About us

Who we are
The World Health Organization (WHO) HIV/AIDS Department provides evidence-based, technical support to WHO Member States to help them scale up treatment, care and prevention services as well as drugs and diagnostics supply to ensure a comprehensive and sustainable response to HIV/AIDS. WHO is a Cosponsor of UNAIDS. The Department is located in the Cluster for HIV/AIDS, TB, Malaria and Neglected tropical Diseases. (HTM). It is closely linked to other related departments and programmes of WHO. These include sexual and reproductive health; tuberculosis; blood safety; child and adolescent health; essential drugs and medicines policy; disease surveillance; mental health; vaccine and microbicide development; gender and women's health; health education and substance dependence.

HIV/AIDS Department structural organigram pdf, 99kb WHO departments working in HIV-related areas

What we do
Since the beginning of the epidemic, WHO has led the global health sector response to HIV. As a cosponsor of the Joint United Nations Programme on AIDS (UNAIDS), WHO takes the lead on the priority areas of HIV treatment and care, and HIV/tuberculosis co-infection, and jointly coordinates with UNICEF the work on prevention of mother-to-child transmission of HIV. In 2011, WHO Member States adopted a new Global health sector strategy on HIV/AIDS for 2011-2015. The strategy outlined four strategic directions to guide actions by WHO and countries for the next five years.

Optimize HIV prevention, diagnosis, treatment and care outcomes. Leverage broader health outcomes through HIV responses. Build strong and sustainable health systems. Address inequalities and advance human rights.

WHO's core activities on HIV also include:

improving the availability and quality of HIV related medicines and diagnostics tools; setting norms and standards for scaling up HIV prevention, diagnosis, treatment, care and support services; monitoring and promoting health-sector progress towards achieving universal access to HIV services;

facilitating cohesion and collaboration among partners to achieve the HIV related Millennium Development Goals and the targets set out in the Global health sector strategy on HIV/AIDS, 2011-2015. HIV/AIDS Programme highlights in 2008-2009

Where we work
In addition to the Department at Headquarters, all WHO Regional offices and many country offices have dedicated HIV/AIDS teams and staff.

HIV/AIDS unit of the Regional Office for Africa (AFRO) HIV/AIDS unit of the Regional Office for the Americas (AMRO/PAHO) HIV/AIDS and STD unit of the Regional Office for the Eastern Mediterranean (EMRO) HIV/AIDS unit of the Regional Office for Europe (EURO) HIV/AIDS unit of the Regional Office for South-East Asia (SEARO) HIV/AIDS unit of the Regional Office for the Western Pacific (WPRO)

Internship opportunities
The HIV Department at WHO headquarters in Geneva has been accepting interns from over 40 countries. Interns work on HIV/AIDS prevention and care topics at a global level, and are assigned an experienced supervisor who mentors them on a specific project related to their interests. Internships usually require a commitment of 6 to 12 weeks and are unremunerated. However, a limited amount of scholarships are available through GenevaWISE (A Geneva-based NGO) for students living and studying in resource-limited countries.

Sexually transmitted and reproductive tract infections

WHO

It is estimated that a million people acquire a sexually transmitted infection (STI) including human immunodeficiency virus (HIV) every day. In developing countries, STIs and their complications rank in the top five disease categories for which adults seek health care. Infection with STIs can lead to acute symptoms, chronic infection and serious delayed consequences such as infertility, ectopic pregnancy, cervical cancer and the untimely death of infants and adults.

Global STIs strategy See fact sheet

Sexually transmitted infections

Fact sheet N110 August 2011

Key facts

448 million new infections of curable sexually transmitted (syphilis, gonorrhoea, chlamydia and trichomoniasis) infections occur yearly. Some sexually transmitted infections exist without symptoms. In pregnant women with untreated early syphilis, 25% of pregnancies result in stillbirth and 14% in neonatal death. Sexually transmitted infections are the main preventable cause of infertility, particularly in women. WHO recommends a syndromic approach to diagnosis and management of sexually transmitted infections.

Sexually transmitted infections (STIs) are a public health issue

According to 2005 WHO estimates, 448 million new cases of curable STIs (syphilis, gonorrhoea, chlamydia and trichomoniasis) occur annually throughout the world in adults aged 15-49 years. This does not include HIV and other STIs which continue to adversely affect the lives of individuals and communities worldwide. In developing countries, STIs and their complications rank in the top five disease categories for which adults seek health care.

Infections and transmission

STIs are infections that are spread primarily through person-to-person sexual contact. There are more than 30 different sexually transmissible bacteria, viruses and parasites. Several, in particular HIV and syphilis, can also be transmitted from mother to child during pregnancy and childbirth, and through blood products and tissue transfer.

