HIV/AIDS FAQ Thread

[AdmiraalW238]

This is part one of a series that may answer your questions about HIV/AIDS. A further series will be made dealing with STIs.

GENERAL QUESTIONS.

What is HIV?
HIV is a virus which can cause an incurable and life threatening medical condition called AIDS. HIV stands for the Human Immunodeficiency Virus. Over time, this virus attacks the body’s natural defence against diseases (the immune system), which makes a person vulnerable to certain infections and malignancies.

There are two types of HIV. HIV-1 is the main form found around the world.

HIV-2 is found mainly in parts of West Africa.

What is AIDS?
AIDS is a medical diagnosis caused by long term HIV infection. AIDS stands for Acquired Immune Deficiency Syndrome. Someone has AIDS when their immune system has been damaged so badly by HIV that they are unable to fight off a wide range of illnesses that people without an immune related illness, such as HIV, would normally be able to cope with.

It may take years for signs and symptoms of AIDS to occur. Most AIDS defining illnesses can be treated or prevented with medication. With current medications, many people living with HIV/AIDS remain well for many years and do not need hospitalisation.

How does HIV cause illness?
HIV causes illness by damaging the immune system through infecting the immune system’s helper cells. The immune system is the body’s natural defence mechanism against infection. An important part of this system is a group of white blood cells called lymphocytes. Lymphocytes can be further divided into various subgroups which each perform specific tasks. T4 cells, also called CD4 cells, are a type of lymphocyte that recognise anything foreign and activate the immune system to protect the body.

When HIV enters the bloodstream, it infects and destroys these T helper cells. By doing this, it causes a gradual destruction of parts of the immune system. Eventually, the body becomes vulnerable to other infections.

What type of virus is HIV?
HIV is a retrovirus. Most viruses infect cells and reproduce in the main body of the cell simply by inserting their genetic material (DNA) into the cell’s reproductive machinery. However, a retrovirus has a different type of genetic material (RNA), which needs an enzyme called reverse transcriptase to change the RNA to DNA before taking over the cell’s reproductive machinery. This turns the cell into a virus factory, reproducing copies of HIV rather than new, healthy cells.

HIV is also different from most viruses as is specialises in attacking the very cells that are the body’s defence against viruses – the immune system.

Where did HIV originate?
It is generally agreed that Simian Immunodeficiency Virus (SIV) found in African chimpanzees and monkeys became both forms of Human Immunodeficiency Virus (HIV) in humans (HIV-1 and HIV-2), but exactly how and when this occurred is disputed, although the leading theory is that SIV was transferred to hunters who were infected while butchering monkeys for food.

What are the symptoms of becoming HIV positive?
It can be difficult to diagnose HIV infection, as your body’s response to HIV infection is the same as for any other viral infection. There are no specific symptoms that will tell you that you have been infected with HIV and not everyone who is infected with HIV experiences symptoms, some only mild symptoms and only a small number experience severe symptoms.

However, a few weeks following infection with HIV, some people have a severe “flu-like” illness with fever, rash and swollen lymph nodes (the “seroconversion illness”). During this time the virus spreads rapidly through the body. An HIV test preformed at this time may not show up the virus. It can take several weeks or months for the test to become positive – this is called “the window period”.

It is important to note that anxiety and stress can also cause similar symptoms.

The only way to know if you have become infected with HIV or not is to have a specific blood test after allowing for the window period (see Testing section).

If you have been involved in any high risk activities, such as unsafe sex, and have concerns about possible recent HIV infection, you should consult a GP or a sexual health clinic and consider being tested for all STIs too.

What is the incubation period of the virus? (This is not the same as the window period – see the section on Testing.)
This is the period of time it takes from becoming infected with HIV to developing symptoms of disease or illness. This period varies from person to person, but without treatment, the average time period is considered to be around 7-10 years. This period may also vary due to interventions with anti-retroviral medications. During this time there may be no outward evidence of illness, but the virus remains active (replicating and mutating) in the body, can still be detected by a blood test and the person is infectious.

 

[AdmiraalW238]

Part 2

TRANSMISSION AND PREVENTION.
Who is at risk of HIV infection?
HIV does not discriminate against race, social groups, sexuality or on sexual preference. The virus can infect anyone. It is behaviour that puts a person at risk, not the type of person one is or has sex with.
However, because many factors contribute to health, in some countries, people from minority populations have been disproportionately affected.

How do you become infected?
As previously stated, HIV is the virus, which is transmitted, and AIDS is a later stage condition, which may result from HIV infection.
Transfer of blood or sexual fluids from an infected person into another person’s body (usually by injection or sexual intercourse) is the principal mode of transmission. Once outside the body, HIV is fragile and dies quickly in normal circumstances.

HIV is transmitted by three major means:
Blood to Blood transmission

• By sharing injection equipment, e.g. syringes, water, filters etc, which may contain blood from an infected person. Remember the blood may not be visible.
• By having a tattoo or piercing done where the tattoo/piercing equipment is not sterilised.
• By receiving infected blood via a blood transfusion or blood products. Note: In most countries, the blood supply has been tested for HIV antibodies, however, if a donation occurred during the window period, the test may not have detected HIV. To cover this, all blood donors have to sign a declaration, which states that they haven’t put themselves at risk of acquiring HIV. Today more sensitive testing can be done to further reduce the likelihood of this happening.
• A person may be at higher risk if they received a blood transfusion or blood products overseas.

