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AIDS: The Globalization of Disease Early examples of disease “Globalization” • Black Death (bubonic plague)in Medieval EuropeThe Black Death - YouTube • Monty Python-Bring out your dead! YouTube • Epidemics of influenza, smallpox and measles brought from Europe to Indigenous peoples of the Americas. Syphilis brought back by Columbus crew to Spain. • Recently, avian flu, H1N1, SARS in Toronto all show the same patternsSARS - YouTube REGIONAL trends of AIDS • NORTH AMERICA- In the 1980s it was first reported in males in California. However, HIV can affect everyone, and, in Canada and the US, the fastest rising infections over the past 5 years (as of 2011) have been with young women and not homosexual males or men with multiple partners. • EUROPE-INTRAVENOUS DRUG USERS • ASIA-prevalent in PROSTITUTES of all genders/sexes • SUB-SAHARAN AFRICA-PANDEMIC…EVERYONE IMPACTED even children born with it. This is also where it is believed to have started in the early 20th century in monkey hunters cutting up meat. History of AIDS • 1981: PCP and Kaposi’s sarcoma reported by doctors in NY and Los Angeles. CDC reports in MMW a strange killer pneumonia spreading among gay men. Is was designated as GRID (Gay-Related Immune Deficiency). Referred to as “Gay Cancer.” • 1982-1985: Cases of AIDS in 1982 began to be reported by fourteen nations. In 1982 CDC received its first report of "AIDS in a person with hemophilia (from a blood transfusion), and in infants born to mothers with AIDS.” N.S.-Janet and Randy Conners • 1983: Dr. Montagnier announced the isolation of LAV retrovirus (lymphadenopathy-associated virus), which later was identified as the cause of AIDS. 33 countries reported cases. • 1984: Dr. Robert Gallo of the NCI isolated HTLV-III retrovirus ( Human T-cell lymphotropic virus III). It was later determined that LAV and HTLV-III were the same virus • 1985: AIDS awareness was brought to the public's consciousness, Hollywood leading man Rock Hudson, died of AIDS shortly after making it public thus becoming the first major public figure to announce that he had AIDS. An HIV blood test was brought to large companies to make it available in large scale. PATIENT ZERO • In the early years of the AIDS epidemic, there was controversy about a so-called Patient Zero, who was the basis of a complex transmission scenario compiled by Dr. William Darrow and colleagues at the U.S. Centers for Disease Control (CDC). This epidemiological study showed how Patient Zero had infected multiple partners with HIV, and they, in turn, transmitted it to others and rapidly spread the virus to locations all over the world • Journalist Randy Shilts subsequently wrote about Patient Zero, based on Darrow's findings,in his 1987 book And the Band Played On, which identified Patient Zero as Gaëtan Dugas. Dugas was an Air Canada flight attendant based out of Halifax/Montreal who was sexually promiscuous in several North American cities, according to Shilts' book. He was vilified for several years as a "mass spreader" of HIV, and seen as the original source of the HIV epidemic. History of AIDS • 1986: President Reagan makes his first mention of the word “AIDS” publicly and request the Surgeon General C. Everett Koop to prepare a report which was released in October 1986. Brochure: “Understanding AIDS” sent to 107 million households. It warned that “AIDS is one of the most serious health problems that has ever faced the American public”. 1987: Famous pianist Liberace dies • AZT (also known as Retrovir®, zidovudine, or ZDV) -- GlaxoSmithKline -- became the first anti-HIV drug (a Nucleoside Reverse Transcriptase inhibitor) approved by the FDA. Reverse transcriptase is the enzyme that HIV uses to make a DNA copy of its RNA. This is necessary for the production of the viral double-stranded DNA which is integrated into the genetic material of the infected cell. AZT is used in combination with at least two other anti-HIV drugs. History of AIDS • 1987: A touch of a Princess: On March 20, 1987 princess Diana changed the public perception of AIDS at the opening of a special ward at London’s Middlesex Hospital. She was seen not wearing gloves and shaking hands with people with AIDS. Princess Diana: AIDS activist – YouTube 1990: Death of Ryan White, a nineteen year old, white, heterosexual, teenager from Indiana died because of AIDS which he contracted from blood products, as part of his treatment for hemophilia. Elton John: Ryan White Saved my life part 2 – YouTube AIDS Boy Banned From Attending School - 1st August 1985 - YouTube YouTube - Elton John - The Last Song CBC News In Depth: Tainted Blood 1991-Freddie Mercury, singer in “Queen” dies • Magic Johnson combats AIDS misperceptions - USATODAY.com • Tainted blood scandal Canada’s Red Cross late 1980s/early 1990s (Hepatitis and HIV) • CBC: Life And Times • CBC News - Nova Scotia - AIDS activist lauded for perseverance • (2015)QUILT • On February 24, 1995, NWA (also featured Dr. Dre and Ice Cube) rapper Eazy-E was admitted into Cedars Sinai Medical Center in Los Angeles with what he believed to be asthma. Instead he was diagnosed with AIDS, and announced his illness in a public statement on March 16. The disease came about in Eazy because of his sexual