December 1, 2020, marks the 32nd anniversary of World AIDS Day, a time to bring attention to the HIV epidemic, increase HIV awareness and understanding, and speak out against HIV stigma. The theme for this year is “Ending the HIV/AIDS Epidemic: Resilience and Impact.” In honor of World AIDS Day 2020, a virtual forum and discussion on health justice, social activism, remembrance, and hope will be held on December 1, with a taped viewing available here, on the National AIDS Memorial website. Dr. Anthony Fauci, director of the National Institutes of Health’s (NIH) National Institute of Allergy and Infectious Diseases, and Dr. David Ho, director of the Aaron Diamond AIDS Research Center at Columbia University in New York, are the keynote speakers.
What Are HIV and AIDS?
AIDS, or acquired immunodeficiency syndrome, is a chronic condition caused by the virus known as HIV, or human immunodeficiency virus. HIV damages the immune system and interferes with the body’s ability to fight infection and disease, which can be life threatening. HIV is considered a sexually transmitted infection (STI), but it can also be spread by contact with infected blood or from a mother to a child during pregnancy, at birth, or while breastfeeding. If medication is not taken for HIV, a person’s immune system can weaken so much that they end up with AIDS.
There is no cure of HIV/AIDS, but medications have improved significantly in recent years to slow the progression of the disease and reduce AIDS deaths.
Symptoms of HIV and AIDS
The symptoms of HIV/AIDS vary depending on how progressed the infection is. Symptoms of primary infection, or acute HIV, the first stage of HIV, can last for a few weeks and include the following:
- Fever
- Headache
- Muscle aches and joint pain
- Rash
- Sore throat and painful mouth sores
- Swollen lymph glands, mainly on the neck
- Diarrhea
- Weight loss
- Cough
- Night sweats
Although the symptoms can be mild, the amount of virus in the bloodstream at this point in the disease is quite high and, as a result, can spread more easily during primary infection than the next stage.
The next stage of the infection is known as clinical latent infection, or chronic HIV infection. During this stage, HIV is still present in the body and in the white blood cells, but people have few new symptoms or infections at this stage. Clinical latent infection can last for many years.
As the virus multiplies and destroys the immune system cells that fight off germs, people may develop mild infections or chronic signs and symptoms. This phase is called symptomatic HIV infection. Symptoms at this stage include the following:
- Fever
- Fatigue
- Swollen lymph nodes
- Diarrhea
- Weight loss
- Thrush (oral yeast infection)
- Shingles (herpes zoster)
- Pneumonia
Untreated, HIV typically turns into AIDS in 8 to 10 years, which is the final stage of HIV. Because of better antiviral treatments, most people with HIV in the United States today never develop AIDS. If AIDS does occur, the immune system has been severely damaged by this time, leaving the body open to opportunistic infections or cancers.
Signs and symptoms of infections derived from AIDS include:
- Sweats
- Chills
- Recurring fever
- Chronic diarrhea
- Swollen lymph glands
- Persistent white spots or lesions on the tongue and inside the mouth
- Persistent, unexplained fatigue
- Weakness
- Weight loss
- Skin rashes or bumps
Causes of HIV/AIDS and How HIV Spreads
HIV is a virus spread through sexual contact, blood, or from mother to child during pregnancy, at childbirth, or while breastfeeding. HIV infection destroys CD4 T cells, the white blood cells that help the body fight disease. The fewer CD4 T cells in the body, the weaker the immune system becomes. People can have an HIV infection for years without being aware of it since symptoms may not be severe or may mimic other illnesses. The normal range of CD4 T cells is between 500 and 1500. When the CD4 T cell count dips below 200, AIDS can develop.
HIV spreads in the following ways: 
- Through sex: HIV can enter the body through sores or tears during sexual activity
- By sharing needles: Needles used during intravenous drug use can spread HIV as well as other diseases, such as hepatitis
- From blood transfusions: Because American hospitals and blood banks now screen for HIV antibodies, the risk of acquiring HIV through a transfusion is now small compared to when the virus was first discovered in the 1980s
- During pregnancy, delivery, or breastfeeding: Infected mothers can pass the virus to babies, but being treated for infection during pregnancy can reduce the risk to newborns.
HIV cannot be spread through ordinary contact, such as hugging, kissing, dancing, or shaking hands.
Risk Factor for HIV and AIDS
Anyone can get HIV/AIDS but taking precautions can reduce the risk significantly. Risk factors include:
- Having unprotected sex: Using condoms and limiting the number of sexual partners can help prevent HIV
- Having an STI: Many STIs produce open sores that are entryways for HIV
- Using intravenous drugs: Sharing needles and syringes exposes people to other people’s blood
Complications of HIV
HIV can weaken the immune system and lead to many infections and some types of cancers, including:
- Pneumocystis pneumonia (PCP): PCP is a fungal infection that can cause severe illness and is the number one cause of pneumonia in HIV-infected people.
- Candidiasis (thrush): Thrush is common in HIV and causes inflammation and a thick, white coating on the mouth, tongue, esophagus, or vagina.
- Cytomegalovirus: This is a common herpes virus that is transmitted in body fluids. As the immune system weakens, the virus, which typically lies dormant in the body, can resurface and cause damage to the eyes, digestive tract, lungs, and other organs.
- Cryptococcal meningitis: This is a common central nervous system infection of the membranes and fluid surrounding the brain and spinal cord that occurs during HIV and is caused by a fungus found in soil.
- Toxoplasmosis: Toxoplasmosis gondii is a potentially deadly parasite that is found in cats and can be passed to humans in their feces.
- Wasting syndrome: Significant weight loss can occur in untreated HIV/AIDS.
