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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


 
    

HIV/AIDS

Daniel H. Smilkstein, M.D.

http://www.caresproject.org/docs/ed/drug/hiv.htm#nottransmitted

 

Introduction:

AIDS stands for Acquired Immune Deficiency Syndrome. Acquired means you are not born with it, but get it from someone. As the name implies, this disease involves a deficiency (destruction) of the the immune system, which is the system that protects us from infections and cancers. Because of this breakdown in the immune system, HIV/AIDS can present with any manifestation of immune deficiency, from sinusitis to cancer. AIDS was first identified in 1981 among homosexual men in California and New York City, and was at one time called the "Gay Epidemic". We know now that HIV can effects anyone, irregardless of sexual orientation. World wide HIV/AIDS is spread most commonly through heterosexual contact. AIDS is still considered lethal infection. Through December 1995, 513,486 people in the United States had been reported with AIDS to the Centers for Disease Control and Prevention, (CDC). Of the 513,486 cases of AIDS reported 318,361, (62%) had died. The annual estimated number of new HIV infections in the United Stats has decreased from approximately 100,000 several years ago to 40,000. The CDC currently estimates that approximately 600,000 to 900,000 Americans are infected with HIV, although many of them are undiagnosed. The number of people infected represents only a small fraction of the number of people who are affected by the epidemic, including family members, friends, and loved ones of infected individuals

 

Substance abusers, especially those who inject drugs, are at greater risk for HIV/AIDS than people who do not use drugs. Individuals who inject illicit drugs account for 20 percent of cases among men, 50 percent of cases among women and about 55 percent of pediatric cases (children of mothers who are injecting drugs or mothers who have sex with males who inject). The type of drug injected does not matter! AIDS has been diagnosed among injectors of various illicit substances, including opiates (heroin, morphine,etc), cocaine, amphetamines, and anabolic steroids. AIDS is also more common among non-injecting drug abusers, such as alcoholics, cocaine "snorters" and "crack" smokers, who are infected through sexual contact.

From new born babies to senior citizens, there is no segment of the population that is immune from the HIV/AIDS epidemic. While every HIV case is a tragedy, the magnitude of that tragedy is amplified when young people are the victims. We can estimate the financial cost of HIV/AIDS infections in the our young population, but there is no way to measure the cost of grief, or put a dollar amount on lost opportunity, productivity and creativity. The most tragic part of this story is that HIV is 100% preventable, with solutions that are easy to identify, but hard to implement. Unfortunately adolescents and teens have been a difficult group to convince that high risk sexual and drug behavior can be lethal. The number of reported AIDS cases among teenagers increased 96% between 1988 and 1990.

What is HIV/AIDS?

The Human Immunodeficiency Virus, or HIV, is the virus that is responsible for AIDS. The virus itself is not a very hardy bug. It dies quickly if exposed to drying by air and common disinfectants kill it with ease. The problem with HIV is what it does when it is introduced into the human body. It is in a group of viruses called retroviruses. They reproduce or technically replicate by using the genetic material of its host (human beings) cells. The virus targets a type of cell called the T-helper lymphocytes. The T-helper cells are responsible for identifying bacteria and viruses and alerting the immune system to make appropriate antibodies to control the incoming organisms. The loss of these cells results in the body's inability to control microbial organisms that the normal immune system controls easily.

The result of this break down in the immune system is that even normally harmless microorganisms suddenly become potentially life threatening infections. These infections are called opportunistic because they take advantage of an HIV damaged immune system. When the HIV enters the body it very rapidly starts this process of T-cell destruction, but it can take from a few years to over a decade for the immune defect to become severe enough for the infected person to become aware that they are sick.

Since the median incubation period between HIV infection, and AIDS diagnosis is about 10 years, it is clear that many people who were diagnosed with AIDS in their 20's became infected as teenagers. During this incubation period, even though the infected person feels perfectly healthy, they are able to spread the virus to others through sexual contact, IV drugs or pregnancy.

The rapidity with which HIV moves from asymptomatic infection to full blown AIDS depends on many factors. There is quite a bit of data that supports that continued drug use (including cocaine and marijuana), tobacco use, high stress and poor general health, are all causes of accelerated progression of HIV/AIDS infections. There is also an association of the abuse of nitrate inhalants ("poppers") among HIV-infected homosexual men and the development of Kaposi's sarcoma, a rare skin cancer associated with AIDS.

The initial presentation of AIDS may be as unalarming as chronic sinusitis or a vaginal yeast infections that won't clear up, although clearly most people with chronic sinusitis and yeast infections don't have AIDS.


