The secret life of HIV

Why is the HIV virus so vicious and, given that an effective vaccine was expected many years ago, why has none emerged?

A normal vaccine works by injecting non-active, or attenuated, viruses of diseases like flu and polio, which the body recognises and responds by producing antibodies, and – in the cases of attenuated viruses – T cells which multiply and actively attack the virus. The system also “remembers” the virus to give continuing immunity. Unfortunately the HIV virus goes straight in to attack the T cells, to destroy them and to use them for replication. It particularly targets the memory T cells which allow the body to prepare for future infections by knowing the old ones.

In fact the HIV replicates on entering a cell very inefficiently, producing several mutant strains. The virus, almost diabolically, alters in so many ways that neither antibodies nor T cells can cope. Our annual flu jab needs to be modified every year to deal with mutations, but the HIV works like lightning by comparison. An effective vaccine would have to be flexible enough to deal with thousands of variations of viruses, not just one.

The first attempt to get around this was to devise a vaccine which would stop the infection at source by changing the outer shell of the HIV, and preventing it from entering healthy cells. Good theory, except that it didn’t work. Following this, an attempt was made to use a vaccine which would substantially reduce the multiplication of the virus by injecting some harmless proteins present in HIV, and so allow the immune system to ready itself for attack. This would at least reduce the transmission of infection to others. But the trial of the most promising system had to be suspended when more cases of infection occurred in the vaccinated group than the group which received a placebo. A trial of a further variation gave equally poor preliminary results, and was called off in July 2008.

But of course the scientists have not given up. There are some monkeys and a few human beings who seem to have a natural control over virus limitation. This may well have to do with minor genetic changes. But studying what the changes are, and the processes through which they work, may provide the needed clues. This is one avenue of exploration. And it may be that past, abortive, attempts can be tuned to achieve greater success. Some outlandish ideas currently proposed may yield surprise answers. There is now much closer collaboration between different research institutes, which have received funding from welfare organisations, including the Bill and Melinda Gates Foundation. Remember that when you next feel like cursing Microsoft. Collaboration does not ensure success, but it improves its chances.

For the time being we have to be content with the antiretroviral drugs which control the outcome of infection, and its transmission – including the perinatal infection of the newborn. Issued in the right complex mix, regularly taken and regularly checked, they can inhibit the virus from triggering Aids over many years.

 Under this regime, mortality rates during the five years after infection are the same as those in the uninfected population, although they accelerate thereafter. But drug therapies may not be easy when necessary hospital visits are required in remote areas, and the good diet required for their effective use is not always available. There is for the time being no known cure because the virus, temporarily stymied, secretly colonises many parts of the body, quietly waiting to become active again.

The major prophylactic continues to be education and good sexual morals. The problem of married couples, one of whom is infected, or both of whom are infected with different strains, remains. This raises a vexing question. While it is always possible for such a couple to abstain from intimate contact throughout their married lives, it is not a real-world solution. Apart from denying the couple a major means of expressing and developing their married love it is a particular difficulty in Third World countries. Wives may often find themselves in a position where they cannot resist marital relations, or, if they do, they are risking infidelity in their husbands – which may destroy the marriage or indirectly lead to a further spread of the virus.

One much-canvassed opinion argues that since in these cases the condom is not being used for contraception but for protection it is legitimate. Many senior Church figures including Cardinal Lustiger, Cardinal Martini, Cardinal Cottier (theologian of the papal household under John Paul II), Cardinal Danneels and Cardinal Murphy-O’Connor have all been cited in support of condoms in the context of Aids in one form or another. But the official position remains unchanged, and it is easy to see why. If a protective intention suffices, then it opens the door to protection from any other infection similarly transmitted.

More fundamentally, the teaching states that it is “absolutely required that any use whatever of marriage must retain its potential to procreate human life”. (Pope Paul VI’s italics.) The issue here is specifically not intention but the objective physical denaturing of the act within marriage. Allow intention, no matter how good, to prevail once and the whole edifice might crumble.

But no decision on this question is as yet on the horizon. For now the ox will not be pulled out of the pit on the sabbath day. After all it took a mere 359 years for the Church to repudiate formally the condemnation of Galileo. Given that this is a matter of life and death a somewhat shorter timetable would be welcome. Secondsightblog.com awaits your comments.

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About Quentin

Science Editor, Catholic Herald. Portrait © Jacqueline Alma
This entry was posted in Bio-ethics, Catholic Herald columns, Moral judgment. Bookmark the permalink.

19 Responses to The secret life of HIV

  1. fraynelson says:

    There is a fine line between accepting and promoting the use of the condom. The problem is that condom’s promotion increases irresponsible usage that then works against the very reasons that first wanted to justify that same usage!

    Condom’s promotion is typically visible in ad campaigns praising “safe sex.” In them, pleasure is portrayed as possible, accessible, limitless and truly an end in itself. Yet once hedoné has got its throne, promiscuity and careless, poor or absent usage follow soon. The neat result is that in no country that I know the promotion of condom’s usage has diminished the number of abortions.

    There is dispute, though, around its real efficacy in preventing AIDS but that’s a lost fight because the promotors always have an ace up in the sleeve: “Oh! You see? Even MORE sexual education and MORE condoms and MORE advertisement is required…!”

    I know no other case of a public policy with so constant failure and so strong public support.

  2. Daisy says:

    Fraynelson is depressingly right. The more that condoms are promoted as the route to safe sex, the more sex becomes a recreational activity and inevitably there are more unwanted pregnancies (therefore abortion) and STDs. But all this has been, and will continue to be, quite independent of the Church’s teaching.
    But I would invite everyone to ask themselves a question. If you were a young married, and your partner was HIV positive (let’s suppose it came from an innocent cause, so as not to confuse matters) would you agree to continence for the rest of your married life or would you settle for condoms? (If you prefer, think of what advice you would give to a married son or daughter.)

  3. Frank says:

    I understand that condoms are not safe, anyway? I have read accounts by doctors and nurses in Africa breaking the news to young married women that they are HIV positive, and these poor young women replying sadly, “But I was told that using condoms would protect me.”

    In answer to Fraynelson, anything is possible with God -even continence under the circumstances she describes. I recall a wonderful homily by our parish priest on the subject of St Joseph. He was a normal chap who thought he was going to have a normal marriage; but it turned out differently. He should be the example for couples caught up in this situation.

    Finally, I was sympathetic to what Quentin was saying until the final paragraph – which sounded very much like special pleading. The Pharisees wouldn’t pull oxen out of holes on the Sabbath – but Christ would. Therefore the Pharisees are nasty and un-Christlike; just as we, who do not jump on the condom/ AIDS bandwagon, must be nasty and legalistic also, eh???!

  4. Of course there are reports of people being infected with HIV despite using condoms. Every method, taking contraception as a measure, has user failure. Safe condom use requires absolutely regularity, proper usage of the condom, and condoms of standard quality. These conditions are reasonably achieved in a settled married couple. The level of risk, observing these conditions, has proved to be less than 1 in 100 woman years. No one, I think, should question these statistics until they have studied the full scholarly report, produced under the auspices of major official organisations at
    http://www.ampartnership.org/abstinence_resources/documents/3-3.pdf
    I have thought much about Frank’s disagreement with my implication of pharisaic behaviour. While my main concern here was the unnecessary delay in facing up to a decision (a tactic the Vatican has often used in awkward matters), it is my judgment that a refusal to countenance condoms in the circumstances described is legalistic and so culpable. But I speak for no judgment other than my own.

  5. Horace says:

    Once again we seem to be in the territory of “double effect”.

    1) The action of using a condom during intercourse. Is this action, by itself and separated from any intention, good, bad or indifferent?
    2) If the action itself is not morally bad then we can consider two possible results of the action
    a) To prevent the transmission of a disease.
    b) To prevent the sperm from reaching an egg.
    3) If we say that (a) is the intention and (b) a foreseen but unintended side effect – then
    4) Is the good result “proportionate to” the bad result?

    Frankly I don’t know the answers to either (1) or (4) – and I suspect that a lot of other, much better qualified, people don’t know either.

  6. Juliana says:

    If, as Quentin says, condoms are only really reliable when used by settled married married couples when using condoms of good quality and with absolute regularity….then isn’t it rather irresponsible to promote them for an AIDS cure-all/ or prevention when most couples passing on the AIDS virus doubtless do not fall into this category…

    Therefore, to whom is Quentin directing his ire as being “legalistic and culpable” in their refusal to “countenance condoms”?

    Surely, whoever “they” are, they are being rather sensible and justly cautious under these circumstances.

  7. I hope that my context makes clear that I was referring only to serodiscordant married couples. I described the very limited relevance of their use as a general solution in my CH article of 30 December 2007. As the Church has no teaching on the use of condoms outside marriage (or any reason to have) we have to employ our own judgment. The Cafod web site has several useful pieces on this, and I am content to leave this matter to the experts.

