conclusion for hiv assignment

Conclusion and Recommendations

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In this conclusion I bring together the various threads of my argument. First, I summarise each chapter in relation to the themes identified and the analytical frame employed in this study. Second, I present my three key arguments. Third, I contextualise my study in terms of where we are today with AIDS at the global level and within Malawi. Fourth, I demonstrate how this study contributes to academic debates. Finally, I present recommendations to improve policies and programmes on HIV and AIDS at the international and national level.

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The focus of this research was to examine how policies and programmes on HIV prevention and the sexual cultural practice of fisi have come to be linked. My findings show that policies have been constructed based on inaccurate imaginings of both the sexual behaviour of rural people, who have been primarily blamed for the spread of HIV, and the Malawian elites’ and international donors’ misunderstanding of the bio-medical evidence surrounding HIV transmission during one heterosexual act. I have shown this by using the example of the fisi practice; a practice that involves a man having sex with girls during initiation. Although there are many sexual cultural practices taking place in Malawi, I focused on this practice, as while I was in Malawi working as Programme Manager for a sexual and reproductive health NGO, it was this practice that was recounted to me at length by those working for NGOs and stimulated a desire to learn more.

According to work on sexual cultural practices, they act as a mechanism rendering women inferior to men, and it is this inferiority that renders them vulnerable to violence (Mkamanga 2000 ; Kamlongera 2007 ). For example, Anderson ( 2012 ) in her study on women’s bodies in Malawi, argues that most women who participate in sexual cultural practices are unable to refuse, as within wider society there is an understanding of a universal ‘masculine sex-right’ where men have the right to make decisions over what can be done with a female body, which makes women vulnerable to violence. Kistner and Nkosi ( 2003 ) argue that masculinity has emerged as one of the key factors at the interface between gender-based violence and HIV/AIDS. Thus, we can see that the practice of such sexual acts can lead to women’s susceptibility to violence.

This research draws attention to the fact that the probability of infection from one heterosexual act, such as the fisi practice, is very low: as reflected in the epidemiological evidence provided in this research (Gray et al. 2001 ; Powers et al. 2008 ). In light of this, the thrust of the study is the exposure of misconceptions among development practitioners and policymakers in Malawi concerning AIDS: this misconception is grounded in the view that certain cultural practices are fueling the HIV pandemic in Malawi. This research has predominately focused on revealing how very little if any bio-medical evidence is being used to inform current policies and programmes on AIDS in Malawi. Instead a handful of Harmful Cultural Practices have been targeted as the problem, which has led to a focus on eradicating those deemed dangerous. Yet I found that there is no evidence that the sexual practice of fisi has a higher transmission rate than other sexual practices that are common within Malawi. While a fisi may be more likely to be HIV positive than the average male, it is the case that intercourse with a fisi is usually a single act of intercourse and is far from an everyday occurrence: since intercourse within marriage is much more frequent and the use of condoms in marriage is infrequent (Chimbiri 2007 ), regular marital relations are thus more likely to lead to infection than intercourse with a fisi . For HIV prevention purposes, it would be far more useful to focus on more frequent practices, such as transmission within marriages or stable couples.

In the health sector, the concept of evidence-based policy has gained ground. Yet as I have demonstrated, a lack of capacity to make use of existing data in policy development and programmes imply that inefficiencies in the development process have not been properly identified and addressed. Most HIV prevention programmes in Africa have also arguably had limited impact because the research behind them focused primarily on risk groups, behavioural change models, and flawed understandings of cultural practices and economic conditions (Packard and Epstein 1991 ; Waterston 1997 ). In other words, the explanations given by the National AIDS Commission and non-governmental organisations for high rates did not rely enough on biomedical facts but rather on constructed categories of ‘at risk’ groups which once interrogated, can be seen to be inaccurate.

In this conclusion I bring together the various threads of my argument. First, I summarise the findings and discussion of this research in relation to the themes identified and the analytical frame employed in this study. Second, I present my three key arguments. Third, I contextualise my study in terms of where we are today with AIDS at the global level and within Malawi. Fourth, I demonstrate how this study contributes to academic debates. Finally, I present recommendations.

Summary of Key Findings

In Chapter 1 , I provide an introduction to the topic including motivation for this research and my methodological approach.

In Chapter 2 I reviewed the literature within the field of anthropology of development, with particular emphasis on the work of Mosse ( 2011 ) and Crewe and Harrison ( 1998 ). Both demonstrate that many actors are involved in the policy process, which is not linear or straight forward: this makes it hard to unravel by whom these policies are constructed. These scholars demonstrate the usefulness of ethnography as a way of understanding the threads that interlock in the formation of policies and thereby have helped me identify how misconceptions seeped into the policy process in relation to HIV prevention in Malawi; although I do not analyse the policy process elsewhere in sub-Saharan Africa, it is likely to be similar to that of Malawi. They critically analyse the complex relationships of power between global multilateral organisations, donors, governments of resource-poor countries and local communities, and their impact on development projects. They also demonstrate how to critically engage with development practice by combining academic development work with academic writing and reflection therefore they have insights due to their positioning. Their approaches have been instrumental in developing my own analytical framework, as my research looks at how different elites working within the field of AIDS are able to construct policies based on vested agendas and interests.

In Chapter 2 the work of Chin ( 2007 ) is also particularly relevant to the central argument of my research, that elites working on HIV and AIDS perpetuate the myth that the fisi practice contributes significantly to the spread of HIV in Malawi. I argue that Malawian elites perpetuate this myth to maintain their professional status and to secure external funding from donors for projects on HIV prevention. Chin ( 2007 ) argues that UNAIDS and AIDS activists accept certain myths about HIV epidemiology to keep the disease on the political agenda and, by implication, ensure funding and jobs.

In Chapter 2 , due to the inter-disciplinary nature of this research, I show how a number of theories influenced by argument. First, using the approaches used within the anthropology of development I provide a critique of HIV policymaking. Second, and in order to understand how policy was constructed based on misconceptions, I draw on elite and policymaking theories to demonstrate how the policy process is being mediated by the agendas of elites as opposed to bio-medical facts. Third, I use postcolonial theory to highlight how the elites are interpreting for themselves the colonial narrative that is founded on a binary opposition; civilised (the elites) and the uncivilised (the rural uneducated population) (Galtung 1971 ). This then enables the elites to distance themselves from those living in rural areas, allowing them to maintain a position of power and access to the resources flowing in from the aid community.

In this chapter I also review literature on HIV epidemiology. Epidemiological studies have estimated the risk of HIV-1 transmission. Although Malawians believe that HIV transmission is inevitable in a single act of unprotected intercourse (Anglewicz and Kohler 2009 ), epidemiologists found that the average rate of HIV transmission is 1 in 1000. These findings demonstrate that HIV is not easily transmitted. This is relevant to my study because the fisi practice occurs as a one-off heterosexual act and therefore it is statistically unlikely that this practice contributes significantly to the spread of HIV.

Moreover, the practice of fisi occurs in only a very small number of rural communities. In this chapter I also argue that the traditional practice of fisi is being utilised as a scapegoat for the spread of AIDS in Malawi to deliberately detract attention away from everyday sexual practices in urban areas of Malawi, such as extramarital relations and multiple sexual partners. As reflected in the evidence below, HIV prevalence is in fact higher in urban areas where the fisi practice does not take place.

In Chapter 3 I demonstrate the powerful and influential role that international donors (bilateral and multilateral agencies and INGOS) play in constructing AIDS policies and programmes. Additionally, this chapter emphasises that aid conditionality can fail to respond effectively to the AIDS epidemic by demonstrating how funding is often donor led. For example, if donors disagree with policies being implemented in the country to which they are supplying aid, whether it is the way money is being spent or the type of policies the government implements, then they will withdraw funds. I provide an example of the British Government suspending aid because it was unhappy with the President of Malawi’s autocratic management style. The paradox of such policies in practice is that they reduce the ability of nation states to be self-sufficient and instead put them in a dependency relationship with international donors.

Data from the Malawi Demographic and Health Survey ( 2004 ) shows that urban residents have a significantly higher risk of HIV infection than rural residents. While 18% of urban women are HIV positive, the corresponding proportion for rural women is 13%. For men, the urban–rural difference in HIV prevalence is even greater; urban men are nearly twice as likely to be infected as rural men (16 and 9%, respectively) (MDHS 2004 , p. 231). This is significant because harmful cultural practices are reported to be largely rural practices, yet infection rates are significantly higher in the urban areas where the majority of the elites—Malawians with at least a university education—live. This highlights the inaccuracy in the elites’ narrative, one that blames rural Malawians for high prevalence rates. The problem is conversely higher in urban areas where the elites live. Further, HIV prevalence rates are higher among women aged 30–34 compared to women aged 15–19 (there is no data for women under 15). The fact that data was not collected and yet this is the demographic that is partaking in initiation ceremonies supports my argument that those blaming the sexual cultural practice of fisi for the spread of HIV lack evidence to support their case. In terms of education and wealth, the HIV prevalence rate is highest among women with a secondary education and above (15.1%) compared to those women with no education (13.6%). In terms of income those women with the highest rates of HIV were in the top wealth quintile. The emphasis of AIDS policies should therefore in fact be attributed more to contemporary patriarchal constructions of gender and power than a one-off highly un-evidenced traditional sexual practice.

I also examined how the advent of AIDS has provoked a reinterpretation of the impact of certain sexual cultural practices, which have now been labeled ‘risky’ or harmful. Some studies carried out have used culture as an explanation for high-risk behaviour, which can lead to HIV infection (Rushton and Bogaert 1989 ; Rushing 1995 ; Caldwell et al. 1989 ). However, this research shows that targeting specific population groups as opposed to addressing gender inequalities and issues of sexual power to a general population can be ineffective and misleading. This book does not argue that the cultural practices such as the fisi practice are not harmful and violent towards women but that these are not adversely contributing to the spread of HIV. Incorrect messages regarding HIV transmission rates are relayed which inhibit effective programme implementation.

Chapter 4 began by reviewing national and international policies on gender-based violence, harmful cultural practices and HIV/AIDS to highlight how these policies have been constructed around harmful cultural practices. I then reviewed literature on elites and used this to inform my own argument that policy processes are driven by elites as opposed to the argument made by Lasswell ( 1936 ) that policy implementation is a linear, rational process. These policies are being constructed around narratives of blame, which portray rural communities as backwards and the parties responsible for spreading HIV. This chapter concludes that the elites use these narratives as an ‘imagined fact’ in terms of how they contribute to high prevalence rates.

In Chapter 5 I argue that elite Christian religious morality has played an active role in portraying indigenous cultural practices as negative and blaming them for the spread of HIV/AIDS. In this chapter I also demonstrate how Christian elites portray themselves and their theology as enlightened in comparison to the minority Muslim population. Thus, casting indigenous cultural practices as responsible for the spread of AIDS with the agenda to undermine forms of traditional culture and validate a Christian lifestyle as unproblematic in terms of AIDS.

In Chapter 6 I examine theories of policy implementation, arguing against scholars such as Lasswell’s ( 1936 ) presentation, that policy implementation is a linear, rational process. Instead, I agree with Lipsky ( 1980 ), Lindblom ( 1980 ), Shore and Wright ( 1997 ), and Sabatier ( 2007 ) who postulate that policy processes are less of a linear sequence but rather a political process underpinned by a complex mesh of interactions and ramifications between a wide range of stakeholders who are driven and constrained by competing interests and the context in which they operate.

