AIDS And You Chapter 1

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AIDS And You Contents

Within a few years every person in the world will probably know personally someone who has died because of AIDS. More than one in 200 of all adults walking on the earth are infected already. It may be an older brother or sister, a cousin, an uncle, a friend, a man in the same street, a shopkeeper, or someone at school or at work. You may not realise it because AIDS is kept so secret. You may think the person died of cancer, but someone somewhere knows otherwise.

It's already the case in most of Africa and parts of South East Asia. By 2002 over 80 million people had probably been infected with HIV - no one knows accurate figures. And HIV is spreading twice as fast across the world today as five years ago.

Some people freak out. They turn the TV channels over whenever AIDS is mentioned. They get scared, if they think someone at the party last night had the disease. They panic about the thought of touching someone with AIDS or picking up a dirty glass without realising and drinking from it. If they actually think several people may have been infected, then panic turns to hysteria.

Ambulance men in "space-suits'

In the early days of the epidemic people acted in strange ways. In the UK, police turned up wearing gloves, masks and overshoes to arrest a suspect, in case he was infected. Ambulance men turned up to transport someone who could have AIDS wearing 'space-suits'. A priest offered someone Holy Communion wearing gloves, with a bit of bread stuck on the edge of a wooden spatula. Old ladies in churches went back to their seats without drinking the wine. Meals-on-wheels delivery service of a hot meal to the home of someone who was ill became a stone cold meal left on the doorstep because the driver was too scared to ring the bell and go inside.

In Calcutta, India, a brand new AIDS ward was padlocked shut because no doctors or nurses could be found to work in it. In the same city a mother and newborn baby were thrown onto the streets when the medics found the mother had HIV infection. In Uganda fellow villagers have turned their backs in the past on people with AIDS dying without food or water, in case they died entering the homes of the sick and dying.

Whatever the culture, whatever the nation, you will find examples of stigma, rejection, hostility and abuse to those with AIDS. Thankfully attitudes are changing in many places but the burden is still there. As a doctor I know of no other illness in living memory that has caused such widespread reactions. Why?

Fear soon turns to anger. Bricks fly through windows or the home is burnt to the ground (this has happened twice in London). People are sacked on the spot and thrown out of their homes. And the problem keeps on growing.

Bored rigid with AIDS

Most people I meet in Western countries are bored rigid with AIDS until they meet someone who has it. It is a terrible shock to find your best friend is dying. It is even worse when you find that no one will talk about it because he has the wrong disease. He doesn't have cancer, and it is as if he has ceased to exist. No one wants to know.

But in countries like Rwanda, Burundi, Zimbabwe, South Africa or Uganda it's very different: every family has experienced AIDS grief and death is ever present - just look at the coffin makers by the side of the road or the steady trail of mourners at cemeteries in South Africa, where space is running out for burials in many cities because of AIDS. But where AIDS is so overwhelming there's another problem: people turn off, slipping into denial.

AIDS is the silent killer because by the time. you know you've got it it's too late. But the trouble is that HIV is spreading fast with 15,000 new infections every day, and in spite of what many Westerners have been told, most of the people infected worldwide are neither gay men nor drug addicts.

And despite what many in the poorest nations have been told, many people dying with HIV have been celibate before marriage and faithful since - infected by partners or medical treatments with infected blood or dirty needles.

Many people in countries like India aren't worried about AIDS because no one they know is dying - yet. But the problem is that by the time you know one friend who is ill, you will probably know a hundred people who are infected and going to die in the future. There is a big time delay.

Chain reaction

People you see on the TV, or read about in the papers, may have been infected in the early 1990s. For the last five to ten years they have felt completely well, perhaps totally unaware of the situation and may have passed on the infection.

One year, only two people in a community are infected, but within twelve months the number has risen to four. By the time another year is up the number has risen to eight and a year later it reaches sixteen. Everyone is well and looking fit. No one has even the remotest idea that anything is wrong. After another year-and-a-half forty are doomed, and a year later almost 100. This kind of pattern of spread has been common in Africa and other parts of the world.

