Search for a Cure- An End to AIDS: Yes We Can

Reasons For Hope (RFH)

is Search For A Cure's national HIV treatment news series.

RFH covers the latest in developing therapies for treating HIV/AIDS.

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Why We Should All be in a Clinical Trial

It is hard to get people to join a study of new medicines nowadays. This is mostly because people think the therapies we have are good enough. It's not true. HIV medicines fail some people. And they are too expensive for most of the world to use.

The medicines we have are not a cure, are a lifelong financial burden and have lots of side effects. The only way to see if new therapies work is to test them on people with HIV. The only way to see if a vaccine will work is to test it on people without HIV. If we want the day to come that HIV is a thing of the past the most important thing we can all do is find a study that needs us and join it.

An End to AIDS: Yes We Can

An Editorial
By David Scondras, Search For A Cure

All of us hope that there will be an AIDS vaccine someday. Most scientists believe that this will take a great deal of time.

But we can end AIDS now with what we already know.

It will be much more difficult without having a vaccine that protects from HIV, but it can be done.

By all of us working together.

Ending any epidemic means getting the rate of infection lower than one newly infected person infected by a person already infected. As soon as the average rate of infection falls below one new infection for each person already infected, the epidemic will eventually burn out.

With this idea in mind, there are five practical steps we could take to ending the epidemic.

1. Test everyone for HIV regularly.

2. Treat everyone who tests HIV positive immediately

3. Make PEP and PREP universally available on demand

4. Support serosorting and risk reduction techniques

5. Support circumcision, treatment of STD’s and Herpes

These five steps taken together along with community based education can reduce HIV transmission to the point the epidemic burns out.

1. Test Everyone

We already know from many studies that when people find out their HIV status, their behavior changes and they are much less likely to infect someone. Many researchers believe that most new infections come from people who do not know that they have HIV.

So the first step is to make HIV tests available to every person, free of cost, wherever and whenever a person might want to get a test. Rapid HIV assays should be made available in bars, drug stores, markets, schools, railroad stations, in other words, where ever there are people gathering. Two types of tests should be made available: fingerstick type fast tests, and tests which use saliva (oral mucosal transudate tests). The latter might be easier to use but they are easier to get wrong—perhaps both should be available for people who test positive on the oral saliva test using the more accurate test to make sure the test is correct. And the tests should have a phone number to call in case they show that you are infected so that anyone can get counseling and advice as soon as they want it. A person should be able to call even before they take the test so that they can get beyond the fear of taking the test.

Keep in mind that as soon as a person is tested they are less likely to get and give HIV. If they test negative they will want to protect that status. If they get test positive most people will want to make sure they do not infect anyone else.

Because this is true, and because the best time to protect the immune system from HIV and reduce infectiousness is as early as possible in the infection, it is important to teach people the symptoms of getting infected so that they can get treated right away if they have been recently infected. If you have a high fever, a headache, swollen glands under your chin and in the groin area, a rash like measles across your chest and feel like you have the flu, and if you had over the past few weeks sex with someone or shared needles, then get tested and if positive get medicine right away. You are most infectious to others at the beginning of the disease and taking medicines will protect your immune system that you need to fight illnesses, and taking medicines will also help protect everyone else from getting HIV from you.

2. Treat everyone who is HIV positive immediately

We know that a person who is treated can get the amount of virus they have in their body very low. And we also know from many studies that people with very low virus are very unlikely to infect another person. Dr. Tom Quinn from Johns Hopkins did a big study of serodiscordant couples over a 30 month period. Serodiscordant means that one member of the pair had HIV and the other did not. Over the 30 months 90 people got HIV from their partner. But NOBODY whose viral load (the amount of virus in your blood) was below 1500 got HIV. HIV meds get viral load much lower usually below 50 and almost definitely below 400. So if a person is infected, treatment is prevention.

3. PEP and PREP

Make PEP and PREP available on demand. PEP means Post Exposure Prophylaxis. PREP means Pre Exposure Prophylaxis. If a person has sex or uses IV drugs and makes a mistake, if they get HIV drugs within 72 hours of exposure they are very likely to protect themselves from getting infected. This is known from many years of studies of PEP used on healthcare workers stuck with contaminated needles.

It works.

PEP (Post Exposure Prophylaxis) on demand means that people who are concerned that they have been exposed should get free HIV medicines for a month that are taken on time every day. It many be that a shorter time than a month will work too but we just don’t know because it has not been tested yet.

We are already pretty sure that Truvada is good for this purpose. Other types of drugs may prove to be good for this use as well, but we have not tested them. Several types of drugs that stop HIV from getting into a cell in the first place might prove to be the best at PREP but we need to test them all to see how practical they are.

PREP on demand is PEP ahead of time. It means getting drugs before you share needles or have sex. Studies show that it does not increase risky behavior but it DOES help protect people from getting HIV. Not 100% but a lot better than nothing.

4. Serosorting and risk reduction

Serosorting means having sex or needles only with people who are like you, HIV positive if you are HIV positive, HIV negative if you are HIV negative. If we all did this, the epidemic would end. People in San Francisco have been doing this and many believe it is one reason the transmission rate fell for the first time ever last year.

Risk reduction means doing things that are less risky.

For example, oral sex, giving it and getting it, is a LOT less likely to transmit HIV than anal or vaginal sex. Anal and Vaginal are much more risky. We know this because only 8% of people with HIV said they got it from oral sex – since getting HIV at all is rare, that makes getting it orally extremely rare.

Another type of sex, frottage, is safe. This means stopping short of entering anus or vagina, not going all the way in.

Pulling out might help reduce risk, because semen has chemicals in it that make HIV a LOT more infectious, maybe 50-1000 times more infectious.

There are other ways to reduce risk. If you have trouble wearing condoms because you get soft, use Viagra. If you find ordinary condoms too tight use a big one. If you don’t like ordinary condoms try out the female condom. Jack off. Masturbate with each other watching a porn movie.

Try out different things so that the most risky things happen less frequently.

5. treatment of STD’s and circumcision

Data on STD prevention and treatment as a prevention intervention for HIV transmission is even better than the data on circumcision as a way to reduce HIV transmission- especially with recent studies on men who have sex with men in developed countries. For this reason, treating herpes, gonorrhea, syphilis and the other common sexually transmitted illnesses might be a very good way to reduce the rate of HIV transmission. With the side benefit of getting rid of other STD’s in the bargain!

Conclusion

It is time to call for an end to the HIV epidemic. Making easy and quick tests for HIV available and free in every drugstore, making counseling available at every drugstore where a person who finds they are positive can go to get free meds for HIV, making sure that condoms are available and free, making sure that every person knows the symptoms of getting infected with HIV so that they test and treat, along with teaching what we already know about abstinence, condoms, and reducing risk can put an end to HIV forever.

We can do this.

It’s the right thing to do.