1. What is HIV?
HIV (Human Immunodeficiency Virus) attacks your body’s immune system, specifically the CD4 cells that help keep the body’s immune system healthy. Untreated, HIV destroys the number of CD4 cells in the body if not treated, making you more vulnerable to infections. Some people can live with HIV for years, and others can get sick very quickly. Not treating HIV as soon as possible can harm your immune system so that the body can’t fight off infections and disease.
What are CD4 – T cells?
These cells play an important role in the immune system and help protect you from infections. A CD4 count measures the amount of these cells in your body. A normal CD4 count for the average person is between 500-1600. When a person who is HIV positive does not go onto ARV treatement, and their CD4 count drops below 200, their bodies are very vulnerable to infections. This is a signal that the person has Aids. Aids is the last stage of HIV infection.
2. How can HIV be transmitted?
HIV is passed on through sexual intercourse and high-risk exposure to the bodily fluids of an HIV-positive person (and not on treatment), like:
- blood
- semen and pre-cum
- rectal and vaginal fluids
- breast milk
These fluids must come in contact with an open sore or get directly into the bloodstream for transmission to occur. The skin of the anus is very soft and there are no body fluids to lubricate penetration. This means anal sex may result in very small tears of the anus which can increase the chances of HIV transmission. Unprotected anal sex has the highest risk for HIV transmission, especially for the passive (bottom) partner.
3. How can HIV be prevented?
You can protect yourself from HIV through the following means:
- The use of condoms and water based lubrication (lube) when you have sex
- Taking PrEP (Pre-exposure Prophylaxis) pills consistently and for at least seven days
- Engaging in less risky sex (eg, oral sex, mutual masturbation)
- Having sex with an HIV negative person
- Having sex with an HIV positive partner who is on effective treatment and is confirmed to be ‘undetectable’ (the virus is suppressed)
4. How can HIV be treated?
There is currently no cure for HIV. However, there are treatment options available that are very effective if taken correctly and every day.
ARVs – antiretrovirals
The medicine used to treat HIV is called ARVs (antiretrovirals) or ART (antiretroviral treatment). ARVs can prolong the lives of people with HIV. It keeps them healthy so that they can have the same life expectancy as someone who is HIV-negative. Taking ARVs as prescribed will also lower the chances of infecting others.
When should I start treatment if I am positive?
It is recommended that people with HIV start ARVs as soon as possible. In people with HIV who have certain conditions, it’s especially important to start ART right away. These include those with:
- a low CD4 count
- certain HIV-related illnesses and co-infections
- early HIV infection
Adherence
For ARVs to work correctly, they must be taken every day and exactly as prescribed. This is called adherence. For people with HIV, treatment adherence is key to staying healthy. Skipping HIV medicines allows HIV to multiply, which increases the risk of drug resistance and HIV treatment failure. Poor adherence to an HIV regimen also allows HIV to destroy the immune system. A damaged immune system makes it harder for the body to fight off infections and certain cancers.
Managing HIV
Because HIV requires lifelong treatment, it’s essential for people with HIV to visit their health care provider regularly. Ongoing medical care includes monitoring to make sure a person’s HIV treatment is keeping the virus under control. An HIV-positive person needs to have their blood tested every six months to see if the medication is working as it should.
5. What is U=U?
U=U is an abbreviation for Undetectable = Untransmittable. It means that someone with an undetectable HIV viral load on ARVs cannot transmit HIV, even without using condoms.
A person living with HIV is considered to have an ‘undetectable’ viral load when antiretroviral (ARV) treatment has brought the level of virus in their body to such low levels that blood tests cannot detect it.
In other words, someone who is HIV positive whose viral load is ‘undetectable’ because of treatment cannot transmit the virus during sex.
U=U is also an international campaign to raise awareness about the benefits of ARVs.
6. How does being HIV positive affect my rights?
The South African Constitution has a Bill of Rights that protects all people. This means that people living with HIV/AIDS have the same rights as any other person. No employer can require that a job applicant have an HIV test before they are employed. You can also not be denied a job because of your HIV status or be discriminated or refused any services in any way.
7. What are STIs?
STI stands for Sexually Transmitted Infection. It is any infection transmitted through sexual contact, caused by bacteria, viruses or parasites. HIV is one of the most commonly known STIs but there are many others.
Having unprotected sex is how most STIs are transmitted. An STI can be passed from one person to another through sexual contact, including vaginal, anal and oral sex. STIs can pass between men and women, and from women to women and men to men. Many STIs can be cured with antibiotics. Some, such as HIV, have no cure but can be treated to prevent them from getting worse or from passing it on to someone else.
You cannot tell by looking at someone (including yourself) whether they have an STI, so it’s essential to get tested or screened regularly. Many people may at first feel fine and do not show symptoms when they have an STI. Using condoms with water-based lube protects not only against HIV but also many other STIs.
