Challenges of the AIDS Epidemic

This article is provided by the Health and Temperance Department of the General Conference of Seventh-day Adventists.

Harvey A. Elder, M.D., is a professor of the Department of Medicine and chief of the Department of Infectious Diseases, Jerry L. Pettis Memorial Veterans Hospital.
Joyce W. Hopp, PhD., M.P.H., is dean and professor of the Department of Health Education, School of Allied Health Professions, Loma Linda University.
John E. Lewis, Ph. D., is associate professor of the Department of Pathology and Laboratory Medicine, School of Medicine, and chair of the Department of Clinical Laboratory Science, School of Allied Health Professions, Loma Linda University.

Acquired immune deficiency syndrome (AIDS) has spread worldwide and, because of its inevitably fatal end, has left fear, rumors, and panic in its wake. Fear of the disease has robbed many Christians of their compassion, health workers of their commitment to caring, and employers of their fair practices.

What does AIDS mean to a minister of the gospel?

The minister's role

The AIDS epidemic presents challenges to all who minister: chaplains in health-care institutions and the armed forces, pastors of congregations, and administrators who serve on boards of educational institutions. Today's world is fueled by information. The epidemic of fear accompanying AIDS is fueled by misinformation and a lack of information. To fill their educational and counseling roles properly, ministers need to have accurate information about AIDS.

The epidemic is not something that happens only to the sexually promiscuous and the intravenous drug users. It happens to family members. It happens to children of "good Christians"; it happens to children who were reared with family worship, regular Bible reading, and prayer. Yes, it is spread to those who only experiment and who are sorry and wish they never had.

The number of cases is increasing so fast that by December of 1991 there will be 170,000 AIDS patients in the United States; 75,000 will die from AIDS in 1992! In practical terms, that means almost every family will be affected. Everyone will know someone who is HIV infected. AIDS will be the major cause of death among babies and young adults. Much of ministers' time and efforts will be spent counseling those suffering with AIDS or grieving from the loss of a dear one through AIDS. AIDS will be hidden pain, the unspeakable sorrow.

Ministers are in a unique position to counsel AIDS victims and their friends and family. They are trusted counselors who know how to help individuals face a life-threatening disease, they can apply the same skills they have used in the past for those suffering from cancer. A significant difference, and one that, touches every caregiver, is that AIDS primarily strikes young people who are in the productive years of their lives, as well as babies and young children. Ministers are experienced at helping people face the eternal question of death and a life here after. Their assistance can be valuable when patients learn they are infected with the AIDS virus.

The educational role of ministers extends beyond their congregation or institution to the community. Although sexual promiscuity and intravenous drug abuse are major factors in the spread of the AIDS virus, the church cannot merely oppose these behaviors. It must do something more. What does the church have to say about healing for the broken people who trade life for sex and drugs? The caring church must become so grateful for the gift of grace that it will extravagantly share the good news as it provides healing from loneliness, ostracism, and guilt. We must realize that gays, prostitutes, and intravenous drug users are Christ's children also.

We need to become communities who realize that ethnicity enhances education, including education to avoid HIV infection. Black and Hispanic churches need to make major commitments to their own young. Inner-city churches need to become refugees for the disadvantaged and those in despair. In these communities, the incidence of infection with HIV is increasing alarmingly. In the United States 24 percent of persons with AIDS are Black, while Blacks represent only 12 percent of the population; 14 percent of persons with AIDS are Hispanic, while Hispanics rep resent only 7 percent of the population. Seventy percent of women with AIDS are Black or Hispanic. 1 The high rate of AIDS in these ethnic groups appears to be related primarily to intravenous drug users, their sexual partners, and babies born to infected women.

When school boards are forced to deal with students known to be HIV-infected, they need the wise counsel of individuals knowledgeable about the disease. Often when groups lack adequate information, they tend to substitute of those boards, can recommend the best of scientific counsel before making policy decisions.

What are the latest facts?

AIDS is caused by a virus called the human immunodeficiency virus (HIV), so named because it attacks and depresses the body's immune system. In particular, the virus attacks the Thelper lymphocyte, the thymus-educated cell that serves as the "leader of the orchestra," to coordinate the re action of the immune system to invading cells. When a person has a depressed or deficient immune system, he or she becomes susceptible to infections and cancers that his or her immune systems normally could ward off.

Under an electron microscope the HIV looks as if it has spikes all over its surface. These spikes are like the hooks of Velcro. When the virus enters the body, through the blood or by sexual intercourse, it binds to body cells that have the appropriate loops, or receptors, for virus attachment. Specific receptors on the host cells, called CD4, are the only sites where the HIV will attach and enter. T-helper lymphocytes, brain cells, macrophages, and colorectal cells all have these receptors. The virus cannot attach to skin cells or to the cells in the respiratory system. This helps to explain why you cannot get the virus by touching a doorknob, tableware, toilet seat, or by breathing in the virus, shaking hands, or touching a person with AIDS.

