HIV AIDS

Marsico

Essential Issues

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Essential Issues

K a t i e

M a r s i c o

HIV/AIDS

Biographies, historic events, current debates, and social issues are all an essential part of the curriculum. Readers can meet these research needs with the Essential Library, a well-researched, well-written, and beautifully designed imprint.

HIV/AIDS

A B D O

Essential Issues

Essential Issues

H Essential i v /AIssues id s

Content Consultant Josh Ruxin, Assistant Clinical Professor of Public Health Department of Population and Family Health Mailman School of Public Health, Columbia University

Essential Issues

credits Published by ABDO Publishing Company, 8000 West 78th Street, Edina, Minnesota 55439. Copyright © 2010 by Abdo Consulting Group, Inc. International copyrights reserved in all countries. No part of this book may be reproduced in any form without written permission from the publisher. The Essential Library™ is a trademark and logo of ABDO Publishing Company. Printed in the United States of America, North Mankato, Minnesota 102009 012010

Editor: Melissa Johnson Copy Editor: Paula Lewis Interior Design and Production: Kazuko Collins Cover Design: Kazuko Collins Library of Congress Cataloging-in-Publication Data Marsico, Katie, 1980HIV/AIDS / Katie Marsico. p. cm. — (Essential issues) Includes bibliographical references and index. ISBN 978-1-60453-955-4 1. AIDS (Disease)—Juvenile literature. 2. AIDS (Disease)—Social aspects—Juvenile literature. I. Title. RA643.8.M365 2010 362.196’9792--dc22

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H i v /A i d s

table of contents Chapter 1

Left Lonely in Uganda

6

Chapter 2

Overview of a Pandemic

14

Chapter 3

Breaking Families

26

Chapter 4

HIV and the Cycle of Poverty

38

Chapter 5

HIV in the United States

50

Chapter 6

How Prejudices Take a Toll

62

Chapter 7

Prevention and Treatment

74

Chapter 8

Offering Hope

84

Timeline

96

Essential Facts

100

Additional Resources

102

Glossary

104

Source Notes

106

Index

109

About the Author

112 •5•

Chapter

1

Millions of children in Africa are orphans because their parents have died from HIV/AIDS.

Left Lonely in Uganda

I

t seemed as though 19-year-old Zahara Nakibuule had nothing but a bright future ahead of her. A June 2009 article in the San Francisco Chronicle reported that she had recently graduated from a well-respected college preparatory school

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H i v /A i d s not far from San Francisco, California. She enjoyed spending her spare moments with friends and looked forward to going to college in the fall. However, life had not always been so happy for Nakibuule. Nakibuule had arrived in the United States seven years earlier after leaving the village of Mbikko, Uganda, in eastern Africa. She was an AIDS orphan. This term refers to a child who has lost HIV as Normal one or both parents to Acquired In countries such as Uganda, HIV is so Immunodeficiency Syndrome widespread that some health-care officials worry (AIDS). AIDS is a disease caused by that people are becomthe Human Immunodeficiency ing too accepting of the virus and its role in dayVirus (HIV), which weakens the to-day life. “People now think that because we body’s ability to fight infections and have had HIV for so tumors. When Nakibuule was only many years, it is a normal condition among the five, her father died of AIDS. Her population,” explained Kihumuro Apuuli, direcmother worked two jobs to support tor of the Uganda Aids Nakibuule and her two brothers, but Commission (UAC). then she also died from the disease in October 2000. Nakibuule, then ten years old, was taken in by a relative—one of a handful of surviving aunts and uncles 1

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Essential Issues who were also infected with HIV and falling ill from AIDS. Her aunt took care of eight other children. Their village was gripped by poverty. Some days there was nothing to eat. Many families in Mbikko also coped with illness on a day-to-day basis. Nakibuule later explained that she attended AIDS-related funerals in Uganda so often that she and her friends regarded them as social gatherings. She recognized the countless children in her village who were sick with AIDS by their bulging eyes and painfully thin faces. In 2007, approximately 11.6 million AIDS orphans were living in sub-Saharan Africa. As of 2007, health-care experts estimated that approximately 940,000 Ugandan citizens were infected with HIV. The epidemic in Uganda, which has a total population of approximately 30 million people, had already killed as many as 1.6 million other residents. As local journalist Jannifer Bakyawa reported in June 2009, “If someone in Uganda tells you they haven’t been affected by HIV/AIDS, they’re lying.”2 Nakibuule escaped this legacy of suffering. A couple from Danville, California, met her through a nonprofit group that raises funds to sponsor AIDS •8•

H i v /A i d s orphans. They adopted Nakibuule in 2002. Despite the new family and opportunities that Nakibuule found in the United States, she will not likely ever forget her past or the impact that AIDS has had on her life. She recalled a grim nursery rhyme that she sometimes recited as a child. The lyrics are all too familiar to Africa’s youth: AIDS, AIDS, you’re unfair to me. . . . AIDS, AIDS, you’re unmerciful to me. . . . AIDS, AIDS, you left me lonely, you took everyone I had. . . . Oh, AIDS, I am left lonely in this world.3

The Issues surrounding a Pandemic Nakibuule’s experiences in Uganda were far from unique. She is one of approximately 1.2 million AIDS orphans in that African republic. In some countries in Africa, more than one in four adults

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Sub-Saharan Africa Of the 33 million HIV cases reported in 2007, approximately two-thirds were from sub-Saharan Africa. This region includes all of the African continent that lies south of the Sahara Desert. People who live in this region often face poverty. The governments of these countries struggle to reform health care.

Essential Issues is HIV positive. However, the virus affects people from a wide variety of ages and ethnic backgrounds around the globe. Studies in 2007 showed that approximately 33 Adapting to Life without HIV million people Like many AIDS orphans who rebuild their worldwide were lives in other parts of the world, Nakibuule infected with experienced a period of adjustment. Once in HIV. In that year, the United States, she had to get used to an environment where hunger, sickness, povapproximately erty, and death did not shape her community. 2.7 million Nakibuule admitted that the transition was a challenge. “It still gets to me when I see one more individuals of my friends leave food on their plate,” she contracted the explained. “I came from a place where eating was day-to-day. I’d go to the garden with my virus. At least mother every day to see what we had. And 2 million people some days, there was nothing.” die from AIDS Nakibuule acknowledged that she had a different perspective on death while she dwelled each year. in Uganda. There, HIV-related funerals seemed Because so like social outings to children. “They were like get-togethers with friends and family,” she many men, women, recalled. “As a kid, because you don’t know and children are what’s going on; they’re fun.” After several years in the United States, Nakibuule learned infected with HIV, to enjoy spending time with her friends in hapit is considered a pier settings. But she acknowledged that her global pandemic. life in Africa and her experiences with HIV will always be a part of who she is. “When you Doctors have no adapt, you lose a little piece of yourself,” she cure for HIV or reflected, “but it’s good, as long as you recognize it was once there.” for AIDS. Some 4

5

6

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H i v /A i d s treatments lessen the symptoms, but these are not always available in poorer areas such as Nakibuule’s childhood village. Although AIDS causes many deaths, physical health is not the only issue at stake. Nakibuule and others like her are living proof that this virus destroys families and sometimes entire communities. In addition, people who are HIV positive may face misunderstanding and judgment. People who do not understand HIV might make incorrect assumptions about how A Spreading Disease HIV is spread. This creates extra While the largest epidemchallenges for individuals who are ics are in sub-Saharan Africa, the disease is trying to cope with the virus. emerging quickly in Society has sometimes Eastern Europe and Central Asia. The number of discriminated against people who people in these areas who tested positive for the have HIV or AIDS. At times, HIVvirus rose by 150 percent positive individuals may have to fight between 2001 and 2007, threatening millions of for fair treatment in their classrooms, lives. workplaces, or communities. Human-rights organizations and community educators work to teach the public about the virus, both to prevent its spread and to improve the • 11 •

Essential Issues quality of life for those who live with it. Educators’ efforts—along with those of nurses, doctors, government officials, and patients—all reflect the many complicated issues surrounding HIV.

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H i v /A i d s

The red ribbon is a symbol of the fight against the AIDS pandemic.

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Chapter

2

Most scientists believe that humans first contracted HIV from chimpanzees.

Overview of a Pandemic

A

lthough HIV gained widespread recognition only in the last decades of the twentieth century, the virus possibly developed more than 100 years ago. However, the exact origin of HIV remains unclear. While scientists are not

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H i v /A i d s positive about the precise date that the virus began affecting humans, they believe it was during the early twentieth century in Africa. The most widely accepted theory is that Simian Immunodeficiency Virus (SIV) passed from chimpanzees to people. The virus infected the hunters who killed and ate chimpanzees or who were exposed to the animals’ blood via open wounds. Scientists suspect that HIV first arrived in the United States in the 1970s. This was the same decade that African doctors began observing an increase in opportunistic HIV Develops into AIDS infections and cancers among their When a person contracts patients. Members of the medical HIV, he or she is considered to be HIV positive. community define opportunistic The HIV virus attacks the immune system—specifillnesses as health problems that ically, the helper T cells “take advantage of the opportunity that run it. Drug therapies can slow or practically offered by a weakened immune stop this process. When 1 the number of helper system.” Tuberculosis, certain T cells in the body falls types of pneumonia, and a cancer below a certain level, the person is diagnosed called lymphoma are examples of with AIDS. With a weakopportunistic illnesses associated with ened immune system, the person is more likely HIV. These infections and cancers to contract opportunistic illnesses. are most resistant to treatment when a person with HIV develops AIDS. • 15 •

Essential Issues U.S. physicians began recognizing a common syndrome affecting large numbers of homosexual men and intravenous (IV) drug users in the early 1980s. A syndrome is a group of symptoms that take place at the same time; in this case, the syndrome featured a number of opportunistic illnesses. By the time doctors began to refer to the syndrome as AIDS in 1982, several people who had received blood transfusions were being diagnosed as suffering from the mysterious and deadly symptoms as well. In contrast, in Africa the disease was initially most common in heterosexual people who had multiple sex partners. Doctors in the United States and Africa realized that their patients suffered from the same condition. Quickly, the world realized that AIDS affected not only homosexual men, IV drug users, and Wasting Away Before doctors and sciblood-transfusion recipients. All entists in Uganda were men, women, and children could able to officially diagnose HIV and AIDS, they simbecome infected. ply referred to the strange and destructive illness as By 1983, approximately 3,000 “slim.” This term reflected cases of the syndrome and a how the first patients appeared to waste away staggering total of 1,000 deaths had before the doctors’ eyes. been reported in the United States. From what scientists could tell, 2

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H i v /A i d s

The HIV virus as seen under an electron microscope. The small blue balls are the virus bursting out of a large human cell.

