..Facing Facts

Like most of us, AIDS started its second century on the planet nine years ago.

No one celebrated, though. There was plenty of hoopla about the new millennium and tons of media hype and hysteria about the potential effects of the dreaded Y2K bug, but nobody seemed interested in doing much about the AIDS virus, except wishing it would go away.

Also curiously absent amid all the media coverage of the news and newsmakers of the 20th Century was much mention of a virus that's already killed more Americans than the Vietnam and Korean Wars added together -- and one that seems poised to kill more people in the first decades of the 21st century than all the wars of the last century combined.

That's why we put together this pamphlet.

Because even though recent news about AIDS treatments and possible vaccines have given us reason for hope, the simple truth is that AIDS -- and the HIV virus that causes it -- is the kind of thing that most of us seem to prefer not thinking about.

But while ignorance about some things may be bliss, ignorance about AIDS can be deadly.

Because as much as anything, HIV runs on ignorance, and unlike AIDS, ignorance can be destroyed -- simply by facing a few facts.

..What is AIDS?

In case you missed it the first time around (or need a review), AIDS -- or Acquired Immunodeficiency Syndrome -- is not a disease, but a set of diseases that follows an infection of the body's immune system.

Dangers linked to AIDS arise from the inability of the body to fight off other infections and diseases.

..How many people have it?

By January 1, 2009, more than 1,050,000 people in the United States had been diagnosed as having AIDS.

Of these, 583,298 had already died of AIDS-related complications.

..Who gets AIDS?

All kinds of people. Although it was once thought of as a "gay disease" affecting only gay and bisexual men, AIDS now affects all of us, in one way or another.

And it's not just a problem in the United States. Today, AIDS is one of the most critical public health problems in the world.

According to the World Health Organization, about 33 million people worldwide are now infected, with the number of new infections growing by 6,800 every day.

Although gay and bisexual men continue as the highest risk group in the United States (representing 53 percent of all new infections), other groups increasingly figure into the HIV equation. Of particular concern are intravenous drug users, who account for one-sixth of all new cases.

Increasingly, though, heterosexual contact contributes to rising AIDS totals. In fact, heterosexual activity is now the only risk factor in 31 percent of all U.S. HIV infections.

..How is it transmitted?

Although much of the early panic surrounding AIDS came from the belief that AIDS could be transmitted through casual contact, experience has proven such beliefs wrong. That's because HIV is only transmitted through an exchange of bodily fluids, particularly semen and blood.

For this reason, all forms of sexual contact that allow direct exchange of bodily fluids are possible routes of HIV transmission.

In addition, the virus can also be exchanged from mother to child during pregnancy and from one person to another by the exchange of contaminated needles and blood products.

..How does AIDS affect the body?

After entering the body, HIV invades CD4+ T-lymphocytes -- white blood cells that defend the body against infection -- where it binds to DNA in the cell nucleus.

In many cases, this is where things stand, and stop, for months or years. But infection at this level is typically only the first phase of the disease process. Usually (and for reasons that are still unexplained), the virus reactivates. At this stage, it kills the host T cell and releases new viruses that invade other T-cells.

As the virus continues its spread, the immune system becomes increasingly impaired and less able to fight off diseases and infections.These secondary "opportunistic" infections can be so devastating that death results.

..What's the outlook for someone exposed to HIV?

Not as bad as it once was. More people are living longer, more productive lives with the disease today than ever before.

In fact, long-term HIV survivors -- some who've lived with the infection for 15 years without progressing to AIDS -- now number in the thousands.

And while researchers estimate that only one in 100 may be naturally immune to the HIV virus, fully three percent of those infected with HIV may not develop the full-blown disease. Why, exactly, is still unclear -- but it's the subject of intense current research.

..What are the symptoms of AIDS?

