HIV and Its Causes
Human Immunodeficiency Virus (HIV) is a virus that invades the body’s immune system and progresses to Acquired Immunodeficiency Syndrome (AIDS) if left untreated. Individuals remain with the virus for life once they are infected because it has no effective cure. However, HIV is controllable through treatments, allowing infected people to live long, healthy lives and prevent transmission to their partners.
HIV disease in humans originated from a type of chimpanzee found in central Africa. The version of the virus reported in the chimpanzee is known as the simian immunodeficiency virus (SIV), which may have been transferred to humans when the latter hunted the animals for meat (The Center for Disease Control, 2021). The virus mutated to become HIV once it was inside the human population. It was first discovered in a human blood sample in 1959 (Pietrangelo & Vinetz, 2020). HIV spread in Africa and other parts of the world over several decades and hit public consciousness in the 1980s (Pietrangelo & Vinetz, 2020). Since then, the World Health Organization (WHO) and governments have been combining efforts to fight and control the spreading of the virus.
Stages of HIV
HIV progresses through three stages if a person infected with the disease does not get treatment. Medicinal interventions slow or prevent the advancement of the disease in other stages. According to The Center for Disease Control (2021), the third stage of the illness is now less common than before because of advanced treatments. The first stage, which is characterized by different symptoms, is also known as acute HIV infection. Infected individuals have a significant amount of the virus in their blood and can easily transmit it to others (The Center for Disease Control, 2021). While some people experience flu-like symptoms, a natural way in which the body responds to infections, others do not feel ill right away or at all. Therefore, persons suspected of being exposed to HIV and experiencing flu-like symptoms should seek medical care and be tested.
The second stage or chronic HIV infection is also referred to as asymptomatic HIV infection or clinical latency. The virus at this stage is still active but reproduces at low levels. No symptoms are reported at this stage, and this period can last longer even without HIV medication. Transmission of the virus to other people is possible in this phase. The CD4 cell count in the blood reduces as the amount of HIV increases at the end of this stage (The Center for Disease Control, 2021). As a result, people may experience symptoms and progress to the last stage.
The third phase of the disease is also called acquitted immunodeficiency syndrome (AIDS). It is the most critical stage of HIV infection, and individuals with AIDS have their immune system damage and are highly vulnerable to various severe illnesses or opportunistic infections. AIDS is diagnosed when a patient’s CD4 cell count goes below 200 cells/mm, or they get infected with opportunistic diseases (The Center for Disease Control, 2021). People with AIDS are very infections due to high viral load and cannot survive for long without treatment.
Symptoms
Once an individual is infected with HIV, the virus enters the clinical latency stage after a month or so, a phase that can last up to decades. While some people do not report any symptoms during this period, others experience nonspecific signs, encompassing headaches, recurrent fever, fatigue, swollen lymph nodes, nausea, diarrhea, skin rashes, and vomiting (Pietrangelo & Vinetz, 2020). They can also have shingles, pneumonia, and recurrent virginal or oral yeast infections.
The chronic HIV infection phase symptoms can vary and be more severe than in the clinical latency stage. They may include weight loss, breathing difficulties, coughing, fatigue, diarrhea, and high fever (Cherney & Murrell, 2020). The symptoms at the AIDS stage are severe chills and night sweats, persistent, high fever, genital or oral sores, persistent headache, white spots in the mouth, memory problems, and red, brown, pink, or purple rashes (Cherney & Murrell, 2020). According to the Center for Disease Control (2021), a person diagnosed with AIDS cannot achieve survival for more than three years.
HIV Window Period
This is the period between when individuals are exposed to HIV and when it becomes detectable in the blood. Once people contract the virus, it reproduces in their body. The virus stimulates the immune system to produce antibodies to fight the antigens. According to Pietrangelo and Vinetz (2020), individuals develop detectable HIV antibodies within three weeks to three months after being infected. Although results for HIV tests may be negative during the window period, people can still transmit the virus to others. Therefore, someone suspecting to have been exposed to the virus but tested negative during the period should repeat the process to confirm the results. Additionally, they should use protection to prevent the possibility of spreading the infection.
