I have HIV. You have AIDS. What's the difference & does it matter?

As we move into the fourth generation of HIV, I often ask myself if the other half of that infamous acronym should still be part of the HIV/AIDS pair. AIDS, even 30 plus years later, conjures images of the archetypal AIDS ‘victim’ of the 80s dying alone and suffering in shame. We know that the more than 30 Million people whom have died from AIDS or HIV-related deaths since the early days were not victims nor did they need to carry any shame of the disease even though society insisted otherwise. Unfortunately, many did die alone and suffered unnecessarily. Such images are not today’s images of people surviving with HIV, and an AIDS diagnosis today does not elicit an automatic downward spiral to death. 

--HIV disease continues to be a serious health issue for parts of the world. Worldwide, there were about 2.1 million new cases of HIV in 2013. About 35 million people are living with HIV around the world, and in 2013, around 12.9 million people living with HIV were receiving antiretroviral therapy (ART) 

--To date, an estimated 658,507 people diagnosed with AIDS in the United States have died 

--An estimated 1.5 million people died from AIDS-related illnesses in 2013, and an estimated 39 million people with AIDS have died worldwide since the epidemic began

 

By no means am I denying the fact that people continue to die from HIV related illnesses or AIDS; however, with today’s treatment and ART options people are dying due to inability to access HIV medications/treatment and the large percentage of people with HIV (including the 1:5 people who do not know they are HIV positive) who are not adherent to medication or undetectable (viral suppression), making them more susceptible to HIV related illnesses. This speaks to the need for universal HIV testing, the importance of knowing you and your partner’s status, and equal access to life saving medications and treatment. 

In the beginning of the HIV/AIDS pandemonium, AIDS diagnoses were common and held inherent dire consequences. The HIV disease progression moved rather quickly from Asymptomatic to AIDS. Over the years, the progression from HIV to AIDS without medication or treatment can still take up to 10 years (more or less for a percentage); however, with correct medication and treatment a person surviving with HIV may never progress to AIDS. Also, once an individual is diagnosed with AIDS, presently, and they become undetectable and their CD4s climb to a healthy range that AIDS diagnosis does not go away: from that point on the individual is labeled as having an AIDS diagnosis. 

So, what is the difference between HIV and AIDS?

Historically, the acronyms of HIV and AIDS have been used interchangeably and, unfortunately, too many people think HIV and AIDS are either the same illness or completely different illnesses. This has contributed to the overall social mis-education and stigma regarding the HIV disease progression to AIDS. So, how does HIV progress to AIDS and is this progression inevitable?

HIV Stage 1: AKA Primary HIV infection or Acute Retroviral Syndrome (ARS). ARS develops within 2 to 4 weeks after infection with HIV; one may feel sick with flu-like symptoms or display no symptoms of ARS. At this time, there is a high production of HIV in the body, which creates the need for more CD4s to fight off the virus creating an overall decrease in CD4s. It is important to know that an individual is most infectious at this time and capable of transmitting HIV to others due to the high replication of HIV in the body. Formation of antibodies takes place at this time (integral in HIV testing) and seroconversion (converting from HIV negative to HIV positive) takes place as well. 

HIV Stage 2: Clinical latency (inactivity or dormancy) is the period that is often called asymptomatic HIV infection or chronic HIV infection. The virus still exists and is developing in an individual at this time without producing any symptoms. It is important to remember that a symptom-free person is still highly capable of transmitting HIV to others. This reflects the need for early and routine HIV testing. If one is unaware of their HIV status, then they are just as unaware of unintentional transmission. If not on ART at this point, a person with HIV viral load will increase and CD4 count will decrease ushering in the AIDS diagnosis. Without treatment, a person lives in the clinical latency stage on average 10 years. With treatment, a person can live in the clinical latency stage for decades and may never progress to an AIDS diagnosis. 

HIV Stage 3: AIDS: This is the stage of infection that occurs when your immune system is badly damaged and you become vulnerable to infections and infection-related cancers called opportunistic illnesses. When the number of your CD4 cells falls below 200 cells per cubic millimeter of blood you are considered to have progressed to AIDS. (Normal CD4 counts are between 500 and 1,600 cells/mm3.) You can also be diagnosed with AIDS if you develop one or more opportunistic illnesses, regardless of your CD4 count. Without treatment, people who are diagnosed with AIDS typically survive about 3 years. Life expectancy once someone has a dangerous opportunistic illness falls to about 1 year. People with AIDS need medical treatment to prevent death. Without ART, a person with AIDS plus an opportunistic infection has an average one year life expectancy. 

Is it sill necessary to distinguish between HIV and AIDS diagnoses?

