Living with HIV Follow-ups, treatment and handling stigma

A life void of medical maladies is quintessential to lead a happy and fulfilled life. Among the many diseases already plaguing the people today, HIV and AIDS can also be listed as diseases that could not only deteriorate one’s live but is also incurable; with the only alternative left is to slow down the disease progression with constant treatment. In line with the World AIDS Day which falls on December 1, the Health Capsule interviewed Acting Consultant Venereologist at the National std/aids control programme (NSCAP) Dr. Iresh Jayaweera to share his insights with us. He explained how HIV and AIDS could challenge the healthy well being of an individual while further explicating on how with the right treatment and support a patient could lead a long and happy life as much as the average person. 

Excerpts of the interview are below. 
QCould you explain the biological aspects of HIV and AIDS? How do you differentiate between the two conditions? 
HIV stands for human immunodeficiency virus and AIDS stands for acquired immunodeficiency syndrome. HIV attacks the body’s immune system, specifically the CD4 cells (T cells), which help the immune system fight off infections. Usually there are about 1000 cells per one milliliter of blood in a normal person without HIV. Untreated, HIV reduces the number of CD4 cells (T cells) in the body, making the person more likely to get other infections or infection-related cancers. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. When the number of cells is below 200 cells/ml we call it AIDS stage. These opportunistic infections or cancers take advantage of a very weak immune system and signal that the person has AIDS, the last stage of HIV infection. 

QWhat causes HIV and how is the disease contracted?

HIV virus passes from one person to another through certain body fluids, such as blood and semen. 
To become infected with HIV,  infected blood, semen or vaginal secretions must enter your body. You may become infected if you have vaginal, anal or oral sex with an infected partner whose blood, semen or vaginal secretions enter your body. 

In some cases, the virus may be transmitted through blood transfusions due to infected blood or blood products. This is extremely rare in Sri Lanka.

 Sharing contaminated intravenous drug paraphernalia (needles and syringes and other equipment) puts you at high risk of HIV and other infectious diseases, such as hepatitis.

 Infected mothers can pass the virus on to their babies during pregnancy, delivery and during breast feeding. This is called mother to child transmission of HIV. Sri Lanka has eliminated Mother to child transmission and is awaiting the certification from WHO.

HIV isn’t spread through casual contact, such as shaking hands, hugging, sneezing, sharing utensils, or using bathrooms.

QSymptomatically, how do you diagnose a patient with HIV and AIDS? 
First of all, the only way to diagnose HIV is by doing a blood test. You can’t rely on symptoms to tell whether you have HIV, because there are no symptoms which are specific to HIV. There are several symptoms of HIV. Not everyone will have the same symptoms. It depends on the person and what phase of the disease they are in. 

In very early disease or acute HIV phase, within 2 to 4 weeks after infection with HIV, about two-thirds of people will have a flu-like symptoms such as fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, mouth ulcers. This can easily be missed unless you have a strong clinical suspicion with a supportive sexual history.

In clinical latency or chronic HIV infection, the virus still multiplies, but at very low levels. People in this stage may not feel sick or have any symptoms. This can last for 8-10 years.
In symptomatic HIV infection rapid weight loss, recurring fever or profuse night sweats, extreme and unexplained tiredness, prolonged swelling of the lymph glands in the armpits, groin, or neck, diarrhea that lasts for more than a week, sores of the mouth, anus, or genitals, pneumonia, red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids, memory loss, depression, and other neurologic disorders can be seen.

QHow does HIV progress towards AIDS? 
If you have HIV and you are not on HIV treatment, eventually the virus will weaken your body’s immune system and you will progress to AIDS. It can be years before HIV has damaged the immune system enough for AIDS to develop. This is the late stage of HIV infection. A person with HIV is considered to have progressed to AIDS when the number of their CD4 cells falls below 200 cells per cubic millimeter of blood or when they develop one or more opportunistic infections regardless of their CD4 count.

QIs there any vulnerable group in particular when it comes to contracting HIV? 
Anyone of any age, race, sex or sexual orientation can be infected. However, you’re at greatest risk of HIV/AIDS if you; have unprotected sex and/or have multiple sexual partners, already have a Sexually Transmitted Infection or Sharing intravenous drugs. 
We have identified Commercial sex workers and their clients, Men who have Sex with Men, Intravenous drug users, Prisoners and Beach boys as key populations who are at increased risk of contracting HIV.  

QWhat preventive measures can be taken up against HIV / AIDS? 
There’s no vaccine to prevent HIV infection and no cure for AIDS, but you can protect yourself and others from infection. 
Abstinence /postpone sex until you are ready- mainly for teenagers. Be faithful and have one faithful partner who is HIV negative. If these two options are not practical to you always use a new condom every time you have sex.

Pre exposure prophylaxis (PrEP) and Post exposure prophylaxis- where you can use antiretroviral drugs before and after a potential exposure to prevent it. Never use drugs or do Intravenous drug use, if you can’t avoid it- do not share it.

Do not donate blood if you had done above risky behaviours.

If you are pregnant get tested for HIV early and do the necessary, follow up to protect your baby. 

QIs there any possibility of preventing a fetus or a new born from contracting the disease from a mother who is diagnosed with HIV? 
If you’re HIV-positive, you may pass the infection to your baby, but if you receive treatment during pregnancy and do the necessary follow up you can prevent it.

QHow effective has the Sri Lanka National STD/AIDS Control Program been in help addressing the issue? 
National STD AIDS Control Program with its 34 Branch clinic network in Sri Lanka is working hard for prevention, and to improve treatment and care services for People living with HIV(PLHIV) and to minimize stigma and discrimination. According to WHO, Sri Lankan set up is a role model to the world for cost effective service delivery.

Due to its success Sri Lanka is a low prevalent country in South east asia for HIV in which community prevalence for HIV is below 0.02%. 

STD clinics offer HIV testing and outreach HIV testing. Anyone can walk into our clinics and get a free test done. 

QVery often, there is a lot of social stigmatization associated with patients living with HIV / AIDS. What message do you have for family members, friends and the caretakers of such patients? 
Stigma and discrimination are major “road blocks” to universal access to HIV prevention, treatment, care and support. Possible consequences of HIV related stigma such as loss of income and livelihood, loss of marriage and childbearing options, poor care within the health sector, withdrawal of caregiving in the home, loss of hope and feelings of worthlessness and loss of reputation causes severe psychological distress in patients suffering from HIV. As a result patient’s general health and well-being is also affected. Also an individual’s willingness to practice prevention, seek HIV testing, disclose his or her HIV status to others, ask for (or give) care and support and begin and adhere to treatment is reduced.

There are many things that you can do to help a friend or loved one who has been recently diagnosed with HIV . Be available to have open, honest conversations about HIV and show them that you see them as the same person and that they are more than their diagnosis. Listen to your loved one and offer your support. Reassure them that HIV is a manageable health condition. Educate yourself about HIV: what it is, how it is transmitted, how it is treated, and how people can stay healthy while living with HIV. Encourage your loved one to take treatment and to stick to the treatment plan. Ask your loved one what you can do to support them in establishing a medication routine and sticking to it. Turn to others for any questions, concerns, or anxieties you may have, so that the person who is diagnosed can focus on taking care of their own health.