By SELENA SEABROOKS
The Dallas Examiner
“Throughout the nation, there are hundreds and thousands of men and women living with HIV. They’re mothers and fathers, sisters and brothers, of all races and backgrounds. Often, they are our neighbors, members of churches and organizations, or a friendly clerk at the grocery store,” Mollie Belt, publisher of The Dallas Examiner, stated during a virtual Links HELP HIV Town Hall Meeting, Oct. 28.
Hosted by the Plano North Metroplex chapter of The Links Inc., the town hall meeting discussed the prevention of and protection against HIV. Belt moderated the event, which featured panelists Dr. Natalie Wilson, assistant professor at UCSF School of Nursing and Dr. Parul Kaushik, infectious disease specialist at Health Service of North Texas.
“Our goal is to raise awareness of the need to protect and prevent the spread of HIV in our community. For more than four decades, the fight to prevent the spread of another virus, HIV, continues,” Michelle Moses-Meeks, president of the chapter, said as she opened the meeting.
The origins of HIV
Wilson discussed basic information about HIV, reviewing the origins of the virus and how it became a global epidemic. She also talked about the transmission of the virus and how it affects the body.
“The human immunodeficiency virus, or HIV, is the virus that causes AIDS, or acquired immunodeficiency syndrome. HIV is a retrovirus, which means it uses RNA as its genetic material. It’s also a slow-acting virus. It takes many years to see the outcome of this virus,” Wilson explained.
She moved on to discuss the two types of HIV – HIV-1 and HIV-2 – which she explained resulted from the cross-species transmission to humans from non-human primates, monkeys. When found in non-human primates, these viruses are referred to as simian immunodeficiency viruses or SIV.
Wilson indicated that the origin of HIV has been traced back to the 1920s in Southern Cameroon, known now as the Democratic Republic of the Congo. Humans likely acquired HIV from the handling of infected primate carcasses, during the killing and trading of primates as bush meat for human consumption. She explained that humans with open wounds on their arms and hands while handling infected chimpanzees and likely infected by the primate’s blood and body fluid. Once the virus was transmitted to the human population, HIV began to spread.
“While sexual transmission was the major driver of the epidemic, unsterilized injections at clinics in the area may have also contributed to the dissemination of HIV,” she added.
HIV in the United States
The arrival of HIV in the United States is controversial, according to Wilson.
She explained that the virus appeared in Haiti in the 1960s and was likely transported by 4500 skilled Haitian professionals who were employed by the Congolese government. It is also possible that one technical assistant, who was infected with HIV, came to Haiti and started a chain of sexual transmission.
She also mentioned that it has been theorized that Haitian male sex workers infected American gay and bisexual men touring Haiti or infected Haitian male sex workers may have brought the virus back to the U.S.
Wilson commented that HIV was likely circulating in the U.S., unsuspected for approximately 12 years, before the initial 1981 case of HIV was recognized.
The transmission of HIV
“The primary source of someone getting HIV is by sexual transmission. And the affected partner has to have detectable virus,” Wilson stated.
Wilson explained that HIV is transmitted through body fluids: specifically blood, vaginal fluids, breast milk, pre-seminal fluid, rectal fluids and semen. She further explained that HIV is not transmitted through hugging, closed mouth kissing, sharing toilet seats, through the air, shaking hands, sweat, tears, saliva, sharing dishes, or mosquitoes or other insects. She stated that HIV cannot survive outside of the human host or reproduce for more than a few seconds to minutes.
“Condoms can serve as a protective barrier between contact with infected fluids and considering all ethnic groups, male, same-sex or penile to anal sex with transgender women, remains the driving force of transmission with men and transgender men, whereas vaginal sex is the main driver for heterosexual transmission. It must be blood to blood or mucous membrane,” Wilson further explained.
HIV invades the normal immune system and cannot be eliminated from the body. It then integrates itself into the DNA and replicates when activated to respond to infection. Reservoirs of the virus are then established in the lymph nodes, the spleen and the gut, according to Wilson, who added that HIV can infect the brain, macrophages and dendritic cells.
