HIV/AIDS

Partly because of its unique relationship to gender inequality and cultural conceptions of sexuality, HIV/AIDS is one of the most difficult public health issues. It is also one of the most challenging medical conditions to treat clinically. Infection with HIV most commonly begins with transmission of the virus during unprotected sex. Children who are born to an HIV-infected mother can become infected with the virus during pregnancy, childbirth, or breastfeeding. HIV can also be transmitted through contact with contaminated blood, a transmission route most often associated with the sharing of needles by injection drug users. Transmission of HIV during transfusions of contaminated blood or blood products has become increasingly rare as screening and heat treatments have been introduced. There is no evidence of HIV being transmitted through kissing, casual contact, or insect bites.

In the United States, HIV disease is commonly divided into four stages. In the acute infection or primary infection stage, flulike symptoms may be experienced for several weeks immediately after exposure. This first stage is the most infectious because the body contains the highest amount of virus that it ever will. However, the body's immune system does not create antibodies during the primary stage, so an HIV antibody test would likely be negative. The second stage is asymptomatic and lasts an average of 10 years.

[Page 426]The HIV virus is not latent during this stage because, although there are often no symptoms, the virus is actively reproducing, gradually diminishing the body's ability to respond to infections. The third stage is early HIV disease, where one or more opportunistic infections may occur. Opportunistic infections appear when the body's immune system is suppressed, causing symptoms such as fever, diarrhea, thrush, loss of vision, neurological dysfunction, skin disorders, respiratory problems, and other pain and discomfort. Opportunistic infections account for about 90 percent of all AIDS deaths and are caused by a variety of viruses, bacterias, and cancers. After further decline in the body's immune response and emergence of serious opportunistic infections and cancers, HIV infection progresses into its final stage, advanced HIV disease or AIDS. The progression of the disease is most commonly measured by the amount of virus on the body (viral load) and the body's immune function (CD4 or T-cell count).

There is no cure for HIV/AIDS. Without treatment, it takes an average of 10 years for primary HIV infection to progress into full-blown AIDS. The recommended treatment for HIV/AIDS in the developing world is Highly Active Antiretroviral Therapy (HAART), which consists of a combination of potent drugs designed to suppress the growth of the virus. HAART has successfully reduced the number of deaths caused by HIV/AIDS and helped improve the quality of life for those living with the disease. However, treatment with HAART is expensive, can cause a number of side effects, and requires almost perfect adherence to be successful. Treatment for HIV/AIDS is made even more complex because the HIV virus is able to mutate, making particular drugs and classes of drugs ineffective. Gender inequality plays a particularly important role in the effectiveness of HIV/AIDS treatment and prevention efforts because those most affected by the disease face invisibility, stigmatization, and racial and cultural stereotypes about sexual behavior. Although women are now recognized as being hit harder by HIV/AIDS than men are, the disease emerged with a strong association with gay male sexuality that, in part, obscured the unique risk the disease poses for women. This entry discusses issues and challenges for society regarding HIV/AIDS.

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