Introduction
HIV (Human immunodeficiency virus) which leads to AIDS (Acquired Immune Deficiency Syndrome) is the most infectious disease that has emerged in more than a century. The human and economic impact has been most apparent in its area of origination, Sub-Sahara Africa where an estimated 24 million people are infected. In seven countries of this region, 20 percent of adults are HIV Positive. In the U.S., the disease was ignored when first discovered in the early 1970s. Even when HIV landed on American shores in 1981, the government did not acknowledge its existence for years. This slow response and general lack of concern by the U.S. is apparent today. Forty thousand new cases are reported every year but just how many people are infected is unknown because the system intended to track cases is flawed and unlikely to be remedied anytime soon. The social impact of HIV has been well documented and widely distributed which has served to educate the public and acted to stem the tide of the epidemic. However, there is a hidden cost that negatively affects business and the economy. This discussion examines the genesis of the virus, why it is difficult to control, the prevalence of infection, its economic impact and how businesses are following the government’s lead by ignoring the growing problem.
The Evolution of HIV Virus
Overview
Given the virus’ precedent for evolutionary transformation, awareness of the evolutionary aspects of HIV greatly assists scientists in controlling the disease. The prospects of realizing a viable vaccine for HIV have been often announced to be ‘soon in coming’ since the 1980’s but as yet none exists nor does a ‘cure’ seem to be forthcoming in the near future. HIV has not responded by succumbing to the human immune system or to bioengineered drugs which can be directly linked to its ability to rapidly evolve thereby evading natural and man-made antibodies (National Institute of Allergy and Infectious Diseases, 2007). Typically, a person who has recently contracted HIV will not progress to the stage where AIDS is diagnosed for up to ten years. This lengthy dormant period between the initial HIV diagnosis and full-blown AIDS has been a factor in the numerous problems in the area of diagnosis, treatment and control of the disease (“Progression of HIV Infection”, 2006).
Origination
HIV made an evolutionary jump from chimpanzees to humans. In all probability, the transfer occurred from using chimps as a meat source. The virus originated, however, in two types of monkeys which were consumed by the chimpanzees. A hybrid of the monkey virus (SIV) spread through infected chimpanzees and a mutated form was eventually transmitted to people in the form of HIV-1. As do chimps, humans carry two types of the disease. HIV-2 is the less virulent of the two. According to Paul Sharp of the Institute of Genetics at University in England; “Because of the similarity between chimpanzees and humans, any virus that successfully adapts to spreading among chimps would be a candidate for a further jump to humans, a potential HIV-3” (cited in Lovgren, 2003). To date, one percent of the world’s population has contracted HIV and the disease is responsible for taking the lives of nearly three million people in 2005 alone.
Treatment
Because of HIV’s ability to evolve at such a massive pace, it quickly counters selective treatments. The HIV cells that survive the initial drug infusion multiply and their decedents carry the drug-resistant strain. This is the reason that patient drug therapy includes what is commonly referred to as a ‘drug cocktail’ (numerous types of HIV drugs used in tandem) which acts to delay the further evolution of the resistant HIV strains. If fewer of the ‘strong’ (resistant) cells survive, the less chance the disease will spread. This is but one of the fundamental evolutionary concepts used by biomedical researchers to fight AIDS. Another example of the evolution theory used to explain HIV mutations also concerns viral resistance.
If a non-resistant and resistant organism is placed in proliferation contest, all conditions being equal and without the assistance of drug therapy, the non-resistant organism will usually win. For example, HIV becomes resistant to a particular ‘cocktail’ of medications ingested by the infected patient. If this patient discontinues the prescription for a period of time, by utilizing the theory of evolution, it can be predicted that the HIV will again evolve reverting back to the non-resistant viral strain. When this same patient then increased their dosage of the original drug cocktail, the strategy has proven to stop the reproduction and greatly reduce the overall level of non-resistant viral cells. “Though this therapy has shown early, promising results, it may not eliminate HIV but it could keep patients’ virus loads low for a long time, slowing progression of the disease” (Zimmer, 2001).
Incidence and Prevalence
The incidence of a disease refers to the extent or rate of occurrence of the disease, especially as it applies to the number of new cases reported within a population over a specified period of time. The prevalence of a disease is closely related to this concept, also referring to the number of cases of a disease within a given population, but differs in that it refers to a specific time period rather than a period of time. Although incidence estimates are more informative about the effectiveness of prevention efforts as well as the likely future course of the illness, they are harder to determine than prevalence figures and numbers are usually further out of date.
“Prevalence data are useful for estimating the current burden of disease in the country and planning for demands on systems providing medical care and social services” (Osmond 2003). Part of the difficulty in obtaining accurate numbers exists in the deficiencies in the system itself. The United States does not have a single surveillance system established to track the infections, so researchers are forced to rely on the numbers that are available through state surveillance systems. Because not all of these systems track along with the same criteria, to the same degree, in the same way and not all states require the same degree of reporting, all estimates must be taken with a degree of error presupposed (Osmond 2003).
