Why Is Haiti Significant
In the 1960s, the ‘B’ subtype of HIV-1 made its way to Haiti. This is thought to have happened because many Haitians had been working in the Democratic Republic of Congo and had then returned to Haiti. Initially, Haitians were blamed for starting the HIV epidemic, and suffered severe racism, stigma and discrimination as a result.
Determinants And Transmission Channels On The Epidemic
To date, HIV/AIDS has reached the proportions of a pandemic. While factors determining the transmission of virus from one individual to another are purely personal, what makes this disease an epidemic is due to factors much more complex and global. Following Bonnel , we can distinguish three groups of determinants for the epidemic: socioeconomic, sociocultural and epidemiological.
Spread To The Western Hemisphere
HIV-1 strains were once thought to have arrived in New York City from Haiti around 1971. It spread from New York City to San Francisco around 1976.
HIV-1 is believed to have arrived in Haiti from central Africa, possibly from the Democratic Republic of the Congo around 1967. The current consensus is that HIV was introduced to Haiti by an unknown individual or individuals who contracted it while working in the Democratic Republic of the Congo circa 1966. A mini-epidemic followed, and circa 1969, yet another unknown individual took HIV from Haiti to the United States. The vast majority of cases of AIDS outside sub-Saharan Africa can be traced back to that single patient. Later, numerous unrelated incidents of AIDS among Haitian immigrants to the U.S. were recorded in the early 1980s. Also, as evidenced by the case of Robert Rayford, isolated occurrences of this infection may have been emerging as early as 1966. The virus eventually entered gay male communities in large United States cities, where a combination of casual, multi-partner sexual activity and relatively high transmission rates associated with allowed it to spread explosively enough to finally be noticed.
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Aids: The Early Years And Cdc’s Response
James W. Curran, MD1
1Rollins School of Public Health, Emory University, Atlanta, Georgia
2Office of the Director, CDC, Atlanta, Georgia
Corresponding author: James W. Curran, MD, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Room 8011, Atlanta, GA 30322 Telephone: 404-727-8720 Fax 404-712-8879 E-mail: jcurran@emory.edu.
Change Has To Happen Both For Those Who Are Living With Hiv And Those Who Arent
One of the biggest challenges around the AIDS crisis in Africa is the social stigma that is applied to people living with HIV. In some countries, UNAIDS reports that HIV-positive patients are denied access to healthcare services based on their status, with known figures ranging from one to six per cent of all people living with HIV to as high as 41 to 53% .
The effects of HIV/AIDS on the poorest households in communities is high and has a negative impact on livelihoods, including workplace discrimination. This leaves people living with HIV among those left furthest behind in the fight to end extreme poverty for all. A baseline survey conducted by Concern in Tonkolili District, Sierra Leone, at the start of a project launched in February 2013 found that only 5.8% of men and 4.3% of women had accepting attitudes towards people living with HIV. Furthermore, only 5.3% of men and 5.8% of women had voluntarily tested for HIV, due in large part to a lack of confidentiality at testing centres. We found similar negative attitudes in Burundi, with only about half of all surveyed respondents saying that they would be willing to care for a family member who became sick with HIV. One-third said they would not buy fresh vegetables from a shopkeeper or food seller who is HIV-positive.
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Hiv And Aids: An Origin Story
When HIV first began infecting humans in the 1970s, scientists were unaware of its existence. Now, more than 35 million people across the globe live with HIV/AIDS. The medical community, politicians and support organizations have made incredible progress in the fight against this formerly unknown and heavily stigmatized virus. Infection rates have fallen or stabilized in many countries across the world, but we have a long way to go.
Image via aids.gov. The WHO estimates that 97 percent of the world’s HIV positive population lives in low income nations where anti-viral treatments are scarce or unavailable.
Preventing Hiv Transmission From Pregnant Women To Children
The Joint United Nations Program on HIV/AIDS reported that the following sixteen African nations in 2012 “ensure that more than three-quarters of pregnant women living with HIV receive antiretroviral medicine to prevent transmission to their child”: Botswana, Gabon, Gambia, Ghana, Mauritius, Mozambique, Namibia, Rwanda, São Tomé and Principe, Seychelles, Sierra Leone, South Africa, Eswatini, Tanzania, Zambia and Zimbabwe.
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Social And Economic Consequences
AIDS is having severe negative social and economic consequences in Africa, and these effects are expected to continue for many years, as suggested by a January 2000 Central Intelligence Agency National Intelligence Estimate on the infectious disease threats:
At least some of the hardest-hit countries, initially in Africa and later in other regions, will face a demographic catastrophe as HIV/AIDS and associated diseases reduce human life expectancy dramatically and kill up to a quarter of their populations over the period of this Estimate.14 This will further impoverish the poor, and often the middle class, and produce a huge and impoverished orphan cohort unable to cope and vulnerable to exploitation and radicalization .