And then one of the people infected early on has a mysterious viral illness and is out of action for six weeks. When he returns he looks really tired, but within a week or two he is back in action again. Six months later his friends notice that he has lost some weight, and one night after dinner he is rushed off to the hospital because he can't breathe.

One of his mates turns up to see him the next day to find he has died of pneumonia. A week later his brother tells someone in the bar that the doctors suspect he died of AIDS. That same night the 102nd person in the club took a risk with someone he thought he knew was 'safe' and became infected. So if you know that ten people in your city or town have died of AIDS, you know that maybe between 250 and 1,000 are walking around the streets every day feeling fine but carrying the killer virus.

Spreading like wildfire

In every country of the world each person with HIV has on average infected one other person within a few months. The time it takes for one to infect two to infect four to infect eight to infect sixteen and so on is called the 'doubling time'. A common cold spreads fast, and has maybe a doubling time of about a week.

So on the first day of term one person has a cold. Over, the following weeks the numbers only rise slowly at first: one, then two, -then four, then eight, then sixteen, then thirty-two. After the fifth week of term something dramatic happens and sixty-four new people go down with a cold. The week after it is even worse and 128 are sniffing and sneezing. After another week 256 are feeling rotten and the week after that 512 want to have a day off.

Actually it is not quite that bad. If 512 people have now been infected, only 256 will still be sneezing because a cold only lasts one week and the rest were infected over a week ago and have got better. If the school has 1,000 pupils then in a couple more weeks you might expect that everyone has had the cold. This never happens because some people, for reasons we don't understand, will manage not to get it at all.

The way the cold spread through the school shows you how HIV can spread - but with one or two important differences. With HIV the doubling time is not a week but often starts off in a country at around six to twelve months. After thousands of people have been infected, the doubling time slows down, perhaps to a couple of years, as it would have done in the school. When there are only 100 people left in the school who have not already had the cold, or are able to fight it off then the numbers getting it each week will suddenly fall - say 256, then 512, then 100, then fifty, then ten, then one. A week later no one in the school has that particular cold.

Injecting death

It is true, however, that while the spread of HIV through sexual contact is relatively slow, because most people do not swop partners every day of' every week, the spread from injecting drugs can be

extremely fast, with one addict infecting at least one other every day. In this situation the numbers of people infected could go over a period of weeks from one, to two, to four, to eight, to sixteen, to thirty-two, to sixty-four, to 128, to 256, to 512 to over 1,000 . This is why Italy, New York, parts of Scotland and other places with a bad drugs problem such as Manipur in North East India soon had a terrible AIDS problem.

Could the whole world die?

AIDS is unlikely to wipe us all out. Within any group, town or nation it spreads rapidly through those most at risk, it spreads more slowly through those at medium risk and spreads very slowly through those at low risk. How many people are infected, and how quickly, depends quite simply on how many people there are in each of those groups. If we can persuade people to change from high-risk living to low-risk living, then we can at least slow down the spread. In Uganda the percentage of adults carrying HIV had fallen dramatically from around 22% to 7%. Education saves lives but it takes time to change the behaviour of an entire community.

Who is 'safe'?

In Italy they talk about AIDS as a plague of drug addicts. In Africa it is known as a plague of men and women. In the UK it was first laballed a plague affecting the gay community ... but all

that is changing. AIDS is a disease of relationships and the virus causing it spreads along the lines relationships. It spreads through a men's drinking club, a factory, an office, a youth club and a school.

One thing is sure: AIDS knows no boundaries of nation, colour, personality or sexual orientation. The virus crosses between sexes and between people of the same sex when they have sex together, or when blood or secretions from one person enter the blood-stream of another.

In the UK, as in the USA, the first group to be badly affected was the gay community. As we have seen, one group only has to be hit a few years earlier than another to have a problem 100 times greater. That creates a misleading impression that you only really develop AIDS if you are a member of that group.

