How You Become Infected
There is HIV virus in body fluids like vaginal secretions and semen. If those fluids are present, they can enter the bloodstream of someone who doesn’t have HIV through an opening such as a mouth sore or a genital ulcer.
Your chances are higher of getting HIV if you:
What Is An Undetectable Viral Load
- Taking antiretroviral treatment reduces the amount of HIV in your body.
- With proper adherence, ART can reduce HIV to such low levels that the virus can no longer be detected in normal blood tests. This is called having an undetectable viral load.
- People with undetectable viral loads cant pass HIV on through sex.
- To know that youre undetectable, you must have your viral load monitored regularly.
- Remember your viral load can change. If you stop taking your treatment properly your viral load will go up again.
Ways Hiv Can Be Transmitted
How is HIV passed from one person to another?
Most people who get HIV get it through anal or vaginal sex, or sharing needles, syringes, or other drug injection equipment . But there are powerful tools that can help prevent HIV transmission.
Can I get HIV from anal sex?
You can get HIV if you have anal sex with someone who has HIV without using protection .
- Anal sex is the riskiest type of sex for getting or transmitting HIV.
- Being the receptive partner is riskier for getting HIV than being the insertive partner .
- The bottoms risk of getting HIV is very high because the rectums lining is thin and may allow HIV to enter the body during anal sex.
- The top is also at risk because HIV can enter the body through the opening at the tip of the penis , the foreskin if the penis isnt circumcised, or small cuts, scratches, or open sores anywhere on the penis.
Can I get HIV from vaginal sex?
You can get HIV if you have vaginal sex with someone who has HIV without using protection .
Can HIV be transmitted from a mother to her baby?
HIV can 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.
Can I get HIV from sharing needles, syringes, or other drug injection equipment?
You are at high risk for getting HIV if you with someone who has HIV. Never share needles or other equipment to inject drugs, hormones, steroids, or silicone.
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Are There Any Side Effects To Being On Hiv Medicines
HIV medicines can cause side effects for some people. Most are manageable. Fortunately, there are numerous HIV medicines available today that people can take without serious side effects. If you do experience any side effects it is important to discuss these with your healthcare provider.
Hiv Undetectable=untransmittable Or Treatment As Prevention
In recent years, an overwhelming body of clinical evidence has firmly established the HIV Undetectable=Untransmittable, or U=U, concept as scientifically sound. U=U means that people with HIV who achieve and maintain an undetectable viral loadthe amount of HIV in the bloodby taking antiretroviral therapy daily as prescribed cannot sexually transmit the virus to others. Thus, treatment for HIV is a powerful arrow in the quiver of HIV prevention tools. Read more about how a durably undetectable viral load prevents HIV transmission with NIAIDs fact sheet 10 Things to Know About HIV Suppression.
For nearly two decades, scientists have recognized that viral load is a key determinant of HIV transmission. Studies conducted before the availability of ART revealed that higher viral loads correlate with higher rates of both sexual and perinatal transmission of HIV. Following the advent of triple-drug ART in 1996, observational studies suggested that viral loads lowered by ART were associated with reduced risk of sexual and perinatal HIV transmission. In addition, epidemiological studies showed that as the number of people in a community who are virally suppressed rises, the number of new HIV transmissions falls.
To read more about the underlying science and the value of U=U, see NIAIDs blog post Science Validates Undetectable=Untransmittable HIV Prevention Message.
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Sex Toys Fingering Fisting And Hiv
Sex toys, such as dildos, come into direct contact with rectal/vaginal fluids and mucous membranes. This means sharing an uncleaned dildo or other toy can pass on HIV. Using sex toys on your own has no risk.
There is no direct risk of HIV from fingering or fisting , but be aware of being rough. Damage to anal/vaginal tissues, especially if there is any bleeding, will increase risk of HIV transmission if you then have anal, vaginal or oral sex later.
If You Swallow The Semen Of An Hiv
The risk of acquiring HIV during oral sex is pretty low, but it isn’t zero. Taking your partner’s ejaculate in your mouth appears to make transmission more likely. Almost all of the individuals who say that oral sex must have been the way they acquired HIV and whose cases have been medically evaluated mention that they took ejaculate in the mouth.
It isn’t actually the swallowing that matters, it’s probably having the ejaculate in your mouth . In the stomach, digestive enzymes and acidity may inactivate HIV.
But the risk of acquiring HIV during vaginal or anal sex is far, far higher than during oral sex. It’s also worth remembering that when a person with HIV receives antiretroviral treatment, the amount of HIV in his body fluids falls dramatically. Put simply there will be very little HIV in his semen, so transmission is highly unlikely. This applies to all forms of sex, including oral sex.
