Examining HIV from the Biological, Social, and Psychological Perspectives

Abigail Beach, Charlotte Blair, and Barrett Houska

Since its discovery in 1983, the understanding of the Human Immunodeficiency Virus and its global impact has been constantly evolving. A sample of the varying areas of research and interest surrounding HIV is explored in the following collection of essays.

HIV: The Facets of a Remarkable Disease

HIV is a highly complicated virus with an intriguing origin, a fascinating genome, and a huge impact on the human body. It has been established that the Human Immunodeficiency Virus (HIV) mutated from a similar virus found in primates known as the Simian Immunodeficiency Virus (SIV) (Sharp and Hahn, 2011). Once the virus made the jump from primates to humans, it became very good at attacking human cells with unprecedented efficiency (Rambaut, Posada, Crandall, and Holmes, 2004). The virus itself has the ability to mutate very rapidly, giving it one of the most complicated and diverse genomes of any virus, making it arguably the hardest virus to fight once it has infected the human body, and complicating the efforts to achieve population immunity (Rambaut, Posada, Crandall, and Holmes, 2004). HIV can be transmitted from one host to another via infected bodily fluids, which can be accomplished horizontally through sexual intercourse and needle-sharing and vertically from mother to baby, among other ways (D’Aquila and Williams, 1987). Because of all of these factors, there is no cure for HIV, but there are some treatment options — usually antiretroviral therapy — to delay the spread of the virus throughout the body (Zulfiqar et al., 2017). In this paper, I will outline 5 different facets of HIV: its origin, how it attacks human cells, its genome and mutation rates, how it is transmitted, and how it is treated. Then, I will discuss current research and the next steps to fighting HIV.

The evidence gathered by Sharp and Hahn in 2011 clearly indicates that Simian Immunodeficiency Virus (SIV) cpz is the origin of HIV-1. SIVs are known to affect primates in Africa. According to Sharp and Hahn (2011), there are many types of SIVs that have infected primates for at least 30,000 years, and there is evidence that the origin of these SIVs is 6–10 million years ago. However, the SIV that is most closely related to HIV-1, the causative virus for AIDS, also known as SIV cpz, is relatively new among one of its natural reservoirs, chimpanzees. The evidence gathered in the study by Sharp and Hahn in 2011 shows that the virus was found in two of the four subspecies of chimpanzees and this suggests that chimpanzees became a natural reservoir for SIV cpz after they diverged into their separate subspecies. This evidence alone illustrates that SIV cpz is a relatively new virus in chimpanzees (it is assumed that chimpanzees acquired SIV through the consumption of other mammals, including other primates, as prey). Sharp and Hahn (2011) also found that, in chimps, SIV cpz is transmitted through coital interaction at almost the same rate as HIV-1 is transmitted between heterosexual humans. It was also found to be transmitted vertically from mothers to fetuses, just as HIV-1 is in humans. According to Sharp and Hahn (2011), the four distinct lineages of HIV-1 each derive from a different event of simian to human transmission — four individual cross-species transmission events. Group M is the most prevalent and is responsible for most of the HIV-1 infections in humans. Group O is much rarer and makes up for about 1% of infections. Group N and group P are even rarer than group O, with only 13 documented cases of group N infections and 2 documented cases of group P infections. A phylogenic tree depicted by Sharp and Hahn in 2011 shows that the most common HIV-1 lineage group, group M, is very closely related to SIV cpz, that virus found naturally in two subspecies of chimpanzees. All evidence suggests that the transmission from primate to human likely occurred through membrane exposure to blood or other infected bodily fluids (Sharp and Hahn, 2011). These interactions most likely occurred during bushmeat hunting. According to analysis, the onset of group M and O epidemics occurred at the beginning of the 1900s (Sharp and Hahn, 2011).

These conclusions were echoed by Pollom et al. in 2013 through a study focused on the genomic RNA structures of both SIV and HIV. This study found that the bases of RNA structures of SIV and HIV were profoundly alike, with a 60% similarity in base-pairing, despite the fact that evolution and mutation had muddied other similarities, showing new evidence of the connection between SIV and HIV.