I have argued that there are a wide range of stakeholders involved in policy construction and implementation. These stakeholders include large, and powerful bilateral and multilateral agencies, such as DFID, USAID and the World Bank, as well as international Non-governmental organisations, national NGOs, international and national faith-based organisations, and the organs of the Malawi government, both at the national and the district levels, each with its own vested interests and each with its own policies. Therefore I argue the evidence produced to apply policies is not objective evidence but narratives shaped by various policy agendas and interests of the elites. As a result policies are pushed in a direction that does not benefit the vast majority of Malawi’s population in terms of HIV prevention, but instead perpetuate these groups’ standings and beliefs.

The Three Main Arguments

In this book I argue that a complex interplay of interests has led to the construction of the narrative that the sexual cultural practice of fisi is contributing significantly to the spread of HIV and AIDS. I argue this interplay can be best understood through three sets of arguments. Although these three sets of arguments are presented separately here, in practice these are interlocking.

The first and main argument is that the ‘narrative of blame’ is maintained by the national elites in Malawi to ensure that HIV is kept on the development policy, thus attracting donor funding and retaining elites’ professional status. I place emphasis on understanding policy construction as a process mediated by stakeholders involved in the policy process and argue that one reason why national elites are able to influence the policy agenda on HIV is due to the narrative they have constructed that has been sold to the donors. Thus they have a vested interest creating and maintaining the narrative of harmful cultural practices as responsible for the AIDS epidemic. This agenda permits them to maintain their own status and positions. Therefore, by maintaining the narrative that the sexual cultural practice of fisi , as well as other cultural practices that the elites consider harmful, drive the AIDS epidemic, they try to ensure that the policies and programmes directed to reduce HIV transmission continue.

The second argument identified in this study is that AIDS is presented by national, urban elites as a rural disease because the sexual cultural practice of fisi is reported to take place in rural areas. Therefore the narrative told by the elites is that the disease is being spread by people living in rural areas who are mainly illiterate and uncivilised. This narrative distances the urban elite from the disease, thus detracting attention from the higher level of AIDS in urban than in rural areas. As I highlight in this study, this ‘othering’ is a result of those elites working in HIV prevention providing explanations to ‘problems’ that satisfy donors and therefore ensure continued funding. Therefore, educated, urban elites who perceive themselves as civilised distance themselves from rural people who they position as uncivilised. I argue that elites in Malawi maintain their positions through adopting concepts of modernity held by the donors that rely upon a binary that divides the modern from the un-modern. Thus, the Malawian elites present themselves to donors, and potential donors, as suitable partners.

The third argument is that the Malawian elites have constructed a category of ‘uncivilised’, populated by those with little education (the majority of Malawians). They contrast these with themselves: educated Christians who are modern and progressive. This leads them to assert their superiority by placing the blame for the AIDS epidemic on those who practice what they call ‘harmful cultural practices’ that they associate with Malawian traditional religions. Within this context, Christian leaders play a role in projecting the narrative of blame as an ideological tool to promote a Christian lifestyle.

Contribution to AIDS Policy in Malawi

I have argued that although findings from epidemiological studies have shown that the probability of infection by one heterosexual act is 1 in 1000, I demonstrate that epidemiological evidence is ignored by policymakers. The gap between research and policy therefore needs to be bridged by disseminating research findings to policymakers so that when development programmes are designed they are based on evidence. Therefore for policy to be effective it needs to be informed by objective, empirical research on the population as a whole. For example, epidemiological evidence is particularly useful when preventing and controlling disease in populations and guiding health and health care policy and planning. Therefore such evidence can enrich health policies and plans to improve the health of a population.

The second contribution I make is a methodological one, enabling an understanding of how policy translates into practice across levels from the global arena down to the community level. The analytical framework and approach I proposed intended to facilitate analysis in evaluative and formative studies of—and policies and programmes on—AIDS, to generate meaningful evidence to inform policy. Therefore this study is not just applicable to Malawi but may be used in any country in the Global South. It is an original contribution to research as it focuses on narratives told by actors working in organisations, which focus on AIDS, while also tracing the impact of these narratives on the production of policies and programmes, rather than on geographically bounded local communities. My analytical framework has built on theoretical propositions and empirical research in development studies, particularly the work of Mosse ( 2011 ) and Crewe and Harrison ( 1998 ). I show that narratives on AIDS and sexual cultural practices are an obstacle to the development process. I argue these narratives become the dominant themes in the construction of policies. As a result, other key themes such as gendered power relationships are ignored or overlooked.

Thirdly, this study demonstrates a contribution to ethnographic research as it has shown how ethnography can be used to help construct policy and practice, which responds to the complexity of peoples’ lives. Using this ethnographic approach has enabled me to highlight why progress is slow in terms of improving gender relations and has emphasised how these narratives of blame are used as a smokescreen to pursue government and donor interests.

The newspaper article by Nyasa Times ‘Gender Minister wants women to hurt “hyenas”’ tells the story of the Minister of Gender who, speaking at an event to commemorate 16 days of activism against gender-based violence, advised women to hurt the hyena. She is reported to have said ‘Hit them (those hyenas) hard in their private parts and I can assure you it hurts’ ( Nyasa Times 2011 ). Of course, advising women to carry out violent acts towards men is not particularly helpful and will not help improve women’s lives: to the contrary, it could leave them more vulnerable to abuse. But it is examples such as this one featured in the Malawi media that can be read by international donors and thereby influence international policy and programmes.

Recommendations

The following recommendations are based on the research I conducted for this study. What this research enabled me to do is develop my critical thinking on this issue.

Policies and programmes developed on HIV/AIDS at the international and national level need to be informed by rigorous evidence, collected through critical, reflexive methodologies.

To advance HIV/AIDS policies and programmes, stakeholders will need to embed policies in epidemiological evidence and pay greater attention to how the wider political contexts at national and international levels impact on the policy and implementation processes.

Stakeholders need to better articulate the link between sexual cultural practices, gender-based violence and women’s health.

Donors need to ensure they visit rural areas so that they understand the culture of the country and respond to local concerns and priorities.

Quantification of the risk of HIV infection after sexual intercourse is difficult to measure therefore more quantitative studies are also needed regarding the risk of HIV infection after sexual intercourse to inform policy.

Research needs to be accessible to non-academics. Researchers need to educate policymakers, by carrying out research that focuses on the ordinary cultural practices, such as extramarital relationships instead of the taken-for-granted understandings of rural people.

Anderson, E. L. (2012). Infectious women: Gendered bodies and HIV in Malawi. International Feminist Journal of Politics, 14 (2), 267–287.

Article   Google Scholar  

Anglewicz, P., & Kohler, H. P. (2009). Overestimating HIV infection: The construction and accuracy of subjective probabilities of HIV infection in rural Malawi. Demography Research, 20 (6), 65–96.

Caldwell, J. C., Caldwell, P., & Quiggin, P. (1989). The social context of AIDS in sub-Saharan Africa. Population and Development Review, 15 (2), 185–234.

Chimbiri, A. (2007). The condom is an ‘intruder’ in marriage: Evidence from rural Malawi. Social Science and Medicine, 64 (5), 1102–1115.

Chin, J. (2007). The AIDS pandemic: The collision of epidemiology with political correctness . Oxford: Radcliffe Publishing.

Google Scholar  

Crewe, E., & Harrison, E. (1998). Whose development? An ethnography of aid. London: Zed.

Galtung, J. (1971). A structural theory of imperialism. Journal of Peace Research, 8 (2), 81–117.

Gray, R. H., Wawer, M. J., Brookmeyer, R., Sewankambo, N. K., Serwadda, D., Wabwire-Mangen, F., … &Quinn, T. C. (2001). Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda. The Lancet, 357 (9263), 1149–1153.

Kamlongera, A. (2007). What becomes of ‘her’?: A look at the Malawian Fisi culture and its effects on young girls. Agenda: Empowering Women for Gender Equity, 21 (74), 81–87.

Kistner, U., & Nkosi, Z. (2003). Gender-based violence and HIV/AIDS in South Africa: A literature review . Johannesburg: CADRE.

Lasswell, H. D. (1936). Politics: Who gets what, when, how . Cleveland: Meridian.

Lindblom, C. E. (1980). The policy-making process . Englewood Cliffs, NJ: Prentice Hall.

Lipsky, M. (1980). Street-level bureaucracy: Dilemmas of the individual in public service . New York: Russell Sage.

Malawi Demographic and Health Survey. (2004). Maryland: NSO and ORC Macro.

Mkamanga, E. (2000). Suffering in silence-Malawi women’s 30-year dance with Dr Banda . Scotland: Dudu Nsomba Publications.

Mosse, D. (2011). Introduction: The anthropology of expertise and professionals in international development. In D. Mosse (Ed.), Adventures in Aidland . Oxford: Berghahn Books.

Nyasa Times . Retrieved November 29, 2011, from http://www.nyasatimes.com/2011/11/29/gender-minister-wants-women-to-hurt-hyenas/ .

Packard, R. M., & Epstein, P. (1991). Epidemiologists, social scientists, and the structure of medical research on AIDS in Africa. Social Science & Medicine, 33 (7), 771–794.

Powers, K. A., Poole, C., Pettifor, A. E., & Cohen, M. S. (2008). Rethinking the heterosexual infectivity of HIV-1: A systematic review and meta-analysis. The Lancet Infectious Diseases, 8 , 553–563.

Rushing, W. A. (1995). The AIDS epidemic: Social dimensions of an infectious disease . Boulder, CO: Westview Press.

Rushton, J. P., & Bogaert, A. F. (1989). Population differences in susceptibility to AIDS: An evolutionary analysis. Social Science & Medicine, 28 (12), 1211–1220.

Sabatier, P. A. (2007). The need for better theories. In P. Sabatier (Ed.), Theories of the policy process . Boulder, CO: Westview Press.

Shore, S., & Wright, S. (Eds.). (1997). Anthropology of policy: Critical perspectives on governance and power . London and New York: Routledge.

Waterston, A. (1997). Anthropological research and the politics of HIV prevention: Towards a critique of policy and priorities in the age of AIDS. Social Science & Medicine, 44 (9), 1381–1391.

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Page, S. (2019). Conclusion and Recommendations. In: Development, Sexual Cultural Practices and HIV/AIDS in Africa. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-04119-9_7

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The human body can’t get rid of HIV and no effective HIV cure exists. So, once you have HIV, you have it for life. Luckily, however, effective treatment with HIV medicine (called antiretroviral therapy or ART) is available. If taken as prescribed, HIV medicine can reduce the amount of HIV in the blood (also called the viral load) to a very low level. This is called viral suppression. If a person’s viral load is so low that a standard lab can’t detect it, this is called having an undetectable viral load. People with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load can live long and healthy lives and will not transmit HIV to their HIV-negative partners through sex .

In addition, there are effective methods to prevent getting HIV through sex or drug use, including pre-exposure prophylaxis (PrEP) , medicine people at risk for HIV take to prevent getting HIV from sex or injection drug use, and post-exposure prophylaxis (PEP) , HIV medicine taken within 72 hours after a possible exposure to prevent the virus from taking hold. Learn about other ways to prevent getting or transmitting HIV .

