Biomedical Issues of HIV/AIDS

MONICA A. DEVANAS
Director, Faculty Development and Assessment Programs
Teaching Excellence Center
RUTGERS UNIVERSITY
116 College Avenue
New Brunswick, NJ 08901-1165
devanas@TeachX.rutgers.edu

Biomedical Issues of HIV/AIDS Webpage

Newer Student Version of the Biomedical Issues of HIV/AIDS Webpage

Abstract

This course teaches the biology of infectious diseases, immunology, and virology through the questions that surround HIV/AIDS: Where did it come from? How is it transmitted? Can I get it? What can we do to help those that have it? Such driving questions motivate students to learn complex scientific content in microbiology and immunology. But these questions cannot be answered solely by an appeal to biology, as they are also related to questions of economics, politics, education, and human emotion and psychology.

Although this is a large (400+) lecture course for non-science majors, it emphasizes active learning through online discussion groups, guest lectures, and research and writing-intensive assignments. Students identify questions related to HIV/AIDS in which they have a particular interest. They investigate clinical studies and educational interventions for specific populations, negotiating library databases, collecting peer reviewed primary research articles, and using these articles and statistics to support their own ideas and proposals for improving the HIV/AIDS crisis in their target population. They are then asked to have friends, family members, and colleagues read and comment on their proposals, as well as one professional with special expertise on some medical, social, or cultural aspect of HIV/AIDS.

In the course of their research, students work hard to uncover the relationships between scientific and medical research and political agendas. They work even harder to find information about how their career choices are impacted by HIV/AIDS; how their projects and studies may help fight risky behaviors in target communities; how to grapple with the questions of AIDS in the workplace; how cultural influences work to obscure and repress acknowledgement of actual sexual behavior. Students are eager to engage their new knowledge and seek forums for discussions where they can debate issues and ask critical questions. Expert guest lecturers, many of whom are HIV positive themselves,bring the reality and immediacy of living with HIV/AIDS to the classroom, helping the students to better understand the connection between their academic learning and everyday life.

Learning Goals

This is a Biological Sciences course and even though it is an introductory level course, it is not to be considered simple or superficial. As a biology course, this curriculum is designed to present the student with the fundamentals of infectious disease, immunology, and virology as they apply to HIV disease. With this knowledge of the biology of the HIV, the impact of the HIV epidemic is examined in a variety of psychological and social arenas.

The Course

Syllabus

Syllabus for Biomedical Issues of HIV/AIDS

Download (DOCX, 16KB)

Course Format – Intertextual Notes

  • Several Versions of the course have been offered over the past nine years. Initially and most prominently was the “large lecture” format with 450
    students each offering. The course was offered in this format nine times in the last eight years. Special sections for adult learners, meeting in a “small” class format of 50 students have been offered on Saturday mornings the past two years. An “Honors Seminar” was also offered this past year for 26. Examples of syllabi from each of the formats are available. Copies of the Course Policy, Learning Objectives, web-based activities, extra credit assignments, grading policy, and email list information can all be found for the current semester on the course’s web page: Biomedical Issues of HIV/AIDS
  • There is no required course, but a highly recommended “Study Guide.” This study guide is a collection of all the images that are used during lecture, together with a brief outline of the lecture and explanatory materials for the major concepts presented.
  • In the large lecture model, more guest speakers were available owing to the budget for the course generated by the enrollment. Among the most notable speakers who have addressed the students have been Dr. Richard Keeling, the Chair of the American College Health Association AIDS Task Force, Dr. June Osborn, the first Chair of the President’s Task Force on AIDS, and Dr. James Oleski of University of Medicine and Dentistry, Newark, NJ who was the first to report AIDS in children. Other regular participants have included AIDS activist and author, River Houston; death and dying counselor, James Jones; AIDS educator, Louise Yohalem; sexual health counselor, John Valesco; and the Director of the Women’s Legal Clinic, Rutgers Law School, Professor Cynthia Dennis. Annually, other visitors have included representatives from the Hyacinth Foundation (a New Jersey AIDS organization), the New Jersey Women and AIDS Network, and the local New Brunswick, New Jersey Chai Project. Presentations have been made by the Mount Sinai Hospital theatre troop, S.T.A.R (Sinai Teen AIDS Repertory), and the Rutgers University S.H.A.D.E.S. (Student Health Advocates Developing Educational Scenarios) performance group.

