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Sydney Tolleson Grand Canyon University PCN-153 Co-Occurring Disorders and HIV/AIDS Dr. Salvucci September 17, 2023 1
Introduction The Human Immunodeficiency Virus, or HIV, is a retrovirus that is known to cause acquired immune deficiency syndrome or AIDS in humans. HIV attacks the body’s cells that fight off infections, making the person who is infected extremely vulnerable to other infections and diseases ( What Are HIV and AIDS? , n.d.). If it is left untreated, HIV is known to cause AIDS, a disease in which there is a significant loss in the body’s natural cellular immunity, which greatly lowers the resistance to all infections and cancers, and inevitably leads to death ( What Are HIV and AIDS? , n.d.). Since the discovery of HIV/AIDS in the late 1900s, there has been a tremendous amount of research done to learn about and help fight this disease. There have been many false theories and myths that have arisen about where it came from as well as who is at risk for infection. However, recent studies provide scientific proof of the evolution of HIV/AIDS, which has helped researchers find a way to slow the progression of the disease. Due to the negative stigma associated with HIV/AIDS, many people have shied away from talking about it, much less getting tested or receiving treatment. This can cause major depression, and other mental health concerns, including substance abuse. Since the discovery of HIV/AIDS, many false theories and myths have surrounded the idea of the disease, making it difficult to know the facts, which negatively impacts those who are diagnosed, making it imperative that counselors and other health care professionals have a solid understanding of the disease to best help the clients. Proven Theory Much confusion has surrounded the origin of HIV/AIDS since the first recognized case in 1981, in which HIV-1 was found to be the causing agent of AIDS (Sharp & Hahn, 2011). Since then, researchers have spent countless resources and time trying to distinguish where this virus 2
came from, and how it suddenly appeared. The first clue was found in 1986 when a similar but distinct virus, which later came to be known as HIV-2, was found to cause AIDS in patients in Western Africa, (Sharp & Hahn, 2011). Although HIV-1 and HIV-2 were not closely related, they were both found to be closely related to is simian immunodeficiency virus (SIV), which is a virus found in chimpanzees and other native African species of monkeys (Sharp & Hahn, 2011). It was also later confirmed that SIV was not a natural pathogen of the original chimpanzees and monkeys it was first found it, but rather it had been generated invertedly in US primate centers be inoculating various species of monkeys with blood and other tissues from the Sooty Mangabey monkeys that are native to Africa (Sharp & Hahn, 2011). After many years of studying the virus, the most widely accepted theory about where it came from, and how it infected humans is that it was naturally found in chimpanzees that were hunted for meat, and that the hunters must have come in contact with the blood of an infected primate (Sharp & Hahn, 2011). Discredited Theories The lack of understanding of the epidemic of HIV/AIDS caused a lot of worry and distress among the public. One of the more controversial theories about how HIV/AIDS came about was that government scientists genetically modified the virus and introduced it into the population via hepatitis B vaccines as experiments performed on gay and bisexual men, especially African Americans, in major cities between 1978-1981 ( Study: Many Blacks Cite AIDS Conspiracy (WashingtonPost.com) , n.d.). This theory was very widely accepted by the gay and black populations, claiming that the government created this disease to control and even wipe out their communities (Heller, 2015). Due to the mistrust in the government and public health by African Americans, half of the African Americans who were surveyed believed that 3
