Answering basic questions about HIV Sixth Edition
This booklet is for you if you have basic questions about HIV such as what it is, how it is transmitted and how it affects the body. If you have HIV and want to find out more about treatment, side effects and how to live well with HIV, visit www.myhiv.org.uk This leaflet covers: 1. What are HIV and AIDS? 2. How is HIV transmitted? 3. What HIV testing involves 4. How does HIV affect the body? 5. Living with HIV 2
1. What are HIV and AIDS? HIV stands for Human Immunodeficiency Virus. It is a virus which causes your immune system to become weaker. Over time, your immune system will not be able to work properly, and illnesses and infections it would normally fight off will be able to enter your body and take hold more easily. HIV medicines (known as antiretrovirals ) keep HIV under control by blocking it at different points as it tries to reproduce. If you are diagnosed early and start treatment on time, your immune system is less likely to get damaged. AIDS (Acquired Immune Deficiency Syndrome) is a term used to describe the point where your immune system is so badly damaged by HIV that it can no longer protect you from opportunistic infections. These are infections and illnesses (such as certain cancers or tuberculosis) which either take advantage of a damaged immune system to get into your body, or which were lying dormant in your body and are able to activate. HIV can lead to AIDS without early diagnosis and treatment but having HIV does not mean that you have or will develop AIDS. Before treatment was available many people with HIV eventually developed AIDS. But as most people now have access to HIV medicines, fewer people receive an AIDS diagnosis. HIV medicines stop the virus from reproducing at the rate it wants to, so most people who are on treatment can suppress HIV to undetectable levels. This means that you are less likely to get opportunistic infections; because of this the terms late stage or advanced HIV infection are usually used rather than AIDS. 3
2. How is HIV transmitted and how can the risks be reduced? HIV is not an easy virus to pass from one person to another. The virus has to get out of an HIV-infected person s body and into the body (via the bloodstream or mucous membranes) of someone who does not have HIV for that person to become infected. Body fluids which contain enough HIV to infect someone are: semen vaginal fluids, including menstrual fluids anal mucus breast milk blood. Other body fluids like saliva, tears, sweat, urine or faeces do not contain enough HIV to infect another person. The following pages list the ways that HIV can be passed from one person to another, and information about how the risk can be reduced. It s important to remember that at least one of the people has to have HIV for there to be any risk of infection. Semen, seminal fluid, 'pre cum', anal mucus and vaginal fluid HIV can be passed on during vaginal, anal and less commonly, oral sex. It is found in high quantities in the semen, vaginal fluid and anal mucus. HIV can also be present in pre cum (the fluid which leaks from a man s penis when he is aroused). Reducing the risk Unprotected vaginal or anal sex are the main ways HIV is passed on. The best way to reduce the risk of HIV being transmitted is to use a condom properly with water- or silicone-based lubricant, if needed. Make sure you put the condom on fully before penetration and check it stays on the penis. Relying on the man to withdraw before ejaculation is not an effective way of preventing HIV transmission. Female condoms are also available - these are used instead of a male condom. 4
Anal and vaginal sex are the most common ways HIV is passed from someone with HIV to another person. There is a low risk of HIV transmission from oral sex but there have been some cases of HIV being passed on when someone who doesn t have HIV gives oral sex to an HIV positive man. This relatively small risk can be reduced by using condoms for oral sex - you may find flavoured condoms more pleasant. If you and your partner choose not to use condoms for oral sex, it is safer to avoid: Ejaculating into someone s mouth if you are HIV positive. Giving a woman with HIV oral sex during her period. Giving someone with HIV oral sex if you have cuts, ulcers or sores in your mouth (or if they have them on their genitals) or if you have had recent dental work. Brushing your teeth before giving someone oral sex. Giving someone with HIV oral sex if you have a sore throat. HIV is not usually passed on when: A man or woman who does not have HIV receives oral sex from someone who is HIV positive. Mother to baby (vertical transmission) If a woman with HIV becomes pregnant there is a risk that without interventions her baby could be born with HIV. This can happen in the womb, during birth or through breastfeeding. Reducing the risk In the UK all pregnant women are offered an HIV test. With careful planning, most babies born to mothers with HIV have less than a 1 per cent chance of acquiring the virus. This involves the mother-to-be taking HIV medicines at certain points during her pregnancy and possibly having a Caesarean birth if she has high levels of HIV in her body. Her baby will be given HIV medicines for four weeks after birth. It is important that a mother with HIV doesn t breastfeed. 5
Blood to blood Bleeding on its own is not enough to pass on HIV as the blood of someone with HIV has to leave their body and get into the bloodstream of an uninfected person. In the UK all blood products have been screened for HIV since 1985, after a number of people with haemophilia were infected with HIV through blood transfusions with infected blood products. Blood can also be passed from person to person through sharing needles. Reducing the risk If you inject drugs such as heroin or steroids, always use fresh needles and never share drug-taking equipment. You can get clean equipment from needle exchanges. HIV is not passed on from one person to another through: Hugging, kissing, cuddling or casual contact. Sharing crockery or cutlery. Sharing a household, bathroom or toilet. Post-exposure prophylaxis (PEP) Post-exposure prophylaxis (PEP) is a course of HIV medicine which may stop someone becoming HIV positive after HIV has entered their body. You need to start it as soon as possible after exposure immediately or up to 24 hours later is best, but it can be taken up to 72 hours later. PEP is available from your sexual health clinic or your local hospital Accident and Emergency (A&E) department. For up-to-date information visit: www.tht.org.uk/pep 6
