Today in the U.S., tens of thousands of people are living with a potentially deadly disease that they don’t know they have. Early diagnosis not only reduces the severity of the disease and risk of death but is also key to slowing and eventually stopping the spread of the disease.
That disease isn’t COVID-19, which the coronavirus causes. It’s acquired immunodeficiency syndrome (AIDS), which the human immunodeficiency virus (HIV) causes.
Since the initial AIDS outbreak in the U.S. in the early 1980s, more than 700,000 people have died from the disease in this country, according to the Centers for Disease Control and Prevention (CDC) HIV surveillance reports. Our World in Data reports that based on data from the Global Burden of Disease, a global epidemiological survey, each year nearly 1 million people worldwide succumb to the disease. While infection rates and deaths continue to decline in many parts of the world, AIDS is now the leading cause of death in some parts of sub-Saharan Africa, accounting for 50% more deaths than heart disease and twice the number of cancer deaths.
HIV and AIDS remain serious public health concerns in the U.S.:
- The CDC estimates that at the end of 2018, 1.2 million people in the U.S. had HIV.
- Even though the number of new diagnoses declined by 7% between 2014 and 2018, about one in seven of the people with HIV, or 14%, were unaware that they had the disease.
From the beginning of the fight against HIV and AIDS, public health officials have led the effort to stop the spread of both through education. COVID-19 presents new and serious challenges for people living with HIV, which makes the need for proper HIV and AIDS education more pronounced than ever.
The resources in this guide help individuals, families, caregivers and public health officials gain the upper hand in addressing this serious threat to public health.
Understanding the Difference Between HIV and AIDS
Viruses cause many diseases in humans, as Medical News Today explains. Some are relatively mild, such as cold sores, the common cold, and seasonal influenza outbreaks. Others are potentially deadly, including measles, mumps, chickenpox, hepatitis, polio, rabies, Ebola, severe acute respiratory syndrome (SARS), dengue fever, Zika virus, Epstein-Barr virus and AIDS.
The U.S. Department of Health & Human Services (HHS) explains that HIV attacks the cells that help our bodies fight off infections. Without these cells, we’re more susceptible to infections from other sources, including other viruses. That’s HIV’s insidious nature: rather than being fatal itself, it destroys the body’s ability to stave off other diseases that can ultimately cause the person’s death.
Efforts to combat AIDS rightly focus on prevention, but successful treatments are now able to boost the immune system of people who contract HIV and prevent the virus from attacking patients’ natural disease-defense mechanisms.
Definition of HIV and AIDS
By impairing the body’s ability to fight infections, HIV makes the people it infects more susceptible to many other diseases and infections. If the people who contract HIV don’t receive treatment, they may ultimately develop AIDS.
HIV is a retrovirus, which is a type of virus whose RNA genetic material replicates inside the host cell, as Healthline explains. HIV uses a reverse transcriptase enzyme to convert its RNA into DNA that’s compatible with the host cell.
At present, HIV has no cure, nor any way to completely remove the virus from a person’s system. However, not everyone who’s infected with HIV develops AIDS. Antiretroviral therapy (ART) allows people with HIV to live long, healthy lives and prevents them from spreading the virus to others.
Difference Between a Virus and a Syndrome
The National Human Genome Research Institute describes a virus as a small bundle of genetic code, whether DNA or RNA, wrapped in a coat of protein. Viruses are unable to replicate on their own, so they depend on parts within the cells they infect to create copies of themselves. The replication process typically destroys the host cell and damages the host organism.
The Cambridge Dictionary defines a syndrome as a group of medical problems that result from a single disease or mental condition. With AIDS, the group of medical problems that HIV causes all result from the virus’s slow destruction of the person’s immune system.
HIV.gov identifies AIDS as the “most advanced stage of HIV infection.” AIDS is diagnosed in two ways:
- When a person with HIV exhibits a condition associated with AIDS (an AIDS-defining condition).
- When a person with HIV has a cluster of differentiation 4 (CD4) that’s less than 200 cells for every cubic millimeter; CD4 is a glycoprotein that’s found on the surface of T-helper cells (T cells) and other immune system cells.
How an HIV Infection Develops into AIDS
As Medical News Today explains, a person with HIV who follows an “effective treatment regimen” is unlikely to have the virus lead to AIDS. However, if HIV is untreated, the person’s immune system will continue to be damaged. The more compromised the immune system becomes, the more likely the person will develop an opportunistic infection.