Heads in the sand

People always think they are safe until it is too late - and governments are no exception. In San Francisco they knew all about this strange new illness called AIDS that killed young men in New York and Los Angeles. They were worried and started to look for signs of spread into their own community. They missed it. By the time they realised they had a problem, one in four of the entire gay community was already infected. It's been the same story in many parts of Africa and in Asia regarding spread between men and women.

Many pastors have their heads in the sand. "We don't have a problem of AIDS in our church" they tell me. "In that case your church must be unique", I reply. Whenever a church is growing, people are finding faith and lives are changing, but infection remains, unless there is a miracle.

'It could never happen here'

In parts of central Africa it seems that one in five of all the young men and women are already doomed by the virus. We now know that AIDS was around in Africa, as in the USA, back as early as the 1960s. People were dying, but even with all the medical teams alerted, we only realised there was a single case of AIDS in Africa in 1983. In that year we suddenly began to realise the silent disaster in central Africa. It was possible that tens of thousands had already perished, and millions were already infected. For them it was too late.

Now AIDS is threatening parts of Asia in a similar way. In Mumbai alone over 1,000 new people are infected every night. I have visited villages in NE India on the Burmese border where out of around 40,000 people, 8,000 inject heroin and 4,000 are infected. I sat on the bed with the dying son of a pastor whose oldest brother had already been killed by HIV. Whole generations are being devastated. And yet as we will see, there is a very simple answer that costs nothing and saves millions of lives every year..

Worse than a war

If everyone infected survived HIV infection only six weeks, the USA would be in national mourning and the economy would be in a state of collapse. There would be mass panic. Vietnam wiped out 50,000 American young men from the US army over ten years. With over a million HIV infections in the US so far, AIDS makes those war deaths look almost insignificant. Even if there is not a single new infection in the USA after the moment you buy this book, the death toll will be the equivalent of twenty Vietnam wars.

And in Africa? We know that armed conflict encourages spread. Most wars today are wars inside nations rather than between them, causing millions of refugees to flee. When law and order breaks down and armed militia roam the streets or spring out of the bush to halt traffic, it becomes impossible to run a health service or pay for it. Prevention campaigns collapse and disease spreads. Ill-disciplined groups of armed men often have many sexual partners, either at gunpoint or in return for favours. All these things mean HIV spreads even faster.

Some informal reports suggest the rate of HIV infection in the Kenya army is up to 90% among some groups. We know that many communities in South Africa are already badly hot with up to one in five infected. This is a pandemic with unimaginable impact on hundreds of millions of people.

So who is safe then?

You are safe from AIDS if you are not infected yourself and are faithful, to one partner, who is also not infected at the moment and remains loyal to you and does not take risks with injecting, or with unsafe medical treatments.

Nothing new about AIDS?

Sex diseases have been around for thousands of years. Syphilis infected and killed tens of thousands of people until a treatment was found forty years ago. Gonorrhoea has continued to spread rapidly and is now often resistant to our drugs. We have a big problem with herpes which causes painful blisters, making sex impossible. It comes and goes for life. There is no cure. Cancer of the neck of the womb (cervix) is becoming more common because you are more likely to get it if you first have sex as a teenager and have a number of different partners. More and more women are also finding they can't have children. This it increasingly because of sex diseases, which damage a woman inside. Usually she doesn't realise until the damage is done.

The great sex age is over

In the ' swinging sixties' people talked a lot about sexual liberation once the pill meant that a woman was safe from getting pregnant. In the seventies, eighties and nineties there was an explosion of sexual activity among young people, and the number of young people needing treatment for sex diseases soared.

We are now living with the results of the sex age where long-term relationships have not been as important as having a good time tonight, where many people have stopped thinking twice before jumping into bed together or before cheating on each other, and where marriage built on faithfulness has often become meaningless.

But what has it all left us with? Our so-called 'wonderful' sex age has left us with millions of casualties; young people who have grown up in households that have fallen to pieces because a parent has had several partners. You don't have to be a doctor or a child psychiatrist to see what a disaster it has been for so many today.

People are also having second thoughts because of AIDS.

AIDS And You Contents

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