Biology Meets the Developing World:

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Biology Meets the Developing World
Victoria Robinson
This leaflet gives some information on the
biology of HIV/AIDS and a few major issues
surrounding this disease in the developing world.
By sharing a few stories from my time in
Swaziland I hope to inspire you to think about
how what you learn in school affects the
developing world, and thenhopefully.to act on
your thoughts.
This tiny red dot on the map is a country called
Swaziland. Many people would say that it is OK
not to have heard of Swaziland because it is only
the size of Wales and is hidden in the very South
of Africa. Do you think they would say this if
they knew Swaziland has the highest rate of
HIV/AIDS infection in the world !! ? 43 of
Swazis are infected with HIV. In people younger
than 30 the figure is roughly 50
Swaziland is
Friendly
Cultured
Beautiful
IN TROUBLE
It is estimated that in 12 years time there
will be no natives left in Swaziland due to HIV /
AIDS!
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What is HIV / AIDS?
How does HIV get into the body?
HIV stands for Human Immunodeficiency Virus

• HIV is found in a number of bodily fluids, but
  those associated with passing on the virus are
  blood, semen, vaginal secretions and breast milk.
• The methods of these fluids entering the
  body are
• Sexual unprotected penetrative sex between
  heterosexuals or homosexual males, oral sex.
• Blood HIV can be contained in blood
  transfusions or blood product donations that
  havent been screened for the virus.
• This is not a problem in the UK because we have a
  good screening system, but the World Health
  Organisation (WHO) estimates that roughly 5 - 10
  of blood transfusions globally are with HIV
  infected blood.
• Contaminated needles needles and injecting
  equipment that have been used by an HIV positive
  person contain traces of blood infected with the
  HIV virus. Therefore if they are used again by
  other people the virus can be injected into
  another person.
• This is especially a problem with injecting drug
  users sharing needles and equipment. But it is
  also a small risk for health-care workers who get
  pricked by used needles. (A needle-stick-injury)
• Vertical Transmission This is the transmission
  of the HIV virus from mother to child and can
  happen during pregnancy, during the birth and
  through breastfeeding.

What happens once the HIV virus is in the body?
1) HIV virus uses its glycoproteins to attach
itself to the outside (membrane) of important
cells in the immune system called T helper cells.
2) HIV virus then fuses with the T-helper cell
membrane and empties its inner contents inside
the T-helper cell.
5) The new HIV viruses (progeny) bud out of the
T-cell eventually causing the cell to burst and
die (cell lysis)
4) Now the HIV virus can use the tools of the
human T-cell to make more viruses from the viral
DNA.
3) HIV then uses its reverse transcriptase
enzyme to turn its RNA into DNA. The DNA then
merges into the human DNA of the T helper cell.
Image adapted from Davidsons Principles and
Practice of Medicine, Boon et al, 20th edition.
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Why is it bad to have HIV replicating in your
body?
What is the general time-course of untreated HIV?
T- helper cells are essential in fighting off
infections in the body. When infected with HIV
each day over 1010 new HIV viruses are produced,
so about 109 T-helper cells die which is 6-7 of
all the T-cells in the body. So with numbers of
T-helper cells increasingly falling as more and
more HIV progeny are being produced, the body
eventually gets to a stage where it cant fight
off opportunistic infections and viruses causing
cancers. Opportunistic infections are ones that
would not normally affect humans with a properly
working immune system. But since HIV infected
people are immunocompromised, these infections
can take the opportunity and thrive. The
opportunistic infections people infected with HIV
get are generally from parasites or fungi.

• Incubation Period
• The HIV infected person wont have any
  symptoms for about 2-4 weeks. It is called the
  incubation period because the virus is just
  quietly multiplying without anything noticeable
  happening. Just like duck eggs being incubated
  before they hatch.
• Acute Infection
• 70-80 of people now begin to feel
  some / all of these symptoms
• fever with rash
• sore throat
• sore joints and muscles
• headache
• ulcers on mucosal surfaces of body e.g. in
  mouth
• This is because there has been a surge in the
  number of HIV viruses produced and the fall of
  T-helper cells.
• Latency Period
• After these initial 6 weeks after first being
  infected by HIV, the person now experiences a
  period with little or no symptoms which can last
  anything between 2-20 years (average is 7-10
  years
• ARC AIDS related complex
• 
  Now because the persons
  helper T cell number has dropped below a certain
  level, they may start to get a number of
  infections that their body cant fight off.
• AIDS (Acquired Immunodeficiency Syndrome. )
• A person is said to have AIDS when they develop
  specifically defined infections or tumours, and
  it signifies that the immune system of that
  individual is now seriously compromised. This
  person is likely to die if they get a serious
  infection.

