World AIDS Day, held on Dec. 1 each year, is an opportunity for people worldwide to unite in the fight against HIV/AIDS, show their support for people living with the virus and to commemorate people who have died. World AIDS Day was the first global health day and was inaugurated in 1988.
In 2011, more than 1.2 million people were living with the virus in the U.S. and globally an estimated 34 million people have HIV/AIDS. More than 35 million people have died from the virus, making it one of the most destructive pandemics in history.
Today, many scientific advances have been made in HIV/AIDS treatment, there are laws to protect people living with he virus and we understand so much more about the condition. But despite this, many people do not know the facts about how to protect themselves and others from HIV/AIDS, and stigma and discrimination remain a reality for many people living with the virus. World AIDS Day is important as it reminds the public and governments that the deadly virus has not gone away—there is still a vital need to raise money, increase awareness, fight prejudice and improve education.
Last year on World AIDS Day, President Barack Obama said that we can achieve an AIDS-free generation “if we stay focused, and if we keep fighting,” and challenged the world to “come together to set new goals” in the war against AIDS. Three decades into the epidemic, important headway has been made thanks to ambitious efforts by the U.S. government to end AIDS here and abroad.
Better HIV/AIDS strategies
The National HIV/AIDS Strategy, released in 2010, is the nation’s first comprehensive road map with clear and measurable targets to be achieved by 2015: reduce new HIV infections, increase access to care and improve health outcomes for people living with HIV and reduce HIV-related disparities. Over the past four years, it has prioritized funding where it will have the most impact.
We can point to successes in combating HIV in the United States:
The overall number of Americans who know their HIV status increased to 84 percent approaching the Strategy goal of 90 percent by 2015. From 2008 to 2012, HIV diagnoses declined among Blacks, Latinos and women nationally. The latest surveillance data show that new HIV infections have been declining among Black women and intravenous drug users. Importantly, AIDS diagnoses (or diagnosing people late in their disease progression) decreased among all racial and transmission groups during this time.
The Affordable Care Act has enabled millions of uninsured Americans to have access to healthcare and get free HIV testing.
The White House’s HIV Care Continuum Initiative has boosted federal efforts to prevent and treat HIV. Meanwhile, a series of recent breakthroughs in HIV cure research have also brought more clarity on the precise steps and tools needed to finally eradicate this disease.
The federal government has prioritized cure research and amfAR, The Foundation for AIDS Research, recently upped the ante on cure research as well, setting a goal to invest $100 million in developing the scientific basis for a cure by 2020.
Unfortunately, we still have work to do. About 50,000 Americans continue to become infected with HIV each year, with nearly 80 percent of infections among men and two-thirds of new infections nationally among gay and bisexual men.
We continue to see high rates of new infections in the South, especially amongst African Americans. Astoundingly, one third of all Black gay men nationally are HIV-positive—and they remain the population with the greatest number of infections in the Black community and the only population in the Black community in which new infections are increasing. Though HIV diagnoses decreased among intravenous drug users from 2008 to 2012, AIDS-related deaths remain the highest in this population. According to Dr. Nina Harawa, HIV cluster leader at Charles Drew University, “In the gay community, there is less concern about HIV, because people [due to advances in treatment] are no longer walking around looking like they are dying,” she said. “But a lot of people are not on effective treatment.”
Viral suppression is key for people living with HIV. Viral suppression means having very low levels of HIV in the body, even though the virus is still there. Achieving viral suppression by taking HIV medicines allows people living with the virus to have nearly normal life spans and greatly reduces their chances of transmitting the virus to others. While there has been progress made in prevention and care, only 30 percent of all people living with HIV have achieved viral suppression. If they are in HIV medical care, however, 76 percent of people achieve viral suppression.
According to Dr. Harawa, in the United States:
• People without HIV/AIDS live an average of 79 years.
• People with HIV/AIDS, diagnosed at age 20, who regularly take medication, live an average of 71 years.
• People with HIV/AIDS, diagnosed at age 20, who are not taking medication, live an average of 32 years.
