Symptoms and Treatments of HIV/AIDS - Essay Example

Running Head: HIV/AIDS Symptoms and Treatments of HIV/ AIDS By _________________ HIV/AIDS HIV mainly infects cells bearing the CD4 surface molecule, which acts as a specific receptor for the viral envelope protein, gp120. Such cells are found predominantly within the immune system and include T-helper lymphocytes, monocytes and antigen-presenting cells. However, there are also CD4+cells within the central nervous system, these being the microglial cells which are of monocyte or macrophage lineage. These cells can be productively infected by HIV in vitro, and in vivo there is evidence of an HIV-induced cytopathic effect since syncytia-like, multi-nucleated cells are seen in the brains of HIV-infected individuals. This CD4-defined tissue tropism explains the major pathological effects of HIV, which are immunodeficiency and neurological disease. However, HIV may also cause damage at sites where CD4 is not expressed. This may be a result of direct infection of CD4-cells, in which low levels of viral replication can occasionally occur, or due to infiltration of tissue by HIV-infected lymphocytes and macrophages, which release toxic viral proteins and/or pro-inflammatory cytokines. (Nye & Paskin, 1994:41) Cells Infected by HIV CD4+ cells Immune System T-helper lymphocytes Monocytes/macrophages Dendritic cells Brain Microglia Skin Langerhan's cells Gastrointestinal Tract Human colorectal cellsa Liver Kuppfer cellsa CD4- cells Immune System CD8 lymphocytes B-lymphocytesa Brain Glial cells Astrocytes Human neuroblastoma cellsa Retina cells Lung Fibroblasts Kidney Epithelial cells Gastrointestinal tract Columnar and epithelial cells Enterochromaffin cells Liver Human hepatoma cellsa Bone marrow Stem cells a intectable in vitro. (Nye & Paskin, 1994:42) Origin of AIDS/HIV There have been a lot of unusual theories attempting to explain the origin of AIDS. Some people have theorized that it began in rural Haiti and spread to urban Haiti, and then to gay men in the United States and to Africans in Kinshasa, Zaire (the capital of that central African nation), where many Haitians were living. This theory is no longer accepted, since HIV research in rural Haiti shows that HIV was very rare there, and that it has been spreading from urban Haiti to rural Haiti, not the other way around. HIV in the late 1970s and early 1980s was more likely to have spread into Haiti from gay men coming from the United States to bisexual male Haitians, and from HIV-infected Haitian men and women returning from Zaire to persons living in Haiti. Some have argued that AIDS and HIV have been around for thousands of years and we are simply seeing a reemergence of the scourge. We know from reading the hieroglyphics on the temple and pyramid walls of ancient Egypt that the Egyptians of nearly five thousand years ago had a similar epidemic where people mysteriously died of immunosuppressive (weakening the immune system) disorders very much like what we see today in AIDS patients. But today we know that HIV mutates very rapidly, changing about 1 percent each year. It is likely that throughout human history, infectious diseases that were highly virulent and immunosuppressive emerged, killing many thousands, and then subsided. A virus that weakens the immune system opens the way for the same kinds of opportunistic infections and cancers that occur in people with AIDS. In other words, the disease would be AIDS-like but not AIDS itself, caused by an HIV-like agent but not HIV itself. Some have claimed that HIV was artificially created in a biological warfare laboratory and purposely released in the population to kill off gay men, injecting drug users, Haitians, and Africans. Near the end of the Cold War in the mid-1980s, the then Soviet Union went so far as to claim that HIV was invented and released just for that purpose from a biological warfare lab in Maryland. The United States Department of State spent much time and effort to counter that argument around the world, insisting there was no truth to the allegation. But could it have happened The evidence makes it appear highly unlikely. We know for certain that HIV has been around since at least the 1950s, may be even earlier. While today there are perhaps a dozen nations in the world with biological warfare laboratories, in the 1950s there were only four countries with such labs: the United States, France, Great Britain, and the Soviet Union. A remote possibility exists that HIV may have been accidentally created during failed research with simian immunodeficiency virus (SIV), a retrovirus that affects some apes and monkeys, and unintentionally released into the population through infection of one of the biological researchers who may have been gay. But there is no way of proving this to be either true or untrue over forty years later, and the evidence for a natural origin of HIV in Africa appears to be much stronger. Others have argued that HIV is not the cause of AIDS at all, and that billions of dollars have been wasted trying to understand a virus that does not cause AIDS. The very earliest explanation, in 1981, of why gay men were becoming ill with this new syndrome was the "overload theory". This theory stated that sexually active gay men had been infected with so many different microorganisms that their immune systems were overloaded, causing them to break down or "overload". Indeed, throughout the