The AIDS Crisis

HIV is transmitted through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast milk.

Most researchers believe that HIV originated in sub-Saharan Africa during the twentieth century; it is now a pandemic, with an estimated 38.6 million people now living with the disease worldwide.

"AIDS kills. In Africa, the proportion of HIV-infected people is so high right now that entire villages are being wiped out. Youths and adults are going to die off in droves. These are the people who make up the work force. Without them, an already-impoverished region will experience total economic CATASTROPHE. Babies are dying of AIDS, adding to an infant-mortality rate that was pretty high to begin with. But those who do survive will not have their parents around to raise them. They will not have adults to educate them. They will not learn the skills they need to be productive citizens. So while an entire generation of people is being decimated by AIDS, the generation that seeks to replace them will be ill-equipped for survival. Meanwhile, the elder generation is a little less affected by HIV, but they, too, will die (though more likely of age or other problems).

Essentially, without HIV prevention measures, Africa will be destroyed both socially (decimation of population) and economically (destruction of work force)."
-Why is AIDS having such a devastating impact throughout Africa?

HIV/ AIDS, tuberculosis, and malaria are devastating entire communities and economies. Poor countries are losing their teachers, doctors and nurses. Businesses are losing their workers. Governments are losing their civil servants. Families are losing their breadwinners.

• TB kills an estimated 2 million people each year and is the leading cause of death for people with AIDS. At least 1 million people die from malaria each year, mostly children in Africa.
• AIDS is the world’s fourth leading cause of death. Since first being reported in 1981, AIDS has killed over 25 million people. AIDS killed an estimated 3 million people in 2006 alone.
• Globally, 15 million children have lost one or both parents to AIDS. 12 million of those live in sub-Saharan Africa.
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PEPFAR Passes 80-16

“Even as Americans face serious concerns at home, the Senate has proved America’s commitment to providing lifesaving medicines to the world’s most vulnerable people. PEPFAR is an investment in people around the world; but it is also an example of America’s generosity and a critical piece of American diplomacy. By treating and preventing disease and saving lives, we can help to create more stable communities and a more secure future for Americans.

Senators Biden, Lugar and Reid are true heroes for their persistence and patience in passing this bill. This legislation received strong support from co-sponsoring Senators on both sides of the aisle, including both Presidential candidates.”

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‘ONE’ More in the Name of Love.

"It's not about charity, it's about justice."
-Bono

For the people in Africa who need your help..

• Ourkids-Ugana.org

• RED

• DATA

• ONE

• EDUN.ie

(RED) was created by Bono and Bobby Shriver, Chairman of DATA, to raise awareness and money for The Global Fund by teaming up with the world's most iconic brands to produce (PRODUCT) RED-branded products. A percentage of each (PRODUCT) RED product sold is given to The Global Fund. The money helps women and children with HIV/AIDS in Africa.

At the University of Iowa, Bono said, "We don't have to guess what is on God's mind here. It bewilders me that anyone can call themselves followers of Christ and not see that AIDS is the leprosy spoken about in the New Testament. God is at work here." (See also: One Modern Day Prophet)

Despite the extreme crisis, there is very little attention paid to AIDS today. In Africa, the AIDS pandemic is destroying an entire continent, especially in the Democratic Republic of the Congo. The death toll every single day in Congo is somewhere between the death tolls of Hurricane Katrina and the September 11, 2001 attacks, and the weekly death toll is about the same as the death toll of the 2004 Indian Ocean earthquake.

²⁰ Looking at his disciples, he (Jesus) said:

"Blessed are you who are poor, for yours is the kingdom of God.

²¹Blessed are you who hunger now, for you will be satisfied.Blessed are you who weep now, for you will laugh.

²² Blessed are you when men hate you, when they exclude you and insult youand reject your name as evil, because of the Son of Man.

²³ "Rejoice in that day and leap for joy, because great is your reward in heaven.For that is how their fathers treated the prophets.

²⁴ "But woe to you who are rich, for you have already received your comfort.

²⁵ Woe to you who are well fed now, for you will go hungry. Woe to you who laugh now,for you will mourn and weep.

²⁶ Woe to you when all men speak well of you, for that is how their fathers treated the false prophets.

-Luke 6:20-26

In Southern Africa, several factors contribute to the spread of the HIV virus. For one, a stigma is attached to admitting to HIV infection and to using condoms. For another, many deny that the HIV virus causes AIDS: Thabo Mbeki and Robert Mugabe have both suggested AIDS stems from poverty rather than HIV infection. And finally, many myths are attached to the use of condoms, such as the ideas that a conspiracy wants to limit the growth of the African population and that condoms stifle the traditional power of the man in his community.

In the 35 African nations with the highest prevalence, average life expectancy is 48.3 years—6.5 years less than it would be without the disease. For the eleven countries in Africa with prevalence rates above 13%, life expectancy is 47.7 years—11.0 years less than would be expected without HIV/AIDS.

Although many governments in sub-Saharan Africa denied that there was a problem for years, they have now begun to work toward solutions.

Health spending in Africa has never been adequate, either before or after independence. The health care systems inherited from colonial powers were oriented toward curative treatment rather than preventative programs. Strong prevention programs are the cornerstone of effective national responses to AIDS, and the required changes in the health sector have presented huge challenges.

Lack of money is an obvious challenge, although a great deal of aid is distributed throughout developing countries with high HIV/AIDS rates. Response to the epidemic is also hampered by lack of infrastructure, corruption within both donor agencies and government agencies, foreign donors not coordinating with local government and misguided resources.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) has predicted outcomes for the region to the year 2025. These range from a plateau and eventual decline in deaths beginning around 2012 to a catastrophic continual growth in the death rate with potentially 90 million cases of infection.

Without the kind of nutrition, health care and medicines (such as anti-retrovirals) that are available in developed countries, large numbers of people in Africa will develop full-blown AIDS. They will not only be unable to work, but will also require significant medical care. This will likely cause a collapse of economies and societies. In all of the severely affected countries, the epidemic has left behind many orphans, who are either cared for by extended family members, or must live in orphanages or on the streets. UNAIDS, WHO and UNDP have already documented decreasing life expectancies and lowering of GNP in many African countries with prevalence rates of 10% or more.

A minority of scientists claim that as many as 40% of HIV infections in African adults may be caused by unsafe medical practices rather than by sexual activity. The World Health Organization states that 2.5% of infections are caused by unsafe medical injection practices and all the others by unprotected sex.

Measuring the epidemic

Health units that conduct serosurveys rarely operate in remote rural communities and the data collected also does not measure people who seek alternate healthcare. And extrapolating national data from antenatal surveys relies on assumptions which may not hold across all regions and at different stages in an epidemic.

Recent national population or household-based surveys, collecting data from both sexes, pregnant and non-pregnant women and rural and urban areas, have adjusted the recorded national prevalence levels for several countries in Africa and elsewhere. These too, are not perfect: People may not participate in household surveys because they fear they may be HIV positive and do not want to know their test results. Household surveys also exclude migrant labourers, who are a high risk group.

Thus, there may be significant disparities between official figures and actual HIV prevalence in some countries.

Access to treatment

"Treatment is technically feasible in every part of the world. Even the lack of infrastructure is not an excuse—I don't know a single place in the world where the real reason AIDS treatment is unavailable is that the health infrastructure has exhausted its capacity to deliver it. It's not knowledge that's the barrier. It's political will." Peter Piot, Executive Director of UNAIDS

ARVs play a central role in prevention as well. When treatments are known to be available, people are more likely to come forward for testing and well as more likely to adopt lower risk behaviours. ARVs also reduce the amount of the HIV virus in the blood, thus reducing the risk of further transmission.

Patients who start HIV treatment generally have to continue taking medications for the rest of their lives. In areas where drug therapy is expensive, some people must interrupt their treatment when they were unable to afford medication. Drug-resistant strains of HIV have been observed in such areas.

The key factor in the expense of ARVs is their patent status, which allows drug companies to recoup research costs and turn a profit, enabling the development of new drugs. International aid organisations such as VSO, Oxfam and Médecins Sans Frontières have questioned whether the revenues generated by ARVs really tally with research costs.

Generic copies of patented ARV drugs are supplied by drug manufacturers in India, South Africa, Brazil, Thailand, and the People's Republic of China. Because fees are not paid to the patent holders, the drugs can be distributed at low prices in developing countries. Generic production competition and 'price offers' (voluntary donations by companies) have forced patent holders to reduce their prices.

ARV patients need regular testing of viral load and CD4 cell count. This requires expensive laboratory equipment and good healthcare logistics. These costs drive the price of generic ARV therapy in African countries up from under $140 USD pppy for the drugs alone to approximately $800 USD pppy when done according to Western standards.

For many Africans, living below the poverty threshold of a $2 USD / day, free (government or NGO-funded) treatment remains the only option.

The World Health Organisation's 3 by 5 initiative aimed to provide three million people with ARV treatment by the end of 2005. International aid organisations have lobbied for an expansion of generic production in developing countries, for immediate short term and stable, predictable long term financing of the 3 by 5 initiative.

The United States AIDS initiative, PEPFAR, is focusing two thirds of its resources on AIDS in Africa. Starting in 2004, expenditures rose from $2.3B world-wide to $3.3B in 2006. A funding level of $4B was requested for 2007.

The DREAM ("Drug Resources Enhancement against AIDS and Malnutrition", formerly "Drug Resource Enhancement against AIDS in Mozambique") initiative promoted by the Community of Sant'Egidio has given access to free ARV treatment with generic HAART drugs to the poor on a large scale. So far, 5,000 people are receiving ARV treatment, especially in Mozambique, but the program is also being built up in Malawi, Guinea, Tanzania and other countries. The program includes regular blood testing according to European standards. It is linked with nutrition and sanitation programs run by volunteers. The compliance rate is 94 per cent.

