I have been to a number of countries
in Africa, but I have never been to the Democratic Republic of Congo. Its capital,
Kinshasa, is famous for two reasons. The first is that it’s one of the world’s
second-closest capital cities to another capital city (it faces Brazzaville,
the capital of the Republic of Congo) with just the river Congo between them.
The second reason is that a man living there was the first known case of someone
infected with HIV-1. He tested positive in 1959. Over the intervening years,
the HIV virus spread throughout the rest of the world. Since global surveillance
and tracking of the epidemic began in 1983, 75 million people have been
infected with the HIV virus and approximately 32 million people have died. Today
it’s estimated that 19.5 million people are surviving and living with HIV thanks
to antiretroviral treatment. However, it is
estimated that there is almost the same number of people living with HIV, who
don’t have access to any treatment at all. There is no cure for HIV.
In the early 1980s, public health
doctors began to use the term ‘acquired immunodeficient syndrome’ or what we
more commonly call to day AIDS. It has taken a long time for scientists and
medical experts to understand the disease, and how it might be treated. I first
became aware of AIDs in 1984, when a patient in the mental health service I was
managing was admitted with an HIV positive diagnosis. He had acquired the virus
through the contaminated blood product Factor VIII. Like many people at the
time, we didn’t know a lot about the disease. There was a great deal of misinformation
about whether you could catch AIDs from him by using a mug he had used, being
in the same room as he was and so on. It was a difficult time, and he had certainly
been subjected to much stigma induced anger and ignorance on the part of others.
I don’t know what happened to him,
as I left the service before he did. The treatments available then were crude
in comparison to what is available today. These days there is a much greater understanding
of how the virus might be transmitted to others, and rates of infection have dropped
over the past five years in many parts of the world. Sadly, sub-Saharan Africa, remains the most
badly affected, and cases there account for over two thirds of all those living
with HIV worldwide. The UK has made much progress in ending the HIV epidemic.
In 2018, Public Health England published a report that detailed this progress
and what still needs to be done. Testing for the virus remains a critical
element in maintaining this progress.
Likewise, as the world learns to
live with Covid19, a different type of virus but just as dangerous, testing
will increasingly become an important part of dealing with the disease and containing
the rate of infection. Whether we will ever get to a Covid19 version of the U=U
stage is difficult to say as we simply don’t know enough about the disease yet.
UK readers of this blog will be aware that a new track and trace testing initiative
has been launched last week. The official description of what is involved can
be found here, but if you, like me prefer pictures to words, have a look at
this and perhaps this too.
Tracking and tracing those who
test positive for Covid19 is of course, a ‘must do’ initiative in bringing the
rate of infection under control. South Korea, Singapore, New Zealand, and parts
of India have provided indisputable proof that this approach can have a massive
impact on reducing the number of people who could unknowingly be the source of
spreading the virus.
Will it work in the UK as well as
it has done in these other countries? Two weeks ago, I would have answered with
a resounding yes. Now with the Barnard Castle factor, I’m not so sure. And
although I try hard not to do politics here, I just have to say that I, like so
many others, am both angry and disappointed that Dominic Cummings chose to do
what he did in the face of all those who made significant sacrifices in order to
obey the rules. With hindsight, I perhaps should not have expected anything
different from this man. He is part owner of the farm he went to in Durham. It’s
a farm that has received over £235,000 in EU grants, despite Cummings being a decrier
of the EU and being the major architect in developing Boris Johnson’s Brexit
strategy. Hypocrisy doesn’t even begin to describe my feelings.
Anyway, now I have vented my spleen,
back to the track and trace UK initiative. I sincerely hope that people do sign
up for the app, and if contacted, do self-isolate and their families too. One
of the major motivators that eventually led to the HIV epidemic being
controlled was people seeing how easy the virus could be spread through
engaging in everyday activities, including very loving and caring activities,
and then seeing so many people succumb to AIDs and dying. Condom use, which at
first was largely rejected, over time became the new normal. Nowadays, those
people who can prove their adherence (that’s a good word – it’s a bit like
authenticity) to antiretroviral treatment and who have an undetectable viral
load, are affirmed as people unable to pass the HIV virus on. Hence the Undetectable = Untransmittable U=U
notion. It’s an approach that’s based upon robust scientific evidence (we may
have heard that before somewhere). If you cannot detect the virus in someone who
previously tested positive for HIV, then they cannot transmit the virus to
others.
We are still in the frontiers of
understanding Covid19. We have a new antibody test, which will tell you if you
have had Covid19 before. It won’t reassure you that you won’t get it again. There
is not enough evidence yet to predict whether that might be the case. It also
means we should not ignore social distancing measures. Even as the lockdown
measures get scaled back, it still remains an imperative that if you don’t have
to leave your home for work (or birthday celebrations), then stay at home, stay
alert when out taking your daily exercise or shopping and if you get contacted by
one of the 25,000 tracing folk, just be polite to them on the phone. They are
back in employment and that has to be a good thing!
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