The annual number of new HIV infections has dropped by 33 percent since 2001. And more people are receiving lifesaving antiretroviral treatment, leading to historic declines in AIDS-related deaths worldwide.
The United States leads the world in its commitment to combating AIDS globally. American investments through the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) as well as the President’s Emergency Plan for AIDS Relief (PEPFAR) have been transformative in the global response to AIDS. PEPFAR is helping provide lifesaving HIV treatment to 6.7 million people, and has prevented countless infections among infants born to HIV-positive mothers in some of the hardest hit regions.
An estimated 35 million people worldwide are living with HIV, 19 million of them do not know they are infected, and more than 2 million become infected each year. HIV medications remain out of reach for far too many globally—more than 20 million are unable to access treatment—and budget cuts among nation states threaten the advances that have been made and the possibility of ending the AIDS epidemic by 2030.
Congressional support is vital to provide level funding for PEPFAR and the Global Fund in fiscal year 2015, and increasing contribution in subsequent years. Level funding for PEPFAR alone will allow an additional 272,000 people on treatment, keep an additional 17,000 infants from being born with HIV and avert an additional 62,000 AIDS-related deaths.
Evidence continues to show that the scale-up of treatment for people living with HIV not only saves lives, but also greatly reduces the chances of an HIV-positive person transmitting the virus to others. UNAIDS recently declared that, “If the world does not rapidly scale-up [treatment] in the next five years, the epidemic will spring back with a higher rate of new HIV infections than today.”
New treatment option: Pre-Exposure Prophylaxis (PrEP)
“PrEP” stands for Pre-Exposure Prophylaxis. The word “prophylaxis” means “to prevent or control the spread of an infection or disease.” PrEP is a way for people who don’t have HIV to prevent HIV infection by taking a pill every day. The pill contains two medicines that are also used to treat HIV. If you take PrEP and are exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from taking hold in your body.
Along with other prevention methods like condoms, PrEP can offer good protection against HIV if taken every day.
The CDC recommends PrEP be considered for people who are HIV-negative and at substantial risk for HIV infection. This includes anyone who:
• Is in an ongoing relationship with an HIV-infected partner;
• Is not in a mutually monogamous relationship with a partner who recently tested HIV-negative; and is a gay or bisexual man who has had sex without a condom or been diagnosed with a sexually transmitted infection within the past six months; heterosexual man or woman who does not regularly use condoms when having sex with partners known to be at risk for HIV (e.g., injecting drug users or bisexual male partners of unknown HIV status); or
• Has, within the past six months injected illicit drugs and shared equipment or been in a treatment program for injection drug use.
For heterosexual couples where one partner has HIV and the other does not, PrEP is one of several options to protect the uninfected partner during conception and pregnancy. People who use PrEP must be able to take the drug every day and to return to their health care provider every three months for a repeat HIV test, prescription refills, and follow-up. PrEP is a powerful HIV prevention tool. However, for sexually active people, no prevention strategy is 100 percent effective. Therefore, individuals who use PrEP should use it along with other effective HIV prevention strategies. These include:
• Using condoms consistently and correctly
• Getting HIV testing with your partners
• Getting STD testing with your partners
• Choosing less risky sexual behaviors, such as oral sex.
• If you inject drugs, participate in a drug treatment program or use sterile drug injection equipment.
Also, PrEP is only for people who are at ongoing substantial risk of HIV infection. For people who need to prevent HIV after a single high-risk event of potential HIV exposure—such as sex without a condom, needle-sharing injection drug use, or sexual assault—there is another option called postexposure prophylaxis, or PEP. PEP must begin within 72 hours of exposure. For more information on PrEP, visit www.aids.gov.
Sticking to your treatment
Once you start taking medicine for HIV/AIDS, you will have to take medicine for the rest of your life. You will always need to take medicine on time so that it works. Here are some tips for deciding when to start treatment and how to stick with it when you do:
Know your options and what to expect. Talk to your doctor about all treatment options and drug side effects.
