AIDS viruses reproduce in CD4 cells and circulate in the blood. In this electron micrograph of a white blood cell, AIDS viruses can be seen as the small white dots covering the cell’s surface.
Credit: Centers for Disease Control and Prevention

Today, December 1, 2022, is World AIDS Day. AIDS is the final, life-threatening stages of infection with the human immunodeficiency virus (HIV). HIV damages the immune system, the human body’s most important defense against disease. AIDS stands for acquired immunodeficiency syndrome or acquired immune deficiency syndrome. On this day, we honor over 40 million people who have lost their lives to AIDS and look ahead to ending the AIDS pandemic through research, healthcare, and community support. The World Health Organization reported that 38.4 million people were living with HIV across the globe at the end of 2021.

AIDS is a relatively new life-threatening disease. HIV is spread through sexual intercourse with an infected person or exposure to blood from an infected person, many times through shared needles used to inject drugs. At first, it mainly affected young adults. In the public imagination, the disease soon became associated with risky sexual behavior and with drug abuse. For all these reasons, efforts to address AIDS or to prevent the spread of HIV have at times faced unique social challenges. An infected pregnant woman can transmit HIV to her unborn child before and during the delivery, even if the woman shows no symptoms. An HIV-infected mother may also pass HIV to her baby through breast-feeding.

Since 1986, the international health community has worked to coordinate the global fight against HIV and AIDS. The World Health Organization’s Global AIDS Programme formed the Joint United Nations Programme on HIV/AIDS (UNAIDS) in 1996. Since that time, UNAIDS has worked with other international partners to coordinate the global fight against HIV and AIDS. UNAIDS reported recently that one obstacle to ending AIDS around the world is gender inequality. Many girls and women live with HIV and AIDS without treatment and education to prevent infection. They report that in countries where girls do not receive an education, the rates of HIV infection are higher. UNAIDS also stated that in countries where same-sex relationships are criminalized the probability of infection is increased.

Many individuals and organizations have worked to increase public awareness of AIDS. The most active organizations include community-based groups and the American Red Cross. They hope that greater awareness will generate more compassion and support for people living with AIDS. They also hope to ensure adequate funding for HIV prevention, treatment, and research. One prominent project bringing attention to the crisis is the AIDS Memorial Quilt. Begun by the NAMES Project Foundation in 1987, the quilt consists of thousands of individually designed panels. The panels memorialize people who died of AIDS. The quilt has been displayed throughout the world.

Poor understanding of HIV has at times stoked public fears, leading many people with the virus to suffer unjustly. Some of the infected have lost or been denied jobs or housing. Others have been denied medical care and health insurance. Many children with AIDS were initially barred from attending school or playing on sports teams. To prevent discrimination, people with HIV and AIDS are often included under laws protecting the rights of people with disabilities. The United States government and some states have also strengthened laws safeguarding the confidentiality of medical records relating to HIV infection and AIDS.

Preventing discrimination against people with HIV is not only just—it also protects public health. When people can live without fear of discrimination, they are more likely to seek counseling and treatment. In many cases, such measures lead to earlier diagnosis and a reduction in risky behavior.

AIDS was first identified as a disease by physicians in California and in New York City, New York, in 1981. Doctors recognized the condition as something new because all the patients were previously healthy, young gay men. They sought medical care because they were suffering from otherwise rare forms of cancer and pneumonia. In 1982, the disease was named AIDS. Scientists soon determined that AIDS occurred when the immune system became damaged. They also learned that the agent that caused the damage was spread through sexual contact, shared drug needles, and infected blood transfusions.

AIDS occurs in every nation. In areas such as Africa south of the Sahara, Southeast Asia, and India, HIV transmission has occurred mostly among heterosexual men and women, particularly young adults and teens. Many developing nations carry enormous burdens of HIV infection. For example, the United Nations reports that in some parts of Africa, the infection rate may reach over 30 percent in some urban areas. The huge number of young adults dying of AIDS in Africa south of the Sahara has decreased overall life expectancy across the continent. A growing number of people have also become infected in countries with increasing drug use, such as Russia, China, and the nations of central Europe.

An electron microscope shows monkeypox virus particles.
Credit: Cynthia S. Goldsmith and Russell Regnery, CDC

On May 13, 2022, the World Health Organization was notified of two confirmed cases of monkeypox in the United Kingdom. Not the chickenpox, monkeypox! Since then, cases have been detected in Canada, Italy, Portugal, Spain, Sweden, and the United States. Many people are now asking: what is monkeypox and how bad is it?

Monkeypox is a viral disease that affects animals and, in rare cases, human beings. Scientists first isolated and identified the monkeypox virus from laboratory monkeys in 1958. They obtained it from monkeys that had an unusual rash of skin pustules (small bumps filled with fluid). Historically, such pustules were called pox, leading to the name monkeypox. Other animals, including rats, squirrels, and mice, can also carry monkeypox.

People that eat or get bitten by infected animals can catch monkeypox, but the virus does not spread easily from person to person. The disease is uncommon in human beings. The first human case of monkeypox was not recorded until 1970.

