How Does Being Durably Undetectable Affect My Risk Of Transmitting Hiv To A Sexual Partner
People living with HIV who take antiretroviral medications daily as prescribed and who achieve and then maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner.
Three large multinational research studies involving couples in which one partner was living with HIV and the other was notHPTN 052, PARTNER and Opposites Attractobserved no HIV transmission to the HIV-negative partner while the partner with HIV had a durably undetectable viral load. These studies followed approximately 3,000 male-female and male-male couples over many years while they did not use condoms. Over the course of the PARTNER and Opposites Attract studies, couples reported engaging in more than 74,000 condomless episodes of vaginal or anal intercourse.
Learn more about HIV treatment as prevention.
Stage : Acute Primary Infection
The early symptoms of HIV can feel like having the flu. Around one to four weeks after getting HIV, you may start to experience these flu-like symptoms. These normally dont last long . You may only get some of the symptoms and some people dont have any symptoms at all.
Symptoms can include:
- joint aches and pains
- muscle pain.
These symptoms happen because your body is reacting to the HIV virus. Cells that are infected with HIV are circulating throughout your blood system. In response, your immune system tries to attack the virus by producing HIV antibodies this process is called seroconversion. Timing varies but once you have HIV it can take your body up to a few months to go through the seroconversion process.
Having these symptoms alone does not mean you definitely have HIV. The only way to know if you have HIV is by taking a test. You should always visit your healthcare professional if youre worried about or think youve been at risk of getting HIV, even if you feel well and dont have any symptoms. They can then arrange for you to get tested.
HIV will not always show up in a test at this early stage, and you may need to test again later to confirm your result . Your healthcare professional will talk to you about the timing of your test and answer any concerns. Its important not delay speaking to a healthcare worker if you are worried about HIV.
Lack Of Symptoms In Early Stages
ARS is common once a person has HIV. Still, this isnt the case for everyone. Some people have HIV for years before they know they have it. According to HIV.gov, symptoms of HIV may not appear for a decade or longer. This doesnt mean that cases of HIV without symptoms are less serious. Also, a person who doesnt experience symptoms could still transmit HIV to others.
Symptoms in early HIV tend to appear if the rate of cell destruction is high. Not having symptoms can mean that not as many CD4 cells, a type of white blood cell, are killed early on in the disease. Even though a person has no symptoms, they still have the virus. Thats why regular HIV testing is critical to prevent transmission. Its also important to understand the difference between a CD4 count and a viral load.
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Hiv Is Detected With A Blood Test
Blood tests are the most common and reliable tests for HIV. The virus is detected by taking a sample of your blood either with a conventional blood test or a rapid test .There is a short period of time between exposure to HIV and the ability for tests to detect HIV or its antibodies. This is often referred to as the ‘window period’ between 2 and 12 weeks.
Most tests used in Australia can detect HIV as early as 2 to 4 weeks after infection.
If your blood test shows that HIV or its antibodies are present, you are HIV-positive.
If you have no antibodies in your blood you are HIV-negative. Sometimes negative results might also mean you are in the window period, so you might need a follow-up blood test to make sure.
Sharing Needles And Injecting Equipment
If you inject drugs, you shouldn’t share needles, syringes or other injecting equipment such as spoons and swabs as this could expose you to HIV and other viruses found in the blood, such as hepatitis C.
Many local authorities and pharmacies offer needle exchange programmes, where used needles can be exchanged for clean ones.
A GP or drug counsellor should be able to advise you about free injecting equipment provision including needles.
If you are having a tattoo or piercing, it’s important that a clean, sterilised needle is always used.
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Hiv Stigma And Discrimination
HIV can prompt intense feelings in people, regardless of their HIV status. It is sometimes viewed with a sense of unacceptability or disgrace. A person with HIV may feel shame and despair about their status. An HIV-negative person may be fearful or angry when they discover someone has HIV. The relationship of these feelings to HIV is referred to as stigma.Felt stigma refers to deep feelings of shame and self-loathing, and the expectation of discrimination. It can have serious negative impacts on the health and wellbeing of people living with HIV by discouraging them from getting tested, receiving support, or taking treatment. It may also lead people to engage in high-risk behaviours that harm their health, and contribute to new HIV infections.Enacted stigma is the experience of unfair treatment by others. For people living with HIV this can be in the form of being treated differently and poorly, or through rejection, abuse, or discrimination.HIV stigma is particularly harmful when it overlaps with other factors that are stigmatised such as if a person uses drugs, is a sex worker, is trans or gender diverse.Breaking down stigma is a community response where:
If you have experienced stigma or discrimination from a health care provider, and are unable to resolve your complaint with them directly, contact the Health Complaints Commissioner
Hiv Testing And Your Rights
Testing for HIV is voluntary and can only be done with your informed consent, except in exceptional circumstances.
