Why everyone should get an HIV test and how to live
In 2015, the HIV epidemic remains in Russia one of the most acute problems, and people who suffer from this disease are still treated with apprehension and prejudice. At the same time, it is possible to make a test and find out your status for free in many state institutions, and even if the result is positive, with proper treatment, you can live a long life and have a healthy child. However, many of us prefer not to think about the problem, nor about prevention, believing that it cannot touch them.
About why the situation is more serious than it seems, we talked with representatives of the non-profit partnership "EVA" - the first non-state network organization in Russia that helps HIV-positive women. The company's executive director, Yulia Godunova, and the monitoring and evaluation specialist, Irina Evdokimova, explained how to change society’s attitude to HIV, where to look for help, and why you shouldn’t be afraid to link your life with an HIV-positive partner.
When HIV testing is required
IRINA EVDOKIMOVA: In accordance with the Federal Law "On the Prevention of the Spread in the Russian Federation of the Disease Caused by the Human Immunodeficiency Virus (HIV)", "medical examination is carried out voluntarily." HIV testing is mandatory only for blood donors, organs and tissues, as well as representatives of some professions.
Being tested for HIV can be offered to a person before surgery, while visiting KVD, to women in antenatal clinics during pregnancy. The idea is that in any of these situations, the doctor or nurse must sign informed voluntary consent with the client before taking the blood. This consent is called informed voluntary, because it assumes that: 1) the person was explained how the testing will take place, report the result, and make sure that he understood what it was about; 2) the person understood everything and agreed to take an HIV test; no one forced him to do so.
In what situations is voluntary testing for HIV worthwhile?
IRINA EVDOKIMOVA:According to the Ministry of Health for 2014, more than 700,000 HIV-positive people are officially registered in Russia. This is comparable to the population, for example, Togliatti. From the trends, about which experts do not get tired to say: the annual increase in new cases by 10%, the increase in the share of women, the increasing prevalence of the sexual (heterosexual) mode of transmission. People most affected by HIV are over 30 years old.
In today's situation, testing is worth going through to any person who has had unprotected sexual contact with a partner whose HIV status is unknown to him. And, of course, to those who have ever (even fifteen years ago and once) tried injection drugs. The easiest way to get into a situation when you are offered to take an HIV test is for pregnant girls. During pregnancy they are offered to test three times. Or the one who is going to a planned or urgent operation. Therefore, if you are a man who has had no surgical interventions for a long time (or never), or a non-pregnant girl, take the initiative and take an HIV test.
This is not an easy task, which is now being considered not only in Russia: how to involve men in testing. Ideas about strong men who are not afraid of anything, do not get sick and do not succumb to the blues, and only do that make money, are very conducive to the spread of HIV. Because if you are strong and hard-working, it seems to be completely useless to monitor your health. Among my acquaintances there is a couple in which her husband showed HIV infection, which asymptomatically proceeded for 15 years. This happened only when the immunity fell completely and against this background, tuberculosis appeared, which was impossible not to notice. Now imagine if a young man had a habit of taking tests every year. Or if, at the beginning of sexual relations, they would have a conversation with their future wife about going and testing for STIs.
Human nature is such that only by realizing something to the end and making a decision, we can easily follow it. If the decision to be tested was our own, it means that we are aware of our risks and, in the event of a positive result, accepting the diagnosis and starting treatment will be much easier. And if an HIV test is negative, then a person who has consciously tested will be more likely to try to prevent risky situations in the future (a significant role in this is also played by the extent to which quality counseling was done before and after the test).
Why should the test be accompanied by consultation
IRINA EVDOKIMOVA: One of the most important parts of HIV testing is pre-test and post-test counseling. This means that you first discussed possible risks with you, provided information on how to protect yourself, told you about modern ideas about HIV, treatment, life expectancy, the possibility of having HIV and having a baby free from infection; mentioned that the test result can be positive, negative and doubtful (and what it means); necessarily informed about the "window period" - an interval of 3-6 months, when a person may be infected, but the test still does not show it.
When a person came to know the test results, he should be provided with post-test counseling. During this meeting, the person is given a test result (positive, negative, doubtful), explaining what it means. Further conversation takes place depending on the result of the analysis. In the event of a positive result, people talk about living with HIV, treatment, the opportunity to have a healthy child and live the same number of years as without HIV, and measures to prevent further transmission of HIV. When a negative result, discuss ways to prevent risks and the need to pass the next test if there is a suspicion of a "window period".
This is the perfect picture. In real life, it is not enough in which institution all these procedures are carried out (and in vain). Because if you signed some paper, donated blood, it’s not known what, and then got an unexpected result, you have much less time to think about your risks, HIV, and somehow realize what is happening.
Where to do the test
IRINA EVDOKIMOVA: An HIV test can be taken free of charge in many medical institutions if you ask the doctor for a referral: polyclinic, ARC, women's consultation. Such a test will be non-anonymous. Or anonymous, but then paid. If you want to take the test for free and anonymously, then contact the Center for Combating Infectious Diseases (sometimes called the “AIDS Center” in the old manner) of your city. There are more chances to get competent pre- and post-test counseling. You can anonymously, but for a fee to pass an HIV test in a commercial medical centers.
In many regions of Russia, non-profit organizations (including ours), together with government agencies, began to conduct rapid HIV testing among the population. Imagine, after work you get off the train and right at the station square you can go to the mobile laboratory (specially equipped bus) and find out the result within 20 minutes. It is free, anonymous, with pre- and post-test counseling and confidentiality. This is a very good initiative, and it helps to involve people in testing who will not reach a medical institution soon. Now such actions are taking place in many cities (not only large ones) of Russia.