To illustrate this difficulty, Dennis Osmond (2003) indicated the minimum number of HIV-infected persons living in the United States through December of 2001 was estimated to be around 506,154, a number calculated by adding the total number of persons living with AIDS to the number of persons living with HIV as they were reported to the CDC (Center of Disease Control). However, he added that there are probably another 200,000 or more people who are living with HIV who have not been recorded within this system either because they have been tested at anonymous sites, they live in states that don’t require named reporting or because they have the disease but have not yet been tested. “CDC estimated HIV prevalence in the United States in 2000 between 850,000 – 950,000. A lower estimate is obtained if the 650,000 estimates for 1991 (midyear of sample collection) from the adjusted NHANES III data is projected forward to 2002 by the difference between annual AIDS deaths and the estimate of 40,000 new HIV infections each year. That calculation gives a prevalence of approximately 720,000 by the beginning of 2002. The current trend of about 20,000 deaths each year implies that prevalence is increasing by about 20,000 per year if the incidence is 40,000 per year” (Osmond 2003).
A Gay Man’s Disease
The number of HIV-infected persons in the U.S. would have been much lower had the government addressed the issue at its onset. The reason it didn’t was, in a word, prejudice. HIV was initially thought to be a ‘gay man’s disease.’ Many, including government officials, considered HIV to be a cure for homosexuality rather than a social disease. The 1980’s was a time period was that of intense bigotry regarding homosexuality to the point where a deadly disease that affected this group alone was widely considered as a curse rather than a disease. This was true to those of conservative thought especially. The film showed a clip of Reagan winning the election which personified the conservative swing the country had taken and one of Jerry Falwell, well known for his stance against homosexuality, announcing from the pulpit that God, in essence was punishing the homosexuals for their sins. A public statement such as this was not only tolerated by the public but was the consensus of the majority.
Intravenous Infection
Risk Factors
Drug use by injection is the cause of approximately one-third of all new AIDS cases in the United States each year. According to the Centers for Disease Control and Prevention (CDC), from 1981 to 1999, nearly 700,000 new cases of AIDS had been confirmed in the U.S. alone (“Trends”, 1998). This number has risen to approximately 800,000 cases today. Currently, the CDC estimates over one million Americans are HIV infected with approximately 40,000 new infections identified every year. Risk factors associated with intravenous drug use accounts for twenty-five percent of these cases. Hepatitis, a disease contracted by ‘dirty needle’ use affects more than four million Americans.
Women who have been infected with the HIV virus via the process of sharing previously used needles or if they have had sexual relations with a person who has been infected from IDU can possibly transmit the virus to their child either before or during childbirth birth or through breastfeeding. 36 percent of all AIDS cases can be traced to IDU when ‘mother-to-child HIV transmission and sexual contact with an IDU are taken into consideration. The Substance Abuse and Mental Health Services Administration approximates that “as many as 2.4 million Americans may be injecting drug users” (“Policy Facts”, 2001).
The connection between HIV, as well as other blood-born diseases, with the abuse of drugs via injection and the consequential spread to children and sex partners cannot be understated or refuted. The transmission of viruses can occur either directly, such as when an infected IDU shares the same needle with others, or indirectly, when an infected IDU shares injection equipment such as spoons, water or cotton, or when they use the same needle and drug with other IDU’s. Blood-born viruses are transmitted very efficiently through the practice of injection. A vitally essential approach in the prevention of disease transmission involves making certain that habitual IDUs have unrestricted access to sterile syringes (Guydish et al, 1993).
A Critical Health Concern
It has been estimated that each IDU uses the syringe approximately one thousand times per year. Even considering the number of IDUs in a medium-sized city, this amounts to millions of injections each year and a similar number of syringes. “Most IDUs who continue to inject are currently unable to obtain a sufficient number of sterile syringes to effectively reduce their risks of acquiring and transmitting blood-borne viral infections” (Lurie, Jones, & Foley, 1998). Access to syringes continues to be a critical health concern. Another concern is the method by which IDUs normally obtain their syringes when alternatives such as NEPs or legal purchases from pharmacies are not possible. They must go through illegal, ‘black market’ sources such as drug or needle dealers, from friends, ‘drug dens’ or from diabetics. Syringes obtained from these sources may or may not have been used or be sterile. Used syringes may be repackaged and sold as new while being contaminated with infected blood. If a NEP is not available in a community, the legalization of syringes sold by pharmacies without a prescription would be of some help in alleviating the problem (Gleghorn et al, 1995). “Most states have legal restrictions on the sale and distribution of sterile syringes” (Gostin et al, 1997).
