AIDS And You Chapter 3

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AIDS And You Contents

The trouble with AIDS is that most people are far too scared to ask the things they really need

'My boyfriend says that I don't love him because I don't want to have sex with him.'

One thing is absolutely certain: he doesn't love you - or if he does, he doesn't respect you. If he is pressurising you to give yourself to him with no real commitment on his part, he is more interested getting pleasure for himself than in building a relationship with you.

'I know my boyfriend and he says he's a virgin too, so it must be safe.'

A man will tell you anything he wants in, order to have sex with you, if he wants it enough. The world is full of hurt girls and women who have been badly let down. They agreed to have sex as a way of tying him down, out of fear that the relationship would break up, because he promised that they would get married one day. But he had no intention whatsoever of getting 'trapped for life'.

You may be looking for a home, a husband who will love you, care for you and be a good dad to your children. But your boyfriend may be just looking for a good time, no strings attached, and a relationship can turn off like a tap when one day he sees someone new or gets bored. In the meantime you will hear everything you have dreamed of hearing: 'I love you. You are the only girl for me. I am committed to you.'

Anyway, even if he is a virgin now, do you really think that he is never going to sleep with any other girl for the rest of his life? Is this really it? Is he really the guy who is never going to look at another girl again? If he is so keen to have sex with you now before any commitment in marriage , he'll be just as keen to try it out with someone else later on, even maybe after he has married you.

'The two of us are getting married next year. We have not had sex together. But both of us, if we're honest, have had a bit of a past. Should we both be tested before we get married?'

This is a really urgent issue for many couples now, especially in Africa where the risks of marrying someone who is infected are enormous. Many people ask to be tested for these reasons. I think there is a good case for it. It depends on how big the risk has been. A member of church came up to me the other day. He had been an injector of heroin until a few years ago when became a Christian, which changed his entire life and he broke the habit. Should he be tested before going any further?

These questions need expert individual counselling. There is no standard right answer. As a general rule, if it is possible that you or your future partner may have been exposed to HIV then you will both want to be tested out of love and care for each other. How terrible it would be to kill the one you love. Many churches in countries where AIDS is a big problem are now refusing to marry people without HIV tests first.

And what of the results? If both are negative then that is wonderful news. If one is positive and the other is negative then the consequencies ofcould be very serious. I am not saying they should not be allowed to marry. This seems to me to be a personal choice, but they do need to understand the risks. It will mean very careful use of a condom every time they make love, and finding other ways to express intimacy and affection other than full intercourse. It will mean (probably) a decision not to have children since making a baby would carry a real risk of killing the future mother or father. If both are already infected, then there is no reason for them not to marry, since they are not going to kill each other by transmitting the virus. They will have the same dilemma over whether or not to have children. marriage

The best person to talk over HIV testing with is a specialist advisor at a clinic for genito-urinary diseases (STDs). Most major hospitals have them. You usually don't need an appointment, and they will respect complete confidence-they have to, otherwise no one would ever go to them.

"How infectious is HIV?"

HIV is much less infectious than for example Hepatitis B. Let us suppose there is an accident while a doctor is taking blood from someone with HIV and he pricks himself with the needle. We know from many such events that infection is unusual as a result - it is a risk of one in 200 or more. So a doctor would need to have around 200 accidents like that on average before becoming infected himself, because the amount of HIV you need is quite high to get an infection. But with Hepatitis B a doctor would only need to have 5 accidents on average to get infected.

Now if it is the case that the risk is only one in 200 even when you are jabbed by a medical needle, you can see that the risk from - say - a splash of blood onto your hand is very, very small indeed. Intact skin is usually a brilliant barrier against HIV. But a squirt of blood into the eye can be dangerous. So is injecting drugs like heroin with shared equipment, where the previous person's blood is mixed up into the next person's injection.

During normal sexual intercourse between a man and a woman, the risk is around one in 200 of infection from a single episode of unprotected sex with an infected partner. But if one or other has another untreated sex disease such as chancroid or gonorrhoea, and the person may not realise, nor their partner, then the risk of transmission could be ten or twenty times higher.

