HIV/AIDS (Acquired Immuno-Deficiency Syndrome/Human Immunodeficiency Syndrome)

HIV Prevalence (in the Human Development Area)

In this context, Hiv means: the percentage of people aged 15 — 49 years who are infected with HIV.

Concepts of HIV Infection and AIDS

AIDS stands for Acquired Immunodeficiency Syndrome. It is caused by a virus called the Human Immunodeficiency Virus (HIV). HIV (or, as it is popularly known, the “AIDS” virus) can attack and seriously disrupt the body’s immune system, its defence against disease.

HIV-infected individuals progress through different stages of immunodeficiency. HIV infection must thus be viewed as a continuum ranging from the absence of any symptoms at one end, to the presence of clinical symptoms associated with AIDS, at the other. AIDS is now only regarded as the final stage of HIV infection. HIV disease or HIV infection is the “umbrella” term associated with the progression of the disease from initial infection to the end-stage of AIDS.

Upon infection, HIV usually remains dormant. During this time, the infected person will generally feel and appear well (the person is “an asymptomatic carrier of HIV”) although he or she is presumed to be able to transmit HIV to others. Anywhere from six weeks to six months later, and perhaps even longer, infection can be tested through the presence of antibodies (see Section C below).

HIV causes a progressive deterioration of a person’s immune system. In some if not all infected persons, a series of events, still not fully understood, will trigger HIV to replicate. HIV can then destroy certain lymphocytes (T4 white blood cells). The progressive destruction of these lymphocytes leads to a corresponding decline in immune function. This, in turn, renders the infected person vulnerable to a host of “opportunistic” infections, diseases and conditions. A person is clinically diagnosed as having AIDS, the last stage in the progression of HIV infection, when certain specific opportunistic infections, diseases or conditions are present.

Among these opportunistic infections, diseases and conditions are Kaposi’s sarcoma (a cancer), pneumocystis carinii pneumonia (PCP) and dementia (a progressive deterioration of the individual’s mental abilities). In Canada, PCP is the primary disease associated with more than half of the AIDS cases reported to date. Kaposi’s sarcoma is the next most common primary disease, affecting almost 20 per cent of AIDS cases. Other opportunistic infections account for approximately 19 per cent of AIDS cases.

How HIV is Transmitted

This other entry deals primarily with the privacy issues relating to HIV/AIDS. To address these issues, however, the reader must understand how HIV is transmitted. The means of transmission have a direct impact on resolving the privacy issues.

If, for example, HIV were transmitted like the common cold, those around an infected person would have a “life and death” interest in knowing that the person was infected. The infected person’s privacy might legitimately have to take a back seat to the public interest in disclosure.

If, on the other hand, HIV cannot be spread by casual contact with an infected person, those who do not know of the person’s infection are at no health risk by simply working, living or socializing (non-sexually) with that person. The infected person’s privacy can be protected without threatening the lives of others.

Many misconceptions remain about how HIV is transmitted from person to person. Attempts at public education have only partly succeeded in separating fact from fiction. Fears that HIV infection is spread through sharing toilet facilities or shaking hands, for example, have caused some people to call for strict measures to separate infected persons from the rest of society. Evidence has shown, however, that these fears are unfounded and their proposed control measures unnecessary.

Fortunately, HIV is not spread by casual contact. It is significantly more difficult to become infected with HIV than, for example, with the virus that causes Hepatitis B (another dangerous and occasionally fatal disease).

HIV may be present in the blood, semen, vaginal fluid and breast milk of an infected person. It has also been isolated in other body fluids such as saliva, urine and tears, but there is no evidence that these other fluids cause infection. It should be noted that, between Canada and the United States, approximately 100,000 cases of HIV/AIDS have been reported and none have identified saliva, urine or tears as the means of transmission.

HIV can be transmitted in four basic ways:

through contact with sexual fluids (i.e. semen and vaginal fluid) during intercourse. The lining of male and female genitals and anus are less effective barriers against infection by these fluids than unbroken skin on other parts of the body. The pattern of transmission can be male to male, male to female, or female to male. Insertive intercourse, either anal or vaginal, presents the greatest risk of transmission. In Canada, the great majority of HIV/AIDS cases are traced to homosexual or bisexual activity. In other parts of the world such as Africa and the Caribbean, the majority of HIV/AIDS cases result from heterosexual activity;
through blood or blood products. Blood and blood products which test positive for antibodies to HIV have been screened out in Canada since 1985. Those who received blood or blood products before screening began, however, may have become infected with HIV. Needles and other skin-piercing equipment contaminated with infected blood can also transmit HIV. In the eastern United States and in other pockets throughout the Western world, the sharing of infected needles has resulted in a massive increase in HIV infection among intravenous drug users;
from infected mother to child during pregnancy, at or about the time of birth, and possibly from breast milk;
from sperm, tissue, breast milk or solid organ donations from an infected donor.

HIV is not spread through casual contact normally associated with work or school. It is also not transmitted by air. Touching and hugging, handshakes, coughing or sneezing do not spread HIV. Nor do insect bites, water or food, cups, glasses, plates, eating utensils, toilets, public baths, communal swimming pools or dormitories. The normal social interaction of infected persons with others poses no danger of transmitting HIV.

Testing for HIV/AIDS

“AIDS testing” as it is colloquially known, or more accurately, “HIV antibody testing”, does not assess whether a person has HIV/AIDS. Instead, it examines a person’s blood sample for antibodies to HIV. Antibodies are proteins produced by the body to respond to an invasion of foreign substances such as viruses.

To test properly, a series of blood tests may be required. If the test produces a negative result (i.e. showing no antibodies to HIV), no further testing is usually necessary unless clinical circumstances warrant it. The person who provided the sample is generally assumed to be free of HIV infection. There are, however, important qualifications to a negative finding.

The Meaning of a Positive HIV Antibody Test Result (“HIV Seropositivity”)

The presence in a person’s blood of antibodies to HIV indicates that the person has been infected by HIV. A diagnosis that a person has been infected by HIV is called a diagnosis of “HIV seropositivity”. The test result is referred to as a positive HIV antibody test result.

Even though some questions remain about the precise significance of seropositivity, there appears to be sufficient medical consensus to draw the following qualified conclusions: the development of antibodies should be assumed to indicate the continuing presence of HIV in the body; infection with HIV is probably irreversible; and a person with antibodies is probably capable of transmitting HIV to others.

The Meaning of a Negative HIV Antibody Test Result (“HIV Seronegativity”)

A negative HIV antibody test result generally means that a person has not developed antibodies to HIV. In most cases this is because the person has not been exposed to HIV. However, it may also mean that the person has been exposed to HIV but has not become infected. In either case, there is no danger of the person transmitting HIV to another because there is no HIV in the person’s body to be transmitted.

The vast majority of negative test results are accurate. False negatives can nonetheless occur.

AIDS/HIV (Acquired Immuno-Deficiency Syndrome/Human Immunodeficiency Syndrome) and Prostitution

See in this encyclopedia.

HIV