Human Sexuality and Gender/STIs and HIV/AIDS

Gonorrhea
Gonorrhea is a sexually transmitted disease (STD), spread by skin to skin contact of the genitals, mouth, or anus. Gonorrhea can also spread during childbirth from an infected mother. Ejaculation does not have to occur the gonorrhea to spread to the uninfected person. The bacterium grow and develop in moist areas, causing painful sensations while urinating, burning of the throat, swollen testicles, yellow or green discharge from the penis/vagina or increased vaginal discharge. Gonorrhea, if left untreated, can develop into pelvic inflammatory disease (PID) or Epididymitis, both which can lead to infertility and possibly death if left untreated. Gonorrhea can be easily detected through a series of laboratory tests executed on the likely infected areas (i.e. cervix, rectum, throat etc.). Treatment includes a high dose of antibiotics, which stops the infection, but does not repair any damage caused by the infection. To avoid contracting gonorrhea, the obvious answer would be abstinence, however other options are now available for everyday use, such as latex condoms (2010). .

Syphilis
Although many people are concerned with chlamydia at the moment, another STD to worry about is syphilis because, like chlamydia, it can be asymptomatic until its later, more serious stages. According to the Centers for Disease Control and Prevention (CDC), “in the United States, health officials reported over 36,000 cases of syphilis in 2006, including 9,756 cases of primary and secondary (P&S) syphilis…The incidence of P&S syphilis was highest in women 20 to 24 years of age and in men 35 to 39 years of age.”

Chlamydia
Chlamydia is one of the leading STDs in the American population and the numbers continue to rise. Most people with the STD are not able to detect it due to a lack of symptoms. Because symptoms are generally mild or absent, chlamydia can often times purpose permanent damage. Infertility is just one of the many complications that may occur without the knowledge of it until its too late. Testing for such STD is relatively curable with antibiotics, or other painless methods.[Joseph Shaffer, Dir. Of health with the TriCounty Health Department]. With more than 1.2 million cases reported in 2008, Chlamydia Trachomatis infection is one of the most common reported STD in the United States. Chlamydia has the potential to cause serious complications in women such as ectopic pregnancy, chronic pelvic pain, and infertility. One of the leading causes of pelvic inflammatory disease or PID is Chlamydia. An estimate from the Journal of Women's Health, states that Chlamydia infection develops into PID in up to 40% of untreated women. Women are left untreated for a number of reasons, but one cause it the limited knowledge people have about the STD. Friedman et al. (2010) conducted a interviews to explore participants' Chlamydia knowledge. In the Friedman et al. (2010) interviews, less than one fifth of respondents (23 of 125) were able to cite information about Chlamydia beyond that it was a curable STD

HPV
Controversy has arisen over the Human papillomavirus (HPV) vaccine for many reasons, including safety of the vaccine, effectiveness, patient health and religious reasoning. Parents decide whether or not to vaccinate their daughters, the vaccination is a useful resource to prevent cervical cancer, but its worry-some because of the reasons listed above. The vaccination is recommended to be given to girls prior to any sexual activity to achieve the best results. British Columbia, Canada publicly funded a HPV vaccination program that was implemented through public schooling. All girls in grade 6 were eligible to participate. The parents who agreed to be surveyed, and had their daughters vaccinated, said they did so mostly because of the effectiveness of the vaccine. In contrast, the majority of parents who chose not to vaccinate their children said they did so mostly because of their concerns in the vaccines safety. In this particular survey, the more education the parents had, the more likely they were to have their children vaccinated. The HPV Vaccine can cause one, or several, of the following symptoms: fever, nausea, pharyngitis, dizziness, NVD, upper respiratory infection, gastroenteritis, appendicitis, PID, and bronchospasm. HPV itself can cause several health problems including genital warts, and cervical cancer that can lead to death. The virus is much more serious for women than men, as men are just carriers. They could unknowingly spread the virus to various sex partners and not realize it. No health side effects have been reported by men with HPV.

Herpes
Herpes is a viral infection that affects both men and women. Herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2) is common in the United states. one out of every six people 14 to 49 have Hsv-2. Even With so many people infected, there is still no cure for the infection. Genital HSV-2 infection is more common in women (approximately one out of five women 14 to 49 years of age) than in men (about one out of nine men 14 to 49 years of age). Transmission from an infected male to his female partner is more likely than from an infected female to her male partner. Herpes has no real cure; the medicines out there treat the sores and prevent future outbreaks. Even with no noticeable sores the infected person may shed enough virus to infect a sex partner. In 2000, researchers reported a vaccine that protected women who had never been infected with a herpes virus from getting HSV-2. But the vaccine didn't protect women who were already infected with HSV-1, and it offered no protection for men (WebMD 2002). With no cure about to be on the market, safe sex and abstinence is the only way to really protect oneself from catching it.

