What is it
Acquired immune deficiency syndrome AIDS is the clinical name of a syndrome that was first reported in the United States in 1981 and is now recognized as a pandemic. It is one of the most dangerous health problems of modern times. Because of the complexity of this disease, and the rapid development of new treatment strategies, treating MDS should be carried on with the advice and care of an expert health professional. Preventing the spread of AIDS, however, is straightforward and a responsibility that each person can and should undertake.
AIDS is caused by a blood borne virus known originally as HTLV III and now simply as HIV (for human immunodeficiency virus) that attacks the body’s immune system and can eventually destroy it. A severely impaired immune system leaves the infected person increasingly unable to fight off invading bacteria and viruses, and thus susceptible to a whole host of infections and diseases. These “opportunistic infections,” as they are called, can eventually cause death. The Centers for Disease Control and Prevention (CDC) has cited nearly 30 diseases and sets of symptoms associated with AIDS in the United States. These include Kaposi’s sarcoma (a form of skin cancer), tuberculosis, pneumonia, and certain neurological disorders such as meningitis.
In many infected people, AIDS can be slow to develop, and the full effects of the disease may not appear until 8 to 12 years or more after the initial infection. (In children with AIDS, the time between exposure to HIV and the appearance of symptoms is often measured in months rather than years.) Once AIDS develops, it is almost always fatal—typically within three to five years after serious symptoms first appear.
So far there is no cure, and no vaccine to prevent the disease. New vaccines are in various phases of testing, but making a successful vaccine has proved to be very difficult. The development and availability of new medications have allowed increasing numbers of HIV-infected people to delay the onset of symptoms. These treatments have also slowed the course of the disease for those who have developed AIDS, improving the quality of their lives and enabling them to live longer. During 1995, the number of AIDS-related deaths in the United States decreased substantially for the first time since the epidemic began in 1981 a nationwide decline of about 12 percent that Federal officials attributed to the success of drug therapies introduced in recent years, along with better access to care and increased financing for AIDS treatment. The decline continued during 1996 and is expected to continue.
Yet even as the death rate has declined, both the number of new infections with HIV and the number of full-blown cases of AIDS have continued rising (though the rate of infection has slowed since the early 1990s). Scientists estimate that as many as 1.5 million Americans and more than 20 million people worldwide are infected with HIV. AIDS has become the leading cause of death among all Americans age 25 to 44. The Harvard AIDS Institute estimates that by the year 2,000, there will be more than 100 million HIV infections around the world.
Symptoms
Symptoms vary depending on how the AIDS virus affects a person’s immune system. Milder clinical symptoms of HIV infection include the following:
- Persistent fatigue
- Fever that can last a few days to a month or longer, with no other symptoms present
- Night sweats
- Unexplained weight loss
- Diarrhea
- Swollen glands
Once AIDS destroys a sufficient amount of the body’s immune system, certain otherwise controllable infections, such as a specific type of pneumonia or cancer, can then gain a foothold.
What is it
Acquired immune deficiency syndrome—AIDS— is the clinical name of a syndrome that was first reported in the United States in 1981 and is now recognized as a pandemic. It is one of the most dangerous health problems of modern times. Because of the complexity of this disease, and the rapid development of new treatment strategies, treating MDS should be carried on with the advice and care of an expert health professional. Preventing the spread of AIDS, however, is straightforward and a responsibility that each person can and should undertake.
AIDS is caused by a bloodborne virus known originally as HTLV III and now simply as HIV (for human immunodeficiency virus) that attacks the body’s immune system and can eventually destroy it. A severely impaired immune system leaves the infected person increasingly unable to fight off invading bacteria and viruses, and thus susceptible to a whole host of infections and diseases. These “opportunistic infections,” as they are called, can eventually cause death. The Centers for Disease Control and Prevention (CDC) has cited nearly 30 diseases and sets of symptoms associated with AIDS in the United States. These include Kaposi’s sarcoma (a form of skin cancer), tuberculosis, pneumonia, and certain neurological disorders such as meningitis.
In many infected people, AIDS can be slow to develop, and the full effects of the disease may not appear until 8 to 12 years or more after the initial infection. (In children with AIDS, the time between exposure to HIV and the appearance of symptoms is often measured in months rather than years.) Once AIDS develops, it is almost always fatal typically within three to five years after serious symptoms first appear.
