International House (I-House) is a residential community on UCSD’s campus that houses domestic and international students and organizes programs which foster multicultural curiosity and understanding. Global Forums which explore topics of international and local interest are held weekly in the Great Hall. The following information was discussed at the Global Forum on Jan. 24, 2018. Marjorie was a panel speaker at this event.
Human immunodeficiency virus, otherwise known as HIV, is a virus that attacks the immune system of the host. It does so by attacking and destroying CD4+ white blood cells; if too many are destroyed, then the host will have trouble fighting off diseases. Today, HIV is one of the largest epidemics in the world. 
What is AIDS?
AIDS (acquired immunodeficiency syndrome) is the last stage of the HIV infection. People with AIDS are especially susceptible to get infections or cancers that seldom occur in people who don’t have it. This is because they have a low CD4+ cell count. It can be very deadly.
How are they different? (Symptoms, Contraction, Treatment, Facilities)
While HIV refers to the virus which attacks the host’s immune system, AIDS is the set of illnesses and symptoms that occur in the final stage of the HIV infection. If left untreated, the immune system of the person living with it will, eventually, be almost completely destroyed, and thus almost utterly unable to defend itself at all. It can be passed through semen, blood, vaginal and anal fluids, breast milk ; as such, it can be contracted through the sharing of needles, the use of dirty needles, from an HIV-positive pregnant mother to child (note: this is not a 100% guarantee, and if you or your partner is HIV-positive and are thinking about childbearing, there are HIV specialists that can inform you about steps to conceive safely), and, of course, through unprotected sex. HIV cannot be passed through casual contact, such as sweat, saliva, urine, or touch. In its early stages, about 40%-90% of people have flu-like symptoms within 2-4 weeks after having been exposed to the HIV infection, although symptoms are not always visible.  Currently, there is no cure for HIV, but there is treatment that can help people with HIV live long and healthy lives. If you do have HIV and are not on ART (antiretroviral treatment), eventually your immune system will be broken down and lead to AIDS. Still, the only way to know if you have HIV, is to get tested, and of course, the earlier diagnosed, the sooner antiretroviral treatment can begin.
A Timeline of HIV and AIDS since the 1980s
In the early 1980s, people believed that AIDS would only affect certain people: hemophiliacs, homosexual men, heroin users, and those of Haitian origin, also known as the “four-H club.”  By the end of the year, of the 270 reported cases of severe immune deficiency amongst gay men, 121 of them had died.  In the summer of 1982, officials began labelling the disease as gay-related immune deficiency (or GRID) because many believed its cause was sexual. That September, the CDC used the term ‘AIDS’ for the very first time. The following year, AIDS
was reported in the female partners of men who carried the disease, thus verifying that it could be passed on through heterosexual sex. In the summer, after the first reports of AIDS in children, people thought that one could contract the immune deficiency from casual contact, but by September, the CDC identified all major routes of transmission and ruled out transmission by casual contact, food, water, air or surfaces.  The following year blood banks began screening their supplies for the virus in the United States. At the same time, Ryan White, the teen from Indiana, who contracted AIDS through contaminated blood product which were used to treat his hemophilia was banned from school.  In February 1987, the WHO launched The Global Program on AIDS to, among other things, raise awareness, generate
research, promote the rights of those living in HIV, and in March, the FDA approved the first antiretroviral drug, zidovudine (AZT), as treatment for HIV.  By that December, the WHO received 71,751 reports of cases of AIDS, of which 47,022 were in the United States.  In 1988, the first World AIDS Day was declared by the World Health Organization on December 1st.
At age 18, Ryan White dies of an AIDS-related illness on 8 April, 1990. In June, the 6th International AIDS Conference in San Francisco protested against the USA’s immigration policy which stopped people with HIV from entering the country.  The following month, the United States enacted the Americans with Disabilities Act, which prohibits discrimination against people with disabilities, including those living with HIV. The following year, NBA star Magic Johnson revealed he was HIV-positive, which helped dispel the stigma that it was a “gay disease.” At the same time, the FDA licensed a 10-minute testing kit which could be used by healthcare professionals to detect HIV-1.  In 1994, it approved an oral test- the first non-blood test- for HIV.  By 1997, highly active retroviral therapy (HAART) became the treatment standard of the time, causing a 47% decline in death rates.  That same year, the FDC approves Combivir, a combination of two antiretroviral drugs, taken as a single daily tablet, making it easier for people living with HIV to take their medication.  In 1999, the WHO announced that AIDS was the fourth biggest cause of death worldwide and number one killer in Africa, and at the same time, it was estimated 33 million people were living with HIV and 14 million people had died from AIDS since the start of the epidemic. 
