What Providers Need to Know about Community Beliefs Regarding the Origins of HIV

Kathleen A. Clanon, MDPaula Runnals, MAEast Bay AIDS Education & Training Center 2006 Asilomar Conference – October 4, 2006

1. What beliefs about the origins of HIV have you heard/seen/read about, and from what groups?

2. What are the likely consequences of these beliefs for people in terms of agreeing to testing and treatment for HIV?

3. How should the HIV treatment community respond to people about these beliefs?

4. What further research or interventions should be done about this issue?

Does HIV Cause AIDS? Mechanism: HIV attacks the immune

system’s CD4 Tcells.

Monitoring and Progression: Normal CD4 count = 500 – 1500, AIDS CD4 count < 200. On average, it takes 10 years to develop AIDS from time of initial infection with HIV.

Effect: As a person’s CD4 count decreases, he/she is more prone to opportunistic infections.

Evidence that HIV Causes AIDS:

Timing: HIV and AIDS appeared in the world at the same time. As HIV spreads, so does AIDS.

Mode of Spread: HIV spreads from person to person by sex and blood, which is also how AIDS spreads.

Pathologic Mechanism: HIV destroys immune T4 cells, and most AIDS probs result from T4 deficiency or dysfunction.

Effect of Rx: HAART, which targets HIV, extends life for people with AIDS.

T Cell with Budding HIV

Origins of HIVHIV-1 likely descended

from SIVcpz

HIV-2 likely descended from SIVsm

Pan troglodytes troglodytes Sooty Mangabey

Origins of HIV: Simian Zoonosis

Simian Immune-deficiency Viruses (SIVs), which exist in many primate species, routinely infect humans but don’t usually survive long enough to become established and spread.

On at least four occasions (M, N, O and SIV 2), the SIV mutant was different enough to establish itself in the human host and become transmissable to other humans.

Origins of HIV: Evidence

Close Genetic Relationship: SIVs are older evolutionarily than HIVs, logical “parent” viruses.

Geography: HIV first seen in areas of SIV prevalence.

Mechanism: Other infections move from monkeys to humans.

Two Types of HIV

HIV-1 vs. HIV-2

HIV-1 More virulent Responsible for

worldwide epidemic

Severity of infection varies from person to person

HIV-2 Primarily found in

western Africa Not transmitted as

efficiently Genome more

closely related to SIVmm than HIV-1

Origins of HIV

Researchers believe that chimpanzees are the source of HIV-1. SIV cpz is HIV-1’s closest relative.

Caveats: Chimps are only rarely infected with SIVcpz

Actual Reservoir maybe a third unidentified primate species

Only 6 CPZ with SIV available for study. Definitive source remains elusive

How did it happen? Human killing and eating of chimpanzees

contact with infected blood ingestion of uncooked or undercooked meat

Chat - polio vaccine Hypothesis: HIV is a recombinant construct that

occurred when SIV from a contaminated vaccine was administered to humans and arose when human antigens were incorporated into the SIV

Two reports in 2001 discount this theory

(Blanco P. et al. and Berry N. et al.)

When did it happen? Three earliest known HIV infections

1959 - serum sample from an adult male living in what is now the Democratic Republic of Congo

1969 - tissue samples from a teenager who died in St. Louis

1976 - tissue samples from a Norwegian sailor

January 2000 - study by Dr. Bette Korber estimates first case of HIV infection to be 1930

Study based on complicated computer model of HIV’s evolution and has a 20yr error margin

Where did it happen?

The primates that carry the SIVs most closely related to HIV are indigenous to west and central Africa

Chimpanzee Range

HIV/AIDS in Africa

Community Beliefs

1972 – The Tuskegee Syphilis Experiment

2005 Katrina

Community Beliefs About HIV: RAND Study 500 African Americans surveyed by phone Education:

High school grad or less 51% Some college or more 49%

Income: <$35,000 53.4% >$35,000 46.6%

Community Beliefs: RAND Results

Institutions are trying to stop HIV 75.4 % People who take new meds are guinea pigs 43.6 % AIDS is a form of genocide 15.2 % AIDS was produced in a government lab. 26.6 % Information about AIDS is being withheld 58.8 % Cure for AIDS exists, but withheld from poor 53.4 % Medicines used to treat HIV are saving lives in the black

community 38.4%

Bogart, Thorburn (2005)

Community Beliefs and HIV Prevention

Men had stronger conspiracy beliefs than women

Men who had higher conspiracy beliefs had more negative attitudes about condoms and less likely to use condoms (OR 4.52)

Bogart, Thorburn (2005)

Belief in AIDS as a genocidal conspiracy (%)

“AIDS is an agent of genocide created by the US

government to kill off minority populations.”

A.A. Hispanic AsianWhite

M F M F M F M F

True 27.3 31.2 21.4 23.8 11.2 7.2 19.2 21.7

Don’t 16.6 18.6 12.5 18.5 7.0 4.0 3.5 5.2

Know

Total n 206 235 251 204 145 154 200 97

Ross, JAIDS, March 2006

HIV & Genocide: Other Surveys The AIDS virus was “deliberately created in a

laboratory in order to infect black people.” (NY Times/WCBS Poll 1990)

Believed to be true by 10% of African Americans

Believed might be true by another 20%

AZT is a plot to poison African American people. Urging condom use is a scheme to prevent African

American births. Distributing clean needles is designed to

encourage drug abuse.

Copyright 2003 American Medical Association. All Rights Reserved

HIV & Genocide “Well, this is just my opinion. The population is

growing. People are dying at slower rates. So they said, ‘let’s see what happens if we infect this (HIV) out there’.” (Corbie-Smith 1999)

“I think [experimentation on Blacks] is still going on now. Like AIDS, it was man-made but it kind of got out of hand.” (Freimuth 2001)

Copyright 2003 American Medical Association. All Rights Reserved