The Wisdom of Forgiveness

“If we think only of ourselves, forget about other people, then our minds occupy very small area. Inside that small area, even tiny problem appears very big. But the moment you develop a sense of concern for others, you realize that, just like ourselves, they also want happiness; they also want satisfaction. When you have this sense of concern, your mind automatically widens. At this point, your own problems, even big problems, will not be so significant. The result? Big increase in peace of mind. So, if you think only of yourself, only your own happiness, the result is actually less happiness. You get more anxiety, more fear.”  Dalai Lama XIV, The Wisdom of Forgiveness

“Is this what you have in mind,’ I asked the Dalai Lama, ‘when you say in teachings that the buddhas and bodhisattvas of the world are the most selfish beings of all, that by cultivating altruism they actually achieve ultimate happiness for themselves?’

Yes. That’s wise selfish,’ he replied. ‘Helping others not means we do this at our own expense. Not like this. Buddhas and bodhisattvas, these people very wise. All their lives they only want one thing: to achieve ultimate happiness. How to do this? By cultivating compassion, by cultivating altruism.”  Dalai Lama XIV, The Wisdom of Forgiveness

National Geographic Pic of Day April 6 2013

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Myths Abound

Choose a myth that you can imagine circulating in your own community, imagine that you have just overheard a conversation in which someone was repeating that myth, and write out a “script” that you might use in helping to clear things up.

“HIV was introduced into the human population by Africans who had sex with monkeys”

If you search the internet for information about monkeys and humans in Africa, there is a vast amount of information regarding bush meat hunters, who continue today, to hunt wild animals using both guns and traps [2].  In Cameroon today, large numbers of these animal carcasses are transported to the capital of Yaounde by train from remote areas [1].

In many places people rely on hunting.  Poor families may get almost all of their protein from hunted animals, and need to trade some of their catch for a source of income [2].  Primate flesh is rare and expensive in today’s markets [1].

HIV-AIDS researchers in Africa often encounter bush meat hunters and observe close contact between the hunters and bloodied animals during butchering [3].  However, it is very difficult to find any literature (reputable or otherwise) that provides evidence of sexual contact between humans and primates, which are often very aggressive [2, 4], making the idea of sexual contact even less likely.

There is scientific evidence that HIV is a descendant from SIVcpz, which infects chimpanzees [5, 6].  This categorises HIV as a zoonosis [6], meaning an infection which can transmit between animals and humans, and most viruses infecting humans originated in animals [3].  Cross-species transmission of viruses between animals and humans is thought to occur regularly [5] and across the globe, wherever humans have contact with domestic or wild animals, especially where people living in poverty are more likely to have close contact with livestock and wild animals [7].

When Beatrice Hahn presented her findings about SIVcpz, she showed photographs of chimps that had been slaughtered in a presentation to 5000 scientists in Chicago, where people source their meat from supermarkets and restaurants.  Her audience were horrified, and New York Times Magazine compared this hunting to cannabilism [9, 10].  The “sex with monkeys” theory seems an extension of this horror, which has no place in an objective analysis of the facts.

Most HIV infection occurs via sexual transmission, but “contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids” is also a possible transmission route [8].

The evidence of HIV originating from the infected blood of primates in contact with humans, is strong.  However, the contact is overwhelmingly likely due to bush hunting practises.

References:

1. https://www.youtube.com/watch?v=FDMFuOGyLsw

2. https://www.youtube.com/watch?v=HOe_4lTRhU0

3.  http://www.ted.com/talks/nathan_wolfe_hunts_for_the_next_aids.html

4.  http://www.scientificamerican.com/article.cfm?id=why-would-a-chimpanzee-at

5.  http://www.avert.org/origin-aids-hiv.htm

6.  http://www.prn.org/index.php/progression/article/origin_of_the_aids_pandemic_58

7.  http://r4d.dfid.gov.uk/pdf/outputs/livestock/zoomapdfidreport18june2012finalsm.pdf

8.  http://www.cdc.gov/hiv/topics/basic/#spread

9.  http://www.thebody.com/content/art2761.html

10. http://www.nytimes.com/2003/06/15/books/almost-cannibalism.html?pagewanted=all&src=pm

Epidemiology of HIV in Africa

Discuss the prevalence of HIV in Sub-Saharan Africa.

With all of the publicity around AIDS in Africa, whilst the numbers are certainly shattering, it was very surprising to learn that only 2.8% (24 million people) of the total population of Africa’s 850 million people, are HIV positive [1].  Most of these live n Sub-Saharan Africa, where 23.5 million people were estimated to have HIV in 2011 [1]. This represents almost 70% of the worldwide burden of disease (estimated to be 34 million people) [2, page 8].

