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Running head: EXTERNAL FACTORS OF AIDS

AIDS: A Comprehensive Study of Its External Factors

Student’s Name

University
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EXTERNAL FACTORS OF AIDS

Abstract

Acquired Immunodeficiency Virus (AIDS) is by far the most ravaging pandemic in

contemporary times. Ever since it first entered the public fray in the 1980s in the United States, it

has gone onto destroy individuals, families, communities and even entire countries in some cases

throughout the globe. Its reach extends from Thailand in the Far East to sub-Saharan Africa and

the US. Unlike most diseases which are exclusive to a certain geography, race or socioeconomic

class, AIDS draws no such distinction. The developed world as well the underdeveloped are at

its mercy. However, it is important to note that it is the underdeveloped regions which have

suffered much more from the disease than the developed world. This paper will examine the

various external factors which have been conducive to the spread and persistence of the disease

throughout the globe. Furthermore, a thorough assessment of present and previous policies will

be carried out to be followed by a few feasible recommendations as well.

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AIDS: A Comprehensive Overview of its External Factors

AIDS is caused by a virus known as Human Immunodeficiency Virus (HIV). The disease

does not manifest itself in the form of physical symptoms as soon as the virus infects the body

but rather the virus stays dormant for a period before it cripples the immune system. The disease

has a relatively brief history, unlike malaria or cholera. It was only in mid-1970s and 1980s that

AIDS became a public health concern. It was originally concentrated in the US and Africa.

The origins of the strong strain of HIV (HIV-1) have been traced to a type of chimpanzee

in Democratic Republic of Congo. It is argued that the “chimpanzee version of the

immunodeficiency virus most likely was transmitted to humans and mutated into HIV when

humans hunted these chimpanzees for meat and came into contact with their infected

blood”(“Where did HIV come from? | The AIDS Institute,” n.d.). This mutation of the virus into

HIV has been dated back to the 1920. But it was not until 1959 in DRC that the first blood

sample was found to be HIV positive. However, another strain of HIV, albeit a weaker one, HIV-

2, passed from “sooty mangabey monkeys rather than chimpanzees” (“Origin of HIV & AIDS,”

2015). The mode of transmission was similar to that of HIV 1.

HIV virus is transmitted between humans when certain fluids from a HIV infected person

come into direct contact with someone else’s mucous membrane, damaged tissue or bloodstream.

These fluids include “blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast

milk” (How is HIV transmitted, 2017). The most common activities that facilitate transmission

are unprotected anal and vaginal sexual intercourse along with sharing needles and syringes with

a HIV positive individual.

The exact location of the virus’s origin is the town of Kinshasa is DRC. The spread of the

virus from the town was “contingent upon an active transportation network that connected the
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country’s main population centers to other regions of sub-Saharan Africa” (Faria et al., 2014)

The highly active sex trade coupled with the high number of migrants along the town’s

transportation infrastructure explains the spread of the virus.

In the 1960s, Haitian workers in the DRC returned to their country. Most of these

workers were infected with the HIV-1 subtype M and thus they spread the virus in Haiti. Today

this very subtype is the most geographically spread out globally.

It was in the 1980s that the very first cases of AIDS started to come into the picture in the

US. Centered around the homosexual community, the disease was labeled as ‘gay plague’, ‘gay

cancer’ amongst other homosexuality-related names. The spread of rare diseases and

opportunistic infections amongst gays in New York and California was attributed to some

infectious disease causing them. The disease was officially named as AIDS in 1982 when the

virus was found in hemophiliacs as well as heroin users thus negating AIDS as a homosexual

exclusive disease. The US government and society did little to stop the spread of the disease by

continuously stigmatizing and blaming the 4 H Club- Haitians, Hemophiliacs, Heroin Addicts

and Homosexuals.

The United States was the main exporter of the virus to Western Europe as well as to the

Far East. A medical virologist at the University of Oxford remarked that “It was only when it

entered the USA that it became a pandemic” (CNN, n.d.). The spread of the virus is also owed to

the massive amount of sexual activity migrants and tourists undertake in different regions. The

transmission dynamics also determine what section of the society is more affected. For example,

in Western Europe the vast majority of HIV positive individuals are homosexuals. In stark

contrast, drug users in Eastern Europe constitute the major bulk of AIDS patients since the

sharing of vaccine is rife within the region. “Persistent violence in Africa in the form of civil
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wars and inter-state war has also aided to the spread of the virus between regions” (Iqbal & Zorn,

2010).

Other than armed conflict, there are a multitude of factors which have contributed to the

spread of the disease globally. It is important to note that the same reasons do not necessarily

apply to every region. Chronic poverty and underdevelopment, cultural norms, flawed political

policies and attitudes, and the massive stigmatization of the disease have all contributed to the

continuous proliferation of AIDS. This paper will now pay in-depth attention to all of these

determinants.

