On the Today show Tuesday, Charlie Sheen announced that he's been HIV positive for the past four years. He said he decided to go public with the news after being blackmailed and paying out millions in hush money.
Sheen's "coming out" prompted some criticism from observers who felt that his decision to hide his health status for so long brought us back to the early, stigma-filled days of HIV/AIDS in the 1980s.
But the actor deserves a lot of credit for his announcement. Unlike many celebrity discussions of health, which usually involve wildly inaccurate claims and medical misinformation, the former Two and a Half Men star was remarkably responsible in how he discussed the issue.
In fact, the announcement today may be the most responsible thing Sheen — known for public outbursts and bizarre meltdowns — has done in years.
Most importantly, he brought his doctor, Robert Huizenga, on the air to explain some of the nuances of his condition. This was a deft move, because even if Sheen himself wasn't completely clear on a few medical questions, the doctor was able to describe, in simple language, what was going on.
Sheen's doctor cleared up a lot of misconceptions about HIV
Huizenga, an associate professor of clinical medicine at the University of California Los Angeles's School of Medicine, explained that just because Sheen has the HIV virus doesn't necessarily mean he also has AIDS.
"AIDS is a condition when the HIV virus markedly suppresses the immune system and you're susceptible to rare, difficult cancers and infections," Huizenga said. "Charlie has none of those. He is healthy."
This may seem obvious to some, but it's a distinction that many people still get confused by (even some media outlets reporting the story, Today co-host Matt Lauer noted). The doctor did a good job of explaining the difference between the virus and the condition it can cause.
The HIV virus can be suppressed — but not cured — with medications
Huizenga also elaborated on another underappreciated fact about HIV: Effective treatment can reduce the amount of virus in the blood to nearly undetectable levels.
These medications don't cure people, but they do control the virus so that it is no longer powerful enough to attack the immune system. As Huizenga said:
Charlie has contracted the HIV virus. He was immediately put on treatment—strong antiviral drugs, which have suppressed the virus. Unfortunately, we don't have a cure yet. It's suppressed the virus to the point that he is absolutely healthy from that vantage, and my biggest concern with Charlie as a patient is substance abuse and depression from the disease, more than what the HIV virus can do in terms of shortening his life because it's not going to.
This jibes with the experience of many doctors treating HIV patients today. Effective medications mean that HIV is more a chronic disease than a death sentence. People have to keep taking medication, but they can otherwise live normal lives. Doctors treating HIV patients can focus on managing other health issues, such as the depression and substance use Huizenga referred to.
It's unlikely Sheen will transmit the virus — but it's not impossible
Notably, the doctor also corrected Sheen on one important point.
The actor had told the Today show that it's "impossible" for him to pass on the virus to others. But Huizenga clarified this point, saying that "individuals who are optimally treated, who have undetectable viral loads, who responsibly use protection" have a very small risk of transmitting the virus. "We can't say it's zero, but it's a very, very low number."
Again, that's because the medications bring people's "viral load" (the levels of HIV in the blood) down to the point where it's much harder to pass on. That reduces the risk that an HIV-positive person will pass on the virus by 96 percent, according to government data.
Still, the risk of transmission isn't zero, and people should be aware of that.
For instance, the risk of transmission can obviously go up if the patient forgets to take his or her medications. Matt Lauer noted that Sheen has admitted to drug abuse in the past — so what happens if his behavior causes him to fail to take his medication?
Huizenga agreed that this was a real concern. Again, because antiretroviral medications aren't a cure, HIV never goes away. If a patient isn't religious about taking his daily pills, HIV levels can rise. "We're so, so anxious that if he was overly depressed, if he was abusing substance, he would forget these pills," the doctor said. "That's been an incredible worry."
Huizenga and Sheen deserve credit for discussing this — it's a real issue with HIV-positive patients and something that deserves more awareness. Fortunately for Sheen, he said he has never missed taking his medications, and Huizenga confirmed that the actor's consistent blood tests confirm that. "Magically, somehow in the midst of incredible personal mayhem, he's managed to continue to take these medications," Huizenga said.
In the end, viewers of the Today show got a balanced and accurate view of what it's like to live with HIV. In an age of health misinformation and irresponsible celebrity health advice, that's a big deal.