A vaccine for Acquired Immune Deficiency Syndrome (AIDS) may be as little as five years away, VaxGen announced at the XIV International AIDS Conference in Barcelona this past August. That’s the good news. The bad news: the HIV/AIDS pandemic remains in its infancy and is rapidly becoming drug resistant, according to reports by the Journal of Ameri can Medical Association.
Some studies indicate that abstinence education reduces risky behavior. Other studies indicate that safe sex instruction and hypodermic-needle exchange programs stem the tide of new infections. In the debate over which prevention measures are most effective, only one point is without controversy: risky behavior must change.
If infection rates do not change, generations of children-already 13.4 million and counting – will be orphaned, reports compiled by USAID indicate. Sub Saharan Africa, the world’s first region to take a heavy toll, provides a grim object lesson. Economies are collapsing, life expectancy in 11 countries is less than 30 years of age, and famine is on the rise as AIDS prevents local populations from tending crops. The crisis has spooked foreign investors, who are beginning to demand HIV/AIDS impact reports of South African businesses, the British Broadcasting Company reports. Because of the pandemic’s far-reaching consequences, the U.S. government and United Nations Security Council has characterized it as a grave international security threat.
If it sounds like a horror movie plot, it should. The truth, unfortunately, is that it is not. As tempting as it may be to turn away from such dire news, doing so only guarantees that it will grow more deadly.
“We know from experience with AIDS that all estimates so far have understated the extent of the problem,” says Mathilde Krim, Ph.D., chairperson for the American Foundation for AIDS Research. To obtain control of the disease, we must be willing to confront the challenge in our neighborhoods, schools, work places, and social lives-because whether we are aware of it or not, we’re all connected in some way to someone who has been infected.
The human immunodeficiency virus (HIV) suspends the body’s defenses, making way for one of 26 opportunistic infections that collectively characterize AIDS, reports the Centers for Disease Control and Prevention (CDC). Symptoms of initial infection include a fever, fatigue and malaise. After making its initial entry into the body by means of unprotected sexual contact, blood or breast milk, HIV-infected individuals may appear healthy for up to a decade, in some cases even longer. A dry cough, frequent night sweats, rapid weight loss, swollen lymph glands, white spots in the mouth and throat, diarrhea in excess of one week, or frequent vaginal infections in women any of which may also indicate an unrelated illness-may eventually occur in those who are infected with HIV.
To confirm the absence or presence of HIV, follow-up testing may be necessary at least six months after the most recent potential HIV exposure. This process may also help rule out rare but potential false-positives produced by laboratory error, Lupus, pregnancy, corticosteroids, a recent influenza vaccine, or other causes. Once an infected individual confirms a positive diagnosis with the Western blot, or similarly approved testing method, preventive treatment is often recommended to delay AIDS onset.
Critics such as Christine Maggiore, director of Alive and Well AIDS Alternatives, argues that antiretroviral treatment for HIV can, in and of itself, produce some of the symptoms associated with AIDS. Dissenters believe that illicit drug use, not HIV, has spurred a resurgence of rare diseases. They point out that opportunistic infections predate the discovery of HIV/AIDS and none are unique to AIDS. The National Institute of Allergy and Infectious Diseases cautions the public against buying into such arguments. It is no longer a matter of debate among the mainstream medical establishment as to whether or not HIV causes AIDS.
The health crisis may be subject to controversy, but its toll is undisputed. The holocaust continues to claim lives.
In medieval Europe, Bubonic Plague wiped out roughly half of the population. Today, National Intelligence Council predicts a second wave of HIV/AIDS infections is poised to carve an intercontinental swath through five nations in which 40 percent of the world’s population lives. In Russia, India, China, Nigeria and Ethiopia, as many as 50 to 75 million people may be infected by 2010, according to the declassified report. Among those, infection rates are rising most rapidly in Eastern and Central Europe, according to the United Nations Children’s Fund.
Although researchers have theorized that HIV may have originated in primates early in the 20th century, the source of the retrovirus is uncertain. The uncertainty has prompted many explanations over the years. Among the most controversial are the hypothesis that HIV/AIDS may have been the product of a laboratory experiment gone awry or that HIV, prior to scientific discovery, contaminated Polio vaccines.
Whatever the origin, the epidemic appears to have taken hold in New York during the latter part of the 1970’s. Subsequently, it is estimated to have infected 60 million people globally thus far. Without intensive intervention, it may kill over 68 million people in the next 20 years. According to UNICEF, there are 14.000 new infections worldwide taking place daily. Approximately half of those infected are under age 24.
Although IV drug users, prostitutes and gay males are among those hardest hit, they are not the only ones standing in harm’s way according to experts. As attitudes toward sexual promiscuity become increasingly lax, sexually transmitted infections have also risen among heterosexual populations in the United States and Europe. Two-thirds of teens become sexually active prior to age 18, the CDC reports, and one in four is infected with a sexually transmitted infection (STI). Untreated STI’s increase susceptibility to HIV by two to five times, health experts warn. Women, likewise, are physiologically vulnerable to HIV/AIDS and account for half of new HIV infections, according to the Bill & Melinda Gates Foundation. Complicating efforts to protect women is a common double standard; many cultures turn a blind eye to male promiscuity which places their partners at risk.