    

How is HIV/AIDS Transmitted?

There is a great deal of myth and prejudice related to the disease of HIV/AIDS and how it is spread. When it was first identified in the early 1980's there was little information about the virus and how it was contracted. Out of this lack of information and AIDS paranoia many misconceptions, fears and in turn prejudice arose. Over the past 20 years a great deal has been learned about the virus and the disease of AIDS, but the AIDS paranoia has been slower to change. Here is what we know about how HIV/AIDS CAN NOT be transmitted.

In an individual infected with HIV, the virus can be found in blood, semen, vaginal fluid, breast milk, saliva and tears. Contact with saliva and tears has never been shown to result in transmission of HIV.
Living, working or socializing with an HIV infected person is not a risk. There have been no instances of non-sexual transmission of HIV in studies of thousands of households where families daily share kitchen, laundry and bathroom facilities, meals, eating utensils, drinking cups and glasses with AIDS patient. If HIV is not transmitted in these household settings, it is even less likely that it would be transmitted in less intimate work and social settings. Despite these facts, HIV/AIDS infected individuals are still denied access and admittance to some schools, clubs and social organizations.
HIV is not transmitted by insects.
Closed mouth or social kissing does not put a person at risk for HIV. The CDC recommends against open mouth kissing with an infected individual because of the potential for blood/saliva contact, although they have never had a documented case of HIV spread from any kind of kissing.

There are only three ways that HIV can be transmitted:

  • intimate sexual contact
  • exposure to infected blood or blood products
  • from an infected pregnant mother to her fetus

 

Sexual transmission

Any unprotected sexual contact which involves the exchange of bodily fluids can theoretically transmit the HIV virus. The highest risk type of contact is anal intercourse. The high risk associated with anal sex is due to the trauma (multiple small tears and bleeding) that occur in the rectum and anal area. The lining of the lower intestine is made up of a type of cell that is easily damaged during intercourse, thus allowing for the easy passage of the HIV viral particle from an infected person to an uninfected individual. It is also significantly more likely, during normal heterosexual intercourse, that HIV will be transmitted from an infected male to an uninfected female, than from and infected female to an uninfected male.

If a condom is used, and used correctly every time, it can prevent 99% of unwanted pregnancies and HIV/AIDS infections.

Other potential modes of sexual transmission of HIV, such as oral-genital sex and open mouth kissing are recommended against by the Center for Disease Control (CDC), although as noted above no documented cases of HIV transmission have reported from any kind of kissing.


GET HIGH, GET STUPID, GET AIDS: HIV transmission and drugs

Drugs can increase the risk of acquiring HIV in three ways:

(1) Through shared dirty (HIV contaminated blood) needles

(2) Impaired judgment leading to increased incidence of unplanned and/or unprotected intercourse with an infected individual

(3) Drug addicted individuals selling sex for drugs, or money to buy drugs. This is both a risk for the seller as well as the purchaser

The most common way for drug abusers to become infected is by sharing needles and syringes. Direct inoculation of blood containing HIV occurs when someone injects themselves or another person with heroin, cocaine, amphetamines, steroids or any other injectable drug after an HIV-infected person has used the same needle.

Facts about IV drug users

  • They comprise less than 1% of our population
  • They account for nearly 1/3 of all AIDS cases in this country
  • They account for 20 percent of HIV/AIDS cases among men
  • They account for 50 percent of HIV/AIDS cases among women
  • They account for about 55 percent of pediatric HIV/AIDS cases (children of mothers who are injecting drugs or mothers who have sex with male injecting drug abusers)

Drugs, Sex and HIV/AIDS

Not all drug related AIDS cases are due to injecting drugs. A large and increasing number of cases are the result of sexual intercourse with infected individual. The association of alcohol and/or drug use at the time of their last sexual intercourse among teens is as high as 35% in one study. A 1991 report from the National Commission on AIDS stated that there was a clear association between non-injectable substances, such as alcohol and crack, and the practice of unsafe sexual activity which can result in the spread of HIV. Partying with drugs and alcohol increase the risk of contracting all STD's (sexually transmitted disease) with the consequences ranging from life long recurrent sores (herpes), to potential infertility (clamydia), to death (HIV). It has been shown that kids who are high or intoxicated are more likely to have unplanned sex and not use a condoms during sexual intercourse.The National Institute on Drug Abuse targeted young adults in its ad campaign, "Get High, Get Stupid, Get AIDS," after its studies confirmed that many young adults use alcohol and other drugs to lose their inhibitions with members of the other sex, combining two high-risk behaviors for contracting HIV.