Regional analysis

East-central Africa

• A 2005 survey by the Central Statistical Agency of Ethiopia showed that Adult (ages 15-49) prevalence was only 1.4%, with prevalence among women at 1.9% and among men at 0.9%.

Most governments in the region established AIDS education programmes in the mid-1980s in partnership with the World Health Organization and international NGOs. These programmes commonly taught the 'ABC' of HIV prevention: a combination of abstinence (A), fidelity to your partner (Be faithful) and condom use (C). The efforts of these educational campaigns appear now to be bearing fruit. In Uganda, awareness of AIDS is demonstrated to be over 99% and more than three in five Ugandans can cite two or more preventative practices. Youths are also delaying the age at which sexual intercourse first occurs.

There are no non-human vectors of HIV infection. The spread of the epidemic across this region is closely linked to the migration of labour from rural areas to urban centres, which generally have a higher prevalence of HIV. Labourers commonly picked up HIV in the towns and cities, spreading it to the countryside when they visited their home. Empirical evidence brings into sharp relief the connection between road and rail networks and the spread of HIV. Long distance truck drivers have been identified as a group with the high-risk behaviour of sleeping with prostitutes and a tendency to spread the infection along trade routes in the region. Infection rates of up to 33% were observed in this group in the late 1980s in Uganda, Kenya and Tanzania.

West Africa

HIV prevalence in West Africa is lowest in Chad, Niger, Mali, Mauritania and highest in Burkina Faso, Côte d'Ivoire, and Nigeria. Nigeria has the second largest HIV prevalence in Africa after South Africa, although the infection rate (number of patients relative to the entire population) based upon Nigeria's estimated population is much lower, generally believed to be well under 7%, as opposed to South Africa's which is well into the double-digits (nearer 30%).

The main driver of infection in the region is commercial sex. In the Ghanaian capital Accra, for example, 80% of HIV infections in young men had been acquired from women who sell sex. In Niger, the adult national HIV prevalence was 1% in 2003, yet surveys of sex workers in different regions found a HIV infection rate of between 9 and 38%.

Southern Africa

Nearly every country in the region has a national HIV prevalence level of at least 10%. The only exception to this rule is Angola, with a rate of less than 5%. This is not the result of a successful national response to the threat of AIDS but of the long-running Angolan Civil War (1975-2002).

Most HIV infections found in Southern Africa are HIV-1, the world's most common HIV infection, which predominates everywhere except West Africa, home to HIV-2. The first cases of HIV in the region were reported in Zimbabwe in 1985.

Impacts of the AIDS Epidemic

The social impact of HIV/AIDS is most evident in the continent's orphans crisis. Approximately 12 million children in sub-Saharan Africa are estimated to be orphaned by AIDS. These children are overwhelmingly cared for by relatives including especially grandmothers, but the capacity of the extended family to cope with this burden is stretched very thin and is, in places, collapsing. UNICEF and other international agencies consider a scaled-up response to Africa's orphan crisis a humanitarian priority. Practitioners and welfare specialists are sensitive to the need not to identify and isolate children orphaned by AIDS from other needy and vulnerable children, in part because of fear of stigmatizing them. Therefore, there is a search for effective social policies and programs that will provide necessary assistance and protection for all orphans and vulnerable children.

The political impact of the epidemic has been little studied. There has been much concern that high levels of HIV among soldiers and political leaders could lead to a "hollowing out" or even collapse of essential state structures, and an escalation of conflict. Laurie Garrett of the Council on Foreign Affairs is most publicly associated with this position. However, it is also clear that the epidemic has coincided with the entrenchment of democracy in much of Africa, and that governments and armies have learned to cope with the effects of the epidemic.

Spawning new epidemics in Africa and Abroad

• UNAIDS Epidemic Update December 2004
• UNAIDS 2004 Report on the global AIDS epidemic
• Treating AIDS Now, Romilly Greenhill, People & Planet, March 2004
• Encyclopedia of AIDS: A Social, Political, Cultural, and Scientific Record of the HIV Epidemic, Raymond A. Smith (ed), Penguin Books. ISBN 0-14-051486-4.
• Tony Barnett and Alan Whiteside, "AIDS in the 21st Century: Disease and Globalization," Palgrave Macmillan, 2003, ISBN 1-4039-0006-X
• John Iliffe, "The African AIDS Epidemic: A History," James Currey, 2006, ISBN 0-85255-890-2
• Nicoli Nattrass, "The Moral Economy of AIDS in South Africa," Cambridge University Press, 2003, ISBN 0-521-54864-0
• Alex de Waal, "AIDS and Power: Why there is no political crisis--yet," Zed Books, 2006, ISBN 1-84277-707-6
• Pieter Fourie, "The Political Management of HIV and AIDS in South Africa: One burden too many?" Palgrave Macmillan, 2006, ISBN 0-230-00667-1

  Infection by HIV

  AIDS is the most severe manifestation of infection with HIV. HIV is a retrovirus that primarily infects vital components of the human immune system such as CD4+ T cells (a subset of T cells), macrophages and dendritic cells. It directly and indirectly destroys CD4+ T cells. CD4+ T cells are required for the proper functioning of the immune system. When HIV kills CD4+ T cells so that there are fewer than 200 CD4+ T cells per microliter (µL) of blood, cellular immunity is lost, leading to the condition known as AIDS. Acute HIV infection progresses over time to clinical latent HIV infection and then to early symptomatic HIV infection and later, to AIDS, which is identified on the basis of the amount of CD4+ T cells in the blood and the presence of certain infections.

