HIV is no longer always a death sentence

Charlie Sheen is one of 35 million people living with the virus and treatments mean he is likely to be able to keep illness at bay

In 1985, when a shocked world learned that the actor Rock Hudson had Aids, and six years later, when Queen’s lead singer, Freddie Mercury, died the day after he had made his diagnosis public, HIV was a death sentence and carried a massive stigma.

Today, HIV is a chronic disease. Charlie Sheen is one of 35 million people living with the viral infection worldwide. About 1.5 million died of Aids-related illnesses in 2013, the last year for which there are complete figures, but Sheen is unlikely to follow them any time soon. HIV in the affluent parts of the world is successfully kept at bay with a cocktail of antiretroviral drugs, which became available in the late 1990s, causing death rates to fall dramatically.

There are still serious issues in some of the poor African American communities of the US, however, where HIV rates are high and those infected are slow to be diagnosed and struggle to get treatment after joining waiting lists for drugs.

HIV is a blood-borne virus that can also be present in semen, transmitted through the sharing of needles and through sex. It is suppressed by the the three-drug cocktail known as antiretroviral therapy (ART) but it cannot be eradicated. It has been shown to lurk at almost undetectable levels in the body. Scientists hunting for a cure are now working on drugs to “wake up” the latent virus and then more drugs to kill it.

HIV infection is entirely preventable, however. Messages about safe sex through use of condoms and about not sharing needles have been promoted around the world, though with limited effect. In recent years, there has been a resurgence of risky sexual practices in the US and Europe, possibly because HIV is no longer the killer it was.

Today, the same drugs that keep people alive can also protect the sexual partners of those with HIV. The lower the level of virus in the bloodstream, the less infectious somebody with HIV is. More recently, it has been shown that those at risk of infection can be protected by taking the drug themselves in the form of PrEP, or pre-exposure prophylaxis.

Freddie Mercury
Freddie Mercury died the day after making his diagnosis public. Photograph: Ilpo Musto/Rex

There is still stigma, but not as it was in the 1980s and 90s, when it was partly caused by homophobia. The first known infections were in the gay communities of San Francisco and New York. It was not until the scale of the tragedy affecting sub-Saharan Africa really became evident that it was widely recognised that HIV is transmitted sexually between men and women as well. Today, the hardest groups to reach with help and support are sex workers and drug users, because they are marginalised and, in some countries, criminalised.

In the last decade, the drugs have been introduced to the developing world thanks to campaigning by activists and the dropping of prices after Indian companies made cheap copies available. In 2013, nearly 12 million people worldwide were on Aids drugs.

• For more information:

National Aids Trust

Terrence Higgins Trust

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AmfAR (Aids research)

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Sarah Boseley Health editor

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