HIV/AIDS doesn’t get as many headlines as it did in the early ‘80s, yet 33.4 million people around the world are living with it. With World AIDS Day on December 1 approaching, we asked Kathryn Dort, a nurse practitioner with the Ryan White Program, to answer some common questions about HIV/AIDS in Charlottesville, nationally and globally.
How common is HIV in Charlottesville?
We follow the national trends. Human immunodeficiency virus (HIV) is an equal opportunity virus. Newborn babies, women, seniors, teens and people of all races and nationalities can have HIV. The prevalence of the virus in different groups varies (as it does for other diseases), but it can affect anyone.
The greatest increase in new infections is in people ages 13-29. It’s hard to engage them and get them to seek appropriate medical care.
What services does the Ryan White Program offer for HIV patients?
Ryan White was the Indiana teenager who had hemophilia and got HIV from a blood transfusion. His struggle to be accepted in a public school with HIV/AIDS helped educate the public about HIV.
He died in 1990, the same year Congress passed the Ryan White Care Act. This legislation covers primary health care and support services that help HIV-infected individuals — especially low-income, uninsured and underinsured men, women and children — have access to appropriate medical care and medications. Our clinic services continue to grow. We offer:
- Primary care
- Coordination with other medical specialists
- OB/GYN care for women
- Pediatric HIV specialty care
- Medication assistance
- Dental care
- Nutrition support
- Psychiatrists, psychologists and substance abuse support and counseling
Some of the Ryan White program’s patients travel hundreds or even thousands of miles for HIV care in Charlottesville. What is it about UVA’s program that makes people willing to travel long distances?
I believe it is because our clinic is a safe and caring place to get medical and psychological support. Everyone here is here because they care about the disease and the people affected by the disease. We offer help not only for their infection, but also with combating AIDS-related stigma and discrimination.
People living with HIV confront stereotypes and rejection on a daily basis out in the community based on assumptions of what HIV is and who is infected. The negative attitudes can even come from medical professionals, religious groups, family and friends. The stigma of who gets infected includes race, sexual characteristics, physical appearance and even gender.
Does the Ryan White program have a relationship with other local community organizations such as the AIDS Services Group (ASG)?
We rely heavily on the support that the ASG and other agencies provide. We work with them and the Charlottesville/Albemarle Health Department to provide free HIV testing, outreach and education. ASG provides community and psychological support and links people to medical care.
In the 80s, HIV was often a death sentence. What does it mean now to be diagnosed?
It means you have a chronic illness that needs appropriate medical care and treatment, including medications called highly active antiretroviral therapy (HAART). With early and appropriate care, you can live a long and healthy life.
Does being diagnosed with HIV mean you’ll eventually get AIDS?
No. There are very effective medicines to treat HIV. When people are diagnosed with AIDS, that means HIV has affected their immune system to the point it can no longer fight off diseases that a healthy immune system would. This usually occurs because the person:
- Was not diagnosed early in the disease process
- Chose to not get medical care
- Couldn’t access appropriate care
- Couldn’t take medications as prescribed
What’s the most common way U.S. residents get HIV?
Unprotected sexual encounters with someone who has HIV and is not being treated. HIV is spread through blood, semen, vaginal fluid, breast milk or other fluids containing blood.
Are there any common misconceptions about AIDS and HIV you hear through patients or in the community?
- Beliefs that HIV can be cured – through specific sex acts or new medicines – are unfounded. There is no cure for HIV. HAART can reduce the presence of the virus but not eliminate it. Even with effective treatment, HIV can accelerate the aging process. It continues to impact the person’s immune system and can cause psychological impairments such as early dementia and depression. It also puts infected persons at a higher risk for certain cancers.
- Young women report they have anal sex in order to avoid pregnancy. This is very risky behavior. HIV can be in the blood, semen, pre-seminal fluid or vaginal fluid, The lining of the rectum is thin and may allow the virus to enter the body more readily. Condoms break more easily during this type of sexual encounter.
- Many people think they can look at a person and tell if they have the virus. People can have HIV and look and feel well for many years.
Why should someone get tested for HIV?
A better question is, why not get tested?
People with HIV often have no symptoms for years. Meanwhile, their immune system weakens, and they can transmit the infection to others. Studies show the earlier people infected with HIV get into appropriate care, the better the health outcome.
The testing experience includes education about risk factors. Even if this information is not helpful to you, share it with someone you love to help them stay uninfected.
If you have HIV, how much do condoms reduce the risk of giving it to someone else? What else can you do to reduce your risk?
Follow these guidelines:
- Get tested. The CDC recommends everyone between 13-64 be offered HIV testing in any health care setting at least once. Pregnant women should be tested for HIV as part of the initial prenatal testing and again in the third trimester with each pregnancy. People with high-risk behaviors should be tested yearly.
- If you’re infected, seek medical care so you can begin HAART. HAART can reduce HIV transmission. Studies of mother-to-child transmission show the use of HAART in the mother during pregnancy virtually eliminated HIV transmission to the infant. HAART use in Africa with couples where only one person had HIV was associated with a 92 percent reduction in HIV transmission. Although HAART reduces the viral load in blood and vaginal or seminal fluid, it does not eliminate the virus from the system.
- Discuss your HIV and other STD history/status with your partner and use condoms. Studies of couples where only one partner is infected show latex condoms are highly effective at preventing infection. The key is consistent and correct use of them. While condoms aren’t 100 percent effective, the main reason they fail is incorrect or inconsistent use, not failure of the condom itself. Using oil-based lubricants can weaken the latex, causing the condom to break. Use water-based lubricants.
In June 2012, the U.S. Food and Drug Administration (FDA) approved Truvada (emtricitabine/tenofovir) for uninfected individuals having sexual activity with HIV-infected partners. Although the drug can help prevent transmission, individuals should still follow these other tips and talk to their healthcare providers.
The World Health Organization (WHO) has promoted circumcision as a way for heterosexual men to reduce the risk of acquiring HIV. Is it really effective? Is this a compelling reason for parents in the U.S. to consider circumcising their newborns?
In August, the American Academy of Pediatrics (AAP) updated its policy on male circumcision. Research shows it has clear health benefits, including lower risks of acquiring HIV, genital herpes, human papilloma virus and syphilis. Circumcision also reduces the risk of:
- Penile cancer
- Cervical cancer in sexual partners
- Urinary tract infections in the first year of life
The Ryan White Program raises money so patients can go to HIV Family Camp. What exactly is the camp, and why is it so meaningful for these families?
For many children, whether they have HIV or someone in their family does, life with the virus can be very isolating. Our clinic has held a weekend Family Camp at Camp Holiday Trails every spring since 2005. Participation grows every year. We started the camp to give children a safe and happy place to go and enjoy time with their families. It removes them from the day-to-day stressers of chronic illness, and they get the opportunity to just be children. The camp is free to participants, supported by generous donations from the community and from grants from the BAMA Works Fund (Dave Matthews Band), among others.