Getting and staying on HIV treatment because it reduces the amount of HIV in the blood (also called the viral load) to a very low level. This will keep the patient healthy and prevents illness.
It is a major prevention benefit. People living with HIV who take HIV medication daily as prescribed and get and keep an undetectable viral load have effectively no risk of sexually transmitting HIV to their HIV-negative partners. This is called treatment as prevention.
If a person doesn’t get treatment, HIV attacks the immune system and can allow different types of life-threatening infections and cancers to develop. If the CD4 cell count falls below a certain level the person is at risk of getting an opportunistic infection. These are infections that don’t normally affect people with healthy immune systems but that can infect people with immune systems weakened by HIV infection. The healthcare provider may prescribe medicines to prevent certain infections.
HIV prevention research was in the spotlight recently on the second full day of presentations at the 10th International AIDS Society Conference on HIV Science (IAS 2019), to share some highlights from those studies.
They discussed research about a new experimental implantable form of HIV pre-exposure prophylaxis (PrEP), additional analysis of a drug combination being considered for PrEP, and findings from two studies that looked deeper into population characteristics and transmission dynamics to better inform HIV prevention and treatment interventions.
After 12 weeks, the research indicated that the implants were generally well-tolerated and drug concentrations in the body were above target levels anticipated to be needed for protection. They then conducted modeling studies to predict drug concentrations over longer periods of time and found that the implant could potentially deliver a protective drug level for one year.
Dieffenbach (2019) also discussed an NIH-funded study that evaluated strategies to identify and support men who have sex with men and transgender women with unsuppressed HIV in the United States. Dieffenbach (2019) described these individuals as “hardly reached” by HIV services, rather than “hard to reach,” noting that the new language more accurately describes the fact that effective HIV services were not reaching them. He noted that researchers found a high number of individuals who knew their HIV status but were not engaged in HIV care because they had found that the healthcare system didn’t meet their needs and/or they had many other social, economic, or health conditions that interfered with their ability to enter and remain in HIV care.
The above findings provide hope not only for people who are living with HIV/AIDS but also for healthcare workers, providing care daily for patients who are deteriorating by the minute. In their paper, Case and Paxson (2009) document the impact of the AIDS crisis on non-HIV-related health services in 14 sub-Saharan African countries using data from multiple waves of Demographic and Health Surveys (DHS) for each country. Their analysis reveals deterioration in the delivery of healthcare which was highly correlated with an increase in AIDS prevalence.
In the in-depth interview one healthcare worker explained:
There are patients that one avoids serving because it is evident by just looking at them that they are HIV positive or even have full blow-AIDS and seem very ill. You are even scared to touch them, and the scary part is that we have to take a needle and inject them. However, I have to take their blood pressure, weight and sometimes ask them to take their clothes off. Then you find out that they even have a rash or open wound on their bodies and they normally do not mention when you talked to them about their problems. Normally, I become so scared and frustrated when I come across cases like that one. Sometimes you just have to pray that God protects you from getting this disease while helping patients.
(Training Community Health Workers to Scale-up HIV Care in Rural Lesotho: Implementation Lessons from the Field. World Journal of AIDS, 2, 135–142. doi: 10.4236/wja.2012.23019). Rigodon J., Joseph K., Keshavjee S., Cancedda C., Haidar M., Lesia N., et al. (2012). Training Community Health Workers to Scale-up HIV Care in Rural Lesotho: Implementation Lessons from the Field.)