The spread of the disease in the US is owed to the apathetic, lethargic, and negligent role

of the government in the early 1980s. Dismissed as nothing but “gay cancer”, Ronald Reagan did

not “even use the word “AIDS” in public until he gave a speech in 1985” (“The Deadly, Rapid

Rise of HIV,” n.d.). Similarly, it took the World Health Organization until 1985 to discuss the

outbreak of the virus. This proved to be too late for by the end of 1986, “85 countries had

reported 38,401 cases of AIDS to WHO” (“The Deadly, Rapid Rise of HIV,” n.d.). It can be

argued that if timely regulations and corrective measures had been taken on a global scale, the

disease could have been contained. The early policies were thus characterized by their lethargy,

but the subsequent ones were logically flawed and failed to address the issue. The WHO adopted

a ‘rational health belief model’. The main assumption underlying this approach was that if

people were educated enough about how AIDS spread (unprotected sex and needle sharing),

people would avoid these activities thus inhibiting the transmission of AIDS. However, this line

of thinking was extremely simplistic for “continuously applying a seemingly logical universal

policy” only served to exacerbate the problem (Das, 1996). It failed to consider the massive

cultural, societal and political differences between regions and even within regions. Treating the
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whole infected populous as a whole was a grievous mistake for the dynamics of these people

varied massively. Once an epidemic like AIDS establishes itself in any society, it has a

“tendency to affect the most marginalized and impoverished groups” (Parker, 2001) These

groups are largely constrained by economic and cultural factors which constrains them from

making the logical choices that the rational health belief model predicts. This is especially true

for women in both Africa and US. The fear of divorce or a beating would force a woman to have

unprotected sex with a HIV positive partner in Africa. In the United States, a strong cultural

stigma against the use of condoms leads to many well educated and aware women to engage in

risky activities. To further elucidate the critique of the logical model, it has been proven that

“women in many parts of the world must choose between the risk of AIDS in the future and the

risk of starvation today” (Das, 1996).

Furthermore, the rational belief model relies on educating the masses yet the logistics for this

are extremely difficult in HIV concentrated areas like sub-Saharan Africa. The role of the World

Bank and IMF in exacerbating rather than alleviating the problem cannot be understated. Aid

packages and loan agreements were given under the neoliberal belief that governments need to

cut down public spending on healthcare and education and let the private sector take over.

However, these policies only focused on increasing economic growth whilst social inequality

and poverty increased massively. The lack of emphasis on building healthcare facilities only

served to depriving AIDS patients from proper treatment and others from timely HIV testing.

Additionally, these programs are targeted towards urban development thus the massive

movement of people from rural areas potentially leads to the virus spreading from villages to

cities. This is counterproductive for “HIV prevalence is higher in cities, where the vibrancy,

stress, and anonymity of urban life, and its bustle of encounters and interactions, provide
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increased opportunities for behaviors and sexual networking that may increase the risk of HIV

infection”

Poverty and underdevelopment is related to the political policies states and international

bodies draw up. However, poverty and underdevelopment should not be the seen as the main

determinants of the disease. There is a massive gulf in socioeconomic status of HIV positive

individuals in the US and African states thus highlighting AIDS does not discriminate amongst

the rich and the poor. But, poverty does force people into certain activities that are more at risk

for transmitting HIV. For example, drug addicts are usually poor and once they engage in

unhealthy needle and syringe sharing practices they are at extremely high risk of contracting

HIV. Similarly, it is the very poor women in societies who turn to prostitution which involves

unprotected sexual intercourse. It is also to be understood that HIV spread is not only facilitated

by certain activities but rather malnutrition plays a major role in making a person’s immune

system more susceptible to the disease. Studies have shown that “protein-energy malnutrition

(general calorie deficit) and specific micronutrient deficiencies, such as vitamin A deficiency”

make a person more at risk of HIV. (Poku, 2002) Thus, Africa, where every 4 out of 10 people

live in absolute poverty the risk of contracting HIV, is very high. Biological literature has also

gone onto show that the “presence of an untreated STD can enhance both the acquisition and

transmission of HIV by a factor of up to ten” (Poku, 2002). This again is of paramount

importance in the African context for Africa has the highest incidence of curable STDs amongst

its people. Another way poverty puts certain people at risk of HIV is that it forces partners apart

in the search for work. This increases the risk of promiscuous sexual behavior especially in the

case of men who find pleasure only in alcohol and sex once away from home. On a more

structural level, poverty does not only facilitate the transmission of the virus but becomes the
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virus’s sustaining bedrock in society. Once the husband or the wife becomes infected, it is very

likely that the other partner becomes infected too. Upon the birth of a child, there is a high risk

that HIV is passed to the child through breastfeeding as well. Therefore, the parents of the family

get ill, the family’s income falls and soon the guardians of the children pass away leaving them

with little or no sustenance. Young women in most cases then turn to prostitution and become

infected themselves whilst boys turn to drugs ever so often in times of high poverty. Thus, the

cycle of HIV being transmitted through multiple generations is facilitated by poverty.  

