Advanced drug therapies are allowing HIV-positive people to live normal lifespans and reduce threats of transmission to near zero. Why is it taking the general public so long to catch up information-wise?

HIV/Aids has become a hotly debated topic in recent weeks following a controversial claim by an HIV-positive advocate announcing he would teach people how to have unprotected sex safely, which was met with overwhelming backlash. Many media, Facebook pages and medical professionals rushed to clarify the issue and educate the public.

The incident has raised society's awareness on HIV/Aids. At the same time, it also reflects how much -- and how little -- most people know about the subject.

Despite modern medicine allowing people living with HIV a chance at a normal life, HIV/Aids remains largely stigmatised and misunderstood by the public at large.

"People still see those stereotypically grotesque images of patients in pitiful conditions being associated with HIV/Aids. Mostly, they are just old beliefs. This condition is something we can treat now, though not completely cure. It can be made untransmittable, and HIV-positive people can be in a relationship, build a family, and live a long life like others," said professor emeritus Dr Praphan Phanuphak, director of the Thai Red Cross Aids Research Centre.

Current situation

According to UNAids, there are around 480,000 adults and children living with HIV in Thailand today -- 94% of them are aware of their status and 75% are on antiretroviral therapy (ART). The first case of HIV in Thailand was discovered in 1985. At its peak, there were more than 100,000 newly infected people a year. The amount is down to 6,400 people now. Dr Praphan said that number has remained steady for the past few years with relatively no further decrease.

The country launched a national strategy to end the Aids epidemic by 2030, which he said is "statistically possible". "We know where newly infected people get it from. It's either from those who are HIV-positive but are unaware of their own status or those who are not getting the treatment and pass the virus to others through unprotected sex and sharing needles. To cut the cycle, we have to find those who are infected and get them on medication," he said.

ART involves taking daily medicines to reduce the viral load and risk of transmission. The treatment is not difficult, said Prof Praphan, but it's a global challenge to get people to take them in the first place. It's impossible to get people to take medicine if they don't get tested and don't even know they're HIV-positive.

"People often don't want to and don't think they should get tested, or even to believe they could be at risk," he said. "Don't think that you can have unprotected sex with a person who looks clean and pretty and you won't be at risk. That's not it. If you have unprotected sex, get tested."

Who should get tested?

"Everyone," said Dr Praphan matter- of-factly.

Every year, people already get tested for blood sugar level, cholesterol, diabetes and more as part of their annual health check-up. So why not HIV too?

Dr Praphan insists that everyone should take the test at least once in their life, even better at the same time as their sex partner. If both parties test negative, then they don't need to take it again unless one party participates in risky behaviours, such as having unprotected sex with multiple partners. Those at risk should take the test more often.

It should be noted that men who have sex with men and transgender women have higher risks of getting HIV.

"It's hard to pinpoint exactly why that is so. There are many factors to it. However, this doesn't mean gay men are bad or that they all behave the same."

The Thai government allows its citizens free HIV tests twice a year. This, unfortunately, happens to be a largely unknown fact according to Dr Praphan. HIV has four-week window period. The test can be done at any hospital. Once tested, it takes just about one hour to find out the result.

Professor emeritus Dr Praphan Phanuphak, director of the Thai Red Cross Aids Research Centre. Photo: Melalin Mahavongtrakul

Preventive care

Condoms are highly effective at preventing HIV infection, as well as pregnancy and sexually transmitted diseases and infections.

For HIV, other preventive methods include pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). If taken at the right dose, they can prevent HIV almost 100%.

"Is there anything more effective than PrEP at the moment? There is, which is to not have sex at all. Can you do it? You can't. Can you wear a condom every time? Many can't either," said Dr Praphan.

PrEP is taken daily prior to possible exposure. There is also PrEP on Demand for those who only have sex once in a while and can plan ahead. This event-based method has similar efficacy to the daily PrEP but it only works with men, not women.

PEP, on the other hand, is reserved as an emergency means similarly to the morning after pill. It should be taken within 72 hours following potential exposure. This should be taken by everyone after having unprotected sex.

While there have been rumours of HIV/Aids vaccines, Dr Praphan said there is still "a long way away".

U=U and why it matters

Finally, it's not the end of the world if you're found to be HIV-positive.

By adhering to daily ART as prescribed, it can lower the viral load in the body to the point where it's undetectable, which equals to untransmittable. This is known as the U=U concept. HIV-positive people who are able to maintain their viral load to undetectable levels carry no risk of transmitting HIV to their partner through sex.

"It's important to note that U=U isn't telling people not to wear condoms, or to be promiscuous. All it's saying is that, regardless of whether people wear or don't wear condoms, they won't be able to transmit HIV to their partner even if they want to," Dr Praphan said of the much misunderstood point regarding U=U.

"So, it's implied that having sex with known HIV-positive people who are on ART and are undetectable is actually safer than sleeping with just anybody as you could never know if they're infected or if they've been tested at all."

There are many benefits to U=U, added Dr Praphan. It encourages people to get tested, treated and take medicine regularly to attain the undetectable status, which is good for both the infected and their partners. They can also feel more confident to tell their partners of their condition. Most importantly, it reduces stigma around the issue of HIV/Aids.

"U=U normalises HIV as a chronic non-infectious disease, and thus improves the quality of life of HIV-positive people. It also normalises family and sexual life, which are basic rights of all humans.

"For one, they don't need to blame themselves or feel guilty that they could infect the people they love most. Society, too, need not perceive them as scary or dangerous if they're on proper medication, and hence no need to discriminate them from work or getting ordained.

"But this will only work if the public truly understands the U=U concept," he said.

Beyond HIV is the stigma that surrounds it. And while we see improvement with medicine, the same can't be said regarding the level of discrimination experienced by people living with HIV.

"I've been working in this field for 35 years and nothing has changed when it comes to HIV-positive people being discriminated against, especially within the workplace. All they want is an understanding and a chance. They, too, have skills and they belong in our society," said Dr Praphan.