HIV Aids/Cure/Medicine

HIV Aids/Cure/Medicine

Human immunodeficiency virus infection and acquired immune deficiency syndrome is a spectrum of conditions caused by infection with the human immunodeficiency virus . Following initial infection, a person may not notice any symptoms or may experience a brief period of influenza like illness. As the infection progresses, it interferes more with the immune system, increasing the risk of common infections like tuberculosis, as well as other opportunistic infections, and tumors that rarely affect people who have working immune systems. Some bodily fluids, such as saliva and tears, do not transmit HIV. Methods of prevention include safe sex, needle exchange programs, treating those who are infected, and male circumcision. There is no cure or vaccine; however, antiretroviral treatment can slow the course of the disease and may lead to a near­normal life expectancy. Treatment is recommended as soon as the diagnosis is made. Without treatment, the average survival time after infection is 11 years. In 2015 about 37.3 million people were living with HIV and it resulted in 1.2 million deaths. HIV/AIDS is considered a pandemic—a disease outbreak which is present over a large area and is actively spreading. HIV is believed to have originated in west central Africa during the late 19th or early 20th century. AIDS was first recognized by the United States Centers for Disease Control and Prevention in 1981 and its cause—HIV infection—was identified in the early part of the decade. HIV/AIDS has had a great impact on society, both as an illness and as a source of discrimination. The disease also has large economic impacts. The disease has become subject to many controversies involving religion including the Catholic Church's decision not to support condom use as prevention. It has attracted international medical and political attention as well as large scale funding since it was identified in the 1980s. Signs and symptoms There are three main stages of HIV infection: acute infection, clinical latency and AIDS. Clinical latency The initial symptoms are followed by a stage called clinical latency, asymptomatic HIV, or chronic HIV. to over 20 years . While typically there are few or no symptoms at first, near the end of this stage many people experience fever, weight loss, gastrointestinal problems and muscle pains. Another group consists of those who maintain a low or undetectable viral load without anti­retroviral treatment, known as "elite controllers" or "elite suppressors". Acquired immunodeficiency syndrome Acquired immunodeficiency syndrome is defined in terms of either a CD4+ T cell count below 200 cells per µL or the occurrence of specific diseases in association with an HIV infection. Which infections occur depends partly on what organisms are common in the person's environment. People with AIDS have an increased risk of developing various viral induced cancers, including Kaposi's sarcoma, Burkitt's lymphoma, primary central nervous system lymphoma, and cervical cancer. The second most common cancer is lymphoma, which is the cause of death of nearly 16% of people with AIDS and is the initial sign of AIDS in 3 to 4%. Additionally, people with AIDS frequently have systemic symptoms such as prolonged fevers, sweats, swollen lymph nodes, chills, weakness, and unintended weight loss. Diarrhea is another common symptom, present in about 90% of people with AIDS. They can also be affected by diverse psychiatric and neurological symptoms independent of opportunistic infections and cancers. Transmission HIV is transmitted by three main routes: sexual contact, significant exposure to infected body fluids or tissues, and from mother to child during pregnancy, delivery, or breastfeeding . It is possible to be co­infected by more than one strain of HIV—a condition known as HIV superinfection. Sexual The most frequent mode of transmission of HIV is through sexual contact with an infected person. About 15% of gay and bisexual men have HIV while 28 percent of transgender women test positive. While the risk of transmission from oral sex is relatively low, it is still present. The risk from receiving oral sex has been described as "nearly nil"; however, a few cases have been reported. The per act risk is estimated at 00.04% for receptive oral intercourse. In settings involving prostitution in low income countries, risk of female to male transmission has been estimated as 2.4% per act and male to female transmission as 0.05% per act. Risk of transmission increases in the presence of many sexually transmitted infections and genital ulcers. During the first 2.5 months of an HIV infection a person's infectiousness is twelve times higher due to this high viral load. Rough sex can be a factor associated with an increased risk of transmission. Sexual assault is also believed to carry an increased risk of HIV transmission as condoms are rarely worn, physical trauma to the