STIs are caused by bacteria, viruses and parasites. Some of the most common infections are below.
Common bacterial infections

Neisseria gonorrhoeae (causes gonorrhoea or gonococcal infection) Chlamydia trachomatis (causes chlamydial infections) Treponema pallidum (causes syphilis) Haemophilus ducreyi (causes chancroid) Klebsiella granulomatis (previously known as Calymmatobacterium granulomatis causes granuloma inguinale or donovanosis).

Common viral infections

Human immunodeficiency virus (causes AIDS) Herpes simplex virus type 2 (causes genital herpes) Human papillomavirus (causes genital warts and certain subtypes lead to cervical cancer in women) Hepatitis B virus (causes hepatitis and chronic cases may lead to cancer of the liver) Cytomegalovirus (causes inflammation in a number of organs including the brain, the eye, and the bowel).

Parasites

Trichomonas vaginalis (causes vaginal trichomoniasis) Candida albicans (causes vulvovaginitis in women; inflammation of the glans penis and foreskin [balano-posthitis] in men).

STIs without symptoms

Some STIs exist without symptoms. For example, up to 70% of women and a significant proportion of men with gonococcal and/or chlamydial infections experience no symptoms at all. Both symptomatic and asymptomatic infections can lead to the development of serious complications, discussed below.

STIs adversely affect the health of women

Untreated STIs can have critical implications for reproductive, maternal and newborn health. STIs are the main preventable cause of infertility, particularly in women. For example, 10 - 40% of women with untreated chlamydial infection develop symptomatic pelvic inflammatory disease. Post-infection tubal damage is responsible for 30 - 40% of cases of female infertility. Furthermore, women who have had pelvic inflammatory disease are 6 - 10 times more likely to develop an ectopic (tubal) pregnancy than those who have not, and 40 - 50% of ectopic pregnancies can be attributed to previous pelvic inflammatory disease.

Infection with certain types of the human papillomavirus can lead to the development of genital cancers, particularly cervical cancer in women.

STIs and adverse outcomes of pregnancy

Untreated STIs are associated with congenital and perinatal infections in neonates, particularly in regions where rates of infection remain high. In pregnant women with untreated early syphilis, 25% of pregnancies result in stillbirth and 14% in neonatal death an overall perinatal mortality of about 40%. Up to 35% of pregnancies among women with untreated gonococcal infection result in spontaneous abortions and premature deliveries, and up to 10% in perinatal deaths. In the absence of prophylaxis, 30 - 50% of infants born to mothers with untreated gonorrhoea and up to 30% of infants born to mothers with untreated chlamydial infection will develop a serious eye infection (ophthalmia neonatorum), which can lead to blindness if not treated early. Worldwide, 1000 - 4000 newborn babies become blind every year because of this condition.

STIs and HIV

The presence of untreated STIs (both those which cause ulcers or those which do not) increase the risk of both acquisition and transmission of HIV by a factor of up to 10. Prompt treatment for STIs is thus important to reduce the risk of HIV infection. Controlling STIs is important for preventing HIV infection, particularly in people with high-risk sexual behaviours.

STI syndromes
Although many different pathogens cause STIs, some display similar or overlapping signs (what the individual or the health-care provider sees on examination) and symptoms (what the patient feels such as pain or irritation). Some of these signs and symptoms are easily recognizable and consistent, giving what is known as a syndrome that signals the presence of one or a number of pathogens. For example, a discharge from the urethra in men can be caused by gonorrhoea alone, chlamydia alone or both together. The main syndromes of common STIs are:

urethral discharge genital ulcers inguinal swellings (bubo, which is a swelling in the groin) scrotal swelling vaginal discharge lower abdominal pain neonatal eye infections (conjunctivitis of the newborn).

STI syndromic approach to patient management

The traditional method of diagnosing STIs is by laboratory tests. However, these are often unavailable or too expensive. Since 1990 WHO has recommended a syndromic approach to diagnosis and management of STIs in patients presenting with consistently recognized signs and symptoms of particular STIs. The syndromic approach uses flowcharts to guide diagnosis and treatment is more accurate than diagnosis based on clinical tests alone, even in experienced hands. The syndromic approach is a scientific approach and offers accessible and immediate treatment that is effective. It is also more cost-effective for some syndromes than use of laboratory tests. The pathogens causing any particular syndrome need to be determined locally and flow charts adapted accordingly. Furthermore, regular monitoring of the organisms causing each syndrome should be conducted on a regular basis to validate the treatment recommendations.

