Stigma and Discrimination

HIV/AIDS is stigmatised heavily around the world with differing levels of severity . Some of the main reasons for why HIV/AIDS is stigmatised in societies around the world can include:

  • People believe HIV/AIDS is a deadly virus that cannot be properly treated.
  • Many people lacking awareness believe HIV is highly contagious and can be spread through simple acts such as sharing a water bottle and holding hands
  • People often associate those with HIV/AIDS with other behaviours already stigmatised in society such as intravenous drug use, homosexual relationships and prostitution.
  • Religious beliefs and values can lead to some religious people believing that people became infected with HIV as a result of moral flaws, such as promiscuity.

This stigmatisation often leads to the discrimination of people infected with HIV/AIDS. Discrimination of those with HIV/AIDS can take many forms with some of these listed below:

  • Refusal of health services
  • Denied family planning services, breakdown of relationships
  • Isolation from communities and families
  • Loss of income, unable to gain employment
  • Verbal and physical abuse
  • Involuntary sterilisation of women living with HIV in countries such as Kenya, Namibia and Chile

The stigmatisation and discrimination that follows can result in people being reluctant to be tested for HIV and also undergo HAART which can further perpetuate the spread of HIV. The video shown below illustrates some of the effects that stigmatising HIV/AIDS and the discrimination that follows can have on the lives of those infected with HIV/AIDS.

Whilst people with HIV/AIDS are stigmatised and discriminated against quite heavily around the world, the situation is improving slowly. When HIV/AIDS was first discovered in 1981 there was very little information about the disease and HIV was greatly feared. People with the disease where often ostracized to extreme lengths until more was understood about the disease. An example of the extreme discrimination experienced by sufferers is the story of Ryan White, a child who contracted HIV/AIDS from a blood treatment for his haemophilia in December 1984. He was expelled from middle school in 1985 and widely shunned by students and teachers alike due to misinformation about how HIV was spread. In the present today much more is understood about HIV/AIDS and people are generally much more well educated about the disease, this has led to the stigma and discrimination associated with HIV/AIDS slowly decreasing over time.

To stamp out the stigmatisation and discrimination associated with HIV/AIDS education and raising awareness of the disease is pivotal. Anti-stigma programs have been shown to be extremely effective in reducing the stigma associated with HIV/AIDS. Much still has to be done in the future before those infected with HIV/AIDS aren’t stigmatised and discriminated against and can lead near normal lives.

Sources

1.        Global report: UNAIDS report on the global AIDS epidemic 2013 [Internet]. World Health Organization; 2013 November [cited 2014 April 11]. Available from: http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf

2.        Youtube. HIV AIDS Awareness Video [Internet]. Youtube; 2010 Mar [cited 2014 Apr 8]. Available from: https://www.youtube.com/watch?v=COfdnY27LP4&w=420&h=315

Coinfections and Opportunistic infections

HIV patients have a weakened immune system, which predispose them to infections. The most common type of coinfections seen in HIV patients is tuberculosis. HIV patients are 12-20 times more likely to develop tuberculosis than healthy individuals and TB is the leading cause of death among HIV patients. The image below shows the prevalence of TB in people living with HIV.

Screen Shot 2014-04-06 at 2.09.57 pm

The WHO developed a framework of “Three I’s” to deal with the problem of coinfections of HIV and TB. The “Three I’s” includes Intensify case TB findings, Isoniazid preventive therapy and Infection control for TB.

Intensify case TB findings
  • All people living with HIV should be screened for tuberculosis.
  • Xpert MTB/RIF should be used to screen for TB as this diagnostic tool has a high sensitivity.
Isoniazid preventive therapy
  • Isoniazid preventive therapy helps prevent TB in HIV patients.
  • The uptake of IPT should be promoted because less than 25% of HIV patient are receiving it.
Infection control for TB
  • Education on reducing the spread of TB

 

 

In order to reduce the mortality rate resulting from tuberculosis in HIV patients, WHO recommended Antiretroviral therapy should start within 8 weeks after the start of the antituberculosis treatment in all HIV patients diagnosed with TB regardless of their CD4 counts.

