HIV, stigma and you

In many ways, the outlook for people with HIV in this country has never been better. More and more is understood about how to prevent and treat HIV; indeed many doctors are now optimistic that with appropriate treatment a person with HIV could live a normal lifespan.

But there is still a lot of stigma attached to HIV. I encounter it in one way or another at least once a week, often in the form of  wildly inaccurate or prejudiced press reports.

I know I’m not alone in finding that some people treat me differently or less favourably because I have HIV. For example, I once had a dentist who insisted that I was his last patient of the day, claiming that this would enable his staff to clean the surgery properly to ensure there was no infection risk to his other patients. That’s quite simply rubbish – dentists and healthcare workers should always use what are called “universal infection control procedures” that are sufficient to prevent infections being transmitted from patient to healthcare worker or other patients.

Because stigma and discrimination are encountered by so many people with HIV, NAM have produced a new booklet called HIV, stigma and you . It explains where stigma and discrimination are often encountered, and provides some tips information on how the law can protect people with HIV from discrimination as well as providing some tips about standing up to stigma.

Although many people with HIV have immense courage and strength, stigma isn’t something you have to face alone. There are HIV organisations around the country who can help you get justice and you’ll find details of some in the booklet.

Anti-HIV treatment – experimental drug on expanded access

The aim of anti-HIV treatment is to suppress the level of HIV in the blood to undetectable levels. This allows the immune system, measured by CD4 cells, to increase (therefore reducing the risk of illness) and prevents HIV becoming resistant to HIV drugs.

However, some people have found it very difficult to achieve effective control of their HIV. Sometimes this is because they received suboptimal HIV treatment in the past, usually before effective HIV treatment became available, or because they didn’t take their treatment properly. In both these circumstances, drug resistant HIV can emerge and make it very difficult to find an effective combination of anti-HIV drugs.

Thankfully in recent years, doctors have become more skilled at treating HIV even in people with a lot of treatment experience and resistance. The use of resistance tests to select the most effective drugs, as well as newer, powerful protease inhibitors such as tipranavir (Aptivus) combined with the fusion inhibitor T-20 (enfuvirtide, Fuzeon) mean that many people who have taken a lot of HIV drugs in the past can now achieve an undetectable viral load and seem to have a good outlook.

Other drugs are in development which it is also hoped will benefit people with a lot of resistance. One of these drugs, maraviroc, will shortly become available to people who need it to construct an effective anti-HIV combination. The drug is still in clinical trials, but the results so far have been good enough for its makers, Pfizer, to announce an expanded access scheme.

Maraviroc belongs to a completely new class of anti-HIV drugs called chemokine antagonists, and unlike other HIV drugs that attack HIV once it has entered CD4 cells, it prevents HIV from gaining access to CD4 cells in the first place.

The drug is taken orally, twice a day. To be eligible, people must be have what is called “CCR5-tropic” HIV (clinics can test for this), be clinically stable, at least 16 years old, have limited or no treatment options available to them because of resistance or side-effects, and their current regimen must be failing to achieve an undetectable viral load.

Micronutrients and HIV

Many people with HIV take nutritional supplements or vitamins in the hope that they will help support their immune system or to help prevent or lessen the side-effects of drugs they are taking to treat HIV or other infections.

In the past, studies have looked at micronutrient levels in people not taking HIV treatment.

There is some evidence that, in people who are not taking anti-HIV treatment, the use of a simple, complex multi-vitamin tablet can have a modest effect on the immune system. Other studies have found that people who are not taking treatment have low levels of micronutrients such as selenium.

Now a study has looked at levels of micronutrients in people taking HIV treatment. It found that zinc was the only micronutrient that was commonly deficient in people on HIV treatment. But even in the 40% of men and 36% of women with low levels of zinc, it did not seem to have a negative effect on either CD4 cell count or viral load.

The researchers also found that although many people in their study were taking nutritional supplements, this didn’t have any effect on how well their HIV treatment worked.

Entry to the US for people with HIV

According to a statement from the White House, “President Bush is dedicated to ending discrimination against people living with HIV/AIDS” and has therefore issued instructions to make it easier for people with HIV to visit the country.

At the moment, the US has severe restrictions that effectively ban routine entry for people with HIV. The White House statement says that these restrictions will be “eased” and applications for short-term tourist or business visits “streamlined.”

It is currently possible for people with HIV to obtain a special “visa waiver” to enter the US, but they have to be interviewed at the US embassy, and also have to provide extensive documentation about their health and finances. The visa waiver given to people with HIV is placed in a person’s passport and effectively discloses a person’s HIV status to immigration officers around the world.

The entry ban for people with HIV has been in place since 1987, but members of the recently elected US Congress have vowed to introduce legislation to over turn it.

Many people with HIV travel to the US and simply ignore the ban. However, there have been cases of people being deported after customs officers found their HIV medication. Some people with HIV take unofficial breaks from their treatment in the hope that this will make it easier to enter the US, but this could involve health risks, such as a rebound in viral load, illness or drug resistance.