Celebrate World AIDS Day Today, December 1, 2010 - Part I

Obviously we do not exactly celebrate the existence of this terrible viral disease.  What we celebrate is an awareness of this pandemic, a pandemic that is our closest modern equivalent to the black death, the bubonic plague of the 14th century in Europe.  Following the premise that when we don't learn from history, we are doomed to repeat it, I would like to share with you a brief overview of other pandemics, (as distinct from epidemics) before focusing on ours. The purpose of the historic overview is to establish common patterns in the past as a foundation, a frame, a focus for looking at our approach to AIDS, in the hope of finding greater insight and understanding for our response to it.


Lets begin with definitions, for those of you not following the links - a pandemic differs from an epidemic in several criteria: 1. broader geographic boundaries than normal infections, and 2. the degree to which the illness exceeds expected infection rates, with a pandemic being much more severe than an epidemic.   To be a pandemic the spread of an illness only has to be one or the other; AIDS/HIV is both.  And 3. duration of the disease outbreak; normal illnesses tend to be seasonal in their peak periods while epidemics can be seasonal but tend to run longer, while pandemics can span many decades, even centuries, but are usually defined by their peak outbreak periods.  This is another of the unique aspects of the pressures common to pandemics.  The final criteria is that while pandemics affect across all social groups and classes, over the longer duration of pandemics, the less powerful or influential the demographic, the greater the degree to which they are affected both directly and indirectly.  This relates very much to my post of a few days ago, which caused some dismay among my colleagues.

I would add two other criteria for the purpose of this post, although it is common to both epidemics and pandemics as distinct from normal illness patterns: fatality rates; and odd, unsuccessful desperate attempts at solutions, that you do not find in the spread of less widely fatal illnesses.  Because these too make pandemics and plagues unique historically - not that we don't as a species do stupid things all the time, but the uniquely greater pressures of pandemics exacerbate our stupidity, and our cruelty. 

So, let me begin with a brief list of historic pandemics, to provide context, especially illustrating duration:

Plague of Athens, Mediterranean, 430 BC, Typhoid
Antonine Plague, Mediterranean, 165-180, probably smallpox,
   (still unknown definitively)
Cyprian Plague, Roman empire, 251-266, probably smallpox
   (may be a continuation of the Antonine Plague)
Plague of Justinian, Egypt to Constantinople, 541 - 750, bubonic plague
Black Death, Asia to Europe and the UK, 1340 - 1480, bubonic plague
Great Plague of London, UK and Europe, 1665-66, bubonic plague
   (may have been the last outbreak continuation of the Black Death, 14th century)
First Cholera Pandemic, Asia, 1816-1826, cholera
Second Cholera Pandemic, Russia and Europe,UK, Africa, back to Asia,, 1829-1851 cholera
Third Cholera Pandemic, Asia and Northern Africa, 1852-60, cholera
Fourth Cholera Pandemic, Europe and Africa, 1863-1875, cholera
Third Pandemic, China and India, spreading worldwide, 1855-1945, bubonic plague;
   (we continue to have outbreaks in parts of the U.S. especially western U.S. to date, directly resulting from this specific pandemic)Fifth Cholera Pandemic, worldwide, 1881-1896, cholera
Sixth Cholera Pandemic, Asia, 1899-1923, cholera
Seventh Cholera Pandemic, Asia, 1962-1966, cholera
AIDS/HIV-1and 2, worldwide, identified 1981-to present, but dates back to Africa c. 1900, HIV retrovirus aka the Human Immunodeficiency Virus
   some define this as a syndemic, two or more diseases in aggregate acting together, because of the related  but distinct illnesses which occur, or can occur, as part of the progress of the disease (as distinct from the religious idea that it results from a 'sin'demic- pun intended)
Eighth Cholera Pandemic, Asia, 1991-2002, cholera (new type)

So, lets begin with the history of AIDS in part 1 of celebrating World AIDS Day; when you read Penigma, I want you to feel you leave with a greater depth AND breadth of information than you might get elsewhere.

The AIDS virus is believed to have originated in non-human primates, and then spread to humans in the late 19th century -yes, that long ago, not the 1980s.  The 1980s are responsible for some regrettable things, in terms of taste and culture, but we cannot blame that decade for this.  The more pandemic strain is HIV-1, and is closely related to a version found in our nearest taxonomic cousin, an ape, the chimpanzees in central Africa, and in certain varieties of Gorillas.  HIV-2 is less transmissible, less pandemic, and is mostly found only in west Africa.  It is associated with another primate, a monkey, the Sootey Mangabey as well as people.

The whole monkey/ape connection is significant because HIV evolved from mutations of SIV, or Simmian Immunodeficiency Virus. The original non-mutated SIV, or 'Monkey AIDS' still exists; it has been around for an estimated 32,000 years, and it affects more than 30 kinds of primates, and it can develop into SAIDS, the monkey/ape version of human AIDS.  The mutated HIV became zoonotic, meaning it could jump entire species, much the way avian flu affect people not just birds, and swine flu doesn't only affect pigs, and rabies doesn't only affect the host animal.  I'll spare our readers the nerdy science details of molecular phylogenics, even though I love this stuff.  Suffice it that it deals with relatedness.

Of all the mutations forming the numerous groups of HIV1 and 2, only four are transmissible to humans:
HIV-1, M & O, and HIV-2, A & B).

We don't know exactly when SIV mutated and jumped to humans (zoonosis), but the best scientific guess puts in the later 1800s, possibly the early 1870's, long before it was recognized by the CDC in 1981.  The most likely mode of transmission to humans was blood-borne from the hunting and eating of various monkeys, chimpanzees, and gorillas.  People in central African countries do show antigens, indications of infection, to SIV.

The European 'Scramble for Africa' of the 19th century, by Europeans colonizing Africa and the resulting urbanization was important in disrupting traditional tribal cultures.  One of the greatest contributing factors to the spread of HIV, one which continues now, was the need for a largely masculine labor force which drew men away from their homes in widespread parts of Africa into the congested, and often unhygenic cities.  As a result of the separation from families, promiscuity became a cultural problem to a degree which it had not been before in Africa.  The practice of using unsterile hypodermic needles for vaccinations and other injections to help control some of the resulting diseases, as part of colonial injection campaigns in Africa.  There were very active campaigns into the mid 20th century, especially for certain illnesses like sleeping sickness, but this kind of transmission is also associated with increased antibiotic use for all kinds of infections.  AIDS transmission has NEVER been only or even primarily about primitive people behaving badly in relation to sex.  (If you're curious, I would refer you to the articles of Marx, Alcabes, and Drucker, c. 2001)

I mention the alternate vectors of transmission because unfortunately primarily the sexual one gets the attention, and the resulting judgements on AIDS sufferers, including but not limited to the notion that AIDS is a curse from God for homosexuality and promiscuity, among others.

The role of urbanization and travel of populations is directly significant in the difference between epidemics and pandemics.  It is important in the AIDS/HIV epidemic, and it is a crucial reason why AIDS/HIV prevention in the areas most intensely afflicted - in this case, Africa - should be using the most effective AIDS transmission, namely condoms.  The lives we save could well be our own, given the possibility of future mutations like the ones which made this such a deadly, and difficult to stop pandemic.