A generalized graph of the relationship between HIV Viral Load and CD4 counts over the average course of untreated HIV infection; any particular individual’s disease course may vary considerably. CD4+ T cell count, cells per µL – HIV RNA copies per mL of plasma
HIV Treatment is HIV Prevention. They are inter-twined, dependent on each other. You can not effectively have one without the other. Treatment of people with HIV/AIDS means reducing their Viral Loads. The lower someone’s Viral Load is, the less infectious they are. The less infectious people are, the fewer new infections. That’s Basic Prevention 101. Treating infected people and making them less infectious is how you stop an epidemic from spreading.
One of the key problems is that 20% of HIV infected people don’t know their HIV status. We can assume that these people not only have high viral loads, but also are not practicing safer sex and therefore are out there infecting other people. Some doctors believe these people are THE link to new HIV infections.
The Florida Department of Health estimates that there are 125,000 Floridians infected with HIV/AIDS and more than 25,000 of these do not know their status. Nationwide there are more than 1,000,000 Americans infected with HIV/AIDS with more than 200,000 not knowing their HIV status.
The CDC is currently estimating that 56,000 Americans become infected with HIV every year. Each HIV infection will cost more than $600,000 in prescription drugs and medical coverage. The numbers are staggering both as a national health issue and as a national economic issue. HIV/AIDS is not only a personal health problem, it’s a national epidemic of enormous proportions. You can not have a healthy America without healthy Americans.
The answer may not be as complicated as you might think, Test, Treat and Educate. Seek and Treat is what they call it in British Columbia, Canada. Treatment not only saves lives, it can be one of the most compelling prevention tools we have.
We need to reduce the barriers that prevent people from getting tested. The fear of testing positive will always be there, but we can reduce the stigma of being positive. Knowing that if they test positive, treatment will be available, will also encourage people to get tested and know their status.
This site advocates not only a Seek and Treat program to reduce new infections but also education. When you test someone, you also counsel them on their risk factors so they can make more informed decisions. Negative people need to be counseled to take personal responsibility for staying negative. Risky behavior is like playing Russian roulette. If you keep pulling the trigger, sooner or later the cartridge is going to have the bullet. Law or no law, when 20% of HIV positive people don’t know their status, disclosure laws are not going to keep someone negative.
We also believe that the CDC guidelines for when someone positive starts drug therapy should reflect not only the patient’s own personal health, but also their level of infectiousness. Currently the CDC reccomends starting drug therapy based on CD4 T-Cell counts. We believe it should be based also on the Viral Load. A healthy CD4 T-Cell count with a High Viral Load might indicate that the patient personally doesn’t need HIV drug therapy, but reducing his viral load will help him from infecting other people.
But as budgets are cut nationwide, ADAP (AIDS Drug Assistance Program) are also being cut. Today there are over 2,700 Americans, over 1,000 Floridians and over 300 Broward County residents on ADAP waiting lists. Even during budget cutting, there are some programs that make no sense to cut. A program that dramatically impacts a national health epidemic is one of them. As a nation, we can not afford to cut ADAP. The cost of 56,000 new infections each year will cost the nation more than the current costs of providing AIDS Drugs. We must find ways to reduce those tragic numbers.
Seek and Treat or Test, Treat and Educate, I don’t care what you call it,just do it. If not for the physical health of the individuals then do it for the long term economic health of the country. This is the right thing to do.
POZitive Attitudes 
Prevention messages are so confusing these days, both in terms of what our prevention advocates (ASO’s, the CDC, etc) are telling us, and what we are negotiating amongst ourselves.
Condom usage is ebbing again, and being dismissed altogether among large portions of gay men who are HIV positive (http://marksking.com/my-fabulous-disease/condoms-bareback-sex-at-gay-summit/).
Your points about maintaining treatment are right on, especially since poz men are practicing sero-sorting more often (http://marksking.com/my-fabulous-disease/my-fabulous-disease-video-10-serosorting-and-sex-clubs/). The new question isn’t so much “what’s your status?” but should probably be “What’s your viral load?”
I’m glad you’re advocating on behalf of ADAP and educating people about why treatment adherence is so damn important. Thanks.
Mark,
We need to talk about this. So much of this is confusing to me that doesn’t get covered in these discussions or just gets barely mentioned. I’ve been accused of promoting barebacking and called a condom-Nazi. Too often we narrowly focus on HIV We sometimes view the world as if there are two groups of guys out there, Poz and Neg when in fact there are THREE groups out there. Negative, POZ who know it and Poz who don’t know it. Sero-sorting is a problem to me from many angles, although I personally advocate it sometimes. Sero-sorting would indicate to “negative” men that they too can practice bareback sex without fear of becoming HIV-infected. We know that’s not true. 20% to 44%, depending on the survey, of Gay men do NOT know their HIV-status and these men are the MOST infectious. Secondly, what about sero-sorting for Hep-C infected individuals. I have guys in my group that swear they were infected with Hep-C through sex. Thirdly, lumping all other sexually transmitted diseases together ignores the fact that syphillis is at epidemic levels down here in South Florida greatly beyond what the Health Department and CDC are reporting. The Health department is recorded about 300 cases of syphillis in Broward county last year. I know 2 doctors that treated that many cases. And syphillis will knock the heck out of your immune system. I don’t know whether someone can contract another strain of HIV, but I do know that if you dip it enough down here, you will get syphillis. Fourthly, we need to be on guard about any new epidemics that may be spreading in our community that just hasn’t surfaced yet. The guys who were dying of AIDS in the early 1980’s were infected with HIV in the 1970’s. We just didn’t know it. We should talk about this. You do an awesome job at interviewing. I’m going to ask you to come to Wednesday Group as a guest speaker on some subjects.
Thanks
-Steve
HIV / AIDS PREVENTION & EDUCATION: MARCH 04-11; 2012
The Aids Names Quilt Hangs for a limited time ~ in Fort Lauderdale Florida. Go see before they are gone…. tell your friends. Dont Wait~ or ~ Hesistate.
from March 4-11 at the National Week of Prayer for the Healing of HIv / Aids. 2501 Ne 30 Street FTL FL 33306 954-563-4271.
Near Oakland Park Blvd and Federal Highway. Across the street from Plaza 3000.