Upon hearing his HIV status, my most recently diagnosed HIV-positive patient made a very profound statement; he said that he always thought that if he ever got HIV, it would be from an indiscretion with some girl from a club or person of that ilk. He never expected that it would be (literally) from the 'girl next door'. After their relationship ended, rumours about her health and his emerging problems made him suspicious that she infected him. He readily accepted his HIV-positive status with a view to beginning further investigations and appropriate treatment.

Being HIV-positive no longer puts us into the proverbial 'pre-departure lounge' - HIV/AIDS is now classified as a chronic disease. Thanks to the unflagging efforts of the Ministry of Health and the National Health Fund, antiretroviral drugs used in the highly active antiretroviral therapy (HAART) for HIV/AIDS are readily available at little or no cost to needy individuals.

Up to last year, it was calculated that there were 33.4 million adults and 2.1 million children living with HIV/AIDS worldwide. About 430,000 children were born with HIV and some 2.7 million people became infected during that year. About two million died from AIDS-related illnesses. This figure would have been much higher were it not for the availability of antiretroviral drugs.

Act decisively

With approximately 230,000 people living with HIV/AIDS (PLWHA), the Caribbean ranks second only to sub-Saharan Africa (one per cent and 5.2 per cent adult HIV prevalence, respectively). In Jamaica, 1.6 per cent of adults are known to be HIV-positive. We have an estimated 27,000 PLWHA and about 18,000 of our citizens are unaware that they have the virus. Although there is currently no cure for individuals infected with HIV and a vaccine is a long way off, we can significantly limit the spread of this disease if we act decisively.

During a workshop on 'Universal Access and Human Rights - Building the capacity of private physicians to support treatment and care of persons with HIV/AIDS within a multi-sectoral frame-work' (organised by the National AIDS Committee in collaboration with the National HIV/STI Programme and the Pan American Health Organisation), Dr Debbie Carrington reminded us that the vast majority (70 per cent ) of PLWHA are known to have contracted the virus through sexual contact. Haemophiliacs (who, because of their inherited bleeding disorder sometimes require repeated transfusions), intravenous drug users and blood transfusion recipients account for a tiny minority of PLWHA. Vertical (mother to child) transmission accounts for seven per cent and 23 per cent remains undetermined.

Factors pushing epidemic

Dr Carrington listed the factors driving the HIV/AIDS epidemic as early initiation of sexual activity; limited life skills and sex education; multiple sex partners; insufficient condom use; stigma and discrimination; commercial and transactional sex; substance abuse - crack/cocaine, alcohol; men having sex with men and homophobia; gender inequity and gender roles.

Taking steps to avoid or correct the factors listed above will certainly have a great impact on this epidemic. However, another potent weapon against the spread of HIV/AIDS - provider initiated testing and counselling (PITC) - was put forward by the team of Georgia Simmonds and Claudia Beckford. PITC utilises physicians, nurses and contact investigators. It aims to offer and encourage HIV testing as a routine investigation (much like cancer, diabetes and hypertension screening) to adults (18 years old and over).

HIV does not respect our social standing, financial status, sexual orientation, gender, age or appearance. Every sexually active individual (whether categorised as high-risk or not) should seek to ascertain his/her HIV status. This essential knowledge will go a far way in preventing the spread of HIV and in allowing those infected to seek life-saving medications.

Garth A. Rattray is a medical doctor with a family practice. Feedback may be sent to garthrattray@gmail.com or columns@gleanerjm.com.