Treatments Options, Regimens, and Side Effects
HIV treatment should start immediately after diagnosis regardless of the viral load. Antiretroviral therapy, a mixture of daily medications that inhibit the reproduction of the virus, is the main treatment for HIV. The therapy protects the CD4 cells and maintains the immune system’s strength needed to fight against the infection (Pietrangelo & Vinetz, 2020). It also prevents the progression of HIV to AIDS and reduces the risks of transmitting the disease.
Most ARV therapy medications approved to treat HIV are categorized into six classes. They include nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors, fusion inhibitors, CCR5 antagonists, also known as entry inhibitors, and integrase strand transfer inhibitors (Pietrangelo & Vinetz, 2020). The treatment regimen comprises three medications from at least two of the above classes. According to Pietrangelo and Vinetz (2020), the combination prevents HIV from developing resistance to the medications. Healthcare professionals choose the regimen, which should be taken daily, depending on health and personal factors. Possible side effects of ARV therapy include headaches, dizziness, nausea, liver or kidney damage, and swollen mouth.
HIV Prevention
HIV transmission can be prevented by taking different measures because there is no vaccination against the virus. Notably, the virus is mainly transmitted through unprotected vaginal or oral sex. The risk of contracting HIV through this method can be minimized by taking different precautions. It cannot be eradicated unless individuals abstain from sex. It is recommendable to get tested for HIV and other sexually transmitted infections. Knowing one’s HIV status and that of their partner is essential because it helps people avoid behaviors that can expose them to the virus (World Health Organization, 2020). Equally, they should get appropriate treatment if they test positive for STIs since the latter increases the risks of contracting the infection.
The use of male and female condoms and adhering to HIV medication also prevent transmission of the virus. People should learn the correct way of using condoms every time they are having sex (World Health Organization, 2020). They should also avoid virginal or oral contact with the pre-seminal fluids because they can contain the virus. Pietrangelo and Vinetz (2020) indicate that HIV medications minimize the chances of transmitting the virus to others or the sexual partner.
Other methods of preventing HIV transmission are used post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) and avoiding sharing paraphernalia and needles. PEP reduces the risks of contracting HIV after exposure to the virus. PEP comprises three antiretroviral medications that should be started before 72 hours lapse and taken for 28 days after suspected exposure (Pietrangelo & Vinetz, 2020). Conversely, PrEP lowers the possibility of acquiring HIV among individuals with higher chances of contracting the virus.
HIV Diagnostic Tests
HIV is diagnosed using different tests such as antibody/antigen tests, antibody tests, and nucleic acid tests (NAT). The most commonly used tests are antibody/antigen tests that can detect the virus 18 to 45 days after exposure to HIV. The tests check blood for antigens or HIV and antibodies. The virus activates the immune system to produce antibodies to respond to the infection.
The antibody tests focus mainly on assessing antibodies in the blood. The body develops detectable HIV antibodies between 23 and 90 days after exposure to the virus (Pietrangelo & Vinetz, 2020). Healthcare providers use blood or mouth swabs to test for antibodies. The tests can be performed in clinic settings or healthcare providers’ offices, and patients get their results within 30 minutes (Pietrangelo & Vinetz, 2020). OraQuick HIV test and Home Access HIV-1 Test System are other antibody tests that can be done at home.
The nucleic acid test (NAT) is the most expensive way of diagnosing HIV and is not used for general screening. The tests are used for individuals with known risk factors or exhibiting early symptoms of HIV (Pietrangelo & Vinetz, 2020). Unlike the previous tests, NAT looks for the virus itself, which can be detected in the blood from 5 to 21 days after exposure.
Social Issues Regarding HIV
Stigma and Discrimination
HIV-related stigma and discrimination involve abuse, negative attitude, and prejudice directed at individuals living with the infection. More than 50 % of the population in HIV-affected countries report having discriminatory attitudes towards persons living with HIV (“HIV Stigma and Discrimination”, 2020). The issue can be associated with the fear that surrounded the emergence of the HIV epidemic in the 1980s, which persists even to date in some countries (“HIV Stigma and Discrimination”, 2020). The fear led to false perceptions about the disease, such as it is associated with death, and immoral behaviors. Stigma and discrimination against individuals living with HIV may lead to loss of income, marriage, livelihood, reputation, hope, and childbearing options (“HIV Stigma and Discrimination”, 2020). Additionally, the issue can cause the withdrawal of caregiving and poor care in the health sector.
