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Overview: Basic Science and Epidemiology

1998

Synopsis:

  • Acquired immunodeficiency syndrome (AIDS) is not a single distinct disease, but rather a disorder characterized by a severe suppression of the immune system. This immunodeficiency renders the body susceptible to a variety of normally manageable infections, cancers, and other diseases.

  • AIDS is caused by the human immunodeficiency virus (HIV), a virus that infects certain cells throughout the body. Most significantly, HIV infects white blood cells of the immune system (particularly T cells, or more specifically CD4+ cells), the role of which is to help clear disease-causing substances from the body.

  • AIDS is the name given to a late stage of HIV infection in which there is evidence of significant impairment to the immune system. Because the illness is best understood as a continuum from initial infection to, in many cases, death, the term HIV/AIDS is frequently used.

  • There are two versions of HIV, both of which can cause AIDS: HIV-1, which has spread throughout the world, and HIV-2, a far less common and somewhat less harmful version largely restricted to West Africa. In the absence of further clarification, the generic term "HIV" almost universally refers to HIV-1, including throughout this volume.

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  • HIV has spread throughout human populations across the globe and is being intensively tracked by health authorities using the tools of the science of epidemiology.


Coverage in the Encyclopedia

Most of the entries listed in this section emphasize the biochemical workings and the spread of HIV (the virus) rather than medical complications of AIDS (the medical condition resulting from HIV infection). The specific illnesses relating to HIV infection and AIDS are covered below under "Pathology and Treatment."

The Basic Science entries focus on describing HIV itself, how it causes disease, where it originated, and how it relates to other human and animal viruses (particular the subtype of viruses called retroviruses). This group also includes entries on the various types of cells that comprise the human immune system and how they are affected by HIV and how HIV infection can eventually lead to AIDS.

The Epidemiology entries focus on the study of how disease in general, and HIV in particular, spreads over time through human populations.


Entries on Basic Science

AIDS, Pathogenesis of
Animals
Antibodies
B Cells
HIV, Description of
HIV, Origins of
HIV Infection, Resistance to
HTLV
Immune System
Monocytes and Macrophages
Natural Killer Cells
Retroviruses
T Cells


Entries on Epidemiology

AIDS, Case Definition of
Epidemics, Historical
Forecasting
Geography
GRID (Gay-Related Immune Deficiency)
Seroprevalence
Surveillance


 


Perspectives on the AIDS Epidemic: Basic Science and Epidemiology

Challenging the Mainstream Consensus: AIDS Dissidents

In the context of the discussion of AIDS, the term dissidents refers to individuals who oppose mainstream or officially sanctioned understandings of the epidemic (including those views presented throughout this encyclopedia). Such dissidents have faced many challenges, from the skepticism of individual scientists and the probing questions of reporters, to public demonstrations by AIDS activist groups. For dissidents, varying issues are in contention, including the probable cause or causes of the syndrome; the disease's geographic origins; the politics and economics of research and treatment; the value of AIDS education, safer-sex, and blood-testing programs; and the role of the media in establishing consensus. Although many AIDS dissidents share certain attitudes and opinions, they by no means form a unified force. They may be described by several overlapping categories: dissenters regarding the cause of AIDS, political dissidents, proponents of alternative treatments, and proponents of mental and spiritual approaches to healing and prevention.

The most radical dissidents are those who have disagreed with what they call the "HIV-AIDS hypothesis" -- the contention, which they consider unproven, that HIV is the cause of AIDS. Included among them are a number of prominent academics, most notably microbiologist Peter H. Duesberg of the University of California at Berkeley and Kary Mullis, the 1993 Nobel laureate in chemistry. Since 1989, AIDS dissidents have held a number of international conferences to discuss and promote their views. An advocacy organization, The Group for the Scientific Reappraisal of the HIV-AIDS Hypothesis, was established in 1993.

The most widely proposed alternative to the HIV-AIDS hypothesis is a multifactorial model that ascribes the infections usually attributed to AIDS to combinations of factors, including recreational drug abuse, use of antibiotics, multiple sexually transmitted diseases, impure blood products, malnutrition, and other factors that can cause immunosuppression.

