Welcome to Prep and Play, where we have conversations
about safer sexual pleasure. This podcast is
dedicated to empowering listeners through open,
honest discussions surrounding keeping our minds,
bodies, and spirits healthy while being sexually
active. My name is Danielle, and I'm the Role
and Minority Outreach Specialist at AIDS Alabama
South, and today I have with me My name is Caitlin
Bricat. I'm the Prevention Education Outreach
Coordinator at AIDS Alabama South. And today
we're going to be talking to you a little bit
about HIV 101, which is what we talk to people
about probably most often. Almost every day.
Almost every day. OK, so we're going to talk
a little bit about what HIV is, the difference
between HIV and AIDS, the modes of transmission.
We're going to dispel a few common myths and
then talk about ways to prevent and treat HIV.
So first off, Caitlin, you want to kick us off.
What is HIV? So HIV is the human immunodeficiency
virus. It is a virus is basically sexually transmitted.
There are other ways that is transmitted, but
it is going to attack your body by destroying
your immune system or your CD4 plus T cells.
These cells are important for helping fight off
other bacteria, diseases, viruses. But basically
the HIV virus is going to attach to the helper
T cell or your CD4 plus T cell. It's going to
transmit its DNA into the nucleus of that T cell
using that T cell's own DNA to replicate new
copies of itself, destroying the T cell in the
process and then releasing hundreds of new virus
particles in your bloodstream. Yeah, you know,
Caitlin really broke that down. I like to think
of it, if you want to think of it super simple,
human immunodeficiency virus. Immunodeficiency,
it makes your immune system deficient. Virus,
it's a viral mode of transmission and human means
anybody in the human race is eligible for it.
When people think about HIV, the term AIDS commonly
comes up and AIDS stands for acquired immunodeficiency
syndrome. It's actually an older term than HIV,
which Chance and I will talk a little bit about
in our advances in HIV care episode. But essentially,
the way to understand the difference between
HIV and AIDS is to look at the stages of HIV.
So the first stage of an HIV infection is when
a person first comes into contact with the virus,
when the virus first starts entering those cells
and making copies. early symptoms are going to
be flu -like, occurring two to four weeks after
exposure. Somebody might have a fever, they might
have swollen lymph nodes, things like that, and
it might easily be overlooked as like a different
type of, you know. Oh yeah, totally. You might
think it's just a common cold that you're going
to get over. Yeah, exactly. And you will because
your body will fight it off, but it's the repetitive,
the destroying your immune system as it continues.
That's really devastating. Yeah, exactly. So
your body doesn't fight the virus off, but it
does fight the initial flu -like symptoms off.
And that leads to the second stage, which is
chronic HIV or the clinical latent stage. It's
where HIV is active, but it's producing at such
low levels because again, it's skyrocketed those
hundreds of copies out in the beginning. And
it's producing at such low levels now that you're
not really having symptoms. And so during this
time period, people might not know that they
have HIV, but they're still definitely spreading
it if they're not being treated. And then AIDS
is actually what we like to think of as stage
three or end stage HIV. It's the most severe
phase and it's defined as a CD4 plus T cell count
of below 200 cells. or the presence of opportunistic
infections. So when people die of AIDS -related
illness, it's not the virus itself that's killing
them. It's things like rare forms of cancer and
rare viruses that are attacking their immune
system that would normally be fought off very
easily by a healthy immune system. These things
are able to kill someone living with HIV and
someone suffering from AIDS. I think it's important
to note too that it's less than 200 of those
CD4 plus T cells per milliliter of blood. Well,
your normal range is between 600 and 1200. Yeah,
yeah. So that's what, like a third to a sixth?
A third to a sixth. You're highly immunocompromised
once you've reached AIDS. And yeah, and immunocompromised
is the term that we like to use when someone's
immune system has been weakened that far. And
so just moving on to modes of transmission here.
I like to say that HIV is spread by five and
a half bodily fluids. Five and a half? Do go
on. So there are five and a half bodily fluids
capable of transmitting the HIV virus, as you
said. Those include blood, vaginal fluids, rectal
fluids, breast milk, semen, and pre -adjaculate.