Linking Science and Social Issues

Links to SENCER Ideals

We have identified eight “ideals” that we hope SENCER courses and programs will embrace. In this section, the ideals are identified in bold italic and the developer suggests how the course reflects them in plain text.

SENCER robustly connects science and civic engagement by teaching “through” complex, contested, capacious, current, and unresolved public issues “to” basic science.

Biomedical Issues of HIV/AIDS uses the phenomenon of AIDS and HIV to connect biomedical principles with the public policy issues around HIV. These issues include, but are not limited to, as access to medical and social services, treatment opportunities, prevention and risk reduction strategies, activism, and understanding the processes that create these policies. Students learn the biomedical principles to help them make better-informed decisions in personal, political and organizational issues.

SENCER invites students to put scientific knowledge and scientific method to immediate use on matters of immediate interest to
students.

Students are constantly challenged to re-examine their experiences in the light of new scientific information presented in the course materials. Issues of infectious disease and epidemiology give students a framework in which to discuss sexually transmitted diseases in the context of their lives and relationships. Students use scientific knowledge and scientific method as they address the context of the topic of their research papers. They collect primary resources to present a clear definition of a population with an HIV/AIDS problem. Students are guided in how to apply the information to a detailed solution plan that is then reviewed and assessed by an educator, health-care practitioner, or other professional.

SENCER helps reveal the limits of science by identifying the elements of public issues where science doesn’t help us decide what to do. (To be sure, a good SENCER course would also help students identify what kinds of knowledge would help.)

Biomedical facts prevent people from being overly influenced by irrational fears when addressing difficult social issues, such as HIV+ children in schools, needle exchange programs, xenophobia and homophobia. Biomedical principles and data help students understand the vulnerability of all humans to infection, the risks associated with various behaviors, and the drug toxicities that influence decisions made by individuals who need to consider, not just how long to live, but the quality of the life they are living. The value of knowledge is clear, but knowledge needs to be applied to circumstances and conditions unique to the situation demanding the decision. Throughout the course, but especially in the latter lectures and the guest presentations, the students are introduced to the critical analysis and interpretation of facts and situations in which there are no “right” – or, at least, still unclear “scientific” – answers.

SENCER shows the power of science by identifying the dimensions of a public issue that can be better understood with certain mathematical and scientific ways of knowing, thus illuminating those elements with that knowledge.

HIV/AIDS elicits a plethora of opinions, not all of them rational, that can drive public policy. Scientific ways of knowing can inform students of the data collected, such as the efficacy of needle exchange programs, treatment strategies, and target funding. However, objective statistics and rational numbers do not affect “not in my back yard” reactions, the concern for quality of life in treatment considerations, and the detrimental effects of insufficient funding in areas of great need. Examining and discussing research findings challenge students to restructure their own value systems with objective mathematical and scientific reasoning. In many cases, the dissonance created between rational scientific results and personal opinions is very uncomfortable, requiring new structures to replace old, and new feelings to replace old.

The trends in the demographics of HIV/AIDS have indicated that education and prevention programs have been valuable in certain populations, e.g. the gay community. However, these gains have not, unfortunately, resulted in “permanent cures,” as the evidence of increasing infection rates among young gay men powerfully illustrates. One variable that seems unchanged is the high risk of infection among lower socioeconomic groups. Here students need to grasp that, while biomedicine can explain the process of infection, other factors will determine risk. These factors include access to prevention strategies, advocacy programs, the incorporation of prevention measures into various cultures, social determinants, and personal behaviors.

The understanding of the pathogenicity of HIV infection, the universal vulnerability of humans, and the history of molecular biology and virology are important in understanding the risk factors facing all people. Trust is an important issue. Many students come to the course with long term beliefs that AIDS is “the government’s” or “The Establishment’s” secret plan to eliminate minority populations.

One of the oldest beliefs that affects attitudes about HIV/AIDS is that having AIDS is a shamethe idea that infection occurred due to personal failure or immoral and illegal acts. These ideas are sometimes changed when students actually meet more HIV+ guest speakers.

SENCER conceives the intellectual project as practical and engaged from the start, as opposed to science education models that view the mind as a kind of “storage shed” where abstract knowledge may be secreted for vague potential uses.