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AIDS is the late stage of HIV infection that occurs when the body’s immune system is badly damaged because of the virus.

In the U.S., most people with HIV do not develop AIDS because taking HIV medicine as prescribed stops the progression of the disease.

A person with HIV is considered to have progressed to AIDS when:

• the number of their CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3). (In someone with a healthy immune system, CD4 counts are between 500 and 1,600 cells/mm3.) OR
• they develop one or more opportunistic infections regardless of their CD4 count.

Without HIV medicine, people with AIDS typically survive about 3 years. Once someone has a dangerous opportunistic illness, life expectancy without treatment falls to about 1 year. HIV medicine can still help people at this stage of HIV infection, and it can even be lifesaving. But people who start HIV medicine soon after they get HIV experience more benefits—that’s why HIV testing is so important.

How Do I Know If I Have HIV?

The only way to know for sure if you have HIV is to get tested . Testing is relatively simple. You can ask your health care provider for an HIV test. Many medical clinics, substance abuse programs, community health centers, and hospitals offer them too. If you test positive, you can be connected to HIV care to start treatment as soon as possible. If you test negative, you have the information you need to take steps to prevent getting HIV in the future.

To find an HIV testing location near you, use the HIV Services Locator .

HIV self-testing is also an option. Self-testing allows people to take an HIV test and find out their result in their own home or other private location. With an HIV self-test, you can get your test results within 20 minutes. You can buy an HIV self-test kit at a pharmacy or online. Some health departments or community-based organizations also provide HIV self-test kits for a reduced cost or for free. You can call your local health department or use the HIV Testing and Care Services Locator to find organizations that offer HIV self-test kits near you. (Contact the organization for eligibility requirements.)

Note: State laws regarding self-testing vary and may limit availability. Check with a health care provider or health department Exit Disclaimer for additional testing options.

Learn more about HIV self-testing and which test might be right for you .

Related HIV.gov Blogs

• HIV Testing Day National HIV Testing Day
• World AIDS Day
• HIVinfo.NIH.gov – HIV and AIDS: The Basics
• CDC – HIV Basics
• NIH – HIV/AIDS
• OWH – HIV and AIDS Basics
• VA – HIV/AIDS Basics

• Introduction
• Acknowledgements
• Glossary of terms
• Epidemiology of HIV infection in Australasia
• Natural history of HIV infection
• Basic HIV virology
• HIV immunology
• Virological tests
• Immunological tests
• Primary HIV infection
• Respiratory tract infections in patients with HIV infection
• Tuberculosis
• Non-tuberculous mycobacterial infections in people with HIV infection
• Opportunistic infections of the gastrointestinal tract
• Ocular disease in patients with HIV infection
• Opportunistic infections acquired in localised geographical regions of the world
• Human papillomavirus-associated malignancy
• Skin disease
• Opportunistic infections of the nervous system (coming soon)
• Malignant and lymphoproliferative conditions complicating HIV infection (coming soon)
• Opportunistic infections and cancers of the mouth and oropharynx (coming soon)
• Haematological disorders
• Heart disease
• Rheumatological disease
• Neurological disease (coming soon)
• Pulmonary disease – incl. sarcoidosis and COPD (coming soon)
• Sexually transmissible infections among people with HIV infection
• Hepatitis C virus
• Hepatitis B virus
• Hepatitis E virus
• Antiretroviral drugs
• Initiation of antiretroviral therapy in treatment-naïve people
• Long-term management of antiretroviral therapy
• Antiretroviral therapy guidelines
• Immune reconstitution inflammatory syndrome and other immune reconstitution disorders
• Prevention of opportunistic infections with antimicrobial therapy (coming soon)
• Drug-drug interactions in patients with HIV infection
• Adverse reactions to antiretroviral and other drugs in people with HIV infection
• Vaccines in people with HIV infection
• Atherosclerotic vascular disease
• Endocrine disorders
• Bone disease in patients with HIV infection
• Renal disease
• Ageing with HIV infection
• Psychiatric disorders in people with HIV infection
• Adolescents transitioning to adult care
• HIV infection in Aboriginal and Torres Strait Islander people
• Pregnant women (coming soon)
• PEP and PrEP
• Microbicides
• ASHM PrEP guidelines
• New HIV Diagnosis
• Late presentation of new HIV diagnosis
• Partner notification and contact tracing
• Key Affected Populations
• Pregnancy and midwifery considerations in HIV
• Paediatric issues
• Client education
• Nursing considerations of major clinical issues
• HIV-associated neurocognitive disorder
• Adherence support
• Health promotion
• Clinical supervision for nurses in the HIV sector
• Biomedical HIV prevention
• Evolving roles of nurses in HIV care
• Nursing ethics in the care of people with HIV

Antiretroviral therapy as prevention is currently front and centre stage. Nurses have a key role in service provision, education, support, and innovative research as NPEP and now PrEP assume a more prominent role in HIV prevention.

Essay on AIDS for Students and Children

500+ words essay on aids.

Acquired Immune Deficiency Syndrome or better known as AIDS is a life-threatening disease. It is one of the most dreaded diseases of the 20 th century. AIDS is caused by HIV or Human Immunodeficiency Virus, which attacks the immune system of the human body. It has, so far, ended more than twenty-nine million lives all over the world. Since its discovery, AIDS has spread around the world like a wildfire. It is due to the continuous efforts of the Government and non-government organizations; AIDS awareness has been spread to the masses.

AIDS – Causes and Spread

The cause of AIDS is primarily HIV or the Human Immunodeficiency Virus. This virus replicates itself into the human body by inserting a copy of its DNA into the human host cells. Due to such property and capability of the virus, it is also known as a retrovirus. The host cells in which the HIV resides are the WBCs (White Blood Cells) that are the part of the Human Immune system.

HIV destroys the WBCs and weakens the human immune system. The weakening of the immune system affects an individual’s ability to fight diseases in time. For example, a cut or a wound takes much more time to heal or the blood to clot. In some cases, the wound never heals.

HIV majorly transmits in one of the three ways – Blood, Pre-natal and Sexual transmission. Transfusion of HIV through blood has been very common during the initial time of its spread. But nowadays all the developed and developing countries have stringent measures to check the blood for infection before transfusing. Usage of shared needles also transmits HIV from an infected person to a healthy individual.

As part of sexual transmission, HIV transfers through body fluids while performing sexual activity. HIV can easily be spread from an infected person to a healthy person if they perform unprotective sexual intercourse through oral, genital or rectal parts.

Pre-natal transmission implies that an HIV infected mother can easily pass the virus to her child during pregnancy, breastfeeding or even during delivery of the baby.

AIDS – Symptoms

Since HIV attacks and infects the WBCs of the human body, it lowers the overall immune system of the human body and resulting in the infected individual, vulnerable to any other disease or minor infection. The incubation period for AIDS is much longer as compared to other diseases. It takes around 0-12 years for the symptoms to appear promptly.

Few of the common symptoms of AIDS include fever , fatigue, loss of weight, dysentery, swollen nodes, yeast infection, and herpes zoster. Due to weakened immunity, the infectious person falls prey to some of the uncommon infections namely persistent fever, night sweating, skin rashes, lesions in mouth and more.

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AIDS – Treatment, and Prevention

Till date, no treatment or cure is available for curing AIDS, and as a result, it is a life-threatening disease. As a practice by medical practitioners, the best way to curb its spread is antiretroviral therapy or ART. It is a drug therapy which prevents HIV from replicating and hence slows down its progress. It is always advisable to start the treatment at the earliest to minimize the damage to the immune system. But again, it is just a measure and doesn’t guarantee the cure of AIDS.

AIDS prevention lies in the process of curbing its spread. One should regularly and routinely get tested for HIV. It is important for an individual to know his/her own and partner’s HIV status, before performing any sexual intercourse activity. One should always practice safe sex. Use of condoms by males during sexual intercourse is a must and also one should restrict oneself on the number of partners he/she is having sex with.

One should not addict himself/herself to banned substances and drugs. One should keep away from the non-sterilized needles or razors.  Multiple awareness drives by the UN, local government bodies and various nonprofit organizations have reduced the risk of spread by making the people aware of the AIDS – spread and prevention.

Life for an individual becomes hell after being tested positive for AIDS. It is not only the disease but also the social stigma and discrimination, felling of being not loved and being hated acts as a slow poison. We need to instill the belief among them, through our love and care, that the HIV positive patients can still lead a long and healthy life.

Though AIDS is a disease, which cannot be cured or eradicated from society, the only solution to AIDS lies in its prevention and awareness. We must have our regular and periodical health checkup so that we don’t fall prey to such deadly diseases. We must also encourage and educate others to do the same. With the widespread awareness about the disease, much fewer adults and children are dying of AIDS. The only way to fight the AIDS disease is through creating awareness.

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Introduction to HIV

What are HIV and AIDS? How AIDS Works in the Body HIV Treatment Who Should be Tested for HIV? HIV Contraction Common Misconceptions About Contraction The Importance of HIV Testing and Diagnosis How Does HIV Testing Work? Test Counseling Conclusion

What are HIV and AIDS?

The Human Immunodeficiency Virus, which is commonly called HIV, is a virus that directly attacks certain human organs, such as the brain, heart, and kidneys, as well as the human immune system. The immune system is made up of special cells, which are involved in protecting the body from infections and some cancers. The primary cells attacked by HIV are the CD4+ lymphocytes, which help direct immune function in the body. Since CD4+ cells are required for proper immune system function, when enough CD4+ lymphocytes have been destroyed by HIV, the immune system barely works. Many of the problems experienced by people infected with HIV result from a failure of the immune system to protect them from certain opportunistic infections (OIs) and cancers.

Defining the terms

People infected with HIV are broadly classified into those with HIV disease and those with Acquired Immunodeficiency Syndrome, or AIDS. A person with HIV disease has HIV but does not yet have any symptoms or related problems, and still has a relatively intact immune system (that is, a CD4+ lymphocyte count greater than 200 cells/mm3). A person with AIDS, on the other hand, has very advanced HIV disease and his or her immune system has incurred significant damage. As a result, people with AIDS are at very high risk for a number of OIs, cancers, and other AIDS-related complications. The Centers for Disease Control have defined the conditions that mark a progression from HIV disease to AIDS. They are: certain infections, such as repetitive pneumonias, Pneumocystis carinii pneumonia (PCP), and cryptococcal meningitis certain cancers, such as cervical cancer, Kaposi's sarcoma, and central nervous system lymphoma CD4+ count less than 200 cells/mm3 or 14 percent of lymphocytes

How AIDS Works in the Body

Before highly active antiretroviral therapy (HAART) became available, most people who contracted HIV eventually progressed to AIDS and had some AIDS-related complication, such as:

• a deterioration of immune system function and an increased risk of infections and cancers
• brain damage that may cause dementia or memory loss
• heart problems that can cause heart failure and symptoms such as shortness of breath, fatigue, and swelling of the abdomen and legs
• severe kidney damage requiring dialysis
• an inability to perform activities of daily living such as balancing a checkbook or driving a car
• metabolic changes that may cause significant weight loss or diarrhea

Due to these potential problems, a person with AIDS is at very high risk of becoming very ill, and, if some action is not taken to protect the person from these infections or reverse the damage done by HIV, he or she is at risk of dying.

