Mar 09, 2008 - 04:05:07 CDT
Every HIV test that turns up positive crosses Rachel Birk's desk at the State Department of Health.She's the HIV Aids surveillance coordinator. The last few years, about 20 to 25 new people were added to the state's statistics each year. About half were diagnosed in another state and moved here.
'It's hard to find a trend with a small number," Birk said. "In 2007, we could see a higher rise in heterosexual contact. It's hard to trend with 20 people. Statistically, it is not significant."
Consistently, the state ranks last in the nation for the number of HIV and AIDS cases. By no means does that mean the disease doesn't happen here.
"It's also a consistently conservative state," Ryan White Program manager Krissie Mayer said, in addition to the state's small population. "Part of what we suspect is the numbers are higher. There is a stigma still."
In the United States, there are an estimated 500,000 unknown cases of HIV or AIDS, Birk said. Nationally, there were 1 million to 1.1 million cases of HIV and AIDS reported in 2003, according to the Centers for Disease Control and Prevention.
Currently, about 167 people with HIV or AIDS live in the state. Since the state started tracking how many residents have HIV and AIDS disagnosis, there have been 413 people diagnosed or living in North Dakota since 1984. The remainder have moved or died. The state tracks who died. There was a high mortality rate the first six years that statistics were kept, then HIV and AIDS patients started living longer because of treatments.
Most of the state's HIV positive cases in 2006 are from men having sex with men. This trend is changing, said Dr. Kent Martin, an infectious disease doctor at Medcenter One. The statistics for 2007, which will be released in April, will reflect a change from mostly infection from men having sex with men to infection through heterosexual sex, Birk said.
The virus that causes AIDS, the human immunodeficiency virus, known as HIV, is transmitted through bodily fluids. It is primarily transmitted through intercourse and used needles.
"You do not get it by coughing or touching or putting your hand all over the skin of someone who has it," Martin said. "The only way to get it is if blood or body secretions get in a cut in the skin."
The virus then replicates in the immune system, attaching itself to a person's genetic code, Martin said. The virus attacks the immune system by killing off the T cells, leaving a person susceptible to other diseases. Martin likens it to a military campaign strategy that kills the generals. If a person's count of T cells is below 200, they are considered to have AIDS.
The spread of HIV can be prevented in two ways.
"Don't be promiscuous, and don't do drugs," Martin said.
For people who do continue those behaviors, he recommends they get tested.
There are 30 testing sites in the state. Last year, the state did 3,000 tests. It is a saliva test, and if it comes back positive, then the person has a blood test for verification. The person who gets a positive test result also is required to learn the law regarding their HIV status and notify their previous sexual partners. North Dakota Century Code 12.1-20-17 requires HIV-positive people to not spread the virus through unprotected sex or needle sharing. It is punishable by up to 20 years in prison and a $10,000 fine if a person knowingly spreads the disease.
The testing sites are free. A primary care physician also can perform the test.
Most people who get the free test pick up the results, and the state has not had an issue with positive results not being picked up.
"If you go to the point to get tested, you want to know," Birk said. "It's the people not getting the test that we worry about."
It takes two weeks to get the test result back from the state lab. The test looks for antibodies in the saliva, which are not the live virus. Kissing someone with HIV or AIDS does not give an uninfected person the virus, Martin said.
People have the opportunity to notify past partners on their own, or the state will help. They also provide education about HIV.
For people who use intravenous drugs, they should always use clean needles instead of sharing needles. To stop the spread of HIV through sex, people should use condoms or get tested every six months. It takes at least six weeks for the virus to show up on a test.
If a person does have HIV, they can choose to go on a drug regimen to stop the virus from replicating . If they do not go on drug treatment, then their immune system continues to weaken and they become susceptible to illnesses most healthy people are able to overcome.
"There's no reason to die of HIV," he said.
The state also runs the Ryan White Program, which helps HIV and AIDS patients cope with the disease. Some of this includes covering expensive medications. On average, medications cost about $2,800 per month. They also provide other health needs, including dental and mental health.
(Reach reporter Sara Kincaid at 250-8251 or sara.kincaid@bismarcktribune.com.)
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