Why is HIV singled out from other STIs?

Question

If HIV is an STI, then why is HIV often listed separately?

Examples:

• HIV & Sexually Transmitted Infections Fact sheet
• STDs and HIV – CDC Fact Sheet
• What You Need To Know About the Links Between HIV and STDs

Answer 1

This is a good question, and although as you correctly state that HIV is an STI (see STI vs STD vs Sexually Transmitted Virus?) there is a difference with HIV which is one reason why it may be separated from others.

It can be thought that HIV is separated from STIs in factsheet titles etc. because HIV is a virus when others are not, but there are other STI viruses. For example, there is:

• Human Papilloma Virus (HPV), which is the name for a group of viruses that affect your skin and the moist membranes lining your body.
• Herpes, which is caused by the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2).

It can also be thought that HIV is separated from STIs in factsheet titles etc. because HIV can be fatal, but there are other STIs which can lead to death. For example:

• Syphilis can affect multiple organ systems, including the brain, nerves, eyes, liver, heart, and blood vessels. The effects on the heart can lead to death.
• Gonorrhea can also spread to the blood and cause disseminated gonococcal infection (DGI). DGI is usually characterized by arthritis, tenosynovitis, and/or dermatitis. This condition can be life threatening.
• HPV (Human Papillomavirus) can cause cervical and other cancers including cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer).

Possible reasons for separating HIV from other STIs in factsheets

1. The key thing with HIV is that apart from Hepatitis, which is also viral, all other STIs are generally only transmittable only through sexual contact. HIV can be transmitted through infected blood transfusions, use of infected needles, or through contact between broken skin of 2 or more people.

Note: Skin to skin contact with unbroken skin is safe

2. STIs are infections and STDs are the diseases as a result of the infection. Some STDs don't share the same name as the STI which caused it.

3. (This applies to your question) The linked factsheets etc. you provided are talking about the links between HIV and other STIs.

How reason 3 applies here

Reading the detailed version of the CDC factsheet on HIV and STDs:

[P]eople who get syphilis, gonorrhea, and herpes often also have HIV or are more likely to get HIV in the future. One reason is the behaviors that put someone at risk for one infection (not using condoms, multiple partners, anonymous partners) often put them at risk for other infections. Also, because STD and HIV tend to be linked, when someone gets an STD it suggests they got it from someone who may be at risk for other STD and HIV. Finally, a sore or inflammation from an STD may allow infection with HIV that would have been stopped by intact skin.

Another interesting fact is that studies that have lowered the risk of STD in communities have not necessarily lowered the risk of HIV. Risk of HIV was lowered in one community trial (Grosskurth, et al. 1995), but not in 3 others (Wawer, et al., 1999; Kamali, et al., 2003; Gregson, et al., 2007).

Also, treating individuals for STDs has not necessarily lowered their risk of acquiring HIV (Ghys, et al., 2001; Kaul, et al., 2004).

Further Reading

What is HPV? — NHS
Genital HPV Infection Fact Sheet — CDC

Hepatatis Factsheets - CDC

Genital Herpes Fact Sheet - CDC

References

Ghys, P. D., Diallo, M. O., Ettiegne-Traore, V., Satten, G. A., Anoma, C. K., Maurice, C., ... & Laga, M. (2001). Effect of interventions to control sexually transmitted disease on the incidence of HIV infection in female sex workers. Aids, 15(11), 1421-1431.
Retrieved from: https://journals.lww.com/aidsonline/Fulltext/2001/07270/Effect_of_interventions_to_control_sexually.12.aspx

Grosskurth, H., Todd, J., Mwijarubi, E., Mayaud, P., Nicoll, A., Newell, J., ... & Changalucha, J. (1995). Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. The lancet, 346(8974), 530-536.
DOI: 10.1016/S0140-6736(95)91380-7

Gregson, S., Adamson, S., Papaya, S., Mundondo, J., Nyamukapa, C. A., Mason, P. R., ... & Anderson, R. M. (2007). Impact and process evaluation of integrated community and clinic-based HIV-1 control: a cluster-randomised trial in eastern Zimbabwe. PLoS medicine, 4(3), e102.
DOI: 10.1371/journal.pmed.0040102

Kamali, A., Quigley, M., Nakiyingi, J., Kinsman, J., Kengeya-Kayondo, J., Gopal, R., ... & Whitworth, J. (2003). Syndromic management of sexually-transmitted infections and behaviour change interventions on transmission of HIV-1 in rural Uganda: a community randomised trial. The Lancet, 361(9358), 645-652.
DOI: 10.1016/S0140-6736(03)12598-6

