provide substantial peer-review of two of your cl

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Path to an HIV Cure: The Approaches, Potential Treatments, and Obstacles

Justin Caceres

Columbia College

Psyc. 385 DEB: Human Sexuality

Scott Myers

February 17, 2022

Abstract

Human immunodeficiency virus (HIV) is a type of virus that affects the immune system within humans in a very significant manner. More notably, this virus is known to cause acquired immunodeficiency syndrome (AIDS), which invades and destroys the ability for our immune systems to be able to combat diseases. An unfortunate issue, that is just as big of a concern, is that there are currently no existing cures when it comes to HIV and AIDS. While there are no notable cures that exists to this present day, there are still approaches that humans can take to live and longer and healthier life. Perhaps, these approaches can help future researchers have a deeper understanding of HIV/AIDS within itself, as well as having further understanding regarding what potential cures for these deadly viruses can be. Along with describing what can be the potential approaches and cures for HIV/AIDS, this literature will also analyze how close mankind is when it comes to finding the cure for HIV and AIDS, as well as briefly detail the challenges, impediments, and barriers that can interfere with the goal of finding a truly reliable cure for HIV/AIDS.

Keywords: HIV, AIDS, approaches, cures, treatments

Path to an HIV Cure: The Approaches, Potential Treatments, and Obstacles

Human immunodeficiency virus, or in short HIV, is described as a virus that attacks the immune system, and if not treated, it can lead to acquired immunodeficiency syndrome (AIDS) (Centers for Disease Control and Prevention (CDC)). Regarding some of the background about HIV: the Centers for Disease Control and Prevention states that HIV infections in human beings had initially come from a type of chimpanzee located in Central Africa; according to studies, the jump in which HIV was passed on to humans may have dated as far back to the late 1800s and has existed in the United States since the mid to late 1970s (CDC). As of this present day, there are no notable cures for HIV. The fact that there are currently no cures for HIV may even present challenges for individuals that are affected by this devastating virus; it can be assumed that having this virus could potentially affect the daily life of someone that is diagnosed with HIV. For example, a journal under Basavaraj and co-authors (2010) suggest that HIV infections may impact a person’s quality of life; such factors that may be impacted can be their physical and emotional well-being, life roles, and even their own social support systems.

Indeed, while there is no one and single cure that can completely eradicate HIV and AIDS, there are still approaches that exist in order for those, that are affected by them, to have a higher chance living at a higher quality of life. As it pertains to this present day, there are still many efforts in finding such approaches that are aimed to combat HIV. The existence of varying approaches towards combating HIV may also give researchers and scientists a better understanding of the concepts of HIV as a whole, and perhaps become a few steps closer in potentially discovering a future cure for this disease. While it must be noted that this literary work aims to list some of the approaches that humans can do in order to hinder some of the effects of HIV occurrences, it is very important to also claim that there are still a great deal of obstacles and challenges that researchers and scientists have to overcome when attempting to find a cure for HIV. Indeed, these obstacles can also serve as one of the reasons to as of why finding a cure for HIV is such a challenge, and why there are still no existing cures in contemporary societies. The following sections will describe both the approaches that we can take when taking on HIV, as well as going more into detail about those obstacles and challenges that serve as impediments in researchers’ and scientists’ path towards finding a cure for HIV. Furthermore, this literature will briefly describe how close we are when it comes to finding cures for HIV.

Approaches Towards HIV

As indicated in the previous section, there is no cure for HIV, as this means that the individual that gets this virus is with them for the rest of their lives. However, there are several approaches that allow us to have a better understanding about the concepts of HIV, as well as comprehending the factors that can limit the effects, instances, or occurrences of the virus. Though it is important to state that these approaches do not serve as an ultimate (or one) solution towards the eradication of HIV or AIDS, hence the term approaches and not cures.

With that being stated, one of the approaches in minimizing the instances of HIV occurrences and rebounds are the early utilizations of antiretroviral therapies (ART). According to the literary works of Ash and her co-authors (2021), the advances in ART have enabled people, that are diagnosed with HIV, to prolong and lengthen their lifespan and even in some cases, diminish the level of the virus within these affected individuals. Though, it must be emphasized that it is very important that potentially affected individuals seek ART as early as possible. Later utilizations of ART may increase the hardships when dealing, managing, and combating HIV (more specific details mentioned in the following section).