AIDS appeared to spread through blood and other bodily fluids that pass from one person to another during sexual intercourse, pregnancy, the birth process, or nursing. In 1984, researchers identified the HIV virus as the cause of AIDS. Once a person is infected with HIV, it can take years for AIDS to develop. Doctors soon realized that they were facing a disease that was affecting almost every section of the globe. • 17 •

Essential Issues Fear and Misunderstood Facts As AIDS claimed a growing number of lives in the late 1980s, the public had more questions than experts could answer. Fear and misunderstanding led many people to draw inaccurate conclusions about HIV and how it is spread. Scientists emphasized that the virus was transmitted only by the exchange of blood, semen, vaginal fluids, and breast milk. However, many people remained Facts and Falsehoods HIV is most commonly transmitted through suspicious. Many unprotected sexual intercourse, the sharing of were concerned needles by drug users, and from mother to baby that HIV could during pregnancy, the birth process, or nursing. People can also become HIV positive if they be transmitted receive infected blood through a transfusion. through any form The virus may also be passed through unsterilized medical equipment or improper disposal of contact with an of medical waste, though such methods of infected person. transmission occur less often in more developed nations. HIV can also spread through Some people were unclean tools used in tattoo parlors or shops afraid to use the that offer ear and body piercings. same drinking Researchers continue to emphasize, however, that it is basically impossible for the virus fountains as HIVto be transmitted by kissing infected individupositive individuals als or sharing a cup or utensil with them. The virus cannot be spread by sneezing or coughor to hug and kiss ing. People cannot contract the virus simply by them. Others were using the same bathroom facilities or visiting the same swimming pools as those who test nervous about positive.

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H i v /A i d s being in the same room with anyone Growing Awareness who had contracted the virus. Initially, many heterosexual men and women who Communities all over the world did not abuse drugs had were torn apart by these fears. Men, little fear of AIDS or the mysterious virus that later women, and children who were became known as HIV. As the 1980s progressed, living with HIV found themselves however, the public increasingly isolated by mainstream started to realize that people other than homosociety. An example of this prejudice sexual men and drug addicts were getting sick. occurred in Indiana in 1985. Ryan “When it began turning White, an HIV-positive teenager who up in children and transfusion recipients, that was had developed AIDS, was banned a turning point in terms of public perception,” noted from school. Ryan protested this a worker with the United discrimination, which he and others States’ Centers for Disease Control and Prevention like him would continue to endure in (CDC). “Up until then it was entirely a gay epithe years ahead. demic, and it was easy for As HIV spread rapidly during the the average person to say, ‘So what?’ Now everyone 1980s and members of the public could relate.” grew increasingly concerned, even people who did not suffer from the virus were met with prejudice. Homosexuals frequently faced hatred as a result of the popular misconception that “HIV is a gay disease.”4 Because AIDS was first observed mainly in homosexual men, many people had difficulty accepting the fact that heterosexuals shared similar risks for contracting HIV. 3

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Essential Issues

Ryan White celebrated after a court ruled that his school had to allow him to attend despite his HIV-positive status.

Others were confused about the relationship between HIV and AIDS and assumed that the virus and the syndrome were one and the same. In reality, it often takes several years for an HIV-positive person to develop AIDS. Many individuals with the virus do not initially show any symptoms of being ill. HIV attacks a person’s immune system over time. Once a person’s immune system becomes less • 20 •

H i v /A i d s functional, the symptoms begin to appear. Today, this process can often be slowed down and virtually halted with medication.

Education, Prevention, and Medical Advances In the late 1980s, efforts were made to end the misinformation that surrounded HIV and to halt the spread of the infection. Beginning in the homosexual community but spreading to the public at large, activist groups battled to improve education. The government devoted more resources to researching the disease and spreading information. HIV testing became more readily available as did more controversial measures related to prevention. Some people supported efforts to provide drug users with clean needles and to pass out condoms in public settings, such as schools and clinics, to improve safer-sex practices. These programs sparked controversy. Opponents noted that, although passing out clean needles or condoms might slow HIV transmission, it also seemed to encourage premarital sex and drug abuse. Though sexual activity outside of marriage is accepted in some societies, other cultures consider • 21 •

Essential Issues it a serious violation of moral codes. A large number of countries, including the United States, regard drug use as an illegal activity. People against the distribution of condoms or clean needles argued that a better solution was to promote avoiding sex outside of marriage altogether. They also suggested organizing programs to help individuals avoid drugs or recover from addiction. While controversy raged about the most effective ways to combat Expensive Treatment HIV during the 1980s and 1990s, Although several of the medications used to treat researchers scrambled. They worked HIV and AIDS are capable of improving health to develop a vaccine to prevent the and lengthening an virus and a cure for those who had infected person’s life, they are often expensive. This already contracted HIV. Beginning makes drug therapy especially difficult for citizens in 1987, certain medications in developing nations designed to delay HIV sufferers such as Zimbabwe, which is located in southfrom becoming seriously ill went on ern Africa. “People are giving up [their] drugs,” the market. Specific combinations observed the head of a of these drugs were proven to stop local Zimbabwean nonprofit organization serving a person’s immune system from HIV and AIDS patients in 2005. “They have to growing weaker. In many cases, choose between feeding these drugs also prevented infected and educating their kids or taking [medications].” mothers from passing HIV to their babies during birth. However, as of 5

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H i v /A i d s 2009, scientists had failed to develop an effective vaccine or cure.

No Cure

Progress toward a Vaccine In September 2009, researchers working in Thailand announced that they had found a vaccine combination that was slightly effective against HIV. Scientists debated whether the results were significant or due to chance. The vaccine is not effective enough to be used in the fight against HIV, but the research may help guide future research.

In 1997, the percentage of AIDSrelated deaths in developed countries declined as a result of drug therapies, and they have continued to do so. However, the new medications are by no means a miracle cure. Drug combinations that can lower the virus to undetectable levels in some patients are now available. However, no medicine on the market is capable of truly curing the disease, and each drug has several possible side effects. In addition, some HIV and AIDS medications are only readily available in countries with well-funded health-care systems. According to the international AIDS charity AVERT, fewer than one-third of the people in Africa who need the drug therapies actually receive them. Some countries, such as Botswana, Rwanda, and Namibia, have much higher rates of access—as high as 80 percent. But other countries, including Chad and Ghana, have much lower rates than average. Since • 23 •

Essential Issues

Early Years of HIV It is difficult to determine how many people were HIV positive prior to the 1980s. However, scientists suggest that hundreds of thousands of individuals likely suffered from the virus before it was officially identified. Jonathan Mann, then director of the World Health Organization’s Global Program on AIDS, explained in 1989, “The dominant feature of this first period was silence . . . (HIV) was unknown and transmission was not accompanied by [enough] signs or symptoms . . . to be noticed. . . . By 1980, HIV had spread to at least five continents (North America, South America, Europe, Africa and Australia). During this period of silence, spread was unchecked by awareness or any preventive action, and approximately 100,000 [to] 300,000 persons may have been infected.”6

the advent of international initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002, access has been improving across the continent. At the same time, fear and misunderstandings continue to shape public perception of HIV in many areas around the globe. The problems, challenges, and controversies continue for those who suffer from the infection, as well as for the individuals who are dedicated to helping them. Three decades after the virus captured worldwide attention, people everywhere are still struggling to find the answers that will save and improve lives. As they do so, they are discovering the ways in which HIV affects far more than a person’s body.

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H i v /A i d s

Many of John West’s friends died from AIDS early in the epidemic. He survived because he received HIV medication in time.

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Chapter

3

Pascazia Mukamana, left, of Rwanda had to stop going to school to care for her younger siblings after her parents died from AIDS.

Breaking Families

M

any parents are fortunate enough to enjoy lighthearted discussions with their preschoolers. They talk about carefree topics such as ice cream, toys, and trips to the park. For a young Chinese mother named Ling, however,

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H i v /A i d s conversations with her four-year-old focused on far weightier subjects. Shortly after Ling had become pregnant with her son, she discovered she was HIV positive. Adding turmoil to her already tragic situation was the AIDS-related death of her husband a mere 11 days after their baby was born. Luckily, her son was not infected with the virus. Nonetheless, it shaped his life in tremendous ways and forced him to cope with realities that are difficult for most young children to comprehend. Ling explained: I tell him that his father died of a disease, but I never specify what disease it was, nor do I tell him about my disease. But he knows I need to take medicine and, if I forget, he will say to me, “If you don’t have medicine, you will die, and I will have no mother.”1 For Ling and her child, HIV became an accepted part of everyday life, as did related issues such as death. Their relationship is an example of the devastating impact the disease has all over the world. HIV has the power to rob children of their childhoods and to redefine people’s roles within their families and communities. It can bring life to a standstill within formerly close-knit towns

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Essential Issues

HIV and Education In 2002, James Wolfensohn was the president of the World Bank Group (WBG), an agency that offers aid to developing nations. He offered his thoughts on HIV, poverty, and education in developing countries. “More than 113 million children not in school in the poorest countries already presents a major challenge,” noted Wolfensohn. “However, HIV/AIDS makes this [challenge] much greater in those countries where the education system is already struggling to grow, [or] teachers are dying or are too sick to teach. And every year, more children are losing their parents and the support that allows them to go to school. Achieving education for all in a world of AIDS presents an unprecedented challenge to the world education community.”2

and villages by affecting everything from education to health care to agriculture. Perhaps most importantly, though, the virus forces world citizens to reevaluate their perspectives on sickness, death, and survival.

Children with Changed Lives

Once HIV strikes a family—and especially one living in poorer or less developed areas—its day-today existence is changed forever. Children frequently have no choice but to take on more adult responsibilities. They often have to abandon school to care for ill relatives or to help earn money. These young people often grow up quickly and without basic necessities such as adequate food and clothing, let alone luxuries such as games or toys. They have little free time to relax with friends, and HIV-related funerals might sadly be their main form of socialization. • 28 •

H i v /A i d s In addition, these children routinely deal with the likelihood of being orphaned or moved from home to home as their caretakers The Destruction of Entire Families grow ill and die. Stephen Lewis is the former UN SecretaryAt the same time, General’s Special Envoy for HIV/AIDS in Africa. He has described how the virus can destroy their bodies might family life. He based much of his observations be struggling on a visit to Zambia in central Africa in 2003. “In Zambia,” Lewis recalled, with the physical [we] were taken to a village where the challenges of the orphan population was described as virus, which are out of control. . . . We entered a home and encountered the following: To the made worse by a immediate left of the door sat the eightylack of nutrition four-year-old patriarch, entirely blind. and medical care. Inside the hut sat his two wives, visibly frail, one seventy-six, the other seventyNot surprisingly, eight. Between them, they had given birth many suffer from to nine children; eight were now dead, and the ninth, alas, was clearly dying. On depression and the floor of the hut, jammed together with anxiety. They may barely room to move or breathe . . . were 32 orphaned children ranging in age from cope by behaving two to sixteen. . . . It is now commonplace in ways that put that grandmothers are the caregivers for them at greater risk orphans. for contracting the The grandmothers are impoverished, their days are numbered, and the [destruction] virus. “Condoms of families is so complete that there’s are for those with often no one left in the generation coming up behind. We’re all struggling to find a time,” noted one viable response. . . .3

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Essential Issues young man in Kenya, a republic in eastern Africa. “But here time is never on your side.”4 Others exhibit a lack of interest in their futures, which seem destined to be cut short.

