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The war on diseases never stops: celebrating polio's eradication and preparing for a future endeavour

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Prelude: In 1959, at the same time the U.S. and the world were celebrating the defeat of polio, a new lethal disease was silently incubating. In Edward Hooper’s book, The River, he describes a man degenerating from a myriad of diseases brought about by an indefinable virus. He describes a former sailor named David Carr, as his health steadily and painfully declines. In 1958, the strong, healthy, and soon to be married man, suddenly developed gum disease, profuse rashes, and experienced chronic fatigue. Soon he developed hemorrhoids, and experienced extreme weight loss, fevers, and his coughing would bring forth mucus mixed with blood. Shortly after his ailments began he quit his job, as his co-workers rumored that David had leukemia. David’s health descended further with the hemorrhoids growing into a softball sized crater. The doctors in Manchester, UK, suspected tuberculosis, syphilis, or Wegener’s granulomatosis, and in an attempt to eradicate his unique disease, subjected David to radio and chemotherapy, steroids, and an assortment of drugs. Later enormous boils broke out on David’s face, which he attempted to cover with facial hair. He remained in bed-rest at the hospital and as the boils blossomed into ulcers, eating away at his lips and facial tissue, he began discouraging visitors. A year after his initial symptoms David’s skin hung loosely upon his withering frame. His symptoms now included various ulcer outbreaks across his body and difficulty breathing from lack of oxygen, which subsequently turned his swollen extremities blue. During his final days in agony, the doctors sedated him with an amalgam of morphine, cocaine, and gin. The virus responsible for David’s suffering, leading to his death, and two similar cases that occurred simultaneously, would not be defined for another 24 years. This revelation occurred in 1983, when Dr. Luc Montagnier et al. at the Pasteur Institute in Paris identified a retrovirus named lymphadenopathy-associated virus (LAV), which would infamously become known as the Human Immunodeficiency Virus or HIV, the virus that inevitably leads to the development of the fatal Acquired Immune Deficiency Syndrome or AIDS (Begun et al. 1998, 4).

HIV Overview The human immune system’s main weapon of defense is a team of five white blood cells, individually named the macrophage, T4 cell, T8 cell, plasma B cell, and the memory B cell (Begun et al. 1998, 5). Each cell has its own distinct function. When an invading virus enters, the macrophage will sound the alarm, stimulate the production of thousands of T4 cells, and partially consume the invading virus; while the T4 cell will attack it and call for reinforcements in the form of B cells and T8 “killer” cells (Begun et al. 1998, 5). The T4 cells also signal the B cells to divide into either memory cells that record the attacker and increase the immune response if the invader ever returns in the future, or the B cell morphs into plasma cells, which create antibodies that work to inhibit the invader (Begun et al. 1998, 5). The mighty T8s with the aid of some T4 cells will then destroy the infected cell (Begun et al. 1998, 5).

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This defense is not enough to counter the complex construction of HIV. The HIV is unlike the majority of viruses, which usually consist of only three genes, while HIV possesses seven and is able to reproduce faster than any known virus (Begun et al. 1998, 5). A protein shell surrounds the HIV core, and an outer layer fatty membrane strafed with glycoproteins act in conjunction as a shield, protecting itself from the human immune system and its barrage of white blood cells (Begun et al. 1998, 5). Once HIV enters a human, it principally attacks a detachment of the immune system known as CD4, and also assaults the immune sentinels-the T cells, while minimally engaging the macrophages. (Begun et al. 1998, 5). Researchers at Oxford discovered in 1995 that the HIV actually mutates and renders the immunes system’s main offense, the T8 cells, incapacitated, which allows the HIV to thrive (Begun et al. 1998, 6). As the T8 cells become infected, they actually aid in spreading the virus to other immuno cells, as the bloodstream disperses them throughout the body. The virus is not confined to inhabiting immuno cells alone. New research has shown that HIV can reside in surrounding brain and spinal fluid, and in cells within the intestines, bone marrow, and nervous system (Begun et al. 1998, 7).