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Viral Load And Hiv Transmission
A low viral load means a person is less likely to transmit HIV. But its important to note that the viral load test only measures the amount of HIV thats in the blood. An undetectable viral load doesnt mean HIV isnt present in the body.
Its also possible to transmit HIV to partners by sharing needles. Its never safe to share needles.
HIV-positive people may also want to consider having an open and honest discussion with their partner. They can ask their healthcare providers to explain viral load and the risks of HIV transmission.
Does Hiv Treatment Always Work
About one in six people on their first HIV treatment regimen either never have an undetectable viral load or their treatment stops working in the first year. During the second year on treatment, the chance of your therapy ceasing to work is about one in twenty and this declines further over the next decade to about a one-in-fifty chance of failure in any one year.
So, the longer youve been on a particular HIV therapy, the less likely it is to stop working. Almost everyone who goes on to a second or third regimen reduces their viral load to an undetectable level.
If someones treatment does not result in viral load becoming undetectable, this is usually because they are having problems taking their treatment as prescribed, i.e. they dont take all their pills at the right time, without missing doses. Occasionally missing a dose of medication is unlikely to cause your viral load to become detectable again, but frequently missing doses may lead to a detectable viral load and should be avoided.
If you are having problems sticking with your treatment, talk to your doctor and they may be able to find a drug combination that suits you better.
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Testing Positive On Hiv Antibody Tests
Since the early days of the HIV epidemic, we have used antibody tests to test for HIV. Antibody tests are the most affordable and accessible HIV tests. They are the most common types of HIV tests at testing sites around the world because they provide rapid, on-the-spot results.
Antibody tests do not detect HIV. Instead, they detect antibodies that the immune system produces in response to HIV infection.
WHAT ARE ANTIBODIES?
Our immune systems develop antibodies in response to all kinds of pathogens. Anytime you get sick or get any kind of infection, your body builds up a defense system and creates antibodies to try and fight that specific infection off. If these antibodies are successful, some infections will go away but the antibodies never do. They will remain in your body, helping to protect you from getting the same infection in the future.
In this way, antibodies allow our bodies to remember a specific infectious agentlike a particular strain of the fluand then respond to it more quickly if exposed to it again in the future. Once we develop antibodies to a virus we may have those antibodies for life or for many years.
HIV ANTIBODIES WHEN YOURE UNDETECTABLE
What Does This Mean For Reproductive Health Such As Conception Pregnancy And Breastfeeding/chestfeeding
Knowing that an undetectable viral load prevents HIV transmission through sex may be especially useful for people wishing to conceive a baby without using assisted reproduction methods. An undetectable viral load also dramatically reduces the risk of transmission during pregnancy, birth, or breastfeeding. For more information on HIV and reproductive health, such as pregnancy and breastfeeding/chestfeeding, please refer to the sources below.
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More Sensitive Viral Load Testing
In NSW we now have more sensitive viral load testing, which means laboratories across the state can detect small amounts of the virus as low as 20 copies/mL. For HIV positive guys this means that they may see some change from their previous viral load readings from below 20 copies/mL a new, potentially higher number. This should not be a cause for concern as any viral load of 200 copies/mL or less is still considered undetectable. A person with this level of viral suppression cannot transmit HIV to their partners, however if you still feel concerned, we recommend speaking with your doctor.
How Do I Explain This To A Sexual Partner
If you have sexual partners who are not living with HIV, explaining U=U to them is likely to be mutually beneficial. If you had previously relied on other means of preventing HIV transmission , you may jointly decide that these methods are no longer necessary because of U=U.
It may take some time for an HIV-negative partner to accept the U=U message and to rely on it as the sole method of preventing HIV. Some HIV-negative people may reject the message or deny its accuracy. It may be helpful to direct your partner to information resources that explain the accuracy and significance of U=U. NAM has also produced a page for people who dont have HIV to help them understand the impact of an undetectable viral load on HIV transmission.
Another option could be for your partner to hear about U=U from a healthcare worker or another reliable and trusted source.
Despite sharing this information, some people may still not accept that U=U. In this kind of situation, it is important to find a balance between providing your partners with information and taking care of yourself.
Many people find it difficult to talk about sex, even with the person who is closest to them. If this is the case, you might want to discuss your concerns with someone at your HIV clinic, sexual health clinic or a support organisation. This can help you clarify your thoughts and what youd like to say.