Prevention
The most effective means to avoid becoming infected with or transmitting a sexually transmitted infection is to abstain from sexual intercourse (i.e., oral, vaginal, or anal sex) or to have sexual intercourse only within a long-term, mutually monogamous relationship with an uninfected partner. Male latex condoms, when used consistently and correctly, are highly effective in reducing the transmission of HIV and other sexually transmitted infections, including gonorrhoea, chlamydial infection and trichomoniasis.

WHO response
The control of STIs is a priority for WHO. The World Health Assembly endorsed the global strategy for the prevention and control of STIs in May 2006. More recently, the United Nations Secretary-General Global Strategy for Women's and Children's Health highlighted the need for a comprehensive, integrated package of essential interventions and services. The Strategy urges partners to ensure that women and children have access to a universal package of guaranteed benefits, including family-planning information and services, antenatal, newborn and postnatal care, emergency obstetric and newborn care and the prevention of HIV and other sexually transmitted infections. Such a package could accelerate the response towards meeting the lagging health-related Millennium Development Goals.
For more information contact:

WHO Media Centre Telephone: +41 22 791 2222 Email: [email protected]

HIV/AIDS
Fact sheet N360 November 2011

Key facts

HIV is one of the world's leading infectious killers, claiming more than 25 million lives over the past three decades. There were approximately 34 million people living with HIV in 2010. HIV infection can be diagnosed through blood tests detecting presence or absence of antibodies and antigens. A cure for HIV infection has not been found but with effective treatment with antiretroviral drugs, patients can control the virus and enjoy healthy and productive lives. In 2010, around 6.6 million people living with HIV were receiving antiretroviral therapy in lowand middle-income countries, but over 7 million others are waiting for access to treatment.

The Human Immunodeficiency Virus (HIV) targets the immune system and weakens people's surveillance and defence systems against infections and some types of cancer. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient. Immunodeficiency results in increased susceptibility to a wide range of infections and diseases that people with healthy immune systems can fight off. The most advanced stage of HIV infection is Acquired Immunodeficiency Syndrome (AIDS), which can take 10-15 years to develop. This stage is defined by the development of certain cancers, infections, or other severe clinical manifestations.

Scope
HIV is one of the world's leading infectious killers, claiming more than 25 million lives over the last 30 years. In 2010, there were approximately 34 million people living with HIV. Over 60% of people living with HIV are in sub-Saharan Africa.

Signs and symptoms

The symptoms of HIV vary depending on the stage of infection. Though people living with HIV tend to be most infectious in the first few months, many are unaware of their status until later stages. The first few weeks after initial infection, individuals may experience no symptoms or a flu-like illness including fever, headache, rash or sore throat. As the infection progressively weakens the person's immune system, the individual can develop other signs and symptoms such as swollen lymph nodes, weight loss, fever, diarrhoea and cough.

Without treatment, they could also develop severe illnesses such as tuberculosis, cryptococcal meningitis, and cancers such as lymphomas and Kaposi's sarcoma, among others.

Transmission
HIV can be transmitted via unprotected and close contact with a variety of body fluids of infected individuals, such as blood, breast milk, semen and vaginal secretions. Individuals cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water. Examples of HIV transmission routes include:

unprotected anal or vaginal sex with an HIV- infected partner; mother-to-child transmission during pregnancy, childbirth, or breastfeeding; transfusion with HIV-infected blood products; sharing of contaminated injection equipment, tattooing, skin-piercing tools and surgical equipment.

Risk factors
There are certain behaviours that put individuals at a greater risk for contracting HIV. These include:

having unprotected anal or vaginal sex; having another sexually transmitted infection such as syphilis, herpes, chlamydia, gonorrhoea, and bacterial vaginosis; sharing contaminated needles, syringes and other infecting equipment and drug solutions for injecting drug use; receiving unsafe injections, blood transfusions, medical procedures that involve unsterile cutting or piercing; experiencing accidental needle stick injuries, including among health workers.

Diagnosis
An HIV test reveals infection status by detecting the presence or absence of antibodies to HIV in the blood. Antibodies are produced by individuals' immune systems to fight off foreign pathogens. Most people have a "window period" of 3 to 12 weeks during which antibodies to HIV are still being produced and are not yet detectable. This early period of infection represents the time of greatest infectivity but transmission can occur during all stages of the infection. Retesting should be done after three months to confirm test results once sufficient time has passed for antibody production in infected individuals. People must agree to be tested for HIV and appropriate counselling should be provided. HIV test results should be kept confidential, and everyone should receive post-test counselling and follow-up care, treatment and prevention measures as appropriate.

