Text produced by William Meneses, graduating in journalism at IDP.

“It all depends on your ability to take the sourest lemon and make lemonade,” said Dr. Nathan Katowski. The dialogue makes up a scene from the series This Is Us in which a doctor who works with HIV/Aids patients talks to a distressed father. You don't even need to have watched it to understand what it means.

Basically, it's about being able to face a big problem in front of you, face it and overcome it. It is necessary to go through this process when you discover that you are a carrier of the HIV virus, which causes AIDS. Raimundo Nonato Lima is an example of overcoming in this case. The diagnosis came at what he considers to be the peak of his personal and professional life.

“At 43 I discovered it. It was a very critical moment because I was at the peak of my career, of my entire life. I was unwell for a long time, but I'm really well now. For this, I am very grateful every day”, recalled Raimundo, currently 61 years old.

Nonato is a psychologist and sociologist trained at the University of Brasília (UnB), a community therapist and is retired. Born in Maranhão, he moved to Brasília in 1980. Out of curiosity, it was precisely during this period of his move that the AIDS epidemic was discovered around the world. The disease, at the time, was full of ignorance, paradigms and a lot of prejudice. To overcome the impact of the diagnosis, Raimundo counted on the support of his family, especially his wife, friends and doctor. 

For doctor in psychology Eliane Maria Fleury Seidl, coordinator of the extension project “Coexistence and Integrated Actions for Study and Care for People with HIV and Aids and Their Families”, at the UnB Psychology Institute, this type of support that Nonato received is great importance. But she highlights that the reaction of each diagnosed patient is unique. 

“Seropositivity, unlike other chronic conditions, has the issue of not telling, not revealing, so people often choose to postpone this moment. This is very much the issue of stigma, so when people feel they need to tell, when the diagnosis is revealed, the way to help without being invasive is to be respectful, with great sensitivity”, he explains. 

The psychologist warns that the support network often ends up causing discomfort to the patient, if it is invasive. “It is as if social support doubts how much the person can manage their treatment, autonomously, independently, with self-care”, he pointed out.

HIV is not synonymous with AIDS 

The Human Immunodeficiency Virus (HIV) is completing 40 years since its first diagnosis. It is important to highlight that not everyone who has HIV (the virus) has AIDS (the disease). It's exactly the opposite. With advances in science over the years, ways have been created to prevent HIV-positive people from reaching the stage of the disease, even making the virus almost imperceptible. Formally, this person who carries a low viral load is called undetectable. 

There are two forms of treatment to reach this level: one to prevent the individual from becoming infected (PrEP) and another to treat the problem (PEP). Prevention, called Combined, opens up a range of possibilities, precisely so that people can find each other and engage in the most convenient behaviors and strategies. PEP, Post-Exposure Prophylaxis, is for people who have been exposed to the virus and who take intervention to protect themselves from infection. PrEP, Pre-Exposure Prophylaxis, is for those who want to be protected from becoming infected before having sexual intercourse. Strategy used by those who have a partner with HIV or have ended up having unprotected sex. 

Infection is not 'simple'⠀⠀

⠀⠀⠀⠀⠀

For a long time, it was believed that transmission occurred easily, like simply sharing cutlery, for example. It is now known that not even kissing is capable of passing the disease from one person to another. The ways in which transmission occurs are through blood transfusion, sharing of infected syringes, non-sterilized piercing objects, pregnancy, childbirth, breastfeeding and sexual intercourse, the latter being the most common.

HIV is a microorganism that promotes a reduction in the body's defenses, acting cautiously, progressively weakening it, which results in greater ease of acquiring diseases. Therefore, the virus 'opens the door' for other types of diseases to take hold. Therefore, AIDS leaves HIV-positive people in profound fragility.

Using a condom during sexual intercourse is a good way to try to avoid transmission, which in other cases can be done through routine tests to find out whether or not you have the virus or if you are simply at a stage of high risk of passing to another person. This includes PrEP and PEP. For pregnant women, it is important to know whether you are HIV positive or not so that you can take measures to reduce the chance that your baby will also carry the virus.

Result is not immediate

Assuming you have been exposed to the virus, getting tested right away will not reveal a result. This is what is called the 'serological window'. The time between exposure and infection, and the time in which the test becomes positive is due to the body's ability to mount an immunological response and produce antibodies detectable in the test. Currently, this window can be 22 days. A few years ago, it took at least 3 months for the virus to be installed in the body for detection. 

Even with all the advances in exams, there are still 'false negatives'. At the current stage, the exam effectiveness rate is 99.8%. With appropriate treatment, the viral load can decrease to the point that the viruses do not even appear in control tests. This is the case of Raimundo Nonato, for example.

Life that goes on ⠀

Dr. Eliane emphasizes that many HIV-positive people, once their viral load is reduced, do not need to change their life plans. “There is the possibility of having children without transmitting HIV, which makes aspects of motherhood and fatherhood very hopeful and calm. The possibility that life projects will be maintained and that the person will be able to live well, with physical and mental health. Medicines with a very small number of tablets, most therapeutic regimens are one or two tablets a day, with a reduction in side effects, so there is a lot of progress”, said the professor.

Raimundo himself managed, with all the support he received, to move forward despite the virus. Particularly well resolved, it can be said that he doesn't distance himself when speaking professionally: “In the job market I didn't have much difficulty because I already had a job and all of this was easier to overcome. Today, even though I’m retired, I continue working”, revealed the psychologist. Raimundo's regularity of exams, however, is a little higher than average. “I have medical follow-up every 6 months, I take exams to see how my health is going.”

Nonato and many other Brazilians benefit from advances in medicine regarding HIV and AIDS, which is still on the way to finding a definitive cure. Speaking specifically about Brazil, Eliane Maria recalled that the Brazilian system, historically, is copied by several countries. “Free universal treatment, anyone living in Brazilian territory, even being a foreigner, being here, can have the right to medication and treatment for free. There is no shortage of medicine. We also have a good, solid network, of course better in the capitals or larger cities, but we do”, analyzed the doctor. The DF, for example, has eight health units specialized in HIV treatment. 

Reduction

According to the Department of Chronic Diseases and Sexually Transmitted Infections, of the Ministry of Health, in December 2020, Brazil recorded a large drop in the number of AIDS infections in recent years, as shown in the graph below.

Link to the graphic: https://app.flourish.studio/visualisation/7944620/

⠀⠀⠀⠀⠀⠀⠀⠀⠀