What is HIV/AIDS?
Human immunodeficiency virus (HIV) is a retrovirus that attacks white blood cells known as T4 (CD4) lymphocytes . The function of the T4 cells is to determine if foreign matter such as bacteria or viruses has entered the human body . Upon interaction with a bacterial or viral cell, a T4 cell will alert the immune system to its presence . The immune system responds by attacking and eliminating the foreign matter and any infected cells using an array of white blood cells (both B and T lymphocytes). In an HIV-infected individual, the functioning of the immune system gradually becomes impaired as HIV virions infect and alter the behaviour of the T4 cells, ultimately destroying the T4 cell population and circulating the HIV virus throughout the body. This puts HIV carriers at risk of developing infections from which they may not recover.
Healthy adults normally have T4 cell counts of anywhere from 800-1200 per mL of blood . When the T4 count of a person infected with HIV drops below 200/mL they are diagnosed with acquired immunodeficiency syndrome (AIDS) . Individuals suffering from AIDS are unable to fight infections and certain cancers. At this time, there are no vaccines or cures for HIV or AIDS.
What are the methods of HIV transmission?
An HIV-negative individual can only contract the HIV virus if they come into direct contact with certain body fluids of an infected individual . The body fluids that can lead to HIV transmission are normally exchanged via sexual intercourse, injection drug use, blood transfusions, and during perinatal events (i.e. intrauterine, birth, breast feeding) . An isolated report of HIV transmission was reported as a result of kissing in 1997 . It is thought that an infected man passed the virus to his female partner because both suffered from severe gum disease . However, physicians still consider kissing to be a very low risk activity in terms of HIV transmission!
According to the American Center for Disease Control, insects, tears, sweat, coughing, or sneezing cannot spread HIV . Furthermore, daily contact with infected persons will not result in HIV transmission. As long as clothes, eating utensils, drinking glasses, phones, and toilet seats remain free of infected blood, HIV cannot be passed on .
Where is HIV thought to have originated?
There are two strains of the HIV virus: HIV-1 and HIV-2. HIV-1, the more common precursor to AIDS, was found to originate in chimpanzees in equatorial West Africa . Primates are carriers of SIV (Simian Immunodeficiency Virus), and researchers determined that the genetic composition of SIV found in the chimpanzee subspecies Pan troglodytes troglodytes was very similar to the composition of HIV-1 . It is thought that the virus jumped from primate to man as a result of human consumption of chimpanzee meat. Giving weight to this hypothesis is evidence that the strain of the SIV virus found in Pan troglodytes troglodytes is actually derived from the transmission and recombination events of the SIVs found in smaller monkeys on which chimpanzees prey . The scientists who performed this study argue that if the virus can be passed from a monkey to a chimpanzee, it can also be passed from a chimpanzee to a human under similar circumstances (i.e. consumption of infected meat).
The first documented case of human HIV infection occurred in 1959 in an area now known as the Democratic Republic of the Congo (a blood sample taken at this time was subsequently analyzed for the virus years later) . However, the virus was not actually detected until a few decades later. In 1981 American physicians started reporting incidences of an unknown immune deficiency disorder that seemed to target homosexual men, injection drug users and hemophiliacs (frequent blood transfusion recipients) . The acronym of AIDS was quickly adopted to describe the disease. French researchers discovered the HIV virus shortly thereafter and were able to systematically link its progression to AIDS .
Who does it affect?
In short, anyone and everyone. Children, youth, and adults alike continue to become infected with HIV at alarming rates. In a recent publication entitled AIDS epidemic update 2004, UNAIDS and the WHO estimated that 39.4 million people across the globe were living with HIV/AIDS in 2004 . During this same period, 4.9 million people were thought to have contracted the HIV virus, while 3.1 million died from AIDS.