The speed of progression to AIDS The damage caused by HIV occurs more quickly in some people than in others, but generally an untreated HIV-infected person can expect that they will progress to AIDS within 10 years of their infection. During the time the person is infected with HIV, a war rages between the person's immune system and HIV , with HIV slowly wearing the immune system out.

A slow progress: A number of factors can affect how rapidly HIV progresses, some that can be controlled, and some that can't. Some people have certain genes that slow HIV progression, or they are infected with a weak strain of HIV that their immune system is more able to control. In general, taking better care of yourself and following your doctor's advice also slows the progression of HIV disease to AIDS.

A more rapid progress: Factors that may cause a more rapid progression to AIDS are: infection by a virulent strain of HIV, having a high viral load setpoint (a certain level of HIV replication that varies from person to person), older age, and the abuse of drugs or alcohol .

HIV Treatment

In the time between initial infection and AIDS, the infected person may feel relatively normal, despite the constant attack by HIV. People living with HIV have to understand, however, that despite feeling well on the outside, significant damage can be occurring on the inside. Fortunately, over the past five years, significant progress has been made regarding the treatment of HIV and prevention of some of the infections and cancers that may be caused by it. Antiretroviral medications can directly attack HIV and stop it from reproducing and causing further damage. For most people, the biggest factor in preventing progression to AIDS is adherence to HAART, which can suppress HIV replication to very low levels and not allow it to continue to attack the body.

Prophylactic medications In addition to HAART, other steps can be taken to prevent illness in people living with HIV and AIDS. Certain antibiotics, called prophylactic medications, can effectively prevent opportunistic infections. A physician can help to assess the appropriateness of these medications in a particular treatment program, and which ones to use, but it is important that they be taken as prescribed so that infections can be prevented. With careful monitoring, OIs and certain cancers can be detected in their early stages before they have spread, and the antibiotics can work more effectively to ward off further serious complications. I recommend that every person living with HIV or AIDS see a physician for appropriate monitoring and treatment.

Who Should be Tested for HIV?

In the early 1980s, when HIV infections were first starting to appear, HIV was associated primarily with gay men. Then it became associated with intravenous drug users and hemophiliacs. During the past 20 years, however, HIV has become a disease that can affect almost anyone who is not monogamous with an uninfected person .

HIV contraction

HIV is contracted through an exchange of bodily fluids, such as blood, semen, or vaginal secretions. As a result, the most common ways of acquiring HIV are sharing needles while doing intravenous drugs, and sex, especially anal intercourse. While the highest risk of HIV transmission is associated with anal intercourse, vaginal intercourse is becoming a common means of spreading HIV. Vaginal intercourse is the most rapidly growing risk factor for acquiring HIV infection in the United States and in the developing world it is the most common method of HIV transmission. Everyone must take appropriate steps to prevent the spread of HIV : Safer sex with condoms and dental dams and not sharing needles can help prevent the spread of HIV.

Common misconceptions about HIV contraction

People are often concerned that HIV can be contracted through common contacts with an HIV-infected person, such as shaking hands or sharing glasses or eating utensils. These are not risk factors for contracting HIV. There is no evidence that HIV can be spread through these means, and people should not be afraid to be around people who have HIV or to use a glass, eating utensils, or plate that an HIV-infected person has used, or to have other common contacts.

Those who should consider being tested for HIV include :

• people who received a blood transfusion or blood product at any time, but especially in the late 1970s or 1980s
• homosexuals and heterosexuals who have a history of unprotected sex with potentially infected persons
• people who have had multiple sex partners
• people who have had a sexually transmitted disease such as syphilis or gonorrhea
• people who are intravenous drug users
• pregnant women

The importance of testing and diagnosis

The importance of HIV testing and diagnosis has increased over the past five years. Before the improvements in antiretroviral therapies, many people believed that there was little that could be done to prevent the progression of HIV and so they did not get tested. While these people were right about the ineffectiveness of the antiretroviral therapy available at that time, they failed to recognize that medicines had been discovered that could prevent many of the common infections that afflict AIDS patients. Thus, many people were diagnosed with HIV only after they were admitted to the hospital with severe infections, especially PCP. Some died needlessly because they had not sought appropriate medical care and did not receive one of the medications that could have prevented PCP from occurring.

Now, there are even more reasons to seek HIV testing and medical care. Within the past five years, the medicines to prevent infections have been significantly improved and effective antiretroviral therapies have been developed that can not only halt the progression of HIV, but can also reverse much of the damage that has already been done. Therefore, it is important that HIV is diagnosed while the person is relatively healthy and before a major, potentially life-threatening OI occurs, such as PCP or cerebral toxoplasmosis. With HIV, what you don't know can hurt you.

If you think you are at even slight risk of having HIV-if you have had numerous sex partners or if you have had sex with someone who might have been bisexual or had a history of intravenous drug use-you should be tested. If you test positive , you can then receive medical care necessary to keep you healthy and prevent the diseases that occur in untreated AIDS patients. If, on the other hand, you wait until you feel sick before you are tested, you may already have progressed to AIDS and your immune system may already have incurred significant damage that may not be reversible.

Pregnant women Recent advances in therapy have also led to effective methods of preventing mother-to-child transmission of HIV. Virtually every pregnant woman, especially those who have a history of intravenous drug use, have had sex with someone in a high-risk group, or who have had numerous sexual partners, should be tested for HIV. HIV-infected mothers should consider taking antiretrovirals, which can effectively prevent transmission to the infant. Since breast-feeding can also cause transmission of HIV to the infant, HIV-infected mothers should not breast-feed their infants if there is an available alternative. Many states also require testing of the infant at birth, so that appropriate treatment can be provided.

Testing is voluntary and confidential Under most circumstances, HIV testing is voluntary. Unless there are special circumstances, most states require a person to give specific permission, called informed consent, before he or she can be tested for HIV. Privacy and confidentiality are legitimate concerns for people who are being tested for HIV. Most people do not want other people or organizations , such as their employer, to know they are HIV-infected and most don't even want them to know that they are being tested. Most states have laws that protect the confidentiality of HIV testing and the diagnosis of infection. While accidental disclosure of a person being HIV positive can occur, in my experience it is extremely rare. It's a mistake to avoid testing because of fear of accidental disclosure.

Also, there are other options including anonymous testing in a clinic or at home (for example, Home AccessR), where you are identified by a number, not by name, and no one but you knows your number. The cost of testing is generally between $30 and $100, and some groups, including many health departments, provide testing free of charge.

How Does HIV Testing Work?

HIV is usually diagnosed by a blood test , but newer tests can be done on saliva or urine. If you're squeamish about getting blood drawn, there are alternatives you can discuss with your doctor. Generally, the purpose of the test is to search for antibodies to the virus. The initial test is an enzyme-linked immunoabsorbent assay (ELISA) and is confirmed using a test called the Western Blot. The antibody tests are very reliable, but may not be able to detect an infection during the first six months after an exposure. There is also a test that can test for the presence of the virus itself, and this test is called an HIV PCR. HIV PCR is used to test for HIV after a potential HIV exposure, but before antibodies have developed. Because infants may have their mother's antibodies in their blood confounding the HIV antibody test, HIV PCR is also useful for them. However, HIV PCR may not be reliable in detecting HIV in all infected patients, especially those with a low viral load.

How long do the results take?

It used to take several days to a week to get test results back. Now there are rapid detection methods that allow reliable results in less than an hour. As a result, HIV testing can be completed while you are still in your doctor's office.

Test counseling

Pre-test and post-test counseling and education are important parts of HIV testing. Counseling gives people who test negative for HIV an opportunity to learn more about HIV and how to avoid becoming infected . For those who test positive for HIV, counseling gives them a chance to learn about the importance of being medically evaluated and, if appropriate, treated so as to prevent disease progression or OIs. These counseling sessions take about 15 minutes, including time for questions. They are a very valuable part of the testing process, regardless of the test results.

HIV disease is a chronic disease that used to be fatal for virtually everyone who got it. Now, things have changed and effective treatments are available to treat HIV and, in most cases, these treatments can prevent HIV from doing further damage and can keep the person healthy. In order to take advantage of these treatments, you must be tested and diagnosed with HIV. All persons who may have been infected with HIV and virtually all pregnant women should be tested as soon as possible.

Brian Boyle, MD, JD, is an Attending Physician at the New York Presbyterian Hospital-Weill Cornell Medical Center and Assistant Professor of Medicine in the Department of International Medicine and Infectious Diseases at Weill Medical College of Cornell University. Dr. Boyle has authored and co-authored more than 100 publications and abstracts relating to the treatment of HIV and hepatitis. In addition, he has lectured across the country on the latest advances in the treatment of HIV, Hepatitis C Virus and Hepatitis B Virus as well as many other HIV/AIDS and hepatitis related topics.

next: HIV, AIDS, and Older Adults

APA Reference Staff, H. (2021, December 23). Introduction to HIV, HealthyPlace. Retrieved on 2024, May 22 from https://www.healthyplace.com/sex/diseases/introduction-to-hiv

Medically reviewed by Harry Croft, MD

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Some NYU students being disciplined for protests must reflect on a ‘Simpsons’ episode: ‘What, if anything, could Lisa have done or thought about to make better decisions?’

Would Lisa Simpson set up a tent at New York University to protest the war in Gaza? How would Principal Skinner respond if she did?

Hard to say, but some NYU students facing discipline for their actions during this spring’s pro-Palestinian protests have been assigned a 49-page workbook that includes a “Simpsons”-based module on ethical decision-making. Some have been asked to write an apologetic “reflection paper” and submit it “in 12-point Times New Roman or similar font.”

Like colleges across the U.S., NYU was the  scene of protests over Israel’s response to the Oct. 7 Hamas attack  during the last weeks of the spring semester.

More than 100 NYU students were arrested when police cleared an encampment at the university’s Manhattan campus on  April 22,  and about a dozen more were arrested at a smaller encampment on May 3.

NYU’s school year  has ended,  but the university is requiring some student protesters to go through a disciplinary process that includes answering questions like “What are your values? Did the decision you made align with your personal values?” in a double-spaced  reflection paper.

Others must complete a 49-page “Ethos Integrity Series” that asks students to rank their values from 1 to 42 and complete assignments like “write about how your values affect your daily life and the decisions you make.”

One section is based on an episode of “The Simpsons” in which Lisa uncharacteristically cheats on a test and is wracked by guilt. Principal Skinner, meanwhile, wants to keep the cheating under wraps so the school can get a grant. Questions in the ethics workbook include “What, if anything, could Lisa have done or thought about to make better decisions?” and “What are the potential and actual consequences of Principal Skinner’s decisions?”

An NYU group called Faculty & Staff for Justice in Palestine criticized the assignments in a news release.

Sara Pursley, an associate professor of Middle Eastern and Islamic Studies, noted that students completing the reflection paper are told they must not try to justify their actions or “challenge a conduct regulation.”

“Since they can’t write anything justifying their action, students seem to be banned from writing about personal values that might be relevant here, such as a belief in freedom of expression, the responsibility to oppose genocide, or the duty of nonviolent civil disobedience under certain circumstances,” Pursley said. “This seems rather ironic in an essay on integrity.”

NYU spokesperson John Beckman said the disciplinary process is meant to be educational.

“The point of these essays is to reflect upon how a student’s way of expressing their values might be having an impact on other members of the NYU community,” Beckman said. “We think that’s a worthwhile goal.”

