The State of HIV/AIDS: December 1, 2008
Research in the Past Year
Male circumcision in Africa has been linked with a sharp reduction in HIV transmission rates. The delicate foreskin routinely acquires tiny tears during normal sexual activity, which increases the chances of getting HIV. However, male circumcision does not affect transmission rates among men who have sex with men in the United States. Speaking of men who have sex with men, the difference in transmission rates between them and exclusively heterosexual men cannot be explained by behavior differences alone. Yet behaviors do matter: 1 in 3 HIV-positive gay men report that they have unprotected sex. High risk behaviors are often amplified by a lack of information. Gay and bisexual men report knowing little about pre- and post-exposure prophylaxis drugs, which may prevent HIV transmission. Abstinence-only sex education has not shown to be effective, accurate, or ethical in its portrayal of safer sex, which certainly affects rates of HIV transmission. Sexual behavior counseling among Russians who are in drug treatment programs have shown to reduce HIV transmission rates. In nations where women are subject to high levels of domestic violence, such as India and South Africa, they are far more likely to contract HIV.
Mathematical models have shown that universal testing could slash new infection rates by 95% – if it were at all feasible to carry out such a scheme in poor countries or countries with considerable stigma about HIV/AIDS. In the period between 2000 and 2005, 330,000 people in South Africa alone died due to a delay in beginning anti-retroviral medications after being diagnosed with HIV. When people in the United States know that they have HIV, they take measures to prevent transmission. Stigma means that some of the most feasible prevention efforts in Africa are indirect, such as treating other STIs as an exclusive way to prevent HIV transmission.
People who are infected with one STI or who have yeast infections have higher rates of HIV contraction. The interaction between HIV, the other STI, and drugs used to treat them may be complex: herpes drugs, for example, have been shown to inhibit HIV. Anti-obesity drugs may prevent HIV and other viruses from traveling within the body. Certain HIV treatments are less effective when used with anti-tuberculosis treatments. Depression interferes with a person’s ability to strictly follow anti-retroviral regimens, though treating depression improves a patient’s efforts. Africans who evolved certain genetic variations to combat malaria have shown to be more susceptible to HIV; on the bright side (sort of), they live about two years longer than other infected people.
The nature of HIV is under constant investigation. In 2008, there has been new research on previously unexamined mutations, how HIV in one patient reacts when it is exposed to treatment-suppressed HIV in another, a discovery of a key protein that helps HIV overcome the body’s defenses, investigation into how HIV can break the blood-brain barrier, how HIV overtakes “resting” T cells, if there may be a connection between intestinal worms in Africa and HIV contraction and resistance, and many more topics. A man who appears to have been “cured” has drawn a lot of attention; he suffered from terminal leukemia as well, and survived a risky bone marrow transplant. The transplant may have cleared his body of HIV, though the method’s use is unfeasible for widespread use. Genetic resistance may be a more applicable avenue to explore in the search for a vaccine, though other forms of resistance have also come to attention. A long-standing belief that Hepatitis C inhibits the body’s ability to recover after HIV treatment begins has been rebutted. There is hope that a rectal gel may prevent transmission, though last year a gel trial was stopped in Brazil after several human subjects were infected with HIV as a result of the testing.