Before you are tested, you will be provided with information about what is involved. what the results might mean for you, and how to prevent HIV transmission in the future. All people who request an HIV test must receive this information from the test provider.
Under Australian and Victorian law, it is unlawful to discriminate against anyone who has HIV. Test results, and details on whether someone has been tested are strictly confidential. It is illegal for any information about a person being tested or a person with HIV to be disclosed without their permission.
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What Happens If I Test Positive For Hiv
If your initial test is positive for HIV antibodies, then additional testing is required to confirm that the first one was accurate. Sometimes this involves a second blood test.
When you are first diagnosed you will probably experience strong emotions. During this time, do not try to cope on your own. Seek support by speaking with your doctor, or contact your local community organisation. They have trained peer workers available to help you through the initial stages of a positive diagnosis, but also through your journey of living well with HIV.
Part of testing best practice includes pre- and post-test counselling. Post-test counselling is important, regardless of the outcome. If you test positive, counselling can provide emotional support, further information about living with HIV, and referrals to support services.
If the test is negative, counselling can provide education about HIV and how to reduce your HIV risk in the future. are community organisations that provide support and advocacy for people with HIV. Peer workers are also available to help you navigate living with HIV.
If you have recently been diagnosed with HIV, visit Next Steps for more information.
How Often Do You Need To Get Tested For Hiv
How often you should get tested depends on your personal practices, risk behaviours, and how often you engage in them.
For most people, it is important to have a full sexual health test at least once each year. This testing includes:
- HIV
Even if you always use condoms, it is recommended you get tested annually as condoms dont provide 100% protection against HIV and STIs.
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When To Get Tested For Hiv
FAST FACTS
If you think you might have been exposed to HIV, its best to speak to a healthcare professional immediately.
Even if you dont think you have been at risk, testing regularly is good practice for people who are having sex. Its important to test for HIV during pregnancy. If you know your status, you can avoid passing the virus on to your baby. A window period is the amount of time it takes after infection for a test to give you an accurate result. Its good to know about window periods, but dont delay getting tested if you think you might have been exposed to HIV.
How Common Is Hiv
At the end of 2017, there were an estimated 5099 people in Scotland living with HIV. The majority got the virus through sex.
Around 1 in every 1087 people in the Scotland has HIV, but the three groups with highest rates of HIV are:
- gay and bisexual men or other men who have sex with men
- people from countries with high HIV prevalence, especially sub Saharan African countries
- people who share injecting equipment or who have sex with people who inject drugs
The World Health Organisation estimates that around 36.9 million people in the world are living with HIV.
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What Is Usually The First Sign Of Hiv
The initial presentation of an HIV infection is a flu-like illness which includes:
- Rash
- Swollen lymph nodes: Lymph nodes are a part of the bodys immune system that helps get rid of bacteria and viruses. An HIV infection, like many other infections, can cause the inflammation of lymph nodes, which can be felt as round or nodular swellings in the armpit, groin, and neck. The swelling is often associated with aches and pains in these areas.
How Long Does It Take To See The Signs Of Hiv
The signs and symptoms of HIV may first appear within two to four weeks of infection. The stage in which the symptoms appear is called the stage of acute HIV infection. The symptoms appear due to the resistance or fight of the immune system against HIV. In the initial stage, the virus multiplies rapidly and spreads throughout the body. It targets and destroys the CD4 cells . As a result, the level of HIV in the blood and the chances of transmission at this stage are very high. It is crucial to recognize the early signs and seek medical help, since early diagnosis and treatment of HIV gets the best results.
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Routes Of Hiv Transmission
In Scotland, HIV is most commonly transmitted by having sex with someone who has HIV without using any form of protection, such as HIV PrEP or condoms.
A person with HIV can only pass the virus to others if they have a detectable level of virus. People living with HIV who are taking treatment and have undetectable levels of virus in their bodies can’t transmit HIV to others.
Over 90% of people living with HIV in Scotland have undetectable levels of virus.
The main routes of transmission are unprotected receptive or insertive vaginal and anal sex. The risk of transmitting HIV through oral sex is extremely low.
Other ways of getting HIV include:
- sharing needles, syringes and other injecting equipment
- from mother to baby before or during birth when the mother isn’t taking HIV medication
- from mother to baby by breastfeeding when the mother isn’t taking HIV medication
- sharing sex toys with someone infected with HIV and who isn’t taking HIV medication
- blood transfusion
How To Tell If Symptoms Are Hiv
There are three types of HIV tests:
- An NAT involves drawing blood from a vein. It can tell if you have HIV or how much virus is present in your blood. While an NAT can detect HIV 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 exposure, or a possible exposure and have early symptoms of HIV infection. This test takes several days for results to come back.