Early symptoms can include any of the following:

• Whitish coating or spotting on tongue or throat
• Swollen lymph glands
• Unexplained fatigue, aches, and pains
• Heavy cough (often with shortness of breath)
• Persistent fever, "night sweats"
• Skin rashes or blotching of skin
• Diarrhea
• Weight loss not due to diet or increased activity
• Decreased appetite
• Persistent yeast infection in women

Early symptoms can be mild, but later symptoms are much harder to ignore.

Secondary symptoms can include a life-threatening "wasting syndrome" and other problems, including brain and central nervous system damage, pneumocystis carinii pneumonia, and a rare form of cancer known as Kaposi's sarcoma.

..Is there a reliable test for AIDS?

Yes. In fact, the FDA has approved new urinalysis and saliva tests, along with home-test blood kits.

The new tests are said to be more sensitive, accurate, and safer than previous tests because they measure the number of CD4 cells -- the cells targeted by the HIV virus -- rather than the amount of HIV in a sample.

Because of the sensitivity of the tests, doctors can now detect infection long before the virus itself is detectable. In addition, the level of infection can be more accurately judged.

And knowing as early as possible if you are infected -- and how long you've been infected -- is increasingly critical, because new treatments are most effective when used early.

..What treatments are effective?

The most promising treatments to date involve a new group of drugs called protease inhibitors.

The drugs, which evolved out of research that produced the early AIDS drug, AZT, are used in combination with AZT and other antiviral agents in so-called multi-drug "cocktails."

The new cocktail treatments, which were instituted on a large-scale in 1996, are proving effective at reversing many AIDS symptoms, even causing full-scale remission in some patients.

In fact, the drugs are proving so effective that researchers are daring to hope what a few years ago was almost unimaginable: that HIV might soon become a manageable, chronic disease -- like diabetes or ulcers.

Still, the new drugs do have a downside. They don't seem to work for everyone (15 percent of patients don't respond) and they're expensive -- annual costs can run up to $20,000 per patient. But at least they offer serious hope to people for whom hope had been in seriously short supply.

..What can I do to reduce my risk?

Be celibate or be careful. Realize that even though the odds of HIV happening to you may seem remote, the risks are still real.

According to the U.S. Centers for Disease Control, more than a million Americans are now living with HIV infection. And perhaps more are infected but uncounted, "silent" carriers of an infection they don't even know about.

The most troubling fact of all is that each may be able to transmit the virus to others -- even if they don't show any symptoms of infection.

That means if you're sexually active or you use drugs, you'd better take measures to protect yourself:

• Limit partners.
• Use condoms and practice safer sex.
• If you're an intravenous drug user, quit.
• If you can't quit, don't share a needle with anyone.

Because if we've learned nothing else over the years sifting rumors and facts about HIV, we've learned that it is possible to prevent AIDS from happening.

Be wise. And if you can't be wise, be smart.

For More Information
The National AIDS Hotline:
1-800-342-AIDS or 1-800-344-SIDA (Spanish)

..Sidebar1 | Making Sex Safer

Since sexual contact is the primary means of HIV transmission, the best way to reduce your chances of bumping into the virus is to limit your sexual partners.

Given what we know about HIV, the only foolproof way to do that is to refrain from all activities that could lead to an exchange of bodily fluids -- which would include giving up sex altogether.

Since that doesn't seem to be in the cards for billions of people any time soon, experts suggest avoiding certain higher-risk sexual practices -- anal intercourse, for example.

Others urge the use of condoms in all types of sexual activity as well as "safe sex" alternatives -- love games that don't involve intercourse at all.

Included in this category is almost everything from massage to mutual masturbation, as long as it doesn't lead to an exchange of bodily fluids.

Still, it does leave room for exchanging the kind of intimacy that real love is supposed to be about.

..Sidebar 2 | If You Think You've Been Exposed to HIV

• Avoid sexual contact.
• Contact your local or state health department.
• Don't panic.

If You Have Been Exposed to HIV

• Avoid sexual contact.
• Don't donate blood or sperm.
• Don't share toothbrushes, syringes, or other personal products that may spread blood or body fluids.
• If you're a woman, postpone any planned pregnancies.