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Information about the virus/syndrome.

What is HIV/AIDS?

HIV = Human Immunodeficiency Virus

This is the virus that can lead to

AIDS = Acquired Immune Deficiency Syndrome

Note:

AIDS is not a disease but a syndrome (i.e. a collection of symptoms/ conditions) resulting from the suppression of the immune system as a result of HIV infection. 

Someone living with HIV is said to be "HIV positive" (HIV+)

Doctors diagnose AIDS when the immune system has broken down to a point where a number of conditions are present. However, AIDS is an emotive term and is sometimes replaced by "HIV related illness" or "HIV disease".

      HIV is a weak virus which dies very quickly on exposure to air. It can only

      survive in the warmth and safety of blood and other body fluids. Unlike other

      Viruses (e.g. colds and 'flu) it's not airborne, nor can it be passed on through

      ordinary everyday contact. 

There are 4 main transmission routes:

·        Through penetrative sexual intercourse (heterosexual or homosexual) with an infected partner. The receptive partner is more at risk, but not exclusively so. Condom use significantly reduces the level of risk. Unprotected oral sex also carries a small, but significant, risk.

·        Through infected blood products. In the developed world, all blood products are now screened for HIV and heat-treated.

·        Through sharing contaminated injecting equipment e.g. intravenous drug users. There is also some risk from unsterilised equipment e.g. in tattoo parlours.

·        From mother to infant ("vertical transmission") in the womb, during birth or through breastfeeding. Breast milk contains high concentrations of HIV which can easily pass through the under-developed mucas membranes of the infant's mouth.

Although traces of HIV can be found in saliva, the virus is never present in sufficient quantity to pose a threat. HIV cannot be passed on by hugging or kissing, sharing cutlery, crockery or the Communion Chalice, nor via toilet seats or swimming pools.

Vertical transmission is now largely preventable in the developed world through careful monitoring, medication and avoidance of breastfeeding. However, this is not the case in the developing world where effective medical care is not so readily available and where there is no viable alternative to breastfeeding due to poor sanitation and/or cultural factors.

At the point of infection there's usually little indication that anything is wrong.  The newly infected person may experience mild 'flu like symptoms within a day or so.  The body produces antibodies in response to the HIV but it can take up to 3 months for these to appear.

The virus invades CD4 or T-Helper cells - key players in the body's immune system. Often the virus lies dormant for a very long time - sometimes years. For reasons not yet fully understood, but possibly related to the triggering of the immune system in response to another infection, the HIV is eventually activated and re-writes the DNA of the host cell, turning it into a virus factory where it starts to replicate itself.

Eventually the host cell "explodes" releasing the replicated virus into the body. As a result, the immune system of the patient is compromised and the patient becomes vulnerable to a wide range of opportunistic infections, including rare forms of pneumonia and cancer.   Some of these will be life-threatening. (Note: Technically, no one "dies of AIDS" - they die as a result of an opportunistic infection caught as a result of having a compromised immune system.)   

Technically an "HIV antibody" test (and most certainly NOT an "AIDS Test") this is a blood test that searches for the presence of HIV antibodies

in the blood. However, the 3 month "window period" (i.e. the time it can take for the body to produce detectable antibodies)  needs to be taken into account, so an HIV test taken the day after a high-risk encounter will only give the HIV status of the patient 3 months ago. A later re-test will be needed to secure a definitive result.

HIV testing is routinely offered to pregnant women but cannot be conducted without express consent in any other situation. 

As a result of recent developments in HIV treatments, those who may have been at risk of HIV infection are urged to be tested as soon as possible as, in the case of a positive test result,  this will allow Doctors to regularly monitor the status of their HIV and to start treatment when required.

Late diagnosis of HIV infection (i.e. when symptoms have appeared) is much more likely to result in the onset of AIDS and death.

The stigma of HIV, along with the mistaken belief that an HIV diagnosis means an imminent death sentence, often discourages people from having an HIV test. 

