An infectious disease specialist separates fact from fiction
How much do you know about HIV/AIDS?
You may be aware, for instance, that HIV is transmitted through blood. But did you know that you can't get HIV from a mosquito? Or by kissing or sharing eating utensils with an HIV-positive person (science says it's not spread through saliva)?
The truth is, even with so much information about HIV/AIDS now readily available, there are still many misconceptions — and Beverly Sha, MD, an infectious disease specialist at Rush University Medical Center, has heard them all.
Sha has been on the front lines of the AIDS battle her entire career. Over the past three decades, she and her colleagues have cared for thousands of people with HIV/AIDS, both at Rush and at the Ruth M. Rothstein CORE Center, the largest outpatient clinic for the treatment of HIV in the Midwest and a leader in research.
We asked Sha to draw upon her experience and expertise to debunk some common myths about HIV/AIDS.
Myth: People in monogamous relationships don't need to be tested for HIV.
Fact: According to Centers for Disease Control, all sexually active people ages 13 to 64 years should be routinely tested for HIV at least once in their lifetimes.
More frequent testing is recommended if you have ongoing risk, including the following:
You are a gay man
You have had unprotected sex with more than one partner since their last test
You have used illegal intravenous drugs
Testing in people 65 years of age and older should also be considered on an individual basis.
If you are in — or are planning to be in — a committed relationship, both you and your partner should be tested before you start having sex. This is especially important if you plan to have unprotected sex, meaning without a condom (the only form of birth control that guards against HIV).
Myth: If I'm in a monogamous relationship, I don't need to use protection.
Fact: Even if you plan to be faithful to each other, one or both of you may have been exposed to HIV in the past. "If one of you is infected and is not on treatment, there's a risk you'll pass it to your partner," says Sha.
She recommends using condoms every time you have sex unless you're certain both you and your partner have tested HIV-negative and are being monogamous.
And if you or your partner has been diagnosed with HIV, it's important to safeguard the non-infected partner. While condoms are always a good protective measure, there is now an alternative: The partner who doesn't have HIV can take an FDA-approved anti-HIV medication called Pre-Exposure Prophylaxis, or PrEP.
PrEP is safe, and is highly effective at preventing HIV infection if taken once daily (for as long as prescribed by your doctor). The medication interferes with HIV's ability to copy itself in your body after you've been exposed.
Myth: AIDS is always fatal.
Fact: "It used to be a death sentence, but it's a whole different ballgame now," Sha says. "Now we have effective therapies. The data tells us that if someone is diagnosed in their 20s, and they are treated with FDA-approved medications — and take their medications as prescribed — we expect they can live into their 70s. Maybe by the time they're in their 70s, it will be even longer than that."
Thanks to those FDA-approved drug therapies, Sha says doctors can now rebuild the immune system of a person with HIV or AIDS.
"How well we’re able to do this varies. But, for instance, there's a woman who I've cared for since the early 1990s, and her T-cell count was 4 when she first came to Rush. Normal is over 600. Her count is now around 1,200," Sha says. "We can't get every patient's T-cells that high, but we can usually improve it, which helps people feel and do better."
The key is early diagnosis. The sooner a person is diagnosed, the sooner treatment can start and the more effectively the disease can be controlled.
While fewer people are dying of AIDS than 30 years ago ... the number of newly diagnosed people remains steady.
Myth: Because people are living longer with HIV and AIDS, I don't need to be concerned about getting it.
Fact: Although there are treatments, there still isn't a cure. And, according to Sha, there may be health consequences to both the disease and its treatments.
"All treatments have potential risks and side effects," she says. "At this point, you have to be on lifelong therapy, and we don't know the complete toxicity of being on an AIDS regimen for 50 years, because it hasn't happened yet. We haven't been able to study the long-term effects of these drugs."
Plus, even when HIV is controlled, research has shown that lingering inflammation in the body can affect your health. This includes increasing your risk of heart problems. Data suggests that people with HIV infection may have a twofold increase in their risk for cardiovascular disease.
HIV that is not well-controlled may increase a person's risk of certain cancers as well, including lymphomas and Kaposi’s sarcoma. And because hepatitis B and hepatitis C raise the risk of liver cancer, people co-infected with hepatitis B or C and HIV may experience faster progression of liver disease.
So even though more people are living longer with HIV and AIDS, it's still better to take every possible precaution to prevent infection.
Myth: HIV/AIDS is no longer an epidemic.
Truth: While fewer people are dying of AIDS than 30 years ago — both in the U.S. and developing nations — the number of newly diagnosed people remains steady. "We have not made a significant dent," Sha says.
What accounts for the majority of these new cases? People who are not aware they are HIV-positive, are not getting treated as a result, and are having unprotected sex. Part of the problem is that in the early stages, people with HIV don’t have symptoms and don't look sick, so they don't know they are infected.
"That's why testing is so important,” Sha says. "Once a person is diagnosed and starts treatment, and we drop their viral load to undetectable, their ability to transmit the virus is far, far lower. There's less virus in the body and, as a result, much less risk of infecting others."
Myth: Only rich people can afford HIV/AIDS treatment.
Fact: It's true that out-of-pocket costs for AIDS medications, which run about $2,000 a month, are daunting. However, all of the approved HIV/AIDS drugs are covered by both health insurance companies and Medicaid; patients are generally responsible for small copays.
Even if you don't have health insurance — and millions more Americans do now, thanks to the Affordable Care Act — you can still be treated.
For instance, Illinois offers the medications free of charge (for those who qualify) through its AIDS Drug Assistance Program, funded by the Ryan White Act.
The CORE Center can also help. "If you go in, they'll try to qualify you for the state's drug assistance program or get you some form of insurance. But even if they can't, they'll still provide you with medications and care," Sha says. "The thing to know is that there are programs and resources available to help. You don't have to face this alone."