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The Many Facets of HIV/AIDS 2017

By Wendi Williams, Editor & HIV/AIDS Prevention Educator

Red RibbonIntroduction
On June 5, 1981, more than 36 years ago, the Centers for Disease Control and Prevention (CDC) issued its first public warning about a rare form of pneumonia (Pneumocystis carinii) that was found among a group of gay men living in Los Angeles. Similar cases emerged in New York and San Francisco. This rare pneumonia was later determined to be an AIDS-related illness or opportunistic infection (MMWR, June 2001). Other opportunistic infections that were common during that time included Kaposi's sarcoma, a type of cancer, and the fungus Candida. The sudden disease outbreaks marked the start of the AIDS epidemic in the United States (US). As of February 2017, the CDC reported that more than 1.2 million people are currently living with HIV in the US, and that 15% or 1 in 7 people in this country are still unaware of their HIV status.

Globally, approximately 37 million people are expected to be living with HIV. In 2015, an estimated 2.1 million people were newly infected with HIV, which accounts for 5,700 new infections daily. And 1.1 million people died as a result of AIDS-related illnesses indicating a 45% decrease since 2005 (KFF, 2017). Although the overall rate of new HIV infections has steadily declined between the years 2010-2014, new infections among adult populations continue to rise in certain regions of the world.  

HIV/AIDS Basics

What is HIV/AIDS?
HIV stands for the human immunodeficiency virus, which belongs to the lentivirus family. Lenti is the Latin word meaning "slow." Viruses that belong to this genus are slow to develop and remain in a long state of incubation, which is a common characteristic of HIV (Lentivirus, 2017).

HIV leads to acquired immunodeficiency syndrome (AIDS) by destroying the human body's immune system, namely the CD4 cells (T-cells) that help to fight off infections. When someone is HIV-positive, it means that HIV antibodies are present in their system. Antibodies are proteins produced by the immune system to identify and fight germs or infections. However, the presence of HIV antibodies does not mean that an individual has AIDS. A person can carry the virus for years and still have the ability to infect others although they look healthy.

How do you get HIV?
HIV is transmitted through the bodily fluids of an individual carrying the virus. These bodily fluids are blood, breast milk, rectal (anal) mucous, semen, and vaginal and pre-seminal fluids (HIV.gov, 2017). HIV can be transmitted in the following ways:

  • Through the exchange or intake of blood, semen, pre-seminal, rectal, and vaginal fluids usually while having vaginal, anal, or oral sex with someone who is HIV-positive. Sex is the most common mode of HIV transmission.
  • By sharing tainted needles or syringes, rinse water, or other equipment (works) used for injection drug use, tattooing or body piercings with someone who is HIV-positive. Note: HIV can live in a used needle for as long as 42 days depending on the temperature and other environmental factors (AIDS.gov, 2015).
  • Through mother-to-child (perinatal) transmission when a HIV-positive woman transmits the virus to her fetus during pregnancy, labor, delivery, or to her baby while breast-feeding. However, HIV treatment during pregnancy can help to reduce perinatal transmission.
  • Through infected blood from a blood transfusion or organ transplant, although these cases are rare.
  • Eating food that has been pre-chewed by an infected person’s blood. Cases have been reported among infants.
  • Being severely bitten (extensive tissue damage) by someone who is HIV-positive.
  • Through broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated bodily fluids.
  • Deep kissing if partners have sores or bleeding gums and infected blood gets into the blood stream.
Note: Beware of other bodily fluids that may contain substantial amounts of blood, such as saliva, feces, nasal fluid, sweat, tears, urine, or vomit. Health care professionals should also be careful when handling fluid surrounding the brain, spinal cord, bone joints, or the amniotic fluid surrounding an unborn baby (HIV.gov, 2017).