He added, “Which is not to say that the specific assignments couldn’t be improved.”

Faculty members and staff from NYU’s Office of Student Conduct will meet in the fall, Beckman said, to consider “what might be done to improve the quality of the prompts for the reflection papers as well as the other educational assignments.”

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Substance Abuse Treatment for Persons With HIV/AIDS [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2000. (Treatment Improvement Protocol (TIP) Series, No. 37.)

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1 Introduction to HIV/AIDS

The first cases of acquired immunodeficiency syndrome (AIDS) were reported in the United States in the spring of 1981. By 1983 the human immunodeficiency virus (HIV), the virus that causes AIDS, had been isolated. Early in the U.S. HIV/AIDS pandemic, the role of substance abuse in the spread of AIDS was clearly established. Injection drug use (IDU) was identified as a direct route of HIV infection and transmission among injection drug users. The largest group of early AIDS cases comprised gay and bisexual men (referred to as men who have sex with men—or MSMs). Early cases of HIV infection that were sexually transmitted often were related to the use of alcohol and other substances, and the majority of these cases occurred in urban, educated, white MSMs.

Currently, injection drug users represent the largest HIV-infected substance-abusing population in the United States. HIV/AIDS prevalence rates among injection drug users vary by geographic region, with the highest rates in surveyed substance abuse treatment centers in the Northeast, the South, and Puerto Rico. From July 1998 through June 1999, 23 percent of all AIDS cases reported were among men and women who reported IDU ( Centers for Disease Control and Prevention [CDC], 1999b ).

IDU practices are quick and efficient vehicles for HIV transmission. The virus is transmitted primarily through the exchange of blood using needles, syringes, or other IDU equipment (e.g., cookers, rinse water, cotton) that were previously used by an HIV-infected person. Lack of knowledge about safer needle use techniques and the lack of alternatives to needle sharing (e.g., available supplies of clean, new needles) contribute to the rise of HIV/AIDS.

Another route of HIV transmission among injection drug users is through sexual contacts within relatively closed sexual networks, which are characterized by multiple sex partners, unprotected sexual intercourse, and exchange of sex for money ( Friedman et al., 1995 ). The inclusion of alcohol and other noninjection substances to this lethal mixture only increases the HIV/AIDS caseload ( Edlin et al., 1994 ; Grella et al., 1995 ). A major risk factor for HIV/AIDS among injection drug users is crack use; one study found that crack abusers reported more sexual partners in the last 12 months, more sexually transmitted diseases (STDs) in their lifetimes, and greater frequency of paying for sex, exchanging sex for drugs, and having sex with injection drug users ( Word and Bowser, 1997 ).

Following are the key concepts about HIV/AIDS and substance abuse disorders that influenced the creation of this TIP:

Substance abuse increases the risk of contracting HIV. HIV infection is substantially associated with the use of contaminated or used needles to inject heroin. Also, substance abusers may put themselves at risk for HIV infection by engaging in risky sex behaviors in exchange for powder or crack cocaine. However, this fact does not minimize the impact of other substances that may be used (e.g., hallucinogens, inhalants, stimulants, prescription medications).

Substance abusers are at risk for HIV infection through sexual behaviors. Both men and women may engage in risky sexual behaviors (e.g., unprotected anal, vaginal, or oral sex; sharing of sex toys; handling or consuming body fluids and body waste; sex with infected partners) for the purpose of obtaining substances, while under the influence of substances, or while under coercion.

Substance abuse treatment serves as HIV prevention. Placing the client in substance abuse treatment along a continuum of care and treatment helps minimize continued risky substance-abusing practices. Reducing a client's involvement in substance-abusing practices reduces the probability of infection.

HIV/AIDS, substance abuse disorders, and mental disorders interact in a complex fashion. Each acts as a potential catalyst or obstacle in the treatment of the other two—substance abuse can negatively affect adherence to HIV/AIDS treatment regimens; substance abuse disorders and HIV/AIDS are intertwining disorders; HIV/AIDS is changing the shape and face of substance abuse treatment; complex and legal issues arise when treating HIV/AIDS and substance abuse; HIV-infected women with substance abuse disorders have special needs.

Risk reduction allows for a comprehensive approach to HIV/AIDS prevention. This strategy promotes changing substance-related and sex-related behaviors to reduce clients' risk of contracting or transmitting HIV.

The first part of this chapter provides a basic overview of the origin of HIV/AIDS and the transmission and progression of the disease. The second part of the chapter presents a summary of epidemiological data from the CDC. This second part discusses the impact of HIV/AIDS in regions of the United States and the populations that are at the greatest risk of contracting HIV.

• Overview of HIV/AIDS

Origin of HIV/AIDS

Of the many theories and myths about the origin of HIV, the most likely explanation is that HIV was introduced to humans from monkeys. A recent study ( Gao et al., 1999 ) identified a subspecies of chimpanzees native to west equatorial Africa as the original source of HIV-1, the virus responsible for the global AIDS pandemic. The researchers believe that the virus crossed over from monkeys to humans when hunters became exposed to infected blood. Monkeys can carry a virus similar to HIV, known as SIV (simian immunodeficiency virus), and there is strong evidence that HIV and SIV are closely related ( Simon et al., 1998 ; Zhu et al., 1998 ).

AIDS is caused by HIV infection and is characterized by a severe reduction in CD4+ T cells, which means an infected person develops a very weak immune system and becomes vulnerable to contracting life-threatening infections (such as Pneumocystis carinii pneumonia). AIDS occurs late in HIV disease.

Tracking of the disease in the United States began early after the discovery of the pandemic, but even to date, tracking data reveal only how many individuals have AIDS, not how many have HIV. The counted AIDS cases are like the visible part of an iceberg, while the much larger portion, HIV, is submerged out of sight. Many States are counting HIV cases now that positive results are to be gained by treating the infection in the early stages and because counting only AIDS cases is no longer sufficient for projecting trends of the pandemic. However, because HIV-infected people generally are asymptomatic for years, they might not be tested or included in the count. The CDC estimates that between 650,000 and 900,000 people in the United States currently are living with HIV ( CDC, 1997c ).

In 1996, the number of new AIDS cases (not HIV cases) and deaths from AIDS began to decline in the United States for the first time since 1981. Deaths from AIDS have decreased since 1996 in all racial and ethnic groups and among both men and women ( CDC, 1999a ). However, the most recent CDC data show that the decline is slowing ( CDC, 1999b ). The decline can be attributed to advances in treating HIV with multiple medications, known as combination therapy; treatments to prevent secondary opportunistic infections; and a reduction in the HIV infection rate in the mid-1980s prior to the introduction of combination therapy. The latter can be attributed to improved services for people with HIV and access to health care. In general, those with the best access to good, ongoing HIV/AIDS care increase their chances of living longer.

HIV/AIDS is still largely a disease of MSMs and male injection drug users, but it is spreading most rapidly among women and adolescents, particularly in African American and Hispanic communities. HIV is a virus that thrives in certain ecological conditions. The following will lead to higher infection rates: a more potent virus, high viral load, high prevalence of STDs, substance abuse, high HIV seroprevalence within the community, high rate of unprotected sexual contact with multiple partners, and low access to health care. These ecological conditions exist to a large degree among urban, poor, and marginalized communities ofinjection drug users. Thus, MSMs and African American and Hispanic women, their children, and adolescents within these communities are at greatest risk.

HIV Transmission

HIV cannot survive outside of a human cell. HIV must be transmitted directly from one person to another through human body fluids that contain HIV-infected cells, such as blood, semen, vaginal secretions, or breast milk. The most effective means of transmitting HIV is by direct contact between the infected blood of one person and the blood supply of another. (See Figure 1-1 for an illustration of the structure of the virus.) This can occur in childbirth as well as through blood transfusions or organ transplants prior to 1985. (Testing of the blood supply began in 1985, and the chance of this has greatly decreased.) Using injection equipment that an infected person used is another direct way to transmit HIV.

Parts of HIV.

Sexual contact is also an effective transmission route for HIV because the tissues of the anus, rectum, and vagina are mucosal surfaces that can contain infected human body fluids and because these surfaces can be easily injured, allowing the virus to enter the body. A person is about five times more likely to contract HIV through anal intercourse than through vaginal intercourse because the tissues of the anal region are more prone to breaks and bleeding during sexual activity ( Royce et al., 1997 ).

A woman is eight times more likely to contract HIV through vaginal intercourse if the man is infected than in the reverse situation ( Center for AIDS Prevention Studies, 1998 ). HIV can be passed from a woman to a man during intercourse, but this is less likely because the skin of the penis is not as easily damaged. Female-to-female transmission of HIV apparently is rare but should be considered a possible means of transmission because of the potential exposure of mucous membranes to vaginal secretions and menstrual blood ( CDC, 1997a ).

Oral intercourse also is a potential risk but is less likely to transmit the disease than anal or vaginal intercourse. Saliva seems to have some effect in helping prevent transmission of HIV, and the oral tissues are less likely to be injured in sexual activity than those of the vagina or anus. However, if a person has infections or injuries in the mouth or gums, then the risk of contracting HIV through oral sex increases.

Role of circumcision in male infectivity

A possible link between male circumcision and HIV infectivity was first observed during studies conducted in Kenya in the late 1980s ( Cameron et al., 1998 ; Greenblatt et al., 1988 ; Simonsen et al., 1988 ). Since then, numerous studies have been done on the possible relationship between male circumcision and HIV infectivity. Data have not revealed a direct causal link between circumcision and HIV transmission, and scientific opinion has been divided on this topic. While some studies indicate that circumcision can play a protective role in preventing HIV infection ( Kelly et al., 1999 ; Moses et al., 1998 ; Urassa et al., 1997 ), the bulk of recent scientific research has concluded that the reverse is true and that circumcision can actually increase the rate of HIV transmission ( Van Howe, 1999 ). Clearly, further research and analysis of circumcision as a prophylactic against HIV transmission is needed.

Risks of transmission

Several factors can increase the risk of HIV transmission. One factor is the presence of another STD (e.g., genital ulcer disease) in either partner, which increases the risk of becoming infected with HIV through sexual contact. This is because the same risk behaviors that resulted in the person contracting an STD increase that person's chance of contracting HIV. STDs also can cause genital lesions that serve as ports of entry for HIV, they can increase the number of HIV target cells (CD4+ T cells), and they can cause the person to shed greater concentrations of HIV ( CDC, 1998a ). For this reason, all sexually active clients, especially women, should be checked regularly for STDs such as gonorrhea and chlamydia. Many STDs that cause symptoms in men are asymptomatic in women. When genital ulcers are treated and heal, the risk of HIV transmission is reduced.

Another factor that increases risk is a high level of HIV circulating in the bloodstream. This occurs soon after the initial infection and returns late in the disease. New drug therapy can keep this level (called viral load) low or undetectable, but this does not mean that other individuals cannot be infected. The virus still exists—it is simply not detectable by the currently available tests. Because the correlation between plasma and genital fluid viral load varies, transmission may still occur despite an undetectable serum viral load ( Liuzzi et al., 1996 ).

Once HIV passes to an uninfected person who is not taking anti-HIV drugs, the virus reproduces very rapidly. It is known that drug-resistant viruses can be transmitted from one person to another. The treatment implications for a person infected with a drug-resistant virus are not yet known, but treatment will likely be difficult.

