The global challenge of HIV/AIDS remains one of the most pressing public health issues today. According to the latest data from UNAIDS, around 38.4 million people worldwide are living with HIV/AIDS, underlining the need for not only medical intervention but also comprehensive awareness, education, and social change. Despite the significant strides made in treatment and prevention, the confusion surrounding the relationship between HIV and AIDS still persists.

Young people have become influential advocates in the fight against HIV/AIDS. Research from UNICEF shows that youth-led initiatives can lower HIV transmission rates by as much as 45% in targeted communities. These young activists utilize digital platforms and peer-to-peer education to dispel myths, promote safe practices, and foster supportive environments for those affected by HIV/AIDS.

Dr Gowri Kulkarni, an expert in Internal Medicine, explains that while the terms HIV and AIDS are often used interchangeably, they are distinctly different. "HIV (Human Immunodeficiency Virus) is a virus that attacks the immune system, whereas AIDS (Acquired Immunodeficiency Syndrome) is a condition that occurs when HIV severely damages the immune system," she clarifies. To understand the implications of these differences, it's important to explore the fundamental distinctions between the two.

1. HIV is a Virus; AIDS is a Syndrome

HIV is the virus responsible for attacking the body’s immune system, specifically targeting CD4 cells, which are crucial for the body’s defense against infections. As HIV progresses, it destroys these cells, weakening the immune system over time. If left untreated, this continuous damage can lead to AIDS.

AIDS, on the other hand, is a syndrome, not a virus. Dr Kulkarni further elaborates that AIDS is a collection of symptoms and illnesses that emerge when the immune system is severely compromised due to prolonged HIV infection. It represents the most advanced stage of HIV, and is characterized by very low CD4 counts or the onset of opportunistic infections like tuberculosis, pneumonia, or certain cancers.

2. Not Everyone with HIV Develops AIDS

A key distinction to remember is that not everyone with HIV will progress to AIDS. Thanks to advancements in medicine, particularly antiretroviral therapy (ART), individuals living with HIV can manage the virus and maintain a healthy immune system for many years, or even decades, without ever developing AIDS. ART works by suppressing the virus to undetectable levels, effectively preventing the damage HIV would otherwise cause to the immune system.

Without treatment, however, HIV progresses through three stages:

- Acute HIV Infection: This stage occurs shortly after transmission and may include symptoms like fever, fatigue, and swollen lymph nodes.

- Chronic HIV Infection: Often asymptomatic or mildly symptomatic, the virus continues to damage the immune system but at a slower rate.

- AIDS: This is the final stage, marked by severe immune damage and the presence of infections that take advantage of the compromised immune defenses.

3. HIV is Transmissible; AIDS is Not

Another key distinction between HIV and AIDS is the way in which they are transmitted. HIV is highly contagious and can be transmitted through the exchange of bodily fluids such as blood, semen, vaginal fluids, and breast milk. It is primarily spread through unprotected sexual contact, sharing needles, or from mother to child during childbirth or breastfeeding.

AIDS, however, is not transmissible. It is not a disease that can be passed from one person to another. Rather, AIDS is the result of untreated, advanced HIV infection and is a direct consequence of the virus’s damage to the immune system.

4. Diagnosis Methods Differ

HIV and AIDS are diagnosed through different methods. HIV is diagnosed through blood tests or oral swabs that detect the presence of the virus or antibodies produced by the immune system in response to the virus. Early detection of HIV is crucial, as it allows for timely intervention and treatment, which can prevent the virus from progressing to AIDS.

AIDS, on the other hand, is diagnosed using more specific criteria. Dr Kulkarni notes that the diagnosis of AIDS is made when the individual’s CD4 cell count falls below 200 cells/mm³, or when opportunistic infections or certain cancers (such as Kaposi's sarcoma or lymphoma) are detected. Diagnosing AIDS involves a more thorough assessment of the individual’s immune function and overall health, as opposed to just the detection of HIV.

5. Treatment Goals Are Different

The treatment goals for HIV and AIDS differ significantly, although both involve antiretroviral therapy (ART). For HIV, the primary treatment goal is to suppress the virus to undetectable levels, thus maintaining a strong immune system and preventing further transmission of the virus. People living with HIV can often live long, healthy lives if they adhere to ART.

For individuals diagnosed with AIDS, the treatment plan becomes more complex. While ART remains an essential part of managing the virus, treatment for AIDS also focuses on addressing the opportunistic infections and secondary health complications associated with severe immune suppression. The goal of treatment for AIDS is not only to manage the HIV virus but also to improve the quality of life and extend survival by treating these secondary health issues.

Role of Community Engagement in Combatting HIV/AIDS

While the medical community has made great strides in managing HIV, the battle to curb its transmission is also a social and cultural issue. Dr Daman Ahuja, a public health expert, highlights that HIV/AIDS awareness and education are vital to reducing transmission rates and supporting those affected by the virus. "Young people, especially, have become key advocates in the fight against HIV/AIDS," says Dr Ahuja. "Research from UNICEF shows that youth-led initiatives can lower HIV transmission rates by as much as 45% in targeted communities."

Additionally, grassroots activism plays a significant role in raising awareness and addressing stigma. As the World Health Organization reports, community-based interventions have been proven to increase HIV testing rates and improve treatment adherence, which are crucial in the fight against the pandemic.

The ultimate goal of organizations like UNAIDS is to eliminate the HIV/AIDS pandemic by 2030. Achieving this requires global collaboration, from medical treatment advancements to public health strategies, education, and advocacy. Dr Kulkarni’s insight underscores the importance of early detection, treatment adherence, and community support in the fight against HIV/AIDS.

Dr Gowri Kulkarni is Head of Medical Operations at MediBuddy and Dr Daman Ahuja, a public health expert and has been associated with Red Ribbon Express Project of NACO between 2007-12.

At 22, the young woman had little reason to think she would soon be facing a major cardiac surgery. Newly married and otherwise healthy, she suddenly lost movement in her right arm and leg. Her family was devastated and struggled to understand how a young, healthy woman could have suffered a stroke.

Investigations revealed an unusual cause: a tumour in her heart, with a small piece believed to have broken away and travelled into the blood vessels supplying her brain. She was advised to undergo immediate open-heart surgery to remove the tumour.

But the prospect of open-heart surgery frightened her. Despite repeated counselling, she refused the procedure. Two months later, she suffered a second stroke. This time, she lost much of her ability to speak and eat, while her heart function had also fallen to 35%. Once again, open-heart surgery was advised. Once again, she refused.

Her Condition Worsened As Treatment Was Delayed

Over the next three months, her condition continued to deteriorate. She weighed only 35 kg, was weak and withdrawn, and required feeding through a Ryle's tube. Her husband continued looking for another option.

A neighbour eventually suggested that the family consult a doctor in Kolkata who performed robotic heart surgery. The family approached Dr Soumya Guha, Cardiothoracic and Vascular Surgeon, BM Birla Heart Hospital, initially through an online consultation, as the young woman was unwilling to visit a hospital.

This was an extremely high-risk case. She had already suffered two strokes, her heart function had come down to 35%, she was severely underweight at 35 kg and was physically very weak. The tumour was also large. Given her condition and the complexity of the surgery, I was initially reluctant to take up the case for robotic heart surgery. But the family was desperate, and we felt that if we could first improve her physical condition and prepare her psychologically, we could give her a chance. She needed to be built up before we could think of taking her safely through such a major procedure.

The team therefore spent time preparing her for surgery, working to improve her nutritional and physical condition while counselling her repeatedly to help her overcome her fear of surgery. Once she was considered ready, she was brought to Kolkata.

Also read: From 365 Shots To 52: How Could Lilly’s Newly-Approved Weekly Insulin Injection Change Diabetes Care

Two Tumours Found During Robotic Heart Surgery

The surgery presented another unexpected finding. What had been thought to be a single cardiac tumour turned out to be two tumours in the heart. Both were removed using robotic heart surgery.

Given her small body size, weakness and small blood vessels, the procedure required additional precautions during cardiopulmonary bypass. The team used artificial conduits to establish bypass and employed NIRS monitoring along with multiple filtration modes to support her during the procedure.