At Higher Risk Children who are too sick to attend school or who cannot go because they are working or caring for ailing relatives are at greater risk for contracting the virus. Studies indicate that young people with “little or no education”are more than twice as likely to end up HIV positive as are individuals who have at least completed grade school.5 Education ensures that children know how the virus is transmitted. Education helps empower girls to control their own bodies and their own economic welfare. Education helps children make healthier decisions. Children with an education have hope in the future and the motivation to keep their lives on track. Regrettably, in some parts of Africa, enrollment has dropped 25 to 30 percent because of HIV and AIDS. When AIDS orphans are left with no surviving, healthy family members, these boys and girls are turned onto the streets. Though some may be fortunate enough to be rescued by private • 30 •

H i v /A i d s

Natasha lives in a privately funded home for HIV-positive children in South Africa.

organizations and shelters, others are not. Other children become dependent upon the government for assistance, which can be unreliable. Too many of these children strain the resources of troubled governments. Other children are forced to find their own ways to survive. This often means turning to a • 31 •

Essential Issues life filled with crime and risky behavior, continuing the cycle of illness and poverty.

Mothers, Fathers, Grandmothers, Grandfathers Women from developing nations, who often are traditionally expected to cook, clean, and care for their families, must often assume other roles as they lose their fathers, husbands, and brothers to HIV. Forced to choose between watching their relatives starve or laboring outside the home, most choose the second option. One woman from Zimbabwe reported: I used to stay with the children, but now it is a problem. I have to work in the fields. Last year I had more money to hire labor, so the crops got weeded more often. This year, I had to do it myself.6 As more people within a family unit become sick or die, fewer family members are left to work. At the same time, however, medical and funeral costs create greater expenses. Women who work outside the home are usually still expected to nurse their ailing relatives and tend to their children and homes. Exhausted and desperate for money, some turn to

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H i v /A i d s prostitution—the sale of sexual services—as a quick and easy way to pay the bills. In turn, this boosts their risk of contracting the virus.

No Resources When these women and other members of younger generations fall ill, grandparents and older relatives must suddenly become caretakers. While such individuals might not have HIV or AIDS, they frequently have age-related health problems of their own. Generally, they do not have the resources to care for large numbers of orphaned grandchildren. What money they have quickly disappears in feeding, clothing, and educating these youth. All too often, the children have already contracted the virus from their parents, which creates additional medical expenses. As a result, their health and financial resources are often destroyed as they attempt to lead an oversized household. • 33 •

Spending Cuts To cope with increased medical costs and decreased income, people within families affected by HIV are gradually forced to abandon day-today necessities. In South Africa, researchers conducted a survey of such individuals. Their study reported that 21 percent of those surveyed reduced their clothing purchases to make ends meet. Another 16 percent limited electricity use, and 6 percent bought less food.

Essential Issues

Unsafe Funerals? HIV-related death is such an accepted part of everyday life for some African young people that many attend gatherings known as disco funerals after the passing of a friend or relative. Young people spend time at the deceased person’s house for several days after the funeral to dance, listen to music, and socialize. Gambling at disco funerals often pays for burial expenses. Several researchers believe that these gatherings might actually contribute to the HIV pandemic. Studies reveal that drugs, alcohol, and the overall atmosphere at disco funerals potentially increase the likelihood of partygoers having unprotected sex.

Ugandan grandmother Lucy was only one of many older women who have had to take on new burdens. Not only did she lose several of her family members to complications related to HIV—she also had to battle to scrape by on a day-to-day basis because of the scarcity of food, money, and other resources. “By the time my sons became ill with AIDS, one of my daughters-inlaw had already died of tuberculosis, and the other had become mentally sick,” explained Lucy in 1997. So I was the closest person to my sons. I had to resume the role of a mother caring for her sick children. I was the only one who could ensure that their physical and emotional needs are met. . . . My heart shrunk whenever I thought of caring for my grandchildren after the death of their fathers. Their sickness had started encroaching on the savings I had made for my own welfare in old age. . . . My sons

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H i v /A i d s

This grandfather from Cameroon cares for his grandson, who was orphaned when his parents died of AIDS.

left behind six orphans, and now I am once again a mother to children ranging in age from eight to fifteen. Two of my grandchildren were also HIV-infected. One has already died, and one is still living at age eight, though she has started falling sick. I am taking care of them alone because, in our culture,

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Essential Issues it is the family of the father who must care for orphans. . . . I feel so sad that I have gone back to the beginning, and I have to struggle to get resources to ensure that their basic needs are met, such as school fees, medical care, [and] clothing. . . .7

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H i v /A i d s

HIV/AIDS deaths affect entire communities.

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Chapter

4

Poverty and AIDS are dangerously intertwined issues in much of Africa and other developing regions.

HIV and the Cycle of Poverty

T

he tragic link between HIV and poverty is especially clear in developing countries in portions of Africa, Asia, Central and South America, the Caribbean, and Eastern Europe. A study conducted by the United Nations (UN) in

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H i v /A i d s 2005 revealed challenges presented by the HIV pandemic in those parts of the world that lack developed health care and public welfare systems. The UN’s research indicated that the highest HIV rates are generally found in poorer nations across the globe. Most experts agree that the connection between poverty and the virus is complex. Communities that severely lack basic resources and funding frequently lead to circumstances that favor the spread of HIV. At the same time, the virus contributes to a cycle of poverty that is often passed down from one generation to the next.

An Ideal Setting for the Virus to Spread While HIV affects people of all ages, races, and economic backgrounds, many factors lead poorer countries to be a prime setting for the spread of the disease. • 39 •

HIV in Developing Countries Of the total number of people worldwide who are infected with HIV, an estimated 95 percent are citizens of what are considered developing countries. Put another way, of the approximately 33 million cases of the virus reported in 2007, a little more than 31 million live in these areas. In comparison, only 1.2 million HIV-positive individuals live in North America and approximately 730,000 reside in Central and Western Europe.

Essential Issues On the most basic level, these nations typically have fewer financial resources to educate their citizens about the virus and its prevention. These nations’ health-care systems may also lack the funding to provide widely available testing and treatment to HIV-positive individuals. In addition, people who live in Risks for Women poverty are more Some estimates indicate that approximately often exposed to 75 percent of the HIV-positive females in the world live in sub-Saharan Africa. There, approxbehaviors that imately 12 million women were reported to increase the risk of have HIV in 2007, compared to only 8.3 million men. What accounts for these numbers? acquiring the virus. Biologically, women are more susceptible For example, girls to HIV than men because they have more unprotected membranes exposed to the virus and women who during sex. In addition, women in developing are responsible for countries may not have the same rights as men. helping support It may not be socially acceptable for them to demand that their sex partner practice safe sex. their families In certain countries, a man can rape a woman in economically without serious legal consequences. Women in war-torn regions are also prone to rape by disadvantaged enemy soldiers. A lack of education and career countries opportunities may force women into dangerous situations with a higher risk of infection. sometimes turn to Women may be unable to leave an abusive or are forced into partner, or they may be forced into prostitution. prostitution. They All of these factors lead to situations that add to women’s risk of becoming infected with HIV. might not always • 40 •

H i v /A i d s be able to use condoms that would decrease their chances of becoming infected or spreading HIV. “I’m married, and my husband is HIV positive,” revealed one prostitute in Burma, a republic in southeastern Asia. “I had a lot of problems and no one to depend on.”1 She explained that she had few other career choices that offered enough money to support her family. She also admitted that, tragically, some of her customers preferred not to practice safe sex and therefore were at greater risk of contracting the virus from her. Often, the IV drugs that are sold in poorer areas greatly contribute to the HIV crisis. Users with less money frequently choose substances such as heroine that can be injected. This method is cheaper and produces more immediate effects. The needles that addicts sometimes share are another way HIV is transmitted. An estimated 13 million people across the world use IV drugs. The greatest numbers of these individuals are from developing nations in Asia and Eastern Europe. Even actions that are not related to risky practices can spread the virus within poorer communities. An HIV-positive mother can pass the infection to her babies through her breast milk. If they have not • 41 •

Essential Issues

Facing poverty and few options, these women became sex workers despite the risk of contracting HIV.

been tested for HIV, many of these women may be unaware of their health issues when they begin nursing. Others may realize they are HIV positive but have never been educated about how the virus can be transmitted through breast milk. Some may have this knowledge but cannot afford to buy formula. They might feel their only choice is to feed their infant or abandon it. • 42 •

H i v /A i d s Harm to Developing Economies Just as poverty appears to further the HIV crisis, the virus also seems to lead to ongoing hardship. AIDS continues a cycle of poverty within communities where infection is widespread. Smaller towns and villages are especially hard hit by its economic side effects. Medical costs strip families of their incomes. Sick men and women are eventually unable to work. In turn, areas with too many sick people have too few people to work in the fields and in local businesses. This leaves developing countries unable to establish permanent and stable communities. AIDS also places a strain on already impoverished health systems. Budgets are stretched to provide more services when they can barely keep up with basic health-care needs. AIDS-related health-care spending is money that might otherwise go • 43 •

Slowed Development Experts at AVERT, an international AIDS charity, reported that the majority of people in Africa who are living with HIV or AIDS are between the ages of 15 and 49. As that span of time is often considered the most productive period in a person’s life, the continent’s labor force has been severely affected.

Essential Issues

When people contract HIV, their communities lose their labor from the workforce.

toward government services. The virus takes a massive toll on schooling, health care, agriculture, and business in parts of the world that are still developing. Since experts argue that education is essential to helping end the pandemic, decreased academic enrollment as a result of HIV poses a particularly serious problem. • 44 •

H i v /A i d s Children in plagued communities are thrown into the tragic cycle of sickness and disadvantage. With ill or dying parents, many have to quit school to earn money for their families. As a result, many never receive an education. Without education, they have little chance of overcoming poverty. Some ultimately turn to prostitution or low-paying, backbreaking labor to help relatives who cannot work.

Lost Labor The growth of shops and businesses, which would ideally help developing countries become more stable and successful, also is slowed by HIV. Employees are frequently absent from work due to their own illness or because they are caring for sick family members. Employers’ profits are further reduced because they must recruit and train new workers to replace ones who grow ill • 45 •

Shortened Life Expectancy In some areas, HIV has reduced the average life expectancy of residents by approximately 20 years. In Swaziland, in southeastern Africa, the average life expectancy is just 31 years—less than half the age residents would reach if not for HIV.