HIV is only transmitted by: Engaging in oral, anal, or vaginal sex with an infected person (worldwide 70% of all transmission is via heterosexual intercourse; it is responsible for 94% of all infections in Africa).

By sharing intravenous drug needles with an infected person.

Perinatally, from an infected mother to her baby at the time of birth, or possibly through breast milk.

By receiving blood or organs from infected donor. (Begun et al. 1998, 18) The initial HIV symptoms usually resemble a sudden flu, which then vanish and may not reappear for up to 11 years, and in very rare cases, may take as long as 16 before developing into AIDS (Begun et al. 1998, 7). Once HIV has decimated the human immune system, the door is open for the arrival of any number of “opportunistic infections” or OIs (Begun et al. 1998, 9). A patient is defined as having AIDS if he or she acquires one infection, which usually occurs when the host’s immuno cells, CD4, drop from a normal count of 1000 down to a mere 200 (Begun et al. 1998, 17). Once the CD4 drops to this miniscule amount the body becomes susceptible to an infinite number of infections, which can only be temporarily delayed in the short term by using antibiotics, yet in the long term there is no viable prevention from the onslaught of infections. A list of frequent OIs is shown in the illustration below. (Graphic 1) In the preceding story, David was symptomatic of AIDS. After his immune system had been rendered impotent from the HIV, various OIs infiltrated his body causing his death. It should be noted that in every instance, AIDS is fatal.

Using immune detractors such as alcohol and cigarettes works to quicken the symptoms of AIDS; consequently, HIV patients are discouraged from consuming these products (Begun et al. 1998, 9).

Nigeria Overview Twice the size of California, with a landmass of 356,668 square miles, and a diverse population of 123.3 million people, Nigeria is the most populated country in Africa (statistics from PRB Data Sheet). The landscape consists of forest in the south, and savanna in the north, and the land is rich in minerals and fossil fuels (Falola 1999, 2-3). (Graphic 2) Yet, the Nigerian stratocracy has consolidated power and consistently depleted the nation’s wealth and resources without adding to its citizen’s economic mobility. Despite it’s abundant resources, Nigeria is one of the poorest countries in the world with an inflation rate of 12.5%, an unemployment rate of 28%, a per capita annual income of only $970, resulting in 34.1% of the population living under the poverty line, compared to the U.S. with 12.7% below the poverty line (CIA World Factbook). For nearly 40 years the stratocracy has adversely affected Nigeria since it achieved its independence from Britain in 1960 (statistic from the World Bank). In addition, the country is experiencing severe environmental catastrophes such as desertification, soil erosion, oil pollution, coastal contamination, widespread deforestation-losing an estimated 90% of its forest this century alone, and the expansion of the ghettos in urban areas (Falola 1999, 4).

Finally, the southwestern border of Nigeria meets the Atlantic Ocean, which less than two hundred years ago exposed the country to the appalling societal ill of the Cross-Atlantic Slave Trade. Today Nigeria’s principal tribulation is a biological manifestation, a lethal virus that has adversely affected the nation’s economy, social interactions, and most immensely the health of the populace. In the year 2001 the dominant ill that presently plagues the landscape of Nigeria is HIV/AIDS.

