HIV is a virus that attacks the immune system; AIDS is the disease that may develop as the immune system is weakened. Here's the full story of HIV and AIDS, complete with a surprise appearance from Charles Dickens…

What is HIV?

HIV blood test

HIV has been called our fiercest predator. It has killed 25 million people and infected more than 65 million people.

Nobody knows how it entered the human population, nor when. It was first recognised and named in the early 1980s, yet it may well have been multiplying and mutating in humans long before then.

 

What the Dickens does Charles Dickens have to do with it?

Charles Dickens (1812-1870) in his study at Gad's Hill Place. HIV AIDS
Charles Dickens his study at Gad's Hill Place

Charles Dickens didn’t know about HIV, but he had a keen eye for interesting clinical symptoms, describing characters with features representing conditions as diverse as tuberculosis and epilepsy.

The HIV/AIDS story began with eagle-eyed doctors noting a strange skin cancer amongst homosexual men in America (HIV has since infected both homosexuals and heterosexuals, and 29 children were diagnosed with HIV in the UK in 2014).

Dickens spoke out for the rights of those with socially 'unacceptable' symptoms, such as Tiny Tim, who would otherwise be shunned and ridiculed. In the 1980s, blame, shame and discrimination surrounded those diagnosed with HIV. In his time, Dickens raged against poverty. Today, HIV has its greatest impact in the poorest countries of the world.

I will, therefore, tell the story of HIV using some of Dickens’ most famous book titles.

 

A tale of two cities (or continents)

everything you need to know about HIV and AIDS
In sub-Saharan Africa, 12 million children have lost a parent to AIDS

According to Dr Michael Brady, Medical Director of the Terrence Higgins Trust, an HIV-infected patient receiving effective treatment can expect to “live a life as long and full as people who haven’t been infected with HIV”. Many people in the UK today fit into this category.

In sub-Saharan Africa, meanwhile, 12 million children have lost a parent to AIDS and over 13 million people have died. Life expectancy in countries such as Botswana and Swaziland has dropped to below 40 years, mainly as a result of AIDS. Farms, schools and houses are abandoned; households are left to be led by grandparents or teenagers: ‘bleak houses’ indeed.

Without treatment, HIV can lead to dementia, a diarrhoea-wasting disease often called ‘slim disease’, skin cancer and infections such as tuberculosis.

A Tanzanian study this year also revealed that untreated HIV-infected adults have a twofold increased incidence of heart attack and stroke, and a fourfold increased rate of sudden cardiac death.

Read more: How football is helping those diagnosed with HIV

 

Hard times

Bill and Melinda Gates
Bill and Melinda Gates in Africa working for their Foundation. Image via Stanford Daily

With anti-HIV drugs having such a huge impact on survival, the race is on to find even more effective drugs, or even a vaccine to prevent HIV.

Money has flooded in, helped by private charities such as the Bill and Melinda Gates Foundation, or concerts such as the ‘Live 8’ event organised by Bob Geldof. Yet scientists are having a hard time finding a vaccine, because the virus has a tendency to mutate, thus evading detection and destruction by a vaccine.

It’s also proving hard to get treatment through to poorer countries: there’s a lack of access to anti-HIV drugs and a low uptake of HIV testing. People don’t want to know if they are infected for fear of stigma and discrimination.

 

Great expectations

terrence higgins trust HIV and AIDS
Volunteers for the Terrence Higgins Trust

Despite these challenges, the mission of the Terrence Higgins Trust remains ‘an end to the transmission of HIV in the UK’.

Professor Bruce Walker of Harvard Medical School says:

“Despite robust challenges, momentum toward the development of an effective HIV vaccine is growing. Now, 35 years into the epidemic, there are clear reasons for optimism. New trials are about to begin, with candidate vaccines that have achieved impressive protection in animals. There is no question that there is still a long path ahead, but ample reasons to be optimistic that extensive global collaborative efforts currently underway will meet this challenge”.

‘One World, One Hope’ was the theme of the 11th International AIDS conference and that hope remains today.

 

Read more: Why are many older adults ignoring STIs?

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