The estimate predicted that AIDS would generate increased political instability and slow democratic development. The World Bank has reached similar conclusions with respect to Africa’s economic future:
The illness and impending death of up to 25% of all adults in some countries will have an enormous impact on national productivity and earnings. Labor productivity is likely to drop, the benefits of education will be lost, and resources that would have been used for investments will be used for health care, orphan care, and funerals. Savings rates will decline, and the loss of human capital will affect production and the quality of life for years to come.
Rural Livelihoods
Workforce Depletion
Security
Case Definition For Epidemiological Surveillance
According to a study published in the Proceedings of the National Academy of Sciences in 2008, a team led by Robert Shafer at Stanford University School of Medicine discovered that the gray mouse lemur has an endogenouslentivirus in its genetic makeup. This suggests that lentiviruses have existed for at least 14 million years, much longer than the currently known existence of HIV. In addition, the time frame falls in the period when Madagascar was still connected to what is now the African continent the said lemurs later developed immunity to the virus strain and survived an era when the lentivirus was widespread among other mammals. The study was hailed as crucial, as it fills the blanks in the origin of the virus, as well as in its evolution, and could be important in the development of new antiviral drugs.
In 2010, researchers reported that SIV had infected monkeys in Bioko for at least 32,000 years. Previous to this time, it was thought that SIV infection in monkeys had happened over the past few hundred years. Scientists estimated that it would take a similar amount of time before humans adapted naturally to HIV infection in the way monkeys in Africa have adapted to SIV and not suffer any harm from the infection.
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Pop Culture Opens Up Conversations
In 1985, actor Rock Hudson became the first major public figure to announce he had AIDS. Before he died that same year, he donated $250,000 to help establish the organization later known as amfAR, the Foundation for AIDS Research. Friend and actress Elizabeth Taylor was the national chairperson until her death in 2011.
In 1987, Princess Diana also made international headlines after she shook hands with an HIV-positive man.
Pop culture icon Freddie Mercury, singer for the band Queen, passed away from AIDS-related illness in 1991. Since then, many other public figures have revealed that theyre HIV-positive, including:
- tennis star Arthur Ashe
- former basketball star and entrepreneur Magic Johnson
- Pedro Zamora, a cast member on MTVs The Real World: San Francisco
- actor Charlie Sheen, who announced his status on national television in 2015
- hairstylist and television personality Jonathan Van Ness
- actor and singer Billy Porter
Homeless People And Intravenous Drug Users In New York
A volunteer social worker called Betty Williams, a Quaker who worked with the homeless in New York from the seventies and early eighties onwards, has talked about people at that time whose death would be labelled as “junkie flu” or “the dwindles”. In an interview for the Act Up Oral History Project in 2008, she said: “Of course, the horror stories came, mainly concerning women who were injection-drug users … who had PCP pneumonia , and were told that they just had bronchitis.” She continues: “I actually believe that AIDS kind of existed among this group of people first, because if you look back, there was something called junkie pneumonia, there was something called the dwindles that addicts got, and I think this was another early AIDS population way too helpless to ever do anything for themselves on their own behalf.”
Julia Epstein writes in her book Altered Conditions: Disease, Medicine and Storytelling that: “As we uncover more of the early history of HIV infection, it becomes clear that by at least the 1970s the virus was already making major inroads into the immune systems of a number of diverse populations in the United States and had for some time been causing devastation in several countries in Africa.”
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Women And Girls Are At Especially High Risk Of Contracting Hiv
The face of AIDS in 2021 is that of an adolescent girl. Of the 200,000 new diagnoses of HIV in Africa last year, young women and adolescent girls ages 15-24 made up 27% of those new cases. The United Nations reported 1,000 new infections per week in this demographic.
Gender inequalities and gender-based violence restrict the rights of women and adolescent girls, including their ability to refuse unwanted sex or negotiate safer sex, and to access HIV and sexual and reproductive health services. Learn more about how gender inequality impacts the AIDS crisis.
Leadership Reaction In South Africa And Elsewhere
In the rest of Africa, many heads of state, including the presidents of Uganda, Botswana, Nigeria, and several other countries, are taking major roles in fighting the epidemic. Several regional AIDS initiatives have been launched. For example, in August 2003, the Southern African Development Community agreed to an AIDS strategic framework, including the creation of a regional fund to fight the disease. The New Partnership for Africa’s Development , in partnership with the African Union, UNAIDS, and other multinational entities, has formulated a range of strategies for countering AIDS, though the products of these efforts appear to be limited at present.
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The Importance Of Behavior
The critical role of behavior is the main lesson drawn from the success of Uganda in containing its HIV/AIDS epidemic . Many qualitative and quantitative studies were conducted at a small scale on the evolution of behavior in Uganda. Although they do not allow making direct comparisons in time, they led to the conclusion that attitudes and behaviors had changed notably in Uganda. More than 300 documents were examined by UNAIDS and allow to note a link between a decrease in the number of new infections and changes observed in condom use, age at the onset of sexual activity and sexual intercourse with multiple and non-regular partners.