Sexual Transmission
Unprotected sexual intercourse is considered a high risk activity for both partners.
Having vaginal or anal sexual intercourse without a condom, or any other sexual activity where blood, semen, or vaginal fluid from an infected person may pass into the blood stream of another person, can lead to infection. Breaks in the skin caused by eczema, sores, or ulcers, could increase risks by allowing infected semen, blood or vaginal fluid to enter the blood stream. Absorption can also occur through the mucous membranes lining of the female cervical canal, the rectum, the male urethra and under the foreskin.

Parent to Child Transmission
HIV can be transmitted to an unborn child through the placenta during pregnancy, during a natural delivery as the baby comes into contact with infected blood and vaginal secretions in the birth canal and through milk if breast-feeding.

To reduce the possibilities of having a HIV positive child the infected parent should be on HIV anti-retroviral medications with undetectable or very low levels of the HIV virus present in their blood. To prevent infection to the baby during birth, delivery should be by a caesarean section. And to prevent infection to the baby after birth breast feeding should not be done.

The risk of transmission from the infected individuals to the baby increases if in the later stages of HIV/AIDS or if a woman is infected during pregnancy.

Can HIV be transmitted through oral sex?
Oral sex is considered to be a low risk for the transmission of HIV. HIV is not transmitted by saliva (see below “Can you become infected by kissing?”) however having cuts, ulcers, or damage to the mouth and gums may allow infected blood, semen, or vaginal fluid into the bloodstream via the mouth.

There is virtually no risk of acquiring HIV from receiving oral sex as the exposure is only to saliva. However, you should remember that other STIs may be transmitted this way.

How infectious is pre-seminal fluid (pre-cum)?
Pre-seminal fluid has been found to contain HIV in infected persons.
For this reason any penetrative sex without a condom must be considered unsafe. This includes coitus interruptus (withdrawing the penis before ejaculation). Any pre-seminal fluid involved in oral sex would also pose a theoretical risk of infection, however the actual risk would seem to be low. Studies are presently being conducted to measure to levels of HIV virus in semen.

Can you become infected by kissing?
Although HIV has been detected in saliva in some HIV positive people, it is in much lower concentrations than in semen, blood or vaginal fluid and therefore is not considered a risk for transmission of HIV. It is believed that some of the proteins in saliva may partially inactivate HIV.

Can you become infected with HIV through mutual masturbation?
The skin is a very effective barrier that keeps things like blood and sexual fluid, and therefore HIV, out of the bloodstream. It is not possible for HIV to enter the bloodstream via intact skin.

Theoretically, infection with HIV through masturbation could only happen if there are open (meaning bleeding or fresh) cuts or abrasions on the fingers, hands or on the body that come into contact with sexual fluid or blood. There are no documented cases of HIV transmission in which mutual masturbation was the only risk factor.

Can a person become infected with HIV from receiving or giving a massage?
As stated in the previous question, there is no entry point to the blood stream through intact skin. Blood, sexual fluid or vaginal secretions would need to get into the bloodstream. Blood or sexual fluid would need to get into a significant area of skin loss (such as a bleeding wound), which is extremely unlikely from massaging or being massaged.

I have seen a sex worker and am now worried that I may have been exposed to HIV. Can I catch the virus by having sex with a sex worker?
As mentioned, it is not the “type” of person who you have sex with but the behaviour that puts a person at risk. The principles of HIV transmission apply to everyone who you have sex with and the type of sexual behaviour that has occurred.

If safe sex is practised (see “what is safe sex” below), you will not be at risk.

Can other sexually transmitted infections make you more susceptible to HIV?
The presence of other STIs can make it easier for HIV to enter the blood stream during unprotected sex (or in/on the mouth of a person performing oral sex). Having a STI makes it easier to both infect another and become infected with HIV.

Can you get infected at the doctor’s, dentists or by ear piercing, electrolysis, acupuncture or tattooing?
Not if professional infection control guidelines are followed. If you have any procedure, which pierces the skin, ask how equipment is sterilised between clients. All professional service providers are required to follow strict infection control guidelines. If you have any doubts, check that your practitioners use either disposable or sterile equipment for each client, and that they follow infection control procedures.

Can you become infected by pricking yourself on a hypodermic needle by standing on it or otherwise piercing the skin?
The risk of acquiring HIV from a discarded needle and syringe is very low. To date there is no documented cases of this happening. The reasons for this low risk of transmission are:
• The used needle and syringe is usually very small, therefore holding no or very little potential infectious fluid.
• It may be some time since the needle was used, therefore any viral matter present has died.
• There may be no blood in the syringe.
• If there is blood in the syringe, it would have congealed and could not be injected out of the needle.
• The injury from the needle may not be deep.

Other blood borne viruses are more easily transmitted than HIV, such as Hepatitis B and C; even so, there are still only two documented cases of transmission of any of these viruses (one Hepatitis-B and one Hepatitis-C) occurring from discarded needles. Seek medical advice if you are concerned.

If infected blood is spilt, how can the area be disinfected?
Even though skin is a good barrier to HIV infection, it is recommended that you wear gloves to clean up the spill. Use paper towels if possible. Then wash the area with detergent, clean the cloth in the normal way and put gloves and paper towels into a plastic bag for disposal.

Can you get infected by household contact such as kissing or hugging, coughing or sneezing, or by sharing toilet seats, glasses, cutlery, towels, books or other implements?
You cannot become infected with HIV through general social contact. It would be unwise, however, to share razor blades or toothbrushes as blood might be present and able to pass through cuts or breaks in your skin, which may be a risk for other blood-borne diseases.

Can you get infected in swimming pools, spas, hot tubs or saunas?
Chlorine or salt water will destroy the virus. In water, the virus would also be diluted which means there will be no risk of transmission.

