HIV & AIDS

AIDS= :

Facts vs. Fiction

By John Dietrich, M.D.

When Magic Johnson announced he had the= virus that causes AIDS, health clinic h= otlines
went crazy.  After all, if a sports&nb= sp;hero like Magic could get this disease,&nb= sp;people assumed
anybody could get it.  But when Magic&= nbsp;was named MVP at the NBA All-star g= ame a few
months later, a lot of people probably = ;relaxed.  After all, if an infected per= son could look so
good and play so well, AIDS must not&n= bsp;be all that bad.

      So who's telling the&n= bsp;truth about this frightening disease?

      As a physician special= izing in infectious diseases, I've treated hu= ndreds of AIDS
patients during the past 10 years of t= his epidemic.  Based on that experience, = ;I want
you to know two things about it:

· You don't want to get this d= isease. It's = ;a terrible, slow and sometimes excruciatingly
painful way to die.

· You don't have to get it if you&nbs= p;don't have it already.

Unraveling the mystery

      The words "HIV"&n= bsp;and "AIDS" are made from letters&nbs= p;of phrases that describe them.
The Human Immunodeficiency Virus = ;leads to the Acquired ImmunoDefic= iency Syndrome.

      This may sound complic= ated, but it's actually pretty simple if = ;you start from what you
know about viral illnesses and then plug&nb= sp;in what's different about HIV.

·         Viruses are very small organisms = that can cause diseases like colds and f= lu.  HIV is
so small that 5,000 HIVs would fit sid= e by side on the diameter of the pe= riod at the
end of this sentence.

·         Your body's immune system is cons= tantly alert for potentially harmful invaders = ;(micro-
organisms) trying to make you sick.  H= IV attacks the immune system, weakening&nbs= p;its
ability to protect you from certain disease= s that healthy people don't usually get.=

·         White blood cells called T helper= cells work with eater cells (macrophages),&n= bsp;memory cells
and other cells to recognize surface molecu= les (antigens) of invaders and immediately
launch a counterattack.  This is why y= ou don't get diseases like chicken pox m= ore than
once.  But HIV tricks these guardians = of health by implanting material inside th= em,
crippling them even while multiplying itself&nbs= p;safely within them.

·         Some viruses cause disease quickly.&nb= sp; HIV infection, after causing an initial&n= bsp;reaction in
many cases from two to six weeks after= exposure, may then cause no further sym= p-
toms for years.  During all this time&= nbsp;an infected but apparently very healthy = person
can infect others without even knowing h= e or she is sick!

      This is the most&n= bsp;treacherous characteristic of HIV — that= millions of people will infect
millions of others who will infect millions= more, without anybody knowing for years = ;that
they have acquired a fatal disease.  A= lthough by the end of 1991 over 130,000&= nbsp;people had
died of AIDS in the United States, an= estimated two million others were infected&n= bsp;— and
infecting others.

Who's at risk?

      A lot of people t= hink that no matter how the numbers or&n= bsp;statistics sound, they'll be
among the lucky few who escape.  Teena= gers and young adults are especially prone&nb= sp;to this,
which explains why so many of them tak= e risks their parents would never consider.
      I want you to tak= e HIV as seriously as anything you've ev= er thought about.  At the
time, as a medical scientist, I am obl= igated to tell the truth: not everybody = is at risk.  But
it's not a question of race, age, gend= er or even sexual orientation.  It's mai= nly a matter of
what you do or what you don't&nbs= p;do that controls your risk of infection= .  Again, it's not comp-
licated at all: HIV is spread in only&= nbsp;three ways — through sex, exposure = ;to blood and blood
products, and from a mother to her bab= y.

SEXUAL TRANSMISSION:
·         So far, about 65 percent of = AIDS cases in the United States have been acquired
through sex (60 percent homosexual; 5 perce= nt heterosexual).

      Homosexual practices mo= re easily spread HIV because of multiple = ;partners, anal
intercourse, and the fact that homosexuals = often have other sexually transmitted diseases
(STDs) causing skin sores, which make it&nb= sp;easier for the HIV to enter the blood= stream.

      Heterosexuals are at r= isk when they have sex with an HIV–= ;infected partner, regardless
of how the partner became infected.  T= ransmission occurs both ways, male to female o= r
female to male — and is more lik= ely when either has STD–caused skin sor= es.

BLOOD TRANSMISSION:
·         From 12,000 to 15,000 recipients = of transfusions acquired HIV between 1978 and=
1985, before blood screening for HIV was&nb= sp;developed.  The infection rate from a = ;single
unit of tainted blood was nearly 100 p= ercent.  This demonstrates how potent this
virus is and the most efficient mode o= f transmission — blood to blood.  = Most of these
patients have now died.

·         Another extremely efficient way to&nbs= p;get infected is by sharing HIV–contaminate= d and
unsterilized needles or syringes, as in int= ravenous drug use where blood is often d= rawn
into the needle and syringe before the = ;drug is injected.  So far 50,000 of&nbs= p;U.S.&= nbsp;AIDS
cases have occurred this way.