In 2000, UNAIDS negotiated to reduce the price of antiretroviral drugs for developing countries, and two months later, the UN adopted the Millennium Development Goals including the goal to reverse the spread of HIV, malaria and TB.  In 2002, the FDA approve a rapid HIV diagnostic kit, which had 99.6% accuracy in as little as 20 minutes.  In 2003, the CDC reported that 40,000 new infections occurred every year, and that more than half of those transmissions came from people who didn’t know that they were infected. 
In early 2010, the US travel ban preventing the entry of HIV-positive people into its border, was lifted. In August, Comlera was approved by the FDA. In 2012, the majority of people eligible for treatment were receiving it (54%).  Then in 2014, UNAIDS launched the 90-90-90 targets that aim to diagnose 90% of those living with HIV, ensure that 90% of people with HIV have access to treatment, and have 90% of those with HIV achieve viral suppression for 90% by 2020.  In 2015, UNAIDS announced it had achieved its MDG related to AIDS and HIV six months ahead of schedule.  In 2016, the number of people living with HIV in Russia reached 1 million, culminating in data depicting that 64% of all new HIV diagnoses that occurred in Europe stemmed from Russia.  That same year, UNAIDS announced that 18.2 million people were on ART, including 910,000 children, and although good, the WHO released a report centering around the increased issue of greater risk of drug resistance.  As of 2017, AIDS has killed between 28.9 mill
ion and 41.5 million people worldwide, and an estimated 36.7 million people are living with HIV, making it one of the most important global public health issues in recorded history. 
GRID, HIV, AIDS and Stigma
In 2017, homophobia and anti-gay sentiment, more generally, continue to be a pressing issue around the world. This was not any different, and in many cases much worse, when the HIV epidemic became a leading issue in the 1980s. In an interview with The Independent, Michael Penn, age 75 and one of the longest surviving people in the UK with HIV, recalls that “back in the day it was very worrying. I had many friends dropping like flies. My partner and I lost friends and no one knew why so many people were dying.”  In the space of half a decade, 20 of Michael’s friends, and eventually his partner of 17-and-a-half-years, died, and later he would say, “I think [he] knew it was going to be a death sentence.”  Mass death quickly became the routine and checking obituaries to learn of friends’ or acquaintances’ deaths became the norm. As one man put it, “I even did my obit scans during the workday, grabbing the paper in a local bar where I’d stop after lunch… A lot of free time had to be sacrificed for hospital visits and memorial services, but [I] merged them into my schedule like haircut appointments.” In 1982, AIDS was referred to as “Gay Related Immune Deficiency”, otherwise known as GRID. During that time, no one knew how you could get it and everyone was afraid. And while it certainly reformed the club scene and increased the advertisement for safe sex through condoms, etc., suspicion and discrimination against those with HIV was rampant. California’s Proposition 64 called for AIDS to be added to the CDC’s list of communicable diseases. In 1985, Los Angeles Times poll discovered that 50% of Americans supported the idea of quarantining people with AIDS.  The government’s response? Former President Bush brushed off a reporter’s question regarding HIV research by responding that most people don’t agree with ‘that lifestyle’ indicating HIV research wasn’t a priority ; Reagan’s White House press secretary Larry Speakes insinuated a reporter was gay himself for even caring about the subject ; and many AIDS organizations felt that when HIV research was finally in place, money was diverted from communities that really needed it to “combating the disease among college students, heterosexual women and others who faced a relatively low risk of contracting the disease.”  Also under the Reagan administration, the White House slashed funding for the GRID budget in order to cut government spending, even as the disease continued to spread. In New York City, the only hospital that would admit GRID patients was the NYU Medical Center, but even that changed to admittance only through the emergency room.  William F. Buckley proposed to the New York Times that “everyone detected with AIDS should be tattooed in the upper forearm, to protect common-needle users, and on the buttocks, to prevent victimization of other homosexuals.” Eventually, this sentiment diminished, but it wasn’t clear sailing. Even with medication, the first AIDS “cocktails” often required the patient to take as many as 30 pills a day, some with food, other twice a day or every 8 hours, others on an empty stomach- it was like a full-time job, and the side-effects could be severe.  Gradually, however, newer and better medications were released and others were combined into one pill. Today, while most Americans no longer consider AIDS a “major problem,” in the U.S. alone 8,000 people are on the waiting list for the AIDS Drug Assistance Program (ADAP) due to underfunding, and currently there are 33 million people living with HIV, including 1.1 Americans.  In Africa, HIV/AIDS continued to devastate people in the region, constituting 60% of the global population living with HIV or AIDS; however, the WHO reports that the number of HIV-positive on antiretroviral medicines had increased eight-fold between 2003 and 2005.  The United Kingdom is said to be a world leader when it comes to HIV. It has both lower rates of undiagnosed HIV (at approximately 25%) and better access to ART (in 2012, 86% of those with HIV were receiving treatment).  Still, there is no room for complacency if we are ever to reach the goals of “Getting to zero” or “Halving it.”
