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Preface

No one has said it better than Ryan White, Because of the lack of education on AIDS,
discrimination, fear, panic, and lies surround me, (1988 White). HIV or Human
Immunodeficiency Virus only affects humans and weakens your immune system (San Francisco
Aids Associations, n.d. n.a).. This disease has been in our world for many years but is still not
fully understood by most of the general public. The purpose of this ISU is to reverse the message
Ryan Whites quote sends by developing an understanding of the barriers that keep the world
from coming up with solutions to stop HIV/AIDS. This way the public knows AIDS to a full
extent and all of the facts that can eliminate some of the barriers such as, lack of education
causing discrimination and religion causing ignorance.
Without treatment, people who progress to AIDS typically survive about 3 years. Once
you have a dangerous opportunistic illness, life-expectancy without treatment falls to about 1
year, (2013 Aids Government n.a.) . From a reliable source, one in seven people diagnosed
with HIV do not know they are carrying the virus (2014 Aids Government Statistics n.a.). Nor
do they know much about the disease. Education could have helped them avoid acquiring the
virus. Education is a vital step towards halting the epidemic and overcoming the prejudice and
fear faced by people living with HIV/AIDS. Even with todays communication techniques and
abilities to get information around the world, people still lack the education needed in the subject
of AIDS. This is seen by the amount of people diagnosed with HIV that has still stayed
prominent and increasing every year. As told when we were young education is the key.
Although many people are ignorant of HIV/AIDS there are some places around the world that
have cut its HIV prevalence rates significantly. In Uganda, simply from mobilized leaders at all
levels and extensive education campaigns, they have estimated that the AIDS virus went from
14% in the early 1990s to around 8% in the 2000s (2006 Greece, Halperin, Nantulya).
No one can deny the statistics that state 78% of all newly infected men are gay/bisexual
(2015 HIV among Gay and Bisexual n.a.). However because homosexuals have a greater
chance of contracting HIV there is a lot of stigma surrounding homosexuals out of fear of getting
AIDS. These stigmas include

Thinking all gay people have AIDS


Not wanting any physical contact with someone who is gay
Thinking all gay people are promiscuous
Thinking you can catch AIDS through the work place (Human Diseases and

Conditions n.d. n.a.)


This therefore enhances homophobia altogether.
In a recent research survey with 438 participants (36% were Catholic, 37% were
Lutheran, and 26% were Pentecostal), 53% of the total participants believe that HIV is a
punishment from God. Further more, 81% of the participants believe that prayers can cure
HIV/AIDS (2009 Health Canada n.a.). With people under the religious illusion that HIV is not
something you can contract but rather a punishment for their sexual preferences, HIV/AIDS in
religious communities will continue to increase. This barrier can only be broken if religious
communities become more informed on how people really contract HIV. These outrageous
survey responses are the unfortunate reality in most religious communities, and are due to how
they bring up the subject. On April 1st 2002, in Kenya, U.S. blacks preach an abstinence Gospel
(2002, Sprinkle). Abstinence, although the most effective way in combatting against HIV, is an
unrealistic route to discuss HIV/AIDS because eventually everyone will have sex. Once they do,
they will not have the education to help stop the spread of HIV.
In the past, we have seen what prejudice, fear and ignorance can do to the world through
things like racism, and hate crimes against women. If the barriers that stop us from overcoming
HIV/AIDS continue to overpower us, many innocent people will be neglected, the chance of
finding a cure for HIV will be set back years, and the rates of HIV victims will continue to
increase.