  In the absence of antiretroviral therapy, the median time of progression from HIV infection to AIDS is nine to ten years, and the median survival time after developing AIDS is only 9.2 months. However, the rate of clinical disease progression varies widely between individuals, from two weeks up to 20 years. Many factors affect the rate of progression. These include factors that influence the body's ability to defend against HIV such as the infected person's general immune function. Older people have weaker immune systems, and therefore have a greater risk of rapid disease progression than younger people. Poor access to health care and the existence of coexisting infections such as tuberculosis also may predispose people to faster disease progression. The infected person's genetic inheritance plays an important role and some people are resistant to certain strains of HIV. An example of this is people with the CCR5-Δ32 mutation are resistant to infection with certain strains of HIV. HIV is genetically variable and exists as different strains, which cause different rates of clinical disease progression. The use of highly active antiretroviral therapy prolongs both the median time of progression to AIDS and the median survival time.

  Diagnosis

  Since June 5, 1981, many definitions have been developed for epidemiological surveillance such as the Bangui definition and the 1994 expanded World Health Organization AIDS case definition. However, clinical staging of patients was not an intended use for these systems as they are neither sensitive, nor specific. In developing countries, the World Health Organization staging system for HIV infection and disease, using clinical and laboratory data, is used and in developed countries, the Centers for Disease Control (CDC) Classification System is used.

  WHO disease staging system for HIV infection and disease

  Main article: WHO Disease Staging System for HIV Infection and DiseaseIn 1990, the World Health Organization (WHO) grouped these infections and conditions together by introducing a staging system for patients infected with HIV-1. An update took place in September 2005. Most of these conditions are opportunistic infections that are easily treatable in healthy people.

  • Stage I: HIV disease is asymptomatic and not categorized as AIDS
  • Stage II: includes minor mucocutaneous manifestations and recurrent upper respiratory tract infections
  • Stage III: includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis
  • Stage IV: includes toxoplasmosis of the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposi's sarcoma; these diseases are indicators of AIDS.

  CDC classification system for HIV infection

HIV test

Symptoms and complications

HIV affects nearly every organ system. People with AIDS also have an increased risk of developing various cancers such as Kaposi sarcoma, cervical cancer and cancers of the immune system known as lymphomas.

Additionally, people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss. After the diagnosis of AIDS is made, the current average survival time with antiretroviral therapy (as of 2005) is estimated to be more than 5 years, but because new treatments continue to be developed and because HIV continues to evolve resistance to treatments, estimates of survival time are likely to continue to change. Without antiretroviral therapy, death normally occurs within a year. Most patients die from opportunistic infections or malignancies associated with the progressive failure of the immune system.

The rate of clinical disease progression varies widely between individuals and has been shown to be affected by many factors such as host susceptibility and immune function health care and co-infections, as well as factors relating to the viral strain. The specific opportunistic infections that AIDS patients develop depend in part on the prevalence of these infections in the geographic area in which the patient lives.

Major pulmonary illnesses

In developing countries, it is still one of the first indications of AIDS in untested individuals, although it does not generally occur unless the CD4 count is less than 200 per µL. Tuberculosis (TB) is unique among infections associated with HIV because it is transmissible to immunocompetent people via the respiratory route, is easily treatable once identified, may occur in early-stage HIV disease, and is preventable with drug therapy. However, multi-drug resistance is a potentially serious problem.

Major gastro-intestinal illnesses

Major neurological illnesses

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease, in which the gradual destruction of the myelin sheath covering the axons of nerve cells impairs the transmission of nerve impulses. It is caused by a virus called JC virus which occurs in 70% of the population in latent form, causing disease only when the immune system has been severely weakened, as is the case for AIDS patients. It progresses rapidly, usually causing death within months of diagnosis.AIDS dementia complex (ADC) is a metabolic encephalopathy induced by HIV infection and fuelled by immune activation of HIV infected brain macrophages and microglia which secrete neurotoxins of both host and viral origin. Specific neurological impairments are manifested by cognitive, behavioral, and motor abnormalities that occur after years of HIV infection and is associated with low CD4+ T cell levels and high plasma viral loads. Prevalence is 10-20% in Western countries but only 1-2% of HIV infections in India. This difference is possibly due to the HIV subtype in India. Cryptococcal meningitis is an infection of the meninx (the membrane covering the brain and spinal cord) by the fungus Cryptococcus neoformans. It can cause fevers, headache, fatigue, nausea, and vomiting. Patients may also develop seizures and confusion; left untreated, it can be lethal.

