In this new episode, Portuguese tennis player Frederico Gil is accompanied by Dr. António Diniz, Coordinator of the Immunodeficiency Unit at Centro Hospitalar Lisboa Norte, to look at the history of triumphs of Arthur Ashe, the American tennis player, and imagine: what other roles he would have assumed in tennis and activism if I hadn't died prematurely from AIDS?
An athlete and an icon
Arthur Ashe's death from complications from HIV infection is especially strong due to the role he played in his communities – that of tennis and the African American community.
“His sporting achievements were incredible, especially for an African-American in the 60s, and playing tennis – a traditionally elitist sport”, begins by explaining Frederico Gil. Despite the obstacles, Ashe had a tennis career filled with unique achievements: in 1968 he became the first African American to win the US Open and, in 1975, the Wimbledon tournament.
Alongside his exemplary tennis career, Arthur Ashe was essentially a man of causes. In his fight against racial segregation and civil rights, which has accompanied him since his first title, he was vocal about the end of Apartheid. Later, after the heart attack that reformed him, he became part of the American Heart Association, and, after his diagnosis with HIV / AIDS, he created the Arthur Ashe Foundation to Defeat AIDS.
One transfusion in a million
In September 1988, Arthur Ashe was hospitalized after paralysis in his right arm which, after a series of tests, was found to be toxoplasmosis, a disease typically found in people infected with HIV. After confirming that the tennis player was HIV-positive, doctors were able to understand the source of the contamination: a blood transfusion made during his second coronary bypass surgery in 1983.
"We must remember the following: we were in 1983", explains António Diniz.
The first cases of HIV infection followed in the USA in 1981. At this time, scientific efforts were focused on identifying the virus, understanding the disease and characterizing the risk of infection in various parameters. Despite evidence that infection is transmitted through blood and sexual contact, the risk of infection through transfusions was estimated to be low – "one transfusion in a million" – so blood safety policies were unchanged until 1983 .
The HIV / AIDS virus was isolated in 1983, simultaneously in France and the USA, which allowed part of the research to focus on the biological aspects of disease transmission and responses in the human body. Thus, during 1984, several companies began to develop a test to detect antibodies produced in response to the virus, and thus indicate exposure to HIV.
The first test, known as an enzyme-linked immunosorbent assay, or ELISA, was approved for use in March 1985. This test was able to detect between 96-98% of infected blood samples. However, due to their high sensitivity, false positives were common. For this reason, a second test was created, called Western Blot, which, although more expensive, was able to refute or confirm the false positives of the ELISA test.
None of the tests made it possible to detect the virus in the first 6 to 8 weeks of infection – the time it takes for the first evidence of antibodies to appear in the donor's blood.
Although 142 Americans contracting HIV / AIDS through blood donations are only a fraction of the total 9,600 cases of infection in the United States, the fear of contaminated blood was high. For this reason, the test was implemented in blood donation centers in April 1985 and, in July of the same year, the available blood bank declared completely free of HIV / AIDS.
"If Arthur had had an operation 4 or 5 years later, the laboratory screening of blood available for transfusion in the USA would undoubtedly be done," concluded António Diniz.
Since the implementation of the initial ELISA test, new and more sensitive tests have been implemented, as they allow to reduce the time window for virus identification. Thanks to the global use of these tests, the current risk of contracting HIV infection through a blood transfusion is estimated to be less than 1 in 420,000.
A personal decision
Although Arthur initially decided to keep his diagnosis a secret, everything changed in 1992, when the American newspaper USA Today reported his illness, forcing him to go public.
"A person revealing or not revealing that he is HIV positive is a right that the person has, and he will only do it if he feels comfortable with it", says António Diniz.
According to Portuguese law, an HIV-positive person has no legal obligation to disclose his status. Portuguese laws provide HIV-positive people with a legal framework to protect their privacy and protect themselves in the event of discrimination.
However, studies show that people who have revealed their positive HIV status to family and friends respond better to treatment. Having emotional support and the support of loved ones is essential to deal with the feelings and emotions of the diagnosis. They can also be a fundamental support in seeking and adhering to treatment.
“It can help itself, but it can also help fight discrimination. If everyone admitted that they are HIV positive, it is certain that discrimination and stigma would start to fade, ”explains António.
“What Arthur Ashe did was take a stand. In practice, Arthur, what he did was to follow his life line. Arthur's life was a life of causes, the racial cause in America, the racial cause in South Africa, and now the cause of HIV ”, concludes the doctor.
Undetectable = Non-transferable
Arthur Ashe ended up dying from complications caused by the HIV virus in 1993. HIV positive a decade ago, he considered himself a long-term survivor of the infection, and about 10 years would be the expected life for a diagnosed person.
However, the introduction of triple retroviral therapy in 1996 would have greatly affected the tennis player's average life expectancy. “He doesn't catch this season… it seems like it's always the wrong time!”, Comments António. Today, the average life expectancy of an HIV / AIDS patient is similar to that of the general population.
“Today, the effectiveness of treatments is enormous, but it has gone further. And the treatment also works to prevent the disease itself. ” António refers to the concept of Undetectable = Non-transferable, a recent discovery in the area of combating HIV / AIDS.
An infected person who is undergoing consistent antiretroviral treatment, when reaching a negative viral load – this means that the virus is not detected in the blood using traditional tools – does not transmit the virus to other people.
In 2011, a study showed that regular use of antiretroviral treatments reduces the risk of infection among couples by more than 96%. This discovery, confirmed by several studies in recent years, was one of the greatest achievements in the fight against HIV / AIDS.
Everything points to that the therapy is the best tool in the fight against the spread of the virus: for each 10% increase in coverage of antiretroviral treatments to infected, there is a drop of 8% in the existence of new diagnoses.
The latest data from 2018 show that 62% of all people globally infected with HIV had access to treatment. Of these, 53% had suppressed viral load.
"This is important for several reasons." concludes António. “First, for the person, then for those who are at ease to know that they do not transmit and also for the people with whom they are also connected. But it has another effect that is just as important: it helps decisively to combat stigma and discrimination. ”
The correct treatment and real prevention of the HIV virus was one of the workhorse of Arthur Ashe, who used his position as a sport hero to fight the HIV / AIDS virus through its foundation. What if he had access to modern therapies? How would this fight have continued?
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