Background

Scientists have recently found a chimpanzee in West Africa with an earlier version of
HIV. It is understood that the first HIV case in humans probably came from blood contact with
the Chimpanzee or their meat that was not cooked. The earliest known case of infection with
HIV-1 in a human was detected in a blood sample collected in 1959 from a man in Kinshasa,
Democratic Republic of the Congo (how he became infected is not known). Genetic analysis of
this blood sample suggested that HIV-1 may have stemmed from a single virus in the late 1940s
or early 1950s (The Aids Institute, n.d. n.a.) . Fast forward to June 5th 1981, U.S. Centers for
Disease Control and Prevention (CDC) publish a report in cases of rare lung infections in five
young, previously healthy, gay men in Los Angeles. By the time the report is published two men
were already dead. This was the first official reporting of what became known as the AIDS
epidemic. By the end of the year, there was a cumulative total of 270 reported cases of severe
immune deficiency among gay men, and 121 of those individuals had died (A timeline of
AIDS n.d. n.a.). The first diagnosis of AIDS in Canada happened in 1981. The first Canadian
death attributed to AIDS occurred in 1983, and approximately 21,000 people in Canada have
since died while infected with HIV or AIDS (2007, A Brief History of HIV/AIDS in Canada
n.a.). With this data, it is easy to see that HIV/AIDS quickly became an epidemic all over the
world.
Certain bodily fluids from an HIV-infected person can transmit HIV. These body fluids
are blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk (2014, How Do
You Get HIV/AIDS? n.a.). Once the HIV infected fluid has entered the body, it goes from T-cell
to T-cell. A T-cell is a type of white blood cell in charge of helping other immune cells ingest
germs that could potentially turn into a virus (2014, What is HIV/AIDS n.a.). When the HIV
virus goes into the cell, it takes control of the T-cell, kills it, becomes the host of the cell and
programs it to make duplicates of itself. This whole process can happen in seconds. The first
stage of the HIV virus is called the Acute Infection. During this stage, large amounts of the virus
are being produced through out the body. Many people (but not all) begin to develop influenza
like symptoms and deem it as The worst flu I have ever gotten.

Eventually the immune response will begin to bring the level of virus in the body back
down which in counter, increases the amount of T-cells or CD4 count in the body. This is then
called the viral set point. This means the level of virus in the body is relatively stable. Once the
T-cells increase, the Clinical Latency stage begins. During this stage the virus continues to
multiply with little or no symptoms and lasts an average of ten years, but some people may
progress through this stage faster. Eventually the viral load will begin to rise and the CD4 count
will begin to decline. As this happens, someone may begin to have constitutional symptoms of
HIV as the virus levels increase in the persons body and continue to kill off the T-cells. In a body
with a healthy immune system, someone has CD4 counts between 500 and 1600 cells per cubic
millimeter of blood (cells/mm3). A person is considered to have progressed to AIDS if their CD4
count falls below 200 cells per cubic millimeter (2013, Stages of HIV Infection, n.a.).

Expert

Many different people have made contributions in the fight against AIDS. One of the
largest contributors is named Robert Charles Gallo. Dr. Gallo was born in Waterbury,
Connecticut on March 23rd, 1937. When Robert was a young boy, his sister Judy was diagnosed
with Leukemia. Judy dying at the age of six, sparked Roberts passion for medical treatments and
research. Gallo then went to Thomas Jefferson University to major in Biology (2010, Robert
Gallo Facts n.a.). In the following thirty years, he worked as head of his Laboratory of Tumor
Cell biology for the National Institutes of Healths National Cancer Institute . In 1984, Gallo codiscovered HIV as the cause of AIDS (In Their Own Words, n.d., n.a.). Without his expertise
the steps to overcome HIV would not be where they are today. As well as co-discovering HIV,
Gallo also created the first HIV blood test. This invention helped health care workers all over the
globe test for HIV in an efficient and fast way (About Dr. Robert C. Gallo n.d. n.a.). Gallo is
one of the leading scientists that are on the verge of discovering a cure to HIV. Today, Dr. Gallo
works at IHV (Institute of Human Virology). He co-founded IHV in 1996 with the rest of his
team. Dr. Gallo has accomplished a lot in his life time. His achievements include
Discoveries that have led to both diagnostic and therapeutic advances in cancer, AIDS and
other viral disorders while his vision remains unprecedented in the field of virology.
International recognition as well as election into the National Academy of Sciences and
the Institute of Medicine. He has been awarded honors for his contribution to science from
countries around the world and holds 32 honorary doctorates. Dr. Gallo was the most
referenced scientists in the world in the 1980s and 1990s, during which he had the unique
distinction of twice winning America's most prestigious scientific award - the Albert
Lasker Award in Medicine - in 1982 and again in 1986. Dr. Gallo is the author of more
than 1,200 scientific publications and the book "Virus Hunting - AIDS, Cancer & the
Human Retrovirus: A Story of Scientific Discovery." (About Dr. Robert C. Gallo n.d.
n.a.)
Dr. Gallo has influenced the way people look at the immune system as a whole. Prior to
Gallo making the discovery of HIV, he was also the first to identify the existence of retroviruses.
A retrovirus is the viruss ability to replicate themselves through the cell from DNA/RNA.
Before identifying the retrovirus, scientists did not believe it existed (SOM Faculty Profile:

Robert C. Gallo, f.d., f.a.). Gallo has eliminated barriers that would currently create an
additional negative impact with HIV/AIDS. Without him, the research in HIV would not be
where we are today. I had the fortunate opportunity to communicate with Dr. Gallo through EMailing, the following is the mini interview speaking with Gallo himself.
When did you and your partners know you were onto something when discovering HIV?
For me, the big Eureka! moment, if there was one because this truly was a process, came when
my lab was able to mass-produce the virus in cell lines. When we knew we could produce it
forever, we knew we could get enough for the blood tests and really link this virus causatively to
AIDS.
What would you say is the greatest accomplishment in your life?
Scientifically, discovering human retroviruses was momentous since people called me crazy
for thinking they could even exist. We isolated the first human T cell leukemia virus, HTLV-I,
and demonstrated that the virus caused leukemia. (I have participated in the discovery of five
new viruses, and was instrumental in early efforts to culture T cells, discovering the growth
factor interleukin-2). The most practical scientific accomplishment is the development of the
HIV blood test, which has saved many lives.
Personally, having a child was the most passionately overwhelming moment of my life. I also
enjoy being invited to give students choice lectures to scientists in training around the world.
Do you think the world will ever find a cure for HIV?
I think a functional cure is possible. In fact, we are really reaching that stage when we have
drugs that allow people to live a reasonably normal life and with the lack of the profound
suffering that used to occur prior to therapy. But I know the question really means can we have
patients never again needing therapy, and yes, once again, I do believe that is a possibility. The
approach that I would think best would be continued research on long-acting, safe, non-toxic
drugs. Some of the new integrase inhibitors may fit that requirement. Perhaps these integrase
inhibitors coupled with some of the more powerful broad neutralizing monoclonal antibodies

might make a serious difference. My concern about the use of the monoclonal neutralizing
antibodies is their longevity. They may not last very long and this may alter the dynamics of the
antibody virus interactions as the monoclonals are needed to be used again and again over a
period of time. Nonetheless, I do believe that we could reach a situation where we will have
safe, long-lasting therapies that allow people to withdraw from drug therapy.
As for total eradication of the virus from a person infected with HIV, really, of course, this is
only a guess because no one knows the answer to this question. My best guess is that it is very
unlikely, and to prove it would require a post-mortem examination because we have seen many
times that in monkey models we thought no virus was left until post-mortem found some viral
sequences in some lymph node tissues. We can also question the logic of making this a
monumental pursuit at the expense of some other areas that might be more pressing and more
practical like reaching out to communities at high risk by testing and earlier treatment. I recall
hearing that the U.S. Centers for Disease Control and Prevention (CDC) estimates 20% of those
infected in the U.S. are unaware they are infected.
In terms of preventive vaccine where are we and where do we go?
I just wrote with my Institute of Human Virology colleagues, George Lewis and Tony DeVico, a
perspective in the U.S. Proceedings of the National Academy of Sciences. In this perspective,
we pointed out that our thinking is that we must target the gp120 component of the HIV
envelope, and since it is hyper-variable we have to target conserved regions which are hard to get
at. We also believe there are approaches to do that. We believe that the variation of HIV is not
the most serious problem rather that it is the longevity of the antibodies that target gp120. For
unclear reasons, they do not last very long, usually ending in months. This is not unique there
are other antigens that induce antibodies that are short-lived. We feel that we must find the
answer to that because continued boosting is neither feasible, practical nor without risk, and
likely in the end would fail as the quality of the immune response will change after repetitive
boosting. This is a basic immunology science question and we think there are approaches to find
answer to it and indeed our Institute is very much involved in such research. There is however
an additional problem and that is that we know we need T cell help to make antibodies, and when
we pursue agents that give higher antibody titer and possibly longer lasting antibodies in monkey