Kaul, R., Kimani, J., Nagelkerke, N. J., Fonck, K., Ngugi, E. N., Keli, F., ... & Ronald, A. R. (2004). Monthly antibiotic chemoprophylaxis and incidence of sexually transmitted infections and HIV-1 infection in Kenyan sex workers: a randomized controlled trial. Jama, 291(21), 2555-2562.
DOI: 10.1001/jama.291.21.2555

Wawer, M. J., Sewankambo, N. K., Serwadda, D., Quinn, T. C., Kiwanuka, N., Li, C., ... & Ahmed, S. (1999). Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomised community trial. The lancet, 353(9152), 525-535.
DOI: 10.1016/S0140-6736(98)06439-3

Answer 2

Question: If HIV is an STI, then why is HIV often listed separately, for example:

• HIV & Sexually Transmitted Infections Fact sheet
• STDs and HIV – CDC Fact Sheet
• What You Need To Know About the Links Between HIV and STDs

Reason 1. The articles linked above have "HIV and STI" or "HIV or STDs" in the titles because they describe how a person with a certain sexually transmitted disease (STD), for example, genital herpes is at increased risk to catch HIV virus. So, there is not really any "listed separately" situation here.

Reason 2. In some older articles, like this one from 1994, "STDs and AIDS," are separated to make an emphasis on AIDS and compare the known STDs with AIDS, which was relatively new at the time.

Apart from the fact, that AIDS is the most severe/deadly STD, there is no biological reason to list them separately: HIV is a virus but so is Herpes; AIDS is a systemic disease and if left untreated it is often deadly, but the same is true for syphilis. It's more about how the authors decide to title their articles.

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Explanation of the terms used to prevent confusion:

HIV refers to either the human immunodeficiency virus or, when this enters the body, to HIV infection, which is a sexually transmitted infection (STI). HIV infection becomes a sexually transmitted disease (STD), namely AIDS, only when it causes damage to the body and, usually, symptoms. So an STI is not already an STD, but in practice, both acronyms are often used as synonyms.

Answer 3

From a rigorous scientific viewpoint, it at first makes indeed not much sense to list STIs and HIV separately. HIV is a virus that once it is in your body and you have antibodies developed will have caused an STI, which once it progresses to the symptoms of AIDS, becomes an STD that nobody wants.

So it is mainly a historically formed cultural response to single out HIV. And a result of attention marketing.

HIV spread very rapidly in the West from the late 70s onwards, it was seen as an incurable deadly disease – that was new, and initially not even widely recognised as an STD, but sometimes as God's revenge, a form of cancer etc. –that just takes long enough to kill everyone infected to enable all those promiscuous sinners to infect a large number of people.
_{(Jaques Pepin: "The Origins of AIDS", Cambridge University Press: Cambridge, New York, 2011, ch 13 Globalisation.)}

At the time of identification the public mind just had a lot of sex from the sexual revolution and saw other STDs as a souvenir from being very active, to be worn in pride since antibiotics could cure the most prominent bacterial infections with unprecedented effectiveness. This carefree and wrong attitude towards many STDs is still somewhat prevalent.

The advent of the gay liberation movement in the late 1960s and 1970s led to the creation of a more self-confident ‘out’ gay community with a number of activist and campaigning groups. Sexual liberation became an important component of gay life; many sexually active gay men came to regard attendance at STD clinics as a regular, if inconvenient, aspect of sexual life.
By the mid-1960s, the number of attendances at STD clinics was increasing dramatically. The ‘sexual revolution’ of the ‘permissive society’, the advent of the oral contraceptive pill and the declining popularity of the condom all contributed to an increase of STDs, particularly viral infections. The increased incidence of STDs was seen in official circles as ‘primarily a reflection of sexual promiscuity in the population’; rather than prostitutes, however, the main social groups now seen to be responsible were teenagers, immigrants, asymptomatic promiscuous women and homosexuals.
_{(Roger Davidson and Lesley A. Hall (Eds.): "Sex, Sin and Suffering. Venereal disease and European society since 1870", Routledge: London, New York, 2001, p 246–247.)}

In the case of HIV/AIDS these social background factors of scientific medicine still linger on:

Scientific discoveries such as the discovery of a new disease exert a fascination not only on the scientific community and the lay public, but also on social scientists. For the first, discovery is the main drive and the ultimate goal. For the lay public, it is often accompanied by the promise of curing illnesses and improving people’s lives. For social scientists, scientific discoveries are the domain where the role, influence, and limitations of social factors – such as interests, resources, and relationships – can be perhaps best examined.
That such factors play a role in discovery making has not been contested; the question is whether scientific discoveries are evaluated, acknowledged, and accepted by the scientific community according to universal standards of rationality or according to the resources, influence, and social relationships of the scientists themselves. The positivist tradition has solved this problem by distinguishing between the context of discovery and the context of justification. Whereas the former is messy (involving serendipity, accident, resources, interests, and the like), the latter is determined by rigorous criteria of universal applicability.
This distinction has been contested by sociologists and historians of science alike who argue that, in practice, the two contexts are indistinguishable: justification takes place in the process of discovery itself (e.g., Nickles 1992, p. 89; Hacking 1996, p. 51). Consequently, justification is not exclusively determined by logical criteria; factors such as interests, resources, and networks of relationships play a considerable role (Stump 1996, p. 445).

