Learning from HIV and AIDS (review)
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After more than two decades since the initial descriptions of AIDS, there has been great progress in understanding the virology and immune pathogenesis of the disease. The development of effective antiretroviral therapy has outpaced the progress in antiviral therapy for other viral pathogens. HIV infection, however, continues to spread, here in the United Sates as well as globally. The characteristics of the epidemic are quite different across the world, with the populations at risk changing over time. A few countries have been successful in decreasing transmission, but astonishingly, the reasons for the success of these programs evade us.
One thing is certain: no country or group has conquered the disease or been able to halt the spread of this disease. Even in the United States and Western Europe, where antiretroviral therapy has significantly decreased the morbidity and mortality, the disease continues to spread.The CDC has reported that the incidence of HIV has increased in 29 states, and that over the last several years (1999-2002), the majority of newly diagnosed patients with HIV infection have been African Americans. Despite all the knowledge about the biology of HIV, its natural history, and modes of transmission, we have been unable to develop effective prevention strategies. Although many infectious diseases have been controlled by the development of vaccines, this is a modality that will not be available any time soon, and its promise may actually impede progress toward other preventive measures.
Learning from HIV and AIDS is an outgrowth of a U.K. BioSocial Society symposium held at the Institute of Education in May 2001. This conference was a [End Page 150] multidisciplinary meeting of several different groups to discuss how HIV/AIDS affects populations at many levels. The volume has been designed to present data from several different fields, with an emphasis on the need for input from the social sciences in helping to control HIV transmission. It is also different with respect to its global perspective. Individual chapters discuss the biology of HIV, the epidemiology, the demography, clinical care experiences in the United Kingdom, preventive health care promotion, and finally the politics of HIV. Most clinicians in the United States and Western Europe are schooled about the importance of comprehensive HIV care and antiretroviral therapy, and keeping up with this literature is challenge enough. To put this in perspective, however, antiretroviral therapy is a modality currently only available to 0.1% of the persons living with HIV/AIDS worldwide.
The chapter on HIV biology is clear and concise. It aptly describes how HIV has evolved as a human pathogen and compares HIV infection to other infectious diseases.This chapter also discusses genetic variation and other factors that affect susceptibility to infection and differences in disease progression. As pointed out, however, this knowledge of the biology and pharmacotherapy of HIV has had little impact on the pandemic. The chapter on clinical experiences of HIV care providers in London, where there is access to comprehensive care, illustrates how social barriers interfere with adherence and undermine the benefits of therapy.
The chapters on the quantitative social sciences—epidemiology and demography—not only review the impact HIV has had on populations, particularly high-risk groups, but also the limitations of current methodologies. They also highlight how little work has previously focused on sexual behaviors of different populations and the effects of sexual behaviors on an infectious diseases epidemic. With respect to demography, there is discussion about how slowly the effects of HIV have been incorporated into demographic models. There is also a need to look at more measures than just fertility rates, such as the rate of growth of orphan populations.
HIV prevention requires an understanding of the social context of individuals at risk. The competency to understand multiple diverse cultures is beyond the capacity of any individual or organization. The cultural competency required necessitates collaboration between communities and researchers in the qualitative social sciences, anthropologists, sociologists, and psychologists. Although community advocates understand the social...
