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The human immunodeficiency virus (HIV) is part of a family of retroviruses that have the capacity of reproduction from RNA in the nucleus of a helping cell of the human immune system. Using enzymes—chemical substances in the human organism that enhance reactions without intervening in them—the virus breaks through the cell membrane to the nucleus, where it is reproduced. Infection with HIV leads to the disease known as AIDS.
The origin of HIV is unknown, but it is widely understood that it is a mutation of a similar retrovirus, such as the simian immunodeficiency virus. It is speculated that the virus developed the capacity to infect human beings through the practice of ingesting raw meat or blood in religious rituals in isolated parts of Africa. Even though the first AIDS cases were reported in Africa in the early 1980s, several known cases were before this date.
The Discovery of HIV
At the beginning of the AIDS epidemic, the virus was initially called human T-lymphotropic virus type III (HTLV III) by the U.S. research group under the leadership of Robert Gallo. The virus was also discovered at about the same time by researchers at the Pasteur Institute of France under the leadership of Luc Montagnier, who named it lymphadenopathy-associated virus (LAV). Following an international controversy between the two researchers, who both claimed credit for the discovery, the name HIV was agreed upon.
By 1982 it had been established that HIV had caused the destruction of the immune system of numerous individuals, rendering them susceptible to infections that produced a combination of diseases, such as Kaposi sarcoma and pneumonia. This overall disease process was called acquired immunodeficiency syndrome (AIDS). By this time it had also been established that the virus was transmitted via body fluids, such as blood and semen.
A number of factors—including the migration of infected people to populated zones, overpopulation in certain communities, difficulties in access to medical care, and ignorance of the disease—led to the infection becoming a pandemic by the end of the 1980s. The first AIDS cases in the United States were reported in the summer of 1980, when the Centers for Disease Control and Prevention (CDC) reported several cases of young males with opportunistic infections and a compromised immune system. The number of reported AIDS cases then began to increase in a geometrical way through the entire world. According to the CDC, the cumulative estimated number of diagnoses of AIDS through 2003 in the United States was 929,985. Adult and adolescent AIDS cases totaled 920,566, with 749,887 cases in males and 170,679 cases in females. The remaining 9,419 cases had occurred in children under age 13. At the end of 2003, it was estimated that 1,039,000 to 1,185,000 persons in the United States were living with HIV/AIDS and that between 24 and 27 percent were undiagnosed and unaware of their condition.
Testing for HIV
There is a test to detect the presence of HIV antibodies. A more specialized test, the polymerase chain reaction (PCR) test, can identify the virus, but it is only used for special cases or research due to its high cost. For the general public, the ELISA test is used, which only detects the presence of HIV antibodies. This test is highly sensitive for negatives, which is why it is commonly used for screening possible cases. But because of this sensitivity, ELISA tests that are positive must be confirmed with a more accurate test, called the Western blot. Both tests are readily available through public health services, and many health community-based organizations provide the test at outreach activities in the communities.
Treatment and Prevention
As of 2007 there was no available vaccine for HIV. More than 95 percent of all new infections were in developing countries, making HIV/AIDS one of the most serious threats to global health and global development. Many believe that only a vaccine will stop the spread of the infection. Developing a vaccine will thus represent a huge milestone in the AIDS epidemic, and several clinical trials are being developed in different countries. However, the versatility of the virus and other concerns have made this a difficult task.
Due to the nature of HIV infection and the lack of a cure or vaccine, the only way to address the epidemic is by means of prevention. Primary prevention programs target vulnerable populations by means of culturally and competent interventions designed to help people avoid being infected. Because the virus is transmitted by contact with fluids, sharing infected needles for drug use, having sexual intercourse without protection, and mother-to-infant transmission are the main venues for the virus to be introduced to human beings. Important primary prevention interventions have been developed and evaluated in the United States and other industrialized countries, and these are being transferred to other communities around the world. These prevention programs include education about the virus, condom distribution, clean needle distribution for drug addicts, and peer counseling, and they have slowed the spread of HIV. The basic idea is that by learning the ways the virus is transmitted and by developing personal and social skills that protect and empower atrisk minority communities, it is possible to stop the spread of the infection.
Advances in treatment have yielded important new AIDS therapies, but the cost and complexity of their use put them out of reach for most people in the countries where they are needed the most. In industrialized nations, where the drugs are more readily available, side effects and increased rates of viral resistance have raised concerns about the long-term use of these therapies. Since the mid1990s, HIV infection has spread most rapidly among women, children, and sexual minorities. Both in the United States and in developing countries, the incidence of HIV infection has had a disproportional impact on communities of color. Efforts at primary prevention must therefore take into consideration the social and cultural context and meanings of what are known as “high-risk behaviors.”
It is also important of course to pay attention to those already living with HIV/AIDS, with the goal of providing them access to care and secondary prevention. By engaging people living with HIV/AIDS in appropriate treatment, the quality of life of these individuals can be enhanced. This level of treatment will also reduce the continuing transmission of the infection. For this to happen, the human rights of people living with HIV/AIDS need to be protected. This will encourage them to get tested and receive medical and social care.
The Stigma of AIDS
Jonathan Mann, the founding director of the World Health Organization’s Global Programme on AIDS, described the HIV epidemic as more than just a biological disease. It is also a social phenomenon that he identified as potentially explosive because it is an epidemic of social, cultural, economic, and political responses to the disease. This social epidemic is characterized above all by exceptionally high levels of stigma, discrimination, and at times collective denial.
The concept of stigma dates to ancient Greece, where it was used to describe persons who had been involved with certain bad deeds, for which they were distinguished from others by the application of bodily marks or tattoos. People so marked were to be avoided by the general populace. The concept has also been associated with an unnatural mark in the bodies of saints, a mark made with a hot iron on the flesh of slaves, a bad reputation, and even a physical dysfunction. Some authors have described stigma as a social construction associated with the recognition of a “difference” based on a specific characteristic, which is used to devalue the person who possesses that characteristic. All of these definitions share the idea that a stigma is the negative evaluation of a particular difference that may be identified in a person. The stigma associated with AIDS has become the biggest obstacle for HIV/AIDS prevention, because it hinders the possibility of dignity and access to care for people living with the infection.
- Centers for Disease Control and Prevention. 1981. Kaposi’s Sarcoma and Pneumocystis Pneumonia among Homosexual Men: New York City and California. Morbidity and Mortality Weekly Reports 30: 305–308.
- Centers for Disease Control and Prevention. 1981. Pneumocystis Pneumonia: Los Angeles. Morbidity and Mortality Weekly Reports 30: 250–252.
- Centers for Disease Control and Prevention. 2004. HIV/AIDS Surveillance Report. Vol. 15, Cases of HIV Infection and AIDS in the United States, 2003. Atlanta, GA: Author.
- Goffman, Erving. 1963. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice-Hall.
- Herek, Gregory M. 1999. AIDS and Stigma in the United States. American Behavioral Scientist 42 (7): 1106–1116.
- Herek, Gregory M., and John P. Capitano. 1999. AIDS Stigma and Sexual Prejudice. American Behavioral Scientists 42 (7): 1130–1147.
- HIV Vaccine Trials Network. “The Step Study”: HVTN 502/Merck 023 A Merck/HVTN Proof-of-Concept Vaccine Trial. http://www.hvtn.org/science/step.html.
- Joint United Nations Programme on HIV/AIDS (UNAIDS). 2003. Report on the Global HIV/AIDS Epidemic, December 2003. Geneva, Switzerland: UNAIDS.
- Kalichman, Seth C. 1998. Understanding AIDS: Advances in Research and Treatment. Washington, DC: American Psychological Association.
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