vagina or rectum is likely, and there may be a greater risk of concurrent sexually transmitted infections. Body fluids The second most frequent mode of HIV transmission is via blood and blood products. The risk of acquiring HIV from a needle stick from an HIV infected person is estimated as 0.3% per act and the risk following mucous membrane exposure to infected blood as 0.09% per act. and in some areas more than 80% of people who inject drugs are HIV positive. and in the United States it was one in 1.5 million in 2008. In low income countries, only half of transfusions may be appropriately screened, and it is estimated that up to 15% of HIV infections in these areas come from transfusion of infected blood and blood products, representing between 5% and 10% of global infections. Although rare because of screening, it is possible to acquire HIV from organ and tissue transplantation. Unsafe medical injections play a significant role in HIV spread in sub Saharan Africa. In 2007, between 12 and 17% of infections in this region were attributed to medical syringe use. The World Health Organization estimates the risk of transmission as a result of a medical injection in Africa at 1.2%. It is not possible for mosquitoes or other insects to transmit HIV. Mother To Child HIV can be transmitted from mother to child during pregnancy, during delivery, or through breast milk resulting in infection in the baby. This is the third most common way in which HIV is transmitted globally. Antiretrovirals when taken by either the mother or the infant decrease the risk of transmission in those who do breastfeed. Many of these measures are however not available in the developing world. Virology HIV is the cause of the spectrum of disease known as HIV/AIDS. HIV is a retrovirus that primarily infects components of the human immune system such as CD4+ T cells, macrophages and dendritic cells. It directly and indirectly destroys CD4+ T cells. HIV is a member of the genus Lentivirus, part of the family Retroviridae. Lentiviruses share many morphological and biological characteristics. Many species of mammals are infected by lentiviruses, which are characteristically responsible for long duration illnesses with a long incubation period. Lentiviruses are transmitted as single stranded, positive sense, enveloped RNA viruses. Upon entry into the target cell, the viral RNA genome is converted into double stranded DNA by a virally encoded reverse transcriptase that is transported along with the viral genome in the virus particle. The resulting viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host co­factors. Once integrated, the virus may become latent, allowing the virus and its host cell to avoid detection by the immune system. Alternatively, the virus may be transcribed, producing new RNA genomes and viral proteins that are packaged and released from the cell as new virus particles that begin the replication cycle anew. HIV is now known to spread between CD4+ T cells by two parallel routes: cell­free spread and cell to cell spread, i.e. it employs hybrid spreading mechanisms. In the cell free spread, virus particles bud from an infected T cell, enter the blood/extracellular fluid and then infect another T cell following a chance encounter. The hybrid spreading mechanisms of HIV contribute to the virus's ongoing replication against antiretroviral therapies. Two types of HIV have been characterized: HIV­1 and HIV­2. HIV­1 is the virus that was originally discovered . It is more virulent, more infective, and is the cause of the majority of HIV infections globally. The lower infectivity of HIV­2 as compared with HIV­1 implies that fewer people exposed to HIV­2 will be infected per exposure. Because of its relatively poor capacity for transmission, HIV­2 is largely confined to West Africa. Pathophysiology After the virus enters the body there is a period of rapid viral replication, leading to an abundance of virus in the peripheral blood. During primary infection, the level of HIV may reach several million virus particles per milliliter of blood. This response is accompanied by a marked drop in the number of circulating CD4+ T cells. The acute viremia is almost invariably associated with activation of CD8+ T cells, which kill HIV infected cells, and subsequently with antibody production, or seroconversion. The CD8+ T cell response is thought to be important in controlling virus levels, which peak and then decline, as the CD4+ T cell counts recover. A good CD8+ T cell response has been linked to slower disease progression and a better prognosis, though it does not eliminate the virus. Ultimately, HIV causes AIDS by depleting CD4+ T cells. This weakens the immune system and allows opportunistic infections. T cells are essential to the immune response and without them, the body cannot fight infections or kill cancerous cells. The mechanism of CD4+ T cell depletion differs in the acute and chronic phases. During the acute