_{Alex Preda: "AIDS, Rhetoric, and Medical Knowledge", Cambridge University Press: Cambridge, New York, 2005, p47.}

"Getting AIDS" is still seen by the larger public as the most dangerous of all STDs, with most others either classified as manageable or less important in their consequences. Whether true or not is irrelevant in the public's mind, and even these attitudes seem in decline and attention is unhealthily highly put on AIDS/HIV treatment advances, "normal lives", and now even the possibilities of vaccinations getting closer.

If this reason for keeping HIV singled out when talking about STI/STDs is historical, why keep it separate?

On the one hand, there is this connection between other STDs and HIV/AIDS, mentioned in other answers: having one increases to chance of catching the other. But it is also theorised that from a public health standpoint awareness and acceptance of preventive measures, testing and treatments might be improved simultaneously – not to mention the all important funding of research, prevention programs – the hypothesis of "epidemiological synergy (Wasserheit 1992; Fleming and Wasserheit 1999)."

_{Charles Klein & Delia Easton: "Structural Barriers and Facilitators in HIV Prevention: A Review of International Research"; Sevgi O. Aral & Thomas A. Peterman: "STD Diagnosis and Treatment as an HIV Prevention Strategy"; in: Ann O’Leary (Ed.): "Beyond Condoms. Alternative Approaches to HIV Prevention", Kluwer Academic Publishers: New York, Boston, 2002.)}
STD control for HIV prevention is a controversial interface between well-financed HIV prevention programs and less wealthy STD prevention programs. STD experts are frustrated at the lack of HIV and other resources committed to this HIV prevention strategy. Some HIV experts are skeptical of the motivations of the proponents of this strategy, and think the potential for HIV prevention by STD control has been exaggerated. Between these two camps lies a huge mass of data accumulated by hundreds of studies conducted over the past 15 years. Synthesizing this data is particularly important for HIV prevention world wide, because the developing countries where STD control programs have been weak are often the countries where the AIDS epidemic has been most devastating. While epidemiological and microbiological evidence support the existence of a two-way relationship between STDs and HIV infection, the relationship between early and appropriate diagnosis and treatment of STDs and prevention of spread of HIV needs to be further elaborated. The parameters that need to be specified in such elaboration include 1) factors related to the STI: the specific STI; whether the STI is symptomatic or asymptomatic; whether the STI is incident (new) infection or prevalent (chronic or long standing) infection; and perhaps the stage of the sexually transmitted infection; 2) factors related to the population, which may also function as multipliers of the STI effect: age-gender composition; patterns of sexual mixing and concurrency; prevalence of male circumcision; 3) factors related to the phases of the STD and HIV epidemics: for example, whether the HIV and STD epidemics are nascent or generalized epidemics; 4) factors related to the goals of the HIV prevention program: objectives related topreventing the acquisition of infection among the uninfected; objectives related to preventing the transmission of infection by the infected; objectives related to provision of services to protect the personal health of individual members of the population; objectives related to protecting public health, i.e., limiting the spread of HIV infections: objectives related to targeting primary prevention of HIV through behavior change versus primary prevention of HIV through control of co-factors. The appropriate approach to the implementation of STD control for HIV prevention in a specific setting depends on the values of all of the above factors. In addition, many of the above factors are interdependent, and it is important to consider their reciprocal influences.

It seems quite useful from an epidemiological view to just not neglect one of the two closely interconnected halves of this problem realm. And previously, after the advent of penicillin, the public mind and imaginations (including those of politicians) did start to neglect other STDs as long as the discussion went for funding, morals and opinions were always cheap.

From this perspective, rhetorical practices are not an obstacle but rather a necessary ingredient of expert democracy. Bridging the gap between science and the general public has become crucial to the public sphere and democracy. This means we must acknowledge that rhetorical practices do matter and act accordingly.
_{Preda (2005): "How Rhetorical Practices Matter for AIDS Prevention", p229ff.}

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To sum this position up: HIV/AIDS was seen as something different from what was known as STI/STDs even by medical professionals, it is still seen as "different" in the public eye. Apart from being "on of the most "popular" STIs it is also seen as the deadliest. Apart from the historical reasons that lead to it being listed separately, this separation is continued for science communication reasons. It is thought to help with awareness, prevention, testing and treatment. In really short terms: sticklers, like me, point out quite rightly that HIV/AIDS is an STI/STD. But the usual presentation now is both historically grown and useful.