Major HIV-associated malignancies

• Kaposi's sarcoma (KS) is the most common tumor in HIV-infected patients. The appearance of this tumor in young homosexual men in 1981 was one of the first signals of the AIDS epidemic. Caused by a gammaherpes virus called Kaposi's sarcoma-associated herpes virus (KSHV), it often appears as purplish nodules on the skin, but can affect other organs, especially the mouth, gastrointestinal tract, and lungs.
• High-grade B cell lymphomas such as Burkitt's lymphoma, Burkitt's-like lymphoma, diffuse large B-cell lymphoma (DLBCL), and primary central nervous system lymphoma present more often in HIV-infected patients. These particular cancers often foreshadow a poor prognosis. In some cases these lymphomas are AIDS-defining. Epstein-Barr virus (EBV) or KSHV cause many of these lymphomas.
• Cervical cancer in HIV-infected women is considered AIDS-defining. It is caused by human papillomavirus (HPV).

In addition to the AIDS-defining tumors listed above, HIV-infected patients are at increased risk of certain other tumors, such as Hodgkin's disease and anal and rectal carcinomas. However, the incidence of many common tumors, such as breast cancer or colon cancer, does not increase in HIV-infected patients. In areas where HAART is extensively used to treat AIDS, the incidence of many AIDS-related malignancies has decreased, but at the same time malignant cancers overall have become the most common cause of death of HIV-infected patients.

Other opportunistic infections

Transmission and prevention

Sexual contact

Sexually transmitted infections (STI) increase the risk of HIV transmission and infection because they cause the disruption of the normal epithelial barrier by genital ulceration and/or microulceration; and by accumulation of pools of HIV-susceptible or HIV-infected cells (lymphocytes and macrophages) in semen and vaginal secretions. Epidemiological studies from sub-Saharan Africa, Europe and North America have suggested that there is approximately a four times greater risk of becoming infected with HIV in the presence of a genital ulcer such as those caused by syphilis and/or chancroid. There is also a significant though lesser increased risk in the presence of STDs such as gonorrhea, Chlamydial infection and trichomoniasis which cause local accumulations of lymphocytes and macrophages.

Transmission of HIV depends on the infectiousness of the index case and the susceptibility of the uninfected partner. Infectivity seems to vary during the course of illness and is not constant between individuals. An undetectable plasma viral load does not necessarily indicate a low viral load in the seminal liquid or genital secretions. Each 10-fold increment of blood plasma HIV RNA is associated with an 81% increased rate of HIV transmission. Women are more susceptible to HIV-1 infection due to hormonal changes, vaginal microbial ecology and physiology, and a higher prevalence of sexually transmitted diseases. People who are infected with HIV can still be infected by other, more virulent strains.

During a sexual act, only male or female condoms can reduce the chances of infection with HIV and other STDs and the chances of becoming pregnant. The best evidence to date indicates that typical condom use reduces the risk of heterosexual HIV transmission by approximately 80% over the long-term, though the benefit is likely to be higher if condoms are used correctly on every occasion. The effective use of condoms and screening of blood transfusion in North America, Western and Central Europe is credited with contributing to the low rates of AIDS in these regions.

Promoting condom use, however, has often proved controversial and difficult. Many religious groups, most noticeably the Catholic Church, have opposed the use of condoms on religious grounds, and have sometimes seen condom promotion as an affront to the promotion of marriage, monogamy and sexual morality. This attitude is found among some health care providers and policy makers in sub-Saharan African nations, where HIV and AIDS prevalence is extremely high. They also believe that the distribution and promotion of condoms is tantamount to promoting sex amongst the youth and sending the wrong message to uninfected individuals. However, no evidence has been produced that promotion of condom use increases sexual promiscuity. Pope Benedict XVI commissioned a report on whether it might be acceptable for Catholics to use condoms to protect life inside a marriage when one partner is infected with HIV, or is sick with AIDS. Defenders of the Catholic Church's role in AIDS and general STD prevention state that, while they may be against the use of contraception, they are strong advocates of abstinence outside marriage. Conversely, some religious groups have argued that preventing HIV infection is a moral task in itself and that condoms are therefore acceptable or even praiseworthy from a religious point of view.

The male latex condom, if used correctly without oil-based lubricants, is the single most effective available technology to reduce the sexual transmission of HIV and other sexually transmitted infections. Manufacturers recommend that oil-based lubricants such as petroleum jelly, butter, and lard not be used with latex condoms as they weaken the latex, making the condoms porous. If necessary, manufacturers recommend using water-based lubricants. Oil-based lubricants can however be used with polyurethane condoms. Latex degrades over time, making them porous, which is why condoms have expiration dates. In Europe and the United States, condoms have to conform to European (EC 600) or American (D3492) standards to be considered protective against HIV transmission.

The female condom is an alternative to the male condom and is made from polyurethane, which allows it to be used in the presence of oil-based lubricants. They are larger than male condoms and have a stiffened ring-shaped opening, and are designed to be inserted into the vagina. The female condom contains an inner ring, which keeps the condom in place inside the vagina – inserting the female condom requires squeezing this ring.