This is where the dilemma of the HIV related illnesses and deaths versus AIDS deaths come to a head. Today, once an individual is diagnosed with AIDS (either newly diagnosed or due to lack of ART) death is not the only possible outcome. The advent of having over 30 HIV medications in five different medical classes is how one can easily move from an AIDS diagnosis back to surviving with HIV and returning to a healthy status. Following this line of medical ‘logic’, then what is the significance of distinguishing between HIV and AIDS? At this point and in today’s HIV culture, AIDS-related deaths today may actually be HIV-related deaths.  I urge the medical community to move from AIDS diagnoses to diagnosing individuals among an HIV Illness Continuum. 

Not only does the AIDS diagnosis never go away neither does the AIDS-associated stigma. Just as AIDS conjures up the gloomy images of early AIDS sufferers, AIDS also implies death without exception. We have learned that this does not have to be the case at this point in the HIV realm. Thus, the medical community needs to realize the irrelevance of distinguishing HIV and AIDS. This only creates a culture of have and have nots where it is better to be HIV positive than to have AIDS or any other mutation of this form of skewed thinking. 

Perhaps, a shift in the HIV/AIDS paradigm may be the shift in social stigma associated with HIV and AIDS. Part of the HIV-related stigma is due to the AIDS era when one became HIV positive and transitioned to AIDS quickly ending in an untimely death. The fear of the disease and death are real and has far-reaching consequences. 

In closing, the landscape of HIV is forever changing and AIDS may no longer need to be such an influential diagnosis. Moving away from AIDS is by no means denying AIDS or forgetting the millions whom have suffered from and succumbed to AIDS since the ominous plague of the early 80s. It is imperative to remember and preserve the legion who have died and revere them by distinguishing their plight as AIDS and honoring them as warriors. This fourth generation of HIV may be the watershed where we move into a post-AIDS (possible AIDS-free) society. 

Bryan Heitz

Risk Reduction Specialist

Ryan White: What You Need to Know

Next Tuesday, August 18th, marks a momentous milestone in the world of HIV--the 25th anniversary of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. The Ryan White CARE Act has undergone five legislative reauthorizations (1996, 2000, 2006, 2009, and 2013) and is now known as the Ryan White HIV/AIDS Program (RW Program). 

Ryan White HIV/AIDS Program (RW Program)

The Ryan White CARE Act was passed by Congress in 1990 in response to the growing number of new HIV diagnoses, more people progressing to AIDS, and a vast majority of people living with HIV/AIDS (PLWHA) were uninsured or not adequately insured facing insurmountable medical costs. 

The RW Program by its 'Parts'

Part A funds may be used to provide continuum of care (medical and psychosocial support services) for people living with HIV. Core medical and support services are limited to:

• Outpatient and ambulatory medical care
• AIDS drug assistance program
• AIDS pharmaceutical assistance
• Oral health
• Early intervention services
• Health insurance premium and cost-sharing assistance for low-income individuals
• Medical nutrition therapy
• Hospice Services
• Home and community-based health services
• Mental health services
• Substance abuse outpatient care
• Home health care
• Medical case management, including treatment adherence services

To discover agencies in Las Vegas offering services funded by RW Part A

Part B funds core medical services and support services. Support services that are needed for people with HIV/AIDS to achieve their medical outcomes include respite care for caregivers of people with HIV/AIDS, outreach services, medical transportation, linguistic services, and referrals for health care and support services.

Core medical services include:

• Outpatient and ambulatory health services
• ADAP
• AIDS pharmaceutical assistance
• Early intervention services
• Health insurance premium and cost-sharing health services
• Mental Health
• Outpatient substance abuse care
• Medical Case Management
• HIV Treatment adherence services

To learn more about RW Part B and the above services in Las Vegas

Part C funds cover the following:

• Primary care providers
• Lab, x-ray, and other diagnostic tests
• Medical and dental equipment and supplies
• Patient education in conjunction with medical care
• Transportation for clinical care providers to provide care 
• Other HIV/AIDS-related clinical and diagnostic services and periodic medical evaluations of people with HIV/AIDS
• HIV post-test counseling

Sadly, I speak with many people living with HIV or not that have no recollection of who Ryan White is or is simply known as that kid with AIDS from the 80s. In 1984, at the age of 13, Ryan White was diagnosed with AIDS. At the time, Ryan was living with his mother, Jeanne, in a small blue-collar Indiana town, Kokomo, where they were instantly met with fear, prejudice, discrimination, and hate. He experienced instant stigma due to little to no HIV/AIDS-specific education. Ryan was barred from school in Kokomo and local parents only perpetuated the stigma by keeping their kids out of school until he was removed. Finally, the energy in their town became so toxic that the family moved to a more accepting town.

