1. What Providers Need to Know about Community Beliefs Regarding the Origins of HIV Kathleen A. Clanon, MD Paula Runnals, MA East Bay AIDS Education & Training Center 2006 Asilomar Conference – October 4, 2006

2. 1. What beliefs about the origins of HIV have you heard/seen/read about, and from what groups? 2. What are the likely consequences of these beliefs for people in terms of agreeing to testing and treatment for HIV? 3. How should the HIV treatment community respond to people about these beliefs? 4. What further research or interventions should be done about this issue?

3. Does HIV Cause AIDS? Mechanism: HIV attacks the immune system’s CD4 Tcells. Monitoring and Progression: Normal CD4 count = 500 – 1500, AIDS CD4 count < 200. On average, it takes 10 years to develop AIDS from time of initial infection with HIV. Effect: As a person’s CD4 count decreases, he/she is more prone to opportunistic infections.

4. Evidence that HIV Causes AIDS: Timing: HIV and AIDS appeared in the world at the same time. As HIV spreads, so does AIDS. Mode of Spread: HIV spreads from person to person by sex and blood, which is also how AIDS spreads. Pathologic Mechanism: HIV destroys immune T4 cells, and most AIDS probs result from T4 deficiency or dysfunction. Effect of Rx: HAART, which targets HIV, extends life for people with AIDS.

5. T Cell with Budding HIV

7. Origins of HIV HIV-1 likely descended from SIV cpz HIV-2 likely descended from SIV sm Pan troglodytes troglodytesSooty Mangabey

8. Origins of HIV: Simian Zoonosis Simian Immune-deficiency Viruses (SIVs), which exist in many primate species, routinely infect humans but don’t usually survive long enough to become established and spread. On at least four occasions (M, N, O and SIV 2), the SIV mutant was different enough to establish itself in the human host and become transmissable to other humans.

9. Origins of HIV: Evidence Close Genetic Relationship: SIVs are older evolutionarily than HIVs, logical “parent” viruses. Geography: HIV first seen in areas of SIV prevalence. Mechanism: Other infections move from monkeys to humans.

10. Two Types of HIV

11. HIV-1 vs. HIV-2 HIV-1  More virulent  Responsible for worldwide epidemic  Severity of infection varies from person to person HIV-2  Primarily found in western Africa  Not transmitted as efficiently  Genome more closely related to SIV mm than HIV-1

12. Origins of HIV Researchers believe that chimpanzees are the source of HIV-1. SIV cpz is HIV-1’s closest relative. Caveats:  Chimps are only rarely infected with SIV cpz  Actual Reservoir maybe a third unidentified primate species  Only 6 CPZ with SIV available for study. Definitive source remains elusive

13. How did it happen? Human killing and eating of chimpanzees contact with infected blood ingestion of uncooked or undercooked meat Chat - polio vaccine Hypothesis: HIV is a recombinant construct that occurred when SIV from a contaminated vaccine was administered to humans and arose when human antigens were incorporated into the SIV  Two reports in 2001 discount this theory (Blanco P. et al. and Berry N. et al.)

14. When did it happen? Three earliest known HIV infections 1959 - serum sample from an adult male living in what is now the Democratic Republic of Congo 1969 - tissue samples from a teenager who died in St. Louis 1976 - tissue samples from a Norwegian sailor January 2000 - study by Dr. Bette Korber estimates first case of HIV infection to be 1930 Study based on complicated computer model of HIV’s evolution and has a 20yr error margin

15. Where did it happen? The primates that carry the SIVs most closely related to HIV are indigenous to west and central Africa

16. Chimpanzee Range

17. HIV/AIDS in Africa

18. Community Beliefs

19. 1972 – The Tuskegee Syphilis Experiment

20. 2005 Katrina

21. Community Beliefs About HIV: RAND Study 500 African Americans surveyed by phone Education:  High school grad or less51%  Some college or more49% Income:  <$35,00053.4%  >$35,00046.6%

22. Community Beliefs: RAND Results Institutions are trying to stop HIV 75.4 % People who take new meds are guinea pigs 43.6 % AIDS is a form of genocide 15.2 % AIDS was produced in a government lab. 26.6 % Information about AIDS is being withheld58.8 % Cure for AIDS exists, but withheld from poor53.4 % Medicines used to treat HIV are saving lives in the black community38.4% Bogart, Thorburn (2005)

23. Community Beliefs and HIV Prevention Men had stronger conspiracy beliefs than women Men who had higher conspiracy beliefs had more negative attitudes about condoms and less likely to use condoms (OR 4.52) Bogart, Thorburn (2005)

24. Belief in AIDS as a genocidal conspiracy (%) “AIDS is an agent of genocide created by the US government to kill off minority populations.” A.A.HispanicAsianWhite M F MFMFM F True27.331.221.423.811.27.219.221.7 Don’t16.618.612.518.57.04.03.55.2 Know Total n20623525120414515420097 Ross, JAIDS, March 2006

25. HIV & Genocide: Other Surveys The AIDS virus was “deliberately created in a laboratory in order to infect black people.” (NY Times/WCBS Poll 1990)  Believed to be true by 10% of African Americans  Believed might be true by another 20% AZT is a plot to poison African American people. Urging condom use is a scheme to prevent African American births. Distributing clean needles is designed to encourage drug abuse. Copyright 2003 American Medical Association. All Rights Reserved

26. HIV & Genocide “Well, this is just my opinion. The population is growing. People are dying at slower rates. So they said, ‘let’s see what happens if we infect this (HIV) out there’.” (Corbie-Smith 1999) “I think [experimentation on Blacks] is still going on now. Like AIDS, it was man-made but it kind of got out of hand.” (Freimuth 2001) Copyright 2003 American Medical Association. All Rights Reserved