Most students come to a course on HIV/AIDS with many questions and practical problems. The first session is usually dedicated to answering their questions. Anxiety and fear are hidden in the typical questions: “I have friend who…” “Can you get AIDS from…” and “Why is there no cure?” Using these student-driven needs for information, the course helps students discover answers to their questions.

With each topic introduced and discussed, the “why” is explained. For example, why are we learning about the structure of viruses? We stress the connection because their structure is important to understand strategies for vaccine preparations, the efficacy of disinfection of injection mechanisms in minimizing transmission, the viral infection process, some theories explaining the selective death of T-helper cells. Another example is the inflammation process: we learn about that because the steps in the process are consistent regardless of the cause of tissue damage that initiates the inflammation process. The swelling in the lymph nodes associated with early stages of HIV infection, the runny nose of a cold, and redness of a sunburn are all manifestations of the inflammatory response.

SENCER seeks to extract from the immediate issues, the larger, common lessons about scientific processes and methods, as well as
more “transcendental” – or at least less time-bound – scientific concepts.

Many of the discussions of HIV/AIDS issues are associated with “fast-track” drug testing, the rapid treatment of infected individuals with “highly active antiretroviral treatments,” and the need for immediate post-exposure prophylactic treatment of “needle-stick” accidents. All these anxiety-producing, immediate problems still need to be grounded in sound scientific method. The “fast-track” drugs may provide high levels of immediate efficacy, but without some long-term testing, unanticipated side effects such as lipodystrophy are likely to occur. Again, the student finds the need to balance the desire to provide effective new drug treatments quickly with the risk of incurring unknown side-effects and how these new conditions impact on the patient’s quality of care and quality of life. Another anxiety-laden issue is the risk of infection to health care workers. Students must consider the fact that exposure to blood-borne pathogens is very real for health care workers. These workers who take post-exposure prophylactic treatment may also suffer from adverse side effects of drugs used and from psychological stress due to the threat of infection following an exposure incident.

The immediate issues that demand attention and rapid “fixes” can sway students to ignore the common lessons of scientific method-the careful, deliberate and sometimes time-consuming studies that reduce the risks of treatment. In an age of rapid delivery of information, students expect cures to be delivered with the same ease and speed. Careful thought, deliberate studies, replicated and validated results have always been the foundation of scientific method. Students can appreciate some of this deliberateness and care as we review the history of the epidemic. The collection of symptoms that were first used to identify an infected individual, through the international race to identify and name the viral causative agent, all illustrate the need for step-by-step, bit-by-bit, accumulation of information that marks good scientific method. Following fact-collection comes the development of a framework to link the new knowledge to the existing body of knowledge and the examination of concurrence of this new knowledge with the system of thinking already established.

SENCER locates the responsibility (the burdens and the pleasures) of discovery as the work of the student.

Teachers present information, but learning does not happen until students take in the information, process it, relate it to information they already know and come to have an understanding of its relative value in their universe of meaning. Knowledge is valuable only when it can be used to explain ideas, theories, and the world. Teachers can teach, but learning does not happen until the student uses the information. The joy of discovery comes when the student works through the effort of understanding information, relating it, and using it in a way that makes the outcome only the desire for more discoveries.

In Biomedical Issues of HIV/AIDS there are many opportunities for students to process information, relate it to previous knowledge, find value and investigate further. Beyond the usual learning environments of the classroom and personal study, there is a major research writing assignment. Students are asked to find original scholarly works on several aspects of a question of their own choice regarding a population with a problem with HIV disease (see section on Writing Assignment). When students discover that they have the ability to find information that helps to answer their own questions, they are empowered in several ways. First, they find that their questions are not trivial, but are of concern to the scholarly community. The students realize that there are many sources of information, but the validity and authenticity depend on the source. For example, statistical studies of successful prevention programs published in peer-reviewed journals are more reliable than opinion columns on activist web sites, even though both may argue for the same interventions, such as needle exchange programs. Lastly students find that their own ideas for solutions may have solid foundations in psychosocial theories so that they too are contributing to the body of knowledge, especially when they share their solutions with professionals practicing in the field.

