Human Immunodeficiency Virus (HIV) is a major global public health issue, having claimed 36.3 million lives so far. There is currently no cure for HIV, but with proper medical care, HIV can be controlled. This year’s focus for HIV/AIDS awareness is normalizing and de-stigmatizing HIV so that we can Stop HIV Together.
What is HIV?
HIV is a virus that attacks the body’s immune system by destroying important cells that fight disease and infection. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). While there is currently no effective cure for HIV, advances in medical care have allowed those living with HIV to live long and healthy lives while protecting their partners.
Where did HIV come from?
HIV infections in humans came from a type of chimpanzee in Central Africa; this version of the virus (called simian immunodeficiency virus, or SIV) was probably passed to humans when humans hunted these chimpanzees for meat and came in contact with their infected blood.
Studies show that HIV may have jumped from chimpanzees to humans as far back as the late 1800s. Over decades, HIV slowly spread across Africa and later into other parts of the world. We know that the virus has existed in the United States since at least the mid to late 1970s.
How do I know I have HIV?
The only way to know for sure whether you have HIV is to get tested. Knowing your HIV status helps you make healthy decisions to prevent getting or transmitting HIV.
Currently there are 3 types of HIV tests available: nucleic acid tests (NAT, antigen/antibody tests, and antibody tests. HIV test are typically performed on blood or oral fluid and may also be performed on urine.
A NAT looks for the actual virus in the blood and involves drawing blood from a vein. The test can either tell if a person has HIV or tell how much virus is present in the blood (known as HIV viral load test). While a NAT can detect HGIV sooner than other types of tests, this test is very expensive and not routinely used for screening individuals unless they recently had a high-risk of exposure or a possible exposure and have early symptoms of HIV infection.
An antigen/antibody test looks for both HIV antibodies and antigens. Antibodies are produced by your immune system when you’re exposed to viruses like HIV. Antigens are foreign substances that cause your immune system to activate. If you have HIV, an antigen called p24 is produced even before antibodies develop. Antigen/antibody tests are recommended for testing done in labs and are now common in the United States. This lab test involves drawing blood from a vein, and there is also a rapid antigen/antibody test available that is done with a finger prick.
HIV antibody tests only look for antibodies to HIV in your blood or oral fluid. In general, antibody tests that use blood from a vein can detect HIV sooner after infection than tests done with blood from a finger prick or with oral fluid. Most rapid tests and the only currently approved HIV self-test are antibody tests.
Are there Symptoms of HIV?
Some people have flu-like symptoms within 2 to 4 weeks after infection (called acute HIV infection). These symptoms may last for a few days or several weeks. Possible symptoms include:
Swollen Lymph Nodes
It’s important to note that some people may not feel sick during acute HIV infection. These symptoms also do not necessarily mean you have HIV as other illnesses cause these same symptoms.
What are the Stages of HIV?
When people with HIV don’t get treatment, they typically progress through three stages of infection. However, HIV medicine can slow or prevent progression of the disease. With the advancements in treatment, progression to Stage 3 is less common today than in the early days of HIV.
Stage 1: Acute HIV Infection
In this stage newly infection people have a large amount of HIV in their blood and are very contagious. Some people will exhibit flu-like symptoms as this is the body’s natural reaction to infection. However, some people may not feel sick right away or at all. At this point only antigen/antibody tests or nucleic acid tests (NATs) can diagnose acute infection.
Stage 2: Chronic HIV Infection
This stage is also called asymptomatic HIV infection or clinical latency as HIV remains active in the body but reproduces at very low levels. People may not have any symptoms or get sick during this phase, and without taking HIV medication, this period may last a decade or longer, while some may progress faster. People in this stage can transmit HIV, and by the end of this stage the amount of HIV in the blood (called viral load) goes up and the CD4 cell count goes down. The person may then exhibit symptoms as the virus levels increase in the body, and the person moves into Stage 3. It’s important to note that people who take HIV medicine as prescribed during this phase have a better chance of never moving into Stage 3.