The opportunistic infections that are most likely to affect AIDS patients include the following:
- Invasive cervical cancer, lung cancer, Kaposi’s sarcoma and other cancers
- Candidiasis, which is a fungal infection that affects the throat and lungs
- Pneumocystis pneumonia, which is a fungal form of pneumonia
- Toxoplasmosis, which is a parasitic infection that affects the brain
- Cryptococcosis, which is a fungal infection that often causes pneumonia
Treatability of HIV vs. Treatability of AIDS
Early HIV treatment prevents the virus from leading to AIDS. HIV.gov explains that treating HIV entails taking medications that slow the virus’s spread in the person’s body. ART is the recommended treatment for people with HIV — no matter how healthy they are or how long they’ve had HIV.
- The medications must be taken every day, as prescribed by a caregiver.
- The medications reduce the amount of HIV in the blood, which is called the viral load.
- A low viral load keeps a person healthy and prevents illnesses.
- When the medications have reduced the viral load to undetectable levels, the risk of sexually transmitting HIV is effectively eliminated.
By contrast, no singular approach exists for treating the opportunistic infections that arise as a result of AIDS. Medical News Today describes the three stages of AIDS (note that not everyone who’s infected with HIV experiences these or other symptoms):
- The first acute stage appears two to four weeks after the initial HIV infection. Its symptoms include fever, fatigue, chills, muscle aches, sore throat, rashes and night sweats.
- The second clinical latency stage may be accompanied by minor symptoms or none at all. The virus can be kept at this stage with medication.
- The third and final stage typically arises 2 to 15 years after the initial HIV infection in the absence of effective treatment. At this stage, the compromised immune system allows one or more opportunistic infections to spread unchecked.
Misconceptions Regarding HIV and AIDS
From the earliest days of the AIDS epidemic, the disease has been clouded in mistruths and half-truths that led to people with HIV and AIDS being stigmatized. Nearly 40 years later, as HIV continues to spread around the world, misinformation about the condition proliferates.
One of the greatest challenges public health officials face in educating communities about HIV and AIDS is overcoming these misconceptions. Government agencies, non-governmental organizations and healthcare providers highlight the importance of disseminating accurate and timely information to the public, and especially to the segments of the population most likely to be infected with HIV.
HIV and AIDS Transmission
- Myth: HIV can be transmitted simply by being around people who are HIV-positive.
- Fact: As WebMD explains, HIV can’t be transmitted via touch, sweat, tears, saliva or urine. It’s perfectly safe to hug, kiss, shake hands, share eating utensils and use the same gym equipment as someone with HIV.
- Myth: If both partners are HIV-positive, they don’t have to practice safe sex.
- Fact: HIV has many different strains, and new strains may arise that are resistant to current ART approaches.
HIV as a Terminal Disease
- Myth: HIV is a fatal and incurable disease.
- Fact: Michael Horberg, who leads Kaiser Permanente’s HIV/AIDS clinical research and care management, states in Healthline that with proper treatment, people who are infected with HIV can expect to live a normal life span.
- Myth: The worldwide death rate from AIDS continues to rise.
- Fact: The HIV/AIDS fact sheet from the World Health Organization (WHO) indicates that between 2000 and 2019, HIV-related deaths decreased by 51%, and the rate of new HIV infections decreased by 39%. The WHO estimates that ART has saved 15.3 million lives in the past two decades.
HIV and Sexuality
- Myth: Heterosexuals don’t have to worry about contracting HIV.
- Fact: The CDC reports that as of 2018, heterosexuals accounted for 24% of the nearly 38,000 new HIV infections in the U.S.
- Myth: You can tell whether your partner is HIV-positive just by appearance.
- Fact: People who have HIV may remain symptom-free for years after the initial infection, as the CDC explains. The only way to confirm whether a person is HIV-positive is by testing blood for antibodies, but the antibodies may not appear for weeks or months after exposure, according to Healthline. That’s why experts recommend safe-sex practices as the most effective way to reduce the risk of contracting HIV.
Treatment of HIV and AIDS
- Myth: Pre-exposure prophylaxis (PrEP) medication allows HIV-positive people to have unprotected sex without any risk.
- Fact: PrEP medication has been shown to be effective for preventing HIV transmission when taken daily. However, PrEP doesn’t protect people against other sexually transmitted diseases, as Healthline points out. A 2015 Kaiser Permanente study found that half the PrEP patients in the study contracted a sexually transmitted disease within 12 months.
- Myth: HIV always leads to AIDS.
- Fact: Richard Jimenez, a professor of public health at Walden University, states in Healthline that today’s therapies keep HIV infection levels low. The therapies also help people prevent opportunistic infections and maintain a robust immune system. As a result, their HIV never progresses to AIDS.