With consistent and correct use of condoms, there is a very low risk of HIV infection. Studies on couples where one partner is infected show that with consistent condom use, HIV infection rates for the uninfected partner are below 1% per year.

The United States government and health organizations both endorse the ABC Approach to lower the risk of acquiring AIDS during sex:

Abstinence or delay of sexual activity, especially for youth,
Being faithful, especially for those in committed relationships,
Condom use, for those who engage in risky behavior.

This approach has been very successful in Uganda, where HIV prevalence has decreased from 15% to 5%. However, more has been done than implementing the ABC Approach as Edward Green, a Harvard medical anthropologist put it, "Uganda has pioneered approaches towards reducing stigma, bringing discussion of sexual behavior out into the open, involving HIV-infected people in public education, persuading individuals and couples to be tested and counseled, improving the status of women, involving religious organizations, enlisting traditional healers, and much more." Other programs and initiatives promote condom use more heavily. Condom use is an integral part of the CNN Approach. This is:

Condom use, for those who engage in risky behavior,
Needles, use clean ones,
Negotiating skills; negotiating safer sex with a partner and empowering women to make smart choices.

Criticism of the ABC approach is widespread because a faithful partner of an unfaithful partner is at risk of contracting HIV.

Current research is clarifying the relationship between male circumcision and HIV in differing social and cultural contexts. UNAIDS believes that it is premature to recommend male circumcision services as part of HIV prevention programs even though male circumcision may lead to a reduction of infection risk in heterosexual men by up to 60%. Moreover, South African medical experts are concerned that the repeated use of unsterilized blades in the ritual circumcision of adolescent boys may be spreading HIV.

Exposure to infected body fluids

The risk of transmitting HIV to blood transfusion recipients is extremely low in developed countries where improved donor selection and HIV screening is performed. However, according to the WHO, the overwhelming majority of the world's population does not have access to safe blood and "between 5% and 10% of HIV infections worldwide are transmitted through the transfusion of infected blood and blood products".

Medical workers who follow universal precautions or body substance isolation such as wearing latex gloves when giving injections and washing the hands frequently can help prevent infection of HIV.

All AIDS-prevention organizations advise drug-users not to share needles and other material required to prepare and take drugs (including syringes, cotton balls, the spoons, water for diluting the drug, straws, crack pipes, etc). It is important that people use new or properly sterilized needles for each injection. Information on cleaning needles using bleach is available from health care and addiction professionals and from needle exchanges. In some developed countries, clean needles are available free in some cities, at needle exchanges or safe injection sites. Additionally, many nations have decriminalized needle possession and made it possible to buy injection equipment from pharmacists without a prescription.

Mother-to-child transmission (MTCT)

Studies have shown that antiretroviral drugs, caesarean delivery and formula feeding reduce the chance of transmission of HIV from mother to child. Current recommendations state that when replacement feeding is acceptable, feasible, affordable, sustainable and safe, HIV-infected mothers should avoid breast-feeding their infant. However, if this is not the case, exclusive breast-feeding is recommended during the first months of life and discontinued as soon as possible. In 2005, around 700,000 children under 15 contracted HIV, mainly through MTCT, with 630,000 of these infections occurring in Africa. Of the estimated 2.3 million [1.7-3.5 million] children currently living with HIV, 2 million (almost 90%) live in sub-Saharan Africa.

Prevention strategies are well known in developed countries, however, recent epidemiological and behavioral studies in Europe and North America have suggested that a substantial minority of young people continue to engage in high-risk practices and that despite HIV/AIDS knowledge, young people underestimate their own risk of becoming infected with HIV. However, transmission of HIV between intravenous drug users has clearly decreased, and HIV transmission by blood transfusion has become quite rare in developed countries.

Treatment

Current treatment for HIV infection consists of highly active antiretroviral therapy, or HAART. This has been highly beneficial to many HIV-infected individuals since its introduction in 1996 when the protease inhibitor-based HAART initially became available. Current optimal HAART options consist of combinations (or "cocktails") consisting of at least three drugs belonging to at least two types, or "classes," of anti-retroviral agents. Typical regimens consist of two nucleoside analogue reverse transcriptase inhibitors (NARTIs or NRTIs) plus either a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor (NNRTI). Because HIV disease progression in children is more rapid than in adults, and laboratory parameters are less predictive of risk for disease progression, particularly for young infants, treatment recommendations are more aggressive for children than for adults. In developed countries where HAART is available, doctors assess the viral load, rapidity in CD4 decline, and patient readiness while deciding when to recommend initiating treatment.

• Abacavir is a nucleoside analog reverse transcriptase inhibitors (NARTIs or NRTIs)
• Atazanavir is a protease inhibitor.

Anti-retroviral drugs are expensive, and the majority of the world's infected individuals do not have access to medications and treatments for HIV and AIDS. Research to improve current treatments includes decreasing side effects of current drugs, further simplifying drug regimens to improve adherence, and determining the best sequence of regimens to manage drug resistance. Only a vaccine is postulated to be able to halt the pandemic. This is because a vaccine would possibly cost less, thus being affordable for developing countries, and would not require daily treatments. However, after over 20 years of research, HIV-1 remains a difficult target for a vaccine.