- An antigen/antibody test is recommended for testing done in labs and is now common in the United States. It involves drawing blood from a vein, and results take several days to come back. There is also a rapid antigen/antibody test available that is done with a finger prick and takes 30 minutes or less to get results.
- 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. Antibody tests can detect an HIV infection 23 to 90 days after exposure. Most rapid tests and the only currently approved HIV self-test are antibody tests. They take 20 minutes or less to provide results.
Keep in mind, any positive result would necessitate a second test to confirm it. The only test that would not require a second confirmatory test is the NAT.
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How Do You Get Hiv
HIV infection can occur in the following ways:
- Unprotected sexual intercourse, especially receptive anal intercourse
- Multiple sexual partners
- Sexually transmitted diseases: Chlamydia and gonorrhea infections increase the HIV transmission risk by three times syphilis raises the transmission risk by seven times and genital herpes raises the infection risk by 25 times during an outbreak
- Sharing IV needles or injections
- Receiving HIV infected blood products
- Needle-stick injuries
- Maternal HIV infection : The risk of transmission can be reduced at birth by practices like cesarean delivery and prenatal antiretroviral therapy in the mother, and antiretroviral therapy in the newborn immediately after birth
Hiv: A Brief Overview
HIV, or human immunodeficiency virus, is a sexually transmitted virus that spreads through exposure to certain body fluidsâlike genital secretions or blood. HIV transmission can also occur from a mother to a child during pregnancy, childbirth, or breastfeeding.
HIV attacks and impairs the bodyâs immune cells, which weakens the immune system and can eventually progress to acquired immunodeficiency syndrome if it isnât treated. AIDS can be a life-threatening condition, particularly if HIV treatment is not initiated promptly, which is why HIV testing is crucial for protecting your health.
Learn more: What is the difference between HIV and AIDs?
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What Is Involved In Taking Pep
First, a doctor or nurse will assess whether the risk of HIV transmission is high or low, using the risk assessment described above. If the risk is high enough, PEP will be prescribed.
PEP should only be used by people who are HIV negative. When a person starts PEP, an HIV test must be done to determine their HIV status. If the person is HIV positive they should be referred to HIV care and treatment.
If rapid HIV testing is not available, the test result may not be ready for one to two weeks however, PEP will be started immediately. PEP should be discontinued if the PEP user tests HIV positive, or if the contact person is confirmed to be HIV negative.
PEP medications need to be taken consistently and correctlyevery day for four weeksor the risk of HIV infection will increase. A counsellor, doctor, nurse, pharmacist or staff member at an AIDS Service Organization can suggest strategies to help a person adhere to the pill-taking schedule and/or manage any side effects of the drugs.
A person taking PEP needs monitoring for side effects and other complications such as drug toxicity, though this is rare. Blood tests may be needed to ensure that the medications are not causing harm to the body. If side effects and toxicity are a problem, a doctor may decide to change one or more of the drugs being used for PEP.
What Are The Symptoms Of Hiv
Dr Dutt says most people with HIV experience a short illness with flu-like symptoms. This normally occurs 2-6 weeks after HIV infection and can last for a couple of weeks.
“Once these symptoms eventually disappear, you might not notice any symptoms for many years, even though the virus can continue to damage your immune system.
“This ultimately means that many people with HIV won’t realise they’re infected, unless they get tested for it,” she explains.
Other symptoms of HIV besides flu include:
- Swollen lymph nodes around the neck and groin.
- Skin rashes.
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How Can People Access Pep
The Canadian PEP guidelines recommend that PEP should be readily available in places where it is likely to be needed urgently. These include emergency departments, sexual health clinics and other clinics serving populations at increased risk of HIV.
The decision to provide PEP lies with the healthcare provider and is made on a case-by-case basis. Many healthcare providers are unaware of non-occupational PEP or may be unwilling to prescribe it. The Canadian guidelines outline practical advice for physicians providing PEP, including how to assess risk in people who present for PEP, how to provide monitoring and follow-up, and recommended drug regimens.
People starting PEP may be offered a starter pack of pills, so that PEP can be started right away, along with a prescription that needs to be filled to receive the full 28-day course of medications. Most emergency departments will have PEP starter packs available.
Anti-HIV drugs are expensive: a month-long course of PEP can cost $900 or more, depending on the drugs used. Although occupational PEP is normally covered by workplace insurance, coverage for non-occupational PEP varies across Canada. Non-occupational PEP medications are covered by some private and public health insurance plans coverage varies depending on the province or territory and the type of exposure.
Acknowledgement