What are the most significant factors that contributed to
HIV/AIDS becoming a global problem?
There were approximately 34 million people living with HIV around the world in 2011[1]. It is, without any doubt, the worst pandemic outbreak of the XX century. But how did it started and how did it get so “big”? That’s what I’ll try to explain.
First we have to understand what it is and where did it came from. HIV stands for Human Immunodeficiency Virus and the AIDS means Acquired ImmunoDeficiency Syndrome. There are two known genetically distinct AIDS viruses: human immunodeficiency virus-1 (HIV-1) and human immunodeficiency virus-2 (HIV-2), both HIV-1 and HIV-2 are of primate origin. The origin of HIV-1 has been established to the chimpanzee (Pan troglodyte, troglodytes) and HIV-2 to the sooty mangabey (Cercocebus atys).[2] We cannot say for sure when, but at some point the virus crossed species from chimpanzees to humans.[3] Initially these animals lived deep in the jungle and with very few contact with humans, but with the increase of population, deforestation, building of roads for trade and transportation, increased the butchering of chimpanzees and the repeated exposure (contact, cuts, blood, eating them) of local hunters/workers, have made the leap to infect people through a mutation on the stripe or adaption to the human host. To illustrate this factor there is a report that around the mid XX century, where a hunter seems to have picked up the virus from a chimpanzee in the southeast corner of Cameroon, then he carried the pathogen along the main route out of the forest through the Sangha River, and into Leopoldville (modern-day Kinshasa). [4]
As it was said, HIV is a virus, but a specific kind of virus. It is not only is a retrovirus, but also a lentivirus [13]. This means that the period of time it takes for a person infected to fall ill varies can take between several months to several years. Therefore an infected person can spread the virus unknowingly [11]. Not only that, but the virus remains at the host during all the person's life who will remain infected and infectious until his death [14].
Now that we know how the transmission started from animals into humans, it’s time to focus on how it is transmitted from human to human. The World Health Organization identified three main routes of HIV transmission among the general population. The first one is through sexual transmission, exposure to blood mainly through transfusion and needles sharing is the second most common route of transmission and the prenatal or substantial vertical (mother to child) transmission constitutes the third major route of HIV transmission. [1]
All forms of sexual intercourse may result in the transmission and constitute the single most important HIV transmission route. Having unprotected anal or vaginal sex and/or having another sexually transmitted infection (syphilis, herpes, chlamydia, gonorrhoea, bacterial vaginosis) are the main risk factors. The evolution of the spread of AIDS has shown, particularly in forms involved in its transmission, as are sexual practices, this process is very complex and transcends the explanation closely linked to the biological discourse. Yet we cannot forget that it is a biological urge inherent in any species and in the human case also associated to pleasure and therefore common to the majority of the population. In direct association is the role that organization of the commercial sex industry and the availability of causal sex partners can play in the spread of HIV in a country [5]. Human trafficking and the spread HIV/AIDS are also linked in many cases. Women and sometimes very young girls are trafficked for commercial sex, and the outcome is the epidemic of HIV/AIDS that is being currently experience globally and particularly in sub-Sahara Africa.[7] It has been estimated that as many as 500000 women were trafficked into Western Europe for forced prostitution in 1996 and more than 800000 people are trafficked annually across international borders in 2004 in the US [6] Most of these trafficked women and girls are coerced, forced, or trickled into commercial sex are more likely to be infected with HIV/AIDS. So forcing girls and women into violent, unprotected sex acts with multiple partners is a significant factor in the spread of the AIDS pandemic and the chances of a person resort to commercial sex workers (and thus caught in a large network of sexual partners) grow exponentially [8]
Blood transfusions became somehow of a routine in medical practice, but in the early stages doctors where unaware of how easy it was for the HIV virus could spread and there where no screeners for it. This blood was transported worldwide and could infect anyone who received the transfusion. Compounding this fact, in the 1960’s haemophiliacs also began to benefit from blood clotting Factor VIII witch was produced from the blood of hundreds of donors, meaning that that one single donation of HIV+ blood could contaminate a huge batch of Factor VIII and putting at tremendous risk the haemophiliac population. [9] Sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs, other medical procedures that involve unsterile cutting or piercing and accidental needle stick injuries, among health workers or not, make the final part of this section. The increase use of recreational drugs (injectable) and the sharing of syringes contributed to a widespread of HIV through a major part of drug user population. [10]
Pregnant women do transmit the virus (HIV) to their babies during pregnancy or birth and also through breast milk (without treatment). Nine out of ten infected children are done through one of these ways. If we have in consideration that at the end of 2010, there were 3.4 million children living with HIV around the world, it’s easy to realize that it’s a significant part of transmission.[1]
To these factors are also associated, increased mobility, amplitude and velocity of flows of people and goods, technological innovations in the field of transport, the political and economic world that contributed to the increase in international migration (refugees, migrant workers, etc.) putting in contact previously distant populations and enhancing the processes of international spread of disease. The phenomenon of international mass tourism also had the same effect.
In a world increasingly interconnected and interdependent notion of a border as a barrier or separation gives way to design contact place or place of passage, prevailing ideas of movement, relationships, communication and exchange of closed border to border open. [12]
It was established that through the means of transmission (sexual, mother to child, blood transfusions, use of contaminated syringes/needles) HIV can “get” to almost anyone. The fact that the infection is silent and does not manifest itself during a long time and the constant migration of people that can travel from one part of the globe to opposite side in a short period of time are the ingredients of the pandemic that is AIDS.
But there is hope, if the technology had an important part in the shortening of distances of the transmission, is the same technology that can expedite the process of decision-making, especially when it comes to interventions to contain outbreaks and epidemics. Once that we know the means of transmission, education and prevention are essential in order to try to contain this scourge of pandemic proportions.
First we have to understand what it is and where did it came from. HIV stands for Human Immunodeficiency Virus and the AIDS means Acquired ImmunoDeficiency Syndrome. There are two known genetically distinct AIDS viruses: human immunodeficiency virus-1 (HIV-1) and human immunodeficiency virus-2 (HIV-2), both HIV-1 and HIV-2 are of primate origin. The origin of HIV-1 has been established to the chimpanzee (Pan troglodyte, troglodytes) and HIV-2 to the sooty mangabey (Cercocebus atys).[2] We cannot say for sure when, but at some point the virus crossed species from chimpanzees to humans.[3] Initially these animals lived deep in the jungle and with very few contact with humans, but with the increase of population, deforestation, building of roads for trade and transportation, increased the butchering of chimpanzees and the repeated exposure (contact, cuts, blood, eating them) of local hunters/workers, have made the leap to infect people through a mutation on the stripe or adaption to the human host. To illustrate this factor there is a report that around the mid XX century, where a hunter seems to have picked up the virus from a chimpanzee in the southeast corner of Cameroon, then he carried the pathogen along the main route out of the forest through the Sangha River, and into Leopoldville (modern-day Kinshasa). [4]
As it was said, HIV is a virus, but a specific kind of virus. It is not only is a retrovirus, but also a lentivirus [13]. This means that the period of time it takes for a person infected to fall ill varies can take between several months to several years. Therefore an infected person can spread the virus unknowingly [11]. Not only that, but the virus remains at the host during all the person's life who will remain infected and infectious until his death [14].
Now that we know how the transmission started from animals into humans, it’s time to focus on how it is transmitted from human to human. The World Health Organization identified three main routes of HIV transmission among the general population. The first one is through sexual transmission, exposure to blood mainly through transfusion and needles sharing is the second most common route of transmission and the prenatal or substantial vertical (mother to child) transmission constitutes the third major route of HIV transmission. [1]
All forms of sexual intercourse may result in the transmission and constitute the single most important HIV transmission route. Having unprotected anal or vaginal sex and/or having another sexually transmitted infection (syphilis, herpes, chlamydia, gonorrhoea, bacterial vaginosis) are the main risk factors. The evolution of the spread of AIDS has shown, particularly in forms involved in its transmission, as are sexual practices, this process is very complex and transcends the explanation closely linked to the biological discourse. Yet we cannot forget that it is a biological urge inherent in any species and in the human case also associated to pleasure and therefore common to the majority of the population. In direct association is the role that organization of the commercial sex industry and the availability of causal sex partners can play in the spread of HIV in a country [5]. Human trafficking and the spread HIV/AIDS are also linked in many cases. Women and sometimes very young girls are trafficked for commercial sex, and the outcome is the epidemic of HIV/AIDS that is being currently experience globally and particularly in sub-Sahara Africa.[7] It has been estimated that as many as 500000 women were trafficked into Western Europe for forced prostitution in 1996 and more than 800000 people are trafficked annually across international borders in 2004 in the US [6] Most of these trafficked women and girls are coerced, forced, or trickled into commercial sex are more likely to be infected with HIV/AIDS. So forcing girls and women into violent, unprotected sex acts with multiple partners is a significant factor in the spread of the AIDS pandemic and the chances of a person resort to commercial sex workers (and thus caught in a large network of sexual partners) grow exponentially [8]
Blood transfusions became somehow of a routine in medical practice, but in the early stages doctors where unaware of how easy it was for the HIV virus could spread and there where no screeners for it. This blood was transported worldwide and could infect anyone who received the transfusion. Compounding this fact, in the 1960’s haemophiliacs also began to benefit from blood clotting Factor VIII witch was produced from the blood of hundreds of donors, meaning that that one single donation of HIV+ blood could contaminate a huge batch of Factor VIII and putting at tremendous risk the haemophiliac population. [9] Sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs, other medical procedures that involve unsterile cutting or piercing and accidental needle stick injuries, among health workers or not, make the final part of this section. The increase use of recreational drugs (injectable) and the sharing of syringes contributed to a widespread of HIV through a major part of drug user population. [10]
Pregnant women do transmit the virus (HIV) to their babies during pregnancy or birth and also through breast milk (without treatment). Nine out of ten infected children are done through one of these ways. If we have in consideration that at the end of 2010, there were 3.4 million children living with HIV around the world, it’s easy to realize that it’s a significant part of transmission.[1]
To these factors are also associated, increased mobility, amplitude and velocity of flows of people and goods, technological innovations in the field of transport, the political and economic world that contributed to the increase in international migration (refugees, migrant workers, etc.) putting in contact previously distant populations and enhancing the processes of international spread of disease. The phenomenon of international mass tourism also had the same effect.
In a world increasingly interconnected and interdependent notion of a border as a barrier or separation gives way to design contact place or place of passage, prevailing ideas of movement, relationships, communication and exchange of closed border to border open. [12]
It was established that through the means of transmission (sexual, mother to child, blood transfusions, use of contaminated syringes/needles) HIV can “get” to almost anyone. The fact that the infection is silent and does not manifest itself during a long time and the constant migration of people that can travel from one part of the globe to opposite side in a short period of time are the ingredients of the pandemic that is AIDS.
But there is hope, if the technology had an important part in the shortening of distances of the transmission, is the same technology that can expedite the process of decision-making, especially when it comes to interventions to contain outbreaks and epidemics. Once that we know the means of transmission, education and prevention are essential in order to try to contain this scourge of pandemic proportions.
[1] (WHO, 2011 www.who.int/en)
[2] (Hirsch, 1989; Gao, 1992)
[3] http://www.infoplease.com/cig/dangerous-diseases-epidemics/hiv-origins.html
[4] http://evolution.berkeley.edu/evolibrary/news/081101_hivorigins
[5] (Larson, 1989)
[6] http://www.unodc.org/unodc/en/human-trafficking/global-report-on-trafficking-in-persons.html
[7] http://www.ungift.org/knowledgehub/en/about/human-trafficking-and-hiv-aids.html
[8] Report on the global HIV/Aids epidemic - UNAIDS - Jul.2002
[9] http://www.avert.org/
[10] http://www.cdc.gov
[11] (Akisolu, 2004)
[12] Martin, A .R. (1992) Fronteiras e nações: Repensando a geografia.
[13] - Jawetz, Melnick, & Adelberg's Medical Microbiology, 25e
[14] - James W. Curran, 2012
Essay done to the Coursera course about AIDS from Emory University
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