How do children get HIV/AIDS?
If the parents are infected, infants can become infected during pregnancy or at birth. Also, the virus can be transmitted through breast milk. Children are not at risk during normal home, school, or playground activities even when HIV infected children are present. Children should be made aware of the risks of contact with blood and should be instructed not to touch or play with discarded needles or syringes. Games such as “blood brothers” are not advised.

In the past (before 1985) children have become infected during transfusions of blood products (such as Factor 8 to treat haemophilia). This is unlikely to occur today as blood banks test all blood donations and heat process some blood products such as Factor 8 to inactivate the virus.

What is “safe sex”?
Safe sex is any sexual practice, which does not allow infected blood, semen, or vaginal or anal secretions to pass into the blood stream of another person.

Wearing a condom during sexual intercourse is the most effective protection. Condom breakage can occur if not used properly. Remember to squeeze the air out of the tip of the condom to leave room for the ejaculate. Always use water-based lubricants (e.g. wet stuff, KY). NEVER use oil based lubricants, (such as moisturisers, baby oil, or Vaseline), since these lubricants weaken the condom's latex and increase risk of breakage. If a condom does break, douching (flushing the area with water) is not advised as this may increase the risk of infection by weakening the lining of the rectum or vagina. Condoms should be stored as recommended and used before the expiry date, which is printed on the wrapper. Store condoms away from direct sunlight preferably in a cool place.

How long does the virus stay active outside the body?
We know that the virus is fragile and cannot survive long outside the human body in normal conditions. An exact time cannot be given as it depends on the environmental conditions, but HIV is extremely sensitive to changes in external temperatures, dilution and drying out.

Can I be infected by a HIV positive person?
Yes, but by specific means only, such as unprotected sexual intercourse or sharing needles with them You cannot become infected by casual social contact, such as: kissing, hugging, sharing food or cutlery/crockery, toilet seats, swimming pools, coughing or sneezing.

Is transmission of HIV by HIV positive people automatic?
There are recorded cases of one partner remaining uninfected despite regular sexual contact. However, the risk of transmission is high without appropriate precautions and avoidance of contact with blood, semen, vaginal or anal secretions is strongly recommended. It is not always clear why sometimes an infection occurs when on other occasions it has not.

Can you tell when people are HIV positive?
Most HIV positive people are healthy. The only way to tell someone has HIV is by a specific blood test. Therefore, if you do not know the status of your sexual partner, it is wise to take precautions and always use condoms.

Are HIV positive people a danger in the workplace?
The virus is mainly transmitted by sexual contact or sharing needles. HIV positive people can work in all professions and do not need to inform their employer. It is unlawful in Australia for an employer to ask an employee their HIV status.
Some people are required to know their status and change their practices if they are HIV positive. This is only for people who in the course of their job perform “exposure prone procedures”, such as specific types of surgery or dentistry. It does not relate to all health care workers. Standard infection control precautions should be in place to prevent contact with blood or body fluids in every workplace regardless of whether employees are known to be HIV positive or not.

Do I report people with HIV/AIDS?
Doctors have the responsibility to make such legal notifications as necessary while maintaining patients' confidentiality. (Legal requirements for doctors to notify health authorities may vary from country to country) However, in Australia, all notifications of a new HIV diagnosis is coded in such a way as to not divulge the identity of the client.

People living with HIV have the same right to confidentiality as anyone.

Is there a Vaccine for HIV?
Despite many years of research, a vaccine has not been successfully developed, although one was recently being trialled but that trial has since ceased.

 

[AdmiraalW238]

Part Three

NOTE: This section deals with PEP...not all countries off PEP. This is being included as information. Check with your countries health authorities to see if PEP is offered

HIV PEP - An Emergency Treatment for High Risk Exposures.
What is HIV PEP?
Post Exposure Prophylaxis or PEP is the immediate treatment with anti-retroviral medications following high risk exposures to HIV. It is thought that PEP may prevent HIV infection from occurring by reducing transmission. PEP is a 4 week course of a combination of two or more medications taken once or twice a day. For treatment to be effective PEP should be started as soon as possible following exposure and the entire course of medications taken.

How does a person “qualify” for the PEP program?
If a person has had a high-risk incident where exposure to HIV is possible, and they seek medical assistance within a seventy-two (72) hour period, they may be eligible for PEP.

A high-risk incident is usually where unprotected penetrative sexual intercourse with either a person who engages in high risk behaviours or a person who is known to be HIV positive, or where there is sharing of injecting equipment. Other significant risks may be identified through the assessment process in which a full sexual history and risk assessment is taken.

Oral sex is not usually considered high risk (see Transmission section). A Needle-stick injury, from a needle found in a park or on the street is also not usually considered a high risk exposure (see Transmission section).

Are there side effects from taking these drugs?
There can be some side effects, most of which are mild and are usually experienced in the first week of treatment. In some circumstances following discussion with their Doctor some people discontinue PEP because the side effects are unpleasant.

Symptoms can vary from person to person but may commonly include feeling tired, nausea, diarrhoea, rash and/or headache(s). Symptoms such as these may be able to be controlled or alleviated by other medication. It is necessary to consult a HIV clinician if side effects occur. Some medications interact with PEP, so the Doctor should be informed of all other medications, including over the counter preparations, that you are taking at the time.

Where can I go to get PEP?
Check with your local health authorities to ascertain if PEP for a non-occupational exposure is available in your jurisdiction

What will happen on my first visit to get PEP?
This can vary because different health facilities have different procedures.
Initially a clinician will do an assessment by asking questions regarding the incident to establish the level of risk. Depending on the risk you may or may not qualify for the PEP treatment. You may be referred to an alternative service if this is necessary.