HIV/AIDS Inception in Nigeria AIDS was rumored to be present in Nigeria in 1985, and the virus was first confirmed in Nigeria in 1986. The government however, denied its existence publicly until 1987 (Okafor 1997, 105). Why? The government did not believe that AIDS existed due to some initial tests by an ad hoc health committee, and thought that it would be foolish to throw money and resources at a problem that had not been substantially proven, even though evidence suggests that by 1987 an estimated 42,000 people had already died as a result of AIDS worldwide (Okafor 1997, 106). In addition, no acceptable local words existed to define or relate what the AIDS was (Okafor 1997, 114). Furthermore, the impoverished government was preoccupied battling other social, economic, and health crises during the arrival of HIV/AIDS. In 1987, the Federal Ministry of Health, Nigeria’s chief health agency, conducted a study which determined that 90 people were infected with HIV, which as previously discussed is a precursor to AIDS. By 1989, a new commission was created to thwart the disease, the National AIDS Committee, which was headed by the health minister (Okafor 1997, 107). The initial strategy to contain the epidemic consisted of four key elements: 1. Program Management 2. Information, Education and Communication or IEC 3. Blood and Blood Products 4. Epidemiology, Clinical Management, and Counseling (Okafor 1997, 107) This comprehensive plan led to the establishment of more safe blood banks, HIV testing facilities, and supported broader awareness through education. These developments coincided with the then President of Nigeria, General Ibrahim Babangida declaring a “War Against Aids” or WAA in 1991 (Okafor 1997, 111). The President declared a national emergency and requested that state, local, and non-government organizations actively participate in the WAA. The Nigerian Government also made HIV/AIDS education compulsory in all schools (Okafor 1997, 113). However, the scholastic educational impact should not be overstated since, as of last year, only 67.3% of males and 47.3% of females were literate (statistics from CIA World Factbook). By early 1992, 400,000 (.05% of the population) Nigerian HIV cases were reported by the minister of health (Metz 1992, xxvi). Some of the measures of the Nigerian government in 1992, are shown below. (Graphic 3) A poor economy has led to lax screening for HIV antibodies in blood, and in addition has not allowed for any AIDS research domestically (Okafor 1997, 114).

Despite the government’s conscientious intervention and ample strategy for containing the deadly virus, two additional events must occur in order to successfully achieve their goal. A social change is necessary to alter and abandon “at risk behavior”, and additional funding and infrastructure is needed to equip the medical network facilities with adequate supplies and resources to combat the deadly virus.

Nigeria & HIV/AIDS in 2001 Today, 4.1% or over five million of Nigeria’s population lives with HIV/AIDS, while only 7% of the population uses modern contraception, compared to modern contraception use of 71% in the US (statistics from PRB Data Sheet). Five thousand respondents reported that in urban areas, 78% of males aged 20-24 and 86% of females 12-24 were sexually active (Uwakwe 1997, 40). Cultural beliefs often lead Nigerian males to refuse condom use outright (Okafor 1997, 114). The freedom of the sexual revolution has ushered in liberalized practices that contradict Nigeria’s traditional and religious practices, originally implemented to prevent sexually transmitted diseases (STDs). Arguably at the worst time in history, Africa as a whole has newly accepted promiscuous heterosexual and homosexual behavior, pre-marital and extra-marital intercourse, and multiple partners (Uwakwe 1997, 41). On the other hand, some traditional ideologies are equally guilty for the spread of HIV/AIDS. Here are some examples: A widespread belief throughout Africa is that an ill person will be cured if he or she can pass on the ailment to another (Uwakwe 1997, 41). Another common belief is that a virgin will cure a man of all STDs. These superstitions have led to the raping of younger and younger girls and consequently their infection of HIV by men who are desperately seeking virgins to alleviate their disease (Uwakwe 1997, 41). Another practice that perpetuates the spread of HIV/AIDS is the practice of “wife inheritance”. Once a practical means of supporting a deceased relative’s widow by taking her on as a second wife, the practice has become a deadly bridge, where AIDS can travel from infected widow -to new husband -to the new husband’s first wife; once the new husband dies of AIDS, his recently infected wife will be inherited by a relative, which will repeat the cycle all over again (Begun et al. 1998, 106).

