When Charlie Sheen disclosed his HIV infection last fall, sexually transmitted infections were back in the public eye. His case will likely contribute to the belief many people have that HIV is caused by sexual promiscuity or injection drug use, when in reality having unprotected sex with someone HIV-positive just one time can lead to HIV infection.
April is STD Awareness Month. The new term for STD is STI -- sexually transmitted infection -- to focus on the infection rather than the disease it could lead to. One way to mark the occasion is to get tested for HIV and thus help eradicate the stigma. A focus on HIV for STD Awareness Month is appropriate since HIV, though preventable, is non-curable and debilitating. HIV testing is now possible with a simple oral swab -- no needles required, and results are ready 20 minutes later. Further, the process is completely confidential, and self-test kits can be purchased in local pharmacies, over the counter, for testing at home.
According to the Centers for Disease Control and Prevention (CDC), in the United States more than 1.2 million people live with HIV, the virus that causes AIDS, yet, alarmingly, as many as 25 percent of persons infected may be unaware of their HIV status. Even though more than 30 years have passed since HIV was discovered, education on how the virus is transmitted is far from universal. Even today, some believe it can be acquired from kissing, using the same toilet seat, or hugging an infected person. Yet another common belief is that "only someone who looks sick" has HIV. All false, these beliefs perpetuate HIV stigma, causing fewer people to get tested, even though the CDC recommends routine testing for anyone 13-64 years of age.
There was a time when experts thought an HIV vaccine would be available within five years of the discovery of the virus. While important advances bring us closer than ever to reaching that dream, a vaccine is still years off. Condoms, when used correctly and consistently, remain our best tool against HIV infection. Few people know that if HIV exposure has occurred, drugs, to be taken soon after exposure, are available to reduce the risk of actual infection.
Even when vaccines exist, they face an uphill battle for use. For example, the human papillomavirus (HPV) vaccines have now been available for over 10 years. They help prevent cancer (cervical cancer in women, penile cancer in men, oral and anal cancer in both) but less than 50 percent of adolescent girls and fewer (around 30 percent) boys in the United States get all three doses. This is much lower than any other vaccine, likely because:
1. Pediatricians are reluctant to bring up the vaccine with parents, fearing that parents interpret the recommendation as meaning that their children are already sexually active.
2. Parents may refuse or postpone the vaccine, believing that their children are not yet sexually active. This leads to waiting until exposure, even though the vaccine works best before first sexual contact.
3. Even though the vaccine has been around for 10 years, parents may want more information prior to agreeing to have their children vaccinated since they may not know much about it, leading to missed opportunities.
4. The vaccine is seen by many parents as an STI vaccine (against genital warts, since the vaccine protects against that as well) rather than a cancer prevention vaccine.
The absence of symptoms does not equate to the absence of an STI. Some STIs, including HPV, can even be transmitted while using condoms. Some STIs can be transmitted during oral sex, when condoms are rarely used or promoted. One reason STIs are becoming more prevalent is the increasing number of internet dating sites. With more connectivity and the rapid proliferation of cell phones, it is easier than ever before for people to meet. The conversation on STIs, however, has not kept pace for the most part.
STIs have many symptoms including itching, burning, blisters on the genitals, pain when urinating, appearance of sores on the body, swollen lymph nodes, a skin rash, sore throat, genital discharge, nausea, and fever to name a few. HPV is the most common STI in the United States, but other common STIs include gonorrhea, syphilis, and chlamydia, all of which are curable and can be treated with antibiotics. Other STIs such as HIV, herpes, and genital warts (HPV) are more troubling, have no cure, and require management of the disease and symptoms.
But there is a silver lining! Most STIs can be prevented by using condoms consistently and correctly during both vaginal and anal intercourse, using condoms or dental dams during oral sex, responsible drug and alcohol use before sex, communicating with one's partner on STI testing and any symptoms, and getting the HPV vaccine to prevent the most common STI.