By Henrylito D. Tacio
John grew up in the province and didn’t know if he should come out in the open. Knowing that his parents are very conservative, he decided to keep his being a homosexual a secret. For how long, he would never know.
After graduating from high school, John told his parents he wanted to go to Davao City to pursue his dream of becoming an engineer. His parents didn’t object to his plan. In fact, they supported him.
He was already in his junior year in college when he met Mike, another closeted gay. They soon became lovers. He moved to Mike’s apartment to be with him. John did not learn, until later, that Mike already had several lovers prior to meeting him.
Months later, John observed that his lover was getting sickly – frequently having fever, weight loss and cough that would not go away. Mike dismissed his observation, saying he was only stressed out from work. But when Mike’s condition did not improve, John decided to bring him to the hospital.
At first, Mike protested. But John insisted and said he would go with him to the hospital.
Initially, the doctor could not find anything wrong with John’s lover. But when he learned that Mike had many sexual conquests before, the doctor tried to confirm from the laboratory what he had been suspecting.
Laboratory findings showed that Mike had human immunodeficiency virus (HIV), the virus that destroys the immune system and causes Acquired Immune Deficiency Syndrome or AIDS.
This happened in 2008 when two people per day were diagnosed of having the virus, according to the records released by the Epidemiology Bureau of the Department of Health.
Since then, the number of Filipinos being infected with HIV daily surged. Every day, 7 people were infected in 2011, 13 in 2013, and 22 in 2015. For this year, the number of people diagnosed daily with HIV is 32.
“Our country has the fastest-growing HIV infection rate in the Asia-Pacific region,” bares Dr. Louie Mar A. Gangcuangco, an infectious disease researcher whose expertise in HIV field is recognized internationally. “This is something we should be very concerned about.”
Not only that. The Philippines “has also become one of the eight countries that account for more than 85 percent of new infections in the region,” stated a report from the United Nations AIDS (UNAIDS).
The exponential increase in HIV infection in the country, according to Dr. Gangcuangco, is “very alarming because the people who are affected are mostly young individuals.”
In February 2018, for instance, about 871 new HIV cases were recorded by the HIV/AIDS and ART Registry of the Philippines. The median age among those reported cases was 27 years old. Half of those infected were 24-35 years old and 29 percent were 15-24 years old at the time of testing.
A patient infected with HIV can have the virus for many years without having any physical symptoms. When the immune system is destroyed by the virus, a person is considered to have AIDS and the weak immune system places him or her at risk of various infections and even cancer. “Between HIV and AIDS, there is a window period of as much as five years,” said Dr. Jordana P. Ramiterre, chief of the Reproductive Health and Wellness Center of the Davao City Health Office.
AIDS is caused by a deficiency in the body’s immune system. “It is a syndrome because there are a range of different symptoms which are not always found in each case,” explains Dr. John Hubley, author of The AIDS Handbook. “It is acquired because AIDS is an infectious disease caused by a virus which is spread from person to person through a variety of routes. This makes it different from immune deficiency from other causes such as treatment with anticancer drugs or immune system suppressing drugs given to persons receiving transplant operations.”
HIV is present in all body fluids of an infected person but is concentrated in blood, semen and vaginal fluids. Virtually, it is present in all body tissues and organs including the brain and spinal cord. It can be found in tears and saliva although these are not considered significant routes of infection.
Generally, HIV is transmitted in the following ways:
• Sexual contact with an infected person, during which the mucous membrane lining of the mouth, vagina, penis, or rectum is exposed to contaminated body fluids. This usually happens when unprotected sex is practiced.
• Injection or infusion of contaminated blood, as occurs with blood transfusions, the sharing of needles, or an accidental prick from an HIV-contaminated needle.
• Transfer of the virus from an infected mother to a child before birth, during birth, or after birth through the mother’s milk.
HIV is NOT transmitted through kissing, sharing food, hugging, handshake or touching.
A DOH report cited sexual intercourse as the leading mode of transmission in the Philippines. Men having sex with men through anal intercourse, where the penis penetrates the anus of the other person, is currently the leading mode of transmission. Vaginal intercourse, where the penis penetrates the vagina, is the second most common route of transmission.
“A single sexual encounter can be sufficient to transmit HIV,” Dr. Hubley wrote. “Although the risk from an individual sexual act may be low, the more times a person has sex, the greater the likelihood that transmission will take place. Women appear to be more at risk than men from heterosexual sex. The transmission of HIV from man to woman is believed to take place more easily than from woman to man.”
Unknowingly, HIV is relatively fragile and can be easily killed by household disinfectants. But once it is inside the human body, there is no way a person can eliminate the dreaded virus.
Unlike flu, which already gives you the symptoms the following day after acquiring it, HIV infection can show no symptoms for several years. Studies have shown that it could be as short as three years or as long as 12 years.
