Jennifer Hansen
Applied Epidemiology
AIDS Synopsis – Week 1 Assignment
Epidemiologists must take on many roles when studying the distribution and determinants of
health-related events in history and applying that knowledge toward preventing and controlling
diseases. In 1981, epidemiologists began working diligently toward identifying risk factors for AIDS in
order to describe its natural history, identifying those at greatest risk of acquiring HIV and where they
are located spatially, monitoring all aspects of the disease and infected persons over time, aiding in
gathering information, promoting public policy for prevention and treatment, and determining the
efficacy of these policies and treatments, and informing the public of the various aspects and risk factors
for the disease. Following is an outline depicting the ways in which epidemiologists carried out these
duties in the fight against the AIDS pandemic.
Factors Identified as Increasing Risk of Acquiring AIDS
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Being active in gay lifestyle
Having many sexual partners
IV drug use
Living in an area in which sex is commercialized and high rates of IV drug use is common
Being the spouse/child of someone who exhibits some/all of the above-mentioned risk
factors
AIDS Natural History
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After discovering the initial cases of AIDS died in just months of diagnosis, AIDS is
termed a lethal disease
Using blood samples, discovered the first case of AIDS was passed from a single
chimpanzee to a single human in 1930
Tracked first AIDS death to 1959 in Congo
Identification of HIV as virus that kills Helper-T cells to suppress the immune system and
the molecular characteristics of HIV; determination that HIV causes AIDS
Description of what happens to HIV and infected person under antiretroviral
therapy/triple cocktail
HIV never disappears from infected person’s bodies, even with triple cocktail/ART
Documentation of types of infections/illnesses/symptoms infected persons present with
(Karposi’s sarcoma, pneumocystis pneumonia, etc)
Discovery of HIV as virus by its ability to pass through filter for production of Factor 8
Individuals and Populations at Greatest Risk for AIDS
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Young, gay men
Sexually promiscuous
Populations with high rates of commercial sex workers
Hemophiliacs; those in need of blood transfusions
IV drug users (40% of all AIDS cases)
Those living in southern and eastern Africa and India
Babies of infected mothers (In Africa, almost 50% of children in pediatric wards tested
positive for HIV)
Where Public Health Problem is Greatest
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Countries whose leaders do not want to address the issue of AIDS due to stigmas,
reputation, cultural beliefs; therefore, lack of education in these populations
Eastern Europe, southeast Asia, China due to following trends for drug trade and
commercial sex business (clustering)
Monitoring AIDS over time
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First AIDS case documented in 1981, then 5 more cases in Los Angeles over the course
of a few months
Monitor spread from central Africa to US/Europe via Haitians
Documenting and tracking mortality and morbidity rates of AIDS throughout the span
of the disease and prevalence rates from initial stages of outbreak to later stages when
ART becomes available and prevention strategies are widely spread and in use
o 1987 Asia reports 208 cases, US 45000 cases, Europe 7000 cases, Africa 6000
cases
o 1995 AIDS is named as #1 cause of death for Americans ages 25-44 by CDC
o 1996 AIDS is no longer #1 cause of death for all Americans, but still for African
Americans
o In 2005, estimated 16,000 AIDS related deaths and 1.2 million living with AIDS
o South Africa has almost 5 million infected with AIDS, only 40,000 on ART
The impact on prevalence rates of people with hemophilia due to contamination of
blood supplies
Tracking new cases in new locations (first appearance in Russia following heroine and
commercial sex business) clustering
95% of all new AIDS infections are in poor countries
Evaluation of the Efficacy and Effectiveness of Prevention and Treatment Programs
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Monitoring vaccine efforts
ART treatments and undetectable viral loads, how long does this last?
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Uganda efforts for educating and implementing prevention strategies proved successful,
death rates began to decline
Effect of anti needle-exchange laws on infection rates
In absence of treatment, prevention and education only options
ABC approach – effectiveness of abstinence versus condom use
Provision of Useful Info in Health Planning and Decision Making for Establishing Health Programs with
Appropriate Priorities
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Determine how to help and implement effective programs for infected persons who
have lost their support systems, jobs, families, etc due to stigmas involved in spread of
AIDS
Showing blood transfusions can transmit AIDS in order to encourage formation of
policies/procedures to stop this line of transmission
o Baby dies of AIDS by transfusion from infected person
Researching and identifying means of transmission
o Casual contact does not spread AIDS
Estimate over 40 million new infections over the next decade without advanced
treatments and prevention methods
Research and understand different cultures, governing bodies, and their belief systems
and how this will impact effectiveness of individual treatment programs and prevention
strategies.
Figure out what prevention strategies are most effective
o ABC approach
o Abstinence versus condom education and use
Assistance in Carrying out Public Health Programs
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Get audience with governing bodies and leaders in order to get attention focused on
AIDS efforts and reducing the spread of fear
o Nelson Mandela, Mbeki, Bush, Clinton, etc.
Encourage tolerance among leaders and physicians alike
Calling for action from political leaders to provide care for AIDS patients without
insurance, funds for medications
Being a Resource
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Collaborate with other experts to identify at-risk populations and predicted prevalence
rates in locations throughout the world
Gain trust of AIDS populations in order to get them to cooperate with prevention
methods
Communication of Public Health Information
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Provide information and education for activists in order to encourage political leaders to
move on AIDS stigmas and research
Constantly provide up-to-date information for physicians, experts, medical community,
public health leaders, activists, and political leaders in order to maintain the best
possible medical treatments, prevention strategies, and outcomes for AIDS patients
One of the initial approaches used by epidemiologists to study AIDS early on was the
widespread study of gay men due to vast majority of cases being seen in gay men. This led to the
labeling of AIDS as GRID (Gay-Related Immune Deficiency) syndrome, which turned out to be an
inaccurate description and, unfortunately, caused a lot of fear and distrust of those in the gay
community by the rest of the community. In contrast, researchers quickly found that there were many
cases of women being infected with HIV, as many as men, and this helped to dispel some of the
inequalities in stigmas surrounding AIDS and the gay community.
Another approach used to study AIDS as the disease progressed was laid out in the protocol for
Project Inform. This was a proposal to have open lines of communication for sharing information
regarding HIV and AIDS cases, accelerate advances in treatment, and promote prevention strategies.
This was a positive approach because in accelerating advances in treatment programs, more people
were allowed access to the antiretroviral therapy medications, which led to a reduction in self
medication with potentially dangerous drugs.
As AIDS progressed and more people became infected, new strategies for developing and
providing the expensive medications became necessary. In 1995, intensive studies were being
conducted in attempts to find a viable vaccine for use against HIV. One such attempt initially failed to
successfully use protease inhibitors to help the body overpower the reproduction of HIV, but did allow
scientists to determine the rate at which HIV replicates inside the human body and how the body reacts
by increasing production of helper T cells. With this information, scientists were able to develop a
protease inhibitor, saquinavir, which was capable of slowing the reproduction rate of HIV; thus,
prolonging quality and quantity of life for infected patients. Soon after, the triple cocktail became
available. These advancements in medications for AIDS treatment were huge breakthroughs in the fight
against the effects and spread of the disease. While there is still a lot of work to be done in this fight,
combining the advancement of such medications with the promotion and education of prevention
strategies and reduction of stigmatized thinking against AIDS sufferers, has allowed great strides to be
made in the global community against AIDS.