Another approach that can be done when going up against issues regarding HIV are the considerations for designing and implementing “combination HIV cure trials.” As opposed to “single” interventions, there are some biomedical scientists that suggest that combination HIV cure trials are more effective when it comes to a long-term viral suppression (Dubé, et al., 2021). In other words, a more effective approach, rather than combating HIV through one single method, is to use and combine multiple potentially curative interventions (Dubé, et al., 2021). For example, and based on the information from Dubé and co-author’s literary work, we may want to apply two or more clinical interventions, along with attempting to represent multiple mechanisms of action, plus the intention of multi-modal targeting of HIV and immune modulating interventions that aim to boost the immune systems for people that are living with HIV.

An article under Palmer and co-authors (2011) states some of the ways that people can approach HIV reservoirs from a clinical standpoint. Based from the information that is presented from their literary work, some form of understanding and comprehension towards the mechanisms that can maintain HIV latency, may be necessary. Some of the mechanisms that require further understanding are: the chromatin environment, the suppression viral mRNA that is able to cause a reduction in viral protein translation, as well as knowing the viral integration site (Palmer, et al., 2011). It can be assumed here that if many more scientists and researchers are able to understand more of the concepts and the mechanisms that maintain HIV latency, there can be an expanded knowledge around the scientific world, in which we have more of an ability to bring even more methods that emphasize long-term suppression for a much more expanded group of people that are living with HIV.

Obstacles When Finding an HIV Cure

While there are approaches, when combating HIV, that exist within scientific nature, it is also just as crucial to be able to understand the obstacles that come when we are trying to find the cure(s) for it. After all (and as indicated in previous sections) and simply put, the obstacles towards the mission in finding a potential HIV cure is what is holding such efforts back. In other words, such challenging obstacles can serve as one of the main reasons to as of why societies have not found a true cure against this virus. More specifically, we must be able to understand HIV reservoirs, as they serve as one of the barriers in the efforts in finding a cure.

In their article, Chun and co-authors (2015) state that latently infected and resting CD4+ T cells directly and indirectly contribute to a rapid viral rebound reoccurrence, despite the utilization of treatments, such as the fairly effective antiretroviral therapies (ART). Interestingly enough, Ash and her colleagues (2021) suggest that the occurrences of HIV neuroinvasion is also possible, and that such an action/interaction with the brain may even lead to a cognitive decline within an individual that is affected by it. With this information in mind, this can also mean that it would become much harder and more complicated for researchers and scientists to be able to come up with effective ways, that are intended to eradicate the virus completely. Additionally, a rapid viral rebound occurrence can also indicate that the use of drugs alone would be considered ineffective.

As suggested in the previous section, one of the ways to minimize HIV reservoirs are earlier applications/uses/initiations of ART (Chun et al., 2015). Though, despite many of the benefits of the advances of ART, especially when it is used at much earlier stages, it is also very critical to state that it can only suppress the HIV infections and not eradicate it entirely (Palmer et al., 2011); at the same time, noting its limitations should not be mistaken as a change of intention to avoid the use of ART, rather the statement was more intended to state that (and repetitively) it should not be seen as a one and only ultimate solution when we are trying to find a potential cure. As far as further methods when minimizing HIV reservoirs, the utilization of CD8+ T lymphocytes may also play a role in the attempts of minimizing HIV reservoirs, as they are intended target viral reservoirs and suppressing HIV viral replication (Chun et al., 2015).

How Far Away are We From a “Cure,” and is it Still Achievable?

As previous sections indicate, there is much more scientific advancement and knowledge, as far as the concepts of HIV and being able to suppress it, compared to years past. However, it would not be wise to conclude that a cure will be imminent. There are indeed still many barriers when it comes to finding the cure for HIV, from both a scientific standpoint and ethics standpoint from our own approaches previously mentioned. For example, one of the approaches presented in this literature, which is the implementation of combination HIV cure trials and interventions, faces a good amount of challenges itself, from an ethical and practical standpoint (Dubé, et al., 2021). Varying obstacles will continue to impede the mission to find a cure for HIV, but this does not mean that mankind should downplay their efforts to continue to accomplish that task. Additionally, Lewin and co-authors (2011) suggest that finding a cure not only requires a greater scientific advance, but it also requires help for those that are outside of the scientific field, such as affected communities, industries, and politicians; it is through many different professions and occupations that, in a way, should work together in scientists’ efforts when finding a cure for HIV. This statement may also suggest that help from other occupations such as politicians, industries, and other communities may also play a role regarding the timeline in which mankind is able to accomplish the task of finding a reliable and long-term cure.

