We Don’t Talk About HIV Anymore and a Lot Has Changed
If you grew up in the 1990s, you practically got your AIDS degree just by being – or at least that’s how you felt. Over the years, tests and treatments have improved and we now know more about the virus, but this information is not generally known. HIV and AIDS have disappeared from our radars.
Of course, this comes up from time to time, such as when Charlie Sheen recently announced that he was HIV positive . And the article you are reading right now is one of many published annually on World AIDS Day (responsible for the red splashes in this Google Trends chart ).
Not everyone can afford the luxury of forgetting about HIV and AIDS. In Africa, about 25 million people live with the virus . In Asia , AIDS-related adolescent mortality is indeed on the rise . And that’s a known issue in the gay dating scene: Gawker’s Rich Juzwiak wrote about his experience here .
“The HIV epidemic still exists, and it remains a serious health problem in the United States,” said a statement in bold in the latest version of the National HIV / AIDS Strategy . Every year 50,000 new diagnoses are made. According to the CDC, this rate has remained stable since the mid-1990s , so the number of people living with HIV continues to rise.
What Happened to AIDS?
AIDS is no longer a plague or a panic thanks to a range of advances: better treatments for HIV mean it rarely turns into AIDS. People who get tested can find out their status faster thanks to better tests, and people seem to be more aware of the dangers of unprotected sex.
AIDS is only a late stage of HIV infection. Today, only about 2% of people with HIV have AIDS . But in the 1980s and 1990s, says Dr. Michael Colber, director of the University of Miami’s Comprehensive AIDS Program , people with HIV were generally only diagnosed at a later stage.
“We have all the tools we need to get rid of HIV,” says Dr. Colbert. But not enough people get tested, either because they don’t know what they should or because they don’t have access to tests. Those who do find they are positive sometimes are unable or unwilling to take the virus-containing medication.
This is why public health groups, including the government’s Centers for Disease Control and Prevention , are pursuing many initiatives to bring testing to more people, make medicines more affordable and accessible, and improve people’s understanding of disease. Along these lines, here are some things you might not know about HIV, but you probably should.
You should probably get tested
Currently, 1.2 million people are infected with the virus, about the same as the population of New Hampshire. And 12.8% of those infected do not know they have it.
If you are HIV positive, knowing your status gives you a huge advantage. You can start treatment before you have symptoms of infection, which greatly reduces your chances of developing serious illnesses , including those associated with AIDS. Treatment also lowers your chances of passing the virus on to others. Know your status, you can tell their sexual partners that they should be screened, and then they too will benefit from early treatment.
If you need to refresh your memory: The virus can be transmitted through body fluids, including blood, semen and pre-ejaculatory fluid, vaginal and rectal secretions, and breast milk . You are likely to get HIV from saliva, tears, sweat or not. This newsletter gives a rundown of the transmission routes , including scenarios such as kissing where transmission is very rare but technically possible.
According to the CDC, everyone between the ages of 13 and 64 must get tested at least once in their life . Annual testing applies to everyone with risk factors , including those who have sex with people whose HIV status is unknown to you.
“Test technology has come a long way,” says Jerry Shohetman, senior director of diagnostic research at Abbott Laboratories . (Abbott conducts HIV tests.) Older HIV tests detect antibodies that the human body makes in response to the virus. It takes weeks or months to produce enough antibodies to be detected on a test. Newer combination tests detect antibodies and the virus itself, and the CDC recommends this type . Combination tests can detect HIV up to a month after infection , and often earlier.
You can ask your doctor for a test, go to a clinic like Planned Parenthood , or find testing services at a myriad of other facilities, such as drug treatment programs and mobile testing vehicles. With this tool, you can find testing services near you, or even order a kit to test yourself at home .
If one of these tests comes back positive, Shokhetman said, you will be offered a different type of test to confirm the diagnosis and will usually seek counseling to help you understand your diagnosis and what you can do to avoid putting others at risk.
You should also be referred to an HIV specialist so that you can start treatment even if you do not have symptoms yet.
HIV is not a death sentence, but an easy walk
HIV can be managed with timely and consistent treatment: the amount of virus in the blood of an infected person can drop to undetectable levels, and the life expectancy of someone with HIV may be the same as that of someone without .