late 1970s and early 1980s gay men increasingly were developing intestinal parasites through sexual exposure, and it is now known that some of these pathogens will weaken the immune system. In 1983, a year before HIV was first reported as the cause of AIDS, there were many other theories attempting to explain what might be causing this emerging and rapidly spreading epidemic. One of the many theories espoused at the time was put forward by Jane Teas, a microbiologist, who said AIDS was caused by African swine fever virus (not to be confused with African swine flu virus, which is different). African swine fever virus (ASFV) is spread through pigs and goats in central Africa and Haiti. However, the nature of a retrovirus such as HIV is that it does proliferate slowly throughout the body and that it is not necessary for the virus to be found in large quantities in organs and human tissue for it to do its damage. The major reason why we know for certain that HIV is the cause, or at least the primary cause, of AIDS is that throughout the world all (or at least nearly all) of those who develop AIDS-related illness are HIV-positive. In other words, HIV is (with a few rare exceptions) a necessary condition occurring before the onset of AIDS. Where HIV appears, AIDS usually follows. The global occurrence of HIV and of AIDS is virtually identical. The most prevalent theory has been that AIDS and HIV started naturally in Africa. In the mid-1980s it was thought that the common African green monkey was the culprit, infecting humans through bites, scratches, being skinned, and being eaten by some African populations. We now know that the African green monkey is not the cause of HIV, since the monkey retrovirus that it carries (SIV) is only very remotely related to HIV found in central Africa. Actually, as we have already discussed in the Introduction, there are two kinds of HIV in Africa: HIV-1, the more common AIDS-related virus found throughout the world, including central Africa; and HIV-2, found mostly in West Africa. Recent research shows that the SIV found in sooty mangabeys (a kind of monkey in West Africa) is virtually identical to HIV-2 in humans in West Africa. There is also some speculation that the virus found in wild chimpanzees in central Africa may be closely related to HIV-1. The question of the origin of AIDS has been a very sensitive one. Some maintain that even suggesting that it originated in Africa is racist. They point to the discrimination that has occurred against Africans and Haitians, who were stigmatized as the source of HIV and blamed for its spread. Indeed, much of the early speculation in the popular press about the origin of AIDS in Africa and Haiti was very racist. There was nonsensical talk about Africans having sex with monkeys and ''promiscuity'' as the reasons why it was spreading in Africa. The truth is that if it did begin in Africa, Africans cannot be held responsible for its spread. There is no reason to believe that the average African is any more sexually active than the average American, and Africans certainly do not have sex with monkeys. If AIDS began in Africa, the tropical and subtropical climate there is likely to be to blame, since we know that diseases tend to proliferate in such climates more easily than they do in more moderate climates. (Douglas & Julia, 1998:1-5) HIV/AIDS in Africa For those countries worst affected, AIDS represents a human tragedy and developmental emergency of huge proportions. Yet by exposing how prevailing gender relations and other patterns of structured inequality are implicated in its spread, the AIDS pandemic offers the possibility of change, indeed necessitates it. It lays bare the need to engage with the mutuality of interests among sexual partners in seeking forms of protection, which can ensure survival of themselves, their children and their communities. However, AIDS also exposes women's vulnerability. Both men and women are affected by AIDS, but women particularly so, given how gender relations configure with sexual behavior and economic security. Gender relations not only underlie women's particular vulnerability; they also inhibit women's attempts to protect themselves and their families. If interventions around AIDS are to be effective, they must address the factors, which drive the epidemic. Such factors are deep-seated and intransigent, embedded in the very power relations, who define male and female roles and positions, both in intimate relations or the wider society. Women (and men) need protection now and cannot wait for deep structural changes. (Carolyn & Janet, 2000:1) That AIDS has gained so tight a grip on a number of African countries is partly a consequence of their poverty, as represented by deficiencies in nutrition, hazards of living, and lack of access to medical care. In some cases, national indebtedness and regimes of structural adjustment have exacerbated difficulties of securing livelihoods and restricted access to health services, further contributing to a broad risk ecology in respect of AIDS. The very character of the (distorted) development they have experienced has figured in the spread and entrenchment of HIV/AIDS in these countries. Through its impact on productivity and the costs it entails, the epidemic is operating in turn to frustrate further developmental progress, so much so that it has been belatedly acknowledged by international institutions to be the