Blood commonly transmits HIV in cases of sharing
needles or blood transfusions. Vaginal fluids
can transmit HIV through unprotected vaginal
sex. Rectal fluids can transmit HIV through unprotected
anal sex. And breast milk can transmit HIV from
mother to baby during breast milk and semen,
including pre -ejaculate. That's that half there,
guys. Did you catch it? It can transmit HIV through
unprotected vaginal, anal, or oral sex. And I
like to specifically include pre -ejaculate.
Because you would be surprised how many times
we get the, well, he didn't come, so there wasn't
a problem, right? It's also probably important
to point out that vaginal fluids are capable
of transmitting the HIV virus to a baby during
childbirth. Yes, if the mother is untreated.
Nowadays, as we'll talk about a little bit more,
we've gotten treatment down to where not necessarily
always a conduit of the virus. Oh, absolutely.
So how is HIV not transmitted? So HIV is not
transmitted by hugging, kissing, sharing dishes,
sharing toilet seats with someone who is HIV
positive. It is not transmitted through the air.
Yeah, it's not transmitted by any of those things
that we commonly think of as casual contact.
Again, like it can only be transmitted by those
five and a half bodily fluids. So let's take
a look here at some common myths about HIV. So
myth number one, HIV is the same as AIDS. Caitlin,
why isn't that true? Well, we already went over
that, basically. AIDS is the end stage of HIV.
It is where your immune system is most compromised,
where your CD4 plus T -cell count has dipped
below 200. And most of the time, it's kind of
fatal at that point, although we do bring people
back from AIDS diagnosis nowadays. Yeah, it's
it's fatal when we find somebody in full -blown
AIDS and they haven't received treatment yet
People will say all the time. Oh, I want an AIDS
test and the thing about that is like You want
your CD4 plus T cell count check to see if it's
below 200 knowing that you're living with HIV
Interesting because you could just be on treatment
but whatever and so yeah, that's commonly that's
something we hear a lot and so that really just
clarifies You know, you can get tested for HIV
and if you are living with HIV if you don't get
treatment, you know, that could result in AIDS
later on. And so myth number two is that HIV
can be transmitted through casual contact. Caitlin
went over all those ways you can't get HIV, and
it's really just those five and a half bodily
fluids. If you would like me to repeat them,
it is blood, breast milk, rectal fluid, vaginal
fluid, and semen, including pre -ejaculate. I
hope you're not really coming into contact with
any of those things casually guys that's not
just like your everyday walking around coming
into contact with those i mean sometimes we come
into contact with those things a lot no judgment
but there usually is some intention behind coming
into contact with those things so myth number
three only certain groups are at risk for hiv
so it is very well stigmatized that hiv began
as a gay men's virus. In fact, it was called
the gay cancer as the early stages of the 1980s.
But that is just not true. HIV does not discriminate.
It does not attack certain racial groups, does
not attack just certain sexualities. Anybody
is capable of contacting the HIV virus. Yeah,
I like to think about this. It's not called the
gay immunode. deficiency virus is that called
the black immunodeficiency virus it is the human
immunodeficiency virus literally anyone in the
human race could come into contact with this
virus especially if you are sexually active or
um using injection drug needles that's a very
good way of putting it for human and myth number
four you can tell if someone has hiv just by
looking at them that's kind of crazy um Can you
tell if somebody has diabetes just by looking
at them? That's another chronic illness that
someone would have to manage. It comes from the
early times of the virus when gay men were developing
those carposy, sarcoma, cancers. They were losing
rapid amounts of weight. But you don't see that
very much anymore. With modern day treatments,
people are staying undetected and staying healthy.
And so it's important to mention, you know, when
she's talking about you know, in those early
days, those people clinically had AIDS. They
had their CD4 plus T cell count was extremely
low and they were seeing those opportunistic
infections and cancers. And so I don't want to
say you could tell if somebody has AIDS just
by looking at them, but that is a much more serious
case of illness where a person might actually
be suffering the health consequences that could
show up physically. Oh, yes, absolutely. You
did not see those in normal healthy people. A
normal healthy person's immune system would fight
those off on its own. But you only see it when
that immune system is extremely compromised.