Rehabilitation Helps Her Regain Movement, Speech And Swallowing

Her recovery was also a major part of the treatment. Following surgery, she underwent extensive physical rehabilitation along with speech and swallowing therapy. Nursing, intensive care, physiotherapy, dietary support and ward care were all part of the recovery process, with the hospital administration also providing financial assistance to the family.

Today, the young woman is able to stand and walk on her own. She has begun speaking a few words and has progressed from Ryle's tube feeding to eating small amounts of mashed food.

For her family, the change has been remarkable: from watching a young woman suffer two strokes and gradually lose her ability to speak and eat, to seeing her prepare to return home on her own feet.

The surgery was only one part of this patient's journey. Given how weak she was, getting her through the operation safely was important, but helping her regain movement, speech and swallowing afterwards was equally important. This required the efforts of the surgical and anaesthesia teams, perfusionists, nursing staff, ICU and ward teams, physiotherapists, speech and swallowing rehabilitation and the dietician. The support from the hospital administration also made a difference to the family. Every one of these teams had a role to play in getting her to where she is today.

While dementia is generally associated with older age, its onset can begin much earlier, including in middle age. A new study led by an international team of researchers found that muscle loss as people age may be an important warning sign for dementia risk.

The study, published in the International Journal of Food Sciences and Nutrition, also found a surprising difference in how obesity was linked to dementia depending on a person’s age.

What Did The Study Find?

Researchers analyzed more than 80 studies examining the links between body weight, body fat, muscle health and dementia.

They found that people with sarcopenia — the loss of muscle mass and strength — had a 42 per cent higher risk of dementia.

People with obesity in middle age, or before 65, had a nine per cent higher risk of dementia. In contrast, obesity in people aged 65 and over was linked to a 17 per cent lower risk.

The findings showed that body weight alone did not tell the full story when it came to dementia risk.

“It’s not just about how much you weigh – maintaining muscle strength and function also appears to be important as we age,” said lead researcher Dr Uraiporn Booranasuksakul from Burapha University, Thailand.

“Our findings suggest losing muscle could be an important warning sign for dementia risk.”

Why Muscle Health Matters

Sarcopenia is a condition where people lose a greater amount of muscle mass, strength and physical function, often as they get older.

Dr Booranasuksakul said the findings highlighted the importance of looking after muscle health throughout life.

“Maintaining muscle is an important part of healthy ageing, and regular physical activity and good nutrition can help support muscle strength and function,” she said.

Obesity And Dementia Risk Change With Age

Corresponding author Professor Mario Siervo from Curtin University’s School of Population Health said the findings also challenged the idea that dementia risk could be understood simply by looking at a person’s weight.

“We found that obesity in middle age was linked to a higher risk of dementia, but this relationship changed in later life,” Professor Siervo said.

“This does not mean people should gain weight as they get older. Rather, it shows us that the relationship between body weight, ageing and dementia is complex.”

What About Sarcopenic Obesity?

The researchers also looked at sarcopenic obesity, where a person has both low muscle mass or function and excess body fat.

Only four studies met the criteria for this part of the analysis, and researchers found no statistically significant link between sarcopenic obesity and dementia.

Professor Siervo said more research was needed to understand whether the combination of muscle loss and excess body fat affected dementia risk.

“There is still a lot we don’t know about how changes in muscle and body fat interact over time,” Professor Siervo said.

“More long-term research is needed to understand whether having both low muscle mass and excess body fat increases dementia risk.”

A Lifelong Approach To Healthy Ageing

The researchers said the findings reinforced the importance of taking a lifelong approach to maintaining healthy body composition, including preventing unhealthy weight gain during middle age and maintaining muscle strength and function as people get older.

India has a target to eliminate dog-mediated rabies by 2030. It has strengthened access to post-exposure prophylaxis for people exposed to rabid animals, but controlling transmission among dogs still remains a challengge.

India's National Action Plan for dog-mediated rabies elimination rests on human-health component, which focuses on post-exposure prophylaxis and awareness among bite victims, and the animal-health component, which focuses on vaccinating and sterilising stray dogs.