Educating the Public About HIV and AIDS
Healthcare professionals play a vital role in helping people understand the differences between HIV and AIDS. Statistics reported by the CDC demonstrate the positive effect that public education about HIV and AIDS has on new infection rates:
- HIV infection rates among gay and bisexual men declined by 7% between 2014 and 2018.
- Infection rates among Blacks/African Americans also fell by 7% in the period.
- Infection rates among all heterosexuals dropped by 10%, and among heterosexual men, rates dropped by 13%.
However, HIV infection rates continued to climb among certain ethnic groups:
- Rates increased by 6% among American Indians and Alaska Natives (15% increase among gay and bisexual men in this ethnic group).
- Rates grew by 55% among Native Hawaiians and other Pacific Islanders (78% increase among gay and bisexual men in this ethnic category).
Dispelling Misinformation About HIV and AIDS
By taking appropriate precautions, people can nearly eliminate their risk of contracting HIV. The goal of public health outreach is to disseminate precautions about HIV and AIDS, including dispelling misinformation that conflates HIV and AIDS. HIV.gov lists the tools currently available to combat the spread of HIV and AIDS:
- HIV testing to prevent undiagnosed cases from transmitting the virus
- HIV medications to prevent transmission of the infection, including mother-to-child transmission: PrEP and post-exposure prophylaxis (PEP)
- Preventive interventions, such as condom distributions and needle exchanges to stem infections among intravenous drug users
- Medication-assisted therapy and other drug treatments
- Diagnosis and treatment of sexually transmitted diseases
Among the strategies that are effective in promoting risk-reduction strategies for people with HIV are media campaigns, behavioral interventions and medication reminders.
Calming Fears Without Trivializing Their Seriousness
The public’s fears surrounding HIV and AIDS focus on three primary concerns, as the HIV and AIDS information resource Avert explains:
- Uncertainty about how HIV is transmitted from person to person
- Whether to get tested for HIV because of the fear of a positive test result
- Concern about the stigma of being HIV-positive among family, friends and others
The first fear can be dispelled by educating people about the limited ways that HIV can be contracted:
- Sex without a condom
- From pregnant mother to baby
- Sharing injection equipment (needles, syringes, etc.)
- Receiving a contaminated blood transfusion or organ transplant
Taking an HIV test is simple, confidential and painless, requiring only a small amount of blood or a mouth swab. Avert’s HIV testing information page walks through the testing process and explains what to do after receiving the test results.
To overcome the stigma that may be associated with a positive HIV test result, people can learn about how others are living full, vibrant lives after a positive diagnosis with the support of family, friends, healthcare providers and community groups.
Educating People on Prevention and Treatment Strategies
The cornerstone of efforts to prevent the spread of HIV and AIDS is widespread testing. As stated above, approximately one in seven people in the U.S. with HIV don’t know they’re infected. Educating people about the need for testing and for appropriate precautions after testing positive would reduce the rate of infection substantially, according to the CDC.
By delivering a timely diagnosis, testing allows people with HIV to receive the treatment they need to maintain a healthy immune system and keep AIDS at bay. HIV.gov emphasizes recent improvements in HIV testing that identify infections sooner, which reduces the chances of the person transmitting the disease during the acute phase of the infection when viral loads are highest and the risk of another person contracting the virus is highest.
Incorporating HIV and AIDS Education in Community Outreach
The National HIV/AIDS Strategy for the United States: Federal Action Plan, which the federal government originally published in 2015, was updated in 2020. The plan highlights the important role played by community-based organizations (CBOs), healthcare providers and informal networks of people who have HIV in achieving the goal of making new infections rare and ultimately nonexistent.
Another important goal of the federal strategy is to ensure that everyone who’s living with HIV has access to quality care and has the opportunity to live a full, healthy life free of discrimination and stigma. The plan calls for the CDC to support “community mobilization efforts” to strengthen CBOs’ social network strategies. It also recommends national campaigns targeting segments of the population who are at the greatest risk of contracting HIV.
Resources for HIV and AIDS Education and Prevention
Education is central to the goal of treating, preventing, and ultimately eradicating HIV and AIDS. The strategy for achieving that goal unites community organizations with research and social services agencies at all strata of government. The organizations are among the HIV and AIDS resources available to public health educators and the public.
Use of Online Tools for HIV and AIDS Education
The CDC’s “HIV/AIDS Prevention Tools” page features links to prevention programs available from the agency and from its partners:
- The CDC’s “Intervention Research” page describes evidence-based interventions (EBI) and replicating effective programs (REP).
