**3. Pathophysiology**

250 Social and Psychological Aspects of HIV/AIDS and Their Ramifications

endowment of physical resources (land, minerals and raw materials), in addition to its endowment of human resources (the number of people in a country and their skill level) (Dhar, 1995). However, the latter seems to have been demoted by the scourge of the HIV/AIDS pandemic within regions that are most affected. That HIV/AIDS epidemic has been ravishing the world for the past three decades, is a given fact and, therefore, calls for urgent action both individually and collectively. This paper attempts to ascertain the possibility of a relationship between HIV/AIDS and productivity of worst affected regions pursuant to broadening knowledge regarding HIV/AIDs as it affects the global economy.

• HO1: there is no significant relationship between the productivity of a total population and the productivity of a reduced population owing to the HIV/AIDS epidemic. • HA1: there is a significant relationship between the productivity of total a population and the productivity of a reduced population owing to the HIV/AIDS epidemic.

Since its inception, several definitions have been developed for epidemiological surveillance such as the Bangui definition and the 1994 expanded World Health Organization AIDS case definition. However, clinical staging of patients was not an intended use for these systems as they are neither sensitive nor specific. In developing countries, the World Health Organization's staging system for HIV infection and disease relied on clinical and laboratory data (UNAIDS, 2004). In 1990, the World Health Organization (WHO) grouped these infections and conditions by introducing a staging for patients infected with HIV-1, which was updated in September 2005 (WHO 2006). Most of these conditions are opportunistic

ii. Stage ii: includes minor mucocutaneous manifestations and recurrent upper respiratory

iii. Stage iii: includes unexplained chronic diaorrhea for longer than a month, severe

iv. Stage iv: includes toxoplasmosis of the brain, candidacies of the esophagus, trachea, broneli or lungs and Kaposi's Sarcoma, which are all diseases that are indicative of

Previously, the Centre for Disease Control and Prevention (CDCP) did not have an official name for the disease, and had often referred to it by other diseases that were associated with it, for example, lymphadenopathy, a disease after which the discoverers of HIV originally named the virus. They also used Kaposi Sarcoma, an opportunistic infection, and named a task force after this, which was set up in 1981. In the general press, the term GRID, which abbreviated Gay-Related Immune Deficiency, was also coined (Goldstein, 1983). However, after determining that AIDS was not confined to the homosexual community, the term GRID became misleading, therefore, AIDS was adopted at a meeting in July 1982 (Altman, 1984). By September 1982, the CDCP began to use the name AIDS to include all HIV positive people with a CD4+T cell count below 200 per μl of blood. However, 14% of all cases in

AIDS diagnosis still applies even if, after treatment, the CD4+T cell count rises to above 200 per μl of blood, and even if other AIDS-defining illnesses are cured (Black, 1986, Nomcebo, 2005). The following criteria should be satisfied before a diagnosis of AIDS can be made:

developed countries use either this definition or the pre-1993 CDCP definition.

The following hypothesis is proposed:

infections that are easily treatable in healthy people.

bacterial infections and pulmonary tuberculosis.

i. Stage i: HIV infection is asymptomatic and not categorized as AIDS.

**2. Diagnoses of HIV/AIDS** 

tract infections.

AIDS.

Retroviruses have a unique method of reproducing, which allows the virus to copy its genetic information into a form that can be integrated into the host cells' own genetic code. Each time the host cell divides, viral copies are produced along with more host cells. The HIV attacks and gradually depletes a specialized group of lymphocytes, T helper or T4 cells. T cells normally play a key role in setting the immune system's responses in motion (McMichael, 2000). They send out chemical signals that stimulate production of antibodies and trigger maturation of other types of cells within the immune systems (B cell, macrophages and nerve cells). HIV not only depletes T helper cells, but also prevents remaining cells from functioning properly. B-cells become defective in an ability to produce immunoglobulin in response to appropriate stimuli. Loss of immunity is selective and affects primarily parts of the immune system that are involved in defenses against parasites, viral and fungal organisms, hence people who have AIDS, develop certain unusual life infections (ibid).

