“The Most Devastating Pandemic in Human History”

BY AWAKE! WRITER IN SOUTH AFRICA

“No war on the face of the world is as destructive as the AIDS pandemic.”​—U.S. SECRETARY OF STATE COLIN POWELL.

THE first official report on AIDS (acquired immunodeficiency syndrome) appeared in June 1981. “None of us involved in those early days of Aids could have imagined the scale of the epidemic that has unfolded,” says Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). In 20 years it has become the greatest pandemic ever, and indications are that it will continue to increase.

It is estimated that over 36 million are infected with HIV (human immunodeficiency virus), and another 22 million have died from the effects of AIDS.a In the year 2000, three million died of AIDS worldwide, the highest annual total since the epidemic started. This is despite the use of antiretroviral drug therapy, particularly in wealthier nations.

AIDS Invades Africa

Sub-Saharan Africa, with an estimated 25.3 million infected, has become the epicenter of the pandemic. In this region alone, 2.4 million died from the effects of AIDS in the year 2000, which is 80 percent of the worldwide total. AIDS is the major cause of death in the region.b

South Africa has the highest number of infected people of any country in the world, estimated at 4.7 million. Here 5,000 babies are born HIV positive every month. In his address to the 13th International AIDS Conference, held in Durban in July 2000, former South African President Nelson Mandela stated: “We were shocked to learn that within South Africa 1 in 2, that is half, of our young people will die of AIDS. The most frightening thing is that all of these infections, which statistics tell us about, and the attendant human suffering . . . could have been, can be, prevented.”

AIDS Onslaught in Other Countries

Rates of infection are also increasing rapidly in Eastern Europe, Asia, and the Caribbean. At the end of 1999, the number infected in Eastern Europe was 420,000. By the end of 2000, that figure was conservatively estimated to have risen to 700,000.

A survey conducted in six large American cities revealed a 12.3 percent rate of HIV infection among young gay men. Further, only 29 percent of those who were HIV positive knew that they were infected. The epidemiologist who led the survey said: “We were so disheartened to find out that so few HIV-positive men knew they were infected. That means newly infected people are transmitting the virus without knowing it.”

At a meeting of AIDS experts in Switzerland in May 2001, this disease was declared “the most devastating pandemic in human history.” As noted, the AIDS onslaught has been particularly severe in sub-Saharan Africa. Our next article considers why.

[Footnotes]

[Blurb on page 3]

“The most frightening thing is that all of these infections . . . and . . . human suffering . . . could have been, can be, prevented.”​—NELSON MANDELA

[Picture on page 2, 3]

Many people who are infected with HIV do not know it

[Picture Credit Line on page 3]

UN/DPI Photo 198594C/Greg Kinch

AIDS Spreads in Africa

“We’re dealing with a kind of contemporary apocalypse.”

THOSE words of Stephen Lewis, UN special envoy for HIV/AIDS in Africa, echo the concern of many about the AIDS situation in sub-Saharan Africa.

A number of factors are involved in the spread of HIV. AIDS, in turn, has exacerbated other problems. The conditions that prevail in some lands in Africa and in other parts of the world where AIDS is gaining ground are often related to the following.

Morality. As sexual contact is the primary means of HIV infection, a lack of clear moral standards evidently promotes the spread of the disease. Many feel, though, that it is not practical to advocate sexual abstinence for the unmarried. “To simply warn teens to abstain from sex will not work,” writes Francois Dufour in The Star, a newspaper of Johannesburg, South Africa. “They are bombarded daily with sexual images of what they should look like and how they should behave.”

This analysis appears to be confirmed by the conduct of young people. For example, a survey in one country indicated that about a third of youths between the ages of 12 and 17 had engaged in sexual intercourse.

Rape has been described as a national emergency in South Africa. A news report in the Citizen newspaper of Johannesburg stated that it “is so rampant that it overtakes every other health risk posed to this country’s women and, increasingly, to its children as well.” The same article noted: “The rape of children has doubled in recent times . . . These acts are committed seemingly in perpetuation of the myth that an HIV carrier who rapes a virgin will be cured.”

Sexually transmitted disease (STD). There is a high rate of STDs in the region. The South African Medical Journal noted: “The presence of an STD increases the risk of HIV-1 infection 2- to 5-fold.”

Poverty. Many countries in Africa are battling poverty, and this creates a climate favorable to the spread of AIDS. What may be considered basics in developed countries are not available in most developing lands. Large communities have no electricity and no access to clean drinking water. In rural areas roads are inadequate or nonexistent. Many residents suffer from malnutrition, and medical facilities are minimal.

