How do we define HIV and AIDS?
What is HIV?
HIV is a virus that attacks the immune system, which is our body’s natural defence against illness. The virus destroys a type of white blood cell in the immune system called a T-helper cell and makes copies of itself inside these cells. T-helper cells are also referred to as CD4 cells.
As HIV destroys more CD4 cells and makes more copies of itself, it gradually breaks down a person’s immune system. This means someone living with HIV, who is not receiving treatment, will find it harder and harder to fight off infections and diseases.
If HIV is left untreated, it may take up to 10 or 15 years for the immune system to be so severely damaged it can no longer defend itself at all. However, the speed of HIV progresses will vary depending on age, health and background.
Basic facts about HIV
- HIV stands for human immunodeficiency virus.
- There is effective antiretroviral treatment available so people with HIV can live a normal, healthy life.
- The earlier HIV is diagnosed, the sooner treatment can start – leading to better long term health.
- HIV is found in semen, blood, vaginal and anal fluids, and breast milk.
- HIV cannot be transmitted through sweat, saliva or urine.
- Using male condoms or female condoms during sex is the best way to prevent HIV and other sexually transmitted infections.
- If you inject drugs, always use a clean needle and syringe, and never share equipment.
- If you are pregnant and living with HIV, the virus in your blood could pass into your baby’s body, or after giving birth through breastfeeding. Taking HIV treatment virtually eliminates this risk.
What is AIDS?
AIDS is not a virus but a set of symptoms (or syndrome) caused by the HIV virus. A person is said to have AIDS when their immune system is too weak to fight off infection, and they develop certain defining symptoms and illnesses. This is the last stage of HIV when the infection is very advanced, and if left untreated will lead to death.
Basic facts about AIDS
- AIDS stands for acquired immune deficiency syndrome.
- AIDS is also referred to as advanced HIV infection or late-stage HIV.
- AIDS is a set of symptoms and illnesses that develop as a result of advanced HIV infection which has destroyed the immune system.
- Treatment for HIV means that more people are staying well, with fewer people developing AIDS.
How do we achieve an AIDS-FREE Caribbean?
“There is absolutely no reason that at this time in human history, people should be dying from AIDS; no one has to die from AIDS” Professor Clive Landis, Deputy Principal, Cave Hill Campus, UWI, Barbados, Chairman, Caribbean Cytometry & Analytical Society (CCAS) and Director, Ladymeade Reference Unit Laboratory, Ministry of Health, Barbados spoke these words, during his ground-breaking presentation at the PANCAP Faith Leaders Consultation, 1–2 February 2017.
Professor Landis illustrated his argument by positing an example of a young man from Africa who was brought to doctors literally on his ‘death bed’ due to a weak immune system from advanced AIDS. The young man had never received any form of treatment. However, after the right treatment and support, including treatment with the use of antiretroviral drugs (ARTS), the young man made an astonishing recovery.
Treatment as Prevention
Professor Landis utilized the young man’s example to explain ‘Treatment as Prevention’, which he heralds as ‘the scientific breakthrough of the decade’.
With the use of Antiretroviral therapy, People Living with HIV can expect to live longer, with an improved quality of life as new ARTs have less side effects. HIV positive people on Antiretroviral therapy is a tremendous asset to the health-care system since Antiretroviral therapy reduces the chances of HIV transmission.
Professor Landis explained that this is possible since Antiretroviral therapy suppresses the viral load of an HIV-positive person; this makes transmission of the virus less likely to occur.
What is Antiretroviral therapy?
- Antiretroviral therapy combines three or more drugs, which stop the HIV virus from progressing.
- First used in 1996, it involves a combination of three or more drugs that stop the HIV virus from replicating
- This means damage to the immune system caused by HIV can be prevented and it stops the disease spreading to others
- More recent drugs are even more efficient and have fewer side effects
- The World Health Organization recommends that antiretroviral therapy is started as soon as possible after diagnosis
Professor Landis emphasized that new ARTs have significantly improved the quality of life of People Living with HIV as they offer less side effects.
A recent article by the British Broadcasting Corporation (BBC) highlighted the case of Jimmy Isaacs, 28, who discovered he had been infected with HIV by a former partner.
Jimmy takes three drugs once a day at 18:00 and will continue to do so for the rest of his life.
He stated “my health is absolutely fine. I’m eating healthily and drinking healthily”.
“It doesn’t impact on my job and hasn’t impacted on my social life either.”
Although it took two changes of medication to find the right combination for him, he says he now has no side effects at all.
“I had heard a lot of bad stories about the drugs back in the ’90s – but when I did some research, I realised the drugs had completely changed.”
Isaacs is an ideal example of the progress of Antiretroviral therapy. The new generation of drugs are more effective at suppressing viral load and offer less side effects. This provides People Living with HIV with enhanced quality of life and can potentially achieve the elimination of AIDS.
Professor Landis has described an AIDS-free Caribbean as one in which People Living with HIV are non-infectious. That is, they are incapable of transmitting the virus because it has been effectively supressed through the use of Antiretroviral therapy.
This scenario would present a tremendous public health benefit as the virtual elimination of HIV transmission would result in a reduction of deaths from AIDS.
How do we achieve this?
Achieving 100% suppression of the HIV virus among HIV-positive persons in the Caribbean of course requires a more effective response to HIV testing from persons exposed to the virus. Only when people who are HIV positive know their status can they receive Antiretroviral therapy and contribute towards the elimination of HIV transmission and reduction of deaths from AIDS. These include persons who were infected through sexual intercourse and mother-to-child transmission.
While mother-to-child transmission has been eliminated in some Caribbean countries, other forms of infection persist including infections among drug users utilizing needles. To eliminate these forms of infection, persons exposed must seek testing and prevent infecting those who are HIV-negative.
As noted by Gardner et al., treatment as prevention can only work effectively at population-level if a high proportion of all HIV-infected people are: (i) tested for HIV, (ii) linked to clinical care in a timely manner, (iii) retained in care, (iv) receive effective ART, and (v) adhere to treatment and are regularly monitored (Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ (2011) The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin.Infect.Dis. 52: 793–800).
Some experts have declared Antiretroviral therapy the harbinger of the end of HIV transmission and deaths from AIDS.
The Swiss Federal Commission for HIV and AIDS has stated that ‘after review of the medical literature and extensive discussion, an HIV-infected person on antiretroviral therapy with completely suppressed viraemia (“effective ART”) is not sexually infectious, i.e. cannot transmit HIV through sexual contact’.
The evidence for success utilizing Antiretroviral therapy in the region can be found in the documented Best Practice titled ‘Ten Year Trends in Community HIV Viral Load in Barbados: Implications for Treatment as Prevention’ by R. Clive Landis , Songee Lynn Branch-Beckles, Shawna Crichlow, Ian R. Hambleton and Anton Best.
The study noted ‘we have demonstrated a significant trend towards optimal viral load (VL) suppression in clients utilizing the services of the national HIV treatment programme in Barbados over a 10-year period. Estimates of VL suppression at a population level are similar to reports in developed countries that applied similar methodologies and this could suggest a public health benefit of ART in minimizing the risk of sexual transmission of HIV. Continued efforts are warranted to extend HIV testing to hidden populations in Barbados and linking infected persons to care earlier in their disease’.
The evidence provided by the study makes a clear correlation between minimising the risk of HIV transmission via sexual intercourse and the use of Antiretroviral therapy.
How do we get ‘Treatment as Prevention’ to work?
Eliminating the possibility of HIV transmission from people who are HIV positive through the use of antiretroviral therapy will be a significant benefit to the health care system. However, to achieve this emphasis must be placed on more people being tested and aware of their HIV status. This is the foundation of the United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 Targets, which state:
- By 2020, 90% of all people living with HIV will know their HIV status.
- By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
- By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.
These are aligned with the vision of an AIDS Free Caribbean, since achieving suppression of the HIV virus among HIV positive patients will result in improved health outcomes and eliminate AIDS-related deaths.
Dr Shanti Singh-Anthony, MPH, Knowledge Coordinator for the PANCAP Knowledge for Health Project and former National AIDS Programme Manager, Guyana, shares this vision for an AIDS-Free Caribbean. ‘Placing the majority of HIV positive people on ARTs will significantly reduce the transmission of the virus,’ stated Dr Singh-Anthony, ‘ensuring that they remain on antiretroviral therapy for the remainder of their lives will be a tremendous benefit to the health care system since less HIV positive people will develop AIDS and the likelihood of transmission of the virus will be lowered. An AIDS-free Caribbean is possible when we commit to ensuring that all HIV positive people have sustained access to antiretroviral therapy’.
What are the barriers to achieving an AIDS-Free Caribbean?
The main barriers to achieving 90% of all People living with HIV knowing their status are fear, stigma and discrimination.
According to Professor Landis, high-risk populations are hard to reach because of two (2) reasons 1) they do not know their status and have not been tested. Hence, they are living with high levels of the virus in their bodies and are extremely infectious and 2) they are aware of their status but are afraid to attend clinics; therefore they are not on ARTs and are highly infectious.
He also posits that it is the attitude and behaviour of society that determines whether an HIV-positive person will seek testing and treatment. People exposed to the HIV virus are significantly less likely to seek health care services if they expect discrimination from their families or professionals within the health care system.
This is of particular importance to key populations including men who have sex with men (MSM), sex workers, drug users utilizing needles and youth within these groups.
Hence, the key to achieving the 90-90-90 targets and overarching goal of an AIDS-Free Caribbean is the removal if these barriers of fear, stigma and discrimination. The critical factor is therefore creating an environment in which people who have been exposed to the virus feel motivated to seek health care services and are encouraged to adhere to the requirements of antiretroviral therapy without fear of being stigmatised or having their confidential information exposed.
Professor Landis eloquently described the danger of stigma and discrimination to achieving an AIDS-Free Caribbean when he stated ‘when we express scornful attitudes or place barriers in the way of persons to know their status or receive ART treatment, then we place ourselves at greater risk of HIV infection’.
It is ironic that our own attitudes towards people seeking HIV testing and treatment can determine our level of exposure to infection; less people getting tested because of discrimination will result in the continued transmission of the virus since these persons will not know their status or receive antiretroviral therapy.
An AIDS-Free Caribbean is not impossible. If we fully commitment to exercising care and support rather than stigma and discrimination, evidence suggests there will be more People Living with HIV receiving antiretroviral therapy, zero HIV transmission and no deaths from AIDS. Indeed, our ability to support people infected with HIV will be the defining factor in achieving a truly AIDS-Free Caribbean.