HIV/AIDS: the forgotten pandemic?

HIV continues to be a major public health concern, and now the Covid-19 pandemic could prevent people recognising that they have the virus and disrupt vital services. Ahead of World Aids Day on 1 December, we talk to a campaigner about the ongoing risks for seafarers of not getting tested and how living with HIV should be a 'non-issue'.

Fears that the global Covid-19 pandemic could be masking another hidden maritime health disaster has been raised by campaigners ahead of World AIDS Day on December 1.

Between 70% and 90% of people experience symptoms soon after HIV infection, but few know these symptoms are HIV related. People who are infected with HIV can initially suffer flu-like symptoms such as nausea, vomiting, night sweats and swollen glands, alongside other common symptoms like sore throat, rash and fever. Campaigners are worried that seafarers may assume they have Covid and fail to test for other common infections including HIV.

'Very often HIV only makes somebody feel unwell once, with a mystery flu-like illness that doesn't quite fit anything ever felt before,' Matthew O'Crowley, an ex-seafarer and HIV campaigner, explains. 'Some people may believe that they had a bout of Covid but were actually sero-converting.'

Sero-converting is the process during which an antibody develops and becomes detectable in the blood. After sero-conversion has occurred, the antibodies can be detected in blood tests for the disease.

Mr O'Crowley urges all seafarers who have experienced a mystery illness to go and check their HIV status – 'even if they have had a negative Covid test (or no test at all).

'It will more than likely be fine, but best to be safe,' he says.

Mobile population

Seafarers are advised to be aware of their health since the global nature of the maritime industry may make them vulnerable to HIV infection and expose them to greater risk in some overseas countries than is the general case in the Western world.

The increased risk that seafarers face also makes their families and home communities more vulnerable to HIV and other sexually transmitted infections (STIs).

Different international rules on medications that can be taken as Pre-Exposure Prophylaxis (PrEP) to prevent HIV may also discourage those seafarers who use PrEP from continuing their regime while away from home.

Seafarers are a highly mobile population who frequent shore-based medical and information services infrequently, and who are often prevented from receiving HIV messages through lack of time or ability to understand the local language.

If any person is concerned that they may have come into contact with HIV, they should seek medical advice and treatment as quickly as possible.

Myth busting

A culture of silence can still surround HIV at sea, with many seafarers worried about the reaction from crew mates, employers and officials alike.

There is no risk to fellow workers or the general public from normal social and work contact with an employee who is infected with HIV. Where first-aid treatment is required, standard precautions taken to reduce the risk of other infections are equally effective against HIV infection.

Employees who contract HIV are perfectly capable of working normally, subject to periodic medical review as clinically indicated. A seafarer living with HIV who displays no reasonably foreseeable risk of disease progression from side-effects of treatment, and who has no requirements for frequent surveillance, may be given an unrestricted ENG 1 certificate. Such a seafarer would only be certified as permanently unfit if there were impairing HIV-associated conditions present without scope for improvement.

Mr O'Crowley says that seafarers living with HIV can take anti-retroviral medication that can make the virus non-contagious. But it must be taken continuously – which can cause problems when visiting or transiting countries where anti-retroviral drugs are illegal.

'HIV is such a non-issue, and yet seafarers stop taking their medication to keep their jobs because of "certain countries" and captains,' he says. 'If you take your pill every day, you have a good chance of being undetectable. I hit that mark in less than 30 days.'

Know your rights

This year marks the 10-year anniversary of the first international labour standard on HIV and AIDS in the world of work (adopted at the International Labour Organisation (ILO) Conference in June 2010).

'Recommendation 200', as it is called by ILO, reinforces the ILO Code of Practice on HIV/AIDS in the workplace. The Recommendation contains several principles including the recognition of HIV and AIDS as a workplace issue and non-discrimination or stigmatisation of workers based on real or perceived HIV status.

The Recommendation also states that there should be no mandatory HIV testing or screening for employment purposes and recognises that the response of trade unions, employers and governments to HIV 'contributes to the realisation of human rights, fundamental freedoms and gender equality for all'.

In the UK MSN 1886 (Amendment 1) makes reference to HIV, with the associated Approved Doctor's Manual (July 2020) going into greater detail. MSN 1886 specifically states: 'HIV testing should be a matter for the individual and their clinical advisers and not a condition for obtaining employment.'

Mr O'Crowley says: 'If you do test positive, don't panic – in many cases people will need just one pill a day and the virus will eventually become undetectable; meaning that you cannot pass it on.

'Stigma is still attached to HIV, and a positive diagnosis can feel like embarrassing and like it will be career-ending, but it doesn’t need to be.'

If you do test positive, don't panic – in many cases people will need just one pill a day and the virus will eventually become undetectable; meaning that you cannot pass it on

WHAT IS WORLD AIDS DAY?

World AIDS Day takes place on 1 December each year. It's an opportunity for people worldwide to unite in the fight against HIV, to show support for people living with HIV, and to commemorate those who have died from an AIDS-related illness.

WHY IS WORLD AIDS DAY IMPORTANT?

Globally, there are an estimated 38 million people who have the virus. Despite HIV only being identified in 1984, more than 35 million people have died of HIV or AIDS, making it one of the most destructive pandemics in history.

Today, scientific advances have been made in HIV treatment, there are laws to protect people living with HIV and we understand so much more about the condition. Despite this, each year thousands of people are diagnosed with HIV, people do not know the facts about how to protect themselves and others, and stigma and discrimination remain a reality for many people living with the condition.

World AIDS Day is important because it reminds the public and government that HIV has not gone away – there is still a vital need to raise money, increase awareness, fight prejudice and improve education.

HOW CAN I SUPPORT WORLD AIDS DAY?

World AIDS Day is an opportunity to show solidarity with the millions of people living with HIV worldwide. In the UK most people do this by wearing an HIV awareness red ribbon on the day. You can order a red ribbon through the National Aids Trust online shop.

The World Health Organization will hold several virtual events for World AIDS Day. Its annual report on HIV/AIDS surveillance in Europe, including the number of HIV and AIDS cases in all 53 Member States, will be published just prior to World AIDS Day together with the European Centre for Disease Prevention and Control. A Region-wide social media campaign will be conducted during the week of the event.