Ryan was diagnosed in that first wave of AIDS and died, at the age of 18, in 1990, just months before Congress passed the Ryan White CARE Act. Ryan White became a voice for AIDS but should be remembered as a young man who was more than a voice for AIDS and as the son of his mother Jeanne, who is an amazing HIV activist in her own right! Read about Ryan in her own words here. 

On a personal note, I remember Ryan White and the intense fear of the time. In 1984, I was 10 years old and had recently moved from California to Wabash, Indiana, which is a small town less than an hour from Kokomo and Ryan White. The stigma and ignorance was so rampant that my classmates and I were introduced to AIDS because the fear of the disease spreading to surrounding schools was real. Ryan was my introduction to the world of AIDS, the power of stigma, and the need for education. To learn more about Ryan, visit http://www.ryanwhite.com.

Bryan Heitz

Risk Reduction Specialist

Hepatitis: What You Need to Know

Since National Hepatitis Testing Day was last week, it seems as if a discussion regarding Hepatitis, HIV, and Co-Infection is needed to emphasize why such testing days are important and need to be celebrated. It is vital for all people to be tested for Hepatitis (A, B, and C), but it is imperative for those of us living with HIV to be tested on a regular basis. Other than testing, it is important for all, especially those of us living with HIV, to be vaccinated for Hepatitis A and B. Unfortunately, there is not a vaccination for Hepatitis C. It is important to remember that testing and early detection is vital to treatment and survival. Treatment exists for Hepatitis A, B, & C. Presently there is only a cure, relatively new, for Hepatitis C. FDA-approved drugs have recently had a 90% cure rate for HCV; however, the costs related to such meds are expensive but should decrease as competitive medications begin to be approved.

This is a condensed lesson on Co-Infection of HIV & Hepatitis, as well as an explanation of differences among the three most common types of Hepatitis virus: HAV, HBV, and HCV.

Co-Infection HIV & Hepatitis

• Conditions associated with Hepatitis B and C are currently among the leading causes of hospital admission and death in the HIV-infected population
• Therefore, the adequate management of Hepatitis B and C is now being considered a priority in HIV co-infected patients
• Since there is not a 'cure' at this time for Hepatitis B, the main goal of treating HBV/HIV co-infection is to stop or slow down HBV viral activity as much as possible and for as long as possible
• It is important to remember that both HIV and HCV are treatable for most patients, including the majority of HIV-positive people
• Once an individual is either HIV-positive or HEP B/C positive, they are still able to be re-infected with another strain of HIV or HEP virus OR a drug-resistant strain
• Because HBV & HIV are both blood borne viruses transmitted primarily through sexual contact and injection drug use, a high proportion of people at risk for HIV infection are also at risk for HBV infection
• About 1/4 of HIV-infected persons in the United States are also infected with HCV
• There are < 1.2 million people living with HIV in the U.S.

Hepatitis C (HCV)

• HCV is spread primarily through contact with the blood of an infected person
• In 2012, there were an estimated 21,870 cases of acute Hepatitis C virus infections reported in the United States
• An estimated 3.2 million persons in the United States have chronic Hepatitis C infection. Most people do not know they are infected because they don't look or feel sick
• Approximately 75-85% of people who become infected with Hepatitis C virus develop chronic infection
• Today most people become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs
• The risk of sexual transmission increases for those who have multiple sex partners, have a sexually transmitted disease, engage in rough sex, or are infected with HIV
• Although anyone can get Hepatitis C, some people are at greater risk, such as:
• Current injection drug users (currently the most common way HCV is transmitted in the U.S.)
• Past injection drug users, including those who injected only one time or many years ago
• Recipients of donated blood, blood products, and organs prior to 1992
• People who received a blood product for clotting problems made before 1987
• Hemodialysis patients or persons who spent many years on dialysis for kidney failure
• Recipients of blood or organs from a donor who tested positive for the Hepatitis C virus
• HIV-infected persons
• Approximately 15,000 people die every year from Hepatitis C-related liver disease
• Of every 100 people infected with the Hepatitis C virus:
• 75-85 people will develop Chronic HCV
• 60-70 people will go on to develop chronic liver disease
• 15-20 people will go on to develop cirrhosis over a period of 20-30 years
• 1-5 people will die from cirrhosis or liver cancer

Hepatitis B (HBV)