Once HIV was transmitted from primates to humans, via SIV, it had to infect human cells successfully in order to replicate and survive. HIV is very successful in its colonization of the human body. According to Arrildt, Joseph, and Swanstrom (2012), much of the success of HIV virions depends on the virion envelope itself. At the onset of the disease, the envelope proteins are able to interact with the coreceptors on CD4+ T cells — a type of white blood cells that identify pathogens in the blood. However, HIV is so advanced that its env gene can evolve over the course of infection in order to encode a protein with altered receptors and coreceptors and allow it to infect alternative host cells (Arrildt, Joseph, and Swanstrom, 2012). This adaptation allows the virus to replicate in other cells, sometimes including cells in the neurocognitive tissues. Once the virion envelope binds to the cell coreceptor, the envelope fuses with the cell membrane, allowing the viral RNA to penetrate the cell (Rambaut et al., 2004). This process is called fusion. At this point, viral RNA is released into the cytoplasm. Once released, a process called reverse transcription occurs. Reverse transcription occurs when the enzyme reverse transcriptase is used to synthesize DNA from an RNA template. In other words, single-stranded RNA is reversely transcribed to double-stranded DNA via enzyme interaction. This is required because the human hosts use DNA to store genetic information in the nucleus, not RNA. After this process is complete, another process called integration occurs. Integration is when the proviral DNA is inserted into the host’s DNA using an enzyme called integrase (Rambaut et al. 2004). Once the viral DNA is incorporated into the host’s DNA, the viral RNA is transcribed, as if it were human DNA. After transcription occurs, the cell translates coded viral proteins and assembles virions for release. Finally, the virions are packaged with viral RNA and released into the body via budding to infect other host cells.

HIV has a diverse genome and astounding mutation rate. HIV is a very dangerous virus in the fact that it mutates and evolves drastically within each individual host. According to Rambaut et al. (2004), for every five replication cycles, HIV makes one error, and it makes many more errors during other processes. These errors give HIV a very high mutation rate. Another contributing factor to the diverse genome of HIV is its sheer replication speed. HIV has a viral generation time of approximately two and a half days and generates anywhere from 10 billion to one trillion new virions each day (Rambaut et al., 2004). In 2004, Rambaut et al. theorized that another large factor in the diversity of the HIV genome is natural selection. Rambaut et al. (2004) argues that the virus continues to evolve to evade immune response from the host with the idea that once the immune system recognizes a viral trait, that very particular strain of the virus will be obsolete. Evolution within individuals and evolution within populations has little to no correlation for HIV. The amount of intra-host evolution has no bearing on partner exchange. In other words, when looking at HIV evolution and diversity, it is necessary to look at evolution within individuals and evolution within populations separately (Rambaut et al., 2004). One of the most widely recognized reasons for HIV’s incredible diversity is the fact that it is an RNA temperate virus, which means that when replicating, the task is simplified by half, since RNA temperate viruses have to copy less genetic material than viruses with DNA in order to replicate. HIV yields an estimated three recombination events during genome replication, giving it one of the highest recombination rates of all organisms and exceeding the mutation rate per replication (Rambaut et al., 2004). There is evidence of occurrences of dual infection, or one host getting infected with two separate strains of HIV, which illustrates the rates at which this virus is able to mutate and evolve. HIV mutates so quickly that scientists encounter difficulties when studying genetic lineage.