If the risk is significant, medications will be prescribed on the day and should be taken immediately.

What if an individual has been sexually assaulted?
There are special considerations for individuals who have been sexually assaulted apart from the usual protocol for accessing PEP. Additional specialist care is always needed. Usually a medical examination by a doctor is performed to gauge what trauma has occurred to the person’s body. Individuals who have been sexually assaulted should be referred to a sexual assault service at a hospital or referred to an organisation such as the Rape Crisis Centre. On going counselling and support is imperative for sexual assault situations.

Is there any cost for the PEP medication?
This will depend your jurisidiction so check with your local health authorities

How effective are these drugs in preventing HIV infection from occurring?
Studies have found that health care workers, who took PEP after exposure to HIV in a health care setting, were up to 80% less likely to become infected than those who did not take PEP.

There are few studies on PEP and sexual or injecting drug use transmission, mainly due to the difficulties in knowing a casual partner’s HIV status. We do know that PEP is not 100% effective.

What help is available to cope with the stress of being on the PEP program?
The experience of being assessed, taking medications, being tested and waiting for results can be very stressful. As such most organisations should be able to provide the necessary support and/or follow up referrals as needed. Never the less it is a good idea to ask at the place where you are getting PEP as to what the PEP program involves. Most services should have free counselling, Social Workers and/or Psychologists.

What happens after an individual finishes the course of PEP?
The PEP process may vary between organisations, but most will require a series of follow up appointments for further review and testing over a six month period. This not only provides good support but is necessary as taking PEP, may delay the three month seroconversion period to six months. Additional testing for hepatitis C exposure may also be necessary as the window period for which a conclusive negative result for hepatitis C can be received is six months. After completing the PEP program, individuals should not require any further follow up. Education and strategies for the continuation of safe sex will be given.

Is there anything else I should know about PEP?
All individuals who inquire about PEP after a sexual risk (whether their risk is high or low) are encouraged to have a full sexual health screen.

 

[AdmiraalW238]

Part 4

NOTE: This section is provided for information only. Testing procedures differ from country to country. Please check with your local health authority as to the testing procedures in your country.


TESTING FOR HIV.
What is the HIV antibody test?
Specific blood tests are used to determine whether there are antibodies to HIV in the blood or not. Detection of HIV antibodies would mean you have been infected with the HIV virus. More than one test may be used to confirm a positive result.
The first test usually done is known as an ELISA test (Enzyme-Linked Immuno-Sorbent Assay.) This test is extremely sensitive, and while it gives very accurate results, it can occasionally give a false positive result. This is why a positive ELISA result will always needs to be confirmed by a second test, called a Western Blot.

When both of these tests are done, a result is considered extremely reliable. A positive ELISA and positive Western Blot test together means that a person is infected with HIV. A negative result on the Western Blot test means that a person does not have HIV even if the result has come back positive on an ELISA test.

What are antibodies?
Antibodies are chemical compounds found in the blood, which are produced by the immune system in response to the presence of a foreign substance, such as an infection. With many infections, the antibodies help the body to recover and fight off infections. With some viruses such as measles, hepatitis A and chicken pox, the antibodies can protect a person from future infection. This is not the case with HIV.
What is the window period? (Or why do I have to wait 12 weeks to test?)
This is the time it takes, following a possible risk of infection with HIV, until a HIV antibody test can give a conclusive result. With the tests that are used for HIV screening in Australia this “window period” is considered to be 12 weeks.
Tests for HIV in Australia look for antibodies to HIV, not for the actual virus. It can take up to 12 weeks for your body to produce these antibodies if you have been infected so testing will be usually be done 12 weeks following the risk . During the window period it is still possible to be infected and to infect others with HIV. It is therefore strongly suggested that condoms be used at all times or that a person abstains from activities that may put them or their partner/s at further risk.
Under certain circumstances it may be possible to get a result before the 12 week window period. However, it is recommended that people wait at least 12 weeks after a risk to ensure result accuracy.

Are there other tests for HIV?
The p24 antigen test looks for the presence of a specific HIV protein. This protein can be found before the appearance of HIV antibodies in a recently infected person. Although this test is useful in certain circumstances it can not be used for confirmation of HIV infection alone. While a positive p24 antigen result means HIV infection, a negative result does not confirm that there is no infection with HIV. Therefore this test is not routinely done when testing for HIV infection but may be used if suspecting a very recent infection when antibody tests are negative and in the 'seroconversion' or 'window period'.

HIV pro-viral DNA PCR testing is not widely available as most laboratories do not have the equipment to run this test. It is sometimes called Nucleic Acid testing (NAT) or PCR testing and is most sensitive test available for confirming the presence of HIV virus. The main use for this test in detecting HIV is in situations when standard testing is inappropriate such as in the diagnosis in newborn infants, pre-seroconversion or where standard testing has been disputed or inconclusive. This test does not replace screening tests or diagnostic testing alone.

ß2-microglobulin testing can be used to see if a HIV infection is recent or not. The test looks for a protein found in blood serum which has been shown to increase the longer a person has had HIV. Elevated concentrations are also found in serum of individuals with advanced HIV infection and in spinal fluid of individuals with AIDS Dementia Complex (ADC), a neurological complication of advanced HIV disease.

HIV RNA or viral load testing is most commonly used to measure the amount of HIV in the blood of someone who is already diagnosed HIV-positive.

