A True American Tale about a Lentivirus - Essay Example

Background A True American Tale1 Born on 6 December 1971 Ryan White was diagnosed with HIV in the mid 80s. Ryan had the misfortune to be born with hemophilia and contracted HIV from infected blood products he received to treat the condition. The Kokomo, Indiana school board expelled him from school claiming he was a health risk to other students. Fearing for their lives after gun shots were fired at their home, the family moved to Cicero, Indiana to start a new life. Ryan died on April 8, 1990, aged 19 – but spent his short life educating people that AIDS was not confined to the homosexual community. In recognition of his contribution, in late 1990, the US Congress passed the Ryan White Care Act which provides funding for care, education and prevention of Human Immunodeficiency Virus (HIV). What is HIV? HIV is a lentivirus which attacks the immune system. There are two main strains of the virus: HIV-1 which is particularly virulent, and HIV-2. The name lentivirus means slow virus – due to the fact that they take years to destabilize the immune system. Lentivirii have been found in a number of mammals, but of particular interest is the Simian Immunodeficiency Virus (SIV) which is found in monkeys. HIV-2 is very similar at molecular level to SIVsm which afflicts the sooty mangabey (also known as the green monkey), naturally found in West Africa. The Origins of HIV - Zoonosis In 1999 Paul Sharp of Nottingham University and Beatrice Hahn of the University of Alabama completed a 10 year study into the origin of the virus in humans. They satisfied the scientific community that the HIV-1 virus had crossed from chimpanzees to humans. The cross-over of viruses from one species to another is called zoonosis. It is believed that the virus mutated once it found a new host in humans to become HIV-1. Since the virus is most easily transferred by blood, most of the theories suggest that the route of transmission must have been either the consumption of an infected chimpanzee or through a contaminated vaccine or syringe. The earliest known death from HIV-1 took place in 1959. However, Dr Bette Korber of the Los Alamos National Laboratory presented results in January 2000 at the 7th Conference on Retroviruses and Opportunistic Infections which indicated that the HIV-1 strain has been around since the 1930s. Belgian researchers led by Dr Anne-Mieke Vandamme, published findings in ‘Proceedings of the National Academy of Science’ in 2003. Their conclusion was that HIV-2 originated in sooty mangabeys around 1940 - 1945. They claimed that the most likely place of origin was the former Portuguese colony of Guinea-Bissau and the virus spread during the war for independence between 1963 and 1974. Interestingly, some of the first European cases of HIV-2 were found in Portuguese war veterans. Many of them had needed blood transfusions, been exposed to un-sterile injections and had unprotected sex. If the claims made above are true then the only monkeys to date who have been found with SIV live on the African continent. There is no evidence that monkeys from Asia or South America carry SIV. A Global Pandemic How HIV went global in the first place is not clear, but we do know the most common transmission routes are unprotected sex, intravenous injection, contaminated blood and breast milk. The sexual revolution which began in the 1960s and became compulsory behavior throughout the 1970s and 1980s no doubt had a great deal to do with the ease with which HIV spread. The fact that HIV leads to long term debilitating conditions with no symptoms in the first years after infection also assisted the spread of the virus. Cheaper national and international travel for young people also paid its role, as did the promiscuous behavior of heterosexuals and homosexuals both home and abroad. To date there has only been one recorded case of female-to-female transmission of the virus – thought to be due to sharing a sex toy.2 Hemophiliacs require Factor VIII for its blood-clotting properties. Unfortunately it takes hundreds of donations to produce a batch of the coagulant. Due to the policy of paying for blood donations in some countries – including the USA – many desperate intravenous drug users donated blood. Until hemophiliacs began to test positive for HIV blood donations remained unscreened, and was sent worldwide, contaminating recipients. Worldwide AIDS Related Conditions (ARCS) was said to be responsible for the deaths of 20 million people while there was believed to be approximately 42 million people HIV positive.3 Risky Behaviors The main cause of the spread of the disease seems to be ignorance. An astonishing number of people do not know about it, or understand how it is transmitted or the importance of altering their sexual behavior. The at-risk groups are still promiscuous heterosexuals and homosexuals, intravenous drug users and commercial sex workers. Worryingly, there is a new at-risk group: young people who are commencing sexual activity at an earlier age, with multiple – usually older –partners. People are literally dying of ignorance. Global and Regional Statistics for HIV & AIDS, end of 20064 1990: 8m living with HIV. 2006: 40m living with HIV. 25.2m (63%) are in Sub-Saharan Africa Region Adults & children living with HIV/AIDS % of Total Adults & children newly infected Adult prevalence (15-49 yrs) Deaths of adults & children Sub-Saharan Africa 24,700,000 63% 2,800,000 5.9% 2,100,000 South and South-East Asia 7,800,000 20% 860,000 0.6% 590,000 Eastern Europe & Central Asia 1,700,000 4% 270,000 0.9% 84,000 North America 1,400,000 4% 43,000 0.8% 18,000 Latin America 1,700,000 4% 140,000 0.5% 65,000 East Asia 750,000 2% 100,000 0.1% 43,000 Western & Central Europe 740,000 2% 22,000 0.3% 12,000 North Africa & Middle East 460,000 1% 68,000 0.2% 36,000 Caribbean 250,000 1% 27,000 1.2% 19,000 Oceania 81,000 0% 7,100 0.4% 4,000 Global Total 39,500,000 100% 4.3 m 1.0% 2.9 m The latest statistics on the world epidemic of AIDS & HIV were published by UNAIDS5 in November 2006, and refer to the end of 2006. Vital Statistics At least 25m people have died of ARCs since 1981. There are 12m orphans in Africa as a direct result of ARCs deaths Worldwide 17.7m (48%) of adults living with HIV are women. In the sub-Sahara 14.57m (59%) of all carriers are women. 