What Is HIV/AIDS?

The history of acquired immunodeficiency syndrome (AIDS) and its underlying cause, infection with human immunodeficiency virus (HIV), is not one story, but many. Every victim of AIDS has different health problems, personal struggles, and losses. In the early 1980s, when the first AIDS cases attracted the attention of doctors and scientists, no treatment was known. Victims who wrote about their lives described growing more and more seriously ill, watching sick friends die, and waiting to die themselves. As research moved ahead and the cause of HIV/AIDS was finally understood, medicines were developed that delayed disability, prolonged life, and decreased the spread of HIV. A positive diagnosis no longer meant death within two years but a slower journey through the disease. However, this journey often came with increasing ill health and disability and devastating medical and drug expenses. Decades after the first AIDS cases baffled the medical community, no cure or preventive vaccine has been developed.

With its cause and method of spreading now understood, HIV/AIDS is a preventable disease. Yet it remains a major health threat in many parts of the world. In addition to disrupting the lives of its millions of victims, AIDS has upset the lives of whole families, communities, and entire countries. The epidemic brought confusion to politics and governments and quickly became both a national and a worldwide problem.

Although the history of AIDS is filled with illness, pain, loss, and death, it is also filled with caring, determination, and hard work. Many dedicated health researchers have spent decades working to understand the cause of AIDS, develop treatments for its victims, and find ways to prevent and cure the disease. Though AIDS has not yet been eliminated, these efforts have finally given the world hope for the future. The 2013 global report from the Joint United Nations Programme on HIV/AIDS (UNAIDS) says there was a 33 percent decline in the number of new infections worldwide, and more people are receiving life-saving antiretroviral therapy. The number of AIDS deaths is also declining, with 1.6 million deaths in 2012, down from 2.3 million in 2005.

Understanding AIDS

According to the World Health Organization, there were 35.3 million adults and children around the world living with HIV at the end of 2012 (the last year for which data is available). The most affected region is sub-Saharan Africa, where nearly 1 in every 20 adults is living with HIV. Sadly, more people become infected with the virus each year, and others who were already infected die from AIDS. However, the number of new infections have fallen since 1999, the year in which it is thought that the AIDS epidemic peaked. The decline reflects the increased availability of antiretroviral therapy, as well as care and support, to people living with HIV, particularly in middle- and low-income countries. Among young people, HIV/AIDS remains a major public health issue. WHO estimates that 3.4 million children were living with HIV at the end of 2011 (the most recent year for which data is available). Ninety-one percent of those children live in sub-Saharan Africa. Most children contract the virus from an HIV-infected mother during pregnancy, birth, or breastfeeding. The Centers for Disease Control and Prevention (CDC) estimates that more than 1.1 million people aged 13 years and older are living with HIV in the United States, with almost 1 in 6 (15.8 percent) unaware that they are infected. Young people aged 13–24 accounted for 26 percent of all new HIV infections in the United States in 2010 (the most recent year for which data is available). Most disturbingly, almost 60 percent of youth are unaware they are infected. (This is largely because of the low rate of HIV testing; for instance, only 13 percent of American high school students have been tested for HIV.) The Public Health Agency of Canada estimates there were approximately 71,300 people living with HIV (including AIDS) and 3,175 new infections in Canada in 2011 (the most recent year for which data is available). Twenty-five percent were unaware that they were infected due to lack of testing or diagnosis.

The 2013 UNAIDS Report says increased HIV education and prevention efforts are showing promise. New HIV infections have fallen by 33 percent worldwide since 2001, and the number of adult and adolescent HIV cases declined by more than 50 percent in 26 countries including Cambodia, Ethiopia, India, Thailand, and the Ukraine. Among children, the number of new infections have declined by 52 percent since 2001. However, evidence points toward a resurgence of risky sexual behavior in several countries including Congo, Ethiopia, Guyana, Rwanda, South Africa, the United Republic of Tanzania, and Zimbabwe, as well as a decline in condom use in Côte d’Ivoire, Niger, Senegal, and Uganda.