experiments we find that these approaches reactivate too many T cells which provide new targets
for HIV infection and thus we can lose the efficacy of the vaccine. Consequently, we need to
find the right balance between inducing the right titer and longevity of antibodies and the T cell
response. Again, I think this is doable but will require additional basic research.
Do you believe there is complacency around HIV infection?
Yes, there is more complacency today its obvious, and its understandable because we have
such good therapy.
Having said that we have to emphasize that HIV/AIDS is not a disease which is cured. People
obviously live better and longer but they still have virus and that still leads to a slightly shorter
lifespan, an increase in cancers as well as cardiovascular disease. So the problem is far from
over even in the people who are getting adequately treated. Of course a lot of people arent
adequately treated. As I said earlier, Ive heard an estimate that in the U.S. with all our care, only
about 20% of people are adherent to drugs and getting the right therapy.
Why do young people need to be concerned about HIV infection today?
Well, of course the antiretroviral drugs do not solve the issue but make it much better. We are
still in danger of getting infected. If you were infected, you would have to take drugs for the rest
of your life at this stage. Who likes to do that? Some of the drugs will have long-term side
effects, although not very bad, so far. And as I mentioned, already there is an increase in
incidences of cancer, cardiovascular disease and a shortened lifespan. So for all those reasons
and more, you should not want to get infected and you should still be cautious.
Did AIDS change peoples attitudes towards minority issues?
Yes I do believe there is a change of attitude. I think one of the good things that came out of this
horrible story of AIDS is that there is a greater understanding of differences in peoples sexuality.
There is also a greater understanding of differences of people of North and South, East and West,
and a greater cooperation between us. Additionally people are paying more attention to womens
rights.

What is your current ambition?


My current leadership ambition is to leave a legacy of an exceptionally good Institute the
Institute of Human Virology (IHV) at the University of Maryland School of Medicine which I
co-founded. My second ambition is to leave the legacy of the Global Virus Network (GVN),
which I co-founded only four years ago.
As for my laboratory ambition, it is to gain a greater understanding of infectious causes of
cancer. I have a few of them so far. I would like to find more associations of infections and
demonstrate that they are they are involved in the cause of human malignancies. I have a goal
with AIDS as well. I would like to see a functional cure and I would like the IHV to contribute
to that. More than that, I hope our vaccine candidate will be important in moving the field
towards the ultimate truly successful preventive vaccine against HIV. We hope our candidate
vaccine will start clinical trials in June.

Role of Control
At first glance, it seems that UNAIDS (United Nations AIDS) is in control. However with
further investigation, UNAIDS is just an international organization. Each country has a different
body in control, however their contributions and regulations surrounding HIV/AIDS are very
similar (UNAIDS, n.d., n.a.). The Public Health Agency of Canada has the most control over
domestic cases of HIV/AIDS. The Public Health Agencys job is to protect and inform Canadians
on diseases, have preparation for any National or Domestic health emergencies, and continue to
create international and intergovernmental relationships. Public Health Agency of Canadas
priorities lie with [...] preventing chronic diseases, like cancer and heart disease, preventing
injuries and responding to public health emergencies and infectious disease outbreaks (Public
Health Agency Of Canada n.d. n.a.).

The Public Health Agency of Canada has many jobs when fighting against HIV/AIDS in
our own country. One of their main steps in fighting against HIV/AIDS is something called the
Federal Initiative. The Federal Initiative is associated with the PCHAC to
prevent the acquisition and transmission of new infections , Slow the progression of the
disease and improve quality of life , Reduce the social and economic impact of HIV/AIDS
and Contribute to the global effort to reduce the spread of HIV and mitigate the impact of
the disease, ( 2012 Publc Health Agency Of Canada in Federal Institution n.a.).
In order to continue the fight with HIV/AIDS it is clear that the Federal Initiative must
work with their partners. However it is difficult to work with government owned organizations
because of the jurisdiction. The department therefore tries to have close ties to all other nations,
and is in directly involved with non-governmental organizations such as UNAIDS . Since HIV
breaks down the immune system, some people with the virus are vulnerable to other infections.
Programs will address barriers to services for people living with or vulnerable to multiple
infections and conditions that have an impact on their health. Those affected will play a key role
in overcoming these barriers, (2012, Federal Initiative to Address HIV/AIDS, n.d., n.a.)
The Public Health Agency of Canada is therefore held accountable for the success of the
Federal Initiative, which includes partnerships with other countries, and continuous supervision
over the Federal Initiatives plans. The Public Health Agency of Canada is also responsible for
communications, social marketing, national and regional programs, policy development,
surveillance, laboratory science and global engagement focussing on technical assistance and
policy advice. (2012, Strengthening Federal Action in the Canadian Response to HIV/AIDS
n.d, n.a)
Another portion of the Public Health Agency of Canada is Health Canada. Their
responsibility is to educate communities around Canada about HIV/AIDS and also partner with
First Nations so that ALL of Canada can be aware of the HIV/AIDS epidemic. Finally, The
Public Health Agency Of Canada is responsible for Correctional Service Canada. This agency
treats HIV/AIDS through the legal system with prisoners that are sentenced to jail for two years
or more. (1998, Drugs and Drug Policy in Canada n.a)