Sexual contact is also a common route of transmission between drug abusers and sexual partners. The trading of sex for drugs or money has played a key role in the spread of HIV/AIDS, just as it has with other sexually transmitted diseases. The AIDS epidemic has had a profound effect on minority communities, particularly African Americans and Hispanic/Latinos. One half the individuals who have IV drug related AIDS are African American and 29% are Hispanic/Latinos. Woman represent another group where HIV/AIDS is taking a notable toll. Most woman contract HIV through sexual intercourse, although IV drug use is a significant contributing factor. AIDS is now the fourth leading cause of death among women of childbearing age in the United States.


    

Prevention

Preventing HIV/AIDS from drug abuse

Don't confuse treatment with prevention. While there are several drug combinations that are significantly altering the course of HIV disease, there are no cures, and AIDS is still considered to be 100% lethal. There also does not seem to be hope for a reliable vaccine in the near future. Because there is no reliable cure or vaccine for HIV infection the only effective method for slowing the spread of HIV infection is through education to alter risk behavior. The methods of prevention are easy to identify and very difficult to implement. Among IV drug abusers, the most effective way to avoid infection is to stop injecting drugs and avoid sexual contact with individuals who may be HIV-infected. Former drug abusers and individuals in Methadone maintenance therapy have a lower incidence of HIV/AIDS than their drug abusing counterparts on the street. The National Institute on Drug Abuse (NIDA) is very active in research on methods of rehabilitation and disease prevention among drug addicts. These programs have reached tens of thousands of drug abusers and their sexual contacts and has changed drug abusing behaviors in many individuals. The success of many of the programs have met with limited success, including HIV serological test, counseling about HIV infection, and partner notification projects. IV drug abusers by their nature exist on the fringes of society and have limited access to health care and limited motivation to change their behavior or protect others from potentially risky behavior.

Outreach efforts to identify infected drug users and encourage them to enter treatment is still an important part of AIDS prevention. Controversial efforts such as needle exchange programs are not intended to change the drug abusing behavior, but only decrease the spread of HIV, Hepatitis B and C. HIV is the number one cause of death in IV drug users, and Hepatitis C is now the number one cause of liver transplants in the United States. AIDS prevention is helped by general prevention efforts aimed at reducing levels of alcohol consumption and eliminating illicit drug use.

Preventing HIV/AIDS through sexual transmission

You cannot tell someone has the HIV virus by looking at them. A blood test is the only way to be sure, and even there a blood test done too early in the course of the infection may be falsely negative. Avoiding sex all together, or at least avoiding unprotected sex is the key to prevention. The role of alcohol and other drug use in contributing to high risk sexual behavior is the focus of education campaigns directed at particular risk populations, including teenagers, young adults, and homosexuals. Teenagers and young adults tend to enter into risky behavior at a higher rate than the adult population in general. Research suggests that the relationship of alcohol and other drug use with sex may be different among young people than among adults. Much like driving a car, novices tend to make more mistakes, and adolescents and young adults learning about drinking and sexual activity are no exception. The combination of experimentation with drugs, alcohol and sex in the era of HIV is Russian Roulette. Unfortunately this group is one of the most difficult to reach in terms of the HIV prevention message.

Unprotected sex with an infected partner is the most common way to contract HIV. When it comes to HIV, you are in effect having sex with everyone who that individual has had unprotected sex with, or everyone who that individual may have shared a needle with, or that persons previous partners partner who may have shared a dirty needle with who knows who...The more sex partners you have, the more chance you have of getting AIDS.

How to avoid the risk of HIV

  • There are only two sure ways to avoid the AIDS virus -- not having sex and not sharing needles
  • If you choose to have sex, always use a condom to help reduce the risk of getting AIDS
  • Know ahead of time how you will respond to pressure to have sex. This pressure may be from a boyfriend, girl friend, or the crowd you hang with
  • The first thing to remember is you're in charge of your body and what you choose to do with it
  • The second thing to remember is there is a lot at stake -- a decision about sex can have consequences that last a lifetime
  • It helps to Make a Plan and Stick to it
    • Then if someone offers you drugs or suggested sex, you'll know what to do
    • Plan not to use drugs so you can keep a clear head
    • Plan how to say no, to be careful, and to think about what to do
    • The time to make your plan is when you have a clear head.

How to make a plan

  • Think about who you are and what's important to you
  • Think about how using drugs and having sex could affect that
  • When you have a plan it's easier to handle situations where you want to have fun with friends but don't want to use drugs or have sex
  • Know what your response to pressure will be ahead of time
    • If someone pressures you about drugs you can say nicely but firmly, "I'm not interested," or, "I don't use drugs."
    • If someone pressures you about sex you could let them know where you stand by saying: I'm not ready for it yet," or, "Maybe it feels right for you, but it's not for me."