      But sharing contaminate= d needles and syringes in other ways is&= nbsp;also very dangerous; for
instance, athletes injecting steroids, ear pierc= ing, getting tattoos or participating in &quo= t;blood
brother" rituals.  If you want to = ;live past 30, stay away from these thin= gs.

Casual transmission&nbs= p;doesn't happen
Although some microorganism= s are spread in normal day-
to-day activities, there is no proof that&n= bsp;HIV is transmitted
casually.

You ca= n't get it from a toilet seat, or f= rom restaurant
silverware. There is no&nbs= p;case where family members
of AIDS patients have acquired HIV [ex= cept through
sexual intercourse, unprotected healthcare, or&n= bsp;child-
birth] even when household items and= facilities were
shared. If it doesn't happen there,&n= bsp;it won't happen
elsewhere.

So—there&= nbsp;is no risk of infection from living = ;in the same
apartment, being in the same classroom or&n= bsp;nursery, using
public restrooms, hugging or touching, sitting&n= bsp;in a waiting
room with an AIDS patient, or even car= ing for one, except
in a health care setting where some di= rect blood exposure
has occurred.

You ca= n't get it from mosquito bites, shaking hands,
being coughed on or even from kissing&= nbsp;(though
deep kissing may not be absolutely saf= e).

    &nbs= p; So—the kind of ostracism that = ;often occurs once it is
known that a certain person is HIV–po= sitive is based on
fears that have no basis in medical sc= ience.  This irrational
fear must be overcome by anyone who wa= nts to relate to
AIDS patients with compassion and love.

            &= nbsp;                 &= nbsp;                 &= nbsp;                —= John E. Dietrich, M.D.<= /p>

·         Health care workers (and rarely t= heir patients) are at risk from blood–<= br> to–blood exposure.  Needle sticks occur&nb= sp;relatively frequently in a health
care setting.  If the patient is infec= ted, the worker may acquire HIV.  Five dental patients of one Florida dentist got H= IV while he worked on their
teeth.  But no other medical or dental= cases of transmission from health
care worker to patient have been documented= .

BIRTH TRANSMISSION:

· In the U.S. about 3,000&= nbsp;babies have become HIV—infected through = ;their
infected mothers. This occurs before birth= , during labor and delivery or
through breast—feeding.

      That's it! If&nbs= p;you're not infected already, these are the&= nbsp;only ways
you can become HIV—positive.

How to keep your risk zero

      Want to forget all&nbs= p;about HIV?  Here's how:  Don't have&nb= sp;sex before marriage.  If you
marry, stay faithful to an uninfected partn= er.  Don't inject drugs and avoid other&= nbsp;activ-
ities that bring an infected person's blood= , semen or vaginal fluids into your body= .  That's
all it takes!

      Staying uninfected sounds&n= bsp;simple enough, so why is this disease&nbs= p;spreading?

·         The sexual revolution lives on, w= hispering that sex is okay between consenting=
partners as long as nobody is hurt.

Fact: Your very first ex= perience with sex can kill you if your&n= bsp;partner is infected.  And how
will you know that person isn't infected?&n= bsp; You can't, because if he or she&nbs= p;has been sexually
active before you, it is possible he o= r she is infected without even knowing <= span class=3DGramE>it  .  .  .  = ;or lying,
to take advantage of you.

·     &nbs= p;   Adolescents believe that "everybody&nb= sp;is doing it," and waiting until marri= age is
weird or abnormal.

Fact: The majority of hi= gh schoolers are not doing it.  T= hey're waiting, even if they're
not boasting about it because they don't&nb= sp;want to be laughed at.  You can = wait, too.  Self-
control is self–protection.

· &nbs= p; For years "sex educati= on" programs have promoted "safe sex,&qu= ot; especially sex using a condom
(rubber). Certain high—profile public fig= ures have supported this, including Magic Joh= nson
during the frenzy of press coverage immedia= tely following his initial announcement.

·     &nbs= p;   Fact: There is no= such thing as "safe sex," which&nb= sp;explains why the term "safer sex"
is being used more by people who belie= ve that emphasizing abstinence is unrealistic.
Condoms have a proven track record o= f failure — as high as 20 percent&= nbsp;among teens
trying to prevent pregnancy.  HIV is= 30 times smaller than the width of = ;a human
sperm cell.  All it takes is a ti= ny hole in that latex, or a tear, o= r possibly slippage—and
you could be on your way to the g= rave.

If you've been placed&nbs= p;at risk
1.  See your doctor, and be totally&nb= sp;honest about it.

2.  Get tested.

3.  If uninfected, stay that way.

4.  If you can't seem to control = your behavior in relation  to
     sex or IV drugs, get&nb= sp;help:

from= your&= nbsp;physician.
from= a&nbs= p;counselor.
friends and&n= bsp;family.
from= your&= nbsp;pastor.

If you are&= nbsp;infected
1.  Protect others; don't spread it.

2.  If you've exposed others, you have= a moral obligation
to tell them, so they can get tested,&= nbsp;seek treatment and
keep from passing HIV on to somebody e= lse.