There are different forms of HIV-related forms of stigma that lead to discrimination, including self-stigma, governmental, healthcare, employment, community, and household stigma, and restrictions to entry, stay and travel (“HIV Stigma and Discrimination”, 2020). These stigmas inhibit controlling the disease and increase the risks of the vulnerable populations contracting the virus because people fear what others will say or do if they realize they are HIV positive (Kimera et al., 2020). For instance, the fear of discrimination and negative self-judgment in worthlessness and shame limit an individual’s ability to live a positive life, adhere to medication and seek health services and quality of life. Equally, discriminatory laws, rules, and policies regarding the disease in some countries exclude individuals living with the virus, perpetuating the stigma surrounding HIV (Stangl et al., 2019). For example, the criminalization of sex work and all aspects related to it in most countries increase the vulnerability of sex workers and the risk of transmitting the infection to many people.
Homophobia
The irrational intolerance, fear, and hatred towards the LGBT community define homophobia. The issue is manifested in bullying, negative comments, media representation, discrimination, and physical attacks. Homophobia is the leading factor that inhibits the effort to end the global HIV epidemic (“Homophobia and HIV”, 2020). The problem negatively impacts the provision of HIV services to LGBT people. These services remain inadequate in most countries because these groups are not governments’ priorities, and their data is under-reported.
Gender Inequality
The social process of not treating men and women equally increases girls’ and women’s vulnerability to HIV and limits their access to HIV services. The issue is reinforced by harmful traditional practices, intimate partner violence, and inequitable laws in some countries. As a result, it limits women’s opportunities, choices, and access to information, education, employment, as well as social and health services (“Gender inequality and HIV”, 2020). Discriminatory cultural and social norms in most countries lead to laws that inhibit young women’s autonomy. For example, laws in more than 100 countries allow girls below 18 years to marry with their parent’s consent, increasing their vulnerability (“Gender inequality and HIV”, 2020). Discrimination against women also undermines the response to the HIV epidemic.
Human Rights Violations
While international human rights laws endow every individual with the right to quality healthcare services, violations of these privileges in the context of HIV are a significant social issue. Abuse of these rights encompasses criminalization and enactment of punitive laws targeting HIV-affected individuals (“Human rights and HIV”, 2019). For example, most countries criminalize gays, people who inject drugs, and sex workers. The laws act as barriers to accessing HIV and other healthcare services and increase people affected vulnerability to the infection. Therefore, promoting, protecting, and respecting human rights is important since it can ensure access to health services and facilitate affected responses to HIV.
Health Issues Regarding HIV
People living with HIV experience other health issues, some of which are directly related to the infection or its treatment. These health problems increase the care cost burden due to frequent hospital visits, medical tests, and medications. HIV-infected individuals are vulnerable to other diseases such as hepatitis B and hepatitis C, tuberculosis (TB), and opportunistic infections (OIs). Hepatitis B virus (HBV) and hepatitis C virus (HCV) can be transmitted by drug injection or sexually like HIV. HIV.gov (2019) notes that many HIV-infected individuals l in the United States is also infected with either HCV or HBV. If the former and latter are left untreated, they can cause liver cancer and liver disease, and ultimately the organ fails.
The TB-causing germs are spread through the air from a person with the disease. Although the illness mainly affects the lungs, it can attack other body parts such as the spine. HIV increases vulnerability to TB, which is potentially detrimental when left untreated. According to HIV.gov (2019), TB is a major cause of death among people living with HIV. HIV-infected individuals should be tested for TB and embark on treatment if confirmed positive.
Opportunistic infections occur due to a weakened immune system caused by HIV. The risks of contracting OIs such as cancer, Herpes simplex virus 1, candidiasis, and salmonella infection are high when the CD4 cell count is below 200 cells/mm (Pietrangelo & Vinetz, 2020). Other health conditions associated with HIV include chronic inflammation, cognitive disorders, kidney disease, cardiovascular illness, and bone malady. Therefore, individuals living with HIV should adhere to medication to lower the possibility of getting other health conditions.
Facts about HIV Transmission
Infected individuals transmit the virus through different body fluids such as blood, breast milk, semen, and virginal and rectal secretions. The ways of transferring the infection from one person to another are by sharing tattoo equipment and piercing tools such as needles and syringes without sterilizing them between uses and through anal or virginal sex (Pietrangelo & Vinetz, 2020). Notably, the latter is the common route of transmitting HIV. The disease can be spread during breastfeeding and during pregnancy or delivery from infected mothers to their babies.
