Category: AIDS

More commonly known as AIDS, acquired immunodeficiency syndrome is a lethal disease originating from the human immunodeficiency virus (HIV). If HIV is left untreated, the infected person’s immune system will become significantly weaker and this will lead to the progression of AIDS, which is classified as the most advanced stage of the HIV infection 5.

There are countless speculations surrounding the origin of the human immunodeficiency virus and many believe that the virus was contracted by humans who hunted meat from monkeys and became exposed to their contaminated blood 1, 3, 7. In 1999, researchers discovered a strain of the simian immunodeficiency virus (SIV) in a subspecies of chimpanzees which were native to equatorial West Africa. This virus attacks the immune system of the Cercopithecoidea family, much like HIV does to the human immune system. Today, there is authentic evidence that HIV and SIV are practically identical which proves that HIV virtually derived from SIV.

Genetic analysis carried out after 1960 derived that HIV may have originated as early as 1910. From his preserved blood samples, researchers identified the first trace of HIV from 1959 in a deceased man from the country now known as the Democratic Republic of the Congo 7. In the early 1970s, doctors caught sight of multiple patients having severe and rarer opportunistic infections but were unaware at the time that a virus was the root cause of the development of these sicknesses. In its early days this disease was named “the disease gay-related immune deficiency”, or GRID for short, as both physicians and scientists established a class of signs and symptoms which were predominantly found in men who had sex with other men 7. However, in 1982, doctors found that intravenous drug users were also experiencing the same symptoms and realised that these were a result of a damaged immune system. The disease was then renamed to “acquired immunodeficiency syndrome”, AIDS for short 7.

HIV damages the human immune system and over time leads to AIDS. AIDS is the final stage of the HIV infection and at this point, the immune system is critically damaged and too weak to fight off normal infections 4, 8. Normally, when pathogens invade the body they can cause infections. The body’s immune defence is triggered as a response to these events and specific white blood cells, involved in immune response, are activated. The specific type of white blood cells, helper T cells, boost the immune system’s response to pathogens in two different ways 8. The first way involves helper T cells releasing chemicals called cytokines which stimulate other white blood cells to move to the sight of the infection. These added white blood cells bombard the invading pathogen, as well as other infected cells. Secondly, helper T cells also release cytokines which instruct various white blood cells to multiply and these newly made cells create markers known as antibodies. Antibodies can pinpoint the identical non-self-intruders all around the body and attach to the invasive bacteria or virus, marking them as the aim of attack for the immune system to destroy 8.

When infected with HIV, the virus journeys through the blood and other body fluids to mar and kill CD4 cells (crucial helper T cells) 4, 8. The virus enters these primary targeted helper T cells and once inside exploits the T cells’ ability to produced copies and increases its number by repeatedly copying itself. As these virus particles are produced, they exit the crippled helper T cell to invade other cells, leaving it impaired and unable to protect the body from the ongoing infection and finally, the T cell will die. It is in this way that HIV spreads and wipes out more helper T cells, resulting in a weakened immune system 4, 8. Exhausted immune systems are more vulnerable to other infections which take advantage of the body’s inability to protect itself. These infections are called opportunistic infections which often cause discomfort and in more serious cases, death 8. An opportunistic infection can be described as an illness that may occur more regularly or fatally in an individual who has a damaged immune system 5, 8. Inflammation of tissues covering the brain and spinal cord, called meningitis and respiratory illnesses such as tuberculosis and pneumonia are just a few of the many AIDS-related opportunistic infections, which themselves have associated symptoms.

HIV is passed from an infected person to an uninfected person via infected blood and body fluids, such as vaginal fluid and semen 2, 4, 5, 8. Unprotected sex and sharing hypodermic needles when using drugs are the two main methods of HIV transmission, however it can also be acquired from contaminated blood during organ transplants or blood transfusions 5, 8. HIV may also be passed from mother to child when breastfeeding or during childbirth 5, 8. A few weeks post-infection by HIV, flu-like symptoms such as chills and joint pain may occur, however, as the immune system deteriorates, the disease is usually asymptomatic until it has advanced to AIDS 5, 6. This is the stage at which infected patients will experience symptoms such as rapid weight loss and profuse night sweats from the underlying sicknesses which take advance of the hindered immune system 5.

A simple at home HIV test measures the CD4 count in the body, a positive test will detect a low count which will indicate the robustness of the immune system 5. A more accurate clinic test could be done to diagnose HIV, however, results could take up to 12 weeks 9. Although there is no cure for HIV, there are a class of drugs called antiretroviral (ART) medications which prevent the production, assembly and spread of new viruses by disrupting them from attaching to cells, giving the immune system a chance to fight infections 5, 8. These medications reduce the viral load so low that often, a test cannot detect the virus and this is called an undetectable viral load. In recent years, many organizations have supported the undetectable=untransmittable initiative which means that a person with an undetectable viral load cannot transmit HIV 6, 7.

The main ways in which HIV transmission can be prevented is by avoiding unprotected sex and sharing unclean needles 8, 6. Taking daily recommended doses of ART drugs can help infected patients to live long and healthy lives 5, 8.

In conclusion, it is “estimated that 1.1 million people in the United States have HIV, but one is seven people do not know it” 5, 7. Regular testing and educating people on the severity and transmission of this life-threatening disease may be the only way to reduce these statistics.

References

1. Gao, F. (1999), Origin of HIV-1 in the chimpanzee Pan troglodytes troglodytes, retrieved from, http://www.ncbi.nlm.nih.gov/pubmed/9989410
2. Faria, N.R. (2014), The early spread and epidemic ignition of HIV-1 in human populations, retrieved from, http://www.sciencemag.org/content/346/6205/56.abstract
3. Bailes, E. (2003), Hybrid Origin of SIV in Chimpanzees, retrieved from, http://www.ncbi.nlm.nih.gov/pubmed/12805540
4. Center for Substance Abuse Treatment. Substance Abuse Treatment for Persons with HIV/AIDS. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2000. (Treatment Improvement Protocol (TIP) Series, No. 37.) Chapter 1– Introduction to HIV/AIDS, retrieved from, https://www.ncbi.nlm.nih.gov/books/NBK64928/
5. The official U.S. Government website managed by the U.S. Department of Health & Human Services and supported by the Minority HIV/AIDS Fund, What are HIV and AIDS? and Too many people living with HIV in the U.S. don’t know it, updated 17 June 2019, retrieved from, https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids
6. Felman. A. (2018), Explaining HIV and AIDS, medically reviewed by Daniel Murrell, MD, 29 November 2018, retrieved from, https://www.medicalnewstoday.com/articles/17131
7. Nall, R. (2018), RN, MSN, CRNA, HIC and AIDS: A timeline and history, medically reviewed by Daniel Murrell, MD, 4 December 2018, retrieved from, https://www.medicalnewstoday.com/articles/323877
8. Nucleus Medical Media, (2013); video on Medical Animation: HIV and AIDS, retrieved from, https://www.youtube.com/watch?v=ng22Ucr33aw&t=1s
9. Mayo Clinic Radio Health Minute (2018), HIV Testing, retrieved from, https://www.mayoclinic.org/tests-procedures/hiv-testing/about/pac-20385018

Ethnography has formed the basis for my research and I have been using participant observation (Reeves, 2008). As I explained in the introduction section, the formulation of research was based on certain assumptions about HIV/AIDS and Land which influenced my choice of methods. The decision to select this approach was informed by the nature of the objects of the study, HIV/AIDS and land relations which are embedded within the cultural context therefore I needed explore their meanings through observation, talking to people and spending long and sufficient time in the field. I had to start viewing land relations through the lenses of HIV infection with the broad question, “what is the material footprint of HIV/AIDS?”