There are many misconceptions regarding HIV transmission. For example, HIV is not passed from one person to another in normal daily contact that does not involve either exposure to blood or sexual contact. It is not carried by mosquitoes and cannot be caught from toilet seats or from eating food prepared by someone with AIDS. No one has ever contracted AIDS by kissing someone with AIDS, or even by sharing a toothbrush (although sharing a toothbrush still is not advised). Other misconceptions people may have include the following:

“ It can't happen to me. ”—HIV can infect anyone who has sex with, or shares injection equipment with, someone who is infected.

“ I would know if my sex partner (injection partner) were infected. ”—Most people infected with HIV do not look or feel sick and do not even know they are infected.

“ As long as I get treated for any sexual infections I pick up, I'll be safe. ”—No current form of treatment can cure or prevent HIV, and although treating other infections reduces risk, there is still a high chance of getting HIV through unprotected sex or sharing injection equipment.

“ If I'm only with one sexual partner, and don't share injection equipment, I don't need to worry about HIV. ”—This is true only if the partner is uninfected and has no ongoing risk of infection. If the partner is or becomes infected, then anyone who has sex with him or shares his injection equipment is at high risk for HIV, and the only way to detect infection is to be tested.

“ If I douche or wash after sex, I won't get HIV. ”—Douching and washing will not prevent HIV.

“ If I don't share my own syringe, I won't get HIV. ”—HIV can also be spread through shared cookers, filters, and the prepared drug.

Life Cycle of HIV

It is possible to prevent transmission even after exposure to HIV. In San Francisco, postexposure prophylaxis is being offered to people who believe they have high risk for HIV transmission because of exposure with a known or suspected HIV-infected individual. Treatment is started within 72 hours of exposure and includes combination therapy, which may include a protease inhibitor, for a period of 1 month and followup for 12 months.

Once an HIV particle enters a person's body, it binds to the surface of a target cell (CD4+ T cell). The virus enters through the cell's outer envelope by shedding its own viral envelope, allowing the HIV particle to release an HIV ribonucleic acid (RNA) chain into the cell, which is then converted into deoxyribonucleic acid (DNA). The HIV DNA enters the cell's nucleus and is copied onto the cell's chromosomes. This causes the cell to begin reproducing more HIV, and eventually the cell releases more HIV particles. These new particles then attach to other target cells, which become infected. Figure 1-2 illustrates how HIV enters a CD4+ T cell and reproduces.

Diagram of HIV Entering Cell and Reproducing.

Measuring HIV in the blood

Physicians can measure the presence of HIV in a person by means of (1) the CD4+ T cell count and (2) the viral load count. The CD4+ T cell count measures the number of CD4+ T cells (i.e., white blood cells) in a milliliter of blood. These are the cells that HIV is most likely to infect, and the number of these cells reflects the overall health of a person's immune system.

CD4+ T cells act as signals to inform the body's immune system that an infection exists and needs to be fought. Because HIV hides inside the very cells responsible for signaling its presence, it can survive and reproduce without the infected person knowing of its existence for many years. Even though the body can produce sufficient CD4+ T cells to replace the billions that are destroyed by untreated HIV each day, eventually HIV kills so many CD4+ T cells that the damaged immune system cannot control other infections that may make the person sick. This is the late stage of HIV, when AIDS is often diagnosed based on the presence of specific illnesses (i.e., opportunistic infections).

The viral load represents the level of HIV RNA (genetic material) circulating in the bloodstream. This level becomes very high soon after a person is initially infected with HIV, then it drops. Viral load tests measure the number of copies of the virus in a milliliter of plasma; currently available tests can measure down to 50 copies per milliliter, and even more sensitive tests can measure down to 5 copies per milliliter. To explain the relationship between CD4+ T cell count and viral load count and how together they are used to gauge a person's stage in disease progression, a “moving train” analogy can be used. The CD4+ T cell count is used to measure the person's distance to the point of high risk of contracting opportunistic infections, or death. The viral load count is used to measure the rate at which CD4+ T cells are being destroyed. Therefore, the CD4+ T cell count is the train's position on the track, and the viral load is the train's speed toward the outcome (i.e., AIDS and then death).

After a person is infected with HIV, the body takes about 6 to 12 weeks and sometimes as long as 6 months to build up proteins to fight the virus. These proteins are called HIV antibodies (disease-fighting proteins) and are detected by an HIV test called the ELISA (enzyme-linked immunosorbent assay). The ELISA is very sensitive—it almost always detects HIV if it is there. Rarely, ELISA tests will give false-positive readings (a positive test in someone uninfected). For this reason, a positive ELISA test must always be confirmed with a second, more specific test called the Western blot. According to the CDC, the accuracy of the ELISA and the Western blot together is greater than 99 percent. Rapid HIV tests and home sample collection tests also are options for clients; see Chapter 2 for a more detailed discussion of these types of tests.

The 6 to 12 weeks between the time of infection and the time when an ELISA test for HIV becomes positive are called the “window period.” During this period, the individual is extremely infectious to any sexual or needle-sharing partner but does not test positive unless a more expensive viral load test is performed.

The level of virus is determined by using a viral load test; three types of viral load tests are HIV-RNA polymerase chain reaction (PCR), HIV branched DNA (bDNA), and HIV-RNA nucleic acid sequence-based amplification (NASBA). Each of these tests measures the amount of replicating or reproducing virus in the bloodstream; thus a lower value signifies less risk of rapid progression. The best viral load test result is “none detected,” although this does not mean the virus is gone, only that it is not actively reproducing at a measurable level.

Disease Progression

Once a person is infected with HIV, she should understand the progression of the disease from initial infection, through the latency period, symptomatic infections, and finally AIDS. The course of untreated HIV is not known but may go on for 10 years or longer in many people. Several years into HIV infection, mild symptoms begin to develop, then later severe infections that define AIDS occur. Treatment appears to greatly extend the life and improve the quality of life of most patients, although estimating survival after an AIDS diagnosis is inexact.

Initial infection

Primary HIV infection can cause an acute retroviral syndrome that often is mistaken for influenza (the flu), mononucleosis, or a bad cold. This syndrome is reported by roughly half of those who contract HIV ( Russell and Sepkowitz, 1998 ) and generally occurs between 2 and 6 weeks after infection. Symptoms may include fever, headache, sore throat, fatigue, body aches, weight loss, and swollen lymph nodes. Other symptoms are a rash, mouth or genital ulcers, diarrhea, nausea and vomiting, and thrush. The CD4+ T cell count can drop very low during the early weeks, although it usually returns to a normal level after the initial illness is over. The initial illness can last several days or even weeks.

The greatest spread of HIV occurs throughout the body early in the disease. Approximately 6 months after infection, the level of virions produced every day may reach a “set point.” A higher set point usually means a more rapid progression of HIV disease. Early treatment may be recommended to reduce the set point, potentially leading to a better chance of controlling the infection.

Alcohol and drug counselors should discuss symptoms that suggest initial HIV infection with their clients and encourage clients to be tested for HIV if they experience such symptoms. This not only will encourage clients who are infected to enter treatment early but also will provide an opportunity for the counselor to help uninfected clients remain that way.

Latency period

After initial infection comes the latency period, or incubation period, during which untreated persons with HIV have few, if any, symptoms. This period lasts a median of about 10 years. The most common symptom during this period is lymphadenopathy, or swollen lymph nodes. The lymph nodes found around the neck and under the arms contain cells that fight infections. Swollen lymph nodes in the groin area may be normal and not indicative of HIV. When any infection is present, lymph nodes often swell, sometimes painfully. With HIV, they swell and tend to stay swollen but usually are not painful.

Early symptomatic infection

After the first year of infection, the CD4+ T cell count drops at a rate of about 30 to 90 cells per year. When the CD4+ T cell count falls below 500, mild HIV symptoms may occur. Many people, however, will have no symptoms at all until the CD4+ T cell count has dropped very low (200 or less). Bacteria, viruses, and fungi that normally live on and in the human body begin to cause diseases that are also known as opportunistic infections.

Early symptoms of infection may include chronic diarrhea, herpes zoster, recurrent vaginal candidiasis, thrush, oral hairy leukoplakia (a virus that causes white patches in the mouth), abnormal Pap tests, thrombocytopenia, or numbness or tingling in the toes or fingers. Most of these infections occur with a CD4+ T cell count between 200 and 500. Symptoms of these infections usually signal a problem with the immune system but are not severe enough to be classified as AIDS. Please refer to Appendix D for a complete checklist of symptoms.

In the 1980s, AIDS was defined to include a depressed immune system and at least one illness tied to HIV infection. AIDS-defining conditions are diseases not normally manifest in someone with a healthy immune system. These should prompt a confirmatory HIV test. The additional 1993 AIDS-defining conditions led to the diagnosis of more AIDS cases in women and injection drug users. Since 1993, the list of AIDS-defining conditions has included pulmonary tuberculosis (TB), recurrent bacterial pneumonia, and invasive cervical cancer. HIV-infected persons with a CD4+ T cell count of 200 or less are classified as persons with AIDS ( CDC, 1992 ).

TB and invasive cervical cancer are two AIDS-defining conditions that warrant special mention. Pulmonary TB is the one AIDS-related infection that is contagious to those without HIV. It generally causes a chronic dry cough (sometimes with blood), fatigue, and weight loss. Pulmonary TB requires ongoing treatment for at least 6 months, and close associates of the infected person must be tested for TB. If TB is only partially treated (i.e., the TB patient does not take all of the medications), resistant TB will develop, which can then be passed to others. Although TB, coupled with a positive HIV test, is an AIDS-defining diagnosis, it also can occur while the CD4+ T cell count is still high. If TB occurs late in the disease after the CD4+ T cell count has dropped, it may not be found in the lungs, and symptoms may include only weight loss and fever, without a cough. It should be noted, however, that the Mantoux PPD test (a test routinely administered to screen for TB by determining reaction to intradermal injection of purified protein derivative) may not be positive if the patient is anergic (i.e., if he has sufficient immune system damage to cause inability to respond to the PPD).

Cervical cancer may progress rapidly in women with HIV but usually is asymptomatic until it is too late for successful treatment. Women who are HIV positive should have Pap tests at least once every 6 months and more often if any abnormality is found.

AIDS symptoms

Most AIDS-defining diseases are severe enough to require medical care, sometimes hospitalization. Some of these diseases, however, can be treated earlier on an outpatient basis if symptoms are reported when they are mild. (Please refer to Appendix C for a complete list of AIDS-defining conditions.)

Cough is a symptom common to several AIDS-related infections, the most frequent of which is Pneumocystis carinii pneumonia (PCP—not to be confused with the drug by that name, phencyclidine). PCP is characterized by a dry cough, fever, night sweats, and increasing shortness of breath. Recurrent bacterial pneumonia (i.e., two or more infections within a year) also is an AIDS-defining condition. It often causes a fever and a cough that brings up phlegm. Coughing is also a symptom of TB. As a general guideline, if a cough does not resolve after several weeks, it should be checked by a medical practitioner.

Several skin problems can occur in HIV/AIDS. Kaposi's sarcoma (KS), a rare malignancy outside of HIV disease, may be the best-known skin condition in HIV infection. KS is a cancer of the blood vessels that causes pink, purple, or brown splotches, which appear usually as firm areas on or under the skin. KS also grows in other places, such as the lungs and mouth. KS is highly prevalent among men with AIDS, of whom 20 to 30 percent may develop the condition in contrast to 1 to 3 percent of women with AIDS ( Kedes et al., 1997 ). However, since the introduction of combination anti-HIV therapy, KS is seen less frequently.

