Vibration helps people suffering from type 2 diabetes who tend to develop foot ulcers.(Photo: AP)
London: There
is now a deadly virus, which anyone can catch from sex with an infected
person. If we’re not careful, the people who’ve died so far, will be
just the tip of the iceberg… If you ignore Aids, it could be death for
you.” It has been hailed as one of the most memorable health campaigns
ever created. The UK led the way with its HIV campaigns. The thing I am
most struck by now, however, is how over-the-top they seem.
It’s now 30 years since HIV was discovered. During my training as a doctor in central London in the late 1990s, people were still dying of AIDS. But since then, incredible pharmacological advances have been made in how the virus is treated. Combination medications — termed “highly active antiretroviral therapy” or Haart — have resulted in being able to maintain the infected person’s immune system and prevent the opportunistic infections that resulted in Aids and death. Despite working in the centre of London with high-risk groups such as sex workers and drug addicts, I haven’t seen someone die of HIV for years. Recent statistics show that in 2012, less than one per cent with HIV died. It’s hard, now, to argue that HIV is a death sentence.
Those who are dangerously ill with the disease are often immigrants who have been infected for years, and come to hospital late. One study suggested that around 75 per cent of HIV-related in-patient admissions are immigrants. For the vast majority of people with HIV in this country, the disease is managed entirely in outpatient clinics. HIV/Aids wards and specialist units have closed simply because there are no patients. This is a hugely encouraging fact, which would have seemed impossible to those who stood, in the 1980s and 1990s, as loved ones faded away. What is startling is the speed with which medicine responded to HIV.
A recent large epidemiological study showed that, for those diagnosed with HIV now, life expectancy is similar to someone who does not have the virus. The medical profession now considers HIV a chronic disease like type-2 diabetes. As a doctor I can tell you that I’d rather have HIV than diabetes. While this might sound shocking the facts speak for themselves: the prognosis for those with type-2 diabetes is much worse than for those with HIV. The risk of stroke in newly treated type-2 diabetes is more than double that of the general population. People with diabetes are four times more likely to have cardiovascular disease. In 20 to 30 per cent of people with diabetes, there’s damage to the kidney.
Damage to the delicate vessels in the eye is a leading cause of blindness and damage to nerves is a leading cause of foot ulcers, which frequently lead to amputations. For those with HIV who take medication, there are very few problems.
Many people are complacent about diabetes in a way that would seem reckless with HIV. People consider type-2 diabetes an irritant — something that can be easily fixed with tablets. But this is wrong. Regardless of how well it is controlled, type-2 diabetes is a progressive disease, which results in the need to increase pharmacological therapies over time. A recent study in Australia showed that, after six years, 44 per cent of patients no longer responded to oral medication and required insulin injections. Now compare this with HIV.
Fixed-dose medications have meant that most of those infected simply take a tablet a day. While no one wants to take medication for the rest of their lives, it’s a lot easier than injecting insulin. And, of course, there are side effects, but that’s true for diabetes medication and, with trial and error, most people find a medication that suits them. To put it starkly, the latest statistics show that because of Haart, HIV now no longer reduces your life expectancy, while type-2 diabetes typically reduces it by 10 years. But this isn’t an easy thing to say publicly.
The news about our incredible progress against HIV is only whispered about because there are concerns that if it is emphasised, then people will no longer avoid infection. The HIV charities are out of touch with the new realities of the disease. They still rely on outdated fears about the disease to promote safe sex in a way that, for example, diabetes charities never do about eating a healthy diet.
Throughout its brief history, HIV has been both medicalised as a disease and moralised as a stigma. It is the social impact that now forms the focus after diagnosis, often far more than the physical aspects. It is the fear of being ostracised that is the biggest problem for those who are newly diagnosed. Rates of depression in those with HIV are nearly 10 times higher than among the general public, because of the stigma. And if HIV still has status as a scary disease, that’s down to society’s attitude — rather than the virus itself.
It’s now 30 years since HIV was discovered. During my training as a doctor in central London in the late 1990s, people were still dying of AIDS. But since then, incredible pharmacological advances have been made in how the virus is treated. Combination medications — termed “highly active antiretroviral therapy” or Haart — have resulted in being able to maintain the infected person’s immune system and prevent the opportunistic infections that resulted in Aids and death. Despite working in the centre of London with high-risk groups such as sex workers and drug addicts, I haven’t seen someone die of HIV for years. Recent statistics show that in 2012, less than one per cent with HIV died. It’s hard, now, to argue that HIV is a death sentence.
Those who are dangerously ill with the disease are often immigrants who have been infected for years, and come to hospital late. One study suggested that around 75 per cent of HIV-related in-patient admissions are immigrants. For the vast majority of people with HIV in this country, the disease is managed entirely in outpatient clinics. HIV/Aids wards and specialist units have closed simply because there are no patients. This is a hugely encouraging fact, which would have seemed impossible to those who stood, in the 1980s and 1990s, as loved ones faded away. What is startling is the speed with which medicine responded to HIV.
A recent large epidemiological study showed that, for those diagnosed with HIV now, life expectancy is similar to someone who does not have the virus. The medical profession now considers HIV a chronic disease like type-2 diabetes. As a doctor I can tell you that I’d rather have HIV than diabetes. While this might sound shocking the facts speak for themselves: the prognosis for those with type-2 diabetes is much worse than for those with HIV. The risk of stroke in newly treated type-2 diabetes is more than double that of the general population. People with diabetes are four times more likely to have cardiovascular disease. In 20 to 30 per cent of people with diabetes, there’s damage to the kidney.
Damage to the delicate vessels in the eye is a leading cause of blindness and damage to nerves is a leading cause of foot ulcers, which frequently lead to amputations. For those with HIV who take medication, there are very few problems.
Many people are complacent about diabetes in a way that would seem reckless with HIV. People consider type-2 diabetes an irritant — something that can be easily fixed with tablets. But this is wrong. Regardless of how well it is controlled, type-2 diabetes is a progressive disease, which results in the need to increase pharmacological therapies over time. A recent study in Australia showed that, after six years, 44 per cent of patients no longer responded to oral medication and required insulin injections. Now compare this with HIV.
Fixed-dose medications have meant that most of those infected simply take a tablet a day. While no one wants to take medication for the rest of their lives, it’s a lot easier than injecting insulin. And, of course, there are side effects, but that’s true for diabetes medication and, with trial and error, most people find a medication that suits them. To put it starkly, the latest statistics show that because of Haart, HIV now no longer reduces your life expectancy, while type-2 diabetes typically reduces it by 10 years. But this isn’t an easy thing to say publicly.
The news about our incredible progress against HIV is only whispered about because there are concerns that if it is emphasised, then people will no longer avoid infection. The HIV charities are out of touch with the new realities of the disease. They still rely on outdated fears about the disease to promote safe sex in a way that, for example, diabetes charities never do about eating a healthy diet.
Throughout its brief history, HIV has been both medicalised as a disease and moralised as a stigma. It is the social impact that now forms the focus after diagnosis, often far more than the physical aspects. It is the fear of being ostracised that is the biggest problem for those who are newly diagnosed. Rates of depression in those with HIV are nearly 10 times higher than among the general public, because of the stigma. And if HIV still has status as a scary disease, that’s down to society’s attitude — rather than the virus itself.
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