HIV and AIDS

HIV (human immunodeficiency virus) is a virus that can weaken the immune system, making it harder for the body to fight off some infections. HIV is not the same thing as AIDS.

What is AIDS?#

AIDS (acquired immune deficiency syndrome) is the most advanced stage of HIV infection. It is when the immune system is at its weakest and a person develops one or more specific illnesses.

Modern HIV treatments are highly effective. By reducing the damage the virus does to the immune cells it targets, they allow most people living with HIV who are on effective treatment to expect long, healthy lives without ever developing AIDS. Where treatment is widely available, AIDS has become uncommon.

How HIV spreads#

HIV is a blood-borne virus. It is carried in blood and in some body fluids, including semen, vaginal fluids, anal mucus and breastmilk. It can pass from one person to another through:

• unprotected anal or vaginal sex, where condoms or other prevention methods are not used
• sharing needles, syringes or other injecting equipment
• from a parent to a child during pregnancy, childbirth or breastfeeding, which can happen when a person does not know they have HIV or is not on effective treatment
• very rarely, through needle-stick injuries or procedures such as tattooing that use unsterile or reused equipment

Having another sexually transmissible infection (STI) can increase the chance of HIV transmission.

People on treatment who reach and maintain an undetectable viral load cannot transmit HIV sexually. As prevention and treatment have improved, the number of new HIV infections diagnosed each year is falling in many countries.

What does not spread HIV#

HIV is not spread through everyday contact. It is safe to share food and drinks prepared by someone with HIV, even if they are not on treatment. HIV is not passed on by:

• kissing, hugging, massaging, mutual masturbation or other body contact
• ordinary social contact, such as shaking hands
• sharing food, dishes, utensils or drinking glasses
• air or breath, such as coughing or sneezing
• mosquito, insect or animal bites

Preventing HIV#

There are many effective ways to prevent HIV, and it helps to find the method, or combination of methods, that works for you and your partners. Practising safer sex is a shared responsibility and supports a healthy sex life. Ways to prevent HIV include:

• using condoms, ideally with lubricant
• taking HIV treatment to reach and maintain an undetectable viral load (U=U)
• PrEP (pre-exposure prophylaxis) for people who do not have HIV but are at higher risk
• PEP (post-exposure prophylaxis) after a possible exposure
• getting regular sexual health checks
• reducing risks linked to drug use, including injecting and chemsex

Condoms#

For people who do not have HIV, condoms are the simplest way to prevent transmission. Using condoms on penises, or dental dams on vulvas and anuses, reduces the risk of HIV and other STIs. Water- or silicone-based lubricants help reduce the chance of condoms breaking and can also increase pleasure.

Condoms come in a range of sizes, shapes, styles, colours and flavours, so it is worth finding what works for you and your partner. Do not assume a partner will feel confident using condoms, and make sure you know how to use them correctly. Internal (female) condoms are also an excellent option and can be used for vaginal or anal sex. Condoms are widely available from pharmacies, supermarkets and sexual health or family planning clinics.

Undetectable viral load (U=U)#

An undetectable viral load means a person on HIV treatment has reached and maintains very low levels of virus in their body. This is sometimes called treatment as prevention (TasP), and is summed up by the phrase Undetectable = Untransmittable (U=U): people cannot transmit the virus when their viral load is undetectable.

Starting treatment as soon as possible after diagnosis helps the viral load become undetectable faster. For some people this takes a few months, and for others it may take up to 6 months. The threshold used for an undetectable viral load is less than 200 copies/ml. Even if this strict threshold is not reached, treatment still significantly reduces the amount of virus in the body and improves health, though the risk of transmission is lowered rather than eliminated.

It is important to wait until viral suppression is confirmed before having condom-less sex. Your HIV specialist will let you know when the risk of passing HIV to others is zero. Remember that being on treatment with an undetectable viral load does not protect you from other STIs, so if you are having casual sex it is still best to use condoms and lube, and to test regularly.

PrEP#

PrEP (pre-exposure prophylaxis) is an anti-HIV medication taken by people who do not have HIV but are at risk of infection. Taken consistently as prescribed, it is up to 99% effective at preventing HIV. It does not protect against other STIs.

