HIV/AIDS: Global Health Impact, Stigma, and Quality of Life

HIV/AIDS Prevalence and Medical History

HIV/AIDS was identified as a disease in 1983 when the laboratory of Dr. Luc Montagnier at the Pasteur Institute in Paris and the laboratory of Dr. Robert Gallo at the National Cancer Institute in Washington, D.C., independently determined that the human immunodeficiency virus (HIV) was the causative agent of Acquired Immunodeficiency Syndrome (AIDS) (Chermann, 1983; Barre-Sinoussi, 868). At the time of the disease's discovery, more than 4,000 patients in the United States had been diagnosed with HIV/AIDS, and no effective treatment existed. By 1993, approximately 332,468 patients had died from the disease.

In 1986, the first antiretroviral compound proven to be effective received approval from the Food and Drug Administration (FDA). The compound, a thymidine analogue known as azidothymidine (AZT), inhibited HIV replication by terminating reverse transcription—a critical step in the virus lifecycle. However, by 1989, it became clear that the benefits of single-drug treatments were only temporary, owing to the rapid emergence of drug-resistant viral variants (Larder, 1731). The development of HIV inhibitors in the early 1990s targeting both reverse transcriptase and protease led to combination drug treatments that proved more effective for the long-term control of HIV infection (Cheeseman, 141).

Three or more drug combinations became known as Highly Active Antiretroviral Therapy (HAART). Due to the success of HAART, there was a sharp decline in AIDS-related deaths in the United States. Nevertheless, the number of newly HIV-infected individuals continued to rise. Approximately 33.3 million people worldwide were living with HIV at the time of this writing, and an estimated 20 million deaths had occurred from the disease. Sub-Saharan Africa remains the most severely affected region, where AIDS is the leading cause of death, while globally it has been identified as the fourth largest killer (UNAIDS, 2).

Economic Impacts and Global Spread

Many countries lack the funds needed to obtain sufficient quantities of antiretroviral medications and lack the patient care infrastructure necessary to administer these treatment regimens and educate patients about HIV/AIDS prevention. As a result, their societies are most threatened by the disease pandemic. In more developed nations, the emergence and spread of combination drug-resistant HIV variants has complicated efforts to control the epidemic. Prevention of antiretroviral drug resistance requires at least 90% patient adherence to HAART (King, 2046).

HIV/AIDS had become a global epidemic by the mid-1980s. Medical and public health communities in different countries began recognizing the disease between 1981 and 1984. In the United States, the earliest cases appeared in 1981, when young gay men visited medical clinics exhibiting symptoms of Kaposi Sarcoma (KS) and Pneumocystis carinii pneumonia (PCP) (CDC, 1981). In the years that followed, the number of people with AIDS in the United States grew from 7,239 in 1984 to 160,969 in 1990 (amfAR.org, 1). Medical doctors in Kenya were among the first in Africa to describe HIV/AIDS. In their article "Acquired Immunodeficiency in an African," Obel described a case intended "to alert medical practitioners to the possibility of AIDS occurring in Africans and to emphasize the point that no race may be exempted from this highly lethal syndrome." The Kenyan HIV prevalence rate reached 14% during the mid-1990s but has since stabilized to 6.3% (USAID, 2011).

The Centers for Disease Control and Prevention (CDC) reported that at the end of 2003, between 1,039,000 and 1,185,000 adults and children in the United States were living with HIV or AIDS, and that approximately 24–27% of these individuals were undiagnosed and unaware of their serostatus. By the end of 2005, an estimated 341,524 males, 126,964 females, and 6,726 children under 13 years of age were living with HIV or AIDS in the country. Americans aged 40–44 years (101,027) and non-Hispanic Black Americans (224,815) accounted for the highest numbers of persons living with HIV or AIDS (PLWHA). Male-to-male (MTM) sexual contact remained the number one mode of transmission, followed by high-risk heterosexual contact, injection drug use (IDU), and a combination of MTM sexual contact and IDU (CDC, 2007).

Research, Development, and International Response

The AIDS International Research and Training Program (AITRP) was designed in response to the Institute of Medicine report Confronting AIDS, published in 1986 (Bridbord, 2007). This report was intended to advise the U.S. federal government on a national HIV/AIDS response. It outlined the international dimensions of the epidemic, including its impact on foreign policy and research (Institute of Medicine, 2), and emphasized the need for international HIV/AIDS research collaborations with researchers from low-resource countries. The report highlighted the importance of involving multiple disciplines, generally falling into four fields: biostatistics, biomedical research, epidemiology, and socio-behavioral research. Meeting this need for research expertise, both in the United States and abroad, required the engagement of higher education. The AITRP was designed to facilitate that engagement. As the global health arm of the National Institutes of Health, the Fogarty International Center (FIC) designed and administered the AIDS International Research and Training Program.