A plague for the 21st Century

As World Aids Day approaches, Luke Boulter and Jonathan Fleming examine the future of the infamous HIV virus.

To look at it, you wouldn’t suspect a blob of cells of being on the world’s most-wanted-list of-viruses-to-find-a-cure-for. In an age where, let’s face it, size really does matter, this one only has nine genes in its arsenal, after all.

Yet Human Immunodeficiency Virus, or HIV, is one of the most dangerous organisms on the planet. It takes hundreds of thousands of victims, allowing killer cancers and other fatal infections to invade their systems. With antiviral treatments it can be warded off – but never stopped. But why is it such a natural-born killer? And if the HIV virus is really the best of the molecular best, will we ever be good – or smart – enough to stop it?

‘The gay disease.’ Not only is this a homophobic categorisation of HIV but, today more than ever, it’s an ignorant one. HIV is now more prevalent in the heterosexual community than ever before. If we’re going to get statistical – and in health debates, that’s near impossible to avoid – 75 per cent of HIV sufferers are not gay; the only label we can assign most of them is that of living in sub-Saharan Africa.

Delving further into the statistical well, then: by the end of 2005, according to the World Health Organisation, 25 million people had died from HIV/ AIDS-related illnesses. A further 2.9 million died this year (and we’re still counting) – 0.38 million of these were children. Between 2005 and 2006, the number of infected individuals jumped from 38.5 million to 39.5 million – close to the total population of Argentina.

If we zoom in on individual countries, our view becomes even bleaker. When two-fifths of any sub-Saharan nation are carriers of HIV, ‘crisis’ seems a reasonable label. What is a reasonable response? The support of the international community? Yet it’s not a simple hand-into-pocket job. Although modest resources can yield valuable returns – if targeted effectively – combating HIV on a global scale will not be cheap. The Copenhagen Consensus of 2004 estimates that $27 billion is needed to prevent 28 million cases of HIV. Investing in HIV prevention, however, makes sense, in both warm humanitarian and cold, hard financial terms. Experts predict that economic benefits outweigh investment by a factor of 40. The billion dollar question, then: can the world afford not to make this investment?

Philanthropy, an evermore popular choice for the benevolent celebrity, may provide part of the solution. The “fondest dream” of Bill Gates’s wife Melinda is the discovery of an HIV vaccine. The couple have pumped $32 billion into their Bill and Melinda Gates Foundation, lending serious financial muscle to this search.

The hunt is an increasingly difficult one, however. HIV/AIDS is accelerating, with the rate of new infections flying from 4 million in 2005 to 4.3 million in 2006. Most worryingly, 95 per cent of new infections are in regions unlikely to have the resources to respond. Consider Lesotho, in which over a quarter of the adult population carries HIV. In 1995, life expectancy was nearly 60 years. AIDS-related mortality has slashed predictions of life expectancy in 2015 from 69 to a disastrous 34 years. AIDS primarily strikes young adults, unlike other threats more likely to kill the very young or old. Half of new infections are in the 15-24 age group, with 6000 new cases every day.

Economies, denied their most active workers, will suffer too. According to the UN Food and Agriculture Organisation, slowed growth in agricultural output will lead to food insecurity in Kenya, Malawi, Tanzania and Zambia by 2010. Weakened economies will have fewer resources to invest in the education, health and nutrition of the young.

6.8 million people in developing nations are in immediate need of life-saving drugs, but only 1.65 million will receive them. Antiretroviral drugs are simply too expensive. James Cochrane, director of Glaxo’s international division states, “Even at 10 cents a day, many African governments can’t afford it, so at $2 a day, there’s no way.”

One prevention strategy backed by the current American administration is the “ABC” approach. It seeks to replace risky behaviour among young people with safer alternatives: “A” stands for abstinence; “B” stands for being faithful; “C” stands for condom use. This approach has shown some success – in Uganda, for example, although this resulted from a combination of factors, including behaviour change, post-war social stabilisation, strong Government leadership and emphasis on voluntary testing and counselling.

Nevertheless, there are influential dissenting voices. President Thabo Mbeki of South Africa sparked controversy with his belief that poverty, rather than HIV, is the cause of AIDS. Pope Benedict XVI believes, “The traditional teaching of the church has proven the only failsafe way to prevent the spread of HIV/AIDS”. Archbishop Raphael Ndingi Nzeki goes further, opining “AIDS… has grown so fast because of the availability of condoms”. It is difficult to conceive of any rational mindset in which condoms, which reduce the risk of HIV infection by 90%, could represent a greater evil than the global HIV epidemic. A divided message is dangerous. Who should we believe?

So is it bleak news for future generations, or can we counter what has become the plague of the 21st Century? There are hopes. The ideal strategy is to vaccinate against HIV infection, and many believe this to be achievable, but the reality of it is not an easy one. The way HIV replicates means that it can induce massive changes in its genome known as mutations. Its mutation rate is so high that in several generations of viral replication the new viruses are almost entirely different from the original viral infection. Anti-viral drugs are also being developed to prevent those who are infected with HIV from going on and developing AIDS.

Again, with such a variable virus, this will be tough. There are, however, parts of the virus that remain the same, and current research suggests that it may be possible to make a universal vaccine. There is currently no viable cure for HIV. But, with continual investment and research, the likelihood of one being discovered is higher now than ever.

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