• Hepatitis B is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness
• Hepatitis B is most commonly spread through sexual contact and accounts for nearly two-thirds of acute Hepatitis B cases
• Many people with chronic HBV infection do not know they are infected since they do not feel or look sick. However, they can still spread the virus to others and are at risk of serious health problems themselves
• Hepatitis B is 50-100 times more infectious than HIV and can be passed through the exchange of bodily fluids such as semen, vaginal fluids, and blood
• Although anyone can get Hepatitis B, some people are at greater risk, such as those who:
• Have sex with an infected person
• Have multiple sex partners
• Have a sexually transmitted disease
• Are men who have sexual contact with other men
• Inject drugs or share needles, syringes, or other drug equipment
• Live with a person who has chronic Hepatitis B
• Are infants born to infected mothers
• Are exposed to blood on the job

Hepatitis A (HAV)

• Hepatitis A can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months
• Hepatitis A is usually spread when a person ingests fecal matter - even in microscopic amounts - from contact with objects, food, or drinks contaminated by the feces, or stool, of an infected person
• Hepatitis A is the least common of the Hepatitis viruses with only about 3,000 cases in 2012

Bryan Heitz

Risk Reduction Specialist

Serodiscordant Relationships: What You Need To Know

Viral Suppression, Risk, and Serodiscordant Relationships: Should Serodiscordant couples practice safer sex practices? What's the real-life risk of HIV transmission? 

Remember seroconversion from your HIV 101: the physiological conversion from being HIV negative to becoming HIV positive. HIV statuses are reported in terms of positive and negative. Thus, Serodiscordant couples, also referred to as Magnetic Relationships, are those couples where one partner is HIV – and the other partner is HIV +.

As we enter the fourth generation of HIV, we are surviving the disease and living longer lives than those in previous generations. Along with this amazing gift of survival, HIV positive men and women are faced with a myriad of new issues including mixed-status dating and relationships, creating a number of Serodiscordant couples. Serodiscordant couples are presented with a unique set of circumstances to circumvent in order to have an open relationship and a healthy, safe sex life. 

In a 2013 article, John Sovec discusses how Serodiscordant couples are faced with more anxiety and fear than many relationships due to the fear of unintentional HIV transmission: often both the positive partner fears transmitting HIV and the negative partner fears becoming infected. Other challenges include worries regarding HIV care if the positive partner becomes sick, finding psychosocial support for both partners (more services available for the negative partner in a Serodiscordant relationship are needed), and issues of disclosure (who do you tell that your partner is positive?) to name a few. Creating an open dialogue is crucial for any healthy long-lasting relationship; however, it may be more crucial for Serodiscordant couples due to the health risks involved in keeping secrets and lack of communication. "These worries can create a barrier to true intimacy and leave each partner feeling unfulfilled. This is a time when each partner must risk talking about his or her needs, what forms of sexual contact feel safest, likes and dislikes, and how the couple can find ways to keep their sex life active and intriguing."

Are safer sex practices necessary in a Serodiscordant relationship if the HIV positive partner is in treatment, seen regularly by a doctor, and is undetectable? 

 Serodiscordant couples persist with a silent goal in mind: to keep the HIV negative partner negative and to keep the HIV positive partner healthy and undetectable. The goal of becoming undetectable, or viral suppression, is two-fold. One, viral suppression is key in HIV positive people to maintain a healthy CD-4 count, an undetectable HIV viral load, and long-term survival. Second, viral suppression is integral to HIV Prevention due to the fact that having an undetectable viral load carries a low to no risk of HIV transmission depending upon the research. 

Research conducted and reported upon over the last several years regarding Serodiscordant couples and HIV transmission, when the HIV positive partner is undetectable, cumulatively suggest that the real life transmission of HIV between mixed-status partners is extremely low to none. Most recently, the PARTNER study (a study on HIV transmission among Serodiscordant couples where viral suppression is reached in the HIV positive partner) reported on their findings after the first 2-year mark (the full report will be expected in 2017 after the final phase of the study is complete). The findings are remarkable and may offer astounding news about preventing HIV transmission with or without condom use. The unique thing about this study in regard to many earlier studies is that both heterosexual and homosexual couples and sex are included in this study: data from over one thousand mixed-status couples and thirty thousand sexual encounters were collected. Two years into the study, not one instance of HIV has been transmitted regardless of condom use, regardless of whether the couples engaged in anal or vaginal sex. The study also reports that the maximum chance of HIV transmission during viral suppression is 1% for anal sex (insertive or receptive) and 4% for anal sex with ejaculation (with a receptive negative partner). "When asked what the study tells us about the chance of someone with an undetectable viral load transmitting HIV, presenter Alison Rodger said: Our best estimate is it's zero." 