But not everyone agrees with the treatment regimen. “Young people do not like to take medicine when they are healthy,” says Dr. Colbert. Some potential patients fear the side effects of drugs, but other factors contribute to a depressing percentage of people with HIV infection receiving adequate care: things like poverty , racial inequality and homelessness . “If you have support services, such as housing, you will take better medication than if you didn’t have them,” says Colbert.
Other health conditions can also interfere with treatment. Mosaic recently introduced several UK HIV patients , none of whom have had an easy life. One, named Hugh, first avoided treatment and then found himself unable to swallow the pills . Depression later prevented him from taking medications, and when his immune system was damaged, he contracted toxoplasmosis infection, which led to a seizure, and lymphoma, which required chemotherapy. Now he lives with his parents and walks with a cane. He is 35 years old.
HIV medications are expensive – about $ 2,000 a month, Colber estimates. A list of medicines and their costs can be found here ; most of them have no universal equivalent. Private insurance and various government programs can help cover costs. Usually a person takes three or more drugs in a “cocktail,” sometimes combined into one pill, but which medications they take will depend on the specific strain of the virus they have.
Medicines also have side effects that can become serious over time as people (ideally!) Have been taking them for decades on end. Keeping up with health care is not just about controlling HIV; you also need to monitor whether the drugs are still working and whether they harm your body. This can include, for example, liver damage and osteoporosis .
Medicines can prevent HIV transmission
Surprisingly, we have a pill that an HIV negative person can take to reduce the chance of contracting HIV by as much as 99% . It’s called Truvada and it costs about $ 1,000 a month. ( This handy flowchart will help you understand how to cover the costs of insurance and assistance programs.)
HIV treatment itself is also a form of prevention. If you have HIV but take your medications as directed, the chance of transmitting the virus is reduced to 96%, depending on the study .
Treatment can make your viral load undetectable, so it may be better to sleep with someone who has tested positive and has it under control than someone who might be infected with HIV but doesn’t know it yet. In this case, they will be in the acute phase of infection when they are most infectious.
People with HIV can also have uninfected children. Treatment during pregnancy can reduce the chances of mother-to-child transmission of the virus. This is why HIV testing is often part of a routine blood test in the first trimester .
Still no cure or vaccine (but we’re getting closer)
During the hot minute, it seemed that the child had been cured of HIV. She was born prematurely to an HIV-infected mother, and doctors took the unusual step of curing the baby immediately after birth. She stopped taking medication in early childhood and her viral load has not been measured for over a year. This girl, the “Mississippi child,” seemed to be cured. This was until the virus returned at the age of three .
When a patient’s viral load becomes undetectable, the HIV virus still remains in the patient’s body. It hides in “reservoirs” such as lymph nodes and bone marrow . One possible treatment strategy is to “shock” the virus by forcing it to come out of hiding and then kill it. AIDS researcher Paul Wolberding, who is working on this approach, told CBS News :
We say that our goal is to find a cure in five years, and I think everyone understands that this is more desirable than real. But I think it’s realistic to think that in five years time we will go much further than we do now.
Vaccines have been in development for a long time, and some people think we are very close to it. Researcher Louis Picker told Forbes that the vaccine he is developing could be ready in ten years. It only works after a person is infected and tricks the immune system into killing the body’s own cells in the reservoirs where the virus lurks. The vaccine efficacy in monkeys is 50%.
“We would love to have 100% protection,” says Dr. Colbert. “But think about it: if you had at least 10-20% protection, you would have significantly reduced the transmission, and this is a significant positive effect.”
With a vaccine or medication, HIV can be a thing of the past. But for now, it’s best to take advantage of the tests and treatments we already have.
Michael A. Colbert, Ph.D., M.D., professor of medicine at the University of Miami Miller School of Medicine, where he also serves as Vice Chair of Clinical Affairs, Director of the Comprehensive AIDS Program, and Director of Adult HIV Services. …
Jerry Shohetman, Ph.D., is Senior Director of Diagnostic Research at Abbott Laboratories.
Illustration by Tara Jacoby.
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