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Ask Anything: 10 questions with John Paul Womble, with The Alliance of AIDS Services

John Paul Womble, with The Alliance of AIDS Services - Carolina, answers your questions about being infected with HIV, treatment and myths surrounding the disease.

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John Paul Womble
If someone suspects they may have been intimate with a person who is HIV positive, what would be their first course of action? – Rita Dozier, Apex

That’s a great question, Rita, and a great place to begin. There are four ways in which HIV disease can be transmitted: through blood, semen, vaginal fluids and breast milk.

If you have been participating in risky behaviors, like intravenous drug use or unprotected sex, then it’s safe to assume that you need to have an HIV test. Testing is quick and easy, and can be done at your doctor’s office or at several points in the community.
Local health departments have free and confidential testing, and my agency, The Alliance of AIDS Services – Carolina, also offers free and confidential testing. For a listing of local testing sites, click here.
When I was little, I don't ever recall hearing about AIDS. How long has AIDS been around? – Willie Collins, Fayetteville

Sometimes it seems like AIDS has been around since the beginning of time, but it was actually only identified in 1981. What started out as a seemingly normal day in a Los Angeles emergency room, when five men showed up and died of pneumonia, actually altered the course of history.

Did I mention they were gay? And did I mention that they all died from a pneumonia so rare that it had almost never been seen in the United States? And certainly not in one city.

It was so unique a situation that it caught the eye of the Center for Disease Prevention and Controls, or the CDC, and made it into the June 5 issue of the Weekly Morbidity and Mortality Report. And because they had to call it something, they referred to it as GRID, or Gay-Related Immune Deficiency. Today, though, we know it as AIDS.

From that handful of initial reports, from those five gay men, AIDS has grown into a global pandemic effecting men, women and children in nearly every country in the world. Today we know the face of AIDS could be anybody.

According to the United Nations, since the pandemic began, 65 million people across the globe have been infected with HIV, and an estimated 32 million have died. Today, over 39 million people around the world are living with HIV.

Are people with AIDS today still discriminated against? How is having AIDS today different from having the disease in the 70s and 80s? – Jill Glenn, Fuquay-Varina

Thanks for writing in, Jill. Since it was identified and labeled in the early 1980s, individuals living with HIV/AIDS have been treated more equally – particularly since the general population has learned that HIV disease isn’t just waiting for you in the swimming pool or on the fast food countertops … but there’s always room for improvement.

We human beings are uniquely able to judge first and ask questions later. Stigma surrounding HIV – and those living with the virus – is as prevalent in 2008 as it was in 1981 … it’s just a little quieter.

For someone living with HIV disease today, he or she can expect everyone who shakes their hands to wipe their palms on their jeans; nobody to ever share a drink with them; strangers to expect that they are living radical Bohemian lifestyles; that they have no regard for others around them; or that they are living off government stipends for a disease they could have prevented themselves.

HIV/AIDS is really no different in its treatment of the body than, say, cancer or multiple sclerosis. The difference comes in the form of unfair and uninformed assumptions of strangers. That can sometimes be the worst treatment of all.

Now, rather than end on a sour note, let me also assure you that for each chilly person we encounter we encounter at least one loving, caring and non-judgmental friend.

How long after exposure would someone test positive? – Judy Johnston, Wilson

Here formality and information are key. HIV will show up in an antibody test as long as the test is administered 90 days after exposure. Most people will test positive after 30 days, but in order to be certain, it’s better to wait 90 days.

Having said that, North Carolina’s state lab conducts routine RNA testing in order to identify folks in early stages of infection. With that in mind, it’s possible that if you are tested in North Carolina, a positive diagnosis may be identified in less than a month after exposure.

RULE: If you are at risk … get tested today! Period.

The CDC recommends that everyone over the age of 12, whether sexually active or not, be tested at least once a year. If you are participating in risky behaviors, like intravenous drug use or unprotected sex, then you need to be tested far more regularly – at least twice a year.

Traditional HIV tests require a blood sample and a two-week processing period. Rapid HIV tests require an oral swab and take 20 minutes.

If you suspect that you’ve been exposed to HIV disease, then you need to be tested as soon as you can. For a listing of local testing sites, click here.
How long does the HIV virus live outside of the body? For example, the possibility of HIV infected blood on a door knob being transferred to another uninfected person when they come in contact with that door knob. – John, Cary
HIV does not live long outside the body. You cannot become infected by shaking hands with or hugging an individual living with HIV disease. The HIV virus doesn’t live on plates or flatware or drinking glasses; it’s not laying in wait on drinking fountains or door knobs
There are four very specific ways, only, in which HIV is transmitted: through blood, semen, vaginal fluids and breast milk. Pay attention to what you’re doing and how you’re doing it.
What percentage of people living in the Triangle area HIV positive or have AIDS? Is this a high or low number compared to other parts of our state and country? – Erin M., Chapel Hill

The N.C. Department of Health & Human Services estimates that as of Dec. 31, 2007, there are 33,000 individuals living with HIV disease in North Carolina – some of whom do not even know they have HIV (See question 4).

In the Triangle area (including Durham, Orange, Wake and Johnston counties), more than 4,000 people are living with HIV, and official estimates are that at least 25 percent more are unaware of their status. Here at home, HIV disproportionally affects African Americans, women and gay and bisexual men … folks whose health and well-being have traditionally been a low priority.

