Many communicable diseases have been evolving around the world resulting in millions of deaths and no cure. Communicable diseases are infectious diseases that can spread easily through direct contact such as human immunodeficiency virus (HIV). HIV is an infection that causes AIDS and can weaken the immune system. It has become a global and public health concern causing approximately 35 million deaths worldwide (WHO, 2018). HIV is the leading cause of death in Africa. It has had the most impact in Sub Saharan Africa where people live in poverty and don’t have access to medications, technologies or condoms, resulting in high death rates and short life expectancies. It’s known as the ‘silent’ disease because its symptoms tend to show up after a few weeks, which can be difficult to treat later. HIV/AIDS is a type of disease that doesn’t have a fixed cure, it can only be prevented or controlled by medications and technologies.
It is assumed that HIV first developed in apes around the 1900s, and its first encounter was with a hunter who had contracted the disease through direct contact with its blood. In 1981, it became headlines that five gay men were fighting a life-threatening infection called ‘PCP pneumonia’ that kills those with HIV/AIDS. Centers for Disease Control and Prevention decided to name this disease ‘acquired immunodeficiency syndrome’ and started to warn people of the spread of the disease through sexual and mother-to-child contact. The spread of AIDS started to occur in some parts of Africa in the early 1980s. In the same year, researchers Luc Montagnier and Francoise Barre-Sinoussi discovered a virus in a lymph gland of an AIDS patient, therefore confirming that HIV causes AIDS in people over time (Canadian Foundation for AIDS Research, 2016). Many researchers such as Mark Wainberg have contributed to the prevention and treatment of HIV/AIDS.
HIV can be classified through two distinct areas: microbiology and transmission. Microbiology focuses on different types of micro-organisms such as bacteria, virus, fungi, parasites and many more. This area classifies the type of microbe or agent the communicable disease is. In the case of HIV, it is a type of virus that can be treated by vaccines to prevent growth, but no cure to eliminate. Transmission looks at how the communicable disease can be transmitted to humans or animals. HIV can be transmitted through direct and indirect contact (blood, semen, body fluid), as well as perinatal contact, during pregnancy or breastfeeding.
HIV/AIDS is a global disease burden due to its high rates of death around the world. The case definition stated by WHO (2007) can help individuals with their illness at all stages: a suspected case would be a person presenting signs or symptoms such as fever, rash, swollen lymph nodes, and weight loss; a confirmed case would include adults and children 18 months or older who has had a second positive HIV antibody test or positive virological HIV (HIV-RNA or HIV-DNA) test and children younger than 18 months who have a positive virological HIV test that is confirmed the second time taken after four weeks of birth are diagnosed with HIV (Appendix A). The burden of disease also looks at the morbidity and mortality rates of a communicable disease. In Canada, the estimated incidence cases for HIV/AIDS were 2,165 in 2016, whereas the prevalent cases were 63,110 which has decreased from 2014. This decrease isn’t good because more people are dying which raises questions on whether the treatments aren’t good enough (Government of Canada, 2016). Risk factors for HIV/AIDS include unprotected sex, needles, contaminated blood, other infections such as chlamydia.
An article by T. Qi et al. (2016) is a cross-sectional study based on the etiology and clinical features of bloodstream infections among Chinese HIV/AIDS patients. This study took place at Shanghai Public Health Clinical Center (SPHCC) in Mainland, China between September 2009 through December 2014. The researchers evaluated 2442 HIV patients and amongst those, 229 patients had at least one positive blood culture (22.7% cryptococcus neoformans, 18.8% penicillium marneffei, 15.3% mycobacterium tuberculosis and 14.8% non-tuberculosis mycobacterium). Those patients who presented contaminants such as S. aureus were excluded from the study. A cross-sectional study design was used to measure the disease and exposure at the same time, also known as the ‘prevalence.’ In this study, the researchers found that penicillium marneffei (fungi) contributed to bloodstream infections much more than the other blood cultures and can be an emerging fungal infection in China. As a result, bloodstream infections are an important morbidity factor due to the prevalence of 9.38%, which led to poor prognosis in these HIV/AIDS patients.
