The Many Facets of HIV/AIDS Updated January 2009 Photos courtesy of Jon Rawlinson, Flickr By Wendi Williams, HIV/AIDS Prevention Educator

Introduction
On June 5, 1981, 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 pneumonia was later determined to be an AIDS-related illness (MMWR, June 2001). Other opportunistic infections that were common during that time included Kaposi's Sarcoma, a type of cancer, and the fungus Candida. This period in history marked the start of the AIDS epidemic in the United States (US).

As of December 2008, the CDC reported that more than 1.2 million people are now living with HIV/AIDS in the US, which includes 440,000 living with AIDS. In 2007, the Joint United Nations Programme on HIV/AIDS (UNAIDS) reported that more than 33 million people (between 30-36 million people) are expected to be living with HIV worldwide. In the same year, an estimated 2.7 million people were newly infected, while 2 million people died as a result of AIDS-related illnesses. Although much progress has been made to get this epidemic under control, it is clear that much more work needs to be done in the areas of prevention education and treatment since there is no cure for AIDS.

Most medical professionals today believe that HIV causes the Acquired Immunodeficiency Syndrome (AIDS) by weakening the body's immune system and its ability to fight 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 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 up to 10 years or longer and still have the ability to infect others although they may look perfectly healthy.

You can contract the virus:

• Through the exchange of blood, semen, and vaginal secretions while engaging in vaginal, anal, or oral sex with someone who is HIV-positive.
• By sharing needles or syringes used for injecting prescribed or illegal drugs, tattooing, or ear piercing with someone who has HIV.
• An HIV-positive mother can pass the virus to her baby while breastfeeding, through the umbilical cord during pregnancy, or via contact with vaginal fluids and/or blood during birth.

Luckily, the virus does not survive long outside the human body and is not contracted casually by touching, hugging, talking to, or sharing common living quarters with a person infected with HIV. You cannot contract the virus by using the same eating utensils, swimming pools, hot tubs, drinking fountains, toilet seats, doorknobs, gym equipment, or telephones with infected individuals.

No one to date has contracted the disease by having an infected person spit, sneeze, cough, sweat or shed tears on another individual. Kissing is also an uncommon way to transmit the virus and only one known case has ever been reported involving the intake of blood (from bleeding gums) as a result of kissing (MMWR, 1997). Although a small amount of HIV has been found in the saliva of some AIDS patients, there are no reported cases on record to conclusively say that HIV is transmitted through the saliva of an infected person. Furthermore, there is no scientific evidence that verifies the transmission of HIV from mosquito to man. The virus does not infect insects and HIV has not been detected in insect feces. However, human bite cases from HIV-infected persons, with the presence of blood and severe tissue damage, have been reported to health officials although biting is also an uncommon way to transmit the virus.

As for giving blood, it is considered safer to undergo blood transfusions today since donors are screened for risk factors and donated blood is tested for the presence of HIV antibodies.

The Origin & Types of HIV
There are many theories about the origin of HIV/AIDS. Some individuals believe the first strain of HIV and its cousins HIV-2 and the simian immunodeficiency viruses (SIVs) evolved as a result of experiments for a genocidal or biological warfare program to thin certain segments of the world population. Notable scholars claim to have credible documentation on the epidemiology of AIDS that corresponds with a section of a government report detailing its "special virus program." These researchers also claim there is no direct scientific evidence to support the natural evolution of HIV-1 from monkeys to humans (Horowitz, 2001).

Both the HIV-1 and HIV-2 strains share a common ancestor, the SIV. Journalist Edward Hopper suggested in his book The River, that HIV can be traced to CHAT, an oral polio vaccine that was administered to more than 1 million Africans living in Belgian Congo, Ruanda, and Urundi in the late 1950s (de Boer, 2008). Then in 1999, a group of researchers from the University of Alabama-Birmingham studied frozen tissue from a chimpanzee and discovered that the simian virus it carried was almost identical to HIV-1. It is now widely claimed that West-African chimps were the source of HIV-1 and the virus did indeed cross from chimps to mankind via human consumption or genetic experimentation (Kanabus, Allen, 2003; de Boer, 2008). HIV-2, on the other hand, is believed to have come from the SIV strain SIVsm found in sooty mangabey monkeys in West Africa.

We may never know the true origin of HIV, but we do know that some of the earliest known cases of HIV are documented as follows:

• A blood plasma sample taken in 1959 from an adult male living in the Republic of Congo suggests that HIV could have been introduced into humans around the 1940s or the early 1950s. However, some scientists believe the disease has been around for 100 years or longer.
• HIV was found in 1969 in the tissue samples from an African-American teen living in St. Louis.
• HIV was found in a lymph node sample in 1960 from a female living in the Congo Republic.
• The presence of HIV antibodies was found in the tissue samples of a Norwegian sailor who reportedly died in 1976 (Kanabus, Allen, 2003; de Boer, 2008).

