Written by Marius Strydom
In the run up to World AIDS Day on 1 December, I take the opportunity this week to share some stats about the disease (life expectancy is up to 62 years and ARV treatment numbers are more than 3.1 million), speak about recent developments (ARV injection every 2 months and progress with vaccines) and encourage everyone to help to reduce the stigma surrounding HIV/AIDS. Being HIV positive is not a death sentence. Get tested, get treated and live a long and productive life.
We are winning the fight against AIDS in SA and the world. Antiretroviral (ARV) treatment in SA is free and being rolled out to more people every day, leading to dramatic increases in life expectancy. New treatments are being tested and viable vaccines may be around the corner. A key challenge remains the stigma surrounding the disease, with many people not knowing their status and not benefiting from treatment. Being HIV positive is not a death sentence. Get tested, get treated and live a long and productive life.
In the past decade the life expectancy of the average South African has increased from only 54 years to 62 years. The increase was more extreme for HIV positive individuals and likely in line with recent Canadian research showing a 16 year increase in life expectancy for HIV individuals to 65 years (over the period since 2000). HIV positive individuals who are on ARV treatment can expect to live almost as long as people who are HIV negative and longer than people who have Type 2 diabetes.
The main driver for the improvement in life expectancy in SA is the aggressive roll-out of ARV treatment. In 2004 almost no-one received ARV treatment and this has increased to 3.1 million people in 2014. Since January 2015, anyone with a CD4 count of less than 500 cells/μl can receive ARV for free (compared with 350 cells/μl previously). This means that even if you show no symptoms of the disease, you will be able to receive free medication that can 1) help you to remain symptom free and 2) help reduce your infectiousness, i.e. your ability to infect your sexual partner.
It is therefore vital that you find out your status as soon as possible. AIDS has become like cholesterol, diabetes and TB. The best thing you can do is to know whether you are affected and to get treatment. The sooner you start, the less likely you are to get sick and the less likely you that you make other people sick.
One of the main reasons why people avoid getting tested for HIV (in addition to lack of knowledge) is the stigma that is associated with the disease. People are worried about what their friends and family will think and they are worried about being treated differently. However, with 3.1 million people on treatment (and rising), we all know HIV positive individuals, even if they are not public about it. It would help a great deal to counter the stigma if people on ARV treatment speak out and encourage their friends and family to get tested. They need to share the good news that being HIV positive is not a death sentence, that treatment is free and that you can live a normal life while being treated.
In addition to ARV treatment being rolled out aggressively, there are also positive developments on the pharmaceutical front that offers hope. In the past, ARV treatment was quite onerous and patients had to take three pills per day and if they did not stick to their treatment regime, the pills would lose their effectiveness and patients would get sick. Today, an increasing proportion of ARV treatment is in the form of a single pill, taken once a day. This makes it much easier to maintain a treatment regime, similar to taking cholesterol medication.
Last week, results from a clinical trial on an 8-weekly ARV injection were published. They show that patients receiving this injection experienced even more viral suppression (95%) than patients taking oral medication daily. Imagine not having to worry about taking your ARVs and just having to go in for an injection every 2 months. This should have a very positive impact on adherence and results. At the moment, it looks like the injection will hit the market in 2020, but hopefully this can be achieved sooner. The Department of Health has been very proactive in keeping track with developments so chances are good that they will provide the injection once it hits the market.
Many AIDS vaccines have been developed and tested since the disease started in the 1980s, but none have proven successful enough to be rolled out in the market. However, last month a new human vaccine trial was announced, which shows promise. The “full-length single chain” vaccine has been extensively and successfully tested on monkeys and will now be tested on human subjects. In addition, two promising vaccines are being tested in SA. The first is based on a study in Thailand and will involve 5000 subjects next year. The second study will involve 3900 people in America, South America and sub-Saharan Africa. Results are expected in 2020 and 2018 respectively.
There have been many failed attempts at vaccines and we should not place all our hope in such vaccine research. However, because of the success of ARV treatment, we have time on our side. As long as HIV positive individuals get tested and treated, we can slow the spread of the disease and increase the longevity and quality of life of patients. The key is to know your status.
What can you do to help in the fight against AIDS? Step 1 is to find out your status and to seek treatment if you are HIV positive. Step 2 is to speak out if you are HIV positive. Encourage your friends and family to be tested. Explain to them the benefits of treatment. Comfort them if they test positive. Step 3 is to practice safe sex as this is still the most effective way of slowing the spread of the disease. Step 4 is to support people that are HIV positive. Do not discriminate against them, do not make them feel ashamed and do not shun them. Help to reduce the stigma associated with HIV/AIDS. Together, we can beat this disease and turn it into a chronic condition like high cholesterol or Type 2 diabetes. Please do your part.
Do you believe that HIV/AIDS is a chronic condition? Did you know that you can live a long and productive life if you receive ARV treatment? Do you know your status? Will you stop discriminating against HIV positive people? I would love to hear your feedback.
In the mean time, keep your talking straight!