In the developed world, the principal treatment for HIV is HAART (Highly Active Anti-Retroviral Therapy). This consists of a "cocktail" of drugs ("Combination Therapy") each of which acts in some way to prevent the replication of the virus within the CD4 cell or to prevent the "explosion" of the host cell.

It sometimes takes time to find the best combination therapy for a particular patient and some of the drugs have unpleasant side effects, especially at the outset of therapy. However, it is often possible to find an effective and well-tolerated combination.

In time, the virus may become resistant to a particular combination, at which point an alternative will be sought.  When a patient's HIV becomes resistant to a specific combination, it isn't possible for the patient to ever return to that particular therapy, so future treatment options are reduced.

If a person has a drug-resistant strain of HIV and infects another person, the newly infected person inherits the drug resistance, so his/her treatment options are immediately reduced. 

Doctors monitor the health of people living with HIV by regularly checking the level of HIV in the blood ("viral load") and the number of healthy CD4 cells ("CD4 count"). 

HAART is not so readily or affordably available in developing countries.

Its effectiveness is also heavily dependent upon the patient adhering to a strict medication regime e.g. taking tablets at certain very specific times and/or taking tablets with food etc. Such compliance is not always possible in developing countries, even when the drugs themselves are available.

There is currently no sign of a cure for HIV and it may still be some time before a vaccine becomes available.

So, is it possible to be HIV+ and yet to be otherwise healthy?

YES.  In countries like the UK, it's possible for someone living with HIV to remain well for over 10 years - and in many cases much longer.

When a patient's viral load and/or CD4 count give cause for concern, HAART can help to suppress the virus and maintain good health.

Patients are advised to maintain as healthy a lifestyle as possible, with a nutritious, balanced diet and to avoid stress as much as possible

Children with HIV have their viral load, CD4 count and general health monitored in a similar way to adults. Where medication is necessary, the dosage has to be carefully calculated in relation to height and weight. On the whole, children seem to be more tolerant of the drugs and often experience fewer side effects than adults. However, it is still too early to give a long term prognosis; we're still learning about how HIV behaves in younger people and what the long-term effects of the medication might be.

That's a very good question!

When we think about HIV we're confronted with issues such as sex and sexuality, blood and body fluids, disease and mortality. Many people - not least people of faith, often feel very uncomfortable about thinking or talking about these things. There are also still many people who are ignorant about HIV and believe that they might "catch AIDS" (sic) from ordinary day to day contact with an HIV+ person.

Many people who are HIV+ are understandably fearful of disclosing their status, so they remain silent and invisible…….and therefore often incredibly lonely. 

As well as isolating people living with the virus, the ongoing stigma surrounding HIV undermines all efforts to raise awareness and to stop the spread of the HIV/AIDS pandemic.

           Most people who are infected with HIV, at least within the UK, hate to be

           labelled as "victims", so terms such as "HIV Victim" or "AIDS Sufferer"

           should be avoided at all costs.  Remember, many people with HIV

           will not have developed AIDS. The best generic term to use is "People

           living with HIV". (This also has the advantage of emphasising that they are

           living with the virus rather than dying of it). 

It's not usually appropriate to ask someone living with HIV, "How did you become HIV positive?" 

There are several reasons for this:

·        In view of the stigma of HIV, the person may be feeling extremely vulnerable and unsure of your reaction as a representative of a faith community. 

·        The question is (or certainly should be) irrelevant. Your concern should be to support the person in their current situation. This is one condition where it's not helpful to ask historical questions. Ask yourself why you want to know!

·        The question may suggest to the person (rightly or wrongly) that you wish to make a value judgment about how much support (s)he "deserves".

·        Infection may have been the result of a sexual encounter or activity that the person doesn't want to discuss with a relative stranger.

It's better to let the person take the lead and allow him/her to volunteer the information when ready.  As with so many things, build a relationship of trust and take it from there……

Revd Trevor Thurston-Smith
Chaplain for people affected by HIV
May 2006

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