This week, I’m not only busy, but also inconveniently unwell, so I unfortunately don’t have as much time to devote to a long blog post about World AIDS Day as I would like. However, I would be truly remiss in my duties as a public health volunteer to forego mentioning it entirely. I’ve spoken a lot about HIV issues here in Kenya on this blog, but today, I’m going to reach out to the rest of my blog readers – the majority of whom are American – and proselytize to *you* a little bit.

Here, I deal a constantly with attempting to right the unfounded mythos of HIV: you can cure HIV by having sex with a virgin, or by drinking tree-bark tea, or by having sex with lots and lots of people (as though your body has a finite number of viruses, and you can “give them all away.”) Some believe you cannot get HIV the first time you have sex, or if you have sex with someone who is pregnant. In America, the myths are different, but the presence of misinformation is the same: HIV is for “druggies and drag queens” (yes, that is an actual quote.) The HIV virus doesn’t cause AIDS, meth use and “the gay bathhouse lifestyle” does. AIDS is only spread through anal sex, not any other behavior or activity. Young people don’t get HIV. Only African-Americans can get HIV (while minorities are disproportionately represented in new infections, they are FAR from the only ones contracting the virus.) Even if you get HIV, you can live forever. Alternatively, if you get HIV, you’re going to progress to AIDS and die almost immediately, so why find out early?

In many instances, this misinformation is more dangerous than bare ignorance. So here are a few things you should do:

  • Understand your risk: There was a time in American history when people (wrongly) thought HIV was limited to “the four H’s”: “homos” (gay men, though pretty much all modern researchers/activists reject the derogatory term used here), heroin addicts, “Haitians” (for more information on this puzzling category, read The Origin of AIDS by Jaques Pepin), and hemophiliacs (who often received dozens of blood product transfers per year before our national blood banks were considered “safe.”) Everyone else assumed they were ok.

    While unprotected male-to-male sexual contact remains one of the riskiest behaviors in terms of contracting HIV, nearly four times as many Americans contract HIV from heterosexual contact as from injectable drug use. Young women are twice as likely to be infected this way, although the highest overall age group for new infections isn’t “young people,” but those who are 35-45 years old. Doesn’t exactly fit the stereotypical profile of young, gay, drug-addicted men being the “typical” person living with HIV, does it? EVERYONE – every single person – could be at risk.

  • Know the modes of transmission: HIV is present in all body fluids of an infected person – saliva, urine, sweat, tears – but not all fluids are created equal: in only three are the viral loads high enough to be a vector for transmission. HIV is spread through blood, sexual fluid, and breastmilk. You can become infected with HIV through sex (unprotected anal sex being the highest risk, vaginal sex in the middle, oral sex being very low but not non-zero risk). You can pass it on to your child during birth or through breastfeeding. You can get HIV if you’re in a car accident and someone bleeds on you, if you share a needle during IV drug use, or if you’re in the healthcare field and you get “pricked” (although if I recall correctly, the risk there is still 0.3%). Contrary to what virtually all of my students here – both children and adults – believe, you cannot get HIV through saliva when kissing. Nor can you get HIV through someone dripping sweat on you on the soccer field. Nor from sharing cups, plates, or public swimming pools. Nor from spending too much time at nightclubs in the company of “loose women” (as long as you refrain from the other, above-mentioned activities.) It’s also worth mentioning that the rate of transmission through sexual or blood contact isn’t 100%: one broken condom or stray needle won’t automatically change your status. But it’s better to minimize your own risks than play the odds, which brings us to …
  • Take precautions: Preventing HIV through sexual contact is as easy as ABC:

    A – Abstain. You don’t have to be having sex all the time. But for most people, this isn’t realistic, so …

    B – Be faithful. Only having sex with one person, who is *also* only having sex with you, reduces your chances DRAMATICALLY. Especially if you both get tested before you start.

    C – Condoms! Condoms condoms condoms! This is probably the best option for most of us. They’re cheap, they’re readily available, they really don’t make THAT much of a difference in sensation, they protect from a wide range of STIs, not to mention the pregnancy thing … what’s not to love? Just make sure you’re using them correctly every single time (many people don’t! Check your knowledge against the helpful how-to guide at the link.)

    As for the other modes of transmission, don’t use drugs, don’t share sharp things, get tested for HIV if you become pregnant (your doctor can help you reduce the likelihood of you passing your infection onto your baby), and if you find yourself exposed, seek post-exposure prophylaxis.

    By the way, there IS one documented case of HIV acquisition through kissing: the man had gum disease, so there was blood present, and his female partner drew the short straw by having some cut or lesion in her mouth that allowed transmission. You’re more likely to win the lottery while being struck by lightning than having this happen to you, but it’s food for thought.

  • GET TESTED! – Here in Kenya, they’ve got the US beat: you can’t throw a rock without hitting a VCT (Voluntary Testing and Counseling) center. In the US, getting tested can be an ordeal; when I got tested the first time before Peace Corps, I had to wait in line at the county health department instead of going to my normal doctor’s office. Still, don’t let that delay you. Most major cities have STI clinics, everywhere has Planned Parenthood, and if you’re in Washington DC, you can just head down to the Department of Motor Vehicles and get tested while you wait in line.

    You should be getting tested at least once per year (twice is better), plus every time you get a new partner. Even if you’re old. Even if you’re married. Even if you’re a shut-in who spends all your time with your cats. It’s worth it: HIV is not the death sentence it once was, and the sooner you find out your status, the sooner you can start on medication and/or making lifestyle (mostly diet and exercise) changes that will give you a happy, long life. Yes, it can be scary. Take a friend if you want so they can hold your hand in the waiting room, then go to Starbucks to celebrate your newfound peace of mind with a peppermint latte.

    IF you suspect you’ve been exposed, PLEASE PLEASE PLEASE do NOT get tested by donating blood. Yes, they screen all blood products, but there is a window of several weeks after exposure wherein you’re SUPER infectious but have not yet developed adequate antibodies to show up on the test. So if you’re worried about infection, get tested once, then again 3-6 months later. That will give you your most accurate results.

As for me? I’ve gotten tested twice in the past year (once last year on World AIDS Day, then again more recently) and will probably do so once more today as a show of solidarity and to lead by example. It’s not terrible. I promise. Sometimes it involves a little-bitty blood prick, sometimes a cheek swab – but honestly, isn’t a minor discomfort worth knowing?

There are around 50,000 new cases of HIV every year in the United States. We are lucky to live in a nation where the majority of people who need anti-retroviral drug treatments can access them, and the overwhelming tide of death that characterized the AIDS crisis that characterized the 1980s and early 90s has been much moderated. We should all work to accept those who are “living positively” as strong and capable people with long lives ahead of them. But if we have a chance to prevent becoming infected with a chronic disease ourselves, shouldn’t we take it? Today is World AIDS Day. I challenge every person reading this blog to do three things:

1. Further educate yourself. This post covers the basics, but isn’t comprehensive. Here is a website designed by students which offers a little more on the history in the US as well as a list of myths and facts. For more detail on the history of the virus and its entrance onto the world stage, I again recommend Origin of AIDS by Jacque Pepin.

2. Get tested. It’s worth it, I promise.

3. Tell your friends. Viruses spread – but so does knowledge! Give your friends information to help them make safer decisions, and if you hear them repeating myths, call them out on it.