HIV/AIDS: What you should know
The doctor on the phone seemed slightly apologetic. "I was wondering if you would accept the referral of a patient for management and care during her pregnancy and delivery." As an obstetrician, pregnancy and deliveries were my "bread and butter." "Of course I'll accept her," I replied. "Well, before you decide," he said, "you must know she is HIV positive." "No problem," I replied. The doctor let out a sigh of relief. "I thought you would, but she has tried two others, and they both suggested she go to the downtown hospital that specializes in HIV/AIDS, but she doesn't want to go to a clinic setting."
I found the patient to be a picture of health. She was just 29. A recent immigrant to Canada, she was preceded by her husband. He had sought sexual comfort from women of the street, become infected with HIV, and passed it on to his wife when she arrived months later. Now both of them and the developing fetus were in grave danger.
Just what is this disease? Both HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immunodeficiency Syndrome) are viral infections, caused by a virus so fragile that it requires direct inoculative transfer. The virus dies if dried or exposed to sunlight, but is readily transmitted in body fluids--through sex, blood products, or contaminated shared needles.
The June 5th issue of the CDC Bulletin, 1981 (produced by the U.S. Centers for Disease Control) reported five cases of pneumocystic carinii pneumonia in young homosexual males, ushering in our current acquaintance with this infection. Since then, the virus has been identified as a RNA (riboxynucleic acid) virus. These viruses are called "retro" viruses and require a retrograde transcription into the cell nucleus. The virus particle carries the enzyme required for this process within its structure. Once inscribed into the DNA code of its host, the nucleus commences the process of replicating long rolls of RNA by commandeering the host's cell machinery. The actual particles of the virus are "nipped off" by an enzyme called a protease, and new cells are then up for colonization. The cells at risk are those carrying a particular protein called CD 4 on their surface. This protein acts as a "lock" into which the viral "key" fits, opening the cell to the entry by the virus particle, and the cycle repeats itself. Unfortunately for the victim, CD 4 cells are lymphocytes that play a strategic role in the immune system. In time, the task of producing viral particles depletes and overwhelms the invaded cells--resulting in failure of the immune system. Infections by nearly any ordinarily readily managed organism begin to threaten the victim. Unusual cancers often affect the HIV-infected person, and in time begin to rampage, as tuberculosis did in earlier generations.
This immune deficiency process takes years to show itself in most cases, though HIV infections in people already weakened by disease or malnutrition may cause death in a matter of weeks or months.
The clinical course of AIDS begins with mild aches and pains, sometimes a transient rash, some enlarged lymph nodes, and a feeling of malaise that the doctor may diagnose as "flu" or a "viral infection," which, of course, it is, but unlike influenza, it persists.
Initially, the HIV viral count rises rapidly in the blood. There is a fall in the CD 4 lymphocytes, but after three to six weeks, the viral count declines, the CD 4 lymphocytes recover somewhat, and a type of "cold war" begins. The infected individual now looks well, feels well, functions well, and without specific testing, cannot be distinguished from a healthy person. The virus has a predilection for certain sites: lymphocytes, genital organs, and brain. This ensure its transmission and its inaccessibility to eradication with current measures.
Tests used to detect HIV
The most common tests are those that identify an antibody to HIV. Antibodies usually take three to six weeks to be reliably produced, so tests during this interval may be "negative" despite the presence of infection. Occasionally there may be delayed production of antibodies--sometimes for a few months or more--so that while a positive test is rather convincing, a negative test is not totally conclusive.
Fortunately, falsely negative or positive results can be cleared up by more expensive but more accurate tests that measure actual viral particles (called copies) in each unit of blood.
Misconceptions about HIV/AIDS
What are some of the misconceptions about HIV/AIDS?
1. HIV/AIDS is not treatable. This is not true. Though not curable, treatment results available from medications are encouraging. Viral counts are suppressed, and white cell (CD 4 ) counts rise. Drug recipients have an improved quality of life and survive longer than those who do not receive treatment. However, AIDS medications are extremely costly. In addition, drug resistance is a big problem, and side effects are common. But even after weighing all these negatives, life expectancy is up for those who go into treatment early. However, treatment of HIV/AIDS does not cure the diseases. If infected people stop taking the drugs that suppress viral reproduction, their immune systems will again be threatened by the virus.
2. Only homosexuals get HIV/AIDS. This is also untrue. While it is true that men-with-men sexual relationships carry a greater risk of transmission, the virus is transmissible in heterosexual relationships as well. The virus capitalizes on breaks in the skin and mucosal membrane surface, so men having sex with men have a greater opportunity for transmission. However, in heterosexual relationships, women are about eight times more vulnerable to infection from sex with infected males, contrasted with males who have sex with HIV-positive females. The reason for this is that women have a larger genital surface and receive more viral particles during unprotected intercourse.