In Epidemiology, the term “prevalence” is defined as the number of people currently living with a particular disease, whilst “incidence” is defined as the number of new infections occurring in a given timeframe [3].  The Centers for Disease Control and Prevention (CDC) define an epidemic as “the occurrence of more cases of disease than would normally be expected in a specific place or group of people over a given period of time” [4].  The HIV-AIDS epidemic is divided into four defined categories, being:
1.  Generalised – where HIV prevalence in the general population of a given country, region or location is equal to, or more than, 1%;
2.  Concentrated – where the HIV prevalence in the general population is less than 1%, but exceeds 5% in specific high risk groups, such as injecting drug users;
3.  Low level – insignificant prevalence in any group;
4.  The number of people who have died from AIDS is also an important consideration, as a significant number of AIDS deaths may alter the prevalence figures.
[3]

The World Bank provide an interactive table / graph / map on their website [5], which demonstrates the difference in prevalence rates in 15-49 year olds in different countries.  This clearly shows marked differences in HIV prevalence between countries on the African continent for 2011.  Swaziland appears to have the highest rate at 26%, followed by Botswana (23.4%), Lesotho (23.3%) and South Africa (17.3%). These highest prevalence countries are all in Southern, Sub-Saharan Africa.  In contrast, some African countries have much lower prevalence, for example Angola (2.1%), and the northern nations of Burkina Faso (1.1%) and Tunisia (0.1%) [5].

Prevalence rates do not necessarily demonstrate the affliction of disease when translated into numbers, or global burden.  For example, because Nigeria is a populous country of 162.5 million people [6], their prevalence rate of 3.7% amongst 15 to 49 year olds [5] equals 3.3 million, which translates to 10% of the world’s total HIV positive population [7].

Approximately 10% (3.4 million) of all HIV cases worldwide are estimated to be children under the age of 15, and it is also estimated that around 16 million children worldwide have lost at least one parent to AIDS related death [8].  Consistent with the other figures discussed above, most of these children live in Sub-Saharan Africa, and 90% of HIV positive children became infected via Maternal to Child Transmission either peri-natally (before or during birth), or via breastfeeding [8].

Because most HIV transmission in Sub-Saharan Africa occurs during unprotected heterosexual intercourse, and because women are much more vulnerable to infection via heterosexual transmission, women are much more likely to become infected with HIV via this exposure route [9].  In 1985 HIV prevalence in Sub-Saharan Africa was approximately equal between men and women [9], but due to the vulnerability of women to infection, 58% of all HIV positive people in this region are now women [2].

There are many other sub-populations with varying prevalence rates, for example sex workers, injecting drug users, men who have sex with men, and prisoners, who are all vulnerable to HIV transmission for differing reasons [19] which go beyond the scope of this assignment.

Prevalence rates are not a static phenomenon, and they change over time, and within populations.  For example, in South Africa 5.6 million people were estimated to be HIV positive in 2011, which is “the highest number of people for any country” [16].  South Africa has conducted annual ante-natal HIV seroprevalence surveys since 1990, at which time 0.8% of pregnant women were estimated to be HIV positive.  This statistic rose steadily for the next 15 years, and in 2005 30.2% of pregnant women were estimated to be HIV positive [17].  Since this time, HIV seroprevalence in pregnant women in South Africa has remained stable [18].

It is very difficult to compose a concise argument as to what factors influence the different prevalence rates of HIV between populations geographically.  According to the UNAIDS Report on the Global AIDS Epidemic 2012, “behaviour change is helping to prevent sexual transmission in generalized epidemics” [10, page 16].  Across Sub-Saharan Africa, efforts are being made to influence sexual behaviours in young people.  For example the Global Dialogues project, a script writing contest held across the continent, in which winning short films addressing issues in HIV-AIDS are broadcast widely to African television stations, and used as education resources in a wide variety of community contexts.  The narratives are studied “to understand how youths perceive HIV/AIDS and related social phenomena”  [11].  Couples Voluntary Counselling and Testing (CVCT) has also been identified as “the only prevention program proven to reduce HIV incidence in the largest risk group in the world, African couples” [12].

HIV infection rates are highest in poorer populations and the interplay between HIV and poverty is complicated and not easily understood or articulated, with low literacy, gender inequality, early age marriage and child labour being just some of the issues increasing HIV infection risk [13].

Other social factors related to high HIV transmission rates include sexual violence, high sexually transmitted infection (STI) rates, low rates of male circumcision, population transience and mass movement into cities [14].  Concurrent sexual partnerships have been defined as “situations in which an individual has overlapping sexual relationships with more than one person”, and are reportedly much more common in Sub-Saharan Africa [15], however the connection between concurrent partnerships and HIV transmission rates remain hotly debated [15].  There are also some possible physiological causes for higher rates of HIV transmission, including transmissibility of different virus sub types, genetic factors, and co-infection with certain helminths [14].

Political leadership at global, national and local levels is considered a key influence in the outcome of HIV prevention programs [20].  Weak economies and political unrest are considered significant barriers to successful prevention programs in many places, but South Africa and Botswana are two examples of countries showing committed leadership with improved outcomes [7].

1.  http://www.unaids.org/en/resources/campaigns/20121120_globalreport2012/epislides/ (Slide 4/12)
2.  http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/2012_FS_regional_ssa_en.pdf
3.  http://www.avert.org/aids-statistics.htm
4.  http://www.cdc.gov/excite/classroom/intro_epi.htm (See Disease Transmission)
5.  http://data.worldbank.org/indicator/SH.DYN.AIDS.ZS/countries/all?display=default
6.  http://data.worldbank.org/indicator/SP.POP.TOTL
7.  http://www.avert.org/aids-hiv-africa.htm
8.  http://www.avert.org/children.htm
9.  http://www.avert.org/women-hiv-aids.htm
10.  http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/20121120_UNAIDS_Global_Report_2012_with_annexes_en.pdf
11.  http://globaldialogues.org/the-issues/hivaids/#.UUhYB1fV5Fs
12.  http://www.rzhrg.org/couples.html
13.  http://www.un.org/wcm/content/site/chronicle/home/archive/issues2011/hivaidsthefourthdecade/impactofhivaidsoneducationandpoverty
14.  http://www.avert.org/aids-africa-questions.htm
15.  http://www.aidsmap.com/Concurrent-sexual-partnerships-and-the-spread-of-HIV-the-evidence-is-limited/page/1437223/
16.  http://www.avert.org/aidssouthafrica.htm
17.  http://www.hivsa.com/static/hiv-aids-in-south-africa
18.  http://www.avert.org/south-africa-hiv-aids-statistics.htm
19.  http://www.avert.org/hiv-aids-vulnerable-groups.htm
20.  http://www.ncbi.nlm.nih.gov/pubmed/21161769

Some HIV Stuff

I’m studying at the moment, so my writings are essays, but that doesn’t mean they aren’t from the heart, and they are (to my mind at least) interesting.

Essay 1:

What are the most significant factors that contributed to HIV/AIDS becoming a global problem?

The first people to become infected with the HIV-1(M) virus, which causes 97% of HIV infections worldwide, were probably bush meat traders in the Democratic Republic of Congo (DRC) [1].  When the chimpanzee species Pan troglodyte troglodyte was killed, eaten, or blood got into cuts or wounds on the hunters’ skin, a hybrid form of the Simian Immune Deficiency Virus (SIVcpz) crossed from chimpanzee to human host, where it mutated into what we now know as HIV [2].  It is thought that by the 1960s up to 2,000 people in West Africa may have been infected by HIV-1, but the first signs of an epidemic occurred in the 1970s after an infected individual travelled from Cameroon, down river to Kinshasa, DRC, where the virus was able to spread quickly by a wide urban sexual network [3].  This scenario appears to provide early evidence of two of the main factors influencing the rapid spread of HIV – human mobility and human sexual behaviours.

The virus is thought to have spread quickly in parts of Africa due to widespread labour migration, a high ratio of men in urban populations combined with a low status of women, leading to a thriving sex trade, as well as lack of circumcision in men and high rates of sexually transmitted diseases, which provide a vulnerable environment for the virus to take hold [3].

HIV belongs to a subgroup of Retroviruses, named Lentiviruses, meaning slow viruses.  There is a significant period of time between the time of infection with a Lentivirus, and the beginning of symptoms [4].  This aspect of HIV allows it to spread unwittingly between people who may remain unaware of their infection for up to several years [5].

The spread of HIV followed human movements, with the highest prevalence rate of HIV in Africa in 1988 being found on the main highway linking Tanzania and Zambia, and by the late 1980s most of Southern Africa was significantly afflicted [3].  It is thought that the first case of HIV in South Africa was a white American air steward, who died in 1982 from Pneumocystic Pneumonia in 1982, and in 1983 16% of tested gay men in Johannesburg were HIV positive [3].  It was around this time that conditions now known as AIDS-defining illnesses began to appear in gay men in the USA, as well as a small number of heterosexual men and women, many of whom had a history of intravenous drug use [6].

HIV positive people may remain unaware of their infection for years before developing symptoms, due to the long latency period of the virus.  This reduces the likelihood of people altering high risk behaviours before diagnosis.  Such behaviours may include multiple sexual partners and unsafe IV drug use (eg sharing needles) .  Prior to identification of the virus and without implementation of protective measures (now routinely employed in first world donor blood), it is also able to transmit between humans via blood transfusions [7].  These factors combined with the changing pattern of domestic and international travel which occurred around the same time as the virus crossed over to human hosts, allowed it to spread rapidly across human populations around the globe.