 

Opportunistic infections

 

Opportunistic infections refer to all the bacterial and viral infections developed in immunosuppressed patients that do not normally happen in a healthy individual. Opportunistic infections usually occur when the CD4 drops below 200 cells/mm3. HIV patients will be diagnosed with AIDS when they have contracted one or more opportunistic infections. A few examples of opportunistic infections are Candidiasis of bronchi, trachea or lungs, Herpes simplex and recurrent Salmonella septicaemia.

 

Taking herpes simplex as an example, reactivation of the virus maybe more severe in AIDS patients. Severe mucocutaneous lesions and dissemination to internal organ may also occur. However, in healthy individuals, reactivations are usually mild.

 

Sources:

1.        Global report: UNAIDS report on the global AIDS epidemic 2013 [Internet]. World Health Organization; 2013 November [cited 2014 April 11]. Available from: http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf

2.        World Health Organisation. Tuberculosis fact sheet N.104 [Internet]. World Health Organisation Media Centre; [updated 2014 March 1; cited 2014 Apr 11]. Available from: http://www.who.int/mediacentre/factsheets/fs104/en/

3.        World Health Organisation. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection [Internet]. World Health Organisation – Programmes; 2013 June 30 [cited 2014 April 12]. Available from: http://www.who.int/hiv/pub/guidelines/arv2013/download/en/

Economic effects of HIV/AIDS

HIV/AIDS does not only affect the individual carrying the virus, it also carries much wider roll-on effects to global and individual country’s economy.

 

Developing Countries

People living with AIDS are often severely affected and are not only unable to work but require costly medical care. Antiretroviral treatment (ART) costs about AU$18000 per person per year. The impact can be especially debilitating for governments of developing countries that have larger AIDS populations, as they lose their workforce and have greater financial demand on often shaky public health systems.

As AIDS is primarily a disease of young adults the transfer of knowledge and abilities from one generation to the next is disrupted in tandem with this decrease in human capitol. Therefore the workforce may become unskilled and less productive, especially in areas dominated by female professionals (such as education) because females are most affected by AIDS in developing countries. Grandparents are also often required to care for AIDS orphans without a reliable form of income.

 

The tax-paying population of countries with widespread AIDS is reduced since it is the young adult workforce that are most affected. This slows the growth of the economy as less tax is being collected and there is increased demand on health-care, workforce education, sick pay and care for orphans – positive expenditures must be cut to try and compensate. Economic growth rates have been predicted to decrease in 30 Sub-Saharan economies with prevalence rates >10% over the period between 1990-2025.

 

In the Global economy the private sector has started to realize the direct and indirect impacts of HIV/AIDS. The Overseas Development Institute estimated that a return of US$3 could be made for every US$1 invested in employee health as it reduces absenteeism and employee turnover, and increases productivity. Many multinational corporations are starting to get involved in three main ways: community-based partnerships, supply chain support, and sector-based initiatives. Yet studies have shown that direct foreign investment decreases with increasing rates of HIV/AIDS – even in small numbers.

 

 

In Australia

Nationally, 1,253 cases of newly diagnosed HIV infections were registered in Australia in 2012 and, of these, 88% were men who had sex with men, 9% involved heterosexual contact and 1% were injecting drug users. De Witt argues that increasing rates are due to human error and more risk-taking behaviours. From the data above it can be seen that populations most at risk are young adults participating in male-male sex, and intravenous drug users. He argues that further campaigning and better education can reverse the trend of increasing incidence in Australia, and reduce the numbers of people signing up for a lifetime of ART paid for by the government.

Not only that but people living with HIV/AIDS in Australia are economically hit themselves, most commonly due to leaving work or unemployment because of psychosocial problems and/or the progression of the disease.

 

Globally

Just quickly to finish off, here is a graph and table showing the cumulative signed funding supplied by the Global Fund by year for HIV/AIDS, Malaria, Tuberculosis and Health Systems Strengthening to show the increasing global costs of HIV/AIDS and how it compares to other areas of health need.

2013 data sourced from draft consolidated financial statements as at 23 January 2014.