The treatment of HIV
To treat HIV, Wilson explained that taking antiretroviral therapy – known as ART – stops HIV from replication and allows the CD4 T cells, which help coordinate the immune response, to survive and recover. Wilson stated that it takes approximately one to six months of treatment for the virus to become undetectable. After 12 months, there is effectively no risk of transmitting HIV to a sexual partner.
“Diagnosis is very critical to ending HIV/AIDS. When someone is diagnosed, it actually reduces transmission by behavioral change. People, once they know, are careful with sexual activities or some of the other risk factors that cause HIV – and, also by treatment,” she said. “Therefore, the most important method of a continuum of care is diagnosis because that enters people into that continuum.”
Approximately 86% of those living with HIV have been diagnosed, which means that nearly 14% of people living with HIV, do not know that they have HIV and are not receiving or accessing the care and treatment they need to stay healthy and are potentially transmitting the virus to others.
Nearly 80% of new HIV infections come from about 40% of those who either do not know that they have HIV or those who were diagnosed but did not receive care or treatment. Black gay and bisexual men have the highest number of new HIV diagnoses, when compared to other groups. For women, the highest number of new HIV diagnoses is occurring from heterosexual contact, which makes up approximately 92% of new HIV cases in women, She stated.
How to end the HIV epidemic
“In order to end the HIV epidemic, we have a plan for America and that goal is to reach 75% reduction in new HIV infections by the year 2025,” Wilson said. “We also want at least 90% reduction by 2030 to actually end the epidemic and we have the technology to do that.”
Wilson said the Department of Human and Health Services will work with each community to establish local teams on the ground to tailor and implement strategies to 1) Diagnose all people with HIV as early as possible after infection, 2) Treat the infection rapidly and effectively to achieve sustained viral suppression, 3) Prevent new HIV transmissions by using proven interventions, including pre-exposure prophylaxis – known as PrEP – and syringe service programs – known as SSPs, and 4) Respond quickly to potential HIV outbreaks to get needed prevention and treatment services to people who need them.
The current status and disparities of HIV
Next, Kaushink discussed the current status of HIV. She stated that by the end of 2019, worldwide, there were 36.2 million adults and 1.8 million children – 15 years old and younger – that were living with HIV/AIDS. Approximately 600,000 adults and 95,000 children had died of AIDS.
In the U.S., nearly 1.2 million people were reportedly living with HIV/AIDS, with 36,400 new HIV diagnoses by year-end 2019. Dallas County was rated the second-highest county in Texas with the highest number of HIV infections at the end of 2019, with a total of 755 new HIV diagnoses, 383 cases of AIDS, and 19,493 individuals living with HIV, she added.
“There’s a disproportionate number and definitely very disproportionately high percentage of African American men and also women that have or acquire HIV cases as opposed to Whites. That’s also true with Hispanics. The disease is much higher in minorities,” she said.
Kaushink stated that health disparities play a large role in HIV/AIDS among Blacks in Texas. HIV affects heterosexual Black women more than women of other races and ethnicities. Black women are 14.5 times more likely to die from HIV infection than White women and Black women have an AIDS rate of 15 times more when compared to White women. Black men and women are less likely to be diagnosed as quickly as Whites, which results in Blacks being less likely to be treated as quickly as Whites. Kaushink explained that these differences are a result of social-economic differences, poverty and an increased rate of incarnation among Blacks.
Kaushink offered the following tips to prevent new cases of HIV infections, provided by Health Services of Texas:
- Using protections when having sex (condoms, HIV preventative medication)
- Using HIV preventative medication such as PrEP (pre-exposure prophylaxis) or PEP (post-exposure prophylaxis)
- Never sharing needles
- Minimizing the number of sexual partners
- Knowing your status and your sexual partner(s) status
Kaushink ended her presentation with a discussion on the HIV-related services that are provided by the Health Service of North Texas. Those services included HIV/AIDS testing and education, pre-exposure prophylaxis or PrEP, counseling, prescription assistance program and case management.
