HIV/AIDS

Even though AIDS has been in the news for over 20 years, many people are still unsure of the facts, of what puts them at risk, and of how to keep themselves safe.

WHAT IS IT?
42,000,000 people are living with HIV/AIDS. Of them, 980,000 live in the United States. Each day, 14,000 new people get HIV worldwide. Every 10 seconds, another person with HIV dies.

HIV stands for Human Immunodeficiency Virus. These three letters are helpful to understanding how the disease is transmitted and what it does. “Human” means that the virus can only be passed from human to human – so people can’t get it from mosquitoes, or monkeys, or anything else that isn’t human. “Immunodeficiency” describes what the virus does in the body – it attacks the immune system, the system that helps people fight off diseases and infections. “Virus” refers to what type of organism it is.

HIV is the virus that causes AIDS. AIDS is not a separate illness. AIDS is a diagnosis. The acronym AIDS stands for Acquired Immune Deficiency Syndrome. “Acquired” simply means that a person has to do something (namely, contract HIV) to get it. “Immune” and “Deficiency” describe what happens to the body after HIV infection. “Syndrome” means that there are a number of symptoms.

In the United States, some of the first people to get HIV were men who had sex with other men, people who injected drugs, and people who regularly received blood transfusions (like hemophiliacs). We know now, however, that who you are doesn’t determine whether or not you will get HIV. Whether or not you will get HIV depends on what you do.

HOW IS IT TRANSMITTED?
Certain bodily fluids of HIV-infected people transmit HIV. Waste fluids [like urine (pee), sweat, saliva (spit), and tears] don’t contain enough virus to transmit it. The only bodily fluids that can transmit HIV are blood, semen, vaginal secretions, and breast milk.

HIV can be transmitted when any of these fluids are exchanged. There are three main ways that HIV is transmitted:
1. Through unprotected sexual intercourse of any type, whether it is oral,
anal, or vaginal.
2. By sharing needles of any sort, whether those needles are used to inject
drugs, for piercing or tattoos, or for anything else.
3. From an HIV+ mother to her child. This can occur while she is pregnant, during birth, or during breast-feeding.
Early in the epidemic, many people got HIV from blood transfusions. Beginning in 1985, however, all the blood that is donated in the United States is checked for HIV. It is perfectly safe to give blood and now extremely safe to receive it.

WHAT ARE THE SYMPTOMS?
Of all the people living with HIV in the United States, it is estimated that 1/3 of them do not know that they are infected with the virus. Most people who have HIV look and feel perfectly fine.

Because it’s possible to have HIV without being sick, many people do not know they’ve got the virus. Often, they don’t get tested until they start showing symptoms, which doesn’t usually occur until they’ve had HIV for a while.

Unfortunately, many symptoms of HIV are similar to symptoms of other, less serious illnesses, like the flu. Usually, what alerts people they have something more than just a nasty case of the flu is that the symptoms tend to be chronic (long-lasting) and severe. Common symptoms of HIV infection include:

o Fever
o Recurring yeast infections in the throat or vagina
o Diarrhea
o Night sweats
o Nausea (upset stomach) and vomiting (throwing up)
o Fatigue (tiredness).

It’s best that people with HIV start to get treatment and help as soon as possible.

HIV is the virus that causes AIDS. Only a doctor or health care professional can determine whether or not a patient has AIDS. A clinician will give an AIDS diagnosis if a person is HIV-positive and has a T-cell count of 200 or less. Some clinicians also use the presence of an “opportunistic infection” to diagnose AIDS. T-cells are the cells in a person’s body that help fight off diseases. People with healthy immune systems usually have T-cell counts between 800-1200. If a person is HIV+ and their T-cell count drops below 200 (even if it goes back up), they have AIDS. People with very low T-cell counts can get things called “opportunistic infections.” These are rare diseases that people with healthy immune systems don’t usually get. There is a long list of opportunistic infections, including things like Kaposi’s Sarcoma (a type of skin cancer), Pneumocystis Carinii Pneumonia, certain leukemias, and other illnesses.

WHAT ABOUT HIV TESTING?
All people who have ever engaged in a behavior that could transmit HIV should get tested.

Most areas offer HIV testing that is free, confidential (they know your name but they can’t tell anyone without your permission), or anonymous (they never know your name). There is also a home test kit that can be bought at most drug stores (for about $50) that allows a person to collect their own blood for HIV testing. The blood is mailed to a lab and the person obtains their test results over the phone.

Most HIV test sites use blood or saliva to determine whether or not someone is HIV-positive. A few sites use urine (pee). These tests check for the antibodies to HIV, not for the virus itself. When a person encounters a germ of any sort, their immune system begins working immediately to fight it off by making ‘antibodies.’ When people get HIV, their immune system begins developing antibodies to it. If these antibodies are present in the body fluids of a person, we know that they have HIV in their system. There are tests that can count the actual number of HIV viruses in a person’s body, but those are not performed until the person is determined to be HIV-positive.

