- What is HIV and AIDS?
- A Brief History of AIDS/HIV
- Preventing Transmission of HIV
- What are the symptoms of HIV? Can I tell if I am infected?
- HIV Treatment
- Getting Tested for HIV
- Post-Exposure Prophylaxis
- AIDS Drug Assistance Program
- APA Office on AIDS (external link)
What is HIV and AIDS?
HIV, the Human Immunodeficiency Virus, acts as a retrovirus in the body attacking both essential cells of the immune system and cells of various organs. It is responsible for AIDS, acquired immunodeficiency syndrome, which is a syndrome in which the immune system begins to fail. The spread of HIV involves sexual contact or blood-to-blood contact. People with HIV are said to be HIV-infected. HIV infection generally leads to AIDS over a period of time. The AIDS diagnosis results from the presence of one of the CDC-defined AIDS indicator illnesses, also known as opportunistic infections, or a CD4+ blood test with a count of less than 200.
Opportunistic infections affect weakened immune systems. Therefore, people with healthy immune systems generally have no problem in warding off these infections. HIV-infected individuals, however, are unable to fight off the infections since the infection weakens their bodies’ illness-fighting capabilities. Opportunistic infections include Kaposi’s sarcoma (cancer of the blood vessels), pneumocystis jiroveci pneumonia, AIDS dementia complex (results from HIV-infected brain cells), and many common bacterial infections.
Medications may slow the transition from HIV to AIDS by slowing the rate at which the infection weakens the immune system. There are also medications that aid the patient in fighting off opportunistic infections once their immune system is weakened.
The diagnosis of AIDS will never be changed (i.e. revert to HIV-infected) once the person is announced to have AIDS.
A Brief History of AIDS/HIV
In 1981, Kaposi’s Sarcoma and Pneumocystis Carinii Pneumonia (PCP) surprising infected small groups of young gay men in California and New York. Kaposi’s Sarcoma generally occurred only in the elderly, and PCP could usually be cured within a few days of medicinal treatment. The rarity of these illnesses manifesting themselves in such young men, and particularly in the gay community, began to spur a number of theories, many of which were considered by the CDC.
Initially, there was speculation that the cancers and opportunistic infections affecting the gay community were a result of the use of poppers, immune overload, or the cytomegalovirus. People began to worry about the contagious aspects of this new infection. Many incorrectly assumed that the gay population was the only community at risk for contagion, leading to the early names for AIDS including GRID (gay-related immune deficiency), “gay cancer,” and “gay compromise syndrome.”
Soon, however, injecting drug users of both sexes where found to be infected with PCP leading to the knowledge that transmission could occur outside of the gay community. In June of 1982, a report containing information on a group of infected men in Southern California furthered knowledge about the disease when they suggested that it could possibly spread through sexual contact. Within a few months, other populations, such as Haitians and hemophiliacs were likewise succumbing to the illness, and with these new pieces of information, the name of GRID had to be changed to correctly label the disease. AIDS, acquired immune deficiency syndrome, was the name suggested at a meeting in Washington, D.C. in July of 1982, and the scientific community quickly adopted the name.
Soon organizations such as the Gay Men’s Health Crisis (GMHC) and the San Francisco AIDS Foundation (SFAF) were offering safe-sex advice to the gay community in hopes of limiting the spread of the disease. However, little was still known about transmission.
In December of 1982, a child received a blood transfusion that resulted in an AIDS associated death. The CDC came to the understanding that AIDS was indeed spread by an infectious agent and began to worry about the safety of blood transfusions. With the infection of women who were not drug users or receiving blood transfusions, further speculation involved possible sexual transmission.
French doctors isolated what they believed to be the cause of AIDS in 1983. Named LAV, or lymphadenopathy-associated virus, a sample was sent to the CDC where little attention was paid to the finding. The nation virtually remained in the dark about LAV’s involvement in AIDS.
The lack of knowledge brought a sense of terror to the nation about AIDS. Homosexuals, hemophiliacs, injection drug users, and people of Haitian decent were seen as the only people who were being infected. Discrimination ensued. Landlords evicted tenants, police wore special equipment when possibly dealing with an AIDS infected individual, and that casual contact could lead to transmission. Gay bath houses and sex clubs were closed in San Francisco to prevent the spread of disease.
Not until April 1994 did an American scientist isolate a virus that was believed to be the cause of AIDS. Dr. Robert Gallo announced his discovery of the HTLV-III virus and with it came the promise of test to detect HTLV-III in the blood and later a vaccine. As it turned out, the HTLV-III and the LAV viruses were the same. Precious time was lost in research due to this blunder on the CDC’s part.
The FDA approved the first blood tests for AIDS in 1985 and declared anyone presenting LAV/HTLV-III antibodies unfit to donate blood. This eased people’s fear about the blood supply, but raised the issues of confidentiality and informed consent.