For a long time, AIDS was viewed under the rational health belief and behavioral change

models. The cause of spread of AIDS was seen to be in the behaviors of certain people which

reflected in only certain communities becoming the disease’s victims. Thus, broader issues like

poverty and underdevelopment along with malnourishment were overlooked to focus upon

changing people’s behaviors. Australian demographer, John Caldwell argued that the virus was

rampant in Africa since “people there tended to have more sexual partners than people

elsewhere” (“Why is AIDS Worse in Africa?” n.d.). It is established that sexual activity on a

wide commercial scale is highly conducive to the spread of HIV. Thailand is a classic example

where 65% of prostitutes are HIV positive. Furthermore, the initial spread of HIV amongst only

the homosexual community in the US was attributed to the HIV risky anal sex. The argument for

promiscuous sexual activity leading to the spread of AIDS is strengthened by the fact that the

disease is rare in Muslim countries in West Africa where religious doctrines are strict on sex.

But, some argue it is not Islam’s doctrines that stop AIDS but rather the practice of male

circumcision. Countries where male circumcision is common, HIV rates tend to much lower than

in countries where male circumcision is looked down upon. Several studies have gone onto show

some form of correlation between the two variables. Biologists argue that “male circumcision
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removes receptors for HIV which reduces the risk of HIV by almost 70%” (“Why is AIDS

Worse in Africa?” n.d.).

The world has promised to commit itself fully to end AIDS by 2030. Extraordinary

accomplishments have been made in the last decade and a half to curb the spread of the disease

and to treat those who are infected. Between 2014 and 2016, “the number of people living with

HIV on antiretroviral therapy has increased by about a third” whilst since 2003 “annual AIDS-

related deaths have decreased by 43%” (“Factsheet - Latest statistics on the status of the AIDS

epidemic,” n.d.). Thus, significant progress has been made ever since the earlier lethargic and

neoliberal policies to deal with the pandemic were set aside. The focus now is on a Fast-Track

approach which involves “substantially increasing and frontloading investment over the next five

years to accelerate scale-up and establish the momentum” to stop AIDS totally (“Factsheet -

Latest statistics on the status of the AIDS epidemic,” n.d.). The approach seems to have been

working for “since 2010, new HIV infections among adults have declined by an estimated 11%”

(“Factsheet - Latest statistics on the status of the AIDS epidemic,” n.d.). Furthermore,

transmission between parents to offspring has been dealt with as well for now “76% of pregnant

women living with HIV had access to antiretroviral medicines to prevent transmission of HIV to

their babies” (“Factsheet - Latest statistics on the status of the AIDS epidemic,” n.d.). These

statistics add up for new cases of HIV in children has decreased by 47%. Even though on paper

the picture seems bright, the disaster is far from over. There are still 36.7 million people infected

with HIV all over the world. And even though new cases have been continuously decreasing for

the past decade, there is still a considerable increase in infected with “2.1 million new HIV

infections worldwide in 2015” (“Factsheet - Latest statistics on the status of the AIDS epidemic,”

n.d.). Ironically it seems that the world is too focused on Africa in the context of AIDS. This
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seems relatively absurd for Africa has been the most overlooked continent throughout history,

but recent statistics show with a considerable improvement in AIDS in the continent there “has

been a 57% increase in HIV patients in Central Asia and Eastern Europe” (“Factsheet - Latest

statistics on the status of the AIDS epidemic,” n.d.).

Furthermore, the stigma attached to the disease is still extremely high. Especially in orthodox

Muslim and Christian communities, treatment for AIDS is out of the question for many as most

AIDS patients are marginalized and ostracized by the state. As of 2016, “72 countries had laws

allowing specifically for HIV criminalization. (Mondal & Shitan, 2013)” Thus, the very sections

of the population who are most at risk of HIV-homosexuals, sex workers, and drug addicts are

the most marginalized which distances them from HIV services. It is imperative that

international bodies stop suffocating African countries by forcing them to cut down on public

spending and keeping them in massive debt.

The way forward for the eradication of AIDS is not a straight road. A complex strategy

needs to be developed which caters to every region’s socio-economic-political dynamics. There

is a huge need for the alleviation of poverty within society for poverty not only breeds HIV but

also sustains it. Women empowerment is necessary to prevent young girls turning to prostitution

whilst regular HIV screening for the masses is necessary along with sex education. Lastly, the

stigma surrounding homosexuals and drug addicts must be done with and these at-risk groups

need to be brought within the folds of the society so that they have more access to HIV services.
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