What about CD4 testing?
T-cells or CD 4 cells are one of the immune system cells and are destroyed by HIV.
CD4 testing is a common test to look at the strength of the immune system. Although having a low CD4 cell count can indicate immune system damage, it does not necessarily mean that a person has HIV. A HIV test should be taken if there is any concern about HIV. More information on CD4 testing for people who are HIV-positive can be found at the end of this booklet.

What about Rapid HIV Tests?
Rapid tests give same day results but due to a higher number of false positive results two separate tests must be done to confirm a positive result. This means that all potential positive rapid test results cannot be considered confirmatory until standard blood testing is done.

What about Home Test kits?
Home Testing Kits may sound convenient. It involves taking a blood spot or saliva sample at home and then posting it to a laboratory for testing. However, this type of testing may mean that the individual does not receive adequate pre and post-test information, nor counselling and support. The current guidelines for HIV testing in Australia require certain issues to be discussed to enable the individual to make an informed decision regarding testing. At present these test kits are not licensed for use in Australia.

What about Self Test Kits?
A self test kit is defined as one where an individual can administer the test and read the result themselves. Although at present there are self test kits available in some countries, they are not yet licensed nor approved for use in Australia, the United States, United Kingdom or Canada. The accuracy of this test kit is thought to be comparable to that of the rapid testing and home test kits mentioned above.

When should a HIV test be done?
In most cases, it is recommended to wait at least 12 weeks after the possible exposure. This is to allow enough time for HIV antibodies to appear which is what the most commonly run test to detect HIV infection. During this period it is recommended that a person practise safe sex and use condoms to ensure they do not pass HIV on to their partner(s). There may be circumstances when testing earlier than 12 weeks might be considered, eg. due to the presence of specific symptoms, but a conclusive result may still take 12 weeks.

If you are considering testing for HIV, you should also consider testing for other Sexually Transmitted Infections at the same time.

How can I get a HIV test?
Tests are available from your GP or your nearest Sexual Health Clinic

HIV test results can take up to a week to come back from the laboratory. This is because HIV tests are done in batches and may not be run every day.

Having a HIV test has many implications. Someone should discuss these implications with you as HIV testing should only be done with informed consent (see “What is informed consent” below). For this reason we suggest going to a centre where pre and post-test counselling is carried out.

What is informed consent?
This means you should be able to understand what you are testing for and weigh up the advantages and disadvantages of having a HIV test and assess the potential implications of a positive or negative result. Things to consider are how you would cope with a positive result given your current life circumstances, what supports you would have, and how you have coped with a crisis in the past. It is also necessary under law (in some jurisidictions) that a person diagnosed with HIV must inform current and future sexual partners of the diagnosis before engaging in sex, even if condoms or other methods of protection are used. These things should be discussed with you prior to having a test. The testing procedure will also give information regarding how to potentially prevent HIV infection.

Protection of your privacy.
In most jurisidictions, testing and reporting of a HIV result using a person’s full name and address is unlawful except under specific circumstances, such as for insurance or immigration purposes, testing a hospital patient, or when the person being tested has consented to their name being recorded. It is a good idea to ask the centre where you wish to be tested if they use a coding system that does not identify people by personal details.

 

[AdmiraalW238]

Part 5

ANTIBODY NEGATIVE QUESTIONS.
What does a negative result to the HIV antibody test mean?
An antibody negative result means that HIV antibodies have not been detected in your blood. This means that you are not infected with HIV provided that you have waited at least 12 weeks since any activity that may have put you at risk (the window period).

If you have received a negative result 12 weeks following the initial risk with no further risks occurring within the window period or after your blood was taken, you can consider yourself not to be infected with HIV. The exception to this may be if taking PEP in which the window period may be extended from three to six months.
A HIV negative result does not mean you are immune to HIV infection.

How can I stay negative?
You can stay negative by always practising safe sex (use of condoms during sexual intercourse or when sharing sex toys) and/or safe drug use (not sharing injecting equipment), which avoids the transmission of blood, semen or vaginal secretions from one person to the other.

Unless both partners have disclosed, it is unsafe to assume your sexual partner is the same HIV status as you based on their behaviour. Even when a person thinks they are HIV-negative there is no guarantee of this as there may have been risks since they last tested, or they might be in the window period and have been given a negative result. Remember, that you are responsible for ensuring your own protection.

ANTIBODY POSITIVE QUESTIONS.
What does a positive result to the HIV antibody test mean?
Receiving a HIV antibody positive test result means that you are infected with the virus. You must also consider yourself infectious (i.e. capable of passing the virus on to others) from the moment of infection, even though you may have no symptoms.

Can HIV positive people have sex?
HIV positive people can have normal sex lives however care should always be taken not to pass HIV on to others and this is the responsibility of both sexual partners. Using a condom for penetrative sex is the most effective means of preventing semen or vaginal fluid entering another’s body where there is high risk of entering the bloodstream and causing infection.

It should be noted that there maybe a requirement in your jurisidiction that if you have been diagnosed as HIV positive, whether you practise safe sex or not, you have an obligation to inform all sexual partners of your status.

People who are HIV positive should take care not to come into contact with other STIs as these may act as co-factors in the progression of HIV illness. It should be noted that although condoms reduce the risk of transmission of STIs, syphilis, gonorrhoea, chlamydia, hepatitis A, hepatitis B and herpes it can also be passed on by contact other than sexual intercourse (e.g. oral sex, sex toys).