Diarrhea is a very common symptom of AIDS. Many AIDS-defining conditions cause diarrhea, including parasitic, viral, and bacterial infections. HIV itself can cause diarrhea if it infects the intestinal tract. Diarrhea also is a common side effect of HIV/AIDS medications. Weight loss can be caused by inadequate nutrition, untreated neoplasms and opportunistic infections (which often are associated with diarrhea), and deranged metabolism ( Dieterich, 1997 ).

Changes in vision, particularly spots or flashes (known as “floaters”), may indicate an infection inside the eye. A virus called cytomegalovirus (CMV) is the most common cause of blindness in people with HIV/AIDS. CMV progresses very rapidly if not treated and is among the most feared of AIDS-related infections. Fortunately, it almost never occurs until the immune system is almost completely destroyed, so it is not usually the first symptom. Counselors can screen for early signs of CMV using the Amsler Grid (see Appendix D ). The client also can be taught to screen himself using this screening tool.

A severe headache, seizure, or changes in cognitive function may herald the onset of a number of infections or cancers inside the brain. The two most common brain infections in HIV/AIDS are cryptococcal meningitis, a fungus that usually causes a severe headache, and toxoplasmosis, which can present with focal neurologic deficits or seizure. Seizures also can be caused by the cancer of the central nervous system called lymphoma. Progressive multifocal leukoencephalopathy (PML), a brain disease that causes thinking, speech, and balance problems and dementia also can occur as a result of HIV infection.

End-stage disease

A person with HIV/AIDS can live an active and productive life, even with a CD4+ T cell count of zero, if infections and cancers are controlled or prevented. The newer antiviral medicines can even help the body restore much of its lost immune function. In the past few years, a phenomenon called the Lazarus syndrome has developed among patients with AIDS, wherein, because of optimal drug therapy, someone who had seemed very near death improves and returns to fairly normal function. Untreated, the disease eventually overwhelms the immune system, allowing one debilitating infection after another. Sometimes the possible combinations of medication are no longer effective, the side effects are intolerable, or no further therapy is available.

Hospice care is an appropriate choice for those who have run out of therapeutic options. In hospice care, the individual is treated for pain and other discomforts and allowed to die of the disease. Pain therapy at this stage invariably requires narcotics. It is crucial that the client and other treatment professionals understand that using opiates for pain is entirely different from using them to feed an addiction. The client will develop a need for high doses and will have withdrawal symptoms if the drug is stopped, but will not “get high.” If drugs must be stopped (which is uncommon), they can be tapered under medical supervision. See Chapter 2 for a more in-depth discussion of pain management.

Hospice care allows the person with end-stage HIV/AIDS a peaceful death and a chance to address those relationships or experiences that are important. Hospice goals involve maintaining dignity and allowing the client's significant others to dictate how they will cope with this final stage.

• Changes in the Epidemiology of HIV/AIDS Since 1995

With the advent of new and effective treatments, the epidemiology of HIV/AIDS is changing. The study of HIV/AIDS epidemiology helps to identify the trends of the disease. Surveillance of AIDS cases since 1996 shows substantial declines in AIDS-related deaths and increases in the number of persons living with AIDS, although the decline is slowing ( CDC, 1999b ). As people live longer with HIV/AIDS, the ability to use AIDS surveillance data alone to represent trends has diminished. It is difficult but important to track the distribution of prevalence (i.e., existing) and incidence (i.e., new) of both HIV and AIDS cases to detect changes in geographic, demographic, and risk/exposure trends ( Ward and Duchin, 1997–1998 ).

With the mid-year 1998 edition, the CDC started to include information from both HIV infections and AIDS cases in the HIV/AIDS Surveillance Report ( CDC, 1998c ). It should be noted that the number of HIV cases in the report is a conservative estimate of the number of people living with HIV because not all people with HIV/AIDS have been tested (and those who have been tested anonymously are not reported to State health departments' confidential, name-based HIV registries). At the end of June 1999, 30 States and the U.S. Virgin Islands were reporting HIV cases.

This section presents an overview of the trends in the HIV/AIDS pandemic and discusses how the pandemic intertwines with substance abuse. The information is organized to provide a general look at the pandemic in the United States and its Territories, a discussion of the trends and the populations which are most at risk for contracting the infection, and a regional look at the pandemic (the regions are defined by the CDC). Finally, there is a discussion of special populations and how they are affected by the HIV/AIDS pandemic. For more detail about HIV/AIDS epidemiology, readers are encouraged to visit the CDC's Divisions of HIV/AIDS Prevention Web site, at www.cdc.gov/nchstp/hiv_aids/dhap.htm . The latest CDC HIV/AIDS surveillance reports can be downloaded, and the site provides a wealth of information about the pandemic.

To see the distribution of HIV/AIDS in the United States, see Figures 1-3 through 1-6 . Figure 1-3 shows the AIDS rates for male adults and adolescents reported from July 1998 through June 1999. Figure 1-4 shows the number of adult and adolescent male AIDS and HIV cases reported from July 1998 through June 1999. Figure 1-5 illustrates the AIDS rate for female adults and adolescents reported from July 1998 through June 1999, and Figure 1-6 shows the number of female adult and adolescent AIDS and HIV cases reported from July 1998 through June 1999.

Male Adult/Adolescent AIDS Annual Rates per 100,000 Population, For Cases Reported From July 1998 Through June 1999, United States.

Female Adult/Adolescent HIV Infection and AIDS Cases Reported From July 1998 Through June 1999, United States.

Male Adult/Adolescent HIV Infection and AIDS Cases Reported From July 1998 Through June 1999, United States.

Female Adult/Adolescent AIDS Annual Rates per 100,000 Population, For Cases Reported From July 1998 Through June 1999, United States.

Current Trends in the HIV/AIDS Pandemic

Current trends in HIV/AIDS disproportionally affect racial minority populations, especially women, youth, and children within those populations. HIV prevalence is higher among African Americans than in other ethnic groups; from July 1998 through June 1999, African Americans accounted for 46 percent of adult AIDS cases, while representing 12 percent of the total U.S. population. Hispanics accounted for 20 percent of adult AIDS cases from July 1998 through June 1999, while making up only 11 percent of the total U.S. population ( CDC 1999b ; U.S. Bureau of the Census, 1998 ). Together, African Americans and Hispanics represent the majority of AIDS cases thus far in the pandemic ( CDC, 1999b , 1999c ). In addition, of the HIV cases reported from the 30 States and one Territory from July 1998 through June 1999, 54 percent were among adult and adolescent African Americans, and 10 percent were among adult and adolescent Hispanics. Substance abuse is a primary mechanism by which these vulnerable groups become HIV-infected populations.

It is important to be aware that, although it is customary to categorize cases based on broad ethnic labels, this procedure glosses over fundamental ethnic and cultural differences among people of color and fails to address the underlying economic and social infrastructure that fuels the spread of substance abuse and HIV ( National Commission on AIDS, 1992 ). Categorizing all persons with African racial heritage as “black” mixes together people of distinct ethnic and cultural heritage (e.g., ethnic descendents of African slaves, Caribbean immigrants) as well as individuals from different socioeconomic groups. Similarly, “Hispanic” refers to a multiethnic and multicultural blend of people from more than 30 geographic regions. Social, political, and economic forces have led to the “ghettoization” of African Americans and Hispanics in the inner cities where there are high rates of drug trafficking, unemployment, poverty, racism, and a lack of access to health care, all of which contribute to high rates of addiction and HIV/AIDS ( National Commission on AIDS, 1992 ). It is within urban, poor, African American and Hispanic communities that HIV/AIDS is most prevalent.

These oppressive socioeconomic factors also have led to high rates of incarceration, sex work, and homelessness for members of African American and Hispanic communities. Drug offenses account for the highest number of Federal crimes for which people are incarcerated ( Mumola, 1999 ). For example, a survey of new commitments to California State prisons found that more than 75 percent of the offenders had histories of drug use ( California Department of Corrections, 1998 ). Not surprisingly, these individuals also have high rates of HIV infection ( Stryker, 1993 ). Sex workers, many of whom are poor, homeless, and substance dependent, are likely to be more concerned with immediate needs such as housing, food, or substance abuse than HIV or substance abuse prevention and intervention ( Kail et al., 1995 ). This is also true for the homeless or marginally housed who often are dealing with both substance abuse and mental health or mental retardation problems ( St. Lawrence and Brasfield, 1995 ).

However, the highest HIV and AIDS rates among at-risk populations are still found among MSMs ( CDC, 1999b ), who from July 1998 through June 1999 represented 38 percent of AIDS cases and 30 percent of HIV cases. Minority MSMs especially are at high risk for contracting the infection. See the section “HIV/AIDS Epidemiology Among Groups” later in this chapter for further discussion of HIV/AIDS and MSMs.

HIV/AIDS is epidemic among the heterosexual population as well and is fueled by sexual contact with HIV-infected, injection drug-using, or bisexual partners. Heterosexuals located in communities with high prevalence of HIV/AIDS and addiction are at greatest risk for contracting HIV/AIDS from heterosexual contact. This type of heterosexual contact, defined generally as sexual contact with an “at-risk” person (e.g., injection drug users, bisexual man) or an HIV-infected person whose risk was not specified, from July 1998 through June 1999 accounted for about 15 percent of all adult and adolescent AIDS cases and about 17 percent of reported adult and adolescent HIV infection cases ( CDC, 1999b ). Of these, 61 percent of AIDS cases were women and 39 percent were men; of HIV infection cases, 68 percent were women and 32 percent were men.

From July 1998 through June 1999, there were 4,296 new AIDS cases and 2,321 new HIV cases among women who reported heterosexual contact ( CDC, 1999b ). Of these, 28 percent of AIDS cases and 21 percent of HIV cases were among women who reported sexual contact with injection drug users, 5 percent of AIDS cases and 6 percent of HIV cases who reported sexual contact with bisexual men, and 66 percent of AIDS cases and 72 percent of HIV cases who reported sexual contact with an HIV-infected person, without reporting the origin of the partner's infection. Of the 2,754 AIDS cases and 1,070 HIV cases for men who reported heterosexual contact, the majority reported sexual contact with an HIV-infected person without reporting the origin of the partner's infection (77 percent of AIDS cases and 80 percent of HIV cases). These data are supported by earlier research that found that HIV infection among heterosexual clients in alcohol abuse treatment, who were primarily male, was largely caused by unsafe sexual behaviors ( Avins et al., 1994 ; Woods et al., 1996 ).

Figures 1-7 and 1-8 illustrate the trend of male and female AIDS cases contracted through heterosexual exposure from 1993 to 1998 by ethnicity. These figures depict only self-identified heterosexual men and women.

New Male AIDS Cases (1993–1998) From Heterosexual Exposure by Ethnicity.

New Female AIDS Cases (1993–1998) From Heterosexual Exposure by Ethnicity.