Another intriguing aspect of HIV is the virus’ mode of transmission. According to the Centers for Disease Control (CDC), only certain body fluids — blood, semen (cum), pre-seminal fluid (pre-cum), rectal fluids, vaginal fluids, and breast milk — from a person who is HIV positive can transmit HIV (2017). Furthermore, the CDC stresses that transmission cannot happen unless infected fluids contact a mucous membrane, damaged or exposed tissue, or are distributed directly into the bloodstream of an individual (CDC, 2017). Although HIV is widely known as a sexually transmitted disease, transmitted horizontally through sexual activity, it can also be transmitted from infected individuals to other individuals by other means. HIV is transmitted through intravenous drug use, and through blood (or other certain bodily fluid) transfusions and is known to be transmitted vertically from mother to baby in utero (D’Aquila and Williams, 1987). The rates of vertical transmission, also called mother-to-child transmission, have decreased substantially in developed regions, while in underdeveloped regions, rates remain as high as 23% (Coelho et al., 2017). Now that there is widespread understanding about the transmission of HIV, there is less panic surrounding the disease. In fact, there are recommendations, put in place by the German Association for the Control of Viral Diseases (DVV) and the Society for Virology (GfV)., which, when followed, allow healthcare workers to continue work even if they are HIV positive. These recommendations state that HIV positive health care workers should be allowed to perform any type of procedure as long as they practice double-gloving and closely monitor their HIV infection. HIV transmission is clearly understood by healthcare professionals and under control in nosocomial, or hospital, settings.

While part of the scientific community focuses on preventing the transmission of HIV, another facet focuses on treating those already infected with the virus. There is no established cure for HIV and no vaccine to prevent it. There are still treatment options, however, that very effectively slow the onset of Acquired Immunodeficiency Syndrome (AIDS). According to the CDC, the best treatment for HIV is a combination of many different antiretroviral drugs. This treatment is called antiretroviral therapy (ART) and the CDC attributes the drop in AIDS-related death rates in the last two decades to the success of ART (CDC, 2017). ART represses viral replication and reduces the viral load below 50 RNA copies/mL, also known as the level of detection (Zulfiqar et al., 2017). There are more than 30 licensed antiretrovirals which can all be classified into the following five classes: nucleoside or nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), entry inhibitors (co-receptor antagonists and fusion inhibitors), and integrase inhibitors (INSTIs) (Zulfiqar et al., 2017). NRTIs work by preventing reverse transcription through competitive inhibition while NNRTIs prevent reverse transcription through allosteric inhibition. PIs work by targeting enzymes vital for viral maturation; without the protease enzyme, the virus cannot complete its life cycle. Entry inhibitors prevent the attachment and fusing of the viral envelope with the cell membrane, preventing the viral RNA from entering the cytoplasm. INSTIs are specific in the fact that they target the enzyme, integrase, which allows the process of viral DNA being inserted into host DNA to take place. INSTIs work through allosteric inhibition (Zulfiqar et al., 2017). ARTs have also been used to prevent vertical transmission. Data shows that ART reduced vertical transmission by 48% between 2009 and 2014 in 21 African countries (Coelho et al., 2017). In fact, ARTs have proven to be so successful that there was a case of vertical transmission in Mississippi in which the infant was treated with ART from birth until 18 months of age. At 30 months, there were still no traceable levels of viral RNA in the system, suggesting that HIV can be cured in infants if they receive post-natal ART soon enough (Zulfiqar et al., 2017). So, although there is no proven cure or vaccine for HIV, there are very effective means of treating the disease that enable its victims to live a relatively long and healthy life.

Much progress has been made in terms of understanding HIV since its discovery in the 1980s. Today, there is clear genetic evidence of evolution from SIV to HIV, allowing scientists to understand its origin. There is a thorough understanding of the HIV life cycle, how it attacks human cells, and what happens within attacked human cells. There has been extensive research regarding HIV’s incredibly diverse genome and its unusually fast mutation rates, allowing members of the scientific community to identify specific problems that only arise with such a virus as HIV. There is a very clear and widely communicated understanding of how HIV is transmitted and what can be done to prevent transmission, even in nosocomial settings. And finally, there has been extensive research in the area of treating HIV, yielding highly successful drug therapies that allow people who are unfortunate enough to be HIV positive to no longer view HIV as a sure death sentence. In fact, today, in addition to ART, there are other treatment options being developed. According to Mehta et al., there are potential HIV treatment options in the area of genetic modulation therapy (2017). There are rare cases in which people have stayed uninfected by HIV even after being exposed to an astounding viral load. The reason for this is that these patients have a mutation in their co-receptor C-C chemokine receptor type 5 (CCR5) because of a 32-base pair deletion (Mehta et al., 2017). Scientists are now trying to find a way to transfer those same genes into other infected people to give the world a new way to fight the HIV/AIDS epidemic.

