AIDS – One of the Deadliest Pandemics in History

Millions have been affected by this disease and numerous people remain unaware that they are HIV positive. This is frightening especially considering how advanced our country is in the medical field. Prevention and education are a major way to slow HIV spreading and increasing awareness will help with the pandemic. As seen with drugs like Narcan which helps counteract an opioid overdose, laws can be put in place to help people. Getting the preventative measures like pre-exposure prophylaxis or ""PrEP more accessible could help the current state of affairs.

Education should not only be available to people who are most likely to contract HIV but the general population to diminish the stigma of HIV, causing more people to be more inclined to get tested. Also what is HIV and how is it related to AIDS, how is it diagnosed and how is it treated?

What are the demographics?

About 25 million people have died of AIDS since 1981, making the disease one of the deadliest pandemics in history. In the United States, the CDC's recently revised estimates indicate that about 945,000 people have been diagnosed with AIDS since 1981, and about 1.2 million are currently living with HIV infection. About a quarter of these people are unaware that they are infected with the virus. The CDC estimates that there are 56,300 new cases of HIV infection in the United States each year (Laberge, Monique, and Frey).

The Large number of people who don't realize they are ill, are too high of a number and need to be decreased. There are ways to confidently decrease that number. A good solution for this could be too look at the populations in the most saturated areas and offer more education. If there is more education and resources, there could be a better outcome and a deceleration of the spread of the virus. Education is one of the key elements but there are also other methods as well.

Recently there has also been a big endemic of opioid abuse in the United States. Many people have become addicted to these powerful prescribed medications. If the medication was abused then the persons breathing slows down and eventually leads to heart failure. The medications are so strong that people were overdosing and by the time first responders had arrived the patient was in critical condition. It would usually result in the person being in the hospital in the intensive care unit. Also the overdose could lead to death. What was the answer to this debate? Laws were passed and eventually pharmacists were able to prescribe the medication Narcan, the antidote, to people who were already taking opioids.

Most insurances companies cover this medication and now Narcan is on the street. What this means is that now someone has the medication if they or someone around them overdoses they or whomever they are with can have a chance to have a better outcome. Now, what does this have to do with HIV or AIDS? It would seem to be a good idea to have the same opportunity to prevent a disease that is not only harmful to one person but possibly hundreds. Preventative medications are available to people who are at higher risk to contract the virus. These are currently medications that require a prescription from a doctor. Narcan is also a prescription medication but who plans to overdose or contract HIV? If theses preventative medications can be prescribed and dispensed by pharmacists then it would be more likely to be in the hands of someone who needs it.

There are other medications that have been by prescription only in the past like Narcan and the Plan B pill. Now the Plan B pill is an over-the-counter medication and is a back-up method to contraceptive. The bottom line is these medications are available to the public and they are very effective. The preventative method for HIV is called ""PrEP as mentioned earlier. This method is a combination of two medications that is retailed as the medication Truvada. Now, this is a great idea to have it available by a pharmacist but, the medication is expensive, so how will it be paid for? The medication Narcan is usually fully covered by the state and federal funded program Medicaid. This would be something that could not only protect one person but if it could possibly help prevent the disease from spreading it could ultimately save on future medical costs and reduce future costs to fight this disease.

Education is a very good way to help people stay healthy. If we could just focus on the population that are mostly affected by this disease then it should decrease the spread of the malady. To reach the population who are most likely to be affected by this we have to find out who they are.

The CDC gives the following statistics for specific groups within the United States:

• Males account for 74% of persons with HIV infection in the United States, although worldwide, the figure for males is 50%.
• In terms of race or ethnicity, 47% of persons with HIV infection are African American, 34% are Caucasian, 17% are Hispanic, and 2% are Native American or Asian American.
• In terms of method of transmission, 50% of infected persons are men who had sex with men; 33% had highrisk heterosexual sex; 13% are injection drug users; and the remainder are people who engaged in more than one high-risk behavior.
• In terms of age group, one percent of infected persons are under 13 years of age; 15% are between the ages of 13 and 24; 26% are between the ages of 25 and 34; 32% are between the ages of 35 and 44; 20% are between the ages of 45 and 54; 8% are 55 or older (Center for Disease Control and Prevention).

