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Awareness matters

Tuesday, November 27, 2018

This year's theme for World AIDS Day, is “Know your status”.  Three in four HIV people know they are infected, though ideally, all should, says Ronita Torcato

At the outset, a clarification for those who don't know the difference. The human immunodeficiency virus (HIV) infects cells of the immune system, whereas AIDS is a stage of advanced infection. Around 36.9 million  people were living with HIV in 2017. Of these, almost 20 million are in low-and middle-income countries. And 1.8 million of these were children.

Back in the mid-eighties when the dread disease first reared its ugly head in Africa and Ronald Reagan's America, fear and panic  were the predominant reactions. Especially among the infected. There were those who, filled with rage and hatred, proceeded to infect unsuspecting others. According to the United Nations Joint Programme on HIV/AIDS (UNAIDS), nearly half of all HIV-affected couples in the world are serodiscordant, meaning that one partner is HIV-positive while the other is HIV-negative.The U.S. alone has over 140,000 serodiscordant heterosexual couples, many of whom want children. It is a well documented fact that infected men have passed on HIV to their unsuspecting, innocent wives who produced HIV infected babies. 

Mercifully, advanced antiretroviral therapy (ART) can help minimise transmission to both the unborn baby and uninfected partner in serodiscordant couples.  In 2017, eight out of 10 pregnant women living with HIV, or 1.1 million women, received antiretrovirals (ARVs).

High risk groups include men who have sex with men, drug addicts, prisoners, ‘sex workers’ and their clients, and transgenders. That being said, it must be noted that homosexuals are infected most—the risk of getting HIV from anal intercourse is 18 times greater than vaginal intercourse by the "sexually active", which includes bisexuals, ‘sex workers’ and men who frequent them.

The  HIV virus can spread via wounds and HIV-infected blood or blood-contaminated body fluids, and the sharing of contaminated needles, syringes and surgical equipment. Oral sex between a HIV-positive partner and a HIV-negative partner can result in the infection of the latter. HIV cannot spread through casual contact. But the world tended to equate dental work and blood transfusions on par with gay sex as equal modes of transmission. Still does.

World AIDS Day was formally declared at the 1988 World Summit of Ministers of Health on Programmes for AIDS Prevention.  Things have  changed somewhat 30 years down the line.  Know thyself is a moral exhortation. The philosophy of Socrates still shines today. This year's theme for the UN designated World AIDS Day, is ‘Know your status’.  Today, three in four people living with HIV know they are infected.  Ideally, all should.

As a UNAIDS report, however, shows, an estimated 25% of people with HIV or 9.4 million people remain undiagnosed and don't know their infection status. Figures aren't available for India but around 20 percent of the 1.2 million Americans infected with HIV are  unaware of their status. HIV is a reportable status in the US, which means that a positive test result will be reported to the state health department. It is possible fear prevents people from HIV testing which would protect them  and their loved ones. In other words, save their lives. The good news for those apprehensive of stigma and discrimination is they can resort to innovative HIV-self-testing and partner notification.

In the run-up to December 1, World AIDS Day, the UN issued a clarion call for

raising awareness about the importance of knowing one’s status and calling for the removal of all barriers to accessing HIV testing. Needless to say, HIV testing programmes must be expanded.  And affordable drugs be made easily available. Starting ART early can prevent serious AIDS-related (and non-AIDS-related ) diseases.  HIV therapy can reduce the risk of transmission by 96%. Around 21.7 million people were receiving HIV treatment in 2017. Globally though, only 59% of the 36.9 million people living with HIV  were receiving ART.

The price of drugs is a barrier— since  those infected by greed and avarice make HIV drugs either unavailable or more expensive than other essential medications. Not just the AIDS virus, people have to be  wary of germs that take advantage of the immune system weakened by HIV.  Thankfully,people with healthy immune systems are unaffected by these germs.

