Introduction
Acquired Immunodeficiency Syndrome (AIDS) is a disease first discovered in 1981 and presented in a paper in the New England Journal of Medicine. Dr. Michael Gottlieb observed four homosexual men with no known connection to one another, presenting with the same two uncommon illnesses: Pneumocystis carinii pneumonia and cytomegalovirus infections, and generally compromised immune systems.
Although AIDS can be treated to extend a patient’s life expectancy, no cure currently exists. This is further exacerbated by the fact that the illness is heavily stigmatized due to its association with practices seen as immoral. As a result, AIDS went on to become a major pandemic, affecting large populations across the world.
The 1980s
In the first decade after its discovery in the U.S., people suffering from AIDS were heavily stigmatized and discriminated against. This is in part due to the risk groups for it being perceived as “undesirable” (Mehta & Quinn, 2016). Because of this, the government failed to address the spreading epidemic and suggest any ways of combating it, instead advising ineffective methods like sexual abstinence.
Despite mounting evidence for transmission vectors other than sexual or blood-borne, the public denied the dangers of HIV. For example, in 1988, an article in Cosmopolitan claimed that women were safe to engage in unprotected intercourse with HIV-positive men (Mehta & Quinn, 2016).
Initially, the newly-discovered syndrome was termed GRID: Gay-related immunodeficiency because its primary victims were male homosexuals (Grimm & Schwartz, 2018). The more descriptive modern term, AIDS, was established by late 1982. During the next few years, “4 H’s” were identified as risk groups for the new disease: homosexuals, heroin addicts, hemophiliacs, and Haitians (Mehta & Quinn, 2016). The existing stigmatization against the first two of these groups contributed to the negative public perception of people suffering from AIDS.
Religious stigmatization
Similarly, religious groups found the newly-discovered disease offensive for largely the same reasons. Homosexuality and drug use, two of the risk factors for contracting AIDS, are seen as sinful by many religions. Religious groups also maintain that a keeping a lifestyle that avoids such practices is crucial for one’s health. Therefore, such groups would blame the person suffering from the disease for contracting it, viewing it as a divine punishment for these behaviors (Reyes-Estrada, Varas-Díaz, Martinez-Sarson, 2015). This view spread to the U.S. culture at large and contributed to an exaggerated representation of the disease as a “gay plague” in the media (Labra, 2015).
Early efforts
Medical research of the disease progressed quickly, discovering methods of transmission besides sexual. Tragically, before it was discovered that HIV can be transmitted through blood, a significant percentage of hemophiliacs had been exposed to the virus through contaminated blood products. However, the U.S. government failed to provide any meaningful support, thus, the populace remained in denial. As illustrated by the Cosmopolitan article referenced earlier, the people refused to believe that they were at risk as much as those “undesirable” groups (Mehta & Quinn, 2016). This denial further contributed to AIDS’ spread as a major national epidemic.
Treatment
The first treatment for AIDS was actually discovered in 1964 (Rubin, 2015). The drug, called Azidothymidine (AZT), alternatively known as Zidovudine (ZVD) or Retrovir, was initially synthesized as a potential therapy for cancer. That experiment failed, but 20 years later, its antiviral properties made it a potential cure for HIV. Despite a high toxicity, it was approved by the Food and Drug Administration in 1987 as the first AIDS drug (Rubin, 2015). It significantly reduced the death rate and opportunistic infections, and further trials showed that AZT’s dosage could be lowered to reduce toxicity without compromising efficacy (Rubin, 2015).
Since 1987, HIV medication has advanced significantly, with over 25 new types approved by the FDA (Cihlar & Fordyce, 2016). This allowed to reduce mortality and morbidityto levels where a person with HIV lead a relatively unimpeded life for decades, given appropriate treatment (Cihlar & Fordyce, 2016). However, despite these advances, the virus cannot be fully eradicated, meaning that one is still dependent on a developed medical system for medication and updated treatment plans.
