In the past 20 years the medical implications of an HIV diagnosis have changed completely, almost miraculously. Antiretroviral drugs allow people living with HIV to have unprotected sex without passing the virus to their partners, to have HIV-negative children and to live healthy lives well into old age.
In fact, in 2016 the stigma surrounding HIV is probably more life-threatening than HIV itself. The fear of being "outed" as HIV positive stops a lot of people from seeking treatment. A delay in treatment allows the virus to spread, and in many cases, leads to death.
Stigma has many causes, one of which is a genuine fear of contagion. Despite the fact that HIV is now a treatable condition, "educational" messages on HIV prevention are still based on fear, and almost universally exaggerate the risks of HIV infection and its consequences.
Many of us still seem to view HIV as a life-threatening disease rather than a relatively mild condition.
Most people think that HIV is transmitted easily through unprotected sex, though the transmission rate is less than one per cent per act. When a person is taking antiretroviral drugs, the virus is suppressed and transmission is nearly impossible. Many of us still seem to view HIV as a life-threatening disease rather than a relatively mild condition.
In Canada, a person who is diagnosed with HIV and has unprotected sex can be sent to jail for aggravated sexual assault, even if they are taking medication and are virally suppressed. Such criminal convictions are based on and perpetuate misinformation. When it comes to HIV prevention, proper adherence to antiretroviral drugs is actually more effective than condoms.
What's more, Canadian policy specifically discourages testing and treatment, because a diagnosis makes you criminally responsible. Treatment prevents the spread of HIV, so a policy that criminalizes HIV transmission could actually increase the spread of the virus. Even worse -- high-risk individuals (those who frequently engage in unprotected sex) are the most susceptible to a conviction and therefore the least likely to get tested and treated. In November, the United Nations urged Canada to limit criminalization to cases of intentional transmission.
Misinformation and an inflated fear of HIV infection are widespread.
I study barriers to HIV testing in Malawi, a small country in southern Africa with an HIV infection rate of around 15 per cent. I recently ran a large-scale information experiment to correct a common misconception: most participants didn't know that an HIV-infected person who is taking antiretroviral drugs is not contagious. Providing this information reduced stigma at the community level which caused a significant increase in HIV testing.
While Canada is a long way from Malawi, the social issues surrounding HIV are in some ways similar. Approximately one in five people living with HIV are undiagnosed. Misinformation and an inflated fear of HIV infection are widespread.
In a 2012 survey of Canadians commissioned by the Public Health Agency of Canada, nearly half believed that AIDS was always fatal, and only one-third believed that antiretroviral drugs were very effective. Half of survey respondents were not comfortable drinking from a glass once used by an HIV-infected person.
I understand the instinct to overstate the risks of HIV in order to encourage prevention, but messages that stoke fear and stigmatize HIV come with serious unintended consequences. Antiretroviral drugs are our best hope of ending the HIV epidemic.
In fact, "treatment as prevention" was a strategy developed right here in Canada, at the B.C. Centre for Excellence in HIV/AIDS. It has now been embraced by both the UN and the WHO. Rather than pushing prevention through fear, we should mobilize to support people living with HIV.
Good policy should focus not on fear, but on providing accurate information, encouraging HIV testing and providing universal access to life-saving medication.
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Only one quarter of the 1.1 million people with HIV have their condition under control, where "under control" means the virus has been suppressed, according to a report released this summer by the Centers for Disease Control and Prevention. CORRECTION: The first sentence has been reworded to more accurately reflect the number of people with HIV.
Even though two men were, for a time, able to go off antiretrovirals because their HIV had been reduced to undetectable levels after receiving bone marrow transplants, the HIV eventually returned in the men, according to news reports. In 2012, the news of the men’s undetectable HIV levels made headlines. The men, who were both HIV positive and taking antiretroviral drugs, had received bone marrow transplants for Hodgkin’s lymphoma. They had received the transplants while they were also taking the antiretroviral medication. However, in late 2013, preliminary results showed that the HIV had returned. This slide has been updated to note more recent developments related to the procedure.
New HIV infection rates can be dramatically lowered by making antiretroviral drugs free, a study from Canadian researchers found. The Canadian Press reported on the study, conducted by B.C. Centre for Excellence in HIV-AIDS researchers, which showed that British Columbia -- a province that offers free access to antiretroviral therapy -- had the lowest rate of new HIV infections over a more-than-10-year period, compared with Ontairio and Quebec.
More than half of HIV-infected young people are unaware that they have the virus, according to a Centers for Disease Control and Prevention report. "Given everything we know about HIV and how to prevent it in 30 years of fighting the disease, it's just unacceptable that young people are becoming infected at such high rates," Reuters reported CDC Director Dr. Thomas Frieden saying. The report also showed that for young people, 72 percent of the new HIV infections were in men who have sex with men, while almost 50 percent were in young, African-American males, Reuters reported. These figures are based on 2010 data.
The number of people living with HIV has increased by 18 percent from 2001 to 2011, according to a report released this year from the United Nations Programme on AIDS. An estimated 34.2 million people around the world are living with HIV. The report also showed that deaths from AIDS have dropped, from 2.3 million in 2005-2006 to 1.7 million in 2011, Reuters reported.
According to the same United Nations report, costs for the cheapest UN-recommended antiretroviral therapy drugs have also decreased over the past 10 years, Reuters reported. A year's worth of the drugs used to cost $10,000 in 2000 for one person; now, it costs $100 a year.
The Food and Drug Administration this year officially approved the drug Truvada -- which has been used since 2004 as a treatment for HIV -- to be sold as a preventive measure for people who don't have the infection, but are at high risk for it. The FDA said that the pill should be considered for preventive use not only by gay or bisexual men who are at high risk for HIV, but also heterosexual men and women who may also face HIV risks, the Associated Press reported. Heterosexual men and women make up more than one-fourth of new cases of HIV, and "that's not a portion of the epidemic we want to ignore," the CDC's Dr. Dawn Smith, who was the lead author of the new recommendations, told the Associated Press. The FDA also approved a new drug this year, Stribild, to treat HIV, Reuters reported.
In findings published this year in the journal PLoS Pathogens, scientists from the University of California, Los Angeles found that it's possible to genetically engineer stem cells to attack living HIV-infected cells in mice. While the study was only for "proof-of-principle," it "lays the groundwork for the potential use of this type of an approach in combating HIV infection in infected individuals, in hopes of eradicating the virus from the body," study researcher Dr. Scott G. Kitchen, an assistant professor of medicine at UCLA, said in a statement.
People should be screened for HIV even if they're not at high risk of contracting the infection, according to draft recommendations released just last month by the U.S. Preventive Services Task Force. The recommendations would mean that everyone between the ages of 15 and 65 should be screened for HIV, even if they're not at high risk for it, Reuters reported. "The prior recommendations were for screening high-risk adults and adolescents," Dr. Douglas Owens, a member of the USPSTF task force and a Stanford University medical professor, told Reuters. "The current recommendation is for screening everyone, regardless of their risk."
All HIV patients should be treated immediately with antiretrovirals, according to new guidelines issued this year from a panel of the International Antiviral Society-USA, as reported by TIME. The recommendations are counter to previous guidelines, which said that antiretrovirals should only be used if the CD4 count -- a measure of immune cells in a person's body -- becomes less than 350 cells for every mm3 of blood.
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