Confidentiality and consent were extremely important at the time due to the general public’s treatment of HIV-infected patients. People who had become positive through blood transfusions were seen as victims, while gays and drug users “brought it on themselves.” Some parents removed their children from schools if an AIDS patient was attending.
It was not until September 1985 that President Reagan finally addressed the nation about AIDS. He requested research funding and made it obvious that little was known about the syndrome.
In September of 1986, the drug AZT, azidothymidine, proved effective in slowing the progression of AIDS. Its general use for AIDS was approved by the FDA in 1987.
Various organizations sprung up in the US and UK to inform people about AIDS and AIDS’ prevention. The United States government, however, did not formally address the awareness problem until 1988 when they distributed 107 million copies of “Understanding AIDS” written by the Surgeon General C. Everett Koop. In 1990 with the Ryan White CARE Act and the Americans With Disabilities Act, the US government passed legislation aimed at improving the quality of care for AIDS patients as well as increasing funding for research and limiting discrimination.
In 1996, HAART, highly active antiretroviral therapy, arose as a method of AIDS treatment. However, it’s incredibly complicated regimen makes it a difficult but effective way to prolong the life of an HIV-infected individual. Currently, research is geared towards finding new treatments that delay the progression of AIDS, while organizations like WHO are striving to prevent the spread of AIDS in places like Africa. Many other organizations on a local level are trying to prevent further infection in the gay and drug-user communities with safe-sex information and needle exchange programs.
Preventing Transmission of HIV
HIV can be passed from one person to another through blood, semen, vaginal fluid, or breast milk. It can cross any of the mucus membranes in the body, including the anus or rectum, penis, vagina, and mouth, or through cuts, sores, and veins. Most commonly it is passed through sexual intercourse, needle sharing in injection drug users, and from mother to baby during pregnancy or after birth.
It is possible to get HIV from oral sex, although it less likely to be transmitted orally than anally or vaginally. The risks increase during oral sex if the giver has cuts or sores in his mouth or throat, the receiver ejaculates in the giver’s mouth, or the receiver already has another STD since STD’s may create sores breaks in the skin or illicit an immune response in the genital area that makes transmission more likely. To reduce the risk of passing HIV from one partner to another during oral sex, it is important to use a condom. It is the only way to effectively reduce the spread of the HIV virus between two partners since it prevents the transmission of cum or pre-cum from giver to receiver and protects the mucus membrane of the giver’s mouth.
HIV can be spread through anal sex since HIV is found in semen, pre-cum, and blood. The “bottom” usually is at greater risk of getting AIDS from a “top” than a top would be from a bottom. The reason for this is that the bottom is receiving the top’s semen, and the lining of the rectum is thin, which may allow the virus to pass from the top’s ejaculate into the bottom’s blood stream. However, the top is not entirely free from risk. He may get the virus through his urethra or through small cuts, sores, or abrasions on the penis. One of the best ways to cut down the risk is to use a condom with lubrication. The lube will reduce the risk of the condom breaking during sex.
It is also important to switch condoms between partners or after extended use to prevent the spread of HIV or the wearing down of the condom. 98-100% of people who use condoms consistently and correctly every time they have sex with an HIV+ partner do not become infected. In addition, limiting the number of sexual partners a person has, being knowledgeable about a partner’s HIV status, and making safe sex practices a priority will reduce the spread of AIDS.
Due to superinfection being HIV+ and having unprotected sex with other HIV+ individuals does not obliterate risk. Once a strain of HIV is established in a person’s body and a medical regimen is set up for treatment, it is possible to be superinfected, or re-infected, by a different strain of the virus that may be resistant to current medications. A person may therefore suffer at the hands of an untreatable combination of strains.
Mixing drugs with sex also increases the risk of spreading HIV. Crystal meth in particular has become linked to the spread of the disease through the gay community. This is due to the fact that men who are high on crystal meth generally have more partners, have more unprotected sex, and take part in more risky sexual behaviors than men who are not high. Key to prevention in this case is preparing ahead of time to limit the risks once high or to simply not get high. If a person does choose to take crystal meth and then have sex, the individual should prepare ahead of time by carrying multiple condoms with him (remembering to change between partners and intermittently throughout long durations). Carry the condoms in a wallet, next to car keys, or someplace else where they are easily accessible and likely to be remembered.
Bottom-line: take the steps necessary to reduce your risk and ALWAYS USE A CONDOM.
Injecting drugs, particular due to needle sharing, is another high risk behavior. HIV may be passed through the reuse of blood-contaminated syringes, water, containers, cottons, or needles. It is important to use a clean needle every time. See the needle exchange programs link on the Resources/Links page for programs in the area. In general, injecting drugs is dangerous, so either completely abstaining from the drug or finding a safer way of using the drug is important.
See www.thebody.com for more information.
What are the symptoms of HIV? Can I tell if I am infected?
The only way to diagnosis someone as HIV-infected is through HIV antibody testing. Many HIV-infected individuals may not have any symptoms for years after they contract the illness, so there are not always tell-tale signs of infection. However, for someone who does not get tested/diagnosed before the disease progresses, there are a few warning signs including rapid weight loss; recurring fever; recurring respiratory tract infections; unexplained severe fatigue; swollen lymph nodes throughout the body; pneumonia; reddish blotches on the skin around the mouth, nose, or eyes; herpes zoster; chronic diarrhea; neurological disorders; or white spots on the tongue or in the mouth or throat. These symptoms, however, are not always indicative of HIV-infection and may in fact be the results of various other illnesses. The same holds true for AIDS. The only way to determine a diagnosis of AIDS is through the CDC count rather than through various symptoms.
Twenty-five medications have been approved in the U.S. for HIV treatment. Many more are currently in development. Each medication falls into a class, and each class fights HIV a little differently. The best results stem from what is known as a “drug cocktail” or a regimen of drugs that are from various classes. The combined effects are better at slowing the advancement of HIV than a single drug. Remember, none of these drugs will cure HIV; they will however slow the progression of the illness.
HIV medication regiments are determined primarily by a person’s viral load and T-cell count (CD4 count). The viral load test indicates the HIV content of the blood whereas a T-cell test indicates the strength of a person’s immune system since T cells are a critical component in illness prevention. Both give an overall picture of the level to which the HIV-infection has progressed. Treatment usually begins when the T-cell count nears 200 or drops below 200. A normal count would be somewhere between 500 and 600.
To effectively slow the progression of HIV, medications must be taken consistently and exactly as prescribed. Therefore, it is important to begin a regimen that fits into the lifestyle of the HIV/AIDS patient.
A combination of three drugs, known as Highly Active Anti-Retroviral Therapy (HAART), is capable of controlling the replication of HIV and maintaining a healthy immune system. The drugs usually are drawn from different classes of HIV treatment drugs. These classes include nucleotide/nucleoside reverse transcriptase inhibitory (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), fusion inhibitors, and protease inhibitors (PIs). As their inhibitor titles suggest, all of these drugs interfere with HIV’s replication. When combining three drugs as part of HAART, a physician considers the potency, side effects, prescription instructions, and future sequencing potential of the drugs. The idea of sequencing is especially important as it sets up the potential for future options in case the current treatment is not working, which occurs due to resistance of the strains to medication. A HAART regimen is considered to not be working when T-cell counts drop and viral load increases. When a strain becomes resistant to one medication, it may become resistant to all of the drugs within its designated class. Therefore, a doctor must present a regimen consisting of drugs that the virus will be more susceptible to.
Side effects to HAART may include high cholesterol, metabolic complications including fat loss or gain in certain parts of the body, insulin abnormalities, a build of lactic acid in the body, diarrhea, and psychological problems. It is important to inform the prescribing physician about any side effects as they may in fact be a sign that the medication is not working.
Ultimately, the key to treatment is to find a regimen that fits into an individual’s life. The number of times pills must be taken a day along with the number of pills is an important factor since treatments are only effective if they are taken correctly at least 95% of the time. Therefore, in addition to side effects, sequencing, and potency, the daily life of the individual must be considered to find a therapy that he can adhere to so that they treatment may be successful.
Getting Tested for HIV
The test for HIV involves detecting the presence of HIV antibodies in the body. Within 3 months after infection, most people will have developed HIV-antibodies, but in some rare cases it can take up to 6 months. However, the average is about 25 days after infection. The Center for Disease Control recommends testing 6 months after possible exposure to the virus.
The rapid test is a screening test for the presence of HIV antibodies that gives a result in 5 to 30 minutes. The more common tests give a result in 1-2 weeks. Both are blood tests.
A positive result means that the individual is indeed infected with HIV and may or may not develop symptoms. They are now capable of spreading the illness to others.
A negative result may mean that the individual does not have HIV, has not yet developed antibodies to HIV and needs to be re-tested, or will never develop HIV antibodies (which is very rare).
Confidential testing involves linking your name to your test and making the results part of your medical records. The records, however, can only be released with your permission. Anonymous testing involves identification as a number rather than by your name, and there is subsequently no paper trail. The only person who will ever know the results of an anonymous test is you.
To get tested, got to the Resources/Links part of the webpage and click on Free HIV and STI Testing Centers or HIV Testing and Support.
As a four-week antiretroviral combination therapy, Post-Exposure Prophylaxis, or PEP, works to prevent HIV from becoming established within the body (meaning that it prevents HIV from getting into the cell nucleus and starting replication). It was originally developed for health workers who had been exposed to HIV through an incident at work, like a needle stick. However, more recently it has become an avenue by which people exposed to HIV through sex or drug use may prevent infection within the first few days after exposure.