Treatment limitations
Despite being relatively effective, current treatment options for AIDS have their limitations. These limitations arise from the virus developing a resistance to medication after prolonged use, and the tolerability of individual drugs (Cihlar & Fordyce, 2016). Therefore, a patient’s treatment plan has to be chosen from a variety of available options, limited by “potential adverse effects, pill burden, dosing frequency, drug-drug interaction potential, resistance test results, comorbid conditions, and cost” (Cihlar & Fordyce, 2016, p. 52). Furthermore, as a patient’s condition changes, his or her plan has to be updated to account for these changes, necessitating frequent medical observation (Cihlar & Fordyce, 2016). Current research focuses on combating viral resistance and improving medications’ tolerability (Cihlar & Fordyce, 2016).
Treatment adherence issues
As noted, successfully controlling an HIV infection requires a personalized treatment plan and strict adherence to this plan. However, a major challenge for health care providers is ensuring this adherence in patients. The reasons for failing to adhere range from adverse drug effects of medication, social stigma, drug abuse and mental disorders, which are prevalent among people living with HIV (Bhatti, Usman, & Kandi, 2016). Finally, poor literacy and low socioeconomic status can also hamper a patient’s adherence to treatment (Bhatti et al., 2016).
PrEP
Currently, although HIV is still impossible to fully cure, a prophylactic method is available. Pre-Exposure Prophylaxis, or PrEP, can be achieved with a drug called Truvada, which has been approved by the FDA in 2018. Trials have shown these drugs, combined with safer sex practices, to be over 90% effective at preventing AIDS, provided a strict adherence to the regimen (Spinner et al., 2015). Therefore, the Center for Disease Control and Prevention (CDC) recommends prescribing this medicine to patients in risk groups (CDC, 2019).
PrEP complications
Despite PrEP’s availability, it is not being adopted as quickly as one might hope. A survey of gay men conducted in 2016 revealed that only 45% were even aware of the drug, and 39% were willing to use it, and only 1% actually did so (Grimm & Schwartz, 2018). The reasons for this slow adoption were concerns about possible side effects and the cost of medication (Grimm & Schwartz, 2018). Another study noted that there is insufficient information on PrEP to reach the risk groups.
PrEP stigma
A study by Grimm and Schwartz (2018) explored stigmatization regarding the use of PrEP among gay men. It found that although most interactions with their health care providers were positive, respondents generally had some experiences that could be interpreted as stigmatizing, although it was more related to homosexuality in general (Grimm & Schwartz, 2018). Curiously, this study also revealed stigmatization and distrust towards the users of PrEP by other gay man (Grimm & Schwartz, 2018). This stigmatization links the medication to promiscuity and sexually-transmitted infections (Grimm & Schwartz, 2018). Another misconception observed is that PrEP users are HIV-positive, thus extending general HIV stigma to them (Golub, Gamarel, & Surace, 2015).
Influence of religion
Today, religion is still an important factor in preventing, treating and controlling the spread of AIDS. Although in some cases, religious stigmatization of the condition is unchanged from the original moral panic in the 80s, religion can help patients with psychological well-being and coping (Reyes-Estrada et al., 2015). On the other hand, religious biases have been noted to affect health care professionals, as well (Reyes-Estrada et al., 2015) Therefore, health care providers should account for it when interacting with patients and examine their religious biases (Reyes-Estrada et al., 2015).
Current demographics
The incidence rate for HIV has been decreasing since the initial measures were implemented in the 80s. However, it has stabilized at about 39,000 new diagnoses per year (CDC, 2016). Most of these new victims are African American, Latino, gay and bisexual men (CDC, 2016). However, heterosexual people and drug users are represented in these statistics, as well (CDC, 2016). The CDC attributes this stabilization and population-specific trends to “effective prevention and treatment are not adequately reaching those who could most benefit from them” (CDC, 2016, p. 1).
Conclusion
AIDS/HIV has been since its emergence in the 1980s, and still remains a national epidemic in the U.S. Through its existence, it has been heavily stigmatized by religious and moral groups, which led to reduced awareness of the condition and worse outcomes. Although reduced, stigmatization remains, related to the condition itself and the populations affected by it. Currently, the incidence rate of HIV infections in the U.S. is stable, and additional measures are needed to decrease it further. Since most cases of AIDS are preventable, changes focusing on increasing awareness and facilitating prevention, are key towards this improvement.
References
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Centers for Disease Control and Prevention (2016). HIV Incidence: Estimated Annual Infections in the U.S., 2010-2016.
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