Trichomoniasis
Trichomonas vaginalis during pregnancy can cross into the amniotic fluid and result in preterm labor. According to Jundishapur Journal of Microbiology, of 450 pregnant women,150(33.3%) had preterm labor and 300(66.7%) term delivery. Two (1.3%) patients with preterm labor were positive for T. vaginalis but in term labor T. vaginalis was not found.Therefore, pregnant women with Trichomanas vaginalis are at risk of preterm labor,PROM,and LBW infants so it is necessary to take precautions to control and prevent complications of the disease. T. vaginalis is a parasitic protozoan that causes Trichomoniasis. Trichomoniasis is possibly the most common curable sexually transmitted disease worldwide, it is associated with potentially serious complications such as preterm birth and human immunodeficiency virus acquisition and transmission. The prevalence of Trichomoniasis in inner city U.S. STD clinics typically approaches 25% but may be higher in certain populations. Signs of infection include vaginal discharge (42%), odor (50%), and edema or erythema (22 to 37%). The discharge is generally described as frothy, but it is actually frothy in only about 10% of patients. Colpitis macularis (strawberry cervix) is a specific clinical sign for this infection but is detected with reliability only by colposcopy. Other complaints may include dysuria and lower abdominal pain. Nearly half of all women with T. vaginalis are asymptomatic and will not be diagnosed unless specifically screened for Trichomoniasis. The prevalence of Trichomoniasis in males is less characterized; the infection is usually asymptomatic, but it has been suggested as an important cause of non-gonococcal urethritis.

Turberculosis and HIV
Tuberculosis (TB) is an infectious disease that usually infects the lungs, but can attack almost any part of the body. Tuberculosis is spread from person to person through the air. When a person with TB in their lungs or throat coughs, laughs, sneezes, sings, or even talks, the germs that cause TB may spread through the air. If another person breathes in these germs, there is a chance that they will become infected with tuberculosis. Tuberculosis and HIV have been closely linked since the emergence of AIDS. HIV infection has contributed to a significant increase in the worldwide incidence of tuberculosis.By producing a progressive decline in cell-mediated immunity, HIV alters the pathogenesis of tuberculosis, greatly increasing the risk of developing disease in coinfected individuals and leading to more frequent extrapulmonary involvement and atypical radiographic manifestations. Although HIV-related tuberculosis is both treatable and preventable, incidence rates continue to climb in developing nations where HIV infection and tuberculosis are endemic and resources are limited. Worldwide, tuberculosis is the most common opportunistic infection affecting HIV-seropositive individuals, and it is the most common cause of death in patients with AIDS. This chapter will review the epidemiology, pathogenesis, and management of tuberculosis in the setting of HIV infection.Tuberculosis can develop through progression of recently acquired infection (primary disease), reactivation of latent infection, or exogenous reinfection. Recent data suggest that in urban areas within the United States, recent transmission accounts for a larger proportion of cases than was realized previously.(19,20) Molecular genotyping studies in San Francisco and New York reported that 30-40% of new cases were due to recent infection with rapid progression to disease. In both studies, HIV infection or AIDS was an independent risk factor for recent acquisition of infection and rapid progression to disease.

HIV/AIDS
Human Immunodeficiency Virus (HIV) is a sexually transmitted disease that attacks the immune system. Our main cells (T4), which are needed to fight off illnesses, become overwhelmed by diseases and are then unable to protect the body from illnesses and infections.

The herpes simplex type 1 virus (HSV-1) was determined to have three origins of replications that were identified and that they were large. Generally a plasmid usually only has 1 origin of replication. Replication occured by the rolling circle mechanism for this virus. HSV-1 infects a human by first gaining access to a person's sensory neurons and then traveling through the axons of the neurons in order to start an infection in the sensory neurons that aggravate the site of infection. Vial latency is where the viral DNA is present however it stays in the body without having symptoms in a subdued form where symptoms do not appear until the virus is triggered. Lehman, Robert. Wanderings of a DNA Enzymologist: From DNA Polymerase to Viral Latency. Annu. Rev. Biochem. January 16, 2006.

Individuals at risk
For decades, the Human Immunodeficiency Virus (HIV) has been a growing concern among homosexual males who engage in promiscuous acts of sexual behavior, as most are unaware of their partners’ HIV status. For instance, Kelly et al.(1991) examined the responses of 470 men who attended gay bars or social organization meetings. "Forty-five percent of men were classified as ‘laspsers’ (those who have had unprotected anal intercourse in the previous 6 months) and 24% were classified as ‘resisters’ (those who successfully resisted urges to engage in this behavior)." Results revealed that well over 80% said that they had used condoms, including lapsers half the time. However, most acts of spontaneous behaviors happened with acquaintances who had claimed to be HIV free. Homosexual men who continue these high risk behaviors are in danger of obtaining HIV and spreading it without knowing. One interesting finding was that 2/3 of the respondents had no knowledge of their partners’ or their own HIV status.

