What To Know About HIV This World AIDS Day

Yesterday, we asked 10almonds readers to engage in a hypothetical thought experiment with us, and putting aside for a moment any reason you might feel the scenario wouldn’t apply for you, asked:

❝You have unprotected sex with someone who, afterwards, conversationally mentions their HIV+ status. Do you…❞

…and got the above-depicted, below-described, set of responses. Of those who responded…

• Just over 60% said “rush to hospital; maybe a treatment is available”
• Just under 20% said “ask them what meds they’re taking (and perhaps whether they’d like a snack)”
• Just over 10% said “despair; life is over”
• Two people said “do the most rigorous washing down there you’ve ever done in your life”

So, what does science say about it?

First, a quick note on terms

• HIV is the Human Immunodeficiency Virus. It does what it says on the tin; it gives humans immunodeficiency. Like many viruses that have become epidemic in humans, it started off in animals (called SIV, because there was no “H” involved yet), which were then eaten by humans, passing the virus to us when it one day mutated to allow that.
  • It’s technically two viruses, but that’s beyond the scope of today’s article; for our purposes they are the same. HIV-1 is more virulent and infectious than HIV-2, and is the kind more commonly found in most of the world.
• AIDS is Acquired Immunodeficiency Syndrome, and again, is what it sounds like. When a person is infected with HIV, then without treatment, they will often develop AIDS.
  • Technically AIDS itself doesn’t kill people; it just renders people near-defenseless to opportunistic infections (and immune-related diseases such as cancer), since one no longer has a properly working immune system. Common causes of death in AIDS patients include cancer, influenza, pneumonia, and tuberculosis.

People who contract HIV will usually develop AIDS if untreated. Untreated life expectancy is about 11 years.

HIV/AIDS are only a problem for gay people: True or False?

False, unequivocally. Anyone can get HIV and develop AIDS.

The reason it’s more associated with gay men, aside from homophobia, is that since penetrative sex is more likely to pass it on, then if we go with the statistically most likely arrangements here:

• If a man penetrates a woman and passes on HIV, that woman will probably not go on to penetrate someone else
• If a man penetrates a man and passes on HIV, that man could go on to penetrate someone else—and so on
• This means that without any difference in safety practices or promiscuity, it’s going to spread more between men on average, by simple mathematics.
• This is why “men who have sex with men” is the generally-designated higher-risk category.

There is medication to cure HIV/AIDS: True or False?

False so far (though there have been individual case studies of gene treatments that may have cured people—time will tell).

But! There are medications that can prevent HIV from being a life-threatening problem:

• PrEP (Pre-Exposure Prophylaxis) is a medication that one can take in advance of potential exposure to HIV, to guard against it.
  • This is a common choice for people aren’t sure about their partners’ statuses, or people working in risky environments.
• PEP (Post-Exposure Prophylaxis) is a medication that one can take after potential exposure to HIV, to “nip it in the bud”.
  • Those of you who were rushing to hospital in our poll, this is what you’re rushing there for.
• ARVs (Anti-RetroVirals) are a class of medications (there are different options; we don’t have room to distinguish them) that reduce an HIV+ person’s viral load to undetectable levels.
  • Those of you who were asking what meds your partner was taking, these will be those meds. Also, most of them are to be taken in the morning with food, so that’s what the snack was for.

If someone is HIV+, the risk of transmission in unprotected sex is high: True or False?

True or False, with false being the far more likely. It depends on their medications, and this is why you were asking. If someone is on ARVs and their viral load is undetectable (as is usual once someone has been on ARVs for 6 months), they cannot transmit HIV to you.

U=U is not a fancy new emoticon, it means “undetectable = untransmittable”, which is a mathematically true statement in the case of HIV viral loads.

See: NIH | HIV Undetectable=Untransmittable (U=U)

If you’re thinking “still sounds risky to me”, then consider this:

You are safer having unprotected sex with someone who is HIV+ and on ARVs with an undetectable viral load, than you are with someone you are merely assuming is HIV- (perhaps you assume it because “surely this polite blushing young virgin of a straight man won’t give me cooties” etc)

Note that even your monogamous partner of many decades could accidentally contract HIV due to blood contamination in a hospital or an accident at work etc, so it’s good practice to also get tested after things that involve getting stabbed with needles, cut in a risky environment, etc.

If you’re concerned about potential stigma associated with HIV testing, you can get kits online:

CDC | How do I find an HIV self-test?

(these are usually fingerprick blood tests, and you can either see the results yourself at home immediately, or send it in for analysis, depending on the kit)

If I get HIV, I will get AIDS and die: True or False?

False, assuming you get treatment promptly and keep taking it. So those of you who were at “despair; life is over” can breathe a sigh of relief now.

However, if you get HIV, it does currently mean you will have to take those meds every day for the rest of your (no reason it shouldn’t be long and happy) life.

So, HIV is definitely still something to avoid, because it’s not great to have to take a life-saving medication every day. For a little insight as to what that might be like:

HIV.gov | Taking HIV Medication Every Day: Tips & Challenges

(as you’ll see there, there are also longer-lasting injections available instead of daily pulls, but those are much less widely available)

Summary

Some quick take-away notes-in-a-nutshell:

• Getting HIV may have been a death sentence in the 1980s, but nowadays it’s been relegated to the level of “serious inconvenience”.
• Happily, it is very preventable, with PrEP, PEP, and viral loads so low that they can’t transmit HIV, thanks to ARVs.
• Washing will not help, by the way. Safe sex will, though!
  • As will celibacy and/or sexual exclusivity in seroconcordant relationships, e.g. you have the same (known! That means actually tested recently! Not just assumed!) HIV status as each other.
• If you do get it, it is very manageable with ARVs, but prevention is better than treatment
• There is no certain cure—yet. Some people (small number of case studies) may have been cured already with gene therapy, but we can’t know for sure yet.

