Penetrating Questions | What's the difference between HIV and AIDS?

Jiná Ashline Columnist

What is the difference between HIV and AIDS? I’m embarrassed to ask because I feel like everyone knows this but me. With all the new drugs available now, do I even have to worry about getting them?

—Uncertain

Dear Uncertain,

Don’t be embarrassed; many people don’t fully understand the difference or the associated issues.

Human Immunodeficiency Virus (HIV) is a virus that breaks down a person’s immune system over many years and eventually causes Acquired Immune Deficiency Syndrome (AIDS). A syndrome is a collection of symptoms and susceptibilities to other diseases. AIDS patients are particularly prone to rare diseases such as Karposi’s Sarcoma and rare forms of pneumonia. Before drug treatments became available, HIV developed into AIDS within about 10 years, but powerful anti-retroviral therapies developed in the last 15 years can slow HIV’s progress by changing the way that he body recognizes and attacks the virus. These therapies can prevent or cure some illnesses associated with AIDS, but neither HIV nor AIDS has a cure or a vaccine.

HIV is transmitted through bodily fluids such as blood, sexual fluids (semen, pre-ejaculate and vaginal fluid) and breast milk. Transmission can occur if these fluids enter the bloodstream. The disease can be passed during unprotected vaginal, anal or oral sex with an infected person; through sharing a needle during intravenous drug use with an infected person; or from an infected mother to her fetus during pregnancy, delivery or breastfeeding.

There are few symptoms that accompany HIV before it causes AIDS, so if you don’t get tested regularly, you could be infected with HIV for years without knowing, putting both yourself and partners at risk. If symptoms appear at all, they usually take several years to manifest. Even without symptoms, however, the virus causes serious damage to the immune system.

When the AIDS epidemic began in the United States in the early 1980s, the virus was not well understood. There was no effective treatment, and it primarily affected gay men. Today, many mistakenly believe that HIV/AIDS is no longer a major concern. I once encountered a doctor who said that AIDS is not a concern because it is “a chronic and manageable disease like diabetes.” I later came across the same statement in a human sexuality textbook. I cannot overemphasize how dangerous such false assurances can be.

First, claiming that AIDS is a manageable disease encourages an apathetic view toward HIV/AIDS education and information about prevention. People lower their guard and fail to use protection to prevent infection. An HIV-positive status no longer results in an immediate death sentence like it did in the 1980s, but there still is no cure for AIDS.

Secondly, HIV is only manageable if you have enough money for a decent doctor and extremely expensive drugs. If you can access treatment, several drugs are needed, depending on the strain of the virus and what stage it has reached. Drug therapies often combine four or more HIV medications, and each drug can cost anywhere between $300 and $1000, or more, per month. The drugs must be taken for the rest of your life, and may need to be switched if your strain of the virus develops resistance to them; you may also have to increase dosages as the disease progresses. Even if you’re wealthy and lucky enough to find the right doctor and the right combination of drugs, the treatment can only delay the onset of AIDS. It cannot prevent it.

Numerous factors determine how “manageable” the infection is, and getting access to drugs for treatment is only one factor among many. Each HIV/AIDS drug causes different side effects and has different levels of efficacy for different people. Once you find the appropriate “drug cocktail,” you must schedule your life around it. HIV/AIDS patients take dozens of pills every day, some of which must be taken in the morning, some at night, some on a full stomach, some on an empty one and some spaced hours apart. You also must deal with the social reaction to your infection because of the stigma and shame that still surrounds this disease.

According to the Joint United Nations Program on HIV/AIDS (UNAIDS), an estimated 33.2 million people were living with HIV in 2007. Two-and-a-half million were newly infected, and 2.1 million died of AIDS. Each day worldwide, there is an average of 6,800 new infections. According to the Centers for Disease Control (CDC) an estimated 850,000-950,000 people were living with HIV in 2000 in the United States, and about one-fourth didn’t know they were infected. That’s a quarter of a million people unknowingly walking around with HIV.

According to CDC analysis of HIV diagnosis in the United States, 49 percent of people diagnosed in 2006 were black, 30 percent were white and 18 percent were Latino. People aged 25-44 constituted 57 percent of new diagnoses. Fifty percent of the total number of transmissions came from men who have sex with men, and 46 percent came from exposure through heterosexual sex or injection drug use. Males accounted for 73 percent of all new HIV diagnoses, while 80 percent of females were infected through heterosexual sex.

HIV does not discriminate. Anyone can become infected. You cannot tell if a person has the virus simply by looking at him or her, but there are certain behaviors that increase risk. Unprotected sex and sharing needles are both high-risk activities. It is never a good idea to combine drugs and alcohol with sex because you may do something you’ll regret later, like not using protection—a mistake that could have lifelong consequences. Staying uninfected requires understanding the risks and learning how to reduce them. Make personal decisions about what you are willing to do during sex and communicate them clearly to your partner before you take your clothes off.

The best ways to stay protected are abstinence or exclusively having protected sex with a long-term mutually monogamous partner who is not infected with HIV or other sexually transmitted infections (STIs). As with any STI, birth control pills do not protect against HIV. Latex condoms and dental dams are the only effective barriers against infection. A study of HIV-negative individuals in sexual relationships with HIV-positive partners concluded that latex condoms used correctly with every sex act were 98-100 percent effective at preventing the HIV negative partner from contracting the virus.

If you are sexually active, you should be tested regularly for STIs. Insist that each new partner be tested. If he or she is unwilling, you should consider whether sex with him or her is worth the risk.

Standard tests look for HIV antibodies that the immune system produces to fight HIV. It can take up to three months for the body to make enough antibodies to show up on a test. So if an infected person tests too soon after exposure, the test may not detect the virus, but the person can still infect others.

Today, there are several types of HIV tests that can be taken at home or in a doctor’s office, testing urine, blood or saliva. In many places, confidential and anonymous HIV counseling and testing are available, including the Dutchess County Department of Health walk-in clinic on Mondays from 1-4:30 p.m., Thursdays from 3-4 p.m. and Thursday evenings by appointment. Call (845) 486-3401 or visit 387 Main Street in Poughkeepsie for more information or to schedule an appointment.

There is more information on HIV/AIDS than I can cover here, and new information is always coming out. I urge you to become informed so you can make healthy choices. Accurate information is available on the Web sites of the Center for Disease Control (cdc.gov), the Gay Men’s Health Crisis (gmhc.org), the American Social Health Association (ashastd.org), the U.S. Department of Health and Human Services (aidsinfo.nih.gov) and UNAIDS (unaids.org).

—Jiná Ashline ’08 is a religion major with a women’s studies correlate. She is also president of C.H.O.I.C.E. Each week she will answer a question about sex and sexuality. Send your questions to jiashline@vassar.edu or by dropping a note in Box 2172.