CULTURE

HIV 101: The basics, how to prevent it, and where to get tested

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Despite the global trend in the decline of HIV incidents, the Philippines remains one of only nine countries in the world that recorded a more than 25 percent increase in HIV incidence. Our HIV situation is a public health concern, and we all need to take part in addressing this problem.

Editor’s note: Vince Liban is an advocate of human rights, gender equality, and sexual and reproductive health and rights. He is also a member of Akbayan, the political party that championed the passage of the Philippine HIV and AIDS Policy Act alongside many lobby groups in the 17 Congress.

Manila (CNN Philippines Life) — The only way to know if you have HIV is to get tested. Knowing your status doesn’t have to be scary. Knowing facts about HIV can save you a lot of worry. If you ever tested positive, here are things you need to know especially with the new HIV Policy Law.

With the passage of the new Philippine HIV and AIDS Policy Law (Republic Act 11166), our hopes of normalizing getting tested and de-stigmatizing HIV and AIDS are within our grasp. We have an HIV epidemic most Filipinos are too shy, too unaware, or too afraid to talk about. This is because stigma and discrimination have prevented us from asking questions that really matter and providing solutions that actually work.

Despite the global trend in the decline of HIV incidents, the Philippines remains one of only nine countries in the world that recorded a more than 25 percent increase in HIV incidence. In fact, the Philippines had the fastest growing HIV epidemic in Asia Pacific, with 32 recorded cases every day. Our HIV situation is a public health concern, and we all need to take part in addressing this problem.

The basics

HIV stands for human immunodeficiency virus. It is a virus spread through certain body fluids that attacks the body’s immune system, particularly the CD4 cells (also known as T cells) which help the immune system fight off infections. If untreated, the virus reduces the number of CD4 cells, making the body unable to fight off infections and diseases. Once opportunistic infections take advantage of a very weak immune system, this might signal that the person has acquired immunodeficiency syndrome or AIDS. AIDS is the most severe phase of HIV infection, but not all HIV infections progress to AIDS.

No effective cure currently exists for HIV. But with proper medical treatment, HIV in the body can be controlled, and the lives of people living with HIV (PLHIV) can be prolonged to close to the lifespan of someone who does not have HIV. Antiretroviral therapy or ART keeps PLHIV healthy and greatly lowers their chance of infecting others.

HIV transmission

A lot of people still do not know how HIV is transmitted, and this usually leads to them being more vulnerable to the virus. The bigger problem is that there are myths about how the virus is transmitted, further adding to the stigma about HIV and to the persons living with it.

HIV is spread mainly by having anal or vaginal sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV. The virus can also be transmitted through sharing needles or syringes; from mother to child during pregnancy, birth, or breastfeeding; or by being pricked with an HIV-contaminated needle (an occupational hazard for health workers).

The sexual transmission of the virus is a complex process that begins with exposure and ends with infection. There are four necessary conditions for the virus to be transmitted, easily remembered with the ESSE mnemonic: Exit, Sufficiency, Survival, and Entry. The virus has to exit from a human, with the sufficient amount of viral load, in an environment conducive to its survival, and find a route of entry to another human.

Remember that there are only certain body fluids — blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk — that have sufficient viral load which can transmit the virus from a person who has HIV to an uninfected person (Sufficiency). Viruses are infectious agents that can only replicate themselves inside the living cells of other organisms. This tells us that HIV does not survive for long when exposed outside the human body (Survival). For transmission to occur, these fluids must come in contact (Entry) with a mucous membrane (e.g. foreskin and urethra on the penis, cervix and vagina, anus and rectum) or damaged tissue or be directly injected into the bloodstream (from needle or syringe). The virus cannot enter through our skin unless there are cuts and/or wounds present.

We have an HIV epidemic most Filipinos are too shy, too unaware, or too afraid to talk about.

HIV prevention

While the complex process of HIV transmission makes it difficult for the virus to complete infection, we need to understand that there is no way of reducing the risk of infection once exposure occurs. Hence, avoiding exposure in the first place — by using condoms and knowing your and your partner’s HIV status — is the most effective method of HIV prevention.

Sexual contact remains to be the predominant mode of transmission of HIV in the Philippines. In a 2018 report by the DOH, it is stated that 86 percent of those who acquire HIV through sexual contact are males who have sex with males (MSM). There are, of course, several ways to prevent getting or transmitting HIV through sex.

If you are HIV-negative, you can lower the risk of getting HIV when you:

• Use condoms.
• Reduce your number of sexual partners.
• Take Pre-exposure prophylaxis (PrEP), a daily medication that can reduce your chances of getting HIV.
• Take Post-exposure prophylaxis (PEP) within 72 hours after a possible HIV exposure.
• Choose less risky sexual behaviors (sexual activities that don’t involve contact with body fluids, e.g., mutual masturbation). Abstinence is also an option.
• Get tested and treated for other STIs.
• Encourage your partner to get tested and treated for other STIs, and to get and stay on treatment if they are HIV-positive.