Immune system
Immune system
© Articulate Graphics/Custom Medical Stock Photo
Although AIDS was not identified until the early 1980s, the AIDS virus has existed in humans for about 100 years, a study suggests. That’s decades longer than scientists had thought previously, according to an October 2008 article published in the journal Nature. HIV, the virus that causes AIDS, originated between 1884 and 1924, according to genetic analyses. Experts estimate that it likely started in about 1908. So while scientists around the globe continue to search for a cure for AIDS, others are making startling discoveries about its origin.

Since it was first recognized in 1981, AIDS has killed millions of people. “It is the worst and deadliest disease that humankind has ever experienced,” according to Mark Stirling, UNAIDS director of East and Southern Africa. What’s worse, there is no cure for or vaccine against AIDS. In September 2009, researchers announced the results of the first successful large clinical trial of an HIV vaccine called RV144. The vaccine is a combination of two older vaccines and was found to be 31 percent effective in lowering the rate of HIV infection. Although the study was considered a “moderate” success, most health professionals agreed that it represented an important advance in HIV research. In recent years, antiretroviral therapy has shown major reductions in the rates of death and suffering when it is used during the early stages of the disease. Antiretroviral therapy uses a combination of three antiretroviral (ARV) drugs. According to a 2011 study published in the New England Journal of Medicine, antiretroviral therapy can reduce the risk of HIV transmission by as much as 96 percent. Since 2013, WHO has recommended ARV use to suppress the HIV virus and stop the progression of HIV, “particularly for pregnant women, young children, and key populations exposed to HIV risk.”

Although these statistics are frightening, you are not powerless against AIDS. It is true that HIV/AIDS is a growing danger for everyone, but it is a danger we can understand and avoid. As medical researchers continue searching for a cure, it is important to remember that AIDS is preventable. Taking the proper precautions to prevent infection is the first step in fighting this disease that affects so many people.

There is still a lot of ignorance and misinformation about AIDS. Replace these with useful knowledge. Scientists and researchers are working hard to make this disease extinct. You can play your part by learning how to protect yourself and the people you care about from AIDS.

How HIV/AIDS is Contracted

The HIV virus began in animal populations—possibly the monkey or chimp populations of Africa—and then passed to humans. A human might have contracted the disease after making contact with the animal’s blood when it was hunted or cooked.

HIV is passed among humans through contact with bodily fluids, such as semen or vaginal secretions during sexual contact. It does not spread by touching other people, or even through saliva, as many people thought when the disease was first beginning to spread during the 1980s. The only way to contract the disease through saliva or by kissing someone is if one person has cuts, open sores, or bleeding gums, and blood is passed to the other person.

Sexual activity is not the only way HIV is passed. Blood transfusions are also one way in which the disease can be passed from person to person. Sharing needles or other drug paraphernalia is also a way to pass bodily fluids from one person to another and spread the disease.

A mother can also pass the disease to her child when it is in the womb, during a vaginal delivery, or through breastfeeding.

Symptoms and Phases of the Disease

The first signs of an HIV infection often come within two to four weeks after the person has been exposed. The symptoms are similar to the flu. A person may have a fever, diarrhea, headache, or muscle ache. Other symptoms include rashes, chills, sore throat, swollen glands, and joint pain. Open sores in the mouth or on the genitals, called ulcers, are also possible signs of the virus.

This first stage is sometimes called a primary HIV infection, and the stage may last anywhere from a few weeks to a few months. Many people describe this phase as being like a very bad flu. However, not all people experience this stage exactly the same way. For some, the symptoms may be so mild that a person will not notice them or feel they are enough to cause alarm. It is during this stage of active symptoms—regardless of their severity—that a person is producing the virus rapidly and is most capable of spreading the virus to others. As the virus is being produced in the body, a person’s level of CD4 cells decreases. That’s because the virus uses CD4 cells to reproduce and destroys the CD4 cells as it does so.

