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Biology 103
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The AIDS Epidemic in Sub-Saharan Africa

Katherine Kennedy

In 1979, the very first cases of AIDS appeared in New York. Cases of the disease that had never been seen prior to 1979, but is now considered more deadly than the bubonic plague, continued to surface in California and New York, almost exclusively in homosexual men. In 1981 the Center for Disease Control and Prevention (CDC) names the syndrome GRID, Gay-Related Immune Deficiency, but the stream of reported cases of those who contracted the disease through blood transfusions, and that of heterosexual women, shows that the disease in not limited to the homosexual population and the CDC renames GRID as AIDS, Acquired Immune Deficiency Syndrome, in 1982. Thousands of new cases a year in the early 1980s alarmed health officials around the world as they watched AIDS spread quickly throughout America, though it stayed mostly in urban areas, and scientific studies on the disease began almost immediately. (1)

What was discovered was that AIDS and the disease causing AIDS, HIV- Human Immunodeficiency Virus, is a human retrovirus. What this means is that the HIV virus attaches to the receptor sites of a healthy human cell. Then the virus penetrates the cell wall and empties its RNA into the healthy cell. Single strands of the viral RNA are converted into double stranded DNA by the reverse transcriptase enzyme. The new viral DNA is combined with the cell's DNA, infecting the cell. When the cell divides, the viral DNA is read and long chains of proteins are made and come together making new strands of the virus, which leave the infected cell. These new viruses mature and continue the circular process of the viral infection. (2)

After the infected cell reproduces the virus, it dies. HIV as a particular affinity for the body's immune cells known as CD4 cells, as the virus quickly moves throughout the body, it kills off the immune cells, making it difficult for the infected person's immune system to fight off disease or even small, otherwise harmless, infections. A healthy person has 1,000 CD4 cells (also known as T-cells) per micro liter of blood. The CD4 cells of those with HIV are dramatically, and continually reduced. When a person with HIV only has 200 CD4 cells per micro liter of blood their ability to fight off disease is almost completely lost. At this point they are considered to have full-blown AIDS. (2) People infected with HIV and AIDS do not actually die of either. Instead, what they do die from is opportunistic infections. These include fungal infections like pneumocystis pneumonia, meningitis, and tuberculosis. Others include members of the herpes virus family, cytomegalovirus (infection of the retina of the eye), and blood cancers. (3)

HIV and AIDS are spread in three major ways. The first is sexual contact with others that are infected. HIV is spread through bodily fluids such as semen, vaginal fluids, and blood, all of which can be exchanged during sex. The virus then goes to work in its new host, reproduces and kills off healthy CD4 cells. The second way is through contact with infected blood, in a way that does not include sex. This occurs when people who use injected drugs share hypodermic needles and syringes, or when health professionals are who are regularly exposed to contaminated blood either accidentally stick themselves with infected needles or expose open cuts to infected blood. Initially, at the beginning of the virus' appearance, there were cases of individuals who contracted AIDS from blood transfusions in the hospital. Prior to the discovery of AIDS, donated blood and organs went through very little screening for diseases, but after the AIDS scare and the thought that the nations blood supply could be contaminated, policies on testing blood were passed so this is no longer a major cause of the disease. The third way is from an infected mother to her unborn baby before and during birth, as well as from breast milk. (4)

When a person contracts HIV they probably will not find out immediately. Symptoms include fever, headache, sore muscles and joints, stomachaches, swollen lymph glands, and skin rashes. These all occur for about one to two weeks. Some people disregard the symptoms because most are not very extreme, or believe they have the flu, others have no symptoms at all. HIV immediately begins to reproduce in the body, but it can take weeks or months before the immune system begins to combat it with antibodies. However, once the body produces the antibodies the infected person will test positive for HIV. As the virus kills CD4 cells, and the immune system has a more difficult time sustaining itself, other symptoms of HIV will begin to appear and continue for weeks.(5)

In 1999, 5.4 million people in the world were infected with AIDS, adding to the 34.4 million people who are currently living with the disease. 2.8 infected individuals died in 1999, which is almost 15% of the total number of 18.8 million who have died with AIDS since the beginning of the AIDS epidemic. Alone these numbers are astounding, but perhaps the most upsetting set of statistics are that of the counties is sub-Saharan Africa. Today in Africa it is estimated that 24.5 million people live with HIV/AIDS. That is more than 70% of all of the HIV/AIDS cases in the world. (6) The rates of HIV infection in African countries range fro 13% to 36%. In South Africa, whose rate is 13%, 1,700 people contract HIV a day.