Does this mean that those of us in Serodiscordant relationships can toss out the condoms? Not necessarily; however, this is extremely optimistic and viral suppression may be one of our greatest weapons in the arsenal to contain HIV and move closer to the goal of an AIDS-free generation. It is imperative to remember that open and honest communication regarding condoms, unprotected sex, and risk associated with various sexual acts, etc. is necessary for Serodiscordant couples to make their own decisions based on facts and personal decisions. Ultimately, it is up to the individuals within the couple and centers on the HIV positive partner's adherence history and viral load.

Personally, my partner and I have been together for nearly 8 years. We began dating less than a year following my HIV diagnosis. To this day my partner is HIV negative. I become livid when it is assumed that he is HIV positive simply because I am and we are in a relationship. I do not become upset out of shame or fear, but because of the ignorance in that assumption: it is impossible for two mixed-status individuals to have a healthy, 'normal' long-term sexual relationship without both ending up HIV positive. Yet, this assumption is partly to blame for why we see young gay men seek out HIV infection; why some HIV – allow themselves to seroconvert (become HIV +); and why PrEP is being peddled to Serodiscordant couples. 

Hopefully research will continue to support the findings of low to no risk of HIV infection with ART therapy & viral suppression and HIV concerns will no longer be a part of the equation for love and healthy relationships. 

For further reading: 

Should HIV Serodiscordant Couples Always Take Preventative Measures? Experts Debate

Undetectable Viral Load Essentially Eliminates HIV Transmission Risk in Straight Couples 


Bryan C. Heitz
Risk Reduction Specialist
Community Counseling Center  

National HIV Testing Day

 

Saturday, June 27^th is National HIV Testing Day (#NHTD). HIV Testing, and retesting as necessary, is an integral part in HIV Prevention. Testing is the only way to know if you are HIV+ or not.

According to the CDC (2015):

• There are an estimated 1.2 million people living with HIV in the U.S.
• There is an estimated 50,000 new (reported) HIV diagnoses in the U.S. every year (the true number must be higher when we take into account those who become infected, do not test, and do not know they are infected)
• One in five people who have HIV don't know it. That means they aren't getting the medical care they need to stay healthy and avoid passing HIV to others

National HIV Testing Day is a reminder to get the facts, get tested, and get involved to take care of yourself and your partners.

 

Who should get tested?

EVERYONE! The CDC recommends testing at least ONCE a year for:

• —  Sexually active Individuals aged 13-64
• —  MSM(Men Who have Sex with Men)
• —  Injection Drug Users
• —  Men & women w/ more than one sexual partner
• —  Men & women who have had any STIs in their history
• —  Women who are or may become pregnant

When should you get tested?

Once a year or…every 3-6 months for more sexually active individuals & RETEST as needed depending upon your sexual activity

5 Reasons to get tested:

1. In the U.S., 1:5 people infected with HIV are unaware of their status    
2. Testing is the only way to know if a person is living with HIV
3. Even if you have been tested once, guidelines suggest RETESTING
4. If (+) test result, proper healthcare and drug therapies can stop the virus from progressing
5. If (-) test result, you can help stop the virus from keeping yourself protected

Get Tested. Know your Status. Share and Update your Status. Encourage those around you to get Tested. 

Bryan C. Heitz
Risk Reduction Specialist

Community Counseling Center

Newly Diagnosed with HIV? Read This.

Newly diagnosed with HIV? Finding out your positive status can be difficult but you are not alone. Once diagnosed, starting a new regimen of HIV meds is just another challenge. The following is a list of expected and common questions that come to mind prior to beginning treatment. Often one is attempting to make this decision while processing a new HIV diagnosis, compounding the difficulty of the decisions one is forced to make in order to survive with HIV.

The mental challenge of starting a new regimen of HIV meds:

• Are you hesitant to start treatment?
• What if it is the wrong medicine for me?
• Have you heard horror stories from friends or loved ones on HIV meds?
• What should you expect?

Challenges of Side Effects:

• What side effects should I look for from my meds?
• Will my HIV meds interact with other medication I am currently taking?
• How long will the side effects last?

Challenges of Cost and Access to Meds

• Will insurance pay for HIV meds?
• If I can’t afford my HIV meds, where can I find help with paying for my meds?
• Do pharmaceutical companies help pay for meds if I can’t pay for them?

For answers to these questions and a myriad of other questions, please refer to The Body’s web page, Resource Center on Starting HIV Treatment.

Bryan C. Heitz 

Risk Reduction Specialist, CCCofSN

Did You Know?

 

For more information about today's events, please visit the The Gay & Lesbian Community Center of Southern Las Vegas (The Center).