Doing ethnography was not easy and straightforward; many times it was confusing and frustrating: Many researchers often tell success stories of their researches and ignore saying the negative parts like –the days I abandoned doing research after the woman I interviewed the previous day was caught by the police after selling illicit beer and because I was the new person in the village was suspected to be the spy. The day I was intimidated and my status was downgraded by the judge in the court room because the following week the president was visiting the district and despite showing him the introduction letter, he thought I was spying him. The days when I abandoned the research because I realized most of the responses from my interviewees did not answer my research questions and so forth. Overall, ethnography has been to me an interesting site. It has not only been a site for data collection, but a classroom to learn, reshape data collection approaches and provide new insights on how local people view the world. It is important for me to highlight this methodological experience- in many researches involving talking to people we may tend to be deceived by their explanations and we assume their opinions is really what happens in their lives. Or sometimes when we design a questionnaire and ask them sets of questions like was in my case- This is often not true. I shall provide an example:-

In a focus group discussion with three elderly men I asked a question, “Are people infected with HIV/AIDS stigmatized in this village?” Everyone said “No. Nowadays HIV is not an issue” While the discussion was going on, two people came and passed by and stood about seven meters away. I went on asking my HIV/AIDS questions unaware that my informants were silent and were giving signals for me to stop discussing about the topic. Not knowing what was happening, my research assistant who was very close on my left pulled my shirt down a little. I turned aside and looked at her- she gave me a winking movement of both eyes signaling something to me. I understood there was something they did not want to tell me in public- Later when the two men had gone away, one old man told me “Young man,” he pressed my shoulder and reduced his voice more, “One of those two men you saw….the one who was wearing a Chama Cha Mapinduzi T-shirt (a green T-shirt of one of the ruling parties in Tanzania) is infected with HIV. You know these people…if they hear you talking about their HIV infection you may add more burden too many problems they already have. You can make someone die quickly….” Another day on 1st December 2018 (AIDS Day) there was a campaign for free blood testing, I asked one of the three old men who was became my best friend to go for HIV test at Ushirombo. He gave excuses but when I insisted he refused. I asked him why and he said, “I don’t want to die early with stress if diagnosed and found with HIV… I don’t know what other people will say if they realize I am infected” I am writing this because if I was only asking in an interview, “are people stigmatized in this ward?” The obvious answer was “No”. Or for the question “Would you be willing to go for HIV test?” the obvious answer would certainly be, “Yes.” However, participant observation gave the difference. The difference is that relying only on the testimonies from interviewees has shortfalls especially due to speech challenges or sometimes people say things they don’t do (Jackson, 2013; Cornwall and Fujita, 2012)

Another important consideration when doing ethnography is to win the trust from the studied people and this trust can be gained when the gap between researcher and the researched is reduced. It is until the time the ‘researched’ no longer consider you as a ‘researcher’ but one like them. Initially as Clifford Geertz (1998) puts it, I encountered challenges during my research, many people refused to participate in my research and those who participated either gave short responses or replied to satisfy the intentions of my research. I was seen as an outsider, coming from town to fulfil research obligations and leave thereafter. – Like in the example of a woman selling illicit beer I interviewed and the next day she was caught by the police, everyone thought “that young man from Dar es Salaam might have reported this to the police” Long time staying in the field reduced the gap between the researched and the researcher, but the researcher needs also to learn how to reduce any differences between him/herself and the community he studies (Delamont, 2004). The thing which helped me to gain acceptance was to participate in their events such as local beer drinking, cultivation, religious activities, visiting the sick, attending court sessions and ward meetings

HIV/AIDS is caused by the Human Immunodeficiency Virus. The HI virus is most commonly passed from one individual to another through unprotected sexual intercourse in which bodily fluids such as semen are freely exchanged between individuals. However, the virus can be transmitted to a person through any contact of bodily fluids that are infected with the HI virus. This includes, but is not limited to, natural child birth in which the virus can be passed from mother to child and blood transfusions involving unsterile needles can cause someone to become infected as residual blood from an infected patient can remain on the needle and when this is needle used on an unaffected patient the HI virus can enter the person’s bloodstream and infect them. Once the HI virus has entered a person’s body, the virus starts to attack the CD4 cells of the immune system which are responsible for fighting off infections. With less cells to fight off infections, the infected individual’s immune system weakens making them much more susceptible to contracting infections and illnesses. Although there is no cure for HIV, antiretroviral drugs help to keep the virus under control and allow people to live a full life. Without receiving this proper treatment, the HIV could advance to the final stage of AIDS (Acquired Immunodeficiency Syndrome) in which the immune system has become so weak (a CD4 cell count of less than 200 per mm3) that an array of infections, the most common being TB (Tuberculosis) , have entered the body and caused it to become severely infected.

The HIV/AIDS Epidemic

The HI virus only came to the knowledge of medical authorities in the 1980s although the exact origins of the virus is unknown. However, the 1990s marked the start of the beginning of the HIV epidemic in South Africa and by the start of the 21st century about 20% of the South African population was infected. Though, in recent years, according to UNAIDS, in 2017, 36.9 million people worldwide were living with HIV of which 7.1 million of these were found to be in South Africa, making South Africa the country with the most number of infected individuals. Despite this, the number of new cases of HIV have dropped by 30% from 2010 to 270 000 new cases, indicating that the South African governmental programmes to combat the spread of the virus, namely better education and better access to contraception, is successful. However, many groups in South Africa are still vulnerable such as gay men, transgender women, sex workers and drug addicts. It was also found that due to South Africa having one of the highest rape rates in the world, girls between the ages of 15 and 24 were four times more likely to contract HIV than their male counterparts were. Furthermore, an estimated 280 000 children between the ages of 0 and 14 were infected in 2017. But the number of new infections in children declined from 25 000 in 2010 to 13 000 in 2017 owing to the successful implementation of the prevention of mother to child transmission system in which 95% of pregnant mothers received antiretroviral medication. South Africa has developed some of the best and most effective programmes in the world to combat the spread of HIV however the statistics are still extremely high and the country is facing an HIV epidemic.

Contraception

Contraception is any mechanism or technique that prevents a sperm cell from reaching and fertilizing an egg cell thus preventing pregnancy from occurring. However, many contraceptives, specifically those that fall into the category of barrier method, serve a dual purpose as they prevent against pregnancy as well as the spread of STIs and STDs such as HIV. Thus, barrier method contraceptives play an integral part in practicing safe sex and combating the spread of STDs and STIs. In recent years, due to the rise of third wave feminism, and a shift in the general consciousness of populations from sex being a taboo topic to being something that is openly and safely discussed, there has been a large increase in the selection of contraceptives that have become available, particularly for women. Women can now choose the specific type of contraceptive that is suited to their needs and lifestyle. In addition, many governments have also become involved in the sex reform within society and some, such as the South African government, have started to make contraceptives more easily accessible by distributing condoms in public bathrooms and subsidizing the full cost of other forms of contraception such as the birth control pill in public clinics and hospitals. The production and distribution of condoms increased by 60% in 2017. This coupled with better education has allowed people to make more informed decisions regarding their sexual choices and this has lead to a decrease in the amount of unplanned pregnancies as well as the HIV epidemic in South Africa being kept under better control. This can be seen in the amount of individuals who have HIV live longer and more productive lives as it shows that quality of antiretroviral treatments in South Africa has increased. However the rates of teenage pregnancy and people living with HIV still remain high, indicating that South Africa is facing an HIV epidemic and that more measures need to be put in place to get the crisis under control.

HIV in the youth

South Africa is currently facing an HIV epidemic having about 7.1 million people living with the disease. Among the most vulnerable groups are those groups of society who have previously been marginalized such as gay men, transgender women, sex workers, drug addicts and teenage girls. This study will focus on the connection between HIV and the South African youth, most specifically females between 15 and 24 or what, according to the United Nations, is deemed as youth. Approximately 4 million people that suffer from HIV in South Africa belong to this age group. Furthermore, 2.4 million people in the age group have lost either one or both parents to AIDS.

Socio-economic factors such as poverty, violence, food scarcity and poor living conditions all increase an individual’s HIV risk factors. Furthermore, gender also plays a role in developing the youth’s HIV risk factor as young females are four times more likely to contract the disease than males are. These high risk levels are perpetuated by biological susceptibility, unequal economic opportunities for women, unequal status of women in society and in relationships and sexual violence and rape experienced by women.

Although in recent years the South African government has bettered education and provided campaigns to better inform the youth about HIV, in a recent study that was conducted it was found that less than half of the youth knew that condoms prevent against the spread of STDs like HIV and general knowledge surrounding the disease was poor. Furthermore, even though there has been a 60% increase in production and distribution of condoms in South Africa, the use of condoms has decreased by 15% from 2008 to 2012 in males between the ages of 15 and 24.

In addition, this view of contraception not being a worthwhile investment is being perpetuated by certain religious beliefs, ethnicities and cultures, where people are looked down upon for using contraception , and influenced by whether or not people have access to contraception. And even though, first trimester abortion is legal in South Africa for people above 12 years old without parental consent, it was found that, in 2018, 58% of all abortions were back door and illegal. This due to the fact that many cultures and religions shame woman who choose to obtain an abortion thus to not be disregarded by their communities, women choose to keep their abortions a secret and have it performed illegally at places that are often unsafe and unsterile. Furthermore, abortions are not accessible to all South African citizens. An Amnesty International report in 2017 found that less than 7% of the country’s public health facilities were performing abortions. And the cost of an abortion in private facilities is not easily affordable. The reason for discussing abortion in a debate about contraception is to illustrate that even though many are not using contraception to prevent unplanned pregnancy, abortions, theoretically, could be obtained to terminate these pregnancies. However, realistically due to the above mentioned factors, this is not necessarily true.