Only a test can tell whether or not someone has HIV. There is no other way to know for sure. Because the tests check for antibodies and not the actual virus, it can take some time after a person is infected for their body to produce enough antibodies that the test can detect them. This time is called the “window period.” Most people develop a detectable amount of antibodies within 3-6 months of infection. Think of it this way: a negative HIV-antibody test today is proof that the person didn’t have HIV 6 months ago. This means that if someone had unprotected intercourse on a Tuesday and went to get an HIV test on Wednesday, that test would not tell them anything about whether or not they contracted the virus the night before. People that are sexually active or share needles should consider getting tested at least once a year or more frequently than that.

People who get HIV tests at clinics generally receive counseling before and after the test. If the test result is negative (they don’ t have HIV), the counseling session will focus on how they can continue to keep themselves safe. If the test is positive (they have been infected with HIV), the counseling session is more involved than that. The test site counselor will help them deal with the news and also assist them in locating health care and other resources they might need. Depending on where they live, the counselor may also help them with the task of ‘partner notification’ – the process where people who the HIV+ person can identify as partners (either for sex or needle-sharing) are told that someone (they are not given a name) with whom they have had sex or shared needles is HIV-positive.

HOW IS IT TREATED?
There is no cure for HIV or AIDS. Scientists, doctors, and researchers are working to develop medicines that will cure the disease or vaccines that will prevent it, but these are a long way off.

For people that are already living with HIV, there are a number of medications available that help manage the disease. A lot of HIV+ people have had a great deal of success using “drug cocktails” (combinations of two or more different kinds of medications) to keep themselves well. Other people cannot take the medications, either because they cannot afford them (prescriptions for managing HIV can cost thousands of dollars a month) or because they experience too many negative side effects from the drugs. Some people with HIV choose not to take the medications at all. It is important to remember that people who are taking medications to control their HIV are still HIV+ and can still pass the disease to other people if they engage in risky behavior.

Even though there is no cure, it is possible for HIV+ people to live for a long time with the disease, and live well.

HOW CAN I PROTECT MYSELF FROM IT?
The only way to be totally safe from HIV is to avoid engaging in any behaviors that could possibly put a person at risk by abstaining from all forms of sexual intercourse, never sharing needles for anything, etc.

There are a number of things people can do to protect themselves from HIV. The ones that are printed in bold are 100% safe. Everything else is safer than using no protection, but does not guarantee protection from HIV.

o Avoiding all forms of sexual intercourse – oral, anal, and, vaginal
o Choosing to be sexual only with one other person who is not infected with HIV and who is only being sexual with them
o Using condoms or latex barriers for every act of intercourse – oral, anal, and vaginal. Condoms provide excellent (though not 100% effective) protection against HIV.
o Never using needles for any reason
o Using only sterile needles
o Getting tattoos and piercings from professionals only
o Being tested for HIV as often as needed
o Communicating with all needle-sharing and sexual partners about their history, including testing for HIV

People who use needles for drugs, tattoos, or piercing should make sure they never share needles with anyone else. If someone is going to get a tattoo or piercing done, they should make sure the person doing it is a professional. They should be able to see that the needles being used have never been used before (or that they have been properly sterilized) and they should also be able to see them being disposed of after use. If a person decides to share needles with other people for that reason, the needles should be cleaned before and after each use. To clean a syringe, rinse it three times with water, three times with bleach, and another three times with water. This can help reduce the risk of HIV transmission.

Women who are pregnant or thinking about becoming pregnant should get an HIV test. If an HIV+ woman is pregnant, there are medications she can take to reduce the risk of passing HIV on to the fetus while they during pregnancy. During childbirth, HIV+ women are encouraged to deliver by Caesarean section (C-section) because there is less blood involved, which also helps reduce the risk to the fetus. After delivery, women who have HIV are advised not to breastfeed. It is important to realize that an HIV+ will not always give birth to an HIV+ child. Without medication, there is a 20-30% chance that an HIV+ mother will give birth to an HIV+ baby. If the mother takes appropriate medication during her pregnancy, however, that risk drops to 8-15%.

Besides knowing how HIV is spread, it is also important to know how it is not spread. Casual contact – hugging, dry kissing, shaking hands, sharing food, using water fountains, swimming in public pools, etc. – holds no risk for HIV-transmission. No one has ever gotten HIV from playing contact sports. No one has ever gotten HIV from caring for a sick family member. People often ask whether or not it’s possible to get HIV from ‘French kissing.’ It’s not likely, but the CDC (Centers for Disease Control and Prevention) advises against prolonged, deep kissing with someone who is known to be HIV-positive because there is a chance that tiny cuts or sores in the mouth could result, making it possible for blood-to-blood contact to occur.