I read an article in the January 2016 issue of the Journal of Family Practice titled, “HIV Prevention: A 3-Pronged Approach” by N. Yagoda, MD and R. Moore II, MD.
I have been thinking about HIV lately because I know many college students who are blossoming in their new-found freedom and sexual exploration, and they are not thinking about HIV at all. HIV is not in the headlines anymore, and therefore it seems to be less powerful in helping young adults to choose protected versus unprotected sex. This is despite the fact that total HIV incidence has failed to decrease in the last 25 years.
Per the article, there are more than 1.2 million people living with HIV in the USA, and 12.8% of them are unaware that they have it while only 30% of those diagnosed with HIV are receiving treatment to suppress the virus. This means that the virus is out there, multiplying unchecked in almost million people in the US alone.
RISK FACTOR: Unprotected sex.
RISK FACTOR: IV DRUG USE. In my realm of pain management, a scary truth is that a considerable number of people who become addicted to prescription pain medication eventually switch to injected heroin because it is a lot cheaper. In calm suburbs across the country, there are regular people who are secretly injecting drugs due to addiction and finances. Intravenous drug use, or even sex with a person who uses IV drugs, is considered a major risk factor for contracting the HIV virus.
The 3-pronged approach to HIV prevention mentioned in the article includes 1) screening all individuals ages 15-65 for HIV, 2) pre-exposure prophylaxis for high-risk patients (taking anti-viral medications to reduce the risk of contracting HIV), 3) harm reduction.
Pre-exposure prophylaxis is for individuals who cannot or choose not to avoid risky behavior for a period of time in their life. The downsides include possible drug resistance, high cost (although insurance covers part of it), stigma for those who seek to protect their sexual health, and possible affects to the kidney.
Harm reduction is a group of strategies that help IV drug users avoid HIV transmission. Needle and syringe exchange programs and opioid substitution therapy (methadone or buprenorphine) are examples.
The bottom line is that young people need to be educated about safe sex, which means using a condom correctly every time, even if other forms of birth control are already being used. I recommend all college-bound teens to read a book titled, “Seductive Delusions” by Dr. Jill Grimes which goes through all the sexually transmitted infections (STI), the ways you can catch them, and how to treat them, in a very readable format. I also encourage all people to consider screening for STIs, given that infidelity is common, and treatment for STIs is available.