HIV does not live long outside the human body and is not acquired through casual contact such as touching, hugging, talking, or sharing common living quarters with a person infected with HIV or AIDS. You cannot contract the virus:

  • By using the same eating utensils, swimming pools, hot tubs, drinking fountains, toilet seats, doorknobs, gym equipment, or telephones of an infected person.
  • By being bitten by insects such as mosquitoes
  • By having an infected person spit, sneeze, cough, sweat, or shed tears on them.

So, anyone can contract HIV/AIDS regardless of age, sexual orientation, or socioeconomic status.

The Origin & Types of HIV
There are many theories about the origin of HIV, but it is widely believed that HIV crossed from chimps to humans in the 1920s in what is now known as the Democratic Republic of Congo (Avert, 2017). Early HIV cases include:

  • A blood sample of a man taken in 1959 that once lived in the Kinshasa area of the Congo was stored in a freezer for decades. Then in 1998, it was tested and found to be HIV-positive (Carmichael, 2006).
  • A Norwegian sailor that died of immune deficiency in 1966. It is believed that he contracted the virus during his travels to West Africa and to Kenya in 1961. Then in 1967, both his wife and infant daughter dies of immune deficiency. The blood of all three family members tested positive for HIV.
  • Dr. Grethe P. Rask, a Danish surgeon that worked in Zaire (now the Democratic Republic of the Congo) died from opportunistic infection in 1977 (Wiki, 2017).
  • Researchers from the University of Alabama found a strain of SIV (called SIVcpz) in a chimpanzee that was almost identical to HIV in humans in 1999. It is believed that the virus was transmitted via the butchering and consumption of monkey meat, also called “hunter” or “bushmeat theory.” The SIV strain eventually mutated into HIV-1, which is comprised of four different strains: M, N, O, and P (Avert, 2017).

Note: HIV-2 comes from SIVsmm that is found in sooty mangabey monkeys rather than chimps. However, it is believed that as a former zoonotic disease (a disease transmitted from animals to humans), the virus was transmitted from monkeys to humans in the same way as HIV-1. HIV-2 is less virulent and mainly found in West African nations (Avert, 2017).

Global Snapshot of the AIDS Epidemic

The Kaiser Family Foundation reports that the highest concentration of HIV/AIDS continues to be sub-Saharan Africa, which accounts for 70% of people living with HIV. Yet according to the World Health Organization (2017), HIV/AIDS is no longer listed among the top 10 causes of death in the world, but it still remains the number one of cause of death in Africa. As of 2015, the breakdown of the number of adults and children living with HIV worldwide is as follows:

Global Regions
United Nations-World Health Organization

People Living with HIV/AIDS in 2015

Eastern and Southern Africa

19 million

Western and Central Africa

6.5 million

Asia and the Pacific

5.1 million

Western and Central Europe

North America

2.4 million

Latin America and the Caribbean

2 million

Eastern Europe and Central Asia

1.5 million

Middle East and North Africa                          

230,000

Global Total

  37 million

UNAIDS is on a serious and ambitious mission to eliminate AIDS as a major public health threat by the year 2030. The UNAIDS 2016–2021 Strategy is the first in the United Nations to be aligned with its Sustainable Development Goals. The UNAIDS Strategy was designed to ensure that no segment of the world’s human population that is impacted by HIV/AIDS, including women, children, youth, same-sex couples, drug users, sex workers, migrant, or transgender populations are left behind in receiving support to live empowered lives.  

HIV/AIDS in the United States
In the United States, the CDC estimates that approximately 700,000 Americans have died as the result of AIDS-related illnesses, and as many as 1.1 million people are currently living with HIV. On average, an estimated 40,040 people are now diagnosed with HIV annually compared to 56,000 less than a decade ago.