phase, HIV induced cell lysis and killing of infected cells by cytotoxic T cells accounts for CD4+ T cell depletion, although apoptosis may also be a factor. During the chronic phase, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells appear to account for the slow decline in CD4+ T cell numbers. Although the symptoms of immune deficiency characteristic of AIDS do not appear for years after a person is infected, the bulk of CD4+ T cell loss occurs during the first weeks of infection, especially in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body. The reason for the preferential loss of mucosal CD4+ T cells is that the majority of mucosal CD4+ T cells express the CCR5 protein which HIV uses as a co­receptor to gain access to the cells, whereas only a small fraction of CD4+ T cells in the bloodstream do so. A specific genetic change that alters the CCR5 protein when present in both chromosomes very effectively prevents HIV­1 infection. HIV seeks out and destroys CCR5 expressing CD4+ T cells during acute infection. A vigorous immune response eventually controls the infection and initiates the clinically latent phase. CD4+ T cells in mucosal tissues remain particularly affected. Immune activation, which is reflected by the increased activation state of immune cells and release of pro­inflammatory cytokines, results from the activity of several HIV gene products and the immune response to ongoing HIV replication. It is also linked to the breakdown of the immune surveillance system of the gastrointestinal mucosal barrier caused by the depletion of mucosal CD4+ T cells during the acute phase of disease. Diagnosis HIV/AIDS is diagnosed via laboratory testing and then staged based on the presence of certain signs or symptoms. Additionally, testing is recommended for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. Thus HIV infection can only be diagnosed by PCR testing for HIV RNA or DNA, or via testing for the p24 antigen. In 2009, between 3.6 and 42% of men and women in Sub Saharan countries were tested The WHO system uses the following categories: Primary HIV infection: May be either asymptomatic or associated with acute retroviral syndrome. This system classifies HIV infections based on CD4 count and clinical symptoms, and describes the infection in five groups. When condoms are used consistently by a couple in which one person is infected, the rate of HIV infection is less than 1% per year. There is some evidence to suggest that female condoms may provide an equivalent level of protection. Application of a vaginal gel containing tenofovir immediately before sex seems to reduce infection rates by approximately 40% among African women. By contrast, use of the spermicide nonoxynol 9 may increase the risk of transmission due to its tendency to cause vaginal and rectal irritation. Circumcision in Sub Saharan Africa "reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months". Due to these studies, both the World Health Organization and UNAIDS recommended male circumcision as a method of preventing female to male HIV transmission in 2007 in areas with a high rates of HIV. However, whether it protects against male to female transmission is disputed, and whether it is of benefit in developed countries and among men who have sex with men is undetermined. The International Antiviral Society, however, does recommend for all sexually active heterosexual males and that it be discussed as an option with men who have sex with men. Some experts fear that a lower perception of vulnerability among circumcised men may cause more sexual risk taking behavior, thus negating its preventive effects. Programs encouraging sexual abstinence do not appear to affect subsequent HIV risk. Evidence of any benefit from peer education is equally poor. Comprehensive sexual education provided at school may decrease high risk behavior. A substantial minority of young people continues to engage in high­risk practices despite knowing about HIV/AIDS, underestimating their own risk of becoming infected with HIV. Voluntary counseling and testing people for HIV does not affect risky behavior in those who test negative but does increase condom use in those who test positive. It is not known whether treating other sexually transmitted infections is effective in preventing HIV. TASP is associated with a 10 to 20 fold reduction in transmission risk. Pre­exposure prophylaxis with a daily dose of the medications tenofovir, with or without emtricitabine, is effective in a number of groups including men who have sex with men, couples where one is HIV positive, and young heterosexuals in Africa. Universal precautions within the health care environment are believed to be effective in decreasing the risk of HIV. Intravenous drug use is an important risk factor and harm reduction strategies such as needle exchange programs and opioid substitution therapy appear effective in decreasing this risk. Post­exposure A course