A Brief Summary of Everything: HIV/AIDs

This is the first instalment of my ‘A Brief Summary of Everything:’ series and I am starting this off with one of my favourite areas of research- HIV/AIDs. HIV (Human Immunodeficiency Virus) and AIDs (Acquired Immunodeficiency Syndrome) are two terms that are often confused and wrongly used interchangeably. HIV is the virus itself and AIDs is the disease that results from the virus.

HIV was first reported in the 1930s and became the epidemic that it is today in the 1970s. It is a zoonotic disease (it came from another species- so I guess Gatsby’s parties got a little too wild) and there are two main sub-types of the virus: HIV-1 from chimpanzees in Central Africa, and HIV-2 from Sooty Mangabey monkey’s in West Africa. Even still, there are more clades (all the organisms from a common ancestor- essentially ‘you’ all your ‘cousins’ and ‘second cousins’) of the disease and their identification is crucial to tracking the spread and movement of the disease as the different strains are more abundant in certain areas: Type C is most common in the US, Type A and D are more common in East Africa so hypothetically speaking if a new outbreak of Type C occurs in Tanzania around summer time, we can guess that someone from the safari tourist group was the source, rather than a native.

HIV has historically been associated with homosexual men, however, the disease is more prevalent in heterosexual relationships, this may be for a number of reasons- one, there are more heterosexual people on this planet, with researchers disputing on the exact number (because many people are not openly homosexual) they seem to agree that less than 10% of the world population is homosexual. Secondly, semen remains in the vagina after unprotected intercourse and if a woman is younger, with an underdeveloped vagina (prone to tearing) or is raped (statistics suggest as much as 20% of American will be raped in their lifetime) then the danger of infection is higher than those of her homosexual counterparts.

Let’s talk geography for a second (even though I haven’t studied it since my year 7 volcano model), where is HIV/AIDs most prevalent? This is a difficult question because there are so many anomalies like Botswana vs Senegal (we’ll come back to that case study), but essentially in poorer regions- there is more HIV. This is due to things like: less education, less access to healthcare, less use of condoms and less education of women- all these factors contribute to a negative cycle…

Less education means less knowledge of how HIV spreads so people may share needles or have unprotected intercourse, less access to healthcare means people die from AIDs related diseases like TB, less condom use means more sexual contact (75–85% of HIV spread is through sexual activity) and less education of women means earlier sexual debut e.g. in child marriages and research shows that later sexual debut helps reduce HIV spread as people have less sexual partners in their lifetime (education of women will also solve other issues in sub-Saharan Africa like the impending problem of overpopulation but we’ll get to that topic another time).

This principle of poverty = more disease, still applies in developed countries: in poorer regions of the UK, where drug use is more common, there is more HIV. There are anomalies to this principle and other cultural factors like religion play a role, for example- religious men are typically circumcised and research suggests increased circumcision rates leads to decrease of HIV prevalence, similarly, most religion forbids both premarital and extramarital sex and this reduces the number of sexual partners people have thus containing HIV in ‘one place’. An example of an anomaly is Botswana vs Senegal- Botswana has the 3rd highest income in sub-Saharan Africa and Senegal has an average income per capita that is 18% of that of Botswana however, HIV prevalence in adults 15–49 is 24.1% in Botswana and just 0.9% in Senegal.

Let’s get a bit more scientific and discuss the biomedical aspect of HIV/AIDs, this is a brief introduction so we can’t go too in depth but we can brush the surface of ‘viral load’, ‘what HIV does’ and the ‘CD4’ you will hear about in every HIV/AIDs article you will ever read. So, HIV is essentially a super speedy spy- it infects the body before the immune system can react and it hijacks cells, turning them into HIV making factories by converting its own genetic material (RNA) into the DNA of the cell it invades before its clones destroy the cell by bursting out off it. The ‘viral load’ is how much HIV is in your bloodstream at a given time. This number varies because sometimes, HIV is an ‘introvert’ and likes to hide dormant in the body but other times HIV is having a ‘hot virus summer’ turning up everywhere in your body, causing havoc. Your viral load is impacted by whether you were already sick (e.g. 5% of HIV cases in Kisumu, Kenya were linked to Malaria) but can also lead you to get more easily sick and it typically has a peak when you are newly infected (seroconvert).

CD4 is a glycoprotein found on the surface of your helper T cells (that we will discuss in a different article), that are some of the most important members of the cell mediated and the humoral immune response because they ‘wake up’ other cells and tell them it’s time to fight a pathogen. Low levels of CD4, a main side effect of HIV, means your immune response is weakened. That explains why people often say that HIV/AIDs won’t kill you, another disease will- your body cannot protect itself from opportunistic infections (things that ordinarily you could have fought off). Certain diseases are linked with AIDs as they are common killers of people with AIDs, this includes but is not exclusive to TB, Pneumocystis Carinii (a type of pneumonia) and CMV (from the herpes family).

Certain practices will help prevent future spread, like circumcision, later sexual debut, more condom use, fidelity and more frequent testing but it is difficult to enforce these practices and changing behaviours, especially around sexual practices, can be difficult if the oppose cultural norms. The HIV/AIDs epidemic is a lot more complex than this summary- orphaning and the economic impact on a nation are two examples of the domino effect of HIV/AIDs. Hopefully this article has enlightened you and showed some new perspectives on HIV/AIDs and their impact in roughly 1000 words.