A Note on HIV-AIDS

Dr. John J. Billings
Reprint with permission

This disorder was first observed in Africa more than 50 years ago when it was described as "The Thin Disease" because of the progressive development of cachexia, repeated infections and the fatal outcome. The disease was first recognized in the United States of America in 1981 when there occurred a minor epidemic, in which large numbers of male homosexuals living in the United States or Haiti were recognized as suffering from pneumocystis carinii pneumonia, often associated with Kaposi's sarcoma, in which multiple vascular tumour nodules occur on the skin surface or in the viscera. The syndrome was also recognized in drug users. In 1983 the virus was isolated and identified as a retrovirus, belonging to the subfamily of Lentivirus. A number of different strains have now been identified and these present considerable difficulty in reliable detection of all cases of the disease. An antibody test was first developed in 1985.

Infection with the virus creates a viraemia with which is associated symptoms of fever, Iymph gland enlargement and a generalized rash. Within about a month antibody can be detected in the blood and recent scientific work is now enabling the presence of the infection to be detected earlier through DNA studies of the virus. The infection causes an immune deficiency, that is the diminished ability to respond to infection, and that explains the name AIDS, which is an acronym of "Acquired Immune Deficiency Syndrome". The dissemination of the virus to Iymphoid organs is a major factor in the establishment of a chronic and persistent infection. The CD4+T cells and cells of monocytic lineage are the major ultimate targets of the infection. Almost every cell that expresses the CD4 molecule together with coreceptor molecules can potentially be infected with HIV. Virtually any patient with a CD4+T cell count less than 200/ul must be considered to be suffering from AIDS, despite no other evidence to indicate the presence of this complication of HIV infection, that is, apart from the positive antibody test.

The individual manifests the diagnosis of AIDS by the development of pneumocystis pneumonia, tuberculosis, fungal infections, thrush, cryptococcal infections, herpes infections and so on. The increased prevalence of pulmonary tuberculosis resulting from the spread of AIDS has caused tuberculosis to have become more common amongst members of the community who do not have any HIV infection. Kaposi's sarcoma is not so common now as it was when the disease was first recognized in the United States and it is suspected that this disorder may be a complication of some other sexually transmitted agent. The median time for the HIV infection to become manifest by the development of AIDS is 10 years.

In May 1996 a World AIDS Day Conference reported that during the previous year there had been 3.1 million new infections, including 400,000 children. It was estimated that 30 million people around the world were now infected with the disease and that 6.5 million had already died of it. The disorder is now a global pandemic and various estimates have been made for the year 2000, these estimates varying between 40 and 100 million. Because the incidence of AIDS has lagged behind the increase in HIV infection a false sense of security has developed among many who have been infected. The virus is not spread by ordinary social contact and even kissing is extremely unlikely to transmit the virus, even though the virus may be present in saliva. It is now reported that in sub-Saharan Africa, an additional 5,000 individuals acquire the HIV infection every week. The main sources of infection are dependent upon transmission in blood, seminal fluid, cervical and vaginal fluids and also breast milk.

Infected needles have been an important source of transmission of the virus amongst drug users who may share needles or syringes. In Australia, the transmission from an infected mother to her child has been almost eliminated by the intensive treatment of the mother by injections of an anti-viral agent such as Zidovudine (AZT) weeks before a pregnancy comes to term, delivery by Caesarean section and treatment of the infant with AZT by mouth for six weeks, with the avoidance of any breastfeeding of colostrum or milk. This has reduced the incidence of transmission to these children from 30% to about 2%.

The virus is transmitted by homosexual and heterosexual relationships, particularly the former, and the transmission of the virus is facilitated by the presence of other sexually transmitted diseases. Except in places where there are large numbers of active homosexuals the incidence of the disease is approximately the same in men and women. Where homosexual practices continue the male to female ratio increases to 8 to 2 or even 9 to 1. Where there is much drug addiction with sharing of syringes and needles the male: female ratio remains 1 to 1.