AIDS has a negative impact on business and industry. As more employees become infected, mining companies are feeling the effects of lost production. Some are considering ways to automate and mechanize certain operations in order to compensate. It was estimated that at one platinum mine in the year 2000, the number of AIDS cases among employees nearly doubled, and about 26 percent of the workers were infected.

A sad outcome of AIDS is the large number of children who become orphans when their parents succumb to the disease. In addition to losing parents and financial security, these children must endure the stigma attached to AIDS. Extended family members or communities are often either too poor to give assistance or are not willing to do so. Many orphans drop out of school. Some turn to prostitution and thus increase the spread of the disease. A number of countries have established government or private programs to give assistance to these orphans.

Ignorance. A large number of those infected with HIV are unaware of it. Many do not want to be tested because of the stigma connected with the disease. “People with, or suspected of having, HIV may be turned away from health care services, denied housing and employment, shunned by their friends and colleagues, turned down for insurance coverage or refused entry into foreign countries,” observed a press release of the Joint United Nations Programme on HIV/AIDS (UNAIDS). Some have even been murdered when their HIV status was discovered.

Culture. In numerous African cultures, women are often not in a position to question their partners about extramarital affairs, to refuse sexual contact, or to suggest safer sexual practices. Cultural beliefs often reflect ignorance and denial about AIDS. For example, the illness may be blamed on witchcraft, and help may be sought from witch doctors.

Inadequate medical facilities. Already limited medical facilities have been overtaxed even more as a result of AIDS. Two large hospitals report that over half the medical inpatients are HIV positive. The principal medical officer of one hospital in KwaZulu-Natal said that his wards operate at 140-percent capacity. At times, two patients have to share a bed, and a third one will be on the floor underneath it!​—South African Medical Journal.

Tragic as the situation is in Africa, indications are that it could get worse. “We are still at the early stages of the epidemic,” observed Peter Piot of UNAIDS.

It is evident that in some countries efforts are being made to deal with the disease. And for the first time, in June 2001 the United Nations General Assembly held a special conference to discuss HIV/AIDS. Will human efforts bring success? When will the deadly march of AIDS finally be halted?

[Box/Picture on page 5]

THE AIDS DRUG NEVIRAPINE AND SOUTH AFRICA’S DILEMMA

What is nevirapine? According to journalist Nicole Itano, it is “an antiretroviral drug that tests have shown can halve the likelihood of AIDS being transmitted [from a mother] to her child.” A German drug company offered to supply it to South Africa free of charge for the next five years. Yet, by August 2001, the government had not accepted the offer. What is the problem?

South Africa has 4.7 million HIV-positive people, more than any other country in the world. The Economist of London reported in February 2002 that South African President Thabo Mbeki “doubts the conventional view that HIV causes AIDS” and “is suspicious of the cost, safety and usefulness of anti-AIDS drugs. He has not banned them, but South African doctors are discouraged from using them.” Why is this a major concern? Because thousands of babies are born with HIV each year in South Africa and 25 percent of pregnant women carry the virus.

As a result of this conflict of views, a legal case was mounted in the courts to force the government to distribute nevirapine. South Africa’s Constitutional Court issued its opinion in April 2002. According to Ravi Nessman, writing in The Washington Post, the court ruled that “the government must make the drug available at health institutions with the capacity to administer it.” While the South African government had been offering the drug at 18 pilot sites across the country, this new ruling is said to have offered hope to all the HIV-positive pregnant women in the nation.

[Box/Picture on page 6]

A CUNNING VIRUS ENTRAPS THE CELL

Step for a moment into the minute world of the human immunodeficiency virus (HIV). A scientist observed: “After many, many years of peering at virus particles through the electron microscope, I have still not ceased to be amazed and excited by the precision and intricacy of design in something so very, very small.”

A virus is smaller than a bacterium, which, in turn, is much smaller than the average human cell. According to one authority, HIV is so small that “230 million [particles of HIV] would fit on the period at the end of this sentence.” A virus cannot multiply unless it infiltrates a host cell and commandeers the cell’s resources.

When HIV invades the human body, it must contend with the considerable forces that are at the disposal of the immune system.a A defense network composed of white blood cells is produced in the bone marrow. The white blood cells include two main types of lymphocytes, known as T cells and B cells. Some other white blood cells are called phagocytes, or “cell eaters.”

The various categories of T cells have different assigned functions. Those called helper T cells play a key role in the war strategy. Helper T cells assist in identifying foreign invaders and issue instructions for the production of cells that attack and destroy the enemy. In its attack, HIV particularly targets these helper T cells. Killer T cells are activated to destroy body cells that have been invaded. B cells produce antibodies that are recruited in the fight against infections.

