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The human immunodeficiency virus (HIV) is a blood-borne virus (BBV) and sexually transmitted infection (STI) that affects the immune system. Untreated HIV slowly destroys the cells that help the body stay healthy by fighting off disease. 

Without treatment, HIV can lead to a very weakened immune system within 10 years. At this point, the body can no longer fight infections or stop cancers from developing. This is called acquired immunodeficiency syndrome (AIDS). AIDS is extremely rare in Australia because highly effective HIV treatments are available.

There is currently no cure for HIV, but people living with HIV who take effective antiretroviral treatment will not develop AIDS and can live long and healthy lives. This is because these medicines control the amount of virus in their blood (‘viral load’) and protect the immune system.  

Effective HIV treatment can reduce a person’s viral load to such low levels that they are undetectable, which means that the person cannot transmit HIV to sexual partners (untransmittable). This is known as ‘Undetectable Equals Untransmittable (U=U)’.

Stigma and discrimination

Despite big improvements in treatment and quality of life, stigma and discrimination exist around HIV. People living with HIV may experience discrimination and isolation because of outdated, incorrect and harmful beliefs and attitudes. This can affect their mental, social and physical health, overall quality of life, financial stability, and access to care. 

HIV stigma can prevent people living with HIV from accessing appropriate treatment and care or be a barrier for people at risk of getting HIV from being tested. It is common for those living with HIV to experience self-stigma, where they begin to apply the stigma associated with HIV to themselves.

Awareness of HIV stigma and discrimination is essential in reducing the spread of HIV and improving the lives of people living with this chronic health condition.

Contact your local PLHIV (people living with HIV) community-led organisations for support and information about managing stigma and discrimination.

Signs and Symptoms

When first infected with HIV, some people may have no symptoms. Other people may experience a flu-like illness called ‘seroconversion illness’, which often occurs around 1 to 4 weeks after infection and may be difficult to tell apart from other infections.

When first infected with HIV, a person may have

• fever
• fatigue
• swollen glands
• nausea and vomiting
• painful ulcers in the mouth or around the anus or penis
• headache
• rash, typically on the torso
• muscle and joint pain
• weight loss

After this initial illness, people living with untreated HIV typically have no symptoms for many years, though they carry the virus. This is why regular testing is the best way to detect HIV. You can view a list of sex worker-friendly sexual health clinics on our Where To Test page.

There are no visible signs of HIV to look for when checking clients for STI symptoms.

Transmission

People living with HIV who are on effective treatment cannot pass HIV on to a sexual partner. This is because effective treatment reduces the levels of HIV in a person’s semen or vaginal fluid to undetectable levels. 

HIV is generally passed on when someone doesn’t know they have the virus or when they are in the early stages of an HIV infection where the viral load (amount of virus in the body) is high. 

The only bodily fluids that can transmit HIV are blood, semen, vaginal fluid and breast milk. 

Transmission can occur through:

• anal or vaginal sex without protection such as a condom, PrEP, or an undetectable viral load
• unprotected oral sex, although this is very rare
• sharing injecting equipment
• ‘needlestick injuries’ (e.g. during some BDSM services)
• getting blood or bodily fluids in your eye
• tattooing, piercing and other procedures with unsterile needles or equipment
• transmission from mother to baby during pregnancy, childbirth or breastfeeding
• receiving a blood donation, though this is now extremely rare

HIV is NOT spread through

• urine, poo, spit, vomit, or sweat (as long as no blood is present)
• kissing
• coughing or sneezing
• holding hands
• sharing eating utensils or drinking glasses

HIV is transmitted most often through unprotected anal or vaginal sex. The presence of another STI, especially genital ulcers or sores, increases the chance of sexual transmission of HIV.

HIV transmission and menstruation (periods)

Menstrual blood touching unbroken skin poses no HIV transmission risk. If it comes into contact with broken skin or is swallowed, HIV transmission is possible but still unlikely. The menstrual blood of someone living with HIV with an undetectable viral load cannot pass on HIV.

Prevention

Here are some things you can do to reduce the risk of HIV transmission 

• Use condoms, dams, gloves and other barriers during sex. 
• Treatment as Prevention (TasP), PEP and PrEP significantly reduce the risk of HIV transmission (more information below).
• Use water-based or silicone lube during sex, especially when not using barriers.
• Cover cuts, abrasions and wounds with waterproof dressings to reduce the likelihood of blood-to-blood contact.
• Be aware of the potential or presence of blood in your working environment and minimise the risk of exposure to someone else’s blood.

• Always wash your hands thoroughly if you have touched someone else’s blood. 
• Always clean up blood with paper towels, soapy water, isopropyl alcohol, or undiluted bleach. Wear gloves if you can. 
• Viraclean, a cleaning solution commonly used in the sex industry, is effective against HIV. You can use it to clean reusable toys and disinfect surfaces that may have come into contact with infected body fluids. 
• Always use sterile syringes and injecting equipment and dispose of them safely. You can use this website to find your nearest Needle Syringe Program (NSP).
• Regular sexual health screening can help detect other STI, which may increase your risk of getting HIV. You can view a list of sex worker-friendly sexual health clinics on our Where To Test page.

Treatment as Prevention (TasP)

Treatment as Prevention (TasP) is the use of specific medication to prevent the transmission of HIV to sexual partners.

HIV treatments ensure that a person living with HIV’s immune system remains healthy and reduces the risk of disease progression associated with HIV. These treatments can suppress the levels of HIV (viral load) in a person’s blood and other bodily fluids to ‘undetectable’ levels.

Most people living with HIV in Australia only take one tablet daily, with 2-3 drugs combined.

Several recent trials (HPTN052, PARTNER, and the Australian study Opposites Attract) have confirmed that Treatment as Prevention is effective at preventing HIV transmission. In these studies, there were no cases of HIV transmission among couples where one partner was HIV-positive and the other negative, where the HIV-positive partner’s viral load was undetectable. 

There is ZERO risk of HIV transmission from someone on HIV treatment with an undetectable viral load.

Pre-Exposure Prophylaxis (PrEP)

HIV Pre-Exposure Prophylaxis (PrEP) is the regular use of HIV medications by HIV-negative people to reduce their risk of getting HIV. 

See our PrEP page or contact your local sex worker peer organisation for more information.

Post Exposure Prophylaxis (PEP)

Post Exposure Prophylaxis (PEP) is for HIV-negative people potentially exposed to HIV. PEP is a month-long course of HIV medication that, if taken within 72 hours (3 days) of exposure to HIV, can significantly reduce the chance of getting HIV after a risk exposure like a condom breakage or removal. 

See our PEP resource or contact your local sex worker peer organisation for more information.

Testing 

The only way to know your HIV status is through testing. Here’s some information about testing for HIV. 

You can view a list of sex worker-friendly sexual health clinics on our Where To Test page.

Testing Method

• You can test for HIV by getting a blood test from your GP or a sexual health clinic. 
• Rapid testing is available in some places. This test either collects blood using a finger pinprick or takes a saliva sample. Rapid testing can give you a result within 10 to 20 minutes, but a positive result will always need to be confirmed by another blood test. 
• Self-testing (also known as home testing) uses a finger-prick blood test. Like rapid testing, this can give you a result within 10 to 20 minutes, but a positive result will always need to be confirmed by a laboratory blood test. There is currently only one HIV self-test approved for sale in Australia. For more information, see the AFAO HIV Self-test Fact Sheet.

When to Test

• Self-testing (also known as home testing) uses a finger-prick blood test. Like rapid testing, this can give you a result within 10 to 20 minutes, but a positive result will always need to be confirmed by a laboratory blood test
• Test at least twice a year as part of routine sexual health screening.
• Most people who get HIV will test positive within 1 month. For a small number of people, it could take up to 3 months to show up on a test. 

Other Info

• Public sexual health clinic testing is bulk billed. The test will most likely be free if you don’t have Medicare. For more information on HIV testing when you don’t have Medicare, visit the Multicultural HIV and Hepatitis Service’s Testing Options page.
• You may pay a fee or be bulk billed if you see a GP. 
• Early diagnosis is very important and can stop you from developing long-term health issues.
• HIV is most infectious during the ‘window period’ (the time between when you had contact with the virus and when the virus reliably shows up on a test). 

