Overview - AIDS

AIDS
Current Issues , 2010
AIDS, acquired immunodeficiency syndrome, is one of the most devastating diseases of modern times. As of
2009, more than 25 million people have died since the AIDS pandemic began in the early 1980s, with the most
damaging effects felt in sub-Saharan Africa. Around 63 percent of people living with HIV, the virus that causes
AIDS, are in sub-Saharan Africa. Researchers and doctors still search for a cure or a vaccine. Billions of dollars
have been spent on AIDS research, treatment, and prevention. The disease and its consequences raise difficult
questions for people who have AIDS and for their families and friends, health-care workers, policy makers, and
others.

Cause and Spread of the Disease

AIDS is caused by HIV, the human immunodeficiency virus. People who have been infected with HIV can live up
to ten years without symptoms, but the virus eventually attacks white blood cells that play a key part in the
immune system. As these cells are destroyed, the body becomes weak and unable to resist infections that can
lead to serious illnesses, such as tuberculosis and pneumonia. This is the last stage of HIV infection, known as
AIDS.

HIV, which may be present in body fluids such as blood, semen, vaginal fluid, and breast milk, can be spread in
several ways. The most common means of transmission is through sexual intercourse without the use of a
condom with someone who has HIV. Intravenous drug users also risk contracting HIV when they share
contaminated needles and syringes. Women who have the virus can pass it to their children before or during
birth or through breast-feeding. Preventive treatments developed in the 1990s have significantly reduced the
number of cases of mother-to-child transmission in the United States. In rare cases, HIV can be transmitted
through a blood transfusion from an infected person. Since 1985, all donated blood in the United States has
been carefully screened for HIV. The virus cannot be spread by casual contact.

History of AIDS
In June 1981, the U.S. Centers for Disease Control and Prevention (CDC) reported the first cases of the disease
that would later be called AIDS. By the mid-1980s doctors and researchers had identified HIV and discovered
how it is transmitted. In 1987 the drug AZT became available to help fight the disease. The first AIDS vaccines
were tested the same year but were unsuccessful. By the early 1990s, about 1 million Americans and 10 million
people around the world were infected with HIV. In 2006 the number of people living with the virus worldwide had
risen to nearly 40 million.

In 1996 doctors began prescribing two new drugs, lamivudine and zidovudine, which are combined with AZT to
make up an expensive but effective "cocktail." These medicines have helped many patients with HIV live longer
by restoring immune system cells and slowing the destruction caused by the virus. However, these drugs cannot
eliminate HIV entirely from an infected person, and the "cocktail" must therefore be taken for the remainder of a
patient’s life. In 2001 researchers were encouraged by early tests of some new AIDS vaccines, but no vaccine
has been developed yet and research continues.

A Worldwide Epidemic
AIDS has impacted people of all ages, ethnic groups, and sexual orientations. While the estimated number of
new cases has leveled off in highly industrialized countries, the disease continues to spread rapidly in other
areas.

The epidemic is most severe in sub-Saharan Africa, a region that had about 22 million people infected with HIV
in 2009. Most cases of HIV/AIDS among Africans have been contracted through heterosexual intercourse. Men
who are working away from home often visit prostitutes, become infected with HIV, and then bring the virus back
to their wives and girlfriends.

Other severely affected areas include countries in South and Southeast Asia. By 2009 these areas had 3.8
million people living with HIV, the second-highest number of cases in the world. The AIDS epidemic did not hit
Eastern Europe and Central Asia until the early 1990s. Most new cases there have been related to an increase
in intravenous drug use. The disease has dealt a particularly hard blow to Russia.

In the United States, the CDC estimates that in 2001 between 800,000 and 900,000 people were infected with
HIV. By 2007 that number had grown to more than 1.1 million. African Americans, who represent approximately
12 percent of the U.S. population, accounted for 51 percent of new HIV infections in 2007. The number of new
AIDS cases and related deaths decreased during the 1990s as a result of the availability of effective drugs.
However, since 1998, this downward trend has leveled off. The success of new AIDS drugs has created the false
impression that the disease is no longer serious, and some people are not taking precautions. Studies released
in mid-2001 showed that young urban homosexual men and poor heterosexual black women are most at risk for
contracting the disease because of failure to use condoms. Drug use is a contributing factor in about 25 percent
of HIV/AIDS cases in the United States.

