August 18, 2022
James N. Nkhoswe and Renée Hartig
Part 1: Shall we speak of today’s reality in regards to HIV/AIDS?
Disease often knows no boundaries. Long a worldwide issue, Human Immunodeficiency Virus (HIV), a virus that damages the immune system and weakens the body’s ability to fight infections and disease, can lead to Acquired Immunodeficiency Syndrome (AIDS), unless treated. AIDS is marked by a severe decrease in white blood cells, namely the immune system’s CD4 helper T cells, which HIV attacks. This cascade of events renders the body useless in fighting off bacterial and other viral infections. But hooray! The good news is that HIV can now be treated successfully, and those with the virus have a fair shot at a good life. Here, we chronicle some of the challenges of combating HIV/AIDS, along with recent advances in the biomedical laboratory, and how life with HIV can be made better as a result of science and education.
State-of-the-art treatments coming to fruition
Since 1988, the World Health Organization (WHO) has designated the 1st of December as World AIDS Day to remember and acknowledge the continuous, important fight against HIV and AIDS. This fight is currently carried out in the biochemical laboratory as well as in the real world. While there is no cure for HIV/AIDS, there are life-saving treatments available — treatments that otherwise would not have been developed without basic and translational research. Thanks to antiretroviral drugs, the lifespan of a human with or without HIV is roughly about the same. Life expectancy at age 20 jumped from 19 to 53 in the HIV group from 1996 to 2011 with the help of antiviral medication1. This statistic contrasts starkly against a quarter-century ago, when HIV/AIDS was the leading cause of death among Americans aged 25 to 44 (CDC, 1996).
Animal research has been crucial for every major breakthrough in HIV treatment, in part because HIV is very similar to the Simian Immunodeficiency Virus (SIV), which infects chimpanzees and macaques. Consequently, non-human primates were instrumental in testing the safety and effectiveness of the earliest antiretroviral treatments, including AZT (known also as azidothymidine or zidovudine), the first drug approved by the U.S. Food and Drug Administration (FDA) to treat HIV/AIDS (see more here). Studies showing that non-human primates could be immunized against SIV (e.g. Hansen and colleagues in 2013) further helped to demonstrate the feasibility of a vaccine for HIV in humans.
But antiretrovirals are not the only treatments. A translational treatment, brought to fruition by researchers at Temple University (Pennsylvania, USA), is based on gene-editing technology (see also here, here). The team at Temple developed EBT-101, a CRISPR-based (Clustered Regularly Interspaced Short Palindromic Repeats) therapy. This therapy was successful in targeting and eliminating HIV from infected cells in humans, mice, and monkeys. This therapy has now also been approved by the FDA, opening the way to the first clinical trials of a CRISPR-based therapy for HIV infection. In addition to gene-editing technology, an idea to wake up latent HIV within a patient’s immune cells in order to neutralize has been in the works following positive results in monkeys. This research program is currently underway at GlaxoSmithKline’s HIV division, ViiV Healthcare.
One might think we can stop HIV dead in its tracks by targeting the underlying mechanisms through which HIV infects healthy immune cells. The virus presents a daunting scientific challenge because its surface provides few targets for the immune system and it evolves rapidly. Researchers at the Scripps Institute (California, USA) are working to identify stable regions on the outer surface of HIV that could be targeted by neutralizing antibodies.
HIV contraction can also be prevented through pre/post exposure prophylaxis (PrEP/PEP). Here, for example, individuals at high risk for HIV can take antivirals prior to or immediately after being exposed to individuals with HIV. PrEP/PEP reduces the risk of contracting HIV to essentially zero. It was at the 2016 International AIDS Conference, when the society’s President at the time, Chris Beyrer, called for unity so that 2016 may mark “the beginning of the PrEP era.” Four years later, the chronicles of PrEP/PEP use were turned into a short YouTube film by a doctor who began PEP while unsure whether or not he had come into contact with the virus.
With groundbreaking therapies on the horizon, there is also an ambition to develop a cure for HIV by 2030. The mission of the International AIDS Vaccine Initiative (IAVI) is to translate biomedical science into global impact. It is worthwhile to note the role an HIV/AIDS vaccine can play in this timeline. If the vision for ending the HIV/AIDS outbreak by 2030 is well calculated, the world is 8 years away from an entirely different future. Nevertheless, there are still many unspoken bottlenecks attributed to combating HIV/AIDS, and the adoption of the latest medical interventions has not been streamlined worldwide. Many disparities remain and truly equitable treatment comes hand-in-hand with education as well as regulation and reduction of drug costs (e.g. here). Informing ourselves of the process from bench to real life may help greatly in garnering further support and awareness for the complexities of managing and treating HIV/AIDS.
The unspoken bottlenecks to HIV/AIDS cure and treatment: Where are we still getting it wrong?
