The Latest in Preventing and Surviving HIV/AIDS

Most of the reporting on the impact of HIV and AIDS focuses on men who have sex with men. But, CIS and transgender women are also at risk for this sexually transmitted infection — including those in monogamous relationships.

Thankfully, the latest prevention, testing, and treatment options save thousands of lives from what was considered an early death sentence in the 1980s and 90s.

Who is affected by HIV?

“The majority of the new cases of HIV infection in the U.S. still occur among men who have sex with men. However, there are a considerable number of new infections among women in the United States, in South Florida, and especially internationally. Transgender women are also a population with high rates of HIV,” says Maria Luisa Alcaide, M.D., an infectious diseases expert with the University of Miami Health System.

“In Sub-Saharan Africa, young women, adolescent girls, and women represent the highest number of new HIV infections,” Dr. Alcaide says. “In the U.S., about 20 to 30% of new infections occur in both younger and older women, most of them heterosexual. Many times, they do not report having multiple sex partners.”

What makes some women vulnerable to HIV infection? 

Namely, having another sexually transmitted infection (STI) plus exposure to the virus through sexual contact. 

“Women who have an STI have more inflammation in the genital tract. Also, changes in the vaginal flora increase inflammation and make the vaginal and cervical mucosa more susceptible to get infected with HIV if exposed to the virus,” Dr. Alcaide says.

“When we talk about sexually transmitted infections, most people think of chlamydia and gonorrhea. But, other infections like herpes (a virus) and trichomoniasis (a parasitic infection) can also increase the chances of HIV acquisition,” Dr. Alcaide says. 

“Changes in vaginal flora (caused by bacterial vaginosis, which is very common) also cause inflammation of the genital mucosa and predispose women to acquire HIV.” 

This increased risk also applies to men who have an STI.

“The Black and Latino communities are disproportionately affected by HIV/AIDS, especially in the South, because HIV affects people who suffer from other social determinants of health. There’s also a lot of HIV-associated stigma in these communities, which lowers the frequency of testing, prevention, and access to treatment,” Dr. Alcaide says.

“Blacks and Latinos are also disproportionately affected by low socio-economic status, poor education, high rates of substance use, and untreated mental health issues. This combination of factors, including lower access to preventive and reactive access to healthcare, makes these populations more vulnerable to HIV/AIDS and other infectious diseases.”

How can you protect yourself and others from HIV?

The first line of defense is knowledge of your HIV status. 

Everyone who is sexually active should regularly get tested for HIV (and other STIs). Knowing your status empowers you to get STI treatment and take extra steps to prevent the spread of viral, bacterial, fungal, and parasitic infections contracted through skin-to-skin contact and bodily fluids.

“It’s certainly reasonable that women, even those in monogamous relationships, get regularly tested for HIV,” Dr. Alcaide says. 

Use protection. 

Penial and vaginal condoms, when used correctly and consistently, are still a trusted way to reduce the risk of catching or spreading many STIs.

If your sex life puts you at risk, get on PrEP. 

Pre-exposure prophylaxis (called PrEP) is a prescription medication recommended for men and women with multiple partners, inconsistent condom use, those with a partner diagnosed with HIV, people diagnosed with another STI, and those who share needles or injections. This medication, when taken as a daily pill as prescribed, is about 99% effective at preventing the spread of HIV. PrEP can also be administered every two months as an effective injectable medication.

“Access to PrEP has expanded significantly, especially at the University of Miami, where we are one of the pioneers of PrEP delivery and implementation,” says Dr. Alcaide. “We have an HIV prevention clinic and a mobile unit and are conducting pioneering research with the goal of increasing the uptake of PrEP in our community. We are confident that PrEP is making a big impact on reducing HIV transmission in Miami and South Florida.” 

Protect your partners with ART. 

If you’ve been diagnosed with HIV, you can greatly reduce your risk of developing AIDS, improve your mortality risk, and significantly lower the chances of giving the virus to your sexual partners by taking antiretroviral (ART) medications. 

“Access to antiretroviral therapy, the sooner the better, is key for anybody who is infected with HIV,” Dr. Alcaide says. “People who take ARTs consistently can achieve an undetectable viral load. ‘Undetectable’ equals ‘intransmissible,’ meaning that people with HIV who take the medication do not transmit the virus to their partners.”

For HIV to remain undetectable and intransmissible, antiretroviral therapy must be taken consistently. With this medication, the virus remains dormant, so if a patient stops taking ART, the virus will reactivate because, currently, there is no cure for HIV. 

New hope and treatment for people with AIDS 

When taking ART as prescribed, people diagnosed with HIV have a life expectancy that’s almost the same as people without HIV infection. 

“Even people who have AIDS can benefit from antiretroviral medications,” Dr. Alcaide says. “When we start this treatment later in the disease progression, patients can still benefit from an undetectable viral load, and their immune systems can slowly recover.

“The diagnosis of AIDS is based on a weakened immune system, which leads to opportunistic infections that wouldn’t affect that person if they didn’t have AIDS. So, in those cases, we have to treat both HIV as well as those opportunistic infections. When we do this, and the immune system gets stronger and recovers, people with AIDS greatly benefit from the therapy, and survival improves. Fortunately, we are seeing a reduction in the number of people who present with late diagnosis and AIDS,” she says.

Beyond saving lives, new treatments are easier for patients to access and take. 

UHealth promotes early access to ART with a program focused on rapid entry. “This means that we can start patients on antiretrovirals the same day they get an HIV diagnosis,” Dr. Alcaide says. “They get on treatment as soon as possible to reduce the impact of HIV and prevent transmission to others.

“We have also moved away from prescribing many pills taken many times a day. Now, most people with HIV can take one pill once a day. We even have injectable medications administered once every two months that can control HIV infection.”

Is this the end of the HIV epidemic?

Dr. Alcaide says we have the tools to end the HIV epidemic in the U.S. “We need to diagnose everyone who is HIV-positive, put them on treatment, identify those who are at risk, and get everyone to use the available prevention measures. All of this together will make us successful in preventing infection. We just have to find ways to put these effective tools together and implement them to end HIV.”  

New infection numbers have gone down significantly, and survival rates have skyrocketed since the AIDS epidemic of the late 1980s through the mid-90s. 

“But we still see new infections, and those transmission numbers are sometimes higher than expected. Just like with many other infections, if we drop our guard, the numbers will go up,” Dr. Alcaide warns.

Dana Kantrowitz is a contributing writer for UHealth’s news service.

Tags: Dr. Maria Alcaide, HIV from sex, hiv test, infectious disease care in Miami, risk of getting hiv, sexual health in Miami, stages of hiv