foremost development issue for the present and foreseeable future. However, the grip which AIDS has in Africa is also a consequence of the pace of social change, as registered in high rates of mobility in search of economic security, later marriage in consequence of more widespread education, a loosening of former mechanisms of sex education and, in consequence, changing patterns of sexual behavior. As an example, in the Kilimanjaro region of Tanzania, AIDS has been perceived by many as being bound up with a 'slowly emerging cultural crisis, a crisis rooted in transformations that began before the turn of the century'. Ideas about sex and work reproduction and production have been fashioned in accord with changing opportunities and new discourses, particularly in the lives of youth, who, in seizing upon them and apparently discarding behaviors and practices which were formerly valued, have been both vilified and placed in positions of greater vulnerability in respect of AIDS. Their elders in turn have seen youths' susceptibility to HIV as vindication of their own anxiety about the apparent abandonment of those former customs, which had provided the social cement for the community's very survival. In this sense, AIDS has generated a similar unease with changing norms of sexual behavior albeit attached to different specific practices as occurred in the North. (Carolyn & Janet, 2000:2-3) The HIV is not the only problem of African people; it has emerged as a global health problem with serious medical, economic and social implications. According to the World Health Organization (WHO, 2000), an estimated 33.4 million people worldwide are infected with HIV. Of these, 22.5 million live in the sub-Saharan Africa. Of the 5.8 million people newly infected with HIV last year, 4 million are Africans. The United Nations estimates that two million Africans died of AIDS in the previous year: this number accounts for over 80% of the worldwide death toll (WHO, 2000). Within the West African sub-region the HIV prevalence rate ranges between 2% - 8%, with the exception of Cote d'Ivoire and Togo, reporting rates of 8% - 32%. Senegal, on the other hand, is below 3%. However, the likelihood of adults in sub-Sahara Africa becoming HIV infected is ten times greater than for an adult in North America and 20 times greater than an adult in Western Europe (WHO, 2000). With a population of 113 million people, Nigeria is the most populous African nation. In Nigeria, the HIV epidemic is growing at an alarming rate, with zero-prevalence rates increasing from 0.9% in 1990 to 1.8% in 1992, 3.8% in 1994, 4.5% in 1996, and 5.4% in 1999 (Federal Ministry of Health, 1996). In specific subpopulations the rates are very significantly higher. For example, Esu-Williams et al (1997) reported that in 2,300 subjects from five states in Nigeria, HIV appears in over 60% of female commercial sex workers, 8% of male clients of commercial sex workers, 8% of blood donors, 9% of truck drivers, and 21% of STD patients. While the HIV epidemic may have been slower to impact Nigeria than many other African countries, these rates suggest that HIV prevalence is high and widely distributed in Nigerian society. Because of their sexual behaviors, Nigerian youth between the ages of 15 and 24 years, like their counterparts in the West, are the most affected age group. Clearly, this study suggests that college students in Nigeria know little about HIV/AIDS, engage in risky sexual activity, and perceived themselves to be at minimal risk for contracting HIV. These findings also differ on gender, with females knowing more about HIV, engaging in comparable risky activities but perceiving themselves at lower risk. Programs addressing health and sexuality education needs need to consider such factors when designing curricula. Based on study findings, we recommend that extensive efforts be made in Nigeria to educate the college population about HIV. In addition, the socio-cultural implications of having HIV/AIDS must be investigated, as a reduction in risky behavior is not an automatic consequence of increased HIV knowledge. By determining which aspects of having AIDS are perceived as most troubling for college students we may be able to develop interventions that address those concerns while encouraging less risky behaviors. To effectively do this, accurate information regarding the health risks for HIV and the accompanying social and cultural implications of being infected for sexual behaviors of college students should continue to be collected over time. Such information would be invaluable in providing direction regarding the best ways to meet the health needs of college students in Nigeria. This exploratory study represents a collaborative effort between academic institutions in the United States and campuses in Nigeria. As we move toward increased international cooperation regarding HIV prevention, it is important for health professionals in the United States to become more knowledgeable about HIV-related risks in other nations of the world. (John, 2005) It is difficult to overestimate the devastation of the AIDS pandemic in sub-Saharan Africa. In that region, 9 percent of all adults are HIV-infected. Africa will soon reach premature death rates not seen since the end of the nineteenth century. In eleven countries, a baby born in 2010 will live, on average, barely beyond his or her thirtieth birthday. The rate of HIV infection