The Public Health Agency of Canada continues to contribute many resources in the fight
against HIV/AIDS. They will do whatever it takes to ensure the safety of our country, and to help
developing nations in their fight by taking part in international organizations all over the globe.
They all have a say in how we tackle the HIV/AIDS epidemic in Canada, and also have a main
influence on countries around the globe such as the United States. They will continue to take
precautions in the rules and regulations Canada has involving stopping the spread, and will
always educate every group in HIV/AIDS.

Logic of Evil
One of the goals in addressing HIV/AIDS through the Public Health Agency of Canada is
[to] reduce the social and economic impact of HIV/AIDS (2013, Expanding the Impact n.a.).
Prejudice towards the gay community is something that has always been apparent. However in
todays society it is even more apparent because of the rule in the Public Health Agency of
Canada and similar rules in countries all over the world that interferes with their goal to reduce
the social impact of this disease. This rule states that
Under the new five-year deferral period, men who have not had sex with men in the past
five years are now eligible to donate blood in Canada. Under the previous indefinite
deferral period, men who had sex with men, even once, since 1977 were not eligible to
donate blood in Canada (2013, Health Canada n.a.).
This regulation interferes with their goal of reducing the social impact of HIV/AIDS
because of the message it sends to people about the gay community. By Health Canada only

letting a homosexual donate blood after being abstinent for greater than five years suggests that
their is something entirely wrong with homosexual mens blood. This therefore creates a barrier
between sexualities and sets back the fight for equality. Health Canada justifies this by a number
of different arguments.
Firstly, they bring up that in the 1980s, thousands of Canadians were diagnosed with HIV
because of tainted blood products. This therefore gave Canadian Red Cross association no choice
but to exclude all men who have sex with other men. This was shortly embedded with Health
Canada in 1992. Only starting in 2013 has Health Canada change it to five years. Health Canada
also states that this is to keep contaminated blood samples down. A five year increment means
virtually no chance of the homosexual being unaware that they have HIV with therefore would
not increase the chances of samples being contaminated with HIV (Commemoration of the
Tainted Blood Tragedy n.d. n.a.).
In an interview with the Canadian Blood Services conducted by the Eureka Team, it has
been confirmed that Western Consolidated Donor Testing Laboratories are responsible for testing
blood products. They test each blood donation TWICE for Syphilis, West Nile Virus, and Human
Immunodeficiency Virus 1 and 2 otherwise known as HIV (2011, Dziwenka, S. Personal
Communication). If all blood samples are being tested for HIV in the first place, there is no
reason to defer five years of sexual content between two people when the likelihood of
contaminations reaching someone who needs blood are extremely unlikely. Furthermore,
exposure to the HIV virus only takes three months to provide highly accurate results. In very
severe cases it takes up to six months.
Five years is an insulting amount of time when the HIV virus can be seen in a maximum
of six months. Their logic in that they want to keep contaminated blood samples low is valid
however, they should rather increase the amount of blood they have to save lives and just be a
little more careful when testing. As well as this, 68% of all Canadians are sexually active by the
age of eighteen. In order to even be eligible to give blood in Canada you must be seventeen or
older (2013, Sexual Behaviour and condom use 15- to 24-year-olds n.a.). Stating that you can
not have any sexual contact with another male for five years is extremely improbable. This is
Canada Healths way in shutting down the idea of getting blood from gay men through out this
country and virtually the world.

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