HIV, AIDS & Infectious Diseases

By Alex Jackson

The Origin of HIV

The origin of HIV is a widely debated topic. The most common theory is that HIV originated in Africa around Uganda, Tanzania or Rwanda when a hunter ate a monkey that had been infected with a similar pathogen to the HIV virus. The HIV virus then mutated inside of the human, allowing it to become effective against humans too. Such a process is rare in nature, but not implausible, so this theory has gained some popularity.

An alternative (more “new world order”) theory is that the virus was created within a laboratory in the USA and was “leaked” into the surrounding environment and spread among humans. This theory is far less plausible, given that it doesn’t really explain how the disease managed to get to central Africa.

Yet another theory is the idea that the disease originated during drug trials in Africa, more specifically in Congo. While under Belgian rule, drug trials took place and several of the drugs were made from monkey parts. These drugs were then administered to the general population. This theory fits the pattern of the initial outbreak of the virus, but is considered biologically implausible.

What Is HIV & AIDS?

HIV and AIDS are not the same thing! AIDS is a disease that results from the HIV virus when left untreated. HIV (Human immunodeficiency virus), is a retrovirus carried within the human bloodstream that essentially destroys white blood cells (more specifically CD4 cells), responsible for protecting the body from many diseases. As the virus destroys these cells, the body’s white blood cell count drops, the body loses its immunity and is said to have AIDS (Acquired immunodeficiency syndrome). The person becomes susceptible to a variety of diseases which ultimately finish the person off.

AIDS wasn’t actually recognised as a medical condition until 1981 and its cause (HIV) wasn’t recognised until 1983. HIV/AIDS has spread rapidly since its initial discovery and is currently considered a global pandemic by the WHO.

AIDS is transferred between humans primarily when bodily fluids are exchanged (blood, during sex etc.). This can be due to using infected needles, either due to drug abuse or due to poor quality health care. Blood transfusions were, but no longer are, a source of HIV/AIDS (transfusions are now screened). HIV/AIDS can also be transferred during pregnancy.

The disease is currently considered incurable and a vaccine doesn’t exist (largely due to the rapidly changing nature of the virus). Antiretroviral treatments are available and can help prolong the life of individuals, but people’s life expectancy still falls substantially once infected with the disease. The actual effects of HIV/AIDS can take many years to appear after infection.

Management Of HIV/AIDS

Given that a vaccine to the disease is many years away and potentially impossible, controlling the spread of the disease and caring for those that are ill is the only way to combat it and alleviate its effects. The use of antiretroviral drugs can help to alleviate some of the effects of the disease and increase the lifespan of an infected individual. These drugs are widely available but are very expensive and, despite costs falling over the past ten years, are not widely available in LEDCS, the countries which most need them.

Predicting the spread of the disease is important as it can allow us to allocate resources in specific areas which are at a high risk of infection. If predictions are combined with an aggressive prevention programme, the disease could potentially be wiped out without the need for a vaccine.

Education is, and will continue to be, the most powerful method for controlling and reducing the spread of the disease. The issue with education is how available it is. In many LEDCs, people can not afford education. In some countries, developed or not, it is difficult for certain groups of people to access education such as women, or homosexuals, who are particularly vulnerable to the disease. The provision of free tools such as condoms also help to reduce the spread of the disease. A somewhat controversial programme in the UK was to offer free, clean needles to drug users in order to help prevent the spread of the disease.

The Spread of HIV/AIDS

1985

Globally, HIV/AIDS is fairly rare. In central Africa, in countries such as Zimbabwe, Zambia and the Democratic Republic of Congo though, HIV/AIDS is very prevalent, with 5-15% of the population infected. HIV/AIDS is also present in the US and Brazil, but at a lower rate of 0.1-0.5%

1995

HIV/AIDS has spread globally and infection rates have increasing exponentially. Infection rates are now 0.5-1.1% (of the population) in America and in nearly all of South America’s countries. In South Africa, Botswana, Zimbabwe and Zambia, infection rates are incredibly high. 5-34% of the population is infected. The infection has spread to Europe too. Spain now has an infection rate of 0.5-1%.

2005

In America and South America, infection rates have remained the same in the past ten years. The whole of southern Africa has an infection rate of 15-34% and most of the rest of Africa has an infection rate of 5-15%. Infection rates have risen greatly in Russia to 5-15% of the population having HIV/AIDS. The disease has also become prevalent in Papua New Guinea, India and some Mediterranean countries.

AIDS in Uganda

Background Information

Uganda, a country located in central Africa, is often though to be where the virus originated. Uganda has been heavily effected by AIDS and HIV. The first case in Uganda (and possibly the world) was diagnosed at Lake Victoria, in southern Uganda. After the civil war (1986), the infection rates of HIV/AIDS had soared with 29% of those in urban areas being infected with the disease. 1 Million people had the disease by 1990 in Uganda. This rose by 1.1 million over the next 11 years and in that time, 800,000 people had died.

In 1987, an AIDS control programme was launched. Since its launch, the prevalence rates have fallen and stabilised between 2001 to 2005 however they now appear to be rising again.

Prevention Programmes

  1. The public has been educated significantly on the disease, prevention and its effects. Religious groups, political groups and non government organisations have been involved in raising awareness of the disease. The government promoted an ABC approach (Abstain, Be Faithful, Use Condoms) to educating the public.
  2. In 1990, a USAID funded programme helped exponentially increase the usage of condoms in Uganda from 7% to over 85% in urban areas.
  3. In 1997, a same day testing and counselling service was launched. Beforehand, people would have to wait two weeks for test results so many didn’t return to collect the results.

Treatment Programmes

In 1998, a programme to distribute antiretroviral drugs was launched, helping to treat those infected and reduce the effects of the disease. The programme was problematic though, as patients had to pay for their treatment. A new programme was launched in 2004 to offer the antiretroviral drugs for free. The programme was funded by the world bank and a Global Fund grant of $70 million. The program would appear to have been successful as by 2008, 50% of those who needed the drugs were receiving them. The infection rates of pregnant women in the capital, Kampala, have fallen dramatically from 31% to 14%.

Ultimately, Uganda wants to produce its own drugs, rather than importing them as this would cut the cost of the drugs down to $2-$9 per patient per month.

Lifestyle Impacts

AIDS has killed over a million people in Uganda and substantially lowered life expectancy. This has created a generation of orphaned children without parents, who themselves could be infected with the disease. In many families, the infection of just one family member can be devastating. It can require people to quit jobs in order to care for the individual but can also require them to obtain more work in order to pay for the treatment. Children have been known to abandon their education to work and care for their parents. A particularly worrying problem is the position of women. Women hold a low status in society in Uganda and many are forced to turn to prostitution to pay for antiretroviral drugs for their family, which can lead to an increased prevalence of the disease.

Impacts on Economic Development

AIDS has drastically reduced Uganda’s agricultural output due to many of the workers being infected and killed by the disease. There has also been a drop in the number of people working in the education and health professions.

In order to fund the antiretroviral drug programme, the country has had to take out significant loans from the world bank and now faces a large debt and a potential GDP fall by 1.25%.

Impacts on Health & Health Care Systems

The massive increase in the number of ill patients and hospital admissions is putting substantial strain on hospitals and health care systems. Hospitals are running out of beds for patients, which is in turn reducing the likelihood of people not recovering, or at least surviving with the disease. Many health care workers have, themselves, been infected with the disease or must care for a family member who has been infected, making health care workers far more scarce. Finally, the administration of antiretroviral drugs requires special training, which costs money and time which is not available in Uganda.