Conclusion

This literary work has stated some of the approaches that people can take when combating HIV, as well as describing some of the challenges people have to endure when attempting to find a cure for HIV. As already suggested in previous sections, there are many challenges, obstacles, and hardships that come along when aiming to combat and eradicate HIV. It is not safe to conclude that we have been able to find a single reliable cure for HIV yet, but the utilization of various approaches and knowledge towards the concepts of suppressing the virus can provide some form of promise for future researchers who want to dive even deeper in the search for a cure. Like what the statements of Lewin and co-authors state, those in the scientific field should not be able to accept that HIV is a long-term illness that affects people for the rest of their lives. The mission and journey towards finding a cure for HIV is a very challenging and demanding task, but if mankind is able to find one in the nearby future, it would be a very rewarding discovery and achievement for the field of science, and a good amount of it will be due to the very detailed but essential concepts of understanding HIV and the ways to suppress it.

References

Ash, K., M., Al-Harthi, L., & Schneider, R., J. (2021). HIV in the brain: identifying viral reservoirs and addressing the challenges of an HIV cure. Vaccines, 9(8), 1-12. https://doi.org/10.3390/vaccines9080867

Basavaraj, H., K., Navra, A., M., & Rashmi, R. (2010). Quality of life in HIV/AIDS. Indian J Sex Transm Dis AIDS, 31(2), 75-80. doi:10.4103/2589-0557.74971

Centers for Disease Control and Prevention. About HIV. Retrieved from https://www.cdc.gov/hiv/basics/whatishiv.html

Chun, TW., Moir, S. & Fauci, A. (2015). HIV reservoirs as obstacles and opportunities for an HIV cure. Nat Immunol, 16 , 584–589. https://doi.org/10.1038/ni.3152

Dubé, K., Kanazawa, J., Dee, L., Taylor, J., Sauceda, A., J., Gianella, S., Smith, D., Deeks, G., S., & Peluso, J., M. (2021). Considerations for designing and implementing combination HIV cure trials: findings from a qualitative in-depth interview study in the United States. Aids Research and Therapy, 18(75), 1-17. https://doi.org/10.1186/s12981-021-00401-8

Lewin, R., S., Evans, A., V., Elliot, H., J., Spire, B., & Chomont, N. (2011). Finding a cure for HIV: will it ever be achievable? J Int AIDS Soc., 14(4). doi: 10.1186/1758-2652-14-4

Palmer S., Joseffson, L., & Coffin, M., J. (2011). HIV reservoirs and the possibilities of a cure for HIV infection. Journal of International Medicine, 270(6). https://doi.org/10.1111/j.1365-2796.2011.02457.x

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Impact of Homophobia in The Black Community

Abstract

A literary review was conducted to understand why the black community in the U.S. greatly suffers from this discrimination, as well as the impact it has on the member of the community. Peer reviewed articles sourced from Columbia College Library were selected for their insight into the root of the problem. Ideologies of the Black Church provided insight to not only the culture of black people, but also the history of black people. Additional articles highlighted the hardships of black LGBTQ members not only in the race community, but also their sexual orientation community. It is concluded that aspects of hypermasculinity, and lack of acceptance in the black community provide little support for LGBTQ members to feel safe. This lack of safety promotes secrecy, therefore forcing black people that do not fit in the traditional sexual orientation categories to forgo their mental, emotional, spiritual, and physical health.

