The beginning of December marked the 35th World AIDS Day, providing an opportunity for medical professionals and community members alike to reflect on advances since the AIDS epidemic began in the 1980s and to look ahead at the progress to come.
Human immunodeficiency virus (HIV) is an infection that attacks the body’s white blood cells, weakening the immune system and rendering the individual susceptible to other illnesses. Acquired immunodeficiency syndrome (AIDS) is the advanced stage of HIV. The virus can be transmitted through specific body fluids from a person with a detectable viral load of the disease, typically via sexual activity, sharing needles, blood or from mother to infant. Although the disease is prevalent in populations like injection drug users and men who engage in sexual activity with men, it spreads beyond those groups. The National Institutes of Health has documented over 700,000 AIDS-related deaths in the United States since 1981, with over 1 million people in the country currently living with HIV. The CDC reports an estimated 32,100 new HIV infections in the United States in 2021, half of which occurred in the southern region, including West Virginia, along with around 1,700 HIV-related deaths in 2020.
While there is currently no cure for the disease, significant strides have been made in treatment and destigmatization, with ongoing efforts at local and global levels. Among these noteworthy advancements are the development and refinement of preventative medications and post-infection treatment.
“We have transitioned from HIV being an acute devastating infection that invariably caused people to die, to now being a chronic disease model where we have multiple tools and interventions to help people live their normal lives,” said Dr. Arif Sarwari, WVU Positive Health Clinic medical director and associate dean for Clinical Affairs at the WVU School of Medicine.
One such tool is pre-exposure prophylaxis (PrEP), a medication that has proven highly effective at preventing HIV infection through sexual activity or injection drug use. Additionally, antiretroviral therapy (ART) is a post-infection medication shown to control HIV in as little as six months. Typically, these treatments are as simple as a pill or a shot. Successful HIV treatment can decrease the individual’s viral load to the point of being undetectable on tests — meaning the patient cannot transmit HIV through sex or perinatally, and largely transmission through injection equipment and breastfeeding.
“I have been [at Milan Puskar Health Right] for 23 years, and even in that period of time, things have improved for people with HIV,” said Milan Puskar Health Right Executive Director Laura Jones. “The medications can basically keep your viral load undetectable. That certainly can prevent the spread of HIV for sure, so that’s really why we want to identify people who might be at risk; 35 years ago, that was not the case, and it was pretty much a death sentence. That is not the case anymore.”
Beyond preventative medication and post-infection treatment, other methods of preventing the spread of infection supported by medical professionals include education, testing and harm-reduction efforts.
“Unfortunately one of the ways you combat HIV is to saturate the community with syringes, and making sure the community of people who are injecting drugs have a clean syringe every time to help prevent the spread of disease,” said Jones. According to the CDC, syringe programs providing “access to and disposal of sterile syringes and injection equipment, vaccination, testing, and linkage to infectious disease care and substance use treatment” are associated with an approximately 50% reduction in HIV incidence.
Along with supporting harm reduction programs, Health Right aims to increase testing and ensure everyone, especially at-risk individuals, knows their HIV status. This has especially become important as HIV rates in West Virginia have grown incrementally through outbreak clusters in recent years.
The WVU Positive Health Clinic provides HIV care services to the northern 33 counties of northern West Virginia. The clinic aims to take a multidisciplinary, comprehensive approach to HIV, working closely with other organizations to accomplish this goal. The clinic typically sees about 35-40 new patients per year — not necessarily in new diagnoses, but new patients. In the past couple years, however, that number has grown closer to 50-60. CDC data shows this increase in the state can be largely attributed to injection drug use.
During Sarwari’s training at the University of Maryland at the peak of the HIV epidemic and his time at the Positive Health Clinic, he saw very few patients infected with HIV through injection drug use; now, however, that is changing.
“More and more of our newly diagnosed patients’ risk factors are substance use disorder, sharing needles, injection drug use — and that is a different disease process,” said Sarwari. “From my perspective, addiction is the primary disease and HIV is the secondary disease. You can’t address the HIV until you combine it with addressing the addiction issues.”
The theme of the 35th World AIDS Day was “Remember and Commit,” highlighting the actions of community groups and medical professionals in moving towards a brighter future for individuals with HIV while honoring those that suffered at the disease’s hands and faced the associated stigma.
HIV testing, treatment and resources are available at numerous locations throughout the region and can be discussed with your primary doctor. Milan Puskar Health Right can provide testing and resources to eligible patients, and the WVU Positive Health Clinic also has treatment and resources available for eligible patients. Visit mphealthright.org and medicine.hsc.wvu.edu/wvu-positive-health-clinic for more information.
