Everyone Should Get Tested For HIV

23 06 2011

June 27, 2011, is the 17th annual National HIV Testing Day. It follows on the passing of the 30th anniversary of the day the Centers for Disease Control and Prevention announced a deadly new syndrome, acquired immune deficiency syndrome, or AIDS. Three decades later, many things have changed about infection with HIV, including life expectancy, groups that it infects the most, and ever-evolving treatment successes.

Why get tested? Because the earlier you get treated, the better it is for you and for people at risk of acquiring infection from you. People who are under treatment are less likely to pass HIV to others than people who are going untreated. Without getting tested, you can’t know if you’re infected. Without getting treatment, you can’t keep yourself healthy or avoid endangering others.

You may be thinking that you’re someone who doesn’t need to get tested. Think again. The CDC says that everyone between the ages of 13 and 64 should be tested at least once. If you’re sexually active or engaged in recreational drugs, you need to be tested. There are, of course, groups at higher risk for infection. According to the National Association of People with AIDS, these groups include:

  • younger sexually active teens
  • poor women of color
  • men who have sex with men
  • people who inject or snort drugs with others
  • sex workers or people who barter in sex for life necessities
  • people who live in HIV “hot spots,” places where infection rates are so high that anyone who is sexually active is at risk. These hotspots can sometimes encompass only a few city blocks.

How can you get tested? Depends on how you want to do it. It’s possible to test at home, sending in blood from a finger prick to a lab for analysis. You can buy such kits at drugstores, but doing it on your own means that you won’t receive appropriate counseling if the result comes back positive. In some places, people can get tested anonymously and still receive counseling. But for National HIV Testing Day, testing events are happening all over the United States. If you’re interested in finding a testing site near you, check this interactive map.

Each of the two types of tests available—one tests for antibodies the body makes if the virus is present, the other tests for the virus itself—requires only a blood draw or even just an oral swab for antibody testing. If you think you’ve recently been exposed to HIV, the viral load testing is the test you need. You can’t rely on the antibody test results if 3 to 6 months haven’t elapsed since exposure, as it takes that long for the antibodies to register.

An HIV test doesn’t take much investment in terms of money or blood or even time. But even in this age of improved therapies and life expectancies with infection, the results can literally mean life or death, not only for you but maybe for someone you love. If you haven’t been tested, isn’t that reason enough to make June 27, 2011, your day to get it done?

By Emily Willingham





April: STD Awareness Month

21 04 2011

There are an estimated 19 million new cases of STDs each year in the United States.  That’s too many.  We can significantly cut that number down.

April, the STD Awareness Month, is a time to shine a light on sex and disease.

STDs know no age limits, they can be visible or invisible and, yes, they can even affect our own sons and daughters. STDs also have a serious economic impact, with direct medical costs estimated at $17.0 billion annually  in this country alone.

The majority of STDs are preventable. Just by having a frank discussion with our partners, and using the appropriate protection, we can prevent most sexually transmitted diseases.

These are practical resources to help individuals and parents learn more about STDs and how to deal with current or potential infections:

There is never anything embarrassing about protecting our health. So wrap it up, protect yourself and keep STDs at bay!

(Photo courtesy of Andy54321)





Over 50? Beware of STDs

6 01 2011

Did you ever think you’d be over 50, sexually active, and dealing with an STD?

Safer sex warnings should not only be directed at teens and younger Americans, but to those of us in the AARP crowd as well.

Americans over 50 are sexually active and many factors account for this, including divorce, the advent of prescriptions for erectile dysfunction, and an increased life expectancy.

And with sexual activity can come sexually transmitted diseases. Unfortunately, age is no protection against STDs. Many older adults assume that because they aren’t regularly practicing high risk behaviors such as IV drug use or sex with multiple partners, they are protected.

Older men and women tend to believe they are immune from “all of that,” speaking euphemistically. But it is that kind of thinking that is leading to an increase in STD infections—everything from herpes to HIV.

HIV/AIDS is rapidly spreading among men and women over 50.  The U.S. Centers for Disease Control and Prevention (CDC) now recommends routine HIV/AIDS testing for all Americans ages 13 to 64. Dr. John G. Bartlett, Chief of Infectious Diseases at the Johns Hopkins School of Medicine, sees the new guidelines as a “call to action that the test will be offered on a more regular basis.”

And some experts, including Dr. Veronica Miller, Director of the Forum for Collaborative HIV Research at George Washington University Medical Center, even feel HIV tests should be as “routine as a flu shot.”

The CDC estimates that those over 50 account for 15% of all new HIV/AIDS diagnoses and 24% of those living with HIV/AIDS in this country.

A quarter of a million people living with HIV are unaware of their infection status and are consequently not seeking help for themselves, and may not be ensuring protection from infection for their sexual partners.

Healthcare providers need to take note of the increasing risk of STD infections in their older patients, and  emphasize testing and sex education at every opportunity.





Safe Sex Can (Still) Save the World!

27 09 2010

At my very small liberal arts college in the late ’80s/early ’90s, talk of safe sex had just begun, trailing the growing HIV/AIDS crisis as public education efforts often do.

They weren’t yet handing out condoms in the student union, but our resident advisors regularly counseled us to “be safe,” and we were given plenty of bananas on which to practice our condom unrolling skills.

Out in the real world (beyond our college campus), movies like Long Time Companion, as well as the touring AIDS quilt were like a Scared Straight (as it were) for college sexual behavior.

Early commercials portrayed AIDS as a death sentence, and they were petrifying performances that had many of us reaching for condoms long before we had a sexual partner.

Fast forward two decades—the picture of HIV/AIDS has changed dramatically, both in terms of survivability and perceived risk of infection. While HIV infection rates continue to grow (approximately 56,000 new HIV infections occur each year in the U.S.),    HIV infection has now become a chronic condition for many.

Today’s commercials are less scary, with ads like this one emphasizing making the right choice (using condoms) during sex:

Once people started surviving AIDS, safe sex lost its immediacy, with a character like the “safe sex angel” now signifying a switch to a lighter, breezier approach.

Also, the fact that condom use and other safer sex behaviors reduce one’s chance of infection with a life-altering STI like gonorrhea, chlamydia, herpes, or HPV is often barely acknowledged in public awareness campaigns, although it should be trumpeted loud and often.  Safe sex isn’t just about HIV prevention.

The misperception that the AIDS crisis is past has allowed many people to back away from safer sex practices that could save their lives. Everywhere, there are indications that safe sex isn’t what it used to be. In Britain, an HIV+ pop star recently admitted to having unprotected sex. and a recent study found that many young gay men (a population at extreme risk for HIV infection) admitted to having unprotected sex with other men.

Studies show that at least 200,000 people are infected with HIV in the U.S. and don’t know it. According to news reports, those most likely to receive a late diagnosis of HIV and to die from AIDS are adults over 50.

HIV leads to AIDS and death, if left untreated. And there is no such thing as safe sex.

Don’t make the mistake of believing that safe sex is a thing of the past.  You can protect yourself from needless infection and chronic health complications by following these simple steps. And as parents, we need to practice what we preach:





RV144: HIV Vaccine Game Changer?

23 08 2010

“Given the significant threat of HIV infection worldwide, an effective vaccine is urgently needed as part of a broader prevention effort to help control the epidemic.” – U.S. Military HIV Research Program

Until recently, hopes of an effective vaccine against HIV remained dim even though a vaccine could potentially impact millions of lives worldwide.

Everyone, from the Global HIV Vaccine Enterprise to the National Institute of Allergy and Infectious Diseases to the man on the street, has dreamed of and/or worked toward the creation of a vaccine that prevents HIV infections.  Even with this huge, global effort, HIV vaccine research languished until a Thai HIV vaccine clinical trial found a modicum of success in 2009.

This U.S. Army and Thailand Ministry of Public Health-sponsored trial, known as RV144, was conducted in Thailand with 16,000 volunteers. The vaccine successfully reduced the HIV infection rate by 31.2%, a relatively modest but still significant scientific achievement. These results were heralded as a renaissance in HIV vaccine development.

The RV144 trial tested the ‘prime boost’ combination of two vaccines derived from two strains of HIV common in Thailand. While the vaccine had no impact on people once they were infected with HIV, it did decrease the number of new infections among recipients compared to those given a placebo.

Scientists don’t yet know why this regimen worked, but it is promising for several reasons:

  • Both of the vaccine components used in the trial had previously failed when used individually. It was only when used in combination that positive outcomes resulted.
  • Even with the modest success, a recent study showed that a semi-effective HIV vaccine given to part of the population could reduce new HIV infections by 1/3rd within 15 years.
  • The study provides scientists with valuable information about how to conduct a large-scale HIV prevention trial.

The future of HIV vaccine research is looking much brighter than it did before results from RV144 were first reported in September 2009, yet further progress is not a foregone conclusion. The global financial crisis has reduced investment in HIV vaccine research and development by 10 percent. And capitalizing on the results of RV144 willrequire a sustained scientific commitment that some countries may no longer be able to afford.





Lessons Learned from Botswana’s AIDS Fight

16 07 2010

In the early to mid-’90s, life expectancy in Botswana was 65 years. Ten years later, it was below 40 years of age due to the impact of AIDS. The children of Botswana were also affected by the pandemic. To date, nearly 100,000 children have lost at least one parent to AIDS

Faced with such losses in a country with a population under 2 million, and determined to save its people, the government took action and the Botswana-Harvard AIDS Institute Partnership (BHP), was founded.

The Institute provides training and research, and acts as point of contact for the efforts to reduce HIV/AIDS in Botswana. In 2001, simultaneous to the opening of a state-of-the-art lab funded by the Institute, the government launched the Masa (or “new dawn”) treatment program, buying antiretrovirals and making them widely available at no cost to infected citizens. The research capabilities of the BHP, along with Botswana’s HIV/ AIDS education, prevention, and treatment efforts, are unparalleled and show impressive results.

Key factors in Botswana’s fight against HIV/AIDS include:

  • International and national funding and research partnerships (represented by the Botswana-Harvard AIDS Institute)
  • Coordination of education efforts at the national level, and targeted to specific populations including school-age children, pregnant and new mothers, and high risk adult populations
  • Education outreach including targeted mobile outreach (involving peer-to-peer education and counseling)
  • Focus on enrolling mothers in the program to prevent mother-child transmission of the disease.

Stemming the tide of mother-to-child transmission of HIV is crucial in halting the spread of disease. In Botswana, peer-to-peer enrollment in the government-sponsored prevention and treatment program slowly increased maternal participation from under 10% to just over 33%.

Both the Masa and the Botswana-Harvard Institute aren’t easily replicated in countries without a similarly high level of financial and governmental support, but the lessons learned can still be applied.

Although it’s unlikely that most developing countries have the resources to accomplish what wealthy Botswana has done, it is a bit of bright news in the otherwise depressing struggle that is HIV/AIDS in Africa.





Access to ART? Good Luck.

4 06 2010

We know how to control HIV—we do it with antiretroviral therapy (ART). We’re so successful, an HIV infection is now a chronic condition rather than a death sentence . . . for some. For those with access to ART.

Before and after ART

But what about those without access? What about everybody else? As of the end of 2008, just 42 percent of those in lower- and middle-income countries were able to get these drugs.

Why is it so hard to provide this lifeline to those in need? A report put out in May 2010 by Médecins Sans Frontières (a.k.a. Doctors Without Borders), says it’s about the lack of infrastructure, particularly human resources, for the administration of treatment and care, including:

  • Inadequate salaries and poor working conditions, which lead to ‘brain drain,’ attrition, and an inability to attract new health workers
  • National policy barriers that block the possibility to shift tasks to lower level health staff
  • Lack of adequate national and international resources committed to address the health care worker crisis
  • Lack of donor funding for recurrent human resource costs, particularly salaries, due to concerns about “sustainability” and other constraints
  • Limits on spending from ministries of finance and international finance institutions, which can hinder governments’ ability to invest adequately in the health workforce

In addition to infrastructure, the AIDS charity AVERT suggests that barriers to universal access to treatment include:

  • A safe and sufficient supply chain of drugs
  • A life-long commitment on the part of patients to antiretroviral drugs (ARVs) and the ability of healthcare workers to help patients stick to the regimen
  • An awareness of the need for testing and treatment

This group goes on to explain that, “Focusing too heavily on treatment can also be problematic if it detracts too much from efforts to prevent new HIV infections, a scenario which would only add to the eventual treatment burden. Furthermore, unless treatment programmes focus on the vital tasks of monitoring and patient retention, many patients will eventually die from treatment failure.”

The real risk of reducing the work being done in prevention by focusing so much on treatment adds a troubling layer to the discussion.

So, there we are—the usual mountain of reasons why we can’t do what needs to be done. But, what’s a mountain? There are steps we as individuals can take to support universal access to ART:

  1. Press our politicians to stop backing off their commitment to help fund HIV/AIDS services in poorer countries.
  2. Find a reputable charity already in place and doing the work, then do a little fundraising of our own and give it to the charities doing the most good.
  3. Keep talking about these challenges, and if we haven’t been doing so, then start talking.  Silence isn’t an option, given the potential outcomes

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HIV Hides Out

8 03 2010

Today, most people who are HIV+ take numerous drugs to control the virus, and they do so for the rest of their lives. Once those drugs start working, their bloodwork typically shows they have no virus in their bodies.

Problem is, the virus is still in the body. It’s just hiding out and sleeping.

The latest hiding place discovered is bone marrow. HIV stays in bone marrow cells and, when those cells develop into blood cells, the virus wakes up, kills those new blood cells, and actively seeks to kill other cells.

Scientists have to figure out how to stop HIV from hiding out in the bone marrow.

They have to find all the hiding places of this virus. When they do, and they discover how to stop the virus from hiding in those places, those who are HIV+ can at some point stop taking drugs, rather than staying on them for life.

What a difference that will make!

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HIV is Still Here

15 01 2010

More than 1 million people in the United States are HIV+, and 25% of them don’t know it.

Thousands infected are between the ages of 13 and 24, and statistics show that 60% of newly-diagnosed youth are African-American.

There are some risk factors unique to adolescents and young adults that increase the chance of transmitting and acquiring HIV:

  • Sexually active youth with no prior HIV/AIDS education typically engage in riskier behaviors.
  • Female African-American youth are at greater risk in part because, for reasons that are not well-understood, this group appears to have a greater chance of becoming infected after exposure. 
  • Young men who don’t disclose their homosexual orientation are less likely to get tested for HIV; consequently, they’re less likely to know if they are HIV+.
  • Young men who don’t disclose their sexual orientation are more likely to have both male and female sexual partners, resulting in increased risk of transmitting the virus to both men and women.
  • Having a sexually transmitted disease (STD) increases the risk that HIV can be both transmitted and acquired. In many areas of the country, teens and young adults have higher rates of STDs than the rest of the population.
  • Drug, tobacco, and alcohol use also contribute to higher rates of HIV transmission among youth. Casual and chronic substance use contributes to high-risk behaviors such as unprotected sex when under the influence of the substance.

It’s important to know your HIV status. If you are HIV+, you need to take steps to avoid infecting others. HIV is not an automatic death sentence. While HIV is not curable, new medications can reduce the amount of virus in your body and help you stay well.

HIV status can be determined by HIV testing. There are three different ways the testing can be done. Blood, urine, and an oral/mouth test can all be used to test for HIV.  Some tests take 3-14 days to get results. A rapid HIV test can give results in 20 minutes.

Free, confidential, or anonymous tests are available. You can visit http://www.hivtest.org to find a testing location or call 1-800-CDC-INFO (available 24 hours a day).

To help stop the spread of HIV and reduce your chances of getting it, avoid having sex or use a new latex condom every time you do have sex. Also, talk about sex and HIV with your partners and friends. Talk to your friends about HIV testing and talk to your partners about their HIV status and past tests. And, talk to your doctor.

If you are sexually active, get tested for HIV.

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HIV/AIDS in 2009

16 12 2009

It’s been a good year in the fight against AIDS. For example, in November 2009, the United Nations reported that global HIV infections remained stable at 33 million for the past two years, and they believe that infection rates may have reached their peak in the late 1990s.

Why have infection rates stabilized?  The WHO and others suggest that increased world-wide access to antiretroviral drugs may be a reason. Forty-two percent of people in the developing world now have access to drugs that increase the life span and decrease viral loads in the patients who use them, perhaps reducing the likelihood of passing the infection to others.  Several organizations, such as the President’s Emergency Plan for AIDS Relief, the Clinton Foundation, and the Gates Foundation have helped to make this increased access possible.

The CDC and the NIH are planning major studies in two large U.S. cities to determine what effect improved diagnosis and treatment for HIV+ people might have on reducing HIV infection rates across the community.

This year has also brought interesting news regarding development of an HIV vaccine. A study in Thailand showed a two-vaccine combination resulted in a modest infection reduction rate.  Although the vaccine appeared to lose effectiveness over time, it is the first time researchers have been encouraged that HIV immunization might work.

Regarding treatment, The New England Journal of Medicine reported on a case study about a patient who had both HIV and leukemia. The patient received a stem cell transplant for the leukemia. Interestingly, the donor blood had a rare gene mutation that was immune to HIV. Now, the patient has no detectable HIV in his blood.

While this therapy has serious drawbacks—this type of donor blood is rare and there is a 30 percent risk of death from having a stem cell transplant, it make one wonder if parts of the concept might one day be part of a cure.

Finally, in 2009, the Obama administration lifted a ban that prevented HIV+ foreigners from entering the U.S., citing that we must make these decisions based on fact and save lives by encouraging HIV testing.

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