HIV: PrEPare for the future

One day I read the magazine “Hello Gorgeous”, a glossy magazine about living with HIV. And I got a lot of looks, you know what I mean, not the ones you hope to get. Will this ever change? How I sometimes wish that I could just to take a quick glimpse into the future and know how everything will turn out. Just like I have this urge to skip to the part in the book where the killer reveals itself. But I never do. What fun is reading when you know the ending, what fun would living be when you know it all? So, I speculate and think about now and the future. And today, I think about the future of HIV.

The Future is now

What kind of world would it be if we would use pills to prevent ourselves from getting HIV?

Well, it is the world we live in now. As we speak healthy men who have sex with men (thus have the greatest risk), are given anti-HIV medication before they have unprotected intercourse in order to prevent them from getting the virus. The name: Pre Exposure Prophylaxis or in short; PrEP. And yes people, it’s a great success in the Netherlands. Instead of swallowing MDMA before going to a Dancefestival, men are PrEP-ing up before going to “party”. And it’s expanding to other countries as well (the usage of PrEP I mean, not parties, well, maybe those too, but…, never mind).

Now I know the most common response: we’re enabling people to have sex without a condom, it only protects against one STD, can’t they just wear condoms instead of taking medications that can have side effects? Oh wait, those were the responses to the contraceptive pill. They only protect against a child and certainly are invented to give us the freedom to protect ourselves to that one particular “STD”. However strange this “new” intervention might seem, maybe in the future we will look back and conclude it’s actually not so different than what we were already doing.

And whilst we’re there, in that future I mean, let’s check if my following HIV predictions came true.

I predict a second spike in HIV infections

With the lack of fear for HIV, I really think we will get a second peak in infections.

But why is this really a problem, I hear you say. Isn’t HIV a chronic disease nowadays that takes just one tablet once a day, so why bother, you add. Well, maybe you’re right (thanks for reading my previous post), … but maybe this will convince you:

There is not just one type of HIV, there are more with different resistance patterns.

If you go through life thinking “I already have HIV so let’s lose the condoms and have some fun”, I would say DON’T. You might attract a new different type of HIV, giving you a high viral load again. This type might be resistant to the drugs you were taking for your own type. Yes, HIV can become resistant to medications just like bacteria. And if that happens and we don’t find a way to cure the virus, we end up with a virus we’re not able to control any longer. And we’re Back to the Eighties, where the first HIV infected people suffered and died.

A different argument not “to shop” for HIV, is that having HIV makes you more susceptible for other diseases, especially other STD’s. Nowadays gonorrhea is becoming more and more difficult to treat and when (not if) the second HIV peak comes, there will definitely also be a gonorrhea outbreak that is not easily cured.

I’m confident that HIV has still unknown tricks to show us. It’s waiting, lurking in the dark…

I predict there will never be a HIV vaccine

Making vaccines is extremely difficult. In general researchers need three things from a disease in order to make a good vaccine.

  1. You can get a natural immunity for it. This means that some people recover from the disease by themselves or there are people known who just don’t get infected.
    HIV: Nobody has developed natural immunity against HIV.
  2. You have to be able to manipulate the pathogen in order to make sure it doesn’t really infect you. You want a vaccine to be safe, not to give you a deadly infection.
    HIV: No manipulation has fully succeeded to make it safe.
  3. You have to get sick from it.
    HIV: Nobody is sick because of HIV. Weird, but true. HIV doesn’t make you sick. It affects your immune system making it inoperable but the virus itself doesn’t cause a disease.

These things in combination with the fact that HIV mutates faster than the X men, outsmarting our immune system and all the different known subtypes, you can imagine the challenge. The attempts to make a vaccine have not been successful and unfortunately, I predict they never will be.

Let’s find a vaccine against stigma

One day I read the magazine “Hello Gorgeous”, a glossy magazine about living with HIV. And I got a lot of looks, you know what I mean, not the ones you hope to get. And that is unfair and unnecessary. If my predictions come true, which I don’t hope of course, HIV is here to stay. It’s a part of our past, present and yes, also our future. Let’s deal with it, accept and not be judgmental about it. My idealistic self would like to urge you to go to a public place and read something that clearly has HIV stated on it to get people used to it. But maybe the best vaccine against it, is just not to give in to stigma.
If you see me or anyone else read the magazine, don’t give that look. Just smile or give a friendly nod. Or, why not, let me be the idealistic hippy my husband always I am for once, let’s hug.

 

HIV, the power of fear

What are the chances of getting HIV? Take a guess. What if you use a needle of an HIV patient? What is the risk when having unprotected sex with an HIV infected person? The answer will follow, but I am 99,7% to 99,9% certain your percentages were too high.

