Ask The Expert: An Interview with HIV Specialist Mark Bloch

Dr Mark Bloch has been working in the field of HIV medicine since 1983 and is now the director of Clinical Research at Holdsworth House in Sydney. We asked Dr Bloch some questions about HIV to gain a deeper insight into his thoughts and experience with HIV-positive patients. 

Dr Bloch has a particular interest in HIV medicine and STIs, and is actively involved in research surrounding HIV and STIs. He previously worked at Albion St AIDS Clinic and Sydney Hospital, and is currently Conjoint Associate Professor of Medicine at the Kirby Institute, University of New South Wales. Dr Bloch completed his medical degree at the University of Western Australia and Master of Medicine in HIV and Sexual Health at the University of Sydney.

We spoke to Dr Bloch to ask him some interesting questions about HIV.

Q: What kind of reaction do you usually see from those who test positive for HIV?

“Everyone is different, but for most people, the news when they find out that they are positive for HIV is a shock and difficult to fully absorb at first. It can take time to adjust to the diagnosis. There can be a number of emotions: anger towards whoever may have transmitted the virus to them, feelings of shame and fears about current and future health. Many people are not fully aware that HIV is a very manageable condition that can be very well controlled on treatment. With treatment, the virus can be suppressed – a person with HIV can live pretty much a normal lifespan and won’t pass HIV onto others.”

Q: What are the main concerns voiced by those who test positive for HIV?

“The main concerns voiced by those who test positive are firstly, could they have put anyone else at risk and transmitted HIV to others? How could they have acquired HIV? Additionally, there are concerns about how having HIV will affect them in the long-term. Will they become unwell? Are they more susceptible to other conditions? What is the treatment for HIV and when is it best to start this? Finally, there is the issue of disclosure – who should they tell and when?”

Q: What support do HIV-positive patients usually require after finding out their diagnosis?

“HIV-positive patients require medical support after finding out their diagnosis – factual information about their condition. They will need additional testing to confirm the diagnosis and find out their viral load (how much virus is circulating in the body) and CD4 count (the condition of the immune system that fights infection). HIV-positive patients may also require support to come to terms with their diagnosis and this may include counselling support. The opportunity to discuss their diagnosis with others who have HIV and can understand their issues may also be helpful.”

Q: Do you feel there remains a stigma around HIV?

“As HIV has become a treatable and manageable condition, some of the stigma around HIV has reduced. However, in many parts of the world and amongst many communities, HIV continues to carry a large degree of stigma. This is often based on ignorance, as well as prejudice against the types of behaviour that can lead to becoming infected with HIV.”

Q: When should HIV treatment start and what does it involve?

“Research has shown that the sooner treatment is started after a person is diagnosed, the better their outcome. Early treatment helps the health of someone with HIV. Also, when the virus is suppressed by treatment, it prevents transmission of HIV to others. Medications used to treat HIV are called antivirals or antiretrovirals. They stop the HIV virus from multiplying in the body and prevent the damage that the infection can cause.”

“The treatments involve a combination of medication – this helps prevent the virus becoming resistant to the treatment. In most cases, the treatment can be combined into a single pill, taken once daily. HIV treatment must be taken every day indefinitely to control the HIV infection. In the future, there will be longer acting treatments in pills or injections that only need to be taken every few months. Research is also looking at finding a cure for HIV – this may be an option one day.”

Q: Can HIV treatment cause any side effects?

“People react differently to medications, but on the whole the currently available treatments for HIV are simple, highly effective and very well tolerated. The side effects from treatment, if they occur at all, tend to be minor. There are different treatment options available, so if one treatment isn’t tolerated, others are possible. The side effects of having untreated HIV infection are much, much greater than any side effects from the treatments for HIV.”

Q: Is taking HIV treatment enough to protect long-term health, or must day-to-day lifestyle changes be made?

“Taking HIV treatment makes a huge difference and helps to protect long-term health. Day-to-day lifestyle changes will improve overall health and reduce the risks of other conditions such as diabetes or heart disease – these other conditions can compound the effects of HIV. Sometimes the diagnosis of HIV can be a wake-up call for a person and help motivate them to change risk-taking behaviour, turn their life around, focus on what is really important in their lives, and concentrate on their health.”

Q: What would you say to somebody who can’t decide whether or not to get tested for HIV?

“HIV testing is a personal decision. I would encourage people to get tested, because the test will reveal the reality of a person’s situation. If the test is negative, that can relieve concern; if the test is positive, then there are very effective treatments that will make a big difference to a person’s outcome and also enable them to avoid transmitting HIV to others.”