3. What HIV testing involves HIV tests find out whether someone has HIV by looking for antibodies. These are produced by your body to try to fight off HIV. The time between becoming infected with HIV and it being detectable in a test is called the window period. This window period can be up to three months. However, if you have had a risk for HIV, whenever it was, it is advisable to go for an HIV test. The clinician will advise you whether you need to come back for a follow-up test. Some HIV tests are called rapid HIV tests and you get your results 60 seconds to 20 minutes later. These tests are carried out by pricking your finger or taking a swab from your mouth. Other tests involve giving a blood sample which is sent off to a lab. You usually get your results 48 hours to two weeks later. A positive result If the test finds antibodies to HIV, the result is said to be positive which means that you have HIV. If you have a positive result you will need to have a confirmatory test to make sure the result is correct. A positive result does not mean that you have AIDS or that you will become ill. A negative result If your test does not find antibodies and you are not in the window period, the result is negative which means that you do not have HIV. If you are in the window period you may be asked to come back to re-test. 7
4. How does HIV affect the body? HIV uses your CD4 cells to reproduce. These are important cells which co-ordinate your immune system to fight off illnesses and infections. HIV destroys many of your CD4 cells, and as the number declines you may not have enough to keep your immune system working properly. At the same time the amount of HIV in your body (the viral load ) will usually increase. Without treatment your immune system will gradually get weaker, making it easier for opportunistic infections to get into your body and take hold. HIV medicines work by blocking HIV at certain points, making it harder for the virus to use your CD4 cells to reproduce. This reduces the amount of HIV in your body so your viral load should get lower and your CD4 count should increase, making it harder for illnesses and infections to enter your body and take hold. If you have HIV your doctor will regularly measure your CD4 count (the number of CD4 cells in a small blood sample) and your viral load. You will start treatment as soon as you need it, which makes it less likely that HIV will cause damage. How effective are anti-hiv medicines? They are very effective when started on time and taken correctly. HIV medicines stop HIV reproducing so quickly. This means fewer CD4 cells are destroyed and the immune system is better able to protect you. If you are diagnosed early and start treatment on time you can expect to live a near-normal lifespan. A recent change in the law means that anyone in the UK can access HIV medicines for free, regardless of their immigration status. There has never been a better time to test. Is there now a cure for HIV? At present there is no cure for HIV and no vaccine to stop people becoming infected with HIV. 8
Viral load and infectiousness If you have a high viral load it is easier to pass on HIV. If you have undiagnosed HIV you are likely to have high levels of HIV in your blood, sexual fluids and breast milk, making you particularly infectious. However, when you start treatment on time and take it correctly your viral load should be suppressed to the point where it is undetectable. This does not mean there is no HIV present just that the levels are too low for the test to pick up. Also, there may be higher levels of HIV in other body fluids such as semen, vaginal fluids or anal mucus. If you are on HIV treatment, there is an extremely low risk of you passing on HIV through sex as long as your viral load has been undetectable for the past six months, you are on HIV treatment and neither you nor your partner has a sexually transmitted infection (STI). Before you make any decision about not using condoms, get advice from your HIV doctor or nurse. Condoms are still the best way to prevent the spread of HIV and other sexually transmitted infections (STIs). They can also prevent pregnancy. 5. Living with HIV After being diagnosed with HIV most people are able to continue their lives without many alterations they can work, have relationships and have families. Other people s reactions to your HIV diagnosis can vary - from being supportive and accepting through to rejection and hostility. The hardest part of life with HIV for many people is telling others about it, as they are uncertain what their reaction will be. As a result, some HIV positive people choose not to tell many people about their HIV status, which can be isolating. There are support groups around the country where HIV positive people can share experiences and offer each other support. Our website myhiv.org.uk has community forums where you can talk to other people who are living with HIV. For more information about support groups and other services, such as counselling, call. 9
Prosecutions Some people with HIV have been prosecuted for transmitting HIV to their sexual partners - however, prosecutions are very rare. In England and Wales you can be prosecuted for two offences reckless transmission and intentional transmission of HIV. You can be found guilty of reckless transmission if all of the below apply: You had sex with someone who didn t know you had HIV. You knew you had HIV. You understood how HIV could be transmitted. You had sex with someone without a condom. You transmitted HIV to that person. To be charged with intentional transmission it has to be proved that you maliciously and intentionally tried to give the other person HIV. There has never been a successful prosecution for this, although charges have been made and then dropped. The law in Scotland is much the same except that you can also be charged with reckless exposure if HIV transmission hasn t taken place, but you put someone at risk of HIV. For more information visit: www.tht.org.uk/prosecutions 10
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The HIV and sexual health charity for life Website: www.tht.org.uk Registered office: 314-320 Gray s Inn Road, London WC1X 8DP Tel: 020 7812 1600 Email: info@tht.org.uk Terrence Higgins Trust, March 2013. Terrence Higgins Trust is a registered charity in England and Wales (reg no. 288527) and in Scotland (SC039986). Company reg. no. 1778149. A company limited by guarantee. Ref: 1700500. The information in this publication was correct at the time of printing. For the most recent version of this leaflet visit www.tht.org.uk If you have any questions about this resource, or would like information on the evidence used to produce it, please email feedback@tht.org.uk