Black Death II?

There are 3 startling differences between the waves of Black Death that first ravaged Europe in the 14th Century and the AIDS epidemic which is now being called its modern equivalent, in some quarters.

The first distinction is speed.

People got sick and died quickly from the plague. From the moment of infection to the throes of death was the incredibly short period of five days when bubonic plague first reached Sicily, Europe in October 1347, three days as the disease spread and the symptoms changed and finally less than 24 hours as a second more virulent form of bubonic plague — the pneumonic type became manifest.

AIDS by contrast is leisurely. A person can live for 7 to 10 years without any symptoms whatsoever not counting the few days of flu—like symptoms a person may experience shortly after he or she becomes infected. Whilst HIV, the Human Immunodeficiency Virus is asymptomatic — it is infective from the moment that a person gets it — even though the infection may not show up in a test for 3 to 6 months.

When the periods of illness, caused by the Acquired ImmunoDeficiency Syndrome that gives the disease its name start, after an average of about 8 years, they manifest with increased frequency, duration and severity and as there is at the moment no cure (the present treatment only suppresses the virus for a time and thereby prolongs life and a period of relative health) the illness will lead ultimately to death.

The second difference is the population structure of victims.

Plague was the epitome of random selection! It affected young and old, men and woman, doctor and patient, rich and poor, town and country without exception. AIDS on the other hand is selective. In those countries with a low incidence of hard drug abuse and reliable blood transfusion services such as South Africa 98 % of all AIDS cases are traceable to consensual sex. True, some are attributable to sharps — shared hypodermic needles etc., and others to rape, but they comprise the exception rather than the rule. This fact should dominate thinking about the crisis and how to overcome it.

The age group shown to be most at risk for the STI—HIV/AIDS Complex in Africa and by extension the World is 10 to 49, more particularly the subgroup 10 to 29.  A notable example is the Kingdom of Swaziland, situated at the North East corner of KwaZulu—Natal adjoining Maputo Mozambique.  Swaziland's population is estimated at 1.13 million, and it is now believed to have the world's highest rate of HIV/AIDS infection. In the seventh Sero—surveillance Report for the year 2000 released at the beginning of 2001 over 78% were in the age groups 10 — 29 years of age. More potentially economically important age groups are affected by HIV/AIDS than less important age groups, foretelling of serious socio—economic consequences as the HIV infected persons start to get sick and die.

The third difference knowledge of its cause. 

A year after the appearance of the Black Death in Europe the learned doctors at the Medical faculty of the University of Paris ascribed it to a triple conjugation of Saturn, Jupiter and Mars which it was said occurred on March 20, 1345 but acknowledged that its "cause was hidden from even the most highly trained intellects," as Barbara Tuchman wrote in her book A Distant Mirror.

That cannot be said of HIV/AIDS. Yet there has been a failure to sift the more important discoveries from the less important discoveries and their implications for coming to grips with the epidemic. A report published by researchers from the University of North Carolina School of Medicine in July 1997 about the results of their study in Malawi [1]. Briefly, they found that the semen of men infected by both HIV and other venereal diseases such as gonorrhea contains eight times as much HIV as that of patients infected by HIV alone. When HIV—infected men were given antibiotics to treat other STDs (Sexually Transmitted Diseases) the amount of HIV in their semen fell dramatically, reducing the chances of them infecting their partners.

Whilst this new discovery failed to have an impact on society in general the importance of the economic and public health implications was immediately recognized by Dr Anthony Fauci director of the National Institute of Allergy and Infectious Diseases who said

... if you can treat a STD with a relatively inexpensive antibiotic, you may prevent a number of HIV infections that would cost a lot more to treat.

And there the matter rests, filed away like the pioneer work of Mendel on the genetics of the garden pea. The triple nature (STD+HIV+AIDS) of the complex is ignored and forgotten due to the well known single and dual acronyms.

But the inescapable reality is that each and every act of casual sex can result in an increase in the number of persons infected by a VD (Venereal Disease — named for Venus — the Roman goddess of love ) and since 1997 we know that an increase in STDs will lead to an increase in  HIV, the precursor of AIDS .

Calling things by their proper names

Gertrude Stein wrote 'a rose is a rose is a rose 'and William Shakespeare  ' a rose by any other name would smell as sweet ' but in China  K 'ung— fu—Tzu a.k.a. Confucius put it in his Analects XIII.3 as follows  —

...if names are not correct ,language will not be in accordance with the truth of things and with time this will lead to the end of Justice, to anarchy and to war

Although there is no unanimity in the choice of names and /or their acronyms — VD, STD and STI (Sexually Transmitted Infections), STD—HIV/AIDS is by far the best name for the complex. The acronym STD was changed to STI only after the advent of AIDS because HIV is asymptomatic — usually for 7 to 10 years — and the disease caused by HIV is called AIDS.

So, to bring about a new way of thinking about HIV or AIDS or HIV/AIDS, there has to be universal recognition that AIDS is the end condition of HIV — the transmission of which is potentiated by other STDs — all of which were caused in the main by casual sex.

According to a 2004 news release

New estimates show that 15—24 year—olds, who represent one—quarter of sexually experienced Americans, accounted for half of newly diagnosed sexually transmitted diseases (STDs) — more than nine million cases  in 2000....

That reality now makes it urgent as well as important to consider a new approach to AIDS.

For this to take effect it is necessary to stop talking and writing about HIV or AIDS or HIV/AIDS and instead to talk and write about the STD—HIV/AIDS COMPLEX.

Note

[1] Myron S Cohen .Sexually transmitted diseases enhance HIV transmission:  No longer a hypothesis. The Lancet 1998 Volume 351, Issue (Supplement III) pages 5—7

Seth Abrahams is a retired lawyer and health information activist.