World AIDS Day
World AIDS Day takes place on December 1st every year. The red ribbon is the symbol for people worldwide to unite in the fight against HIV, to show support for people living with HIV, and to commemorate those who have died from an AIDS-related illness.  Despite such progress, lack of knowledge and stigma continue to surround the issue, and it is for this reason that World AIDS Day continues to be important. In the UK, in a survey by the National AIDS Trust in 2014, only 45% of people could correctly identify all of the ways HIV can be transmitted, and even more shocking, an increasing proportion of the population incorrectly believes that it can be transmitted via routes such as kissing.  At the same time, funding and structural barriers affect access and the understanding of how to receive treatment- particularly in the case of undocumented migrants.  Moreover, while public knowledge about HIV is very low in the United Kingdom, the government intends to cut funding by 50% for HIV prevention.  In Germany, there is concern that the focus devoted on HIV/AIDS over the past two decades has allowed for the proliferation of other STDs- of particular concern is Hep-C.  Even more concerning, in Russia, there’s a conspiracy theory claiming ‘HIV is not real’, despite the fact that the disease continues to spread.  In 2015, HIV screening was at a low at 19.3% in Russia, and although ART access has significantly expanded, new cases of HIV infection continue to outpace enrollment.  In China, Beijing Today noted that, “the government’s negligence and the societal stigma imposed on the gay community has made the group a more vulnerable target for HIV in China,” and as a group men who have sex with men are experiencing the worst spike in new infections.  In a 2010 study, more than 65% of respondents in Shanghai said they believed that people who contracted HIV or AIDS deserved it; moreover, 80% of respondents say they fear people who have HIV and AIDS.  In the United States, the stigma surrounding HIV/AIDS and anti-LGBT+ sentiment perseveres in, among other things, the inability of men who have sex with men (MSM) to donate blood if they’ve been sexually active in the last twelve months.  Moreover, the Trump administration’s hostility toward Medicaid and Planned Parenthood, and its hampering of efforts to develop cures and improve prevention and treatment will surely affect the success of further amelioration of the HIV epidemic.  In sum, World AIDS Day serves as an annual reminder to both the public and government that “HIV has not gone away- there is still a vital need to raise money, increase awareness, fight prejudice and improve education.” 
In Rwanda, a country still recovering from the genocide of the Tutsi ethnic group in 1994, two Southern Californians aim to help the Rwandan people through dentistry. Dr. Tom Lee and Lita Lee hope to not only provide dental care to Rwandans, but to train dentists that will be able to help the country in the future. The Lees have been visiting Rwanda every year for the past several years and have decided to move to Rwanda long-term sometime in the near future. This decision is primarily based around the establishment of the Christian non-profit organization “His Hands on Africa” (HHOA).