- The CDC’s “Effective Interventions” page includes information on diagnosing, treating, responding and preventing HIV infections.
- The CDC’s “What’s New” page links to the latest information on the agency’s website relating to preventing HIV and AIDS.
Best Practices for Effective HIV and AIDS Resource Usage
As more therapies and techniques become available to combat HIV and AIDS, it becomes more challenging to measure the effectiveness of specific approaches, which typically combine a mix of methods:
- Taking medications to treat and prevent HIV infections
- Using condoms to prevent infection
- Engaging only in low-risk sex
- Having sex only with people who have the same HIV status
- Abstaining from sex
The CDC provides best estimates of the effectiveness of HIV prevention strategies based on a review of the scientific literature. The following are among the strategies that are analyzed for their effectiveness:
- ART
- PrEP
- Male condom use
- Circumcision of adult males
Intervention Strategy Resources: Diagnosis, Treatment, Prevention and Response
HIV.gov provides an in-depth review of the official federal government response to the HIV/AIDS epidemic titled Ending the HIV Epidemic: A Plan for America.
- The plan’s goal is to reduce HIV infections in the U.S. by 75% by 2025 and 90% by 2030.
- Early detection and immediate access to care resources improve outcomes for individuals and communities.
- Rapid start treatment programs should be available to all. At the same time, the thousands of HIV-positive people who are aware of their status but aren’t currently receiving treatment should be encouraged to resume their care programs.
- Interventions such as PrEP and syringe services programs (SSPs) have been shown to reduce HIV infection rates.
- Real-time response systems allow communities to quickly identify and address new outbreaks of HIV infections. The systems are made possible by innovative epidemiological techniques and close links between federal, state and local resources.
Efforts to Overcome HIV and AIDS Education Challenges
The greatest challenge to HIV and AIDS education efforts in the U.S. and worldwide is the COVID-19 pandemic. Friends of the Global Fight Against AIDS, Tuberculosis and Malaria examines the impact the coronavirus has had on the most vulnerable communities who suffer the highest rates of HIV/AIDS as well as tuberculosis, malaria and other infectious diseases.
When the AIDS epidemic began 40 years ago, the goal of governments, researchers and healthcare providers was to stop it from spreading and develop effective treatments. Today, the challenges are much different, as a recent United Nations meeting on AIDS discussed:
- Wipe out AIDS by 2030.
- Face sensitive issues relating to sex between men, drug use, prostitution and sex trafficking.
- Use new communication methods to reach young people with a message of prevention, testing and treatment.
Resources for Educating the Public About HIV and AIDS Intervention Strategies
- CDC, Guidelines and Recommendations — The directory covers HIV testing, HIV surveillance, prevention and care, HIV/AIDS program management, and guidelines for preventing new infections.
- CDC, Resources for Persons Living with HIV — The guide is available in English and Spanish and includes information for finding and paying for HIV care, travel, housing, employment, and legal issues.
- CAI, National HIV Classroom Learning Center — The CDC funds this resource that’s intended to help the U.S. achieve the goals of End the Epidemic: A Plan for America.
- Healthy People, HIV — The site from the Office of Disease Prevention and Health Promotion provides an HIV overview, the objectives for reducing the rate of HIV infections, and an extensive list of interventions and resources.
- S. Health Resources & Services Administration, Find a Ryan White HIV/AIDS Medical Program Provider — The Ryan White HIV/AIDS Medical Program links people with HIV to local resources that include medical care, medications, case management and mental health services.
- Office on Women’s Health, HIV and AIDS Resources — The directory includes links to HIV and AIDS information specifically for women and girls, including HIV/AIDS care providers and prevention resources.
Public Health Educators Lead the Fight Against HIV and AIDS
Achieving the goal of eliminating HIV and AIDS in this decade will require a well-orchestrated effort involving agencies and legislatures at every level of government, as well as community leaders and healthcare providers. Public health educators are on the front line in the battle to ensure that people with HIV receive effective treatment and to educate vulnerable populations in particular about how to tell the difference between HIV and AIDS, and how to prevent both.
Additional Reading
gov, Global Statistics
gov, “Successes, Challenges, Opportunities: World AIDS Day 2018”
gov, U.S. Statistics
Mayo Clinic, HIV/AIDS
New England Journal of Medicine, “Four Decades of HIV/AIDS — Much Accomplished, Much to Do”
UNAIDS, Global HIV & AIDS Statistics — 2020 Fact Sheet