The 1980s may well be remembered as the AIDS decade, when our attitudes to infection and immunity began to take on a whole new light. It is an issue that will break the mold of modern medical values and re-establish some much older and more fundamental principles. It will try our community-based preventive medicine resources to their limits, and probably beyond. In short, it is something you should know about.
AIDS is the newest epidemic to threaten human beings. It is supposed to have begun quietly in Central Africa (especially Zaire and Uganda) where it may have been long established in animal populations, but the story there is not yet fully told. It was first diagnosed in America and Britain during 1981. Since then it has spread rapidly among drug abusers and the sexually promiscuous and about half of those affected have since died.
Susceptibility depends on infection with a virus known as HIV (Human Immunodeficiency Virus), HTLV III, LAV or ARV. It only affects humans and can only be caught directly into your blood stream. Once there it arouses an immune response so that within about three months antibody to HIV can be detected in your blood. If you are healthy you can destroy the virus in this way before any damage is done, and the antibody will probably last for the rest of your life.
However this virus is capable of penetrating precisely those blood cells that enable you to make immune responses in the first place, so it brings sharply into focus how vigorous and positive your primal adaptive system is, which is the key to your immunity. If this is deficient when you are infected with the virus it can penetrate the blood cells that you have trained to recognize threats and start an immune reaction. Once that has happened you are no longer able to prevent other organisms and growth processes from plundering and destroying your body.
This catastrophy is not inevitable, even if you are infected with HIV. It affects particularly people who are poorly nourished, have little self-esteem or are poorly regarded by their neighbours and family, or who have little purpose in living. This is the factor common to the two groups in whom the disease has spread fastest — homosexuals and intra-venous drug abusers. Haemophiliacs and their wives do not face these handicaps and have fared very much better. Years after exposure sufficient to cause an antibody response most people remain quite healthy: they have either destroyed the virus or prevented it from penetrating their blood cells or resisted its effects once inside those cells — we don’t yet know which. Most of the rest are showing signs of immune weakness and a minority have full-blown AIDS. A few AIDS sufferers have recovered their health by a monumental effort, rather in the way cancer sufferers sometimes can; but once AIDS is established the chances of surviving longer than a few years are less than even.
Exposure to HIV is spreading rapidly through intra-venous drug abusers, then through their female partners to their children. We have to assume that eventually a sizeable minority of the general population will be exposed to it. A fortress mentality is no defence: we have to think and act positively.
What to do