In the early 1980s, HIV was more prominent among white gay males; however, there has been a steady increase in the number of cases among racial and ethnic populations, as well as among gay and bisexual men, and other men who have sex with men that may not classify themselves as being gay or bisexual. For example, in 2015, African-American women accounted for 60% of all new infections of HIV among women compared to 19% among white women and 16% among Hispanic women. Between 2010 and 2015, the rate of new HIV infections increased among American Indians/Alaskan Natives and Asians increased while the rates for African Americans, Hispanics/Latinos, Native Hawaiians/Pacific Islanders, whites, and persons of multiple races decreased overall. And of all new HIV infections in 2015, 44.3% occurred among African Americans compared to 16.4% among Hispanics, 14.1% among Native Hawaiians/Other Pacific Islanders, 12.2% among persons of multiple races, 8.8% among American Indians/Alaska Natives, 5.5% among Asians, and 5.3% for whites (CDC, 2015). In 2015, 58% of new HIV diagnoses among African Americans were attributed to male-to-male sexual contact and 34% were attributable to heterosexual sex.

Furthermore, among HIV cases that advanced to Stage 3 AIDS, 21.8% occurred among African-Americans, 9.4% among persons of multiple races, 6.8% among Hispanics, 4.1% among American Indians/Alaska Natives, 3.9% among Native Hawaiians/Pacific Islanders, 2.4% among whites, and 1.9% among Asians (CDC, 2015).

Also in 2015, 70% of all HIV infections were attributed to male-to-male sexual contact and injection drug use, while 24% occurred among heterosexual contact. Therefore, sex remains the primary mode of HIV transmission (CDC, 2015).

HIV/AIDS in the South
According to the CDC 2015 HIV Surveillance Report, the South (Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia) continues to have the greatest number of people living with HIV/AIDS at 16.8% compared to 11.6% in the Northeast (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont), 9.8% in the West (Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming), and 7.6% in the Midwest (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin).

Unfortunately, in rural areas, it is not uncommon to find a high concentration of new HIV cases. The virus is globally prominent among cultures or communities with high joblessness, substance abuse, teenage pregnancy, sexually transmitted diseases, poverty, and limited access to healthcare and prevention education.

Since 1982, the Alabama Department of Public Health (ADPH) has conducted HIV and AIDS case surveillance on all patients diagnosed with HIV in Alabama. Confidential, name-based reporting began in 1987 when the Alabama Notifiable Disease Laws were amended requiring all facilities, private and public, including laboratories and hospitals, to report all HIV cases. Since 2011 all positive HIV tests, CD4 test results along viral loads became reportable to ADPH under Alabama Public Health Law. Therefore between 1982 and March 2017, an estimated total of 20,499 cases of HIV infection among Alabama residents have been reported to ADPH. A breakdown of these cases by race and ethnicity is as follows:

Race/Ethnicity

Cumulative HIV in Alabama

African American

13,179 (64.3%)

Hispanic

386 (1.9%)

Multirace

591 (2.8%)

Unknown

135 (0.7%)

White

6,208 (30.3%)

Safe Health Practices

The only way to tell if you have HIV is by being tested. A person living with HIV is diagnosed by a physician as having AIDS when they have one or more "opportunistic infections" associated with an impaired immune system, or when there is evidence their immune system is "depressed" by a diminished supply of CD4 cells in their blood. A person who is diagnosed as being HIV-positive has undergone an antibody test to confirm they are infected with the virus.

To avoid being infected, it's important to make smart decisions. Alcohol and drugs greatly impair the decision-making process. Get tested regularly for HIV regardless of your marital status, age, sexual orientation, or socioeconomic background since everyone is vulnerable to HIV/AIDS. In the state of Alabama, you can get tested for sexually transmitted diseases at the age of 12, which includes HIV screenings.

Here are some other helpful preventive measures.

  • Inform your current and past sex partners about your HIV status.
  • Use a dental dam and/or a new latex condom each time you engage in sex, even if you and/or your partner is HIV-positive.
  • Use water-based lubricants with condoms since oil-based lubricants are known to cause tears or rips in condoms.
  • Don't share sex toys, needles, or other drug paraphernalia.
  • Avoid breast feeding and/or donating blood, plasma, or bodily organs if you are HIV-positive.
  • Do not share toothbrushes or razors.
  • Seek treatment as soon as possible.
  • Use sterile injection equipment and avoid sharing needles, syringes, or other equipment.
  • If you are HIV-positive and have an HIV-negative partner, then you are advised to consult with a physician about the use of a pre-exposure prophylaxis, more commonly known as PrEP. PrEP has been approved for daily use to prevent an HIV-negative person from getting HIV from an HIV-positive partner via sex, or injection drug use. PrEP may reduce the risk of getting HIV from sex by more than 90%, and as much as 70% among people who inject drugs.