Treatment
HIV can be suppressed by combination antiretroviral therapy (ART) consisting of three or more antiretroviral (ARV) drugs. ART does not cure HIV infection but controls viral replication within a person's body and allows an individual's immune system to strengthen and regain the power to fight off infections. With ART, HIV-infected individuals can live healthy and productive lives. An estimated 6.6 million people living with HIV in low- and middle-income countries were receiving ART at the end of 2010. Of this, an estimated 420 000460 000 were children. This is a 16-fold increase in the number of people receiving ART in developing countries between 2003 and 2010.
Access to ART and prevention of mother-to-children transmission (PMTCT) services

Region Sub-Saharan Africa Latin America and the Caribbean East, South, and Southeast Asia

Coverage for ART in Coverage for ART in Coverage for more effective regimen 2010 2009 for PMTCT 2010 49% 63% 41% 60% 50% 59%

39%

33% 22% 9% 39%

16% 79% 4% 48%

Europe and Central Asia 23% North Africa and Middle 10% East Total 47%

Source: 2011 Report on global HIV/AIDS response

Prevention
Individuals can reduce the risk of HIV infection by limiting exposure to risk factors. Key approaches for HIV prevention include:

1. Condom use

Correct and consistent use of male and female condoms during vaginal or anal penetration can protect against the spread of sexually transmitted infections, including HIV. Evidence shows that male latex condoms have an 85% or greater protective effect against the sexual transmission of HIV and other sexually transmitted infections (STIs).
2. Testing and counselling for HIV and STIs

Testing for HIV and other STIs is strongly advised for all people exposed to any of the risk factors so that they can learn of their own infection status and access necessary prevention and treatment services without delay.
3. Pre-exposure prophylaxis (PrEP) for HIV-negative partner

Two trials have demonstrated that a daily dose of antiretroviral drugs tenofovir and tenofovir/emtricitabine taken by an HIV-negative partner is effective in preventing acquisition from an HIV-positive partner. These results are being further investigated by WHO.
4. Post-exposure prophylaxis for HIV (PEP)

This method includes immediate use of ARV drugs within the first 72 hours following accidental exposure to HIV in order to prevent infection. PEP is often recommended for health care workers exposed to needle stick injuries in the workplace. PEP also includes counselling, first aid care, HIV testing, and depending on risk level, administering of a 28-day course of antiretroviral drugs with follow-up care.
5. Male circumcision

Male circumcision when safely provided by well-trained health professionals reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. This is a key intervention in generalized epidemics with high HIV prevalence and low male circumcision rates.
6. Elimination of mother-to-child transmission of HIV (eMTCT)

The transmission of HIV from an HIV-positive mother to her child during pregnancy, labour, delivery or breastfeeding is called vertical or mother-to-child transmission. In the absence of any interventions transmission rates are between 15-45%. MTCT can be fully prevented if both the mother and the child are provided with ART or antiretroviral drug prophylaxis throughout the stages when infection could occur.
7. ART

A new trial has confirmed if an HIV-positive person adheres to an effective antiretroviral therapy regimen, the risk of transmitting the virus to their uninfected sexual partner can be reduced by 96%. WHO is recommending ART as a key part of HIV prevention strategies.

8. Harm reduction for injecting drug users

People who inject drugs can take precautions against becoming infected with HIV by using sterile injecting equipment, including needles and syringes, for each injection. A comprehensive package of HIV prevention and treatment, particularly opioid substitution therapy for drug users includes drug dependence treatment HIV testing and counselling, HIV treatment and care, and access to condoms and management of STIs, tuberculosis and viral hepatitis.

WHO response
Since the beginning of the epidemic, WHO has led the global health sector response to HIV. As a cosponsor of the Joint United Nations Programme on AIDS (UNAIDS), WHO takes the lead on the priority areas of HIV treatment and care, and HIV/tuberculosis co-infection, and jointly coordinates with UNICEF the work on prevention of mother-to-child transmission of HIV. In 2011, WHO Member States adopted a new Global health sector strategy on HIV/AIDS for 2011-2015. The strategy outlined four strategic directions to guide actions by WHO and countries for the next five years.

Optimize HIV prevention, diagnosis, treatment and care outcomes. Leverage broader health outcomes through HIV responses. Build strong and sustainable health systems. Address inequalities and advance human rights.

WHO's core activities on HIV also include:

improving the availability and quality of HIV related medicines and diagnostics tools; setting norms and standards for scaling up HIV prevention, diagnosis, treatment, care and support services; monitoring and promoting health-sector progress towards achieving universal access to HIV services; facilitating cohesion and collaboration among partners to achieve the HIV related Millennium Development Goals and the targets set out in the Global health sector strategy on HIV/AIDS, 2011-2015