Acquired Immunodeficiency Syndrome (AIDS)
by Sheik N. Hassan, M.D., FCCP
Dr. Hassan is a Pulmonologist and Associate Professor of Medicine at Howard University, College of Medicine, Washington, D.C.
AIDS is a worldwide problem and involves more than an illness. It is a problem for all of humanity, and not even the most devout Muslim should ignore it. Anyone, including Muslims, would be naive to think that AIDS is not his or her concern. Every person must learn about it, know how to prevent it, and teach these preventive measures to others. This article briefly describes AIDS as it affects all of us.
AIDS is the acronym for Acquired Immunodeficiency Syndrome. It is a monumental problem worldwide and spares no one, irrespective of national origin, race, religious affiliation or even personal practices. This disease is a disorder, which affects the immune system of the body. The immune system functions to ward off certain diseases, but with AIDS this function becomes inadequate. The immune system itself can become adversely affected by many diseases, and even by therapy for certain illnesses. When the immune system is suppressed, other secondary diseases are likely to develop. AIDS specifically refers to the type of immunosuppression resulting from infection with a virus, which is now known as The Human Immunodeficiency Virus (HIV).
From a historical standpoint, the disease was initially identified a little more than a decade ago, and it has certainly made a massive impact worldwide. In 1981, some unusual forms of infections and tumors were described in the United States of America. In 1982, "high risk" groups to acquire these "new diseases" were identified. This constellation of illnesses was soon to be called AIDS. It became obvious that a virus was responsible, and in 1983 the virus itself was identified. Viruses are very difficult to isolate, thus most laboratories are not equipped to do this, and so an easier method to identify the infection had to be developed. This was accomplished in 1985. This blood test (serology) identifies substances (antibodies) which are produced in response to the presence of the virus. There is a lag between the time of infection with the virus and the time for a positive test. While we have made some inroads into this quagmire, our knowledge of and approach to AIDS continue to evolve. There is no specific therapy for HIV, but many of the illnesses associated with AIDS can be treated or controlled for many years.
It is estimated that world wide, as many as 15,000,000 people are infected with the HIV, and of this, 2,000,000 live in the United States of America. Of those in the United States, about 300,000 have already been diagnosed as having AIDS, and of this number 200,000 have died. The disease is most prevalent in large cities, and it is seen disproportionately among African American men. In the United States, it is the second leading cause of death among men aged 25-44. In 1990, it was the leading cause of death among all young men in five states, and the leading cause of death among young African American men in 9 of the 36 states so analyzed. In several states it was the second leading cause of death among young women. It must be emphasized though, that AIDS is worldwide in distribution, and there are pockets in other parts of the world where the statistics are equally, if not more so, alarming than in the United States.
HIV infection and AIDS are not the same. They represent different ends of the spectrum of a process. The course of the disease varies considerably from one person to another, but several phases can be identified. The first phase is that of initial infection with the HIV. At this time, the person may experience no symptoms, or at worse may develop a mild fever and body-aches, which resolve spontaneously. The second phase is an asymptomatic period of variable time. This symptom free phase can be subdivided into two stages. During the first part of this second phase, the person feels completely well, and if examined by a physician no abnormalities will be detected. He or she will go about all activities of daily living without any problems. Furthermore, even though he or she is infected with the virus, the standard tests to detect the HIV will be negative (seronegative). This, of course, gives a false sense of security, since such a person can transmit the virus to others, and will ultimately develop AIDS. This seronegative stage lasts from two weeks to perhaps several months. The second stage of this second phase is marked by the conversion of the blood test from negative to positive, and the person is now labeled as seropositive for HIV. Even at this time, the person will feel well and physical examination will be normal; and the only way to label him or her as being infected is with the blood test.
This symptom free phase may last up to ten years or more, but the average time is three years. It must be emphasized that once an individual becomes infected with the virus, regardless of how he or she feels, or what the clinical evaluation (including blood tests) reveals, such a person is capable of transmitting the virus to another person by means to be described later in this article. Persons falling in these two phases are not classified as having AIDS. The third phase is the development of AIDS. The actual definition of AIDS has changed over the years, and this is due in large part to the course of certain illnesses in patients with HIV infection. A person is classified as having AIDS when the HIV test is positive, and he or she develops specific illnesses or a specific abnormality in the blood. While the virus itself may cause signs and symptoms directly, most of the manifestations of AIDS are the result of the disturbed immune system, which include many types of infections and tumors. Some of these infections (opportunistic) cannot ordinarily cause diseases in patients who have an intact immune system. It is beyond the scope of this article to describe the clinical manifestations of AIDS, but suffice it to say that they include infections, tumor, dementia, body wasting, loss of appetite, weight loss, debility, and death. The median survival from the time of development of AIDS to death is about one year, with about ten percent of patients being alive after 3 years.
