On the 1st of December every year, the world comes together to commemorate World AIDS Day. This day is not just a remembrance but a celebration of progress and resilience. It's a time to reflect on the struggles and losses of the past, the advancements in medicine, and the ongoing fight for equality and understanding.
The Struggle and Loss
For many gay men, the HIV/AIDS epidemic was a period of immense struggle and heartbreak. The 1980s and 90s saw the loss of countless partners, friends, and family members to the disease. It was a time of fear and stigma, where people living with HIV faced discrimination and isolation. The community rallied together, providing support and care for each other in the face of adversity. Their resilience and solidarity laid the foundation for the advancements that followed.
Living with HIV Disease
Living with HIV comes with multiple challenges, such as coping with stress, adhering to complex medical regimens, and practicing safer sex.
Coping with HIV
Psychological distress varies, with significant anxiety and depression often triggered by diagnosis, symptom onset, and other stressors. Managing HIV involves dealing with the uncertainty of long-term survival and the stigma that can lead to discrimination and rejection. Positive psychological adjustment and stress-reduction interventions can improve quality of life.
Adherence to Medications
Effective treatment requires near-perfect adherence to medication schedules to prevent drug resistance. However, poverty, social marginalization, substance abuse, and mental illness can hinder adherence. Education on the importance of adherence, personalized reminders, and social support can help improve medication-taking behaviours.
Safer Sexual Practices
Despite some HIV-positive individuals avoiding risky behaviours, at least 30% engage in unsafe practices, risking transmission and faster disease progression. Improved treatments have reduced concern about HIV, making sustained behaviour change challenging. Intensive interventions, including stress management and support groups, can help reduce risky behaviours.
Advances in Medicine: U=U
One of the most significant breakthroughs in the fight against HIV/AIDS is the concept of Undetectable = Untransmittable (U=U). This ground-breaking message states that people with HIV who are on treatment and have an undetectable viral load cannot sexually transmit HIV to others.
People with HIV who take antiretroviral therapy (ART) as prescribed and maintain an undetectable viral load have zero risk of transmitting HIV to their sexual partners.
ART reduces the amount of HIV in the body to undetectable levels, meaning the virus is so low that it cannot be detected by standard tests. This prevention method is estimated to be 100% effective. Clinical evidence has established the U=U concept as scientifically sound.
HIV Prevention: The Use of PrEP
In addition to U=U, another powerful tool in HIV prevention is Pre-Exposure Prophylaxis (PrEP). PrEP is a medication taken by HIV-negative individuals to reduce their risk of contracting HIV.
PrEP can reduce the risk of getting HIV from sex by about 99%. PrEP works by preventing the virus from establishing a permanent infection if an individual is exposed to HIV. PrEP is highly effective at preventing HIV. Additionally, using condoms can help protect you from other STIs or an unplanned pregnancy.
Taking PrEP
In clinical trials using PrEP tablets, PrEP has been used in two different ways:
Daily:
Taken regularly: One tablet per day.
Taken only when needed: Two tablets two to 24 hours before sex, one tablet 24 hours later, and a further tablet 48 hours after that. This second method is often called ‘on-demand’, ‘event-based’, or 2-1-1 dosing.
On-demand dosing:
This method has only been studied in gay and bisexual men.
Effectiveness: Both methods have been shown to be very effective for anal sex and penetrative vaginal sex. Daily dosing is recommended for women who need to take PrEP every day for seven days to be protected against HIV.
It's important if you’re using PrEP that you go for regular STI screenings every three months.
Stigma and Discrimination: The Mental Health Impact
Stigma and discrimination against people living with HIV (PLHIV) are pervasive issues that significantly impact their mental health (1). The fear of being judged or ostracized can lead to feelings of shame, guilt, and isolation (2). This social rejection often results in mental health disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD). The constant anticipation of discrimination can exacerbate stress and lead to a cycle of emotional and physical challenges (2).
Psychodynamic Psychotherapy Intervention
Psychodynamic psychotherapy can be a powerful intervention for individuals living with HIV. This therapeutic approach focuses on exploring unconscious processes and how they influence current behaviour and emotions (3). By addressing deep-seated feelings of shame, guilt, and fear, psychodynamic therapy helps individuals understand and process their experiences with HIV.
In therapy, individuals can explore their internalized stigma and work through the emotional turmoil associated with their diagnosis. The therapeutic relationship provides a safe space for expressing feelings and fears, which can be crucial for emotional healing (3). Over time, this process can lead to improved self-esteem, better coping strategies, and a more positive outlook on life.
Conclusion
World AIDS Day serves as a poignant reminder of the significant journey we have embarked upon in the battle against HIV/AIDS, highlighting both the remarkable advancements we have achieved and the considerable challenges that remain ahead.
This annual observance, held on December 1st, is not merely a date on the calendar; it is a powerful occasion to honour the memory of those we have tragically lost to this disease, acknowledging the profound impact their absence has had on families, communities, and the world at large. It is also a day to celebrate the incredible progress we have made in terms of medical advancements, public awareness, and advocacy efforts that have transformed HIV from a fatal disease into a manageable chronic condition for many.
Furthermore, World AIDS Day serves as a rallying point for individuals and organizations to recommit to the ongoing fight against HIV/AIDS, emphasizing the need for continued education, advocacy, and support for those affected. Central to this mission is the understanding of the U=U message—"Undetectable = Untransmittable"—which conveys the critical information that individuals living with HIV who maintain an undetectable viral load through consistent antiretroviral therapy cannot transmit the virus to their sexual partners. This empowering message not only reduces stigma but also encourages those living with HIV to prioritize their health and adhere to treatment.
In addition to the U=U message, the use of Pre-Exposure Prophylaxis (PrEP) has emerged as a vital tool in preventing the transmission of HIV, particularly among high-risk populations. PrEP is a preventive medication that, when taken consistently, significantly reduces the risk of contracting HIV.
It represents a monumental step forward in the realm of sexual health and prevention strategies, offering individuals the autonomy to protect themselves and their partners.
Moreover, the conversation surrounding HIV/AIDS cannot overlook the crucial role of mental health in comprehensive HIV care. The psychological impact of living with HIV can be profound, often leading to issues such as anxiety, depression, and social isolation. Therefore, integrating mental health services into HIV care is essential for fostering overall well-being and improving health outcomes for those affected by the virus.
By addressing both the physical and emotional aspects of living with HIV, we can create a more holistic approach to treatment and support. As we observe World AIDS Day, let us reflect on the progress made while also recognizing the work that lies ahead.
By promoting education, advocating for equitable access to healthcare, and supporting mental health initiatives, we can move closer to a future where HIV/AIDS no longer holds power over any life.
Together, we can build a world that is informed, compassionate, and free from the shadows of stigma and discrimination, paving the way for a healthier future for all.
References:
(1) Sherrell, Z. (2021) What to know about HIV stigma and discrimination, MedicalNewsToday. Available at: https://www.medicalnewstoday.com/articles/hiv-stigma (Accessed: 1 December 2024).
(2) Srivastava, A. (211AD) World AIDS Day 2024: AIDS And Its Impact On Mental Health - 5 Key Insights, As Per Experts, HerZindagi.com. Available at: https://www.herzindagi.com/health/how-aids-impact-mental-health-article-1009744 (Accessed: 1 December 2024).
(3) Psychosocial Interventions for HIV-Positive Individuals (no date) Psychology. Available at: https://psychology.iresearchnet.com/health-psychology-research/hiv-aids-and-psychology/psychosocial-interventions-for-hiv-positive-individuals/ (Accessed: 1 December 2024).
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