Cumulative Signed Funding by Disease

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Cumulative Signed Funding by Disease Table

Year HIV/AIDS Malaria Tuberculosis Health Systems Strengthening
2002 $36,000,000 $17,000,000 $5,000,000
2003 $640,000,000 $190,000,000 $220,000,000 $61,000,000
2004 $1,200,000,000 $460,000,000 $340,000,000 $90,000,000
2005 $1,900,000,000 $960,000,000 $550,000,000 $130,000,000
2006 $3,000,000,000 $1,300,000,000 $870,000,000 $150,000,000
2007 $4,600,000,000 $1,700,000,000 $1,200,000,000 $210,000,000
2008 $5,800,000,000 $2,300,000,000 $1,400,000,000 $260,000,000
2009 $7,200,000,000 $3,900,000,000 $1,900,000,000 $340,000,000
2010 $9,500,000,000 $4,700,000,000 $2,800,000,000 $420,000,000
2011 $11,000,000,000 $5,700,000,000 $3,400,000,000 $670,000,000
2012 $13,000,000,000 $6,800,000,000 $3,800,000,000 $730,000,000
2013 $16,000,000,000 $8,000,000,000 $4,600,000,000 $760,000,000


Sources

1.        Risley CL, Drake LJ, Bundy DAP. Economic Impact of HIV and Antiretroviral Therapy on Education Supply in High Prevalence Regions. PLoS ONE. 2012;7(11):e42909.

2.        Goetzel RZ, Ozminkowski RJ, Baase CM, Billotti GM. Estimating the return-on-investment from changes in employee health risks on the Dow Chemical Company’s health care costs. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. 2005;47(8):759-68.

3.        Asiedu E, Jin Y, Kanyama IK. The Impact of HIV/AIDS on Foreign Direct Investment: Evidence from Sub-Saharan Africa. University of Kansas, Department of Economics, 2012.

4.        Ezzy D, Visser RD, Bartos M. Poverty, disease progression and employment among people living with HIV/AIDS in Australia. AIDS Care. 1999;11(4):405-14.

5.        Bell C, Devarajan S, Gersbach H. The Long-run Economic Costs of AIDS: Theory and an Application to South Africa (PDF). World Bank Policy Research Working Paper No. 3152.

6.        HIV, viral hepatitis and sexually transmissible infections in Australia HIV, viral hepatitis and sexually transmissible infections in Australia: Annual Surveillance Report 2013 [Internet]. Sydney (NSW): The Kirby Institute; 2013 Oct [cited 2014 Apr 7].

An insider view on the Red Party campaign

Red Party is essentially a yearly event to raise money and awareness for HIV/AIDS, it is enormously successful and last year the campaign raised more than $30 000 in Perth, incorporating much more than just a party!

We were lucky enough to catch UWA’s Red Party Coordinator Vibhushan Manchanda for a quick interview about what it is like being such an integral part of a global campaign, what they are achieving, his motivations and how students can get involved  – Thank you very much Vib for an insider’s perspective!

 

Red Party (217 of 262)

Vib at the Red Party Quiz night 2013

1.  Just briefly, what is Red party?  Red Party is a student-run charity initiative with two main goals: to raise funds for Oxfam Australia’s Integrated HIV & AIDS Program in South Africa, and to raise awareness of HIV/AIDS related issues in the wider community. The Red Party is an initiative that originated out of a branch of the medical society Medsin in Manchester, UK. In 2007, with the support of Western Australian Medical Studentsʼ Society (WAMSS), a small group of medical students at the University of Western Australia (UWA) sought to create Australia’s own Red Party. We run a series of fundraising and awareness events as a part of our campaign, culminating in the eponymous Red Party, a great party with a red theme, the internationally recognised colour of AIDS. We aim to create a fantastic event with a positive vibe and diverse entertainment acts to set ourselves apart from other university parties. Since our success in raising over $200 000 over 7 years, 16 MedSocs across Australia now run a Red Party, bringing together thousands of university students to raise money for HIV/ AIDS and promote awareness of the disease and its effects.

2.  Why did you get involved in red party? Back when I was in first year, I heard about it at fresher camp and from older year groups as a fantastic thing to get involved with. What sold it to me, and what I reiterate to people when I approach them to get on board with the Red Army, is the balance between a charitable initiative where you get the warmest fuzzies that money can’t buy, and a fantastic atmosphere as a student where you get to do outrageous things and have more fun than is fathomable anywhere outside of the spectrum of the colour red.

