Special issue on living with HIV/AIDS: Prospects and challenges

The theme for this issue is living with HIV/AIDS. Here, we present a diversity of articles on varying topics. The face of AIDS is ever-changing, with new populations being identified as vulnerable, and others needing ongoing care. Currently, 36.9 million people worldwide are living with HIV/AIDS. Of note, 17.1 million do not know they have the virus and need to be reached with HIV testing and services (U.N. AIDS report, 2014). Of the total identified, 2.6 million are children less than 15 years old, most of whom were infected by their mothers during pregnancy, childbirth, or breastfeeding (AIDS.gov, 2015). An estimated 2.0 million became newly infected in 2014 in the last reading by the U.N. AIDS report (2014); 220,000 were children. According to the World Health Organization (WHO), most reside in Sub-Saharan Africa and 70% of the global total of new HIV infections are in that locale. By far, the majority of people infected with HIV are living in middle- to low-income countries. Sobering statistics reveal that 34 million have died from AIDS related causes, 12 million in 2014 alone.

Even with advances in our understanding of HIV treatment and prevention, as well as years of effort by the global health community, the scientific community, and civil social service organizations, vast numbers have no knowledge of HIV prevention. Of interest to particularly the readership of this journal, 22 million have no access to treatment, including 1.8 million children (UNAIDS, 2015). There is still no known cure. That said, we have made significant advances in effective treatment with antiretroviral drugs and controlling the virus so that people with HIV can attain healthy lives and reduce the risk of transmitting the virus to others.

Thus, social service care plans must take into account the complex set of interacting variables in HIV/AIDS from the experience of the individual carrying the virus, to both the near and far environment. The HIV epidemic not only affects the health of individuals, it impacts households, communities, and the development and economic growth of nations. Many of the countries hit hardest by HIV also suffer from other infectious diseases, food insecurity, and other serious problems (AIDS.gov, 2015). Dyadic research designs which capture the experience of care receiver and caregiver are promising. However, the lack of a quantitative measure of treatment fidelity can and does limit findings. In addition, the use of measures to target the observed behaviors are often lacking in existing intervention literature. While much has been learned at local and global levels in the qualitative studies and cross-sectional research, far fewer intervention studies have been conducted. In part, this situation exists because of the great diversity of populations affected and the associated diversity of need. Capturing diversity of need translates into requiring greater sophistication in developing intervention research. Moreover, because infected groups often survive under the radar of identification, intervention studies often design treatment protocols for known groups only. New groups at risk of contracting and transmitting HIV are less identified. In the United States and other countries in the Western world, groups such as the Orthodox religious, those residing in retirement communities where sexually transmitted diseases are higher than imagined, and younger survivors of sexual abuse, HIV/AIDS may be present but not identified and thus often go unrecognized for years. In such situations, the design and documentation of intervention outcomes and efficacy are delayed. In addition, some at-risk groups are migratory, such as those working in global sex trafficking. HIV/AIDS is a moving target. Limitations may be a result, in part, as individuals affected by HIV/AIDS (both care receiver and caregiver) often exist under the radar of identification because of stigma, thereby making it difficult to conduct large-scale randomized controlled trial studies. Hence, investigators are called on to keep up with the curve of the disease rather than work behind it—a daunting task.

Despite noted challenges, we see successes and promising signs. Innovative global efforts have been mounted to address the pandemic. Preventive efforts have assisted in reducing HIV prevalence rates in a small but growing number of countries. New HIV infections are believed to be on the decline. Further, the number of people with HIV accessing and receiving treatment in resource-poor countries has dramatically increased, especially in the past decade. In June 2015, 15.8 million people living with HIV were accessing antiretroviral therapy (ART) globally, an increase from 13.6 million in 2014 (UNAIDS, 2015). In addition, advancement has been made in preventing mother-to-child transmission of HIV and keeping mothers alive. In 2014, 73% of the estimated 1.5 million pregnant women living with HIV globally were accessing ART to avoid transmission of HIV to their offspring, and new HIV infections among children were reduced by 58% from 2000 to 2014 (UNAIDS, 2015). Thus, while the challenges are noteworthy, progress has also been significant.