Editorial Article

HIV/AIDS and the Global Pandemic: 30 Years Later!

Manoj Pardasani
Fordham University Graduate School of Social Service, USA
*Corresponding author:

Manoj Pardasani, Fordham University Graduate School of Social Service, USA, Email: mpardasani@fordham.edu

In 1984, research groups led by Dr. Gallo, Dr. Luc Mon-tagnier at the Pasteur Institute in Paris, and Dr. Jay Levy at the University of California, San Francisco, all identified a retrovirus as the cause of AIDS. Each group called the virus by a different name: HTLV-III, LAV, and ARV, respectively (The AIDS Institute, 2017). In the 33 years that have passed since that discovery, HIV/AIDS has continued to make an indelible impact on people around the world. Despite advances in prevention efforts, screenings, testing and medication management, the epidemic remains a significant public health crisis. According to UNAIDS (2016a), at the end of 2015, approximately:
☛ 36.7 million people globally were living with HIV;
☛ 2.1 million people became newly infected with HIV;
☛ 1.1 million people died from AIDS-related illnesses; and
☛ 1.9 million adults have become newly infected with HIVevery year since 2010.

The scourge of HIV/AIDS has had a devastating and irreparable impact on communities worldwide. While scientists are working feverishly to find effective treatments for it, a cure has not yet been found. Thus, all current efforts are focused on prevention, early screenings and testing, providing antiretroviral treatments and increasing access to all who are affected by it. Despite the steady number of new infections each year, progress has been made on many fronts with reference to education, raising awareness and increasing the commitment of governments and global organizations to fight this epidemic. However, significant challenges remain. The following challenges need to be addressed in order to enhance the lives of those affected by HIV/AIDS and prevent others from becoming infected by it:

(i) structural inequalities in access to care;
(ii) continued stigma associated with the disease;
(iii) reaching vulnerable and marginalized populations;
(iv) addressing the diverse bio-psycho-social and economic needs of those living with HIV/AIDS;
(v) educating the younger generation; and
(vi) promoting inter-disciplinary efforts.

The global distribution of the HIV pandemic is uneven and its impact on the developing world has been dispropor-tionately higher. In 2014, a UNAIDS report revealed that just 15 countries accounted for more than 75% of the 2.1 million new HIV infections [1]. Of the estimated 37 million people living with HIV, 19 million reside in eastern and southern Africa, 6.5 million reside in eastern and central Africa and 5 million reside in Asia [2]. In sub-Saharan Africa, just three countries—Nigeria, South Africa and Uganda—account for 48% of all new HIV infections [1]. Additionally, there are an estimated 2.4 million people in Western Europe and North America, 2 million in Latin America and the Caribbean, and 1.5 million in Eastern Europe that live with this disease. In South America, Brazil represents the largest number of people living with HIV in Latin America and accounts for 40% of all new infections in the region [2]. Despite its small population size, the Caribbean has the second-highest HIV prevalence globally after sub- Saharan Africa [2]. In Asia, China, India and Indonesia – account for around three-quarters of the total number of people living with HIV in the region [3]. In Eastern Europe, the vast majority (85%) of people living with HIV in the region live in Russia and Ukraine [4].

Poverty plays a critical role in determining access to preventive screenings, medications, social services, adher-ence to treatment and outreach. The countries located in Sub- Saharan Africa, Latin America, the Caribbean and Asia, most impacted from HIV/AIDS, lack the resources needed to comprehensively address the pandemic. Ac-cording to UNAIDS, in 2015, US$ 19 billion was spent in low- and middle- income countries with 57% of the total HIV resources in these countries coming from their own domestic budgets. This means that nearly $4 out of every $10 spent on the disease in the developing world comes from other regions. The rising numbers of new HIV infec-tions in many countries means that US$ 26.2 billion will be required for an effective response to the epidemic in 2020 [3]. Despite their best efforts at increasing testing and ac-cess, many developing countries continue to struggle with providing comprehensive outreach, education, healthcare and support services to individuals affected by HIV/AIDS and their families. Frequently, attention is paid to women and children, but individuals from stigmatized groups (such as gay men, sex workers and injection drug users) may fall through the cracks or be limited in their access.

Worldwide efforts to educate the public and de-stig-matize the disease have had positive outcomes in many communities. The derision, denial, overt discrimination and outright rejection of people living with HIV/AIDS has been significantly reduced in many counties, most notably in the developed world. However, stigma still plays a critical role in this pandemic. Gofman (1963) defined stigma as the rejection of an individual by the larger society because that individual possesses a trait deeply discredited by society. In many societies, a person living with HIV is seen as “undesirable”, contagious and reflective of values that are in opposition to what that society holds sacred and sacrosanct. In other words, an HIV-positive individual is regarded as having breached socially acceptable norms of behavior (sexuality, drug use, premarital sex, etc.) and is therefore deserving of rejection or scorn. In other cases, lack of knowledge causes community members to shun these individuals because of a fear of infection.

Stigma causes the HIV-affected individual to withdraw from society and remain hidden. This prevents individuals from seeking early testing, utilizing safe practices (clean needles, condom use, etc.) or receiving the necessary healthcare. The fear of familial and societal rejection or public shaming causes many individuals to hide their true identity, not disclose their HIV status to sexual partners, and reject any outreach from public health or social service professionals. Stigma can also prevent individuals who have already tested positive for HIV/AIDS and been connected with healthcare services, to continue with treatment for their perceived fear of exposure of their identity.

