HIV is a complicated disease and scientists are learning more everyday about how the virus works and ways to attack, interrupt and cripple HIV, mitigating and minimizing its effects. If you or someone you love has tested HIV+, it is very important to learn everything you can about HIV transmission, medications, the effects HIV can have on the body and how to lessen these effects as much as possible. As with any life-threatening disease, a passive approach can be debilitating and deadly. Empower yourself with knowledge. Knowledge is the beginning of survival.

HIV is the Human Immunodeficiency virus. HIV is a retro-virus that can lead to the development of AIDS. It can hide in the body without making you sick for a long period of time with little or no symptoms. HIV weakens your immune system by destroying important cells that fight disease and infection. If the immune system is weakened enough, a person can develop AIDS. Because of the way HIV reproduces itself, the human body is unable to rid itself of HIV. For this reason, HIV&AIDS are presently incurable.

HIV attacks your body’s defense mechanisms, weakening your immune system by attacking white blood cells, called either CD4 T-cells or CD4+ cells, which fight disease and infection. Essentially, the virus finds a way into a healthy CD4 T-cell; injects its own genetic RNA code to reprogram the healthy CD4 T-cell DNA; then destroys the T-Cell to release viruses to further infect the human body. When the human immune system is weakened enough, a person can develop AIDS.

AIDS (Acquired Immune deficiency Syndrome) is characterized by a significant enough deterioration of the human immune system to the point that the body has great difficulty fighting off illness and infection that a healthy immune system would easily handle.

There are approximately 37 million people living with HIV&AIDS worldwide. About 1.2 million people, living with HIV, reside in the United States.

HIV is transmitted through the direct exchange of bodily fluids such as blood, semen, vaginal fluids, breast milk and from mother to child during pregnancy and child birth; needle sharing when injecting drugs; extremely rare “occupational exposure” in health care or emergency accident settings; and blood transfusions before blood supplies were being tested. These are typically the only ways that HIV can be transmitted. Cases of HIV being casually contracted have yet to be conclusively identified.

Sexual intercourse (vaginal and anal) remains the main method of infection with HIV. HIV may infect the mucous membranes directly or enter through cuts and abrasions caused during intercourse or sores in the genital area. While vaginal intercourse with anyone living with HIV is a high-risk practice, anal intercourse remains a higher-risk activity.

The following bodily fluids have not been identified as causing any person’s HIV infection. Therefore do not contain a high enough concentration of HIV for transmission to occur and are not considered to cause infection:

• Saliva
• Tears
• Sweat
• Feces
• Urine

HIV testing can be done at a doctor’s office, a testing site - such as a church which provides testing, the Department of Health, an AIDS Service Organization, a community-based organization, a mobile testing unit, or at home with an FDA approved HIV home test.

The most commonly used HIV tests detect the presence of HIV antibodies, substances that the body creates in response to becoming infected with HIV. There are tests that specifically look for HIV genetic material or proteins directly. These may also be used to find out if someone has been infected with HIV.

As it can take some time for the immune system to produce enough antibodies for the antibody test to detect the presence of HIV, the “window period” between infection with HIV and the ability to detect it with antibody tests can vary from person to person. During this time, HIV viral load and the likelihood of transmitting the virus via sexual or needle-sharing partners may be very high. Most people develop detectable antibodies within 2 to 8 weeks (the average is 25 days) of their infection. Ninety-seven percent (97%) of people will develop detectable antibodies in the first 3 months. Even so, there is a small chance that some individuals will take as long as 6 months to develop detectable antibodies. Therefore, a person should consider a follow-up test within three months after their last potential exposure to HIV.

Conventional HIV tests are sent to a laboratory for testing, and it can take a week or two before test results are available. There are also rapid oral HIV tests available that can give results in as little as 20 minutes. A positive HIV test result means that a person may have been infected with HIV. All positive HIV test results, regardless of whether they are from rapid or conventional tests, must be verified by a second “confirmatory” HIV test, typically in a laboratory.

There is no cure for HIV&AIDS, but there are many available HIV medications.

There have been many treatment advances over the past decade that make HIV prevention, living with HIV and obtaining and taking HIV medication easier and more convenient than ever before.

HIV medications are referred to as Antiretrovirals or ARVs. These drugs are taken in combination and such therapy is called Antiretroviral Therapy (ART). There are more than 30 HIV antiretrovirals in six classes of drugs currently approved by the FDA and available for use. These are:

• Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• Nucleoside reverse transcriptase inhibitors (NRTIs)
• Protease inhibitors (PIs)
• Fusion inhibitors
• CCR5 antagonists (CCR5s) (also called entry inhibitors)
• Integrase strand transfer inhibitors (INSTIs)

Each class of drugs functions in a different way to thwart HIV’s binding, entry, infection, replication and release processes. Taken together, they are amazingly effective and very powerful. Learn more about HIV treatment here: https://www.aids.gov/hiv-aids-basics/just-diagnosed-with-hiv-aids/treatment-options/overview-of-hiv-treatments .

