme for HIV Infection Prevention and Combating AIDS, run by the National Centre for HIV/AIDS. AIDS (Agenda of the Minister of Health).
The role of medical professionals, including doctors, nurses, counsellors in the care of an HIV-infected patient, is both activities related to improving general awareness related to possible routes of transmission of infection, and conducting per-test counselling itself. As it turns out, explaining to the patient the importance of the diagnostic test, interpreting the results, and then developing an appropriate process for further treatment and counseling, become a guarantee of acceptance of a possible infection.
Epidemiology of HIV infections
In 2021, almost 300 new HIV cases were detected every day around the world, including 45 per day in EU/EEA countries. This results in 106 508 newly detected HIV infections in the Europe and Central Asia region (WHO European Region), including 16 624 from EU/EEA countries [5]. However, statistical analyses found that there was a sharp decline in the number of reported new infections in 2020 – the first year of the COVID-19 pandemic – and new HIV diagnoses reported in the WHO European Region in 2021 remained almost 25% lower than before the pandemic. This shows that testing has stopped in Europe, although there is evidence that in some countries the number of sexual contacts increased significantly during the pandemic [6]. When testing was reinstated in Europe after the lockdown period, a trend was observed: slightly more than half of those newly diagnosed in 2021 had CD4 cell counts below 350 per mm3 at the time of diagnosis, suggesting that they were most likely living with undiagnosed HIV for up to 8 or 10 years. Of these, just over a third had more advanced HIV infection with CD4 cell counts below 200/mm3 (the basis for AIDS diagnosis).
Analysing epidemiological statistics, it is possible to see a correlation – from 2016 to 2019 (data from 2020 are considered insufficiently accurate due to the suspension of testing during the COVID-19 pandemic) in Europe, the dominant group of people who were most frequently diagnosed were men (65%), but it is noteworthy to note that above the vocation of people diagnosed with the infection, they declared to maintain heterosexual contacts [2].
Polish statistics point to significant differences in detectability of HIV infections depending on the voivodeship, which is probably the biggest impact of the deployment of free Consultation and Diagnostic Points (the more points, the greater the detectability), as well as actions for the local community to improve awareness related to sexual health.
The analysis of these data shows a clear need for broad preventive activities, including raising public awareness of methods to prevent HIV and other sexually transmitted infections, as well as regular testing for these infections.
Consultation and Diagnostic Points
As part of the implementation of the National Programme for the Prevention of HIV Infection and Fight against AIDS, there are Consultation and Diagnostic Points (PKDs) throughout the country, where the test can be performed free of charge, anonymously and voluntarily. The costs of the operation of the points shall be borne by the National Centre for AIDS, on the basis of an agreement concluded by the organization running the PKD (non-governmental organization – foundation or association – or entity performing therapeutic activities) with the National Centre. Due to the obligation to maintain the anonymity of clients, per-test counselling may not include: keeping medical records, issuing prescriptions, treatment and use of medicinal products, so it is not part of the public health system, but is still an important part of the public health system.
The benefits provided in the PKD may be provided only by persons who have the right to per-test counselling – advisors for health and safety. HIV/AIDS (the competencies of a doctor, nurse or other medical professional may be additional, but they are not sufficient – doctors working as counsellors must have additional certifications).
Currently, there is a network of 28 PKDs in Poland, where every person residing in Poland, regardless of nationality, place of residence or insurance status, can take advantage of testing and receive professional advice on sexual health.
Completion
Primary prevention in public health is based on actions taken towards a healthy population to reduce the occurrence of a health hazard [7]. For the prevention of HIV and other sexually transmitted infections, it is crucial to understand the potential for transmission, how undiagnosed HIV affects people’s health and lives, and what actions can be taken to reduce transmission and treat the identified infection.
Sexual life is an immanent part of the life of every adult, it is important not to avoid preventive measures in this area, as well as to speak openly about the risks associated with it. It is all the more important to promote free anonymous and voluntary testing in the Consultation and Diagnostic Points, to use the support of the network of advisors for health and safety. HIV/AIDS, as well as an open and inclusive approach to people living with HIV.
Editorial Board’s Note: In the context of the Polish market, care for people living with HIV is crucial in shaping a more health-conscious and socially responsible society. Despite the existence of the PKD system (Consultation and Diagnostic Points) within the National Program for Preventing HIV Infections and Fighting AIDS, which provides psychoterapeutic support and diagnostics, the majority of society is unaware of the existence of this network and the benefits it can offer to those affected by this virus.
Bibliography:
- Timetable for the implementation of the National Programme for the years 2022-2026 – National AIDS Centre [cited 2. 05. 2023]. https://aids. gov. pl/krajowy_program/2022/
- HIV/AIDS surveillance in Europe 2022 (2021 date) [Internet]. 2022 Nov [cited 2 May 2023]. Available at: https://www. ecdc. europa. eu/en/publications-data/hiv-aids-joint-report-surveillance-2021-data
- Barré-Sinoussi F, Chermann J, Rey F. Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science. 1983;220(4599):868–71.
- Esber A, Jansen K, Dorsey-Spitz K, Robb M, Streeck H, Crowell T. Preparing for future European efficacy trials of interventions to prevent HIV and other sexually transmitted infections: Lessons on willingness to participate and barriers to participation from these German clinics serving behaviorally vulnerable men who have sex with men. Vaccine. Volume 14,2023,100302, https://doi. org/10. 1016/j. jvacx. 2023. 100302.
- Lewtak K, Gajewska M, Sugay L, Rutyna A. Disease prevention – definition | Profibaza PZH [Internet]. [cited 28. 04. 2023]. https://profibaza.pzh.gov. pl/publikacje/swiadczenia-zdrowia-publicznego/05-profilaktyka-chor%C3%B3b-definicja
- Stephenson, R. , Chavanduka, T. M. D. , Rosso, M. T. et al. Sex in the Time of COVID-19: Results of an Online Survey of Gay, Bisexual and Other Men Who Have Sex with Men’s Experience of Sex and HIV Prevention During the US COVID-19 Epidemic. AIDS Behav 25, 40–48 (2021). https://doi. org/10. 1007/s10461-020-03024-8
- Tran N, Nishi A, Young L, Endo A, Cumberland W, Young S. The role of perceived health in retention disparity: A HIV-testing-related behavioral intervention among African American and Latinx men who have sex with men in the United States. Preventive Med Reports. 2023;33. https://doi. org/10.1016/j. pmedr.2023.102195.
dr Piotr Karniej