A number of studies have shown that measures to prevent opportunistic infections can be beneficial when treating patients with HIV infection or AIDS. Vaccination against hepatitis A and B is advised for patients who are not infected with these viruses and are at risk of becoming infected. In addition, AIDS patients should receive vaccination against Streptococcus pneumoniae and should receive yearly vaccination against influenza virus. Patients with substantial immunosuppression are also advised to receive prophylactic therapy for Pneumocystis jiroveci pneumonia (PCP), and many patients may benefit from prophylactic therapy for toxoplasmosis and Cryptococcus meningitis.

Various forms of alternative medicine have been used to try to treat symptoms or to try to affect the course of the disease itself, although none is a substitute for conventional treatment. In the first decade of the epidemic when no useful conventional treatment was available, a large number of people with AIDS experimented with alternative therapies. The definition of "alternative therapies" in AIDS has changed since that time. Then, the phrase often referred to community-driven treatments, untested by government or pharmaceutical company research, that some hoped would directly suppress the virus or stimulate immunity against it. These kinds of approaches have become less common over time as the benefits of AIDS drugs have become more apparent. Examples of alternative medicine that people hoped would improve their symptoms or their quality of life include massage, herbal and flower remedies and acupuncture; when used with conventional treatment, many now refer to these as "complementary" approaches. None of these treatments has been proven in controlled trials to have any effect in treating HIV or AIDS directly. However, some may improve feelings of well-being in people who believe in their value. Additionally, people with AIDS, like people with other illnesses such as cancer, sometimes use marijuana to treat pain, combat nausea and stimulate appetite.

Epidemiology

Globally, between 33.4 and 46 million people currently live with HIV. In 2005, between 3.4 and 6.2 million people were newly infected and between 2.4 and 3.3 million people with AIDS died, an increase from 2003 and the highest number since 1981.

The latest evaluation report of the World Bank's Operations Evaluation Department assesses the effectiveness of the World Bank's country-level HIV/AIDS assistance, defined as policy dialogue, analytic work, and lending, with the explicit objective of reducing the scope or impact of the AIDS epidemic. This is the first comprehensive evaluation of the World Bank's HIV/AIDS support to countries, from the beginning of the epidemic through mid-2004. Because the Bank's assistance is for implementation of government programs by government, it provides important insights on how national AIDS programs can be made more effective.

The development of HAART as effective therapy for HIV infection and AIDS has substantially reduced the death rate from this disease in those areas where it is widely available. This has created the misperception that the disease has gone away. In fact, as the life expectancy of persons with AIDS has increased in countries where HAART is widely used, the number of persons living with AIDS has increased substantially. In the United States, the number of persons with AIDS increased from about 35,000 in 1988 to over 220,000 in 1996.

In Africa, the number of MTCT and the prevalence of AIDS is beginning to reverse decades of steady progress in child survival. Countries such as Uganda are attempting to curb the MTCT epidemic by offering VCT (voluntary counseling and testing), PMTCT (prevention of mother-to-child transmission) and ANC (ante-natal care) services, which include the distribution of antiretroviral therapy.

Economic impact

Without proper nutrition, health care and medicine that is available in developed countries, large numbers of people in these countries are falling victim to AIDS. They will not only be unable to work, but will also require significant medical care. The forecast is that this will likely cause a collapse of economies and societies in the region. In some heavily infected areas, the epidemic has left behind many orphans cared for by elderly grandparents.

The increased mortality in this region will result in a smaller skilled population and labor force. This smaller labor force will be predominantly young people, with reduced knowledge and work experience leading to reduced productivity. An increase in workers’ time off to look after sick family members or for sick leave will also lower productivity. Increased mortality will also weaken the mechanisms that generate human capital and investment in people, through loss of income and the death of parents. By killing off mainly young adults, AIDS seriously weakens the taxable population, reducing the resources available for public expenditures such as education and health services not related to AIDS resulting in increasing pressure for the state's finances and slower growth of the economy. This results in a slower growth of the tax base, an effect that will be reinforced if there are growing expenditures on treating the sick, training (to replace sick workers), sick pay and caring for AIDS orphans. This is especially true if the sharp increase in adult mortality shifts the responsibility and blame from the family to the government in caring for these orphans.

On the level of the household, AIDS results in both the loss of income and increased spending on healthcare by the household. The income effects of this lead to spending reduction as well as a substitution effect away from education and towards healthcare and funeral spending. A study in Côte d'Ivoire showed that households with an HIV/AIDS patient spent twice as much on medical expenses as other households.

