by Alessandro Zancla, MD
I sometimes share experience and points of view with colleagues who work abroad and we talk about the differences between countries and healthcare systems. One of the most important topics in Public Health is HIV and its prevention: on this, we all seem to agree that not enough is being done to inform and educate the public (especially young people) on HIV and STDs in general.
Family and the school system have left an educational void on sex and STD prevention; without that education, adolescents often turn to the Web for answers.
If we take a quick look at online forums and websites boys and girls use to share information and advice on sexual matters, we immediately realize one thing: they know little, and what they do know is often dangerously incorrect.
Some teenagers are even convinced that there is a vaccine for HIV or that the contraceptive pill can protect against STDs.
It is clear that there is a desperate and urgent need for correct information and education.
We all share responsibilities in this.
– Families need to acknowledge that the average age for having sexual intercourse for the first time is about 17 years old (https://www.cdc.gov/nchs/nsfg/key_statistics/s.htm). Parents should talk about sex and health with their children, and they should do so in time.
– Governments should seriously consider their role in safeguarding public health and put more effort and resources into education and prevention. This is difficult since it means fighting against pressure from certain ideological and religious groups who insist on standing, for example, against the use of condoms; however, it is necessary now more than ever. Awareness of HIV has progressively decreased among the population in the last 20-25 years, and where lack of precaution is combined with ignorance and false senses of safety, results can be catastrophic.
– Doctors and healthcare professionals, in general, should put more effort into informing young patients and educating parents on how to address these important matters with their kids.
This article aims to shed some light on HIV-related issues and answer some of the most frequently asked questions on the topic.
First of all, let’s take a quick look at some facts:
- About 1.1 million people in the US were living with HIV at the end of 2014, and 1 out of 7 didn’t know they were infected
- In 2015, 39,513 people were diagnosed with HIV
- In 2015, 41% of newly diagnosed patients were aged 13-29
- At the end of 2015, the total number of people diagnosed with HIV was over 2 million
- In 2015, 153,000 people were diagnosed with HIV (the highest annual number since the 1980s)
- It is estimated that around a third of infected subjects do not know they are positive/infected
- What is HIV exactly and how does it cause the disease?
Briefly, HIV is a virus that infects a certain type of immune system cells (T CD4 Lymphocytes), which play a key role in fighting against infections and tumors.
This virus reproduces within the cell and then destroys it, releasing new copies of itself in the blood stream. The virus will, in turn, infect other Lymphocytes, and so on. Initially, thanks to the high number of T cells present in the blood, and to an increase in their production by the bone marrow, the loss of cells is balanced and the immune system keeps on working fine.
After some time, though, if the infection is not diagnosed and treated, the T CD4 cell population progressively decreases (due to the exponential replication of the virus); recurrent infections occur and the risk of tumors increases. As the disease advances, the immune system is heavily impaired until the patient reaches a state of full-blown immunodeficiency (AIDS syndrome).
- How can it be treated?
Let’s get one thing straight: currently, we do not have a vaccine or a complete cure for HIV. Modern drugs allow us to control viral replication, so today HIV patients live longer and healthier lives than previously possible. An early-diagnosed patient may, in theory, have a normal life expectancy, but the toxicity of the drugs used and HIV-related diseases that can arise cannot be underestimated when evaluating the quality of life. Furthermore, only about 25% of the cases are diagnosed early.
- How is it transmitted?
HIV can be transmitted in three ways:
- Through unprotected vaginal, oral and anal intercourse
- Through injection or direct contact with wounds with infected blood or blood-contaminated body fluids or tissues
- From mother to child during pregnancy or, more often, labour
- How can it be prevented?
- By using condoms
- By taking the test (there also is a self-diagnosis test you can buy and do at home on your own, it is almost as precise as the standard laboratory tests)
- By having unprotected intercourse only with a mutually monogamist partner (better if after both have taken the test)
Now let’s answer some of the most frequently asked questions:
- Is it more likely for prostitutes to have HIV and STDs?
Yes, it is, even if it is hard to tell precisely. Since STDs are transmitted through intercourse that is not protected by barrier means (condom), if prostitutes do not use condoms and have a high number of sexual partners, there is a higher risk they may be infected with STDs.
- How long does the virus survive outside the body?
HIV can resist in the environment for only a very short period of time and it is easily destroyed by heat, disinfectants and common soap.
- Can it be transmitted through mosquito bites?
- What symptoms develop when a person is infected?
Depending on the subject’s health conditions and other factors, many months can go by before the first symptoms appear and they are not always specific at the beginning. When typical HIV-related pathological conditions occur (infections by unusual agents, Kaposi sarcoma, lymphomas…) the patient is already in full-blown AIDS stage. This phase can be reached even years after infection occurs.
- Is it true that condoms must be used from the beginning of intercourse?
Yes, because the virus is also present in the lubricating genital secretions.
- What kind of interaction is necessary in order for the virus to be transmitted?
The virus can only be transmitted through blood or unprotected sexual intercourse; it cannot be transmitted through sweat, urine, faeces, coughs, sneezes, saliva, non-sexual physical interactions, cutlery, glasses, towels, shower or by sharing school/sports/work environments.
- Is it true that there is a drug that can be taken before having unprotected intercourse to prevent infection?
Yes, it is true; one of the drugs used to treat HIV infection has lately been released with the indication to be taken before unprotected intercourse in order to prevent HIV infection.
However, I believe that the use of this drug is very dangerous for the following reasons:
- Like all drugs, it doesn’t have 100% efficacy, so there still is a minimum risk of infection.
- It does not protect against other STDs.
- It does not prevent unwanted pregnancies.
- It creates a false and dangerous sense of safety.
- It helps the spreading of other diseases through unprotected intercourse.
- The widespread diffusion of the drug can enhance drug-resistance abilities in the virus (a process that has already begun), and this, in turn, can make our therapies less helpful for those that are infected.
So what can we do to improve the situation?
- Empower families in educating and informing the young.
- Organize sexual education and health classes in schools.
- Eliminate taxes on condoms (this measure would pay for itself through savings gained by the reduction in STDs incidence).
- Broadcast educative TV ads and infomercials.
- Demand serious efforts from ministries and the Government.
As for other STDs, prevention is ALWAYS based on the same strategy: the use of condoms.
In conclusion, the only way we can fight and defeat HIV is to work together, ensuring a high level of awareness, educating and informing people, and acting with responsibility and broad foresight.
Governments should play a more responsible and independent role, setting aside religious pressures to safeguard public health. They should make brave decisions especially in terms of educating young people, promoting the use of condoms and explaining their importance.
But this, maybe, is the hardest challenge of all…
Alessandro Zancla graduated from Medical School at the University of Rome “Tor Vergata”
and is now a Public Health Residency Trainee at the University of L’Aquila – Italy
Sources and useful web links: