HIV 101
What do I need to know about HIV?
HIV is a virus which can affect anyone. HIV stands for Human Immunodeficiency Virus. It attacks the immune system, making it harder for the body to defend against diseases.
AIDS is the most advanced stage of HIV, when the immune system is no longer able to protect against diseases and infections. Thanks to effective treatment, very few people develop AIDS these days, and you can recover from AIDS, with treatment.
We now have very effective treatment for HIV. If diagnosed and on treatment, people living with HIV have a normal life expectancy, and lead full and healthy lives. If treatment is effective, the virus can be so well controlled that it is undetectable – which means the person is uninfectious, and cannot pass HIV on to sexual partners or unborn babies.
There are also other effective ways to prevent HIV, including male and female condoms and PrEP. What works for you will depend on you as an individual.
How is HIV transmitted?
HIV is transmitted, or passed on, from one person to another through body fluids that contain the virus. It can be transmitted through semen, vaginal fluids, rectal secretions, blood or breast milk.
HIV can be passed on through:
Unprotected vaginal sex or anal sex where a condom, PrEP or PEP (Post-Exposure Prophylaxis) is not used.
Sharing equipment to inject drugs.
From a woman to a baby during pregnancy, birth or breastfeeding.
HIV CANNOT be passed on through saliva, kissing, spitting, touching, biting, or scratching. HIV can’t be passed on from toilet seats or sharing eating utensils. People don’t pick up HIV from contact with discarded needles.
Could HIV affect me?
If you think that HIV is something that could affect you, then you should think about what prevention options might work for you. HIV can affect anyone, but you are more likely to get HIV if certain things apply to you. You should think about prevention options if:
You have male partners who find it hard to use condoms, or you and/or your partners prefer not to use condoms.
You have recently had a sexually transmitted infection (STI) or used PEP.
You have a partner who has HIV and is not on treatment, or is on treatment but does not have an undetectable viral load.
HIV is more common in some places or communities, so you could also think about whether you will be having sex in a country or with a partner from a country where HIV is more common.
Your partner has other partners.
If you think you might already have been exposed to HIV, you should take an HIV test. If you were exposed within the last 72 hours, you should consider taking PEP.
How can I prevent HIV?
Condom use is an effective way of preventing HIV transmission. They are estimated to be 80 to 85% effective in preventing HIV, in normal use (where there might be some breakage or slippage) if they are used 100% of the time. Find out more about how effective condoms are from NAM.
Condoms are available for free at most sexual health clinics and community based HIV organisations.
Condoms also help to prevent other sexually transmitted infections (STIs), and can be used to prevent pregnancy. If you want to prevent STIs and/or pregnancy as well as HIV, condoms might be your best option.
Male condoms are most commonly used, but female condoms are also available.
The female condom is easy to use with a little practice. If you can use a tampon, you can probably use a female condom. The female condom comes ready lubricated but you can always add more lubrication if you want to. It can be used for vaginal or anal sex. One of the benefits of a female condom is that you can insert it ahead of foreplay and sex. Female condoms have improved significantly over the years, so even if you have tried them in the past and had challenges, it could be worth trying again.
Always check the expiry date before use. Don’t use expired condoms. Never re-use a condom.
PEP – after a possible exposure to HIV
If you have had a sexual encounter and feel you might have been exposed to HIV, you can go to your local Accident and Emergency unit (A&E) or GUM clinic (during working hours) to ask for something called PEP.
PEP stands for post-exposure prophylaxis. PEP is a tool to prevent HIV, taken after exposure to HIV. It is a 28 day course of drugs used to stop HIV infection. It is most effective if taken within 24 hours of the exposure to HIV, and only works if taken within 72 hours. Find out more about PEP and how to access it at: http://www.tht.org.uk/sexual-health/About-HIV/Post-exposure-prophylaxis
Before getting PEP you will need to talk about the risk to which you feel you have been exposed. This will involve talking about the type of sex you had: (vaginal, anal, with shared sex toys, etc.). You will be asked whether you know the HIV status of the person(s) you had sex with and if you know if they are undetectable on treatment (if they are, you will not need PEP). You will be given an HIV test, to confirm that you do no already have HIV, as PEP would not be right for you. No test can pick up an HIV infection in the first 72 hours, so the test confirms your previous HIV status, and you will then be tested again after completing PEP.