While PEP is not 100% effective in preventing HIV infection, it has been shown to reduce the likelihood of infection by 79%. PEP must be started within the first 72 hours after exposure. After 72 hours, PEP will not be effective. The sooner treatment is begun, the higher the chance that it will be effective.
The treatment is meant for people who have been exposed to HIV or have been in a situation where the likelihood of exposure is considered very high. Typically, exposure it defined as having unprotected sex with someone who is HIV positive or sharing a needle with an HIV positive drug user. However, if the partner’s status is unknown and his/her lifestyle indicates that they may have been exposed to HIV, the physician prescribing PEP may determine that the patient is at high risk and should begin treatment.
Taking PEP involves adhering to a strict regimen of antiretroviral pills for a period of four weeks. If a dose is missed or the treatment is not completed, the likelihood that PEP will prevent HIV infection is reduced greatly. People on PEP may experience side effects such as nausea, headaches, fatigue, and diarrhea. In some cases, the side effects become an impetus behind stopping treatment. However, since this potentially makes the treatment ineffective, it is important to continue PEP and speak to a physician about how to cope with side effects.
When the PEP regimen is completed, it is important to return to the prescribing physician at determined intervals to determine whether or not the treatment has been effective.
Remember, PEP is not 100% effective and should not be used as an alternative to safe sex practices. It can be somewhat expensive and is generally not covered by insurance. However, in the case of an emergency, it is available as an alternate route of prevention.
To find out where PEP is available in your area call on of the following information hotlines:
- HIV/AIDS Treatment Information Service
- National AIDS Hotline
- National HIV PEP Registry
AIDS Drug Assistance Program
Many people who have possibly been exposed to HIV do not seek out testing. This may be due to fear, disbelief, or a desire to be ignorant. However, many uninsured or underinsured people simply do not get tested because they think they will be unable to receive treatment. Basically, testing to individuals without medical care seems pointless.
Unknown to many uninsured HIV-infected individuals, however, is the care provided by the New York State HIV Uninsured Care program. The program was designed by the New York State Department of Health’s AIDS Institute to provide access to free healthcare for those residents who are infection with HIV and are either uninsured or underinsured.
Within the HIV Uninsured Care category are four different programs:
- AIDS Drug Assistance Program (ADAP) – provides free HIV/AIDS and opportunistic infection medication to help people with HIV/AIDS live longer, healthier lives; offered to people with partial insurance or who have a Medicaid spend-down requirement
- ADAP Plus (Primary Care) – provides primary medical care at selected hospital outpatient centers, clinics, physician’s offices, and lab vendors to people with HIV/AIDS
- HIV Home Care Program – provides home-care coverage for chronically medical dependent HIV/AIDS patients; the home care must be ordered by a physician and must be provided by an approved home care agency; the program covers at-home nursing, health aide services, medications, healthcare supplies, and intravenous therapy administration as ordered by the physician
- ADAP Plus Insurance Continuation Program (APIC) – for ADAP eligible clients, APIC pays for commercial health insurance premiums
The eligibility criteria for the programs is as follows:
- The client must be a New York State resident, but U.S. citizenship is not required
- For medical coverage under ADAP, ADAP Plus, and APIC, the individual must by HIV-infected; people who have tested positive for HIV and are asymptomatic are also eligible
- For home care, the individual must have AIDS or HIV and a chronic medical dependency as determined by a physician; the dependency may be due to either physical or cognitive impairment that is a result of the HIV infection
- The client must have an income of less than $44,000/year for a household of one, $59,200 for two, and $74,400 for three or more and liquid assets less than $25,000
- Individuals enrolled in Medicaid are not eligible; however, those awaiting Medicaid eligibility or have Medicaid spenddown requirements are eligible
Enrollment for ADAP, ADAP Plus, or the HIV Home Care Program involves filling out a single application. An additional application is required for APIC. An applicant must provide proof of residency, income, and assets when applying. A medical application signed by a licensed medical professional must be presented to verify that the client is HIV-positive as well as expressing the individual’s medical status. For home care applicants, a physician must submit a treatment plan to the program. Once deemed eligible, the applicant will receive an Enrollment Card to be used to receive care from the various approved providers. The clients will never be charged for any of the services they receive.
For more information on how to apply and the services covered, contact
HIV Uninsured Care Programs
P.O. Box 2052
Albany, NY 12220-0052
Instate Toll Free: 1-800-542-2437
Out of State: (518) 459-1641
TDD: (518) 459-0121
Program’s Hours of Operation: Monday – Friday, 8:00AM – 5:00PM
Or to get an application online go to: http://www.health.state.ny.us/diseases/aids/resources/adap/index.htm