With as many as one-third or more of HIV infections occurring during adolescence, aggressive and honest educational approaches must be implemented. Individuals can only make wise behavioral choices if they understand how the disease is transmitted and the consequences of their actions (Katner, Silber). The main population is primarily African American males between the ages of 35 and 44. In the areas that are densely populated there is a need to have more resources and HIV aid. ""Social determinants of health like poverty, unequal access to health care, lack of education, stigma, and racism are linked to health disparities"" (Richelle). There are nonprofit organizations that offer some help and counseling. ""Most often, the marginalization of vulnerable groups is overlooked in both the planning and practice of health service delivery (Chinyama). The conclusion statement of a study by Julia Raijman states that ""A brief, scalable STD clinic PrEP education intervention led to significantly increased PrEP awareness which shows that education works. Not only do people who are at risk need education but the general population as well. The stigma of the disease needs to be neutralized. Part of the issue with the disease is that it is still seen as sordid. Logically, there is such a high number of individuals who have the disease who are unaware they have HIV that maybe they don't want to know they have it. About fifty percent of African American gay males are fifty percent likely to contract HIV. There are many things that contribute to this high of a number. One of the main things is that firstly it is possibly not culturally acceptable for these men to identify as gay. If so, these people are more likely to be without a solid support system. This paired with the possibility of being diagnosed with HIV may be too much trauma. If HIV was more talked about than just in the gay communities and seen more as devastating, like cancer, than as a vile disease then it would cause more people to get tested. Educating the population as a whole would be beneficial to the declination of the spread of this disease and if stereotypes or stigma of the disease were reduced then it may be seen as more of self-care to get tested. If you feel ashamed about something its only human nature to avoid it or even hide it. This does not help with the spread of the disease. This shouldn't be feared but embarked upon. If there were more support groups and even programs for young adults that set a nonjudgmental tone and really focused on how to proactively protect yourself from this immune weakening illness then progress could be made.

What is HIV and how is it related to AIDS? HIV stands for human immunodeficiency virus. If this disease is left untreated it could lead to AIDS. AIDS stands for acquired immune deficiency syndrome. It is a very complicated disease that can lead to a complicated life both physically and emotionally. AIDS starts out as the infection of HIV and then if left untreated turns into AIDS. When the disease is contracted it attacks your body's immune system. Your body has a first line of defense and a second line of defense which is your body's immune response. Once your body detects an intruder it mounts the immune reaction. This response involves certain cells that are made for fighting off the infection.

The heavy lifters of the immune response are the T and B cells, or lymphocytes. There are two types of T cells. The first type of T cells are called killer T cells and are responsible for seeking out cells that pose a risk to our health and then terminate the diseased cell. The other type of T cells is called the helper-T cell and are considered the most vital. These helper T cells are so important because they are basically like the game Pac-man. The helper T cells are like the ghosts in Pac-man and they circle the whole body. When the ghost finds the infected cell, Pac-man, they mount the immune response. The helper T cells release a chemical called cytokines that are thought of as a chemical signal to the other types of cells involved in the immune system.

The signal is called CD4 and is attached to the exterior of the cell. Once the other type of T cells, killer T cells, reaches the infected cells and then are able to attach itself to the cell and release a chemical called cytoxins which ultimately kill the cell. B cells then create a marker on the cell to detect the virus if it ever tries to invade the body again, the body will recognize the intruder and call on the other cells to help rid the system, thus keeping the body healthy and virus free. Now imagine if you had no defense against something as small as the common cold. This is something the immune system should handle with ease. However, when this system is compromised it could certainly lead to death. How does HIV overtake the immune system?

