What an HIV Diagnosis Means Today

Charlie Sheen’s announcement that he is HIV-positive places in stark contrast how far we’ve come in understanding HIV — and accepting it.

In 2015, nearly 35 years after the virus was identified, the treatments for the infection have multiplied in impressive fashion — in the early days, there was only one drug, AZT, which doctors knew the wily HIV virus could easily outwit and render useless. Today, there dozens approved by the Food and Drug Administration, each more sophisticated than the last, designed to thwart HIV in different ways. Together, in so-called cocktail combinations, these anti-HIV medications can effectively keep HIV from burrowing into healthy cells and churning out more copies of itself.

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These treatments are effective enough to stall most cases of HIV infection before they can progress to full blown AIDS, when the immune system, after a valiant fight, eventually succumbs to the virus.

While new infections of HIV continue to percolate, especially in the developing world, the cases of full blown AIDS are starting to decline, mostly in the developed world where medications are more accessible. In the U.S., in fact, the treatment strategies are so effective that some are beginning to talk about the beginning of the end of the AIDS epidemic. In San Francisco, rates of new HIV infections have dropped dramatically, from several thousand at its peak to under 300 in recent years. That’s led public health leaders in the city to launch an ambitious effort to become the first city to declare itself HIV-free, by offering free HIV testing to every person who comes into the area’s emergency rooms, and providing anti-HIV drugs to those who test positive as well as giving a drug, also free, that can prevent HIV infection to those who are still negative but engaging in behaviors that put them at high risk of getting infected.

There’s even an HIV home testing kit that will allow people who may still be reluctant to go to a doctor or clinic for testing to learn their status more privately, by sending in a saliva swab and calling in to a counselor for their results.

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All of this has changed the conversation about HIV in a subtle but profound way. With so many options for testing and treatment, there is a growing sense of accountability emerging around HIV that wasn’t present before. Knowing your HIV status is not only critical for your own decisions about your health, but a responsibility you have to your partners as well. The only way to contain the spread of HIV is to ensure that people can easily find out if they are positive, and if they are, to start taking anti-HIV drugs as soon as possible. HIV-positive people whose virus levels are so low that they aren’t detectable by blood tests are less likely to transmit HIV to others, which is why public health officials are pushing to get more people tested and finding ways to provide more HIV positive people with medications. Sheen’s doctor says his virus levels are undetectable.

Many AIDS advocates and public health officials now see getting to such undetectable levels as almost a duty, particularly among high risk groups such as men who have sex with men, still the population with the highest rates of new HIV infections in the U.S. And there is progress toward making this accountability less burdensome, as more cities try to provide free testing and access to HIV care. Science can only accomplish so much. Containing HIV and eventually ending the epidemic will require not just state-of-the-art drugs to neutralize HIV’s biological menace, but changes in attitudes and more acceptance to undo its societal and cultural stigma as well.