No doubt that we have come a long way from the days of the movie Philadelphia (the 1993 movie starring Tom Hanks), but making a public declaration of one’s HIV status is still more daunting than declaring one’s personal battle with Type 2 diabetes or genital herpes, for example.
Inevitably, the discourse leads to probing and personal questions as to how HIV was contracted (Sex with men? Multiple partners? Injection drug use?), followed by concerns that others have been knowingly or unknowingly infected. That’s exactly what happened when actor Charlie Sheen revealed his status earlier today.
Given the preconceptions, it is no surprise that Mr. Sheen was blackmailed to keep his diagnosis out of the public eye. Setting aside Sheen’s questionable past personal conduct and outbursts, I do admire his openness about his condition and the circumstances of how he acquired HIV.
HIV “Treatment is Prevention”
Even though the successful development of a vaccine to prevent HIV remains elusive to scientists, treatment of those who are infected prevents new infections. This is one of the reasons why anyone with HIV is now recommended to start treatment immediately.
The tide of the HIV epidemic in North America has now turned (aboriginal and marginalized populations remain the exception) such that we may not see any more new HIV infections 10 years from now. Once the virus in sexual fluids is below a threshold value – or even better fully suppressed – sexual transmission from the HIV-positive member of a “discordant” heterosexual couple almost never occurs; the same likely applies to HIV-suppressed men who have sex with men.
Since 2008, the Swiss have endorsed the provocative concept that discordant couples – couples in which on partner has HIV and the other doesn’t -- need not use condoms. Discordant couples now conceive children without transmitting HIV to their partners or to the newborn, and without the need for sophisticated fertility techniques.
As Sheen has an undetectable virus, I doubt that there are any former partners in the woodwork who will successfully prove that he knowingly infected them … then again, there is no shortage of personal injury lawyers in California.
Will Sheen see a cure for HIV in his Lifetime?
I wish he might, but nothing immediate is around the corner. For now, he has a lifelong requirement to take medication daily to keep the virus suppressed for the sake of his long term health. In future, we might see once monthly rather than once daily treatments to achieve the same end. But as long as he avoids smoking and substance abuse, and leads a healthy lifestyle, his life expectancy compares favourably with the general population.
Dr. Neil Rau is a Medical Microbiologist; Assistant Professor, at the University of Toronto; medical director of Infection Prevention and Control with Halton Healthcare Services, and a consultant for CTV News as the Infectious Diseases Specialist.