The story of Belinda Hernandez
“I knew nothing about HIV/AIDS – zero. I’ve always heard about it. I’ve known that it was out there, but I never dreamt that it would be on my porch with me,” explained Belinda Hernandez, a Dallas native with two daughters, as she shared her personal story of survival with HIV.
Hernandez recalled that her body itched everywhere and that she woke up feeling sick every day. Once she saw a doctor, she was diagnosed with HIV. Hernandez explained that she was shocked by the diagnosis because she is heterosexual and never used or shared needles. She questioned how she contracted the virus but was relieved at the same time because she had a way to manage her disease and the symptoms.
“It is a full-time job. You need to keep up with your medications and they need to be taken at all times,” she noted. “There should never be a reason why you should go without them.”
Acceptance of her diagnosis came in stages.
“It’s been rough knowing that I have HIV. It has been. But I tell you, in the beginning, I was like, ‘Oh my gosh, I have that and I’m going to be so ashamed of it.’ That only lasted for about 90 days. After 90 days, I’m here to help anybody and everybody through this that suffers from it like I do.
“Hold on tight. Follow your physician’s orders. You can win. You’re not going to beat the disease or anything like that, but you can live and function if you follow the directions of your physician. I walk it and live it every day. I’m not afraid anymore. I feel stronger. My mind is clearer.”
Living with HIV
Wilson stated that PrEP is recommended for sexually active people.
“If you are having sex with, especially without a condom, or having sex with someone who might be HIV infected, ask your doctor for PrEP. Definitely, men who have sex with men, PrEP is recommended, and men who have sex with transgender women,” Wilson emphasized. “There are studies on-going now, we have what’s called 211, which is PrEP on-demand, for people who were assigned male at birth. And there are some studies on-going for cisgender women, people who are assigned female at birth.”
Kaushink stated that there is evolving data on the life expectancy of someone living with HIV.
“We now have new drugs, we are treating early and someone who just contracted, giving new diagnosis. It varies depending on when you got started, the treatment,” Kaushink explained. “Someone who has the presence of HIV for 10 years and starts the treatment, might have a different life expectancy than some who starts at, two months back they were negative, or a few months back they were negative, and they just found out they were positive, and they start the treatment.
“Basically, what we believe now is that once you start the treatment, your life expectancy should remain similar to someone who doesn’t have HIV. If you take the medication, it’s almost like you don’t have it anymore, the virus is undetectable, which would be the case with someone who doesn’t have HIV. Yes, there are other effects, but the life expectancy should be similar to someone who doesn’t have HIV.”
Continuing the HIV/AIDS conversation
Auntjuan Wiley, CEO of AIDS Walk South Dallas, discussed what the community could do to continue the conversation related to HIV/AIDS and end the epidemic.
“I am living proof. HIV has been living with me for 29 years,” Wiley stated. “And I say HIV has been living with me because I am in control of my HIV, HIV is not in control of me. And I have friends who are 70 years old, 60 years old, 80 years old, who are living positively with HIV. Meaning they are living a normal life because they are not allowing HIV to control their lives. It’s just a little small part of who we are. There’s so much more to us. We are bold. We have dreams. We have visions. All the things we had before HIV, we have now, living with HIV.”
As a community, Wiley said people have allowed the conversation about HIV/AIDS to become complacent and have forgotten that HIV exists. To change this dynamic, Wiley encouraged everyone to continue the conversation about HIV, normalize it, and consider how it is being talked about. As an example, instead of “I am infected with HIV,” she suggested saying “I am living with HIV.”
“That also destroys the stigma. That also helps change the face of HIV. As you can see, I’m very healthy. As you saw – Belinda, she very healthy – HIV doesn’t have a look,” Wiley said.
“Let’s heed the call to inform, prevent and protect our community from HIV,” Belt said in closing.