One of the most problematic aspects of the HIV virus is how difficult it is to determine whether someone has it in its initial phases. The virus cannot be detected through blood tests until several months after the infection. That means that a negative blood test—one in which the virus is not detected—does not necessarily mean that a person does not have HIV. It may take up to a couple months for a blood test to indicate that the virus is present. During that time, the person is very contagious and can more easily spread the disease than at other stages of the disease.

The only way a person can be sure that he or she is not passing the disease after a possible exposure is to abstain from unprotected sex and avoid other possible methods of transmission for months before taking a blood test.

Another difficult aspect of the disease is that the symptoms of the primary HIV infection are so similar to other diseases that they just seem like the flu or other less serious illnesses. A person would have to visit a doctor and get a special blood test to get a diagnosis of HIV.

After the primary HIV infection stage, the infection enters a latent stage. The virus is present in the body but reproducing at a slower rate. A person may not have any symptoms during this period. Without treatment, this stage lasts an average of ten years before progressing to AIDS, but some individuals may progress to AIDS much faster than others. With treatment, the clinical latency period can last several decades with no symptoms and no progression to AIDS.

Once a person has progressed to the stage of being diagnosed with AIDS, he or she can live up to three years but may die sooner. Treatment can help prolong an AIDS patient’s life, but there is not yet a known cure for the disease. The most life-threatening part of HIV/ AIDS is the likelihood of developing other fatal diseases due to a weakened immune system.

When to See a Doctor

If you feel you may have been exposed to HIV, it’s time to see a doctor and find out. Even if you are not exhibiting the symptoms of a primary infection, it helps to get in touch with a doctor who might be able to monitor you. That way, the doctor can help you decide when the best time to test your blood might be and what to do if you start exhibiting active symptoms. The doctor will likely question you about how you may have come in contact with the disease. Be honest about your sexual activity or any other actions that might have put you in contact with the disease. Ask questions, and try to get informed about the disease. If you do have it, you’ll be relieved to be under a doctor’s care. If you don’t have it, you will be relieved that you took steps to take care of your health and the health of your sexual partner.

People Most at Risk

During the first HIV/AIDS epidemic, in the 1980s, the homosexual community in the United States was hit the hardest. Because of this, people thought that the disease affected only gay men and anyone who had sexual contact with men who have sex with other men. While homosexual populations were at greatest risk in the 1980s because of the course of sexual exposure and contact, anyone can contract the disease.

Today, we might say that people from Africa are most at risk because that is where 70 percent of the new cases are being diagnosed. However, keep in mind that everyone has the potential of contracting the disease if proper precautions are not taken to prevent it. That means that people who have sex without a condom are at risk. Doing anything that provides the virus with an entry into blood or semen is considered risky behavior. In turn, this behavior puts sexual partners at risk of contracting the disease as well. People who have open sores on their mouths or genitals produced by other STDs are also particularly at risk. These diseases include herpes, genital warts, and syphilis.

In addition, people who use needles or syringes are at risk of spreading the disease. Contaminated needles from drug use or transfusion provide an open passage for the virus into the body.

Complications

While the HIV/AIDS virus can be harmful and fatal to the body, the complications of the disease are often the reason that infected individuals do not live out the ten-year life expectancy of the disease. Instead of simply living an average of ten years with the disease without treatment, a patient whose CD4 levels have been lowered to a dangerous level is at greater risk of contracting a whole host of other life-threatening diseases that may result in an even shorter life expectancy. Tuberculosis is one of the most common complications for a weakened immune system.

Other common opportunistic infections include pneumonia, herpes, and candidiasis, also known as thrush. There are opportunistic cancers as well, the most common of which is Kaposi’s sarcoma, a cancer that causes lesions on the skin.