As can be seen above, many factors play a role in shaping the youth’s views,beliefs and actions regarding sex and contraception thus it is imperative that sexual education is healthy, adequate and unbiased. However, according to a study conducted with Sowetan youth in the Southern African Journal of HIV Medicine, it can be seen that there is dire need for youth-friendly reproductive and sexual health services and support that provide the youth with the necessary skills to make informed decisions regarding their sexual health and choices, in our modern world, especially considering the fact that this age group has one of the highest risk factors when it comes to contracting HIV. These services could include, but are not limited to, better access to contraception, family planning clinics, access to pre exposure HIV drugs for victims of rape and accessible testing for and treatment of STDs.

Furthermore, there is a notable gap between sexual education presented in the classroom and what sex has evolved into in our modern society. Many topics such as sexuality, sex between members of the LGBTQI+ community and consent are overlooked in the syllabus and mainly the traditional mechanics of male-female intercourse is taught and not enough emphasis is put on the severity of STDs and the important role that contraception can play in preventing the spread of them. This survey aims to highlight what these gaps in the system are and learn from the youth and their experiences about what they think should be better taught during sexual education as these skills are necessary to having healthy sexual practices in our modern society. The survey also aims to test the participants’ knowledge about various areas relating to sex and contraception in an initiative to further evaluate the adequacy of their previous sexual education. The testing of these two skills will help to give an indication about which topics need to be introduced or taught more effectively in the classroom and this, in turn, will help the government to pinpoint the areas where reform of the curriculum is needed.

In addition, the survey aims to investigate which form(s) of contraception the youth is most likely to use when they become sexually active by evaluating to what extent their religious and cultural beliefs influence their decisions regarding sex and contraception use. Also, whether or not the youth, specifically those belonging to the LGBTQI+ community, are seriously considering the spread of STDs and HIV when deciding on which forms of contraception to use. The above results will enable the government to set up youth friendly sexual and reproductive health and support services that encompass a large range of topics pertaining to sex and sexual health. Furthermore, it could provide a springboard for governments to set up educational programs in communities to ensure that young people are not solely basing their sexual choices off of biased and inadequate religious and cultural beliefs but rather receive all information necessary and are then in a position to make more informed decisions and choices. In a world that is so fast paced and ever changing, young people need to be given the tools to use to help them thrive in this society and, currently, these tools are unavailable to them due to lack of service delivery, heavy influences of cultural and religious beliefs and inadequate sexual education in the classroom. The survey aims to show governments the problem areas and to help them put in place policies and social structure that will empower the youth in their sexual choices while still practicing safe sex.

In one decade over 25,000 lives were lost to a disease thought to affect only gay men: Acquired Immune Deficiency Syndrome. The American AIDS crisis of the 1980s led to an increase in stigmatization and discrimination against the entirety of the LGBT community but encouraged that community to unite and fight for acceptance and understanding. The AIDS crisis also forced the LGBT community into mainstream society, more than it had been in the previous decade, meaning “gay issues” could not be kept out of sight and therefore could not be ignored any longer. AIDS, although not inherently linked to sexual orientation, was first recorded in gay men, which led to a decade long fight against homophobia and fear. The underlying ignorance of the public, promoted by the unprofessional and disrespectful actions of the government, led to an increase in the visibility of homophobia. This paired with the previously established generally negative social attitude towards gay men, in particular, led to immense strain on an already marginalized group of people.

HIV/AIDS, an immunosuppressant disease, became an epidemic in the early 80s, mainly within gay communities, leading to it being coined Gay-related Immune deficiency (GRID). Human immunodeficiency virus suppresses a person’s immune system through targeting cells that fight infection. If left untreated HIV can progress to AIDS, which is medically defined as a person having less than 200 CD4 cells per cubic milliliter of blood or as having multiple opportunistic infections such as pneumonia and tuberculosis (‘What Are HIV and AIDS?’). Without treatment, HIV will most likely progress to AIDS within 10 years, which has a high mortality rate (‘HIV Overview’). As the first recorded cases of AIDS in 1981 were documented, the majority of them were white, gay men. During 1981 and 1982 terms such as gay cancer and GRID became prevalent in both medical and common language. As these marginalizing terms became favored in American society, the perception that AIDS only affected gay men deepened, which allowed for homophobia fueled by fear to affect the publics’ ability to see past prejudice and stigma (‘A Timeline’). This continued throughout the decade even though the medical community had made significant progress in research, determining AIDS was not caused by casual contact or because of sexual orientation. The AIDS crisis magnified homophobia and was therefore instrumental in uniting the LGBT community which had been split based on orientation prior to the 80s.

The 1970s were a defining decade in terms of societal change, as abortion became legal, better contraceptives became available and the gay pride movement led to an overall increase in acceptance of the LGBT community, mainly within the younger generations (Landau). The majority of the population, however, continued to ignore the community. Once the AIDS crisis began in the 80s, this majority had to acknowledge and position themselves in regards to the LGBT community. This meant that many had to face their underlying fears of, or issues with the queer community, which led to a manifestation of negative connotations, stigmas and discrimination regarding AIDS as well as the LGBT community.

During the onset of the AIDS crisis in the early 80s public opinions were influenced through the fear of contracting the disease, the lack of knowledge surrounding the topic, and ignorance based on stigmatization and stereotypes. The ignorance of the general public was also fueled by the lack of communication between the medical community and the remainder of society, therefore many people only had access to older and potentially irrelevant information. Between 1981 and 1984 research was being conducted to determine how AIDS was transmitted, but this information was not being communicated sufficiently or professionally. This paired with the fear of a new, unknown epidemic fueled stigmatization and discrimination, as people began to view gay men as dangerous. In these four years, the death toll increased from 121 deaths in 1981 to 3,665 deaths in 1984, which was a large enough increase for the majority of the population to notice and start looking for information (‘History of HIV and AIDS’). The lack of professional guidance from the government as well as the medical industry during this crucial moment in the development of the public’s perception of the AIDS crisis enabled homophobia and discrimination based on false information and fear regarding the spread of the disease. Examples of ignorance based on homophobia started developing within the medical field from the beginning of the crisis. As more details were discovered pertaining to the spread of AIDS and who it could affect, published doctors began debating their moral obligation to care for patients with AIDS (Christensen). Although such events happened towards the beginning of the crisis, they were not fueled by fear, but by homophobia. As soon as it became common knowledge that AIDS was associated with gay men, moral debates concerning the Hippocratic oath became common as discrimination against the LGBT community was omnipresent at the time. This reached a peak when New York physician Joseph Sonnabend was threatened with an eviction notice due to caring for patients with AIDS in his office. This became America’s first official AIDS discrimination lawsuit (‘A Timeline’). Along with the discrimination LGBT people faced by the medical community as well as the general public, they were also lacking beneficial information on what was happening to their community. This lack of overall support in all areas led to the LGBT community uniting in a way the pride movement had not achieved. During the first four years of the 1980s, discrimination and stigmatization of the gay community were mainly based on the fear of AIDS, largely due to the lack of general knowledge. As medical knowledge increased, public understanding did not, meaning discrimination associated with being gay and having AIDS now stemmed from homophobia and ignorance.

Throughout the decade the US government, actively ignored and ridiculed the events of the AIDS crisis in crucial moments, encouraging the public to perceive AIDS as only being a threat to the gay community. Through the White Houses’ lack of respect, it became socially acceptable and normal to discriminate against LGBT people regardless of their HIV status. This motivated the community to unite to protect their lives and support each other through the crisis and beyond. The AIDS crisis was actively ignored by the government for over half of the decade. This was showcased, between 1982 and 1984, during various official press conferences involving the deputy press secretary Larry Speakes and journalist Lester Kinsolving. In Speakes’ statements, he often made light of the situation while implying that Kinsolving was gay due to his interest in the AIDS crisis and the White Houses’ lack of concern. During these press conferences, the press pool would often laugh at Speakes’ ill-advised homophobic jokes, which shows the overall lack of concern and compassion towards the LGBT community and the number of people affected by AIDS. This attitude was also reflected in the president: Ronald Reagan’s response to the AIDS crisis. The first time Reagan ever mentioned AIDS in public was on September 17th, 1985 (‘Reagan Administration’s’). It took him 5 years, 15,900 cases and almost 5700 deaths to publically acknowledge an epidemic that had already challenged and shaped his country’s society (Christensen). The White Houses’ active avoidance of the crisis encouraged open homophobia in all aspects of society. Although the encouragement of homophobic views alienated the LGBT community from many aspects of mainstream society, it brought the community together in an unprecedented way. Before the AIDS crisis and the homophobia that accompanied it, there was a disconnect in the LGBT community based on privilege and orientation. The governmental, medical and public responses to the crisis enforced discrimination against all LGBT people, which compelled them to stand together against oppression (‘How the AIDS’). Foundations and organizations such as ACT UP were formed to protest against LGBT and AIDS discrimination. ACT UP was one of the most influential organizations, leading several protests in the late 80s, such as the St. Patrick Cathedral demonstrations that over 4500 people attended (Jonsen and Stryker). These demonstrations were instrumental in creating a social change regarding the AIDS crisis, which began in the 1990s.