If you think you have an STI, the earlier you’re tested, the sooner treatment can be given if it’s needed. Untreated STIs can affect your health in many ways.
Some of the most common STIs are:
Hepatitis A
Hepatitis A is a liver infection that’s spread by a virus in faeces (poo). It is spread mainly through contaminated food or poor hand-washing, but also passes on easily through sex, including oral-anal sex (“rimming”) and giving oral sex after anal sex. Gay and bisexual men with multiple partners are particularly at risk. Symptoms of hepatitis A can appear up to eight weeks after sex and include tiredness and nausea. Hepatitis A is not usually life-threatening, and most people make a full recovery within a couple of months.
Men can avoid getting hepatitis A by:
- washing hands after sex (ideally buttocks, groin and penis too)
- changing condoms between anal and oral sex
- using a barrier (such as a condom cut into a square) for rimming
- not sharing sex toys
Hepatitis B
Hepatitis B is a viral infection that causes inflammation of the liver. It often doesn’t cause any noticeable symptoms but can lead to a persistent infection. This can eventually cause severe liver disease, including cirrhosis and liver cancer. Hepatitis B is spread through contact with an infected person’s blood or body fluids.
Hepatitis C
Hepatitis C is a viral infection that causes inflammation of the liver. It often doesn’t cause any noticeable symptoms, but can lead to a persistent infection. This can eventually cause serious liver disease, including cirrhosis and liver cancer. It is spread through contact with an infected person’s blood or body fluids. Hepatitis C can be treated and is curable in many cases.
Gonorrhoea (‘the clap’) and Chlamydia
Both these STIs are bacterial infections of the urethra, rectum or throat. Gonorrhoea and Chlamydia can cause stinging when urinating or the feeling that you want to urinate but can’t. It’s passed on through anal, oral or vaginal sex with an infected person. There may be a discharge from the penis, or pain in the testicles (although chlamydia can be symptom-free). Both STIs are treated with antibiotics.
Genital herpes
Genital herpes is a viral infection. Symptoms can include painful blisters and ulcers on or around the penis or anus, although some men have no symptoms. The virus remains in the body and can cause recurrent episodes of blisters. Genital herpes can be passed on through oral sex with someone with a cold sore around or in their mouth, or by close, skin-to-skin genital contact with someone who has genital herpes. Your doctor or healthcare worker can prescribe pills or a cream to help when herpes symptoms flare up.
Syphilis
Syphilis is a bacterial infection that causes a painless ulcer, usually in the genital area. The ulcer will disappear on its own, but other symptoms may appear, such as a rash on the body and swollen glands. In its early stages, syphilis is very infectious and can be passed on by close skin contact during sex. If it’s left untreated for years, it can spread to the brain or other parts of the body and cause serious, long-term problems. Treatment is with antibiotic injections or tablets.
Genital warts
This is the most common viral infection that appears a few weeks or months after sex with an infected person. It can cause pinhead-sized growths, mostly on or around the head of the penis but also in and around the anus. The sooner warts are treated, the easier they are to deal with. You can’t treat genital warts with the same cream you use for warts on the hands. A doctor will freeze them or use a cream to remove them.
Get tested
If you have any of these symptoms or worried you may have an STI, speak to your GP or healthcare worker. Getting tested regularly is a good idea to ensure you have a healthy sex life.
8. What is PrEP and what does it do?
PrEP stand for Pre-exposure Prophylaxis. It is most commonly taken as a once-a-day-pill by someone who is HIV-negative. It’s a way of preventing HIV infection by taking a pill on an ongoing basis. Trials have shown that PrEP works best when it is taken regularly – this ensures that levels of the drug in the blood are high enough to be protective against HIV. Scientific evidence shows that, when taken consistently and correctly, PrEP reduces the chances of HIV infection to near-zero.
Getting on PrEP is easy and in some places offered for free. You will need to have a quick HIV and liver function test before being given PrEP by a health care professional.
It is important to remember that while PrEP works very well against HIV it does not protect against other STIs.
Most people who take PrEP don’t experience side effects. When people do get them they tend to be minimal or very mild. These usually go away on their own within a few weeks once the body has adjusted to it.
9. What is PEP?
Post-Exposure Prophylaxis (PEP) is an ‘emergency’ course of ARVs (antiretroviral tablets used to treat HIV) given to someone who is HIV-negative after they have had a high-risk event of getting HIV. This could be a condom breaking during anal sex, especially if they were the bottom (receptive partner). PEP reduces the risk of becoming infected but must be taken within 72 hours (3 days) of possible contact with HIV for it to be effective.
PEP is usually used AFTER an instance of HIV exposure (such as after a risky sexual encounter), while PrEP is used BEFORE having sex and is an ongoing medication to prevent HIV.