3. Whole countries will be depopulated by HIV/AIDS. As yet, populations have not decreased because of AIDS, even in Africa where its prevalence is high. This is because the birth rate is higher than the death rate. Some populations in Africa were doubling every 20 years. Such growth has ceased, but declines are not yet to the point that the total population is in decline. Perhaps most disturbing are the changes in life expectancy--down some 20 years in some populations, leaving large numbers of young children orphaned. These demographic shifts have major sociological implications that have yet to be understood and grappled with.
4. HIV/AIDS is transmitted by mosquitoes. Not so. There is no scientific evidence to support such a view.
5. AIDS is not caused by the HIV virus. One hears certain politicians making this statement, particularly in those countries that shy away from facing the issue. The weight of evidence is overwhelming that HIV is the cause of AIDS. To otherwise believe is to deny the most sophisticated and focused research that has ever been done on any disease.
6. HIV/AIDS was created in a laboratory as part of germ warfare. Conspiracy theories abound everywhere on almost every topic. Like many others, this, too, has no factual basis. Most evidence suggests that the virus came from the chimpanzee, and the earliest serological presence of the disease dates back to 1959 in a sample of blood stored in the Congo. This suggests an African origin for the disease and also explains the dire African statistics, since it has been there longer than elsewhere.
7. HIV/AIDS can be spread by kissing. This theory has been studied carefully because the virus has been isolated in saliva; however, no confirmed case of transmission has yet been found. If such transmission is possible, it is certainly not a probable, nor proven, means of transmission.
8. It is dangerous to live in the same home with someone who is HIV/AIDS positive. There is absolutely no risk of transmission by touching and hugging, or by eating with same cookware, cutlery, or dishes. There is no risk bathing or showering in facilities used by a patient, neither is there any risk sleeping in a bed that was used by an infected person. Christians, especially, should refrain from stigmatizing persons with HIV/AIDS.
9. HIV/AIDS can be cured by having intercourse with a virgin. This misconception is prevalent in some countries, especially in South Africa, where young girls as young as two have been raped by ignorant men trying to expunge the virus from themselves. Such behavior is criminal and misinformed. Besides severely traumatizing innocent children, it can transmit the disease to them.
10. HIV/AIDS is not my problem. It is. Doubtless, many families will have members affected sooner or later with this disease. Even if this were not the case, the number of people in need will rise dramatically. Health-care costs will rise, economic productivity and consumption will decline, dependency of large segments of the population will increase. Anyone who feels this is not their problem is living in a fool's paradise, and is lacking in Christian love and empathy.
11. How can I be sure I won't get infected? The best defense against HIV/AIDS is to live a pure and chaste Christian life. The sexual transmission of this virus does not occur when both partners are free of disease. This means a couple who, at the time of their marriage, are disease free do not have to be concerned if they are faithful to their vows. Young people who engage in premarital sexual relationships may consider themselves not to be at risk, but statistics indicate that the earlier they begin to have sex, the more sexual partners they will have. Complete disclosure is certainly not the rule, and even testing is not one 100 percent sure.
The old morality still the best course
A decision to remain a virgin until marriage should be communicated to one's boyfriend or girlfriend, and the relationship should be consciously kept free of tempting situations and permissive environments. Drugs and alcohol are potent agents for reducing inhibitions, and many a case of HIV/AIDS has been traced to irresponsible behavior stemming from drug and alcohol abuse.
Couples contemplating marriage would do well to be tested prior to the marriage. Condoms are often recommended for prevention of HIV/AIDS transmission--data suggests an 85 percent reduction in the transmission when condoms are used, and certainly any success is better than none. However, in many cases condoms are not consistently or properly used, even when young people have been taught the dangers of unprotected sexual intercourse.
Many young people believe that oral sex can keep them from acquiring sexually transmitted disease and HIV/AIDS. Such is not the case, as sexual fluids teem with the virus if a person is infected. Sharing of needles by drug users is also extremely dangerous, for it can result in HIV/AIDS in addition to the other dangers present in drug usage.
Similarly, tattoos and body piercing carry a risk because the instruments used may become contaminated.
Blood supplies in some countries are now extremely safe, while in others serious risks may ensue if one receives blood or blood products. The sophistication of the system testing the blood is important.
Statistics in North America indicate a rising prevalence and incidence of HIV/AIDS in the female population. This does not augur well for the future, as the female infection is closely tied to heterosexual transmission. Considerable interest is focused on a vaccine for this disease. While testing in animals is currently underway, most specialists feel a human vaccine is still several years away. This means a modern disease is still making old-fashioned morals relevant and lifesaving. It would appear that advice to young men and women to keep themselves pure is as pertinent today as always.
Oh, the pregnant patient? Well we treated her and her baby was not infected. She and her husband are both on medication--and are both holding up fairly well. I saw her last year, and she looked fine. The baby is now 7 years old.
Allan Handysides (M.B., CH.B., Edinburg; M.D., Loma Linda University) is the director of Health Ministries at the General Conference of Seventh-day Adventists in Silver Spring, Maryland. His e-mail: firstname.lastname@example.org