Editorial – disclosure
Deciding who, how and when to tell somebody that you have HIV is a difficult decision that people with HIV constantly face.
Telling somebody that you have HIV can be beneficial – it can help you get the love, help and support that you need. A recent study has found that there could also be good medical reasons for being open about having HIV – people who disclosed their HIV and came out as gay had higher CD4 cell counts.
Disclosure can also be a legal issue. It’s important to remember that people have been sent to prison in the UK after they infected their sexual partners with HIV. Key to these convictions has been their failure to tell their partners that they had HIV before having unprotected sex with them.
But let’s be honest – HIV is still stigmatised and people with HIV experience discrimination in their everyday lives. Some people have experienced verbal abuse, harassment or even violence after they disclosed their HIV status. So think carefully who, how and when you disclose. The NAM book, Living with HIV provides some information on this issue, and you might also want to talk through the pros and cons of disclosure with a counsellor – ask at your HIV clinic if this support is available.
Anti-HIV therapy - Side-effects
T-20 (enfuvirtide, Fuzeon) is a very important drug for people who have a lot of experience of anti-HIV therapy.
When taken with boosted protease inhibitors and NRTI drugs selected after a resistance test, combinations that include T-20 can mean that people with very limited treatment options can get a very good response to anti-HIV treatment, including an undetectable viral load and a good increase in CD4 cell count.
There are very few side-effects associated with T-20. However, it is the only anti-HIV drug that is given by injection and some people (and their doctors) have been reluctant to consider the drug because of this. Using T-20 in the long term can cause what are called injection site reactions – bruising, swelling and inflammation on the skin where the T-20 is injected.
A way of taking T-20 without the need for needles and syringes has been developed using Biojector 2000. This is placed next to the skin and T-20 is pushed under the skin using high pressure. Research has shown that people taking T-20 prefer this method to needles.
But use of the Biojector 2000 has now been associated with long-lasting nerve pain, bruising, and bleeding below the skin. The drug regulatory authority in the USA – the Food and Drug Administration – has updated the product label for T-20 to alert patients to this risk. It also advises people using T-20 to avoid injecting the drug near large nerves, such as the elbow, knee, groin and parts of the buttocks. Nor should T-20 be injected near moles, scars, burns, tattoos, above blood vessels, or near the belly button. The recommended injection sites are the abdomen, upper arm, or outer thigh.
Living with HIV
HIV and the law
One group that people with HIV need to consider disclosing their HIV status to is their sexual partners. There have been a number of prosecutions in the UK of HIV-positive individuals for infecting their sexual partners with HIV. The people who were prosecuted had unprotected sex with their partners without first telling them that they had HIV.
The latest conviction is in Scotland. A man was convicted of infecting a woman with both HIV and hepatitis C. He did not tell the woman he had HIV and refused to use condoms when they were having sex. He will be sentenced next month.