So then HIV is far less infectious than most people realise. If that's the case, why does it spread so fast in many places? The reason is that although the risk of an individual act may be quite low, when the same act is repeated over and over again, or where many millions of people are involved, the numbers of risks taken is beyond counting and the virus has a huge number of chances to cross from one person to another.

'I am confused because many people say certain things can give you AIDS and other people say they cannot.'

It is very confusing for people, and most people, most of the time, are more afraid of the stories than anything else. Can I get AIDS from a cup, or what about kissing, or swimming, or mosquitoes or anything else? Before answering all these questions in detail, we need to look at the kind of dangers we put ourselves in every day.

Each time you travel in a car or a bus you could die in a crash, and on a bus you could catch flu. You could get bitten by a dog and mugged on the way home from work. The world can be a dangerous place, but we have to get things in proportion or we would all worry ourselves sick. Some people get overwhelmed by all these things and get, so worked up that they cannot go outside the house. They need expert help. Others laugh at them: 'Surely people realise that the risk of something dreadful happening is incredibly small?'

When it comes to AIDS, even the most sensible of us can start behaving in a very odd manner. A grown man leaves a parcel in the rain at the door of the house because he is afraid to speak to anyone inside. A community worker is afraid to drink her cup of tea. At church people are staying away from communion services because they are afraid of the common cup - even though it is safe. At a conference very few want to shake the hand of a visiting speaker.

A few years ago the ACET community care team with whom I worked needed urgently to find bigger offices. After much searching we found somewhere ideal, but the owners were afraid we would pollute the toilets and refused to let us move in.

The trouble is that if I told you that many of these things had absolutely no risk you probably would no believe me. If I told you there was in fact a risk you will probably spend the rest of your life worrying. I am not interested in alarming or comforting you. I do want you to know the facts so you can make up your own mind. So we will now look at a few examples:

'I read in a paper that an expert had said you could get AIDS by eating a meal. Is this true or not?'

No! I suppose that in theory if an infected waiter was to cut his finger with a sharp knife, and hold his finger while it dripped fresh blood all over your meal, and then after he put it in front of you, as you took your first mouthful, you bit your tongue so blood from the waiter entered through a cut in your mouth, possibly there would he the smallest chance that you could become infected. But it is just as silly as saying you should never travel in a bus in case you crash.

'They say you can't get the AIDS virus from kissing, but I heard it was in saliva and someone got infected from a bite."

You are both right. The virus that causes AIDS can be found in any body fluid from someone who is infected. It is not always there, and sometimes it is only present in very small amounts. If it is present in saliva, then why don't people get infected from kissing?

The truthful answer is that we don't really know, but this is what we think: for a start it appears that there may be certain things in saliva which attack the virus. Secondly, the virus is often only present saliva in very small amounts. Thirdly, even if virus from someone infected does enter your mouth it is doomed unless it can find a way into your bloodstream very quickly. In a few seconds a water fall of saliva will flood it out of your cavernous mouth down a huge pipe into an enormous lake of dead burning acid (your stomach), where the virus will instantly be destroyed and broken up into thousands of pieces to be digested. If it survives in a damaged ' form without being broken up completely, in a few hours it will be ejected from the other end of the gut and down the toilet.

The only way virus in your mouth could infect you is if there was a wound, a mouth ulcer, or a bleeding in gum inside your mouth. Doctors have been looking hard at every single known case of infection to find out how it happened. In all the cases so far throughout the world we have not so far as I know found one that has been caught from a kiss.

However, it is possible that a human bite from someone infected can infect someone else. I can think of two cases where this has happened. In the first, a boy is thought to have bitten his brother, and in the second, a girl bit her sister. It is easy to understand why this is different from kissing. After all, the teeth broke through the skin, injecting a small amount of saliva - just as effectively as a snake bite.'

'So should I stop kissing my boyfriend?'

Of course not! Although, it is true, if I am completely honest, that if I was young and single and I found out that a girl I was going out with was infected, I probably would not want to give her massive long French kisses!

'Can babies be infected from a mother's milk?'