Regional HIV/AIDS Epidemiology

Early in the U.S. AIDS pandemic, the Northeast region of the United States had the most AIDS cases, followed by the South, Midwest, and the West ( Figure 1-9 contains a breakdown of the States that make up these four regions plus the U.S. Territories, as defined by the CDC). In all regions, AIDS incidence increased through 1994, with the most dramatic increases occurring in the South. Between 1997 and 1998, AIDS incidence dropped for all regions, but in 1998 the South still had the highest rate (43 percent), followed by the Northeast (28 percent), the West (17 percent), the Midwest (8 percent), and the U.S. Territories (3 percent) ( CDC, 1999b ). Figure 1-10 demonstrates the change in AIDS incidence of the regions for 1996, 1997, and 1998.

CDC Regional Breakdown of U.S. States and Territories.

Figure 1-10

Estimated AIDS Incidence, by Region of Residence and Year of Diagnosis, 1996, 1997, and 1998, United States*.

The HIV/AIDS pandemic is evolving differently in different regions of the United States, just as drug use varies from region to region. Therefore, alcohol and drug counselors should become familiar with HIV/AIDS prevalence, incidence, and trends in their local areas, their States, and their regions. Appendix G contains a list of State and Territory departments of health (including addresses, phone numbers, and Web sites where readers can obtain information about their State). When available, State AIDS hotlines also are listed.

The 10 States and Territories reporting the most AIDS cases, in descending order, are New York, California, Florida, Texas, New Jersey, Puerto Rico, Illinois, Pennsylvania, Georgia, and Maryland. The 10 metropolitan areas reporting the highest number of AIDS cases, in descending order, are New York City, Los Angeles, San Francisco, Miami, the District of Columbia, Chicago, Houston, Philadelphia, Newark, and Atlanta ( CDC, 1999b ). Not surprisingly, these major metropolitan areas also are high-intensity drug-trafficking areas as defined by the Office of National Drug Control Policy ( ONDCP, 1998 ).

HIV Epidemiology Among Groups

Homosexuals.

The primary route of HIV transmission for MSMs is through sexual contact, which may occur while the participants are engaged in substance abuse, including IDU. Within this group, the focus of the pandemic among MSMs has shifted from older, white, urban men to poorer African American and Hispanic men, men with substance abuse problems (including IDU), and young men. Repeated studies have found that MSMs who abuse alcohol, speed, MDMA (3,4-methylene-dioxymethamphetamine), cocaine, crack cocaine, inhalants, and other noninjection street drugs are more likely than those who do not use substances to engage in unprotected sex and become infected with HIV ( Paul et al., 1991b , 1993 , 1994 ). One hypothesis about the reason for higher rates of HIV/AIDS among MSMs is that substance abuse may increase sexual risktaking. This is because substance abusers experience decreased inhibition, new learned behaviors (such as using substances and then having unprotected anal intercourse), low self-esteem, altered perception of risk, lack of assertiveness to negotiate safe practices, and perceived powerlessness ( Paul et al., 1993 ).

As of June 1999, more than half of all cumulative male adult and adolescent AIDS cases were among MSMs who reported sexual risk only (57 percent) or sexual risk and IDU (8 percent). Of cumulative HIV cases among adult and adolescent males, 45 percent reported sexual risk only and 6 percent reported sexual risk and IDU ( CDC, 1999b ). Even though the cumulative total of AIDS cases among MSMs is still highest in white men (62 percent white, 23 percent African American, 14 percent Hispanic), new AIDS cases among MSMs indicate that the disparity between cases among whites and among minorities is narrowing. From July 1998 through June 1999, 53 percent of AIDS cases were among white men, 29 percent were among African American men, and 16 percent were among Hispanic men. Figure 1-11 illustrates the trend of MSM AIDS cases by ethnicity from 1993 to 1998.

Figure 1-11

New AIDS Cases (1993–1998) From MSM Exposure by Ethnicity.

As with injection drug users, minority MSMs are disproportionately affected by HIV disease. African American and Hispanic MSMs, compared with their white counterparts, are more likely to inject drugs, to be substance abusers, to be poor, to be paid for sex, and to engage in higher rates of unprotected anal intercourse ( National Commission on AIDS, 1992 ; Peterson et al., 1992 ). Sociocultural factors, combined with some community values (e.g., machismo, family loyalty, sexual silence) and lack of access to health care and substance abuse treatment, strongly compete with safe sex and drug practices among gay and bisexual men of color ( Diaz and Klevens, 1997 ).

Sex networks and sexual mixing patterns ( Renton et al., 1995 ) are hypothesized to explain the higher risk of HIV infection related to substance abuse among MSMs. MSM substance abusers may form tight groups characterized by higher HIV seroprevalence rates, higher sexual mixing, greater IDU, and more trading of sex for money, food, and drugs. These factors are another way to account for higher HIV risk-taking sexual behaviors among MSM substance abusers.

Incarcerated persons

A recent study reported that the confirmed rate of AIDS cases among incarcerated people in State and Federal prisons is more than six times higher than in the general population. About 2.3 percent of all persons incarcerated in the United Sates in 1995 were HIV positive, and about 0.51 percent had confirmed AIDS ( MacDougall, 1998 ; Maruschak, 1997 ). According to the Bureau of Justice Statistics in the U.S. Department of Justice, in 1997, 57 percent of State prisoners and 45 percent of Federal prisoners said they had used drugs in the month before committing their offense. In addition, 83 percent of State prisoners and 73 percent of Federal prisoners said they had used drugs at some time in the past. Even with these high rates, which increased between 1991 and 1997, substance abuse treatment services declined during the same time period ( Mumola, 1999 ).

In 1991, only 1 percent of Federal prison inmates with substance abuse disorders received appropriate treatment. For those who completed treatment there were no aftercare services in place to help them remain abstinent after they got out of prison ( U.S. General Accounting Office, 1998 ).

Most incarcerated people who have HIV are infected before they enter prison. One study of 46 prisons found an HIV infection rate of 1.7 percent among people entering prison ( Withum, 1993 ). In some correctional facilities, HIV infection rates are as high as 20 percent among women and 15 percent among men. For MSMs, HIV infection rates ranged from 9 to 34 percent; among injection drug users the infection rate ranged from 6 to 43 percent.

HIV/AIDS and substance abuse interventions implemented in prisons have a great potential to impact the HIV/AIDS pandemic ( MacDougall, 1998 ). Like the HIV-infected population, the incarcerated population has an overrepresentation of minority groups and is characterized by high poverty, overcrowding, IDU, high-risk sexual activities, and poor access to health care. Incarceration presents an opportunity to screen, counsel, and educate inmates about HIV/AIDS, and to provide substance abuse treatment as well. For many incarcerated persons, this may be their first contact with medical interventions as well as with substance abuse treatment.

When prison inmates return to society, their health status will have an effect on the community to which they return. A study of Hispanic inmates in California found that 51 percent reported having sex within the first 12 hours after release and that they preferred not to use condoms ( Morales et al., 1995 ). In addition, 11 percent reported IDU in the first day after release.

Sex workers

The sex workers who are most vulnerable to contracting and transmitting HIV are street workers, who often are poor or homeless, may have a history of childhood abuse, and are likely to be alcohol or drug dependent. A CDC study of female sex workers in six U.S. cities found an HIV seroprevalence of 12 percent, ranging from 0 to 50 percent depending on the city and the level of IDU ( CDC, 1987a ). A study of male sex workers in Atlanta found an HIV seroprevalence of 29 percent, with the highest rates among those who had receptive anal sex with nonpaying partners ( Elifson et al., 1993 ).

IDU was the main risk factor for HIV infection for female sex workers in six U.S. cities ( CDC, 1987a ). Female injection drug users who trade sex for money or drugs are more likely to share needles than female injection drug users who do not engage in sex trading ( Kail et al., 1995 ). The circumstances in which sex workers live also increase their chances of contracting HIV. For example, they may agree to unprotected sex if a client offers more money, if they are desperate for money to buy drugs, or if business has been slow. Violent clients may force unsafe sex, and in many cities police confiscate condoms when they arrest or stop sex workers. HIV prevention outreach to sex workers is difficult because prostitution is illegal. Immediate attention to concerns about food, housing, and drug addiction often take precedence over HIV prevention.

Homeless or marginally housed

Homelessness often occurs in conjunction with substance abuse, chronic mental illness, and unsafe sexual behavior. All of these factors increase homeless people's risk for contracting HIV. A survey of 16 U.S. cities found that 3 percent of homeless people were HIV positive, compared with less than 1 percent of the general adult population ( Allen et al., 1994 ). In other studies, 19 percent of homeless mentally ill men in New York City were HIV positive ( Susser et al., 1993 ), and an 8 percent HIV infection rate was found among homeless adults in San Francisco ( Zolopa et al., 1994 ).

A survey of homeless adults in a storefront medical clinical found that 69 percent were at risk for HIV because of the following factors: (1) unprotected sex with multiple partners, (2) IDU, (3) sex with an injection drug-using partner, or (4) exchanging unprotected sex for money or drugs. Almost half reported at least two of these risk factors, and one fourth reported three or more risk factors ( St. Lawrence and Brasfield, 1995 ). Substance abuse can exacerbate HIV risks because abusers are more likely to forget to use condoms, to share needles, and to exchange sex for drugs. A survey of homeless adults in St. Louis found that 40 percent of men and 23 percent of women reported drug use, and 62 percent of men and 17 percent of women reported alcohol use ( North and Smith, 1993 ).

Adolescents

Because the average period of time from HIV infection to AIDS is about 10 years, most young adults with AIDS were likely infected as adolescents ( National Institute of Allergy and Infectious Diseases [NIAID], 1999 ). Through June 1999 in the United States, 3,564 cases of AIDS in people aged 13 through 19 were reported ( CDC, 1999b ). In the 13- to 19-year-old age group, 60 percent were male and 40 percent were female. When broken down by ethnic group, 30 percent were white, 49 percent were African American, 20 percent were Hispanic, and 1 percent were Asian/Pacific Islander or American Indian/Alaskan Native.

Most adolescents are exposed to HIV through unprotected sex or IDU. Through June 1999, HIV surveillance data show that there were 4,470 cases reported in the 13- to 19-year-old age group. Of those, 45 percent were male, and 55 percent were female. When broken down by ethnic group, 27 percent were white, 66 percent were African American, 5 percent were Hispanic, and less than 1 percent each were Asian/Pacific Islander or American Indian/Alaskan Native ( CDC, 1999b ). Half of the infected male adolescents reported exposure through sex with men.

Almost half (42 percent) of female adolescents were exposed to HIV through heterosexual contact. Another significant trend is the number of STDs reported among adolescents: About two thirds of the 12 million cases of STDs reported in the United States each year are among individuals under the age of 25, and one quarter are among teens. This is significant because the presence of an STD can increase the risk of HIV transmission threefold to ninefold, depending on the type of STD ( NIAID, 1999 ).

Adolescents tend to believe they are “invincible” and therefore engage in risky behaviors. Because of this belief they also may delay HIV testing, and, if they do test and are positive, they may delay or refuse treatment. Alcohol and drug counselors who work with adolescents should encourage them to be tested for HIV if they are at risk. Adolescents can be helped by having information about HIV/AIDS explained to them clearly, by drawing out information about behaviors that may have put them at risk for HIV, and by emphasizing the success of newly available treatments.

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• Cite this Page Substance Abuse Treatment for Persons With HIV/AIDS [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2000. (Treatment Improvement Protocol (TIP) Series, No. 37.) 1 Introduction to HIV/AIDS.
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