For the weak, HIV remains an insidious enemy which attacks  CD4 cells which  find and destroy bacteria, viruses, fungi, and other invasive germs. Without these soldier CD4 cells to fight them, the resulting infections can lead to  fevers, weight loss, lung infection, cancers ( men are more likely to develop a cancer called Kaposi's sarcoma) and illnesses like candidiasis or thrush, a fungal infection in  the mouth, throat, or vagina, and cryptococcus neoformans (Crypto), a fungus that can lead to meningitis. Other viruses can affect the gut, cause encephalitis, TB, eye disease  leading to blindness,severe diarrhea and ulcers. In 2016, at least one million of the 10.4 million people who developed TB worldwide were HIV-positive. That year, approximately 370,000 deaths from TB occurred among  HIV sufferers.

That's not all. Herpes viruses cause bad sores around the mouth and on genitals. HIV causes brain and nerve problems; the infected can suffer from depression, hallucinations, paranoia and think murderous thoughts; this is known as ‘AIDS Dementia’.  When we were green and callow, one of our  favourite catchphrases was "It's all in the mind!" Doctors and scientists know the brain can change and adapt in response to compulsive behaviors thereby averting harmful consequences of sex/drugs. It would be well to keep that in mind in the knowledge that there is no cure for HIV infection.

‘HIV can be kept under control’

Dr Kirti Sabnis,  Consultant, Infectious Disease, Fortis Hospital, Mulund answers FAQs on HIV/AIDS

How can doctors help people to deal with the disease and with  side effects?

Dr Kirti Sabnis Correct and timely professional advice can help people in preventing and acquiring infection in cases of accidental exposures e.g sexual assault victims or exposures to medical staff  handling patients with HIV. This is called as ‘post exposure prophylaxis’ which needs to be started within 72 hours of sexual or non-sexual exposure with known HIV positive patients and is continued up to 28 days.

Another area where medical care-givers form a major part is the treatment of HIV  with medicine. HIV can now be kept under good control like any other long-term illness. But it cannot be eradicated from the patient's body. The majority of treatment for HIV is in the form of tablets, which the patient has to take every day. These medicines effect multiplication of the virus, and tend to have side effects like nausea, vomiting, rashes, sleep disturbances and sometimes, jaundice. Due to these side effects, medications must be prescribed and monitored by physicians. No specific diet has been directly documented to improve the CD4 count or immunity directly and cannot replace need for ART medications. Healthy food habits as well as quitting smoking and alcohol, can help in the reduction of other co-morbidities like heart disease and cancers.

How can HIV- infected people keep from passing their infection to others?

Dr Sabnis Blood, semen, pre-seminal fluids, rectal fluids, vaginal fluids, and breast milk are responsible for transmission of HIV. Hence, HIV positive patients  cannot donate blood at any point in life. HIV patients always have to adhere to safe sex practices and use condoms during sexual intercourse; this also reduces the incidence of STD. HIV positive mothers have to be initiated on medications during pregnancy to prevent transmission to the baby. It can be started under medical supervision as early as the pregnancy detected, this will prevent the majority of babies getting infected from their mothers. These babies also need to continue few medications after birth, for maximum up to 12 weeks post-delivery.

How can people protect themselves  against HIV infection?

Dr  Sabnis As I have said, HIV spreads only through particular body fluids from a person who has HIV. It can be prevented by following ways: Safe sex i.e. using condom during high or low risk sexual exposure, avoiding drug abuse and sharing needles, knowing your and your partner's HIV status (especially important prior to pregnancy or in initial months of pregnancy) and taking the help of qualified health care professionals to prevent infection  from sexual or non-sexual HIV exposure.

Please comment on infected persons who want to have sex with or without informing partners of their infected status.

Dr  Sabnis As there will potential risk of transmission of HIV to the non-infected partner, hence it is recommended that the patient discloses their condition to their partner prior having sexual contact. Under medical law, the treating physician can also disclose the condition to their patient's spouse, if any risk of transmission is suspected.

Ronita Torcato

Short Takes

In the run-up to December 1, World AIDS Day, the UN  issued a clarion call for raising awareness about the importance of knowing one’s status and calling for the removal of all barriers to accessing HIV testing.

HIV testing programmes must be expanded and affordable drugs be made easily available.

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