Welcome to Prep and Play, where we have conversations about safer sexual pleasure. This podcast is dedicated to empowering listeners through open, honest discussions surrounding keeping our minds, bodies, and spirits healthy while being sexually active. My name is Danielle, and I'm the Role and Minority Outreach Specialist at AIDS Alabama South, and today I have with me My name is Caitlin Bricat. I'm the Prevention Education Outreach
Coordinator at AIDS Alabama South. And today we're going to be talking to you a little bit about HIV 101, which is what we talk to people about probably most often. Almost every day. Almost every day. OK, so we're going to talk a little bit about what HIV is, the difference between HIV and AIDS, the modes of transmission. We're going to dispel a few common myths and then talk about ways to prevent and treat HIV. So first off, Caitlin, you want to kick us off.
What is HIV? So HIV is the human immunodeficiency virus. It is a virus is basically sexually transmitted. There are other ways that is transmitted, but it is going to attack your body by destroying your immune system or your CD4 plus T cells. These cells are important for helping fight off other bacteria, diseases, viruses. But basically the HIV virus is going to attach to the helper
T cell or your CD4 plus T cell. It's going to transmit its DNA into the nucleus of that T cell using that T cell's own DNA to replicate new copies of itself, destroying the T cell in the process and then releasing hundreds of new virus particles in your bloodstream. Yeah, you know, Caitlin really broke that down. I like to think of it, if you want to think of it super simple, human immunodeficiency virus. Immunodeficiency,
it makes your immune system deficient. Virus, it's a viral mode of transmission and human means anybody in the human race is eligible for it. When people think about HIV, the term AIDS commonly comes up and AIDS stands for acquired immunodeficiency syndrome. It's actually an older term than HIV, which Chance and I will talk a little bit about in our advances in HIV care episode. But essentially, the way to understand the difference between HIV and AIDS is to look at the stages of HIV.
So the first stage of an HIV infection is when a person first comes into contact with the virus, when the virus first starts entering those cells and making copies. early symptoms are going to be flu -like, occurring two to four weeks after exposure. Somebody might have a fever, they might have swollen lymph nodes, things like that, and it might easily be overlooked as like a different type of, you know. Oh yeah, totally. You might think it's just a common cold that you're going
to get over. Yeah, exactly. And you will because your body will fight it off, but it's the repetitive, the destroying your immune system as it continues. That's really devastating. Yeah, exactly. So your body doesn't fight the virus off, but it does fight the initial flu -like symptoms off. And that leads to the second stage, which is chronic HIV or the clinical latent stage. It's where HIV is active, but it's producing at such low levels because again, it's skyrocketed those
hundreds of copies out in the beginning. And it's producing at such low levels now that you're not really having symptoms. And so during this time period, people might not know that they have HIV, but they're still definitely spreading it if they're not being treated. And then AIDS is actually what we like to think of as stage three or end stage HIV. It's the most severe phase and it's defined as a CD4 plus T cell count of below 200 cells. or the presence of opportunistic
infections. So when people die of AIDS -related illness, it's not the virus itself that's killing them. It's things like rare forms of cancer and rare viruses that are attacking their immune system that would normally be fought off very easily by a healthy immune system. These things are able to kill someone living with HIV and someone suffering from AIDS. I think it's important to note too that it's less than 200 of those CD4 plus T cells per milliliter of blood. Well,
your normal range is between 600 and 1200. Yeah, yeah. So that's what, like a third to a sixth? A third to a sixth. You're highly immunocompromised once you've reached AIDS. And yeah, and immunocompromised is the term that we like to use when someone's immune system has been weakened that far. And so just moving on to modes of transmission here. I like to say that HIV is spread by five and a half bodily fluids. Five and a half? Do go
on. So there are five and a half bodily fluids capable of transmitting the HIV virus, as you said. Those include blood, vaginal fluids, rectal fluids, breast milk, semen, and pre -adjaculate. Blood commonly transmits HIV in cases of sharing needles or blood transfusions. Vaginal fluids can transmit HIV through unprotected vaginal sex. Rectal fluids can transmit HIV through unprotected anal sex. And breast milk can transmit HIV from mother to baby during breast milk and semen,
including pre -ejaculate. That's that half there, guys. Did you catch it? It can transmit HIV through unprotected vaginal, anal, or oral sex. And I like to specifically include pre -ejaculate. Because you would be surprised how many times we get the, well, he didn't come, so there wasn't a problem, right? It's also probably important to point out that vaginal fluids are capable of transmitting the HIV virus to a baby during childbirth. Yes, if the mother is untreated.