  8. Frank says:

    As the late Pope John Paul II and our present Holy Father, Pope Benedict, both teach the same about condoms and the right expression of conjugal love, I assume Quentin includes them in his ‘legalistic and therefore culpable’ opinion? I accept it is his own opinion, but I think we must be cautious in thinking we are right and they are wrong.
    The Church cannot and would not impose her teaching about sex on those outside the Church; however, However, she offers the Truth to all men and women of goodwill, married or single; it seems to me hers is the only voice that consistently upholds the dignity of human beings, whether in their intimate relations or at the very start of life itself.
    People, of course, are free to walk away.
    I still think St Joseph has much to teach us all about married love.

  9. Juliana says:

    Quentin wrote initially that those who are the most successful when using condoms are the settled married couples and I quoted him on that.

    How can these same couples be serodiscordant? This sounds to me like the exact opposite…. although I’ve never come across this word before. And it doesn’t answer my question, which was that if it is a relatively hit-and-miss affair to use condoms successfully then to promote them for an AIDS prevention could be seen to be irresponsible…

    It’s a bit like school children who think that if they use a calculator for Maths they will automatically get the right answer…when in fact they won’t if they don’t know how to use it.

    And, with Frank, I think more should be made of St. Joseph too!

  10. Horace says:

    Serodiscordant means that one of the couple is infected with the AIDS virus but the other isn’t!

  11. Yes, and serodiscordant also covers the couple who are both infected but with different strains.
    No one who is close to the sub Saharan HIV situation thinks that condoms are a catch-all, though they do have a part to play. So I suspect that Juliana’s question is more general.
    I would certainly agree that teaching condoms as a panacea has the side affect of increasing pregnancies and stds. However would a parent who knows that their child is involved in sexual relationships prefer them to use condoms or not? The Church has no teaching on the use of non-abortifacient contraceptives outside marriage, for her own members or anyone else.
    Which is of course a great nuisance because it means that we actually have to do some moral thinking for ourselves, and not read the answer out of a book.

  12. Fariam says:

    This whole issue of condoms and married couples also makes me reflect. I am sometimes tempted to think that the use of condoms in marriage is the lesser of two evils amd might be considered as a form of medical treatment.

    However, it also occurs to me that there are many couples living with the reality of being unable to have sexual relations, as in the case of a partner having a major accident and becoming severly paralyzed and brain damaged, or suffering a major sickness. Is the HIV sufferer in a marriage any different?

    The other question concerns the pro-creative aspect of marriage as a reason for not using a condom. There are two questions here: (a) is it responsible to bring a new life into the world with the almost certain handicap of being a HIV sufferer? And (b) if we say it is irresponsible, are we not also saying the same about every other handicap?

  13. Frank says:

    I thought the Church does have quite clear teaching on the use of non-abortifacient contraceptives outside marriage for her members: that the sexual expression of love is designed for marriage only, so any use of it outside marriage is wrong and sinful? This is the case whether one uses contraceptives or not.

    This teaching does not come,ultimately, ‘from a book’ – which suggests that Catholics of a certain kind are frightened, immature people who can’t think for themselves. It comes from an understanding of one’s body as a temple of the Holy Spirit. What does chastity mean, otherwise?

    If the Church has no teaching on sex for single Catholics, what is wrong with promiscuity (as long as one uses a condom, of course)? Or indeed, any other form of sexual behaviour, such as masturbation – which doesn’t spread disease or cause an unwanted pregnancy?

    Have I misunderstood what Quentin is saying?

  14. Frank, I don’t know quite what it is you have misunderstood. I have never suggested that the Church condones sex outside marriage – whether fornication or adultery. That is one moral issue. On the second moral issue of contraception, her teaching is confined to condemning what she sees as a betrayal of the nature of the act as an expression of the “total giving” demanded by marriage. “Total giving” simply doesn’t apply outside marriage. Hope my view is clear. So we are left to make up our minds about the use of contraception outside marriage. Yet another issue is the use of abortifacients which are wrong, not because they are contraceptive but because they kill babies.
    Fariam raises an interesting point about marriages which cannot be expressed sexually because of physical problems. We would accept, I think, that this comes under the promise of “in sickness and in health”. The theologians and senior prelates who suggest the legitimacy of condoms for serodiscordant married couples base their position on the idea that the primary use of the condom is prophylactic. The contraceptive effect is not intended, and is not the agent which brings about the protection against HIV.

  15. Frank says:

    Well, to reply to Quentin’s question about one’s children, condoms and their sexual relations outside marriage, I think the only answer/advice one can give them is to say that cohabiting is selfish; it is using another person for one’s own emotional/sexual gratification without making the full commitment of marriage.