Social scientists, researchers and service providers have frequently highlighted the challenges of reaching marginalized populations in the fight against HIV/AIDS [5- 8]. Pardasani [6] has highlighted the unique issues faced by sex workers – male, female and transgender individu-als who work in unsafe and unsupported environments. Fowler [5] and AMFAR [9] point to the unique challenges faced by gay and transgender individuals who reside in countries where homosexuality is taboo and/or criminal. According to AMFAR [9] and UNAIDS [10], injection drug users are uniquely susceptible to the disease and are least likely to seek help on their own. Pardasani, Chazin and Fortinsky [7] found that orphaned children born to

HIV-infected mothers were least likely to receive adequate healthcare or supportive services in poorer countries. In many developed countries, there may be undocumented immigrants and refugees who are afraid to approach service providers on account of the lack of a legal status in those countries. Due to the stigma associated with the lives that members of the marginalized groups lead (sex workers, drug users, belonging to the LGBT community, etc.), many individuals resist seeking help like testing or treatment. If the conduct is considered criminal (sex work, using drugs or being gay), then the likelihood of self-identification is even more difficult and many would retreat into the shadows thereby increasing their own vulnerabilities. Frequently, the attitudes of professionals, front-line workers, community members and organizations are discriminatory and judgmental towards members of these groups. This may also lead to services being curtailed or denied on their part. Threats of physical violence, har-assment, lynching, incarceration or exploitation are real challenges faced by members of these vulnerable groups.

As antiretroviral treatments successfully suppress the viral loads, people are able to live longer and enjoy an enhanced quality of life. However, more people living and thriving with HIV/AIDS raises new challenges. Individuals may not just have a need for ongoing healthcare, but they may also require a host of other services in order to be better integrated into society. For instance, many infected individuals may need access to education or vocational training, housing, assistance with securing meaningful employment, substance abuse treatment and mental health counseling. They may also have a continued need for peer support and motivation to maintain positive health behavioral changes (using condoms, adhering to the medication regimen, staying sober, etc.).

Healthcare and social service organizations need to focus on the comprehensive health, economic and social needs of the individuals affected by this disease. This requires com-mitment in financial terms, as well as a paradigm shift in how communities and governments respond to this pandemic. Focusing on “making the person whole” and re-integrating them into society is critical to ensuring sustained change.

According to UNAIDS, nearly 19 million people do not know they are HIV positive [1]. In many developed countries, youth and millennials have not seen or heard of many people dying from HIV/AIDS (The. The publicity that AIDS -related suffering and deaths garnered in the 1980s and 1990s has been replaced by affirming stories of survival and empowerment. For many in the younger generation, HIV/AIDS is equivalent to a chronic disease like diabetes or hypertension. People still fear contracting HIV but the fear of dying from it has been substantially reduced. This has had a direct impact on the motivation of youth to practice safe sex or getting screened on a regular basis. Introduction of a Pre -Exposure Prophylaxis (PrEP), which reduces the chances of contracting HIV by almost 90%, has led to a rise in condom-less sex and STDs [4].

This presents a new challenge for public health profes-sionals – how to we reach this cohort of individuals and effectively engage them in prevention efforts. The need for continued outreach, education, and consciousness-raising is critical at this time. Providers need innovative methods to engage this group and subsequently lower the rate of new infections among this cohort.

As noted earlier, the response to this pandemic has to be global, comprehensive, diversified and substantive. Cultural norms, societal values, attitudes, individual country legisla-tions and regulations, availability of economic resources and community capacities have to be taken in to account when creating plans of action. Additionally, the response has to be multi-layered and inter-disciplinary. Frequently, professionals, policy makers and service providers work in silos and focus on their singular missions. While somewhat effective, this fragmented approach does not lend itself to holistic and integrated solutions. Each discipline brings a set of values, specialized knowledge and skills to the table. When integrated, the service provided to individuals liv-ing with HIV/AIDS and the community-at-large can be strengths-based, comprehensive and more effective. Not only does such an integrated approach address the diverse needs of individuals and communities, but it also enhances the quality of life, builds self-efficacy of individuals and families, and empowers communities [10-13].

The aim of this journal is to promote scholarship and dialog on all issues related to HIV/AIDS. By highlight-ing research on unmet needs, effective practice models of outreach, prevention and treatment, evidence-based interventions, new innovations in medicine and psychol-ogy, macro-level advocacy and other critical issues, we hope to educate, inform and illustrate effective methods to address this global pandemic.

1. UNAIDS Press Release (2014). UNAIDS report shows that 19 million of the 35 million people living with HIV today do not know that they have the virus.
2. UNAIDS (2016a). Global HIV Statistics. Fact Sheet: November 2016.
3. UNAIDS (2016b). The Prevention Gap Report.
4. Centers for Disease Control and Prevention {CDC} (2017). Pre-Exposure Prophylaxis (PrEP).
5. Fowler N (2014). HIV remains a global health problem. The Guardian, June 8th.
6. Pardasani M (2005). HIV/AIDS prevention and sex workers: An international lesson in empowerment. International Journal of Social Welfare, 14(2), 116-126.
7. Pardasani M, Chazin R, Fortinsky L (2010). The Orphans International Tanzania (OIT) Family Care Model: Strengthening kinship networks and empowering families. Journal of HIV and Social Services, 9(3), 305-321.
8. Parker R. (2002). The Global HIV/AIDS Pandemic, Structural Inequalities, and the Politics of International Health. American Journal of Public Health, 92(3): 343–347.
9. AMFAR (2010). The Shifting Global Health Landscape: Implications for HIV/AIDS and Vulnerable Populations.
10. UNAIDS (2009). AIDS and Global health.
11. Averting HIV and AIDS {AVERT} (2017). Global HIV and AIDS Statistics. Retrieved from
12. European Centre for Disease Prevention and Control (2015). HIV/AIDS Surveillance in 2015.
13. The AIDS Institute (2017). Where did AIDS come from?

Published: 05 July 2017

Copyright:

© 2017 Pardasani. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.