A Cunning Strategy

HIV is classified as a retrovirus. The genetic blueprint of HIV is in the form of RNA (ribonucleic acid) and not DNA (deoxyribonucleic acid). HIV belongs to a specific subgroup of retroviruses known as lentiviruses because it can be latent for a lengthy period before serious symptoms of disease become manifest.

When HIV gains entry into a host cell, it is able to use the cell’s mechanism to further its own ends. It “reprograms” the DNA of the cell to make many copies of HIV. But before it can do this, HIV must use a different “language.” It must change its own RNA into DNA so that it can be read and understood by the host cell’s machinery. To accomplish this, HIV employs a viral enzyme called reverse transcriptase. In time, the cell dies, after first producing thousands of new HIV particles. These newly produced particles infect other cells.

Once the number of helper T cells has dropped significantly, other forces can overrun the body without fear of attack. The body succumbs to all sorts of diseases and infections. The infected individual has advanced to full-blown AIDS. HIV has succeeded in crippling the whole immune system.

This is a simplified explanation. It must be borne in mind that there is much that researchers do not know, both about the immune system and about how HIV operates.

For the best part of two decades, this little virus has engaged the mental and physical resources of top medical investigators around the world, which has entailed large financial expenditures. As a result, much has been learned about HIV. Dr. Sherwin B. Nuland, a surgeon, commented some years ago: “The amount of information that has . . . been gathered about the human immunodeficiency virus and the progress made in mounting a defense against its onslaughts are nothing less than an astonishment.”

Nevertheless, the deadly march of AIDS continues at an alarming pace.

[Footnote]

[Picture]

HIV invades the lymphocytes of the immune system and reprograms them to produce HIV

[Credit Line]

CDC, Atlanta, Ga.

[Picture on page 7]

Thousands of young people do adhere to Bible standards

Will AIDS Be Halted? If So, How?

FOR some time there has been denial in many African countries about the AIDS epidemic. It is a subject some people would rather not discuss. In more recent years, though, efforts have been made to educate the youth in particular and to encourage open discussion. These efforts have had limited success. People’s life-styles and customs are firmly entrenched, and it is difficult to effect change.

Medical Progress

On the medical front, scientists have learned much about HIV and have developed drugs that have prolonged the lives of many. A combination of at least three antiretroviral drugs, referred to as highly active antiretroviral therapy, has been used effectively.

While not a cure, these drugs have succeeded in reducing the death rate of HIV sufferers, particularly in developed countries. Many people stress the importance of supplying these drugs to developing countries. The drugs are expensive, however, and far beyond the means of most people in these lands.

This has brought an issue to the fore: Is financial profit more important than human life? The situation was acknowledged by the director of Brazil’s program on HIV/AIDS, Dr. Paulo Teixeira: “We cannot allow thousands of people to be set adrift for the lack of drugs with which to survive, simply in the name of profits far in excess of those normally earned.” He added: “I am extremely concerned that commercial interests should not be placed ahead of ethical and human considerations.”

A few countries have decided to override some of the patents of large pharmaceutical companies and to make or import generic versions of some drugs at a much lower cost.a According to one study, “minimum prices [of generic drugs] were found to be 82% less than the benchmark US prices,” reports the South African Medical Journal.

Treatment Obstacles

In time, the large pharmaceutical companies started to offer AIDS drugs at much lower prices to developing countries in need. It was hoped that in this way many more people would be able to make use of the drugs. However, there are major obstacles to overcome to make such drugs readily available in developing lands. One of these is the cost. Even at drastically reduced prices, the drugs are still far too expensive for the majority of the people who need them.

Another problem is that the drugs are not easy to administer. Many pills must be taken daily, at specified times. If they are not taken correctly or if the medication routine is interrupted, this could lead to the development of drug-resistant strains of HIV. It is difficult to ensure adherence to correct dosages in African conditions, where there may be little food, a low supply of clean drinking water, and few medical facilities.

Further, those taking the drugs must be monitored. If resistance develops, their combination of drugs must be altered. Experienced medical staff are needed for this, and the tests are expensive. Also, the drugs do have side effects, and drug-resistant strains of the virus are developing.

In June 2001 at the UN General Assembly special meeting on AIDS, a Global Health Fund was proposed to assist developing countries. It was estimated that an amount of between $7 billion and $10 billion was needed. Total pledges for this fund have so far been way short of the targeted amount.

Scientists entertain strong hopes of finding a vaccine, and various ones are being tested in different countries. Even if these efforts are successful, it will be several years before a vaccine has been developed, tested, and proved safe for general use.

Some countries, such as Brazil, Thailand, and Uganda, have had notable success with treatment programs. Brazil, by using locally manufactured drugs, has halved the AIDS-related death rate. The small country of Botswana, which has the financial means, is making efforts to provide antiretroviral drugs to all in need in the country and is striving to provide the essential health-care facilities.

