Poorly Formed Thoughts: HIV and World AIDS Day

The 27th World AIDS Day was yesterday 1 December, 2015. This year’s theme is #rethinkHIV. And among other things I saw yesterday this Facebook teaser from The Economist was one of the more confusing:

Economist Facebook World AIDS Day

There’s a lot here. My media consumption choices are on display (Economist via Facebook) ( Make what you will of those, I won’t dwell on them now). The article headline is “The AIDS virus is being beaten back ever faster.” It is subtitled with this dodgy conglomerate statistic ‘Annual new infection rates have fallen 24% since 2005.’ And then the whole thing is announced with a chirpy: Too many people are still dying right now, but we can fix it in 15 years! Um….Yay? Finally, this article is actually from July so while pertinent to World AIDS Day, it wasn’t exactly current.

This messy, messy communication (from a reputable publication) about a fascinating and difficult disease+social issue really illustrates why HIV is such a murky problem, and I think casts into doubt that cure by 2030 suggestion. It also makes clear why #rethinkHIV is a good theme.

So what’s wrong here? There’s a tiny bit of a branding problem that I think we’re not going to be able to overcome because the event began as World AIDS Day and not World HIV Day, but it is important to understand that there is no “AIDS virus.”

AIDS = Acquired Immune Deficiency Syndrome. The ID means that a person’s immune system does not work well enough to fight off infections, the S points out that there are multiple symptoms of this immune system failure, and the A means that the person had a normal, functioning immune system at some point. This is in contrast to people who are born with immune systems that don’t work. Lots of things can cause immune deficiency. Most of us will be, briefly, immune deficient in our lives. Alcohol and even some common infections can temporarily depress or disable your immune system. Many cancer and transplant patients technically have AIDS for a period of their treatment. Their immune system is eliminated or reduced to allow their bodies to accept new tissue. Just like AIDS patients they are susceptible to even very common infections. Please note, The Economist gets the wording exactly right when they say ‘AIDS-related deaths’ because the lack of an immune system itself is not fatal. It’s the infections one can get and complications of the lack of immune system that will eventually cause a person to succumb. The reason this gets all conflated is that the most common cause, non-intentional cause of AIDS is infection with HIV.

HIV = Human Immunodeficiency Virus. It attacks the immune system, destroying immune cells and disrupting the communication within the immune system that makes it function. If the virus destroys enough cells the immune system cannot do its job and a person develops AIDS.

HIV is not the only cause of AIDS, which is why we shouldn’t call it ‘the AIDS virus.’ What we want awareness and prevention of is HIV infection.

Now that’s clear, some other rambles:

#RethinkHIV is a great theme. In spite of efforts to universalize awareness and concern for HIV, it still seems to be predominantly associated with gay men, black Africans, and if anyone bothers to think of them IV drug users and prostitutes. It’s enormously easy to say “Not me!” if you don’t fit those demographics, and at their worst some humans would even say “They deserve it.”

Your actual reaction to the stereotypes and the haters should be “Not true!” and “Well I guess everyone deserves it.” Plenty of straight non-black, non-men, non-African, non-prostitute, non-IV drug users have HIV. Here are estimates for the US from 2013 (CDC HIV statistics).

CDC 2013 HIV infection demographic

Never assume continues to be a great life mantra.

“They” deserve it as much as cats, monkeys and the rest of us. Species-specific infections (or infestations) that cause immune deficiency are common throughout the animal kingdom. Every species is in a constant race with viruses which evolve much faster (and WAAAAAAY outnumber us). Don’t be so arrogant. You don’t have HIV? That’s awesome. Next year the flu (another virus) could kill us all. Cheers!

That said, #rethinkHIV also applies deeply to the populations which are still disproportionately affected by the virus.  There are reports of rising infection rates among young gay men, and gay subcultures in which being HIV positive is desirable. With effective long-term treatment widely available, the progression to AIDS and death postponed, the detrimental effects of the HIV are not as visible. In societies which were tempted to ignore HIV’s existence in the place it is once again very easy for HIV to be invisible.  While no one wants to reduce their humanity and think of themselves as a ‘reservoir’ for a major infectious disease that is exactly the role of groups which continue to pass among themselves or spread HIV out of ignorance or intention. And in the case of disease eradication ‘good enough’ isn’t good enough. We should absolutely celebrate the prolonged lives and better overall health of those already infected. But how can reservoir communities be a part of eradication and not the cause of taking a global step back on progress?

If you have any interest in HIV be sure to read lots and lots of sources. Not just to get your science right but to see multiple perspectives. HIV is not just a medical problem. It touches on sexual health, sexual violence and consent, women’s health disparities, poverty, child health and welfare, social stigma, marginalized populations, addiction, community morals, intellectual property, pharmaceutical development…I could go on. I can’t think of another disease that better illustrates so much of what society is doing right and wrong in so many arenas.

If you don’t think about HIV, you should. Not get-up-and-fret-about-it-every-day like you probably should about climate change and terrorism, but spare it a thought now and again. HIV is predominantly sexually transmitted, it’s invisible, permanent, and potentially fatal. You consider and take standard precautions against similar level threats every day (carbon monoxide detectors, hand washing), and what you need to do to consider and prevent HIV are things you know you should do anyway. A great place to (finally) end: #communication #consent #safesex

 

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