Yes. HIV can infect a baby, because the lining of the mouth and stomache are so thin that the virus is able to cross. A mother with HIV may be safest not to breastfeed her child. However it all depends. The child is better off with his or her mother's infected milk than being fed on powdered milk made in unsterile ways - milk feed made up with unboiled water can kill babies with diarrhoea and vomiting.

'Can yon get AIDS from a toilet-seat?'

No!

'You say that the virus cannot cross the skin unless there is a wound. but if that is true, how does it pass from a woman to a man, or the other Way round?'

This is another area where, if I am honest, I have to say we don't really know. The skin on the penis of a man, and inside a woman, is certainly sensitive, thin and delicate. It seems likely that many totally painless, harmless, minute cracks appear in the skin of both partners when they make love. These are how the virus enters. As we have seen, any other sex diseases will make the skin much more likely to bleed.

'Can God heal someone with AIDS?'

Yes! God is God and does what he wills. He is the giver of life and the Great Healer. He is just as likely to heal someone of AIDS as he is of cancer or anything else. No one understands why God choses to heal one and not another. He heals far fewer than we who pray would wish. I have heard many reports of people being healed with HIV or AIDS, usually in the poorest nations where in my experience the experience of the supernatural is often most developed, but no one I know personally has been healed. However a countless number of people with HIV illness have reported improved general health and well-being following prayer even thought they have continued to test HIV positive.

It is easy to pray for healing out of fear rather than with faith. We sometimes pray for healing because we see mistakenly that it is a bad thing for someone to die. But the bible teaches us that for the believer death is not the end. There is no disaster in death for a follower of Jesus but only hope of eternal life. St Paul said that for him to live was Christ but to die was his gain. So when we pray for healing we also pray that God's will be done. Paul's thorn in his side was not healed. Timothy went on having problems with his digestion. And Jesus himself was allowed by his father to be crucified for our sake just as God allows people to be martyred for the sake of the Gospel today.

'If the virus comes out in urine will our rivers and water supply become contaminated?'

The danger is from germs which live in. sewage and cause diarrhoea, not from HIV.

'I have heard that mosquitoes have spread AIDS in Africa. Is this true and could I get AIDS from being bitten in this country?'

Millions of people all over the world are worried this question, and whenever I am in Africa it is one of the commonest things I am asked about. We are sure that the answer is 'no' in Africa and 'no' anywhere else. If AIDS was being spread this route then all the areas of Africa worst affect by malaria would be worst affected by AIDS too, because malaria is carried by the mosquito.

We would also see that all the different age groups were developing AIDS. All ages, after all, get bitten by mosquitoes. In fact, only young children from their mothers and sexually-active young people, in the main, have been affected by AIDS, so we are sure that mosquitoes are not the cause. There may be a small connection between AIDS and malaria, but that is because if you are ill from one thing already, then when AIDS strikes, you are hit twice as hard.

The only insect that we think could possibly transmit HIV is the bed bug, because when they grow big and fat they eat and carry a lot of blood, and some of this can be injected into the next victim. However, the amount of blood is still so small that someone has calculated that you would have to be bitten an average of 15,000 times to he infected!

'Can I get HIV from a barber's blade when shaving me?'

The blade of a barber can transmit HIV if blood is drawn from one person and then the same blade cuts another. You cannot disinfect the blade just by washing. You have to use bleach or other strong disinfectants or heat to a very high temperature.

How accurate is the HIV test?

There are many different methods of testing, almost all of which are indirect, looking for antibodies which form as a reaction to the virus. It can take up to 6 months for the antibodies to develop after someone has been infected so someone who takes a risk in January can go on testing negative until July in some cases even though they are infectious. In most cases the most advanced testing systems detect infection around 6 weeks after infection, sometimes earlier. Occasionally the test result can be wrong, and this happens more often with instant testing kits. The testing processes can be complex, and results are sometimes difficult to interpret, and can sometimes be confused by other illnesses. These are all reasons why doctors in many countries like to do two tests, just to make sure, a few weeks apart, using two different methods. There are direct tests for the virus of various kinds but these are very expensive and difficult to do.

My baby has tested positive for HIV - is it infected?