50% of all new HIV infections are in people under 25 years old – approx 6,000/day. Of the 6.8m people in the poorest countries who need ARV treatment to prevent death, approx 5.17m (76%) are not receiving them. During 2006 approx 3m people died from ARCs despite recent improved access to ARV treatment. Crisis Management A special session of the UN General Assembly was held in 2001. From that session came the Declaration of Commitment on HIV/AIDS. 189 member states agreed to adopt strategies for HIV prevention, treatment, care and support to attempt to halt and reverse the pandemic by 2015. In 2005 the project had a budget of $8.3b in 2005. Progress has been made in the provision of treatment, counseling and testing, education programs for young people, celibacy, fidelity and condom use, the screening of blood and the use of antiretroviral prophylaxis to reduce the risk of transmission from mother to fetus6. The international community rose to the challenge, with partners funneling funds into various agencies: The Global Fund to Fight AIDS, Tuberculosis and Malaria was set up in December 2002 and handles approximately 20% of all the funds for international HIV relief. In 2005 it disbursed $1.1b. By the end of 2005, the World Bank had committed a cumulative total of more than US$ 2.5 billion to HIV programs. The United States President’s Emergency Program for AIDS Relief, announced in 2003 at the State of the Union Address, provided intensive assistance to 15 target countries and supported 100 more. It disbursed US$ 570.2 million in 2004 and committed to an additional US$ 915.6 million in 2005. However, UNAIDS projects that $18.1b will be required in 2007 but that there will be a shortfall of $8.1b. There were other setbacks too:7 HIV prevention programs are failing to reach those at great­est risk. The target was for 90% of young people to be knowledgeable about HIV by 2005. Fewer than 50% of young people achieved comprehensive knowl­edge levels. Only 9% of men who have sex with men received any type of HIV prevention service in 2005; fewer than 20% of injecting drug users received HIV prevention services. Only 9% of pregnant women were covered. Civil society reports from over 30 countries indicated that stigma and discrimination against people living with HIV remains pervasive. The HIV response is insufficiently grounded in the promotion, protection and fulfillment of human rights. 50% of countries submitting reports admitted to policies that interfere with the accessibility and effectiveness of HIV-related measures for preven­tion and care. There is a general failure to provide adequate care and support for the 15m children orphaned by AIDS, and for millions of other children made vulnerable by the epidemic. Strategic Response USAID argue that: Twenty-five years into the epidemic, the global response to AIDS must be transformed from an episodic, crisis-management approach to a strategic response that recognizes the need for long-term commitment and capacity-building, using evidence-informed strategies that address the structural drivers of the epidemic8. Their report recommended the following key actions in order to be able to deliver on the promises of 20019: Clear leadership at Governmental/State level Increased funding to meet the 2015 target to stop HIV/AIDS Anti-AIDS discrimination and enforcement of laws to protect the vulnerable in society, including challenging the ‘traditional’ or ‘societal’ norms that deny human rights to high-risk groups, such as sex workers, drug-users and homosexuals Strengthen AIDS prevention through education programs, particularly targeting high-risk groups. Improved access to modern medicines More training and recruitment of key medical and technical field workers More R&D in drug, microbicides and vaccines – particularly those suitable for children Ground level support for families e.g. China’s four frees and one care program (free antiretroviral drugs, voluntary counseling and testing, drugs to prevent mother-to-child transmission, schooling for orphaned children, and care and economic assistance to affected households) may provide a suitable model The Future The figures speak for themselves – there are an increasing number of new infections each year, an increasing number of people living longer with HIV – mainly due to ARV availability and earlier interventions. Most worryingly, heterosexual women and young girls are over-represented in the newly infected figures. Oftentimes they are not diagnosed until they attend pre-natal clinics; so exposing another generation to this totally preventable disease. It must be remembered that ARVs do not cure HIV/AIDS – they simply slow down the onset of ARCs and death. Once a carrier; always a carrier. Carriers will remain contagious until they die of an ARC. While HIV is allowed to remain prevalent in communities every generation needs to know about the risk. A major concern brought to the fore by such American HIV carriers and commentators as Barry Freiman is the wryness of the focus on Africa of scarce Federal Reserves, while at least 10 states in the USA have waiting lists for uninsured carriers. While the internationalists have managed to reduce the price of medication for low and middle income countries, a month’s medication in the USA – according to Freiman – cost in excess of $1200 per month.10 The problem is that there is an implication from the dearth of attention on HIV in America that the virus that causes AIDs is no longer a problem in the States when nothing could be further from the truth. Freiman makes a number of important points in that article. The likelihood of an American contracting the virus from someone based in sub-Saharan Africa is remote. It’s more likely that s/he’s going to get it from the carrier sitting next to him/her in a nightclub. If we have to expend billions of dollars on the walking dead, let’s make sure they are Americans. The temptation of course is not to do anything for the current generation of carriers, other than to identify and isolate them from the ‘healthy’ members of the community in much the way older civilizations treated lepers. After all, is it not better to spend that money on the ‘healthy’? They can be taught how to prevent contracting the virus, remaining productive members of society, bearing healthy children who in turn will have healthy children? What after all is the point in spending $3b on people who will die of their condition anyway? Surely, it’s better for them to die quickly and with as little suffering as possible? Why prolong the torment with expensive drugs that carriers and their cash-strapped nation states can ill-afford? References Read More