In some instances, affluent businessmen and truck drivers, who often visit brothels while away from home, are at an even higher risk of infection from HIV than the aggregate population (Begun et al. 1998, 106). This is exacerbated by the fact that it is often socially acceptable for a man, and also not uncommon, to have a couple girlfriends in addition to a family (Begun et al. 1998, 106). The diagram on the following page illustrates the danger of engaging in sex for money in Nigeria, as the infection rate for prostitutes climbed to a horrifying 100% in 1994-95. (Graphic 4, from Okafor 1997, 112) In general, however, the lower class in Nigeria has a higher risk than the rest of the population of contracting HIV, since poverty prevents the poor from receiving proper education on the disease. Many of the impoverished are illiterate, do not attend school, and do not have access to radio or television, so that critical information seldom reaches them. Women have been the largest victims of this phenomenon because even if they are fortunate to obtain information about HIV/AIDS, they often do not possess the power to implement corrective actions in their heterosexual relations and often fear abuse or desertion (Uwakwe 1997, 40). All of these factors have contributed to an infant mortality rate (IFR) of 77 in Nigeria, compared to the US’s IFR of only 7 (PRB Data Sheet).

Epilogue The United Nations estimated in 1998 that in 1997, 11.7 million casualties had already occurred as a result of AIDS, 9.7 million of these cases or 83% were in Sub-Saharan Africa (Begun et al 1998, 101). The UN predicts that Sub-Saharan Africa will be 4% less populated in 2005 than they would have been if AIDS had been non-existent (Begun et al 1998, 98). The AIDS epidemic has decreased the life expectancy in South Africa by 7 years, and in Zimbabwe it has decreased by an excruciating 22 years (World Bank 1998). (Graphic 5) Engulfed by surrounding epidemics, Nigeria is embroiled in the battle with an advanced biological virus, and is under equipped for the task. Worse the enormous danger from AIDS is not derived exclusively from the transmission of the virus itself, but from opportunistic infections such as Tuberculosis, which can easily infect others via airborne transmission. As the caseload of AIDS increases, so will the exposure of the remaining healthy population to potentially contagious and fatal OIs. It is compulsory for Nigeria’s citizens to change their risky behaviors and for the government to more aggressively implement effective HIV/AIDS prevention, education, and research programs, as well as buffer the dismal healthcare system. The Nigerian healthcare industry is in shambles, with one doctor to every 16,000 people, few hospital beds, shortages of medicines, which have all helped contribute to the low life expectancy of only 52 years for males & 53 years for women compared to the U.S. life expectancy of 74 and 79 respectively.

Some hope is on the horizon. A condom distribution program in brothels decreased no-condom use from 25.2% to only 3.0%, and a one year survey reported back that 67% respondents had used a condom during their last sexual encounter, and nearly all women surveyed reported the condom use was due to their insistence. This program has demonstrated that education can positively influence Nigerian’s behavior to become safer and consequently avoid infection from HIV/AIDS. Further gains will only be possible with adequate funding to fight the epidemic.

Amazingly, such a gain was made on Saturday, May 12, 2001 when Nigerian President Olesegun Obasanjo met in Washington, D.C. to discuss the AIDS epidemic with U.S. President George W. Bush. Bush pledged $200 million toward a global trust fund to combat AIDS, and his new budget increases the U.S. $460 million budget for global AIDS Programs by 10% (Washington Post De, Young 2001). The immense expenditure necessary to combat the pandemic was voiced by Kofi Annan, chair of the UN, who stated in Washington that $7 – $10 billion is needed for the developing countries to contain the spread of HIV/AIDS (Washington Post De, Young 2001). Hopefully, the countries of the world will unite to eradicate the disease responsible for so much suffering, as they were able to do with Polio, back in 1959. The cost of doing so seems priceless when one evaluates the economic and productivity losses that have occurred. The price seems even more insignificant when considering the estimated 10 million children who have lost one or both parents as a result of AIDS, or for an estimated 460,000 children who in 1997, met the same fate that David Carr did back in 1959.

Nigerian National Anthem Arise, O Compatriots, Nigeria’s call obey To serve our Fatherland With Love and strength and faith The Labour of our heroes past Shall never be in vain To serve with heart and might One nation bound in freedom, peace and Unity (nigeria-government.com)

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