Differences between HIV-1 and HIV-2
Today, there are still two types of HIV: HIV-1 and HIV-2. Although the predominant virus is HIV-1, both types are transmitted through the blood, semen, vaginal fluids, and/or breast milk of an HIV-positive person. HIV-1 and HIV-2 also share similar symptoms as they progress to AIDS. However, HIV-2 is not easily transmitted and the time between the initial infection of HIV and the illness (AIDS) is much longer. There are more cases of HIV-2 in West Africa than any other place in the world (Noble, 2008).

Consequently, HIV-1 is a highly changeable form of the virus with various subtypes that fall within three groups: the major group M, the "outlier" group O, and the rarest group called N. Group O is mainly found in west-central Africa, while Group N was found in the Cameroon. Group M comprises 90 percent of all HIV-1 worldwide. Today, Group M makes up nine subtypes (A-D, F-H, and J-K). The differences between these subtypes primarily rest in their genetic composition (live or vitro), and their mode of transmission. For example, subtype B is common among the disease contracted via blood versus subtypes E and C, which are more easily transmitted via mucous membranes (Noble, 2008).

It is obvious that more research is needed, particularly since subtypes are known to take on different characteristics. Therefore, you can imagine how complicated it is for scientists to find a cure. It is likely the first HIV vaccines, as with any vaccines, will not be 100 percent effective. But progress will continue until a cure is found.

Status of Global Epidemic
In 2009, chances are great that you have met someone who is HIV-positive, or have heard of someone who has died as a result of AIDS. Since 2001, the number of people living with HIV/AIDS rose from 29.5 million to 33 million in 2007, while AIDS-related deaths also increased from 1.7 in 2001 to 2 million during the same period. There were an estimated 5.3 new infections in 2007 alone. The increase in the total number of cases has risen as a result of new infections, people living longer with HIV, and general population growth (KFF, 2008).

The highest concentration of HIV/AIDS continues to be sub-Saharan Africa, which accounts for 67 percent of people living with HIV, 75 percent of the AIDS-related deaths, and 12 million orphans. In August 2008, UNAIDS also provided the following breakdown of the number of adults and children currently living with HIV worldwide:

The transmission of the virus is higher in densely populated areas where the infrastructure does not permit effective treatment or response as found in some parts of Asia, Africa, and rural America. The areas to watch are Indonesia, the Russian Federation, and other countries where people earn high incomes (UNAIDS, 2008).

As one can imagine, the pandemic is causing global emergencies as it destroys the lives of individuals and communities, and it delays political and socioeconomic progress. As Swaziland's King Mswati III once stated during a United Nations conference, "My people are dying. They are dying before their time, leaving behind children as orphans, and a nation in a continuous state of mourning."

In 2005, countries began to take a serious look at the HIV/AIDS efforts. As of March 2008, 105 countries designed a plan to offer HIV prevention education, treatment and care, and support for their citizens impacted by the epidemic.

United States & Alabama HIV/AIDS Statistics
Based on 1981-2007 statistics compiled by the CDC of reported cases, approximately 1.7 million people in the United States (US) have been infected with HIV and more than 565,000 of these Americans have died from AIDS-related illnesses. In 2006, more than 56,300 new infections occurred, a substantially higher number than expected.

In the early 1980s, AIDS was more prominent among whites; however, there has been a steady increase in the number of cases among racial and ethnic populations. For example, African-American women now account for 66 percent of all new AIDS cases compared to 16 percent of Latinas and 17 percent of white women. African-American women also comprise 61 percent of new HIV infections. Overall, 47 percent of African Americans, 34 percent of whites, 17 percent of Latinos, and less than 1 percent of American Indian/Alaska Native or Asian/Pacific Islander are currently living with HIV/AIDS nationally.

Men who have sex with men (MSM) comprised 53 percent of all new infections among men in 2006. Young MSMs between the ages of 13-29 accounted for 38 percent of the total new MSM infections, while young black MSMs in the same age group made up 52 percent of those cases. Men who have sex with men is still the most common method of HIV exposure (63 percent), followed by injection drug users (12 percent), and high-risk heterosexual sex (16 percent).

The South/Alabama
According to December 2008 surveillance data published by the CDC, 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 41 percent compared to 29 percent in the Northeast (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont), 20 percent in the West (Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming), and 11 percent 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.

As of January 13, 2009, 16,014 cases of HIV/AIDS have been reported in Alabama since 1982 according to the Alabama Department of Public Health. Nearly 64 percent of new infections occurred among African-Americans, although they comprise 26 percent of the state's population (ADPH, 2009).

Finding a Cure
Finding a cure may seem impossible because HIV protects itself with a ring of sugars that expose potential antibody binding sites briefly while it infects cells. This diminishes the amount of time a perfect antibody would have to capture the virus. Simultaneously, the virus mutates rapidly and further reduces the likelihood of an antibody match. In addition, the various strains found around the world vary greatly. Therefore, a vaccine that might work in North American strains for instance, may prove to be useless in Africa (Vastag, 2001). On the other hand, even if a vaccine fails to prevent individuals from becoming infected, cell-mediated responses could still ease the course of the disease, keeping viral loads down and reducing the risk of transmission. In other words, it could slow the spread of HIV in the human population.