HIV/AIDS fact sheet for Teens and Adolescents In the U.S.

  • AIDS is still the sixth leading cause of death among people 15-24.
  • In 1995 there were 405 reported AIDS cases among adolescents 13-19 and 2,432 cases among adolescents aged 20 to 24.
  • Sexual contact, (either male-to-male, or heterosexual) accounted for 37% of reported AIDS cases in 1995 among adolescents 13 to 19 years old. In adolescents age 20 to 24, sexual contact, (either male-to-male or heterosexual) accounted for 65% of the cases in 1995.
  • Through December 1995, 513,486 people in the United States had been reported with AIDS to the Centers fro Disease Control and Prevention, (CDC).
  • Of the 513,486 cases of AIDS reported 318,361, (62%) had died
  • The annual estimated number of new HIV infections in the United Stats has decreased from
    approximately 100,000 several years ago to 40,000
  • The CDC currently estimates that approximately 600,000 to 900,000 Americans are infected with HIV
  • The number of people infected represents only a small fraction of the number of people who are affected by the epidemic, including family members, friends, and loved ones of infected individuals
  • The population most affected by AIDS in the United States, continues to be men who have sex with men, (42% of all new AIDS cases in 1995)
  • Injecting drug users, also a high-risk group, accounted for 26% of all new AIDS cases reported in 1995
  • The the number of HIV / AIDS cases in the United States caused by heterosexual transmission is increasing
  • The proportion of AIDS cases among women, racial/ethnic minorities, and children has increased while the
    rate of AIDS among men who have sex with men has remained relatively level
  • AIDS knows no boundaries, and can be prevented only by eliminating risky behavior
  • The percentage of adolescents reporting condom use at their most recent sexual intercourse increased from 46% in 1991 to 54% in 1995
  • The average age of first sexual experience among U.S. Adolescents is 16 and approximately three-fourths of high school students have had sexual intercourse by the twelfth grade
  • 1 in 62 high school students in a CDC study reported having injected an illegal drug
  • Every year approximately 3 million American teenagers contract a sexually transmitted disease (STD). STD's facilitate the transmission of HIV
  • Studies published in 1994, and 1995 revealed that in New York, Pittsburgh, and San Francisco, 9%, 7%, and 9% respectively of males who have sex with males 13 to 25 were HIV positive. These rates are 20 times greater than the estimated rate among overall population, (.4%)
  • Often adults worry that promoting safer sexual activity encourages promiscuity. In fact several studies have show that levels of sexual activity among young adults decreased or remained the same after sex education programs which included information about condoms.

Final thought: It is the role of health educators, parents and physicians to educate young people about HIV/AIDS and how to protect themselves from infection. Specifically we need to educate adolescents and teens about:

(1) The causes of HIV/AIDS

(2) The high risk behaviors that can lead to HIV infections

(3) The need to develop good decision making skills concerning high risk behaviors

(4) The facts...so that teens don't need to experience unnecessary fear related to this serious illness

 


Resources

  • AIDS Coalition for Education. Colorado Responds to HIV/AIDS. Denver, CO. 1997.
  • The American National Red Cross. Living with HIV Infection. 1993.
  • The American National Red Cross. Teenagers and HIV. 1992.
  • The American National Red Cross. Women, Sex, and HIV. 1992.
  • Planned Parenthood of the Rocky Mountains. Planned Parenthood Fact Book. 1997.
  • Planned Parenthood Federation of America, Inc. Sexually Transmitted Infections: The Facts. New York, NY. 1997.
  • Department of Health and Human Services. Centers for Disease Control. What About AIDS Testing? Atlanta, GA. 1988.

National Assistance

  • Public Health Service
    National Institutes of Health
  • For more information call 1-800-662-HELP.

 

Internet Links

 

The Body

  • An HIV and AIDS resource center. One of the best single information resources on HIV/AIDS on the web. Up to date resource, links, articles, chat and more.

 

CDC HIV/AIDS Surveillance reports

  • The HIV/AIDS Surveillance Report contains tabular and graphic information about U.S. AIDS and HIV case reports, including data by state, metropolitan statistical area, mode of exposure to HIV, sex, race/ethnicity, age group, vital status, and case definition category. It is published semi-annually by the Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC).

 

Teens with HIV

  • A personal look at AIDS from the view point of teens. Some good general information links 

Statistical sites for HIV/AIDS: