HIV and AIDS

HIV (Human immunodeficiency virus) damages the immune system, making a person infected with it more likely to develop a range of health problems including infections and cancer. Approximately 33 million people are living with HIV worldwide.

In Australia the experience of HIV and AIDS has been different to that in many other countries with a much smaller proportion of people living with HIV.

* Information about statistics from South Australia is available on the website of Clinic 275
http://www.stdservices.on.net/stats/hiv-aids.htm
* Australian statistics are available on the site of National Centre in HIV Epidemiology and Clinical Research, University of NSW (Australia)
http://www.med.unsw.edu.au/nchecr/
* International information is available on the World Health Organization (WHO) site:
http://www.who.int/hiv/data/en/index.html

Even though most people with HIV in Australia have access to treatments, many people have had their lives profoundly affected by living with HIV/AIDS.


What are HIV and AIDS?

HIV stands for human immunodeficiency virus.

* HIV is a virus that affects only humans. It lives and multiplies within immune cells (mainly white blood cells called T-lymphocytes), destroying them and weakening the immune system, making the body vulnerable to a range of other diseases and infections.

AIDS stands for Acquired Immune Deficiency Syndrome.

* Acquired means people are not born with AIDS. It is not a genetic condition.
* A syndrome is a collection of symptoms or illnesses that occur together as the direct result of one cause. In the case of AIDS, the cause is HIV.
* During advanced stages of AIDS, a person may develop a range of illnesses and conditions typical of the syndrome.


How do you get HIV?

Three body fluids contain HIV in a high enough concentration for the virus to be passed on if even a small amount of one of them enters the bloodstream of another person. These fluids are blood, semen and vaginal fluids. These may enter a person's bloodstream in the following ways:

Unprotected vaginal or anal intercourse ('unsafe sex')

* During unprotected vaginal and anal intercourse, tiny cuts or abrasions in the vagina, anus or penis can allow infected blood, semen or vaginal fluids to enter the bloodstream.
* 'Unprotected' means without the use of a condom and lubricant (see the topic 'Safer sex' for more information).

Blood contact between an HIV-positive and an HIV-negative person

* Sharing syringes or needles (or other injecting equipment) can pass blood from one person to another. After injecting drugs there is often blood left in the needle or syringe, even if the syringe and needle look clean. If another person uses this injecting equipment, they may be exposed to blood containing HIV if the first person is infected.
* HIV can be passed on when any other equipment that is not sterile punctures the skin if it has already been used on someone who has an HIV infection. This includes equipment used for:
o body and ear piercing
o tattooing
o some medical and dental procedures.
* Blood contact can also occur during an accident such as a 'needlestick' injury. However, if proper infection control procedures are used, the chances of infection are extremely small, even if the source of the blood is a person with an HIV infection.

During pregnancy, birth or breastfeeding

* If a woman who is HIV-positive becomes pregnant, there is a less than 2% chance that the baby will also become HIV-positive if she is having appropriate treatment for her HIV infection.
* If a woman is HIV positive and is not having treatment, the risk of her baby becoming infected is about 30%. This may happen:
o during pregnancy, by infected blood passing through the placenta into the baby’s bloodstream
o during the birth itself - vaginal or caesarean delivery
o during breastfeeding (breast milk is not a risk for older babies, children or adults, who all have enough stomach acid to kill HIV. A new born baby, however, may not have enough acid).


Saliva or oral sex

There is no risk of contracting HIV from the saliva of an HIV-positive person.

* HIV infection is only possible when enough of the virus enters your bloodstream. With saliva, around a litre and a half would have to be injected or swallowed.
* If saliva enters your mouth through, for example, kissing an HIV positive person, your own saliva will dilute theirs and your stomach acid will kill the virus.

The risk of getting HIV from oral sex is very low.

* Of the millions of HIV infections in the world, only two or three are thought to have been acquired from oral sex. (If there are bleeding sores in the mouth, gum disease, or cut lips, for example, there is a theoretical possibility of transmission.)


Blood transfusion

* Giving blood is completely safe, as a clean needle is used for each blood donor.
* All blood donated at Australian blood banks is thoroughly screened for HIV. Any blood that shows traces of HIV antibodies is destroyed. Because of this, receiving a blood transfusion from the Australian blood supply is considered safe. No one has contracted HIV through receiving a blood transfusion in Australia since screening began in 1985.


How long does the virus survive outside the body?

HIV is very fragile.

* Unlike some other viruses (e.g. hepatitis C), HIV will not survive outside the body for very long.
* As soon as it leaves the body and is exposed to air, the virus will start to die, particularly if there is only a small quantity of blood, semen or vaginal fluid involved.
* Soap and water, shaving cream and ordinary disinfectants will kill the virus.


Day-to-day contact

There is no risk of contracting HIV through normal day-to-day activity or by caring for a person with HIV or AIDS. For example, you cannot catch HIV through:

* shaking hands with someone
* kissing and hugging
* being sneezed or coughed on
* using toilet seats, telephones, pens or paper
* sharing food, drink, cups, cutlery, towels or a bed
* washing, massaging or rubbing someone
* being in the same room with someone
* touching blood on pads or tampons
* insect or mosquito bites.

Throughout the AIDS epidemic, millions of people have lived with, hugged, kissed and cared for family members, lovers and friends with HIV. If this type of activity was risky, there would be many millions more HIV positive people than there are.


Safe sex?

Can a person who is HIV positive still have safe sex? Yes! That is what 'safe sex' is all about.

* Any sexual practice not involving the exchange of blood, semen or vaginal fluids is considered safe.
* If a condom and water-based lubricant is used properly during vaginal or anal intercourse, the chance of contracting HIV is very low.

Have a look at the topic Safer sex for more information.

Syringes and needles

Sharing or re-using syringes and needles ('fits') is not safe.

* Clean fits are available from a range of Clean Needle Program ('needle exchange') outlets throughout South Australia, free, with no questions asked.


Accidents involving blood

If you are ever required to give first aid, or if there is an accident involving blood, you should treat all blood as if it were infectious. The main risks are from Hepatitis B and Hepatitis C, but it is possible that HIV could be spread this way.

To protect yourself, standard infection control precautions should always be followed:

* wear disposable gloves
* wash the relevant surface with disinfectant (ordinary household bleach is adequate)
* cover open cuts or sores with a water proof bandage
* dispose of waste matter (rags, soiled paper, etc.) in a sealed plastic bag
* wash and dry soiled towels, clothes and linen as normal.


The blood test for HIV/AIDS

When a person is infected with HIV, their blood will produce specific antibodies in response to the virus. If a person's blood contains these antibodies it is because it also contains HIV. If there is no HIV, then there are no HIV antibodies.

Unfortunately, the blood can take some time to produce a sufficient quantity of these antibodies to be detected in a blood test. In 99% of people, the maximum period (window period) this takes is 12 weeks (3 months).

* A positive result means that the blood contains HIV antibodies and therefore contains HIV.
* A negative result means that no HIV antibodies can be found in the blood because either:
o there is no HIV in the blood
o the infection has occurred so recently that the blood has not yet produced a sufficient quantity of HIV antibodies to be detected (seroconversion) i.e. the test has been taken during the window period.
* If you have a test and the result is positive, this result will be accurate.
* If you have a test and the result is negative, and you have not engaged in any unsafe behaviour in the past 12 weeks, then the result will be accurate.
* If, however, you believe that you may have recently been exposed to infection, you should have another follow up test no earlier than 12 weeks after the first. If this result is also negative, and you have not engaged in unsafe behavior during these 12 weeks, then you will not have been infected with HIV.


What happens after a person is infected with HIV?

Once a person has been infected with HIV, they could react to the infection in different ways.

Seroconversion (sero-con-ver-sion)

* Over 50% of people have a short lasting reaction to the infection a couple of weeks after HIV first enters their blood.
* They may develop a cold or flu-like illness from which they will recover quite quickly. Since this reaction is the same as happens with many other virus infections, it is rare for this to be recognized as being due to HIV.
* This is called seroconversion ('sero' means blood), meaning the conversion from being HIV antibody-negative to positive.

Asymptomatic (no symptoms)

* Most people who are HIV-positive will look and feel well for many years after getting HIV.
* This asymptomatic period can last on average in Australia from 4 to 15 years after seroconversion.
* However, the virus continues to replicate during this time and is active in destroying immune cells.
* The virus can also be passed on to other people by unsafe behaviours.

Symptomatic

* A person with HIV may at some point develop lymph gland enlargement that does not go away, in the neck, armpits and/or groin. This is called 'persistent generalized lymphadenopathy' (PGL).
* Other symptoms include a lack of energy, fevers and night sweats, persistent oral or vaginal thrush, persistent diarrhea and weight loss.
* HIV-positive people who have symptoms may get better and be asymptomatic again.

AIDS-defining

* During advanced stages of HIV infection, a person may develop any of a number of illnesses and conditions which indicate they have AIDS.
* These are called AIDS-defining conditions and include:
o continuing weight loss
o neurological (brain) disorders such as dementia
o severe infections that don't get better with normal treatment
o cancers such as Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma.

Over recent years, highly effective treatments for HIV have been developed. It has been proven that by using combinations of powerful drugs, the activity of the virus can be limited a great deal. Before long, HIV may be considered as a manageable long-term condition over the period of a normal life expectancy.


What treatments are available for HIV/AIDS?

The is no cure for HIV infection and there is no vaccine to protect anyone from the infection.

Over recent years, highly effective treatments for HIV have been developed. It has been proven that by using combinations of powerful drugs, the activity of the virus can be limited a great deal. Before long, HIV may be considered as a manageable long-term condition over the period of a normal life expectancy.

Treatments used are dependent on the individual’s needs, circumstances and choice.

* Maintaining a healthy lifestyle
* Preventative (prophylactic) medications to prevent specific illnesses that may arise in someone with HIV/AIDS.
* Treating llnesses that arise in people with HIV/AIDS using the same medications as are used for other people for the same problems. For example, infections may be treated with antibiotics, and cancers may be treated with radiotherapy and/or chemotherapy.
* Antiviral medications - to attack HIV by interfering with its ability to reproduce. This keeps the amount of HIV in the body as low as possible, thus slowing the damage to the immune system.
* Alternative/complementary therapies. The use of alternative medicines and therapies has proven quite successful in assisting many people in dealing with the consequences of HIV infection. Techniques such as massage and meditation, for example, have obvious benefits to a persons general well-being.


Resources
South Australia

* AIDS Council of South Australia (ACSA)
Internet site provides lists of resource agencies, plus links to many other South Australian and Australian organizations, agencies and research organizations.
http://www.acsa.org.au
* Women’s Health Statewide HIV project, support for HIV positive women
http://www.whs.sa.gov.au/project_hiv.php
* People living with HIV/AIDS (SA) and the Adelaide Positive Living Centre
http://www.hivsa.org.au/
* Clinic 275 (Sexually Transmitted Infections Clinic). Free and confidential advice, testing and treatment for all sexually transmitted infections.
http://www.stdservices.on.net
* SHine SA (Sexual health and information)
http://www.shinesa.org.au
* The Second Story Youth Health Service, Youth Healthline 1300 13 17 19
* Department of Health, South Australia HIV Action Plan 2009 - 2012 http://www.health.sa.gov.au/pehs/publications/090525-hiv-action-plan.pdf


References and further reading

AIDS Council of SA, frequently asked questions,
http://www.acsa.org.au

Department of Health, South Australia, HIV/AIDS statistics
http://www.stdservices.on.net/stats/hiv-aids.htm

Department of Health, South Australia 'Human Immunodeficiency Virus'
http://www.dh.sa.gov.au/pehs/Youve-got-what/ygw-hiv.pdf

National Association of People living with HIV/AIDS, Australia (NAPWA)
http://napwa.org.au/

National Centre in HIV Epidemiology and Clinical Research, University of NSW (Australia)
http://www.med.unsw.edu.au/nchecr/

UNAIDS, Joint United Nations Programme on HIV/AIDS
www.unaids.org/en

Women’s Health Statewide, HIV women’s project
http://www.whs.sa.gov.au/project_hiv2.php#support

World Health Organisation and HIV/AIDS
http://www.who.int/hiv/en

Source: http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=243&np=292&id=2446