of antiretrovirals administered within 48 to 72 hours after exposure to HIV­positive blood or genital secretions is referred to as post­exposure prophylaxis . As of 2013, the prevention regimen recommended in the United States consists of three medications— tenofovir, emtricitabine and raltegravir—as this may reduce the risk further. PEP treatment is recommended after a sexual assault when the perpetrator is known to be HIV positive, but is controversial when their HIV status is unknown. The duration of treatment is usually four weeks and is frequently associated with adverse effects—where zidovudine is used, about 70% of cases result in adverse effects such as nausea, fatigue, emotional distress and headaches . If replacement feeding is acceptable, feasible, affordable, sustainable, and safe, mothers should avoid breastfeeding their infants; however exclusive breastfeeding is recommended during the first months of life if this is not the case. If exclusive breastfeeding is carried out, the provision of extended antiretroviral prophylaxis to the infant decreases the risk of transmission. In 2015, Cuba became the first country in the world to eradicate mother to child transmission of HIV. Vaccination Currently, there is no licensed vaccine for HIV or AIDS. Further trials of the RV 144 vaccine are ongoing. Treatment There is currently no cure or effective HIV vaccine. Treatment consists of highly active antiretroviral therapy which slows progression of the disease. As of 2010 more than 6.6 million people were taking them in low and middle income countries. Initially treatment is typically a non­nucleoside reverse transcriptase inhibitor plus two nucleoside analog reverse transcriptase inhibitors . Combinations of agents which include protease inhibitors are used if the above regimen loses effectiveness. Once treatment is begun it is recommended that it is continued without breaks or "holidays". Levels to determine if treatment is effective are initially recommended after four weeks and once levels fall below 50 copies/mL checks every three to six months are typically adequate. In the developing world treatment also improves physical and mental health. With treatment there is a 70% reduced risk of acquiring tuberculosis. inadequate social supports, mental illness and drug abuse. The complexity of treatment regimens and adverse effects may reduce adherence. Even though cost is an important issue with some medications, 47% of those who needed them were taking them in low and middle income countries as of 2010 Specific adverse events are related to the antiretroviral agent taken. and an increased risk of cardiovascular disease. Newer recommended treatments are associated with fewer adverse effects. The United States guidelines recommend treating all children less than 12 months of age and all those with HIV RNA counts greater than 100,000 copies/mL between one year and five years of age. Opportunistic infections Measures to prevent opportunistic infections are effective in many people with HIV/AIDS. In addition to improving current disease, treatment with antiretrovirals reduces the risk of developing additional opportunistic infections. Vaccination against hepatitis A and B is advised for all people at risk of HIV before they become infected; however it may also be given after infection. Trimethoprim/sulfamethoxazole prophylaxis between four and six weeks of age and ceasing breastfeeding in infants born to HIV positive mothers is recommended in resource limited settings. It is also recommended to prevent PCP when a person's CD4 count is below 200 cells/uL and in those who have or have previously had PCP. People with substantial immunosuppression are also advised to receive prophylactic therapy for toxoplasmosis and MAC. Appropriate preventive measures have reduced the rate of these infections by 50% between 1992 and 1997. Diet The World Health Organization has issued recommendations regarding nutrient requirements in HIV/AIDS. A generally healthy diet is promoted. Some evidence has shown a benefit from micronutrient supplements. There is some evidence that vitamin A supplementation in children reduces mortality and improves growth. Dietary intake of micronutrients at RDA levels by HIV­infected adults is recommended by the WHO; higher intake of vitamin A, zinc, and iron can produce adverse effects in HIV positive adults, and is not recommended unless there is documented deficiency. Alternative medicine In the US, approximately 60% of people with HIV use various forms of complementary or alternative medicine, even though the effectiveness of most of these therapies has not been established. There is not enough evidence to support the use of herbal medicines. There is insufficient evidence to recommend or support the use of medical cannabis to try to increase appetite or weight gain. Prognosis HIV/AIDS has become a chronic rather than an acutely fatal disease in many areas of the world. HAART