Olena Bychkovska
Research Paper

Frequent Misconceptions about the Nature and Strategies to Combat HIV/AIDS

            AIDS (acquired immune (or immuno-)deficiency syndrome) is “a severe immunological disorder caused by the retrovirus HIV (human immunodeficiency virus), resulting in a defect in cell-mediated immune response that is manifested by increased susceptibility to opportunistic infections and to certain rare cancers” (“AIDS,” 2013). The earliest case of HIV was documented in Congo at the end of 1950-ties (Zhu et. al, 1997, para. 1); yet, AIDS was first clinically observed in 1981 in the U. S. A. (Centers for Disease Control and Prevention [CDC], 2001, p. 429). Today because of the high prevalence of HIV/AIDS all over the world a global pandemic is acknowledged. In 2010 approximately 34 million people had HIV worldwide and 1.8 million of them died (Kallings, 2008, p. 218).  Overall, this health state is being characterized by a decrease in the number of helper T cells, which causes a severe immunodeficiency that leaves the body susceptible to a variety of potentially fatal infections. AIDS can be transmitted by three main ways: through a sexual intercourse; infected blood and blood products, and through the placenta. An HIV testing can identify infection in the early stage and allows the patient to use preventive drugs, which may slow the rate at which the virus replicates, delaying the onset of AIDS. Moreover, nowadays AIDS is not only syndrome, but it also a state that has a significant impact on economy and socio-demographic situation in numerous countries. Currently, the HIV/AIDS pandemic is being addressed by governments, international organization and scientists. However, HIV/AIDS is often a subject to many controversies and a source for many misconceptions concerning its general nature and effective approaches in its combatting. These frequent misconceptions are being further discussed along with alternative to them evidence-based information.

Distinguishing between HIV and AIDS

To begin with, although HIV and AIDS are being broadly discussed in the global society, these two different terms and the phenomena they represent are being often confused. HIV, which can be understood as the Human Immunodeficiency Virus, is a virus that infects a human being. A person can be infected (HIV-positive) if her or his organism starts to produce antibodies, or not infected with HIV (HIV-negative) if no antibodies are detected. Nevertheless, even if the person is infected, the HIV can have a long incubation period, which means that it would not manifest itself through symptoms. The cure for HIV had not yet been found (“What is HIV?,” 2013, para. 1). Unlike HIV, AIDS is not a virus, but rather a medical condition, a syndrome, a definition to describe the diseases and its symptoms are associated with HIV’s immune system oppression. People are not infected with AIDS; nevertheless, they develop supporting diseases, since their HIV-infected body’s immune system is weak and not capable of opposing those diseases. Just as HIV, AIDS is not curable yet; nonetheless, many scientists are working on HIV/AIDS cure worldwide (“What is AIDS,” 2013, para. 2, 6).

Distinguishing Between HIV Types

 In addition, although researchers still argue about HIV exact natural history and causes, it is widely accepted to distinguish between two types of this virus, which are called HIV type 1 (HIV-1) and HIV type 2 (HIV-2). The first type, HIV-1 is predominant and usually is being referred to when speaking about HIV. Most scientists believe that HIV-1 can be classified into a major group (Group M) and a few minor groups, each of which can also be divided into subgroups. All of the groups represent different kinds of transmission (“HIV Types, Groups and Subtypes,” 2013, para. 2).  The other type, HIV-2 has not been commonly discovered out of Africa. In 2010, 8 groups of this virus were recognized, only two of which are epidemic (Group A and B). Group B is mainly found in West Africa, while Group A has also spread to other countries such as India, Angola, Mozambique, Brazil, and is rarely registered in Europe or the United States of America. Probably HIV-2 is not as easily transmittable as HIV-1 and has a longer time period between the infection and illness itself (AIDS). Recognition of these two types provides the world’s medical community with more sufficient understanding of the human immunodeficiency virus and the disease it causes (Sharp & Hahn, 2011; McNeil, 2010). A common general public misconception is that the Africans are the only responsible for HIV transmission; yet, as can be concluded from the classification, such statements are not correct. 