Monkeypox occurs naturally among wild animal populations of central and western Africa. Since the 1970’s, it has caused occasional outbreaks of illness among people in the region. In 2003, 71 people in Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin became ill with confirmed or suspected cases of monkeypox. They caught the disease after handling prairie dogs that were purchased at a pet shop in Illinois. Prairie dogs do not naturally carry the monkeypox virus. The animals became infected at the pet shop, where they were housed with a rodent called a Gambian giant rat that carried the virus. An animal dealer had imported the rat from Africa to sell it as a pet.

Several people were hospitalized in the 2003 outbreak, but there were no deaths. Physicians and veterinarians quickly quarantined (isolated) people and animals that might have been exposed to the virus. This action was designed to prevent the disease from spreading to other people, pets, or wild animals. Following the outbreak, the United States Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) banned the importation of rodents from Africa. They also banned the transport and sale of prairie dogs and African rodents within the United States.

Symptoms of the disease develop about two weeks after a person is exposed to the monkeypox virus. Symptoms include fever, headache, muscle pain, backache, and swelling of lymph nodes. Following the fever, a rash appears on the face and other parts of the body. The rash develops into fluid-filled pustules, which dry up and fall off. The illness lasts from two to four weeks. In Africa, from 1 percent to 10 percent of people infected with monkeypox die from the disease.

Physicians suspect monkeypox if a person shows the symptoms and has had contact with an infected person or animal. Laboratory tests are used to detect the monkeypox virus in samples from blood, pustules, or scabs of patients.

People can prevent infection by not handling wild animals that may carry the virus. The monkeypox virus is related to the virus that causes smallpox. Smallpox vaccine can protect against monkeypox when it is given before a person is exposed to the virus. Smallpox vaccination given after exposure to monkeypox may help prevent the disease or make it less severe. However, because the disease is uncommon, health officials do not recommend widespread smallpox vaccination to protect people from monkeypox.

September 19, 2013

Infections caused by superbugs could kill hundreds of thousands, if not millions of Americans, if medical and public health professionals as well as ordinary citizens do not combat the threat posed by these antibiotic-resistant bacteria. That is the conclusion of the authors of a new report, Antibiotic Resistance Threats in the United States, 2013, released by the Centers for Disease Control and Prevention (CDC) in Atlanta. In an effort to call attention to the problem, CDC officials have established a new rating system that provides “a snapshot of the burdens and threats posed by antibiotic-resistant germs having the most impact on human health.” CDC officials said urgent steps are needed to prevent some infections from becoming essentially untreatable. “Without urgent action now, more patients will be thrust back to a time before we had effective drugs,” said CDC Director Thomas Frieden.

So-called superbugs are bacteria with the ability to overcome medications and other substances that might kill them or interfere with their growth. Each year, more than 2 million Americans develop antibiotic-resistant infections; some 23,000 of these people die, according to the CDC. The main reason for the rise of the superbugs is the widespread use of antibiotics. Up to 50 percent of all antibiotics prescribed for Americans are unnecessary or inappropriate. For example, people often request and doctors prescribe antibiotics to treat the common cold or flu. However, these infections are caused by viruses, which cannot be controlled by antibiotics. Even more worrisome is the amount of antibiotics used to promote growth and prevent and treat infections in livestock–up to 80 percent of all antibiotics used in the United States. Human ingest these antibiotics by eating meat. The more an antibiotic is used, the more quickly it can develop resistance, the CDC emphasized.

Bacteria, such as these Streptococcus cells, cause many diseases, including ear infections, strep throat, and pneumonia. ((c) Oliver Meckes/Science Source from Photo Researchers)

The CDC rating system includes three threat levels–concerning, serious, and urgent–based on seven factors. These include how common a bacterium is, how easily it spreads, the number of people it infects or kills, and the availablity of antibiotics to combat it. Three superbugs made the “urgent” list in the new report: CRE bacteria, Clostridium difficile (C-Diff), and Neisseria gonorrhoeae.

The CRE family of bacteria includes E. coli, which can cause serious illness or even death. E. coli is often found on improperly washed vegetables. Some CRE bacteria are already resistant to antibiotics.

C-Diff kills up to 14,000 people and causes 250,000 hospitalizations each year. It is often acquired in hospitals in which the staff has failed to maintain sanitary standards. These bacteria are also resistant to many antibiotics. 

Neisseria gonorrhoeae is the drug-resistant form of the bacterium that causes gonorrhea, a sexually transmitted disease and the second most commonly reported infection in the United States, according to the CDC.

The CDC report listed four major steps to fight antibiotic resistance:

• Preventing infections (through immunizations, safe food handling, and handwashing);
• Tracking bacterial infections (to determine factors that contribute to their spread);
• Improving the use of antibiotics (using them only when necessary and appropriate);
• Developing new antibiotics and diagnostic tests (to track the spread of resistance and quickly distinguish between illnesses caused by bacteria and viruses).

Additional World Book articles:

• Sanitation
• Handwashing: The First Line of Defense Against Disease (a special report)
• The War on Superbugs (a special report)