UNAIDS, WHO and the United Nations Development Programme have documented a correlation between the decreasing life expectancies and the lowering of gross national product in many African countries with prevalence rates of 10% or more. Indeed, since 1992 predictions that AIDS would slow economic growth in these countries have been published. The degree of impact depended on assumptions about the extent to which illness would be funded by savings and who would be infected. Conclusions reached from models of the growth trajectories of 30 sub-Saharan economies over the period 1990–2025 were that the economic growth rates of these countries would be between 0.56 and 1.47% lower. The impact on gross domestic product (GDP) per capita was less conclusive. However, in 2000, the rate of growth of Africa's per capita GDP was in fact reduced by 0.7% per year from 1990–1997 with a further 0.3% per year lower in countries also affected by malaria. The forecast now is that the growth of GDP for these countries will undergo a further reduction of between 0.5 and 2.6% per annum. However, these estimates may be an underestimate, as they do not look at the effects on output per capita.

Many governments in sub-Saharan Africa denied that there was a problem for years, and are only now starting to work towards solutions. Underfunding is a problem in all areas of HIV prevention when compared to even conservative estimates of the problems.

The launching of the world's first official HIV/AIDS Toolkit in Zimbabwe on October 3, 2006 is a product of collaborative work between the International Federation of Red Cross and Red Crescent Societies, World Health Organization and the Southern Africa HIV/AIDS Information Dissemination Service. It is for the strengthening of people living with HIV/AIDS and nurses by minimal external support. The package, which is in form of eight modules focusing on basic facts about HIV and AIDS, was pre-tested in Zimbabwe in March 2006 to determine its adaptability. It disposes, among other things, categorized guidelines on clinical management, education and counseling of AIDS victims at community level.

Stigma

AIDS stigma has been further divided into the following three categories:

1. Instrumental AIDS stigma—a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness.
2. Symbolic AIDS stigma—the use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease.
3. Courtesy AIDS stigma—stigmatization of people connected to the issue of HIV/AIDS or HIV- positive people.

In many developed countries, there is an association between AIDS and homosexuality or bisexuality, and this association is correlated with higher levels of sexual prejudice such as anti-homosexual attitudes. There is also a perceived association between all male-male sexual behavior and AIDS, even sex between two uninfected men.

Origin of HIV

Three of the earliest known instances of HIV infection are as follows:

1. A plasma sample taken in 1959 from an adult male living in what is now the Democratic Republic of Congo.
2. HIV found in tissue samples from a 15 year old African-American teenager who died in St. Louis in 1969.
3. HIV found in tissue samples from a Norwegian sailor who died around 1976.

Two species of HIV infect humans: HIV-1 and HIV-2. HIV-1 is more virulent and more easily transmitted. HIV-1 is the source of the majority of HIV infections throughout the world, while HIV-2 is not as easily transmitted and is largely confined to West Africa. Both HIV-1 and HIV-2 are of primate origin. The origin of HIV-1 is the Central Common Chimpanzee (Pan troglodytes troglodytes) found in southern Cameroon. It is established that HIV-2 originated from the Sooty Mangabey (Cercocebus atys), an Old World monkey of Guinea Bissau, Gabon, and Cameroon.

Although a variety of theories exist explaining the transfer of HIV to humans, there is no widely accepted scientific consensus of any single hypothesis and the topic remains controversial. Freelance journalist Tom Curtis discussed one currently controversial possibility for the origin of HIV/AIDS in a 1992 Rolling Stone magazine article. He put forward what is now known as the OPV AIDS hypothesis, which suggests that AIDS was inadvertently caused in the late 1950s in the Belgian Congo by Hilary Koprowski's research into a polio vaccine. Although subsequently retracted due to libel issues surrounding its claims, the Rolling Stone article motivated another freelance journalist, Edward Hooper, to probe more deeply into this subject. Hooper's research resulted in his publishing a 1999 book, The River, in which he alleged that an experimental oral polio vaccine prepared using chimpanzee kidney tissue was the route through which simian immunodeficiency virus (SIV) crossed into humans to become HIV, thus starting the human AIDS pandemic. Subsequently, this hypothesis has been refuted by examination of these original polio vaccine stocks and establishing that they do not contain material of chimpanzee origin.

Alternative hypotheses

AIDS dissidents assert that the current mainstream approach to AIDS, based on HIV causation, has resulted in inaccurate diagnoses, psychological terror, toxic treatments, and a squandering of public funds. Dissident views have been widely rejected, and are considered pseudoscience by the mainstream scientific community.

Common misconceptions

One possibility for the misconception that AIDS infects only homosexual men is that AIDS was termed Gay Related Immune Deficiency Syndrome when it was first recognized in 1981 (it was subsequently renamed after it was recognised that there were methods of transmission other than male-male intercourse). HIV appears to have entered the United States around the late 1960s and seems to have then been unknowingly spread by people throughout the U.S. and Europe. In a survey on AIDS conducted in 1983 in Belgium, Denmark, Finland, France, Germany, Italy, the Netherlands, Norway, Sweden, Switzerland, and the United Kingdom a majority of those infected with HIV were male homosexuals (58% of all cases).

See also:

• ONE Modern Day Prophet
• ONE.org
• What can I do to make a difference in Africa when the problem is so HUGE?
• Why is AIDS having such a devastating impact throughout Africa?

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