What people used to fear

In the 80’s and 90’s people feared HIV. You get a megaload of viruses in your blood at once and your immune system gets severely beaten up. In the next 5-7 years of your life one by one your immune cells get killed by the virus, making it impossible to fight any infections. You get a pneumonia from a fungus that you normally don’t even notice. You die from the “simple” infections that seize any opportunity to make you sick (opportunistic infections). And you would die, weaker than an Autumn tree leaf.

Rules in how to get infected 

There are some “easy” ways to make sure you get HIV is you really want to (why would somebody try to get infected you ask now, just keep reading).
HIV is transmitted by blood and sex. The hospitals and blood transfusion banks test any donated blood for HIV (amongst other infections) so a blood transfusion won’t get you infected. When you are a big fan of injecting drugs don’t use clean sterile needles, same for tattoos. If you have sex with somebody you don’t know the HIV status of, never use a condom. If you do all this, you have a certain risk. Yay! Just kissing somebody won’t get you HIV and neither will hugging, touching or sitting on their toilet seat.

You might think I am crazy. Please understand, some people are really not afraid anymore. They no longer fear it. In some scenes it’s even a matter of “waiting until I get the infection” and they go have sex with HIV positive people to “just get it over with”.

Why people still get infected

Don’t they have self-control? Why is it so difficult to follow the “easy rules” not to get it? (read the previous part and add “not” in every sentence)
There are multiple possible answers to that.

First of all, people are not saints. Even the girls of All Saints asked for Booty Calls, and we all know what that stands for. You didn’t follow the rules all the time. For not following some easy rules, let’s call them mistakes, in life, well, be grateful you didn’t end up getting a horrible disease.

Secondly, using a condom is a bit of a nuisance. You’re in the middle of “something” and then you have to stop, find the condom, free the condom, lock the condom and then probably start the “something” all over again and finish the messing around until there is some unloading in the condom. Not really romantic, so yes, I understand that people in the heat of the moment skip that step.

But the actual answer why people still get infected is not about having self-control or if it is too difficult. It is about having a lack of fear. If smoking one cigarette today would lead to certain death tomorrow, people wouldn’t smoke. If having unprotected sex today would kill you within a week, well, I tink you’d do your utmost to find those condoms.

Low risk, not lethal

What are the chances of getting HIV? The actual risk to infection, and mind you these are rough numbers and very much influenced by the amount of virus in the blood, is actually not so high. If you use the needle from an HIV positive person (not on medication), your risk is approximately 0.3%. I know, you thought it was higher. If you have sex with an HIV positive person (with no medication), that chance is even lower. Depending if the woman or the man is infected it’s around 0.1%. Yes, it’s possible to get infected if you just have sex one time, but you are a very unlucky person. And of course the risks increase if you have sex with more people and especially with anal sex or other ways that give minor (or even major, still not judging) tears in anus or anywhere else getting blood involved.

What is really happening: unprotected sex, low chance of getting HIV, and if getting HIV, you don’t die tomorrow, you probably won’t even die within seven years, in fact: you might just die of old age. Almost overnight, HIV went from this terrible lethal disease to a chronic disease that’s easier treated than some types of diabetes. Some diabetes patients need three tablets three times a day. HIV patients take one tablet, once a day for the rest of their lives, with hardly any side effects.

Why use a condom? There is nothing to Fear.

Second wave of HIV infections?

This change in prognosis for the HIV infected patients was, and still is, great news. The number of newly infected patients with HIV is still declining. Also, great news. However, I predict a downfall, or upfall.

In the beginning of HIV, people were scared. They knew that they would die a horrible disease if they didn’t take care of themselves. They started to use more condoms. The rate of HIV infections went down, as well as for the other STD’s.

These days people are not fearing HIV. They’re less likely to use condoms, increasing their risk to all STD’s. We are already witnessing increases in STD’s like Chlamydia and Gonorrhea. These STD’s are easier to transmit then HIV. That might explain why we don’t see an increase in HIV infections, … yet.
I’m afraid we will be seeing a second spike in HIV infections in the near future. And then we’ll be living in a world with more complicated infections and an ongoing war against bacterial resistance.

It’s ok to be a little bit afraid sometimes. It might save your life.