3.  Pursue knowledgeable medical treatment = immediately,
because new drugs are making this disease&n= bsp;more manageable.

            &= nbsp;                 &= nbsp;                 &= nbsp;                —= John E. Dietrich, M.D.<= /p>

·         When adolescents or young adults = hear the words "abstinence" or "mon= ogamy,"
they think "not having sex very often,= " and "only" with a steady com= panion, as
long as the relationship lasts."

Fact: Abstinence means waitin= g until marriage for sex.  Monogamy mean= s faithfulness
to one partner for life.  Yet even&nbs= p;if you have already lost your virginity,&nb= sp;you can recommit
yourself to abstaining.  If you are fo= rtunate enough not to have already contracted= HIV,
saving yourself for marriage could be the&n= bsp;wisest, healthiest decision you will ever = ;make.

From HIV infection to AIDS<= span style=3D'font-family:"ms sans serif";color:#245890'>

      Just in case you're&nb= sp;still not convinced to take AIDS seriously= , I want to be
crystal clear about what you can expect&nbs= p;if you become HIV–positive.

      A few weeks after = ;getting infected, you'll probably think you = have the flu or
even mononucleosis.  Even if you see a= doctor during this time, the real cause= of
your symptoms may not be diagnosed.  A= fter these flu-like symptoms resolve,
you'll gradually regain your strength as th= e virus becomes dormant, probably for
years.  But whether you feel normal or= awful, you'll still be able to infect&n= bsp;others.

      Your immune system wil= l continue to fight off infections, strongly&= nbsp;at first, less
effectively later on.  If your HIV sta= tus is recognized early enough, there are&nbs= p;ther-
apies available and under development that = can attack the virus itself.  However,
there is no cure.

      At some point, you'll&= nbsp;begin having other symptoms; specifically, pe= rsistent low-
fever (along with night sweats) , diarrhea,= increased fatigue, unexplained weight loss
(more than a pound a week, not = due to dieting) , enlarged lymph nodes a= nd difficulty
swallowing, persistent dry cough and shortness&n= bsp;of breath, sores, rashes or purplish
spots on your skin, and headaches.

      What's happening is th= at your immune system has been weakened = to the point
where it begins to lose its ability to= fight off those invaders I mentioned ea= rlier.
Infections now seize the opportunity (that's&nbs= p;why they're called "opportunistic") to
grow unimpeded in most parts of your b= ody.

      Once the number of&nbs= p;T-helper cells drops below 200, your body&n= bsp;will no longer be
able to defend itself properly, especially = against certain pneumonias, cancers and
infection of the brain, which causes an&nbs= p;Alzheimer's-like dementia.  You have now
crossed the official line between HIV infec= tion and AIDS.

      When this stage is&nbs= p;reached, medicines can fight the infections = ;and malignancies,
winning skirmishes as you fight for life.&n= bsp; But your system will gradually crumble before the never-ending attack, and eventually&n= bsp;you will lose the war and die.

The faces of AIDS

      If there's anything I&= nbsp;want to plant firmly in in your mind, it's that AIDS is no&= nbsp;joke.
It's horrible and dehumanizing.  I've seen&= nbsp;a lot of people die from different = illnesses.
Believe me, AIDS is by far the worst.

      When you see people&nb= sp;go from the pinnacle of physical fitness&n= bsp;and beauty to a
hollow-cheeked shadow of their former self, = ;oblivious to their surroundings because
their brain no longer functions properly, i= solated from their friends and families and feared by their society  .  .  .  you can come to only one&nb= sp;conclusion, as I have.  Before
it's over, AIDS may well become the wo= rst plague in the history of humanity.

      In the summer of = 1991, I found a small envelope on my&nbs= p;desk, tucked away amidst
the journals and charts.  "Dr. Dietric= h," its weakly scrawled script said, &qu= ot;Thank you
for all you did for me in my hour= of need.  May God Bless, Robert."

      This little note reall= y brightened an especially hectic day.  = Robert had been through
the wringer that spring, hospitalized for t= wo grueling months when he was pushed to=
ther brink of death by germs relentlessly&n= bsp;stalking his defenseless body.  At one&nb= sp;point
Robert had fevers to 105 degrees, drenching= sweats that soaked his bed each night,
and a lung infection that forced us to= use a ventilator (breathing machine) just&nb= sp;to keep
him alive.  I just about gave up = hope he would pull through.

      But he did, at le= ast long enough to write me that note.&n= bsp; Sadly, five months later,
AIDS got him.  When he died, Robert&nb= sp;weighed about 90 pounds.  He was lite= rally a
skeleton of his former self.

      For me, Robert's face&= nbsp;stands out among many desperate faces of= AIDS patients
I've treated.  My hope and prayer is&n= bsp;that you will never acquire this disease.=   If you
choose wisely and responsibly, there's no r= eason you should.

John E. Dietrich, M.D.

John E. Dietrich is a board-certi= fied infectious disease specialist, and co-author&= nbsp;of the book:
The AIDS Epidemic:  Balancing Compassion = ;& Justice (Multnomah; Portland, Ore; 1990= ) =