Where to Go for Help in Alabama

If you do not have a physician and/or cannot afford medical care, then contact your local county public health department, an AIDS service organization (ASO), or call the Alabama AIDS Hotline in Montgomery at 1.800.228.0469. An AIDS service organization is just as its name implies. It is an organization that provides HIV/AIDS services such as counselling, screening, shelter, or medical treatment for individuals and families that are affected by HIV and AIDS. You can also find the nearest ASO by typing in your city, state, and/or zip code at https://www.hiv.gov/.

Conclusion

I hope this article paints a clearer picture of HIV/AIDS. While it’s just a snapshot of the AIDS epidemic, I encourage you to read more about HIV/AIDS on your own and how it impacts your community. In an increasingly connected global society, we can no longer afford to make unwise or engage in behaviour that puts us at risk for HIV infection. Anyone can be infected with HIV regardless of your age, sexual orientation, or marital status. Since most HIV tests are free at AIDS service organizations, why not make HIV screenings part of your annual health and wellness check-up! 

Visit http://www.aces.edu/pubs/docs/U/UNP-0045/UNP-0045.pdf to read or to download the HIV/AIDS Fact Sheet.

References

Alabama Department of Public Health. (2016, October 11). Demographics of HIV infection among individuals residing in Alabama at diagnosis. Retrieved from http://www.alabamapublichealth.gov/hiv/assets/hiv_aidsreport_1st_quarter_2017.pdf.

Avert. (2013). Origin of HIV and AIDS. HIV Origins. Retrieved from https://www.avert.org/professionals/history-hiv-aids/origin.

Carmichael, M. (2006, May 30). How it began: Before the age of AIDS. Frontline: The Age of AIDS. Retrieved from http://www.pbs.org/wgbh/pages/frontline/aids/virus/origins.html.

Centers for Disease Control and Prevention. (2001, June 1). First reports of AIDS. Morbidity and Mortality Weekly Report, 50(21). Retrieved from https://stacks.cdc.gov/view/cdc/28395.

Centers for Disease Control and Prevention. (2016, November). HIV Surveillance Report, 2015. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Retrieved from http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html.

Centers for Disease Control and Prevention. (2017, May 30). About HIV/AIDS. Retrieved from https://www.cdc.gov/hiv/basics/whatishiv.html

Centers for Disease Control and Prevention. (2017, June 7). PrEP. Retrieved from https://www.cdc.gov/hiv/basics/prep.html.

HIV.gov. (n.d.). HIV basics. Retrieved from https://www.hiv.gov/hiv-basics.

Lentivirus. (2017, May 31). In Wikipedia. Retrieved from https://en.wikipedia.org/wiki/Lentivirus.

The Henry J. Kaiser Family Foundation. (2017, January). The global HIV/AIDS epidemic. Fact Sheet. Retrieved from http://files.kff.org/attachment/Fact-Sheet-The-Global-HIV-AIDS-Epidemic.

The Henry J. Kaiser Family Foundation. (2017, February). The HIV/AIDS epidemic in the United States: The basics. Fact Sheet. Retrieved from http://files.kff.org/attachment/Fact-Sheet-HIV-AIDS-in-the-United-States-The-Basics.

Sharp, P. M., & Hahn, B. H. (2011, September). Origins of HIV and the AIDS pandemic. Cold Spring Harbor Perspectives in Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234451/pdf/cshperspectmed-HIV-a006841.pdf.

Photo: Red Ribbon by hernán, Flickr at https://www.flickr.com/photos/freizeit/3073488376