- Neurological complications: HIV-associated neurocognitive disorders (HAND) can range from mild to severe and can cause confusion, forgetfulness, depression, anxiety, and difficulty walking as well as dementia, weakness, and inability to function.
- Kidney disease: HIV-associated neuropathy (HIVAN) is an inflammation of the tiny filters in the kidneys that remove excess fluid and wastes from the blood and pass them to the urine.
- Liver disease: Liver disease is a major complication and is most common in people who also have hepatitis B or hepatitis C.
Prevention of HIV and AIDS
Taking precautions against HIV infection is the only way to prevent AIDS until a vaccine is created. Doing the following can help prevent the spread of HIV:
- Using treatment as prevention (TasP): Treatment as prevention means taking medication exactly as prescribed and getting regular checkups to make sure the amount of virus in the bloodstream, known as the viral load, stays undetectable in the blood.
- Using post-exposure prophylaxis (PEP): Taking PEP as soon as possible within the first 72 hours of possible exposure to HIV greatly reduces the risk of becoming infected with HIV. Medication should be taken for 28 days.
- Using a new condom every time: When used as directed (using a new condom or a female condom for women during sex and lubricants that are water based), condoms and dental dams are highly effective in preventing HIV.
- Considering preexposure prophylaxis (PrEP): Sexually transmitted HIV infection in people at very high risk can be reduced by 90 percent by using a combination of the drugs emtricitabine plus tenofovir (Truvada) and emtricitabine plus tenofovir alafenamide (Descovy). HIV from injection drug use can be reduced by more than 70 percent with these drugs. Truvada and Descovy, which need to be taken daily, are prescribed for people who do not already have HIV and who have healthy liver function. Another PrEP may be available soon for women. A breakthrough study in November 2020 suggests that, for women, an experimental drug called cabotegravir injected every two months is 89 percent more effective at preventing HIV infection than a daily Truvada pill. Top NIH infectious disease doctor Fauci calls cabotegravir “a major, major advance.”
- Telling sexual partners you have HIV: All current and past sexual partners need to know about an HIV-positive diagnosis.
- Using a clean needle: Sterile, unshared needles can help prevent HIV in intravenous drug users.
- Getting medical care immediately if pregnant: The risk of passing HIV to a baby is significantly reduced with early treatment.
- Considering male circumcision: Male circumcision can help reduce the risk of getting HIV infection.
Research is ongoing into new drugs and even a vaccine in treating and preventing HIV and AIDS.
Herrick Library Resources on HIV and AIDS
The following books and DVDs on HIV and AIDS can be reserved and checked out via curbside pickup or as e-books in OverDrive*, where indicated:
- 5B: This DVD tells the inspirational story of the doctors, nurses, and caregivers who took extraordinary action to care for patients on the first AIDS ward in the United States.
- 100 Questions & Answers About HIV and AIDS, by Joel Gallant: Provides authoritative and practical answers to the most commonly asked questions by patients and their loved ones.
- Back on Board: This candid documentary tells the story of how Olympic diver Greg Louganis has dealt with his AIDS diagnosis while returning to diving as a mentor of up-and-coming athletes.
- Believing in Magic: My Story of Love, Overcoming Adversity, and Keeping the Faith, by Cookie Johnson: An inspiring memoir by the wife of basketball standout Earnest “Magic” Johnson, who acquired AIDS in 1991.
- Dallas Buyers Club: Based on a true story, this film, which earned Matthew McConaughey a Best Actor Oscar, is about a straight, rough-hewn Texas cowboy who acquires AIDS and tracks down alternative treatments from all over the world, legal and illegal, to treat himself and fellow AIDS sufferers.
- The Gay Rights Movement*, by Eric Braun: An overview of the LGBTQ rights movement, including AIDS activism, that children ages 6-8 would understand.
- How to Survive a Plague: This documentary is the story of the efforts of a group of activists from ACT UP that helped turn AIDS from a death sentence into a mostly manageable condition.
- Me, by Elton John: The autobiography of singer-songwriter Elton John, who is the founder of the Elton John AIDS Foundation.
- The Normal Heart: An HBO Films drama about the rise of the HIV-AIDS crisis in New York City in the early 1980s as seen through the eyes of writer and activist Ned Weeks (Mark Ruffalo).
- Precious: The hard-to-watch but inspirational film of a physically, emotionally, and sexually abused teen, who becomes HIV positive.
- What Nurses Know . . . HIV/AIDS, by Rose Farnan and Maithe Enriquez: An up-do-date, practical health guide for people living with HIV and their partners.
The following magazines have run articles or carried information on HIV and AIDS in recent months and can be read on the Flipster app:
- The Advocate
- Alternative Health Magazine
- Health
- Men’s Health
- Prevention
- Women’s Health
Sources: Mayo Clinic, HIV/AIDS, https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524#:~:text=Acquired%20immunodeficiency%20syndrome%20(AIDS)%20is,to%20fight%20infection%20and%20disease; National AIDS Memorial, World AIDS Day 2020, https://www.aidsmemorial.org/wad2020; National Institutes of Health, Acquired Immune Deficiency Syndrome CD4+ Count, https://www.ncbi.nlm.nih.gov/books/NBK513289/#:~:text=CD4%20cell%20count%20is%20a,1500%20cells%2Fmm%5E3; San Diego Union-Tribune, Study Finds Long-Acting Shot Helps Women Avoid HIV Infection, 11/9/20, https://www.sandiegouniontribune.com/business/nation/story/2020-11-09/study-finds-long-acting-shot-helps-women-avoid-hiv-infection
Graphics: CDC, https://www.cdc.gov/worldaidsday/index.html; HIV.gov, https://www.hiv.gov/events/awareness-days/world-aids-day
