Human immunodeficiency virus, or more commonly HIV, is a deadly and destructive infection that has plagued our world from, potentially, the late 1800s onward. Researchers believe that HIV can be traced to a type of chimpanzee in West Africa and that contact with their blood through hunting is what allowed the virus to enter the human population. HIV and AIDS came to North America in the mid 1970s and in 1981 appeared on the global medical radar when the level of infection was out of control and the pandemic and pandemonium began. As fear of this unknown killer virus spread through the Western world people began to look for answers, solutions, and wrongly, someone to blame. The scapegoat for HIV and AIDS in the 1980s and into today has been homosexual men as this was a major population the virus infected, while this was entirely false the discrimination still exists and is still stigmatizing. In reality, there are several risky behaviours that put someone at risk for infection with HIV. Also, transmission occurs because the individuals partaking in these behaviours are unaware that they are infected with the virus or that the people they are engaging with are. Unfortunately, the spread of HIV is only one of the problems in this discussion, the treatment of HIV and AIDS and the funding required are an entirely separate demon. This is merely an introduction to one of the most controversial and unsettling discussions our world has had and will continue to have as the fight against HIV and AIDS goes on.
This past Wednesday evening I had the pleasure of attending one of the Stephen Lewis conversations, which is an ongoing series of discussions put on by the Faculty of Community Services and Ryerson University in collaboration with the Planetary Health Commission. The discussion, co-hosted by Dr. Alan Whiteside, was on the AIDS pandemic and where we are now in its development. Stephen Lewis is currently a professor of distinction at Ryerson and at one time was the leader of the Ontario New Democratic Party, UN Secretary-General’s Special Envoy for HIV/AIDS in Africa, Deputy Executive Director of UNICEF, Commissioner on the Global Commission on HIV, Board Member of the International AIDS Vaccine Initiative, and the co-founder of the Stephen Lewis Foundation which works with community-based organizations in Africa that are trying to end HIV and AIDS. Dr. Alan Whiteside is an internationally recognized academic and AIDS researcher, he is the co-author of numerous articles and books regarding AIDS, and he established and is the executive director of the Health Economics and HIV/AIDS Research Division at the University of Natal in South Africa. These are two very short biographies of two very remarkable men who exposed some of the truths of this horrible disease to the world and continue to do so. Both Stephen Lewis and Dr. Alan Whiteside focus their HIV and AIDS work in Southern Africa where the virus is still rampant and where their discussion on Wednesday was localized. I will try to relate what was discussed so as to provide a better understanding for those who could not attend.
It is important to note that the vocabulary in health has changed; we say that people are living with HIV and yes that’s true in Canada, there are people living with HIV because they have access to medicine and can remain on that medicine. However, this vocabulary is not necessarily applicable to Southern Africa where people are dying from HIV, where it is still a threat as it once was in Canada. It is believed that HIV has killed over 30 million people since 1981, and that 2 million people are infected annually. According to the World Health Organization (WHO) 1.2 million people died from AIDS-related causes in 2014. HIV is a virus that we know how to prevent and control, and yet there are at least 6 million people infected with HIV in Southern Africa and 400,000 new infections every year. What is going wrong? Why is it that we have the answers but still haven’t solved the problem?
Looking at prevention, there are some very easy ways to slow the spread of HIV. As mentioned above there are certain risky behaviours that put us at an increased risk for HIV infection, these are most commonly having unprotected sex and sharing infected needles. The reason men who have sex with men (MSM) are more readily infected is that HIV is taken up by the body more easily during anal intercourse rather than vaginal. With the added dangers of not using a condom it is more than likely that an untreated individual with HIV will spread the virus to their partner. Unfortunately, the homophobia that is endemic to Africa does not help. Homosexuality is illegal in some African countries. Homosexuals are driven underground and fear death if they are outed, which makes access to medication even more difficult. Another risky behaviour is sharing needles with infected drug users. When intravenous drug users (IDU) shoot up, their blood enters the needle and is then passed on to the next user thus spreading HIV. IDUs have the highest risk of infection as they have direct blood to blood contact with HIV, this makes transmission extremely easy and the virus can spread throughout the community and beyond fairly quickly. One solution to this problem is safe injection sites, such as the Insite in Vancouver, which provides a clean space as well as equipment and medical staff to ensure that IDUs are safe while they are injecting themselves. It may seem odd to help someone inject themselves with illegal drugs that harm them, but these people are suffering from an addiction and still have the right to health. After all, they are still human and if they are going to use drugs we can at least make sure they are doing so safely and negating the spread of disease and avoiding potentially deadly overdoses.