and appropriate prevention of opportunistic infections reduces the death rate by 80%, and raises the life expectancy for a newly diagnosed young adult to 20–50 years. This is between two thirds If treatment is started late in the infection, prognosis is not as good: Risk of cancer appears to increase once the CD4 count is below 500/μL. their access to health care, the presence of co­infections; and the particular strain of the virus involved. Tuberculosis co infection is one of the leading causes of sickness and death in those with HIV/AIDS being present in a third of all HIV infected people and causing 25% of HIV related deaths. HIV is also one of the most important risk factors for tuberculosis. Hepatitis C is another very common co infection where each disease increases the progression of the other. The two most common cancers associated with HIV/AIDS are Kaposi's sarcoma and AIDS related non Hodgkin's lymphoma. osteoporosis, neuropathy, cancers, nephropathy, and cardiovascular disease. As of 2014, approximately 37 million people have HIV worldwide with the number of new infections that year being about 2 million. This is down from 3.1 million new infections in 2001. Of these 37 million more than half are women and 2.6 million are less than 15 years old. It resulted in about 1.2 million deaths in 2014, This means that about 5% of the adult population is infected and it is believed to be the cause of 10% of all deaths in children. Here in contrast to other regions women compose nearly 60% of cases. South & South East Asia is the second most affected; in 2010 this region contained an estimated 4 million cases or 12% of all people living with HIV resulting in approximately 250,000 deaths. As of 2016 about 675,000 people have died HIV/AIDS in the USA since the beginning of the HIV epidemic. In the United Kingdom as of 2009 there were approximately 86,500 cases which resulted in 516 deaths. In Canada as of 2008 there were about 65,000 cases causing 53 deaths. Between the first recognition of AIDS in 1981 and 2009 it has led to nearly 30 million deaths. Prevalence is lowest in Middle East and North Africa at 0.1% or less, East Asia at 0.1% and Western and Central Europe at 0.2%. History Discovery AIDS was first clinically observed in 1981 in the United States. Soon thereafter, an unexpected number of homosexual men developed a previously rare skin cancer called Kaposi's sarcoma . Many more cases of PCP and KS emerged, alerting U.S. Centers for Disease Control and Prevention and a CDC task force was formed to monitor the outbreak. In the early days, the CDC did not have an official name for the disease, often referring to it by way of the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus. They also used Kaposi's sarcoma and opportunistic infections, the name by which a task force had been set up in 1981. At one point, the CDC coined the phrase "the 4H disease", since the syndrome seemed to affect heroin users, homosexuals, hemophiliacs, and Haitians. In the general press, the term "GRID", which stood for gay related immune deficiency, had been coined. However, after determining that AIDS was not isolated to the gay community, By September 1982 the CDC started referring to the disease as AIDS. In 1983, two separate research groups led by Robert Gallo and Luc Montagnier declared that a novel retrovirus may have been infecting people with AIDS, and published their findings in the same issue of the journal Science. Gallo claimed that a virus his group had isolated from a person with AIDS was strikingly similar in shape to other human T Lymphotropic viruses his group had been the first to isolate. Gallo's group called their newly isolated virus HTLV­III. At the same time, Montagnier group isolated a virus from a person presenting with swelling of the lymph nodes of the neck and physical weakness, two characteristic symptoms of AIDS. Contradicting the report from Gallo's group, Montagnier and his colleagues showed that core proteins of this virus were immunologically different from those of HTLV­I. Montagnier group named their isolated virus lymphadenopathy associated virus . Origins Both HIV­1 and HIV­2 are believed to have originated in non­human primates in West Central Africa and were transferred to humans in the early 20th century. The closest relative of HIV­2 is SIV, a virus of the sooty mangabey, an Old World monkey living in coastal West Africa . HIV­1 is thought to have jumped the species barrier on at least three separate occasions, giving rise to the three groups of the virus, M, N, and O. There is evidence that humans who participate in bushmeat activities, either as hunters or as bushmeat vendors, commonly acquire SIV. However, SIV is a weak virus which is typically suppressed by the human immune system within weeks of infection. It is thought that several transmissions of the virus from individual to individual in quick succession are necessary to allow it enough time to