Health and human services reported that 74% of female HIV cases were African American in Harris County, Texas. Unprotected sex was the main cause of HIV in African American females. Studies were conducted with Danish immigrants to see if condom use knowledge is an important factor in condom use. In 2000 there was a study conducted with 100 women to test the correlation between condom use knowledge and condom use. Less than 50% of women scored lower than 70% on the knowledge portion of the questionnaire. It was concluded that women with lower education levels have low knowledge of condom use. Condom use became highly promoted to try to prevent HIV infection, and more promoting is needed in African American areas to increase the condom use in the community.

External risks for those with HIV
One study observing 1130 HIV-seropositive patients without AIDS over the course of 53 months revealed that location, rather than medical history, was the largest factor in HIV-afflicted individuals additionally developing tuberculosis. People are at higher risk in the eastern part of the United States.

Smoking while having HIV and AIDs comes with many health risks. Lifson (2010) examined the different health risks that come with a combination of being a smoker and having HIV/AIDs, and the mortality rates between smokers and non-smokers. The study involved 5472 HIV infected people in 33 different countries. One finding of interest was 3% of participants experienced an AIDs related event. The AIDs related event was the highest among smokers.

Solutions
Medical antiretroviral-drug therapy can completely wipe out AIDS. If someone HIV positive was to take the therapy, they can live a long life and never pass on the virus even through unprotected sex. When the people in the world with AIDS die for any reason, the virus would be gone for good. Within ten years, with this theory, HIV infections in the world will go from 1 in 50 to 1 in 1000 and in about fifty years the AIDS population will fall from 10 percent to one percent. However, there are many obstacles, such as persuading everyone with HIV to start this therapy, etc, to overcome if they want to take this therapy global.

One researcher, Dr. Cosandra McNeil, believes that black churches could play a significant role in the prevention of HIV/AIDS. Dr. McNeil reported that in 1999, of Mississippi’s newly reported HIV infections, 74% were among African Americans. She feels that the churches in urban communities could help combat the fight against HIV and AIDS saying, “Within the black community the church is recognized as a strong institution in reference to its prevalence, independence, and outreach.” In addition, church based prevention programs have been successfully employed to increase breast cancer screening and awareness among African American women. Dr. McNeil conducted her study through surveying 11 pastors and 1 church member on different topics concerning HIV and the church’s role in the community. Dr. McNeil concluded that a larger study would be necessary to fully examine the role of the black church in HIV prevention but feels an impact could immediately be made if the church could serve as a “catalyst for medical professionals to help them understand different beliefs among African Americans.” Another way to enhance HIV prevention would be providing HIV/AIDS prevention workshops for pastors so they can be more trained and educated about the matter. Federal funding would also assist the church in implementing programs and other necessary efforts to fight the ongoing battle against HIV/AIDS.

The HIV Protease
HIV Protease is a symmetric dimer containing a pair of active-site aspartyl residues near to the symmetric axes and the substrate. One of the most important steps in the maturation of HIV is the cleavage of the Gag and Pol polyproteins by the protease. In order to access the substrate of HIV, a movement of the flaps in the apoenzyme are required to move. The enzyme does not undergo any structural change during binding to the substrate. HIV Protease contains catalytic machinery and dynamic properties in its dimerization that prove it to be a difficult drug target.

The Effect of HIV on Research
The HIV infection had a major effect on human sexuality research in the public interest and also in the type of research desired by the people. After the HIV pandemic was in full swing, human sexuality research got an overhaul that would begin a new era of research. At first, research was done to determine exactly what would spread this infection and the sexual behaviors that correspond. Quickly it was determined what these behaviors were and the age of STD prevention education began. Most of the research then switched to determining the best form of prevention, and since the main focus of human sexuality research has been infection prevention. The HIV infection greatly shaped and changed the way research is conducted and its new-found purpose for the better understanding of sexuality. One could say, ironically, that the HIV infection was one of the best things to happen to human sexuality research.

HIV in Other Countries
There are many barriers in the knowledge of how to protect oneself from HIV and AIDS in Swaziland. People of all ages are not as informed as they should be when it comes to sexual activity and condom use. Zamberia (2009) conducted a study that consisted of 37 in-depth interviews with people living with HIV (PLHIV) and five focus group discussions. The collected data was taken from between the times of September 2006 and February 2007. Out of the sample of people, 25 were female and 12 were male. There were three main topics of interest that were brought up amongst the group, 1) women's lack of control over sexual decision-making; 2) persistent HIV- related stigma and discrimination; 3) gender- discriminatory beliefs held by majority of those surveyed. Most women with HIV in Swaziland are forced to remain silent when it comes to their disease because men are not used to the idea of condoms, and women do not want to become embarrassed about their situation. Men, on the other hand are more reluctant to use condoms, especially in terms of marital status, because of their beliefs and suspicion that condoms cause in the marriage.

The barriers to HIV/STD prevention are broad and both gender and cultural factors can diminish the effectiveness of prevention programs. For example Leiber et al. (2009) examined the responses to semi-structured interview questions of 32 urban Chinese market workers regarding a number of themes associated with ineffective HIV/STD prevention. One finding of interest was that the talking about sex remains taboo (75%) and is seen as a barrier to effective prevention programs relatively equally by both males and females.