The Defeat of AIDS

AIDS differs from some other epidemics in one important respect: It is preventable. If individuals are prepared to adhere to basic Bible principles, they can in many, if not all, cases avoid contamination.

The Bible’s moral standards are clear. Those not married should abstain from sexual intercourse. (1 Corinthians 6:18) Married people should be faithful to their partner and not commit adultery. (Hebrews 13:4) Heeding the Bible’s admonition to abstain from blood also serves to protect one.​—Acts 15:28, 29.

Those who are already infected can find great joy and comfort through learning about the disease-free world promised by God for the near future and then through conforming to God’s requirements.

The Bible assures us that in due course all mankind’s woes, including disease, will come to an end. This promise is made in the book of Revelation: “I heard a loud voice from the throne say: ‘Look! The tent of God is with mankind, and he will reside with them, and they will be his peoples. And God himself will be with them. And he will wipe out every tear from their eyes, and death will be no more, neither will mourning nor outcry nor pain be anymore. The former things have passed away.’”​—Revelation 21:3, 4.

That assurance is not just for those who can afford costly medication. The prophetic promise of Revelation chapter 21 is confirmed at Isaiah 33:24: “No resident will say: ‘I am sick.’” Then all living on the earth will abide by God’s laws and will enjoy perfect health. Thus, the deadly march of AIDS​—and all other diseases—​will be halted forever.

[Footnote]

[Box/Pictures on page 9, 10]

THIS WAS THE REAL CURE I WAS LOOKING FOR

I live in southern Africa, and I am 23 years old. I remember the day I found out that I was HIV positive.

I was with my mother in the consulting room when the doctor broke the news. It was the saddest news I had ever heard in my life. I was confused. I couldn’t believe it. I thought that maybe the laboratory had made a mistake. I didn’t know what to say or do. I felt like crying, but I had no tears. The doctor started discussing the antiretroviral drugs and other things with my mother, but I was too shocked to take anything in.

I realized that I may have been infected by someone at the university where I was studying. I very much wanted to talk to anyone who would understand my situation, but I could think of no one. I succumbed to feelings of worthlessness and failure. Although my family supported me, I felt hopeless and scared. Like any other youth, I had so many dreams. I had only two years to go to finish my bachelor of science degree, but that hope was shattered.

I started taking the prescribed antiretroviral drugs and also went to AIDS counselors, but I still felt depressed. I prayed to God to show me true Christianity before my death. I was a member of one of the Pentecostal churches, but no one from the church even paid me a visit. I wanted to know the truth about where I would go after death.

One morning in early August 1999, two of Jehovah’s Witnesses knocked at my door. I was very sick that day, but I was able to sit up in the living room. The two ladies introduced themselves and said that they were assisting people to study the Bible. What a relief it was finally to have my prayers answered. But by then I was so weak that I couldn’t read or concentrate for long.

Nevertheless, I told them that I wanted to study the Bible, and they made an appointment with me. Unfortunately, before the time arrived, I was taken to a psychiatric hospital because of my depression. I was discharged three weeks later and was relieved to find that the Witnesses had not forgotten me. I recall that one of them kept contacting me to see how I was. Physically, I recovered somewhat, and I started studying the Bible toward the end of the year. I didn’t find it easy, though, because my condition was unstable. But the person studying with me was understanding and patient.

I was greatly impressed when I studied about Jehovah and his qualities in the Bible, as well as what it really means to know him and to look forward to everlasting life. For the first time, I also understood the reason for man’s suffering. It brought me great joy to learn about God’s Kingdom, which will soon replace all human governments. It motivated me to change my way of life completely.

This was the real cure I was looking for. How comforting it was to realize that Jehovah still loves me and cares! Previously, I thought that God hated me and that this was why I was infected with this disease. But I learned that Jehovah lovingly made provision for the forgiveness of sin on the basis of the ransom sacrifice of Jesus Christ. I then knew that God cares, as 1 Peter 5:7 says: “Throw all your anxiety upon him, because he cares for you.”

By studying the Bible every day and attending meetings at the Kingdom Hall, I am really working hard to be as close to Jehovah as I can. While it is not always easy, I pour my anxieties out to Jehovah in prayer and ask for his strength and comfort. Members of the congregation are there for me as well, so I am happy.

I regularly share in the evangelizing work along with the local congregation. I want to help others spiritually, particularly those in a situation similar to mine. I was baptized in December 2001.

[Picture]

It brought me great joy to learn about God’s Kingdom

[Picture on page 8]

AIDS counseling team in Botswana

[Picture on page 10]

On the Paradise earth, all will enjoy perfect health