ROY’S MUSINGS: Apocalypse now – The growing threat of AIDS

BY BARUN ROY

Lying pale and exhausted is a young girl of 18, who looks 20 years older. She has lost her eyesight as a virus infected and destroyed her retina. Her head moves constantly because she needs to localize sounds reaching her ears. Even speaking is a physical exertion that leaves her breathless, her speech is punctuated by gasps for air, despite the oxygen being fed into her nose. An organism has infected and destroyed most of her lungs.

A weight loss of 10 kgs in three months has left her wasted and the skin over her once strong arms is pale and dry. Standing out from the pallor are numerous round, purplish lesions. There is one inside her cheek too. Cancerous cells have developed in the blood vessels and are multiplying and migrating out of control. As she attempts to speak, her incoherence and removal from reality become obvious.

Mercifully, this patient is only partially aware of  her surroundings and situation. She has another organism which has invaded her brain to produce the mental changes now so obvious. A battalion of viruses is marching across her placenta this very moment to invade the child in her womb.

This is the description of a once sensitive and intelligent young mother-to-be, a full blown case of AIDS, acronym for Acquired Immune Deficiency Syndrome.

Today, according to Dr. Hiroshi Nakajama, of the World Health Organisation the stress is upon “Sharing the challenge.” The focus is on the need for individuals, groups, communities and nations to partner in preventing the spread caring for the affected and minimizing the social and economic fallouts of AIDS. “We all need to join forces and share the challenge… only partnership gives us a chance of prevailing against the pandemic,” says Dr. Nakajama.

Dr. Robert Gallo and Dr. Luc Montagnier independently discovered the organism that causes AIDS in 1983-84. It was christened as Human Immuno-deficiency Virus or HIV. Today, at least five different strains of the virus have been caused by HIV-1 but HIV-2 has also begun its march. Infection with two strains of HIV is considered more serious.

There is reason to suspect that man could have contracted the repercussion of HIV from certain species of African monkeys. The transmission probably occurred through consumption of monkey blood and meat, considered delicacies by some African tribes. Bizarre rituals during which monkey blood is smeared all over the body seem yet another likely route of infection.

Normally this virus should not have survived in man. That it did, and in a fashion devastating to the human species, shows the virus has masterminded an evolutionary breakthrough. Are we the victims of mere chance or, are we simply being overtaken by a superior intelligence?

The human immune system is equipped with an array of defence mechanisms that come into play on encountering an invader – say, a bacterium. This presupposes that the immune system, to protect the body must itself be infallible. The genius of HIV is that it has learnt to cripple the defences against disease by destroying the single most crucial cell in the immune system, the T4 lymphocyte.

For unless T4 lymphocytes sound the alarm, rather like a commander giving the signal to attack, the immune system will not be alerted to fight and kill and invading organism. T4 lymphocytes are tricked into accepting the virus which then takes over the cell machinery to turn out thousands of new viruses. These set out in search of more T4 lymphocytes with every tick of the clock.

A healthy adult has about 300 billion to 400 billion T4 cells meant to last a lifetime. New T4 cells cannot be created once the T4 factory – the thymus gland – shuts down at adolescence. HIV therefore irreversibly chips away at the immune system and facilitates opportunistic infections to take over, leading to AIDS.

That HIV infection may take years to progress to AIDS is little consolation. Meanwhile, HIV positive individuals remain asymptomatic for years but nonetheless infectious.

Yet another feature of this virus’ bag of biological tricks is its ability to change its appearance. The technical name for this phenomenon is “antigenic drift”. The trick is simple. If an alarm goes out t attack and ill the virus with the “read coat”, it changes into a “blue coat” before the body’s defence forces arrive and escapes identification and thereby destruction.

The fact that very little is understood of AIDS and what little is comprehended is reluctantly shared in the media has created an area of darkness in people’s minds where fear has become a breeding ground for stigma and ostracism of HIV positive individuals. This unfounded fear has stretched the limits of rational behaviour to a point where even the mention of being screened for HIV has led to loss of jobs, friends and families. It is therefore important to recognize not only how HIV can be acquired but also how it is not.

Testing positive for HIV is not synonymous with having AIDS. Being HIV positive means one is HIV – infected, which is infectious.