Certainty of the Data on HIV/AIDS Prevalence

Furthermore, in order to make any assumptions and conclusions about the nature and strategies to combat the HIV/AIDS, the data from various researchers is needed. Nevertheless, such data itself, even if being interpreted correctly, can be itself a source of misconception since a specific uncertainty of data always exists and the data can be distorted. As an example the data collected and stored in the World Health Organization (WHO) and United Nations AIDS (UNAIDS) during the period since 1981 until 2003 can be considered. This data were gathered in the most parts of the world where people live, including North and South America, Europe, Asia, Australia, and Africa. The purpose of the study was to determine the trends of development of HIV/AIDS epidemic worldwide. The key results are as follows.

Figure 3. 2. HIV/AIDS: Episodes in an Evolving Epidemic

Figure 3. 2. HIV/AIDS: Episodes in an Evolving Epidemic (World Health Organization [WHO], 2003, 46) illustrates the trend of developing of the world HIV/AIDS epidemic as well as the chief actions taken in order to combat it and prevent it from further development. The years from 1980 until 2003, starting from the first of identified case of HIV/AIDS, are shown on the horizontal axis of the graph. On the vertical axis the number of people living with HIV/AIDS in millions, starting from zero until 45 millions, is depicted. The descriptions of the key actions taken in order to combat the epidemic are presented in blue and white boxes. Each box is connected by a black line with the year this action was taken.

As it can be seen from this figure, the number of people living with HIV/AIDS has continuously grown starting from 1980 until 2003. There were no sharp rises or falls in such number. In 1980 this number was close to zero and in 2003 it became approximately 40 millions. During 8 years (from 1991 until 1999) the number of people living with HIV/AIDS grew from 15 to 40 millions. Also, in 1999 such growth slowed and until 2003 the number of people remained approximately the same. In the 1981 HIV was first detected in gay men in U. S. A. and during the following two years this health state was further studied and the causal relation between HIV and AIDS was established. Also, in 1983 HIV was detected among heterosexual people in other parts of the world, including Africa. Because there were many of the people living with HIV/AIDS, an epidemic was stated. The scientific developments and researches on this acute problem started to launch; hence, during the 80-ties the first tests in diagnostics and treating drugs were introduced. Also, then it was recognized that HIV/ADS was spreading all over the world. Yet, in the 1991 a decline was detected in the prevalence of HIV among the pregnant women in Uganda and actions were taken to prevent the virus transition from mother to child. In 1995 an outbreak among the drug-addicted people was detected in Europe. Later, in order to combat the spreading pandemic, the new Highly Active Antiretroviral Therapy (HAART) was discussed and United Nations AIDS was found in 1996. Some countries, first of which was Brazil, made antiretroviral (ARV) therapy a part of their public health system. In addition, the clinical trials of efficacy of a vaccine were first conducted in Thailand in 1999. Through the 90-ties UN Security Council first addressed HIV/AIDS and later it called for creating a global fund on HIV/AIDS. In 2002 WHO proposed the program "3 by 5", which goal was to provide ARV treatment for 3 million people mostly in Africa by 2005; nevertheless, already in the 2003 it pronounced the ARV treatment shortage and a gap in its provision to be a global health emergency. Thus, as it can be seen from the figure, most actions were taken during two periods of years - 1981-1988 and 1994-2003 (World Health Organization [WHO], 2003). These are the overall tendencies in HIV/AIDS prevalence and combatting.

            However, it is important to understand that this figure is approximate and can be a source of numerous misconceptions, since it cannot show the exact trends due to a number of reasons. First of all, the graph shows that in 1980 there were from zero to one million of people living with HIV/AIDS. Yet, this number means that there were so many people detected at that time because until 1981 the world community did not know about the existence of HIV/AIDS and as it was mentioned earlier the first case was indicated in 1959 in Congo. The case in 1981 was clinically observed; however, WHO did not mention it and, consequently, many might think that it was the first case indeed. Thus, the number of people living with such state of health might have been larger than the graph shows. That is also true for other periods of time that are being presented in this figure, since they can only show the people with detected HIV/AIDS. Secondly, the information about the developed countries is being continuously gathered, checked, processed, and stored in the databases; however, it is not so for the developing countries. Because of a variety of reasons, it appears to be difficult to conduct researches in the less developed countries, especially in Africa, were there is an HIV/AIDS epidemic. Thus, the scientists experience a shortage of information concerning the situation in the developing regions of the world, which in its turn, influences the preciseness of the estimated made and the figures constructed according to those estimates, which in turn may lead to misconceptions, as with the first detected case. Moreover, the data may be distorted on any stage of its collection and analysis. It can be biased by the respondents or providers of such information, by the researchers who gather it or the organizations which made this report. These basic assumptions are crucial to understand when making any further interpretation of the offered data.

