In the country, if someone is infected with the human immunodeficiency virus (HIV), they are immediately called an acquired immunodeficiency syndrome (AIDS) patient. However, the two are entirely different. If treated well, the possibility of transmission is low, and it has long become a chronic disease that is managed for life, like hypertension.
Professor Kim Yeon-jae of the National Medical Center (NMC) noted on the 9th at the NMC in Jung-gu, Seoul, "Individuals infected with HIV face significant stigma in society, making it difficult even to access hospitals." She added, "Understanding that it can be managed like a chronic disease is the first step toward improving their access to treatment and preventing infections."
HIV is a virus that attacks the human immune system and is mainly transmitted through direct contact with the blood or bodily fluids of an infected person. It cannot be contracted through casual contact, such as shaking hands or drinking from a glass mixed with the saliva of an infected person. If the immune system is significantly damaged after infection, it can progress to acquired immunodeficiency syndrome, or AIDS, which can accompany various infectious diseases or cancers and may lead to death in severe cases.
In the past, being HIV positive was regarded as a 'disease of death,' inevitably progressing to AIDS and leading to death. However, the situation has changed. Professor Kim stated, "With the advancement of treatments, the equation of 'HIV=AIDS' has long been broken, and the mortality rate of AIDS patients has significantly decreased; thus, the perception that 'AIDS=a disease of death' is also a misconception."
According to the '2024 HIV/AIDS Reporting Status Yearbook' released by the Korea Disease Control and Prevention Agency, there were 140 new cases of AIDS among domestic individuals last year, accounting for 19.6% of the total HIV/AIDS reporting. This means that the occurrence of HIV infection progressing to AIDS is low.
Nevertheless, there are about 20,000 individuals living with HIV in the country, and this number is on the rise. While new domestic infections have slightly decreased, the influx of foreign individuals has resulted in approximately 1,000 new infections occurring each year.
Professor Kim stated, "As new infections occur at a steady rate and mortality rates decrease, the cumulative number of individuals infected continues to rise," adding, "We need a 'two-track' strategy, which involves managing existing infections as chronic diseases while expanding preventive measures to reduce the number of new infections."
First of all, individuals infected with HIV can manage the disease lifelong by taking antiretroviral drugs daily, similar to patients with hypertension or diabetes. Antiviral medication suppresses the replication of the HIV virus that has invaded the body. Since the introduction of combination therapy using three drug components in 1996, the mortality rate from HIV has significantly decreased.
If the medication is stopped, the virus will replicate again, so it must be taken at the same time every day. In the past, due to drug side effects, patients had to visit hospitals every three months, but recently developed drugs have no side effects, allowing prescriptions to be obtained every six months, Professor Kim stated.
However, because the medication must be taken daily at a designated time, there is a concern about exposure of the infection status to those nearby. Professor Kim mentioned, "There was a case where a colleague of an infected individual searched the drug identification number and shared the HIV infection status internally," stating that "because of this, individuals infected often experience great fear of being exposed to medication."
For this reason, many infected individuals now prefer long-acting injection drugs that are administered six times a year. Currently, research is being conducted abroad to further extend the dosing intervals.
Professor Kim stated, "HIV is now a manageable disease that can continuously suppress the virus through antiviral drugs or long-acting injections," adding, "While it is not yet a complete cure, with consistent management, individuals can expect a lifespan similar to that of non-infected individuals."
It is also important to reduce the number of infected individuals through prevention. "Pre-exposure prophylaxis (PrEP)" is a method where someone who is at risk of contracting HIV takes the medication in advance to prevent infection.
Currently, there is an oral medication that can be taken daily as PrEP available in the country, known to have a preventive effect of up to 99%. Recently, a long-acting preventive injection, administered once every six months, has also been developed.
The government has also actively promoted pre-exposure prophylaxis to reduce the number of new HIV infections. The Korea Disease Control and Prevention Agency prepared the '2nd Basic Plan for the Prevention and Management of Acquired Immunodeficiency Syndrome (2024-2028)' last year, aiming to cut the number of new infections in half by 2030 compared to 2023.
Men who have sexual relations with men or transgender women, as well as partners of individuals living with HIV or those in high-risk professions, can be considered vulnerable populations for HIV infection. If such individuals wish to receive prescriptions for the purpose of preventing new HIV infections, all co-payments for antigen-antibody tests and pre-prescription tests will be free from January of this year until the end of the year. They will also receive support for all costs except for a co-payment of 60,000 won for the medication.
Interested individuals can check the medical institutions that support PrEP on the iSHAP (LGBTQ+ AIDS Prevention Center) website operated by the Korea AIDS Prevention Association.
PrEP is currently actively used in 79 countries worldwide, and places that have already demonstrated the prevention effect of PrEP exist. San Francisco, USA, started in 2012, achieving PrEP coverage of 72% among vulnerable populations; as a result, new HIV infections dropped from 478 cases in 2012 to 157 cases in 2022, a decrease of 67%.
Although HIV has become a chronic disease that can be prevented and managed, the social stigma surrounding individuals living with HIV in the country hinders their opportunities for treatment and prevention. Professor Kim pointed out that there are still instances in the medical community where treatment for infected individuals is refused.
She mentioned, "An infected individual made an appointment for treatment of a general anal condition at a local hospital, but the hospital canceled the appointment after learning of the HIV infection status, forcing the patient to seek treatment at our hospital," stating that "it is unacceptable for there to be instances where treatment is refused due to the misconception that simple contact can lead to transmission."
The National Medical Center (NMC) is a representative medical institution in the country that specializes in treating individuals living with HIV. It has extensive experience in treating individuals infected with HIV and the highest rate of preventive medication. Professor Kim, an infectious disease expert, has been treating HIV infected individuals for the past 20 years. She has been the inaugural center director of the infectious disease hospital currently under construction at the NMC since 2017 and is currently the head of the Infectious Disease Policy Development Team. She has taken the lead in formulating policies to respond to infectious diseases, including HIV.
Professor Kim stated, "While research related to HIV is active worldwide, studies targeting Asians are relatively lacking, and domestic research is especially insufficient." She added, "Participation rates in domestic clinical trials are significantly low due to fear of exposure to HIV infection." She also noted, "At international conferences, discussions on not only academia but also human rights, discrimination, and stigma are active," suggesting, "We need to create a social atmosphere that embraces diversity."