Black homosexual men make up 1% of the population, yet they account for 25% of new HIV cases annually (Dawson et al., 2019). Black Churches are a staple of the black community and are treated as a viable resource of acceptance and guidance. Although it is not the stated opinion of black congregations to promote homophobia the teachings that are given in direct service or affiliated functions, say otherwise. Hypermasculinity is taught within these environments through homophobic-driven theology and black nationalism (Dawson et al., 2019). A bar is set for black people to constantly raise in order to show that they are just as capable if not better than all other races. These ideas stem from a history of enslavement and discrimination in the U.S. in which freedoms and liberties were not granted producing a community that was deemed as less than or subservient. To expel these common beliefs of the past it is in the interest of the Black Church to stay absolved of nay blemish upon the community. Homosexuality goes against the idea of the traditional family structure causing many black people to feel that it is not beneficial to black nationalism. Being that the Black Church is the most influential institution of its community, it has fostered many of the oldest social institutions in the community (Dawson et al., 2019). Theology that is taken verbatim, leaving no room for interpretation, is what many churchgoers are taught, in turn repeating the teachings to their families. While the Church has made attempts to change this narrative many congregations have not adopted this approach. Black Churches are especially weary to adopt changes made by the Church for fear of underrepresentation due to it being dominated by white men (Dawson et al., 2019). The combination of theology and historic oppression create a perfect environment for hypermasculinity to form. Black men feel pressure to live up to an expected role that is pushed by sermons given in church. Sermons that preach ideas of what it means to be a man result in black men looking inward to find if they meet these requirements, if these boxes are not checked then the need to increase one’s masculinity follows (Dawson et al., 2019). It is also found that feelings of embarrassment from not meeting the standard of what it means to be a man leaves gay, and bisexual men no option to be themselves. When these men choose to hide who they are from their community a decrease in mental, physical, spiritual, and emotional wellness begins.

Many would venture to say that discriminatory behavior against homosexuals does not differ amongst race, but instead is an equally shared burden. Lewis (2003) wrote his article based off information that was gained from roughly seven thousand blacks and forty-three thousand whites throughout 31 surveys conducted since 1973 and found that there was a significant difference. Black homosexuals face a harsher backlash if they announce their sexuality to their families due to an increase in the likelihood, they will be disowned by family members and ostracized by their community. On average black people are 11-14 percent more likely than whites to think that not only is homosexuality is wrong, but that AIDS is a punishment directly from God for immoral sexual behavior (Lewis, 2003). These feelings against homosexuality are not only found in surveys but are more commonly found in day-to-day conversation and social settings. When black homosexuals fear what may happen to their lives if their community were to find out their sexual orientation, they are more likely to engage in risky sexual behavior. Following this type of behavior if their medial health is in jeopardy, they are also likely to follow up with medical appointments. Refuge for black homosexuals is not often found in their own racial community as well as their sexual community. Racism can often be found in the LGTBQ community and cause many black people to steer clear of the social groups that are affiliated with them (Lewis, 2003). Facing discrimination on two different fronts poses black homosexuals with a very different outlook on how open they are with their own sexuality.

Religious condemnation partnered with the lack of community support leads black homosexuals down the path of secrecy. A devastating truth in the LGBTQ community is that black men have the highest number of new HIV cases (Dawson et al., 2019). Their numbers of HIV cases can be directly correlated to the risky sex behaviors they partake in. Black men that have sex with men (BMSM) often have condom-less sex. This choice is particularly risky given the fact that HIV is a sexual transmitted disease that can easily be transferred through small tears in the inner lining of the anus. Having sex without a contraceptive drastically increases the chances of these tears forming and allows no protection for sex partners. Dawson et al. (2019) found that resilience is a psychological factor that impacts the decision to have condom-less sex. In their article resilience is defined as “the ability to recover quickly from stressful life situations”. Community acceptance promotes resilience, but given that black communities lack this support, BMSM often choose risky sex behaviors that align better with their desire for secrecy. Lack of resilience has been found to contribute to internalized homophobia in BMSM creating an additional reason on why they partake in impulsive risky sexual behavior (Dawson et al., 2019). The clear difference in the lifestyle and level of risk in when it comes to BMSM is found in staggering HIV statistic that they make up 25% of new HIV cases annually, but only equate to 1% of the U.S. population.

References

Dawson, E. L., Mendoza, M. C. B., Gaul, Z., Jeffries IV, W. L., Sutton, M. Y., & Wilson, P. A. (2019). Resilience, condom use self-efficacy, internalized homophobia, and condomless anal sex among black men who have sex with men, New York City. PLoS ONE, 14(4), e0215455. https://doi-org.proxy.ccis.edu/10.1371/journal.pone.0215455

Lewis, G. B. (2003). Black-White Differences in Attitudes toward Homosexuality and Gay Rights. Public Opinion Quarterly, 67(1), 59–78. https://doi-org.proxy.ccis.edu/10.1086/346009

Ward, E. (2005). Homophobia, hypermasculinity and the US black church. Culture, Health & Sexuality, 7(5), 493–504. https://doi-org.proxy.ccis.edu/10.1080/13691050500151248

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