Stage 3: Acquired Immunodeficiency Syndrome (AIDS)
The most severe phase of HIV infection is when those living with HIV are officially diagnosed with Acquired Immunodeficiency Syndrome or AIDS. At this point those living with HIV will have a CD4 cell count below 200 cells/mm, or develop certain opportunistic infections. People with AIDS can have a high viral load and be very infectious as their immune systems have become severely damaged and can no longer stave off severe illnesses. Without treatment, people with AIDS typically survive about three years.
Ways HIV Can Be Transmitted
Most people who get HIV get it through anal or vaginal sex, or sharing needles, syringes, or other drug injection equipment (for example, cookers). Anal sex is the riskiest type of sex for getting or transmitting HIV and that’s because the rectum’s lining is thin and may allow HIV to enter the body during anal sex. Being the receptive partner (bottom) is riskier for getting HIV than being the receptive partner (top). However, the top is also at risk because HIV can enter the body through the opening at the tip of the penis (or urethra), the foreskin if the penis isn’t circumcised, or small cuts, scratches, or open sores anywhere on the penis.
Vaginal sex is also a common way to get or transmit HIV especially when not using protection (like condoms or medicine to treat or prevent HIV). Vaginal sex is less risky for getting HIV than receptive anal sex, however either partner can get HIV during vaginal sex. Most women who get HIV get it from vaginal sex, because HIV can enter a woman’s body through the mucous membranes that line the vagina and cervix. Men can also get HIV during vaginal sex through the vaginal fluid and through blood which can carry HIV.
It’s important to note that HIV does not survive long outside the human body (such as on surfaces), and it cannot reproduce outside a human host. Despite common misconceptions HIV cannot be transmitted by:
Mosquitoes, ticks, or other insects
Through saliva, tears, or sweat
Hugging, shaking hands, sharing toilets, sharing dishes, or closed-mouth or “social” kissing with someone who has HIV
Through sexual activities that don’t involve the exchange of body fluids (for example, touching)
Or through the air.
Factors that Increase HIV Risk
The higher someone’s viral load, the more likely that person is to transmit HIV. Viral load is the amount of HIV in the blood of someone who has HIV. The Viral Load is highest during the acute phase of HIV, and without HIV treatment. This is why it’s important for anyone who is exposed or might possibly have HIV to begin treatment right away as HIV medicine can make the viral load very low – so low that a test can’t detect it (called an undetectable viral load). People with HIV who keep an undetectable viral load (or stay virally suppressed) can live long, healthy lives. Having an undetectable viral load also helps prevent transmitting the virus to others through sex or sharing needles, syringes, or other injection equipment, and from mother to child during pregnancy, birth, and breastfeeding.
Alcohol and drug use is also a major risk factor for getting or transmitting HIV, because when you’re drunk or high, you’re more likely to engage in risky sexual behaviors like having sex without protection. Being drunk or high affects your ability to make safe choices. Drinking alcohol, particularly binge drinking, and using “club drugs” can alter your judgement and lower your inhibitions, and impair your decisions about sex and drug use. You may be more likely to have unplanned sex, have a harder time using a condom the right way every time you have sex, have more sexual partners, or use other drugs when you’re under the influence. If you’re going to a party or another place where you know you’ll be drinking or using drugs, you can bring a condom so that you can reduce your risk of getting or transmitting HIV when engaging in vaginal or anal sex. In general, it is best for your overall well-being to cut down on drinking or using drugs, and important to seek out medical help to identify ways to reduce risky behaviors such as alcohol and drug abuse that could put you at risk of getting or transmitting HIV.
HIV can also be transmitted from a mother to her baby during pregnancy, birth, or breastfeeding. However, it is less common because of advances in HIV prevention and treatment. Transmission between mother and child is also referred to perinatal transmission, and is the most common way that children get HIV. Recommendations to test all pregnant women for HIV and start HIV treatment immediately have lowered the number of babies who are born with HIV. If a mother with HIV takes HIV medicine daily as prescribed throughout pregnancy and childbirth, and gives HIV medicine to her baby for 4 to 6 weeks after giving birth, the risk of transmitting HIV to the baby can be less than 1%.
