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Previous | Next An introduction to HIV/AIDS
Dale Guenter
What is HIV, and what is AIDS?
AIDS (Acquired Immunodeficiency Syndrome) is the name given to a collection of diseases or symptoms that only occur when the immune system is severely damaged. AIDS was recognized in 1981 by a group of doctors in the United States, who noticed that some of their patients were exhibiting a new collection of diseases that had not been seen previously.
HIV is the Human Immunodeficiency Virus. A search for the cause of AIDS led to the discovery of HIV in 1985, about four years after the syndrome AIDS was recognized. HIV slowly destroys the body’s immune system, leaving it defenceless against the many germs and other diseases we are in contact with every day.
AIDS occurs in people who have had HIV for long enough that their immune systems are severely damaged. People are said to have AIDS when they have a particular combination of infections (such as tuberculosis, certain kinds of pneumonia, and some forms of meningitis) or cancers (such as Kaposi’s sarcoma and some kinds of lymphoma) that would not occur in someone with a normal immune system.
Where did HIV come from?
Although AIDS was first recognized in 1981, it is clear that it has been on the planet for much longer. Scientists have found stored blood specimens from as early as the 1950s in Africa that contain signs of the HIV virus. It is also clear that HIV first arose somewhere in Africa. There were probably many people who died of AIDS without being diagnosed, since many other health problems on that continent (such as malnutrition, tuberculosis and malaria) can give similar symptoms. Exactly how HIV was “born” is still not at all clear, however. There are many theories that attempt to explain the origin of the virus, the most popular being that it started as a similar type of virus in monkeys and then changed (“mutated”) to a slightly different virus that could infect people. At this point, we are left without an explanation for how the virus came to be.
How do people get HIV?
The virus itself is passed from person to person. It lives in the blood, lymph glands and body fluids such as semen, fluids in the vagina and breast milk. HIV is very rarely found in saliva, urine or faeces, and it is very unlikely that it can be passed from any of these fluids to another person. People can only be infected with HIV if some of the virus gets into their own blood stream. The skin is a very effective barrier to infection, so simply getting fluid that has HIV onto one’s skin is not enough to be infected. There must be an opening in the skin, such as a cut or scrape or sore, in order for the infected fluid to pass HIV to another person. The lining of the bowel, the mouth and the vagina is a special form of skin (called mucous membrane), and also must have openings in it for the virus to pass into another person.
The reason that sexual activity allows HIV to be transmitted is because the friction that occurs causes openings in the skin or mucous membranes, and this allows body fluids to go from one person into the blood stream of the other person. This can happen with vaginal intercourse, from men to women or from women to men. It can also happen with anal intercourse. Anal intercourse occurs between some gay men, but also between men and women in some cultures.
In the early 1980s, HIV was transmitted through blood transfusions, but this is now extremely uncommon since donated blood is carefully tested for HIV and other viruses.
A common way for HIV to be transmitted is the sharing of needles by people who use injected street drugs.
Finally, if a woman has HIV and is pregnant, her newborn baby has a 25% chance of being infected. If it is not infected at birth, it could be infected through breast milk unless she avoids breast-feeding.
No one has gotten HIV from touching, hugging, kissing, sleeping in the same bed, eating from the same dishes, sitting on the same toilet, or doing the laundry of someone with HIV.
Who gets HIV?
At the end of 1997, there were estimated to be about 30.6 million people worldwide infected with HIV, and about 12,000 new infections were occurring every day. Almost half of these infections were in women. Of the global total, there were 1.1 million children with HIV/AIDS, and there were 8.2 million “AIDS orphans” (children without HIV whose parents had died of AIDS). Ninety percent of HIV infections are in developing countries, and there are expected to be 16 million new HIV infections yearly by the year 2000. The continent with the most HIV infections is Africa. This is because the disease started there long before anyone knew it existed. Places such as Asia, Russia and Eastern Europe are experiencing dramatic increases in HIV now that the virus is reaching those areas.
On a global level, the vast majority of infections occur through heterosexual sex. In North America and Europe, where the epidemic started in homosexual men, homosexual infection is now decreasing. Infection by injection drug use and by heterosexual sex is increasing.
In Canada, about one person per thousand is infected with HIV. This is low compared with many other countries. In some African countries, such as Zimbabwe and Botswana, about one in four are infected. In Canada, the number of new infections occurring every year is no longer increasing.
What is it like to have HIV?
Many people who are infected with HIV feel completely well initially and may not even know that they have the virus. This phase can last anywhere from a few months to 15 years or more, depending on how the person’s immune system responds to the virus. On average, the phase of feeling well is about 10 years if the person does not receive medication.
As those infected start to get sick, they may develop fevers, loss of appetite, swollen glands, weight loss, loss of energy and diarrhea. They can also develop many serious infections, such as pneumonia and tuberculosis. In extreme cases, infections of the inside of the eye, the liver, the blood and the brain, and many forms of cancer can occur.
Those who have HIV experience many things on physical, spiritual and psychological levels. Pain, weakness and fatigue can limit their ability to do normal daily activities, or to be employed. Many become severely depressed at some point during their illness. Most have experienced discrimination and/or alienation from family, friends, children, employers, landlords, social service agencies and churches. In some developing countries, many are shunned from their communities completely. Unfortunately, although the disease has been known for almost 20 years, fear and misunderstanding of those with HIV continues.
Is there treatment for HIV?
The medications now available for treatment are better than at any time in history, but still have many problems. There is no cure known yet. Current treatments require that three or more drugs that inhibit the virus be taken together. Although these do not eliminate the virus, they often control it. However, the drugs are expensive, must be taken in a complicated routine, may have unpleasant side effects and can stop working within a few years. People may have so many side effects that taking the medication is worse than the disease itself. However, as newer drugs become available, side effects are also becoming less common.
For some people, the medications can be very effective. The immune system can often repair itself to some degree, and they can return to near-perfect health. Lives can be lengthened by years, and scientists are wondering if some infected people might live as long as those who are not infected, as long as the virus is kept under control.
In most developing countries, there is no treatment available at all, except to those who are wealthy enough to buy medications on their own. There is a great deal of work being done to develop a vaccine that could prevent HIV infection, since this would be the only possible answer in many of these countries. However, an effective vaccine is probably still 10 years away.
So, what can we do about it?
People get HIV for many different reasons. However, what is clear is that those who have less control over their lives are at greater risk. This includes people who are addicted to drugs and have been unable to find the healing they need. It includes those who live in poverty and are sometimes driven to offer sex for money in order to survive. It includes gay men who find no legitimate place of belonging in society, and thus lose all self-respect and desire to live. And it includes women in developing countries who have no choice but to remain with their husbands even if they know that their husbands are not faithful to them. The best way to prevent HIV and AIDS is for us to do all that we can to address powerlessness. This means helping those who are poor to find options, helping those who are addicted to be healed, helping those who are on the margins to feel they belong, and helping to improve the rights of women. In other words, “Love your neighbour” is also a good prescription for HIV prevention.
Dale Guenter is an assistant professor in the Department of Family Medicine at McMaster University in Hamilton, Ont.
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Last modified December 6, 1999.
© 1999 Mennonite Brethren Herald.
Published by the Canadian Conference of MB Churches.
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