Barbados has scored a small victory in the fight against HIV and AIDS. Local researchers have made a groundbreaking discovery – HIV positive people who go on anti-retroviral therapy (ART) on the island, have been showing a suppressed viral load, which means that they have little or no virus in their bodies. To put it simply, says Melissa Rollock, they are non-infectious.
This phenomenon was documented by Professor of Vascular Research at the University of the West Indies (UWI) Cave Hill campus, Clive Landis, and head of the National HIV/AIDS programme, Dr Anton Best, in a body of research entitled: “Ten-Year Trends in Community HIV Viral Load in Barbados: Implications for Treatment as Prevention.” [. . .] The research tried to ascertain what proportion of the HIV – infected population which is about 1.2 per cent of the adults in Barbados – had a suppressed viral load. They discovered that 26 per cent of persons on ART had a completely suppressed viral load.
According to Professor Landis, the significance of this is two-fold. “It is important to the patient because as you know, if your treatment is effective and you stay on your treatment the death sentence is gone. But what has also been appreciated…is that there is a public health benefit, because if you have suppressed viral load, in essence you are non-infectious. That is quite a strong statement to make but it is entirely accurate. If you have suppressed viral load you cannot transmit the virus,” he emphasised. The Professor also believes that viral suppression is much better than what the current statistics indicate. This is where he dropped another bombshell – health authorities have also discovered that quite an unusually and surprisingly large number of Barbadians who are not on ART also have a suppressed viral load.
“We have done some research with Oxford University and it appears that we have inherited a fortuitous set of HLA (Human Leukocyte Antigen) genes which actually render the virus somewhat unfit so we have a little bit of natural immunity here in Barbados and when you come onto the ARTs we [reduce the virus even further],” he said.
The research shows that within months of going on ART, the suppression rate is rapid but it will only work if the individual is on therapy all of the time. However, stigma and discrimination still hinder a lot of HIV-infected persons from accessing treatment.
“The treatment, and I mean state-of-the art treatment, is available here and it has benefits all round; to the patient [and] to the public. But a lot of patients do not access this treatment because they are still deathly scared of the discrimination they face coming to the clinic. They are worried about the healthcare profession and how confidential their information is – that stigma is still enormous. When we did our analysis on the proportion of the whole population that had suppressed viral load, once the person has registered in our programme we outperform. The only other country that has reported this is the [United States] but, unfortunately, only a small proportion of our known HIV-infected persons ever come for treatment. We must overcome the fear in our society and the stigma that is exerted on persons with HIV because we can now treat this and people need to come forward,” Professor Landis said.
[. . .] Anti-retroviral therapy – a triple therapy – has been available since 2002 and once patients adhere to the strict regimen, they can return to all normal function and have the same life expectancy as someone who is uninfected. [. . .] He sees Barbados moving towards a “test and treat” system where when a person tests positive for HIV, they go on therapy sooner.