Symptoms differ widely from country to country. In most cases, HIV infection starts with flu-like symptoms that resemble mononucleosis (the so-called ‘kissing disease’). These may persist for two weeks to a few months after HIV enters the body.
“After the first stage,” says The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments, “symptoms may disappear for several years. How the AIDS patient takes care of himself or herself during this time is extremely important, because HIV is multiplying in the body, slowly at first and then rapidly. As the virus systematically destroys the cells that fight off infection, the immune system begins to fail and the patient becomes vulnerable to various illnesses and tumors.”
Among the diseases that affect people with HIV include tuberculosis (TB), Kaposi’s sarcoma (a tumor primarily affecting the skin), pneumonia, herpes, shingles and weight loss. “Many complications of HIV infection, including death, are usually the result of these other infections and not of the HIV infection itself,” states The Merck Manual of Medical Information.
A person will only know that he or she is infected with HIV if he or she undergoes testing for HIV. “The HIV test works by detecting antibodies produced by a person after exposure to the virus,” explains Dr. Willie Ong, author of Doctors’ Health Tips and Home Remedies. “A common problem here is when to do the HIV test. If a person has become infected with the HIV virus, how long is the lag time before the person test positive?”
According to studies, most persons will develop a positive HIV test within 2-8 weeks after exposure. “Around 97% will develop these antibodies within 3 months of exposure,” Dr. Ong said. “A few rare cases (less than 3 percent) will take six months to become positive. Because of this, experts recommend that a person gets an HIV test at 6 weeks and at 3 months after exposure. It is optional to take another test at 6 months after exposure.”
Currently, there is no cure known for HIV but the virus can be controlled with proper medications called antiretrovirals. “These antiretrovirals are provided for free by the government,” says Dr. Gangcuangco, a Balik Scientist who came to attend the opening of the National Science and Technology Week in Davao City recently. “With healthy lifestyle and if antiretrovirals are taken every day, people with HIV can have ‘undetectable’ virus in their blood.”
By “undetectable,” he means that the virus is still in the body but in very low amounts that it cannot be detected by the machine.
According to Dr. Gangcuangco, there are two benefits of taking medications for HIV. First, it prevents HIV from destroying the immune system of someone with the virus. Second, it prevents the spread of HIV because the virus will also be very, very low in the semen and other body fluids.
Another good news: there is now a medication, when taken every day, can prevent HIV infection. It is called pre-exposure prophylaxis (PrEP for short). “This medication is a pill that contains antivirals,” explains Dr. Gangcuangco. “When HIV enters the body, a person who takes PrEP is protected against HIV infection. PrEP blocks the virus from reproducing in the body and is effective to prevent HIV transmission by more than 90%.”
Three years ago, the Geneva-based World Health Organization (WHO) issued a statement that said: “people at substantial risk of HIV infection should be offered PrEP as an additional prevention choice, as part of comprehensive prevention.”
Dr. Gangcuangco, however, dispel the idea that PrEP can now replace condoms and other preventive measures for HIV. On the contrary, PrEP should be offered together with them. “PrEP is not meant to replace counseling and condom use but should be used as an adjunct to prevent HIV,” he explains.
Unfortunately, PrEP is currently not available nationwide in the Philippines. “PrEP still needs approval by the Philippine Food and Drug Administration and the government needs to procure this to be available nationally,” Dr. Gangcuangco says, adding that it is available but limited in some few HIV treatment hubs.
“I strongly believe that PrEP should be made available nationwide to help prevent HIV transmission,” says Dr. Gangcuangco, who serves as a consultant for the University of the Philippines-Philippine General Hospital study entitled, “Immune Activation Dynamics of HIV Infected Patients on Antiretroviral Therapy in the Philippines.” “PrEP is one of the missing pieces in HIV control in the Philippines.”
The cost of PrEP varies from different countries, but a genetic version has already been approved although the cost is still relatively high – about US$1.99 per tablet. “Worldwide efforts are exerted to bring the cost down,” he says.
Now, the question is: should PrEP be taken only when one is engaged in unprotected sex? “The recommendation is: people who are at risk should take PrEP every day to make sure that enough medication is in the system in case the virus enters the body,” Dr. Gangcuangco replies.
“HIV is not and should not be a death sentence anymore,” he concludes. “Everyone who has engaged in unprotected sex, whether male or female, heterosexual or men having sex with men, are at risk of getting HIV. Screening for the virus is free and confidential in many Social Hygiene Clinics nationwide. If HIV is detected early and if the patient takes antiretrovirals early, the virus can be controlled. There is still no cure for HIV but the bad effects of the virus can be mitigated with healthy lifestyle and early treatment.”
Oct 2018 Health and Lifestyle