Treatment

There is no cure for HIV, but treatment can stop the virus from progressing and prevent transmission. This creates a better quality of life for people living with HIV. 

Here’s what you need to know about treating HIV.

Treatment Method/s

• Antiretroviral medication (ART)
  • HIV treatment is effective when taken correctly. It needs to be taken for life. 
  • Usually, a person living with HIV will be prescribed a few different antiretroviral medications at the same time. 
  • Most people living with HIV in Australia only take one tablet daily, with 2-3 drugs combined.
  • Long-acting injectable HIV treatment is a medication for HIV that is injected every few weeks rather than a daily pill. Like all medications, these newer drugs have their own advantages and disadvantages, and you and your doctor should decide what is best for you. Read more about long-acting injectable HIV treatment here.

Costs and Other Information 

• If you have a Medicare card, treatment can be accessed through the Pharmaceutical Benefits Scheme (PBS) at a lower cost.
• Some states also cover the remaining cost, making treatment free for people living with HIV.
• In 2022, the government committed to providing people living with HIV who are ineligible for Medicare to access their treatment free of charge through government-funded hospital pharmacies. Contact NAPWHA if you are looking for support accessing treatment without Medicare. 
• A doctor specialising in HIV is the best person to talk to about treatments. If your doctor does not have experience with HIV, make an appointment to see a doctor at a sexual health clinic.
• Treatment greatly reduces the risk of transmission of HIV from mother to baby during pregnancy.
• Most people living with HIV achieve an undetectable viral load within 1 to 6 months of starting treatment when taken as prescribed.

If you have been diagnosed with HIV, support and information services are available in each Australian state and territory. You can also contact your local sex worker peer organisation for more information. 

How might this impact my work? 

Practical Considerations

• There are no visible signs of HIV to look for when checking clients.
• The only way to know your HIV status is through testing.
• Sex workers living with HIV can live full and healthy lives but may be impacted by stigma and laws that criminalise sex working with HIV. Peer support can be really helpful. There are sex worker peer organisations and PLHIV (people living with HIV) community-led organisations in every state and territory. 
• Most people living with HIV achieve an undetectable viral load within 1 to 6 months of starting treatment when taken as prescribed.
• If you are diagnosed with HIV, you do not have to wait until you have an undetectable viral load to have sex. Taking appropriate precautions such as using condoms and dams with lube, having partners taking PrEP, being aware of the blood and fluid exchange, and having regular sexual health screening can significantly reduce your risk of transmitting HIV to others.
• People living with HIV may experience menopause a little earlier than those who are HIV-negative, which can impact having sex. You can speak with your doctor or other sex workers about sex and menopause.
• People living with HIV often experience more difficulty maintaining an erection than the general population.
• Some HIV medications can either increase or decrease the levels of erectile dysfunction medication, potentially leading to serious side effects. Speak to your doctor before combining any medications.
• There are possible interactions between some hormonal contraceptives and HIV treatments. Be sure to talk to your doctor if you are going on HIV treatment while taking any birth control hormones. 
• Some people experience anxiety/stress about having sex or experience sexual dysfunction after being diagnosed with HIV. Seeking support from your doctor, local HIV support services, and/or sex worker peer organisations can help. 

Legal and Reporting Considerations

• Some states and territories have laws that criminalise sex working with STIs and/or BBVs, including HIV. There may also be laws about BBV and STI prevention that apply to everyone. See our BBV, STI and the law resource for more information on your jurisdiction and contact your local sex worker organisation to find out more information. The HIV/AIDS Legal Centre (HALC) also provides support and information about HIV-related legal matters. 
• HIV is a national routine notifiable condition, which means that diagnosed cases are confidentially reported to the Commonwealth health department. You can find more information on the requirements for your jurisdiction on our BBV, STI and the Law resource.
• Contact tracing of previous sexual partners (known as ‘partner notification’) is a consideration for some BBV and STI. It should be done with consideration of the unique transmission risk and privacy needs of sex workers. Your local sex worker peer organisation can advise on any partner notification process to ensure it is appropriate for your circumstances.