In countries such as Africa and for that matter India, laboratory tests to identify HIV infection, especially in enormous population are often unreliable.

The pandemic has ripped apart the veil of privacy that surrounds people’s sexual habits and placed the intimate behaviour of the sexually – active members of society under the microscope. We ask our doctors to provide unquestioning medical support to our lifestyles, however questionable they may be. Prostitution, homosexuality and promiscuous behaviour have always been associated with several problems, long before AIDS exploded on the scene. There was the Gay Bowel Syndrom. There were different sexually transmitted diseases, notable genital herpes, syphilis and gonorrhoea. But who cared?

“We just don’t care about veneral diseases (VDs). We wouldn’t care about AIDS if it didn’t kill people,” says Dr. Kuller and Dr. Kingsley, Professors of Public Health, in a New Scientist report.

No one cares about V. D. No one cares about those aspects of a lifestyle that predispose one to V. D. Visits to the V. D. clinic, if at all, take place in shame and secrecy. Should it take a biological time bomb like AIDS  to flush our hypocrisies into the open?

In 1988, only 300 cases of AIDS were documented in Asia. Now the estimated infection in India alone is about one million. Given the scanty attention paid to the virus in India to date, these figures are alarming. Of enormous significance is the fact that in Asia AIDS is spreading largely through heterosexual activity with prostitutes constituting a major mode of spread.

DUSTING FOR FINGERPRINTS

A model set of ground rules framed by eminent immunologist Dr. john Dwyer helps us in identifying and tracking the passage of HIV. Seeking the fingerprints of the AIDS virus in an individual by screening his blood for antibodies to the virus is the best tool for following the flow of the epidemic, planning future health service and helping an infected individual through early diagnosis.

In many societies, women planning pregnancy should be tested as should immigrants. Couples in an evolving relationship will much more commonly seek assurances from each other that their previous sexual experiences have not exposed them to HIV. Screening for antibodies to HIV is doen either through the Western Blot or ELISA (Enzyme – Linked Immunosorbent Assay) tests, using blood samples. The results of these tests; however, call for careful interpretation. If someone tests negative, it only means the person has not been infected three months prior to the date of testing. This because HIV takes three months to invoke a detectable response. To get an all clear signal one needs to repeat the test after three months of risk free behavior.

But the HIV antibody screening is not just another test. A positive result tells an individual that he or she has a potentially life threatening infection. It may also abolish any quality their life may have because of the discrimination that may follow. These problems indicate that no one should have the HIV antibody test without prior counseling about the consequences of a positive result.

Protest counseling should include a discussion of the potential reactions to an AIDS affliction, the necessity of keeping the news of a positive individuals to get life assurance and the fact that being HIV positive is not synonymous with having AIDS and so on.

Similar and immediate counseling must likewise be available to those whose tests turn out to be positive. Although there has of late been a clamour to carry out extensive HIV screening in India by governmental and non-governmental agencies, there is unfortunately no effort to enhance the content of the exercise by making pretest counseling a procedural part of the test itself. This will necessitate not just more funds or more test kits but the availability of readers and counselors who are just not there. The majority of those who test positive are in the dark about the disease and what the test result really means. Situations often arise where HIV positive individuals come out of one government hospital to enter another in the hope that they would be told they are fine there and so on until frustrated, they quit the corridors of overcrowded hospitals to merge with the anonymous multitudes in the streets, slums and brothels, or perhaps join the queue to donate blood.

In countries like India, doctors, paramedical staff, house surgeons and medical students stand a very high risk of contracting the virus in the course of discharging their professional and academic commitments. This is partly due tot eh fact that AIDS awareness even amidst the medical fraternity is a recent phenomenon, and also because teaching, learning and working conditions in many of the medical colleges and hospitals are deplorable. Only a few months ago it was reported that human excrements was found flowing through operation theatre taps of a major hospital attached to a medical college in an Indian metropolis. Disgusting as such details, no doubt are, they can hardly be overlooked in any discussions of who are and who are not facing the risk of infection.

Almost half of the world’s people officially undernourished. One fourth of the world’s urban population has access to safe drinking water. More than one billion people do not have sewage and waste disposal facilities. More than 250 million people are homeless in a world where a slum is considered a home. Such conditions will ensure that AIDS claim millions.