HIV: The epidemic we know so little about
December is here! Many of us couldn’t wait to see this period of the year coming. We probably had (and still have) the roughest academic year of our lives (hail Covid-19!) but, like every year, the final month represents not only an opportunity for students to rest after the autumn term but also a light (small or big) at the end of a dark tunnel.
We normally use it to put whatever we experienced into perspective thereby fostering hope which for many reach its climax with Christmas and New Year’s Eve group gatherings and celebrations. However, before reaching those aforementioned culminating points, it’s perhaps worth mentioning that the World AIDS Day is celebrated on the very first day of our favourite month since 1988.
World AIDS Day constitutes an opportunity for people across the globe to join forces in the fight against HIV. It is also an occasion to express support for individuals living with HIV and to keep alive the memory of those who couldn’t survive AIDS-related illnesses. Back in the days of Pre Covid-19 mass social intercourses, we would have had various awareness and testing campaigns in our universities’ campuses to mark this day for about a whole week if not more. In 32 years of celebration, a lot has been done – there’s no question about that – but there are still many misleading myths gravitating around HIV. Such myths suggest that many of us are quite under-informed about this virus. With this article, I will deconstruct (03) three of these myths and contribute, I hope, in informing more on some HIV-related matters.
Myth 1: HIV = AIDS.
There is the Human Immunodeficiency Virus (HIV) AND there is the Acquired Immunodeficiency Syndrome (AIDS). Let's not use these two acronyms as if they were interchangeable. HIV is a retrovirus that infects humans via blood, vaginal fluids, semen, or even breast milk. HIV infects so-called CD4 cells and uses these cells to generate more viruses. The human body, therefore, begins to produce more CD4 to fight these new viruses. HIV uses these new CD4 cells as new targets to infect to replicate once again (that’s why it’s a retrovirus).
Each cycle gradually weakens the immune system. It is therefore this weakened state of the immune system that makes it vulnerable to opportunistic infections known as Acquired Immunodeficiency Syndrome (AIDS). HIV-positive (HIV+) individuals only reach that stage if they do not treat themselves, they skip several doses of treatment, they develop resistance to treatments (due to them stopping or skipping several doses of treatment), they don’t follow an appropriate treatment; and of course, if they are not tested hence don’t know their HIV status.
Myth 2: HIV = death sentence.
This was probably true three decades ago, but this is not the case anymore (in most countries). In fact, while HIV is life-changing, it isn’t life-threatening anymore with the right medications (in most countries). I’m sure it comes as a shock to receive such a diagnosis, but there are two essential things to focus on: CD4 counts and viral load. And it is these indicators that are constantly investigated. The CD4 count reflects the state of the immune system. The results are given in cells per cubic millimetre of blood. An adult has between 400 and 1600 CD4 per cubic millimetre of blood. Being above 500 CD4 per cubic millimetre of blood is considered normal. Even if an HIV+ individual has low CD4 counts, antiretrovirals (ARVs) can work very quickly thereby enabling their immune system to start functioning properly again.
The Viral load shows how many copies of the virus there are per millilitre of blood. It also shows how/if the treatment works. The goal is to reduce the viral load to an undetectable one (less than 50 copies/ml). Usually, this stage is reached after 06 months of effective treatment at the latest. However, if the viral load does not go down or even increase within this time frame, it probably means that the treatment taken is not working or that it is not taken correctly. It could also mean that this treatment should be changed. HIV+ people who have an undetectable viral load can’t sexually transmit the virus to others. You probably came across U=U (Undetectable = Untransmittable) when moving around Britain; this is what it is about.
Myth 3: The treatment does not work when you miss the day and the hour you need to take it, you are finished, you must start all over again or die.
The treatment works very well and if it doesn’t work it is for one of the reasons mentioned above. ARVs prevent HIV from replicating itself. This therefore considerably reduces the viral load which enables CD4 cells to become robust again (because ARVs don’t directly increase the number of CD4 cells). When HIV+ individuals are not on treatment, their immune systems are depleted (following the cycle mentioned above).
Over time, without ARVs, their immune systems are like dogs trying to bite their respective tails. Under ARVs, their immune systems stop overproducing CD4 cells and therefore have chances to repair themselves and become strong again to ensure their protection. If they follow their treatment and are checked twice a year (once they have reduced their viral load to an undetectable one) they live normal and happy lives. I'm not talking about surviving and I repeat "THEY LIVE NORMAL AND HAPPY LIVES". 01, 02, or 03 tablets every day until they eventually die (as you would expect anyone else to).
There are several classes of treatment, but let's not go into that. What’s important to say is that ARVs are not as rigid as you might think. It is true that adherence is important (the drug present in the body at a more or less equal level for 24 hours to keep the viruses ‘asleep’) but let's say that until one has reached an undetectable viral load they must choose a fixed time to take their medication. Even in that case, an hour margin still applies to them. Once they have an undetectable viral load it becomes even more flexible. If they forget to take their pills, they can still take them up to 8 hours after their usual set time for taking them. If they fall without that time frame, they are advised not to panic, to resume taking their pills the day after (at their usual scheduled time for taking them), and to avoid taking a double dose when they do. And it shall be well.
I can keep dismantling other HIV-related myths like that, but it would probably require another long article like this one, if not more. Besides, there are many resources more reputable and reliable than my informed self that you can always consult when you ever get the chance (Terrence Higgins Trust, I-Base, National AIDS Map, UNAIDS, etc.). To wrap things up, I think what I should highlight is that HIV is a Sexually Transmitted Infection (STI) – in many cases - but that doesn’t necessarily imply promiscuity. It can also be contracted through some unsafe medical interventions and via other non-sexual routes.
What people should understand about HIV and STIs is that they can be transmitted through sexual intercourse, not blended through sexual intercourse. It only takes ONE sexual intercourse to catch an STI regardless of if one had sex before or not, and of if they had sex on several occasions or not. Besides, there are some promiscuous individuals out there who have never been 'caught'. This is most certainly because they don’t embark themselves into unprotected sex (which is great) but that doesn’t make them less promiscuous. It makes them more prudent but certainly not less promiscuous (and who cares anyway?!).
Therefore, they should never feel superior to the 'unlucky ones', make fun of them, or stigmatise them (they should perhaps mind their business as well). The stigma is still huge when it comes to HIV, and this is partly due to some people’s insufficient awareness of its various aspects and implications. Moving forward, I guess what we must all do is fight HIV stigma and discrimination. I hope that this long article (I know, I know…Sigh) and the resources mentioned have provided you with useful information on that enemy some of us know so little about. As Sun Tzu once said, “keep your friends close; keep your enemies closer”. Happy World AIDS Day!