As new research leads to new areas of treatment for HIV, the issue still remains of the availability of this treatment and others to those people suffering from the virus in underdeveloped regions.

HIV: Negligence vs. Maleficence

Peter Singer, a renowned ethicist and moral philosopher, has a principle for deciding what is the moral thing to do in any given situation. Not only are individuals responsible for what they do, but also, they are responsible for anything they could have do to prevent a harmful situation from happening (Rachels, 2012). The amount of people infected with the human immunodeficiency virus (HIV) that leads to the onset of acquired immunodeficiency syndrome (AIDS) has dramatically increased since the epidemic began in 1981 despite many efforts to curtail its spread. In the first fifteen months, 593 cases were reported and 243 resulted in death in the United States alone (Current Trends Update on Acquired Immune Deficiency Syndrome — United States, 1982). This does not include the people infected with HIV when it first crossed from chimpanzees to humans in the 1920s in the Dominican Republic of Congo. Since then, it has spread worldwide and has infected about 36.7 million people, but 95% of those cases have been in developing countries (UNAIDS, 2016). Countries that have a high infection of HIV are less developed because they are not able to receive the same antiretroviral medications accessible by developed countries. HIV dramatically impacts a nation’s ability to increase industrialization and living standards for its citizens; therefore, developing countries are stuck in poverty while developed countries bask in health and wealth.

The classification of a country’s stage of development has been evolving for more than half of a century. In the beginning, the measurements used by nongovernmental organizations were centered around economics including national gross domestic product (GDP) and per capita income. Although this portrays the monetary situation of a nation, it does not fully depict the true level of development. A more holistic characterization takes into account literacy rates, maternal and infant death rates, life expectancy, HIV infection rates, and even living conditions. This is parallel to the proposal of the UN Millennium Development Goals adopted by the United Nations General Assembly that target the issue of poverty. Among objectives such as improving education and creating a global partnership for development is the obstruction of HIV/AIDS and other diseases (Smallman and Brown, 2015).

As of 2016, about 19 million people in eastern and southern Africa were living with HIV, and 470,000 deaths were indirectly caused by AIDS while the remainder of Africa experienced 342,000 AIDS-related deaths. Currently, the area most affected by HIV/AIDS and a lack of development is Southern Africa. The prevalence of HIV substantially impacts the overall quality of life for all ten countries in that region (UNAIDS, 2016).

Malawi is one of the countries in Southern Africa that is suffering from high HIV infection rates and a low economic standing. It had a GDP of $5.47 billion and a per capita income of $294 as of 2016 (Malawi Home). Citizens of Malawi are predicted to live 61 years on average, but approximately 980,000 people are living with HIV and 27,000 die from AIDS-related issues (aids.gov). While the Government of Malawi (GOM) is attempting to aid its citizens by implementing programs that assist Malawians against their plight with famine (HIV and AIDS in Malawi, 2016), it must also attempt to eradicate or at least treat the HIV pandemic simultaneously. Otherwise, the labor needed to supply Malawians with sustenance and provide the country with agricultural exports will decrease.

Although Malawi is not classified as one of the most impacted countries by HIV, Jeffery Sachs’ novel titled The End of Poverty includes riveting and disturbing descriptions of the quality of life for most Malawians. He illustrates a country void of a labor force. The villages are teeming with children and older women; however, there are few able-bodied men and women.