If you are living with HIV, you can prevent passing it to others when you:

• Take HIV medication and antiretroviral therapy (ART).
• Make sure your viral load stays undetectable. Undetectable = Untransmittable.
• Follow your health care provider’s advice.
• Use condoms.
• Choose less risky sexual behaviors (sexual activities that don’t involve contact with body fluids, e.g., mutual masturbation). Abstinence is also an option.
• Get tested and treated for other STIs.
• Encourage your partner to get tested and treated for other STIs.
• Talk to your HIV-negative partners about PrEP and PEP.

Recent developments in the study of HIV have proven that PLHIVs who get treatment to the point where their viral load is undetectable are safe and are unable to transmit the virus to other people. Thus, the life-changing U=U (Undetectable = Untransmittable) campaign.

Regardless of one’s HIV status, we need to make it our responsibility to know our status, be knowledgeable about HIV, and be supportive of key affected populations, especially the youth.

Getting tested

Just like in most sexually-transmitted infections (STIs), you cannot rely on symptoms to tell whether a person has HIV. The only way to know is to get tested. Knowing your status helps you make better and healthier decisions for your sexual health.

The symptoms of HIV vary, depending on the individual and the stage of the infection they are in. HIV has three stages: the early stage, the clinical latency stage, and AIDS (the late stage of HIV infection). It is crucial to note that not all individuals experience these symptoms so it is always important to get tested.

The early stage of HIV is highly infectious and is usually coupled with fever, chills, rashes, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, and mouth ulcers. One should not assume they have HIV just because these symptoms appear. Some of these symptoms can be caused by other illnesses.

At the clinical latency stage (also known as the “chronic HIV infection”), the virus already reproduces at very low levels but is still active and can still be transmitted. Similarly, PLHIVs on this stage may or may not exhibit HIV-related symptoms.

Once the weakening of the immune system is coupled with opportunistic infections, the virus will progress to AIDS, the late stage of HIV infection. Symptoms may include rapid weight loss; recurring fever or profuse night sweats; extreme and unexplained tiredness; prolonged swelling of the lymph glands; diarrhea; sores of the mouth, anus, or genitals; pneumonia; red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids; and memory loss, depression, and other neurologic disorders.

There are currently around 100 Department of Health (DOH) designated HIV treatment hubs and primary HIV care facilities all around the country. You can access the list of treatment hubs as listed in the report of the HIV/AIDS & ART Registry of the Philippines [HARP] or download the SAFELY mobile application to search for the nearest clinic from your location. There are also hundreds of Community-Based Screening (CBS) Motivators, individuals who are trained to conduct HIV screenings outside testing facilities, deployed all around the country to make HIV testing more accessible. It is advisable to get tested regularly depending on how active you are sexually.

The good news is, the passage of the new HIV and AIDS Policy Act (RA 11166) orders the DOH to establish a program to provide free and accessible treatment and medication to all PLHIVs. The law also says public and private hospitals are to become treatment hubs, increasing the accessibility of getting tested and getting treatment to all Filipinos. Moreover, as more and more youth aged 15 to 24 are reported to be infected with HIV, the law now introduces a proactive policy of allowing minors aged 15 to 17 access to “undergo voluntary HIV testing without parental consent,” something that wasn’t previously allowed under RA 8504.

Living well with HIV

Life doesn’t end with HIV. With the effectiveness of antiretroviral therapy (ART), persons living with HIV are living their lives healthier and longer. While HIV doesn’t have an existing cure, it can be treated, just like diabetes.

More importantly, it is high time that we recognize that PLHIVs are no different from people without HIV in that we all have human rights. Republic Act 11166 strengthens the protection of the rights of PLHIVs including the right to privacy and confidentiality, and considers the following as discriminatory acts and practices with stronger corresponding penalties (Article VII):

• Discrimination in the Workplace;
• Discrimination in Learning Institutions;
• Restriction on Travel and Habitation;
• Restrictions on Shelter;
• Prohibition from Seeking or Holding Public Office; 
• Exclusion from Credit and Insurance Services;
• Discrimination in Hospitals and Health Institutions; 
• Denial of Burial Services;
• Act of Bullying; and
• Other similar or analogous discriminatory acts.

Time and again, we are to be reminded that HIV is not a death sentence, but a public health and human rights concern. The Philippines faces an epidemic targeting its youth that nobody usually would dare talk about. The government’s unsympathetic stance on human rights has also contributed to the worsening of this epidemic. It is when we are silent that stigma and discrimination, the real killers, thrive. Stigma and discrimination have been nothing but barriers for people to get tested, access knowledge, and seek treatment.

In a society that ought to value the lives of its people, it is only right and just to reach out and support those who are living with HIV, and to raise awareness to prevent it from further spreading.

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References:

Avert (United Kingdom)

Canadian AIDS Treatment Information Exchange (CATIE)

Department of Health Epidemiology Bureau. HIV/AIDS & ART Registry of the Philippines (2018)

HIV.gov, U.S. Department of Health and Human Services

LoveYourself Philippines

Official Gazette of the Republic of the Philippines (2018). “Republic Act 11166”