AIDS is no longer a death sentence; Getting to Zero transmission is our aim!
By Dr Brighton Chireka
“We have to stop the spread of HIV and it begins with me, Dr Brighton Chireka and begins with you reading this article and also begins with the whole Zimbabwean Community.”
December 1 is World AIDS Day, a day dedicated to commemorate those who have passed on and to raise awareness about AIDS and the global spread of the HIV virus. It has been marked since 1988, after health ministers from around the world met in London, England, and agreed to such a day as a way of highlighting the enormity of the AIDS pandemic and nations’ responsibility to ensure universal treatment, care and support for people living with HIV and AIDS.
Led by the World AIDS Campaign organization, the theme for World AIDS Day 2015 is ”Getting to zero.” Zero New HIV Infections. Zero Discrimination and Zero AIDS-related deaths.
I would like to join hands today in promoting this year’s theme of “Getting to zero”. Raising awareness about AIDS, that it is no longer a death sentence. I welcome the statement by the Executive Director of UNAIDS, Michel Sidibé, in which he said, “Fifteen years ago there was a conspiracy of silence. AIDS was a disease of the “others” and treatment was for the rich and not for the poor. We proved them wrong, and today we have 15 million people on treatment—15 million success stories.”
This week, Zimbabwe hosts the 18th edition of the International Conference on AIDS and STI’s in Africa at The Rainbow Towers Hotel and Harare International Conference Centre from 29 November to 04 December 2015. In his welcoming speech, the Zimbabwean Minister of Health, Dr David Parirenyatwa, had this to say:
“Zimbabwe has a long history in the response to HIV and AIDS. As one of the countries severely affected by the pandemic, we have recorded some internationally acclaimed milestones particularly the reduction of both HIV incidence and prevalence and scaling up access to treatment under difficult conditions as well as our leadership role as a pathfinder in domestic financing for HIV through our AIDS levy, which has now been recorded and shared as an international best practice”
I am a self-proclaimed patient engagement advocate and believe in the patient being at the heart of decision making. I believe in the education of patients on health issues so that they make informed decisions about their health.
Despite the great strides taken so far in raising awareness about HIV/AIDS, there is still a lot of misinformation that is being spread by misguided people. As one who has lost close relatives to AIDS, I find some of the content of this misinformation repugnant. In my practice, I see many people presenting themselves for treatment late. On the other hand, I am also seeing people benefiting from treatment.
I wish everyone could pause, reflect and think about the information that is being spread about HIV/AIDS, and respond proactively. We cannot fold our hands and just blame others for having unleashed “AIDS on us in their endeavour to wipe out black people”. Little knowledge is dangerous and many people are perishing not because they do not have knowledge, but because they decide to ignore knowledge. I make no apologies for saying that it’s high time we stand up as Africans or Zimbabweans and face the issue of AIDS openly and stop scapegoating. HIV/AIDS is no respecter of people and knows no boundaries. It affects the rich and the poor, black or white, African or European.
Having said that, one has to look at the statistics in order to focus the resources so that there are no health inequalities. When resources for combating a certain disease are targeted at a particular group, it becomes easy to to develop the notion that the disease is for one ethnic group, in this case the idea that HIV/AIDS is an “African disease”. HIV/AIDS is a worldwide problem, affecting all races. However, there are interesting facts about this problem that need to be addressed candidly, though they may cause us discomfort as Africans.
Let me answer a few questions and then conclude this discussion.
What is HIV/AIDS ?
AIDS stands for Acquired Immune Deficiency Syndrome and is cause by a virus called the Human Immunodeficiency Virus ( HIV). This virus attacks the body’s immune system that fights off infections. When this defence system breaks down, the body loses its natural powers of protection against diseases and some infections take advantage of that, which is why they are called opportunistic infections. I know many of us have heard that someone “died of AIDS.” This is entirely inaccurate, since it is potentially fatal opportunistic infections, such as pneumonia, that cause death. AIDS is the condition that lets the opportunistic infections attack the body.
