Chapter 1. HIV/AIDS

Synopsis

Michelle Ryder, Daniel Webster College
Pauline Davey Zeece, University of Nebraska - Lincoln

What is AIDS?

^{An AIDS patient at an outpatient clinic in San Francisco}

AIDS (acquired immunodeficiency syndrome) is a separate diagnosis from HIV (human immunodeficiency virus) because AIDS represents an advanced stage of HIV infection in which the immune system is extremely compromised making the patient very vulnerable to various infections. HIV is the virus that causes AIDS and is transmitted from person to person through the direct exchange of body fluids such as, blood, semen, vaginal secretions, and breast milk. Any of these infected fluids have to enter the bloodstream of another person in order for the HIV virus to be transferred. The transmission of the virus is most publicly associated with unprotected vaginal or anal sexual intercourse, but unprotected oral sex does pose a risk of infection. HIV can also be transmitted by receiving a blood transfusion of infected blood or by sharing a hypodermic needle with an infected person. The virus can also be passed from mother to child during pregnancy, childbirth, and/or breastfeeding.

Some History on HIV and AIDS

^{This patient suffers from both AIDS and throat cancer and is being comforted by a volunteer at an AIDS hospice in Washington, D.C.}

On June 5, 1981, Dr. Michael Gottlieb and colleagues from the Centers for Disease Control and Prevention (CDC) reported in the Morbidity and Mortality Weekly Report five cases of Pneumocystis carinii pneumonia, otherwise known as (PCP). PCP is a rare form of pneumonia that is usually only found in severely immune-compromised patients. Since these first five patients happened to be gay men and subsequent cases of this rare pneumonia along with other diseases resulting from immunosuppression appeared in gay men as well, an initial term used to describe this condition was “gay-related immune deficiency (GRID).” The media and others mistakenly proposed an inherent link between homosexuality and this new condition of extreme immune deficiency. Although this disease was assigned the name of AIDS (acquired immunodeficiency syndrome) in 1982, the GRID misnomer launched the beginning of decades of worldwide misunderstanding of, discrimination toward, and even violence against those with AIDS.

Some Statistics on HIV and AIDS

^{Children who are affected with and/or orphaned by AIDS are often left to be cared for by family members or community organizations. Unfortunately, many countries cannot afford proper anti-retrovirals, so these children may be unable to receive treatments.}

As of 2011, 34 million adults and children are living with HIV worldwide versus 29.4 million adults and children living with HIV in 2001. Just over 3 million of those infected are under the age of 15. Sub-Saharan Africa accounts for 69 percent of all the people and 91 percent of all the children living with HIV. In 2011, 1.7 million individuals died from AIDS . That figure contributes to the nearly 30 million who have died from HIV-related causes since the beginning of the AIDS epidemic.

Adolescents and AIDS

^{Source: Centers for Disease Control http://www.cdc.gov/hiv/risk/age/youth/index.html}

In the U.S., teens and young adults between the ages of 13 and 29 are at a growing risk for getting infected with HIV. In 2009, these adolescents accounted for 39 percent of all new HIV infections while they only represented 21 percent of U.S. population. The lists sexual behaviors, substance use, and lack of awareness as risk factors for adolescents and young adults to get infected with HIV. Today’s U.S. teens are having sexual intercourse, often unprotected, at an earlier age. Young men having sex with men, in particular, are one of the least likely populations to have been reached by outreach or intervention education. The Centers for Disease Control and Prevention (CDC) finds a correlation between substance abuse and high risk behaviors, such as unprotected sex. The lack of awareness that many adolescents suffer from includes not knowing their own HIV infection status, not knowing much about the transmission of HIV, not having access to educational resources about prevention and safe behaviors, and even not being particularly concerned about HIV because of their own adolescent egocentrism. Basically, being an adolescent in the U.S. today is risky business.

Case Study: AIDS in Sri Lanka

Case Study: AIDS in Sri Lanka (continued)

In 2012, the World Bank published an article laying out some of the risk factors that make Sri Lanka particularly susceptible to an AIDS outbreak.

• Inconsistent condom use – For example, only 64 percent of men having sex with men, who are a very high-risk population, report using condoms.
• Prominent sex industry – In addition to 35,000 known female sex workers, there are supposed networks of men who have sex with men. These networks may incorporate women and prostitution. This population is extremely vulnerable to contracting HIV.
• Migrant workforce – Many Sri Lankans travel elsewhere for work. Just under half of this migrant workforce is women, and 86 percent of these women are unskilled. Statistically speaking, this transient pattern of working may be conducive to promiscuity, unsafe sexual practices, and potential prostitution or sexual abuse.
• Poor understanding of HIV – Many Sri Lankans are not properly informed about how HIV is transmitted and how to protect themselves.
• Prejudice toward individuals living with AIDS – Because there is such a stigma attached to having AIDS, many may not pursue getting informed, tested, or treated. Potentially, this prejudice may even affect the quality of health care available.

Fighting AIDS

Assessment: Check Your Understanding

^{This patient suffers from both AIDS and throat cancer and is being comforted by a volunteer at an AIDS hospice in Washington, D.C.}

Assessment: Check Your Understanding

^{A volunteer discusses condom use with young women in Madagascar in effort to promote safe health practices.}

Assessment: Check Your Understanding

Assessment: Check Your Understanding

^{A patient suffering from AIDS in Ho Chi Minh City in Vietnam}