A Brief Update on the AIDS Epidemic
Kopansky-Giles, Deborah
On Dec. 1, 2004, the world recognized World AIDS Day. Why should this date be important to doctors of chiropractic? Researchers involved in the treatment of IV/AIDS will tell you that this disease is both creative and devastating, successful primarily because of its reliance human behavior and the way that it spreads. Health practitioners will relay stories of the ineffectiveness of current reatment and prevention strategies and the toll it takes on people’s lives. Politicians and activists will tell you that AIDS is simply an opportunistic disease that preys on human weaknesses and has no respect for human rights and inequities around the globe. All of these things are true. AIDS is a tragic, global pandemic that will not slow down. It will affect each one of us through friends, family, or patients we care for-and inevitably through our pocketbooks as the monetary cost to society for AIDS continues to multiply.
Current Status of the Epidemic
According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), approximately 40 million people were infected with HIV by December 2003. Transmission rates average 5 million new infections each year and 3 million deaths. The disease has been most successful in the disadvantaged population-particuarly in the developing world where it is ravaging whole communities and countries. The perception of the disease is also anging. At the International AIDS Conference in Bangkok, Thailand, in 2004, speakers reported that 58% of all new infections in Sub-Saharan Africa were in young girls and women between the ages of 15 and 24. The disease has now become recognized as a “women’s disease” with greater than 50% of all new infections worldwide occurring in heterosexual women. Mother-to-child transmission rates continue to rise with insufficient provision of medicines that have a very high success rate in prevention of maternal transmission to the developing world.1
The impact of AIDS on families has also been catastrophic. Approximately 13 million children have become orphans because of AIDS worldwide (12 million in Africa alone). Lack of treatment and of effective prevention programs has resulted in failing family support systems for these children who have lost their parents to the disease and very likely have it themselves. Stephen Lewis, UNAIDS special envoy to Africa, has undertaken a global initiative to increase the support provided for these children by the wealthier nations of the world. At the XV International AIDS Conference, Bangkok, Thailand, he passionately advocated for the rights of children when he commented, “Given the scale of the AIDS epidemic, the response to orphan care and support should be urgent and massive.”2
Treatment Options
* HAART (Highly Active Antiretroviral Therapy) has been very successful in reducing viral load in PLWAs (people living with AIDS) and in enabling them to have longer, healthier lives. These drug cocktails, however, have been unsuccessful in curing AIDS. It remains a terminal disease.3
* Vaccine trials to date have been extremely disappointing despite a focus on vaccine research and significant funding over the past 5 years. An AIDS vaccine is at least 9 to 10 years away, according to vaccine researchers presenting at the AIDS conference in Thailand.
* Vaginal microbicides and female condoms have had limited efficacy and rely on the ability of women to have control over their sexual interactions and the availability of these products.
* Nevirapine and other medications have good success rates in preventing mother-to-child transmission when these drugs are made available to women prenatally. World leaders have emphasized that the empowerment of women is key to any effective AIDS strategy (either treatment or prevention).
* There is significant evidence that PLWAs utilize complementary therapies such as chiropractic for a variety of reasons (relief of musculoskeletal symptoms, for example) and emerging evidence that complementary and alternative therapies have a beneficial effect on improving quality of life in PLWAs,45 in addition to supporting their self-management of the disease.6
* Education and prevention initiatives have been demonstrated to be very effective in slowing transmission rates, particularly in those countries whose governments have taken a leadership role in this area.
Chiropractic Involvement
Chiropractic institutions can also play an important role in this effort by educating students and faculty, by supporting community initiatives (participating on local AIDS committees or councils), and by collaborating in health service delivery or research projects with AIDS organizations. Canadian Memorial Chiropractic College (CMCC) has undertaken research initiatives in this area over the past several years. CMCC, in collaboration with Sherbourne Health Centre, has completed data collection for a project evaluating changes in quality of life status for PLWAs accessing chiropractic services at the centre. These data are currently in the process of being analyzed. A second project in collaboration with Sherbourne Health Centre and Canadian College of Naturopathic Medicine is to develop a software modification to the current HIV Ontario Observational Database (HOOD, a central data registry for PLWAs in Ontario) for the collection of CAM treatment data. The HOOD has historically collected medical treatment data only and this project, funded by the Ontario Ministry of Health and Long Term Care through the Ontario HIV Treatment Network, will be the first of its kind that we know of in the world to routinely collect this type of information for a research database.7
All health providers, including chiropractors, should consider participation in World AIDS Day or at the very least, make a commitment to themselves that they will learn more about this disease by next December I to enable transfer of knowledge from chiropractor to patient. It would also reinforce the role of the doctor of chiropractic as a health practitioner, one who recognizes the various influences on health and how these may affect patients. Research has repetitively demonstrated that chiropractic patients’ high ratings of satisfaction are intimately tied into the time DCs take to educate them about health and making healthy choices. I encourage all chiropractors to learn as much as they can about HIV/AIDS, its manner of transmission, response to treatment, impact of complementary and alternative therapies, comorbidities, and the human social burden it brings to our society.
Can we make a difference? I believe each of us can-through educating our patients, encouraging prevention strategies, supporting local initiatives in our own communities, and providing quality supportive health care for those already suffering with this disease. In the process of learning more about HIV/AIDS, please be pro-active in finding out what is being done in your community and how you can participate in deepening and broadening your patients’ knowledge about this devastating disease. As Nelson Mandela said, “It is our children that will bear the burden of this disease.” Please act-for all our generations.
Copyright American Chiropractic Association Dec 2004
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