Essential Issues or die. Employers that provide health insurance also see the costs of that benefit rise. In developing communities, a small number of skilled teachers are often responsible for instructing large groups of students. The damaging impact of the virus becomes even greater when one of these educators becomes ill or is frequently absent due to HIV. When teachers take time off work, their pupils suffer. Schools struggle, often unsuccessfully, to find educators who can replace lost staff. Hospitals in developing countries are also overwhelmed by HIV and AIDS. Research indicates that more than 50 percent of all the hospital beds in sub-Saharan Africa are occupied by people with HIV-related complications. Such patients tend to have longer hospital stays, which causes hospitals and clinics in these areas to become overcrowded. Sometimes, patients are turned away. When individuals cannot obtain adequate health care, their overall health declines and they live shorter lives. Hospital staff members in developing nations are strained by the crisis. Health-care facilities are stretched beyond capacity caring for all the HIV patients. Many staff members are coping with HIV or AIDS themselves or are busy caring for sick friends • 46 •

H i v /A i d s and relatives at home. In addition, there are insufficient resources to train new doctors and nurses or teach them the newest HIV treatments.

Fewer Crops Experts have determined that HIV also decreases a community’s food supply. When a large number of villagers or townspeople in a developing area die or become too ill to labor in local farm fields, fewer crops are grown. Developing countries are especially hard hit when they lose farm labor to HIV/ AIDS. Many of them lack modern machinery to replace workers. Researchers believe that in the future, certain African countries will face more than a 20 percent reduction in their agricultural output as a result of the virus. HIV’s impact on family and community life in developing countries has been devastating. • 47 •

“Our fields are idle because there is nobody to work them. . . . We don’t have machinery for farming, we only have manpower—if we are sick or spend our time looking after family members who are sick, we have no time to spend working in the fields.”2 —Toby Solomon, Malawi government official

Essential Issues However, developing communities are not the only ones ripped apart by the virus. Nations such as the United States have also been deeply harmed by HIV in countless ways.

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H i v /A i d s

AIDS orphans are less likely to go to school and more likely to live in poverty and contract HIV themselves.

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Chapter

5

HIV-positive individuals in the United States are likely to have access to medications that slow the progress of the disease.

HIV in the United States

C

arl discovered he was HIV positive in 2006, when he was still just a teenager. He serves as an example of the more than 1 million people in the United States who carry the virus. A resident of Prince George’s County in Maryland,

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H i v /A i d s he had known that his unsafe sexual behavior put him at risk for contracting the virus. However, he was initially afraid to get tested. Unlike many young people in developing countries where HIV is often a part of day-to-day life, Carl was familiar with the virus only through what he had learned in the classroom and the media. He had few previous experiences with individuals who had tested positive. “I was very uneducated about the subject,” he recalled during an interview with the Washington Post in early 2008. You know, when things came up on TV about AIDS or HIV [or] when they talked about it in school, I kind of ran away from it. You know, cut the channel, [covered] my eyes, ’cause I was scared of . . . the facts; I didn’t want to know the facts, I wanted to stay ignorant to the subject. . . . Because, as long as I was ignorant [about] the subject, I thought, “Okay, I’m fine.”1 Once Carl discovered that he had been infected, he had to learn more about the virus and teach the people around him. “The bad part about it is that my mom was just as ignorant on the subject as I was,” Carl noted, adding:

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Essential Issues So when we got home, it was a circus. . . . I couldn’t share any . . . knives, forks, [or] spoons that [my family] shared. I drank from paper cups . . . [and] ate off of paper plates. Everything was separate.2 His family’s reaction was difficult to take. Yet Carl worked hard to reshape his attitude toward being HIV positive and learn how he could use his HIV status to educate others about the disease. Social workers, doctors, and members of the HIV-positive community taught him to take proper care of himself and avoid risky behaviors. He learned that he could go on to enjoy a fulfilling future. He resolved to share his experiences and what he learned with the people around him. “I’ve embraced being HIV positive,” Carl observed in 2008. Sometimes I even forget I have it. I live a normal life. . . . I’m a college student. I have normal bills, normal student loans. . . . I live a life of a teenager. . . . I think my main message to another teenager, one who would be at risk or not at risk [is]: HIV is alive, is real. If it can happen to me, it can happen to you or can happen to your friend . . . your boyfriend, your girlfriend. It’s alive.3

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H i v /A i d s Comparisons with Developing Countries Of all the industrialized countries across the globe, the United States has the greatest number of HIVpositive citizens. Since the onset of the epidemic decades ago, more than half a million people living within U.S. borders have died of AIDS. In Washington DC, the rate of infection is almost equal to that in parts of subSaharan Africa. How does the epidemic in the United States compare to that of other parts of the world? Because the U.S. health-care system is more advanced than those of developing countries, medical treatment is often more readily available to individuals who test HIV positive. Poorer Americans, who have few or no insurance benefits, may face a greater challenge in receiving drug therapy than wealthier patients, but they still are not without options. Government • 53 •

Rising Infection Rate A CDC report revealed that between 2001 and 2006, the number of HIV infections in bisexual and homosexual men rose by 8.6 percent in the United States. Some researchers believe that this may be due in part to the increasingly available drug therapies used to treat the virus. They suggest that people are more confident that new medicines can help them lead longer lives. As a result, individuals might be less fearful of developing AIDS and more likely to practice unprotected sex.

Essential Issues legislation specifically related to the virus often helps them obtain the necessary care. In addition, with its many social-service agencies, the United States will not likely see the disease devastate entire families and communities. Compared to the total population, few enough individuals are infected that the country does not suffer from a shortage of workers in the way some developing countries have. Physicians, nurses, social workers, and educators all play a part in helping HIV patients stay as healthy as possible. Many of these HIV Spending professionals are trained to offer In 2009, health-care officials requested $24.1 emotional support to their patients, billion from the U.S. as well as their friends and family government to fight HIV. They planned to spend members. These factors increase the approximately 51 percent on caring for individuals odds that Americans who learn of who are living with HIV/ their HIV status early and seek help AIDS. Another 11 percent was requested for medical can often live long and productive research. Officials also hoped to use government lives. Finally, the U.S. health-care money to fund national and social-service systems encourage prevention efforts and to provide cash and housing those who are aware that they are aid to Americans who are HIV positive. infected to practice safer sex and take other precautions to avoid spreading the virus. • 54 •

H i v /A i d s

A man in Washington DC has his cheek swabbed for an HIV test. Testing is critical to preventing the spread of HIV.

Not everyone who is HIV positive is aware of his or her status. Like Carl, many are afraid to be tested. And, unlike residents of the most devastated African communities, many Americans do not know anyone who is HIV positive. They believe HIV cannot affect them, that it affects only homosexual men, drug users, or people from poorer nations. However, people in the United States cannot ignore the reality that anyone who has unprotected sex, shares needles, or engages in other unsafe behavior risks becoming infected. • 55 •

Essential Issues Of the more than 1 million Americans who are living with the virus, researchers estimate that approximately 250,000 have never been tested and do not realize that they have the virus. Many of these individuals discover they are HIV positive after they are already sick, when it may be too late to slow the disease. They may have infected others without knowing. In this way, people in one of the most developed countries in the world continue to contribute to the pandemic.

Which Americans Are Affected Most? African Americans at Risk Research indicates that 1 in 16 African-American males and 1 in 30 African-American females are likely to become infected with HIV during their lives. These rates are staggeringly high compared to those for whites, where the ratios are 1 in 104 for males and 1 in 588 for females.

HIV impacts Americans from all races and economic backgrounds, though certain groups appear to be harder hit than others. When the U.S. epidemic first began to receive attention in the 1980s, the infection seemed to be spreading among homosexual men, drug users who shared needles, individuals who had received blood transfusions, and immigrants from the Republic of Haiti in the Caribbean. Decades

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H i v /A i d s

Programs and advertisements in the United States encourage people to learn their HIV status.

later, HIV still affects gay and bisexual men as well as large numbers of Americans who abuse IV drugs. However, the virus plays a role in other groups, too. For example, the epidemic has taken a massive toll in African-American populations across the country. In 2007, approximately 49 percent of people in the United States who tested positive came from this racial background. However, African Americans make up only 13 percent of the population. Higher poverty levels and poorer health

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Essential Issues care within many African-American communities are some probable reasons behind these statistics. HIV also has a powerful impact on Hispanics and Latinos. Although Hispanics and Latinos make up approximately 15 percent of the U.S. population, in 2007 the group included Obstacles for Immigrants 19 percent of the A large percentage of U.S. residents who test HIV positive receive health care that is not nation’s infected available in developing countries. However, residents. Hispanic that benefit does not extend to everyone who lives within U.S. borders. Some Latino and and Latino men Hispanic immigrants do not have official citiare three times zenship. In early 2009, the U.S. Department of Homeland Security estimated that more than more likely than 11 million illegal immigrants were living in the white men to United States. contract AIDS, Many of these men and women are afraid to visit clinics or hospitals that might require and Hispanic and proof of their citizenship. If they are discovered Latino women are to be illegal immigrants, they can be deported by the U.S. government. Furthermore, medical five times more facilities that service U.S. communities with likely to do so than large Latino and Hispanic populations do not always have bilingual staff. This makes it difwhite women. Like ficult for individuals who do not speak English African Americans, to receive the most effective care. These factors members of this often cause Latinos and Hispanics who are living with HIV in the United States to wait too group often long before they seek help. Others who are face economic unaware of their HIV status may spread the virus by accident. disadvantages • 58 •

H i v /A i d s and limited insurance options. Difficulties in understanding English can create additional challenges for Hispanic and Latino immigrants who are trying to educate themselves about the virus. High percentages of bisexual and homosexual men continue to test positive and account for approximately two-thirds of all HIV cases in teenage and adult males in the United States. However, any type of sex, especially unprotected sex, increases the risk of contracting the virus. People who share needles when using illegal drugs also represent a portion of society that remains especially vulnerable to the virus. Fortunately for U.S. citizens who have HIV, the social and medical benefits of living in an industrialized country frequently allow them to stay healthy longer. Education about the virus is widespread in classrooms and workplaces. However, there continue • 59 •

Not Enough Some Americans are openly critical of the response of U.S. healthcare officials to the HIV crisis. These opponents believe that an industrialized nation such as the United States should be more aggressive and successful in stopping the spread of the virus. As Michael Weinstein, president of the AIDS Healthcare Foundation, noted in June 2009, “The fact that Washington DC’s HIV prevalence rate is now higher than some hard-hit African countries is an indictment of how the CDC [Centers for Disease Control and Prevention] has failed to lead in HIV prevention efforts.”4

Essential Issues to be different perspectives—within the United States and in countries all over the world—regarding the best ways to prevent HIV and to help those who are living with it.

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H i v /A i d s

IV drug users are one group that is more likely to contract HIV.

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Chapter

6

People who are HIV positive have often faced discrimination.