HIV transmission by means of a blood transfusion, although less likely than being struck by lighting, is another risk that has yet to be entirely eliminated. Lenore Gelb, a spokeswoman for the Food and Drug Administration, told the Associated Press in October that the agency continues to find flaws in Red Cross blood screening procedures despite a court-approved consent decree in 1993 that called for improvements.
To place the news in perspective, it is not dangerous to donate blood and the odds of receiving infected blood, according to the FDA, are just one in two million. But minimal risks do not mean efforts to further improve blood safety have ceased. The FDA, the St. Petersburg Times reported in July, is currently investigating a means to cleanse blood supplies. If successful and eco nomically viable new procedures become available, it may eliminate the narrow window of opportunity for HIV to go undetected when an individual has been infected less than two weeks prior to blood donation. With improvements, stories like the San Antonio, Texas resident who tested HIV-positive following surgery in 2000, or the two Florida residents who contracted the disease earlier this year from an infected Florida Blood Services donor, will eventually become a thing of the past.
Until HIV/AIDS does become a thing of the past, however, the search for a cure will continue. In the meantime, the cocktail of drugs, known collectively as highly active antiretroviral therapy or HAART, costs HIV/AIDS patients upwards of $950 per month. Incorrect dosage, timing or medical supervision, are all fac tors contributing to the emergence of drug-resistant HIV strains.
Among those who respond successfully to HIV therapy. it is sometimes possible to reduce what is known as the “viral load” below detectable limits. But despite the obvious benefits to health and longevity, normalized lab results do not indicate a cure. On the contrary, a successfully treated HIV patient may not only infect others. but may also contract yet another strain of HIV from a sexual partner. The ease with which the virus mutates is one reason why a cure remains elusive and one of many reasons why researchers and health organizations encourage the public to remain vigilant. For as long as the HIV/AIDS specter looms, complacency is our greatest threat.
by Diana Lynn Jensen
In the July 6 issue of the Lancet, researchers theorize that 29 million lives could be spared from HIV infection by the year 2010 if multifaceted HIV prevention including: counseling, voluntary testing, condom promotion, syringe exchange, drug treatment, HIV testing and prenatal care were implemented by the year 2005. Experts estimate it would cost about $4.8 billion annually or roughly $5 per person in the U.S. and Western Europe to implement comprehensive HIV/AIDS prevention programs worldwide.
Researchers at Rockefeller University’s Aaron Diamond AIDS Research Center in New York may have discovered why some HIV-infected individuals do not go on to develop AIDS or other characteristic signs of immune system trauma. According to the September edition of science, the differences may stem from three proteins, called defensins, present in healthy CD8 T cells,
Geneticist Steven O’Brian of the National Institutes of Health, notes yet another “natural defense” against HIV may protect a limited number of people of European descent. O’Brian theorizes that some individuals share the same genetic CCR5-delta 32 mutation that may have spared some Europeans from the Bubonic Plague during the middle ages.
An HIV protein known as Vif appears essential to the disease’s ability to disable CEM15, a gene that prevents replication of the virus. When researchers at King’s College London and a team from University of Pennsylvania School of Medicine removed the protein, CEM15 was able to prevent further HIV replication. It is hoped the finding will lead to new treatments.
The National Institutes of Health is currently evaluating several vaccine candidates in the United States, the CDC reports. AIDSVAX is among the first to move to phase three trials.
Health organizations are asking the manufacturers of condoms and lubricants to voluntarily remove Nonoxynol-9 because it does not reduce the risk of STIS, when used rectally, amfAR reports.
An ancient form of contraception-lemon juice-appears to destroy HIV in semen, according to Roger Short, a reproductive research scientist at the University of Melbourne. More study is needed-skeptics say the high acid content may produce irritation.
The International Organization for Standardization (ISO) is working to set standards for the production of non-latex condoms, which are used as an alternative to latex by those who suffer latex allergies. In August, Consumers International, a global lobbying group, asked the ISO to create standards because none exist for the quality of plastic or the type used. Consumers International rejected the ISO’s initial accepted breakage rate of five percent, recommending 1.5 percent in keeping with the norm for latex condoms. According to the CDC, only latex or polyurethane condoms provide sufficient protection against HIV and other STIS.
The CDC has documented a small number of HIV cases through highly unconventional means. Among them are acupuncture, French kissing, dental treatment by an infected individual and severe and mutilating biting. Because it is possible to contract Hepatitis through body tattoos or piercing, the CDC says a similar risk applies to HIV.
The National Institute of Drug Abuse reports that the risk of an STI, including HIV, increases when intoxication from alcohol and drugs precedes sexual behavior. The findings underscore the fact that substance abuse must also become an international priority if HIV/AIDS rates are to be brought under control.
Tuberculosis bacterium (TB) enhances HIV replication and may accelerate the progression of the disease. The Global Alliance for TB Drug Development reports. HIV positive individuals are also 30 times more likely to contract TB and one out of three people with HIV/AIDS worldwide die from TB.
A study financed by the National Institute of Child Health and Human Development suggests that abstinence training, including pledges to postpone sexual involvement, can successfully delay sexual activity among teens.