U=U: Empowering HIV Prevention Through Effective Treatment
For many years, contraction of human immunodeficiency virus (HIV), the cause of acquired immunodeficiency syndrome (AIDS), was a veritable death sentence. The development of effective vaccines and treatment therapies, however, has transformed HIV from an almost certainly fatal infection to a manageable and preventable chronic condition. There is technically no cure for HIV, but sustained viral remission is proven and well documented — and the goal of complete viral eradication may not be far away. HIV/AIDS-related deaths have fallen by 69% since the virus peaked in 2004, and by 51% since 2010. Still, in 2022, around 630,000 people died from AIDS-related illnesses worldwide.
Despite these significant advancements, many people are hesitant to speak about HIV. This taboo treatment contributes to a general lack of understanding, as well as discrimination, misconceptions, and even refusal of service to those most in need. In honor of World AIDS Day, we at American University of the Caribbean School of Medicine (AUC) wanted to take a step toward ending HIV stigma by building awareness of this now-manageable chronic condition.
Undetectable = Untransmittable: What Does It Mean?
Undetectable = Untransmittable, commonly shortened to U=U, explores the likelihood of an HIV-positive partner who consistently takes antiretroviral therapy (ART) transmitting the infection to an HIV-negative partner. ART requires those with HIV to take their medication exactly as prescribed to reduce their viral load, or the amount of HIV in their blood. If they can reach and sustain an undetectable viral load, those with HIV can virtually eliminate the chances of transmission.
Understanding the HIV Care Continuum
The HIV care continuum is a public health model that traces the steps that those living with HIV must take to reach and maintain an undetectable viral load. It also helps identify gaps in services for various populations, so policymakers and service providers can better serve and improve the health and wellness of people with HIV.
The steps in the HIV care continuum are:
- Getting diagnosed
- Accessing medical care after diagnosis
- Undergoing viral load tests to monitor and assess HIV blood levels
- Continuing medical care
- Reaching and maintaining low viral loads
At the end of 2022, an estimated 39 million people globally were HIV positive. Of those:
- 86% were diagnosed and knew their status
- 76% received medical care for HIV
- 71% were virally suppressed
Suppressing Viral Loads with Antiretroviral Therapy
HIV works by continuously destroying white blood cells within the immune system. These blood cells help the body fight off infection and recover after an illness. With ART, people living with HIV can suppress the condition and expect a normal lifespan. Without it, HIV will continuously multiply and attack the immune system, leaving the body more susceptible to illness.
Because of the low number of infection-fighting cells in their body, it’s hard for an HIV-positive person to recover from even a common cold. As the infection worsens and the body’s immune system is badly damaged, the condition progresses to AIDS. People living with HIV/AIDS who are engaged in treatment can now expect to live a normal lifespan, but life expectancy drastically decreases without proper medication. A damaged immune system makes people vulnerable to the worst effects of such opportunistic infections as:
- Cervical cancer
- Herpes
- Lymphoma
- Pneumonia
- Salmonella
- Tuberculosis
ART can suppress the viral load to undetectable amounts, but only if it’s taken as prescribed. ART is an excellent way to reduce transmission; it also improves the health and wellness of those living with HIV and AIDS. ART protects a person’s white blood cell count, which allows the immune system to protect itself, recover from infections, and prevent the infection from progressing to AIDS. ART is most effective if started immediately after an HIV diagnosis, but it can help those living with AIDS manage their condition.
2 HIV-Prevention Methods: PrEP and PEP
HIV prevention can happen before and after an encounter with an HIV-positive partner.
PrEP
Pre-exposure prophylaxis (PrEP) works best before exposure to HIV and can be taken as a pill or shot. Either method works well to prevent HIV in those with a high risk of contracting the virus. Currently, only two pills and one shot are approved for PrEP.
One pill is for anyone at risk of transmission through sex or injection drug use. The other is for males only; it is ineffective for those assigned female at birth or who are at risk through vaginal intercourse. We recommend that those interested in PrEP consult their primary care physician to learn more about their options.
PEP
Post-exposure prophylaxis (PEP) should only be used in emergency situations and is not a replacement for other HIV-prevention methods. PEP should begin within 72 hours of possible exposure and be taken daily for the next 28 days to prevent transmission. If taken after this 72-hour window, PEP may not prevent infection. PEP medications can be prescribed by health care providers or emergency room doctors.
What Is HIV Stigma in Healthcare?
HIV stigma refers to the negative attitudes and beliefs about those with HIV because of misconceptions and a lack of information. Some examples of HIV stigma include:
- Believing HIV can only be transmitted through certain groups or lifestyles
- Assuming those with HIV didn’t take proper precautions to protect themselves against the infection
This stigma often leads to discrimination. Some healthcare professionals may refuse to provide service, avoid physical contact, or use derogatory terms to refer to patients with HIV. This can make it unnecessarily uncomfortable and difficult for those in need of treatment to receive it.
Many people with HIV struggle with self-image and fear they will be treated or seen differently if anyone discovers their status. This can foster an internalized stigma that may cause those living with HIV to avoid getting tested.
What Can Be Done to Reduce HIV Stigma in Healthcare?
Reducing HIV stigma in healthcare begins with speaking openly about and normalizing the subject of HIV. Rather than treating it as something shameful, we should treat it with the same respect given to other medical conditions. This brings awareness to how the infection works, how it can be transmitted, what steps people can take to protect themselves, and, more importantly, how those with HIV can receive treatment.
This awareness can empower those who were previously hesitant to receive a diagnosis to take the first step toward viral suppression. This can both improve the quality of their life and make it easier for them to discuss their status with current or future partners, so they can also take proper steps to protect themselves.
Those in healthcare or aspiring to become healthcare professionals are responsible for providing quality care to those in need.
If you’re interested in the fight against HIV and other ailments, perhaps a career in medicine is right for you. Learn how you can earn a Doctor of Medicine (MD) degree at AUC and become board certified in internal medicine> with a subspecialty in infectious disease. Check out what AUC is all about, explore the campus on beautiful Sint Maarten, and see what it takes to become an AUC medical student. Lean into your future: Apply today!