Episode Transcript
Interviewer: Misconceptions and misunderstandings about HIV AIDS up next on The Scope.
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Interviewer: So we're here with Dr. Adam Spivak. He is an assistant professor in the School of Medicine and a specialist in HIV. What we're talking about today is some of the misconceptions. Even in 2016 we've learned so much about the virus and what it means, but some of these misconceptions still are out there. So, let's go ahead and cover some of these. What about transmission? Like, can you get HIV from kissing another person or touching them or sitting on a toilet seat or some of those old kind of . . .
Dr. Spivak: HIV is transmitted primarily sexually, and it can also be transmitted through blood. It cannot be transmitted through saliva, through casual contact, sharing a toilet seat in a public bathroom, sharing food with someone who is HIV infected. None of these are at all put anybody at risk.
Interviewer: But those stigmas did exist once, right? Because they must've come from somewhere.
Dr. Spivak: Oh absolutely, absolutely, and of course in the early days when AIDS was first described in the early 1980s we didn't actually even know what caused it. It took two years. It was not until 1983 that a novel retrovirus, HIV, was discovered as the cause of AIDS. So you can imagine a disease that was causing such severe illness and deaths and you don't know what causes it. We didn't even know entirely that it was an infection for those first few years that a lot of stigma, a lot of stories circulate, and certainly those are powerful and have a way to persist.
Interviewer: One of the other misconceptions at least historically that might still kind of linger on today is you just see some of these old news clippings or these old photographs and things like that where people are referring to HIV and AIDS as a gay disease, as a gay cancer or something like that. We're starting to find out that that's not true.
Dr. Spivak: Yeah, no, no, no. Worldwide HIV is transmitted sexually actually through heterosexual sex as the predominant form of HIV transmission. In the early days again populations that seemed to be hardest hit were gay men, men who have sex with men, injection drug users, sex workers, and interestingly enough people of Haitian descent. But again, that has persisted along with the recognition of the early spread of AIDS among gay men as this population to be shunned. Of course when we're talking about the 1980s we're talking about a group that was very much discriminated against that felt very marginalized. Unfortunately a new disease, a lethal disease, a disease of unknown origin that seemed to be spreading like wildfire had the effect of amplifying a lot of those frankly prejudices that were already present in society.
Interviewer: What about HIV positive women who might be worried about whether or not they can ever have kids or be pregnant? What are some of the misconceptions about that?
Dr. Spivak: One of the real highlights, one of the bright spots with regard to prevention of HIV transmission is mother to child transmission. What we have learned through a number of really well done studies and now many years of clinical practice is that pregnant women with HIV who are started on anti-retroviral therapy on the treatment for HIV really do not pass on HIV to their infants. We know that even a single dose of the medicines given at the time of delivery can reduce transmission from mother to child. It appears as best we understand it that HIV transmits at the time of delivery. Even just a dose or two doses of the medicine at that time is a very powerful preventative. We go a few steps further than that and get mom fully treated, and in those circumstances transmission from mother to child is almost unheard of in the United States and Europe where we do this on a regular basis today, so a real bright spot in terms of HIV prevention.
Interviewer: What about some of the ideas and maybe stigmas that the disease is a death sentence, that if you catch it your life's over?
Dr. Spivak: When AIDS was first described in the 1980s up until the mid-1990s, we did not have reliable treatment and this often was a cause of death in folks that were otherwise young and healthy and in the prime of their lives. The stigma, the stereotype, the concept that HIV AIDS is a death sentence certainly has its roots in truth. However, it's 2016. Starting in the mid-1990s as we've discussed, 1995, '96, the introduction of what we call combination anti-retroviral therapy, new drugs hit the market. It's still what we use today. These are fabulous treatments for HIV. Our patients are living long healthy lives. They have to take the medicines every day.
Untreated absolutely it is devastating to the immune system. It leads to what we call opportunistic infections and ultimately to death. We saw that very graphically in the first decade and a half of this illness. However, what we see today with patients that are able to come in to our clinic, get access to care, take their medicines on a regular basis is that they are leading long, healthy, productive lives and are doing fabulously well.
Interviewer: What's one of the top things that you would suggest for people to have done on this World AIDS Day?
Dr. Spivak: Oh absolutely I think the most important thing that people can do is get tested. I say that because the vast majority of the United States population has never had an HIV test. Now most people may not be actively at risk for HIV which is to say they're not practicing unsafe sex, they may not be injecting drugs, but we do know and there've been a number of studies that have shown that there are quite a number of people living today who have HIV who are not diagnosed. That's a tragedy on a number of fronts. We've talked about the ability to get these folks treated. It ultimately will affect their health. They're also at great risk of spreading the disease.
So, I think the test we have for HIV is one of the best diagnostic tests in modern medicine. It's incredibly accurate. A negative test in the setting of someone who's not at risk for HIV is very reassuring. It sits on their medical chart and they never need to get tested again. We're trying to get most people from zero to one to get tested. Of course the few folks who may have been at risk in the past or still practicing high risk behaviors with regard to HIV, and we're able to identify them and diagnose them with HIV, we're really going to be able to not only help them but help potentially partners help them from spreading the disease.
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