Another group of dissenters, who generally accept that HIV causes AIDS, might be called political dissidents. In response to what was perceived as inadequate official reaction to the AIDS crisis, a network of local initiatives and political action groups emerged from the gay community during the 1980s. Highly critical of government and scientific policies and of the role of large pharmaceutical companies in the epidemic, these organizations have advocated for improved AIDS care and research, freer access to experimental treatments, and increased emphasis on holistic and self-empowerment approaches. Among the most vocal of these groups have been the various chapters of ACT UP, a grassroots AIDS organization that has gained public attention for its street demonstrations and civil-disobedience campaigns. Political dissidents have also protested against restrictions on the civil rights of those who have tested or who are suspected of being HIV-positive.

Proponents of holistic and alternative therapies form a third group of dissidents. Alternative therapies used to treat AIDS-related conditions have included traditional Chinese medicine (including acupuncture), macrobiotics, nutritional and vitamin therapies, herbalism, and naturopathy. Health Education AIDS Liaison (HEAL) in New York, Positively Healthy in the United Kingdom, and other groups provide advice and holistic and alternative therapies to people with AIDS. These organizations are skeptical of official AIDS policies, in particular of predictions of high fatality rates for those testing HIV-positive. They have attacked the use of nucleoside analog drugs such as azidothymidine (AZT), saying that these drugs are ineffectual and toxic and that they produce side effects similar to AIDS symptoms.

Proponents of mental and spiritual approaches constitute the final group of dissidents. Advocates of meditation and visualization have proposed a variety of mental techniques to strengthen the immune system, and they acknowledge the new science of "psychoneuroimmunology" for its research into the effects of mind-body interaction on health. Some regard mental factors, such as attitude and psychological outlook, as especially important in the genesis of AIDS in individuals.

Separate from other groups of dissidents are those who might be called alarmists. They accuse the government of minimizing the risk of HIV transmission and have suggested the possibility of contagion by insects, casual contact, or proximity. Some alarmists have predicted a world plague of apocalyptic proportions. Other single-issue dissidents question specific aspects of orthodox opinion, such as the possibility of a so-called heterosexual epidemic in the United States. Some investigators have questioned the alleged African origins of AIDS or that AIDS as such even exists in Africa, regarding deaths ascribed to AIDS as actually caused by a combination of malnutrition; drug poisoning; and endemic diseases, many of them curable.

Publication of dissident writings has been scattered and sporadic, and even the most eminent writers have encountered difficulty in airing their views in traditional media. As a consequence, several dissident magazines and newsletters were founded, including Rethinking AIDS in the United States and Continuum in the United Kingdom. In the popular press, the gay newspaper New York Native and the music magazine SPIN consistently covered unorthodox views on AIDS. Addressing why dissenting views on AIDS have been marginalized, dissidents have suggested that medicine relies as much on emotion, cultural assumptions, politics, and economics as it does on science. Today, the prevailing medical model is one of infection, developed in the nineteenth century; other systems of medicine, such as homeopathy, pay as much attention to the characteristics and resistance of the host as to those of the individual pathogens.

Critics of medical orthodoxy have pointed out that the current approach of isolating a single infectious agent and developing a drug to overpower it has created problems, including the dismissal of multifactorial hypotheses, the unwarranted use of toxic medicines such as AZT, and the emergence of antibiotic-resistant pathogenic strains. Some regard the medical establishment's failure to deal effectively with AIDS as further evidence that a reappraisal of western health care is in order. AIDS is thus seen as a crisis not only for public health but also for medical science. Many in the West, dissatisfied with the cost and ineffectiveness of conventional medicine, have wholly or partly abandoned it for homeopathy, naturopathy, and traditional Chinese medicine.

Many dissidents propose that the current "infection model" of AIDS be superseded by a "pollution model." In the latter approach, AIDS is examined not as a single disease, but as a complex of diseases generated by the stresses of modern lifestyles, social conditions, and medical practices. These stresses especially affect the risk groups to which AIDS remains largely confined. This model also suggests that genetic predispositions may affect the development of AIDS in certain individuals.

In general, the critiques of AIDS dissidents have been resisted by both government and mainstream science. AIDS dissidents remain marginalized by what they contend is a premature consensus encouraged by political and economic, rather than scientific, factors.

Ian Young


The Encyclopedia of AIDS: A Social, Political, Cultural, and Scientific Record of the HIV Epidemic, Raymond A. Smith, Editor. Copyright © 1998, Raymond A. Smith. Carried by permission of Fitzroy Dearborn Publishers.

Encyclopedia of AIDS $25 US/832 pp/Illustrated

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