Treatment as Prevention

An approximately 18 month study in serodiscordant couples (where one person is HIV+ and the other is not) show that if the positive partner is on ARV’s and has a low or suppressed viral load, AND the couple practices “safer sex” procedures by correctly using condoms or other barriers and not having accidental exposure through spillage and direct contact with sexual fluids, the risk of HIV transmission to the negative partner is decreased by up to 96%. So, does this mean it is safe to have unprotected sex? Whereas researchers call the risk “negligible” there is still a risk of transmission.

Clinical Trials In HIV Research

There is research being conducted every day to find new ways to fight HIV. More classes of HIV drugs are being studied which provide additional benefit, less side effects and even easier administration. If you would like to join a clinical trial, discuss available options with your doctor. You can also check out www.clinicaltrials.gov for lists of clinical trials and appropriate recruiters.

HIV Home Tests

There are only two home HIV tests currently available: the Home Access HIV-1 Test System and the OraQuick In-home HIV test. It’s important if you are buying a test online to make sure it is FDA-approved. The Home Access HIV-1 Test System is a home collection kit that involves pricking your finger to collect a blood sample, sending the sample to a licensed laboratory, and then calling in for results as early as the next business day. The test is anonymous. If the test is positive, a follow-up test is performed. The manufacturer provides confidential counseling and referral to treatment via phone and online. The tests conducted on the blood sample collected at home find infection later after infection than most lab-based tests using blood from a vein, but earlier than tests conducted with oral fluid. The OraQuick In-Home HIV Test provides rapid in-home results. The testing procedure involves swabbing your mouth for an oral fluid sample and using a kit to test the sample. Results are available in 20 minutes. If the test is positive, a follow-up test is needed. The manufacturer provides confidential counseling and referral to follow-up testing sites in their material. Because the level of antibody in oral fluid is lower than it is in blood, oral fluid tests find infection later after exposure than do blood tests. Up to 1 in 12 people may receive a false negative result with this test. Learn more about HIV home tests at https://www.aids.gov/hiv-aids-basics/prevention/hiv-testing/hiv-test-types.

It is important that anyone taking an HIV home test call the support line and/or reach out to a clinic, church, or use online resources to connect to support and care. It is neither necessary nor advisable to try to handle an HIV diagnosis on your own.

Written by Kay Warren

On March 7, 2013, I had the opportunity to be on a panel entitled, “US Policy Priorities for Women’s Global Health in the Second Obama Term,” at the Center for Strategic International Studies in Washington, DC.  The event was to highlight International Women’s Day (March 8), by focusing attention on issues that directly affect women’s health and well-being.

There were presentations from HHS Secretary Kathleen Sebelius; Christie Turlington Burns of Saving Mothers, Giving Life; Kristie Mikus, the PEPFAR county director in Zambia; Dr. Phil Nieburg and Carla Koppell, the Senior Advisor for Women’s Equality and Empowerment at USAID.  My topic was, “The Rwandan Faith Community Response to Women’s Health and Well-Being.”

Saddleback Church’s PEACE Plan has been active in Rwanda since 2005, and in partnership with the churches of Rwanda – and in many instances the government of Rwanda – we have collaborated in efforts around HIV&AIDS, orphan care, poverty reduction, illiteracy, clean water, land grabbing, training community healthcare workers, leadership development and church health.  More recently, we have expanded our efforts to include three more issues that directly affect women’s health and well-being:

• HPV Vaccinations.  More than 135,000, 12-15 year old girls have been vaccinated against HPV in Rwanda in the last two years through the Pink Ribbon Red Ribbon Initiative.  In the churches with which we partner with, we encourage the pastors to promote the HPV vaccination.  Because the vaccine is new to Rwanda, we have witnessed an ongoing suspicion of Western vaccinations as well as fear of a vaccine related to a sexually transmitted disease.
  
  But the pastors who are at the community level can be “legitimizers,” trusted sources of information in every congregation who can dispel myths and stigma.  Through the PEACE Plan’s Clinical Church- which is an effort to link the church to healthcare at the grassroots level, pastors are becoming powerful allies for better health for the women and girls of their congregations.


• Economic Empowerment.  Since 2008, more than 300 savings groups have been established through local churches.  Each group sets its own rules and standards for participation.  Most require a “seed” donation of 5,000 Rwanda francs ($3 US).  The group decides how they want to use the shared savings.  It is an incredible wealth-creation vehicle for rural women who live in extreme poverty.  Since 2008, they have saved $1 million US!


• Gender-Based Violence (GBV).  The statistics are shocking.  According to the World Health Organization, among women aged 15-44 years, GBV accounts for more death and disability than cancer, malaria, traffic injuries, and war put together.
  
  Through the Orphan Care Initiative, the Rwandan pastors have been exposed to training on GBV.  Last week, at a presentation by the CDC to my colleague and 20 lay social workers being trained by Saddleback, one pastor reported that he used to preach that a woman needed to endure beatings when her husband was drunk because that was her role as a wife.  After just one training last year, he changed his mind entirely.  He met with his denominational leaders and now has a program at his church that includes volunteers going as a group to confront men who are threatening or harming women and children.  They now report abuse to the authorities, bring violence out into the open of the community and have created a safe place for women to go in the community to find safety in an emergency.
  
  The faith community – the church – has a vital role to play in creating better lives for women and girls – from vaccinations, to economic empowerment, to protecting them from gender-based violence.  This is the church at its best, putting faith into action.