AIDS has depleted the workforce; therefore, there are less individuals to maintain the lifestyle of many Malawians which is centered in agriculture. Additionally, hospitals in urban areas are unable to keep up with the influx of HIV infected patients. Sachs’ recollection of Queen Elizabeth Central Hospital in Blantyre depicts just how dire the situation of AIDS is. “There is no medicine in the medical ward… These 450 people are fit into a room with 150 beds by putting three people in or around each bed… [the doctor] knows that each of these patients could rise from the deathbed but for the want of a dollar a day” (Sachs, 2005). The Malawian government was able to form an agreement with a company that supplied antiretroviral drugs to the Malawians for one dollar a day, but the country was so impoverished that the citizens were unable to afford this treatment.

Similarly, Zimbabwe is another country in Southern Africa that is struggling to eliminate HIV. In the year 2015, it had a GDP of $14.42 billion and a per capita income of $814.56 (World Bank). From an economic standpoint, Zimbabwe is much more developed than Malawi. Given only these statistics, one may assume that Zimbabwe’s economic standing would account for a sufficient health care system that could staunch the HIV pandemic. However, 1.4 million people are living with HIV in Zimbabwe and 29,000 die in association with AIDS (HIV and AIDS in Zimbabwe, 2016).

The numbers demonstrate how a country with a smaller population such as Zimbabwe has a significantly higher GDP and per capita income than the nearby country of Malawi, but it fails to show the difficulty of discerning the best governmental policies and the means to enact them. It is true that governments have the authority and power to dispense resources, create beneficial education systems, request financial support from other countries, supply contraception and offer clean syringes to reduce the spread of HIV, and establish programs that assist those trying to therapeutically solve drug abuse. After all, governments can create new policies intended to stop the spread of disease and combat hunger, but no progress is made without complete involvement of the citizens and a commitment by the government to uphold the policies it has made. This dedication not only has a direct effect on the people, but also encourages support from international sources (Boone and Batsell, 2001).

Situations in Malawi and Zimbabwe dramatically contrast more developed countries. For example, the United States is arguably the most developed country in the world and had a GDP of $18.04 trillion as of 2015 and a per capita income of $28,889. The U.S. has a life expectancy of 78 years, and the HIV infection rate was 39,513 out of 324 million in 2015. The number of Americans living in urban areas surpassed those living in rural areas starting in the middle of 2009 (United Nations Population Division). These two countries are radically different in their stages of development.

Although the U.S. was impacted by HIV/AIDS when the epidemic began in the early 1980s, it did not suffer from it as much as Malawi and Zimbabwe. As a highly-developed country, the United States was able to implement and financially support programs that combatted the spread of HIV including efforts focusing on pregnant women and the public knowledge of HIV/AIDS (Twenty-Five Years of HIV/AIDS — United States, 1981–2006, 2006). The success of these programs was not a mystery.

Developed countries have even gone so far as to prevent other countries from combatting the spread of HIV. Smallman and Brown (2015) describe how Brazil was able to produce the antiretroviral drugs for less money than it would be to purchase them. The government offered free treatment for HIV; therefore, more people were willing to be tested for the virus. Because the people with HIV were aware of their status, they received treatment and did not spread it unknowingly. This allowed the individuals with HIV/AIDS to remain in the workforce rather than be hospitalized for their condition. The Brazilian government did not have as many expensive hospital bills to compensate for, and they were able to tax the individuals as well. Brazil was positively impacted by the implementation of free antiretroviral drugs.

However, pharmaceutical companies thought that this would decrease the desire to research the proper medication for HIV/AIDS and furthermore develop plans for its prevention. The U.S. supported this and protected it under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) provision. In other words, developed countries denied developing countries access to treatment known to prevent the imminent death of HIV/AIDS.