COVID-19 Global Emergency
Similar to the Ebola virus situation, the current insurgence of COVID-19 has reduced governments’ focus on HIV/AIDS mitigation in many countries to manage lowering the number of COVID-19 infections. With strained economies, many governments, especially across African nations where HIV-related deaths are highest, have shifted their attention to COVID-19 prevention and treatment, superseding efforts of combating HIV as a tradeoff. Indeed, just examining the annual case counts and reported deaths, COVID-19 mortality ranks much higher, with approximately 6.4 million deaths reported worldwide in the two years since virus emergence (World Health Organization). The continued emergency of highly contagious COVID-19 variants suggest that governments need to adopt new ways of ensuring that COVID-19 prevention and treatment does not result in neglecting other viruses, such as HIV. Such a pandemic is an example of the potential setbacks to HIV/AIDS mitigation, should the resurgence of such pandemics continue. The monkeypox and other viruses remain to be a great threat to the global effort of HIV/AIDS mitigation (see recent report from CBC News). COVID-19 is a wake-up call to the world as to how one epidemic can affect the control and spread of another by influencing the socio-economic status-quo of countries.
Red tape in adoption of new medical interventions
Despite the United States Agency for International Development (USAID) supporting many non-governmental organizations (NGOs) at the grassroots level of fighting against HIV/AIDS, insurgent organizations exploiting foreign aid are not all uncommon. We have analyzed the situation in local economies, particularly in West Africa, and report back on the current situation. Interviews with the locals in Malawi and Zambia have indicated that many organizations are on the scene, mostly for employment purposes and not the actual fight. Funds provided to selected lobbyist groups have been met with corruption or other vices. In extreme cases, millions in aid have been withheld by funding organizations, such as the Global Fund (BBC, 2010; can also see the effect of corruption on HIV/AIDS donor funds: a case study of Namibia).
Recently in Zambia, new inventions of medicines have been reportedly developed among medical doctors and herbalists. Unfortunately, they have not received a perfect reception and acceptance has been subjected to a somewhat discouraging environment from HIV/AIDS organizations and government. Several traditional and religious healers in Zambia claim to have found a cure for HIV/AIDS. However, so far only samples from three herbalists have been tested for efficacy. Former works and supply minister, Ludwig Sondashi, developed the Sondashi Formula. The Mailacin Formula was developed by Howard Maila of Ndola, while Dr. John Mayeya developed the Mayeyanin Formula (see Times of Zambia).
Faith and tradition versus science
The role of religious beliefs in the prevention of HIV and attitudes towards the infected has received considerable attention2. Religious organizations are a fundamental part of the social structure in rural Africa and, since the beginning of the HIV epidemic, they have played a major role providing material and spiritual support to persons living with HIV/AIDS (or PLWHA). Claims that “a myriad of techniques,” such as prayer, divine intervention, or the ministrations of an individual healer can cure illness have been popular throughout history3.
The use of prayer as a means to exorcize ‘evil spirits’ and treat HIV has been associated primarily with revivalist churches. Such services, marketed as “the Lourdes of Tanzania,” are conducted in Dar es Salaam and other major cities despite the disapproval of clerical authorities2. Regarded as a Christian belief that God heals people through the power of the Holy Spirit, faith healing often involves the laying on of hands. It is also called supernatural healing, divine healing and miracle healing, among other things. Healing in the Bible is often associated with the ministry of specific individuals, including Elijah, Jesus and Paul4. “It is a problem on the ground and a major issue when it leads people to stop taking the drugs. Organizations have to work with churches, but also education is needed to help support the community,” said Marshall Mweshi, an HIV/AIDS Prevention NGO advocate from Zambia.
Virtually, scientists and philosophers dismiss faith healing as pseudoscience5. The rapid growth of Pentecostal-type revivalist churches in Sub-Saharan Africa (SSA) during the 1990s has coincided with the burgeoning HIV epidemic. In Tanzania, a quantitative study conducted among parishioners from both rural and urban settings showed that, in spite of widespread belief in the ability of prayer to cure HIV, most respondents would hypothetically be willing to initiate antiretroviral therapy (ART) if diagnosed with the infection6. In contrast, an earlier study conducted in Uganda showed that 1.2% of actual ART users – all of whom were members of Pentecostal churches – had discontinued treatment because they thought that they had been spiritually healed7.
A study conducted on Ethiopian “holy water” was mentioned as a reason for interrupting treatment as frequently as “not being able to afford transportation costs”8. While the role of religious beliefs on treatment adherence is inconclusive, a study conducted in Mali found an association between the belief that HIV is a “punishment from God” and fatalistic attitudes towards the disease9. In Nigeria, a detailed ethnography of a revivalist church provided vivid examples of how individuals may turn to religion as a way of coping with HIV10.