Women and girls in particular are becoming increasingly affected by HIV/AIDS. In comparison with 5 years ago, this segment of the population accounts for an increasing proportion of people living with AIDS. One of the more alarming statistical figures to support this statement comes from sub-Saharan Africa where nearly 65% of world’s HIV-infected people live. An astounding 76% of young people aged 15-24 with HIV in this region are female . This infection rate can be attributed to a lack of education and gender inequality. A UNICEF survey conducted amongst young women in high-prevalence countries found that 50% displayed no knowledge of the basic facts of AIDS . In addition, most women are infected by the high-risk lifestyles of their male partners . Thus, cultural and domestic roles often prevent women from avoiding HIV exposure.
What are the major challenges posed by HIV/AIDS?
According to UNAIDS, the major challenges are :
The female face of the epidemic. While men have traditionally accounted for a majority of positive HIV diagnoses, women are increasingly at great risk of infection. By the end of 2003, women accounted for nearly 50% of all people living with HIV worldwide and for 57% in sub-Saharan Africa. Unfortunately, women and girls also bear the brunt of the impact of the epidemic in a number of ways. They are most likely to take care of sick people, to lose jobs, income and schooling as a result of infection. In addition, women and girls often face stigma and discrimination that can increase their odds of contracting HIV, or lead to ostracism if they are known carriers of the virus. Many factors such as gender and cultural inequalities, violence, and ignorance contribute to the vulnerability and risk experienced by women. These issues must be urgently addressed to protect the female population from further HIV infection.
Young people. Almost half of all new HIV infections in the world occur in 15-24 year olds. This demographic group is the largest youth generation in history and needs regular schooling and access to health and support services if the HIV/AIDS epidemic is to be stopped.
Treatment programmes. More funds are needed to provide life-prolonging antiretroviral therapy. By the end of 2003, a mere 7% of the people who needed antiretroviral treatment in developing countries had access to the proper drugs.
Public services. A number of sub-Saharan countries in Africa are experiencing great difficulties in providing vital public services that are imperative to preventing the spread of HIV/AIDS. Some of the explanations for the lack service include the migration of key people from public to private sectors, migration abroad, and the deadly impact of the AIDS epidemic itself.
Universal prevention education. Current prevention programmes only reach one in five people at risk of HIV infection. In addition, only one in ten pregnant women receive treatment to prevent mother-to-child HIV transmission in low- and middle-income countries. Similar problems also exist in high-income countries, where treatment is often a higher priority than prevention. As a result, HIV transmission has risen in high-income countries for the first time in ten years.
Eliminating stigma and discrimination. Stigma and discrimination inhibit the effectiveness of AIDS responses – they stop people from being tested for HIV, they prevent the use of condoms, they encourage HIV-positive women to breastfeed their babies, and they prevent marginalized groups such as injection drug users from receiving treatment and support.
Mass orphanings. In sub-Saharan Africa, nearly 12 million children have been orphaned after one or both parents died from AIDS. A large number of these children are not properly cared for.
What is being done?
Many countries have taken a number of effective steps to decrease the incidence of HIV infection. By distributing condoms , setting up needle exchange programs , implementing effective blood screening measures , and making zidovudine (an antiretroviral drug) accessible to pregnant women , it has been found that HIV transmission rates can be reduced in all segments of the population. These steps can also lower treatment costs, allowing limited medical resources to reach those who need them.
One of the major challenges posed by HIV/AIDS is the poverty that is inherent to many of the countries experiencing epidemics. Without the funds to implement comprehensive educational and prevention programs or to provide antiretroviral drugs to expectant mothers (and the rest of the population for that matter), the HIV virus continues to spread rapidly. Fortunately, the international community is committed to eradicating HIV/AIDS and is making concerted efforts to achieve that end.
Since 2001, annual global funding for HIV/AIDS has increased from US$2.1 billion to US$6.1 billion in 2004 . This financial boost has greatly improved access to key prevention and treatment services in 73 low- and middle-income countries that are home to nearly 90% of infected peoples worldwide . In these nations, the number of high school students receiving AIDS education has tripled and the number of individuals undergoing voluntary counseling and testing has doubled since 2001 . Further evidence of the success of the increased funding is the fact that number of women receiving treatment to prevent mother-to-child transmission has increased by 70% over this same period. While the number of people who have been to obtain antiretroviral drugs has also risen by 56%, 9 out of 10 infected people still do not have access to them . To deal with this troubling statistic, major efforts are underway to cheaply distribute the much-needed medications.
Both the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) have established the 3 by 5 Initiative. This initiative seeks to treat 3 million people in low- and middle-income countries with antiretroviral drugs by the end of 2005. The ultimate goal of this UNAIDS/WHO partnership is to provide HIV/AIDS infected persons with universal access to antiretroviral therapy.
Another recent initiative taken by UNAIDS and donor countries is the Three Ones. The principles of this initiative are based on the belief that HIV/AIDS epidemics must be tackled by the affected countries themselves. To ensure resources are used effectively and efficiently, and to ensure rapid action and proper management of the efforts, the following principles were endorsed :
– One agreed HIV/AIDS Action Framework to coordinate the work of all partners.
– One National AIDS Coordinating Authority to oversee a country’s efforts.
– One agreed country-level Monitoring and Evaluation System to determine the effectiveness of prevention and treatment programs.
While the premises of Three Ones and the 3 by 5 initiative are sound and show great promise, only time will tell if they prove effective in halting the spread of HIV/AIDS. Indeed, the difficulties faced by the orchestrators of any comprehensive HIV/AIDS action plan are perhaps best summed up in the following quotation from the AIDS epidemic update 2004 publication:
“A massive effort is needed to achieve a response on a scale that matches that of the global AIDS epidemic. Without invigorated HIV prevention strategies that deal boldly with the epidemic, and that also address the wider imperatives of social justice and equality, the world is unlikely to gain the upper-hand over AIDS in the long run.” (p.10)
How does HIV/AIDS affect British Columbians?
Vancouver’s Downtown Eastside is plagued by rampant unemployment, substance abuse, prostitution, and homelessness, making it one of North America’s poorest neighbourhoods. The combination of the drug trade and the sex industry has led to HIV infection rates amongst the resident population that are the highest in all developed countries. Aboriginal peoples are particularly at risk of contracting HIV in British Columbia and a study published in the Canadian Medical Journal in 2003 found that aboriginal injection drug users were being infected with HIV at twice the rate experienced by other drug users in the Downtown Eastside . This problem of HIV infection within the aboriginal community is not just limited to Downtown Eastside inhabitants. Recent data released by a team of epidemiologists in BC indicates that 7.9% of aboriginal drug users in Prince George are infected with HIV (compared to 17% in Vancouver) . Physicians with the BC Centre for Excellence in HIV/AIDS are worried that the spread of HIV in northern British Columbian communities could reach epidemic proportions in a few years. To combat this threat a three-stage strategy is being proposed that promotes prevention education, establishes addiction services, and ultimately addresses the social causes of HIV transmission.
What is being done in Vancouver to address HIV/AIDS?
While HIV does exist in Vancouver’s heterosexual and homosexual populations, the majority of new infections appear in drug addicts. In an effort to deal with the social problems that lead to and are caused by drug addiction the City of Vancouver has adopted the Four Pillars Drug Strategy. This approach is designed to address the effects of drugs on our communities through the four pillars of harm reduction, prevention, treatment, and enforcement. While the Four Pillars Strategy wasn’t introduced to specifically target HIV/AIDS, its mandate involves reducing the spread of HIV and Hepatitis C, and providing medical care and support for those who are infected with these diseases.
In September 2003, the first supervised safe injection site in North America was opened in Vancouver. By providing addicts with needles, it was hoped that reducing syringe sharing would halt the further spread of blood borne communicable diseases. A team of Vancouver-based researchers corroborated this belief earlier this year when they published a study that outlined the effectiveness of safe-injection sites in attracting injection drug users, preventing needle-sharing, reducing the spread of disease, and providing addicts with medical treatment and addiction referral services.
Various public health initiatives targeting school-age children and teenagers also exist in Vancouver that seek to educate students on safe sex practices.
(artwork by Stephanie Cheung)