mutate into HIV. Furthermore, due to its relatively low person to person transmission rate, SIV can only spread throughout the population in the presence of one or more high risk transmission channels, which are thought to have been absent in Africa before the 20th century. Specific proposed high risk transmission channels, allowing the virus to adapt to humans and spread throughout the society, depend on the proposed timing of the animal to human crossing. Genetic studies of the virus suggest that the most recent common ancestor of the HIV­1 M group dates back to circa 1910. Proponents of this dating link the HIV epidemic with the emergence of colonialism and growth of large colonial African cities, leading to social changes, including a higher degree of sexual promiscuity, the spread of prostitution, and the accompanying high frequency of genital ulcer diseases in nascent colonial cities. While transmission rates of HIV during vaginal intercourse are low under regular circumstances, they are increased many fold if one of the partners suffers from a sexually transmitted infection causing genital ulcers. Early 1900s colonial cities were notable due to their high prevalence of prostitution and genital ulcers, to the degree that, as of 1928, as many as 45% of female residents of eastern Kinshasa were thought to have been prostitutes, and, as of 1933, around 15% of all residents of the same city had syphilis. The earliest well documented case of HIV in a human dates back to 1959 in the Congo. The earliest retrospectively described case of AIDS is believed to have been in Norway beginning in 1966. In July 1960, in the wake its independence, the United Nations recruited Francophone experts and technicians from all over the world to assist in filling administrative gaps left by Belgium, who did not leave behind an African elite to run the country. By 1962, Haitians made up the second largest group of well educated experts, that totaled around 4500 in the country. Dr. Jacques Pépin, a Quebecer author of The Origins of AIDS, stipulates that Haiti was one of HIV's entry points to the United States and that one of them may have carried HIV back across the Atlantic in the 1960s. the vast majority of infections occurring outside sub Saharan Africa can be traced back to a single unknown individual who became infected with HIV in Haiti and then brought the infection to the United States some time around 1969. The epidemic then rapidly spread among high risk groups . By 1978, the prevalence of HIV­1 among homosexual male residents of New York City and San Francisco was estimated at 5%, suggesting that several thousand individuals in the country had been infected. AIDS stigma has been further divided into the following three categories: Instrumental AIDS stigma—a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness. Symbolic AIDS stigma—the use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease. Often, AIDS stigma is expressed in conjunction with one or more other stigmas, particularly those associated with homosexuality, bisexuality, promiscuity, prostitution, and intravenous drug use. In many developed countries, there is an association between AIDS and homosexuality or bisexuality, and this association is correlated with higher levels of sexual prejudice, such as anti­homosexual/bisexual attitudes. There is also a perceived association between AIDS and all male­male sexual behavior, including sex between uninfected men. In 2003, as part of an overall reform of marriage and population legislation, it became legal for people with AIDS to marry in China. Economic impact HIV/AIDS affects the economics of both individuals and countries. Without proper nutrition, health care and medicine, large numbers of people die from AIDS­related complications. They will not only be unable to work, but will also require significant medical care. It is estimated that as of 2007 there were 12 million AIDS orphans. Returning to work after beginning treatment for HIV/AIDS is difficult, and affected people often work less than the average worker. Unemployment in people with HIV/AIDS also is associated with suicidal ideation, memory problems, and social isolation; employment increases self­esteem, sense of dignity, confidence, and quality of life. A 2015 Cochrane review found low­quality evidence that antiretroviral treatment helps people with HIV/AIDS work more, and increases the chance that a person with HIV/AIDS will be employed. By affecting mainly young adults, AIDS reduces the taxable population, in turn reducing the resources available for public expenditures such as education and health services not related to AIDS resulting in increasing pressure for the state's finances and slower growth of the economy. This causes a slower growth of the tax base, an effect that is reinforced if there are growing expenditures on treating the sick, training, sick pay and caring for AIDS orphans. This is especially true