Slabbert, N. F., et al. (2015) performed a cohort study on HIV/AIDS patients who may be influenced by antidepressant treatment within the major depressive disorder (MDD) population. MDD is highly associated with people who have HIV/AIDS because the disease puts a type of burden on the individual such as shame and their poor lifestyle choices which are mostly seen in women that can further affect their health and progression of the disease. This six-year prospective study took place in South Africa and included two main objectives: to determine the prevalence of MDD and HIV/AIDS patients and its impact on gender and how the compliance of antidepressants is affected in these patients who also have MDD. The researchers looked at two groups: 12, 270 patients with only MDD (comparison group) and 127 patients with both MDD and HIV/AIDS to compare which group would or wouldn’t comply to antidpressant treatment. At the end of the study, it was found that those who had both HIV/AIDS and MDD were associated with a decrease compliance of antidepressant treatment than those who did not have HIV/AIDS. It was predicted in the start of the study that people with infectious or chronic diseases don’t usually correlate with antidepressant treatments and that most women tend to have higher risks of MDD than men.
The epidemiological triangle is based on the complex relationships between the agent, host, and the environment that can be used towards explaining the HIV/AIDS pandemic. The agent in this case is the virus, HIV because it’s the cause of disease. The agent then comes in contact with the host which can be influenced by its factors such as age, sex, and behaviours. Humans are the host because HIV can be transmitted through broken skin, cuts, and mucus by risk factors including blood, sex and breastfeeding which is why even babies from the womb may have the disease. Early-like symptoms includes fever, headaches, and rashes, whereas severe symptoms can lead to opportunistic infections such as tuberculosis or cancer tumors. HIV has no cure yet, which is why treatments such as antiretroviral therapy (ART) can slow the process over time to avoid complications (AIDS info, 2018). The environment is where the agent and host interact causing either an increase or decrease of the disease. HIV lives in the cells of the human body which can be influenced by factors outside the body. Lifestyle choices such as avoiding drugs and alcohol, eating healthy, being active can lead to a better outcome, along with HIV medications and technologies. On the other hand, poor sanitation and stigma can result in AIDS development or early death (Appendix A).
Chain of Infection
It is important to break the chain of infection because it can prevent the spread of the disease to another person and eliminate it forever. Since HIV has been a result of a big percentage of deaths around the world, it is necessary to eliminate it so that death rates can decrease, and one major disease is out of the picture. The chain of infection starts with the infectious agent which is the human immunodeficiency virus which is part of the retroviridae family. HIV has a high pathogenicity and virulence because it can cause AIDS overtime if the individual has not been treated or hasn’t taken initiative to prevent the disease which can lead to severe outcomes such as death. When HIV comes into contact with a human, it becomes its reservoir. A person with HIV can be an asymptomatic carrier because the symptoms don’t show up for about a few weeks or even a month. HIV then leaves the human through a portal of exit which can be either the skin through cuts and needles, during pregnancy or breastfeeding from a mother to its baby, and body fluids such as semen or blood. The modes of transmission associated with HIV are direct contact through sexual intercourse, vertical transmission from a mother to its baby, as well as indirect contact by vehicle borne transmission such as blood and fomites. The way HIV leaves the host is similar to the way it enters a new host through the portal of entry which includes the placenta, semen, and skin (Skerrat, 2018). Lastly, individual factors and choices can determine how HIV will influence the person. Thus, if the individual avoids having sex, alcohol, and drugs, it can help control the growth of HIV in the cells of the body.
Natural History of Disease
The natural history of disease shows the individual’s disease progression overtime when they are not being treated. In the preclinical phase, the individual infected with HIV may not even know they have the disease which is known as the latent period. During the incubation period, individuals will start to show early symptoms such as fever, headache and cough after 2-4 weeks. HIV treatments such as antiretroviral therapy (ART) can help produce seroconversion to avoid growth overtime which allows patients to live longer (CDC, 2018). In the clinical phase, the infectious period is where people with HIV can transmit the disease through sexual intercourse, needle-sharing, or even pregnancy which can spread directly or indirectly from one person to another. During the symptomatic period, people will start showing signs and symptoms of HIV so if they don’t continuously get treatment then they may develop AIDS early on. AIDS don’t usually develop until about 10 years, but may result in opportunistic infections such as tuberculosis, cancer or death (CDC, 2018). It is important to understand the natural history of HIV/AIDS because it can help recently infected individuals take precautionary steps to treat and control the disease, along with living longer and healthier. In addition, it can change their individual lifestyle choices and motives in life.
