While catching up on several TV series lately, I noticed something strange. It seems like there’s been a sudden increase in human immunodeficiency virus (HIV) drug ads. Maybe it’s because of something in my personal ad algorithm, or maybe it’s just the platforms I’m choosing, but I’ve heard the same thing from several others. In general, there are more ads for HIV drugs because there are more HIV drugs on the market than ever before.
Great strides have been made in the fight against HIV and AIDS. The treatments now available can prevent its spread and give those affected long and positive lives. But with 31,800 new cases in the US in 2022, the fight isn’t over yet.
What is HIV?
“Human Immunodeficiency Virus,” as the name implies, is a virus that attacks the immune system, leaving the infected person vulnerable to other diseases, including tuberculosis, other STIs (like HPV) and some cancers (including vaginal cancer). Left untreated, HIV will progress to AIDS (Acquired Immunodeficiency Syndrome) and eventually death, largely because the body loses the ability to fight off infections [1].
How does HIV spread?
HIV is spread person to person, by bodily fluids like semen, vaginal fluids, blood, and breastmilk, but not by saliva. Typically, HIV is transmitted sexually, especially by anal sex (the highest-risk behavior for HIV), or by sharing needles for IV drug use. It can also be transmitted vertically from a mother to her unborn baby.
Who is at risk?
Because of these transmission vectors, those most at risk are gay and bisexual men, and IV drug users. However, these are not the only populations at risk.
In the US in 2018, 7,129 women were diagnosed with HIV, making up 19% of new diagnoses. 85% of these women got their HIV from a male sexual partner, and 15% from IV drug use.
Black women in particular make up a disturbingly high majority of new female HIV cases. 58% of new female HIV patients in 2018 were black, while black women make up only 13% of the total US female population.
Women with a bacterial vaginosis infection have been found to be at greater risk of contracting STIs, including HIV, as well as passing HIV to a sexual partner or unborn baby. Concerningly, women on the Depo-Provera birth control shot have been found to be at a greater risk of contracting HIV compared to other women. Finally, those who maintain multiple sexual relationships at a time are more likely to acquire HIV than those who move from partner to partner in series.
HIV symptoms
Symptoms of early “acute” HIV infection are similar to a cold or flu, though early infection may be asymptomatic, making it especially important to get tested if you think you may have been exposed. A person is most likely to spread HIV during the first few months he or she has it, before the body has had a chance to develop any antibodies.
The second stage of HIV infection, known as “chronic” or “asymptomatic” infection, may be completely silent while the virus slowly multiplies in the body. Because it targets the immune system, it makes you more susceptible to other kinds of infections, including other STIs. Women with HIV usually require more frequent Pap smears to watch out for an HPV infection that could develop into cervical cancer.
Fortunately, HIV testing involves a quick and simple blood test. The sooner treatment begins, the better the outcomes.
HIV Treatment
Unfortunately, there is no cure yet for HIV. However, the good news is that currently available antiretroviral therapies (ART) are effective in decreasing symptoms, strengthening the immune system, lengthening life expectancy to near normal, and preventing disease transmission. If treatment brings down the virus in the blood to levels too low to detect with a test, then a person cannot sexually transmit HIV to someone else. This is the “Undetectable = Untransmittable” or “U=U” tagline I’ve been seeing in all those drug ads.
The catch? Once diagnosed with HIV, you’ll be on ART every day for the rest of your life. Fortunately, in the US, these drugs are fully covered by most health insurance plans.
Pregnancy and HIV
HIV can be transmitted from mother to baby either via blood in utero, or via breast milk after birth. Thanks to increased advancements in care, mother-to-child transmission has dramatically decreased since its 1991 peak.
HIV testing is now part of routine pregnancy blood work [2]. While research is limited on ART use during pregnancy and breastfeeding, stopping ART is not recommended. The sooner ART is started, the less chance the baby will contract HIV from their mother. With today’s antiretroviral therapy, there is a less than 1% chance of passing HIV to your child if the correct treatment plan is followed.
Prevention
For most Americans, lifestyle choices like monogamy and needle safety can effectively eliminate HIV risk. It’s also important to note that hormonal birth control does not prevent STIs, including HIV.
For those at increased risk of contracting HIV, there’s Pre-Exposure Prophylaxis (PrEP), which must be taken while a person is still HIV-negative. PrEP medication attacks any HIV virus a person is exposed to, decreasing risk of infection from sex by up to 99% and infection from drug use by up to 74%. PrEP is available as either a daily pill or a bimonthly injection. Possible side effects include diarrhea, nausea, stomachache, headache, or fatigue. Ask your doctor about PrEP if your partner is HIV positive, if you have an IV drug addiction, or if you have any other reason to think you’re at risk for HIV.
Condoms have long been promoted for preventing HIV, especially abroad, but even with perfect use they are only about 90% effective. And while African countries have been flooded with condoms by Western aid organizations, HIV rates remain devastatingly high. Obianuju Ekeocha, an African biomedical scientist and activist who sounded the alarm about Western aid with strings attached (specifically, the heavy-handed promotion and widespread distribution of contraceptives in order to receive financial aid), has noted that foreign officials have recklessly chosen to push risky condom use over an effective “ABC campaign”: Abstinence until marriage, Be faithful in marriage or to one partner, Condom use if A and B are impossible.
Human immunodeficiency virus (HIV) remains a global epidemic
Since the mystery and terror of the AIDS crisis in the 80s, science and education have brought cases in the United States down dramatically. Human immunodeficiency virus is still a problem, but it’s one to which we have a clear solution. On the other hand, on a global scale, HIV and AIDS are still a major concern and area of international medical focus.
In the United States, approximately 1.2 million people have HIV and only 23% of those are women. Globally, however, about 37.9 million people have HIV and more than half—52% of those—are women. Mother-to-child HIV transmission rates range from 15 to 45%, though antiretroviral treatment can drastically cut transmission rates to 5%. These stats are so dramatically different, they look like two almost completely separate epidemics.
The majority of global cases of HIV/AIDS are in Africa, where factors such as violence against women, legal discrimination against those with HIV, and lack of access to health care have prevented the same decline seen in other parts of the world. Progress is being made, however slowly, and case numbers continue to decrease every year. These steady declines have led public health experts to remain hopeful that the global community will meet the target of solving the AIDS epidemic by 2030.
The American TV ads for HIV drugs like PrEP typically show the smiling faces of gay men, but solving and treating HIV globally is also an important women’s (and children’s) health issue.
Additional Resources:
NW Video Interview: Obianuju Ekeocha
NW Podcast: A Global Perspective on Women’s Health