The use of the modern anti-viral drugs in Australia and the United States produced 93% reduction of mortality in the short term, and 83% reduction of illnesses associated with AIDS and a 60% reduction of hospital admissions. Unfortunately none of the most useful anti-viral drugs are widely available in the poor countries. In Tanzania, Rwanda and Mozambique, for example, 80% of hospital bed-days are HIV-related. In Australia careful testing of all blood provided by the Red Cross Blood Bank has reduced the transmission by transfusion of blood products to one case in a million. Other risk of transmission by infected blood is removed by the avoidance of sharing of needles and syringes and by careful antiseptic and aseptic practices in all surgical and dental procedures, even of a minor variety.

So far as transmission by sexual activity is concerned, three possible modes of protection have been suggested:

  1. Total avoidance of any sexual activity.
  2. Confining any sexual activity to a relationship between two uninfected individuals which is monogamous and where the two individuals can trust each other to be honest in reporting sexual activity with any other individual.
  3. By carefully and correctly using condoms during every sexual contact.

With regard to the latter point, unlike the two courses of action mentioned, this use of condoms cannot provide certain protection against transmission of the AIDS virus during genital contact. It is important to understand that AIDS is a fatal disease which is caused by a virus. The epidemic of AIDS, however, is caused not only by the virus but by the additional influence of sexual promiscuity, that is by sexual activity with multiple partners. The epidemic is continuing to spread and the continuing spread will persist as long as people gain a false sense of security as a result of educational programs which suggest that the condom provides reliable protection. It is that kind of irresponsible education which causes people to keep to a lifestyle which exposes them to the risk of the AIDS virus infection, or persuades other individuals to enter into such a lifestyle when they would not have done so had they been given accurate information.

Reliable scientific studies have demonstrated that the AIDS virus is transmitted despite the practical use of condoms in every genital contact, carefully following instructions regarding the way the condom should be used. The only statistical effect observed is that the rate of transmission is slowed so that eventually those who have always used condoms according to the instructions eventually reach the same level of transmission.

Encouraging people to any false acceptance of the mythology that condoms provide effective protection against transmission of the virus promotes sexual promiscuity and relationships with multiple partners. In simple words, such recommendation or misleading statements promoting confidence in condoms is equivalent to treating the disease with what is responsible for the epidemic of that same disease and the epidemic will continue until at last truth and common sense prevail. There is often a lack of understanding that encouraging people to believe that the use of condoms provides effective protection against sexually transmitted diseases promotes a life pattern of sexual irresponsibility such that a large proportion of these individuals, often the majority of the younger age group, do not continue to use the condoms regularly, if at all. So the advice to use condoms is self-defeating from the beginning.

In stark contrast is the result so often seen when there is an active program of teaching natural family planning. The gentle discipline of the Billings Ovulation Method engenders a remarkable development of the relationship between a couple, because the generous acceptance of a time of waiting without intercourse for the sake of the other person, means that they grow in love for each other and are thus motivated to remain faithful. It is only a natural family planning method that can really promote the sexual responsibility that is necessary to protect individuals and stop the epidemic of HIV/AIDS.

The Centre for Communicable Diseases in Atlanta, Georgia, has made a clear statement of the scientific evidence that demonstrates the inability of the condom to provide certain protection. The Catholic Bishops in the United States referred to the report of a Presidential Commission to study HIV infections which indicated that the promotion of condoms as "safe sex" is contrary to the truth. They stated that condom use is one of the "quick fixes" which the Presidential Commission says fosters a "false sense of security and actually leads to a greater spread of the disease." This statement was contained in a document "Called to Compassion and Responsibility: A Response to the HIV/AIDS Crisis" issued in November 1989 by the National Conference of Catholic Bishops.

It is interesting that, contrary to what is observed in airports generally around the world, a large notice is evident in the airport in Singapore, which has never claimed to be a Christian country, stating in regard to AIDS infection: "Avoid casual sex. Prevention is the only cure for the disease."

What is always to be remembered is that the Christian response to the patient with HIV/AIDS is always the same, however the infection was acquired: compassion, love and the provision of the best possible medical care.