Early in the epidemic, the public perception of AIDS as a most fatal chronic illness with a rapid downward trajectory was crystallized. as early as 1991 in the medical sociology literature, a number of investigators were already discussing HIV/AIDS as a chronic illness thereafter, most of psychosocial investigations of small groups of long-term AIDS survivors appeared in the literature, although these cases were still seen as infrequent exceptions. It was not until the advent of protease inhibitors in 1996, which ushered in the era of highly active antiretroviral therapy (HAART), that the view of AIDS as an acute illness became widely accepted. These medications were touted in the mass media as ‘miraculous’ due to the fact that they reduced the risk of opportunistic infections and extended survival by suppressing viral replication and increasing CD4 cell counts. Their availability was said to have “reinserted the word ‘hope’ into the discussion about AIDS for the first time in a decade of treatment trials” and to have offered infected individuals the opportunity for a “second life” Among those at advanced stages of the disease, recoveries have often been so dramatic that they have been dubbed the ‘Lazarus Syndrome’, referring to the rising from the dead, made possible by these new treatments.¹

Origin of AIDS:

Although mass vaccination programs have resulted in the eradication of a lots of human infectious diseases, vaccine contamination has been a persistent concern. In particular, it is now known that the early polio vaccines were contaminated with at least one monkey virus, SV40. The transfer of monkey viruses to man via contaminated vaccines is particularly relevant to the acquired immunodeficiency syndrome (AIDS), as the causative agent of AIDS human immunodeficiency virus (HIV), is considered to be derived from a simian precursor virus. Further, human infection with this virus appears to be a relatively recent event. We hypothesize that the AIDS pandemic may have originated with a contaminated polio vaccine that was administered to inhabitants of Equatorial Africa from 1957 to 1959. The mechanism of evolution of HIV from this vaccine remains to be determined.

Symptoms:

AIDS patients present with some symptoms common to all patients with advanced disease, such as pain, nausea and fatigue. However, patients with advanced AIDS also present with unique and challenging symptoms and pain syndromes. This is especially where the large number of patients still does not have access to antiretroviral therapy (ART). Some common symptoms include fever, Headache, rash, swollen lymph glands, diarrhea, weight loss, muscle aches and joint pain.²

Age distribution of AIDS

Antiretro Viral Therapy:

The introduction of highly active antiretroviral therapy (HAART) has produced a dramatic reduction in mortality among HIV-infected individuals Whereas the level of adherence to HAART is closely associated with suppression of the HIV viral load in plasma a relationship between adherence and disease progression has not been established. Here we examine the relationship between pill-count adherence and progression to AIDS, in a representative cohort of homeless and marginally housed individuals.² Three hundred and thirty HIV-positive individuals were recruited into the Research in Access to Care in the Homeless (REACH) cohort between July 1996 and April 2000. We performed adherence assessments in 76 of the 81 (94%) individuals without AIDS who were taking HAART on or after January 1998. Pill counts are conducted every 3–6 weeks at the subject's usual place of residence (single room occupancy hotel, shelter, or other) on an unannounced day as previously described. The HIV-1 viral load was determined monthly and the CD4 cell count was determined quarterly. Record match, through the San Francisco Department of Public Health AIDS Surveillance Registry, was used to identify opportunistic infections not otherwise detected by study protocol. No patients were lost to follow-up during the study.² Spreading of aids The analysis of articles about AIDS published from 1982 to 1986 in 6 national French dailies sheds light on how the ‘AIDS social phenomenon’ was constructed during this period. The press passed information about this new disease from the medical domain into the public sphere. As the press circulated AIDS news (information) among various groups and emphasized the rapid extension and catastrophic proportions of this unforeseen ‘epidemic’, AIDS became an issue around which social relations polarized. The processes at work during the four phases of the construction of this social phenomenon are described: naming, comparisons with past epidemics, popularization of medical knowledge and symbolic values attributed to it, competition over claims to discoveries and patents, discourses about the other (in particular, homosexuals). During each phase, a concept or fact related to progress in the medical sciences served as the basis for attempts to make a meaning out of this new disease.³ The report discusses inter-related parts of blood transfusions systems, and presents an overview of the parts that need to be strengthened in Central Asia. Numerous parts are in serious need of organizational restructuring, new investment and increased budgetary support for operation and maintenance. This report sets them out such that each can be addressed in turn and some simultaneously. The report also discusses the health threat posed by alarmingly low levels of blood supplies, fostered by a culture that places little value on donating blood, public fear of being infected by giving blood, and the near absence of donor promotion campaigns.⁴

HIV:

