SINGAPORE - World Aids Day takes place on Dec 1 each year. It is an international day for people worldwide to unite in the fight against the human immunodeficiency virus (HIV) and to show support for people living with HIV.
This December, Dr Choy Chiaw Yee, a consultant with the National HIV Programme at the National Centre for Infectious Diseases, addresses knowledge gaps about the disease and highlights what one can do to support people living with HIV.
1. The number of new infections is decreasing in Singapore. Why should I still be concerned about HIV?
While the number of new HIV cases reported has been decreasing since 2017, 62 per cent of people who are newly diagnosed have late-stage HIV infection.
If not treated early, HIV can lead to a compromised immune system that increases the risk of opportunistic infections and even development of certain types of cancers. It also increases the risk of HIV transmission to sexual partners.
2. What symptoms should I look out for?
Many people with HIV infection may not have any symptoms at all, as almost all of them will undergo a period known as clinical latency, during which they do not have any signs and symptoms even though the virus is actively replicating in their bodies.
For most people, three to 10 years will pass before their immune systems weaken to the point that they start to fall sick and show symptoms.
It is thus not reliable to look for signs and symptoms to try and determine if you have been infected with HIV. The only way to find out your HIV status is to get tested.
There are various ways to get tested for HIV infection. HIV testing is widely available at healthcare institutions, including polyclinics, private clinics, hospitals and at anonymous HIV test sites where personal particulars are not required for a test.
People can also now buy HIV self-testing kits at the Department of Sexually Transmitted Infections Control Clinic and Action for Aids that they can use in the privacy of their own homes.
3. How is HIV confirmed and treated?
HIV testing is the only way to diagnose HIV infection.
Anyone who is sexually active is at risk of contracting HIV and should be tested at least once in their lifetime. Those who engage in high-risk behaviour should go for regular HIV screening. These would include:
- People who exchange sex for money, or partners of such people
- People with multiple sexual partners
- People who engage in sexual activities under the influence of alcohol or other drugs (including partners of such people)
- People with history of intravenous drug use
- People who are seeking treatment or have been diagnosed with any sexually transmitted infection should also be routinely screened for HIV infection at each visit for a new complaint.
HIV is treated using highly effective antiretroviral therapy (ART) and involves taking a combination of HIV medicine every day.
ART is recommended for all people who are infected with HIV, and can also reduce the risk of HIV transmission; however, it does not prevent transmission of other sexually transmitted infections (STIs).
4. What can one do to prevent HIV infection?
Steps to prevent HIV infection can be taken before, during and after potential high-risk exposures.
Individuals are encouraged to use the “ABCD” approach – A (Abstinence from casual sex), B (Be faithful), C (Correct and Consistent condom use) and D (early Detection and treatment for viral suppression) – which is the most effective way to prevent HIV infection and is the first line of defence against HIV.
One may also take precautions such as taking pre-exposure prophylaxis, medicine taken by individuals at risk of HIV prior to sexual acts, to reduce the risk of HIV transmission.
HIV-infected individuals should also be on treatment to suppress their HIV viral load and reduce the risk of infecting their partners.
If someone has been exposed, the risk of infection can be greatly reduced if the person seeks medical attention and is offered post-exposure prophylaxis within 72 hours of exposure.
Combination HIV medications are given for four weeks, which has been shown to greatly reduce the risk of HIV infection taking place in the exposed individual.
5. People may think that having HIV is a death sentence. Can one still live a normal life with HIV?
The advent of combination antiretroviral agents has transformed HIV infection from a fatal illness in the 1980s to a chronic condition – although not yet a curable disease – today.
With antiretroviral agents, deaths related to HIV infection have been reduced by at least 80 per cent and the risk of non-acquired immune deficiency syndrome related death by 50 per cent. Individuals living with HIV infection and who are on treatment can now live healthy lives no different from the rest of the population.
6. Is there a cure for HIV?
Although there is currently no cure, there is highly effective treatment that can keep HIV under control and enable people living with HIV to live no differently from others.
People living with HIV who take HIV medicine exactly as prescribed can suppress their HIV viral load to an undetectable level and hence cannot transmit HIV to others sexually. This concept is known as U=U, or Undetectable = Untransmittable.
This is an important concept because it improves the lives of people living with HIV infection by reducing the shame and fear of transmission, opens up possibilities for conceiving children without alternative means of contraception, and encourages people living with HIV infection to start and stay on treatment.
The reduction in the risk of transmission also brings us closer to ending the epidemic of HIV infection.
7. What are some of the misconceptions about HIV?
I can get HIV if I share food and drink with someone who has HIV.
HIV can be transmitted only through an exchange of certain body fluids, for example, semen, vaginal fluids, blood, pre-ejaculatory fluids and breast milk.
It is not transmitted by saliva. The heat from cooking the food and our stomach acids would also have destroyed the virus.
HIV can be transmitted through a mosquito bite.
HIV is not transmitted by mosquitoes, ticks or any other insects. This is because the virus is destroyed in the stomach of mosquitoes.
In addition, the mosquito has two one-way channels when it is sucking blood, that is, the alimentary channel whereby it sucks the blood of the person it bites, and the salivary channel whereby it inoculates saliva into the person it bites. Thus, even if a mosquito bites a person who has HIV and then bites someone else, it cannot transmit HIV to the next person.
HIV can be spread through non-sexual contact such as handshakes and hugging.
HIV is not spread by shaking hands or hugging an HIV-positive person. It cannot be spread through physical contact unless you have an open wound which comes into contact with the body fluids of an HIV-positive person who has not been effectively treated – which is extremely rare and highly unlikely in a normal social setting.
Body fluids such as sweat and tears cannot transmit HIV. It is also not spread via body fluids such as urine and faeces. Hence, it is not spread through the sharing of toilet seats.
You can get HIV from sharing a swimming pool with someone who has HIV.
HIV can be transmitted only through an exchange of certain body fluids, hence, it is unlikely to be transmitted via swimming. In addition, it is a sensitive virus and is easily destroyed during the water treatment process. Hence, HIV cannot be spread via water in the swimming pool.
HIV can be spread through air, from sneezing, coughing and through the air-conditioning.
HIV cannot survive for long in the air. When fluid leaves the body and is exposed to air, it dries up. As drying occurs, the virus, if present, becomes damaged, dies and is not infectious. HIV cannot be transmitted through air and droplets.
HIV is more likely to infect certain groups of people.
The risk of HIV transmission is best understood through sexual behaviour, rather than particular groups. The protection afforded through the use of prevention measures such as using condoms and taking pre-exposure prophylaxis benefits all who use them correctly and consistently.
8. From your experience treating HIV patients, what is one worrying observation you notice among patients? How can we, as a society, better support people living with HIV?
Patients with HIV infection who take their medication as prescribed can suppress their viral loads, maintain their health and live no differently from others.
However, sometimes patients have difficulties being compliant with taking their medication. The most common reason often stems from the shame of stigma and discrimination they face in society, whether it is from their family, friends or colleagues.
In any illness, support from friends and family is crucial to help an individual stay on track with their treatment. If you know someone who is living with HIV, it is important to be supportive of them.
Educating yourself about HIV infection will go a long way in supporting your loved ones and reassuring them that HIV is a chronic, manageable disease. Encourage them to get treatment and remain adherent to treatment to maintain a healthy life.