Where to turn if the HIV test result is positive
IRINA EVDOKIMOVA: First you need to contact the Center for Combating Infectious Diseases ("AIDS Center") of your city. There, doctors will conduct an additional examination, which will allow you to learn about the state of the immune system. With certain indicators of immunity, treatment is prescribed immediately, in other cases it may take several years before antiretroviral therapy is started. Although already this year, the World Health Organization announced that it recommends prescribing treatment regardless of immunity parameters. I think in the coming years, Russia will also adopt and implement these recommendations.
In order to get emotional support, you can turn to an equal consultant (a person who has been living with HIV for some time and has counseling skills) or go to a mutual help group meeting. The ability to communicate with people who have already passed the crisis of making a diagnosis helps to overcome fear and isolation by itself, and it is easier to start treating some things. In our organization, meetings of self-help groups for HIV-positive women are held. Girls discuss their relationship with a doctor, talk about experiences related to starting antiretroviral therapy, share their experience discussing status with a partner. Our network includes equal consultants from different regions of the country, so we always try to find someone with whom you can discuss your status with a person from Syktyvkar or Nadym (in the extreme case, this could be an online consultant). In addition, there are many sites and groups in social networks for people living with HIV: in some they discuss treatment, in others they get to know each other, and in the third they come up with joint leisure activities.
Can in Russia introduce compulsory HIV testing, for example, before the wedding
Yuliya Godunova: It is important to emphasize that Anna Yurievna (Popova is the chief state sanitary doctor of Russia. - Note ed.) did not take such an initiative. She answered the question of whether to support testing young people before the wedding. Yes, it is, but everything should be within the law (and therefore voluntarily) - that was her message.
It is important to talk with young people about HIV. Because if you do not talk about how to protect your sexual and reproductive health now, not to form the habit of having protected sex, to undergo regular tests (not just for HIV), then tomorrow it may be too late. By the way, testing has long been viewed as a measure of HIV prevention. A person who knows his status, to a greater extent will think about protecting a partner. And if he takes antiretroviral treatment and has a suppressed viral load, then even in the case of an emergency with a condom, the probability of infecting a partner is almost nil.
Why HIV and its prevention are still stigmatized
IRINA EVDOKIMOVA: The statement by A. Yu. Popova (about testing young people before the wedding. - Note ed.) filed in some media, of course, directly refers to the so-called traditional values. Naturally, such headlines in the media about compulsory testing before the wedding look a bit threatening, because the overwhelming majority of Russians enter into sexual relations long before marriage. And then immediately and about compulsory testing, and references to the norms, when the couple should not have sex before marriage. Not surprisingly, the head of Chechnya, Ramzan Kadyrov, instantly reacted to the news and offered to share experiences.
Meanwhile, if you look at the video recording of A. Yu. Popova’s speech, you can see that she quite openly spoke about the use of condoms as a way of protection against HIV. The situation with HIV in Russia today, alas, is characterized by the fact that there are no longer any particularly prosperous or disadvantaged segments of the population. People living with HIV who have experienced injecting drug use live with HIV, and people who are far from drugs and often change partners. For several years, doctors have been talking about the feminization of HIV. This means that among those who live with HIV, every year there are more and more women. Often these are women who received HIV from a regular partner / husband and could not even conceive that it would affect them. By the way, this is one of the most difficult categories of people for work.
A person who did not perceive himself at risk for HIV at all, takes such a state of things much longer, blames himself, becomes angry with his partner, locks himself up and stops communicating with friends, delays the start of ARV therapy. I strongly welcome the situation when an HIV-positive partner talks about his status as an HIV-negative before sexual relations begin. Or when a couple, holding hands, comes to a medical institution for tests, and then discusses the results in the evening. I know discordant couples (a couple where one partner is HIV-positive and the second is HIV-negative), who have long and harmoniously lived together, but hide the HIV status of one of them from other relatives. The situation of compulsory testing before the wedding may draw attention to the analysis of those people whom the information on the HIV status of the new relative should not concern at all.
How to have children if you or your partner is HIV-positive
Yuliya Godunova: HIV status, of course, is not a contraindication for entering into relationships, marriage, child birth. There are a few things that are important to remember if your lover is living with HIV. The first is that HIV is a chronic disease that cannot be definitively cured, but can be controlled with antiretroviral therapy. Antiretroviral therapy provides an opportunity to live a long and fulfilling life (provided it is properly and for life), have sexual relations and get married, give birth to children free from HIV.
If you are not practicing injecting drug use, then the only way you can get HIV from a partner is unprotected sex. The safest way to protect yourself from HIV is to use condoms all the time during sex. The second most reliable is the reception of an HIV-positive partner in antiretroviral therapy (WHO now recommends prescribing therapy to a person who has an HIV-negative partner, if he wants to, regardless of immunity indicators). And if your partner takes therapy and has an undetectable viral load for more than half a year, this greatly reduces the risk of HIV transmission if suddenly sex is unprotected. This can be useful if you are thinking about conceiving a child. In some countries (for example, the United Kingdom), if a man has HIV status, it is recommended that a couple try to conceive in this way during ovulation in a woman — it is only important that the viral load in an HIV-positive partner is suppressed. But, of course, in this situation it is very important to consult an infectious diseases specialist.
According to various estimates, between 30% and 50% of HIV-positive people live with an HIV-negative partner. My husband and I are just an example of a typical discordant couple. My husband is living with HIV, we are together for seven years, I am still HIV-negative. Our son is five years old and he also lives without HIV. I think it is very important that from the very beginning of the relationship we spoke openly about HIV, our relationships, sex, condoms. My husband is very consistent in this matter, and no stereotypes about difficult, not enjoyable sex in a condom are uncharacteristic for him. We, like any couple, are experiencing different periods in our relationship, but this is not related to HIV.
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