HIV 101

I happened to see a NY Daily News today with the headline, "Vicious New Strain of HIV," and that got me to thinking about how people think about this entity in our midst, "the virus," Human Immunodeficiency Virus. It isn't actually vicious, of course. It has no purpose, no intention, no moral status. But people often endow it with a psyche. This is partly because metaphor is an essential human way of understanding. Metaphor can deepen understanding and communication, but it can also be misleading, especially when people have limited concrete understanding of the subject.

I have spoken with many HIV-infected people about their situations. We have discussed their understanding and experience of being HIV-infected, their experiences with physicians and the health care system more broadly, how they made decisions about their own treatment, and how they have implemented those decisions -- for example, how closely they follow the pharmaceutical "regimen," as it is called, prescribed by their doctors.

Most people, it turns out, do not understand HIV in quite the same way that their doctors do. One woman, quite well educated and knowledgeable about many subjects, told me that she couldn't understand what viral load was until "This guy told me that it's how many babies the mother virus is having. When she's having a lot of babies, that's a high viral load." Logically enough, she always referred to the virus as "she." Many people believed that if they didn't take their pills regularly, their bodies would become resistant to them and they would no longer be able to defeat the virus. However, their ideas of what consituted taking the pills regularly were often quite different from what their physicians must have believed.

Of course, their doctors also did not believe that erratic pill consumption would make their patients' bodies resistant to the drugs. They believed, instead, that it would make the virus resistant to the drugs. The difference between drug resistant patients and drug resistant virus is not a quibble, it is of the utmost importance to humanity.

Drug resistant patients may sicken and die. Bad. Drug resistant virus may spread from person, to person, to person. Much worse. People who are already HIV infected, who are worried about becoming a drug resistant person and are therefore taking their pills 100% of the time, on schedule, may presume that since they are already HIV infected, and they are taking their pills, getting infected again is inconsequential. People who are not HIV infected may presume that if they do become infected, they can take the pills, and count on remaining reasonably healthy. The new strain of HIV which people in New York City are worried about is quite likely a result of these mistaken conclusions. I will leave it to the reader to imagine how that came to be, and the possible further ramifications.

The reason so many people have this fundamental misunderstanding is that they do not really understand how viruses replicate, and they do not understand Charles Darwin's theory of evolution, which is the mechanism by which drug resistant virus is created. In order to understand the former, you have to know something about eukaryotic cells, the gene-protein system, and the genetic transcription process involving DNA and RNA. In order to understand the latter -- evolution -- you need only have been provided with a coherent explanation. This coherent explanation would not only make you wiser -- it might one day save your life, and the lives of people you care about.