Globally, approximately 38 million people live with HIV, and 1·7 million people are newly infected yearly.^{1, 2} Although new infections have substantially decreased since the peak of 2·9 million people in 1997, prevalence has steadily increased because of the successful scale-up of antiretroviral therapy (ART), increasing the lifespan of people with HIV.3 At current growth rates, over 42 million individuals will live with HIV by 2030.HIV disease burden disproportionately affects lower-income and middle-income countries (LMICs). This is evident in sub-Saharan Africa, a region that accounts for less than 15% of the global population but 68% of people living with HIV or AIDS and 57% of new infections. Although AIDS deaths have declined 46% since 2010, in southern and eastern Africa,5 sub-Saharan Africa is at an inflection point due to its burgeoning youth population, among the most vulnerable populations for HIV infection. These changing demographics could cause resurgence in new infections.⁶

Quality of life:

People living with HIV experience an overall lower quality of life. Individuals might cope with physical manifestations of HIV-related and treatment-related symptoms for extended periods, including fatigue, weight gain, pain, discomfort, and restricted mobility; even when on stable, long-term ART, individuals can experience comorbidities.7 People living with HIV also confront social and psychological challenges, such as the prospect of financial losses, depression, substance abuse, physical abuse, poor access to quality social support systems, and discrimination. AIDS as Sexually transmitted disease Industrial workers are a vulnerable population for HIV and sexually transmitted infections (STIs). This cross-sectional study assessed the general knowledge about sexually transmitted infections (STIs) and HIV transmission risk among 289 industrial workers in Northern Vietnam. Results indicated that most workers could identify common routes of HIV transmissions and were aware of common STIs. However, insufficient knowledge about HIV transmission via anal sex practices, as well as common signs and symptoms of STIs were observed. Gender, marital status, education, locality status and health information sources were associated with the knowledge. This study reveals a gap of knowledge about HIV and other STIs, and suggested further tailored education interventions to improve the knowledge and promote sexual health-seeking behaviors in industrial workers.⁸

Prevention:

At the individual level, treatment as prevention can significantly reduce the risk of HIV transmission and will likely remain a keystone biomedical strategy to reduce incidence. At the population level, however, the effect of ART as a prevention modality has been underwhelming, due in part to delayed treatment initiation, poor adherence, and limited access to treatment.9 More concerning, the ECHO study35 revealed high incidence rates among women in eastern and southern Africa with high ART coverage. Recent modelling suggests an HIV cure, especially one that protects from re-infection, could reduce HIV incidence; the effect would be most profound in scenarios with poor access and adherence to ART, PrEP and other interventions.36 Drawing from other sexually transmitted infections with high prevalence despite an available cure, the HIV cure agenda must actively engage people living with HIV to avoid perceptions of reduced risk or that discontinuing treatment will increase their chance of receiving a cure, factors that would mitigate the effect of a cure.

1. Dybul M, Attoye T, Baptiste S, Cherutich P, Dabis F, Deeks SG, Dieffenbach C, Doehle B, Goodenow MM, Jiang A, Kemps D. The case for an HIV cure and how to get there. The Lancet HIV. 2021 Jan 1;8(1):e51-8.
2. Nguyen DN, Vu HM, Nguyen QN, Nguyen CT, Do HT, Vu TM, Tran BX, Latkin CA, Ho CS, Ho R. Gaps of Knowledge about HIV and Sexually Transmitted Infections Among Industrial Workers in Northern Vietnam. AIDS and Behavior. 2022 Jan;26(1):188-95.
3. Dybul M, Attoye T, Baptiste S, Cherutich P, Dabis F, Deeks SG, Dieffenbach C, Doehle B, Goodenow MM, Jiang A, Kemps D. The case for an HIV cure and how to get there. The Lancet HIV. 2021 Jan 1;8(1):e51-8.
4. Marquez PV. Blood services in Central Asian health systems: a clear and present danger of spreading HIV/AIDS and other infectious diseases
5. Herzlich C, Pierret J. The construction of a social phenomenon: AIDS in the French press. Social Science & Medicine. 1989 Jan 1;29(11):1235-42.
6. Bangsberg DR, Perry S, Charlebois ED, Clark RA, Roberston M, Zolopa AR, Moss A. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. Aids. 2001 Jun 15;15(9):1181-3.
7. Norval DA. Symptoms and sites of pain experienced by AIDS patients. South African Medical Journal. 2004;94(6):450-4
8. Elswood BF, Stricker RB. Polio vaccines and the origin of AIDS. Medical Hypotheses. 1994 Jun 1;42(6):347-54.
9. Siegel, Karolynn; Lekas, Helen-Maria AIDS as a chronic illness: psychosocial implications, AIDS: Volume 16 - Issue - p S69-S76