Think about why you might have a hard time with treatment. For example, it might be hard to take all the drugs when you’re supposed to take them or at specific times such as the weekend. Practicing your treatment regimen ahead of time using jelly beans can help you figure out which doses are hard to remember. Talk to your doctor about these problems and how you can make your treatment plan fit your lifestyle. For instance, it is helpful to take them in accordance with something you do every day, such as when you get out of bed in the morning.
Plan your meals. Some drugs have to be taken with food or with no food. If this is true with any of your medicines, plan when you’ll eat so that you take the right drugs with the right amount and type of food.
Write down information about the medicines. This includes the drug name, when to take it, how much to take, and if you take it with food or on an empty stomach. Use a planner to organize your medicines. Don’t leave your doctor’s office until you understand how to take your medicines.
Organize your medicines. Use daily or weekly pill boxes or other organizers.
Don’t forget! Use timers, alarm clocks, or pagers to remind you to take your medicines. You could even write it in your planner. Some people use family and friends to help them remember. Others use smartphone applications (apps).
Take advantage of technology. Examples of smartphone apps include an HIV glossary from AIDSInfo; texting reminders from Med Action Plan, Truvada, and others (see blog.aids.gov for more info); and even state health departments. Your doctor may even use new technology to keep tabs on your treatment or to communicate with you. Ask your doctor for suggestions.
Plan ahead. Weekends and holidays make it harder to remember to take your medicines. Come up with a plan ahead of time so you won’t forget. If you’re traveling, keep medicines with you, just in case your luggage is lost. Some people keep an extra dose of medications with them or at work in case they are away from their medications when they are supposed to take them.
Get refills on time. Don’t wait until the last minute. Don’t miss a dose!
Write down the problems you have with the drugs. It will help you remember and track your problems.
Tell your doctor right away if you have side effects or other problems. Don’t wait. Side effects that may seem minor could mean there are serious problems. You might be able to change your treatment so it’s better for you.
Get a treatment buddy. Some people find that having someone to help them remember to take their HIV drugs is important, especially early on in treatment. If you don’t know anyone you can ask, your doctor or counselor may be able to help you find someone.
Talk to people who can help you cope. This process is no easy task. Talk to people who can help you get through this. Don’t isolate yourself. Reach out to those you love and who can help you stick to your treatment. Think about joining a support group to talk to other people with HIV.
The Oasis Clinic is a full spectrum clinic that treats every aspect of the HIV/AIDS patient. No one is denied treatment, said director Dr. Wilbur Jordan, who has run the clinic since 1979 and has treated more that 3,000 individuals.
In addition to treating infected patients, the clinic has a program that enables people who are indulging in risky behavior to take preventative medicines to prevent spreading of the virus.
As studies show that one of the fastest growing infected populations is teens and women infected by men, Dr. Jordan feels one of the key reasons why the virus continues to expand among this populations is the lack of the sense of self he sees within the group. “They don’t know their history or value and therefore don’t care enough about themselves to care about others.”
In the past, Dr. Jordan said Oasis included Black History lessons as part of the treatment and found that those who received that information were more adherent to medical treatment, more respectful and appreciative. For more information on the Oasis Clinic, visit www.blackaids.org.
Spectrum Community Services and Research is a community-based clinic on the campus of Charles R. Drew University that focuses on mental health service, substance abuse and case management, according to clinical director Charles Hilliard.
Among the services provided to patients and their affected family members are case management services, helping people access the various benefits they might qualify such as food stamps, housing subsidies, or enrolling in the federal AIDS/HIV drug progam(s).
According to clinic director Charles Hilliard, Spectrum also conducts patient education and peer support in the various subgroups.
Spectrum also operates a program called Linkage to Care designed to connect with individuals who have fallen out of care and get them back in. Ideally the goal is to find out why an individual has stopped going in for care and remove the obstacles that have caused the blockage, and get them back to treatment within five sessions, if possible. For more information visit http://www.cdrewu.edu/community/Clinics/SPEC
Sources: Centers for Disease Control, CNN Newsource, and Medline Plus.