PEP#

PEP (post-exposure prophylaxis) is an anti-HIV medication that can be prescribed after a known or suspected exposure to HIV. It must be started within 72 hours of a possible exposure and taken for 28 days. Reasons to consider PEP include:

• having sex without a condom with someone who has HIV and is not on treatment
• having sex without a condom with someone whose HIV status is uncertain
• sharing needles or other injecting equipment

Reducing risks from drug use and chemsex#

Some people use drugs such as crystal meth, GHB, MDMA, ketamine and cocaine to enhance sex, known as chemsex. This can lower inhibitions and become risky if you inject drugs, have sex without condoms, or forget to take your HIV medications.

If you inject drugs, always use clean, sterile equipment to protect against HIV and other blood-borne viruses such as hepatitis B and hepatitis C. Never share or reuse needles, syringes, spoons, swabs, filters, water or tourniquets. Needle and syringe programs can supply sterile equipment and offer information, safer-injecting advice and referrals.

Methods that are not reliable#

Some people use unreliable strategies to lower their risk, including:

• serosorting, choosing partners based on having the same HIV status
• strategic positioning, where an HIV-negative person is the insertive partner
• withdrawal before ejaculation

None of these reliably prevent transmission. Choosing partners by assumed HIV status is risky, because a person may believe they are HIV-negative when they have been exposed since their last test, or have never tested. Combining proven methods such as condoms, PrEP and an undetectable viral load is the best way to prevent transmission.

Signs and symptoms#

You may not know you have HIV, because not everyone develops symptoms, and early symptoms can resemble other illnesses such as glandular fever or the flu. When they occur, symptoms usually appear 1 to 3 weeks after exposure and can include:

• flu-like symptoms, such as a runny or blocked nose, sore throat, cough and fever
• extreme, constant tiredness
• fevers, chills and night sweats
• rapid weight loss for no known reason and reduced appetite
• swollen lymph glands in the neck, underarm or groin
• a continuous or dry cough
• diarrhea

If you think you have been exposed to HIV or have any of these symptoms, see your doctor.

Getting tested#

Testing for HIV is easy, confidential and available from a doctor or a sexual and reproductive health clinic. It is voluntary and can only be done with your informed consent, except in exceptional circumstances. It is a good idea to have some pre-test counselling, where a doctor, nurse or peer tester can discuss your level of risk and what a result may mean.

How often to test depends on your personal circumstances and how often you have higher-risk experiences. For most people, a full sexual health check at least once a year is sensible, even if you always use condoms, since condoms do not give 100% protection. People at greater risk are usually advised to test more often, such as every 3 months, and the timing may vary with the number of partners. Talk with your doctor or sexual health specialist for advice tailored to you.

Blood tests and the window period#

HIV is detected by testing a sample of blood, either with a standard laboratory blood test or a rapid finger-prick test. There is a short period after exposure during which a test cannot yet detect the virus or its antibodies. This is called the window period and is usually between 2 and 12 weeks, although many modern tests can detect HIV as early as 2 to 4 weeks after infection.

If antibodies or virus are found, you are HIV-positive. If none are found, you are HIV-negative, though a negative result might also mean you are still in the window period, so a follow-up test may be advised if you are unsure.

Rapid and self-tests#

Rapid tests are convenient for people who need to test more often, and can be done by a healthcare provider or with a self-test kit bought from a pharmacy or online. A rapid test uses a drop of blood from a finger prick, with results in about 15 to 20 minutes.

For most people a standard blood test is the more reliable choice. Rapid tests only detect HIV antibodies, which take longer to develop, so they have a longer window period. A laboratory blood test detects both the virus and antibodies. For this reason, a positive rapid test should be confirmed with a blood test.

Getting your results#

Most results are available within a week, and a negative result may come back within a few days. If an initial test is positive for HIV antibodies, further testing, sometimes a second blood test, is needed to confirm the result, which can take up to a week.

Post-test counselling is important whatever the outcome. If you test positive, it can offer emotional support, information about living with HIV and referrals to support services. If you test negative, it can provide education about HIV and how to lower your risk in future.

