The AIDS epidemic has been considered one of the most important health emergencies in the contemporary world due to the destabilizing social, economic, and political consequences of its global spread and the unsuccessful attempts to develop vaccination against it.
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At the same time, some scientists have argued that the problem in tackling AIDS is not so much the insufficient scientific and medical developments, but the politics of the global response to the disease.
The acronym AIDS stands for acquired immunodeficiency syndrome. From a medical perspective, AIDS is not a singular disease, but a series of symptoms that occur for an individual person who has acquired the human immunodeficiency virus (HIV). HIV belongs to the family of retroviruses, first described in the 1970s. The characteristic trait of viruses from that family is that their genetic material is encoded in ribonucleic acid (RNA), which is located in the inner core of the viruses and surrounded by an outer membrane made up of the fatty material taken from the cells of the infected person. Furthermore, HIV belongs to the virus group of lentiviruses, which produce latent infections. This means that in the initial state of HIV infection, the virus remains inactive and asymptomatic, and its genetic material is hidden in the cell for a period of time. In some cases, HIV has remained inactive indefinitely. In most of the cases, after the inactive period, HIV does progressive damage to the immune and nervous systems.
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The first stage of HIV activity in the body of an infected person is called AIDS-related complex (ARC). In ARC, only a partial deficiency of the immune system occurs. The second state of HIV activity is AIDS, which is a more advanced immunodeficiency. There are three main transmission modes of HIV: through sexual penetrative intercourse, the transfusion of blood or blood-related products, and from infected mother to child during birth or breast-feeding. Furthermore three important characteristics of the HIV infection have been identified. First, the condition is incurable. Second, the person with HIV is infectious for life, including during the initial (inactive) HIV infection period. Third, the effect of the HIV infection is the increased vulnerability to various infections due to the undermined immune system. Therefore HIV/AIDS has been linked with a series of other diseases such as pneumonia, various fungal and protozoa infections, lymphoma, and Kaposi sarcoma (a rare form of skin tissue cancer).
It is believed that the origins of HIV are linked to an HIV-related virus located in Africa. There are two different types of HIV: HIV-1 and HIV-2 (the latter is present almost exclusively in Africa). The first cases of AIDS infection were observed in 1977–80 by doctors in the United States, who identified clusters of a previously rare health disorder among members of the gay communities in San Francisco and New York. Because the first AIDS cases were diagnosed in gay communities, the condition was initially termed Gay-Related Immune Deficiency Syndrome (GRID). AIDS-related diseases were later observed also among hemophiliacs and recipients of blood transfusions, prostitutes, intravenous drug users, and infants of drug-using women. In 1984, the virus causing AIDS was identified by the French researcher Luc Montagnier of the Pasteur Institute in Paris and confirmed by an American researcher, Robert Gallo of the National Cancer Institute. Also in 1984 the first test for AIDS was developed. The first commonly used tests for AIDS were the ELISA test and the Western blot test.
After the 1980s the statistics of HIV epidemiology showed a constant rise in the number of infected persons and those directly affected by AIDS. The major group at risk was identified by the Joint UN Programme on HIV/AIDS (UNAIDS) as sexually active adults and adolescents between 15 and 50 years. According to UNAIDS in 2005 there were approximately 40.3 million people living with AIDS, and over 150 million directly affected by AIDS. It is also important to place the HIV/AIDS epidemic in a broader demographic context. The statistics of the HIV/AIDS Department of the World Health Organization (WHO) showed that in sub-Saharan Africa, in Asia, and in the former Soviet republics young women with low incomes and living in rural areas constitute a particularly vulnerable social group, with the highest rate of new HIV infections.
Global and national responses to AIDS included various prevention and treatment policies. After 1996 the so-called antiretroviral drugs (ARVs), compounds that treat the virus infections, were in use. Antiretroviral drugs were available in single therapies, double therapies, and triple therapies. One example of an antiretroviral therapy was the Highly Active Anti-retroviral Therapy, which had a relatively high cost of between US$10,000 and $20,000 per patient per year. Most of the populations of the North American and western and central European regions could gain access to antiretroviral drugs and antiretroviral therapies. This systematically decreased the number of deaths due to AIDS-related diseases. As a result, in the Western world living with AIDS was gradually transformed into an endurable and nonfatal condition. The costs of the drugs and treatments made them inaccessible for most of the world.
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The 13th World AIDS Conference in Durban in 2000 marked a significant shift of global attention to AIDS treatment. In 2002 the UN set up the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) in order to spawn more generous international funding of AIDS-related programs and to increase the supplies of ARVs. GFATM functions as a platform for cooperation between the public sector, the private sector, and the civic society. Between 2003 and 2005 GFATM granted $4.3 billion to various projects in 128 countries, including $1.9 billion specifically to HIV-related projects. Other key donor organizations are the World Bank’s Multi-Country HIV/AIDS Program (MAP), the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the European Union HIV/AIDS Programme. There are also numerous private foundations, charities, and private-sector support networks that participate in the global struggle against HIV/AIDS. In 2003 UNAIDS and the World Heath Organization initiated a campaign known as the “3 by 5” initiative, whichaimed at making ARVs available to 3 million people in poor- and middle-income countries by 2005.
In 2003 an HIV vaccination clinical trial proved unsuccessful. The obstacles to developing a vaccination against HIV included mutability of the virus, what effective immunological reaction the vaccination should generate, and various practical problems in the testing of the vaccine. The Global HIV Vaccine Enterprise created a forum for public and private organizations, as well as research institutes, to cooperate and generate funding for the development of an HIV vaccine. Important organizations working on an HIV vaccine included the International AIDS Vaccine Initiative in New York.
In the Western world, in particular in the United States, where AIDS was initially linked to marginal social groups, it raised prejudices and contributed to their stigmatization and discrimination in employment, education, residence, and health care. The religious standpoint created a link between liberal sexual patterns and the spread of AIDS, which framed AIDS as an issue of personal morality, guilt, and punishment. In contrast, leftist standpoints phrased the AIDS issue as a problem of the protection of civil liberties and nondiscrimination. In spite of contrary medical evidence, it was a widespread public belief in the 1980s that AIDS could be contracted by casual contact. This raised a number of social and legal controversies where individual rights to privacy were weighed against the collective right to protection from the spread of the disease.
The main site of the AIDS epidemic remains sub-Saharan Africa, where the virus spread primarily through unprotected heterosexual intercourse and reuse of medical instruments and contaminated blood supplies. Experts suggested that the dynamics of the spread of AIDS and its social and geographical distribution in sub-Saharan Africa both reflected and exacerbated the systemic characteristics of the migration and mobility patterns, the social sexual behaviors, the social inequalities and impoverishment, and the breakdown of family structures in the region. A study by the investment bank ING Barings indicated that in South Africa HIV/AIDS policies cost over 15 percent of the country’s GDP. The personal and collective consequences of the AIDS epidemic in Africa were equally disruptive. One of the most serious consequences of HIV/AIDS in Africa was the increased number of orphans, whose parents died due to AIDSrelated diseases. It was predicted that by 2010 the number of orphans in Africa would reach 40 million, out of which approximately 50 percent would be orphaned by causes related to HIV/AIDS.
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Magdalena Zolkos