HIV is an illness that first popped into the public consciousness in the early 1980s with a series of public health campaigns which followed a brief national panic about the disease. However, HIV now seems to have slipped off the agenda somewhat – with more emphasis on other STIs such as Chlamydia instead. That said, HIV is still specifically mentioned in Key Stage 4 science curriculum, nevertheless, the old prevailing myths and ignore still somehow prevails.
Although most young people have heard of HIV – very few know how it is transmitted or what it does, let alone that it should be something for them to be concerned about. To be fair, young people are not alone in this respect. The confusion which surrounded HIV in the early days has never really dissipated, even though we have been publicly aware of HIV for over thirty years. It is still a subject of prejudice and misconception– let’s try and clear up some of the facts…
HIV & AIDS definitions:
HIV: Human Immunodeficiency Virus
Which all sounds very complicated, but if we break it down it is actually pretty self explanatory. HIV is a virus, a infectious parasite which uses the cells of its host in order to replicate. The Human bit tells us who it infects – humans are the host, so it is a virus which is passed from humans to humans. Finally, immunodeficiency tells you what it does; HIV attacks the cells of the immune system, the very cells which help to fight of illnesses in our bodies, weakening us from the inside. Eventually the immune system becomes so compromised that other illnesses we would usually be able to deal with become more serious and potentially deadly.
HIV infects vital cell in the human immune system such as helper T cells – specifically those where CD4 protein is present, as it uses this protein to replicate, as a result the hosts immune system starts to fail. Once an individual with HIV develops a number of particular resulting illnesses, they are said to have AIDS.
Acquired Immune Deficiency Syndrome:
Now this is where many of the misconceptions come in. You can’t catch AIDS – it’s not actually a thing per-say. If we break it down it makes more sense – the person with HIV’s immune system is deficient – it has become compromised as it has got (acquired) a number of specific illnesses (syndrome).
There is lack of understanding between the differences between HIV and AIDS as the terms are often mixed up and misused, especially within the media. To clarify, HIV is the illness you catch from another individual. When someone has HIV they are said to be HIV+. AIDS is simply a term we use to mean that a person is very poorly as their immune system has become so weak due to having HIV. A person cannot catch or pass on AIDS.
Routes of Transmission:
HIV can be found to be present in a number of different bodily fluids however, only five such fluids carry enough of the virus in order for transmission to occur; these are:
- Cervico-vaginal secretions (vaginal fluid)
- Rectal secretions
- Breast milk
By rectal secretions we mean the mucus the rectal passage produces as a lubricant and not faeces. There is no HIV present in faeces, unless the faeces contains blood.
In order for infection to occur the virus must be present in an individual, plus there must be a clear route of transmission from that individual to another. Simply coming into contact with an infected fluid is not enough, there must exist a route for the infection to be moved from one person’s body into another. Inside the body HIV is very resilient, hard to contain or to destroy, however outside of the body HIV is relatively fragile, surviving for next to no time in the open air. Again, there are four main recognised routes of transmission in which HIV is known to have been passed:
- Transfusion (from contaminated blood products)
- Sharing needles
- Mother to baby
In the UK all blood products are now screened for HIV and other illnesses, however this was not always the case; many haemophiliacs contracted both HIV and Hepatitis through infected blood product brought in from the USA for transfusions during the 1980s. Indeed, there is currently still a court battle going on for compensation. Even today, not all countries world wide screen their blood products used for transfusions.
Unprotected sex is currently the most common form of transmission. HIV is what we call an “Equal opportunity” disease, despite the early myths of HIV as the ‘gay disease’ – HIV does not care who you have sex with, or what type of sex you have. Both vaginal fluid (including cervical mucus) and semen can carry the HIV virus, so it is easily passed between heterosexual couples engaging in vaginal sex as well as through anal sex. There is still much discussion and argument about whether HIV can be passed through oral sex, however it seems unlikely.
Injecting drug users or needle stick injuries carry a risk of contracting HIV. However it is not the needle which poses the threat, but actually the barrel of the syringe which is air‐tight, keeping any infected blood products alive. It was Margaret Thatcher who introduced needle exchanges for ‘junkies’, as an economic decision – however, it also reduced the injecting drug user HIV population to less than 1% – compared to still ridiculously high rates in the US often given around 70% in some areas.
If you live in the UK the current risk of an infected mother passing HIV on to her baby is less than 1%. If you happen to live in sub Saharan Africa the risk is more like 85%. HIV is not passed across the placenta, but is more likely to be transmitted during labour or through breast feeding after birth. In the UK it is procedure to test all expectant mothers as a matter of course. Babies are then delivered through caesarean section for any infected mothers and it is recommended that the mother does not breast feed their baby as a final precaution.
Upon transmission – most people experience flu like symptoms. It is the first few months that a person is most infectious, and most likely to pass on HIV to others. This is due to the fact that they will have a high viral load as their body’s immune system will be playing catch up, producing anti‐bodies to help slow down the infection. Once a person is diagnosed and is receiving treatment, it is much harder to pass on the virus – again in the UK less than a 1% chance through unprotected sex with a HIV+ partner on meds – as their viral load will be relatively low, assuming they adhere to their treatment and are in otherwise good health.
Indeed, in the UK HIV has more recently been de-classified from a terminal illness, to a chronic illness – meaning that there is no reason why as a patient who is HIV+ with medication can’t live a full and active life. They will be on meds for the rest of their life – however, through drug regime improvements both the toxicity and number of tablets has been greatly reduced.
Monitoring & Testing:
Testing has likewise improved greatly over the last couple of years. From the time of exposure there used to be a three month window period for infection to be confirmed. This has changed as tests have improved, a positive test can be confirmed within four weeks of exposure. The latest tests do not even involve taking a blood sample and can instead be done by taking a saliva swab and results can be returned within 15‐20 minutes.
Once diagnosed a person’s blood work is taken every three months and their CD4 and viral load count is monitored. Once the CD4 levels drop and their viral load escalates treatment is discussed. Treatment is highly toxic and brings with it unpleasant side affects. There is still no cure for HIV, however life expectancy has now been extended beyond our ability to predict.
Currently treatment involves a regimented series of tablets known as HAART – HIV antiretroviral treatment, which have to be adhered to strictly in order for them to be affective. HAART attempts to slow down and hinder the replication of HIV cells in the body.
The average age for a diagnosis is around 35 years old in the UK.
Not many people are aware of PEP: Post Exposure Prophylaxis which is an emergency treatment that can be given to someone who has become exposed to HIV as a last result, for example if a condom breaks. PEP will reduce the chances of them contracting the virus and becoming HIV+. PEP is not a cure and is not 100% effective, neither is it given to everyone. PEP are basically a four week course of HAART which must be taken within 72hours (at the latest) of exposure to the virus. PEP are powerful drugs and often carries with it not very nice side affects, but if a patient fails to adhere to the full course of treatment it is likely to be ineffective.
You can be prescribed PEP from specialist sexual health and HIV services or from A&E.
PrEP: Pre-Exposure Prophylaxis – is a drug treatment for people who don’t currently have HIV, who are at a high risk of contracting the virus. In clinical trials PrEP has been used in two different ways: taken once daily, and only when needed (two tablets 24 hours before unprotected sex). Both methods have been shown to be highly effective and dramatically reduce transmission.
You may have heard about PrEP as there has been much media attention after the NHS lost a court battle when they refused to pay for the treatment as a preventative measure. Currently, government is still looking at whether and how PrEP will be made available in the UK.