Monday, September 7, 2015

HIV - Not a Monster

by Shengjie Xu

Several months ago I received a phone call from a friend who expressed her panic about having had a dinner with a friend who MAY have a seropositive partner. She was considering stopping contacting her friend because of that. I was shocked.

30 years ago when HIV was first identified among homosexual men, because of ignorance people were scared. It was believed to be a punishment to gay people since it was mostly prevalent among the homosexual community. As we know now the method of transmission is through blood, blood-contaminated body fluids and mucosal contact as the virus can breach through the mucosal membranes. However even though we know about the science behind the nature of the virus, there’s still a big hurdle that prevents the society from accepting HIV seropositive people.

I spent hours try to comfort her, telling her that there’re many unknown factors that will lower the possibility of her being infected by dining with her friend. My arguing point is that physical contact and saliva are not the method where virus gets passed among people. I’m sure my friend knows about all the science, but when there’s a slight chance that she may get contact with “HIV” this word, she couldn’t pick up her mind to think rationally.

There are probably many people that still panic when hearing the word HIV even in a well-developed country. The social stigma and isolation of seropositive people remains a big problem of this battle. We have the resources to prevent and control viral spread, diagnose, and also treat patients for free. We know the science behind this sneaky virus. We know how to prevent and treat it. We even have research studies going on constantly to test for prophylaxis and vaccines. But why panic? The reason I used the title “not a monster” is because when we don’t know about a threatening creature, we call it “monster”. But when we start to know the nature of the unknown species, we start to face it calmly and start to call it “shark” or “lion” or “tiger”. HIV is like it: small amounts of people know the nature of HIV thoroughly and fight against it at the front line fearlessly. But the vast majority still sees HIV as a “monster” and even refuses to get contact with the warriors who risk their life helping the ones in need.

Educating the public should be an ongoing program of this campaign. The focus of the education part was on prevention. As the prevention part has done great jobs in reducing the incidence quite a lot in the past decades, maybe we should start bring our attentions to those underrepresented population who live with HIV in our society.

As Dr. Bartlett pointed out in his lecture about the antiretroviral study HPT 052, the use of antiretroviral therapy can reduce the sexual transmission of HIV-1 in serodiscordant couple by 96%. When the viral load of patient is minimally detectable, the risk of transmission is much reduced. This stunning number indicates that even as a HIV carrier, it is possible to live a normal life not passing the virus to their loved partner. There are also effective pre-exposure prophylaxis and post-exposure prophylaxis available for people who are at high risk of exposing to HIV. Science has also made it possible for HIV seropositive people to have healthy children. With the right treatment, living with HIV is not impossible. As we have good control and treatment methods, we may want to reconsider our unconscious discrimination against HIV+ population because of our ignorance.

6 comments:

  1. Thanks for sharing Shengjie,
    I just returned from five weeks in South Africa (I had spent 6 months there previously as well) and it is so interesting to see the difference in people's awareness in a high prevalence country (SA) and low prevalence country (US). I think stigma is pervasive and in certain communities people are more understanding than in others; however, as Dr. Bartlett pointed out awareness and political will are first steps. Having the President of Kenya demonstrate appropriate condom use is a fantastic first step! Although awareness is one thing, acceptance and de-stigmatization are another.

    While at a hospital in South Africa, I took a photo of a sign in the shape of a HIV ribbon made out of condoms which I was happy to see proudly displayed on the kitchen wall. I have a hard time imaging this in most US hospitals unless it were a specialized HIV clinic or a very forward-thinking clinic in a specific neighborhood.

    Brittney Sullivan
    **I was unable to post the photo but will in the blog on Thursday, as myself and Laura P will be blogging about Tuberculosis :)

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  2. The challenge of HIV and AIDS and the stigma associated with is a continuing problem affecting the global village. Constantly, before family to translate what we learn into practice and no matter how many times we are taught how it is spread our actions are the opposite. We fear less what may be considered risky and stigmatize those that pose no risk to us. A change in our mindset is required to promote behavioral change. I am from a country which is also highly burdened with HIV and AIDS and the life expectancy is low. One the things I have had a problems with is PMTCT, where in developing countries I feel mothers so not really have a choice on the option to take and most of them are encouraged to take option B+ as per policy. This has helped lower the transmission rate and also death from diarrheal infection with the limited water resources to make milk. However the lack of autonomy of mothers on the option to either breastfeed or not breastfeed remains an issue I seek to explore. Do we make them all breastfeed just because majority can't afford? Do we let the minority choose then how will the majority react when they realise the minority has a choice and they don't have?

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  3. I agree with Shengjie that we should start bring our attentions to those underrepresented population who live with HIV in our society. One question that comes to my mind is how we can identify these underrepresented population. For instance, many people who live in rural areas of Myanmar rely mainly on traditional medicines when they feel sick. This is because they can’t access to clinics or hospitals where they can be tested for HIV and received appropriate treatment.

    Shengjie also made a good point that educating the public in HIV/AIDS should be an ongoing program. I think one of the challenges in providing HIV education is how we can provide HIV/AIDS education in conservative societies where sex education is not allowed and culturally unacceptable. A few years ago, my organization provided HIV education for adolescent in one of the refugee camp at Thai-Burma border; as a result, we were criticized harshly by the community. Changing cultural norm in conservative society is a bit challenging and the goal to achieve universal HIV/AIDS education may take time.

    Nan Sandi

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  4. I am not surprised by your story because I have heart a boy was thrown out by his village last year in China since he has HIV positive, and the reason of throwing him out is that people of the village were afraid at being "infected" by him (I think you can find this article in BBC news).
    People usually afraid at things they do not know, things they are not familiar with. People are afraid at HIV and people with HIV in China because the government do not provide a school-base education about the disease, because the information about people with HIV are limited in China. We only know those people are in hospitals but we do not know what treatments they are receiving, how those treatment are. Are they killed by HIV or surviving?
    It is true that education campaign have been holding in China for several years, then why the stigma and discrimination toward HIV still remain? I think it is because governor only provide the information about what HIV is and how it cause. Governor should also provide positive information about the effectiveness of vaccine, treatment, and medication. Except to eradicate the incidence and transmission of HIV, we should also pay attention to eradicate the fear toward HIV among ordinary people.

    Yan Huo (Phoebe)

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  5. You probably know about this but I wanted to share this article with you. It is about the new WHO guidelines recommending the expansion of HIV treatment for about 9-10 million more people worldwide:
    http://www.nytimes.com/2015/10/01/health/millions-more-need-hiv-treatment-who-says.html?ref=health

    The WHO has just published new guidelines for HIV treatment this week. Among the features based on 2 key recommendations made in 2015 are the following:
    (1) "Antiretroviral therapy (ART) should be initiated in everyone living with HIV at any CD4 cell count"
    (2) "The use of daily oral pre-exposure prophylaxis (PrEP) is recommended as a prevention choice for people at substantial risk of HIV infection as part of combination prevention approaches"

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  6. In Rwanda I worked a lot doing HIV prevention campaigns among Rwandan youth. One of the things I always tried to balance was how to promote HIV prevention practices among youth and educate them about HIV transmission, but also remain sensitive to the fact that a handful of youth in the crowd were probably aware that they were HIV positive already. I think it's important to emphasize during HIV-education campaigns, that it is still possible to live a long life if you are HIV positive as long as you take ARV drugs properly. What do you all think is a good balance of promoting prevention, while also trying to reduce stigma against HIV positive people and trying to get the message across that getting HIV these days is not an automatic death sentence?

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