There are 3 startling differences between the waves of Black Death that first ravaged Europe in the 14th Century and the AIDS epidemic which is now being called its modern equivalent, in some quarters.

The first distinction is speed.

People got sick and died quickly from the plague. From the moment of infection to the throes of death was the incredibly short period of five days when bubonic plague first reached Sicily, Europe in October 1347, three days as the disease spread and the symptoms changed and finally less than 24 hours as a second more virulent form of bubonic plague — the pneumonic type became manifest.

AIDS by contrast is leisurely. A person can live for 7 to 10 years without any symptoms whatsoever not counting the few days of flu—like symptoms a person may experience shortly after he or she becomes infected. Whilst HIV, the Human Immunodeficiency Virus is asymptomatic — it is infective from the moment that a person gets it — even though the infection may not show up in a test for 3 to 6 months.

When the periods of illness, caused by the Acquired ImmunoDeficiency Syndrome that gives the disease its name start, after an average of about 8 years, they manifest with increased frequency, duration and severity and as there is at the moment no cure (the present treatment only suppresses the virus for a time and thereby prolongs life and a period of relative health) the illness will lead ultimately to death.

The second difference is the population structure of victims.

Plague was the epitome of random selection! It affected young and old, men and woman, doctor and patient, rich and poor, town and country without exception. AIDS on the other hand is selective. In those countries with a low incidence of hard drug abuse and reliable blood transfusion services such as South Africa 98 % of all AIDS cases are traceable to consensual sex. True, some are attributable to sharps — shared hypodermic needles etc., and others to rape, but they comprise the exception rather than the rule. This fact should dominate thinking about the crisis and how to overcome it.

The age group shown to be most at risk for the STI—HIV/AIDS Complex in Africa and by extension the World is 10 to 49, more particularly the subgroup 10 to 29.  A notable example is the Kingdom of Swaziland, situated at the North East corner of KwaZulu—Natal adjoining Maputo Mozambique.  Swaziland's population is estimated at 1.13 million, and it is now believed to have the world's highest rate of HIV/AIDS infection. In the seventh Sero—surveillance Report for the year 2000 released at the beginning of 2001 over 78% were in the age groups 10 — 29 years of age. More potentially economically important age groups are affected by HIV/AIDS than less important age groups, foretelling of serious socio—economic consequences as the HIV infected persons start to get sick and die.

The third difference knowledge of its cause. 

A year after the appearance of the Black Death in Europe the learned doctors at the Medical faculty of the University of Paris ascribed it to a triple conjugation of Saturn, Jupiter and Mars which it was said occurred on March 20, 1345 but acknowledged that its "cause was hidden from even the most highly trained intellects," as Barbara Tuchman wrote in her book A Distant Mirror.

That cannot be said of HIV/AIDS. Yet there has been a failure to sift the more important discoveries from the less important discoveries and their implications for coming to grips with the epidemic. A report published by researchers from the University of North Carolina School of Medicine in July 1997 about the results of their study in Malawi [1]. Briefly, they found that the semen of men infected by both HIV and other venereal diseases such as gonorrhea contains eight times as much HIV as that of patients infected by HIV alone. When HIV—infected men were given antibiotics to treat other STDs (Sexually Transmitted Diseases) the amount of HIV in their semen fell dramatically, reducing the chances of them infecting their partners.

Whilst this new discovery failed to have an impact on society in general the importance of the economic and public health implications was immediately recognized by Dr Anthony Fauci director of the National Institute of Allergy and Infectious Diseases who said

... if you can treat a STD with a relatively inexpensive antibiotic, you may prevent a number of HIV infections that would cost a lot more to treat.

And there the matter rests, filed away like the pioneer work of Mendel on the genetics of the garden pea. The triple nature (STD+HIV+AIDS) of the complex is ignored and forgotten due to the well known single and dual acronyms.

But the inescapable reality is that each and every act of casual sex can result in an increase in the number of persons infected by a VD (Venereal Disease — named for Venus — the Roman goddess of love ) and since 1997 we know that an increase in STDs will lead to an increase in  HIV, the precursor of AIDS .

Calling things by their proper names

Gertrude Stein wrote 'a rose is a rose is a rose 'and William Shakespeare  ' a rose by any other name would smell as sweet ' but in China  K 'ung— fu—Tzu a.k.a. Confucius put it in his Analects XIII.3 as follows  —

...if names are not correct ,language will not be in accordance with the truth of things and with time this will lead to the end of Justice, to anarchy and to war

Although there is no unanimity in the choice of names and /or their acronyms — VD, STD and STI (Sexually Transmitted Infections), STD—HIV/AIDS is by far the best name for the complex. The acronym STD was changed to STI only after the advent of AIDS because HIV is asymptomatic — usually for 7 to 10 years — and the disease caused by HIV is called AIDS.

So, to bring about a new way of thinking about HIV or AIDS or HIV/AIDS, there has to be universal recognition that AIDS is the end condition of HIV — the transmission of which is potentiated by other STDs — all of which were caused in the main by casual sex.

According to a 2004 news release

New estimates show that 15—24 year—olds, who represent one—quarter of sexually experienced Americans, accounted for half of newly diagnosed sexually transmitted diseases (STDs) — more than nine million cases  in 2000....

That reality now makes it urgent as well as important to consider a new approach to AIDS.

For this to take effect it is necessary to stop talking and writing about HIV or AIDS or HIV/AIDS and instead to talk and write about the STD—HIV/AIDS COMPLEX.

Note

[1] Myron S Cohen .Sexually transmitted diseases enhance HIV transmission:  No longer a hypothesis. The Lancet 1998 Volume 351, Issue (Supplement III) pages 5—7

Seth Abrahams is a retired lawyer and health information activist.