3.  What is your role in the red party campaign? As the Red Party Coordinator, my role is to make sure that the entire campaign runs smoothly! This includes all our events, media releases and also to liaise with parties such as WAMSS, Oxfam and the WA Aids Council. I also get to decide who gets to be absolutely reckless in the adopted persona of the RedArmy Leader.

4.  How can people get involved in Red Party? It’s BIG, it’s RED, it needs YOU. You can get involved by joining the committee or one of our subcommittees, attending our events, helping us promote or simply to spread awareness of the issues we focus on. Head to our website at redparty.org or contact me personally at redparty@wamss.org.au

5.  How is the red party campaign making a difference globally, and working towards the 6th Millennium Development Goal? is it helping AIDS/HIV in Australia too? The entirety of the funds we generate are donated to Oxfam Australia’s Integrated HIV & AIDS Program in South Africa, focussing on the Eastern Cape, Kwa-Zulu Natal and Limpopo region. 68% of the people with AIDS around the world live in Sub-Saharan Africa, and 16% of people within these regions are HIV positive. The program aims to improve health outcomes relating to HIV/AIDS, TB and water-related infections and diseases, to increase and sustain food security and livelihood options available to households, and to increase and uphold access to social protection and human rights. By these mechanisms, our campaign targets the most greatly affected area of the world when it comes to the impact of HIV/AIDS at all levels – spanning from the provision of antiretroviral treatment and social support for affected persons and their families, to providing clean water for families and advocating for the representation of marginalised groups to governments and local authorities.

Our awareness campaign contributes greatly to lessen the stigma attached to, and increase the education level of people in Australia. Events such as our Film Night and Quiz Night are eye-openers when it comes to some common misconceptions about the virus and we have a wider impact through the Paint the Town Red campaign and our media releases.

6.  What do you think is the best part of the Red Party initiative? The wide scope of our campaign. We get involved with people on so many different levels and the atmosphere of our events varies so greatly, that there really is something for everyone. We continue to get stronger and bigger, and the infectious energy to make Red Party a success each year is simply outstanding. People seem to catch the bug and then they simply cannot leave the Red Army!

 

How did you go?

Here are the Quiz answers and your results in a nutshell:

Overall we can see that the participants (115 participants, 83% recruited via Facebook) have a good general understanding of HIV/AIDS in that they knew what HIV/AIDS is, who it effects, how it spreads, how to treat it and how it kills. Participants generally didn’t know how many people are affected; who or how many people are receiving treatment, trends in incidence and how many deaths are actually occurring due to HIV/AIDS. These are possibly more specific details yet they were often grossly over/under-estimated.

90.4% correctly answered Question 1, selecting Sub-Saharan Africa as the region most affected by HIV/AIDS in the world.

Only 40.0% answered Question 2 correctly that 35.3 million people are living with HIV/AIDS worldwide (41.7% said 102 million).

For Question 3 the correct answer was 61% of people living in lower-middle income countries are receiving treatment. Only 12.2% got this correct, 37.4% chose 5% and 34.8% chose 34%.

91.3% knew that HIV/AIDS is a viral disease for Question 4.

For Question 5: Australia, Eastern Europe and Central Asia have increasing incidence rates despite the Global decreasing trend, not Sub-Saharan Africa! Only 20.9% got this right, with 53% responding with Sub-Saharan Africa, Australia and South East Asia.

Question 6 was answered well, 79.1% correctly said that a cocktail of antiretroviral drugs most effectively manages HIV/AIDS.

The answer for Question 7 was 3% (percentage of deaths worldwide attributed to HIV/AIDS) but only 34.8% of people answered correctly, the most common answer was 4.3% with 37.4% of responses.

Breastfeeding is the answer for Question 8, it can spread HIV/AIDS; 85.2% of people got this right.

Finally, the most common cause of death in people with HIV/AIDS is opportunistic infections as correctly stated by 93.9% of participants.