Furthermore, the described tendencies and additional sources of misconceptions can be deeper explained and better understood if we consider the particularities of the HIV/AIDS as a state of health and its epidemic’s development through years. The first case was detected in gay men, which automatically might have brought a belief that it can be spread only through homosexual sexual contacts; thus, it does not have to be treated and addressed seriously, because the majority of population is secure from it. Yet, in 1983 it was already known that Africa had an epidemic, which later became a pandemic.  An effective antiretroviral therapy was found in 1995, 14 years later after the first case of HIV/AIDS detection, and during all of that time the virus has continued to spread through the world. Moreover, few actions were taken between 1988-1994 years; nevertheless, the epidemics during these years grew significantly. In addition, the figure shows that the actions on helping the third-world countries combat HIV/AIDS were taken in the 90-ties, while before that the main focus was settled on U.S.A. and Europe. That might have triggered the world pandemic, because the third-world countries are the once where a lot of people with HIV/AIDS live, and where it is most difficult to control the epidemic. Likewise, as it is shown on the graph, in the same period, when the number of people living with HIV/AIDS reached approximately 40 millions of people, the United Nations started to design broad action plans. This figure illustrates that after designing such actions the number of people living with HIV/AIDS did not decline, but remained stable. Nonetheless, it is again not easy to understand if those are the real numbers or the politicians and world organizations want to prove that those designed actions are effective. In order to verify that, one has to conduct an independent study, which requires a lot of resources and might not be affordable for any other organizations, except the large ones and supported by governments.

Misconceptions about Africa’s Ability to Combat HIV/AIDS and Need of Help

As it can be also seen from the discussed graph and provided information, the HIV/AIDS prevalence in Africa is high. Consequently, one more common misconception among the policy actors and researchers that follows from such data is that HIV/AIDS is impractical to be effectively combated in Africa; yet, a large body of evidence, which is being further presented, proves that the world’s community should help Africa to combat HIV/AIDS. As mentioned above, AIDS is a dangerous syndrome, which leaves the body susceptible to a variety of potentially fatal infections. However, still there is no cure or vaccine against it; thus, the consequences of HIV/AIDS spreading in Africa are fatal and such epidemic is a thread for the health and welfare of the whole world.

            HIV/AIDS prevalence in Africa is the highest in the world, which exposes this continent to a number of significant risks. Although about 14.5% of the world's population lives in Africa, it is estimated to be home to 69% of all people living with HIV and 72% of all AIDS deaths occurred in that region. With approximately 22.9 million people infected, Sub-Saharan Africa is the worst affected region of Africa, as well as in the world. Moreover, the epidemic reaches very high levels in such countries as Swaziland, Botswana, Lesotho, Zimbabwe, Zambia, and Namibia. Yet, the impact of the syndrome is not only measured by the number of deaths. In Africa HIV/AIDS has a significant negative influence on various sides of the peoples’ life such as life expectancy and productivity,  households’  prosperity; evolvement of  healthcare, education and economy (“HIV and AIDS in Africa,” 2013). Furthermore, the population growth in Africa has stopped and prenatal mortality grew dramatically. The life expectancy has fallen to 49 years in South Africa, whereas it is 78 years in Europe and North America. It was reported that the annual costs associated with sickness and reduced productivity as a result of HIV/AIDS ranged from $17 per employee in a Kenyan car manufacturing firm to $300 in the Ugandan Railway Corporation. These costs reduce competitiveness and profits (Dixon, 2002, para. 6). What is more, there is a possibility of extinction of the whole country caused by HIV/AIDS. The infection rate in Swaziland is unprecedented and the highest in the world at 26.1% of all adults and HIV/AIDS currently causes 61% of all deaths in the country; thus, United Nations Development Program has states that if the expansion continues unabated, the existence of this country will be questioned (Kaiser Family Foundation, 2008, p. 2).