Exactly. So someone living with HIV whose immune
system is not compromised in that way, they live
a perfectly normal, healthy looking life. Yeah,
you would you would never know again, since it's
not something that can be that's only affecting
certain groups, or it's not something that discriminates
anybody could have HIV, which is why It's so
important to get tested because many people don't
show symptoms. As we were saying earlier, those
initial flu -like symptoms occur, but after that,
and especially if you think that was just a cold
or flu, nobody can really tell until they get
tested that they are living with HIV. That's
why we recommend being tested every 90 days,
testing often and frequently. Especially if you're
having multiple or anonymous partners. Yes, yes.
And that's one of the top ways to prevent HIV
is just frequently testing if you're sexually
active. And if you are in the mobile area, you
can always come to AIDS Alabama South to get
tested. Our clinic hours are 9 a .m. to 3 30
p .m. Monday, Wednesday, and Thursday. And then
on Tuesday, it's 9 a .m. to 7 p .m. And then
Friday is appointment. If you are not in the
mobile area, local health departments usually
test for HIV and all other STIs for free or low
cost. Some other methods of prevention. So one
of the most common and frequent is condoms. Condoms
are 99 % effective at stopping HIV virus prevention
and other types of barriers including dental
dams. I always find it hilarious when we go out
and we have to explain what a dental dam is,
and more often than not somebody's pulling one
out and showing. It's usually me. It's usually
me who opens the dental dam and shows them how
to use it. Anyway, and then we also, so in addition
to condoms and barrier methods, we also have
pre -exposure prophylaxis, which is a medication
taken by HIV negative individuals every day to
prevent infection. It's kind of like birth control,
but for HIV prevention. can be a pill taken every
day or there is also a shot taken every other
month. And these are over 99 .8 % effective at
preventing HIV if a person does come into contact
with the virus. We are very hopeful that a six
month injectable is on its way. I believe they've
started testing in the US now. Awesome, awesome.
PEP or post exposure prophylaxis is basically
the same thing as pre exposure prophylaxis, but
used in emergency circumstances. So it involves
taking one pill for 28 days. It is the same antiviral
medications that we used to treat HIV, but as
a post exposure. So you have a 72 hour window
or three days to come down to our clinic or any
of your other health professionals to get on
PEP if you think you might have been exposed
to the HIV virus. You do not have to know for
certain that you were exposed to the virus to
get on PEP. If you think there's a possibility,
if you wake up in the next morning and you don't
know who you slept with and they're already gone,
hey, come on down. We could just start on a round
of PEP, post -exposure prophylaxis. Yep, yep.
And that also comes in super handy in cases of
assault. If a person just wants to feel safe
and secure that even though their physical body
was violated, their health doesn't have to be,
PEP works great. And we mentioned testing already,
last but not least, certainly not least, we have
safe needle practices. So I would love it if
everybody could avoid doing injection drugs in
the first place. Like I would seriously love
that, but I do know that we don't live in a perfect
world. So avoiding sharing needles is a huge
way that people can lower their risk of contracting
HIV. Because again, you can't tell if someone
has HIV just by looking at them. You don't know
if your buddy next to you is living with the
virus. They might not even know. So avoiding
sharing needles. It's not just sharing needles
too, using the same spoon or something to draw
from as somebody else, you know, there's transmission
that occurs in that as well. So just sharing
any kind of equipment used to prepare or inject
drugs is probably not in your best interest.
That's a really good point. And then also there
are harm reduction services, you know, that apply
there. And Caitlin was talking a little bit about
personal protective equipment. If you're working
in the healthcare field at all, you know, using
gloves, using protection when handling bodily
fluids is super important. It also went hard
to get on PrEP too. So I got on it just because
of this job being in the constant going out and
trying to find HIV and get those people that
are, you know, living with HIV and not knowing
it at risk for being exposed to it myself. So
getting on PrEP was something that I chose to
do. And then also, HIV is more treatable than
it has ever been. So antiretroviral therapy is
the treatment that we are using to control HIV.