Unlike the instances of HIV in America, which still are predominantly linked to the gay community, or those of Eastern Europe, which are linked mostly to shared needles from a large drug culture, the cases in Africa are mostly heterosexuals who do not use injected drugs. Another great difference in the HIV situation of Africa compared with that of other countries is that more women in Africa are infected than men. In other areas, the spread of HIV to women has occurred more slowly. In Africa the spread of HIV/AIDS is mostly contributed to "poverty, ignorance, the prohibitive cost of AIDS drugs, an aversion to discussing sex and, some say, promiscuity." (7) Rapid urbanization and a mobile work force contribute to an astonishing rate of the spread of HIV. In larger cities, 40% to 50% of the population has HIV. Another issue leading to the extremely high rates at which AIDS is spread through the continent is the tendency of African men to frequent prostitutes, of whom, it is believed, 90% have AIDS. Also, lack of funds for drugs that help to inhibit the spread of HIV throughout the body gives way to superstition. "In some areas infected men believe they can be cured by having sex with a virgin, and 12-year-old girls become infected." (7) Also, most Africans that if a person looks healthy, they cannot possibly be infected with AIDS, and therefore, present no danger so unprotected sex is all right. (7)

Africans with AIDS now are mostly in their prime ages of productivity and reproductivity. As more and more Africans die with AIDS, the workforce is dieing as well. Often times two or three people are trained for the same job to make sure that at least one will be there for a while. It has been estimated that AIDS related deaths in Africa and the loss of such a great percentage of the population from the deaths of women of child-bearing age could mean that by 2010, sub-Saharan Africa will have 71 million fewer people than it would otherwise. (7)

But a more immediate problem than the future population of Africa is the issues dealing with the population now. 95% of orphans in the world are African, most of whose parents have died with AIDS. Children are left to grow up unaccounted for in the streets of villages, perhaps even young children of about 10 to 14 raising their younger siblings.

Today, people infected with HIV/AIDS take a number of drugs in order to suppress the spread of the virus. These drugs, combinations of nucleoside reverse transcriptase inhibitors, can cost up to $15,000 a year, a price that most people cannot afford in America's booming economy, let alone the poverty stricken, developing countries in sub-Saharan Africa. (8) While these drugs are incredibly effective, and increase the life span as well as the quality of life for those living with AIDS, most African governments cannot afford to spend the necessary money it would take to make these drugs more available to their citizens. For instance, the United States spends $10 billion a year on research, treatment, and prevention of AIDS for its population of 274 million, while African countries, with a population of 543 million, spend about $165 million. (9)

Recently, however, African scientists found that heating breast milk of an infected mother can kill the HIV infection, yet maintain the nutrients, meaning that an infected mother could potentially use her own milk to feed her child and not pass on the disease- saving money on drugs that would otherwise perform this function or would be wasted when given to a mother while pregnant so that she would not pass on the HIV but then would later breast feed and pass it on anyway. Another medical breakthrough that could save lives as well as money in the new AIDS vaccine, which will begin clinical trials in February. (10)

Monitoring, preventing, and attempting to cure the AIDS virus in Africa is of great importance to the future of the world. Though the sub-Saharan region is home to a very large population, it is only half of that of India and a sixth of that of China, two nations where the AIDS epidemic is just beginning to strike. We must be prepared to fight the same battle in those countries as is being fought now in Africa, and we cannot lose or the problems of Africa now will be the problems of the world in less than approximately 30 years.

WWW Sources

1. Acquired Immunodeficiency Syndrome

2. Retroviruses

3. Acquired Immunodeficiency Syndrome in depth

4. Acquired Immunodeficiency Syndrome, How HIV Infection Spreads

5. What Is AIDS?

6. Global Estimates of HIV/AIDS Epidemic As of End 1999

7. AIDS in Africa: Dying by the Numbers

8. FDA Approves HIV Drug Combo

9. Scarce Money, Few Drugs, Little Hope

10. South African Medical Council Announces AIDS Vaccine Trials




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