Like the one responsible for the common cold, HIV needs a living cell for it to make more viruses, and to do all of the other nasty things that viruses do. HIV mostly infects CD4 cells, also known as T cells, or T-helper cells. These are the body’s soldiers, coordinating the defence system against infections. Once inside the cell, HIV starts reproducing into millions of little viruses, which eventually kill the host and then go out to infect other cells, weakening the whole defence system. All of the drugs (ARVs) marketed to treat HIV work by interfering with this reproductive process.
Was HIV created in a laboratory to kill off blacks, gays and junkies?
Creating a complicated retrovirus like HIV was way beyond scientists’ abilities in 1959, which is the date of the first confirmed case of AIDS, in Kinshasa, Africa. It is probably beyond their abilities now, too.
We know where this fear is coming from. It’s not an entirely irrational one, considering not only social prejudices of recent history, but also the history of experiments on live, uninformed human subjects. Between 1932 and 1972, for instance, a Tuskegee, Alabama study left 400 black men untreated for syphilis, long after they could have been cured with penicillin—just to see what would happen.
Theories abound on where HIV came from, but one thing and one thing only turned HIV from a disease of the West African bush into a global epidemic. No, it wasn’t changes in sexual behavior; it was international travel. AIDS spread along trucking highways and airline routes.
I have heard that HIV doesn’t cause AIDS.
If you take a cross-section of people with HIV worldwide, nothing else connects an African baby, a Thai housewife who has only had sex with her husband, an Indian transsexual, a San Francisco gay man and a Russian IV-drug user but having the virus.
How is HIV Transmitted?
HIV enters the body through open cuts, sores, or breaks in the skin; through mucous membranes, such as those inside the anus or vagina; or through direct injection. There are several ways by which this can happen:
● Sexual contact with an infected person.
● Sharing needles, syringes, or other injection equipment with someone who is infected.
● Mother-to-child transmission. Babies born to HIV-positive women can be infected with the virus before or during birth, or through breastfeeding after birth.
● Transmission in healthcare settings. Healthcare professionals have been infected with HIV in the workplace, usually after being pricked with needles or sharp objects containing HIV-infected blood. As for HIV-positive healthcare providers infecting their patients, there have only been six documented cases, all involving the same HIV-positive dentist in the 1980s.
● Transmission via donated blood or blood clotting factors. However, this is now very rare in countries where blood is screened for HIV antibodies.
HIV is NOT transmitted by the following :
HIV is NOT transmitted by the following circumstances so you don’t have to worry about because they will not put you at risk for becoming infected with HIV:
● Being bitten by a mosquito, other insects or an animal.
● Eating food handled, prepared or served by somebody who is HIV positive.
● Sharing toilets, telephones or clothing with someone who is HIV positive.
● Sharing forks, spoons, knives, or drinking glasses.
● Touching, hugging or kissing a person who is HIV positive.
● Attending school, church, restaurants, shopping malls or other public places where there are HIV-positive people.
● HIV cannot be transmitted through urine, faeces, vomit, or sweat. It is present, but only in negligible quantities, in tears and blister fluid. It is present in minute amounts in saliva in a very small number of people.
More information on how HIV is transmitted
The reason why sexual activity is a risk for HIV transmission is because it allows for the exchange of body fluids. Researchers have consistently found that HIV can be transmitted via blood, semen, and vaginal secretions. It is also true that HIV has been detected in saliva, tears, and urine. However, HIV in these fluids is only found in extremely low concentrations. What’s more, there hasn’t been a single case of HIV transmission through these fluids reported in the world.
If semen leaks out during intercourse and the insertive partner is HIV positive (or his HIV status is not known), contact a healthcare provider or hospital emergency room to discuss the risk and the possibility of post-exposure prophylaxis (PEP).
PEP involves a 28-day course of antiretroviral (ARV) drugs that needs to be started within 72 hours of possible exposure to the virus. Generally speaking, only people who have had a high-risk situation (e.g., condomless receptive anal or vaginal intercourse with someone known to be HIV positive) are considered to be good candidates for PEP.
I do not know my HIV status, should I go for testing?
When it comes to HIV testing, the old cliché “knowledge is power” still holds true. Knowing your HIV status, whether negative or positive, puts you in the best position to protect your health and the health of your sexual partner(s). At present, there is no cure for HIV/AIDS, but there are medications available that allow HIV-positive individuals to live a normal, healthy life. And being aware of your HIV status makes it less likely that you will pass the virus to others. My advice is; yes, go ahead and get tested as HIV is like any other chronic condition and has treatment available.
What are the types of HIV tests?
There are several different tests that can be used to determine if you have HIV. The first test developed is still the most frequently used for the initial detection of HIV infection: the Enzyme-Linked Immunosorbent Assay, or as it’s more commonly known, the ELISA or EIA.
The time it takes the body to produce antibodies after HIV infection has begun is known as the “window period.” For the vast majority of those who contract the virus, antibodies to HIV will develop within four to six weeks after exposure. Some people will take a little longer. Until antibodies are present, an ELISA test will come up negative for HIV. So if someone has contracted the virus, but hasn’t yet developed antibodies at the time of taking an ELISA HIV test, this can result in a false negative.
The newer HIV tests will detect an infection by about three weeks following exposure to the virus; with the older HIV tests, the window period could be as long as three months. Correctly identifying acute cases of HIV is crucial for HIV prevention because viral loads are typically very high during that period of infection, making someone much more likely to pass on the virus.Because of this window period, it is important to know what type of HIV test your healthcare provider is using. With the older tests, getting tested before three months may give you an unclear result or a false negative.
No diagnostic test will ever be 100 percent reliable, but if you test negative at the appropriate time (i.e., 3 weeks after possible exposure to the virus with the newer HIV tests or 13 weeks after possible exposure to the virus with the older HIV tests), you can consider that to be dependable confirmation that you are HIV negative. This means that if you are not sure about when you may have got exposed, you must have the test twice 3 months apart to confirm that you are HIV negative.
I have tested positive for HIV, does it mean I am dead?
Do not panic just because you have tested positive for HIV. Testing positive is not the end of the world, neither is it the end of your sexual relationship or the end of you. Testing positive should make you strong, even if you first feel numb about it. It will be a challenge to yourself and to the people in your life, but it will also be an opportunity to grow. Nowadays, HIV is like any other chronic disease, such as diabetes or high blood pressure, in that you can control it by taking your medication regularly and can live a normal life.
Do I have to tell everyone that I am HIV positive?
Disclosure should be at your speed and to whomever you choose. Disclosure can be a relief, and it can even be empowering, but there may be reasons why you would want to keep it a secret to anyone or everyone. I would strongly recommend that you tell your sexual partner as it is unfair, and criminal in some countries, to fail to tell your sexual partner if you are HIV positive. Remember there is no requirement for you to tell all members of the public.
If I am HIV positive can I have children who are HIV negative?
HIV positive women who control their virus with medication during pregnancy, have a Caesarean section and do not breastfeed, reduce the risk of passing on HIV to their baby to a mere 1 percent.
A positive man hoping to conceive with a negative woman can avail himself of a technique called “sperm washing” that separates HIV from sperm.
Sperm washing involves the man giving a semen sample to a clinic, then a special machine spins it to separate the sperm cells from the seminal fluid. (Only the seminal fluid contains HIV; sperm cells themselves do not carry HIV). The washed sperm is then tested for HIV. Finally, a catheter is used to inject the sperm into the woman’s uterus. In vitro fertilisation (IVF) may also be used, especially if the man has a low sperm count. The good news is that there has been no cases of HIV transmission to women from sperm washing.
If I am positive can I have sexual intercourse?