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After I Begin Hiv Treatment How Long Does It Take For The Risk Of Sexually Transmitting Hiv To Become Effectively Zero
There is effectively no risk of sexual transmission of HIV when the partner living with HIV has achieved an undetectable viral load and then maintained it for at least six months. Most people living with HIV who start taking antiretroviral therapy daily as prescribed achieve an undetectable viral load within one to six months after beginning treatment.
A persons viral load is considered durably undetectable when all viral load test results are undetectable for at least six months after their first undetectable test result. This means that most people will need to be on treatment for 7 to 12 months to have a durably undetectable viral load. It is essential to take every pill every day to maintain durably undetectable status.
How Do You Get Or Transmit Hiv
You can only get HIV by coming into direct contact with certain body fluids from a person with HIV who has a detectable viral load. These fluids are:
- Semen and pre-seminal fluid
- Rectal fluids
- Vaginal fluids
- Breast milk
For transmission to occur, the HIV in these fluids must get into the bloodstream of an HIV-negative person through a mucous membrane open cuts or sores or by direct injection.
People with HIV who take HIV medicine daily as prescribed and get and keep an undetectable viral load have effectively no risk of sexually transmitting HIV to their HIV-negative partners.
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Tattoos And Body Piercings
- There are no known cases in the United States of anyone getting HIV this way.
- However, it is possible to get HIV from tattooing or body piercing if the equipment used for these procedures has someone elses blood in it or if the ink is shared. This is more likely to happen when the person doing the procedure is unlicensed because of the potential for unsanitary practices such as sharing needles or ink.
- If you get a tattoo or a body piercing, be sure that the person doing the procedure is properly licensed and that they use only new or sterilized needles, ink, and other supplies.
How Can Service Providers Improve The Uptake And Correct Use Of Hiv Treatment And An Undetectable Viral Load To Prevent The Sexual Transmission Of Hiv
Educational and counselling activities for people whether they have HIV or are at risk for HIV should include information on the HIV prevention benefits of treatment and an undetectable viral load, along with information on the other highly effective ways to help prevent HIV. These include PrEP, PEP, condoms for sex and new equipment for using drugs. Encourage clients to choose the combination of strategies that will work most effectively for them as there are multiple approaches to HIV and STI prevention that can be combined in different ways. Discuss how the use of HIV treatment to maintain an undetectable viral load fits into a comprehensive plan for sexual health including regular STI testing and safer sex practices.
Education and counselling on the use of this HIV prevention strategy should include a discussion about the large body of evidence showing that people on HIV treatment who maintain an undetectable viral load do not transmit HIV through sex. Education should also include the factors necessary for maximizing the effectiveness of this strategy. Emphasize the following:
You can also lead or support efforts to improve awareness of the use of HIV treatment to maintain an undetectable viral load as a prevention approach among a range of service providers in your area including doctors, nurses, pharmacists and non-clinical staff at community-based organizations.
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How Variable Is An Undetectable Viral Load Can This Change Over Time
HIV specialists have decades of experience managing antiretroviral therapy and are confident that you can remain uninfectious as long as you:
- take your medication every day as prescribed, and
- have your viral load checked regularly.
The presence of other sexually transmitted infections can potentially affect viral load, but in the PARTNER study there were no HIV transmissions even when other STIs were present. Those results held through the PARTNER 2 trial as well.
It is however important to remember that HIV treatment can only be successful if you have access to it and are taking it as prescribed.
Why Undetectable Matters While Living With Hiv
Reaching undetectable can help you live a healthy life with HIV-1. According to the U.S. Department of Health and Human Services , taking HIV treatment every day and getting to and staying undetectable prevents transmitting HIV through sex. That means you can be part of ending the epidemic by preventing the virus from being passed to others.
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About Undetectable And Hiv
Chances are youve probably heard of the term undetectable, undetectable viral load or UVL when chatting to friends or potential sexual partners, on apps or social media, or in blogs, magazines and medical journals.
But, what does it mean?
Having an undetectable viral load not only improves a HIV positive guys overall health, but it also means he wont transmit HIV to his partners. When a HIV positive guy is on treatment, within six months he can, in most cases, achieve an UVL.
Do Viral Blips Increase The Chance Of Transmission
Small transient increases in viral load known as blips sometimes occur on effective ART when people are taking their medication as prescribed by a healthcare provider. After a blip, viral load typically returns to undetectable levels without any change in treatment. Viral blips have not been shown to increase the transmission of HIV. Unless the viral blips start to increase in frequency, they do not mean treatment isnt working and are normally not of concern to healthcare providers. For more information about viral load testing and frequency, please see question 11.
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