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HIV was man-made, and one quarter believed that it was produced by the government (Heller, 2015). While there are still many who believe this theory, it was largely discredited when other ethnicities and sexual orientations were also largely affected by HIV, and by research showing that people with HIV greatly benefit from the Hepatitis B vaccine (Mohareb & Kim, 2021). Another theory that circulated among the public during the HIV/AIDS epidemic also revolved around a vaccine, the oral polio vaccine theory. This theory suggested that chimpanzees from a certain region were the source of SIV, and that the tissues from these chimpanzees were used in preparation of the oral polio vaccine, thus contaminating those who were vaccinated (Worobey et. al., 2004). This theory was suggested in 1999 by Edward Hooper, who proposed that early batches of the OPV were grown in cultures of infected chimpanzee kidney cells (Worobey et. al., 2004). The OPV theory was quickly discredited when a vial of the batch most implicated by Hooper was tested and they found no sequences of HIV/SIV or cellular components of chimpanzees (Worobey et.al., 2004). Five samples of OPV from the Belgium Congo between 1958 and 1960 were also analyzed and found no chimpanzee DNA (Worobey et.al., 2004). This theory was ultimately discredited due to other molecular biology and phylogenetic tests revealed that the circulating virus in humans was distinct from all strains of HIV-1, providing direct evidence that these chimpanzees were not the source of the human AIDS pandemic (Worobey et.al., 2004). There are many more theories surrounding the HIV/AIDS epidemic, most of which stem from distrust in the government and other public health organizations by the populations that have been most affected by the virus. Myths The negative stigma and lack of knowledge and understanding of HIV/AIDS has led to many myths surrounding the disease, spreading unnecessary worry and judgement. One of the 4
most common myths that is still believed by many, is that HIV/AIDS can be spread by sharing utensils or drinks with someone who is infected ( Ways HIV Is Not Transmitted | HIV Transmission | HIV Basics | HIV/AIDS | CDC , n.d.). Studies have confirmed that the virus cannot live outside of the human body long enough to be transmitted through the air, by touch, saliva, sweat, or tears ( Ways HIV Can Be Transmitted | HIV Transmission | HIV Basics | HIV/AIDS | CDC , n.d.). Moss (2013) explains that HIV/AIDS can only be transmitted through blood, semen, vaginal fluids, and other delicate mucus membranes such as breast milk. Another common myth is that HIV/AIDS only affects certain sexual orientations, such as gay and bisexual men, which is often believed since the virus was first recognized in gay man in the early 1980s. While certain populations are at a higher risk, HIV/AIDS can affect anyone regardless of race, ethnicity, gender, or sexual orientation ( HIV by Group | HIV | CDC , n.d.). In recent years there have been many advancements in treatment, but with that more myths have also arisen. A more recent myth that has emerged is that the new medications that are used to treat HIV and lower the viral load, actually cure the disease HIV ( Newly Diagnosed With HIV | Living With HIV | HIV Basics | HIV/AIDS | CDC , n.d.). The new antiretroviral therapies (ART) can make the viral load undetectable, which is the best way for an infected person to stay healthy and not transmit the disease, no longer making it a death sentence but rather a lifelong manageable chronic disease (Moss, 2013). The latest commercials and positive hype about these medications without actual knowledge of the disease is a big reason for this myth. When HIV/AIDS was first discovered, the government and other public health officials were responsible for misinformation and misleading the public for many years (Schechter, 1993). These and many more myths about HIV/AIDS are still believed today due to the lack of awareness, understanding and willingness to learn the facts about HIV/AIDS. 5
Statistics Recent studies from the CDC (2023) show that in the United States alone in 2021, over 36,000 people received a new HIV diagnosis. Georgia is no exception, with over 2,500 new infections in 2019 of people 13 years of age and older (Georgia Department of Public Health, 2023). Of the newly infected cases, 79% were males, 19% females, and 2% were transgenders (Georgia Department of Public Health, 2023). Of the females, 90% was attributed to heterosexual contact, while 83% of the reported male cases were attributed to male-to-male sexual contact, however in 2021 more heterosexual males reported new cases than IV drug users and IV drug users with male-to-male sexual contact, which indicates that anal sex (male-to-male or male-to-female) is a more likely way to transmit HIV than IV drug use (Georgia Department of Public Health, 2023). Among the 18 Public Health Districts in Georgia, Fulton and DeKalb had the highest numbers and rates of persons diagnosed with and living with HIV infection most likely due to the higher populations of these