Preventing and Controlling HIV/AIDS
Prevention and control are important actions to take in reducing the pandemic of HIV/AIDS. In epidemiology terms, agent control (HIV) can be prevented through antiretroviral therapy. This treatment involves the use of medications to help treat patients and reduces the growth of HIV in the body (AIDS info, 2018). Though most effective, low-income countries may not have access or enough money to get any type of services or medications. In addition, governments may not have optimal allocation due to limited resources in these health sectors. Therefore, organizations and the people need to work together to create a policy or program that can tackle this issue. Route of transmission control can include methods such as the use of condoms to prevent infected semen, to reduce needle-sharing to avoid blood to blood contact, and breastfeeding. All these methods prevent the transmission of HIV, but also promote safe sex, open injection sites, and other alternatives (Bertozzi et al., 2006). In addition, screening and testing is important to understand what stage the individual may be at to avoid the risks that can occur overtime and how to prevent and control it on time. Lastly, environmental control such as surveillance, vaccines and behavioural choices are steps towards preventing HIV/AIDS. These include monitoring, good nutrition, staying active, and avoiding alcohol and drugs. Education programs, counselling, and support groups can also promote awareness, and motivate people to take action, along with tackling other issues including stigma or depression (Appendix A).
Socio-political-globalization factors associated with HIV/AIDS
Since the HIV/AIDS pandemic, many organizations have stepped up to reduce and eradicate the disease that is causing millions of deaths around the world. The Joint United Nations Programme on HIV/AIDS (UNAIDS) was formed in 1996 with a goal to end AIDS. This organization works towards creating new policies, advocating, and working with governments to help deliver and monitor the communicable disease (UNAIDS, 2019). In addition, it works directly with countries that are mainly affected to provide funds and other resources to improve the health of their people. As of now, this organization is aiming to end AIDS by 2030. Furthermore, a study done by Saki et al. (2015) provides insight on a social issue that people diagnosed with HIV/AIDS go through: stigma and discrimination. Stigma is a structural barrier that puts an extra burden on the individual’s choices and health which further leads to discrimination. It can coincide with other health issues such as depression or isolation that can hinder the spread of disease and access to treatment. Thus, educational programs for example can provide knowledge on HIV/AIDS and can lead towards reducing stigma and discrimination.
- AIDS info. (2018). HIV/AIDS: The basics. Retrieved from https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/19/45/hiv-aids–the-basics
- Bertozzi, S., Pandian, S. N., Wegbreit, J., DeMaria, M. L., Feldman, B., Gayle, H., . . . Isbell, T. M. (2006). HIV/AIDS prevention and treatment. In disease control priorities in developing countries (18). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK11782/
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- Public Health Agency of Canada. (2018). Summary: Estimates of HIV incidence, prevalence and Canada’s progress on meeting the 90-90-90 HIV targets, 2016. Retrieved from https://www.canada.ca/en/public-health/services/publications/diseases-conditions/summary-estimates-hiv-incidence-prevalence-canadas-progress-90-90-90.html
- Qi, T., Zhang, R., Shen, Y., Liu, L., Lowrie, D., Song, W., . . . Lu, H. (2016). Etiology and clinical features of 229 cases of bloodstream infection among Chinese HIV/AIDS patients: A retrospective cross-sectional study. Eur J Clin Microbiol Infect Di, 35, 1767-1770. doi10.1007/s10096-016-2724-7
- Saki, M., Kermanshahi, K. M. S., Mohammadi, E., & Mohraz, M. (2015). Perception of patients with HIV/AIDS from stigma and discrimination. Iran Red Crescent Med J, 17(6) doi: 10.5812/ircmj.23638v2
- Skerrat, S. (2018). Chain of infection/Disease transmission [PowerPoint slides]. Retrieved from http://carlin.uit.yorku.ca/faculty/relay/2017-18Winter/sskerrat/IHST3100M/Chain_of_Infection_-_20180107_163413_33.html
- Slabbert, F. N., Harvey, B. H., Brink, C. B., & Lubbe, M. S. (2015). The impact of HIV/AIDS on compliance with antidepressant treatment in major depressive disorder: A prospective study in a South African private healthcare cohort. AIDS Research and Therapy, 12 doi:10.1186/s12981-015-0050-2
- UNAIDS. (2019). About UNAIDS. Retrieved from http://www.unaids.org/en/whoweare/about
- WHO. (2007). WHO care definitions of HIV for surveillance and revised clinical stating and immunological classification of HIV-related disease in adults and children. Retrieved from https://www.who.int/hiv/pub/guidelines/HIVstaging150307.pdf