In the developed world, the pandemic had first appeared and was confined to homosexual and injection drugs users populations and this is precisely why prevention policies were exclusively based on a safe behavior. This orientation was maintained in HIV/AIDS prevention policies in sub-Saharan Africa, which until recently focused on the ABC approach consisting in altering behavior by practicing Abstinence, Being faithful and using Condoms.
Patterns Of Work And Migration
Black workers were only allowed to visit, but not stay with, their families in the cities, and to work under the terms of the pass laws. The relatively few black women in this new urban environment found work serving the households of white families and a few survived by providing the sexual needs of the men in the mine compounds. This back-and-forth form of migration led to widespread prostitution or, in some cases, town-wives’ at the mines, with black men returning to their tribal wives only during their periods of leave.
Such conditions were fertile ground for the rampant spread of sexually transmitted diseases. In a classic paper of 1949 on the social pathology of syphilis, Sidney Kark first spelled out the mode of transmission of epidemic sexual disease and provided the dismaying data to demonstrate it. The route of migratory labour from city to tribal reserve created the trellis for transmission of syphilis.
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Development Of The Aids Pandemic
In retrospect, it is clear that several characteristics of HIV/AIDS resulted in a serious underestimation of the importance of the epidemic by both individuals and societies. One feature of HIV/AIDS that is highly unusual for an infectious disease is its consistently long incubation period combined with a high rate of disease development. Most organisms cause clinical signs or symptoms in only a fraction of those they infect. When infection occurs, as in diseases such as measles or smallpox, the induction period is short. HIV/AIDS is unique in that it regularly causes lethal disease after a prolonged induction period that lasts several years. As a result, the vast majority of HIV-infected people are clinically asymptomatic and do not know they are infected unless they undergo serologic testing. Because HIV-infected asymptomatic people can transmit the virus to others, the epidemic accelerates robustly. In some settings, a significant fraction of the population becomes infected before disease and death have provided the most evident lesson of the need for vigilance.
Aids Antiretroviral Treatment Issues
Access by the poor to antiretroviral drugs has been perhaps the most contentious issue surrounding the response to Africa’s AIDS epidemic. ARVs are used in a treatment regime generally dubbed Antiretroviral Therapy . Three or more ARVs are often used in combination to halt the genetic replication of the HIV virus at different stages in its life cycle this treatment regime is known as Highly Active ART . ART can enable AIDS victims to live relatively normal lives and permit long-term survival rather than early death. ARVs have proven highly effective in developed countries, including the United States, where AIDS, the eighth-ranked cause of death in 1996, was no longer among the top 15 causes by 1998, according to the U.S. Health and Human Services Department.
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Lessons For The Future
In three decades, AIDS has emerged has a major global health problem. As the world faces the long struggle to combat the epidemic, several lessons from the early days emerge.
First, excellent surveillance of the initial AIDS cases was critical in responding to the epidemic. Surveillance was first needed to track the epidemic and direct etiologic investigations but later became critical in formulating early prevention and safety recommendations before HIV was discovered. Surveillance remains equally important now throughout the world to target resources and evaluate prevention efforts.
Second, the rapid identification of HIV as the causal agent of AIDS led to a much better understanding of transmission, natural history, and spectrum of illness. This understanding allowed for more targeted prevention efforts and paved the way for development of the first effective treatments.
Fourth, as with most health problems where the etiology is well understood, prevention deserves primacy. Several million persons become newly infected with HIV each year, yet only approximately five to six million persons worldwide have been treated with HAART. The goal of universal HIV treatment cannot be met unless HIV incidence can be reduced. Furthermore, as long as the majority of HIV-infected persons are unaware of their infection status, prevention and treatment efforts will be hampered.
Origin And Epidemic Emergence
Several of the theories of HIV origin accept the established knowledge of the HIV/SIV phylogenetic relationships, and also accept that bushmeat practice was the most likely cause of the initial transfer to humans. All of them propose that the simultaneous epidemic emergences of four HIV groups in the late 19th-early 20th century, and the lack of previous known emergences, are explained by new factor that appeared in the relevant African regions in that timeframe. These new factor would have acted either to increase human exposures to SIV, to help it to adapt to the human organism by mutation , or to cause an initial burst of transmissions crossing an epidemiological threshold, and therefore increasing the probability of continued spread.
Genetic studies of the virus suggested in 2008 that the most recent common ancestor of the HIV-1 M group dates back to the Belgian Congo city of Léopoldville , circa 1910. Proponents of this dating link the HIV epidemic with the emergence of colonialism and growth of large colonial African cities, leading to social changes, including a higher degree of non-monogamous sexual activity, the spread of prostitution, and the concomitant high frequency of genital ulcer diseases in nascent colonial cities.
Social changes and urbanization
Colonialism in Africa
This theory was later dubbed “Heart of Darkness” by Jim Moore, alluding to the book of the same title written by Joseph Conrad, the main focus of which is colonial abuses in equatorial Africa.
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