Over the past several decades there have been key medical breakthroughs that have advanced the treatment and control of HIV to prevent this deadly virus from spreading. Pre-exposure prophylaxis (or PrEP) is medicine taken to prevent getting HIV and is highly effective for preventing HIV when taken as prescribed. PrEP can reduce the risk of getting HIV from sex by about 99% while it reduces the risk of getting HIV from injection drug use by at least 74%. Since PrEP only protects against HIV, condom use is still important for the protection against other STDs.
PEP or Post-Exposure prophylaxis is the use of antiretroviral drugs after a single high-risk event to stop HIV seroconversion. PEP must be started as soon as possible to effective – and always within 72 hours of possible exposure.
Antiretroviral therapy or (ART) involves taking medicine that reduces the amount of HIV in the body. Although there is no effective cure for HIV, proper medical care can control HIV so that transmission is less likely. Most people who begin HIV treatment can get the virus under control within six months and go on to live long and happy lives. This is why it is important to start treatment as soon as possible after diagnosis. HIV medicine is recommended for all people living with IV, regardless of how long they’ve had the virus or how healthy they are. Delaying treatment will allow HIV to continue to harm the immune system and puts you at higher risk of developing AIDS.
HIV stigma is rooted in a fear of HIV and the many ideas and images about HIV that first appeared in the early 1980s. Today, there are still misconceptions about how HIV is transmitted and what it means to live with HIV. The lack of information and awareness combined with outdated beliefs lead people to fear getting HIV. Additionally, many people think of HIV as a disease that only certain groups get. This leads to negative value judgements about people living with HIV.
HIV stigma and discrimination affect emotional well-being and mental health of people living with HIV, because they often internalize the stigma they experience and begin to develop a negative self-image. They may fear they will be discriminated against or judged negatively if their HIV status is revealed.
“Internalized stigma” or “self-stigma” happens when a person takes in the negative ideas and stereotypes about people living with HIV and start to apply them to themselves. HIV internalized stigma can lead to feelings of shame, fear of disclosure, isolation, and despair. These feelings can keep people from getting tested and treated for HIV.
Screening for HIV
Approximately 1.1 million persons in the United States are currently living with HIV according to the United States Preventative Services Task Force (USPSTF), and more than 700,000 persons have died of AIDS since the first cases were reported in 1981. The estimated prevalence of HIV infection among persons 13 years and older in the United States is 0.4% (0.7% in males and 0.2% in females). Data from the Centers for Disease Control and Prevention (CDC) 2017 HIV Surveillance Report show a significant increase in HIV diagnoses starting at age 15 (compared with ages 13-14 years). While the annual number of new cases of HIV infection diagnosed in the United States has decreased slightly in recent years, from about 41,200 new cases in 2012 to 38,300 in 2017, approximately 15% of persons living with HIV are unaware of their infection. This has led to about 40% of transmission of HIV in the United States being from persons who are unaware of their HIV status.
HIV/AIDS remains to be a major public health concern and the best way to prevent the transmission of HIV is by knowing your HIV status. The USPSTF recommends that clinicians screen for HIV infection in all pregnant persons, including those who present in labor or at delivery whose HIV status is unknown. For adolescents and adults aged 15 to 65 years of age, the USPSTF recommends that clinicians screen for HIV infection especially for those who are at increased risk of infection.
Let’s Stop HIV Together
Although gay and bisexual men are the most at-risk group for getting and transmitting HIV, it’s important to remember that HIV is indiscriminate and one can get HIV regardless of your background or sexual orientation. Misconceptions and misinformation regarding HIV can be dangerous because it allows certain groups to be less cautious when engaging in behaviors that still carry a slight risk for getting and transmitting HIV. That is why it’s important to talk openly about HIV because it can help normalize the subject and provide opportunities to correct misconceptions and help others learn more about HIV. However, it is also important to be mindful of how you talk about HIV and people living with HIV so as not to further stigmatize the subject.
We can all help end HIV stigma through our words and actions in our everyday lives by leading others with your supportive behaviors. For tips on what you can do when you witness stigma check out the Let’s Stop HIV Together scenarios page from the Centers for Disease Control and Prevention. For more information about HIV, you can also check out these resources below: