Develop(ing) VI: Combating HIV/AIDS

HIV/AIDS is not a typical topic of conversation in any place I've ever visited. It is one of those scary infectious diseases that is so often swept under the carpet, so often avoided because of the associations it conjures about transmission.

Which is all the more reason it has to become a topic of conversation. All the more reason that open conversations about sexual health and practices must happen. All the more reason that we talk to our partners about sexual health checks and condom use.

In Australia, there are numerous sexual health campaigns, one of which I always noted on the tram ride from Melbourne Central to the University of Melbourne while I was doing my undergraduate degree.  While a Google search is not finding this particular campaign, the image was of a young man with fire in his underpants, reminding us that getting checked is important. The campaign was so amusing that it started conversations and, many times, friends would mention that they had recently or would soon go to their GP for a check up. I was always impressed that this could be such an open conversation.

When I was in Ghana, I was struck by the huge billboards in some villages that had "STOP HIV/AIDS" written in huge letters above our heads. I asked one of the nurses if HIV/AIDS was a big issue in Ghana and she responded in the affirmative. While Ghana has nowhere near the HIV rates of South Africa, it still has a 1.8% incidence, of which more than half is female and 10% are children.

HIV, which is an acronym for the Human Immunodeficiency Virus, is a lentivirus of 100nm diameter, 9.7kBase double-stranded RNA genome that is enveloped.  It has both structural and non-structural proteins, coding for reverse transcriptase, protease and integrase.  Because it contains a reverse transcriptase, it can integrate its code into the host cell's DNA, avoiding detection by immune cells.  HIV has a high viral turn over with a short half-life of 2 days. It also specifically targets immune cells, meaning that it destroys the body's ability to kill the virus. As immune cells have a half life much longer than 2 days, the virus mutates at a rate far quicker than uninfected host immune cells can prepare an attack (it takes approximately a week for adaptive immunity to kick in).

HIV is managed through anti-retroviral drugs that reduce the viral load, meaning that newly produced immune cells can fight the remaining HIV in the body and reduce the number of immune cells killed off by infection. As a result, this means that a person infected with HIV will have a greater ability to fight off other pathogens. As a general rule, it is not HIV/AIDS that kills a person, it is an opportunistic infection that causes pneumonia or mitral valve endocarditis or recurrent tuberculosis (among others).

According to a lecture I had in Stage 1 Medicine, the estimated HIV transmission risk is at 0.01% from a single exposure during vaginal sexual intercourse and 1.0% from a single exposure during anal sexual intercourse. An injecting drug user has approximately the risk as someone exposed during sexual intercourse, while vertical transmission (mother to foetus) and breastfeeding carry 12-50% risks. A blood transfusion can have upwards of 90% infection risk from a single exposure.  While these percentages make it look like vertical transmission is the highest risk factor, sexual intercourse carries the highest global importance because it affects many more people at any one time.  If you want to know more, this report is incredibly informative.

Listening to these lectures about the sheer virulence of HIV made my cohort shake in our boots. This is a virus that is defying our scientific ability to fight it. But there are a lot of things that we can do to prevent or reduce its spread. There are the easy things - abstain from sex, wear a condom, get frequent sexual health checks (if infected, this will at least reduce your viral load). In many countries, especially in the continent of Africa, circumcision has been advocated as a means of reducing infection rates.  A group of Israeli doctors recently invented a surgery free form of circumcision that involves two visits to the doctor, no blood and very little pain. This easy-to-perform procedure could pave the way for cheap disease reduction.

 The biggest infection prevention strategy, though, is beginning a conversation. It is normalising the sort of behaviour that means we can talk about infection without fear. It is allowing people who are infected with HIV to speak about how it affects them without fear of social exclusion or isolation. It is being honest with ourselves and our partners. When we remove the fear, we can begin healthy discussions. When we talk, we solve problems.

What would be your HIV/AIDS awareness campaign?


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