For HIV+, the World Is Getting Smaller

In 1967, US Surgeon General William Stewart declared the time had come to close the book on infectious disease.

Barely three decades later, medical researchers, public health officials and international organizations were warning that the world was shrinking. The unprecedented movement of people and products, relaxed trade restrictions, ease of travel and immigration (legal or otherwise) -- along with environmental degradation and global inequality -- were ushering in a new age of hitherto-unknown infections.

By 2013, SARS, Lyme disease, Avian flu, MRSA, Ebola virus and West Nile virus had entered our vocabularies. The plague that spread via fleas on rats in the holds of ships killed over half the population of Europe in the 14th century. The desolation of whole swathes of the continent hastened the end of the feudal system.

By one estimate, 60 million people undertake more than 2 million international flights each week. Today, these don't have to take a long sea voyage. These threats are hopping rides on airplanes to our shores.

Scientists agree (a very few outliers excepted) that HIV most likely began with certain Africans eating infected monkeys. Those infected with HIV have to be extra-careful of these new infections coming down the pike, the latest being Middle Eastern Respiratory Syndrome (MERS).

"The HIV population is at risk for any and all new and reemerging infections," Theodore White, an emergent infectious disease and global health expert at the University of Missouri Kansas City, told EDGE. "Any emerging infection is more severe and more common in HIV patients and in developing countries where much of the population is HIV positive."

Early in such outbreaks, transmission tends to be poorly understood. The threat of the disease spreading from human to human is particularly alarming to those whose immune system is already compromised.

"Major attention must be focused on populations presumably more susceptible to develop severe complications with H7N9 infection, such as HIV-positive individuals," a researcher wrote in this year in peer-reviewed journal AIDS Review. H7N9 is a strain of avian flu whose origins have been traced to China in 2013.

Even emergent diseases with less dramatic impact on the general population pose a greater risk for those whose immune systems are compromised. The sole fatality of an outbreak of H3N2v, another variant flu strain, in 2011 was an Ohio woman identified as having "underlying medical conditions."

"Underlying conditions" may have played a part in the development of antiviral-resistant strains of influenza, constituting another risk for those living with HIV. In February 2010, the World Health Organization reported 225 cases of H1N1, a virus resistant to oseltamivir, a flu-fighting drug marketed as Tamiflu. An estimated two-fifths of the reported cases were people with severely compromised immune systems.

Fortunately, zanamivir, another common anti-viral drug, has proved effective in treating all known cases of Tamiflu-resistant H1N1 thus far. The Centers for Disease Control hopes that people with HIV will respond to znamivir, probably taken along with Tamiflu for good measure. It remains to be seen how well that will work in the face of new flu strains.

"We're becoming more and more appreciative of co-infection," said White, referring to HIV and these new flu strains. "In the past, we frequently didn't appreciate the compounding effects of conditions."

Waiting Until It’s Too Late

The effects of globalization put people living with HIV at risk in less obvious ways that, so far, have received little attention. White cited climate change, ozone depletion, land degradation, human mobility and poverty as all contributing to the problem.

We know the toll that co-infection of HIV and tuberculosis is having in the developing world. But those living with HIV in the United States may become apparent soon enough, White warned. "As climate change happens, vectors for things like dengue fever, Chagas disease and malaria are moving into what used to be colder climates like Texas, Florida, and the Southwest," he pointed out.

The effect of the global recession on identifying and isolating outbreaks was made apparent last year when Russian researchers complained that their ability to study a new, especially virulent and rapidly spreading strain of HIV called 02_AG/A was undermined by funding cutbacks.

Back here in the States, turmoil in Washington and reductions in research budgets have resulted in what research funds "grinding to a halt," White said. "Research funds are in a huge downward spiral."

The biggest problem, however, may be that we don't even recognize a new disease or strain until it's already broken wide. Back in 1996, Paul Farmer, a pioneer in the then-nascent field of global health, warned that the term "emerging disease" is a misnomer.

These diseases were already emerging, he reasoned, but the media and public health officials only start to pay attention after they move out of affected poor and marginalized groups. Other times, certain outbreaks garner media attention because they have a sudden and dramatic impact, such as Legionnaire's disease, which struck 182 attendees in one Philadelphia hotel at an American Legion convention in 1976; 29 people eventually died.

With researchers competing for a piece of an ever-shrinking pie, diseases confined to the poor will receive even less attention, White complained. Like the proverbial frog in the pot, the public won't take notice until it comes to a boil.

AIDS got less press, media coverage and official recognition than Legionnaire's disease -- or, for that matter, tainted bottles of Tylenol, which killed a total of seven people in 1982.

At the same time, more and more gay men were succumbing to something that hadn't even been identified. Then it began to strike Haitians, then intravenous drug users. Finally, when it had spread to hemophiliacs and people that had received drug transfusions, and a well-known Hollywood star, Rock Hudson, died, AIDS began a national crisis.

One would think we learned. One would be wrong.

"We don't do a good job of stacking up the things that cause the most risk," White said. "We react to what sounds like the scariest thing."

Christine Malcom is a Lecturer in Anthropology at Roosevelt University and Adjunct Faculty in Liberal Arts and Visual and Critical Studies at the School of the Art Institute of Chicago. She is a physical anthropologist, theater geek, and all-around pop culture enthusiast.

This story is part of our special report: "What's Happening Now". Want to read more? Here's the full list.