The development of the U.S. has not been hindered by the outbreak of HIV/AIDS in the country to the same extent that developing countries have been. The health of a country determines its ability to participate in globalization and develop. Without the cooperation of developed countries and developing countries, the overall global health will not see positive results. It is necessary that programs are instituted that benefit developing countries as much as they do developed countries. Because the world is becoming increasingly globalized, countries must work together in order to remain harmonious. Each has committed to a compact that cannot be voided. It is difficult for people in developed countries to understand this concept, but Malawi, Zimbabwe, and many other nations in similar situations are in a state of crisis. Its citizens live with diseases such as HIV that most individuals in First World countries do not think about. Developed countries should not be negligible toward developing countries, for that would be nearly equivalent to malefic behavior. They can prevent the further spread of HIV and famine; therefore, they are responsible for assisting in that millennial goal.

Although it is clear that the presence of HIV can have tremendous effects on regions and populations in areas like economics and development, attention must also be drawn to the effects of HIV on individuals and those who love them. It must be understood that an HIV+ diagnosis is not only a psychological whirlwind for those diagnosed, but for their loved ones also.

HIV: The Psychological Effects and Stigma Associated With a Diagnosis

Psychological stress is when people believe that they cannot meet what their environment is demanding of them. Everyday life contains amounts of stress that people must deal with; some medical professionals believe that this stress contributes to contraction of disease. Anything can cause psychological stress, but it mainly depends on what the person can handle or deems ‘normal’ as their own individual. Overstimulation of the hypothalamic-pituitary-adrenocortical axis and sympathetic-adrenal-medullary system, which can be activated by stressors, leads to the body not being able to fully fight disease (Cohen et. al. 2007). When people experience stress their body goes into a panic and lowers their response rate of physiological processes. Chronic illnesses change people’s lives drastically and cause their entire lifestyles to have to be changed.

The point at which a person becomes the most vulnerable is when they are waiting for their results to see if they have a chronic disease (Center for Substance Abuse Treatment 2014). One of the most stressful situations a person can be in, according to Office of Mental Health in New York State, is waiting for a diagnosis from a medical professional. Once a person becomes diagnosed with an illness they oftentimes do not know what to do. The brain must adjust to this new news of illness, and must process the best course of action. When a patient is diagnosed, they need to be observed so that they stay positive; it is important that their mind does not take a turn for the worse, as it is very easy for a person to have dark thoughts during this stressful time. For patients to adjust to the diagnosis of a chronic illness they should remain active. It would also help if they share their emotions and take control of everything that they feel. The biggest thing for patients to do that will help them to keep a good attitude is to always think positively. (Ridder et al. 2008). This “psychological adjustment” could be a wide range of changes. Patients may have to change their entire lifestyles in order to ensure they stay positive and can adjust psychologically; or they may only have to make minimal, yet crucial, changes. Patients that have a chronic illness tend to have anxiety and have difficulty responding in a healthy manner to certain situations due to constantly having the illness nagging the back of their mind. If a patient is diagnosed and seems to need psychological help they must seek it out on their own. People cannot be forced into expressing their feelings. (Ridder et al 2008). Medical professionals cannot force their patients to focus on psychological adjustment-the patient must be willing and able to want to adjust their own mindset (Ridder et al 2008).

Not only does HIV/AIDS (Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome) effect the mentality of the patients but it also can affect close family members and friends by causing stress that may lead to a mental disorder or enable them to become more prone to disease (Richter 2004). A important and often overlooked group that that is affected by HIV/AIDS patients are the children of these patients. Children are forced to take care of families, are discriminated against, leave school, and become more vulnerable to acquiring HIV/AIDS (Richter 2004). Children can be exposed to a wide variety of outcomes that may affect their development as a whole such as: debt, moving, change/loss of caregivers, additional family responsibilities, loss of education, health, as well as psychological disorders (Richter 2004). When a parent is diagnosed with HIV/AIDS, the family’s goal is to get that person better and in the process the diagnosed the children often get left out of the picture. These factors can affect any child who has lost a parent and are not specific to HIV/AIDS, however due to the intensity of the treatment for HIV/AIDS, children tend to become forgotten (Richter 2004). When forgotten, these children suffer from a wide variety of stressors that force them to mature at a rapid rate, putting a lot of pressure on them emotionally. Kelly (1994) lays out how the infection of HIV can snowball into long lasting effects on the children of those who are affected. Kelly (1994) advocates for a focus on prioritizing children’s health in fight against HIV/AIDS. Kelly (1994) states that the main intervention that needs to occur is to provide economic and other support to poor families to ensure they are receiving equal access to services.