Firstly any test can be incorrect in a small number of cases which is why doctors usually like to repeat it just to make sure. Secondly when a baby is born the test does not work correctly. The test we use is for anti-bodies - which are the body reaction to HIV. But a newborn baby is carrying antibodies from the mother so all babies of an HIV infected mother will test positive for HIV, whether or not they are actually infected themselves. You have to wait for the mother's antibodies to be used up and for the baby to have time to make it's own. Around a year after birth the baby can be tested again. In most cases it will test negative, and if the mother was treated with anti-HIV medication during pregnancy then the risk of a positive test a year after birth will be even less.

In 90% of cases the baby is not infected before labour begins. Most infection from mother to child occurs during birth itself. The sicker the mother during pregnancy, the higher her virus levels and the more likely her baby will get infected. Without treatment, around one in four babies will be infected after birth, but this can be as low as 8 in 100 when drugs like AZT (Zidovudine) or HIV protease inhibitors are given to the mother from around 14 weeks of pregnancy until birth and to the infant for 6 weeks afterwards. When drugs are used and the baby is delivered by Caesarean section, the infection rates can be as low as one baby in 50.

I have heard some say HIV does not cause AIDS

In a free world of 6 billion people you will always find a small number with very strange ideas on any issue and AIDS is no different. Despite overwhelming scientific research over twenty years, there are a very small number of doctors, scientists and journalists who say things like: "There's no proof HIV causes AIDS." This is a very stupid and dangerous comment. They get publicity because the media like people with extreme views - they make news. The trouble is that they don't understand medical science. You see, nor is there any "proof" in the way they want that smoking causes lung cancer, yet the evidence is strong enough to convict in a court of law. I say again. You cannot prove that smoking causes cancer. However almost everyone believes this to be a fact, as indeed do I, based on the research. For example we see tobacco tar causes cancer changes in cells in the laboratory. We see smokers are far more likely to get lung cancer than non-smokers. But I cannot prove that the reason a particular person is dying of lung cancer is because they smoked. And smoking itself does not kill: it is the effects of smoking on the tissues of the body that create diseases which then go on to kill.

The smoking argument also applies to HIV. We see the effects of HIV on cells in the laboratory, killing white cells. We know why people get illnesses like TB: it is because these soldier cells are damaged. People do not "die" of HIV any more than people "die" of smoking. They die because of what happens when HIV damages cells in the body. In fact the commonest cause of HIV-related death is TB but I cannot prove to you that the reason someone is dying of TB is because they also have HIV. Some people die of TB anyway and HIV may not be the reason in a particular person even if they are infected. But we do know that people with HIV have a limited life-expectancy compared to those who are uninfected, and can predict the range of problems they will have. Wherever HIV goes, TB surely follows, in a form that is hard to treat and often causes rapid death.

Even a small child understands that a man is given a pint of infected blood and then a few years later becomes ill. He tests positive for HIV, as does his wife, and their young child. All become ill and all die. Another man given an uninfected pint of blood is still well twenty years later. He, his wife and child all test negative and remain well, not developing the classic illnesses associated with AIDS.

This is my challenge to people who say HIV does not cause AIDS: if you are so sure, go and inject yourself with blood from someone with HIV. None of them do, because deep down they are still worried. Yet they seem very happy to encourage everyone to ignore health messages, putting people's lives at risk, and as a result even more people may die. I believe this is irresponsible.

In Africa some of these open-air question-and, answer sessions would last several hours with hundreds of people. At the end what I used to say was this: At the moment people are terrified about all the ways they might get infected without having sex. I do not wish people to be any less terrified of getting AIDS. I just wish they were as terrified of the things they really ought to be terrified about, and not afraid at all of the things which are quite safe. 1 wish people would be as afraid of sleeping around as they are at the moment of actually setting foot inside the home of someone with AIDS.

Almost all the questions I am asked by people concern these same areas of non-sexual spread. I hope you have seen that the vast majority of these risks are very, very small and you do not need to alter what you are doing, whereas now is the time, if you have not already done so, to make some radical changes in your sexual behaviour and expectations and to he very careful about anything which pierces the skin.

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