Once a person contracts HIV, the virus starts to attack the immune response. It does this by what is called a retrovirus. A retrovirus is what makes HIV or AIDS so complex and challenging to eradicate. The virus is so vicious that it essentially incorporates its viral information into DNA itself. This then changes the DNAs genetic make-up then ultimately replicates the bad DNA, creating an enormous problem. In retroviruses, the RNA is used to transcribe DNA, which is exactly opposite to the way genetic material is transcribed in all other living things. This reversal is why they are named retrograde, or backwards, viruses (Hoyle). How does the virus become AIDS? When white blood cells are decreasing they reach a certain number ""Normally, the body has 500 to 1,500 of these cells, called CD4 lymphocytes, per cubic millimeter of blood. A diagnosis of AIDS is made when that number drops below 200. (Katner, Silber) ""The name AIDS was coined in 1982. Victims of AIDS most often die from opportunistic infections that take hold of the body because the immune system is severely impaired (Hoyle). The virus can be contracted in a few different ways. The first way is through bodily fluids, this could be through blood to blood contact, meaning if you have a broken skin barrier and the HIV positive person has been bleeding and the blood comes in contact with the compromised barrier. There could also be a contraction from bodily fluid from sexual contact. IV drug users could also get the virus from sharing needles. Also sadly, a mother with HIV can still give her baby the virus before or after child birth. Also another now more of a rare way is to get the virus from blood transfusions. There is also a greater risk to get HIV if the person has had a sexually transmitted infection. How is HIV diagnosed? There are a few tests that can be performed to diagnose if an individual has contracted HIV. ""AIDS has a long latency period, some persons may be infected with the virus for 10 years or longer before they develop symptoms of AIDS ""(Wells). With most cases it takes approximately three months to cultivate a noticeable level of antibody. A common test used to diagnose is called the ELISA test which stands for Enzyme-linked immunosorbent assay. This test takes a sample of the person's blood and combine it with antigen that is attached to a bead surface or plastic tube. When the blood is added and extra protein is removed then a second antibody with an enzyme is added. After those steps a chemical is added that will change a positive test a certain color which is then measured by a specific instrument. There are a few other test that can detect the virus but a really convenient test is now available that you can take at home. The results can take only about 20 minutes but is recommended that if it does test positive that the person seek out further testing.

How is the virus treated? Fortunately there are a few different treatments for this virus. These treatments can actually extend the life expectancy of a person with HIV to pervious life span without treatment. It is now more of a normal life span depending on the treatment adherence. However, if HIV is left untreated it could lead to AIDS, ""The double burden of tuberculosis (TB) and human immunodeficiency virus (HIV) is one of the major global health challenges of the 21st century. TB is the leading immune suppressing infection and the commonest cause of death among HIV-infected patients (Tesfaye). If HIV is a virus why isn't there a vaccination available like an influenza vaccination? Previously described, HIV is a very complicated disease. In an effort to develop a vaccination against HIV scientist have had hit many roadblocks. In order to create a vaccination scientist essentially must use recombinant DNA technology. This technology is essentially joining two types of DNA from different species in hopes that in this case the new combination will work in the body and the HIV combination will be isolated letting the new DNA takeover and recover the immune system. This is compared to finding a needle in a haystack. The tests ""have failed due to lack of efficacy and/or transiently increased HIV infections in some vaccinated individuals. These unanticipated results from clinical trials have brought to light the importance of understanding host immune responses induced against viral vectors in HIV vaccination. (Auclair).

In conclusion, AIDS is one of the deadliest pandemics in history. Many people have been affected by this disease and there are still people who live with the disease that are unaware. The key prevention to help eradicate this epidemic has proven to be education. Hopefully getting the preventative measures like ""PrEP more accessible will provide assistance in eliminating AIDS as well. Hopefully we can hear the words on a news channel or read them on a headline in our life time, that there has been an end to AIDS.

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