A GP Writes: HIV and AIDS

Dr Farah Paruk writes…

The 1st of December marks World AIDS Day. This day serves as a moment to reflect on those who have tragically lost their lives to this virus while also celebrating the advancements made in recent years. There is hope; significant progress has been achieved in treatment, reduced transmissibility, and diminishing stigma. However, challenges remain.

This week, I conducted a teaching session where students had the opportunity to meet a patient living with HIV. For many of them, it was their first encounter with someone who is HIV positive. The patient pointed out that while he may be the first person to share his status openly, he likely wasn’t the first HIV-positive individual they had met. This remark prompted deep reflection. We should ask ourselves: Why does stigma around HIV persist? What steps can we take to lessen it? How can we work towards eradicating this disease? What insights can we gain from those living with HIV?

Over the past 40 years, 35 million people have died from AIDS-related illnesses. In the 1980s, receiving an HIV diagnosis in the UK often felt like a death sentence. Many endured severe and debilitating side effects from the limited and potent medications available at that time, which understandably deterred people from getting tested. Today, HIV is treated similarly to other chronic diseases in the UK, with medications being far less burdensome and side effects more manageable. Those recently diagnosed can expect a normal life expectancy and can live with HIV instead of dying from it. Individuals on treatment often achieve “undetectable” levels of the virus, and extensive research has shown that if the virus is undetectable, it becomes not transmissible—leading to the widely recognised slogan U=U. This is a monumental advancement in the fight to eradicate HIV.

2030 Goal & Normalising Testing

The ultimate goal is to eliminate new HIV diagnoses in the UK by 2030, making it the first country to achieve this remarkable milestone. Progress is being made; access to early testing and more effective, manageable medications is improving. Innovations like implant devices and biannual injections are developing, easing the burden on those concerned about daily medication. Furthermore, preventative medication such as PrEP (Pre-exposure prophylaxis) is now available to everyone, thanks in large part to the steadfast efforts of the HIV community.

However, there are still concerning developments. Recent data from this month reveals that diagnosis rates in 2023 have risen across the UK, particularly among ethnic minorities and women. This serves as a critical wake-up call for all of us—we need more people to come forward for testing, expand testing availability, and make it more routine and less stigmatised. The virus is not transmissible when well-managed, and to manage it effectively, we need to identify individuals with HIV as early as possible. Achieving the 2030 target will necessitate tremendous collective effort. The HIV community—clinicians, scientists, volunteers, policymakers, and those with lived experience—has consistently risen to each challenge and played a more significant role than we might initially think. They have paved the way in other fields, promoting expert patients, support groups, and online communities and placing those with lived experience in clinics to help reassure newly diagnosed individuals and reduce stigma. They have won numerous legal battles, including one last month concerning the HIV Fertility Rights Law, and consistently keep the needs of HIV-positive individuals at the forefront of national and global discussions. A vital part of eliminating this virus is ensuring that no positive individuals remain undiagnosed.

So, to address the question of why stigma persists, we must shift our perceptions and normalise testing, celebrate the fact that HIV cannot be transmitted if everyone has access to treatment, and foster openness with patients, colleagues, and ourselves to seek and offer support.

At Teladoc Health, our GPs and Mental Health support services are available to discuss any concerns or questions you may have about HIV, including your risks. Please feel free to reach out to us.