HIV/AIDS

HIV/AIDS is not a new phenomenon but for the purpose of more knowledge, let’s examine what it is. First, HIV is the causal agent while the disease itself is AIDS. HIV stands for human immunodeficiency virus and is like most other viruses contracted by humans, except that while the body’s immune system can destroy most viruses and clear them from the body, but that is not true for HIV. The immune system cannot get rid of HIV because the virus attacks a key component of the system (the T-cells), invades them, uses them to produce copies of itself, and then destroys them. AIDS (acquired immunodeficiency syndrome) on the other hand is a complex condition caused by HIV, which kills or impairs cells of the immune system and systematically destroys the body’s ability to fight infection and disease. As a result, people with AIDS are vulnerable to diseases that should not even be a threat on a normal day but due to the damaged immune system, there is no way the diseases can be fought off. The term AIDS applies to the most advanced stages of HIV infection. Medical treatment is available to delay the onset of AIDS.

It is important to point out that AIDS is acquired and not hereditary. It is not just transmitted from one person to another easily through the common forms like air or water or skin contact. Rather, for infection to occur, there must be entry of the virus into the bloodstream. The virus causes an immune deficiency, and the body cannot defend itself against infection and disease. Over time, a person with a deficient immune system may become vulnerable to infections by disease-causing organisms such as bacteria, viruses, parasites, or yeasts. These opportunistic infections may cause life-threatening illnesses. HIV infection brings about a combination of symptoms, infections, and diseases. This combination of health effects is known as a syndrome that is then referred to as AIDS.

Origin and Strains of HIV

DNA analysis has identified the HIV-1 virus as originating in a sub-strain of chimpanzees in west equatorial Africa (Gao et al., 1999). Scientists theorize that HIV-1 moved from chimps to humans when hunters were exposed to infected blood while handling bush meat (the flesh of various primates, including chimps and gorillas). Once in the human population, HIV quickly became a global pandemic, driven by travel and migration patterns, sexual practices, drug use, and war.

There are at least two types of HIV virus: HIV-1 is the cause of AIDS, and HIV-2 is a related group of viruses found in West African patients that is less easily transmitted. Worldwide, the predominant virus is HIV-1. Most of the West Africans infected with HIV-2 show none of the symptoms of classical AIDS. Viral load tends to be lower in persons infected with HIV-2, which may explain this type’s lower transmission rates and nearly complete absence of perinatal transmission. Most persons infected with HIV-2 do not develop AIDS, although when they do, the symptoms are indistinguishable from HIV-1. A few cases of HIV-2 infections have been found in people in the United States.

HIV mutates readily, leading to many different strains of HIV, even within the body of a single infected person. Based on genetic similarities, the numerous viral strains may be classified into types, groups, and subtypes. HIV-1 comprises four distinct groups: M, N, O, and P. Group M was the first to be discovered and represents the pandemic form of HIV-1 (Sharp & Hahn, 2011).

Impact of HIV/AIDS

HIV/AIDS is a global pandemic causing millions of death around the world. Since the first case of AIDS was diagnosed in 1981, AIDS has killed more than 630,000 Americans (CDC, 2013a). The daunting human and economic costs of this disease in the United States are eclipsed only by its international impact. Since 1981, 33.4 million people worldwide have died from AIDS, and an estimated 35.3 million people were living with HIV in 2012. Presently though, infection rates of HIV are declining globally, but in the year 2012 alone, the number of deaths recorded from AIDS stood at 1.6 million.

Almost all (95%) of the newly infected people live in the developing world, particularly southern Africa, where it is the leading cause of death. Sixty-nine percent of all people living with HIV are living in this region, and nearly 1 in every 20 adults is infected with HIV (amfAR, 2013). In 2012 more than 9.7 million people were receiving AIDS drugs in low- and middle-income countries, and the United Nations has set a target to raise that to 15 million by 2015 (WHO, 2013).

GLOBAL HIV/AIDS STATISTICS, 2012

35.4 million People living with HIV

32.1 million Adults (17.7 million women)

3.3 million Children under 15 years

2.3 million People newly infected with HIV

2.0 million Adults

260,000 children under 15 years

0.8% prevalence among people 15–49 years

1.6 million AIDS deaths

1.4 million Adults

210,000 children under 1

6,300 new HIV infections a day

95% in low- and middle-income countries

700 in children under 15 years

5,500 in adults 15 years and older

47% in women

39% in young people 15–24 years

Source: WHO, 2013.