The AIDS crisis took place at a crucial time in the history of LGBT rights, as it appeared just after the pride movement started gaining positive traction. As there were a lot of stigmas and stereotypes surrounding AIDS diagnoses, many relating to being gay, the LGBT community began facing more blatant homophobia. This paired with the preexisting, more concealed discrimination led to the consolidation of the entire community. As the LGBT community gained attention mainly due to the AIDS crisis in the 80s, many people associated being gay with having AIDS. These misconceptions weren’t cleared up until the early 90’s when the government as well as American society changed their approach to the crisis and became more open to civil conversations, leading to an eventual decrease in stigmatization surrounding AIDS and the LGBT community. The development of the AIDS crisis in its early stages was critical in the development of the LGBT community as well as its public reception.

HIV/AIDS is a globally infamous pandemic that still continues to spread all around the world, with its substantial effects on public health, social attitude and social disadvantages still evident even in today’s setting. HIV/AIDS does not only influence the physical health of those affected but has also become a historically consistent role in the perpetuation of systematic social inequalities, such as the marginalisation of minorities and those of lower socio-economic status, both on a micro and macro scale. This essay will mainly focus on the geographical and psychological aspect of the HIV/AIDS pandemic and truly analyse the social, political and behavioural effects this pandemic had, in different areas around the world. It will concentrate especially on how the outcome of contracting HIV/AIDS in the United States during the 1980s, gradually resulted in becoming an expression of social disadvantage, a root cause for poor mental health in those affected, an opportunity for activism against a biased system and a cautionary lesson for safer social and cultural practices. However, in order to fully understand the severity of the HIV/AIDS pandemic, it is important to firstly have a basic biomedical understanding of the virus and how it operates.

HIV stands for human immunodeficiency virus, this is the virus that causes HIV infection. The HIV infection affects the body’s immune system by attacking the T-Cells and reprogramming them, in way where they are able to make more copies of the virus. T-Cells are essentially what defend the body from infections, diseases and a variety of other foreign invaders (HIV.gov, 2019). The loss of these T-Cells result in the increased vulnerability of the body and so due to its weakened immune system, it becomes more and more difficult for the body to naturally fight off infections. Therefore, without treatment, HIV can gradually destroy the immune system and inevitably advance to AIDS, AIDS stands for acquired immunodeficiency syndrome. It is the most advanced stage of HIV infection; the normal T-Cell count range is between 500 – 1500, a person is diagnosed with AIDS when the T-Cell count drops below 200 (AIDSinfo, 2019). When diagnosed positive, the situation quickly becomes detrimental to a person’s ability to live happily and healthily. As the autoimmune disease develops, needs such as the ready availability and access to medication becomes an even more crucial necessity.

Unfortunately, availability of medication is not a possible reality for many people, especially those who are either from developing countries and/or are members of socially marginalised groups. This is very distressing as it becomes clear that the HIV infection has historically been increasingly concentrated in the poorest, most marginalized sectors of society in all countries (Wabiri, 2013). This is a reality that is extremely important to note because it principally addresses the idea that infections (like HIV/AIDS) can become and is an expression of social disadvantage. This is transparently evident when looking at marginalised groups everywhere, even in developed countries such as the United States where “…disproportionate levels of HIV infection have been documented among racial and ethnic minority populations. Rates are especially high among gay and bisexual men in communities of colour and among heterosexual women living in poverty in the inner cities. “ (Wabiri, 2013)

1. Factors that contribute to the HIV/AIDS epidemic is Botswana

A. Gender Inequalities, Social/Historical

One strong factor that still assist in the AIDS epidemic are the gender equalities in Botswana. The two most contributing factors are biologically women will more likely be infected with HIV/AIDS than men as well as women unfortunately having less control in their relationships (Phaladze and Tlou, 2006).

Women are more biologically susceptible to contract HIV/AIDS than men through unprotected sex (Phaladze and Tlou, 2006). There are simple precautions to prevent STIs and unwanted pregnancies however due to the gender inequalities in Botswana it was harder for women to ask for safer sex such as using male condoms (Phaladze and Tlou, 2006). Partly because of age gaps in marriage younger women generally marry older men who may have already contracted the virus, and, many women are dependant economically on their male partner often having lower paying jobs such as fronts desks jobs or working domestically in the home (Phaladze and Tlou, 2006).

Overall if women can negotiate safer sex in their marriages and in short term relationships there would be more decline in the spread of HIV, including protecting the next generation of children from contracting HIV/AIDS from their mothers.

B. Stigma and Discrimination, Social/Political

Stigma is a mindset of belittling and shaming others for their association or diagnosis with HIV/AIDS. This also applies to the affected patient who is afraid or being discriminated in their community more commonly known as Internalized Stigma (Ogasawara, 2009). In 2007 an Epidemiological Fact Sheet on HIV/AIDS found that approximately 11,000 people including children died from HIV/AIDS related causes, yet HIV and Stigma do not only affect community health but also lead to mental and social complications (Ogasawara, 2009).

The vicious social norms in Botswana have led to women and other minority groups being discriminated and shamed as HIV/AIDS is transmitted mainly through unprotected sex and Botswana is primarily as Christian country (Ogasawara, 2009). Even children who transmitted HIV through their parents face social stigma (Ogasawara, 2009). There is also discrimination against homosexual males and female sex workers, unfortunately there are no laws to help/protect sex work (prostitution) and Homosexuals, and sex workers and homosexuals (MSM Male with Male sex) are illegal in Botswana (Ogasawara, 2009). Ultimately, stigma and discrimination have made it harder for some to speak up about the treatment they need, and the governments policies also prevent a large minority from speaking up and preventing more HIV prevention (Ogasawara, 2009).

2. Responses to the HIV/AIDS crises

Both government and non-government organisation have responded to the HIV crises for over a decade now, and results have shown decline in HIV for children and adults, yet the number still remains high with approximately 800,000 of the population still infected (40%) (Soschildrensvillages.ca, 2007).

A. Non-Government

Many non-government agencies have joined to spread awareness and education for youth about HIV and how to stay safe. UNAIDS, UNICF, UN Women, UNDP, WHO and other organisations are working in correlation to Sustainable Development goals to achieve “Zero new infections” and “Zero aids related deaths ending the AIDS epidemic by 2030” (Unaids.org, 2019).

Educating the Botswana population especially adolescents and young adults if important to efficiently canton HIV infection. USAID, United States Agency for International Development recommend the ABC method to prevent infection Abstain, Be Faithful, Wear a Condom, this is a simple method that helps all age groups people from being infected and has been effective in preventing new infections (Soschildrensvillages.ca, 2007).

More HIV prevention is being aimed towards young people to help future generation from contracting HIV. For example, on Worlds AIDS Day 2016, Tune Me (bw.tuneme.org 2019) educates younger people on their sexual health and rights and how to stay safe; their website has categories about puberty/menstruation, safe sex, and consent, helping young women become equal to their male partners to use contraception (bw.tuneme.org 2019). Additionally, 11,150 condoms were provided for both males and females on World AIDS day 2016 (Unaids.org, 2019).

B. Government

The Government of Botswana have created a “Zero New Infection by 2016” action plan. Although it was unsuccessful improvements have been to the HIV epidemics (Soschildrensvillages.ca, 2007).

Internationally HIV/AIDS has only decreased by almost 20% in the past seven years. In Botswana life expectancy fifteen years go was 35 years on average, in 2011 life expectancy rose to 55 years (Gov.bw, 2011) (Cia.gov, 2019).

