HIV and stigma
Many people with HIV in the UK have a lot to be optimistic about.
HIV treatment means many people with HIV are living full, healthy lives. Indeed there are very few things that you can’t do just because you have HIV.
However, sometimes people with HIV experience stigma, prejudice or discrimination. Research has shown that HIV-related stigma causes psychological distress in people with, or affected by, HIV. Now, researchers in Holland have looked at certain situations where stigma occurs and the effects these have on people with HIV.
People taking part in the survey were asked about stigmatising behaviour from others in six different settings: with friends; with family; in healthcare settings; with partners; at work; and in leisure activities. Situations that caused the most distress to people with HIV were mostly related to behaviour in family settings, particularly being advised to conceal their HIV status, being avoided or experiencing exaggerated kindness. Awkward social interactions in healthcare settings also caused significant distress.
There are mechanisms in place to protect the rights of people with HIV in the UK, including an important law called the Disability Discrimination Act, which has made it illegal to discriminate against people with HIV in areas such as employment, housing and education. But there is also plenty of support and help available with dealing with stigma and prejudice.
NAM produces a booklet on HIV & Stigma. It is available free to people with HIV in the UK, as well as on our website and through HIV clinics and organisations in the UK.
Changing HIV treatment because of a detectable viral load
With successful HIV treatment, many people with HIV are now living long and healthy lives.
However, sometimes a particular treatment can stop working as effectively, which means that it is no longer adequately suppressing the amount of virus in the patient’s body (viral load).
If this happens, it is important that the patient changes treatment so that they don’t develop resistance to that drug and others in the same class of drugs.
Some people will have had to change drugs a number of times because a treatment has stopped working for them. A study in the US has looked at people who have had to change treatments at least once.
This has shown that multiple treatment failures are happening much less often than they used to, even among people whose first treatment regimen has failed. But it has also shown that people whose second regimen has stopped working have an increased risk of dying earlier, especially if they had a low CD4 count and/or a high viral load at the time, or have had an AIDS-defining illness.
The investigators noted that the period of the study (1996 to 2005) means that it doesn’t show the impact of some of the most recent drugs, which provide additional options to people who have been on a lot of different anti-HIV drugs in the past. The range of drugs available now means that even people in that situation may be able to achieve an undetectable viral load.HIV, women and bone loss
HIV itself can cause a thinning of the bones. Loss of bone density can also be a side-effect of some anti-HIV drugs. This can be of particular concern to women, who are more likely experience osteopenia or osteoporosis (loss of bone mass and density) following the menopause.
However, a recent study in the US has shown that, in the short term, loss of bone density occurs at about the same rate in HIV-negative and HIV-positive women. And HIV treatment was not shown to be a factor in bone loss, even if it included tenofovir (Viread, also in the combination pills Truvada and Atripla ), a drug sometimes associated with bone problems.
Some information suggests that bone loss might happen faster in women immediately after they start HIV treatment, but that bone mineral density stabilises once they have been on treatment a while.
Other factors that contribute to the risk of bone loss for anyone include a family history of it, smoking and lack of exercise. Leading a healthy lifestyle will help prevent or reduce the impact of problems like bone density loss.
You can find out more about the tests that can be done to measure the health of your bones in NAM’s booklet, CD4, viral load and other tests. It is available free to people with HIV in the UK, as well as on our website and through HIV clinics and organisations in the UK.
Circumcision, gay men and HIV prevention
There is strong evidence that being circumcised protects men against HIV infection in heterosexual sex.
Research has suggested it is of less benefit to gay men, who are more likely to become HIV-infected through receptive sex than insertive sex. An Australian study now indicates that being circumcised may protect gay men whose preference was to be the insertive partner in anal sex.
The study did show that, overall, circumcision did not reduce the risk of HIV infection amongst gay men and the investigators suggest that more research into the relationship between circumcision and risk of HIV for gay men is needed, although they recognise such studies would be difficult to conduct effectively.
Unprotected anal and vaginal sex have the greatest risk of HIV transmission. Condoms, used properly, provide the best protection against being infected with – or passing on – a range of sexually transmitted infections, including HIV, or being reinfected with another strain of HIV.
You can find out more about safer sex in NAM’s booklet, HIV & sex. It is available free to people with HIV in the UK, as well as on our website and through HIV clinics and organisations in the UK.