Beginning as a benign simian immunodeficiency virus (SIV) found in the African chimpanzee population, SIV evolved into a human-killer in the early 1930s, long before it was recognized as a disease. Analysis of a blood sample of a Bantu man who died of an unidentified illness in the Belgian Congo in 1959 made him the first human confirmed case of the SIV infection, later to be identified as HIV infection. The virus stayed in remote Africa until jet travel, big cities, and the sexual revolution spread it worldwide, according to Tanmoy Bhattachary, a researcher at the Los Alamos National Laboratory in Los Alamos, New Mexico (Associated Press, 2000).

In 1978, gay men in the United States and Sweden and heterosexuals in Tanzania and Haiti began to exhibit signs of the SIV infection. Between 1980 and 1983, there were 3,422 deaths in the United States attributed to the virus. During that time, doctors in New York and Los Angeles reported an unusual and deadly form of lung infection (Pneumocystis carinii pneumonia) and a rare skin cancer (Kaposi’s sarcoma) among young homosexual men. In 1983, researchers at the Pasteur Institute, a private foundation dedicated to the prevention and treatment of diseases through biologic research, identified the cause of these conditions as the lymphadenopathy-associated virus. Referred to as HTLV-III (human T-cell lymphotropic virus), the virus was later renamed the human immunodeficiency virus (HIV). In 1986, HIV was identified as the virus that causes several conditions we now call acquired immunodeficiency syndrome (AIDS). In 1988, as an attempt to educate the public about this disease, the U.S. Surgeon General published and mailed a pamphlet, “Understanding AIDS,” to more than a million citizens (Aegis.com, 2006; Avert.org, 2006; Fohn.net, 2006). Extensive research has led to the discovery that human immunodeficiency virus is carried in the blood, blood products, and body fluids such as semen. It is transmitted primarily through intimate sexual contact or through the sharing of needles by intravenous drug users.

Global statistics, representative of cases in Africa, Asia, Europe, and North America, have remained fairly constant during the years 2001 through 2005. Figure 34-1 depicts the global distribution of HIV/AIDS as of 2001. In the year 2005, there were an estimated 39.4 million people living with HIV/AIDS worldwide compared with 40 million in 2001 (United Nations, 2006). Additionally, 2005 global statistics (MacNeil, 2006; United Nations, 2006) show that:

In the United States, at the beginning of 2004, approximately 1,039,000 to 1,185,000 individuals were infected with HIV, and an estimated 405,925 individuals were living with AIDS. Approximately 25% of those individuals affected were women, compared with 20% in 2001. An estimated 21.8 million deaths have occurred since the first cases of AIDS were identified in 1981 (Seattle Biomedical Research Institute, 2003; United Nations, 2006).

The AIDS virus attacks an individual’s immune system and emerges in the form of one or more of 12 secondary infectious diseases or opportunistic infectious diseases (an infection that occurs as a result of the individual’s weak or compromised immune system resulting from AIDS, cancer, or immunosuppressive drugs such as chemotherapy). Although the average time of the development of AIDS is about 10 years, HIV can occur between 6 months and 5 years after exposure to the virus. However, some people may carry the virus without showing symptoms of the disease for an indefinite period.

AIDS is frequently described as a tragic and complex phenomenon that provokes a shattering emotional and psychosocial impact on all who are involved with the illness. Indeed, AIDS connects medicine and psychiatry to a greater degree than any other major illness. Certain population groups have been identified as at risk for the psychosocial impact of AIDS, including:

The most serious psychosocial problems occur for those clients who actually have the disease. Most people with AIDS are relatively young, were previously healthy, and had not experienced a major medical illness. The confirmation of this diagnosis can be catastrophic for the client, eliciting a series of emotional and social reactions. These reactions include:

In addition, emotional crises may result from the client’s increasing isolation as he or she attempts to cope with the nearly universal stigma faced on a daily basis. AIDS clients experience rejection from all parts of society, including significant others, families, friends, social agencies, landlords, and health care workers. For many, this constant rejection causes a re-living of the “coming-out process,” with a heightening of the associated anxiety, guilt, and internalized self-hatred. The fear of spreading AIDS to others can lead to further isolation and abandonment, commonly at a time when there is an ever-greater need for physical and emotional support. Clients with AIDS may respond with intense anger and hostility as their conditions deteriorate and they confront the everyday realities of this illness: loss of job and home, forced changes in lifestyle, the perceived lack of response by the medical community, and the often crippling expense associated with the illness.