Firstly, during the early outbreak of HIV/AIDS in the 1980s the Government of Botswana concentrated on checking/screening blood to stop spread to be eliminated through blood transfusion (AVERT, 2018). Then, treatment was aimed for all of Botswana’s citizens, including providing those most affect with anti-retroviral medication (AVERT, 2018). The plan was unsuccessful because the government didn’t have enough workers or facilities to accommodate their goals; yet, the government has received more funding approximately 340 million (USD) in 2008 (AVERT, 2018). The government has spent this money to spread awareness and resources about HIV/AIDS, such as Billboards, media (radio/tv) (Gov.bw, 2011); evident between 2001 and 2009 HIV rates between 15-19-year olds has decreased from 25% to 13% (Unaids.org, 2010).

3. SWOT analysis of HIV/AIDS crises responses

Non-Government NGOs

Strengths

• Provides youth with education with accessible resources
• Helps the UNs’ sustainable living goals “Zero New [AIDS] infections”

Weakness

• Non-Government relies heavily on donations and volunteers
• Opposing values between GOs and NGOs, example religious values of no contraception whether Tune Me belies in contraception.

Opportunities

• More research to end the HIV/AIDS epidemic and prevent it from remerging in the future
• This new information can help future disease and present HIV cases globally.

Threats

• More urgent cases of HIV need more attention and funding.
• Lack of funding will lead to the cycle starting over again with rising infections and myths of Aids.

Government GOs

Strengths

• Effective blood screening to prevent dangerous transfusions
• Citizens values and government values align e.g strict religious ideas

Weakness

• The government doesn’t have enough funding on their to sustain there goals
• The government has had unsuccessful plans previously and have had lots of assistance from NGOs.

Opportunities

• The government has longer term plans and a healthy population has higher economic success.
• The government can be sustainable and wont need to rely on NGOs once the HIV/AIDS epidemic concludes

Threats

• The HIV/AIDS crises will not end if help isn’t provided to Sex Workers and MSM (homosexual male couples) as its illegal and condemned in their society
• Without gender equality HIV between women and their children will only increase as they cant negotiate protected sex.

4. Evaluation and Justification of responses

Both Non Government organisations and government organisations have different yet effective approaches to tacking the HIV epidemic. However, based on results it indicates Non government organisations are providing more assistance and results for the people of Botswana. The Government of Botswana is also having blood screening for safe blood transfusions while also keeping the citizens values conscious. In addition, the Non-Government agencies also assist in social issues helping minorities although it may clash with the government policies, as shown when government agencies treat MSM and educate about sexual health opposing strict Christian values.

Overall, its clear non-government organisations have shown longer term responses to HIV/Aids and inequalities in Botswana, providing education and resources for sexual health has helped decrease HIV cases including in newborns and adolescents. A decline in new infections can’t be achieved if minority groups such as sex workers and homosexual males are illegal and shamed, and if gender equality is reached women will have the power to argue for safer sex and prevent themselves and their future children from being infected by HIV/Aids. More education for all citizens will help improve gender equality and provide understanding, with decreased social stigma for everyone to feel safe to speak up about HIV and receive equal treatment.

Human immunodeficiency virus (HIV) is a recurring health issue with flu-like symptoms that continues to affect millions of people around the world, transmitted through bodily fluids and sexual contact. Additionally, the virus has the ability to progress into acquired immunodeficiency syndrome (AIDS). This sexually transmitted disease (STD) originated from a chimpanzee carrying the Simian Immunodeficiency Virus (SIV), known to be closely related to HIV, in West Africa in the 1920s. The virus was then crossed to humans as a result of the Africans hunting and consuming the animal, damaging their immune systems and thus, making it difficult to fight off infections (Origin of HIV and AIDS, 2019). As of today, only treatments exist for HIV and an effective cure has yet to be discovered, continuing to be a major global concern to the public’s health.

East and South Africa are the most HIV affected regions with 20.6 million people infected as of 2018, including young women, homosexuals, and sex workers. Moreover, there were 800,000 new cases of HIV infections based in these regions, which is just under half the global total. Young women at 15-24 years of age are more than double HIV prevalent than men in 2018, due to excessive levels of age-disparate sexual relationships and transactional sex. Furthermore, studies have shown that young women married to men who were 16 or over years older are three times more vulnerable and 50% more likely, if faced with sexual violence, to contract HIV (HIV and AIDS in East and Southern Africa, 2019).

In the present day, HIV continues to globally spread, with approximately 37.9 million people living with the STD and 21% unaware of their status as recorded in 2018 (Global HIV and AIDS Statistics, 2020). Mortality and morbidity are ultimate indicators to track the quality of HIV care for those who have been diagnosed. This is reflective of the number of cases reducing from the start of the epidemic with 32 million illnesses related to AIDS resulting in death, to 770,000 in 2018. In the same year, specifically looking at Eastern and Southern Africa, several countries have seen a decrease by approximately 20,000 in their case numbers of new HIV infections as a result of treatment. Africa’s mortality rate has been able to achieve a decrease of 40% since 2010 (Ford & Spicer, 2012). However, other countries such as Angola, Madagascar and South Sudan, are progressing poorly and giving rise to an increase in illnesses. Living and working conditions play a major role in one’s vulnerability to HIV/AIDS and thus, low- and middle-income countries often have a higher HIV prevalence with approximately 68% of people living in sub-Saharan Africa.

56% of more than 9 million orphans in sub-Saharan Africa have lost at least one of their parents due to HIV/AIDS, resulting in a number of negative consequences that heavily impact these children. Namely, a lack of education and family support leads orphans to be at a higher risk of being sexually abused and thus, more likely to contract the infection (Raymond & Zolnikov, 2018). Moreover, those who live in rural areas also have a greater HIV prevalence, for example, Ethiopia and Uganda, due to unsafe sexual contact, early sexual debut and marriage. Many countries within the Eastern and Southern region of Africa do not have access to health care services and therefore, have an increased probability of having the virus transmitted to them through bodily fluids and sexual contact. Sub-Saharan Africa’s social factors play a significant role in the region’s HIV prevalence, including sexual violence, poverty, lack of education, poor health facilities and the low societal status of women (Shao & Williamson, 2012). Additionally, behaviour would also be considered as an important factor regarding the number of HIV cases, such as, the use of condoms, early sexual debut and frequency of intimate relations.

Although there is no vaccine effective enough to cure HIV, treatments and prevention mechanisms exist to minimise the likelihood in contracting the virus. Despite the fact that sub-Saharan Africa is considered ‘disadvantaged’, few countries within this region have access to Antiretroviral (ARV) drugs, which enables their immune systems to continue to function and impede illnesses. Approximately 16.3 million Africans have access to this treatment, which fights against the transmission of HIV from mother-to-child, sexual intercourse, sharing of needles and breastfeeding (Olakunde et al., 2019). Additionally, another form of prevention from picking up the STD is the use of condoms and since the 1980s, approximately 50 million HIV infections have been prevented (Evans et al., 2018). This mechanism is considered to be 98% effective and acts as a barrier from any sort of STDs that can be found in bodily fluids (Corlis, 2015). In spite of the fact that all countries within this region fail to meet the global target regarding condom use, there is slow improvement in sub-Saharan Africa (Smith, 2018). Furthermore, HIV programmes have been implemented as “a combination of behavioural, biomedical and structural interventions” (HIV Prevention Programmes, 2019). For example, the mechanism behind this prevention strategy emphasises on the fact that young children who are vulnerable to the virus should be provided with education regarding sexual health. In addition, they should also have access to health services without economic barriers in relation to excessive costs and structural barriers, such as parental consent. Other than condoms being a biomedical intervention, voluntary medical male circumcision was another option and proven to have reduced HIV prevalence by 60% in the mid-2000s (Voluntary Medical Male Circumcision, 2019). Whilst research continues to progress in finding a cure to HIV, there are a number of treatments available to help prevent people from contracting the virus.

With no vaccine to eliminate HIV, the STD continues to be a global health issue that affects many people, with its highest rates in sub-Saharan Africa. Those under poor living and working conditions typically have a greater risk becoming infected with the virus, especially orphans who lack education and start their sexual debuts at an early age. Fortunately, treatments and preventative programmes have been implemented to assist in minimising the number of death cases, as well as new infections.