Want to know more? Check out:

CDC | Let’s Stop HIV Together

Take care!

Is Chiropractic All It’s Cracked Up To Be?

Yesterday, we asked you for your opinions on chiropractic medicine, and got the above-depicted, below-described set of results:

• 38% of respondents said it keeps us healthy, and everyone should do it as maintenance
• 33% of respondents said it can correct some short-term skeletal issues, but that’s all
• 16% of respondents said that it’s a dangerous pseudoscience and can cause serious harm
• 13% of respondents said that it’s mostly just a combination of placebo and endorphins

Respondents also shared personal horror stories of harm done, personal success stories of things cured, and personal “it didn’t seem to do anything for me” stories.

What does the science say?

It’s a dangerous pseudoscience and can cause harm: True or False?

False and True, respectively.

That is to say, chiropractic in its simplest form that makes the fewest claims, is not a pseudoscience. If somebody physically moves your bones around, your bones will be physically moved. If your bones were indeed misaligned, and the chiropractor is knowledgeable and competent, this will be for the better.

However, like any form of medicine, it can also cause harm; in chiropractic’s case, because it more often than not involves manipulation of the spine, this can be very serious:

❝Twenty six fatalities were published in the medical literature and many more might have remained unpublished.

The reported pathology usually was a vascular accident involving the dissection of a vertebral artery.

Conclusion: Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit.❞

Source: Deaths after chiropractic: a review of published cases

From this, we might note two things:

1. The abstract doesn’t note the initial sample size; we would rather have seen this information expressed as a percentage. Unfortunately, the full paper is not accessible, and nor are many of the papers it cites.
2. Having a vertebral artery fatally dissected is nevertheless not an inviting prospect, and is certainly a very reasonable cause for concern.

It’s mostly just a combination of placebo and endorphins: True or False?

True or False, depending on what you went in for:

• If you went in for a regular maintenance clunk-and-click, then yes, you will get your clunk-and-click and feel better for it because you had a ritualized* experience and endorphins were released.
• If you went in for something that was actually wrong with your skeletal alignment, to get it corrected, and this correction was within your chiropractor’s competence, then yes, you will feel better because a genuine fault was corrected.

*this is not implying any mysticism, by the way. Rather it means simply that placebo effect is strongest when there is a ritual associated with it. In this case it means going to the place, sitting in a pleasant waiting room, being called in, removing your shoes and perhaps some other clothes, getting the full attention of a confident and assured person for a while, this sort of thing.

With regard to its use to combat specifically spinal pain (i.e., perhaps the most obvious thing to treat by chiropractic spinal manipulation), evidence is slightly in favor, but remains unclear:

❝Due to the low quality of evidence, the efficacy of chiropractic spinal manipulation compared with a placebo or no treatment remains uncertain. ❞

Source: Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain

It can correct some short-term skeletal issues, but that’s all: True or False?

Probably True.

Why “probably”? The effectiveness of chiropractic treatment for things other than short-term skeletal issues has barely been studied. From this, we may wish to keep an open mind, while also noting that it can hardly claim to be evidence-based—and it’s had hundreds of years to accumulate evidence. In all likelihood, publication bias has meant that studies that were conducted and found inconclusive or negative results were simply not published—but that’s just a hypothesis on our part.

In the case of using chiropractic to treat migraines, a very-related-but-not-skeletal issue, researchers found:

❝Pre-specified feasibility criteria were not met, but deficits were remediable. Preliminary data support a definitive trial of MCC+ for migraine.❞

Translating this: “it didn’t score as well as we hoped, but we can do better. We got some positive results, and would like to do another, bigger, better trial; please fund it”

Source: Multimodal chiropractic care for migraine: A pilot randomized controlled trial

Meanwhile, chiropractors’ claims for very unrelated things have been harshly criticized by the scientific community, for example:

Misinformation, chiropractic, and the COVID-19 pandemic

About that “short-term” aspect, one of our subscribers put it quite succinctly:

❝Often a skeletal correction is required for initial alignment but the surrounding fascia and muscles also need to be treated to mobilize the joint and release deep tissue damage surrounding the area. In combination with other therapies chiropractic support is beneficial.❞

This is, by the way, very consistent with what was said in the very clinically-dense book we reviewed yesterday, which has a chapter on the short-term benefits and limitations of chiropractic.

A truism that holds for many musculoskeletal healthcare matters, holds true here too:

❝In a battle between muscle and bone, muscle will always win❞

In other words…

Chiropractic can definitely help put misaligned bones back where they should be. However, once they’re there, if the cause of their misalignment is not treated, they will just re-misalign themselves shortly after you walking out of your session.

This is great for chiropractors, if it keeps you coming back for endless appointments, but it does little for your body beyond give you a brief respite.

So, by all means go to a chiropractor if you feel so inclined (and you do not fear accidental arterial dissection etc), but please also consider going to a physiotherapist, and potentially other medical professions depending on what seems to be wrong, to see about addressing the underlying cause.

Take care!