There are a couple different types of medication
that are used. Caitlin was explaining earlier
about how HIV attaches to a cell, enters into
that nucleus, replicates and spits back out copies
of itself. So yeah, today there are six different
types of medications. I can't tell you exactly
what they are, but I know each of them does a
specific different thing for the body. Some of
those medications will stop the HIV virus from
being able to attach to the T cells. Some of
them will strengthen the cell wall so that it
prevents the virus from being able to pass its
DNA into the virus. And some of them will even
stop the virus from being able to come out of
an infected T cell. So our gold standard today
is three different medications from two or more
classes of drugs. and in all that you know an
important thing to remember is like it is through
different medications but most regimens today
are one pill a day regimens absolutely back in
the day people were on cocktails of medications
taking 12 20 pills different times of the day
yeah but today it's one pill a day or there's
also a bimonthly injection as well And this is
super important because with treatment today,
people can go on to live long and happy lives.
And by long and happy, I mean that they can reach
a level of viral suppression where they are no
longer able to transmit the virus to another
person. And we call that U equals U, undetectable
equals untransmittable. So undetectable equals
untransmittable. Basically, we perform a laboratory
test, a viral load test, which is a lab test
that measures the number of HIV virus particles
in a milliliter of your blood. Our modern medical
tests are capable of detecting as few as 20 copies
of the HIV virus in a milliliter of blood. Where
at peak infection, you're going to have over
100 ,000 copies of the HIV virus in that same
amount of blood. But if we can't find it, if
it's less than that 20, that we can detect, you're
considered undetectable at that point. And you
cannot, I repeat, cannot transmit the HIV virus
to another person. Yes, when someone is undetectable,
they are untransmittable. And it's important
to note that as medical tests have gotten better
and better, we've been able to detect fewer and
fewer copies. But the standard for being untransmittable
is actually the standard for viral suppression,
which is a bit older based on tests that were
not able to pick up as many copies. So the standard
for viral suppression is, I believe, 200 copies
per milliliter of blood, even though the test
might be able to pick up a little bit more. If
somebody is under that 200, they are not able
to transmit the virus to another human being.
And that's huge. When I first started in HIV
a little over a year ago, I was told that it
was at 50 copies, but I have since learned that
we've gotten better and it's down to 20. Yeah,
and so the test just keeps getting better and
better. But, you know, as long as somebody is
under that 200, they cannot transmit to another
person. And that's easily achieved, usually within
the course of one to three months of being on
antiretroviral therapy. So not only is somebody
who is virally suppressed unable to transmit
the virus to another human being, but it also
kind of helps a lot with some of that stigma,
stigma that was surrounding HIV. Because when
you think about it, 20, 30 years ago, HIV was
still something that could be a death sentence
to many people. And so, to take away some of
that fear, if you contract HIV today and you
discover it before it hits that age stage and
you are suffering from a rare type of cancer
that nobody knows how to treat, if you discover
it before then and get on treatment, there's
no reason that you should ever suffer detrimental
health consequences because of living with the
virus. In fact, our patients typically lead healthier
lives than most other people because they come
see the doctor so often to get tests to make
sure their medications doing what it's supposed
to be doing, that they're catching other things
earlier and quicker. Yeah, and that's truly awesome.
So it's even promoting health at this stage.
And so we've talked to you a little bit about
the basics of HIV, what it is, how it's transmitted,
those different stages. We've dispelled a few
myths and explained how you can both prevent
and treat HIV. I just want to remind everybody
how important it is to get tested, you know,
every 90 to 180 days, every 36 months. And if
you do frequently come into contact with with
any of those five and a half bodily fluids, the
importance of pre -exposure prophylaxis, which
is readily available for anybody who wants it,
and adherence to treatment if you are living
with HIV. You can find more resources and support
at AIDSAlabamaSouth .org or you're always welcome
to come into our clinic. We give out free condoms.
We do give out free condoms. Thank you so much
for joining me, Caitlin. It's been my pleasure.
And on our next episode, I'll be with Chance
talking about advances in HIV care. Thank you.