Sexually transmitted infections (STIs) have presented significant challenges to the medical and scientific communities for nearly half a century. Perhaps no sexually transmitted diseases have been viewed as more vital to research and treat than the life-threatening duo responsible for millions of global deaths beginning in the 1980s: HIV and AIDS.
HIV (human immunodeficiency virus) is a sexually transmitted virus that attacks the immune system and reduces white blood cell counts until it potentially progresses to the status of acquired immune deficiency syndrome (AIDS), an outcome that is less certain today than it used to be. Over the past four decades, scientists have met the challenges of the AIDS crisis with steadfast determination, and now, modern treatments allow people with HIV to live long and bountiful lives without putting sexual partners at risk or fearing the advance of their condition into AIDS.
Development of HIV treatments
HIV medicines have come a long way. In the past, people with HIV had to manage many different medicines, each of which served a unique purpose and came with specific dosing instructions. Today, people with the illness can live long lives without ever really worrying about the condition developing into AIDS. New HIV treatments require patients to take only a single pill a day.
Combination antiretroviral therapy (ART) is the most effective means of treating HIV. Since the early 1980s, doctors and medical researchers have sought to minimize suffering and advance survival rates among people with HIV and AIDS. The first few years were marked by attempts and failures, but by 1986, scientists had begun to work with dideoxynucleoside reverse transcriptase inhibitors (NRTIs). This meant that short-lived but positive results during clinical trials would lay some of the groundwork for ART options today.
In the decades after researchers began experimenting with NRTIs, they continued to explore treatment options by testing and refining combinations of effective and semi-effective drugs from different classes. The first truly effective HIV treatments varied and generally required the patient to manage multiple types and classes of drugs in their daily regimen.
Patients also experienced severe and sometimes debilitating side effects from early HIV drugs. At the time, the top priority was increasing survival rates among HIV and AIDS patients, and it took a multitude of drugs to do this—not to mention the sometimes complex instructions required to take the treatments properly—and that could lead to any number of adverse reactions in patients.
Those early efforts contributed immensely to the medicines available today. As side effects were minimized or eliminated over time, and patients began living longer, healthier lives, legislative and social efforts also helped create channels of support for people seeking access to medication.
Now, doctors working with new diagnoses of HIV can confidently prescribe patients an easily manageable medication plan. Social programs help people get the lifesaving medicines they need through programs like Medicaid and the Ryan White HIV/AIDS Program.
Modern HIV treatments and prevention
Modern ART medicines are able to prevent the virus from multiplying inside the body, and in doing so, they keep the viral load count down. The goal of treatment with new patients is to get them immediately and consistently on medication so that within six months, the viral load drops to undetectable levels.
Once HIV is undetectable, the damage it does to the system is all but neutralized and the patient will remain with an undetectable status so long as no significant health event or deviation from treatment occurs. It's important to remember that HIV medicines will not prevent the transmission of other STDs. The only way to verify your sexual health status and viral load count is to receive professional screening from a qualified medical provider.
Another optimistic aspect of medicine and HIV is the effectiveness of pre-exposure prophylaxis (PrEP). PrEP is a once-a-day medication people can take to avoid contracting HIV in the event they are exposed to it. It works by blocking an HIV-specific enzyme to prevent the disease from being able to replicate in sufficient quantities to survive inside the system.
Another development that resulted from those early efforts and clinical trials, PrEP has helped reduce the number of new HIV diagnoses per year. The Centers for Disease Control and Prevention (CDC) describes PrEP as being about 99 percent effective in preventing HIV transmission during sex and about 74 percent effective at preventing transmission during shared injection drug use. Anyone who participates in activities considered to be high risk for contracting HIV (e.g., unprotected sex, shared injection drug use) should consider talking to a doctor about getting on PrEP. Circumstances and requirements may change based on things like the patient's location and insurance coverage.
When HIV progresses to AIDS and/or the presence of additional, potentially opportunistic infections is confirmed, additional medications may be necessary.
Barring a few isolated and highly unique examples, HIV cannot be removed from the body altogether. It is an incredibly difficult virus that stores aspects of itself directly in the DNA of the seropositive person. That said, the most modern HIV medications are considered nearly 100 percent effective at reducing HIV's viral load count to undetectable levels and preventing the numbers from climbing again.
Outside of circumstances involving a derailing health issue or a life obstacle that may disrupt treatment, doctors expect to see patients newly diagnosed with HIV reach and maintain undetectable status while taking ART.
Another benefit of HIV treatment is the role it plays as a method of reducing new HIV cases. The CDC reports the following likelihoods of HIV transmission when the seropositive person maintains an undetectable viral load:
- Oral, anal or vaginal sex: Effectively no chance of transmission.
- Pregnancy, labor and child delivery: One percent chance of transmission, dependent on the mother's adherence to treatment protocols and the infant's consumption of HIV medicine for four to six weeks after birth.
- Shared injection drug use: Uncertain, but reduction in risk currently assumed.
- Breastfeeding: Substantial reduction, but not the elimination of risk. Breastfeeding is currently not recommended for mothers with HIV.
Mental impact of living with HIV/AIDS
A wide array of factors can contribute to an HIV/AIDS diagnosis' effect on a person's mind. An estimated 32 million people have died from complications resulting from HIV/AIDS since the start of the epidemic, a number that represents a little less than half of all people diagnosed. On some level, we are all aware of the massive death toll of this virus. The suffering of past patients has become a visceral part of our collective consciousness.
On a deeper level, anybody who is diagnosed with or is close to someone diagnosed with HIV is likely to have personal experiences or feelings surrounding issues like sexuality, relationships, bigotry, sexual health or any number of complex cultural issues that sometimes intersect with the world of HIV. Even though HIV is a manageable condition in the best of circumstances and AIDS is no longer a looming inevitability for the newly diagnosed HIV patient, these mental and social factors still hold tremendous weight.
If you've recently been diagnosed with HIV or you know someone who has been, remember that real support in whatever form available is crucial. HIV is a stressor and an experience that might prove to be too much at times, and that’s okay. Resources you might tap into can include counseling, behavioral support medications (e.g., antidepressants, anti-anxiety meds), art therapy programs, support groups and community organizations. Even simple, neighborly warmth can go a long way toward making any person's day better. For seropositive and seronegative people alike, these seemingly benign sources of support and comfort could be lifesaving on any given day.
If you or someone you know is living with an HIV diagnosis or has experienced trauma related to HIV or AIDS, remember the interpersonal definition of "treatment" is just as important as the medical one: How we treat one another, as well as how we treat ourselves, is part of what leads to better advancements in medicine and better practices by people. We've finally begun to learn to treat people living with HIV and AIDS with decency and respect. Overcoming the stigma and mental health hurdles associated with these conditions is the next step.