HIV is a modern paradox, both an example of stunning scientific success in controlling disease, yet an indictment to our inability to respond to a global public health threat.
The patients I am privileged to see in my work are the faces of HIV today. They're of all colors and walks of life. Some contracted the virus before science could tell us it existed. Others were born with it. A combination of science and spirit has gotten us this far in fighting the disease, but much more is required. I believe humanity is up for the task; the first step is education.
HIV is a retrovirus, meaning it's transmitted not as DNA but as RNA. It hijacks our cellular machinery to make copies of itself. HIV particularly attacks CD4 T cells, key components of the body's immune response. Initially, HIV can cause fevers, lymph node swellings and variable rashes. In many cases, symptoms are initially mild and may go unnoticed. But over time it gradually lowers the CD4 cell population to a level so low the body can't stop infections that a normal immune system would handle easily. Other complications, like accelerated aging, are being studied, too.
HIV is spread via blood-to-blood and sexual contact. The actual rate of transmission per exposure is far from 100 percent, but it's important to take precautions any time there's risk of exposure. The CDC has recently recommended that all people ages 19-64 be offered universal HIV screening, without regard to risk factors. This is a change from previous standards and is designed to miss fewer cases.
For those living with HIV, and their loved ones, there are increasingly effective and well-tolerated treatments available. Medications that were once notorious for severe side effects have been replaced with newer options. For most HIV-positive patients, complex regimens with dozens or more pills are a thing of the past. It has gone from a mysterious, painful, certain death to a manageable illness for those engaged in their treatment and who have access to expertise. Below are a few recommendations for how specific groups of people can protect themselves.
• Health care providers: We should be extra cautious any time exposure to blood and/or body fluids is possible. Outside the medical setting, it's important for those of us in the industry to emphasize that HIV is not spread through casual contact. Sharing a meal, a hug, a handshake or a kiss on the cheek does not spread HIV.
• Those sexually active: Barrier methods, including condoms and dental dams, are effective but not foolproof, even if used properly. There will always be some risk, but it can be lessened substantially by ensuring the lubricants used are compatible with the condoms. Latex can be degraded by silicon products, lessening the protection. Remember, all types of sex are associated with some risk of HIV transmission.
• Those sharing a living space with someone HIV positive: Avoid sharing razors and toothbrushes. No other special precautions are needed.
• Recreational drug users: Realize that snorting paraphernalia and needles (basically anything that comes in contact with blood or moist tissue) can be a source of transmission.
• Athletes: Avoid direct blood-to-blood contact with those HIV-positive and seek immediate medical/coaching staff attention if this occurs. There is no risk if unbroken skin comes into contact with blood.
• Pregnant women and mothers: Basic prenatal care includes universal HIV testing. HIV can be transmitted during pregnancy and breastfeeding. There are medications approved for use during pregnancy that can minimize this risk once the diagnosis is made.
HIV remains a stigmatizing disease. Knowledge that someone is HIV-positive can trigger prejudices and hurtful assumptions. And in many parts of the world, HIV remains a dangerous killer, due to lack of access to screenings and treatment. Even in Omaha, where high-quality care and treatment is available, there are still misconceptions about HIV.
What impact can you have?
• Get tested. If you've had recent exposure, retesting after 6-12 weeks may be recommended.
• Learn. Talk to your provider. Do some research from a trustworthy source. I recommend the CDC website, familydoctor.org or the National Library of Medicine.
• Check your preconceived notions at the door. We often make assumptions about "those kind of people." Remember that HIV doesn't discriminate who it affects.
• Get involved in AIDS advocacy and treatment efforts. Donate or support organizations like the Nebraska AIDS Project or an international group, like Partners in Health
Alex Dworak is a family physician at OneWorld Community Health Centers and faculty member at UNMC, where he consults for the HIV clinic and is part of the Family Medicine residency.