8 to 12 weeks after you have completed the course of PEP, you will be tested for HIV. It is important to use condoms if you have sex during this period, to ensure you get an accurate result from this test.
PrEP
PrEP (pre-exposure prophylaxis) is a type of HIV prevention method. It is a medicine you take every day that helps you stay HIV negative.
PrEP is an antiretroviral (ARV) pill that has been used for many years as a treatment for HIV. Scientific studies found that it is also effective in preventing HIV. People who do not have HIV take it every day to considerably reduce their chances of getting HIV.
PrEP combines two different ARV drugs in one pill. The two drugs are called TDF and FTC (both are required for PrEP to be effective). PrEP is sometimes called Truvada as Truvada is a brand name for TDF-FTC. Generic versions of TDF-FTC are also available. These are exactly the same drugs, just made by different companies.
Treatment as prevention (U=U)
If a person living with HIV is on treatment, they are taking it as prescribed, and it is working effectively, the amount of virus in their blood will become undetectable, meaning there is too little of it for tests to pick up.
Once they have been undetectable on treatment for six months, it means they are uninfectious. This is called UNDETECTABLE = UNINFECTIOUS (U=U), and means that if you have HIV and you’re on effective treatment, and you are undetectable for six months, you cannot pass it on to your partners.
Find out more at: https://www.preventionaccess.org/undetectable
Clean needles
HIV transmission through sharing needles or drug injecting equipment is very low in the UK at around 4% of all diagnoses ever reported. This is due primarily to needle exchange programmes and other harm reduction interventions such as methadone maintenance. You can access clean works and information through your local drug and alcohol service.
Personal story: condoms
I am a woman living with HIV, though I once was not living with the virus. I have had passionate sex, steamy heated moments and tender caresses. Mainly with condoms in the equation. Thing is, I have a latex allergy and sensitivity, so latex condoms most often caused water infections, thrush and friction sores. None of which were fun, particularly when in the throes of passion and longing.
Non-latex condoms are not supplied freely in GUM clinics so, for any sex or passion event I preferred to either be at home where I had a supply, or tried to ensure I carried supplies with me. So, once, maybe twice, I had condomless sex with someone who had HIV and I contacted the virus. Not at home, without supplies. Caught up in a moment. I am not of childbearing age so am not taking the pill. Now, I could take PrEP.
How can I test for HIV?
HIV can be managed really effectively with treatment if it is diagnosed early, so testing is really important. In terms of looking after your health, it’s much better to know. It can seem scary, but remember that today HIV is no longer a life threatening condition now. Treatment is effective and available free of charge to everyone in the UK (regardless of your immigration status) and there is great care and support available.
You can test in sexual health clinics (sometimes called GUM clinics), at the GP, and at other health services. Some charities also provide HIV testing.
It is also possible to order tests to use at home. There are two options: home sampling kits (you send off a sample and your result is sent back to you) and home testing kits (you find out the result yourself at home). Some can be bought, and others can be ordered for free. Find out more from THT.
HIV tests and treatment are free and universally available in the UK. Having an HIV test can be a positive choice, and so can testing with a partner. If you or your partner are found to have HIV, effective treatment is available that can both keep the person living with HIV healthy, and prevent transmission to others. Knowing whether you have HIV allows you to make informed choices about your health, and prevention with partners.
For great information about testing, including where and how to access it, please go to: http://www.tht.org.uk/sexual-health/About-HIV/Testing-for-HIV#locations
Your sexual health
Good sexual health is important for everyone. This includes having the sex you want, how you want, with who you want, when you want. Pleasure is a vital part of this. Good sex is important! Looking after your sexual health is also important. You can find out more about sexually transmitted infections, how to prevent them, how to get tested, and how they can be treated or managed, at these sites:
https://www.sexwise.org.uk/stis
https://www.decolonisingcontraception.com/
For some women, contraception can also be an important part of sexual health. To find out more about your options, including a tool to help you figure out what is right for you, visit: https://www.sexwise.org.uk/contraception. This site also information and advice about abortion, and about conception.