Other at risk groups are sex workers, if they are having unprotected sex, and most notably women. In Southern Africa women are the population with the highest infection rates of HIV. The reason women have such high infection rates is because they face sexual violence. Women are often raped and abused sexually and this is the gateway for their infection. These women then have children and pass the infection onto their offspring, who will not live a long or enjoyable life if not given medication. Within the infected female population in Southern Africa, teenage girls have the highest rates of infection; they have 8 times the level of infection compared to boys in the same age group (15-18), again due to sexual violence. This is an at risk population that does not have an easy solution. How do you stop girls from being raped? Unfortunately, I don’t know the answer but I do know that if these girls are given medication and resources they can stop the spread of HIV to their children and other sexual partners and live a much better and longer life. If medication is the answer to this problem and we have the medication, then why is the disease still spreading. The answer is simply that these people are not getting the medication. They belong to stigmatized and oppressed groups that no one cares to think about and often are left to die. HIV infection is in itself a stigmatizing factor in Africa; add in the fact that you are a homosexual, a drug user, a sex worker, or a woman and people stop caring whether you live or die. Aside from the oppression that keeps people from their medication, there are rumblings that global AIDS funding given to African governments keeps disappearing after it is given out.
Corruption within African governments is not a new phenomena and it doesn’t seem to be going away. Both Stephen Lewis and Alan Whiteside commented on the way Southern African countries are run by their kings and while the King of Swaziland has a jet his people can’t seem to find their HIV medication. There are billions of dollars raised and donated to AIDS funds every year and for some reason the grassroots organizations in Southern Africa aren’t seeing this money. Where is it going? The United Nations (UN) stipulates that global AIDS funding needs to be distributed through HIV and AIDS committees which give the money to governments and presumably health departments to be used for medication, education, and the spread of resources so that infected individuals can live. However, people are still dying and being infected and kings are buying jets. Of course, some people in Africa are getting medication but money is still evaporating. The only way to determine where this money is going and to make sure it is going to the right places is through auditing. Neither Mr. Lewis or Dr. Whiteside knew why these governments are not being audited. What makes this reality even more terrifying is that AIDS funding is beginning to flatline globally. While the global funding is not going down very much it is not getting any higher and there is a risk of it beginning to diminish. Countries are slowly stagnating with their funding, such as the Netherlands which cut its AIDS funding by 1 billion Euros. Additionally, at the UN the funding for communicable diseases is starting to be targeted by non-communicable diseases as they begin to take a stronger chokehold on global populations. The funding pie is now being sliced for more diseases and more causes and this means that eventually HIV and AIDS will begin to lose funding. This leads into a much larger ethical discussion that is beyond my scope, but I will leave you with a question: how do you decide which diseases need more funding, how do you decide the cost of human life?
Dr. Whiteside did have one suggestion for the issue of AIDS funding and it was to be smarter about the way researchers and organizations go about asking for money and how it is spent. Dr. Whiteside was explicit in that governments should be responsible for the health of their constituents and that non-government organizations (NGO) should be there to pick up the pieces and to remind governments of the diseases that are being forgotten. Unfortunately, this is not the case in Africa at the moment. The grassroots organizations are the ones providing health to the people of Africa and the money is going to the government. So one solution is to get the money to the organizations on the ground and skip the corrupt kings and health ministers. How this will be done still needs to be determined.
In our society we don’t always think about the threat of AIDS. However, prevention is shockingly simple and that’s probably the more devastating side of this story. A simple condom or having access to safe and clean injection sites- in essence having harm reduction policies in place will protect us. HIV and AIDS have been devastating our world for over 30 years and they are not going away unless everyone takes the responsibility to be safe. Behaviour change is difficult and it takes time but isn’t it worth it? Isn’t your life worth wearing a condom?
HIV and AIDS are two topics that require lengthy conversation and attention and that is why I will be writing about them again in another post on December 1, World AIDS Day. In the meantime, to learn more about HIV/AIDS visit the Center for Disease Control and Prevention, UNAIDS, the Stephen Lewis Foundation, and the World Health Organization. One last side note, free condoms and lube are available at the Student Centre, as well as at Ryerson’s Medical Clinic (KHW 181). Outside of Ryerson but still close to campus there is the Toronto People with AIDS Foundation at Sherbourne and Gerrard and the Hassle Free Clinic at Church and Gerrard (above Starbucks) where free medical testing is also available.