Living a long, healthy life as an HIV-positive person, once a fairytale, is now a reality, and one that continues to draw strength as advancements in medicine and awareness grow.
Antiretroviral therapy and making the correct lifestyle choices are the two main factors in prolonging one’s life and living well.
“The key to living healthy is understanding and accepting your diagnosis,” says Dale Pierce, president of Different Roads Home, a Charlotte-based non-profit working with those suffering from chronic illnesses. “HIV is not a death sentence anymore. You need to get into a good infectious disease specialist and work together to gain a regimen of medication that works best for your lifestyle together with your physician. Not everything works for everyone, but there are choices today so understand them and pick what will work best for your lifestyle.”
“The largest impact is having hope and a sense of relief to know that HIV is not going to be what kills an individual living with HIV as long as the choice is made to be adherent to antiretroviral therapy,” says Roberto Olmo Bermudez, a youth peer navigator and PrEP counselor with RAIN, a Charlotte-based HIV non-profit.
According to a study presented earlier this year at the Conference on Retroviruses and Opportunistic Infections comparing life expectancies of HIV-positive and HIV-negative people, while life expectancy in HIV-positive people has improved, there remains a 13-year gap between those infected and not infected with the virus.
Lifestyle choices were the largest determining factor in closing the gap.
Starting antiretroviral therapy early, not having hepatitis B or C, and not abusing drugs and alcohol all raised life expectancy. Smoking was the biggest difference, meaning those with HIV can improve their situation dramatically simply by quitting the habit. HIV-positive people who had never smoked had a life expectancy of just over five years lower than HIV-negative people.
“People with HIV are living longer, so they need to take better overall care of their health,” Pierce advises. “Get into an exercise ritual, eat as healthy as possible, and maintain a close working relationship with a primary care physician. Some people do become resistant to medications over time, so regular monitoring is very important.”
He adds that it is important to “create safe and healthy sexual contacts with your partners.”
“It is much easier to date with HIV than ever before. When an individual with HIV achieves viral suppression, the chances of HIV transmission occurring is virtually zero. Add PrEP and condom usage, the likelihood of HIV transmission is just about gone,” Bermudez says.
PrEP, which stands for Pre-exposure prophylaxis, is a prescription drug strategy to prevent HIV infections in those who may be exposed to the virus and is sold under the brand name Truvada.
“When taken consistently, PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92 percent. PrEP is much less effective if it is not taken consistently,” says the Centers for Disease Control and Prevention (CDC). The pill must be taken every day and the CDC recommends seeing a healthcare provider every three months for follow-up.
An analysis by Dawn Smith at the CDC presented at the 2013 Conference on Retroviruses and Opportunistic Infections showed that condoms were effective at preventing HIV transmission 70 percent of the time.
Since PrEP does not prevent other sexually transmitted infections (STIs), and with the rise of antibiotic resistant gonorrhea, using both condoms and PrEP can be a powerful one two punch against STI infection.
In October, the second case of someone contracting HIV while taking PrEP daily was reported.
Bermudez cautions against allowing rare cases such as this from scaring people off looking into PrEP as a form of HIV prevention.
“PrEP is an amazing biomedical layer of protection that we have against HIV,” he says. “We at RAIN are super advocates for it and will link an individual to it even if they do not have the means to pay; that is how strongly we believe in it. I would not be worried of reports like that, cases like that occurring are extremely rare and have a lot more behind the story than what is being reported. PrEP has been proven to prevent HIV and is key to preventing thousands in the near future from becoming HIV-positive.
“We cannot control what people decide to do or not to do. We are not here to judge. We have a duty to protect communities impacted by HIV and provide every tool possible. Our PrEP clients are counseled about condom usage and STI prevention. With any intervention, there are a few hiccups that need to be addressed.”
“PrEP is a great tool to have in your toolbox. PrEP alone is not the answer, we still need to stress condom use and safer sex practices for the encounters that are happening,” Pierce agrees. “A person on PrEP must also stay on PrEP and be monitored regularly like a person that has the virus, to make sure it is effective.”
Pierce also notes that reducing stigma is an important step that will help create the opportunity for HIV-positive people to lead happier lives.
“Stigma is still one of the hardest things to overcome,” he says. “We live in the South, so the reality is that stigma is there. Again, education and knowledge is the key. We need HIV-positive people to speak out and show the ‘new face’ of HIV. Not every person that has HIV is a gay, white male, or a sex worker, or drug user. The face of HIV is changing and we need to address that in advertising and education.”
Still, he recognizes the need to reach out to all affected communities in the fight for prevention and treatment.
“We need to get all those infected people in care and undetectable,” he urges. “We need to use education and tools like PrEP to stop the spread of new cases. We also need to meet the people where they are. If sex workers or IV drug users are still getting new infections, what can we do to reach these populations? We have all the tools and if we think about strategies outside of the box, we can eliminate new infections. Mainly we can’t be afraid to talk about it, because it is not going away.”
North Carolina passed legislation this summer, House Bill 972, allowing for needle exchange programs intended to help prevent the spread of HIV, as well as hepatitis C, a sign of progress for which advocates had been fighting unsuccessfully for years.
While a cure has yet to appear, the fight continues and in the meantime there are glimmers of light.
“We are always fighting for a cure,” Pierce says. “What I think is more realistic is that we can have an AIDS-free generation in our lifetime. We can do it, we have the tools.”