Human Immunodeficiency Virus (HIV)
HIV weakens the immune system so that it cannot properly fight off infections and diseases. It leaves people vulnerable to other infections because the immune system is no longer able defend the body against serious illness. HIV is able to do this through attacking and destroying CD4+ cells in the body. The CD4+ cells recognize infections in the body and coordinate the immune system to respond to infections like viruses or bacteria.
When HIV enters the body it takes over these cells and uses them to replicate itself, creating more copies of HIV. This leaves your immune system weakened and unable to coordinate a strong offensive against other possible infections.
HIV is the virus that leads to AIDS (Acquired Immune Deficiency Syndrome.) If a person who has HIV is not treated with Antiretroviral (ART)therapy, their immune system generally becomes weaker over time and they can eventually become sick with a life-threatening infection. It is at this point that a person is considered to have AIDS.
How Is It Spread?
HIV infection happens when enough HIV from an HIV-positive person gets into an HIV-negative person’s body. This does not happen through casual contact. You cannot get HIV from sneezes or coughs, toilet seats, shaking hands or kissing or hugging, or from sharing dishes or eating utensils. Saliva, tears, sweat, mucous, urine, feces, and vomit have no risk for HIV transmission. Only five body fluids can contain HIV:
- blood (including menstrual)
- seminal fluid (including semen and pre-cum)
- vaginal fluid
- anal fluid
- breast milk
Living in those five body fluids, HIV can enter the bloodstream: through unprotected sex (oral, vaginal, anal,) unclean needles and syringes, or from an infected mother to her child during pregnancy, delivery or breast-feeding.
The risk of transmission through blood transfusion or blood products is also very low. Since 1985, all blood products in Canada have been tested for HIV.
Prevention
Unprotected sex and sharing needles are the most common ways for HIV to be transmitted. Abstaining from sex is the only way to completely prevent transmission of HIV or other sexually transmitted blood borne infections (STBBIs.) If you are having sex, the best way to reduce your risk is by using condoms, gloves, or dental dams. There are many options for using these types of barriers including: non-latex condoms for people with latex allergies, many condom flavours and textures to enhance pleasure, and female condoms which are inserted into the vagina before sex. Condoms do have an expiry date so be sure to check this before using.
Water-based lubricants (specifically made for sexual activity) reduce the risk of condom breakage and increase pleasure. Lubricant is also very important for comfort during anal sex because unlike the vagina, the anus isn’t self-lubricating.
If you use injection drugs always use new or sterilized needles and other equipment. When getting a tattoo or piercing, it is important to check with the artist that new or sterilized needles, as well as inks, are being used. Sharing with others puts you at risk for HIV, Hep C, and other bacterial infections.
The risk of transmission of HIV from mother to child can be greatly reduced when certain precautions are taken. HIV positive mothers can now have healthy, HIV-negative babies by taking medications during pregnancy and by not breast-feeding. With medical interventions the risk of transmission from mother to child is less than one percent. With no treatment, the risk of a mother who is HIV-positive having an HIV-positive baby is about 25%. HIV-positive partners have options for getting pregnant safely.
For individuals that are living with HIV or an STBBI, communication with sexual partners is extremely important. This way, both partners can take precautions to prevent passing on an infection. Being in a relationship can be challenging and living with HIV or a STBBI can complicate things and may make a romantic relationship seem impossible. Many people living with HIV have happy and healthy relationships, some with partners who are HIV-negative and others whose partners are also HIV-positive. Communication is key in all relationships.
Post Exposure Prophylaxis (PEP)
This is an HIV prevention strategy in which HIV negative people taking antiretroviral medications after coming into potential contact with HIV to reduce their risk of contracting HIV. PEP must be started within 72 hours after exposure.
Pre Exposure Prophylaxis (PrEP)
HIV Prevention Strategy in which HIV negative people take an oral pill once a day before potential contact with HIV to reduce their risk of contracting HIV.
Testing
It is very common that a person has HIV or a STBBI without knowing it. Often people do not have any symptoms at all. The only way to know for sure is to get tested at community health, an STBBI clinic, or your family doctor. You should get tested if you have a new partner, if you think your partner or yourself have symptoms of a STBBI, if you had unprotected sex and have not been tested, or at least once a year as a healthy practice. Medical professionals use a blood sample to test for HIV, Hepatitis B and C, and syphilis. A urine sample is the most common test for chlamydia and gonorrhea. If a person has visible sores or rashes a swab may be taken.
When a person receives a positive test result for HIV, Hep C, or other STBBIs, it is required that current and previous partners are notified, either by the person themselves or by a nurse or doctor. This is so that people can receive treatment and to prevent further transmission of infections. When a nurse or doctor notifies your previous partners, your name is not given.
You must ask to be tested for HIV. It is not done automatically when you give blood during a physical examination or during a Pap exam. You must give your consent to be tested. It is free to be tested for medical reasons.
A blood sample is used to test for HIV. This test is highly accurate. The test does not detect the virus. It measures the antibodies in your blood, which are immune cells that your body makes to fight the HIV infection. It takes three to six months for your body to make these antibodies. If a person is tested before the antibodies show up, the test will be negative even though HIV is in the blood. Remember that being tested too soon may give a false result.
- If no HIV antibodies are detected by the test, and it has been six months since you might have been exposed to HIV, your test is negative, which means you do not have HIV infection. It does not mean that you are immune to HIV infection.
- If HIV antibodies are detected, a second and different test is done on the same sample to confirm the result. A positive test means that you have tested positive for the HIV virus, and are therefore HIV-positive. It does not mean that you have AIDS. If the result of this second test is “indeterminate,” you will need to be re-tested (give another blood sample), usually about one month later. Indeterminate test results are rare.
HIV Test Options
HIV tests must be reported to the public health authorities in Alberta, so it is important to be aware of the different types of tests available:
- Anonymous testing is where the results are linked to the person being tested by a code known only to them. Neither the nurse/doctor ordering the test nor anyone else knows the identity of the patient. Only the test results and any demographic information provided are reported to public health authorities.
- Confidential (or non-nominal) testing is where the results can be linked to the person being tested. The nurse/doctor knows the identity of the person being tested, but keeps it confidential. The name of the person testing positive is not reported to public health authorities, only the test results and any demographic information provided.
- Nominal testing is testing where the results are linked to the person being tested by a personal identifier. Full personal information, test results and any demographic information provided are reported to public health authorities.