Introduction

Human immunodeficiency virus (HIV) is credited with weakening a person’s immune system by killing crucial CD4+ T cells that fight off infections (CDC, 2019). If untreated, HIV can progress to the last and most serious form of HIV often referred to as Acquired Immune Deficiency Syndrome or AIDS. Some Americans are more likely to be at risk for HIV because of several factors, including their sexual behaviors, number of partners, where they live, stigma around their sexuality, and their access to medical care (CDC, 2019). The CDC reports that “38,281 people received an HIV diagnosis in the US during 2017 alone and that 1,140,400 people ages 13 and up were living with HIV at the end of 2016” (CDC, 2019). Of this number, homosexual, bisexual and men who have sex with men (MSM) account for 57% or about 648,500 cases (CDC, 2019). Among the 3 million HIV testing events reported to the CDC in 2015, the percentage of transgender people who received a new HIV diagnosis was more than 3 times the national average (CDC, 2015). These numbers show that the already underserved lesbian, gay, bisexual, transgender and queer (LGBTQ) community is one of the predominant groups of people at risk for HIV/AIDS infection and more education and resources should be dedicated to the LGBTQ community for the fight against HIV/AIDS. In 2015, Arizona ranked 15th among the 50 states in the number of HIV diagnoses with nearly 75% of the population diagnosed with HIV consisting of members of the LGBTQ community that year (AZDHS, 2017).

Target Population

Men who have sex with men (MSM) are at an incredibly high risk for contracting HIV, especially MSM of African American and Hispanic descent (CDC, 2015). The homeless population and IV drug users are also at an increased risk for HIV/AIDS and often go undiagnosed for years as they may have limited access to healthcare or be unwilling to seek testing (CDC, 2015). In addition to MSM, the transgender community reported rates of HIV diagnosis at 2.6% compared to 0.9% for males and 0.3% for females (Levitt, et al., 2017). For this reason, the LGBTQ community and especially people of color (POC) within this community make up our primary target population as they are at increased risk for HIV/AIDS infection. According to the Arizona Department of Health’s State Prevention Plan, the state incidence rate is 11.4 per 100,000 people in Arizona with Maricopa county as high as 13.8 per 100,000 people (AZDHS, 2017). According to the same source, the Arizona state prevalence rate is 260 per 100,000 with Maricopa county as the highest again with 292 per 100,00 (AZDHS, 2017). It should also be noted that in Arizona, LGBTQ youth of color (aged 18-26) are at a disproportionately high risk for contracting HIV (AZDHS, 2017). Due to Phoenix being one of the largest cities in America with an incredibly diverse population, it is important to address HIV in our state as the magnitude of the problem is more severe than in a smaller and less diverse states.

Nature and Magnitude of the Problem

While HIV/AIDS morbidity rates are lower than the peak high in 2004 due to the antiretroviral therapy (ART), an alarming amount of people around the world are still being infected with this preventable disease (UNAIDS, 2019). It is estimated that about “1.8 million people worldwide became newly infected with HIV in 2017 which consists of about 5,000 new infections per day” (HIV, 2018). As of 2016, 708 new cases of HIV were found in Arizona for a total of 17,464 Arizonans confirmed to have HIV and even more not yet diagnosed (AZDHS, 2017). MSM account for 71% of all new HIV infections for males, while 51% of females had no risk reported making it hard to quantify the number of LGBTQ cases in females (AZDHS, 2017).

Another concerning aspect of HIV/AIDS is that a large number of people may be unaware of their status as symptoms may take years to surface (HIV, 2018). It is estimated that globally, 1 in 7 individuals with HIV don’t know they have it which means they aren’t accessing lifesaving treatments readily available (HIV, 2018). This problem is also extremely concerning as those people could be at risk for passing on the infection without realizing it (CDC, 2019). In the United States, talking about sex is a taboo topic and discussing sexually transmitted infections and testing status often doesn’t occur until after intercourse, if at all.

In the United States, it was estimated that about 1,122,900 adults and adolescents were living with HIV at the end of 2015 and about 162,500 or 15% had yet to get a formal diagnosis (CDC, 2019). Shockingly, young people with HIV (ages 13-24) were the most likely to be unaware as an estimated 51% didn’t know their HIV status (CDC, 2019). Some of this may in part be due to the fact that minors may be resistant to talk to their parents about their sexual activity and may not feel comfortable requesting to see a doctor to be tested for sexually transmitted infections (STIs) such as HIV. In addition, once someone is confirmed to have HIV, they will need a lifetime of medication and monitoring, and the cost of care may become burdensome over time, especially for people who are under or uninsured. The social determinants of health tell us that people who are considered to be minorities often have less access to health care which seems to be true for people of color within the LGBTQ community.

Risk Factors

Risk factors for HIV/AIDS amongst the LGBTQ community consist of unsafe sexual practices, multiple sexual partners, not getting tested for HIV, partaking in IV drug use, and homelessness (CDC, 2019). A recent study stated that the LGBTQ community is at an increased risk for “homelessness, joblessness, depression, stigma and may practice risky sexual and non-sexual behaviors as a form of escapism and avoidance of financial pressure and other stressors” (Levitt, et al, 2017). Due to the stigma surrounding LGBTQ lifestyles, many individuals may delay or avoid seeking treatment and may feel uncomfortable discussing their sexual practices with healthcare providers. As mentioned previously, MSM are at especially high risk for HIV/AIDS as they may have multiple partners, practice risky sexual behaviors, or delay seeking medical care due to stigma or fear of violence against them. This population should get tested frequently in addition to using condoms, discussing their HIV status with partners, and abstaining from IV drug use and needle sharing. While many health services are not typically inclusive of the LGBTQ community, certain clinics have LGBTQ specific screenings and services where individuals can seek treatment and prevention methods.

Health, Economic, and Social Consequences

The health consequences of HIV can be catastrophic on an individual and population level. HIV targets the immune system making the affected individual susceptible to a variety of illnesses that may become fatal (CDC, 2019). People with HIV/AIDS are susceptible to opportunistic infections due to their weakened immune systems such as “Herpes Simplex Virus (HSV, Lymphoma, Tuberculosis, Cervical Cancer, Pneumonia, Salmonella, and Toxoplasmosis of the Brain” (CDC, 2015).

Economically, as of 2015, the lifetime treatment cost of HIV was estimated at $379,668 (in 2010 dollars) (CDC, 2015). In 2016, the CDC provided the state of Arizona with $6,279,621 to combat HIV and provide effective prevention methods, comprehensive disease monitoring, and program evaluation (CDC, 2019).

The main social consequence surrounding HIV is the overwhelming stigma associated with the disease. This stigma prevents many people from seeking testing or treatment and ultimately has a tremendous negative impact on the overall health and wellbeing of the affected individual. Several studies have found the internalized homophobia has adverse consequences for mental and physical health and is negatively associated with self-esteem and self-efficacy (Huebner, 2002). A recent study found that the LGBTQ community and people of color face numerous sociocultural barriers resulting in discrimination related to race, ethnicity, socioeconomic status, gender identity, and sexual orientation (Levitt, et al., 2017). An HIV diagnosis is also required to be reported to the state health department and once de-identified, it must be passed on to the CDC (CDC, 2015). While these measures are intended to help track the HIV epidemic, they can deter people from visiting their healthcare provider and delay seeking treatment for fear of a breach in confidentiality. For this reason, it is essential that healthcare providers develop a trusted rapport with their patients and convey the importance of getting tested and seeking treatment for the individual and their partner or partners.

Action Steps to Address the Problem

HIV antiretroviral pre-exposure prophylaxis (PrEP) is an extremely effective method of HIV prevention for populations at risk for HIV, including MSM and members of the LGBTQ population (Grant et al., 2010). A recent study of PrEP efficacy among MSM found that steadfast adherence to PrEP reduced HIV acquisition by 86%, yet the same study found that “there is less than 50% awareness of PrEP amongst racially diverse samples of MSM” (Dolling et al., 2016; Fallon et al., 2017). In addition, once someone thinks they may have been exposed to HIV, it is imperative to seek treatment as soon as possible. Antiretroviral therapy or ART is an effective way to reduce the amount of HIV in the body to a low level which keeps the immune system working and prevents illness (CDC, 2019). Medications aside, there are numerous health behaviors at-risk individuals can adopt to reduce the likelihood of contracting HIV. LGBTQ individuals should practice safe sex, practice monogamy or have only a few trusted and tested sexual partners if possible, in addition to using condoms and getting tested regularly. Needle exchange programs and increased sexual education are also great measures to reduce HIV incidence in the United States (CDC, 2019).

In Arizona, the Southwest Center for HIV and TERROS, Inc. have interventions designed specifically for the LGBTQ community in order to reduce the number of HIV cases in Arizona. “Healthy Relationships” is a five-session intervention for small groups of infected or at-risk individuals focused on gaining skills related to disclosure of HIV status to loved ones, needle sharing partners, and educating the population about safer sexual behaviors (CDC, 2015). This intervention is primarily focused on “Men who have Sex with Men (MSM), Injection Drug Users (IDU), homeless persons, young adults, and Black women and their partners” (AZDHS, 2017). Maricopa county has also partnered with Maricopa Medical Center (MIHS) to create an opt-out HIV testing policy and is helping MIHS provide Antiretroviral Treatment and Access to Services (ARTAS) to people with HIV in Arizona (AZDHS, 2017). This program is incredibly important as it helps link medical care to medical treatment services for individuals in an attempt to lower transmission rates in Maricopa County where the incidence and prevalence of HIV is the highest in Arizona (AZDHS, 2017).