activity, which started when he was twelve and resulted in not only a fatal disease, but six children to FIVE different women. He died due to "complications from AIDS" one month after his diagnosis, on March 26, 1995, at approximately 6:35 PM (Pacific time). He was 31 years old. • Celebrities who died of AIDS Pictures CBS News History of AIDS 1999: Origin of HIV-1 Discovered. A research team from UAB lead by Dr Beatrice Hahn identified a subspecies of chimpanzee native to West-Central Africa as the natural reservoir for HIV-1. Viruses related to HIV-1 had previously been found in chimpanzees and were given the designation SIVcpz (for Simian Immunodeficiency Virus). Both HIV-1 (chimpanzees) and HIV-2 (sooty mangabeys) originated in Africa. Why the epidemic arose in the mid-20th century is not clear. People in some African nations contract the virus by eating 'bushmeat' Pan troglodytes sub-especies and distribution 1. Pan troglodytes verus 2. P. t. vellerosus 3. P. t. troglodytes 4. P. t. schweinfurthii December 2, 2011 Jacques Pepin's 'The Origins Of AIDS' A Canadian professor's groundbreaking look at the genesis of the AIDS virus is generating global buzz for shedding new light onto the world's most devastating pandemic. • • As The New York Times is reporting, Dr. Jacques Pepin's "The Origins of AIDS," published earlier this month by Cambridge University Press, traces the improbable journey of HIV/AIDS to a single bush hunter (dubbed "patient zero") in central Africa who "manipulated chimpanzee meat" in 1921: Dr. Pepin sifts the blizzard of scientific papers written about AIDS, adds his own training in epidemiology, his own observations from treating patients in a bush hospital, his studies of the blood of elderly Africans, and years of digging in the archives of the European colonial powers, and works out the most likely path the virus took during the years it left almost no tracks. Working slowly forward from 1900, he explains how Belgian and French colonial policies led to an incredibly unlikely event: a fragile virus infecting a small minority of chimpanzees slipped into the blood of a handful of hunters, one of whom must have sent it down a chain of “amplifiers” — disease eradication campaigns, red-light districts, a Haitian plasma center and gay sex tourism. Without those amplifiers, the virus would not be what it now is: a grim pilgrim atop a mountain of 62 million victims, living and dead. • Interestingly, Pepin, an infectious disease specialist at the University of Sherbrooke in Quebec who spent many years living and working in Africa, also believes that he (along with well-meaning doctors and nurses) may have inadvertently helped to pass along the AIDS virus himself while working at a Canadian-funded program in Zaire (Congo). • "The chances that this hunter alone could launch an epidemic are very low," Pepin tells Canada's The Globe and Mail. "But there are all the chances in the world that he went to be treated for a tropical disease and a little HIV stayed in the syringe. Then the next patient was injected with it intravenously.“ • Pepin also believes the rapid expansion through sex alone is mathematically impossible -- instead, he names a Port-au-Prince-based plasma center called Hemo-Caribbean as being one "amplifier" in the spread of the AIDS virus. The center, which operated only from 1971 to 1972, was known to have low hygiene standards. Global summary of the AIDS epidemic, December 2008 Number of people living with HIV in 2008 Total Adults Women Children under 15 years 34.4 million [31.1 – 35.8 million] 31.3 million [29.2 – 33.7 million] 15.7 million [14.2 – 17.2 million] 2.1 million [1.2 – 2.49 million] People newly infected with HIV in 2008 Total Adults Children under 15 years 2.7 million [2.4 – 3.0 million] 2.3 million [2.0 – 2.5 million] 430 000 [240 000 – 610 000] AIDS deaths in 2008 Total Adults Children under 15 years 2.0 million [1.7 – 2.4 million] 1.7 million [1.4 – 2.1 million] 280 000 [150 000 – 410 000] At the end of 2007, the CDC estimates that there were 571,378 people living with HIV/AIDS in the 39 states and dependent areas that have a history of confidential name-based HIV reporting, based on reported diagnoses and deaths. However, the total number of people living in the USA with HIV/AIDS is thought to be around 1.1 million. What are the symptoms of AIDS? Early symptoms Some people have flu like illness within a month or two after exposure to the virus They may have fever, headache, malaise and enlarged lymph nodes These symptoms usually disappear within a week More persistent and severe symptoms may not surface for a decade or more after HIV first enters the body in adults: Diarrhea for more than one month Dry mouth and skin rushes Severe headache Dry cough AIDS: this term applies to the most advanced stages of HIV infection. All HIV-infected people who have fewer than 200 CD4+ T cells Opportunistic Infections Most AIDS-defining conditions are opportunistic infections, which rarely cause harm in healthy individuals. In people with AIDS, these infections are often severe Bacteria: • Mycobacterium Avium Complex • Mycobacterium Tuberculosis Viruses: • Varicella-Zoster Virus • Herpes Simplex Virus • Cytomegalovirus Protozoa: • Coccidiosis (Cryptosporidiosis, Cyclosporiasis, and