districts, as well as the fact that Atlanta is included in these areas, where homosexuality is more widely accepted and encouraged. It is also noted that 71% of the new cases were among the African American population. As awareness and truth is presented about HIV/AIDS, it would be reasonable to assume that the number of infections would decrease, however that is not the case. As a result of effective treatment and false information about these treatments, the number of people in Georgia living with HIV has steadily increased (Georgia Department of Public Health, 2023). This indicates the lack of knowledge and understanding that people have about HIV/AIDS, including the people who are involved in high-risk populations and relationships. The statistical data from Georgia proves that HIV/AIDS can affect any person, no matter the ethnicity, race, gender, or sexual orientation, and that the disease can be spread easily if people are not aware of the risks of behaviors that they partake in. 6
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Counseling Co-occurring psychiatric and substance-related disorders are being seen more often than ever before. When a client presents with symptoms of either one or the other, or both disorders, the correct diagnosis and treatment plan is vital to their recovery. Counselors have many tools available today to be able to distinguish between disorders, as well as to treat one or both at the same time with different types of therapies, medications, and other resources depending on the severity of the disorder. The impact of treatment on a client can be the difference between life and death in some cases, and a misdiagnosis could do more harm than good. It is also important when a client is diagnosed with co-occurring disorders, that both of the disorders be treated at the same time with a fully integrated treatment plan, to ensure that the whole client is being treated, to avoid relapse. References About HIV/AIDS | HIV Basics | HIV/AIDS | CDC . (n.d.). 7
https://www.cdc.gov/hiv/basics/whatishiv.html CDC works 24/7 . (2023, September 13). Centers for Disease Control and Prevention. https://www.cdc.gov/ Georgia Department of Public Health. (2023). Georgia HIV surveillance data. Georgia Department of Public Health . https://dph.georgia.gov/epidemiology/georgias-hivaids- epidemiology-section/georgia-hiv-surveillance-data Heller, J. (2015). Rumors and Realities: Making sense of HIV/AIDS conspiracy narratives and contemporary legends. American Journal of Public Health , 105 (1), e43–e50. https://doi.org/10.2105/ajph.2014.302284 HIV by Group | HIV | CDC . (n.d.). https://www.cdc.gov/hiv/group/index.html Mohareb, A. M., & Kim, A. Y. (2021). Hepatitis B vaccination in people living with HIV—If at first you don’t succeed, try again. JAMA Network Open , 4 (8), e2121281. https://doi.org/10.1001/jamanetworkopen.2021.21281 Moss, J. A. (2013). HIV/AIDS Review. Radiologic Technology , 84 (3), 247–267. Newly Diagnosed with HIV | Living With HIV | HIV Basics | HIV/AIDS | CDC . (n.d.). https://www.cdc.gov/hiv/basics/livingwithhiv/newly-diagnosed.html Schechter M. T. (1993). AIDS: the fictions, the facts. CMAJ : Canadian Medical Association journal = journal de l’Association medicale Canadienne , 148 (5), 802–805. Sharp, P. M., & Hahn, B. H. (2011). Origins of HIV and the AIDS pandemic. Cold Spring Harbor Perspectives in Medicine , 1 (1), a006841. https://doi.org/10.1101/cshperspect.a006841 Study: Many Blacks cite AIDS conspiracy (WashingtonPost.com) . (n.d.-b). https://www.washingtonpost.com/wp-dyn/articles/A33695-2005Jan24.html 8
The important role of substance use disorder treatment providers in ending the HCV and HIV epidemics . (n.d.). HIV.gov. https://www.hiv.gov/blog/important-role-substance-use- disorder-treatment-providers-ending-hcv-and-hiv-epidemics/ Ways HIV can be transmitted | HIV transmission | HIV Basics | HIV/AIDS | CDC . (n.d.). https://www.cdc.gov/hiv/basics/hiv-transmission/ways-people-get-hiv.html Ways HIV is Not Transmitted | HIV Transmission | HIV Basics | HIV/AIDS | CDC . (n.d.-b). https://www.cdc.gov/hiv/basics/hiv-transmission/not-transmitted.html What are HIV and AIDS? (n.d.). HIV.gov. https://www.hiv.gov/hiv-basics/overview/about-hiv- and-aids/what-are-hiv-and-aids/ Worobey, M., Santiago, M. L., Keele, B. F., Ndjango, J. B. N., Joy, J. B., Labama, B. L., Dhed’a, B. D., Rambaut, A., Sharp, P. M., Shaw, G. M., & Hahn, B. H. (2004). Contaminated polio vaccine theory refuted. Nature , 428 (6985), 820. https://doi.org/10.1038/428820a 9
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