Stopping HIV

Compassion and correct education go a long way in halting the progression of a virus.

By Winlove Mojica, MD


The HIV epidemic in the Philippines seems unstoppable. From one case every three days in 2000, there are about 35 new HIV cases per day in 2019. Almost 30% of those infected are 15 to 24 years of age. Although HIV awareness has increased with the help of community-based organizations and social media, misconceptions about it still circulate in different communities and affect the health-seeking and risk-taking behaviors of individuals. These misconceptions even echo in the halls of healthcare facilities where people depend on up-to-date knowledge.

There are five common misconceptions about HIV:

HIV is a death sentence. While it’s true that an untreated HIV infection can lead to death, the present triple combination antiretroviral medications allow people living with HIV (PLHIV) to have longer lives. According to a Swiss study in 2017, the life expectancy for PLHIV diagnosed at 20 years old and treated early with the use of combination therapy increased from 11.8 years to about 54.9 years. Because of the availability of effective treatment, HIV has become a manageable chronic illness rather than a death sentence. The key is early and strict adherence to treatment.

It’s important for healthcare professionals to emphasize the benefit of early treatment for HIV regardless of the CD4 or T-cell count. When faced with a patient who has risk factors for HIV, doctors should automatically offer HIV testing because treatment cannot start without testing. Early testing and treatment can prevent complications, additional financial burden, and stigma.

Monogamy alone will prevent someone from having HIV. Having multiple simultaneous sexual partners increases your chances of getting HIV, but even one unprotected exposure is enough for a person to be infected. Monogamy has been used as an excuse by numerous individuals online to practice unprotected sex. This is worrisome, because the assumption is that because an individual is monogamous, the sexual partner of that individual is also monogamous. This isn’t always true. Even if a couple were monogamous, and also using pre-exposure prophylaxis for HIV (PreP), they could pass other sexually-transmitted infections (STIs) with asymptomatic states such as herpes, syphilis, gonorrhea, chlamydia, and human papilloma virus (HPV) acquired from previous sexual contacts. These infections are expensive to treat—and like HIV, herpes and HPV have no cure.

Healthcare workers should remember to counsel their patients on the different ways to prevent HIV and other STIs. Once you have sex with a person, it’s also like sleeping with all the past sexual partners of that individual, therefore, consistent and correct condom use must always be included during patient counseling. Abstinence from sex may be the best method to avoid all these infections, but it’s also the most unrealistic. Counselling should go beyond abstinence.

You will get HIV when you use something used by a PLHIV. HIV is an enveloped virus. This envelope is very susceptible to heating, drying, and aeration—that’s why the virus will only survive in very specific conditions. For it to be transmitted to another person, it must land in an environment that’s moist and has body temperature. The virus must be in sufficient amounts, and must reach the blood stream to cause infection. Sharing towels, utensils, cups, and ballpens won’t transmit HIV. Neither hugging, kissing, nor sitting beside someone with the virus will give someone HIV. You won’t have HIV by being in a room together with a PLHIV, HIV isn’t airborne like chickenpox.

Healthcare workers need to educate patients and their families that HIV can only be passed through unprotected sex, sharing of intravenous needles, transfusion of unscreened blood products, transplant of unscreened organs, and mother-to-baby during pregnancy, delivery, and breast feeding. Other than these transmission routes, HIV cannot be passed to another human. By equipping PLHIV with better information about these transmission routes, it decreases the anxiety they feel about infecting anyone casually. This decreases HIV stigma and fosters a more supportive environment for the complete healing of our patients and their loved ones.

PLHIV are immoral people. Having HIV is a medical diagnosis, similar to having a chronic illness without cure such as diabetes, hypertension, or asthma. It’s not a moral diagnosis, and unfortunately the transmission of HIV is stigmatizing, especially when sex and drugs are taboo topics. Locally, more than 99% of HIV transmissions are through sexual contact. Males are most affected, comprising 94% of all infected. Because 86% of these males are men who have sex with men (MSM), HIV has intensified the hate for the LGBT+ community, which is already persecuted by many religious groups.

The stigma against the LGBT+ and PLHIV continues to worsen the HIV epidemic in our country. It prevents people from accessing health services, creating the fear of being outed as someone having a nonconforming sexual orientation or someone who has HIV. All patients are worthy of quality service, and have the right to consult competent and compassionate health workers.

Sexuality education will increase the incidence of STIs and HIV. Quite the opposite: countless studies worldwide have proven that education helps stop the spread of STIs and HIV. Students who receive age-appropriate sex ed have been found to have delayed sexual debut and fewer sexual partners. This also decreases teen pregnancy and risky behaviors which may lead to STIs.

Sexuality is an integral aspect of all individuals, and to be educated isn’t about knowing sexual positions, or limited to the sexual organs and sex. It’s also about how we think of ourselves, how people communicate with each other through clothes and speech, and the kind of relationships they want to have, sexual or romantic. It can be as simple as letting young students know about their own bodies, and that no one can touch their bodies without their consent.

Healthcare workers should have an open mind when dealing with issues related to sexuality. Patients who present with STIs or consult health facilities for reproductive health concerns shouldn’t be ridiculed. Instead, their visit must be viewed as an opportunity for the health team to help the patient.

In our homes, sex education should be discussed objectively. Children as young as 7 or 8 years old hear sex-related topics from their classmates. Mostly these topics arise from watching pornography. It’s the parents’ duty to enlighten their children about their bodies and the physiology of reproduction, and that children understand that what’s depicted in pornography isn’t what happens in real life and shouldn’t be the standard way of treating a partner. Most importantly, children should feel that they can trust their parents to discuss these issues with them whenever they have questions or are unsure of themselves.

Eradicating HIV is impossible without an effective vaccine or antiviral to kill the virus. Still, the world is hopeful and continues the move to end AIDS in 2030. But while HIV has decreased or stabilized in other countries, the numbers in the Philippines continue to surge. No matter how much money the Philippine government pours on testing and treatment for HIV, if people don’t invest twice as much for prevention strategies, the epidemic will continue to spread. Ensuring that sex education is correctly and consistently taught will help correct simple misconceptions on STIs and HIV. Maintaining open communication with children at home will empower them to say no when they’re not ready for sex. We can still stop HIV, but only if everyone gets involved. HT


References:
Life expectancy in HIV-positive persons inSwitzerland: matched comparison withgeneral population
HIVepicenter Philippines
Department of Health | Epidemiology Bureau HIV/AIDS & Art Registry of the Philippines December 2018
Baldo M et al. Does Sex Education Lead to Earlier or Increased Sexual Activity in Youth? Presented at the Ninth International Conference on AIDS, Berlin, 6-10 June 1993. Geneva: World Health Organization, 1993.
United Nations Joint Programme on HIV and AIDS. Impact of HIV and Sexual Health Education on the Sexual Behaviour of Young People: a Review Update. [UNAIDS Best Practice Collection] Geneva: UNAIDS, 1997.
Institute of Medicine, Committee on HIV Prevention Strategies in the United States. No Time to Lose: Getting More from HIV Prevention. Washington, DC: National Academy Press, 2001.
Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2001.
Alford S et al. Science and Success: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, DC: Advocates for Youth, 2003, 2008.
Kohler et al. “Abstinence-only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy.” Journal of Adolescent Health, 42(4): 344-351.
Kirby D. “Sex and HIV Programs: Their Impact on Sexual Behaviors of Young People Throughout the World.” Journal of Adolescent Health 40 (2007) : 206-217.