Sexual & General Health
HIV and AIDS
Frequently Asked Questions
AIDS (Acquired Immune Deficiency Syndrome) is the result of damage to the immune system caused by the virus HIV. Due to this damage, the body is unable to protect itself against 'opportunistic' infections (so called because they are caused by organisms which 'take the opportunity' to cause disease once the immune system has been damaged).
Infection with HIV (Human Immunodeficiency Virus) is necessary for a person to develop AIDS. HIV infects key cells (called CD4 cells) which co-ordinate the immune system's fight against infection, preventing the system from working properly. Although it is clear that HIV has a central role in the development of AIDS, it is not clear exactly what that role is. The human immune system is incredibly complex and there are many ways in which it can be affected by a virus such as HIV.
HIV is present in the blood, seminal fluid (cum) or vaginal fluid of infected people, but can only be passed on to another person if such a fluid gets into his or her bloodstream.
The main ways in which HIV can be transmitted are:
- Through unprotected sex. HIV is unable to pass through good quality condoms.
- Through blood-to-blood contact. This mainly happens through the sharing of injecting equipment amongst drug users. In the past, before screening was introduced in the UK, this also occurred through blood transfusions or from infected blood products, such as those used to treat haemophilia. Very rarely it can happen through occupational accidents amongst healthcare workers, such as �needlestick� injuries.
- From mother to baby during the course of pregnancy, birth or breast-feeding.
Anyone having unprotected sex (anal or vaginal) with an infected person can be infected with HIV. In this country gay men have been disproportionately affected, with around 80% of infections within the UK occurring through sex between men.
There has been much debate about the safety of oral sex. It has been difficult to establish the contribution oral sex makes to HIV transmission, since few people engage only in oral sex.
Oral sex has been shown to be less risky than unprotected anal sex, but this does not mean that it is risk-free. The danger is increased if you have cuts, sores or abrasions in your mouth or gums, or if you have an infection in your mouth or throat that is causing inflammation.
Individuals need to weigh up the risks and decide what they are willing to do. The following can reduce the risk of being infected with HIV through oral sex:
- Get the insertive partner (the one being sucked) to use a condom.
- Stop oral sex before your partner ejaculates in your mouth.
- Reduce the number of people you have oral sex with.
- Stop performing oral sex altogether.
- Only be the insertive partner.
It's also worth bearing in mind that other sexually transmitted infections, such as syphilis and gonorrhoea, can easily be transmitted through oral sex.
Most people who become infected with HIV do not notice that they have been infected. Some have a short illness soon after they become infected called 'sero-conversion illness' (because it coincides with the time blood tests for HIV convert from negative to positive). This illness may take the form of a sore throat, a fever or a rash, or, more rarely, severe illness. Some people report only a mild flu�like illness 2 to 6 weeks after contracting HIV, but others experience an illness serious enough to require hospitalisation.
Initially, any damage caused by HIV has no outward effect. This is called asymptomatic infection, which may last for many months or years. Sometimes people with asymptomatic HIV infection may have swollen lymph nodes, which is called PGL (Persistent Generalised Lymphadenopathy), but this is not a sign of damage in itself. Studies of people with HIV have shown that as time passes, the likelier it is that more severe infections or tumours may develop. However, such statistics reflect population tendencies: individuals have their own responses to HIV which may or may not lead to more severe illness.
The symptoms of symptomatic HIV and AIDS are caused by opportunistic infections, and not directly by HIV itself. Therefore there are a wide range of possible symptoms, which will vary from person to person, so it serves no real purpose to ask the question: what are the symptoms?
HIV can be detected by a blood test that looks for the antibodies caused by HIV (a positive result indicates the presence of HIV). The majority of people produce antibodies by around 45 days after infection, therefore a person who thinks they may have been exposed to HIV should wait three months from the time of the risk before having a test. A test can be taken before this time, but may not provide a reliable result.
An HIV test is not an 'AIDS test' (there is no such thing).
Before coming to a diagnosis of AIDS, doctors look at a variety of symptoms and tests (there is no �test� for AIDS). Doctors will look for one of the opportunistic infections or cancers in the presence of underlying immune deficiency.
There is no cure that will eliminate HIV from an infected person's body, but the development of new and improved treatments both for the opportunistic infections and the underlying HIV infection have dramatically improved the average prognosis of those living with HIV.
The most significant developments in HIV treatment have occurred since 1995. Substantial reductions in death rates among HIV-positive people have been reported in the (usually wealthier) countries where infected people have access to the latest drug therapies. These drugs can delay or prevent progression to AIDS, and even those with very advanced disease have experienced remarkable recoveries.
A CD4 count measures the level of CD4 immune cells in a person's blood. A viral load count measures the level of cells infected with HIV in a person's blood.
Generally speaking, the higher the CD4 count (and the lower the viral load count), the healthier a person is likely to be. These blood counts are used by doctors to help them determine the health of a person's immune system, and to help plan appropriate treatment.
Some 'strains� of HIV are believed to have become resistant to certain drugs used to fight them. A resistance test is usually carried out prior to starting treatment to determine if a person is infected with one of these strains.
HIV testing is available from clinics and sexual health departments across the country (see our sexual health service guide). It normally takes a week before you receive the result of the test, but some clinics provide a same day or one hour service. Your GP will not be informed of the test result without your consent.
- Use good quality condoms during sex.
- Do not share needles if injecting drugs.
PEP stands for Post Exposure Prophylaxis (PEPSE stands for Post Exposure Prophylaxis following Sexual Exposure). It involves taking a course of anti-HIV drugs (usually lasting a month) soon after exposure to HIV in an attempt to prevent infection. The hope is that the drugs inhibit HIV from reproducing before it can enter cells and establish infection in the body. For it to be effective, PEP needs to be started within 72 hours of exposure. It can cause side effects such as diarrhoea, nausea and headaches, and does not guarantee preventing HIV infection. To find out more, visit CHAPS's PEP information site at www.pep.chapsonline.org.uk.