How Prejudices Take a Toll

W

hen one mother in India learned of her son’s positive HIV status, she reportedly made the following desperate plea, “Save my family; kill my son.”1 While such a request might seem horrifying, it is important to understand

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H i v /A i d s what could drive a parent to utter it. The mother was overwhelmed by the prejudice and discrimination she feared she would face within her village. She also had several daughters who one day would be old enough to marry. She feared that an HIVpositive family member would scare away all potential suitors. This is only one example of how misunderstanding and prejudice continue to play a major role in the HIV pandemic all over the world. As one HIV-positive resident of San Francisco explained: My greatest fear is the fear of being shunned. That’s the only word that I think really describes what it’s like for someone who is HIV positive. It’s really tough to watch people backing away from you, looking at you like you’re some kind of freak with an extra leg or two heads. When people know you’re sick, they don’t want to talk [to] you or touch you. . . .

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The Challenge of Prejudice According to the UN Secretary-General Ban Kimoon, negative attitudes and discrimination surrounding HIV are among the greatest challenges society faces in overcoming the disease. “Stigma remains the single most important barrier to public action,” he explained in 2008. “It is a main reason why too many people are afraid to see a doctor to determine whether they have the disease or to seek treatment if so. It helps make AIDS the silent killer because people fear the social disgrace of speaking about it or taking easily available precautions. Stigma is a chief reason why the AIDS epidemic continues to devastate societies around the world.”2

Essential Issues

Children Facing Prejudice Even children are not free from the prejudice linked to the virus. In Africa, AIDS orphans face daily discrimination and the assumption that they are HIV positive. Discrimination against children also takes place in wealthier nations. One mother in the United Kingdom described the heartache her young HIV-positive foster son experienced at school. “Someone [at the school] broke the confidentiality and told a parent that Michael had AIDS. That parent, of course, told all the others. This caused such panic and hostility that we were forced to move out of the area. Michael was no longer welcome at the school. Other children were not allowed to play with him—instead they jeered and taunted him cruelly. . . . Ignorance about HIV means that people are frightened. And frightened people do not behave rationally. We could well be driven out of our home yet again.”4

Even today, although we like to think we’re more enlightened and tolerant and it’s not politically correct, if people know you have HIV, they still treat you differently.3

The Depths of Discrimination Prejudices related to the virus result in discrimination that can cost people their jobs, their educations, their homes, and sometimes even their lives. Fear is usually at the root of this discrimination. Worldwide, people are afraid of HIV because it remains incurable and it is still looked upon as a relatively new health problem. Scientists may be more aware of how it is spread than they were in the early 1980s, but people also recognize that the disease is associated with a variety of risky behaviors that are unacceptable in some cultures. Some people even believe the virus is a punishment

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H i v /A i d s

Marchers in South Africa protest to end discrimination against people who are HIV positive.

for what they view as immoral actions, including prostitution, drug use, premarital sex, bisexuality, and homosexuality. This judgment, combined with misconceptions about how HIV is transmitted, sometimes prompts people to reject or marginalize those who are infected. Friends and family members have been known to suddenly abandon relatives and acquaintances who are HIV positive. Those worried about infection might ask HIV-positive relatives or friends to leave home or to use separate bathrooms and eating areas. • 65 •

Essential Issues

This dentist sued in court in 1998 for the right to deny care to HIV patients and lost his case.

Laws against Discrimination Some employers seek excuses to fire HIVpositive workers from their jobs, or they create an atmosphere that makes infected people want to quit. Even doctors and nurses may show reluctance to treat • 66 •

H i v /A i d s HIV-positive patients. Technically, these forms of discrimination are illegal in most parts of the world. According to a 2008 study, approximately 67 percent of countries have laws protecting the rights of infected persons. However, these laws are not always effective, and they vary from nation to nation. Some government legislation related to HIV can actually serve as a form of discrimination. For example, the United States, Armenia, Brunei, China, Iraq, South Korea, Moldavia, Russia, and Saudi Arabia have restrictions in place that stop HIV-positive travelers from entering or staying in their countries. While officials from these nations insist that they are simply trying to halt the spread of the pandemic, such laws prevent individuals who are HIV positive from traveling. Prejudices linked to the virus have resulted in deadly acts of • 67 •

Negative Images The international AIDS charity AVERT argues that several negative images that have been associated with HIV/AIDS have fueled the prejudice. These images include: HIV/AIDS as punishment for behavior seen as immoral; as a crime with innocent and guilty victims; as a war or battle to be fought against the virus; as a horror that causes infected people to be feared or demonized; or as a feeling of otherness that sets infected people apart from everyone else.

Essential Issues discrimination, including physical violence. People risk abuse and harassment once they reveal their HIV status; some have been Discrimination in Health Care murdered because Even doctors, nurses, and other medical of it. Individuals workers sometimes treat patients who are HIV positive with discrimination and prejudice. who might not be In certain instances, health-care workers in infected but belong developing countries have to cope with limited space, time, and resources. They may believe to groups that have that people who are infected are destined to been particularly die, so treatment on them is a wasted effort. hard-hit may also Some hospital staff may be reluctant to give HIV-positive patients the same level of care become targets. that they would offer individuals who do not For instance, some have the virus. Such discrimination occurs even in people incorrectly wealthier, more industrialized countries. One assume that all HIV-positive woman in the United Kingdom recounted the following experience in her homosexual men dentist’s office: have HIV or that Eventually, I told them about my condihomosexuals tion. They explained that I would have to be the last appointment of the day. . . . So are primarily I went for the last appointment of the day responsible for last week; they covered the chair [and] spreading it. This the light, [and] the doctors were wearing three pairs of gloves. assumption can Instances of discrimination may cause peolead to hate crimes ple who are HIV positive and require medical against gay and care to avoid it because they fear the prejudice and judgment of health-care workers. bisexual men. 5

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H i v /A i d s Ultimately, fear, misinformation, and the hatred they create can destroy lives. And, as the past three decades have shown, these factors also fuel the pandemic.

Prejudice Fuels the Crisis The attitudes, judgments, and hostility surrounding HIV frequently cause people to view the virus as a shameful secret that needs to be hidden or ignored. This leads individuals to be reluctant to be tested, to reveal whether they have the virus, or to seek the treatments for the disease. As a result, infected persons may continue to spread HIV. Pregnant women who are HIV positive and refuse to tell their physicians have a far greater risk of transmitting the virus to their babies. Such mothers prevent their babies from receiving the medical care immediately after birth that would lessen the likelihood of transmission. • 69 •

The Tragedy of Prejudice Pregnant women in Botswana serve as a tragic example of how the prejudice surrounding HIV contributes to the problem. While most medical centers in that country offer education and treatments to reduce the likelihood of parent-tochild transmission, only 26 percent of expectant mothers take advantage of these services. More than half of the nation’s pregnant women recently refused to be tested for the virus. In addition, almost 50 percent of those who knew they were infected did not accept treatments that would lessen the chances of their babies contracting HIV. Many experts believe that the mothers’ fear of discrimination influenced their decisions.

Essential Issues Mothers who do not know their HIV status or who will not tell their doctors also can infect their infants when they nurse. Concerns about discrimination have caused some HIV-positive people to avoid taking precautions that would reduce their risk of passing the infection to others, including practicing safer sex. Some individuals believe that using condoms will make their partners suspect that they have HIV. Prejudice can also affect the mental and emotional health of HIV-positive individuals. Many begin distancing themselves from their friends, family, and coworkers once they learn they have the virus. If they believe in the prejudices themselves, they may feel worthless or unlovable. They may think God is punishing them. For people who have ignored the realities of the disease or insisted that they could never become victims of it, their ignorance frequently deepens their sense of shame and loneliness. A resident of Vietnam who admitted she had tested HIV positive said: I am afraid of giving my disease to my family members— especially my youngest brother who is so small. It would be so

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H i v /A i d s

Pregnant women need to be tested so they can take precautions to prevent their babies from contracting HIV.

pitiful if he got the disease. I am aware that I have the disease, so I do not touch him—I talk with him only. I don’t hold him in my arms now.6 This woman’s example shows how HIV can destroy people’s lives long before actual illness claims

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Essential Issues their health. But a growing number of people are working to end such prejudice. Their efforts to promote education, awareness, and compassion have given—and continue to give—the world hope that the virus can be overcome.

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H i v /A i d s

People around the world are calling for the discrimination to end.

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Chapter

7

There is much debate in the United States over what should be taught in sex education classes.

Prevention and Treatment

T

he majority of world citizens agree that HIV is a serious pandemic that needs to be stopped. However, people disagree about the most successful ways to prevent the virus. They also have different opinions about how to help individuals who

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H i v /A i d s are already infected. Approaches to the problems of HIV often vary from country to country or even from city to city. Perspectives are affected by everything from religious and moral beliefs to an individual’s personal economic situation. For example, the topic of HIV education raises controversy. Because unprotected sexual intercourse places individuals at increased risk for contracting the virus, many experts encourage schools to offer sex education courses. Studies reveal that teaching teenagers and young adults how to promote healthy relationships and practice safer sex is more likely to prevent the spread of HIV than simply telling them to abstain from intercourse until marriage. Not everyone agrees with this approach. Some believe that the best way to stop the virus is to encourage abstinence. They argue that teaching young people about condoms and • 75 •

Sex Education Sex education is not only effective in helping to stem the HIV pandemic. It is also designed to reduce the spread of other sexually transmitted diseases and unplanned pregnancies. Many schools hope sex education will not only inform young people but also give them confidence in their relationships. However, sex education in a typical classroom setting is not available to everybody. Some schools do not provide it. Also, some people drop out of school. In developing countries, some children cannot afford school or have to work to support their families. Experts hope that community clinics, the media, and informal discussions will spread information about HIV to those who do not receive sex education.

Essential Issues HIV testing condones bisexuality, homosexuality, or having multiple sexual partners before marriage, which are behaviors they consider to be immoral. Opponents of the abstinence approach claim that it is unrealistic in the twenty-first century. They believe that, while abstinence works for some people, others are unlikely to consider it. They also argue that merely avoiding sex until marriage does not take into account that some husbands and wives become infected because their spouses have been unfaithful. They insist that students should be educated about methods that help decrease the spread of HIV. Schools that support this attitude encourage teachers to talk to their students about different options for practicing safer sex. This includes choosing abstinence, remaining honest and faithful within a romantic relationship, and using condoms correctly. Within recent years, many teenagers have revealed that they prefer and appreciate this approach.