among women attending antenatal clinics in sub-Saharan Africa ranges from 10 to 50 percent, with an average rate in some countries of around 30 percent. Women transmit infection to their infants in this region at a rate of 21 to 43 percent. The tragedy is that AIDS in Africa is largely preventable, with models of success found in Uganda and Senegal, where HIV incidence among pregnant women and infants has significantly declined. In North America and Europe, mother-to-infant transmission has been dramatically reduced using a regimen of antiretroviral medication administered to pregnant women and newborns. The estimated cost of the regimen ($200 with discounts in pricing) makes the treatment unavailable to most people in sub-Saharan Africa where the annual health expenditure per person is between $2 and $40. Additional barriers include the difficulty of complying with a regimen that entails administering a drug four to five times daily for weeks, the limited infrastructure for distributing drugs and monitoring compliance, and inadequate maternal-child health care services. (Gostin, 2002) Overall, women represent an increasing proportion of new AIDS cases, but African American women represent a greater number of AIDS cases than white women. There were 7,113 newly reported AIDS cases among African American women in 2001 compared with 1,981 among white women (KFF, 2003b). The majority of women in all groups are most likely to have been infected by heterosexual contact (67 percent African American, 59 percent white) than through injection drug use (30 percent African American, 38 percent white). Heterosexual contact accounts for 75 percent of HIV infection among women ages 13 to 24. (Laura et al, 2004) How to Prevent AIDS To prevent HIV transmission, one must either avoid contact with infected blood, semen, or vaginal fluids in the first place or intercept the virus after exposure but before the onset of infection. Possibilities for post-exposure HIV prevention include the use of topical microbocides to prohibit HIV from binding with susceptible cells, immediate suppression of HIV via chemoprophylactic use of anti-retroviral medications, or mounting an effective immune response against the virus as achieved through a preventive vaccine. Unfortunately, technologies for post-exposure prophylactics are not widely available. Behavioral interventions for HIV prevention are therefore the most viable option for reducing HIV risk. Consistent condom use is effective for reducing HIV transmission. Condom use has increased substantially in many places. For condoms to work against HIV/AIDS, they must be effective, and sexually active people must use them. Many factors, including who uses them with which partners and how consistently and correctly they do so, determine their public health impact, as does the effect of condom promotion on other behaviors. Fortunately, we can now move beyond debating how well condom promotion might work to examining how well it has worked. (Norman & Sanny, 2004) For those people who are HIV positive, a variety of treatment models, such as Solution-focused or Narrative therapy, have come from a constructivist perspective that focuses on an individual's strengths. In contrast to medical models that stress the identification and treatment of pathology, strength-based models work to assist clients in living more productive and satisfying lives. In addition, medical models, with emphases on disease, symptoms, and behaviors that have negatively contributed to one's current health, may further victimize clients in that the models focus on what is wrong and bad about them. Strength-based models are designed to empower clients, "helping people discover the considerable power within themselves, their families and their neighborhoods". (Brad et al, 2003) References Brad Shepherd, Paula J. Britton & Silvia Orsulic-Jeras, 2003. "Counseling Older Adults with HIV/AIDS: A Strength-Based Model of Treatment" in "Journal of Mental Health Counseling". Volume: 25. Issue: 3. Page Number: 233+. COPYRIGHT 2003 American Mental Health Counselors Association. Carolyn Baylies & Janet Bujra, 2000. "Aids, Sexuality and Gender in Africa: Collective Strategies and Struggles in Tanzania and Zambia": Routledge. Douglas A. Feldman & Julia Wang Miller, 1998. "The AIDS Crisis: A Documentary History": Greenwood Press. Gostin, O' Lawrence, 2002. "Aids in Africa among Women and Infants: A Human Rights Framework" in "The Hastings Center Report". Volume: 32. Issue: 5. Page Number: 9+. COPYRIGHT 2002 Hastings Center. John. R. Collins, Chwee Lye Chng, Starr Eaddy & Esther Eke-Huber, 2005. "Nigerian College Students: HIV Knowledge, Perceived Susceptibility for HIV and Sexual Behaviors" in "College Student Journal". Volume: 39. Issue: 1. Page Number: 60+. COPYRIGHT 2005 Project Innovation (Alabama). K. E. Nye & J.M. Paskin, 1994. "HIV and AIDS: Bios Scientific Publishers Laura E. Kaplin, Stephen Gorin, & Evelyn Tomaszewski, 2004. "Current Trends and the Future of HIV/AIDS Services: A Social Work Perspective" in "Health and Social Work". Volume: 29. Issue: 2. Publication Year: 2004. Page Number: 153+. COPYRIGHT 2004 National Association of Social Workers. Norman Hearst & Sanny Chen, 2004. "Condom Promotion for AIDS Prevention in the Developing World: Is It Working" in "Studies in Family Planning". Volume: 35. Issue: 1. Page Number: 39+. COPYRIGHT 2004 The Population Council, Inc. Read More