if the sharp increase in adult mortality shifts the responsibility and blame from the family to the government in caring for these orphans. Religion and AIDS The topic of religion and AIDS has become highly controversial in the past twenty years, primarily because some religious authorities have publicly declared their opposition to the use of condoms. The religious approach to prevent the spread of AIDS according to a report by American health expert Matthew Hanley titled The Catholic Church and the Global AIDS Crisis argues that cultural changes are needed including a re­emphasis on fidelity within marriage and sexual abstinence outside of it. The Synagogue Church Of All Nations advertise an "anointing water" to promote God's healing, although the group deny advising people to stop taking medication. A notable British casualty of AIDS that year was Nicholas Eden, a gay politician and son of the late prime minister Anthony Eden. On November 24, 1991, the virus claimed the life of British rock star Freddie Mercury, lead singer of the band Queen, who died from an AIDS­related illness having only revealed the diagnosis on the previous day. However, he had been diagnosed as HIV positive in 1987. One of the first high­profile heterosexual cases of the virus was Arthur Ashe, the American tennis player. He was diagnosed as HIV positive on August 31, 1988, having contracted the virus from blood transfusions during heart surgery earlier in the 1980s. Further tests within 24 hours of the initial diagnosis revealed that Ashe had AIDS, but he did not tell the public about his diagnosis until April 1992. He died as a result on February 6, 1993 at age 49. Therese Frare's photograph of gay activist David Kirby, as he lay dying from AIDS while surrounded by family, was taken in April 1990. LIFE magazine said the photo became the one image "most powerfully identified with the HIV/AIDS epidemic." The photo was displayed in LIFE magazine, was the winner of the World Press Photo, and acquired worldwide notoriety after being used in a United Colors of Benetton advertising campaign in 1992. In 1996, Johnson Aziga, a Ugandan­born Canadian was diagnosed with HIV, but subsequently had unprotected sex with 11 women without disclosing his diagnosis. By 2003 seven had contracted HIV, and two died from complications related to AIDS. Aziga was convicted of first­degree murder and is liable to a life sentence. Criminal transmission Criminal transmission of HIV is the intentional or reckless infection of a person with the human immunodeficiency virus . Some countries or jurisdictions, including some areas of the United States, have laws that criminalize HIV transmission or exposure. Others may charge the accused under laws enacted before the HIV pandemic. Misconceptions There are many misconceptions about HIV and AIDS. Three of the most common are that AIDS can spread through casual contact, that sexual intercourse with a virgin will cure AIDS, and that HIV can infect only gay men and drug users. In 2014, some among the British public wrongly thought one could get HIV from kissing, sharing a glass, spitting, a public toilet seat, and coughing or sneezing . Other misconceptions are that any act of anal intercourse between two uninfected gay men can lead to HIV infection, and that open discussion of HIV and homosexuality in schools will lead to increased rates of AIDS. A small group of individuals continue to dispute the connection between HIV and AIDS, the existence of HIV itself, or the validity of HIV testing and treatment methods. These claims, known as AIDS denialism, have been examined and rejected by the scientific community. However, they have had a significant political impact, particularly in South Africa, where the government's official embrace of AIDS denialism was responsible for its ineffective response to that country's AIDS epidemic, and has been blamed for hundreds of thousands of avoidable deaths and HIV infections. Several discredited conspiracy theories have held that HIV was created by scientists, either inadvertently or deliberately. Operation INFEKTION was a worldwide Soviet active measures operation to spread the claim that the United States had created HIV/AIDS. Surveys show that a significant number of people believed – and continue to believe – in such claims. Research HIV/AIDS research includes all medical research which attempts to prevent, treat, or cure HIV/AIDS along with fundamental research about the nature of HIV as an infectious agent and AIDS as the disease caused by HIV. Many governments and research institutions participate in HIV/AIDS research. This research includes behavioral health interventions such as sex education, and drug development, such as research into microbicides for sexually transmitted diseases, HIV vaccines, and antiretroviral drugs. Other medical research areas include the topics of pre­exposure prophylaxis, post­exposure prophylaxis, and circumcision and HIV.