Impact of AIDS
HIV/AIDS has not only caused enormous loss of human life, but it has also had devastating social and economic
consequences. In Africa, AIDS has left 14 million children orphaned since the epidemic began there in the late
1970s. Many of those living with the disease are considered outcasts among their families and communities. The
epidemic has had a serious economic impact in Africa. As working-age adults succumb to the disease, the
elderly and children are left without income and the community must deal with a decreasing pool of skilled
workers. In addition, families who must care for infected relatives are less able to afford other necessities,
including food and their children's education.

In Western countries, the burden on health-care resources is great. Total U.S. government spending for AIDS
research, prevention, treatment, and international programs was $10.8 billion in 2000. In 2008 it was $23.3
billion. In his 2010 federal budget request to Congress, President Barack Obama called for $25.8 billion for
domestic and global AIDS programs.

AIDS and Society

In most parts of the world, government, health-care workers, teachers, and nonprofit groups are making an
ongoing effort to educate people about AIDS. Because there is no cure, prevention is the best way of dealing
with the disease. However, the disgrace associated with AIDS in many countries has kept millions from receiving
the education and testing needed to control the epidemic.

The Controversy
In the early years of the epidemic, homosexual men and intravenous drug users were the first and largest groups
to fall prey to AIDS in the United States. As a result, people with AIDS carried a mark of disgrace, even if they
had contracted the disease in another way. Parents tried to bar students with AIDS from the classroom, fearing
that their children could get the virus through casual contact. Employers tried to keep infected persons out of the
workplace, landlords attempted to evict the sick from their homes, and many health-care workers sought to avoid
contact with patients. The storm settled as people began to understand how HIV is transmitted and that anyone
could get it.

The picture of AIDS in Africa stands in stark contrast to that of the United States. Generally, sexual matters are
not openly discussed in Africa. As a result, people do not talk candidly about HIV/AIDS, and in fact, many even
deny its existence. Men often refuse to use condoms, and women are largely powerless to change sexual
behavior. Many who are ill with AIDS refuse to be tested because they do not want others to know they have the
disease. Families often disown members who reveal they are sick with AIDS, forcing them to live alone and
provide for their own needs. Even governments refuse to admit that large numbers of their populations have
AIDS. This denial has contributed to a lack of prevention and testing.

Education and Prevention

Because HIV is most often spread through sexual contact and intravenous drug use, AIDS education has
traditionally caused conflict. Some believe that it should emphasize abstinence before marriage, faithfulness
between couples, and a drug-free lifestyle. Others view this approach as impractical, arguing that unprotected
sex, not sex itself, transmits the virus and that getting addicts to stop taking drugs is very difficult. In their opinion,
educators should encourage people to always use a condom during sex and to never share drug equipment.

In addition to AIDS education programs, nonprofit agencies distribute condoms in locations where unprotected
sex is likely to take place, such as bars, nightclubs, and areas known for prostitution. Free condoms are also
available at clinics, and some public schools provide condoms to students by request. Needle-exchange
programs, active in more than thirty states, prevent the spread of AIDS through the sharing of contaminated
needles. Drug users are given clean needles and asked to turn over their used needles for disposal.

The loveLife program began in the 1990s in South Africa. Jointly funded by two U.S. foundations and the South
African government, loveLife is aimed at teenagers and young adults. It promotes sexual health and has helped
establish a network of clinics and other services where young people in South Africa can obtain condoms and
learn how to prevent the spread of HIV/AIDS. Such prevention campaigns have been quite successful.

Testing
The HIV antibody test was developed to screen the blood supply so that people receiving transfusions will not
become infected. The test detects the existence of antibodies, not the presence of the virus itself. Doctors soon
realized that the test could be used to identify individuals who did not show symptoms of HIV but could transmit
the virus.

Issues Raised by HIV Testing

Debate on HIV testing emerged as different groups raised questions about mandatory versus voluntary testing
and privacy with regard to the reporting of results. Some people believed that being identified as HIV positive
could lead to discrimination in jobs, housing, access to health care and insurance, and the right to travel. They
wanted assurance that people’s rights would be protected. Others saw HIV testing as an opportunity, contending
that identification could play an important role in preventing the spread of the disease. Once a person had been
identified as HIV positive, he or she could begin receiving treatment and take precautions not to infect others.
The issue pitted three groups against each other. Gay rights activists and their supporters favored voluntary
testing, as did public health officials. Many conservatives supported a broad program of mandatory testing. A
compromise was reached that permitted doctors to test for HIV antibodies only after individuals gave their
informed consent. In areas with large numbers of AIDS cases, public health officials encouraged testing by
allowing those tested to remain anonymous.

