Although HIV has taken away so many in our community, in 2010 we consider HIV to be a chronic manageable disease — something you can live with, not die from. We have a multitude of HIV medications that are easier to take, extremely powerful and have fewer side effects. Even patients who have been on medications since the ’90s are often able to switch to these newer regimens. We counsel HIV-positive patients about near-normal life expectancies as long as medications are taken when recommended. At medical conferences, we are now talking about the aging HIV patient. HIV is no longer a death sentence — at least in this country.
In 2010, AIDS still devastates entire villages and urban communities throughout the world, where medical care and HIV drugs are unavailable. Thankfully we live in a city where getting HIV care and necessary medicines is obtainable by nearly all of its citizens. Even for uninsured individuals in Philadelphia, Ryan White Care Act funds are available to cover medical care, and the Special Pharmaceutical Benefit Program will cover the cost of meds and labs.
We need to do a much better job of reaching out to find all of those infected in Philadelphia to bring them into care but, at the moment, we have made their care a possibility and a priority.
In the realm of HIV prevention, some things are as true now as they were at the beginning of the epidemic. Condoms are an incredibly effective way to prevent the virus from passing from one person to another (you just have to wear them!). That being said, one of the most effective prevention strategies is “knowing your status.”
It is estimated that approximately 70 percent of new HIV infections originated from individuals who did not know their status. Too many people don’t get tested regularly or at all, and continue to have unprotected sex without full knowledge of their status. Particularly during early infection, transmission rates can be exceedingly high — without any symptoms at all. Although a decision about using protection during sex is a personal one, making an informed choice is always best. Free and anonymous testing is available throughout the city. The CDC recommends that sexually active individuals be tested at least once a year.
There are other ways to lower HIV-transmission risk as well. When a condom breaks or when risky unprotected sex has occurred, there is medical intervention that lessens the chance that an HIV exposure becomes an HIV infection. This is known as post-exposure prophylaxis (PEP). If significant exposure risk has occurred, you should contact a medical professional as soon as possible to see if prophylaxis can help you. Taking one full month of HIV medications, if started within 72 hours of an exposure, can significantly reduce transmission of HIV.
This month, data were released showing that certain men at high risk for HIV could successfully reduce transmission rates by taking a daily regimen of HIV medication before having sex. This is known as pre-exposure prophylaxis (PrEP). The study suggested that some men may benefit from this method as long as they miss very few pills. While still very controversial, we may have found yet another prevention strategy for our armory to curb the trend of increasing HIV rates among men who have sex with men.
Sex is a natural part of life and something we should talk more about, particularly ways to make it safer to enjoy. Knowing your partners’ status is important information, whether you’ve just met on Manhunt or have been together for many years. We need to be better at talking about sex before we have sex and making informed choices before the moment of passion.
Condoms should always be considered. Choosing lower-risk sexual activities (like oral sex) is certainly a way to reduce risk.
However, when a risky act does occur or if you are always engaging in unprotected sex, talk to your doctor about prophylaxis and whether it’s right for you.
Having HIV is manageable, but most people with HIV wish they were negative. Until we find a cure, using prevention methods is the only way to stay negative.
Dr. Robert Winn is medical director at Mazzoni Center, the region’s only LGBT-specific health center. Mazzoni Center offers confidential rapid HIV testing and STI screening. Make an appointment and get tested.