Needle Exchange Programs
Many studies in the U.S. and various foreign countries have concluded that needle exchange programs (NEPs) are indeed effective in the reduction of HIV and other viral transmissions among drug users. An exemplary example can be found in Southern Australia where 55 NEPs serve a population of 1.2 million. This region of the world has experienced no new cases of HIV infection among IDUs over a three years period. In Hawaii, HIV infection rates among IDUs declined dramatically after a NEP was introduced. In 1989, the rate was five percent but had dropped to just one percent seven years later in 1996. Following the closure of a NEP in Connecticut, a reported increase resulted in the sharing and re-use of dirty syringes among IDUs, hardly a surprising cause and effect revelation. This, of course, caused an increased risk of deadly virus transmissions. (“Policy Facts”, 2001).
HIV and the Economy
The HIV epidemic is a contagious disease that affects more than just the tens of thousands of people infected by it every year in the U.S. It undermines the overall health of multiple societies, negatively affects consumer markets, diminishes the availability of personnel and can sharply reduce business’ ability to be profitable. Because of the unpredictable nature of HIV and the government’s lack of response in combating the disease, it is now negatively impacting the country’s economic progress.
Workplace Woes
Despite the long-standing reality of HIV and AIDS within the greater community, it is apparent that there still exist several misconceptions and glaring shortfalls in how the community, especially the workplace, is responding to the illness. Many employers, especially small employers, have failed to realize the enormity of the disease as well as the guidelines regarding employers’ responsibilities designed to assist employees diagnosed with one of these diseases remain in the workforce as well as to help employees without it become educated about the illness and how to prevent its spread.
Because of the higher morbidity and mortality rates associated with HIV, no sector of the economy is immune to the impact particularly in terms of reducing the available productive and skilled labor and investment. The combined effect of this is to increase the broader service and production costs to business. “Since the infection rate is highest among people in the prime of their working life – 15 to 49 years – the economic and social impact of the epidemic is disastrous” (Hodges 2004). Although half of the companies interviewed said they regarded HIV to be likely to affect their workplace at some point in the future, Mervyn Davies says “the majority of firms questioned do not think about having an HIV policy until prevalence in a country in which they operate affects more than one in five people” (cited in Bloom et al, 2006). The study further suggests that while many companies anticipate HIV will have some kind of impact on their business in the future, most have not worked to identify how their work will be affected nor have those in less concerned countries, such as the United States, worked to establish formal policies within their organizations to address the issue. Davies, writing the preface for a special report on business and HIV (Bloom et al 2006), says “the stark message from the Executive Opinion Survey is that businesses are doing too little, too late in the battle against HIV/AIDS.”
How does this affect the workplace?
Employers Headaches
For many business owners, especially small business owners, the idea of adding one more responsibility to an already overflowing plate in terms of caring for employees seems a little daunting. However, studies conducted over the past 25 years regarding the spread of HIV and AIDS have proven that “where business, government and populations work together, the spread of HIV and AIDS can be slowed and infections reduced” (Roedy quoted in Bloom et al 2006). Mervyn Davies, writing the preface for a special report on business and HIV/AIDS (Bloom et al 2006), says “the stark message from the Executive Opinion Survey is that businesses are doing too little, too late in the battle against HIV/AIDS.”
Employee Remedies
All businesses are required to comply with state and federal civil rights laws that often apply to those suffering from HIV or the AIDS infections. These include Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA) of 1990. “The Americans with Disabilities Act of 1990 (ADA) prohibits discrimination against people with disabilities. Under the law, persons with HIV infection are entitled to the same rights and opportunities as persons with other communicable diseases” (Department of Justice, 1990). In addition, employers are expected to make reasonable accommodations so that people with disabilities, including those with HIV/AIDS, are able to remain employed and productive for as long as they can possibly perform the essential functions of their jobs. This could include the assignment or reassignment of job duties, allowing employees to work at home on a temporary basis, allowing both paid and unpaid leaves of absences and accommodating a flexible work schedule.
Conclusion
For nearly a quarter of a century, researchers have tried unsuccessfully to develop an HIV vaccine but the ever-evolving, mutating virus has been exceptionally persistent. Had the governments of the world including and especially the U.S. reacted in a more timely manner when the disease was first identified, the medical community may have by now caught up with this extremely evasive and devastating virus. A policy specifically addressing HIV/AIDS in the workplace should be included in all companies to help deter the spread of the illness. Although risks might be considered to be low in a small business setting, being prepared and having a plan to begin with can help prevent accidents in the future and education programs can go a long way toward keeping current and future employees safer as they achieve a greater understanding of the risks. The American people have overwhelmingly offered their support for NEPs and numerous scientifically conducted studies have proven their effectiveness in reducing the transmission of viruses but, as is so often the case in this country, special interest groups control the actions of congress. The ignorance and fear of the few continue to cause untold harm to the many.
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