The presumed ability to combat sorcery has also been reported as a crucial factor contributing to the success of the African Pentecostalism movement11,12; whereby, expression of AIDS symptoms is attributed to witchcraft13. The use of traditional medicine to treat HIV symptoms has also been extensively documented in Tanzania and other SSA countries14,15.
Poverty and hunger
Food and nutrition is an important prerequisite to taking HIV/AIDS treatment drugs. Without ample funds to secure sustenance and treatment drugs, another issue is perpetuating the problem through births with HIV positive babies. Nutrition is a vital prerequisite to taking drugs given that most pharmaceuticals are instructed to be taken on a full stomach. When it comes down to the security of financial means, an innate preference is to secure sustenance over pharmaceuticals. When resources are limited, prioritization is given to a human’s basic needs and the acquisition of pharmaceuticals may take the back seat as a consequence.
To reiterate the importance of education and nutrition, tune in tomorrow for an interview with Marshall Mweshi, an HIV/AIDS information advocate and affiliate with the Network of Zambian People Living with HIV.
References and further reading
1 Mascolini, M. (February 22-25, 2016). Conference on Retroviruses and Opportunistic Infections (CROI). USA, Boston MA.
2 Roura, M., Nsigaye, R., Nhandi, B. et al. (2010). “Driving the devil away”: qualitative insights into miraculous cures for AIDS in a rural Tanzanian ward. Tanzania. BMC Public Health 10, 427 https://doi.org/10.1186/1471-2458-10-427
3 Barrett, S. (December 27, 2009). “Some Thoughts about Faith Healing”. Quackwatch. Archived from the original on 2014-02-09. Retrieved 2014-01-23.
4 Village, A. (2005). “Dimensions of belief about miraculous healing”. Mental Health, Religion & Culture. 8 (2): 97–107. doi:10.1080/1367467042000240374. S2CID 15727398.
5 Pitt, J. and Marcello, P. (2012). Rational Changes in Science: Essays on Scientific Reasoning. Springer Science & Business Media. ISBN 9789400937796. Retrieved 18 April 2018.
6 Zou, J., Yamanaka, Y., John, M., Watt, M., Ostermann, J. and Thielman, N. (March 4, 2019). Religion and HIV in Tanzania: influence of religious beliefs on HIV stigma, disclosure, and treatment attitudes. Tanzania. BMC Public Health. ;9:75. doi: 10.1186/1471-2458-9-75. PMID: 19261186; PMCID: PMC2656538.
7 Wanyama, J., Castelnuovo, B., Wandera, B., Mwebaze, P., Kambugu, A., Bangsberg, D. and Kamya, M. (2007). Belief in divine healing can be a barrier to antiretroviral therapy adherence in Uganda. Aids. Uganda. 21(11): 1486-1487. 10.1097/QAD.0b013e32823ecf7f.
8 Deribe, K., Hailekiros, F., Biadgilign, S., Amberbir, A. and Beyene, B. (2008). Defaulters from antiretroviral treatment in Jimma University Specialized Hospital, Southwest Ethiopia. Trop Med Int Health. 13 (3): 328-333. 10.1111/j.1365-3156.2008.02006.x.
9 Hess, R., McKinney, D. (2007). Fatalism and HIV/AIDS Beliefs in Rural Mali, West Africa.
10 Adogame, A. (2007). HIV/AIDS support and African pentecostalism: the case of the Redeemed Christian Church of God (RCCG). J Health Psychol. 12 (3): 475-484. 10.1177/1359105307076234.
11 Newell, S. (2007). Pentecostal Witchcraft: Neoliberal Possession and Demonic Discourse in Ivoirian Pentecostal Churches, Journal of Religion in Africa, 37(4), 461-490.
12 Rio, K., MacCarthy, M., Blanes, R. (2017). Introduction to Pentecostal Witchcraft and Spiritual Politics in Africa and Melanesia. In: Rio, K., MacCarthy, M., Blanes, R. (eds) Pentecostalism and Witchcraft. Contemporary Anthropology of Religion. Palgrave Macmillan, Cham.
13 UNICEF and PANOS (2001). Stigma, HIV/AIDS and prevention of mother-to-child transmission: a pilot study in Zambia, India, Ukraine and Burkina Faso. London and New York PANOS Institute and UNICEF.
14 Plummer, M., Mshana, G., Wamoyi, J., Shigongo, Z., Hayes, R., Ross, D. and Wight, D. (July, 2006). The man who believed he had AIDS was cured: AIDS and sexually-transmitted infection treatment-seeking behaviour in rural Mwanza, Tanzania. AIDS Care. 18(5):460-6.
15 Mshana, G., Plummer, M., Wamoyi, J., Shigongo, Z.S., Ross, D. and Wight, D. (2006) ‘She was bewitched and caught an illness similar to AIDS’: AIDS and sexually transmitted infection causation beliefs in rural northern Tanzania. Culture, Health and Sexuality, 8(1), pp. 45-58.