For those curious about specific numbers and more details please scroll down 🙂 Qu.1 Qu.2 Qu.3 Qu.4 Qu.5 Qu.6 Qu.7 Qu.8 Qu.9

Combating HIV

HIV has always been a global issue. In 2012 there were 35.3 million of people living with HIV, in which 2.3 million of them are newly infected. HIV also accounts for 3% of deaths worldwide. These astonishing figures make combatting HIV a must, especially in developing countries where rates of HIV are much higher. The United Nations, therefore, listed combatting HIV as one of the Millennium Development Goals (MDG). There are two parts in this MDG: the first part aiming to stop and start reversing the increase in incidence of HIV by 2015 while the second part targeting at achieving universal assess to treatment by 2010.

 

Prevention

By 2015, the UN aimed to reduce the transmission of HIV through sex and drug injection by half. Moreover, it is targeted to eliminate incidence in children through the transmission from mother.

 

Sexual transmission is one of the most significant ways of HIV transmission. In developing countries, due to limited education about protected sexual intercourse HIV is often transmitted through unprotected sex. For example, in Sub-saharan Africa, education is still limited and in a research done in 2012, it was found that the use of condoms has actually decreased while the number of sexual partners per person increased. This actually toughens the situation of decreasing the incidence of HIV. Education and promotion of protected sex should, therefore, continue to be done in these countries. Luckily, in the report of 2012, it was stated that HIV transmission through sexual intercourse was expected to decrease after 2012 due to biomedical intervention, which is voluntary medical male circumcision. This practice is found to reduce the transmission rate from female-to-male sexual intercourse by 60%. UN and WHO, therefore, worked out a 5 year framework to provide voluntary medical male circumcision in selected countries in Eastern and Southern Africa to combat the increase in new cases of HIV. The services provided will then be expanded so that the goal of “zero new cases” can be achieved.

 

Unexpectedly, in some developed countries, for example, Eastern Europe, Central Asia and Australia, the incidence has actually increased. This is most probably caused by the increase in unprotected sex among teenagers. Education and promotion through media should therefore be enhanced.

 

Unlike the effectiveness of a decreasing sexual transmission of HIV, the reduction of transmission through drug injections by 50% can’t be achieved. This may due to law regulations that discourage people from accessing medical services and other social counselling. Moreover, limited resources of sterile syringe are available to developing countries. Working with governments of different countries is therefore important to combat the problem of transmitting HIV through drug injection.

 

So far, the elimination of mother-to-children transmission has made the best progress. With the help of antiretroviral drugs, children can be prevented from catching HIV from their mother while pregnant woman are treated. Antiretroviral treatment is continued in infants for 4-6 weeks. It has been estimated that, at least 48% of the cases have been prevented by using ART. The coverage of the ART to women in developing countries will expand such that the elimination of mother-to-children transmission can be achieved.

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Screening and counseling

 

Screening is always important as early detection of HIV can help with an early intervention and prevent the transmission of the HIV, especially in serodiscordant couples (one partner has HIV). You may think, why can’t HIV screening be mandatory? This is because of the confidentiality and autonomy of patients, the screening for HIV must always be the interest of patients. So the increase in screening can only be achieved through promoting the importance of screening.

 

Treatment

 

Highly active antiretroviral therapy (HAART) helps to prevent people living with HIV from developing AIDS and other coinfections. HAART refers to the combination of 3 or more antiretroviral drugs. According to the Treatment 2.0, developed by WHO in 2011, first-line treatment for adults should include at least 2 nucleoside reverse-transcriptase inhibitors and 1 non-nucleoside reverse-transcriptase inhibitors. However, the overall coverage of HAART in HIV patients are low, especially in developing countries, this is mainly due to the cost of providing HAART. It is good to know that the proportion of people who are receiving HAART has actually been increasing in the past few years. With the hard work of UN and the WHO, more support has been given and the proportion of people getting treatment is continuing to increase.

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With the aim to combat HIV, the WHO, UN and the US government worked together to launch the Treatment 2015 plan, in which they aim to scale up the HAART provided in Africa. The three main components of the framework are: Demand, Invest and Deliver.

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With all these continuous strategies suggested by the WHO and UN, it is hoped that one day, HIV will be history and there will be zero new infections and zero deaths due to AIDS.