Nowadays, as we'll talk about a little bit more, we've gotten treatment down to where not necessarily always a conduit of the virus. Oh, absolutely. So how is HIV not transmitted? So HIV is not transmitted by hugging, kissing, sharing dishes, sharing toilet seats with someone who is HIV positive. It is not transmitted through the air. Yeah, it's not transmitted by any of those things that we commonly think of as casual contact. Again, like it can only be transmitted by those
five and a half bodily fluids. So let's take a look here at some common myths about HIV. So myth number one, HIV is the same as AIDS. Caitlin, why isn't that true? Well, we already went over that, basically. AIDS is the end stage of HIV. It is where your immune system is most compromised, where your CD4 plus T -cell count has dipped below 200. And most of the time, it's kind of fatal at that point, although we do bring people
back from AIDS diagnosis nowadays. Yeah, it's it's fatal when we find somebody in full -blown AIDS and they haven't received treatment yet
People will say all the time. Oh, I want an AIDS test and the thing about that is like You want your CD4 plus T cell count check to see if it's below 200 knowing that you're living with HIV Interesting because you could just be on treatment but whatever and so yeah, that's commonly that's something we hear a lot and so that really just clarifies You know, you can get tested for HIV and if you are living with HIV if you don't get treatment, you know, that could result in AIDS
later on. And so myth number two is that HIV can be transmitted through casual contact. Caitlin went over all those ways you can't get HIV, and it's really just those five and a half bodily fluids. If you would like me to repeat them, it is blood, breast milk, rectal fluid, vaginal
fluid, and semen, including pre -ejaculate. I hope you're not really coming into contact with any of those things casually guys that's not just like your everyday walking around coming into contact with those i mean sometimes we come into contact with those things a lot no judgment but there usually is some intention behind coming into contact with those things so myth number three only certain groups are at risk for hiv so it is very well stigmatized that hiv began
as a gay men's virus. In fact, it was called the gay cancer as the early stages of the 1980s. But that is just not true. HIV does not discriminate. It does not attack certain racial groups, does not attack just certain sexualities. Anybody is capable of contacting the HIV virus. Yeah, I like to think about this. It's not called the
gay immunode. deficiency virus is that called the black immunodeficiency virus it is the human immunodeficiency virus literally anyone in the human race could come into contact with this virus especially if you are sexually active or um using injection drug needles that's a very good way of putting it for human and myth number four you can tell if someone has hiv just by looking at them that's kind of crazy um Can you tell if somebody has diabetes just by looking
at them? That's another chronic illness that someone would have to manage. It comes from the early times of the virus when gay men were developing those carposy, sarcoma, cancers. They were losing rapid amounts of weight. But you don't see that very much anymore. With modern day treatments, people are staying undetected and staying healthy. And so it's important to mention, you know, when she's talking about you know, in those early
days, those people clinically had AIDS. They had their CD4 plus T cell count was extremely low and they were seeing those opportunistic infections and cancers. And so I don't want to say you could tell if somebody has AIDS just by looking at them, but that is a much more serious case of illness where a person might actually be suffering the health consequences that could show up physically. Oh, yes, absolutely. You
did not see those in normal healthy people. A normal healthy person's immune system would fight those off on its own. But you only see it when that immune system is extremely compromised. Exactly. So someone living with HIV whose immune system is not compromised in that way, they live
a perfectly normal, healthy looking life. Yeah, you would you would never know again, since it's not something that can be that's only affecting certain groups, or it's not something that discriminates anybody could have HIV, which is why It's so important to get tested because many people don't show symptoms. As we were saying earlier, those initial flu -like symptoms occur, but after that, and especially if you think that was just a cold or flu, nobody can really tell until they get
tested that they are living with HIV. That's why we recommend being tested every 90 days, testing often and frequently. Especially if you're having multiple or anonymous partners. Yes, yes. And that's one of the top ways to prevent HIV is just frequently testing if you're sexually active. And if you are in the mobile area, you can always come to AIDS Alabama South to get tested. Our clinic hours are 9 a .m. to 3 30 p .m. Monday, Wednesday, and Thursday. And then
on Tuesday, it's 9 a .m. to 7 p .m. And then Friday is appointment. If you are not in the mobile area, local health departments usually test for HIV and all other STIs for free or low cost. Some other methods of prevention. So one of the most common and frequent is condoms. Condoms are 99 % effective at stopping HIV virus prevention and other types of barriers including dental
dams. I always find it hilarious when we go out and we have to explain what a dental dam is, and more often than not somebody's pulling one out and showing. It's usually me. It's usually me who opens the dental dam and shows them how to use it. Anyway, and then we also, so in addition to condoms and barrier methods, we also have pre -exposure prophylaxis, which is a medication taken by HIV negative individuals every day to prevent infection. It's kind of like birth control,
but for HIV prevention. can be a pill taken every day or there is also a shot taken every other month. And these are over 99 .8 % effective at preventing HIV if a person does come into contact with the virus. We are very hopeful that a six month injectable is on its way. I believe they've started testing in the US now. Awesome, awesome. PEP or post exposure prophylaxis is basically the same thing as pre exposure prophylaxis, but used in emergency circumstances. So it involves
taking one pill for 28 days. It is the same antiviral medications that we used to treat HIV, but as a post exposure. So you have a 72 hour window or three days to come down to our clinic or any of your other health professionals to get on PEP if you think you might have been exposed to the HIV virus. You do not have to know for certain that you were exposed to the virus to
get on PEP. If you think there's a possibility, if you wake up in the next morning and you don't know who you slept with and they're already gone, hey, come on down. We could just start on a round of PEP, post -exposure prophylaxis. Yep, yep. And that also comes in super handy in cases of assault. If a person just wants to feel safe and secure that even though their physical body was violated, their health doesn't have to be,
PEP works great. And we mentioned testing already, last but not least, certainly not least, we have safe needle practices. So I would love it if everybody could avoid doing injection drugs in the first place. Like I would seriously love that, but I do know that we don't live in a perfect world. So avoiding sharing needles is a huge way that people can lower their risk of contracting HIV. Because again, you can't tell if someone
has HIV just by looking at them. You don't know if your buddy next to you is living with the virus. They might not even know. So avoiding sharing needles. It's not just sharing needles too, using the same spoon or something to draw from as somebody else, you know, there's transmission that occurs in that as well. So just sharing any kind of equipment used to prepare or inject drugs is probably not in your best interest.
