Human Immunodeficiency Virus (HIV) causes progressive damage to the immune system within the body. The immune system usually helps to fight off bacterial, fungal or viral infections and also some cancers. Acquired Immune Deficiency Syndrome (AIDS) is caused by HIV and occurs when the immune system is severely damaged, allowing infections and cancers to develop and become life threatening.
HIV can be transmitted through the exchange of blood, semen, anal mucus, vaginal fluids or breast milk, such as:
- Unprotected anal and vaginal
- Sharing needles and syringes when injecting
- Sharing piercing or cutting instruments that has been contaminated with another person’s blood
- Blood transfusion
- During pregnancy, at birth, or via breast milk
- In rare cases, it is spread through oral sex and needle-stick injuries
In order for transmission to occur HIV needs an entrance point like a cut, scratch, abrasion, open sore or bleeding gums, or to be injected directly into the bloodstream through a needle or syringe. The presence of other STIs, especially genital ulcers or sores, makes sexual transmission of HIV more likely.
In some Australian states, it’s against the law for sex workers living with HIV to work in the sex industry.. Contact the local sex worker organisation to find out more about the rights and responsibilities of sex worker living with HIV.
What is the risk of getting HIV from:
- Deep kissing: Safe. HIV is not in sufficient quantities in saliva for it to be transmitted.
- Oral sex: Very low risk. When giving oral sex, use condoms and dams, especially if the area around and inside the mouth contains any recent dental surgery, bleeding or inflamed gums, oral piercings and/or cuts. Don’t brush or floss teeth beforehand.
- Hand relief: Safe. Make sure the penis and ejaculate is directed away from the eyes if no condom is used. Eye sockets are lined with mucous membranes and small blood vessels which the virus can enter. In addition, make sure any cuts or abrasions which will allow the virus a passage to enter the body are covered.
Signs and Symptoms
Many people don’t get any initial symptoms at all. Others might experience flu-like symptoms (headache, fever, swollen glands and lymph nodes, tiredness, nausea, vomiting, diarrhoea achy muscles and joints) when they first contract HIV, which disappear on their own after a couple of weeks and the person feels fine again. Other identifying symptoms include rash, weight loss and mouth ulcers. There are no visible signs of HIV to look for when checking clients, either.
Testing for HIV
The decision to test is voluntary and should be made with informed consent. People taking a HIV test can request for information and counselling before and after the blood test and the results are confidential. There are a number of different tests used to detect HIV and a combination of these tests can be used together to detect the virus. The current combination HIV fourth generation test detects early markers of HIV infection as well as immune response to the virus. This means that blood test can detect HIV as early as 2-3 weeks from exposure and will be conclusive (either positive or negative test result) at 6 weeks.
Rapid HIV testing is performed using a device that tests for the presence of HIV antibodies or the virus itself (depending on the device), and provides results in about 20 minutes. Rapid HIV testing is currently available in numerous locations in Australia. Rapid testing is not suitable for early detection of HIV as the window period between seroconversion and detection is longer than laboratory blood testing. Seroconversion refers to the period of time HIV antibodies develop and become detectable in the blood. People who suspect that they have recently been exposed to HIV should access PEP.
A reactive result (also called a preliminary positive result) from a rapid test needs to be confirmed with a laboratory test, as rapid tests produce a small number of false positives (a false positive refers to the test producing a positive result even though HIV is not present).
Rapid tests are available in sexual health clinics, some GPs and community-based testing services such as mobile HIV testing vans.