More than ½ of people with HIV will develop a
respiratory infection at some point. TB is
generally the biggest killer.
Hepatitis B and C infection in the liver is
common
Brain and spinal cord
Digestive system E.g. Pain on swallowing, weight
loss, chronic diarrhoea, stomach bugs, cancers
Skin infections especially with parasites and
fungi
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TRIPS - False Promises Due to a massive outcry
from the public and governments of developing
countries, the WTO instigated the Doha Agreement
which enabled countries to obtain a compulsory
patent allowing them to produce cheaper copies of
original drugs (generic drugs) if they were
needed for a public health crisis (such as the
AIDS pandemic). But these drugs could only be
used within the country making them bringing no
benefit to developing countries who lack the
resources to make generic drugs. More protests
led to the WTO granting a waiver to the Doha
Agreement, allowing countries to manufacture,
import and export generic drugs. However, this is
effectively a false promise because the
complicated and extremely lengthy process put in
place to obtain this wavered compulsory patent
requires masses of resources from the generic
company with little hope of success. Therefore
nobody has managed to make use of the
waiver. Funding More Promises to be
Broken? There is a global deficit in the funding
needed to tackle HIV. In the UK-led G8 summit of
2005 world leaders promised to work towards
achieving global access to HIV prevention,
treatment and care by 2010. However it was clear
from the G8 summit meeting in 2008 that this
target is not going to be met by a long shot
unless drastic action is taken. Excuses are often
made that poor infrastructure in developing
countries means that there is little point in
investing money in treatment programmes because
people will not be able to access it and take
their mediation properly in order for success.
This is a poor excuse It is true that many
people cannot reach hospitals or clinics. In
Swaziland I saw many people of the rural
community in such a predicament, one man was
paralysed because HIV had entered and damaged his
spinal cord so he was forced to lie on the floor
of a one-roomed hut 24/7, which smelt strongly of
excrement. We found this man and others like him
by talking to a local herbal healer, who knew
which people were ill. We then drove twice a weak
to these people to give them bread and
painkillers, since that is all we had. But if we
managed to find these people quickly it would
only take a little initiative to find a way for
anitretrovirals to reach all who need them.
Latest figures from the World Health
Organisation and UNAIDS 2008 report 33 million
people are living with HIV around the world. 67
of those people live in Sub-Saharan Africa
Treatment In the UK and other developed
countries, HIV is no longer considered a life
threatening disease. Drugs are available called
antiretroviral drugs (ARVs) which work to prevent
the HIV virus replicating in the body and so give
infected peoples T helper cells a chance to
recover to normal or near normal levels.
Therefore, the risk of catching life-threatening
opportunistic infections is minimised and a
normal life expectancy is achievable. Access
Inequalities Prevention programmes and drug
treatment we take for granted could turn the HIV
AIDS epidemic around.but. Over 2/3 people who
need treatment for HIV arent getting it TRIPS
Western Greed Trade Related Aspects of
Intellectual Property Rights (TRIPS) became part
of international law in 1995. The TRIPS
agreement was made and is enforceable by the
World Trade Organisation (WTO). The TRIPS
agreement means that all members of the WTO have
to adhere to the same patent laws for
intellectual property such as drugs, the minimum
patent length being 20years. Patents allow
pharmaceutical companies who invent drugs to be
the only company to make and sell their product
during the patent, so they have sole control over
the price of the drug with no competition in the
market. Patented drugs are typically extremely
expensive, even developed countries struggle with
them if you think about the fairly recent media
coverage of UK patients being refused certain
cancer drugs due to cost. Unfortunately patents
are very bad news for developing countries who
simply cannot afford to buy antiretroviral drugs.
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Culture and Stigma Although funding for drugs and
the improvement of infrastructure and health care
resources is needed to fight the HIV AIDS
epidemic. There are many other hurdles needed to
be cleared in order for this to be
successful. Each country has its own unique
culture, and it is my opinion that one would have
to be brought up in a culture to fully understand
it as I hope this experience of mine
illustrates. My first thoughts of Swazi men and
women were that they were both very friendly, the
men more extrovert since polygamy is legal in
Swaziland and they were all very eager to propose
to western women. The women seemed in public very
proud and strong with a no-nonsense attitude.
This view stayed with me until a few days before
leaving Swaziland when I was asked to be a
visiting speaker to a class of girls in their
late teens and twenties and talk about HIV/AIDS.
Outside the classroom I was talking to the girls
and we seemed to get on like a house on fire. On
entering the classroom it was announced that I
would be teaching the class and the topic would
be HIV/AIDS. I was left alone with the girls and
the atmosphere immediately changed. The girls
became instantly fearful and uncomfortable. I
was told later that in Swaziland, teachers are
often people to be feared since serious beatings
are very common in schools even to very young
children. It cant have helped that I was talking
about a very stigmatised subject, with HIV
positive people often thought to be immoral or
cursed. I was extremely surprised by how little
these girls new about HIV and how it is
transmitted etc. Only one girl seemed to know
some basic facts because she had access to
magazines. It was then alarming to know that
statistically half my class could be HIV positive
(roughly 50 of Swazis under 30yrs are HIV
positive) and what I was saying would be scaring
them to death. One girl eventually built up
some courage to speak out and said, The problem
is our Swazi men are very passionate, they want
to have sex with us lots and it is never
protected. I then asked what would happen if
they said no to this, and the girl punched her
fist into her hand. I then asked if any of them
would feel able to go and talk to the police if
they were being assaulted. The girls looked at
me as if I was completely mad and another said,
Policemen beat their wives and girlfriends too,
we have no choice. I went home that day very sad
and shocked that I had been unaware of the extent
of physical abuse that occurred to women and
children.
The HIV / AIDS epidemic not only affects
health. If a country has a high prevalence of
HIV, its economy is also badly damaged since HIV
affects people of working age. A knock on effect
of this is that many children are orphaned. 15
000 000 children are currently living as orphans
due to AIDS worldwide, 11 600 000 of those live
in Sub-Saharan Africa.

