Historically a HIV diagnosis meant a very uncertain future and most likely death. This changed with the introduction of what we called Highly Active Antiretroviral Therapy (HAART).
After a rocky start in the early 90’s, by mid-1996 HAART was literally a game changer. It was the first real answer we had to treat this life-threatening infection that has and is still killing millions of people, mostly in developing countries around the world and for some in Australia.
Yet HAART was not without its risks. Treatment with HAART was often delayed until the risk of dying outweighed the toxic side effects of the treatment. The legacy of despair and fear for many people living with HIV in our community along with the practitioners who regret their part in prescribing these medications, persists to this day.
Fast forward to 2020 and the picture is very different. Our HIV medications are usually packaged up in a daily single pill, are more tolerable with few side effects and still improving. Barriers to accessing these medications have been removed in many places, with free dispensing on prescription at community pharmacies throughout NSW.
In mid-2015, the global Strategic Timing of Antiretroviral Treatment (START) Study investigated the benefits and risks of early HIV treatment. This study asked what the most beneficial time was to start treatment for HIV?
The START Study showed that we didn’t need to wait until our white blood cells, called CD4 cells, dropped below 500. More importantly it showed that as soon as we started taking HIV medication, any potential damage by HIV was stopped or slowed to a large extent. This study remains the strongest evidence to date, that early treatment is better than delayed treatment for HIV.
The PARTNERs Studies and Opposites Attract study showed that people living with HIV, whether heterosexual or same sex attracted, who have achieved and maintained an undetectable viral load (UVL) after six months from commencing combination antiretroviral treatment (cART) for their HIV are at zero risk of transmitting HIV to our HIV-negative sexual partners. This proved to be a critical moment for us. Finally the evidence was in. With effective ARV treatment we can actively participate in our fair share of the prevention effort.
Considerations of starting treatment immediately still need to be given to a person’s understanding of what it means to take medication every day for the rest of our life. This ongoing commitment to our health means a person living with HIV will need to take medication consistently and be ready to come to terms with the impact of a diagnosis along with any other priorities that might be on our mind at the time of diagnosis.
For someone who is newly diagnosed with HIV, usually the highest of these priorities is how I can protect my sexual partners and take control of my health and HIV?
Today, living a full and productive life with HIV is possible when we’re on treatment supported by our healthcare team. Today, the biggest challenges of living with HIV are not medical. Stigma and discrimination remain our biggest barrier to living comfortably with HIV, hurdles we can combat with dignity and confidence as we speak up about HIV alongside the people who support us.
For recently diagnosed people living with HIV, notwithstanding the impact of a diagnosis, managing HIV is pretty straight forward. There is a consensus from the majority of doctors in NSW, that when we ask to start treatment within 24 hours of their HIV diagnosis, they will prescribe medication as long as there were no other complicating medical indications.
For more benefits of immediate start to treatment,and strategies to start medication even if you’re Medicare Ineligible or to explore your options regarding immediate start to treatment you can contact Positive Life NSW by calling (02) 8357 8386 or 1800 245 677 (freecall) or email contact@positivelife.org.au