The virus is transmitted from one person to another by sexual intercourse (either homosexual or heterosexual), by intravenous drug use, by transfusion with infected blood or blood products, and perinatally, from infected mother to baby. Semen, blood, pus, and vaginal secretions contain large numbers of the virus. These account for 96 percent of HIV transmission. The remaining 4 percent are transmitted perinatally or by accidents that occur in the healthcare setting. Although saliva, tears, urine, and feces may occasionally contain HIV, they have very low infectivity. None of the first 70,000 reported cases of AIDS studied were transmitted by these fluids.

The virus knows no sexual orientation. It is transmitted by people with high-risk behaviors. High-risk behaviors include sharing blood-contaminated syringes and needles, sexual relations with an intravenous drug abuser and/or an HIV-infected person, and anal sex with infected persons. There is an increased transmissibility if individuals are already infected with another sexually transmit ted disease that produces genital lesions, such as syphilis or herpes.

Before 1985 the virus was frequently transmitted by transfusion of infected blood and blood products. Since that date, the blood supply in the developed countries of the world has been protected by a laboratory test, and the risk of acquiring AIDS from a transfusion is now very low (1 in 40,000 to 250,000). There is not now, nor has there ever been, a risk from donating blood. In fact, with the continuing need for uninfected blood, Christians can give the "gift of life" by donating blood regularly.

Mosquitoes or other biting insects do not transmit the virus. There is good epidemiological and laboratory evidence for this. 2 In Belle Glade, Florida, the documented high infection rate was caused by intravenous drug use, not mosquitoes. Children, who have the most exposure to mosquitoes, had antibodies to mosquito-borne infections, but they did not have antibodies to the HIV. Those with HIV antibodies did not have antibodies to mosquito-borne infections.

For an infectious disease to be vector-transmitted, the infectious agent must survive in the insect long enough for the vector to inoculate another host. HIV cannot do this. Laboratory studies show that after mosquitoes eat a blood meal from an HIV-infected person, the RNA (genetic material) of the HIV can be found in the mosquitoes, but that RNA quickly disintegrates in mosquitoes. HIV does not survive, let alone multiply, in mosquitoes. Even when mosquitoes feeding on HIV-infected blood have their meal interrupted, they do not transmit HIV to a person they bite a few seconds later.

Within three to four weeks of inoculation by the virus, a person becomes capable of transmitting the virus. The person is infectious and remains infectious for the rest of his or her life. The antibody test currently being used, called ELISA (enzyme-linked immuno-absorbent as say) does not test positive until at least six to twelve weeks after inoculation with the virus, and may not yield a positive result for as long as three years. This means that an infected person can infect others even though he or she tests negative. The antibody test remains positive for life, occasionally becoming negative in the late stages of AIDS, although the individual is still infectious. Newer tests under development may be able to detect the virus within two weeks after inoculation, before the individual becomes infectious.

In adults the incubation period, the time between inoculation and appearance of symptoms of AIDS, varies from two to twelve years, and may be even longer in some individuals. Accumulated data has shown that the period from the onset of symptoms to death may vary from one to four years. Newborn children die faster, usually not living beyond two years.

There is no known cure for AIDS. There is no way to remove the virus from the body once it has entered the host cells, although researchers are hunting for points at which to intervene in the life cycle of the virus. Health promotion activities, such as maintaining good nutrition and getting sufficient rest and exercise, may help an HIV infected individual deal with opportunistic infections, but will not cure the infection. Once the virus has entered the host cells, it can remain hidden for years as a "provirus." It produces no symptoms, but the individual remains infectious and will eventually develop symptomatic AIDS.

Studies indicate that in at least 40 per cent of persons with AIDS there is evidence of central nervous system involvement.3 Often symptoms of central nervous systems involvement, such as forgetfulness, loss of concentration, con fusion and slowness of thought, depression, and loss of fine motor skills, precede the onset of other symptoms of AIDS by a year. AIDS dementia complex describes a wide range of impairment of the central nervous system that presents special problems to home caregivers or to employers of individuals thus impaired.

Challenges to Ministers

How will you answer the parents who fear sending their youth to a boarding school when they hear a student with AIDS has been accepted there? Is AIDS transmitted casually, by drinking fountains, in bathrooms, or in the food service? The answer is no. Schools should not discriminate against HIV-infected students, but rather should educate all students about the means of transmission of this virus. The lifestyle that Christians have advocated for centuries is still the best protection: no sexual experimentation before marriage and a committed monogamous relationship with a trusted spouse. Schools can accept students with AIDS who are physically and mentally able to benefit from school attendance.