• What Can You Do?
• Not everybody can go to a developing country and
  provide hands-on help. In reality there are very
  few professions that can help in this way,
  students generally have little life experience
  and qualifications, so going abroad is purely a
  learning experience.
• I would challenge you to
• Find out about issues in the developing world,
  especially if they are in an area that interests
  you, like medicine or philosophy and human
  rights. Information on HIV/AIDS can be found at
  www.avert.org , www.stopaidscampaign.org.uk. Many
  of the social injustice issues surrounding
  HIV/AIDS are present in the UK. Find out more
  from the UK based charity The National AIDS
  Trust, www.nat.org.uk
• Campaign for change. This is one of the most
  effective things for creating big advances e.g.
  there is a new petition online to create a patent
  pool, a new initiative to drive down the cost of
  HIV medication for developing countries and to
  promote development of new drugs for neglected
  social groups like children. Sign the petition
  and find out more at (http//www.stopaidscampaign.
  org.uk/PushForPool.asp).
• Fundraise. You may want to form a school society
  committed to learning about the injustices of a
  particular issue such as HIV and fundraise for
  its cause. E.g. you could give money to Medecins
  Sans Frontieres with directions as to which cause
  you are particularly keen to see change in.
• If you are interested in gaining personal
  experience of the developing world and want to
  volunteer, I recommend it as a life changing
  experience and an invaluable learning curve.
  However, I guarantee you will be given more than
  you can give to a developing community, so please
  go abroad with ethical organisations so you never
  drain communities of their resources by being
  there. The XVP which does 6 month- 1yr
  placements (http//www.jesuit.org.uk/youngpeople/x
  vp.htm) and BOVA who do 1month to 1year
  placements (http//boscovolunteeraction.co.uk/defa
  ult.aspx) are examples of such organisations.