Dr Christian: How PrEP protects against HIV

2nd July 2019

There is a lot of confusion surrounding HIV; how you acquire it, the difference between that and AIDS, and who is at risk. Like with any area of health care (but particularly sexual health), it’s important to educate yourself and so we spoke to our favourite TV doctor, Dr Christian, all about HIV and the revolutionary treatment, PrEP, that protects against it.

What is HIV?

HIV (human immunodeficiency virus) is a virus that, once in the body, begins to attack certain cells of your immune system and leaves you vulnerable to other infections. Untreated, it can be a cruel disease, because the longer you have HIV, the more damaged your immune system becomes and you risk contracting serious infections and cancers.

Thankfully, effective treatments are available which keep the levels of virus in the body down. Whilst these treatments are not able to destroy the virus completely, however, they can keep it at ‘undetectable’ levels and we now know that people on effective treatment cannot pass the virus on to others. This has been a huge breakthrough in HIV management. 

The main thing that Dr Christian thinks is important is the education on how HIV is spread.

“When the epidemic of the 1980s was in full swing, there was a lot of scaremongering around how easy or difficult it was to catch HIV. Some people thought the disease was airborne and could be caught by sheer proximity to someone who was infected. The most common misconception is that you can be infected with HIV from saliva; so kissing, sharing glasses, using the same cutlery, and other similar activities were all believed to be a way to spread HIV, as was sharing a toilet seat.

Unfortunately, a lot of those false ideas still exist today and it’s important that people understand that the HIV virus only exists in a person’s blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk. So it can only be passed from one person to another through these means (having unprotected sex, sharing needles and occasionally during pregnancy, from mother to child). It absolutely cannot be passed through casual contact such as shaking hands, hugging or kissing.”

What’s the difference between HIV and AIDS?

This is something that people often get confused by. In simple terms, AIDS is the end consequence of having untreated HIV. Standing for acquired immunodeficiency syndrome, it occurs when HIV has damaged the immune system to such an extent that certain ‘AIDS-defining’ opportunistic infections can take hold.

It’s not possible to catch or pass on AIDS, but it is possible to pass on it’s cause: HIV.

Who is at risk?

Technically, anyone can contract HIV. However, there are certain groups who are considered higher risk and should protect themselves accordingly.

Men who have sex with men (so gay or bisexual men) are the most severely affected demographic. Even though they make up a relatively small percentage of the overall population, they make up around 2 thirds of all new infections of HIV. This is because anal sex is the riskiest kind for transmitting HIV.

Dr Christian believes there’s more to it than that though:

“Although gay and bisexual men are typically engaging in a high-risk activity in relation to HIV, their risk status is also linked to homophobia, discrimination and stigma. 

We may have come a long way since the epidemic of the 1980s but there’s still a lot of negative attitudes towards homosexuality, and this can put a lot of men off from getting themselves tested, seeking medications to prevent HIV and getting proper care if they do become infected.”

While men who have sex with men make up the highest percentage of those with HIV, they are not the only high-risk group. Injection drug users, sex workers and ethnic minorities are all at higher risk of contracting HIV, as are the over-50s population (often because they are not worried about accidental pregnancies and therefore do not use contraception. Many missed out on good sex education at school and so are unaware of the risks.

What is PrEP?

It’s important to always practise safe sex, whether you at high risk of HIV or not (because you could still be at risk of other infections). However, for those who are particularly vulnerable to HIV, it’s good to know that there is a treatment available which offers an extra layer of protection. 

PrEP (pre-exposure prophylaxis is a medication taken by HIV-negative people to prevent infection. It works by creating a barrier between your cells and the HIV virus so that if you do come into contact with it, it will not be able to attach to your cells or cause any damage.

Dr Christian hopes that PrEP will revolutionise the lives of gay and bisexual men, as well as other high-risk groups:

PrEP typically takes 7-20 days to become effective but from there, it should provide successful protection from HIV. As we all know, prevention is better than cure and PrEP offers a valuable avenue to those who are worried about HIV and are perhaps stigmatised for their risk of it.

All I hope is that the treatment becomes available to more and more people because right now, there are an estimated 101,600 people living with HIV in the UK and a further ~4,000 people being diagnosed each year. Currently, the treatment is only available on selected clinical trials on the NHS so it’s good that a number of private healthcare providers are committing to trying to make PrEP more accessible to those who need it.”