Harmeet Gill, MD
December is HIV/AIDS Awareness Month. It is a time to bring attention to HIV/AIDS, increase knowledge and awareness, and speak out against stigma. With current medications available to prevent HIV, the global health community is working to end the disease worldwide.
HIV, or human immunodeficiency virus, attacks immune cells, making it difficult for the body to fight infections and diseases. If HIV is not treated, it can lead to end-stage HIV called AIDS, or autoimmune deficiency syndrome. More than 30,000 people are diagnosed with HIV each year. Poorly managed HIV and AIDS both increase the risk of very serious infections in the brain, lungs, blood, or digestive tract, as well as certain types of cancer, including lymphoma, lung, or liver cancers.
The virus is transmitted through bodily fluids, including blood, semen, rectal and vaginal fluids, and breast milk. Often, people think HIV is only a risk for gay or transgender men, but the truth is that the virus can infect anyone. The two most common ways a person will contract HIV are through unprotected vaginal or anal intercourse with someone who has HIV, or by sharing drug equipment, such as needles, with an infected person. Often HIV status is not known or discussed prior to sex with a new partner. Additionally, unknown status and possible exposure to HIV and other sexually transmitted infections is one of many considerations survivors must process while coping with sexual assault.
HIV can be spread from a mom to an unborn baby or by needlesticks, although the risk is very low for health care workers. The virus is not spread by kissing, hugging, eating, drinking, or using the bathroom after someone with HIV.
So far, there is no cure for HIV. We only have antiretroviral medications to control the virus in our body. However, the great news is we have medications that can protect us from acquiring HIV. If someone is HIV-negative and exhibits high-risk behavior (unprotected sex, same-sex intercourse, being diagnosed with a previous sexually transmitted infection, or injecting drugs), taking preventive medication as prescribed can reduce the risk of HIV transmission by up to 99%.
Access to HIV medication for prevention is not available in all countries, and a lack of awareness in the public further inhibits access. Only 36 percent of the 1.2 million people in the U.S. who may be at risk for acquiring HIV are taking prevention drugs. Many Americans may think they aren’t at risk or don’t know preventive medication is available.
HIV prevention has transformed since 2012, when antiretroviral medications first became available for high-risk individuals. Medication prevention protocols are targeted for short-term or long-term use: PEP (Post Exposure Prophylaxis) for emergency prevention, and PrEP (Pre-Exposure Prophylaxis) for long-term prevention. Prophylaxis means to prevent or control, as in the spread of disease, and both are used to avoid an HIV infection.
PEP is for emergencies only, such as a condom break, sexual assault, or finding out about HIV exposure after an event. It entails a short-term course of medication to prevent developing HIV. Every hour counts after exposure to HIV; medication should be started 72 hours or less after potential exposure for the drugs to work properly in preventing HIV. It is extremely important to contact your health care provider, an urgent care provider, or an emergency room physician immediately after risk of HIV exposure. If it’s been 72 hours, regular testing is still vital.
PrEP is for those who are regularly exposed to HIV, and often people who use PEP three or more times will be offered ongoing prevention treatment. Candidates for PrEP may include IV drug users, a person in a relationship with someone with HIV, someone with multiple partners, or sex workers. A woman who becomes pregnant with a man with known HIV can also utilize PrEP to protect herself and her baby.
Antiretroviral drugs for HIV prevention are available in pill and injectable form and can be used for at-risk adults and adolescents weighing at least 77 pounds. While it’s not a guarantee, taking these medications as prescribed before or after exposure can decrease the risk of HIV by up to 99% for unprotected sex and up to 75% for IV drug users. Some people may have side effects, such as headaches or gastrointestinal issues, that usually resolve after a few days. Always talk to your provider about any medication side effects.
PEP and PrEP medications and injections must be taken exactly as prescribed for maximum benefit in decreasing your risk of acquiring HIV. Prevention also includes blood tests for HIV, routine lab work, and checking for STIs, depending on each situation. Education on safe sex or IV drug use to prevent further exposure is also important.
Most insurance plans, along with Medicare and Medicaid, now cover PrEP and PEP medications. There are also services available for the uninsured. HopeHealth receives funding from the Ryan White HIV/AIDS Program to provide services for underserved populations with HIV/AIDS.
The long-term goal in the U.S. is to end the HIV epidemic through prevention and treatment. If you are at high risk or have questions about HIV, prevention strategies, or need HIV testing, contact HopeHealth’s Infectious Diseases department. Call (843) 667-9414 or visit hope-health.org to learn more.