Isosporiasis) • Toxoplasmosis • Leishmaniasis (not in the U.S., but in Southern Europe and in many other parts of the world) • Chagas • Malaria Fungi: • Pneumocystis carinii Pneumonia • Candidiasis • Aspergillosis • Cryptococcosis • Histoplasmosis • Coccidioidomycosis • Microsporidiosis Kaposi’s Sarcoma, or KS, is a type of cancer. It causes patches of cancerous tissue to grow under the skin and in the lining of the mouth, nose, throat, or other organs and tissue, including cartilage, bone, fat, blood vessels, tendons, ligaments, or other fibrous tissues. These patches are red, purple or brown and are comprised of cancerous cells and blood cells. These lesions often appear as raised blotches or lumps. In many cases, there are no symptoms besides the red or purple patches, though the patches themselves can be quite painful. KS can spread to the digestive tract or to the lungs, which can make breathing hard or cause internal bleeding, which can render it life-threatening. It can also cause painful swelling, especially in the legs, groin, or around the eyes. When it develops on its own, KS develops slowly. However, in people whose autoimmune system is compromised, especially those with HIV/AIDS, KS can move very quickly. Treating the AIDS itself can help to limit the spread of the lesions and even to shrink them, but for AIDS patients, KS contributes to the overall deterioration of health that eventually leads to death. AIDS treatment Antiretroviral treatment: more than 20 drugs approved. HAART: highly active antiretroviral Therapy combines three or more anti-HIV medications daily. Anti-HIV medications do not cure HIV infection. Four classes of Anti-HIV drugs approved by the U.S. Food and Drug Administration (FDA): 1. Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs):Efavirenz (Sustiva) binds to and block the action of reverse transcriptase. 2. Nucleoside Reverse Transcriptase Inhibitors (NRTIs): zidovudine (Retrovir), tenofovir DF (Viread), and stavudine (Zerit), are nucleotide analogues. They inhibit reproduction of the virus. 3. Protease Inhibitors (PIs): lopinavir/ritonavir (Kaletra) 4. Fusion Inhibitors: enfuvirtide (Fuzeon), are newer treatments that work by blocking HIV entry into cells Core proteins of HIV-1 are produced as part of long polypeptides that are cut into smaller pieces by protease to create functional and mature proteins. Protease inhibitors bind to the active site, where protein cleavage occurs. With the inhibition of protease, new viral particles cannot mature and do not become infectious. This figure is Fig. 3 from Nature Medicine, 2003, 9:867 • • • • • • • Sub-Saharan Africa remains the region most heavily affected by HIV, with southern Africa remaining the area most heavily affected by the epidemic. In 2009, sub-Saharan Africa accounted for approximately 70% of people living with HIV worldwide and new infections among adults and children. The region also accounted for 72 per cent of the world’s AIDS-related deaths in 2009. Most transmission in this region occurs in heterosexual relationships, both in the context of transactional and commercial sex and in longer-term relationships, including marriage. As a contrast, in most other regions, HIV disproportionately affects injecting drug users, men who have sex with men, and sex workers. The epidemic is evolving, however, and national epidemics throughout the world are experiencing important transitions. In Eastern Europe and Central Asia, epidemics that were once distinguished largely by transmission among injecting drug users are now increasingly characterized by significant sexual transmission. In parts of Asia, epidemics are more and more characterized by significant transmission among heterosexual couples. The epidemic in Asia, which has long been concentrated in injecting drug users, sex workers and their clients, and men who have sex with men, is steadily expanding into lower-risk populations through transmission to the sexual partners of those most at risk. Click on the link to download regional HIV and AIDS statistics, 2009 Young people aged 15–24 years account for an estimated 41 per cent of new adult HIV infections worldwide. Globally, young women aged 15–24 years account for 64 per cent of all HIV infections among young people. In sub-Saharan Africa young women aged 15–24 are more than two times more likely to be infected than their male counterparts. In only three regions – South Asia, East Asia and the Pacific and Latin America and the Caribbean – are there more young men who are HIV positive than young women. This reflects the differences in risk behaviours, which requires that interventions be tailored to fit the nature and dynamic of the epidemic. • • • • • • For the First Time Ever: Bono! - YouTube Bono's call to action for Africa | Video on TED.com Bono's Special Message on "No Child Born with HIV" - YouTube (RED): 2 Pills A Day - The Lazarus Effect - YouTube YouTube - 'The Lazarus Effect' Film from (RED) & HBO K'NAAN Speaks on Bill C-393 - Sign the Petition to Save Lives! – YouTube • Let Democracy Win! Let the Senate pass Bill C-393. – YouTube • Frank Valeriote speaks in favour of Bill C-393.mp4 – YouTube (first 2 minutes) • GRANDMOTHERS TO GRANDMOTHERS - GET DRUGS TO AFRICA! - YouTube