Putting it off: Why some men are diagnosed with advanced HIV infection
Despite increased community and government endeavours to encourage early HIV testing, there are still those who present with advanced HIV infection when first diagnosed, writes Lance Feeney.
HIV has been with us for 30 years and we’ve come a long way in understanding the virus since the 80s and 90s.
Gay men, who are negative and sexually active, deal with the possibility of HIV on a regular basis. They’re potentially at risk whenever they have unprotected sex with a partner whose status is unknown -that’s quite often, if social research is reflective of gay men’s behaviour and attitudes.
Yet, despite government and community-based testing, treatment campaigns and access to new rapid testing technologies, some people with HIV present late with advanced HIV infection.
By advanced HIV infection, I mean AIDS (a CD4 count less thn 200 and/or an AIDS defining illness).
The average time from untreated infection to AIDS is about 10 to 11 years. In some cases AIDS may develop sooner (within five years) in those with a very high viral load. From 2009 to 2013, a little over 10 per cent or about 30 people each year in NSW were diagnosed with AIDS. The highest number of late diagnoses is among gay and other homosexually active men, including homosexually active men who inject drugs. Gay men in their 40s and 50s are over-represented in late diagnosis data.
Over the course of the infection, symptoms become more frequent and difficult to treat. Skin conditions (fungal, bacterial and viral), oral conditions (ulcers and fungal infections) and constitutional complications all become more commonand troublesome.
[Image] A fear of discrimination prevents some people from getting tested
People may develop episodes of fever, weight loss, fatigue, headache, joint pain and diarrhoea. They generally have periods of feeling quite unwell. They may even go on to develop serious opportunistic infections, like fungal or bacterial pneumonia, cytomegalovirus in the eye that can cause blindness, fungal meningitis, and some nasty cancers.
The reasons for late diagnosis include confidentiality, beliefs that sexual behaviours were safe, and lack of knowledge about HIV infection on the body. HIV-related stigma and fear of discrimination play a big part in preventing some people from getting tested. Finally it’s picked up, often when they are sick or admitted to hospital.
Lance Feeney is the policy analyst and advocate at Positive Life NSW. He is a member of the NAPWHA PozAction Leaders Group.