HIV/AIDS IN THE UNITED STATES

This part contains statistics from Center for Disease Control and Prevention (CDC).In 1984, the Centers for Disease Control and Prevention (CDC) began to develop a surveillance system in order to uniformly track the HIV/AIDS epidemic in the United States. Information is collected from state and local health departments and reported to the CDC for analysis to determine who is being affected and why. The main goal is to have in a place a nationwide system that combines information on AIDS cases, new HIV infections, and the behaviors and characteristics of people at high risk. As of 2013, all 50 states, the District of Columbia, and six U.S. dependent areas use a uniform HIV infection reporting system for collecting data on HIV infection (CDC, 2013b).

The CDC estimates that more than 1.1 million people in the United States are currently infected with HIV. More than 200,000 of them do not know they are infected and are at high risk for transmitting the virus to others. While antiretroviral drugs have reduced deaths from AIDS, the number of new infections has not changed since the late 1990s. The estimated incidence of HIV has remained stable overall in recent years, at about 50,000 new HIV infections per year and 15,000 deaths from AIDS in the United States (CDC, 2013b).

HIV has been reported in all 50 states, the District of Columbia, and U.S. dependencies. It has not, however, been uniformly distributed. In 2011 ten states accounted for about 65% of HIV diagnoses, and the South accounted for about 48% of HIV diagnoses. The state with the highest number of cases diagnosed in 2011 was California, reporting 5,965 new infections; the District of Columbia had the highest number of HIV diagnoses per 100,000 population (177.9) (Henry J. Kaiser Family Foundation, 2013).

New HIV cases center primarily in large U.S. metropolitan areas (81%), with New York, Los Angeles, and Miami at the top of the list (CDC, 2013b). The epidemic’s scope varies across the country and continues to have a disproportionate impact on certain populations, in particular racial and ethnic minorities and gay and bisexual men.

HIV transmission patterns have shifted over time. New infections among men who have sex with men, who represent about 4% of the population, increased between 2008 and 2010 by 12%. Heterosexual sex has accounted for a growing share of transmissions over time, representing 25% of new infections in 2010. A 3% reduction in infections has occurred among men who have sex with men and also have a history of injection drug use. New infections related to injection drug use also have declined, accounting for 8% of new infections in 2010 (CDC, 2012a).

In the United States, HIV/AIDS has forever altered the landscape of healthcare. Patient activism early in the epidemic spurred a massive research effort that led to greater understanding of AIDS and accelerated the development of innovative drugs. These drugs have slowed the death rate from AIDS in the United States and other countries since 1996, but without a cure and/or increased emphasis on prevention, there is no end in sight to the epidemic.

Antiretroviral drugs have reduced not only morbidity and mortality from AIDS. They have also reduced the public’s level of concern about the deadly nature of this epidemic, creating widespread complacency about the disease. This complacency, coupled with our society’s belief in the power of pharmaceuticals, has undermined prevention efforts. By extending the lives of people with HIV infection, drug treatment has also increased the prevalence (or number of cases per 100,000 people) of the disease and increased the likelihood of transmission. The CDC (2012a) reports that of Americans with HIV, only 28% are currently being treated effectively. Effective treatment reduces the level of virus in the body so transmission to others is less likely to occur.

HIV/AIDS IN WASHINGTON STATE

In Washington State, AIDS cases have been reported since 1984, but HIV cases have only been reported since 1999. By 2011 new HIV cases had decreased significantly, and rates based on reported cases dropped to about 0.4 cases per 100,000 each year since 2007 (WA DOH, 2013a).

WASHINGTON STATE HIV/AIDS STATISTICS, 2012

  11,318 persons are living with HIV/AIDS

  4,989 with HIV

  6,329 with AIDS

  86% male

  14% female

  36% between 45 and 54 years of age

  66% white

  15% black

 

  495 new infections

  410 male (83%)

  85 female (17%)

  278 white (56%)

  96 black (19%)

 

  19,030 cumulative cases of HIV/AIDS

  5,430 diagnosed with HIV

  13,600 diagnosed with AIDS

  7,568 cumulative deaths since 2008

Source: WA DOH, 2013a.

Over half of persons recently infected with HIV in Washington reside in King County, and more than one third are men who have sex with men (MSM) or men who have sex with men and are injection drug users (MSM/IDU) who live in Seattle. More than 1 in 3 HIV infections occur among racial/ethnic minorities (WA DOH, 2013a).

Efforts to screen pregnant women for HIV and to treat those women who test positive for the virus have markedly reduced the incidence of pediatric HIV/AIDS in Washington. Since 2002, there have been only three confirmed cases of perinatal (mother-to-child) HIV transmission (WA DOH, 2013b).