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Red Ribbon World AIDS Day by Leslie Dennis
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ast year a total of 28,000 people died of HIV/AIDS in China, and another 48,000 were newly infected. To mark World AIDS Day on December 1, we spoke to Dr. Jane Eason, who specializes in infectious diseases and internal medicine at Beijing United Family Hospital, about how the disease is still misunderstood. On the difference between HIV and AIDS There is no difference, it’s the same virus, it’s just a difference in the definitions. AIDS is HIV at a more advanced stage. HIV attacks the CD4 – T helper – lymphocytes, part of our infection-fighting immune system. Having a low number of these cells and/or a history of opportunistic infection(s) constitute AIDS rather than just HIV infection. On the symptoms Oftentimes there are no symptoms at all. In acute HIV conversion, the symptoms may be similar to a flu-like illness or any other non-specific viral syndrome. It may be just fatigue, low-grade fevers, sore throat, some lymph gland swelling, sometimes there’s a rash. Or there may be nothing at all. It really is very individual. On the popular misconceptions At the top of the list would be how HIV is acquired. You can’t get it through casual contact. Transmission occurs through exposure of non-intact skin or mucous membranes to contaminated blood and/or other body fluids, but not by contact with body fluids such as urine, sweat, saliva, tears, and not from exposure of intact skin. The risk of virus transmission is increased, however, if such fluids are contaminated with blood and if exposure is to non-intact skin or mucous membranes. On protection The main protection available is latex condoms, used with or without spermicide. They’re not 100 percent effective – you can never say that – and of course condoms do sometimes break. Other barrier methods such as a diaphragm, cervical cap, sponge, have not been shown effective in preventing STD transmission. Latex and polyurethane condoms (NOT sheepskin) are definitely the most
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effective protection, other than abstention. On risk If you’ve had a risk exposure – unprotected sex or the condom broke – you and that sexual partner should be tested and then follow-up testing should generally be done at six weeks, three months and six months post-exposure. Statistics show that up to 97 percent of people, if infected, test positive by three months, so a negative test at three months post-exposure is very reassuring. Testing should, however, be repeated at 6 months, too. Risk of HIV acquisition can be minimized by the use of post-exposure HIV prophylaxis (PEP), a fourweek course of combination antiretroviral therapy. Whether such treatment is warranted depends on the type of exposure, when it occurred (PEP should be initiated within 72 hours of exposure) and how much of a risk it was, something that would be determined by a discussion with one’s healthcare provider. On promiscuous expats People engaging in high-risk sexual behaviors (frequent unprotected encounters, multiple partners) clearly should be tested at fairly regular intervals. As well, they should be screened for other STDs: syphilis, gonorrhea, chlamydia and hepatitis B and C. If they are not immune to hepatitis B, I would advise doing the vaccine series. I do think that the lifestyle that many expats lead (frequent travel, frequent changes in environment, people coming and going regularly) may lead to more spontaneous encounters than one would have in their home environment. But this can be like playing Russian roulette. Through my years of practice, I have encountered many HIVpositive patients who had just one encounter with the “wrong” person. On the fear of getting tested The test done routinely is an antibody blood test. There’s a test which can be done at home, which involves swabbing the inside of your mouth, and you get the results in about 20 minutes. Although it’s a pretty good test, if you have a positive home test, you would certainly need to follow that up
with a blood test for confirmation. I understand how waiting for the results can be difficult, but at BJU the turnaround time is about six hours or less. On confidentiality All of us are acutely aware of the need for confidentiality. We really do provide a very safe place for discussion about these very personal issues and we do everything possible to ensure confidentiality. However, if the initial ELISA antibody test is positive, it necessitates further confirmatory Western Blot testing, and this is done by the local health department. On the groups most at risk Generally, men engaging in sex with men have the highest risk, especially men on the receptive end of anal intercourse. For heterosexuals, rates of transmission are much higher to women with an infected male partner than the reverse situation. On social attitudes HIV continues to carry a lot of social stigma in China as well as worldwide. HIV-positive persons have many concerns, ranging from how/whether to inform their partner(s), how this will affect medical insurance coverage, whether there will be travel/visa problems, if they are an expatriate, would they be deported, could they lose their job, will they be able to live a normal life … Because of general lack of knowledge, many people do not realize the myriad treatment options available, and that their fears of HIV being “a death sentence” could not be further from reality. On facing up to reality I think all of us are alike in that none of us likes going to the doctor, no one wants to hear bad news. However, in the worst-case scenario, i.e. testing positive for HIV, just remember that with appropriate treatment (if needed at all), and regular medical monitoring, most people with HIV do very well, and live long, productive lives. The people I have treated who didn’t do well were those who refused to accept the diagnosis, didn’t take treatment when needed, and failed to come for follow-up for long periods of time.