The effects of AIDS extend well beyond an illness. The physical effects on the patients have only been briefly alluded to already. There is also a significant mental effect. The individual is faced with the fact that death will soon ensue in the wake of a progressive, multi-system, and symptom complex of devastating illnesses. Much time will be spent in hospitals and away from family members and friends. Because of other contagious diseases, he or she may be placed in isolation in the hospital. Social interaction then becomes further diminished. It should be noted that even friends and family members may shun patients with AIDS. All of this leads to despair, despondency, and depression. These mental problems tend to spill over to caregivers and family members who are closely associated with the afflicted ones. Patients and family members thus face many hurdles, which can be difficult to overcome. These include physical, emotional and financial stresses.
Fortunately however, during the past few years some changes in attitudes have occurred, and many have been able to express more empathy to those afflicted, making it easier for the patients and their families to deal with the disease. Caring for patients with AIDS is very costly. This includes the direct costs of hospitalization, diagnosing, and treating all aspects of HIV disease. In addition, all healthcare workers and institutions must adopt universal precautions (i.e., approach everyone as though he/she is infected with the virus) - this adds to healthcare costs. Furthermore, patients and family members frequently must take time off from work because of the illnesses. Not only are wages lost, but industry also suffers from the lost labor. The patient with AIDS also increase the direct healthcare costs of others not only by spreading the HIV, but also by spreading the other infections to persons who are immunosuppressed for any reason, and spreading tuberculosis to anyone -- immunosuppressed or not. Other costs consist of higher insurance premiums for healthcare coverage, and uncompensated care for the uninsured and the underinsured. Finally, there is redistribution of money for research in health issues. This is an unfortunate necessity. It is necessary because AIDS is a major health issue, and many questions are yet unanswered. It is unfortunate because the disease is largely preventable.
Anyone can contract AIDS. In very few cases, the mode of acquiring the HIV infection is unknown. However, certain factors are known risks. These are:
HIV infection is known to occur in marriages in which one partner had no sexual relation outside of the marriage and used no illicit drug, and in fact had no known risk factor except that the other partner either used drugs, or was sexually active outside of the marriage. It must be pointed out that the incidence of AIDS is increasing in the heterosexual population. This is especially true among those with multiple sex partners. When accidental needle sticks in healthcare workers were analyzed, it was found that the incidence to acquire the infection was very low. It must also be emphasized that the risk of becoming infected with the virus from transfusion is very low, and over the last several years, this has become less of an issue. Blood and blood products in any large city or metropolitan areas are provided by a common source. This source collects, screens, and distributes the blood to all hospitals in the area.
Therapy for AIDS will not be addressed in this article. It must be noted though that the best therapy for any disease is prevention. This is especially true for AIDS, and in reality it is the only effective therapy. The good news then is that AIDS is a preventable disease in the vast majority of cases. The sad news here is that most people who contract AIDS do not adhere to the rules of prevention. Behavior modification for preventive measures is extremely effective. This was clearly demonstrated among gay men in San Francisco in whom a ten to twenty fold reduction in the infection rate was noted, following institution of preventive measures.
Current teaching now is that AIDS can largely be prevented by (a) avoid sharing needles when using illicit drugs and (b) practice "safe sex" (homosexual and heterosexual) by using condoms during intercourse, and by limiting the number of sex partners. Some jurisdictions have gone so far as to consider distributing needles to drug addicts, and now some school systems are passing out condoms to youngsters so that they can practice "safe sex". While these measures, if strictly adhered to, will curtail the spread of AIDS, they, in reality, are not practical. How many needles and how many condoms will be given to any one person and over what period of time? This system sends the wrong message, and is morally wrong. These measures literally state it is acceptable to use illicit drugs, and it is acceptable to have sexual relations outside of marriage. These efforts to control AIDS actually encourage behavior which is haram - behavior which Muslims must not engage in, condone, or be silent about.
The solution to the problem of AIDS is very simple: strong moral behavior. This means:
As Muslims, we must teach this to our children and to others. Our discussion with them must be open, sincere, and factual. If we do not educate them about these things, then someone else may very well lead them along the wrong path. Other measures include:
It should be pointed out that one cannot become infected with the virus by embracing someone who is infected, nor by donating blood. No one should be oblivious to AIDS. The disease can occur in the young and the old, the poor and the rich, the non-pious and the pious, and in men and women. Furthermore, everyone in this country is likely to interact with people or relatives and friends of people who are infected with HIV -- often times without knowledge that the other person is infected. We cannot ignore the magnitude of the problem, and we cannot minimize anyone's risk to develop the infection. We must understand the nature of the illness and express empathy to those stricken with it, and to their families and friends.
The absence of symptoms does not exclude HIV infection, and the symptoms of AIDS are not specific for the disease. Therefore, if you know someone who may have been exposed to the virus in the risk patterns described earlier, then you should encourage that person to be tested. This is necessary for close monitoring, and to prevent further spread of the disease. We must lead the way in preaching and practicing strong ethics and morality. As Muslims, we cannot turn our backs to AIDS, since it can and does affect us. We must lead the way with da'wah by words and by example.
Posted November 20, 1998. This article was printed in the November 1993 issue of the Voice of Islam newsletter. (This newsletter is published by the Islamic Society of the Washington Area).