On the other hand, a popular viewpoint is that Africa cannot be provided with help. Some scientist state that there is too little resources available in order to provide treatment for such a large number of people in Africa. In 2003 only 50 000 out of 4 million people, who needed antiretroviral agents, were able to receive it. Moreover, other countries have limited resources and own problems to solve; therefore, it might seem that those countries do not have well-grounded reasons to spend their resources on solving Africa’s problems. For example, there is no adequate water supply and proper sanitation in India, overpopulation is spreading in China and default may take place in the European Union.

Nevertheless, as the evidence shows, Africa is making a progress in combating HIV/AIDS and it has to be helped. HIV/AIDS can be effectively treated and prevented not only in other regions of the world, but in Africa as well, even though it is one of the economically poorest regions. Actually, as an example may serve the “Africa Dream Project”, which is being implemented in some African countries and provides treatment to numerous HIV-positive people (“Projects,” 2011). In addition, nowadays the globalization is taking place; consequently, the problems become more and more globalized as well. It has been widely recognized by the leading scientists that the changes in one region greatly contribute to the changes in other regions; hence, African HIV/AIDS epidemics is not only an African concern, but should be addressed by the world in general.

On the basis of considerations provided it can be concluded that the misconceptions are frequent and refusal to assist Africa on combating HIV/AIDS epidemic appears to be illogical, because it is being caused by and has consequences for the whole world; thus, not taking action now might result in a more serious widespread pandemic in the future. In order to prevent it and save the health of its populations, the world’s community should provide various types of aid to Africa more consistently in order to help it to combat HIV/AIDS.

Effective Ways to Combat the HIV/AIDS Pandemic

 Finally, common misconceptions also concern the most effective tactics in combating the HIV/AIDS pandemic all over the world, especially in Africa, where the resources are limited and actions are urgently needed. In the article “Cost-Effectiveness Analysis of Strategies to Combat HIV/AIDS in Developing Countries” Daniel Hogan and his colleagues present the background and process of a carried out research on cost-effectiveness of various alternatives to combat HIV/AIDS in developing countries and the results of such research. In order to find the most cost-effective strategy the authors estimated the costs and health effects of a range of preventive and treating interventions. The authors explain that, since one of the United Nations millennium goals is to decrease the spread of HIV/AIDS, a number of interventions are being introduced. The evaluation of their cost-effectiveness becomes highly significant due to scarce resources available. Because of the limited data provision, the researchers restricted their analysis to sub-Saharan Africa and South East Asia and all the interventions were modeled. Overall, the results of the research indicate that, due to the mentioned above major ways of HIV transmission, the reduction of such transmission can be most efficiently launched through interventions for sex workers, treatment of sexually transmitted infections, and mass media campaigns, in case that little resources for an intervention are available. In addition, if more resources were allocated, it would have been even more cost-effective to prevent mother to child transmission, perform voluntary counseling and testing, and begin the school based education. Moreover, on the basis of the outcomes of the analysis the researchers conclude that the antiretroviral therapy is at least cost-effective among the all mentioned alternatives (Hogan et. al, 2005). Thus, this research contradicts the misconception that the pandemic cannot be effectively treated and no additional resources are needed by Africa.

Conclusions

Overall, as can be concluded, the misconceptions are common not only for countries’ population, which is often not being properly informed and educated about HIV/AIDS, but also for the political actors and researchers, who have professional interest in this topic. The most frequent misconceptions concern HIV and AIDS distinguishment, types of HIV; the certainty of the data about HIV/AIDS prevalence and its ways of transmission; effective ways to combat the pandemic and Africa’s ability to combat it. These misconceptions contribute to the increasing infection of population and prevent an effective HIV/AIDS combating, since for an effective decreasing of the HIV/AIDS prevalence among the world population adequate evidence is essential. Moreover, various bias and stereotypes play a key role in creating such misconceptions. Yet, such misconceptions can be discarded by the informing of public and collecting the research results, which will be also controlled for uncertainty. Moreover, the discussed evidence proves that effective practices exist, but more resources are urgently needed for the resultative overcoming of the HIV/AIDS pandemic, which has become a worldwide problem.

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