Moreover, mothers living with HIV can infect their babies by chewing their food before feeding them. Another way, though very rare, that the virus can be transmitted is through tissue and organ transplant or blood transfusion. Testing for HIV among donors of tissue, organs, and blood eradicates any possibility of spreading the virus through that method. According to Pietrangelo and Vinetz (2020), other possible means through which an infected person can transmit HIV are oral sex and biting an individual if one has open sores or bleeding gum. Likewise, contact between mucous membranes, open wounds, or broken skin and blood of someone sick.
Nevertheless, HIV does not spread through air or water, hugging, shaking hands, skin-to-skin contact, and kissing. Sharing food and drinks, bedding, towels, and toilets cannot transfer the virus from one person to another (world health organization, 2020). Further, mosquitos and other insects, saliva, sweat, and tears cannot facilitate the spreading of HIV. Pietrangelo and Vinetz (2020) add that transmission of the virus to another person is impossible when an infected individual adheres to HIV medication and has a persistent undetectable viral load.
Living With HIV and Strategies to Cope With the Disease
Living with HIV is challenging due to health and social issues associated with the illness. However, infected individuals can lead a healthy and productive life when treated. It is essential to start ARV therapy immediately after being diagnosed with HIV. Adherence to the prescribed medications is paramount to lowering the viral load and strengthening the immune system (Costa et al., 2018). Individuals living with HIV can also adopt other strategies to improve their health. They can prioritize their health, engage in regular exercise, eat a balanced diet, avoid drugs, and get enough rest (Pietrangelo & Vinetz, 2020). Moreover, they can live with their loved ones and get appropriate support from healthcare providers.
Affected Areas and Vulnerable Populations
While everyone can be infected with HIV, some populations are more vulnerable to the virus than others. These populations include people who inject drugs, sex workers, men who have sex with men, prisoners, women and girls, people with disabilities, transgender, children, and adolescents. For instance, the chances of sex workers to be living with HIV are 12 times higher than that of the general population (“Key affected populations, HIV and AIDS”, 2020). Equally, approximately 14 % of people who inject drugs live with the virus. (“Key affected populations, HIV and AIDS”, 2020) Women account for about 55 % of all adults living with the virus worldwide (Kaiser Family Foundation, 2021). Therefore, these groups should be given special consideration when it comes to fighting HIV.
Although HIV touches every part of the world, it is more prevalent in some regions than others. According to Kaiser Family Foundation (2021), Eastern and Southern African lead with people living with HIV, and the Middle East and North Africa record the lowest number. Eastern and Southern Africa have about 20.7 million, Western and Central Africa 4.9 million, Asia and the Pacific 5.8 million, and Western and Central Europe and North America 2.2 million people are living with HIV. Latin America has approximately 2.1 million people, Eastern Europe and Central Asia with 1.7 million, the Caribbean with 330,000, and the Middle East and North Africa with 240,000 people living with the infection (Kaiser Family Foundation, 2021). The disparities in HIV prevalence worldwide can be associated with social and economic factors such as poverty.
Impacts of HIV Infections
HIV has health, social, and economic impacts on the infected individuals and the community. The infection deteriorates a person’s health since it suppresses the immunity system, increasing risks for other conditions. Social ties weaken due to stigma and discrimination from families and friends. Infected people’s productivity decreases and others lose their jobs, increasing the dependence ratio. Additionally, more resources are directed toward the healthcare sector to manage the disease and other illnesses. As a result, countries are left with fewer resources for accelerating economic growth.
Global Goals and Resources
The sustainable development goals (SDGs) aim at eradicating HIV/AIDS by 2030 to guarantee healthy lives and wellbeing for all populations. Equally, UNAIDS targets to end the HIV epidemic by 2030 by ensuring that 95 % of people living with the virus know their HIV status, are on treatment, and have suppressed the viral load (Kaiser Family Foundation, 2021). The organization estimates that more than $26.2 billion is required every year to meet the global by 2030 (Kaiser Family Foundation, 2021). Indeed, it is possible to end HIV as public health issue when the goals are effectively implemented using the allocated resources.
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