Doc, my man is on ARVs. Can he transmit the virus to me?

Dear doctor,
My boyfriend recently disclosed that he is HIV positive, and that I should not worry about getting infected because he is on medication. Is it true that if someone is on HIV treatment they cannot transmit HIV to their partner? 

Molly

Dear Molly,
When a person living with HIV uses effective medication consistently, then the amount of virus in their blood stream becomes very low to the point of not being detected using the viral load test. This is referred to as achieving viral suppression. A person who has been able to achieve and maintain viral suppression by taking their medication consistently and correctly cannot transmit HIV through sexual contact. There have been several scientific studies that have shown that someone with undetectable viral load cannot transmit HIV through sex. This, however, does not directly apply to mother-to-child transmission, and HIV transmission through injections.You can get more information on this, and also on how to prevent sexually transmitted infections and pregnancy, at the clinic where your boyfriend receives care, or at any other health facility.
 

Dear doctor,
Which medications can be used to prevent HIV? Are they different for men and women?
Juma

Dear Juma,
The medications used to prevent HIV are classified as either PEP (post-exposure prophylaxis), or PrEP (Pre-exposure prophylaxis). PEP is given immediately after or within 72 hours of a potential exposure to HIV. It is given as one tablet once a day for 28 days. A HIV test is done before starting PEP, to completion of the PEP and at 12 weeks after the exposure. For someone to be given PEP:

-    The individual should have negative HIV test. The test is done just before medication is given. 

-    The exposure must have happened within the last 72 hours.

-    The exposure must have been happened through a mucus membrane or broken skin; or through a needle. And the exposure must be from blood, blood stained fluids or other high risk fluids

PrEP on the other hand, is medication given before the HIV exposure, so as to prevent getting HIV when the exposure happens. This is used by persons who are exposed to HIV repeatedly, for example:

-    persons in a discordant relationship (one is HIV positive and the other one is HIV negative), and the HIV positive partner has not achieved viral suppression or is not taking medication as prescribed.

-    Having a sexual partner whose HIV status is unknown, and is possibly at high risk of HIV infection

-    Having multiple sexual partners, or your partner having multiple sexual partners 

-    Sexual activity while having impaired judgement because of being under the influence of alcohol or drugs

-    Having recent or recurrent sexually transmitted infections

-    Using post-exposure prophylaxis repeatedly

-    Being unable to use or negotiate for safer sex practices such as use of condoms, with a person of unknown HIV status

-    Transactional sex or sex work

-    Injecting drug users

PrEP is available as oral medication that is taken daily. Men may be given the oral medication as event-driven PrEP, which is PrEP that is taken before, during and immediately after the exposure, as prescribed by the health professional. There is also an injectable form of PrEP that lasts for two months. Another form of PrEP is the dalpivirine ring for females that can be used for one month.

Both PEP and PrEP cannot prevent other sexually transmitted infections and pregnancy. Additional measures should be taken for HIV prevention such as reduction of risk behaviours; consistent and correct condom use; good adherence to anti-retroviral medication for those living with HIV; and observing safety protocols in high risk jobs

Dear doctor,

My sister died last year, and her four-year-old daughter recently tested HIV positive after being sickly for some time. Are there any tips on how can we can best take care of this child?

Janet

Dear Janet,

Condolences for your loss and thank you for taking up the noble task of taking care of your niece.

Children living with HIV can live a full healthy life and have great achievements. This requires good support, not only for HIV treatment, but also for their overall care. You will receive support from the health facility where the child is receiving care. Some of the considerations for the child’s care include:

•    Regular wellness checks to monitor weight and receive any vaccines

•    Having well balanced meals, clean drinking water and good sanitation

•    Psychological support from the family, or from a professional as necessary, to help the child process grief and loss; and to begin gradual disclosure of the HIV status, and also to support her in accepting herself, the HIV status, the need for medication, and any challenges that may arise from this.

•    Getting support from educational institutions as necessary

•    Adherence support – this is supporting the child to take antiretroviral medication as prescribed. This includes having someone always available to provide medication to the child at the correct time; gradually teaching the child to take their own medication; and enrolling the child in age-appropriate support groups and other services that are beneficial to the child. 

•    The caregivers can also attend learning sessions and support groups, where information is given and there is experience-sharing. In these forums, there are also discussions on how to support the child through different life stages, and how to address other concerns beyond HIV

Send your questions to [email protected]