In a conversation with HealthandMe, Dr Hanul Thukral, Veterinary Epidemiologist, South Asia Field Epidemiology & Technology Network (SAFETYNET), formerly with the Centre for One Health, National Centre for Disease Control (NCDC), Ministry of Health & Family Welfare, Government of India, says that the human-health side of the programme is strong. The bigger challenge lies in giving the animal-health side enough resources, coordination and accountability.

The Gap Of Animal Health Component In Rabies

Dr Thukral talks about an unusual problem at the heart of India's rabies-control efforts. He speaks about the ownership of stray dogs and that they do not fall under any single ministry.

“Stray dogs also do not come under a particular ministry. They do not come under the animal husbandry ministry, the health ministry or the wildlife ministry. They are under the purview of local bodies, including municipal corporations and rural local bodies,” he said.

This is a larger issue as the animal-health component of rabies elimination depends on sustained vaccination and sterilisation campaigns. Dr Thukral said the country currently lacks dedicated funding and resources for this part of the effort.

For India to move faster towards the 2030 goal, he said local bodies need to be given greater financial and operational support, including resources to capture rabid dogs, sterilise stray dogs and vaccinate them.

He added, “There should be an incentive-based model for local bodies like Swachh Bharat. Financial or non-financial incentives could be offered to local bodies for their rabies efforts, including recognition for those that prevent the majority of deaths.”

Also read: 18-Year-Old Dies From Rare Measles Brain Complication As Pennsylvania Death Toll Hits 4

Treatment Is Available But The Patient May Seek Treatment Late

India's human-health response is strong. Dr Thukral said the health ministry has increased access to rabies vaccination and rabies immunoglobulins, with a goal of making vaccines available up to the PHC level and immunoglobulin available up to the CHC level.

Yet the first break in the prevention chain can occur before the health system even knows a bite has happened.

“The prevention chain breaks down where it actually starts. It starts with the awareness of dog-bite victims,” Dr Thukral said. “A person bitten by a dog has to recognise the danger and seek care before the health system can intervene. According to a recent estimate cited during the interview, only around 20-25% of dog-bite victims receive post-exposure prophylaxis, while 60-65% do not. Of those who receive it, only 50% complete it.”

Dr Thukral stressed that these are not definitive figures. “These are just estimates based on a subset of the population,” he said.

That gap can lead to delayed treatment. “In rabies, time is everything,” he said, adding, “If we don't get post-exposure prophylaxis immediately after the dog bite, after 10 hours or after 24 hours, it has virtually no use.”

The 70% Dog-Vaccination Challenge

Human treatment can prevent death after exposure, but elimination requires the transmission cycle to be interrupted among dogs. Around 70% vaccination coverage among dogs is needed to interrupt the transmission chain.

The problem, Dr Thukral said, is that India does not have reliable nationwide data showing what proportion of its stray-dog population is actually vaccinated.

He said, “A nationwide stray-dog census was only recently conducted, counting almost 1 crore 50 lakh stray dogs across the country. Local bodies and panchayats conduct surveys and organise vaccination campaigns within their jurisdictions, but the current effort is very scattered and very non-uniform.”

He added, “If I achieve 70% vaccination in a particular block, the dogs of that block are protected. But there is always a chance that unvaccinated dogs from the periphery or neighbouring blocks can enter that block.”

Also read: Chile Eliminates Dog-Transmitted Rabies: What Other Countries Can Learn

Treatment Alone Can Prevent Deaths, But Not Eliminate Rabies

Dr Thukral says saving people from rabies and eliminating rabies are not the same goal. He said, “One estimate suggests that if India continues increasing post-exposure prophylaxis coverage while carrying out suboptimal dog vaccination, around 400 deaths could be prevented over the next 10 years.”

Another estimate cited by Dr Thukral puts the figure at about 400-500 deaths over the next 10 years, with spending about 5 to 10 crores. But preventing those deaths would still fall short of elimination. “That’s it. We cannot achieve elimination,” Dr Thukral said.

“Humans are not the source of the infection,” he explained. “In this case, dogs or other animals are the source of infection. Unless we target them, we do not move closer to elimination.”

India Does Not Have Reliable Data For Vaccinated Stray Dogs

The same data problem extends to the Animal Birth Control programme, which combines sterilisation with anti-rabies vaccination. The expert says that there is no nationwide figure showing how many stray dogs have been vaccinated or sterilised. The information exists, but it sits across individual municipal corporations and panchayats rather than in one comprehensive national dataset.