Can HIV positive people have sex with other HIV positive people without precautions?
Having unprotected sex with people of the same HIV status is sometimes called “sero-sorting”. While some HIV positive people may choose to have unprotected sex with other people who have HIV, it is important to consider that:

• Unless both partners have disclosed their HIV-positive status, it is unsafe to assume your sexual partner is also positive based on their behaviour.
• Research has indicated that re-infection (sometimes called superinfection) with HIV may further weaken the immune system.
• It is possible to be reinfected with a different strain of HIV which may be more virulent and may damage the immune system more quickly.
• Reinfection may occur with a strain that is resistant to anti-retroviral treatments, either currently being taken or which may be used in the future.
• Being HIV positive can increase the risk of contracting STIs which may be more detrimental to the immune system.
• Recent research shows that Hepatitis C, which is not normally sexually transmitted, can be transmitted from a person who has both HIV and Hepatitis C to another HIV-positive person.

What are the long term prospects for people with HIV?
A positive result to the antibody test means that you have been infected with the virus known as HIV. It does not mean that you have AIDS or an AIDS related condition.

There is currently no cure for HIV. However, since the development of Highly Active Anti-Retroviral Treatment (HAART) therapy, HIV/AIDS may possibly be managed as a chronic, long term, disease.

HAART therapy has successfully slowed the progress of disease amongst some people living with HIV as it slows down the viral replication process. This has resulted in a lower incidence of people progressing from HIV to AIDS and a reduction in AIDS related deaths. However, some people living with HIV may not benefit from HAART therapy due to side effects, rejection, or drug resistance. The complete long-term effects and benefits of HAART therapy have yet to be fully established.

For advice or referrals it is recommended that HIV positive people see a health practitioner or a clinic experienced in dealing with HIV infection for health and lifestyle advice and to have regular health monitoring.

People who are infected with HIV remain infectious for the rest of their lives and are able to transmit the virus to others.

Can HIV positive people donate blood, semen or organs safely?
HIV can be passed on this way so blood, semen and organs can not be donated when it is to be use for others. However, many HIV positive people may be asked to participate in clinical trials and research in which some of these samples are collected.

Can you develop immunity to the virus?
There is no conclusive evidence that anyone has developed immunity against the HIV virus.

What can people with HIV/AIDS do to look after their health?
Generally, a healthy balanced diet, regular exercise, enough sleep and avoiding smoking, excessive alcohol, or use of non-prescription drugs are all recommended. Some recreational drugs may adversely interact with HIV anti-retroviral, or other, medications. It is important to seek information about the use of any non-prescribed substances in relation to HIV treatments.

Regular medical check-ups are important. There are various treatments available that may help people stay well, and there are often clinical trials of new drugs and treatments that people may choose to take part in. Many people benefit from psychological support and counselling, as well as, relaxation, meditation, massage etc.

What are the categories (stages) of HIV infection?
CURRENT CATEGORISATION OF HIV INFECTION
CATEGORY/STAGES DESCRIPTION
(In Plain English)
Category A
Acute Primary Illness This is when/if a person is experiencing
seroconversion illness, i.e. symptoms of initial infection.
(Note: this stage may be without symptoms)

Category B
Asymptomatic Chronic Illness This is the period when a person HIV positive but may not display or experience symptoms, and where slow ongoing damage
to the immune system occurs.

This period can average around 7-10 years without treatment and much longer with anti-retroviral treatment.

Category C
Symptomatic Chronic Illness This is also often called an AIDS diagnosis.
This is where a person is ill with opportunistic infections because of long term immune system damage.

 

[AdmiraalW238]

Part 6

TREATMENT FOR PEOPLE WHO ARE HIV-POSITIVE.
What treatments are available?
There are currently four different classes of HIV anti-retroviral medications which are; nucleoside or nucleotide reverse transcriptase inhibitors (NRTI & NtRTI), non-nucleoside reverse transcriptase inhibitors (NNRTI), protease inhibitors (PI) and fusion inhibitors. Each of these classes specifically target and block one of three specific mechanisms used by the virus to reproduce itself. These medications are usually used together in combination in what we call HAART Therapy.

What is HAART Therapy?
HAART (Highly Active Anti-Retroviral Treatment) therapy or combination therapy has been available in Australia since 1996 and is the standard treatment available today used to prevent the progression of HIV. This therapy consists of 3 or more different HIV anti-retroviral medications from at least 2 different classes of medication being given to a person in combination.

Additional medications may also be prescribed to boost the immune system and/or to prevent infections that a weakened immune system could be vulnerable to.

How does HAART therapy work?
HAART works by reducing the amount of HIV virus produced in the body. It does this by using actions that impair HIV's ability to reproduce. When there is less HIV virus in the system the weakened immune system’s helper cells or CD4 cells have time to reproduce and build up levels and giving the person more immune ability to fight off other infections..

What are T-cells or CD4 cells?
T-cells or CD 4 cells are one of the immune system cells and are destroyed by HIV.
The CD4 cell count gives a rough guide to the health of a person's immune system.

A reading of:
• more than 500 is considered to show no or little immune system damage.
• between 250 and 500 is considered to show moderate immune system damage.
• less than 250 is considered to show severe immune system damage and indicates a susceptibility to serious opportunistic infections.

What is viral load / viral load testing?
The viral load test is a blood test which is used to measure the amount of HIV virus present in the blood of someone who is HIV-positive. The monitoring of a person's viral load is used for HIV management, as the level of HIV can be an indicator of a person's health status, disease progression and effectiveness of treatments.

Generally, HIV positive people with high viral loads are more likely to be susceptible to or experience infections/disease than those with a low or non-detectable viral load. A non-detectable viral load means that HIV has fallen below levels detectable by the test used but a person is still infected with HIV and is still infectious.

The lower the count the less active HIV is in the body.
• 50,000 or more viral copies is considered high.
• 10,000 - 50,000 copies - moderate.
• Less than 10,000 copies - low.
• Below 50 copies is called 'undetectable'.