If one is HIV positive and takes ARVs as instructed and the viral load is undetectable then the chances of transmitting HIV will be very low but that person can still infect others. In view of this, an HIV positive person must practice safe sex regardless of the level of viral load. Also, the HIV negative partner can also take medication daily, usually Truvada (tenofovir plus emtricitabine)—before, during and after possible high-risk exposures to reduce the risk of becoming infected with HIV, in case the condom fails. The treatment that the HIV negative partner can take is called Pre-exposure prophylaxis.
What does undetectable viral load mean?
When you test positive for HIV, you will be offered treatment and the drugs are called Antiretroviral (ARV). Typically, if your HIV medication is working, and you take them exactly as prescribed, your viral load should reach undetectable levels within 3-6 months after you begin treatment.
There has been a lot of confusion over the issue of viral load and testing positive for HIV. I will try to explain this so that it becomes clear to everyone and should help people to stay safe and not let ignorance kill us.
Viral load is only tested in those that are HIV positive because they have the virus so checking the amount of the load is important in monitoring their treatment.
The term “viral load” refers to the amount of HIV in a sample of your blood. When your viral load is high, you have more HIV in your body, and that means your immune system is not fighting HIV as well.
A viral load test is a lab test that measures the number of HIV virus particles in a milliliter of your blood. These particles are called “copies.” A viral load test helps provide information on your health status and how well antiretroviral therapy (ART – treatment with HIV medicines) is controlling the virus. ART can’t cure HIV, but it can help you live a longer, healthier life and reduce your risk of HIV transmission.
The goal of ART is to move your viral load down, ideally to undetectable levels. In general, your viral load will be declared “undetectable” if it is under 40 to 75 copies in a sample of your blood. The exact number depends on the lab that analyzes your test.
Having an “undetectable” viral load doesn’t mean that the virus is completely gone from your body, just that it is below what a lab test can find. You still have HIV and you are still HIV positive and need to stay on ART to remain healthy.If one is HIV negative, then they do not have the virus in their body and there is no need to check the viral load because it will be ZERO.
If my viral load is undetectable, does that mean I am cured?
No, “undetectable” does not mean you are cured or that the virus is gone from your body. It means that the virus is below the level that a lab test can find. You still have HIV and need to stay on ART to remain healthy.
Can I infect anyone with undetectable viral load?
Having an undetectable viral load greatly lowers your chance of transmitting the virus to your sexual partner who is HIV-negative. However, even when your viral load is undetectable, HIV can still exist in semen, vaginal and rectal fluids, breast milk, and other bodily fluids. For this reason, you should continue to take steps to prevent HIV transmission. So, the answer is; yes you can infect other people even if your viral load is “undetectable”. Remember “undetectable ” means that the virus is below the level that a lab test can find, i. e. below 40-75 copies in a sample of blood. This explains why a person with undetectable viral load can have unprotected sex with different partners and not all of them will be infected. This practice is wrong and the advice is that an HIV positive person should have protected sex regardless of the level of viral load.
What are the statistics “saying?”
Unfortunately, what was true last year, the year before, and the decade before that, remains true today: the Black community is the racial/ethnic group most affected by HIV in the USA and in the UK. In fact, it is not overstating the situation to say HIV is a crisis in the Black communities in both the US and the UK.
Black people accounted for an estimated 44 percent of all new HIV infections among adults and adolescents aged 13 years or older in 2010, despite representing just 12 percent of the US population. In Massachusetts, Black people are just six percent of the population but comprise 30 percent of those living with HIV/AIDS.
Black Africans living in England are disproportionately affected by HIV. A third of new HIV diagnoses in the UK are among this group, which makes up only approximately 1% of the UK population. For example, during 2009 there were 2206 new diagnoses of HIV infection among black Africans, representing 33% of all new diagnoses in the UK (Health Protection Agency 2010a).
It is estimated that a total 4% of black Africans living in England have been diagnosed with HIV, compared with 0.1% of the white population (Health Protection Agency: personal communication 2010). Of the 23, 288 black African people who received care for HIV in the UK in 2009, 91.3% reported having acquired the infection through heterosexual intercourse (Health Protection Agency 2010b). Most black Africans (80%) who were newly diagnosed in that year acquired their infection heterosexually in Africa (Health Protection Agency: personal communication 2010).
