U.S. Virgin Islanders continue being diagnosed with HIV/AIDS and hundreds still die in the territory from this preventable sexually transmitted virus and disease, according to the Department of Health, which is emphasizing prevention and testing as World AIDS Day approaches.
When the AIDS pandemic began in the 1980s, testing positive for HIV, the virus that causes AIDS, meant a certain death sentence. Since then, antiviral drug cocktails have made the disease survivable for some. And the stigma has lessened, both with greater awareness of what HIV is and how it is transmitted, and with changing social mores.
But even as the disease has slipped onto the back burner of public consciousness, it continues to spread and claim new victims in the territory, many of whom still die, often after extensive, expensive care –care which is often provided through the territory’s already strained Health Department and public health clinics.
According to the Health Department’s 2011 HIV Surveillance Report, there 579 people living with an HIV/AIDS diagnosis in the U.S. Virgin Islands today, with 975 cumulative cases reported and 412 known deaths to date.
The St. Thomas/St. John district accounts for more than its share of diagnoses, with 58 percent of HIV cases and 60 percent of AIDS cases in the territory.
Despite improved treatments and federal funding for some of the antiviral drugs, a majority of those who have symptoms of AIDS still ultimately die from it. To date, 20 percent of all HIV and 60 percent of all AIDS patients ever diagnosed on St. Croix are deceased. In the St. Thomas/St. John district, 12 percent of HIV and 53 percent of diagnosed AIDS patients have passed away to date.
And the last several years have seen dramatic increases in HIV/AIDS diagnoses, with 21 new cases in 2008; 31 in 2009; 29 in 2010 and 39 in 2011, and an 18 percent increase in the total number of people living with HIV/AIDS, according to the report.
Those figures are alarming, placing the territory’s rates third in the nation, after Washington, D.C., and New York state. And in that vein, the Health Department is emphasizing prevention and early testing and has set a goal of zero new infections in 2013.
But the jump in new diagnoses does not necessarily mean more people are catching the virus; it could reflect increased testing, according to Jason Henry, the Ryan White Program Coordinator at Frederiksted Health Care.
"We are getting results in a short timeframe and we find we are getting more and more diagnoses," Henry said Tuesday. Rather than an upswing in transmission, "it probably means the outreach effort has been working in identifying what we need to identify," he said, thus capturing existing cases.
According to the U.S. Centers for Disease Control and Prevention, the disease is spread through the intimate transfer of bodily fluids, especially contact with blood. Infection routes include sexual contact, reuse of hypodermic needles by intravenous drug users and, more rarely, pre-natal exposure and blood transfusions. The CDC recommends everyone between the ages of 13 and 64 should be tested for HIV at least once in their lifetime. Those at risk, such as those with multiple sexual partners, should be tested at least annually.
Transfer can be made much less likely and largely prevented by safer sex, especially by always using a condom during intercourse. All unprotected sex with someone who has HIV contains some risk. However, according to the CDC, unprotected anal sex is riskier than unprotected vaginal sex, and the risk is greater for the person on the receiving end of penetration.
Intravenous drug users can prevent transmission by never sharing needles.
While it may have initially spread primarily through the gay male community and intravenous drug users, that stereotype no longer holds, and heterosexual transfer is more and more common, Henry said.
Women comprise roughly 47 percent of HIV patients and 33 percent of AIDS patients in the territory, according to the Health Department survey. The local routes of transmission are somewhat difficult to pin down at times, in part because the stigma attached to homosexuality may make patients less likely to report that as the likely transmission vector, Henry said.
According to the report, nearly half the time (44.5 percent) no transmission route is listed in HIV cases in the territory. For AIDS, about a third of the time, no transmission route is specified.
Roughly one in seven cases of AIDS (14.6 percent) is attributed to injection drug use. More than half of AIDS cases and nearly half of HIV cases are attributed to sexual contact, with heterosexual contact cited about a third of the time for both AIDS and HIV.
Avoiding risky behaviors is important. But getting patients tested and onto antiviral medication not only improves that patient’s outlook, it helps reduce transmission of the virus, Henry said.
"We are making treatment a part of prevention, with the goal of getting people onto treatment to stop the virus," he said. Antiviral drugs can reduce the amount of the virus in the blood to very low, nearly undetectable levels, which reduces the risk of transmission and helps prevent new cases, Henry said.
Encouraging safer behavior and condom use remains important, he said – a point Gritell Martinez, Health’s STD/HIV/TB director, also made in an email conversation on the topic Wednesday.
"The use of condoms is still recommended for all patients, including those with undetectable viral load levels, because an undetectable viral load does not completely eliminate the risk of HIV transmission," Martinez said.
National statistics show that more than 39.5 million people, including 2.5 million children, are infected with HIV/AIDS worldwide and that more than 20 million people have died from the disease since it was first diagnosed in 1981.
Acting Health Commissioner Darice Plaskett is urging residents to take advantage of free testing at DOH clinics territorywide.
“Studies have shown that with improved treatment and care, people are now living longer with HIV/AIDS,” Plaskett said in a statement. “However, in order to receive such life-saving treatment, individuals must be sure to get tested and then take action if infected.”
Department of Health clinics offer free and confidential rapid testing from 8 a.m. to 4 p.m. weekdays, and anyone taking the test can know their status within minutes.
The concept of a World AIDS Day originated at the 1988 World Summit of Ministers of Health on Programmes for AIDS Prevention. Since then, it has been taken up by governments, international organizations and charities around the world.
Several informational programs are scheduled around the territory, before, during and after World AIDS Day on Dec. 1. See Relate Links below for more information.