The aim of treatments is to get to “undetectable” and maintain that reading for as long as possible

What is HIV drug resistance testing?
When treatment is less then optimal (such as when a prescribed dose is missed) HIV virus can mutate and become resistant to that medication. The presence of drug resistance can be detected in the blood.

It is also possible that a person can be infected, or if already HIV positive be reinfected, with a strain of HIV that has resistance to some anti-retroviral medications.

Specific testing for any genetic changes enables the clinician to choose the most effective drug combination to which the mutant or dominant strain of HIV virus is most sensitive too. This potentially increases the chances of achieving maximum benefit from HAART therapy.

What is Salvage Therapy?
Salvage therapy is when a person that has HIV is resistant to most available anti-HIV medications and it is not possible to find a new treatment regimen which contains 3 new drugs from at least 2 classes to which there is little or no resistance.

Salvage therapy can involve recycling (trying again) drugs which the person has already been on or using similar drugs to which testing shows only partial resistance.

There is some evidence that continuing with treatments, even when there is resistance, can still be partially beneficial. This is because while resistance mutations may allow the virus to multiply in the presence of drug, the virus still pays a price by multiplying at a lower rate than that of virus that is not being treated.

 

[wendigo3]

Very in-depth. Thanks!

 

[HartfordGuy]

Great info for those uniniformed or misinformed. Thanks for putting it all in one place.

 

[dan1105]

First off, good job!

A lot of it is great information, however, I have a concern where it states:

Can HIV be transmitted through oral sex?

Oral sex is considered to be a low risk for the transmission of HIV. HIV is not transmitted by saliva (see below “Can you become infected by kissing?”) however having cuts, ulcers, or damage to the mouth and gums may allow infected blood, semen, or vaginal fluid into the bloodstream via the mouth.

There is virtually no risk of acquiring HIV from receiving oral sex as the exposure is only to saliva. However, you should remember that other STIs may be transmitted this way.

It's making me queasy as it seems that in the 2nd paragraph, its giving off a 'no risk' attitude instead of 'low risk' attitude.
I don't have a lot of in depth knowledge to HIV/AIDs, which is why i find this post great. I only hope that others don't walk away with the 'no risk' attitude to oral sex as it has been implied (in my eyes anyways)

It seems that you typed this information out of a booklet or pamphlet of sorts? If so, I apologise if it seems like I'm having a go at you, coz I'm not! hehe =)

 

[AdmiraalW238]

First off, good job!

A lot of it is great information, however, I have a concern where it states:


It's making me queasy as it seems that in the 2nd paragraph, its giving off a 'no risk' attitude instead of 'low risk' attitude.
I don't have a lot of in depth knowledge to HIV/AIDs, which is why i find this post great. I only hope that others don't walk away with the 'no risk' attitude to oral sex as it has been implied (in my eyes anyways)

It seems that you typed this information out of a booklet or pamphlet of sorts? If so, I apologise if it seems like I'm having a go at you, coz I'm not! hehe =)

Can HIV be transmitted through oral sex?

Oral sex is considered to be a low risk for the transmission of HIV. HIV is not transmitted by saliva (see below “Can you become infected by kissing?”) however having cuts, ulcers, or damage to the mouth and gums may allow infected blood, semen, or vaginal fluid into the bloodstream via the mouth.

There is virtually no risk of acquiring HIV from receiving oral sex as the exposure is only to saliva. However, you should remember that other STIs may be transmitted this way.

The operative word in the second paragraph is receiving oral sex. It is highly unlike that a person on the receiving end of oral sex will acquire HIV from the other persons saliva as the amount of HIV in saliva is negligable which is why it states 'virtually no risk'...but you should consider that other STIs can be transmitted via saliva.

It seems that you typed this information out of a booklet or pamphlet of sorts,

The answer is yes, I did take this information from a booklet that I helped come up with. The answers to these questions were taken from phone calls received by the NSW HIV/AIDS Information Line and is updated on a regular. I was remiss in mentioning were I obtained the information for the thread as I did not mean to imply that I wrote it all.

My main reason for posting this was to have the information on the forums because it is quite clear that there is some people who just have some questions that are not answered in an ideal way.

 

[3stripes]

Your PEP information is Australian specific, other countries use different rules: from PEP not available full stop, to other criteria.

 

[dan1105]

Thanks for clearing that up.

I'm feeling slightly stupid, but feeling well informed too.

 

[AdmiraalW238]

Your PEP information is Australian specific, other countries use different rules: from PEP not available full stop, to other criteria.

Which is why I inserted

NOTE: This section deals with PEP...not all countries off(er) PEP. This is being included as information. Check with your countries health authorities to see if PEP is offered

at the start of that section.

 

[3stripes]

No, acro-brat, the top does not have to be exposed to blood for them to risk contracting HIV from a pos bottom. The rectal secretions contain viral particles and these can be forced up into the urethra during sex.

Spermicidal lubricant will increase the risk of infection for a bottom. Despite spermicides killing HIV in test tubes, in real life they cause significant tissue irritation and increase infection risk.

 

[bigboyblew]

We have all heard the saying that Oral sex is "safer " sex, which I too to an extent believe to be true with the very limited evidence at hand. However since my diagnosis in June 2005 I have learnt of many people claiming to have contracted HIV the same way as myself, Oral Sex !

Yes we are shunned and even called liars, dismissed as false statistics and accused of trying to scare monger.

Well the fact of the matter is oral transmittion of HIV is a very real threat, and one we should wake up too and invest more research and obtain reliable evidence.