What does this mean?
There are multiple and complex reasons for the disparate rate of HIV infection in the Black community. Black people do not engage in risky sexual behavior at higher rates than people of other ethnicities. (That said, throughout the AIDS epidemic—thanks to racism or the temptation to engage in “blame the victim” thinking (or both)—it has been posited that black gay and bisexual men engage in more risky sexual behaviors than white or Latino gay and bisexual men and that this accounts for the disparities in infection rates. But, this theory has been thoroughly debunked by numerous studies. Some of these studies, in fact, have found the opposite: black gay and bisexual men actually engage in lower levels of risky behavior than their racial counterparts.)
However, Black people as a group (as with any other racial/ethnic group) are more likely to have sex with other Black people. Given that a higher percentage of us are living with the virus compared to other racial/ethnic groups and our risk of infection increases with each new sexual partner. Additionally, factors such as higher rates of poverty and incarceration (especially in America) contribute to disproportionate HIV rates in Black communities.
I support the theme that: “I Am My Brother’s and Sister’s Keeper. Fight HIV/AIDS!” We are infecting each other and the sooner we recognise this and take action the better. I am calling for action in our communities so that we stop the spread of the disease. There is hope out there and let us fully engage and protect ourselves from this pandemic.
There is some positive news, though. HIV testing is one of the most important tools we have to stop the spread of the virus. Knowing your status and promptly seeking treatment if you are diagnosed with HIV is the best way to maintain your health and stop the spread of the virus. Treatment is prevention as we now know that people receiving effective HIV treatment are 96% less likely to transmit the disease to their sexual partners.
I encourage HIV testing for all people especially Blacks. Over 50% of HIV transmissions are from people who are undiagnosed. People diagnosed with HIV are likely to pay greater attention to reducing risk of HIV transmission, and once on treatment, their viral load will reduce and they will become significantly less infectious. Without intensified testing efforts, the number of people infected with HIV will continue to increase. In the UK, there is evidence that we are infecting each other within Black communities. It is reported that there is evidence of significant rates of UK- acquired HIV infection amongst Africans, including amongst those who have previously tested HIV negative. What this means is that there are many HIV negative people who are leaving parts of Africa where there are very high incidents of HIV transmission, only to get infected during their stay in the UK.
This has to stop and it “Begins with me, Dr Chireka and Begins with you reading this article and also Begins with the whole Black Community”.
Knowing your HIV status does change your behaviour and helps in the fight to reduce infection among our community.
We need to make sure that we get tested today, because it is estimated that someone aged 35 who is living with HIV in a developed country (e g UK and USA) is likely to live for a further 37 years with treatment. Also, the same evidence shows that late diagnosis increases the chances of morbidity, mortality and onward transmission. This late diagnosis results in significant ill health for people with HIV, increases rates of hospital admission. In the UK, of those with HIV who were reported to have died in 2010, two thirds had been diagnosed late. This late diagnosis leaves an individual 10 times more likely to die within a year, while a 20 year old diagnosed very late with HIV is thought to have a life expectancy at least 10 years shorter than somebody who starts treatment early.
In conclusion, my message to you all today is: please know your status, and promptly seek treatment if you are diagnosed with HIV. This is the best way to maintain your health and stop the spread of the virus. Remember, the testing is for your benefit and treatment is free. It is your life at stake and it’s all up to you to waste it or save it. If you accidentally have unprotected sex, for example if the condom burst, you must seek urgent medical advice so that you can get what is called post exposure prophylaxis (PEP).
This article was compiled by Dr. Brighton Chireka who is a GP and a Patient Engagement Advocate (PEA) in Folkestone Kent, UK. You can contact him at: firstname.lastname@example.org or read more of his work on DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr. Chireka has used all reasonable care in compiling the information, but makes no warranty as to its accuracy. Consult a doctor or other health care professionals for diagnosis and treatment of medical conditions.