In 2013, Dr. Tom and Lita Lee were planning their 25th anniversary trip. However, things changed after they heard the testimony of Jean-Claude, a genocide survivor. Jean-Claude shared his story on a Sunday at the local church they attend in suburban Los Angeles. He was a teenager during the genocide and witnessed the murders of his father and sister at the hands of his neighbors. He told of his struggles to survive after the genocide and despite the destruction of the life he knew, he spoke of forgiveness towards those who had killed his family. His experiences led him to start an organization called Best Family Rwanda along with his friends who also survived the genocide. He describes his reconciliation with the son of the man who murdered his father and how he accepted him into the organization without hesitation. After hearing Jean Claude’s story, Dr. Tom and Lita Lee were inspired to change their plans and instead go to Rwanda “to serve the orphans, widows and the poor.” Their friendship with Jean Claude has grown over the years and he now refers to Dr. Tom and Lita as “Papa” and “Mama.”
Dr. Tom and Lita Lee made their first trip to Rwanda on a missions team sent by their local church in the summer of 2013. Despite the poverty that they witnessed, the truly memorable aspect of their trip was the warmth of the people they met. Dr. Tom Lee recalls his first experience in Rwanda:
The poverty I saw was beyond anything I have seen. Most roads are unpaved, people are literally surviving from day to day. They have nothing. Yet, they are so happy. You look into the eyes of the children and they are much happier that most of the children I see here in America. The Rwandan people are very kind and warm. They greeted you and welcome you with a gentle and warm smile. The country is one of the fastest growing economies in Africa and there is a sense of hope in the people I meet.
The Lees, along with other people on the team, treated as many patients as they could during their short trip to Rwanda. Dr. Tom Lee talks about one of the patients that particularly stood out:
One of the most memorable stories is when I was able to treat a young mom and save her life. We were in a village near the border of Congo, five hours away from the capital city of Kigali. Five hundred people were waiting to be treated by our medical and dental team. I saw a young mom who had a dental infection, unable to eat for three days. She had fever and was shivering, which are signs that the infection was spreading over her body. I was able to remove two infected teeth and give her antibiotics and treat her. As I completed the treatment, I knew that if she was not treated that day, she could have died from the infection. There were no dentists within hours of where she was. Even though it was obvious she was suffering from a dental infection, she had no access to dental care. Knowing that simple things that we take for granted can help these people so much, even save one’s life left an indelible impression which moved my heart to dedicate the remaining years of my life to serve the people of Rwanda.
Oral diseases cause nearly 15% of morbidity cases in Rwanda and most of these diseases are easily preventable. Rwanda has a population of 11 million people, yet there are less than 40 dentists in the whole country. To combat the lack of access to dental care, Rwanda established its very first dental school in 2014. By implementing a higher education system, the Ministry of Health aims to establish more dental providers and improve dental health overall for the country. The dental school aims to implement entrepreneurship and management in their curriculum. U.S. Institutions have also played an important role in participating in the development of the Rwandan health care education, showcasing the benefit of foreign collaboration.
Rwanda has actually seen incredible health care improvements over the years. Nearly all of Rwandans are technically insured for health care and their health care system is often seen as a promising model for other African nations to follow. However, it is still difficult for many of these people to access this care if they live in isolated villages and oral pain remains one of the top reasons for clinical visits.
In the U.S., a dentist appointment may seem like a pebble in our shoe or a small inconvenience that we must get out of the way every six months or so. In Rwanda, hundreds of people line up for the hope of receiving dental care that they might not ever have access to again.
However, the road to being an established non-profit organization has certainly not been easy. Dr. Lee talks about the different roles that needed to be filled besides dental care. He explains that there was “a wide range of needs such as accounting, marketing, photo/video team, fundraising team, social media, prayer… etc,” but he continues to say, “it [has] been an exciting journey of sharing our vision with many people and seeing how God provides for these needs by moving the hearts of the people to volunteer and support our mission efforts.”
The ultimate goal for HHOA is to create a self-sustaining dental ministry. HHOA aims to essentially accomplish three objectives:
Establish a dental center to train Rwandan dentists who are graduating from the recently established dental school.
Establish a profit-making dental clinic which can provide the funds to establish several community clinics that will provide free dental care and serve the needs to those who have no access to dental services.
Send out trained dentists to other African nations.
His Hands on Africa recently held their inaugural fundraising gala in Los Angeles on November 4, 2017. The event featured a silent auction, musical performances and speeches given by the founders. The event effectively consolidated the evolution of their journey and displayed how the fruits of their efforts came together.