With the huge increase in herpes, syphilis and other STD's our mouth is becoming a more suitable route of transmission as the HIV has the ability to ' piggy back ' into our system.

Since the Thatcher years of huge icebergs and information regarding HIV, I decided that it was something I would never catch. I always used condoms for anal sex and never allowed anyone to ejaculate into my mouth. I never had a condom split on me and wouldn’t even kiss if I had cracked lips. I was obsessed to point that I used to phone the National Aids helpline to ensure what I was doing was safe and that I was protected.

In May 2005 I had oral sex with a stranger, he was fit, toned and looked the perfect bill of health. This didn’t prevent me from practicing safe sex. However without warning the guy ejaculated in my mouth. It happened so quick and with no warning. I was angry that it had happened, but not concerned as oral sex was considered safer sex.

After 4 weeks I fell dreadfully ill, I had a sore on my penis and raised lymph nodes in my groin. I was suffering a temperature of 103 and was listless.

I decided to get myself off to the GUM and gave blood for a HIV test, thankfully the results were back the same day and I was negative ( June 16th 2005 ). I was elated and so very happy and relieved.

I was seen by a Consultant as I had also developed a body rash, he was mildly concerned that I was suffering a seroconversion illness, but from my sexual history and negative HIV test thought improbable.

Due to the severity of my symptoms, it was decided that a special p24 test should be carried out. This test finds the HIV virus rather than the anti bodies, I was to return in 4 days time for the results.

The next 4 days were fine, I had been given a negative HIV test and thought my illness was something doing the rounds. I was not worried about the result, lets face it Oral sex is safer sex right, wrong !

I sat in the GUM waiting room for the nurse to give me the all clear. Instead the Consultant called me in I thought this is odd, what does he want. I sat down and was told that the HIV virus was present in my body and that I was also suffering with herpes. I starred at him and said " this is so unfair ". I had always protected myself, washed hands, rinsed mouth, used condoms covered any grazes I may have had.

I sat there and just kept repeating " this is so unfair " Within 4 days I had been diagnosed HIV negative and then HIV positive. My head was messed up as you can imagine.

The consultant concluded that the guy who ejaculated in my mouth could have been shedding the herpes virus and that the HIV came with it.

I was gutted, the first time I had encountered any kind of ' safer ' ( not safe ) sex and I was infected.

So what are the actual risks of catching HIV from oral sex ? Statistically 1 in 50,000. Yet since my diagnosis more and more people have informed that they too caught it from oral transmission.

We use lube and condoms for anal sex, but what protected apart from saliva do we have for our mouths? How healthy are our gums, how often do we bite our tongue whilst eating, what gum damage do we cause when flossing or brushing, how safe is our tongue after cleaning it. Tooth picks, knives and forks, sharp crisps, and other foods damage our mouth tissue. Hot drinks can burn the lining of the mouth causing small blisters. All these make a perfect opening for HIV and other STD's

Perhaps through the circumstances surrounding my infection, others may consider a little more regarding what risk they are prepared to take when having Oral sex.

Do I feel cheated out by the way I was infected. Yes I do. I didn’t ask the guy to ejaculate and would not have invited such an act. The actions I took were considered safer, but how safe was my mouth.

 

[3stripes]

thank you for your post bigboyblew.

I wish more people would speak out on the risks rather than the head in the sand mentality of far too many.

 

[bigboyblew]

thank you for your post bigboyblew.

I wish more people would speak out on the risks rather than the head in the sand mentality of far too many.

More than welcome

It has become my ambition to educate as many guys as possible on safer sex and encourage then to get tested.

After being HIV for almost 3 years I am still not on medications as my viral load ( amount of HIV in my blood ) is very low and my immune system very high.

I am always willing to answer any questions guys have, dont be afraid to ask.

 

[bigboyblew]

Another thing I heard is that someone who is HIV+, but undectable, has a smaller risk of infecting someone than some one who is HIV+ and dectable.

Is that true?

That is true, however the virus is only tested in blood and not in Cum, so the viral load in an ejaculation could be more than enough to infect someone. Also if they have an STD this makes it even easier to pass on the virus.

 

[TorontoBoi]

Thanks, Bigboyblue, for your post! I hope everyone can have a chance to read your story. And may you be healthy!

 

[CaptainRush]

I read through this all and learned a lot, thank you. Basicly, I was scared shitless all day yesterday thinking I had gotten the HIV virus and possible Herpes. Long story short, I thought I had symptoms but I didn't. I was drunk in a club, a man came up to me and stuck out his tounge and went in to kiss me, being drunk and very happy, my reflex was to kiss him back but only our tounges touched for 2 seconds. I know, gross. Being the most paranoid person I know, and being hung over the next morning, his face was a haze and my imagination took over my mind. My friend told me he had no signs of blisters or sores or anything of the like. My friend teased me into thinking that he had HIV and my mind fucking raced for the rest of the day.


I did the research on Herpes and HIV now.... our lips didn't even touch, just our tounges. He had no ulsers or cuts or anything. Our tounges touched for no more then 2-3 seconds... what's the odds I have gotten the HIV virus? I know it's slim to none, but my mind went through the fucking gutter this weekend.

He was in his mid twenties I think. Seems like a clean guy. I asked 2 nurses on a hotline and they said for saliva he would have to have a cut in his mouth for it to even enter his saliva and then to touch my tounge with it for 3 seconds, the odds were very improbable. She almost was even giggling, which I guess is a releaving thing.


Also, by the way, I don't even know if this guy has HIV. My mind and even my typing is frail at this moment... I don't even want to proof read this message. Thanks for the fast reply.