That's a really good point. And then also there are harm reduction services, you know, that apply there. And Caitlin was talking a little bit about personal protective equipment. If you're working in the healthcare field at all, you know, using gloves, using protection when handling bodily fluids is super important. It also went hard
to get on PrEP too. So I got on it just because of this job being in the constant going out and trying to find HIV and get those people that are, you know, living with HIV and not knowing it at risk for being exposed to it myself. So getting on PrEP was something that I chose to do. And then also, HIV is more treatable than it has ever been. So antiretroviral therapy is the treatment that we are using to control HIV. There are a couple different types of medication
that are used. Caitlin was explaining earlier about how HIV attaches to a cell, enters into that nucleus, replicates and spits back out copies of itself. So yeah, today there are six different types of medications. I can't tell you exactly what they are, but I know each of them does a specific different thing for the body. Some of those medications will stop the HIV virus from
being able to attach to the T cells. Some of them will strengthen the cell wall so that it prevents the virus from being able to pass its DNA into the virus. And some of them will even stop the virus from being able to come out of an infected T cell. So our gold standard today is three different medications from two or more
classes of drugs. and in all that you know an important thing to remember is like it is through different medications but most regimens today are one pill a day regimens absolutely back in the day people were on cocktails of medications taking 12 20 pills different times of the day yeah but today it's one pill a day or there's also a bimonthly injection as well And this is super important because with treatment today, people can go on to live long and happy lives.
And by long and happy, I mean that they can reach a level of viral suppression where they are no longer able to transmit the virus to another person. And we call that U equals U, undetectable equals untransmittable. So undetectable equals untransmittable. Basically, we perform a laboratory test, a viral load test, which is a lab test that measures the number of HIV virus particles in a milliliter of your blood. Our modern medical tests are capable of detecting as few as 20 copies
of the HIV virus in a milliliter of blood. Where at peak infection, you're going to have over 100 ,000 copies of the HIV virus in that same amount of blood. But if we can't find it, if it's less than that 20, that we can detect, you're considered undetectable at that point. And you cannot, I repeat, cannot transmit the HIV virus to another person. Yes, when someone is undetectable,
they are untransmittable. And it's important to note that as medical tests have gotten better and better, we've been able to detect fewer and fewer copies. But the standard for being untransmittable is actually the standard for viral suppression, which is a bit older based on tests that were not able to pick up as many copies. So the standard for viral suppression is, I believe, 200 copies per milliliter of blood, even though the test
might be able to pick up a little bit more. If somebody is under that 200, they are not able to transmit the virus to another human being. And that's huge. When I first started in HIV a little over a year ago, I was told that it was at 50 copies, but I have since learned that we've gotten better and it's down to 20. Yeah, and so the test just keeps getting better and better. But, you know, as long as somebody is under that 200, they cannot transmit to another
person. And that's easily achieved, usually within the course of one to three months of being on antiretroviral therapy. So not only is somebody who is virally suppressed unable to transmit the virus to another human being, but it also kind of helps a lot with some of that stigma, stigma that was surrounding HIV. Because when you think about it, 20, 30 years ago, HIV was still something that could be a death sentence
to many people. And so, to take away some of that fear, if you contract HIV today and you discover it before it hits that age stage and you are suffering from a rare type of cancer that nobody knows how to treat, if you discover it before then and get on treatment, there's no reason that you should ever suffer detrimental health consequences because of living with the
virus. In fact, our patients typically lead healthier lives than most other people because they come see the doctor so often to get tests to make sure their medications doing what it's supposed to be doing, that they're catching other things earlier and quicker. Yeah, and that's truly awesome. So it's even promoting health at this stage. And so we've talked to you a little bit about the basics of HIV, what it is, how it's transmitted,
those different stages. We've dispelled a few myths and explained how you can both prevent and treat HIV. I just want to remind everybody how important it is to get tested, you know, every 90 to 180 days, every 36 months. And if you do frequently come into contact with with any of those five and a half bodily fluids, the importance of pre -exposure prophylaxis, which is readily available for anybody who wants it, and adherence to treatment if you are living
with HIV. You can find more resources and support at AIDSAlabamaSouth .org or you're always welcome to come into our clinic. We give out free condoms. We do give out free condoms. Thank you so much for joining me, Caitlin. It's been my pleasure. And on our next episode, I'll be with Chance talking about advances in HIV care. Thank you.