1st December is World AIDS Day where we remember those who have died in the AIDS epidemic as well as supporting those people living with HIV. Although we are now in the fourth decade of the epidemic with tonnes of facts and figures out there, there is still a lot of confusion and misinformation about HIV/AIDS. Even with all the information available and despite the huge strides in treatment and the availability of revolutionary prevention methods such as PrEP (Pre-Exposure Prophylaxis), for many men who have sex with men, the spectre of HIV still looms large.
As in any war, intelligence is the key so here’s what you need to know.
Most important thing to know is that AIDS and HIV are not the same thing.
HIV (Human Immunodeficiency Virus) is the name of the virus and AIDS (Acquired Immune Deficiency Syndrome) is the name of the condition caused by HIV.
One of the most important parts of our immune system are the CD4 cells also known as white blood cells. These cells fight against all kinds of infections. What HIV does is that in infects and hides in our CD4 cells making it impossible for our body to find the virus and fight it. These infected CD4 cells become ineffective, but they still multiply to fight attacks, but in so doing helps the HIV to multiply too.
Treatment for an HIV positive person is all about the CD4 count, measured by a blood test. A high count of effective CD4 blood cells is needed to fight off infections, while a low count means that the HIV has already rendered too many CD4 cells useless, making it more likely that you will not be able to fight off other kinds of infections. A normal amount is usually between 500 and 1600 but things start to really go bad under 200 at which point you are considered to have AIDS, according to the US Centre for Disease control. You are now in scary territory where even a cold can be life threatening.
OK, so what if you have an HIV test and it comes back positive? It’s incurable right? Yes unfortunately so, but not untreatable. There are many ways to deal with a positive diagnosis. It is no longer the death sentence it once was and nowadays you can live a long and normal life, even with HIV. The most important thing to do when you discover that you are HIV Positive is to go and see a doctor as quickly as possible to find out what your CD4 count is and start Antiretroviral Therapy (ART). The sooner you start treatment the better. ART is a combination of different HIV medicines and the regime will depend on your CD4 count, your medical history and other particular needs. Generally, ART helps lower the amount of the virus in your system by hindering the way it grows and proliferates in the body. It gives your body the chance to grow the number of CD4 cells so you can put up a better fight against other opportunistic infections. Hopefully within a matter of months, with adherence to the right ART treatment, the virus should be restrained and the viral load will drop so low that you will become undetectable.
Undetectable? What does that actually mean? Through the years of the AIDS epidemic we have discovered that as a result of effective treatment, a person’s viral load can become so low that it becomes undetectable which means that they can no longer transmit HIV. They aren’t cured but through diligent and consistent use of ART they have pushed back the virus so far back that it no longer shows up. That is why it is so important to start treatment as soon as possible and know your viral load and CD4 count. With that knowledge, treatment and follow-ups, it can only take a few months before an HIV positive person can start having the sex life they want without fear of transmitting HIV. It’s called Treatment as Prevention or TaSP for short. It still isn’t a cure, and even when you are undetectable, you will have to carry on taking your ARVs daily for the rest of your life.
So, does that mean that if you are negative, you can make out or have unprotected sex with an HIV Positive man without being infected if he’s undetectable? Well you can kiss anyone you like regardless of their viral load. HIV is not transmitted by saliva, but it is by pre-cum, blood, semen and vaginal secretions. Otherwise Treatment as Prevention is as effective as condoms or PrEP in preventing HIV transmission. But remember that you can still get other sexually transmitted infections (STIs).
So now you have taken the test and you are negative and you want to know the best way to stay that way.
- There’s the good old fashioned latex condom which comes in different sizes, colours and flavours. When used properly in conjunction with lots of water- based lube, it will protect you from bodily fluids that might transmit HIV, not to mention other STIs.
- Then there’s PrEP, short for Pre-Exposure Prophylaxis, which has revolutionised the lives of millions of sexually active men who have sex with men. It’s a combination of ARVs that HIV Negative people who are at a higher level of exposure can take regularly to protect them from the virus. If they are exposed, the drugs prevent the virus from entering the cells and replicating, and so the person remains negative. PrEP gives the option of not having to use condoms, though they should still be used to avoid other STIs
- If you are worried that you might have been exposed during a sexual encounter, for example, the condom broke, there is PEP (Post Exposure Prophylaxis). This is a course of ARVs taken every day for a month after exposure which prevents HIV infection. PEP needs to be started within 72 hours of risky sex.
Yet with all we now know, millions of people are not being tested or treated. One reason may be that health services are not always accessible. Ongoing HIV-related stigma is another. The “not knowing” is the most dangerous thing. An HIV positive person who doesn’t know his status can be highly contagious. One of the best ways to fight HIV is to know as much as possible about it. So it’s important to know your status and get tested. You have to feel free to talk about it with your partners and choose the protection that’s the best for you. Remember that your sexual health is your responsibility, not anyone else’s. The fight against HIV/AIDS is far from over but you don’t have to live in constant fear of it. We have great tools (condoms, PrEP, Treatment as Prevention) and treatments have never been so efficient. Something worth thinking about this World AIDS Day!
For free testing, treatment and PrEP:
Cape Town – Ivan Toms Centre for Men’s Health, 1 Portswood Rd, Green Point. Tel: 021 447 2844.
Johannesburg – Yeoville Clinic, corner Kenmere Road and Hopkins Street, Yeoville
Pretoria – Out Well-Being, 1081 Pretorius Street, Hatfield. Tel: 012 430 3272 / 066 190 5812
Visit www.health4men.co.za to find a gay-friendly clinic in your area