A big issue that plays a factor in psychological processing of HIV/AIDS is if it is a choice for a woman to decide if a couple wears a condom during sex. This stigma would provide psychological stress on the woman in the relationship and can cause her to experience different psychological effects. Women need to be encouraged to talk to their partners before having sex so that they take all the precautions to avoiding the possibility of getting HIV/AIDS. HIV prevention strategies involve education on safe sex practices which help to make communication within relationships and the dynamics within the relationship stay positive (Pulerwitz, 2002). A huge issue with the use of condoms is the gender-based power imbalances that put the decision of whether a condom is worn in the hands of the man when the decision needs to be made by both parties engaging in the activity (Pulerwitz, 2002). Not only does the risk of chronic disease effect one person, but it causes people to think differently on the practices of safe sex. In a study done on approximately 388 women, only eight percent of the sample of women had their partner wear a condom while having sex with their partners. (Pulerwitz, 2002).

Another psychological factor involved in being diagnosed with a chronic disease is the stigma attached with it. The expectation of increasing debilitation and eventual death have led to the stigma of HIV/AIDS that we have today (Fife 52). When people are told bad news or something that they are not used to hearing they do not know how to respond. People are diagnosed with HIV/AIDS see their illness as their own fault and in turn punish themselves for it (Fife 53). The stigma of this disease affects the diagnosed as well as the community and gives people the ‘stereotype’ of what a potential suffer of this disease will look like which allows people more opportunities to socially profile others and makes the stigma of the disease even more threatening. HIV/AIDS has been found to prevent medical professionals from providing care to patients. (Mahajan 2008). Due to the stigma of HIV/AIDS being so prevalent amongst society, people who are diagnosed become afraid of judgement and betrayal, thus making them not want to seek out help and tell people about their diagnosis.

When people are, isolated or shunned they have a hard time felling comfortable sharing their feelings. When HIV/AIDS first became known to the public it was called “gay cancer or the gay plague” in the media and some religious leaders referred to it as “God’s punishment” (HRSA). This caused the public to view the disease and any gay man, affected or not, as abnormal. Thus, out casting the gay population and causing them to want to stick together which in turn helped to spread the disease: “So from one epidemic there sprung others — epidemics of isolation and cruelty, epidemics of unmet basic human needs, and poverty” (HRSA). People feared the disease and shunned the entire gay community because of the disease. They also tried to isolate them and make them deal with the disease themselves. Due to people thinking that the gay community was ‘dirty,’ nothing was being done to help them by outside forces. White was a hemophiliac who became infected with HIV as a teen through blood transfusion. This was something that caught the public eye because in this case he was not infected by ‘un-godly practices’ that may have received the same judgement as the other cases being discovered (HRSA). When the gay community found out about White they reached out which helped them to gain the news coverage that they needed to get the help to prevent and treat patients diagnosed with HIV/AIDS (HRSA).

HIV/AIDS has such a stigma that people do not know how to respond to the situation. The psychological effects of chronic disease impact patients, family members, friends, and even society. A more open approach to discussing the implications and stresses of these diseases such as HIV/AIDS is beneficial. People may be more open with talking about their diagnosis and allow them to get the help that they need without feeling shunned and distanced from society. The substance abuse and mental health services administration provides information of coping with HIV/AIDS and how to care for yourself. “In the United States, about 1.1 million people live with HIV, and about one in six (more than 180,000) do not know they are infected” (SAMHSA 2015). This statistic supports the stigma of HIV/AIDS because these people may be afraid to come forward or get tested for HIV/AIDS because of being shunned.

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