Infection by the human immunodeficiency virus is one of the greatest public health problems that our country faces. Although the AIDS epidemic began later in Spain than in the rest of Europe, within a few years we rose rapidly towards the top of the case rating and are now one of the countries with most cases in Europe, with a population severely affected by AIDS.

AIDS is not only a public health problem, but a social and economic problem as well. It affects groups of young people in their prime, and creates intense individual, family and social suffering. The appearance of this disease has revolutionised the framework of society and public health, altering the basic rules of coexistence within the community. AIDS is not a common illness. It is a disease fundamentally linked with human behaviour.

From the moment AIDS first appeared, its social interpretation has been associated with a variety of factors converting the disease into a justification for the rejection, blaming, repression, discrimination and humiliation of HIV-positives, AIDS sufferers and their families; of the so-called 'risk groups' (prostitutes, parenteral drug users, the promiscuous, etc.) and of the famous 3H (homosexuals, haemophiliacs and Haitians).

The social rejection directed at those affected by HIV/AIDS is based on the hard realities of the disease (it is deadly, chronic, progressively incapacitating, contagious, is singularly lacking in support from the social system, and is associated with subjects that are taboo in our society such as sex, drugs, etc.).

HIV/AIDS sufferers often present diverse problems initially or subsequently derived from the actual disease and from psychosocial difficulties. These problems affect, above all, their quality of life. On being diagnosed, they must confront major changes in all the social areas of their lives: with their families and partners, at work, in their sex lives and in their own biological makeup. Those affected by HIV/AIDS suffer from problems such as depression, anxiety, thoughts of suicide, guilt, fear, obsessive disorders, frustration, radical alterations to their long-term lifestyle plans (having children, studies, etc.), sexual dysfunction, separation and divorce, long periods of unemployment and consequent lack of pension cover, difficulties in obtaining food and housing welfare assistance, breakdown in the structure of the family unit, etc.

The Concordia AntiAIDS Association was set up with the aim of meeting the needs of this group. The Association´s mission is to carry out a programme of informative and preventive advice campaigns specially designed to brake the advance of HIV infection and to ensure the comprehensive care of AIDS patients and those infected by HIV, their families and contacts.

 

The pandemic is still spreading: 25 years of AIDS

2006 was the sad anniversary of the AIDS phenomenon, and we now look back on two decades during which a virulent virus has attacked our world with horrific success.

AIDS first made its appearance in 1981, when five adult homosexual men from Los Angeles were diagnosed with pneumonia, in addition to other opportunist infections which occur exclusively in people whose immune system is defective. Within a short time, similar cases came up in other North American cities. These new cases were not restricted to homosexual males: they included women, small children, patients who had recently received transfusions, haemophiliacs and drug addicts. This proved that the AIDS disease was not exclusive to gays, although homosexual males as a group are particularly affected.

Following years of investigation, principally in the Pasteur Institute in France and in North American institutions, the virus was isolated and named HIV (human immunodeficiency virus).

In 1986, there was further news about the virus: a 'new' virus had been isolated in AIDS sufferers coming from West Africa. Investigation showed that the virus was different, but similar to AIDS and belonging to the same family. We now know that there are two AIDS-producing agents: HIV-1, which is the most frequent and the most aggressive, and HIV-2, which occurs principally in Northwest Africa and which is less virulent than HIV-1.

Today, although we know much more about the virus and can limit new infection within certain groups in Spain, this relief is not available to everyone. AIDS is beginning a new triumphal march in the East and continues its course of destruction in Africa and Latin America, and we are now seeing the start of a second generation. It is forcing its way into families, and infections among women and children are on the rise, here in Spain included. We must come to grips with the fact that not being a drug addict or a homosexual is no protection against the disease. It is largely transmitted by sexual contact, the responsibility for which lies solely with our personal conduct.

 

Invader of a special kind: The chameleon of the viruses

HIV is composed of a chain of elements. The surface of this chain contains a glycoprotein known as gp290, which unites with the membranes of cells containing CD4 receptors. Recently, it has been demonstrated that to unite with the cell HIV requires a second receptor called CD26 in addition to CD4.

A comparison can be made between a boat's cargo (HIV) and the dockside of a port (the cell). The unloading procedure involves firstly, immobilising the boat by securing it to the dockside with ropes, and secondly, using a crane to extract the cargo from the hold and land it. In other words, without the CD4 receptor, HIV cannot unite with the cell; without the CD26, it cannot penetrate the cell.

This powerful combination enables HIV to unite selectively with only those cells possessing the two receptors. The receptors (basically, T4 lymphocytes) are the cells that control the immune system.

The introduction of the virus is followed by a latent period during which the protein synthesis is completed; then comes the outbreak, almost a 'birth', of new viruses abandoning the cell, the latter being destroyed. The viruses hunt down new T4 lymphocytes to be destroyed slowly in their turn.

One of the most disturbing factors is that the new viruses are markedly unstable: to put it another way, the 'second generation' viruses are similar to, but not the same as, the 'first generation' viruses. These constantly-changing generations of 'different' HIVs explain why the disease progresses in spite of the fact that the individual presents high levels of antibodies; explain the difficulties in the way of discovering a vaccine, and explain, too, the resistance to treatment with Zidovudina that has been observed during recent months.

The constant and rapid mutation of the virus is the tactic by which it survives and propogates itself with such success. To date, no method has been discovered to combat this behaviour of the virus.