“Vaccinating stray dogs doesn't come under the purview of the health ministry or the animal husbandry ministry,” he said. That makes it difficult to answer a seemingly basic question: what proportion of India's stray dogs is vaccinated at any given time? “We do not have nationwide data,” Dr Thukral said.

Also read: DRC Says Ebola Outbreak Has Peaked, UN Warns It’s Still Growing

Reliable 'One Health' Approach

Rabies is not a problem that can be solved by hospitals alone. At the district level, Dr Thukral said an effective One Health system would require health departments, municipalities, animal husbandry authorities, veterinary services and welfare bodies to have clearly defined responsibilities, adequate resources and a mechanism to coordinate.

He said, “The health department would focus on post-exposure prophylaxis, animal-bite management and awareness. Local bodies would handle dog vaccination, sterilisation and solid-waste management. The animal husbandry department could provide technical support, while welfare bodies could promote responsible dog ownership. Let every department do its job and establish coordination among them.”

That coordination also becomes important after an individual bite. Municipal or animal-health authorities need to communicate with the health department because one reported bite may indicate that additional people have been exposed.

How To Recognise A Rabid Dog?

Another challenge is recognising rabid animals. Dr Thukral said that after a dog is bitten by another rabid dog, it can take up to three months for symptoms to develop. However, he stressed that this does not mean the animal transmits the virus throughout that entire period.

“It will transmit the virus about 10 days before it starts showing symptoms,” he said. He also described several behavioural and neurological changes that can raise concern.

A dog that suddenly becomes aggressive, unusually quiet, or behaves differently from its normal pattern may warrant attention. Other signs described by Dr Thukral include seizures, excessive drooling, and changes in vocalisation.

“The basic thing we need to look out for if we get a dog bite or exposure from a potentially rabid animal is, most importantly, change in the animal's behaviour,” he said.

Also read: World Leaders Call For Obesity & NCD Prevention At BRICS 2026 Summit: Why Focus Is Growing?

India’s Surveillance Gaps

India's surveillance recorded 54 rabies deaths in 2024, according to the Press Information Bureau. But an independent study cited during the discussion put the number at more than 5,700, and estimated that India may have between 3,000 and 7,000 deaths annually.

Dr Thukral said that India's human rabies surveillance system is well equipped to detect, diagnose and report suspected and confirmed cases. But the bigger vulnerability, he said, may occur before a suspected case enters the health system.

“If there are scattered cases, such as one bite or a couple of bites, unless that patient reports to a health facility for potential post-exposure prophylaxis, the health system will most probably fail to capture it,” he said.

In other words, surveillance can only record what comes into contact with the system. Community awareness and care-seeking behaviour therefore remain critical.

The Biggest Challenge In India’s Rabies Elimination Goal

Dr Thukral believes the health component of India's rabies programme is comparatively strong. Post-exposure prophylaxis is accessible, almost free and cost-effective, he said. But it becomes more difficult when the focus shifts to dogs.

“Sterilising and vaccinating a dog currently takes around Rs 1,500 per stray dog to vaccinate it and sterilise it,” he said.

With a stray-dog population of around 1.5 crores, the scale of resources required becomes enormous. According to Dr Thukral, local bodies generally do not have that kind of money to dedicate to rabies control.

“So, yes, our system is very much in place and very strong to detect human rabies cases and treat them and provide them with the necessary care,” Dr Thukral said. “But for elimination, we need to target the source of the infection, which is obviously these stray dogs.”

For India to reach its 2030 goal, he said, the pace needs to pick up in terms of resources, manpower and political intention.

India's rabies challenge is therefore not confined to what happens after a person is bitten. It begins much earlier. With awareness, timely care-seeking, dog vaccination, sterilisation, waste management, reliable data and coordination between agencies working across the human and animal-health systems.

The country can continue expanding access to post-exposure prophylaxis and prevent more deaths. But, as Dr Thukral emphasises, that alone cannot deliver elimination. The question for the next four years is whether India can move from responding to individual exposures to systematically interrupting transmission at its source. As the expert said, “We need to target the source.”