    To say ‘I don’t agree with what you are doing but use a condom, just in case’ is a moral cop-out. It does not help the said offspring to see that they are being selfish – or exploited. (I know of several girls who spent their 20s in this situation, only to be dumped by their ‘partner’ for a younger model as they reached their 30s, and who now long to be married but are finding it hard to find someone.) It is best to follow the Church’s rule: of chastity before marriage and fidelity within it; but usually we have to learn for our mistakes in this area before we learn to appreciate the wisdom of the Church…

    Generally, middle class cohabitees use condoms anyway, without parental ‘guidance’; and social classes 4 and 5 (to use the late Keith Joseph’s terminology) won’t use condoms or anything else as the (teenage) girls are desperate for a baby to give some meaning to anotherwise drab life.

  16. kouin says:

    This is your one chance at life.
    Jesus had his you’ve got yours.
    If its a life its got a choice-should I choose to abort or connect with life’s.

    If it see a lot of laws waiting to be discussed it’s probably just right to choose to manipulate abortion.

  17. RBlaber says:

    With regard to the ‘safety’ of condoms – or the safety of anything, broadly – no, condoms are not ‘safe’, if by that word you mean ‘absolutely, 100% safe’. But then there is no such thing as absolute, 100% safety – we do not live in a world where absolute, 100% safety is possible.
    That does not mean that we should not recommend there prophylactic use against STDs. We have to recognise that people are not well-behaved. The majority of the population are not good Catholics, and don’t take much notice of the Pope. That is extremely regrettable, but a fact.
    Of course we should go on preaching the Word of God, setting a good example, and praying – but if we try and stop sexually active teenagers, say, from getting hold of condoms, not only will we have a lot of pregnant teenage girls, but we will find ourselves with a lot of teenagers with STDs.
    Furthermore, if (and I crave your pardon for my bringing this up) gay men have anal sex without using condoms (and the condoms need to be of the strongest kind), then they put themselves at particular risk of HIV infection, especially if the men are promiscuous – which frequently they are.
    Yes, gay men should not be promiscuous, and yes, they should not engage in anal sex – the Church argues they should not engage in any kind of sex, but should commit themselves to celibacy, if they cannot become heterosexual – but in the meantime gay men are sexually active, and getting HIV positive.
    Intravenous drug users, too, are having unprotected sex and passing on not just HIV but hepatitis B and C and various other diseases.
    In Africa, HIV-AIDS is not a problem of homosexuals, but promiscuous heterosexuals. It has not been helped by the denialists, like ex-President Thabo Mbeki of South Africa and his former Health Minister, who have preferred to recommend garlic, lemon juice and other quack remedies, rather than anti-retrovirals.
    The upshot is that we do not live in an ideal world, but have to be prepared to tolerate an evil where it is plainly the lesser evil. Which is worse, that condoms should remain in use, or that HIV and other STDs should do even more damage than they are doing already?
    Btw, can we please stop using the phrase ‘HIV virus’ – the ‘V’ stands for ‘Virus’ in any event!

  18. Iona says:

    RB, I don’t know what part of the world you are writing from, but here in Britain we have been promoting condoms for years, demonstrating their use in classrooms during sex ed lessons (using a banana, as my own teenage children told me with great hilarity) and still we have “a lot of pregnant teenage girls” and “a lot of teenagers with STDs”, – more, apparently, the more “safe sex” is promoted.

  19. Iona raises an interesting, and very important, conundrum. On the one hand we want to protect our young from the consequences of folly – pregnancy and stds, on the other there is ample evidence that sex instruction which, even implicitly, suggests that early sexual behaviour is at least normal and perhaps even desirable. A similar difficulty occurs with the distribution and encouragement of condoms where HIV is prevalent.
    Many will have read the latest study which gives the UK the highest rating for promiscuity out of all the major Western countries. It notes that the former tendency of women to be less inclined to casual sex than men appears to have lapsed, at least at certain age ranges. Yet we know that, however well instructed, the higher will be the incidence of pregnancy and stds. People are either not equipped or are carried away by the passion of the moment.
    Rightly of course we teach that genital sexual expression is reserved for marriage. But not long ago I discussed this at length with two 14-year olds (intelligent, stable families, convent education). Their minds were compartmentalised: in one compartment they knew the Church’s teaching; in the other was reality as they experienced it. As one said to me: “I’m 14, and I may not get married until I am 28. That’s an awfully long time.”
    Can anyone suggest how we square this circle?

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