Your rights and telling partners#

Test results, and even the fact that someone has been tested, are confidential. It is generally unlawful to disclose this information without the person’s permission, and to discriminate against someone because they have HIV.

If you are diagnosed with HIV, it is important to let any sexual or injecting partners know they may have been exposed, as soon as you are able, so they can be tested and offered PEP if appropriate. You do not have to do this alone. A doctor or a partner-notification service can help you through the process while protecting your identity.

Living well with HIV#

A new diagnosis often brings strong emotions, and you should not try to cope alone. Support is available through your doctor and community health organizations, which can offer trained peer workers to help you through the early stages and the longer journey of living well with HIV. A strong support network of partners, doctors, counsellors, peer workers and loved ones can improve mental wellbeing and help you stay on treatment.

People can live well with HIV. Treatments have improved dramatically over time, transforming HIV into a manageable chronic condition, much like high blood pressure or diabetes.

How treatment works#

HIV treatment, known as antiretroviral treatment (ART), uses medications that reduce the amount of virus in the body by stopping it from making copies of itself. Treatment can lower the virus to undetectable levels, which means the person cannot transmit HIV to others. The sooner treatment begins after diagnosis, the better it controls the virus, the lower the risk of HIV-related illness, and the faster a person can reach undetectable levels.

Treatment usually involves several medications that target the virus in different ways, and many can be combined into a single tablet taken once a day. Some people may be suitable for long-acting injectable antiretrovirals given at intervals such as every 8 weeks. Work with your doctor to decide which treatment is best for you.

If medication is not taken as prescribed, the virus can multiply again and become resistant, making the treatment less effective and possibly requiring a change of combination. Stopping treatment, even briefly, can lead to resistance or harm the immune system. Do not change your treatment without talking to your doctor first. There is currently no cure for HIV.

Monitoring and side effects#

If you are on treatment, see your doctor every 3 to 6 months. Regular blood tests check that treatment is working and is not causing serious side effects. It is also wise to test for STIs, discuss your sexual health and overall wellbeing, keep up routine cancer screening and stay up to date with vaccinations. HIV treatments may cause mild side effects, which can include:

• tiredness and fatigue
• nausea and digestive discomfort
• diarrhea
• difficulty sleeping
• headaches
• skin rashes
• weight gain

Contraception#

Some contraceptives that contain hormones may interact with HIV treatment, and other medications can interact with hormonal contraceptives. Make sure any health professional treating you knows about all the medicines you take, including over-the-counter and herbal products. When choosing contraception, consider whether it is compatible with your HIV treatment, how well it suits your lifestyle, how often you would use it, any pregnancy plans, how it protects you and your partners from infection, and its possible side effects.

HIV stigma#

HIV can stir up intense feelings in people regardless of their own status, and it is sometimes wrongly viewed with shame or disgrace. A person with HIV may feel shame or despair, while an HIV-negative person may feel fear or anger. These attitudes are known as stigma.

• Felt (or internalized) stigma is deep shame, self-loathing and the expectation of discrimination. It can seriously harm wellbeing by discouraging people from testing, seeking support or taking treatment, and may even contribute to risky behaviour and new infections.
• Enacted stigma is the experience of being treated unfairly by others, through being treated poorly, rejection, abuse or discrimination. It is especially harmful when it overlaps with other stigmatized factors, such as using drugs or being trans or gender diverse.

Breaking down stigma is a community effort: health services work to be free from stigma and to help people with HIV build resilience, while people are supported to address internalized stigma and get what they need to live well. If you experience stigma or discrimination from a health provider and cannot resolve it with them directly, you can seek help from a relevant complaints or advocacy service.

Key points#

• HIV can be transmitted through unprotected anal or vaginal sex when condoms or other prevention methods are not used.
• Transmission from parent to child can happen when a person does not know they have HIV or is not on effective treatment.
• People on treatment who reach and maintain an undetectable viral load cannot transmit HIV sexually.
• The number of new HIV diagnoses is falling in many countries as prevention and treatment improve.
• It is safe to share food and drinks prepared by someone with HIV, even if they are not on treatment.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).