It’s important to note that the South represents only 37 percent of the federal population and that in 2005, 41 percent of Americans with HIV lived in the South. Today, three years later, it’s home to 45 percent of new AIDS cases. According to the CDC, 50 percent of all American AIDS deaths occur in the South.

We have become the new US epicenter for AIDS – which means that now, more than ever, it is crucial that we educate our community on the importance of HIV prevention.

Federal funding is few and far between in the South, with the majority of funding going to major metropolitan areas like New York, Atlanta and Miami. And, yet, as devastating as it is to our region, HIV/AIDS is definitely an international crisis from which no country can escape.

Professor David Baltimore, president of the American Association for the Advancement of Science, and also a Nobel laureate, recently commented on the search for an AIDS vaccine to the association’s annual conference:

“The failure of every promising approach to an HIV vaccine had led many scientists to wonder whether it would ever be possible to create one … It's such a sad topic. We have been trying to make an HIV vaccine since the day HIV was discovered. In 1984, we were told that as the virus had been found, a vaccine should be just around the corner. History was on our side – we have been able to make vaccines versus almost all the viruses that affect humans. But we are no closer to a vaccine now than we were then.”

A recent article in POZ Magazine, a national publication that chronicles the HIV epidemic both in the States and overseas, noted that “The causes for the region’s spike in new infections were extreme poverty, wobbly AIDS-service infrastructure, comparatively low federal funding, a high minority concentration, and a large rural population.”
Are there any statistics that show the impact on HIV testing rates due to the switch from anonymous testing to confidential testing? – Andrew Fox, Garner

Wow, what a great question. Confidential testing was implemented in order that public health officials might easily identify folks living with HIV disease and be able to fully reach out to them, educate them and link them into care and treatment before they become extremely ill.

Identifying and treating HIV infection early is, in fact, key to long term survival. Generally, it is safe to say that even with the stigma regarding HIV, the change from anonymous to confidential testing has not appeared to impact people’s willingness to be tested.

Good public health is all about early identification and immediate access – and good public health results in healthy people. I think we all can agree on that being a good thing!

Is physical contact/blood transfusion the only way to catch AIDS? – Willie Collins, Fayetteville

OK, this is a good question, and I’m glad you worded it as you did. People do not “catch AIDS." They may become infected with HIV, the virus that, untreated and unchecked, may possibly develop into AIDS.

According to the CDC, “The three main ways HIV is transmitted are through having sex (anal, vaginal, or oral) with someone infected with HIV; through sharing needles and syringes with someone who has HIV; and through exposure (in the case of infants) to HIV before or during birth, or through breast feeding.”

I've read that there is research being done about a link with HIV and the sexually transmitted disease "trich." Is that true, and what is the relation? – Kathy Brown, Nashville
Kathy, I thought it was a good idea to bring in the big guns, so to speak, and have asked Pete Hare, vice president of the HIV & Immunology Business Unit, and Dr. Judith Ng-Cashin, Infectious Diseases, both of GlaxoSmithKline, to assist in this response.
“An area of interest and research in HIV has been how other sexually transmitted infections (STIs) affect transmission, with the idea that anything that causes an inflammatory state in the genital region for both men and women might increase the likelihood of HIV transmission. For instance, researchers have been investigating whether having active genital herpes might increase transmission and if treating herpes might decrease transmission.

The STI you're asking about is Trichomonas vaginalis or ‘trich’. This is a protozoan infection and is a common one here and in the developing world. Recent research concludes that treating trichomonas might decrease HIV shedding (and therefore transmission). You can read the abstract, Trichomonas Vaginalis Treatment Reduces Vaginal HIV-1 Shedding."
Hi John Paul, I have been a (volunteer) online HIV prevention educator for the past eight years and have grown really frustrated with the lack of education and knowledge people have on this issue. I repeatedly get questions from people who have unprotected sex but are convinced they contracted HIV through a paper cut on their finger. I also have a lot of people who have convinced themselves they have HIV because they have a sore throat, swollen lymph node (you name it). Do you have any ideas or strategies for getting across to the public the truth about HIV/AIDS and dispelling such wide spread myths? Thanks. – Kristen Brannock, Durham
Evelyn Foust, head of the Communicable Disease Branch (a.k.a., The State AIDS director), and you share the same opinion in regard to education and public knowledge about HIV/AIDS. This is an unfortunate reality that 27 years into the epidemic, a large majority of people still think that HIV is spread casually.

Evelyn said, “These situations should be viewed more as teachable moments than ignorance. Recognizing the importance of HIV prevention education is the only way that we can successfully address the AIDS epidemic. Unfortunately, HIV prevention efforts are frequently overshadowed by the increased attention on testing and treatment. HIV prevention education is the best weapon we have to dispel common myths and misconceptions about the disease. In additional to education, folks should not engage in self-diagnosis. The only way to know if you are infected with HIV is to get tested. Once you know your status and your partner's status, you should abstain for engaging in behaviors that will place you at greater risk for infection.”

This concept is practiced by the staff at the Alliance of AIDS Services – Carolina. Step one in prevention is education. Our Prevention Education Department teaches 1,500 sessions reaching more than 20,000 people in Durham, Johnston, Orange and Wake Counties annually. We test nearly 2,000 people, thereby identifying infections early enough to slow the progression of the disease. You and me, and your son or daughter, and your neighbor, and Evelyn, and Pete … we are all the first line of defense in stopping the spread of HIV.

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