The federal government responded to conservative pressure by requiring the testing of military recruits, Job
Corps applicants, and those seeking to enter the foreign service. The government later started HIV testing in
federal prisons and made such testing a condition for immigration into the United States.

Reporting Test Results

All fifty states require medical professionals to provide the names of people who have AIDS to public health
departments. This follows the traditional public health practice of reporting cases of infectious diseases.
However, reporting the names of people who are HIV positive and have not developed AIDS is a matter that
provokes intense debate. Some view reporting as a way for public health officials to track the course of the
epidemic. They argue that this practice ensures follow-up care and enables the development of
partner-notification programs that would reach others who had been exposed to the virus. Opponents believe
that such reporting represents an invasion of privacy and discourages people from being tested voluntarily or
from seeking further care.

Ethical Issues and AIDS

Because AIDS is a fatal disease, many ethical issues exist concerning the behavior of those infected. Other
topics that stir debate are the cost and availability of medicines and the responsibility of government and private
business to help infected people worldwide.

Partner Notification
Identifying the sexual and needle-sharing partners of someone with HIV and informing them that they may have
contracted the disease is known as partner notification. Voluntary partner notification has become an accepted
means of controlling the AIDS epidemic. Individuals who have been exposed to the virus can receive treatment
and education, which prevents the spread of the disease and helps people avoid infection in the future. The CDC
has encouraged states to establish partner-notification programs that are voluntary and confidential and that
recognize the potential negative consequences of notification.

The legislatures of some states, however, have decided to make partner notification mandatory. In Indiana, for
example, HIV-positive individuals who do not inform their present and past partners may face fines or
imprisonment. Health-care providers in Texas are required to inform the partners of a patient who tests positive
for the virus, regardless of whether the person has done so.

Some groups claim that mandatory partner notification does not work in HIV cases. One reason is that the long
incubation period—the time between infection and the beginning of symptoms—associated with HIV means that
past partners must be notified and locating them can be difficult. In addition, sex and needle sharing may have
been conducted with strangers. Some people fear violence from partners who discover they may have been
infected, and others worry that they will be admitting to criminal behavior, such as drug use and prostitution.
Some do not want their partners to be discriminated against, and many HIV-positive individuals worry that
information about past partners may lead to divorce or other legal problems.
Medication Issues
The cost of medicines used to treat HIV, known as antiretrovirals, has become an important issue in recent
years. In the United States, government programs like Medicare and Medicaid help provide medication for some.
Under the Ryan White Care Act of 1990, the government also pays part of the cost of drugs for people with HIV.
Donations from drug companies, private corporations, and nonprofit organizations provide for others.

Western drug companies that develop the medicines need to make a profit in order to continue research and
development of new drugs and vaccines. Yet many AIDS patients, both in industrialized and in underdeveloped
nations, cannot afford the price of the medication. In response, some pharmaceutical companies have agreed to
cut the cost of HIV/AIDS drugs in poor countries severely affected by the disease.

Drug companies in India, Thailand, Canada, and Brazil sell generic versions of antiretrovirals at a fraction of
Western prices. In 1997 UNAIDS began a drug-access program in Uganda, Ivory Coast, Vietnam, and Chile and
has succeeded in getting antiretroviral drugs for HIV/AIDS patients for less money.

Helping Underdeveloped Nations

A basic ethical question posed by AIDS is whether wealthy nations like the United States are obliged to help poor
nations survive the AIDS epidemic, and if so, how much help they should give. Thus far, world aid has been
inadequate. A committee of the World Health Organization began conducting a study in 2001 on ways to get the
most from international public health funding and how much money was needed to produce those results. Early
estimates were that nations giving $500 million each year for HIV/AIDS relief in poor countries would have to
boost that amount to between $5 billion and $10 billion per year to control the pandemic. However, the
committee proposed that money must be combined with a plan for prevention, treatment, community support,
and research and development to produce a vaccine, as well as recommendations for dealing with related health
issues. Changes must also come from within impoverished nations, in the form of strong leadership and practical
education about HIV and AIDS so that the cycle of infection can be broken.

Full Text: COPYRIGHT 2012 Gale, Cengage Learning.

Source Citation:
"AIDS." Current Issues: Macmillan Social Science Library. Detroit: Gale, 2010. Gale
Opposing Viewpoints In Context. Web. 26 Apr. 2012.

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