How will you counsel families caring for persons with AIDS at home? Because of sexual intercourse, spouses risk becoming infected. Studies indicate, however, that other family members are at no risk, even when sharing bath rooms, kitchen facilities, food, even toothbrushes. 4, 5 A simple disinfectant of chlorine bleach (1:10 solution) is sufficient to clean equipment soiled by con tact with the patient's body fluids. Ministers can safely visit such patients at home or hospital, and need not fear giving a comforting touch, even a hug.

Since thus far 78 percent of the cases of AIDS have been among homosexual or bisexual males, what counsel are you able to give to parents of gay sons? First, assure them that today gays are among the most knowledgeable individuals on AIDS. They now know the high-risk behaviors to avoid. Second, avoid judgmental comments about the choices the son has made. Parents have already asked themselves, "Why? What did we do to cause this?" Third, encourage parents to maintain contact with their sons as nonjudgmentally as possible. They need not agree with the choices their sons have made, but rejection will only hurt everyone concerned.

What if persons with AIDS attend your church? Welcome them. Shake their hands, give them a hug. Ask them to become members. Invite them to participate in foot-washing and Communion services. Bring them home to dinner after the services; invite them to the social functions of the church.

How will you help the youth in your church avoid high-risk behaviors? Establish a warm and open relationship with them. Don't use scare techniques, but do make clear the risks involved with sexual and drug experimentation. Even one such contact with an HIV-infected person can be one too many. While health scientists have been shown to be the most credible sources of information about AIDS, well-informed ministers who avoid judgmental pronouncements may also prove trusted confidants.

Chaplains have special opportunities to become members of health-care teams in dealing with the psychological and spiritual needs of HIV-infected individuals and persons with AIDS. Times of particular need are: when a person first learns of an HIV-positive test (it is not an immediate death threat); when an HIV-infected mother delivers an infected baby (50 percent of babies delivered to infected mothers are infected); when a patient comes in with the first opportunistic infection (most of these can be successfully treated); when the AIDS patient is dying (spiritual peace is especially meaningful then).

The church can be an island of sanity in the hysterical response to the AIDS epidemic. The church needs to be about its mission incarnated in a sinful and dangerous world. It needs to move forward with confidence, knowing that it is God's agent of redemption. It can trust God, and with courage minister to those afflicted with HIV infections. It can touch them, knowing that touch heals and does not spread the infection. We can bring a last message of hope to persons with AIDS. God, not AIDS, has the last word regarding eternal life, and persons with AIDS need to know the good news that ministers can share.

1 D. R. Hopkins, "AIDS in Minority Populations
in the United States," Public Health Reports
102, No. 6 (1987): 677.

2 W. Booth, "AIDS and Insects," Science 237,
(1987): 355.

3 D. A. Navia, R. D. Jordon, and R. W. Price,
"Central Nervous System Complications of Immunosuppression,"
inj. E. Parrillo, H. Masur, eds., The Critically ill Immunosuppressed Patient
(Rockville: Md.: Aspen Publishers, 1987).

4 J. E. Kaplan, J. M. Oleske, and J. P: Getchell,
"Evidence Against Transmission of Human Tlymphocyte
Virus/Lymphadenopathy Associated
Virus (HTLV-III/LAV) in Families of Children
With the Acquired Immunodeficiency
Syndrome," Pediacric Infectious Disease (1985):

5 M. A. Fischl, G. Dickinson, G. Scott, M.
Klimas, and W. Parks, "Evaluation of Household
Contacts of Adult Patients With the Acquired Im
munodeficiency Syndrome," quoted in Morbity-
Mortality Weekly Report, January 1981-February
1986, p. 109.

Ministry reserves the right to approve, disapprove, and delete comments at our discretion and will not be able to respond to inquiries about these comments. Please ensure that your words are respectful, courteous, and relevant.

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Harvey A. Elder, M.D., is a professor of the Department of Medicine and chief of the Department of Infectious Diseases, Jerry L. Pettis Memorial Veterans Hospital.
Joyce W. Hopp, PhD., M.P.H., is dean and professor of the Department of Health Education, School of Allied Health Professions, Loma Linda University.
John E. Lewis, Ph. D., is associate professor of the Department of Pathology and Laboratory Medicine, School of Medicine, and chair of the Department of Clinical Laboratory Science, School of Allied Health Professions, Loma Linda University.

March 1989

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