> Diagrammatic illustration of stages of HIV Infection ↓ Development of antibodies (seroconversion)

#### ↓ Asymptomatic carrier state ↓ AIDS related complex (Non-life threatening conditions)

↓

Continuing asymptomatic state -------- recovery ------ continuing illness

↓ AIDS and other life threatening conditions

> ↓ Death

Source: Ukpere, 2007.

HIV/AIDS and the Productivity of Selected Sub-Saharan African Regions 253

primary mode of HIV infection worldwide. Sexual transmission occurs with contact between sexual secretions from one partner with the rectal, genital or oral mucous membranes of another. Unprotected receptive sexual acts have a greater risk of transmitting HIV from an infected partner to an uninfected partner through unprotected anal and vaginal intercourse/sex (Nomcebo, 2005). Oral sex is not without its risks as HIV may be transmissible through both assertive and receptive oral sex (HIV InSite, 2003). The WHO (2006) reported that the risk of HIV transmission from exposure to saliva is considerably smaller than the risk from exposure to semen. Contrary to popular belief, one would have to swallow gallons of saliva, for a person to run a significant risk of becoming infected. About 30% of women in ten countries representing 'diverse cultural, geographical and urban/ rural settings', reported that their first sexual experiences were either forced or coerced, which makes sexual violence a key driver of the HIV/AIDS pandemic. Frequent sexual assaults result in physical trauma to the vaginal cavity, which facilitates transmission of HIV. During a sexual act, male/female condoms can reduce the chances of infection with HIV and other STDs, and of course the chances of becoming pregnant (Rutter & Quine, 2002; Nomcebo, 2005). The best evidence, to date, indicates that proper condom use reduces the risk of heterosexual HIV transmission by about 80% over the long-term. The benefit is higher if condoms are used correctly on every occasion. Promoting condom use, however, has often proven controversial and difficult. Several religious groups, particularly the Roman Catholic Church, have opposed the use of condoms on religious grounds and have sometimes perceived condom promotion as an affront to the promotion of marriage,

WHO (2004) reported that there is currently no vaccine or cure for HIV/AIDS. The only known methods of prevention are based on avoiding exposure to the virus and an antiretroviral treatment, which, when taken directly after a highly significant exposure, called post-exposure prophylaxis (PEP), has a demanding four week schedule of dosage. Current treatments for HIV infection consist of highly active antiretroviral therapy (HAART). This has been highly beneficial to several HIV-infected individuals since its

In the first decade of the epidemic when no useful conventional treatment was available, a large number of people who have AIDS experimented with alternative therapies (Nomcebo, 2005). The definition of "alternative therapies" in AIDS has changed since then. During that time, the phrase often referred to community-driven treatments, were untested by government or pharmaceutical company research, and which most people hoped would directly suppress the virus or stimulate immunity against it. Despite widespread use of complementary and alternative medicines by people who live with HIV/AIDS, effectiveness

Treatment of AIDS consists of treatment of the HIV infection and complications, which result from the immune deficiency. A number of chemotherapeutic agents such as Zidovudine or AZT, Ribavirin, Suramin, Foscarnet and HPA- 23 have been used as antiviral agents, with limited success. Thus far, only Zidovudine has been approved for use in several countries, since it has been shown to cross the blood brain barrier. However, it is expensive

monogamy and sexual morality (BBC News, 2009).

of these therapies has not been established (UNAIDS, 2004).

introduction in 1996 (UNAIDS, 2009).

and toxic to bone marrow.

**5. Treatment** 

Several common diseases such as tuberculosis, malaria, influenza, measles malnutrition and stress temporarily suppress immune response, but once infection subside immune system returns to normal but in AIDS it does not. Antibodies to HIV form in 1 – 4 months after infection but symptoms may not appear for up to 5 years and beyond in some cases and during these years, a person can transmit the virus to others without knowing.
