Time to Rethink HIV

SINCE 1988, Dec 1 has been designated as World AIDS Day.

This is the day dedicated to raising awareness of AIDS and the spread of HIV infection, and also a day devoted to mourning those who have died from the disease.

For nearly three decades, World AIDS Day is also observed as a global public health campaign to educate the world on AIDS prevention and control.

On this day, we rarely, however, reflect on the individuals for have devoted their effort to bring awareness and reduce the stigma associated with HIV and AIDS.

One individual who, undeniably, contributed tremendously to de-stigmatising AIDS was the late Princess Diana.

In 1987, Diana was famously the first member of the British Royal household to have contact with AIDS victims and help to reduce the myths and misconception of AIDS. She held hands with AIDS patients and gave the HIV-positive director of Landmark AIDS Centre a firm handshake before a private tour. Although these actions seem so trivial in the 21st Century, such manoeuvres had tremendous impacts on the mindset of the world that believed HIV could be contracted through casual contact. Even the Queen of England at the time, disapproved of Diana’s visits and told her to do “something more pleasant” with her charity work.

When sat on the bed of a patient with HIV and holding his hand, Diana was asked about her devotion. She famously responded: “HIV does not make people dangerous to know. You can shake their hands and give them a hug. Heaven knows they need it. What’s more, you can share their homes, their workplaces and their playground and toys”.

Following the divorce with Charles, Princess Diana resigned from over 100 charities to spend more time with the six she was particularly passionate about. One of them was the National AIDS Trust. This remained one of the most active causes in the last year of her life.

After her death, Nelson Mandela commented on the work of the late Princess at a dinner party in London.

“When she stroked the limbs of someone with leprosy or sat on the bed of someone with HIV and held his hand, she transformed public attitudes and improved the life chances of such people. She had used her celebrity status to fight stigma attached to people with HIV/AIDS,” he said.

Three decades on and are we any wiser? This is the subject of discussion for one of our readers in this, the first week of December.

Dear Dr. G,

I am 26 years old and I am writing on behalf of my brother.

My brother is 24 and has recently been diagnosed with HIV.

We all felt so sad for him. At such young age, he had contracted such a dangerous disease. Although we have been asking him where he contracted the disease, he is not keen to talk about it.

My parents and I are devastated. We are not sure whether my brother can now live a normal life. Will he die younger? Can he even have normal relationships or father a child in the future? Of course, my brother is also keen to protect us from the virus. Can we contract the virus from sharing food, toilets or laundry? Can the virus be spread from saliva or mosquito bites?

Please help us.

J

This World AIDS Day, the National Aids Trust is challenging people to rethink outdated stereotypes and myths about HIV, with the “Think Positive: Rethink HIV” campaign.

The campaign aims to highlight the positive truths about HIV and sharing stats and information. For example: “People living with HIV who are on effective treatment can expect a normal life expectancy”; “Thanks to great HIV treatment in the UK, only 0.5% of the HIV positive mothers pass on the HIV to their children” and “Kissing does not spread HIV. Ignorance does”.

HIV is mainly spread by having sex or sharing injection needles with someone who has HIV, only bodily fluid such as blood, pre-seminal fluid, ejaculates, vaginal fluid and breast milk from an HIV infected person can transmit the virus. Technically, there are only three ways to get HIV: unprotected sex, sharing needles and mother to child transmission. Unprotected sex constitutes 95% of all modes of infection. Receptive anal sexual intercourse has the highest risk of transmission, followed by vaginal sex. Having multiple sex partners or concurrent other sexually transmitted infections can also increase the risks. Oral sex carries little risk of HIV, but the highest risk is performing oral sex with ejaculation in the mouth. Despite that, the risk is still much lower than anal or vaginal sex.

The HIV virus does not survive long outside the human body. It is not spread by air, water, insect bites, saliva, tears or sweat, therefore there is no risk of transmission by casual contacts, toilet seats or kissing. Open-mouth kissing with a person with HIV and bleeding gums where blood is exchanged is a potential risk, however, such reports have been exceedingly rare.

A HIV-negative person with an HIV positive partner can be considered for pre-exposure prophylaxis (PrEP), a daily pill that can greatly prevent HIV during conception and pregnancy. A mother living with HIV can also reduce the risk of transmission to baby from 20% to 2% by receiving anti-viral therapy during pregnancy, labour and delivery and avoiding breastfeeding. Encouraging the partner to get and stay on the antiviral therapy will also greatly reduce the rate of transmission.

The British journalist and author Shareen El Feki, who works closely on the issues of attitude towards HIV/ AIDS, once said: “Part of my job at The Economist was writing about HIV and that included the grim task of reporting on the state of global epidemic.” She elaborated: “Where you criminalise people living with HIV or those at greatest risk, you fuel epidemic.”

Ignorance and stigmatisation of someone already isolated with HIV is effectively criminalising the person. After three decades of education, is our ignorance still fuelling the epidemic?