In summary, increased education about safe sex practices, PrEP and ART amongst the LGBTQ community should be implemented specifically targeting LGBTQ people of color in Arizona. In addition to the LGBTQ community, the homeless population and IV drug users are also at increased risk for HIV/AIDS and should also be targeted with increased education measures and provided access to resources such as regular and free HIV testing, free HIV management visits, and have access to PrEP in shelters and rehabilitation clinics regardless of their insurance status (Fallon et al., 2017).

References

1. Arizona Department of Health Services (2017). 2014-2017 Arizona Jurisdiction HIV Prevention Plan. Retrieved April 18, 2019 from https://www.azdhs.gov/documents/prevention/tobacco-chronic-disease/hiv-prevention/community-planning/AZHIVPreventionPlan.pdf
2. Center for Disease Control. (2019, January 29). HIV/AIDS. Retrieved March 16, 2019, from https://www.cdc.gov/hiv/statistics/overview/ataglance.html
3. Centers for Disease Control and Prevention. (2015, November). HIV surveillance report, 2014, Vol. 26. Retrieved September 27, 2016, from http://www.cdc.gov/hiv/library/reports/surveillance/
4. Dolling, D. I., Desai, M., McOwan, A., Gilson, R., Clarke, A., Fisher, M., … Nardone, A. (2016). An analysis of baseline data from the PROUD study: An open-label randomised trial of pre-exposure prophylaxis. Trials, 17, 163. doi:10.1186/s13063-016-1286-4
5. Fallon, S. A., Park, J. N., Ogbue, C. P., Flynn, C., & German, D. (2017). Awareness and acceptability of Pre-exposure HIV prophylaxis among men who have sex with men in Baltimore. AIDS and Behavior, 21(5), 1268–1277. doi:10.1007/s10461-016-1619-z
6. Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., & Glidden, D. V. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. The New England Journal of Medicine, 363(27), 2587–2599. doi:10.1056/NEJMoa1011205
7. HIV.gov. (2018, February 21). What Are HIV and AIDS? Retrieved March 16, 2019, from https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids
8. Huebner, D. M., Davis, M. C., Nemeroff, C. J., & Aiken, L. S. (2002). The impact of internalized homophobia on HIV preventive interventions. American Journal of Community Psychology, 30(3), 327-348.
9. Levitt, H.M., Horne, S.G., Freeman-Coppadge, D. et al. AIDS Behav (2017) 21: 2973. https://doi.org/10.1007/s10461-017-1774-x
10. UNAIDS. (2019, January 10). Global Statistics. Retrieved March 16, 2019, from https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics

INTRODUCTION

How much do you really know about HIV/AIDS? How big of a consequence do you think it causes to the human body? 1 in 7 people living with HIV are unaware of their infection (HIV.gov, 2019). The first ever case of acquired immunodeficiency syndrome (AIDS) was announced in 1981, while the human immunodeficiency virus (HIV), the virus that causes AIDS, was isolated in 1983. However, since the first case of HIV/AIDS, infection with HIV has grown to pandemic proportions, resulting in an estimated 36.2 million affected in 2018 (Piot, Bartos, D.Ghys, Walker, Schwartlander et al. 2001). Generally, virulence is defined as the severity of a disease, however, in relation to HIV/AIDS, virulence is interpreted as the rate of progression to AIDS in untreated infections. The HIV/AIDS outbreak have significantly impacted on households, communities and the development and economic growth of nations, especially South African Nations. Although the US government has invested approximately $26 billion every year to research, treatment and services on HIV/AIDS, it still remains to be one of the deadliest infectious disease in the world. Therefore, it is essential that we prevent further transmission of HIV by increasing public health and awareness through campaigns, education systems, hosting educational events and such, to educate everyone just how deadly the virus is.

DISCUSSION

The drivers of most emergence of pandemic diseases, including HIV/AIDS, Ebola, SARS and pandemic influenza are associated with ecological, behavioural or socioeconomic changes (Morse et al. 2012). Even though the first pandemic event of HIV/AIDS occurred in 2006, it still remains as a global epidemic. As of 2018, more than 75 million people have acquired the infection, approximately 32 million have died and 37.9 million people currently infected globally (World Health Organisation, 2018). The vast majority of people infected by HIV are evidently living in low- and middle-income countries, which is mainly connected not only to social and economic conditions, but also environmental and ecologic factors. Many infectious diseases have merged/re-emerged in Africa in the 21st century, including HIV/AIDS, Ebola virus, Zika virus, Chikungunya virus, malaria and more (Fenolla & Mediannikov et al. 2018). Factors such as its tropical climate and environmental change contributes to the basis of Africa holding most of the poorest countries. Tropical weather creates a breeding ground for emerging pathogens, whereas environmental changes, such as global warming/destruction of rainforests, sets an environment for microbes to thrive (Laino et al. 1999). This thus, inevitably led to high rates of individuals diagnosed with different kinds of diseases. Furthermore, Africa is one of the continents that still manage to retain indigenous tribes who maintain their cultures, and because of this many continues to hunt animals in the wild to survive. In consequence, this eventually led to the emergence of HIV/AIDS.

The disclosure of HIV/AIDS, was due to consuming a particular type of chimpanzee in the West African region. It was resolved that the simian immunodeficiency virus (SIV), the chimpanzee version of HIV, was most likely transmitted to humans and mutated into HIV when humans hunted these animals for meat and came into contact with their infected blood (AIDS Institute Inc. 2011). Considering this, the infection not only affects the health of the individuals, but also the households, communities and its development, and economic growth of nations. Additionally, many of the low- and middle-countries, hardest hit by HIV, also further suffer from other infectious diseases, food insecurity and other serious problems. Gradual increase of the human population and frequent international travel further exacerbate the issue by promoting the transmission of HIV/AIDS.

HIV is spread in many ways including having anal or vaginal sex with someone who has HIV without using a condom, sharing injection drug equipment, such as needles or a mother with HIV passing it to her child during pregnancy and more. HIV/AIDS spreads widely and rapidly without knowing, which is especially dangerous to those who aren’t affected yet. The HIV virus stays in the body for life after accommodating the immune system and taken hold of it (Cherney et al. 2018). The immune system becomes weaker, making it harder for the body to fight off infections. Individuals who are infected do not actually know that they are infected as symptoms may not appear for a long period (HIV.gov, 2019). Without treatment, it takes an average of 10 years for someone who gets HIV to develop AIDS, however in saying that, some starts to show symptoms earlier than others.

Within high-income countries, the population most affected by HIV are the gay and bisexuals. At the beginning of the HIV epidemic, gay and bisexual men were frequently blamed as they were seen to be responsible for the transmission of HIV. As a consequence, LGBT people tackles specific challenges and barriers that involves violence, human right violations, stigma and discrimination in their daily life. This negative attitudes about homosexuality discourages gay and bisexual men to find health care to prevent and treat HIV. Jonathan Mann, the former head of the WHO’s global AIDS programme, highlighted what he termed the ‘third epidemic’, which he described as ‘the social, cultural, economic and political reaction to AIDS is as central to the global challenge as AIDS itself’ (Gilbert et al. 2016). Researches have noted that the stigma associated with HIV is a barrier to prevention and treatment efforts, and despite the worldwide attention, it continues to be a hurdle in HIV programmes (Gilbert et al. 2016). From a public health perspective, HIV-related stigma increases risk of developing new diseases because its deters people from getting tested (Kalichman, Simbayi, Jooste Toefy, Cain, Cherry, et al. 2005), making them less likely to acknowledge their risk of infection and discourage those who are HIV-positive from discussing their HIV status with their sexual partners and others (Gilbert et al. 2016).

There are three stages to HIV infection. During stage 1, the HIV infection can be easily transmitted as there is a high level of the virus within the bloodstream (Leonard et al. 2018). Within 2 to 4 weeks of exposure, while many develop flu-like symptoms, others don’t show any symptoms as it is possible for HIV to progress without any indication that the virus is present in the body. These flu-like symptoms represent the body’s natural response to an infection as it attempts to kill off the virus. Though, it is not possible to completely remove it, because the virus replicates itself using the host’s own CD4 cells and spreads throughout the body (Leonard et al. 2018). During this process, the virus weakens the host’s immune system by killing off as many CD4 cells as they can.

