Dec 1 World AIDS Day

"There are more viruses on earth than there are stars in the universe."  National Geographic

AIDS (or the HIV virus that causes it) is an infectious disease that should have woken humanity up to our collective challenge to save civilization two decades ago when it was first recognized in the US in San Francisco, CA.   It didn’t then but still can if we understand how the biology of this virus connects us with each other -- and the rest of the world in multiple ways.

World AIDS Day offers us yet another opportunity to understand it and what’s needed to prevent inevitable catastrophic consequences if we keep ignoring the obvious lessons that this and other viruses repeatedly offer us.  Fundamentally, viruses are “change-causing” agents.  AIDS is one of the best.  But first some simple biology. 

We often take life (and our health) for granted.  We shouldn’t.  Life anywhere in this cold and dark universe is miraculous, rare and infinitely vulnerable.  Every human has over 20,000 different proteins vital for one’s health, procreation, and survival.   A virus has fewer than 200.  And every cell of every person and every other cellular organism in every domain of on earth is vulnerable to viral infections.

Humans want things to stay the same.  We get annoyed when unexpected things happen.  But real life and the entire physical universe is in a constant state of change.  Life forms that fail to adapt face extinction.  We are no exception.  There are two fundamental avenues of change.  Natural selection and human selection.   Nature’s environmental changes select the DNA with favorable traits.  We humans can change the environment to compensate for weakness in our DNA. 

The natural environment favored the evolution of a primate viral infection that didn’t kill the primates infected in the deep rain forest of Africa.  But it became lethal to the human primates that were infected with it while eating lesser primates.  But it did so in a very slow way allowing it to be spread further when these advanced primates mated.  And in the early 1980s this virus started slowly killing gay men in San Francisco. Within 30 years it had killed 39 million people.  Still far short of the records of the 1918 flu which killed nearly 100 million people. Or smallpox which killed over 300 million people in 70 years of the last century (more than all the wars and genocides combined during 100 years of the last century).

But this virus remains with us today for two unique reasons.   First, it hides in the very cells that are supposed to detect it and destroy it.  Viruses have been the greatest threat to all larger life forms of the planet since the beginning.  And immune systems in larger organisms evolved to fight them.  But this type of virus’s high mutation rate resulted in unique strains that infiltrated and fooled the immune system cells with even the most effective anti-virus proficiencies.   Second, the virus didn’t immediately kill its host.  It lingered for a long time without harming any host characteristic that would inhibit its capacity for acquiring sex partners over an extended period of time.

Viruses, likely being the first earthly life form, remain the smallest semblance of life.  They have survived and thrived through every environmental change in earth’s history.  They will do so until the earth’s temperature is hot enough to break their molecular bonds (about 500 degrees F).  Our immune system, like our 11 other biological systems, fail catastrophically at about 110 degrees.   We must learn to adapt to viruses toughness, resilience, and ever evolving killing capacity.

We face other existential threats and create more with each new technology we create.  And just because its modern technology doesn’t mean it doesn’t help viruses spread.  Modern invasive medical procedures greatly enable viruses and other infectious agents.

Nosocomial (hospital acquired infections) kill about 100,000 Americans each year.  Modern food processing and transportation have done the same enabling mass contamination and rapid distribution of infectious agents annually to one in six Americans (about 50 million people) 3,000 of whom will die.   Other modern factors like air travel enable their rapid spread globally.  Combine this with increased human incursion into remote environmental habitats exposing their ‘civilized’ immune systems unknown pathogens and their rapid return to densely populated cities and catastrophic consequences are inevitable.  In this sense our minds belief that what we don’t see won’t hurt us is lethal.  

The greatest advance in human history was the invention of the microscope followed by the invention of technologies to provide clean water and safe removal of waste (the flush toilet).  But again, advances in chemistry and biology have created modern substances that again empower natures pathogens.  Both advanced chemical and biological substances facilitate the mutation rate of existing pathogens.  Chemicals mutate their DNA and RNA.  Antibiotics kill most bacterial pathogens but in the case of Tuberculosis (one in every three people in the world have this bacterium in their bodies) the wrong or unsupervised use and abuse of antibiotics to treat TB has resulted in strains of TB that must be removed 
surgically. And those operated on only have a 50% survival rate.   The HIV virus kicks into high gear when it infects anyone whose health has already been compromised by TB, malnutrition, or some other immune system inhibitor (chemical, biological, environmental, nutritional, economic, political, criminal, military, cultural, or religious).  In other words…anything that doesn’t abide by the fundamental principles inherent in both the “Laws of Nature and Natures God”.

The evolution of pathogens is inevitable regardless of our technological advances.  Advances which too often even accelerate their evolution.   Sometimes intentionally.  Advances in bio and cyber technologies have enabled an increasing global capacity to create designer biological weapons.  Pathogens that make nature’s killers look benign.  Nature’s small pox killed about 3% of those it infected. Weaponized Smallpox perfected by the former Soviet Union was designed to kill over 90%.  The evolution of war ensures the evolution of weaponry, including biological.  As long as war remains an earthly option our species vulnerability is exacerbated in multiple ways (think computer viruses which have much in common with biological viruses).

HIV is an RNA based virus with a 3% mutation rate.  There are about 2 billion replications of the virus every day (20,000 mutations) in each infected person.  The virus continues to change.  We are lucky it is not an airborne virus.  So far.  

Viruses (biological and cyber) consist of the tiniest packets of information (DNA or bits).  Hundreds, sometimes thousands of viruses can fit inside one cell (or computer).  Viruses reproduce faster and in greater numbers than any other life form.   If a person gets infected with a flu virus, they could have up to 100 trillion flu viruses in their body within a few days (more than 10,000 times the number of people on earth).   This hyper reproduction rate contributes greatly to the virus’s survivability in two ways.  Obviously, high numbers.  But, more important, genetic variability due to natural or environmentally induced errors made while multiplying.  IMPORTANT!  All pathogens are NOT the immutable structures that we usually envision in our minds.  They change relatively rapidly.  Not intentionally like we can but don’t, but through random mistakes in their nonsexual (un enjoyable?) process of reproduction resulting in ‘copy errors’ or mutations.  

HIV has a special advantage.  All life forms on earth are based on only two genetic blue prints.  DNA or RNA.  DNA usually uses RNA to make copies of itself with few mistakes.  But RNA can also make copies of RNA but makes more mistakes (mutations).  HIV is an RNA based resulting in far more mutations.  

Errors/mutations may sound like a bad thing. They usually are.  But occasionally (and I mean rarely) mutations are a good thing for the survival of that entity by providing a small but protective survival advantage to that one entity.  And then it reproduces by the thousands.  

Mutations increase the genetic variability of every life form.   It is life’s primary survival mechanism to nature’s inevitable environmental changes.  But now humans are changing the environment.  And those humans who don’t believe we humans as a whole don’t have that much power are contributing to our cultural and political capacity to change/adapt to the coming changes.  This is not rocket science.  Things change. So should we.  Or we will need a lot more rockets to save our species if we trash mother earth or create weapons (bio, cyber, nano, AI…) that destroy civilization first.  Rockets are not a bad idea.  Earth does have an expiration date.  But everything on it need not go extinct.  Advances in technology if focused on mimicking nature’s genius can carry us beyond this solar system…if we learn the ultimate principle of life, cooperation trumps competition.   Both fundamental drivers got us this far.  But things change.  Now cooperation is infinitely more important than competition which will end us.

The greatest survival advantage in this context is diversity.  And, improving our species genetic diversity depends on sexual reproduction.  White supremists have it backwards.  Their genetic purity is extremely vulnerable to extinction.  But, part of the destructive genius of the HIV virus (and other STDs) is its hijacking of the evolutionary strategy of sexual reproduction.  Multiple sex partners and sharing of needles is as harmful to our survival as racism, sexism, and prejudice.   We are free to do and think however we like but we will never be free of the consequences. 

The other genius quality of the HIV virus, its glacially slow rate of degrading the body’s immune system response in developing symptoms, is like depending on the US military to defend the United States from terrorist attacks while employing ISIS agents to operate within the NSA.  It would be advantageous for the NSA to have diversity of thinking (including former ISIS operatives who had the wisdom to ‘change’ sides) to assist in detecting hostile ISIS efforts to infiltrate our expanding vulnerabilities (because we refuse to change).

We were warned!   Shortly after the Sept, 11, 2001 attacks on the US, General Collin Powell was speaking at the UN.  He called HIV/AIDS a greater threat to U.S. national security than Al Qaeda.   He wasn’t referring to the AIDS high mutation rate of 1% (an average untreated HIV infected individual has about 2 billion replications of the viruses in their body on any given day) potentially producing over 20,000 variations of the virus in each person every day!!!   He was referring to the failed states that AIDS created in Africa which provides fertile ground for Al Qaeda expansion. 

Our lack of interest in the health and security of those in poverty on the African continent allowed the spread of HIV for decades.   African nations impoverished by corrupt dictator or unfair trade practices that the US supported – and wars or genocides that we either ignored or facilitated, eventually had US consequences. 

My wife and I were expecting our first child in the early 1980s while living in San Francisco.  I had friends in the gay community but never had a reason to fear AIDS.  Not, until a few months after our daughter was born.  We received a letter from the hospital to come in for an HIV test.  My wife had received a blood transfusion during the birthing.  The blood supply was not being monitored before then.  We were lucky. 

But it wasn’t smart that US foreign, trade and military policy had largely neglected the majority of people in Africa.  If we had been interested in their health, we could have detected the spread of HIV/AIDS at least 3 decades before it started killing Americans.  The economic costs of this virus and others imported mostly by US tourists, soldiers and business travelers returning home is far greater than the costs of preventing the spread of these infectious threats (including terrorism) by investing in global public health, nutrition and education programs. 

The US military has four rational pillars for dealing with threats.  Early detection.  Rapid response.  Research and development (to ensure we have the best means of detection and response). And, Prevention.  Pandemics and the spread of new and re-emerging infectious diseases like AIDS, TB, measles, or polio (just to name a few) require the same approach.   In fact, every threat does. 

We have three places to address the threats we face.  We can wait until they get to our lungs or loved ones (very expensive and often ineffective).  We can try to stop them by sealing our borders and stopping all trade and air travel (extremely costly and ineffective).   We can invest in prevention efforts beyond our shores (by far the cheapest and most effective means of saving US tax dollars and lives).

If we had a macroscope that would allow all Americans to see the invisible forces now threatening us (terrorism, tribalism, global poverty, Cyber threats, WMD proliferation, toxins, species extinctions, polluted oceans, weapons in space…) like the microscope did hundreds of years ago, we would have the second greatest global revolution in protecting human freedom and security.

And the most effective means of limiting or eliminating most of those destructive global forces is funding the 17 Sustainable Development Goals that the world’s governments have already agreed to.  It would be the best investment humanity could make to protect our own health, wealth and cherished freedoms which our nation has always promised as a ‘more perfect union’ with liberty and justice for all. 

Global competition will still have its place.  In the Olympics and in nations competing to provide the money, technology, or services to make sure the 17 SDGs are all met before 2030.

“Things change.  Can we?”  

Nell Temple Brown, WHO”s Washington DC office Director.