Currently, there are medical treatments that slow down the rate at which HIV weakens the immune system. Other treatments have been identified to prevent or cure some of the illnesses associated with AIDS; however, there is no cure for AIDS. As with most diseases, early detection does offer more options for treatment and preventive care. For instance, HIV-positive mothers can reduce the risk of transmitting the virus to their baby if they take antiretroviral drugs during pregnancy, birth and delivery, and if the infant receives these drugs during the first six weeks following birth. They can also reduce HIV transmission to their babies by having a Caesarean birth.

The Food and Drug Administration has approved more than 30 drugs for the treatment of complications due to HIV/AIDS, and other experimental therapies are in the pipeline. However, patient resistance to these drugs still poses a problem. Drugs used to treat HIV fall into the following categories:

• Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
• Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)
• Protease Inhibitors
• Fusion Inhibitors
• Integrase Inhibitors
• Entry Inhibitors
• Combination Drugs

Scientists are working diligently to find an AIDS cure.

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, including youth, singles, married couples, and adults over the age of 50 since HIV/AIDS does not discriminate across gender, age, or racial lines. In the state of Alabama, you can get tested for sexually transmitted diseases at the age of 12, which includes HIV screenings.

In September 2006, the CDC issued updated recommendations for HIV screening among pregnant women, adults, and adolescents. Physicians are now encouraged to screen for HIV during routine physical examinations.

Here are some other helpful preventive measures.

If you're HIV-positive:

• Inform your current and past sex partners about your HIV status.
• Use a new latex condom each time you engage in sex, even if your partner is also HIV-positive.
• Use water-based lubricants with condoms since oil-based lubricants are known to cause tears or rips in the condom.
• Don't share sexual apparatuses (toys), needles, or other drug paraphernalia.
• Avoid donating blood, plasma, or bodily organs.
• Do not share toothbrushes or razors.
• If pregnant, you are encouraged to take antiretroviral drugs to reduce the risk of transmission to your baby. Once the baby is born, you should also avoid breast-feeding. Find a doctor you can talk to openly about your health.

If you have same sex partner(s):

• You risk being infected through bodily fluids (oral and vaginal, including menstrual blood). Therefore you should wear condoms and use a dental dam or another protective barrier during oral sex.
• Avoid sharing sexual apparatuses.

If you're heterosexual:

• Use a latex condom with a water-based lubricant. The female condom also provides effective protection against HIV or other sexually transmitted diseases.
• Use a new condom or another protective barrier during oral sex.
• Don't share sexual apparatuses.

If you're an injection drug user:

• Seek treatment for drug use as soon as possible.
• Use sterile injection equipment and avoid sharing needles, syringes, or other equipment.
• Be sure that all equipment and supplies used (cotton, water and the drug itself) is not contaminated.
• Of course the surest way to avoid HIV infection is to practice sexual abstinence and avoid sharing blood-tainted needles during drug injections or while getting a tattoo or a body piercing.

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 office, an AIDS service organization in your area, or 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.

Alabama AIDS Service Organizations
1917 Clinic at University of Alabama at Birmingham
Phone: 205.934.1917 / Toll free: 877.614.9129
Services: Prevention education, HIV testing & medical care for HIV-positive individuals

AIDS Action Coalition (Davis Clinic) (Huntsville)
Phone: 256.536.4700 / Toll free: 800.728.3603
Services: Education; housing; & emergency financial assistance for people with HIV/AIDS and their families

AIDS Alabama (Birmingham)
Phone: 205.324.9822 / Confidential Help Line: 800.592.2437
Services: Temporary & permanent housing for HIV-positive, low-income, and homeless individuals; substance abuse treatment; transportation; and outreach in rural Alabama

AIDS Outreach of East Alabama Medical Center (Opelika)
Phone: 334.887.5244
Services: Infected or affected by HIV

Birmingham AIDS Outreach
Phone: 205.322.4197
Services: Food financial assistance, counselling, and educational services to people with HIV

The Health Services Center, Incorporated (Anniston)
Phone: 256.832.0100 / Toll free: 866.832.0100
Services: Medical care and support to HIV-positive clients

Montgomery AIDS Outreach
Montgomery Phone: 334.280.3349 / Dothan: 334.673.04994
Services: Case management, housing assistance, counselling, substance abuse treatment and both primary health care and HIV-specific health care to persons with HIV

South Alabama Cares (Mobile)
Phone: 251.471.5277
Services: Financial and housing assistance, education, and support services to people with HIV

West Alabama AIDS Outreach (Tuscaloosa)
Phone: 205.759.8470 / Toll free: 800.722.2437
Services: Direct care, emergency financial assistance for HIV-positive individuals, & free HIV screening

In an increasingly connected global society, we can no longer afford to make unwise or cavalier decisions regarding sex, drug use, or the sharing of tainted needles. Remember, regardless of your ethnic or socioeconomic background, you could become infected with HIV. NO ONE is exempt from this deadly virus. So, do yourself a favor and GET TESTED! It only takes 3-20 minutes to get your screening results depending on the test. It's better to know your HIV status.

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