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

 

When sex becomes more than just fun

Sex is fun, well, it should be, at least most of the time. That first moment when everything is new and exciting. You get caught in the moment and before you know it: a) you’re back on the street at 01.00 at night and the hangover just started b) you wake up at 7.30, smelling the others breath and think Why o Why? Or c) you fall in love and 15 years later have two children and write a blog on infectious diseases…

But although the sex was fun (most of the time), sometimes you’re reminded that you forgot something. Maybe it was the last thing on your mind, maybe you trusted the person you were with. What did you “forget”: a Condom. What is the name of that kind reminder: Sexual Transmitted Diseases, in short STD. 
Most of us are lucky we didn’t attract them, some are still thinking they were lucky and others, well they were less fortunate and got infected.

Let’s look at the STD’s/infectious diseases you don’t want to get after your fun night of sex and what the risk of getting it is. And for your benefit: I ranked it from most to least common.

1. Genital Human Papilloma Virus (HPV)

In first place, winner of the golden medal during the Ugliest STD-Olympics, leading the charts of the most common STD has to be: Genital Warts. Dreaded by all of us (if not, you have a rare fetish). But most of us are actually already infected with this without having any symptoms. Worse yet, this is a virus that can cause cervical cancer in women and anal cancer in men (who got the infection by having sex with another man, the virus doesn’t travel from your penis to your anus). Bad news: once you have it, you never lose it. Good news: we have a vaccine nowadays so we can protect our children from getting these cancers through this virus. Vaccines save our day!

2. Chlamydia

A very contagious runner up which most of us will know. It gives you discharge (for women different than normal, for man: you will know it is not semen). Women are the unlucky ones, because they can become infertile without ever having had symptoms. So, men and women: if you find out you have this, please let each other (or when you had a “busy” month: all of them) know. Easily cured with antibiotics, one pill and you’re done!

3. Trichomoniasis

The bronze medal goes to…Tri…Trichomo… Trichomonisch… sorry what? Trichomoniasis. This STD is unkown by many, but good chance you or someone you know has had it without even knowing it. Not deadly, no infertility, bad itchings and smell, but most don’t need medication. So boring, NEXT!

4. Gonorrhea

Good old Gonorrhea, just missed the top 3 but that doesn’t ruin the fun for this fella. Men come with a nice discharge from the penis or pus – big surprise coming up – in their knee, I know, their knee…. This doesn’t mean they did something like “Kneeing” somebody, but the bacteria likes to travel to a joint. We can treat this with antibiotics, for now at least.

5. Genital Herpes

Ouch. Just so painful to even look at this. Really contagious, just think of the cold sore a lot of people suffer from, it’s the same virus. The thing with Herpes is that if the lesions are located on a different spot than what the condom covers, you can get infected. But the infected person will know he has lesions – crusted spots – so if he/she is really as nice as you say, they will tell you… Maybe check it while you’re down there… Cause you can never get rid of it, it will go away for a while, … until it’s back again.

6. Syphilis

The great mimicker who actually is getting back in the race now that people aren’t scared of attracting HIV any more. Classically, you get sick in 3 stages. First stage is an ulcer that doesn’t hurt and goes away eventually. Some will not even notice this first stage. Second stage is a skin rash that also involves your palms and footpad, will also go away in time. If that doesn’t lure you to a doctor yet, stage 3 is neurosyphilis: when it hits your brain. Yep, this little guy deserves a blog of his own. For now, let’s just say that if you have it (tested in blood), antibiotics will cure you.

7. Hepatitis B

Depending on where you live this virus can be anywhere in the top 10. For example, most developed countries won’t have a lot of patients. There is a high chance of getting this, especially when there’s blood involved, easy peasy anal sex will do. Why? As you may know, the anus is not made to be stretched that way. Micro tears will turn up and they bleed. Blood contact with someone who is infected with hepatitis B gives you about 30% chance of getting it. This virus infects your liver and turns you yellow. Difficult to treat if you get the chronic version of the infection. So maybe at least wear a condom when doing anal sex or when your partner is menstruating? (or maybe without the question mark).

8. Human Immunodeficiency Virus

And last but certainly not least. HIV. Most famous, but actually you have a very small chance of getting. And with modern medicine it is even less. Why is it still so nasty: it is incurable. Not a death sentence anymore – especially in the Western countries – like it was in the 80’s, more like a very nasty chronic illness that requires you to take medication. For some easy with one pill once a day, every day, for the rest of your life, for others more troublesome.

There you have it, the 8 most common Sexual Transmitted Diseases. Some are easily attracted, but also easily cured. Others are more complicated in every way. The bottom line is that you have to know you have it.
Let’s not judge each other, none of us are saints. If you had an “accident”, just go see your doctor and get tested. Nobody will think you’re a slut or stupid, trust me, we’ve seen it all many times (and far worse). Let’s make sex just about fun!