Other places for students to use and value their new knowledge is through the online discussions hosted on the WebCT page supporting the course. The students are challenged to offer their opinions on provocative questions, such as “Should the HIV status of children be disclosed to their teachers?” “Should mothers who deliver HIV+ infants be told of their HIV status?” “Should HIV+ athletes be permitted to compete when bodily fluid exposure is likely?” Students find that debates frequently challenge their opinions and knowledge. These lively discussions have proven very valuable to students when surveyed on end-of-course questionnaires. An active engagement with the information transforms it into knowledge. The need to use this knowledge to examine and defend points of view makes it valuable.

Students also have the opportunity to earn extra credit by writing a critique of three forms of communication of HIV/AIDS information that are not prose text. Students find songs, poetry, art, performance, and advertising that sends a message about AIDS. They analyze the presentation and decide the value and appropriateness of the message to the intended audience. Then they share these critiques with three friends, who are asked if the student’s analysis, interpretation, and insight are accessible to others with less formal knowledge of AIDS. Students report that they enjoy the challenge of finding AIDS information in less traditional media. They also enjoy the opportunity to engage others in conversation about what they themselves are learning.

SENCER, by focusing on contested issues, encourages student engagement with “multidisciplinary trouble” and with civic questions
that require attention now. By doing so, SENCER hopes to help students overcome both unfounded fears and unquestioning awe of
science.

As most students begin the course, they have great levels of respect for “science,” not realizing that the very story of AIDS demonstrates more accurately the “doing of science” than the “dogma of science.” As the course unfolds with the history of the AIDS epidemic, students discover that many ideas about the disease were initially wrong and have been discarded or revised. Thus, the sense of science as a permanent, unchanging collection of facts is quickly debunked. HIV changed the central theory of the flow of genetic information. No longer could the central dogma be that genetic information flowed from DNA to RNA to protein, not when HIV replicated via RNA to DNA to RNA to protein. Science is, rather, a dynamic collection of tested hypotheses that are always under revision and subject to the next discovery.

Science can inform our thinking, but it cannot solve our problems, especially in the case of AIDS. Biology and medicine can explain the disease, its transmission, even its treatment, but the “multidisciplinary trouble” of AIDS, as June described it, is far beyond the boundaries of mere science. Science cannot address definitively the hotly contested issues of ethical treatment. Neither can it provide equal access to treatment or deal with irrational reactions and fears. The “multidisciplinary trouble” of AIDS weaves issues of social, psychological, economic, legal, political, and geographical impact into a major challenge to our aspirations for social justice. The awesome power of science does little for HIV+ orphans.

Knowledge brings responsibility to inform others. Many of the students in the course find venues for activism beyond the classroom. They find themselves talking to peers about their papers, finding professionals to review their solution plans, getting involved in campus health advocacy programs, volunteering with the Children’s’ AIDS Network, New Jersey Women and AIDS Network, or other organizations throughout the state, country and world.

Integrating Science and Civic Questions

We asked each course developer to comment on the connections between their course’s basic science content and the civic issues within which their course is framed.

This course was a groundbreaking effort to present a critical public policy issue, preventing the spread of HIV infection, in the context of biology. The content of the course was deliberately selected to define the scientific principles and topics that explained and presented the rationale for the public policy evolving around the issues of HIV/AIDS. The inclusion of guest speakers, who were public policy experts, lawyers, and AIDS activists, brought the issues clearly to the students. But the framework ofmedical and human health context was developed concurrently to demonstrate the
inseparable reality of human health and public policy.

The scientific principles and topics presented in this biology class are many and varied, as one might expect. Imbedded in the delivery of content on HIV, including epidemiology, sexually transmitted infections, host defense mechanisms, the immune response, virology, and the detection, diagnosis, and treatment, are a myriad of opportunities to link to public policy issues. Discussions of epidemiology and sexually transmitted infections and the reporting of diseases to local health departments and identification of contacts, raise important political questions about privacy and First Amendment rights. Many of the details of the immune response are critical, not only tounderstand the phenomenon of AIDS, but to see the directions and strategies for treatment and prevention. For example, vaccine procedures are the directed and controlled use of antigens to reinforce the anamnestic response. But in what population can we test these vaccines, and where would such testing be “ethical”? Without a clear understanding of how a virus replicates, how can the student understand the efficacy of the highly active anti-retroviral treatments? This question, in turn, leads to a discussion of why the administration of such drugs reduces transmission to the fetus and the need to inform HIV+ women of their options. It also raises the difficult issues of testing theefficacy of treatment on unknowing populations. Many questions of public policy are continually addressed by the students, both in and out of class, particularly on the “Discussion Forum” component of the course web page. To view the web page go to

Homepage of Monica A. Devanas

and follow the links to the WebCT course and the discussion groups there.

Evaluating Learning

Writing Assignment Contract

WRITING ASSIGNMENT CONTRACT

(200 points)

The writing assignment for this semester will be an original research report that focuses on clearly stating and carefully solving a problem of your choice. You will be required to use electronic database resources for reference material and potential solutions for the problem or situation. This assignment will be graded using a “contact” scale. This means that there is a set of minimum requirements of acceptable quality submitted that will used to determine the final grade on the Writing Assignment.

STEP 1. CHOOSE A RESEARCH STUDY for your writing assignment:
Think about:

  1. a particular population of people who have special problems or issues related to HIV disease,
    (pregnant teen-agers in the US and the health care of their babies) or
    (prostitutes in Calcutta and their need for information on sexually transmitted infections)
  2. a specific problem of the HIV/AIDS epidemic
    (need for human trials of drugs and vaccines)
    (federal funding of health insurance)

STEP 2. DO RESEARCH ON YOUR CHOICE OF POPULATION OR PROBLEM:

Using the electronic databases in the libraries to search for legitimate research articles from “peer-reviewed” journals (those that have serious scholars as editors and reviewers). Find at least one article for FOUR out of the eight categories: 1. Medical; 2. Psychological; 3. Political; 4. Educational; 5. Economic, 6. Legal, 7. Ethical, 8. Religious. THREE of these FOUR articles MUST BE FROM 2000! You may use more than four articles, but your must have a minimum of four (three from 2000). Submit a photocopy of the title page of each reference article (not the title page of the journal volume) that you plan to use with your Topic-Database-Reference Search Results.

STEP 3. SUBMIT RESEARCH TOPIC-DATABASE-REFERENCE SEARCH RESULTS NO LATER
THAN THE END OF CLASS ON 28 September 2000:

Use the following format to submit your Topic-Database-Reference Search Results (typed, hard-copy only) to me no later than the end of class on 28 September.

Name:
One or two sentences describing the Population or Problem you have chosen to study:
Database(s) used:
topic(s) searched:
subtopic(s):
Reference citations:

A. List the category that the reference satisfies:
1. Medical; 2. Psychological; 3. Political; 4. Educational; 5. Economic, 6. Legal, 7. Ethical, 8. Religious

B. Then give the Author, Title, Journal, year, volume, page for a minimum of 1 article in each of four topic
areas. Include a photocopy of the Title page of each of the selected reference articles.

For example:
Reference #1: Psychological
P. Van de Ven: A scale of optimism-skepticism in the context of HIV treatments; AIDS Care, Abingdon; Apr 2000; Vol. 12, Iss. 2; pg. 171, 6 pgs

Medical Librarian Jackie Mardikian from the Library of Science and Medicine and Lisa Vecchio from the Douglass Library will be presenting a session to the class on 21 September in the Records Hall Computing Lab. Jackie Mardikian will also be available on-line to answer your questions on how to use Rutgers Libraries electronic resources. She has also provided for special training sessions on how to use these electronic resources in the LSM Electron Resources Classroom. In addition, students can get help at the reference desks at any of the libraries, or make an appointment with Ms. Mardikian during her regularly scheduled reference desk hours or at another mutually agreeable time.

STEP 4. WRITE RESEARCH REPORT:

Using the references, describe the population, the HIV-related issue(s) of that population and how you would
make recommendations for solution(s) to the problem(s). Limit your description and solution to four typewritten
pages (10 or 12 point font). Any material after the page 4 will not be considered!

STEP 5. USE OF REFERENCE MATERIALS:

In the body of your research report, use quotes from the reference articles to support your descriptions of the
population, problem and solution you have chosen for your research.

STEP 6. USE STATISTICS FROM REFERENCE MATERIALS (APPENDIX 1: STATISTICS):

Use statistics, graphs, charts, tables from the reference articles to support your description of the population,
problem or solution. Use an APPENDIX of STATISTICS (page 5) for these data.