Symptoms during stage 1, includes:

• muscle and joint aches and pains
• tiredness
• raised temperature
• ulcers in the mouth
• night sweats
• body rash
• sore throat
• swollen glands

Throughout the second stage, infected individuals usually still don’t show symptoms because even though the virus is active, it reproduces at a slow rate. There is still no cure for HIV/AIDS and so individuals, who decides to follow a treatment program, remains at this asymptomatic stage and reduce the viral reproduction rate to the extent that it is undetectable (Leonard et al. 2018). As a result, the body remains healthy and the virus is untransmittable, nonetheless, if viral levels are detectable, the virus can be passed on despite not expressing any symptoms. Critically speaking, by ensuring a regular monitoring of undetectable level of the virus is necessary to reduce further transmission is crucial. In order for everyone to live a long healthy life, taking appropriate precautions allows avoidance or prevention of transmission of HIV and other diseases.

Stage 3 HIV can also be referred to as AIDS, however, AIDS is a different and separate diagnosis from HIV in that it is a syndrome, whilst HIV is a virus. Those undergoing drug therapy for HIV, prevents their condition from worsening to stage 3 level because their level of immunity remains strong enough to protect them (Leonard et al. 2018). Those without treatment notably increases the viral load, and decrease CD4 cell count. This weaken immunity leaves the body susceptible to various infections and diseases, which can be life-threatening (Leonard et al. 2018). A healthy CD4 count is between 500 and 1,500 cells/mm3, but an AIDS diagnosis from HIV is said to be under 200.

During this stage, symptoms include:

• blotches under the skin or in the mouth and nose
• blurred vision
• diarrhea lasting longer than 1 week
• swollen lymph glands
• constant tiredness
• fever that keeps coming back
• memory loss
• depression
• pneumonia
• weight loss
• mouth, anus, or genital sores

Conditions that commonly develop at this stage further include tuberculosis (TB), fungal infections of the respiratory system, hepatitis, and some types of cancer (Leonard et al. 2018).

WHAT CAN WE DO?

Whether high prevalence or low prevalence of HIV are being experienced, the spread of HIV has gotten to every nation in the world. In low-prevalence nations, in particularly, those with high risk of sexual ad injection drug use behaviours in the population, the priority is to avoid an epidemic. Whereas in high-prevalence nations, the primacy is to reduce the spread of the disease and coping with the morbidity and mortality rates (Gibney et al. 1999). The biomedical approach to preventing HIV transmission includes usage of condoms, a barrier method that stops live virus from touching the genital mucosa, development of microbicides, physical barriers, and vaccines to prevent acquisition of the virus (Gilbert et al. 1999). Behavioural approaches include implementing HIV prevention interventions before adolescents become sexually active, because it facilitates a longer-term impact on sexual behaviour and on HIV prevalence than interventions implemented after the onset of sexual activity. An additional important impediment to adopting safer behaviours is likely to be individuals’ daily encounters with the more pressing problems and challenges that poverty brings; these diminish the attention they are willing or able to pay to something that is not an actual condition but represents a potential threat to their future health (Gibney et al. 1999).

Although there is no cure currently available for HIV/AIDS, but there are treatments that can stop further progression of the disease and allow most people living with HIV the opportunity to live a long and relatively healthy life. Starting antiretroviral therapy (ART) early in the progression of the virus is crucial because this improves quality of life, extends life expectancy, and reduces the risk of transmission (Murrell et al. 2018). More effective and better-tolerated treatments have evolved that can improve general health and quality of life by taking as little as one pill per day. The treatment of HIV involves antiretroviral medications that fight the HIV infection and slows down the spread of the virus in the body (Murrell et al. 2018).

However, there are improvements signified, whereby since 1995, new infection has declined by 81% and since 2002; number of HIV cases has declined by 35.5% (Girum, Wasie, & Worku et al. 2018). ART coverage has increased by 90% among all age and tripled among pregnant women within 6 years. Nationally, 67% of people living with HIV know their status, 88% of them are on treatment and 86% of people on treatment have viral suppression. As a result, AIDS-related death declined by 77 and 79% among all age and children respectively. By 2020, 79% of people living with HIV will know their HIV status, of which 96–99% of HIV infected people will be on ART and more than 86% will have viral suppression.

CONCLUSION

Emerging infectious diseases and pandemic threats remain a major global concern. Epidemic burden that countries face is excessive when it comes to treatment of patients infected with the disease. High prevalence of HIV/AIDS that a country suffers forces them to become reconcile to the incapacitation of the entire society and reduced the nation’s productivity. Effective HIV prevention requires a combination of behavioural, biomedical, and structural intervention strategies. Carrying out actions such as consistent male- and female-condom use, reductions in concurrent and/or sequential sexual and needle-sharing partners, and treatment with antiretroviral medications will reduce the risk of transmission of HIV/AIDS. The future of HIV/AIDS is looking positive as more people are regularly checking up and taking up treatments. A significant decline of death rates shows that we should continue what we’re doing. Hence, HIV/AIDS is not something people should be ashamed of having, be brave and regularly check-up on your body. Does the information provided scare you? It’s not too late to check up now!

The purpose of this paper is to educate you about Aids and how to prevent and the problems that come along with it. HIV/AIDS is a sexually transmitted disease that can be life threating. I will be talking about how it was discovered and if there is a cure or not. And we will look at how the disease came up and the amount of people it affects today.

Cause of disease

HIV is caused by a virus called immunodeficiency. It’s a virus that attacks the immune system. You can catch this disease by coming in contact with infected blood, semen, vaginal fluids and sharing needles with someone with the disease. It can be passed down through a mother in pregnancy, but the most common way people catch the disease is by having unprotected sex with someone who has HIV.

History

HIV is traced back to Kinshasa, the democratic republic of Congo in the 1920s they say it was crossed from chimpanzees to humans. We have no idea how many people had the virus until the 1980s. It was documented that 100,000 to 300,000 people had already been affected been infected. In 1983 doctors from Pasteur institute of France discovered that Lymphadenopathy-Associated Virus could be the cause of aids. Shortly after the first reports of AIDS in children was documented. They found it could be passed via casual contact but later this turned out to be false. Shortly after they found that the children were getting It from their mothers at birth. In 1984 the CDC published their first set of recommended precautions for healthcare workers and allied health professionals to prevent ‘AIDS transmission’. The CDC said to prevent aids don’t share needles with anyone and do not have unprotected sex. By the end of 1984 7,700 cases of aids was made and 3,665 deaths occurred. By 2000 HIV was the leading cause of death in America.

Epidemiology

HIV originated in Africa and so it has the most amount of people infected followed by Asia. There are currently 37.9 million people infected in the world. 25 million of those people live in Africa. There are 1.7 million new people infected this year. Since HIV has been documented 770,000 people has passed away due to the effects of HIV. The disease can be spread in multiples of ways unprotected sex sharing needles and getting in contact with bodily fluids.

Pathology

HIV attacks the body’s immune system by destroying lymphocytes. These are specialized white blood cells that perform many immune functions, such as fighting pathogens. Helper T cells stimulate B cells to produce antibodies, which help destroy pathogens that enter the body. When HIV enters certain cells, it reproduces itself and destroys the cell. As more cells are destroyed, the immune system becomes weaker. Then the body can catch disease easily because it cannot fight them off.

There are three phases of HIV. The first is the infection phase it starts two to four weeks of infection. You would become sick with flu-like symptoms. Like headaches fever vomiting and more. At the stages the HIV levels in your blood are very high. The next phase is called clinical latency stage. In this phase the HIV is reproducing, but the person may not feel ill. This phase can last for decades if treated. The final phase is called Aids. It’s when the helper T cells drop below 200 and the AIDS-opportunistic infections are present.

Response and Treatment

Our immune system fights the pathogen with CD4 and White blood cells, but the HIV virus easily defeats the cells and conquers are immune system. There is no cure for HIV, but people can suppress it by doing antiretroviral therapy. Which basically means taking a bunch of different drugs to help combat the virus. You can totally avoid this disease by doing 3 things. Abstain from sex, do not use anyone’s needles and do not touch anyone else’s blood.

To combat the issue of aids the people who made condoms started to advertise on tv saying they will prevent HIV. The education system started putting HIV in textbooks so kids will learn about it. Doctors started running tests and logging data and projecting how many people has died and is infected by AIDS. A policy to help limit Aids is to not sell any medicine to newly infected people so people will be more cautious. We would have to sacrifice the money that America gets from selling the medicine. Another policy would be that everyone must get a yearly test to see who has HIV. Everyone would have to get a yearly checkup would be the only sacrifice.