Sources

1.        World Health Organisation. Tuberculosis fact sheet N.104 [Internet]. World Health Organisation Media Centre; [updated 2014 March 1; cited 2014 Apr 2]. Available from: http://www.who.int/mediacentre/factsheets/fs104/en/

2.        United Nations. Goal 6: Combat HIV/AIDS, malaria and other diseases [Internet]. United Nations Millenium Goals; [cited 2014 Apr 2]. Available from: http://www.un.org/millenniumgoals/aids.shtml

3.        Global report: UNAIDS report on the global AIDS epidemic 2013 [Internet]. World Health Organization; 2013 November [cited 2014 April 2]. Available from: http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf

 

Aside

Do you have ideas to combat HIV/AIDS?

Check out this great new campaign by Melbourne Youth Force:

“What would you say if you had the chance to tell the leaders in the fight against HIV anything you wanted?

That chance is here. The MYF 2014 Global eConsultation is the chance for us, the youth and young adults of the world, to have our say in this fight. The eConsultation asks you questions about what’s important to you, what works in this fight and what doesn’t, and where to go from here.
Have your voice heard by participating in the eConsultation.
At the end of the consultation, all the responses will be pored over so we can design an effective message for AIDS 2014, and advocate for the things that matter to us most.

Follow us on Facebook and Twitter to stay up to date with all the latest information.”

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Background information

Here’s a very brief overview of what HIV/AIDS is, who has it, who it effects, where it came from and where current research is going with it. Get reading!

Human Immunodeficiency Virus (HIV) is an incurable viral infection of the blood that leads to Acquired Immunodeficiency Syndrome (AIDS) in it’s most advanced form. The virus destroys or impairs immune cells in our body, weakening the immune system and causing sufferers to become susceptible to a wide range of infections and diseases that people with healthy immune systems can normally fight off. AIDS can take anywhere from 2-15 years to develop after initial infection and is defined clinically by manifestations of certain symptoms such as specific cancers or infections.

It is estimated that 35.3 million people live with HIV/AIDS and 69% of those are in Sub-Saharan Africa. Some don’t show symptoms at all, others maintain a good quality of life due to the effectiveness of antiretroviral treatment, and yet there are many that are ostracized from their communities and fall ill to opportunistic infections that they can’t shake and eventually cause death.

Today HIV/AIDS is one of the world’s largest threats to Global Health, consequently the United Nations set it’s sixth millennium development goal (MDG6) as “to combat HIV/AIDS, malaria, and other diseases”; they planned “to have halted and begun the reverse spread of HIV/AIDS by 2015”.  HIV/AIDS is a global priority for researchers, clinicians, policy makers, social workers and funding agencies – many important worldwide organizations are involved.

There are two strains of HIV: HIV-1, the most common strain, is believed to be an evolved mutation of a Simian Immunodeficiency Virus (SIV) in Sub-Saharan Africa, passed from non-human primates to humans in the mid-1930’s and spreading epidemically in human populations worldwide since then, HIV-2 is more localized as it is less transmissible and mostly found in West Africa; Also believed to have passed from monkeys to humans, specifically the old-world monkey ‘Sooty Mangabey’ (Cercocebus atys).

HIV/AIDS was discovered in 1981, and since then a lot has been discovered about the pathology, and immunological and clinical aspects of the infection as well as the structural biology of the virus. Current research is focusing on the search for biomarkers of infection, transmission and progression of the disease, and the search for a universal anti-HIV vaccine. It is interesting to note that genetic contributions can be very significant, for example some patients can be exposed and remain uninfected (exposed uninfected/EU), and some can have the virus but not progress to AIDS (long-term non-progressor/LTNP).

The darker the region the more densely infected the population is.  One in five adults is thought to be HIV positive in Sub-Saharan Africa.

The darker the region the more densely infected the population is. One in five adults is thought to be HIV positive in Sub-Saharan Africa.

Sources

1.         Global Health Topics. HIV/AIDS [Internet]. U S Department of Health and Human Services; [cited 2014 Mar 30]. Available from: http://www.globalhealth.gov/global-health-topics/communicable-diseases/hiv-aids/

2.         World Health Organisation. HIV/AIDS [Internet]. World Health Organisation – Health Topics; [cited 2014 Mar 30]. Available from: http://www.who.int/topics/hiv_aids/en/

3.         Kaur G, Mehra N. Genetic determinants of HIV-1 infection and progression to AIDS: susceptibility to HIV infection. Tissue Antigens. 2009;73(4):289-301.