Next time: the near future of HIV…

 

 

Image: http://www.dailytrust.com

Ground Sero: when the world saw AIDS for the first time

Did I ever tell you that I like infectious diseases? No matter how horrible they are sometimes. The beauty of an infection is that one day it’s the deadliest in the world, like a bacterial pneumonia, the next moment you have penicillin, and everything is different again. Horrible diseases get chronic almost overnight.
The scary thing is: you don’t know from the start what the disease is and if it will ever be treatable. The most notorious diseases in this case is the ultimate queen of infections: HIV, AIDS, SIDA, Kimi. The story is like a movie. Better said: the story is used in many movies. And there’s a reason. It has a spectacular start, a thriller like chase and a (sort of) happy ending. Let’s look at the start and how the world seroconverted.

1981
Reagan has just started his powerplay with the cold Russians, in Tanzania president Nyerere is working his fourth term and the Netherlands are recovering from the inauguration of Queen Beatrix. Three places in the world, miles apart that don’t have anything in common. Or so it seems. This year, all three of them and many more, will be confronted with a disease that nobody knows. Oh, and 13 year old Lisa Lopez has no idea yet that she will be conquering the world a couple of years later with TLC and their hit song “Waterfalls”. Why is that related? Just continue reading.

California, US of A
Out of the blue, hundreds of young men start dying. Young, gay men. It’s a disease nobody had seen before and gets referred to as Gay cancer. The first reports suggest that the disease is spread through inhalation of a substance (like the inhalation of poppers), and really, definitely not an infectious disease. It leads to an immunodeficiency in men with a “particular lifestyle”. Vegans have a particular lifestyle, as do priests and the Eskimo, but in this case they were referring to male patients that, in the year prior to the symptoms, had sex with many different men. Beware, this was before Grindr and the Gay pride. A new term is made to describe the illness: GRID – Gay Related Immuno Deficiency.

Moshi, Tanzania
On a completely different continent, Dr William Howlett also gets introduced to this new disease. However, the case definition is definitely different than the USA one. Here, they look out for flying testosterony hunks, the primary affected group seems to be travelling men and stewards, who can easily transfer the disease from one country to the next. And whatever you may think about business men and stewards, in the definition of Tanzania’s dictionary the word “gay” is absent.

Haarlem, the Netherlands
Closer to my home, my currently retired supervisor (then a flaming thirty-year old) Reinier ten Kate saw a great denial. Most specialists that get in contact with the disease, don’t recognize the disease and can’t evaluate the risks properly. They see regular infections, but then all at the same time. So, they are categorized as many diseases, instead of being this special one. Specialists that never had to deal with acute situations all of a sudden found themselves in the Emergency Room and doctors whose medical fields seemed miles apart suddenly had to sit together and discuss. Could it be? The Gay thingy from the USA? In the small country of the Netherlands, surely we wouldn’t get this disease, right?! But unfortunately, denial is not always the answer.

Moshi, Tanzania
In the meantime, Dr Howlett identified 200 female prostitutes as potentially infected. The idea that a disease could have preference for a sexual orientation is classified as ridiculous. Still today the biggest infected group in this country is women.

California, United States of America
Back to our American friends. It appears to be difficult to get political attention and money to conduct decent research. Since the disease is primarily seen in Homosexuals in this country, the Christians call it the Wrath of the Jedi Khan, wait, no sorry, a wrath of God (I always confuse the two).
However, other patient groups start to get infected. Hemophilia patients, that receive blood transfusions very often, get infected. This proves that the disease is blood transmittable and is not per se related to having sex with men. Regardless, the rule is started that gay men are excluded from being a blood donor. A personal frustration of mine seeing that I have female friends that are at more risk of becoming HIV infected than my best friend that spend years spooning his long-term partner.

1983, World
Apparent is that the term GRID didn’t quite cover the problem and a new abbreviation is introduced to the world: CD (Compact Disc). Oh, and; AIDS: Acquired Immuno Deficiency Syndrome, caused by the Human Immunodeficiency Virus (HIV).

1994, TLC
The newly formed girl group TLC try to help the world with their “Waterfalls” by singing about dangerous lives and the consequences of this, including HIV. In an attempt to cast of the stigma around the disease, they sing about a girl infecting a boy.

Read for yourself:
Little precious has a natural obsession for temptation
But he just can’t see
She give him loving that his body can’t handle
But all he can say is, “Baby, it’s good to me”
One day he goes and takes a glimpse in the mirror
But he doesn’t recognize his own face
His health is fading and he doesn’t know why
Three letters took him to his final resting place 

Other songs about HIV/AIDS:
Madonna – In this life
Elton John – The last song
Bruce Springsteen – Streets of Philidelphia
U2 – One
Acda en de Munnink – Niemand sterft aan liefde
Janet Jackson – Together again
And many more.

That’s the history, this is how we as a species got in contact with this new virus that changed many lives forever. But stay tuned, the story continues next blog!

IMAGE: APAP PHOTO/RICK MAIMAN