Needles, Condoms, and Controversy Education is only one source of debate when it comes to HIV prevention. Societies worldwide remain divided about what government and health-care organizations should do to help • 76 •

H i v /A i d s citizens reduce risky behaviors. Some people believe that making condoms and clean needles readily available to the public is the answer. Many countries have set up needleexchange programs that allow drug users to obtain fresh needles and receive counseling to overcome their addictions. Other groups provide free or low-cost HIV testing to individuals who abuse drugs or engage in prostitution. Some people insist that these efforts decrease the spread of the virus without encouraging risky behaviors. It is unrealistic to assume that every young person will practice abstinence until marriage, they argue. They also say that it is impractical to think that all drug abusers and prostitutes can abandon their lifestyles without assistance. They believe helping these people lessen their chances of contracting or spreading HIV makes sense. • 77 •

Needle-exchange Programs Only 77 countries currently offer needleexchange programs to their citizens. However, in many situations, community groups and social-service organizations are responsible for raising the money to support such efforts because the national government will not fund this approach to HIV prevention. This is the case in the United States, and the practice is not legal in every state. As of 2007, the country featured 185 such programs. Despite the moral and political arguments against needle exchange, research has revealed that it is a successful method of stopping the spread of HIV. Scientists who studied the rate of infection among IV drug users in New York between 1990 and 2001 discovered that incidents of HIV decreased by 41 percent after these programs had been introduced to the area.

Essential Issues

Success in Uganda The African nation of Uganda has seen successful results from its prevention efforts. The number of adult citizens who tested HIV positive decreased from approximately 15 percent in the early 1990s to approximately 5 percent in 2001. Many people believe these statistics are a result of politicians and socialservice organizations openly and aggressively encouraging citizens to be tested for the virus and to practice safer sex by using condoms.

Not everyone agrees. Opponents are quick to bring up that, in many locations, prostitution and drug use are illegal. These critics argue that offering citizens condoms and clean needles is simply another way of approving immoral and illegal behavior that contributes to the HIV crisis. Politicians and health-care officials who oppose such measures may believe that punishing drug abusers and prostitutes is a better way to prevent the spread of the virus. The theory is that fear of punishment will deter others from practicing these bad behaviors. Russia is one nation that has generally followed this approach. Ultimately, several factors affect the role that government and healthcare organizations play in preventing HIV. Developing areas often face especially difficult challenges when deciding how limited funding should be spent. Officials must consider • 78 •

H i v /A i d s

Many people believe that needle-exchange programs help slow the spread of HIV.

which strategies will be most effective based on the factors that contribute to the epidemic in their part of the world.

Difficulties with Treatment Prevention is key to overcoming the virus on a large scale. But providing adequate treatment to those already infected is equally important. Some drug therapies have been proven to keep AIDS at bay, but they are not always a guaranteed solution. • 79 •

Essential Issues

End-of-life Support AIDS patients who are reaching the end of their lives also need support. For this reason, hospitals and social-service organizations in most countries attempt to offer seriously ill or dying AIDS patients some form of hospice care. Hospice programs are designed to minimize pain and increase the overall peace, dignity, and comfort of people who are close to death. Hospice workers often help patients and their friends and family members cope with difficult and complicated emotions.

Their success depends on several factors, including how advanced the virus is by the time treatment begins. Even when patients start receiving therapy shortly after becoming infected, doctors may need time to determine the right combination of drugs to produce minimal side effects. Some patients are hesitant to take HIV medications that are new to the market; other medications seem to make them feel sicker. Medications alone are not enough to keep HIV-positive individuals healthy. Most experts believe that patients also need to pay special attention to their diets. The virus limits the body’s ability to remain nourished, and poor nutrition can lead infected people to become sicker faster. This can be challenging for citizens of developing countries where food is scarce and poverty is widespread. This is why government and health-care officials often • 80 •

H i v /A i d s address the HIV pandemic and world hunger together. People from poorer backgrounds may find it difficult to keep up with the regular physicals that are an important part of monitoring infection. Their low-paying jobs may not offer paid sick time, so they might be afraid to miss work on account of a doctor’s appointment. Or, Family and Friends Handling HIV with little or no HIV can be as emotionally difficult for the health insurance, friends and family of an infected person as it they may be is for that individual. That is why most experts insist that all people affected by HIV receive worried about the counseling. Without support, relatives, spouses, costs of routine partners, and friends often face difficulty helpmedical care. ing their loved ones who have tested positive. An HIV patient in Australia recalled how On the someone close to him dealt with news of his other hand, health: even wealthier He found it incredibly difficult to handle and told me he was terrified. I saw another individuals side to this person, and, for two days, all sometimes fail to he talked about was “how is he going to cope?” At first, I found this startling, as I pay extra attention was the one with the diagnosis, but, in to their health fact, turned all my efforts . . . to helping after testing him cope with his mental health. It took my mind away from what I was supposed positive. A host to be dealing with. However, three days of psychological later, he told me he could cope no longer, and I was sent on my merry way. factors can inhibit 1

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Essential Issues treatment. For one, people may find their HIV status hard to accept. Following treatment plans means having to admit to themselves this difficult reality. Going to the doctor and taking medicine also increases the risk of others discovering that they have HIV—a secret they may want to keep hidden. They may be depressed about their health or anxious about how their friends, family, and coworkers will react. Because of such psychological factors, most experts emphasize that counseling should play a large role in treating HIV-positive individuals. Once patients discover strategies to cope with testing positive, they usually have more hope for the future and less fear of being open and honest with those around them. Many individuals also believe counseling should extend to patients’ friends, relatives, and acquaintances. Counseling may decrease their fears about contracting HIV, while increasing their compassion for those who live with the virus.

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People in developing countries may face many challenges in obtaining the HIV medications they need.

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Chapter

8

Basketball star Earvin “Magic” Johnson was one of several celebrities who contracted HIV and helped raise public awareness about the disease.

Offering Hope

A

t age 16, Ryan White testified before the National Commission on AIDS

in 1988:

I’m a normal happy teenager again. I have a learner’s permit. I attend sports functions and dances. My studies are • 84 •

H i v /A i d s important to me. I made the honor role just recently, with two A’s and two B’s. I’m just one of the kids, and all because the students at Hamilton Heights High School listened to the facts, educated their parents and themselves, and believed in me.1 Though only a teenager, Ryan had become somewhat of a hero in the struggle to overcome HIV-related discrimination in the United States. Ryan had contracted HIV after receiving a blood transfusion. Doctors diagnosed him in the early 1980s, when society still knew little about the virus and reacted to people who were infected with prejudice, hatred, and panic. As a result, when word of Ryan’s condition began to spread throughout Russiaville, Indiana, several local parents fought to keep him out of school and away from their children. “I was labeled a trouble maker, my mom an unfit mother, and I was not welcome anywhere,” Ryan recalled during his testimony. “People would get up and leave, so they would not have to sit anywhere near me. Even at church, people would not shake my hand.”2 Ryan and his family passionately fought such discrimination within their community. Though he had initially been asked to leave classes,

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The Quilt Cleve Jones, a famous advocate of homosexual rights, came up with the idea to create an AIDS Memorial Quilt. Begun in 1987, the quilt features pictures and quotes that remind the world of people who have died as a result of AIDS. Friends and loved ones of the deceased contribute to the quilt. Weighing more than 54 tons (49 t) and measuring 1,293,300 square feet (120,151 sq m), the quilt has been displayed in many countries. It has more than 40,000 patches. Like the red ribbon, it acts as a silent, but powerful, reminder of the numerous lives that have been touched by the virus and the world’s ongoing efforts to ensure that it is overcome.

Indiana’s court system stated that he could begin attending school again in April 1986. By that point, however, prejudice seemed to surround the Whites wherever they went. They moved to Cicero, Indiana, where Ryan ultimately attended Hamilton Heights High School. President Ronald Reagan urged Americans to view Ryan’s struggle as proof that education had to replace the fear and misinformation that surrounded HIV. AIDS claimed Ryan’s life in April 1990. Despite the hardships he faced at such a young age, his story is not one of sorrow. Ryan’s determination to teach others about the realities of the virus led him to become a national spokesperson for HIV education. His courage inspired celebrities to take up his cause. Talk-show host Phil Donahue and performers Alyssa Milano, Charlie Sheen, Elton John, Michael Jackson, and others publicly • 86 •

H i v /A i d s gave their support to infected men, women, and children. This teenage boy and countless other activists have worked to change public attitudes and offer hope that the disease will be conquered.

Public Understanding and Global Progress In the 1980s and 1990s, actor Rock Hudson, rock star Freddy Mercury, and athletes Earvin “Magic” Johnson, Arthur Ashe, and Greg Louganis revealed that they had the virus. Celebrities and politicians who came forward about their HIV status proved to the world that the disease could indeed touch anyone. They gave a human face to HIV. Over time, activists who were living with HIV—as well as many who were not—started to raise greater awareness of the crisis. Much of society gradually became less quick to judge HIV-positive individuals as • 87 •

HIV/AIDS in the Arts Media and the arts have also proven powerful tools in raising widespread public understanding of HIV and putting a human face on the virus. Actor Tom Hanks won an Academy Award for his portrayal of an attorney suffering from job discrimination as a result of AIDS in the 1993 film Philadelphia. The Broadway show Rent depicts how HIV affects the lives of eight friends in New York City in 1989. Numerous documentaries, essays, poems, novels, short stories, and other works of art have also helped educate society about the disease.

Essential Issues unlovable and immoral. Once the world witnessed famous figures such as Britain’s Princess Diana embracing people who were infected, social barriers formed by hatred, fear, and misunderstanding began to crumble worldwide. Little by little, the public realized that it was all right to hug people with HIV and to learn from their experiences. Today, celebrities, including Bono of the popular band U2, work with organizations such as Project (RED) to raise money and awareness for HIV/AIDS prevention and treatment. Yet celebrities are not the only ones responsible for a growing sense of hope. Activist groups rallied and marched to bring government attention to the epidemic in the late 1980s. The government began funding HIV/AIDS research at the activists’ urging. Other governmental groups took up the cause. The World Health Organization (WHO) is a UN agency devoted to international public health issues. In 1988, it declared every December 1 World AIDS Day for the purpose of “raising money, increasing awareness, fighting prejudice, and improving education.”3 The UN has held several special sessions over the past few decades to address topics related to • 88 •

H i v /A i d s

People in Pakistan lit candles on World AIDS Day in 2007.

HIV/AIDS. In addition, it formed UNAIDS, or the Joint United Nations Programme on HIV/AIDS, in 1996. UNAIDS consists of ten separate agencies that work to decrease the rate of infection, aid individuals who are living with HIV/AIDS, and help communities in more than 80 countries recover from the effects of the pandemic. Individual national governments have also played a large role in providing hope that HIV can • 89 •

Essential Issues be overcome. Initially, most African governments ignored the problem of HIV/AIDS. The 1990s were a time of turmoil and economic difficulty in many areas of the continent, and struggling countries did not have the resources to fight the disease. Slowly, governments began implementing programs to educate their people about HIV/AIDS and treat people who had contracted the virus. In 2002, several countries formed The Red Ribbon the Global Fund It is not always necessary to make a speech to Fight AIDS, or win a legal battle to lend strength and support to a cause. One example is how people Tuberculosis demonstrate their commitment to ending the and Malaria. As HIV crisis by simply wearing or displaying red of 2009, this ribbons. The red ribbon started gaining recognition as an international symbol of awareness organization of the virus and AIDS in 1991. Visual AIDS and had channeled Broadway Cares/Equity Fights AIDS—groups dedicated to using art and theater to further more than $15 preventive and education efforts related to billion in AIDS HIV—first developed the idea of having the ribbon represent unity with infected persons. prevention and As time passed, an increasing number of treatment programs celebrities and high-profile figures began wearthroughout the ing the ribbon at public events across the world. It also served as inspiration for other activists world. In 2003, championing causes related to medical issues. President George For example, it led to using the pink ribbon to increase awareness about breast cancer. W. Bush and • 90 •

H i v /A i d s other U.S. politicians formed the President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR includes a variety of strategies to halt the pandemic on a global scale, such as treating HIV-positive individuals, educating people about the disease, and providing condoms. Together, international efforts provide AIDS treatments to more than 2 million patients worldwide. These types of programs demonstrate that nations such as the United States and developing countries in sub-Saharan Africa and elsewhere can partner to stop the spread of HIV. In 2009, Congress set aside $6.3 billion for PEPFAR in the hope that, by 2013, funding will be used to prevent 12 million new HIV infections across the globe. A second goal is to provide care and treatment for the millions of people who already have the virus, as well as the countless others who are affected • 91 •

The Pledge The leaders of the G8 nations (Canada, France, Germany, Italy, Japan, Russia, the United Kingdom, and the United States) made a powerful pledge in 2005. That year, they vowed to ensure that people everywhere will have access to HIV prevention, treatment, and care by 2010. If fulfilled, this promise will offer amazing hope and recovery to nations that have been particularly devastated by the virus. However, by the end of 2009, it appeared that the deadline would not be met. The officials who took the pledge will need increased funding and continued political support to transform their goal into a reality.

Essential Issues

Former U.S. President George W. Bush met HIV patients in Africa in 2003. He helped form PEPFAR, a plan to stop the AIDS pandemic.

by it, including AIDS orphans. While these efforts are promising, unanswered questions about the pandemic, including if and when it will end, persist. • 92 •

H i v /A i d s Evaluating the Future of the Disease Many are working hard to combat HIV by funding research, prevention efforts, education, and treatment. Even so, the pandemic will grow worse unless politicians, scientists, health-care officials, and average citizens intensify their determination to fight it. Researchers are experimenting to find a cure but, as of 2009, have yet to do so. Nor have they developed an effective vaccine to prevent new infections. Without additional funding and social resources to fight it, the virus could eventually bring entire countries to ruin. But this does not have to be the case. Individuals of all races, ages, and economic backgrounds can play a part in reducing the spread of HIV and fostering hope worldwide. Even young people can help. They can participate in fund-raising projects • 93 •

Working Together Former UN SecretaryGeneral Kofi Annan emphasized the importance of people from all walks of life joining together to overcome the virus. He argued that this unity was the only real way world citizens would ever find the necessary strength to end the widespread devastation caused by HIV. “Everyone has his or her part to play. Let us now lay aside all turf battles and doctrinal disputes. The battle against HIV/AIDS is far more important than any one institution or project. Our success will not be measured by resolutions passed, appointments made, or even funds raised. It will be measured in the lives of succeeding generations.”4

Essential Issues organized by their schools and community centers. These events not only bring in money that can be sent to groups dedicated to combating HIV, they also increase awareness about the virus and issues related to it. On a more basic level, children and teens can work toward ending the pandemic by continuing to ask questions and become educated. A person who is educated about HIV/AIDS is more likely to treat someone who is HIV positive with dignity, compassion, and respect. Ultimately, this is how modern generations can work toward guaranteeing that the virus—though tragic and world-changing in the past—does not continue to wield such power in the future.

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The AIDS Quilt preserves the memory of those who have died from AIDS and inspires people to action worldwide.

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Timeline

1900s

1970s

1980

HIV begins to affect humans in Africa.

The first cases of HIV in the United States are reported.

HIV spreads to at least five continents (North America, South America, Europe, Africa, and Australia).

1983

1984

1986

Approximately 3,000 cases of AIDS are reported in the United States, resulting in as many as 1,000 deaths.

Researchers determine that HIV is the cause of AIDS.

Ryan White wins the legal right to attend classes even though he has been expelled due to his HIV status.

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1981

1982

1983

Doctors realize that patients are suffering from a syndrome featuring opportunistic illnesses that are resistant to treatment.

Scientists officially use the term AIDS to describe the syndrome.

Research shows that heterosexuals and those who have never abused drugs or received blood transfusions can acquire AIDS.

1987

1987

1988

Scientists begin to approve the use of some medications designed to lessen the effects of HIV.

Cleve Jones begins the AIDS Memorial Quilt.

Ryan White testifies before America’s National Commission on AIDS.

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Timeline

1988

1993

1996

WHO declares December 1 to be World AIDS Day.

Tom Hanks stars in Philadelphia as an attorney who experiences job discrimination as a result of AIDS.

The UN forms UNAIDS.

2003

2005

2006

President George W. Bush and other U.S. politicians form PEPFAR.

World leaders vow to ensure that everyone will have access to HIV prevention, treatment, and care by 2010.

In the past five years, HIV infections in bisexual and homosexual men rise by 8.6 percent in the United States.

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1997

2001

2002

Due to drug therapies, the percentage of AIDS-related deaths in developed countries declines.

Uganda’s HIV-positive adult population decreased from 15 percent in the early 1990s to 5 percent.

Donor nations form the Global Fund to Fight AIDS, Tuberculosis and Malaria.

2007

2008

2009

Worldwide, 33 million people are infected with HIV; 31 million of these people live in developing nations.

Only one-third of people in sub-Saharan Africa who have the virus receive needed drug therapies.

Scientists announce a slightly effective vaccine, but it is not effective enough to be used in the fight against HIV.

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Essential Facts At Issue Human Immunodeficiency Virus (HIV) weakens the body’s ability to fight infections and tumors. HIV ultimately causes a deadly disease known as Acquired Immunodeficiency Syndrome (AIDS). v HIV is currently recognized as a global pandemic. Studies conducted in 2007 revealed that approximately 33 million people all over the world are infected. Approximately 2.7 million individuals contracted the virus that year. v At least 2 million men, women, and children die as a result of AIDS on an annual basis. v Though researchers have developed medications that can help infected persons enjoy longer, healthier lives, no known cure can completely eliminate HIV from the human body. v Experts estimate that of the 33 million cases of HIV documented in 2007, more than 31 million traced back to developing nations in sub-Saharan Africa, Central Asia, Eastern Europe, the Caribbean, and South and Central America. Scientists have also determined that the virus and poverty are frequently linked. v HIV is capable of devastating the social, educational, healthcare, economic, and agricultural systems within communities in developing countries. v Even in more developed nations, prejudices related to the virus continue to contribute to misinformation, discrimination, and the spread of the virus itself. v

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Critical Dates 1900s HIV likely began affecting humans in Africa. Early 1980s Doctors began to realize that an increasing number of their patients who were homosexual or used IV drugs were suffering from the same syndrome. 1984 Researchers determined that HIV is the cause of AIDS. 1996 The UN formed UNAIDS. 2002 The Global Fund to Fight AIDS, Tuberculosis and Malaria was formed. 2007 Studies revealed that approximately 33 million people worldwide were living with HIV this year. More than 31 million of these people lived in developing nations. 2009 Scientists announce new vaccine research. Their vaccine is only slightly effective, but their work may guide future research.

Quotes “Everyone has his or her part to play. Let us now lay aside all turf battles and doctrinal disputes. The battle against HIV/AIDS is far more important than any one institution or project. Our success will not be measured by resolutions passed, appointments made, or even funds raised. It will be measured in the lives of succeeding generations.”—Kofi Annan, former UN secretary-general “If someone in Uganda tells you they haven’t been affected by HIV/AIDS, they’re lying.”—Journalist Jannifer Bakyawa, June 2009

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Additional Resources Select Bibliography AVERT. www.avert.org. Gallant, Joel E. 100 Questions and Answers about HIV and AIDS. Sudbury, MA: Jones and Bartlett Publishers, 2009. Libman, Howard, and Harvey J. Makadon, eds. HIV. Philadelphia, PA: American College of Physicians, 2007. Shilts, Randy. And the Band Played On: Politics, People, and the AIDS Epidemic. New York, NY: Penguin Books, 1988.

Further Reading Anonymous. Quicksand: HIV in Our World. Somerville, MA: Candlewick Press, 2009. Robinson, Richard. Frequently Asked Questions about AIDS and HIV. New York, NY: Rosen Publishing, 2009.

Web Links To learn more about HIV/AIDS, visit ABDO Publishing Company online at www.abdopublishing.com. Web sites about HIV/AIDS are featured on our Book Links page. These links are routinely monitored and updated to provide the most current information available.

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For More Information For more information about this subject, contact or visit the following organizations. The AIDS Museum 250 Central Avenue, #126, Newark, NJ 07103 877-744-8278 www.aidsmuseum.org As of 2009, this organization does not yet have a permanent location. It hosts several events at various universities and galleries to promote awareness of HIV and AIDS through art. The Koshland Science Museum The National Academies, 500 Fifth Street, Northwest Washington DC 20001 888-567-4526 www.koshland-science-museum.org This museum contains a gallery on infectious disease with exhibits related to the HIV/AIDS pandemic. UNAIDS Secretariat 20, Avenue Appia, CH-1211 Geneva 27, Switzerland +41-22-791-3666 www.unaids.org This organization can be contacted for the most up-to-date information regarding the UN’s efforts to end HIV/AIDS on a global scale.

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Glossary abstinence Refraining from sexual intercourse. bisexual Sexually attracted to both men and women. blood transfusion A transfer of blood from one person to another. developing nations Countries that are characterized by governmental, agricultural, economic, and industrial systems that are not fully established; these nations are often deeply affected by poverty. discriminate To treat unfairly. epidemic An outbreak of an infectious disease that affects a large percentage of people in an area. heterosexual Sexually attracted to members of the opposite gender. homosexual Sexually attracted to members of the same gender. immune system The group of organs and cells that allow the body to fight off infection. industrialized A nation that features widespread technology and manufacturing. intravenous (IV) drugs Drugs that are injected into a person’s vein with a needle.

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opportunistic infections Illnesses that arise when a person has a weakened immune system. pandemic An epidemic that is widespread globally or over a large region. pneumonia A respiratory disease that causes a person’s lungs to become sore and filled with fluid. prejudice An opinion formed ahead of time without knowing all the facts. prostitution The sale of sexual services. sterilize To properly clean something in a way that eliminates germs and bacteria. syndrome A pattern of symptoms usually associated with a particular disease. task forces Units or groups that are formed to focus on a single issue and the related problems it might cause. tuberculosis A highly contagious disease that mainly affects a person’s lungs. virus A microorganism that grows in living cells and causes infection in a person’s body.