So far there is no cure, and no vaccine to prevent the disease. New vaccines are in various phases of testing, but making a successful vaccine has proved to be very difficult. The development and availability of new medications have allowed increasing numbers of HIV-infected people to delay the onset of symptoms. These treatments have also slowed the course of the disease for those who have developed AIDS, improving the quality of their lives and enabling them to live longer. During 1995, the number of AIDS-related deaths in the United States decreased substantially for the first time since the epidemic began in 1981 a nationwide decline of about 12 percent that Federal officials attributed to the success of drug therapies introduced in recent years, along with better access to care and increased financing for AIDS treatment. The decline continued during 1996 and is expected to continue.
Yet even as the death rate has declined, both the number of new infections with HIV and the number of full-blown cases of AIDS have continued rising (though the rate of infection has slowed since the early 1990s). Scientists estimate that as many as 1.5 million Americans and more than 20 million people worldwide are infected with HIV. AIDS has become the leading cause of death among all Americans age 25 to 44. The Harvard AIDS Institute estimates that by the year 2,000, there will be more than 100 million HIV infections around the world.
What causes it
The AIDS virus is an infectious agent known as a retrovirus, which has the ability to take over certain cells and interrupt their normal genetic functioning. Although there is much that we don’t yet understand about HIV, there is a good deal we do know. The virus can be cultured in a laboratory, and scientists have devised reliable tests to detect its presence in blood samples. We also know that the virus is hard to transmit. This is because HIV dies very quickly once it is outside the body. Consequently, it is not transmitted through air or water, nor does it travel easily from person to person, as other infections may. It cannot penetrate intact human skin, and it cannot be spread by casual contact such as touching or hugging, sharing food or a drinking glass, using the same towel, or sharing bath- rooms or toilets.
Rather, the virus is carried in bodily fluids such as blood, semen, vaginal fluids, and breast milk, and it can only be spread by the bodily exchange of these fluids with an infected person. The most common path of HIV transmission is during sexual activity, when the virus in semen or cervical secretions enters cuts or small abrasions. The virus passes from one person to another during anal intercourse more efficiently than it can during vaginal intercourse, and it also passes though rarely during oral sex. The virus can also be spread via blood-contaminated hypodermic needles and syringes, and if donated blood is contaminated blood transfusions. In addition, an infected mother can pass the virus to her child in utero or during delivery. (Although the virus has been found in saliva and tears, scientists behave that transmission via these fluids is unlikely since the virus is present in very low concentrations.)
In Africa and Asia, AIDS is primarily a heterosexual disease. During the 1980s in the United States, AIDS was confined primarily to certain well-defined risk groups males who have sex with males, injection drug users, and people with hemophilia (because they need frequent transfusions). But the number of people infected by heterosexual intercourse began rising in the 1990s and while the rate of infection by this route is still comparatively low, it increases with frequency of intercourse and especially with multiple partners.
What if you do nothing
If you think you may have been exposed to HIV infection or you have developed symptoms that might be AIDS-related, one of the quandaries is whether to be tested. But there are now clear benefits to diagnosing HIV infection early.
- Promising new drugs can slow the progress of HIV, and other drugs can prevent, delay, or treat opportunistic diseases that strike people with AIDS. There are also better ways to monitor the progress of the disease. For a pregnant woman who is infected with HIV, early treatment with antiviral drugs can reduce by two thirds the chances that her baby will be infected with the virus.
- The test has proved to be very accurate. The initial test is a fairly simple blood test, and if it detects antibodies to the virus, it is followed by a confirmatory blood test. The Food and Drug Administration (FDA) recently approved an accurate oral antibody test that uses a special pad to absorb material (not saliva) from the cheek and gum.
- The confidentiality of the test results is now easier to ensure. Not only are there clinics that offer anonymous testing, but there are new accurate, anonymous home tests. Still, some concerns about confidentiality remain.
Because of these benefits, everyone should know their HIV status. Yet according to recent estimates, half of all HIV-positive Americans do not know they are infected. At the very least, each of us should be familiar with and know when to use safer sex practices and other measures for preventing transmission of HIV.
Home remedies
There are no home remedies for AIDS. If you think you have HIV infection or AIDS, you should always consult with a qualified practitioner, who can advise you and help provide medical treatments that may be able to offset or delay symptoms. Be wary of any “miracle” cures; there aren’t any. However, your doctor or another health care professional may advise you about lifestyle changes—such as quitting smoking or making changes in your diet—to help bolster your immune system.
Prevention
Until a vaccine can be developed, halting the spread of AIDS must depend solely on educating those at risk—which includes all sexually active people, particularly those who have not lived in strict, long-term monogamy. Though education may not be the ultimate weapon, it is an effective and powerful means of controlling the spread of the disease.
One common myth about AIDS is that it is a disease of male homosexuals and injection drug addicts; other people have nothing to worry about. It is true that the vast majority of reported AIDS cases in the United States continues to be homosexual or bisexual men or injection drug users. But while these two main risk groups remain for the moment well defined, anybody who has unprotected sex can get AIDS. When it is transmitted heterosexually, women appear to be at greater risk than men: the virus is far less likely to pass from woman to man during vaginal intercourse than from man to woman. More than 75,000 American women have been infected, and the number is rising sharply, especially among poor African Americans and Latinas. As of 1997, women accounted for 20 per- cent of AIDS cases reported nationally.
The frequency of sexual contact appears to be more important than the form. Though a single contact can spread AIDS, people who have multiple sexual partners are in much more danger than those with fewer partners. Prostitutes, both male and female, are more likely to be infected by AIDS and to transmit it, since in addition to frequent exposure, many use injectable drugs.
Ultimately, it is not who you are, but what you do and with whom you do it, that puts you at risk for contracting AIDS. The following are known to be high-risk practices:
- Sharing drug needles or syringes.
- Anal sex (with or without a condom) with someone who might carry HIV. The virus is passed easily during anal sex.
- Unprotected vaginal or oral sex (without a condom) with someone who might carry HIV. Obviously, the more times you have unprotected sex, the greater your risk. Sex with prostitutes is particularly risky.
With that in mind, here are steps you should take to prevent AIDS:
Choose your sexual partners carefully
Learn the sexual history of a potential partner. Any per- son who has had multiple partners or has a sexual relationship with someone who has multiple partners may be at risk. Unless you and your sex partner are both sure you are not infected, you need to take precautions: use condoms, and avoid high-risk practices such as anal intercourse. Couples who have not been monogamous for at least 10 years may wish to consider testing.
Always use a latex condom
Used consistently and correctly latex condoms provide a highly effective AIDS preventive: the AIDS virus cannot penetrate an intact latex con- dom. (“Natural membrane,” or skin, condoms are not effective.) Adequate lubrication with a water-based lubricant (such as K-Y jelly) is important to prevent condom breakage. But you do not have to use a lubricant containing a spermicide, since no spermicide to date can be depended upon to stop HIV transmission. (The spermicide nonoxynol 9 has been shown to kill HIV outside the body, but its effectiveness at preventing transmission of the virus is questionable.) Unless you are certain that you and your sexual partner have not been exposed to AIDS, the use of condoms must be habitual for any and all episodes of sexual intercourse.
Don’t inject recreational drugs
If you do, never share needles.
Age is no barrier against infection
The number of MDS cases diagnosed in people over 50 has climbed steadily through the AIDS epidemic, reaching nearly 7,000 in 1996. A study conducted at the University of California at San Francisco in 1994 found that people over 50 are one-sixth as likely as those in their 20s to use condoms and one-fifth as likely to be tested. Gay men represent the majority of the over-50 AIDS cases, but many cases are low-income women who contracted AIDS through drug use or heterosexual partners.
Health care workers should take precautions
Accidental self-puncture with an AIDS -infected needle is a possible danger for doctors, nurses, dentists, physician’s assistants, and laboratory workers who give injections or handle blood. However, the number of infections acquired in health care settings is quite small: from 1978 to 1997, only 52 cases of HIV infection due to exposure in a health care setting were documented by the CDC. (In fact, health care workers are at considerably greater risk of becoming infected with hepatitis B and C.)
If you are infected with HIV, follow these same preventive measures
It is incumbent upon anyone who is infected to avoid exposing others to HIV. In addition, anyone who is HIV positive and contemplating parenthood should be aware that there is a high risk from one in three to one in two of an infected mother transmitting the virus to a fetus or newborn (though early treatment with medications can help reduce the risk).