STEP 7. OUTLINE OF SOLUTION (APPENDIX 2: SOLUTION PLAN)

Write a detailed outline of your solution, For example, if you design an educational program, list the topics to
be covered in the lesson plan, the length of the class, the frequency, the grade level.

STEP 8. ASK THREE COLLEAGUES to CRITIQUE your RESEARCH REPORT:

When you have completed your research paper, have three friends read and critique your paper. On a
separate piece of paper for each of them, have each one answer these questions as they critique your research
and recommendations.

Name:

Relationship to author:

Occupation:

Critique questions:

  1. What is the unique feature of the study population or problem described by the author?
  2. Is the HIV-related problem or issue clearly described and valid for the study population or problem?
  3. How does the author use comments or data from the references?
    (Does the author describe, and define the problem and/or support the solution?)
  4. How can the author improve this description of the population, the problem and the solution?
  5. Did you learn anything from this research report? If so, what?

STEP 9. REBUTTAL OF CRITIQUES:

On another page, state whether the suggestions from the critics would improve your paper. That is, do you agree with the criticisms and how would you change your paper if you could?

STEP 10. PROFESSIONAL REVIEW OF YOUR SOLUTION PLAN:

Ask a professional in the field, i.e., if you design an education plan, ask a teacher, to critique your Detailed Outline of the Solution, using the same questions that were given for the “colleague critiques”.

STEP 11. SUBMIT YOUR WRITTEN ASSIGNMENT (four page “body” of report) DIGITALLY ON 31 October 2000 TO devanas@rci.rutgers.edu FOR PEER REVIEW.

PEER REVIEW comments returned by November 14.

  • Students are asked to use the electronic databases available through the library to find original, peer reviewed, research studies that assist them in describing the problem, the population, and/or a solution. The students must find at least one article for four of eight categories: medical, psychological, political, educational, economic, legal, ethical, and religious. An outline of the intended discussion, with photocopies of the first page of each of the four articles, is required for a preproposal review to be sure the student has not chosen a topic that is too narrow, too broad, or too obscure. The obscurity issue usually manifests itself when very few references are found, or many references are from years previous to the current year. The currency requirement ensures that current and most accurate information is used, (i.e., data on perinatal transmission has shown reduced rates of transmission in more recent years, due to use of aggressive treatment drug regimes during pregnancy). Using data three to five years old can negatively affect the analysis and interpretation.
  • The paper itself is limited to four pages. Brevity is a valuable commodity when one is reading 450 papers. Secondly, students are really forced to focus on the critical concepts rather than ramble. Before submission, four peers are asked to provide a written critique of the paper, looking for clarity, use of quotes, statistics, convincing argument for the solution plan, and whether they learned anything themselves. This gives the student opportunities to re-write or re-think depending on peers’ comments. Finally, a detailed solution plan is developed in an outline as an Appendix item. Again this keeps the rhetoric to a minimum and ideas and their relationship clear in the hierarchy of the outline. A professional must review the plan if the student wishes to achieve a grade of “A.” Professionals can be teachers who review education intervention plans, health care providers who review clinic outreach programs, or lawyers who comment on the feasibility of suggested legislation.
  • The writing assignment is structured as a contract: the more work contributed, the higher the grade. The Writing Assignment, developed and refined over the years, is a paper that requires research of a student’s own choosing that addresses a problem with AIDS. Essentially the students are asked to select a population that has a problem with AIDS and design a solution plan.

Related Resources

Backgrounders

HIV-AIDS The Once and Future Epidemic backgrounder

HIV-AIDS and Education in Africa backgrounder

Reference Materials

Several reference books are also on Reserve in Alexander Library. These include:

  • G. Stine. (1993) Acquired Immune Deficiency Syndrome: Biological, Medical, Social and Legal Issues.
  • H. Fan, R. Conner, and L. Villarreal. (1994) The Biology of AIDS.
  • G. Stine. (1995) AIDS Update.
  • I.E. Alcamo. (1993) AIDS: The Biological Basis

You may borrow these for two hours at a time by giving the course number, book title and your student ID to the librarian at the Reserve Desk. These books are the personal property of Dr. Devanas so please do not write in them or mark them in any way.