HIV self-testing (also referred to as home testing or HIVST) is a HIV testing tool that allows people to perform a HIV test at home using a rapid testing device or kit. Some HIV self-tests use a swab along the gum line, and some use a finger prick to draw an amount of blood. Clear instructions are provided to guide the user in extracting the sample, performing the diagnostic test and interpreting their results (often similar to interpreting the results of an at home pregnancy test). Sometimes HIVST is used interchangeably with home sampling, which refers to taking a mouth swab or finger prick, mailing it to a laboratory, and the results are delivered by phone, text or online. Both home testing and sampling are available through trial projects in some state and territory HIV organisations. HIVSTs are not yet available to buy over the counter in Australia. However, they can be bought online from overseas or in some states and territories there are HIVST trials for people to join. HIVST is particularly beneficial for people who prefer to test in private, alone or with people they trust, rather than in a health clinic. However, a reactive (sometimes incorrectly referred to as a positive) result needs to be confirmed with a laboratory HIV test that is conducted by a trained testing provider. Additionally, it is recommended that all non-reactive testers retest after six weeks of HIV exposure or if there is a high ongoing risk of exposure to HIV. HIVST is not recommended for people taking antiretroviral drugs such as PrEP or PEP (see sections below), as there is a greater chance of getting a false non-reactive (false negative result). Additionally, HIVST has a longer window period (the amount of time needed for an HIV infection to be detected in a test) than laboratory tests, so for people who have being recently exposed to HIV, a laboratory test will be more effective in detecting the virus.
If unsure about a HIV testing result or feel unsure as to whether the test was performed correctly, contact your community health service for a laboratory test.
HIV treatments, also called antiretroviral drugs, have significantly advanced since they were first introduced and there are many drug treatments to control HIV and reduce the risk of progression to AIDS. However, HIV treatment is often complicated and there are many factors to consider such when to start treatment, reducing resistance, side-effects, monitoring and changing treatments and interactions with other medications. As a result, when starting treatment, it is important to consult a doctor with expertise in HIV management.
Drug treatments (such as combination therapy) also reduce the risk of transmission of HIV from mother to baby during pregnancy. Whilst there is currently no vaccine or cure for HIV these medications enable a better quality of life for people living with HIV.
The proper use of condoms and lube during sex (anal or vaginal) will greatly reduce the risk of HIV transmission. In addition, the use of sterile injecting equipment and biomedical strategies such as TasP, PEP and PrEP will significantly reduce the risk of HIV transmission.
Safer sexual activities include masturbation, touching, voyeurism, kissing, cuddling, body-to-body rubbing and erotic massage.
Treatment as Prevention (TasP)
TasP refers to the use of antiretroviral drugs by people living with HIV to reduce the amount of HIV present in their bodily fluids (such as blood and genital fluids) to undetectable levels, which eliminates the risk of HIV transmission. There is strong evidence of the effectiveness of antiretroviral therapy (ART) as a means of HIV prevention. When ART results in viral suppression, defined as less than 200 copies/ml or undetectable levels, it prevents sexual HIV transmission. People who take ART daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner. This means for HIV undetectable equals untransmittable (U=U).
Three different research studies with serodiscordant couples (where one person is HIV positive, and the other person is HIV negative) using TasP reported no HIV transmission. TasP can also prevent transmission of HIV between serodiscordant couples when conceiving.
Pre Exposure Prophylaxis (PrEP)
PrEP is the use of antiretroviral drugs by HIV negative people to greatly reduce the risk of contracting HIV upon exposure. PrEP is taken on an ongoing basis and is currently available through trial projects in some states and territories, or a script from a doctor or via personal importation. PrEP has recently been listed on the PBS reducing the cost to approx. $40 per month for PBS co-payments. If you are considering PrEP, you should discuss this with a doctor experienced in HIV or sexual health to help decide if PrEP is right for you.
Post Exposure Prophylaxis (PEP)
PEP is recommended for people who have potentially been exposed to HIV. PEP is a course of HIV medication that, if taken in time, can significantly reduce the chance of contracting HIV after being exposed to the virus. The medication must be taken within 72 hours of exposure to be effective. The medication must be taken every day for 28 days. The side effects of the medication can be severe, causing nausea, diarrhoea and headaches. These side effects can disrupt some people’s day to day living, making them too unwell to work. However, the prescribing doctor can alter the medications to minimise the side effects. Some people may not experience these side effects at all.
There are some hospitals and sexual health centres that dispense PEP free of charge. Contact the state or territory HIV/AIDS organisation or sexual health service, or the accident and emergency department of the nearest hospital for more information.
PEP should not replace safer sex practices.