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Source Notes Chapter 1. Left Lonely in Uganda 1. “HIV and AIDS in Uganda.” AVERT.org. 17 June 2009. 28 June 2009 . 2. Ibid. 3. “Ugandan AIDS Orphan’s Long Road to Success.” SFGate.com. 7 June 2009. 28 June 2009 . 4. Ibid. 5. Ibid. 6. Ibid. Chapter 2. Overview of a Pandemic 1. “HIV-Related Opportunistic Infections: Prevention and Treatment.” AVERT.org. 30 June 2009. 25 July 2009 . 2. “History of AIDS up to 1986.” AVERT.org. 22 June 2009. 25 July 2009 . 3. Ibid. 4. “Getting It Straight: HIV as a Gay Disease Is a Myth That Refuses to Die.” TheBody.com. March 1999. 25 July 2009 . 5. “History of AIDS: 2003–2006.” AVERT.org. 28 Apr. 2009. 25 July 2009 . 6. “History of AIDS up to 1986.” AVERT.org. 22 June 2009. 25 July 2009 .

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Chapter 3. Breaking Families 1. “HIV-Positive Mothers Rise from Despair to Hope.” UNICEF.org. 25 July 2009 . 2. “History of AIDS: 1998–2002.” AVERT.org. 20 Mar. 2009. 25 July 2009 . 3. “Aids Orphans.” AVERT.org. 22 July 2009. 25 July 2009 . 4. “Dancing with Death in Kenya’s Nyanza Province.” CrestedJournal. com. 22 Mar. 2009. 25 July 2009 . 5. “The Impact of HIV and AIDS in Africa.” AVERT.org. 22 July 2009. 25 July 2009 . 6. Ibid. 7. “Poverty and HIV/AIDS in Sub-Saharan Africa.” UNDP.org. 25 July 2009 . Chapter 4. HIV and the Cycle of Poverty 1. “Poverty Drives Myanmar’s Hidden Sex Industry.” DailyTimes. com. 26 Apr. 2007. 25 July 2009 . 2. “The Impact of HIV and AIDS in Africa.” AVERT.org. 22 July 2009. 25 July 2009 . Chapter 5. HIV in the United States 1. “A Young Man Learns to ‘Embrace’ His HIV Status.” WashingtonPost.com. 8 Jan. 2008. 25 July 2009 . 2. Ibid. 3. Ibid. 4. “HIV and AIDS in America.” AVERT.org. 2 July 2009. 25 July 2009 .

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Essential Issues Source Notes Continued Chapter 6. How Prejudice Takes a Toll 1. “Abstract: Stigma.” NIH.gov. Aug. 2002. 25 July 2009 . 2, “HIV and AIDS: Discrimination and Stigma.” AVERT.org. 21 July 2009. 25 July 2009 . 3. “Living without HIV Drugs: Jeff.” LivingWithoutHIVDrugs.com. 10 Dec. 2008. 25 July 2009 . 4. “HIV and AIDS: Discrimination and Stigma.” AVERT.org. 21 July 2009. 25 July 2009 . 5. Ibid. 6. Ibid. Chapter 7. Prevention and Treatment 1. “Living with HIV: Emotional Needs and Support.” AVERT.org. 16 July 2009. 25 July 2009 . Chapter 8. Offering Hope 1. “Testimony of Ryan White before the National Commission on AIDS.” RyanWhite.info. 25 July 2009 . 2. Ibid. 3. “1st Dec. WAD.” AVERT.org. 15 July 2009. 25 July 2009 . 4. UN Press Release. “Secretary-General Proposes Global Fund for Fight Against HIV/AIDS and Other Infectious Diseases at African Leaders Summit.” un.org. 26 Apr. 2001. 2 Sept. 2009 .

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Index abstinence, 75–77 activists, 21, 87–88, 90 Africa, 7–10, 11, 15–16, 22, 23, 24, 29, 30, 33, 34, 38, 40, 43, 45, 46–47, 53, 55, 59, 64, 78, 90–91 Botswana, 23, 69 Chad, 23 Ghana, 23 Malawi, 47 Namibia, 23 Rwanda, 23 South Africa, 33 Sub-Saharan Africa, 8, 9, 11, 40, 46, 53, 91 Swaziland, 45 Uganda, 7–10, 16, 34–36, 78 African Americans, 56, 57–58 AIDS Memorial Quilt, 86 AIDS orphans, 6–9, 10, 28–36, 45, 64, 91–92. See also children, HIV-positive Annan, Kofi, 93 Ashe, Arthur, 87 Asia, 11, 38, 41 Brunei, 67 Burma, 41 China, 26, 67 India, 62 Iraq, 67 Saudi Arabia, 67 South Korea, 67 Vietnam, 70 AVERT, 23, 43, 67

Ban Ki-moon, 63 blood transfusion. See transfusion Bono, 88 breast milk, 18, 41–42, 70 Bush, George W., 90 Carl (U.S. teenager), 50–52 celebrities, 86–88 Centers for Disease Control and Prevention, 19, 53, 59 children, HIV-positive, 8, 19, 28–36, 64, 69–70, 84–87. See also AIDS orphans clinics, 21, 46, 58, 75. See also hospitals communities HIV, effects on, 10, 11, 19, 27, 39, 41, 43–48, 54–55, 58, 85, 89 HIV-positive, 52 homosexual, 21 condoms, 21–22, 30, 41, 70, 76–78, 91 crime, 32, 67, 68 cure, 10, 22–23, 93 depression, 29, 82 Diana, Princess, 88 diet, 80–81 discrimination, 11, 19, 63–72, 85, 87. See also prejudice doctors, 10, 12, 15–17, 46–47, 52, 54, 63, 66–67, 68, 70, 80–82, 85

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Essential Issues Index Continued education academic, 22, 28, 30, 33, 40, 44–45, 46, 64 HIV-related, 11–12, 21, 30, 40, 42, 51–52, 54, 59–60, 69, 72, 75–76, 85–94 sex education, 75–76 Europe, 11, 24, 38, 39, 41 Armenia, 67 Moldavia, 67 Russia, 67, 78, 91 United Kingdom, 64, 68, 91 families, 8–9, 10, 11, 26–36, 40–48, 52, 53, 62–63, 65, 70, 75, 80, 81, 82, 85 fear, 18–19, 24, 51, 53, 55, 58, 63–64, 67, 68, 69, 70, 78, 81–82, 86, 88 funerals, 8, 10, 29, 32, 34 Global Fund to Fight AIDS, Tuberculosis and Malaria, 24, 90 Haiti, 56 health care, 7, 8, 23, 28, 39, 40, 43–44, 53–55, 57–58, 59, 68, 76, 78, 81, 93 Hispanics, 58–59 homosexuals, 16, 19, 21, 53, 55, 56–57, 59, 65, 77–79 hospitals, 46, 58, 68, 80. See also clinics Hudson, Rock, 87

images, 67 immigration, 56, 58, 59 immoral. See morality immune system, 15, 20–21, 22 intravenous drug users, 16, 18, 19, 21–22, 41, 55, 56–57, 59, 65, 77–79 Johnson, Earvin “Magic,” 87 Jones, Cleve, 86 Latinos. See Hispanics Ling (Chinese mother), 26–27 Louganis, Greg, 87 Lucy (Ugandan grandmother), 34–35 Mercury, Freddie, 87 morality, 22, 65, 67, 76–76, 77, 78, 88 Nakibuule, Zahara, 6–11 naming the syndrome, 16 needle-exchange programs, 21–22, 77–79 nurses. See doctors opportunistic illnesses, 15–16 origins, 14–17

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Philadelphia, 87 poverty, 8, 9, 28–29, 32–36, 38–48, 57–59, 81 pregnancy, 17, 18, 22, 27, 69, 75 prejudice, 19, 62–72, 85–86, 88. See also discrimination President’s Emergency Plan for AIDS Relief, 91 prevention, 11, 21–22, 24, 40, 54, 59, 60, 74–79, 88, 91–91, 93 Project (RED), 88 prostitution, 33, 40–41, 45, 65, 77–78 quilt. See AIDS Memorial Quilt Reagan, Ronald, 86 red ribbon, 86, 90 Rent, 87 research, 17, 18, 21, 22–23, 33, 34, 39, 46–47, 53, 54, 56, 77, 88, 93 safer sex, 21, 54, 70, 75, 76, 78 secrecy, 69, 82 sex education. See under education. shame, 69–70 Simian Immunodeficiency Virus, 15 symptoms, 11, 16, 20–21, 24

testing, 21, 40, 42, 51, 55, 56, 69, 76, 77, 78 therapy, 15, 22, 23, 53, 80. See also treatment transfusion, 16, 18, 19, 56, 85 transmission, 18, 21, 24, 30, 41–42, 65, 69 travel restrictions, 67 treatment, 11, 15, 22, 40, 47, 52, 63, 68, 69, 79–82, 88, 90–91. See also therapy United Nations, 38, 63, 88–89, 93 UNAIDS, 89 United States, 7, 9, 10, 15–16, 19, 22, 48, 50–60, 67, 77, 85, 90–91 Washington DC, 53, 59 unprotected sex, 18, 34, 40, 41, 51, 53, 55, 59, 75 vaccine, 22–23, 93 White, Ryan, 19, 84–87 women, 19, 32–36, 40–43, 58, 69 work, loss of, 45–47 World AIDS Day, 88 World Health Organization, 24, 88

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About the Author Katie Marsico is the author of more than 50 children’s reference books. She worked for several years as a managing editor before she began her career as a freelance writer. She currently lives near Chicago, Illinois, with her husband, daughter, and two sons.

Photo Credits Ramon Espinosa/AP Images, cover, 3; Mujahid Safodien/ AP Images, 6; Obed Zilwa/AP Images, 13, 31, 97; Gary Wales/ iStockphoto, 14; Scott Camazine/Photolibrary, 17, 96 (top); AP Images, 20, 96 (bottom); Susan Ragan/AP Images, 25; Karel Prinsloo/AP Images, 26; Heiner Heine/Photolibrary, 35, 37, 62; Khalil Senosi/AP Images, 38; Joachim Ladefoged/AP Images, 42; Themba Hadebe/AP Images, 44, 65, 98 (top); Denis Farrell/AP Images, 49; Roberto Borea/AP Images, 50; Evan Vucci/AP Images, 55; Mark Henley/Photolibrary, 57; Bildagentur RM/Photolibrary, 61; Michael C. York/AP Images, 66; Jean-Marc Bouju/AP Images, 71; Gurinder Osan/AP Images, 73; Andy Sawyer/AP Images, 74; Douglas Healey/AP Images, 79; Boris Heger/AP Images, 83; Chris Martinez/AP Images, 84; Khalid Tanveer/AP Images, 89, 99; J. Scott Applewhite/AP Images, 92, 98 (bottom); Ron Edmonds/AP Images, 95

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