December 1, 2008 marks the 20th anniversary of World AIDS Day, a paradoxical milestone because it is unworthy of celebration – a reminder of a devastating disease we would rather exist without. Human Immunodeficiency Virus has claimed millions of lives since it was first discovered, and countless more continue to suffer from the disease, or the social implications of the disease, today.
As a nurse, I can rhyme off the clinical manifestations, pathophysiology, care and treatment for people living HIV positive. I learned how Antiretroviral Drugs, or ARV’s, stop the replication cycle of the virus and allow the patient’s CD4 level, or white blood cell count, rise enough to allow him or her to fight every day infections. I know that there is no cure, and that prevention is the only way to stop the cycle of transmission.
However, my education failed to include the powerful social impact that HIV/AIDS can exert on a community. Because it is usually transmitted through sexual acts, the disease carries a lot of stigma. All sexually transmitted diseases (STIs) continue to be a taboo subject not only in societies where sex is taboo, but also at home. There is still a lot of shame associated with acquiring them, but with 50% of university students receiving treatment for an STI during their schooling, you would think more discussion would surround the issue. Preventing the spread of HIV is very difficult when honesty surrounding all aspects of sex is severely lacking. The stigma is compounded by the false belief that only Africans, drug users, and prostitutes are subject to infection. I’ll have you know, however, that anyone who has ever had an STI could have just as easily acquired HIV instead of the clap.
Here, and within other vulnerable populations, AIDS’ impact ripples through the entire society. In areas where infection rates are up to 1/3 of the population, entire generations are dying, leaving behind families, orphans, and an empty labour market. That is not to discredit the personal suffering associated with a disease that destroys the immune system, a slow and tedious, inevitable death. Transmission is significantly associated with certain population dynamics, such as migration, war, poverty, low education, etc, always affecting those who are already the most vulnerable. Social justice issues increase infection rates, which subsequently increase the prevalence of social justice issues. Although most countries are seeing a decrease in their rates of HIV infection (largely due to prevention campaigns), the cycle isn’t broken yet.
I have met a lot of people who are positive, many of them my friends. Their determination to lead a “normal” life is inspiring, and often very humbling. It pains me to see them treated differently or when people shy away; after all, you can’t be infected from hugging. I have also met a lot of people who are afraid to get tested, their rational being “what’s the point, if I can’t get treatment anyways?”, an attitude I have trouble arguing with. Access to treatment is still difficult to come by. Anyone who tells you that treatment is free for children hasn’t got the whole picture. Which children? How will they come to the clinic once a month if they live in a rural village? What good are the ARVs if their family doesn’t have food to eat? How will their sick mother care for her sick children? What part of all this is, really, free? There are so many barriers left to overcome, and although prevention is important, so is treatment and holistic patient care.
On this World AIDS day, I think it is important to remember that AIDS is not the scourge of only Africa. AIDS affects us all. Not only do the social impacts make their way through global economies, or arouses sympathy for our fellow human, but HIV could also infect you, or someone you love. A recent outbreak in a mid-western American high school proves that it only takes a couple of less-than-safe sexual encounters to start a wide chain of infection. HIV exists in Canada, and is on the rise among our youth population. Like any social disease, open and honest discussion, decreasing stigma, and increasing awareness are important first steps, followed by prevention and testing. Get talking, get tested, and please, please, use a condom. Breaking the cycle starts with you.