Biology Meets the Developing World:

1. Victoria Robinson Biology Meets the Developing World: 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 then…hopefully….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!

2. 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 haven’t 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 thebirthand through breastfeeding. What happens once the HIV virus is in the body? 2) HIV virus then fuses with the T-helper cell membrane and empties it’s inner contents inside the T-helper cell. 1) HIV virus uses its glycoproteins to attach itself to the outside (membrane) of important cells in the immune system called T helper cells. 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 it’s reverse transcriptase enzyme to turn it’s RNA into DNA. The DNA then merges into the human DNA of the T helper cell. Image adapted from Davidson’s Principles and Practice of Medicine, Boon et al, 20th edition.

3. Parts of the body often affected by infection/ tumours due to HIV 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 can’t 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 won’t 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 person’s helper T cell number has dropped below a certain level, they may start to get a number of infections that their body can’t fight off. • AIDS (Acquired ImmunodeficiencySyndrome. ) • 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

4. 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. HIV issues in Swaziland and other developing countries Latest figures from the World Health Organisation and UNAIDS’ 2008 report: 33 million peopleare 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 aren’t 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.

5. 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 can’t 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/xvp.htm) and BOVA who do 1month to 1year placements (http://boscovolunteeraction.co.uk/default.aspx) are examples of such organisations.