Gilmore Health: A Q&A Session on HIV With Dr. Sony Sherpa

Today we are speaking to Dr. Sony to better understand exactly what HIV is, what disease it causes, and all the stigma around it.

Human Immunodeficiency Virus, commonly abbreviated as HIV, is a type of virus that targets and attacks the human immune system, leaving the human body vulnerable to other infectious pathogens and even, non-infectious or opportunistic pathogens. HIV is a widely controversial topic of medicine, with HIV patients often facing scrutiny and judgment from others.

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The virus is usually transmitted through contact with certain bodily fluids like semen and vaginal secretions, which is the basis for ostracization of HIV-infected people but that is not the only way the virus is transmitted.

Approximately 1.7 million people were infected with HIV worldwide in the year 2019, 1.5 million of whom were adults and the rest were children (those under 15 years of age).

Hello Dr. Sony and thank you for taking the time out of your schedule to speak to us. Starting, what is the difference between HIV and AIDS? Are they synonyms of the same condition?

Dr. Sony: Hello, Of course. Well, HIV is the Human Immunodeficiency Virus and when it is in the human body, it weakens the immune system and causes the disease, AIDS, or Acquired Immunodeficiency Syndrome.

So, HIV is the causative agent for AIDS?

Exactly, yes.

And how does one get infected with HIV?

HIV Virus

HIV can only be transmitted through certain activities like engaging in anal or vaginal intercourse or sharing injections with an HIV-positive person with a detectable viral load. For the virus to be transmitted, the viral particles in the bodily fluids of an HIV-positive person (with a detectable viral load) have to reach the bloodstream of the HIV-negative person, otherwise, it cannot be transmitted. It can also be transmitted, although rarely, from an infected mother to her unborn child either during the pregnancy or after, through breastfeeding, or during the process of birth. Other rare methods of transmission are oral sex (almost negligible), blood transfusions, bites from an infected person, or direct contact of broken skin with contaminated bodily fluids.

That’s quite fascinating. You specifically mentioned viral load and its importance in transmission. Can you clarify what you mean by it?

Of course. So, viral load refers to the amount of virus in the serum of a person. If the quantity of virus is not detectable in the serum, then transmission is not possible. So if an HIV-infected person regularly takes their medications, the viral load remains undetectable and they can live a long, healthy life without any risk of HIV transmission.

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That’s amazing. Then why is HIV so stigmatized and why are the patients ostracized and excluded from the community?

That’s a great question. The thing with HIV infections is that HIV was only discovered in 1983 and it was believed to only infect homosexual men, making it quite a controversial topic in medicine. Now, with more research and joint efforts by all countries, more about HIV is understood and the rates are decreasing. More and more people can access HIV treatment and testing with ease, which has made HIV a manageable disease rather than the death sentence it was believed to be.

But there are still gaps in awareness and testing and treatment are still not readily available everywhere. With the combination of all these factors and the fact that we have only recently started to understand this controversial disease, people still stigmatize infected people. And that is negatively impacting those affected by HIV with at least 8 out of 10 feeling the stigma leading to isolation, depression, and feelings of worthlessness.

That’s awful. You spoke about how it was believed to affect only homosexual men, I am curious to know if there are any populations that are at higher risk for HIV than others. And if yes, why?

Yes, so since the infection was discovered, it has had a predilection for homosexual men, and according to 2015 reports, 50 percent of those affected were African American, and 70 percent of those affected were homosexual or gay men. The answer to your second question of why is simple, it’s a numbers game. Socially speaking, a black, homosexual man is more likely to only be in contact with other black homosexual men making it more prevalent in that community than any other.

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Is the high number of cases a sign that they are being reckless?

No, in no way does it mean that. As I said, the homosexual community has a higher risk than any other community. So if someone were to be in the homosexual community and engage in sexual activities, the chances of them getting HIV are higher than a heterosexual male engaging in sexual activities with a female. However, not using condoms with sexual partners does increase the risk significantly, for both groups.

What if someone were to use a condom while engaging in sex with their HIV-positive partner but the condom breaks during sex, would that increase the risk of HIV?

If the condom breaks during sex, the chance of contracting HIV increases. However, the uninfected partner must immediately, or as soon as possible take the post-exposure prophylactic (PEP) drug to ensure that HIV cannot replicate in their body and infect them.  To be able to take PEP, the person should be aware that the person they had sex with was HIV-infected, which is why clear communication is necessary if an HIV-infected person is involved in a polygamous relationship or if they regularly participate in one-night stands.

Most of the time, partners of HIV-infected patients are also prescribed PReP or PRe-exposure Prophylactic drugs that help reduce the risk of HIV transmission. This, along with condoms reduces the risk of HIV transmission. However, PReP is not prescribed to partners of HIV-infected patients in a monogamous partnership or with undetectable viral load. It is also important for partners of HIV patients to get tested for HIV regularly.

How does one get tested for HIV?

If a person has flu-like symptoms, that’s how acute HIV presents itself, along with a belief that they might have recently been exposed to HIV, they must visit the nearest HIV testing centers and get tested. In these tests, they detect antibodies in your serum against HIV which is how your body reacts to the virus. The antibodies may take days to weeks to be formed and hence, detected.

After diagnosis, further tests may be performed to know the stage of the disease like viral titers or viral load and CD4 T cell levels. This is important to know to start medication and also because people are at the highest transmission risks during the early stages of HIV.

Are those the only symptoms of HIV, flu-like symptoms I mean?

In acute HIV infection, mostly yes. In the chronic stage and AIDS, the symptoms include rapid weight loss, sores of the mouth, anus, or genitals, pneumonia, and even, neurological symptoms like memory loss.

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Are there any other populations or ethnicities at a higher risk for HIV?

Homosexual men, especially insertive men (tops) are at the highest risk for transmitting HIV. Transgender women who participate in sexual activities with men, people who share needles, or generally have unprotective sex (without a condom) with multiple partners are generally considered to be the high-risk group, especially in America. Hispanics and the African-American groups have a higher rate of HIV when compared to Asian and Caucasian communities.

Outside of America, women are at higher risk, especially in lower-income countries. This is believed to be because women in these countries do not have any sexual or reproductive rights and find it difficult to use a condom or practice safe sex.

In Africa, HIV is a fact of life. Most people do not get tested and remain unaware of their diagnosis while transmitting it to others by practicing unsafe sex. Moreover, those who do know of their diagnosis often hide or ignore it and do not seek medical help due to the stigma associated with it.

In that case, what is being done to raise awareness and educate people about HIV to break down this stigma?

The basic thing everyone should do is read the CDC’s HIV Stigma Language Guide to learn how to talk about HIV without stigmatizing it. Moreover, many HIV support organizations help spread awareness that people can follow.

That’s great, thank you. How has HIV become a manageable disease, what are the treatment options available?

The treatment for HIV is called ART or antiretroviral therapy which is usually prescribed at the same time as diagnosis. It plays a significant role in keeping viral loads below detectable levels. However, we don’t know the long-term side effects of these drugs but they are extremely efficient and need to be taken for the rest of their life.

Does this treatment help against COVID-19?

There is not enough data present about COVID-19 itself or the association between HIV and COVID-19, but what we do know is that the risk of COVID-19 is higher in those with weakened immune systems. However, based on very little data present, we believe that those taking ART regularly and with undetectable viral loads have the same risk of being infected with COVID-19 as those without HIV. It is important for everyone right now to practice social distancing and to stay at home to help reduce the number of cases and control the pandemic.

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Thank you so much, I did learn quite a bit about HIV which is not a fatal condition, contrary to popular belief.

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