For reasons of clarity, street language is sometimes used on this page. The purpose is not to shock or cause offence, simply to inform everyone clearly about the issues involved. If you have a problem with this, please press your "Back Button" now.
If anyone has questions they wish to ask, submit them and I will answer them on a linked page. Obviously I will not publish your E-mail address but if you wish, you may set your browser to send a fictitious e-mail address anyway. Please use a "pen" name though, "Dear Anon" is not a good start.
For your information, I am NOT a medical doctor, however I have been teaching doctors about HIV for several years.
This page has three functions, firstly, it explains briefly the difference between HIV and AIDS, explaining how HIV can be transmitted from one person to another, and some basic HIV do's and don'ts. Secondly it provides some links to other sites and some telephone numbers (UK use only at the moment, sorry; if you know of any international ones that offer HIV information free of charge, please e-mail me and I'll happily update the page). Finally, there is a request, don't panic, it isn't for money, just the free use of a qualified brain over a cup of tea for an hour. Curious? See here then.
HIV & AIDS - The difference
HIV - Human Immunodeficiency Virus & AIDS - Acquired Immune Deficiency Syndrome are often wrongly grouped together. Sometimes you will hear people say something to the effect of "Well, it more or less means the same thing". It doesn't. Big difference.
HIV is a virus, the virus can be in your body for years - often over a decade - without any particularly unpleasant effects at all. It may take you a little longer than before to get over a cold but other than that, you will probably feel as fit as you usually do. Later on, perhaps some 10 years or so after being infected, the virus starts to multiply rapidly. At the moment we are not sure what causes this sudden increase in replication, all we know is that when it happens, the number of HIV virus increases rapidly.
Unfortunately for us, the virus needs to use some of our cells in order to duplicate itself. It uses cells with things called CD4 receptors on them. The virus attaches itself to these cells like a plug and socket connection. The virus then turns our cell into a little virus producing factory for itself. The cell then releases the new virus and dies. CD4 cells are found on special cells called "T-helpers" which form part of our immune system. This is why sometimes people living with HIV & AIDS are "off-colour" more often than they used to as the immune system is being compromised.
CD4 cells can also be found in other parts of our bodies - our brain for example - sometimes, though not often, this results in a kind of "pre-senile dementia", or, more accurately, neurological impairment. CD4 cells are also found in the digestive system, in some countries - Africa for example - AIDS is still called "slim disease" in some parts - because people tend to lose weight.
It is at this point (after sudden increase in number of HIV) that the person may start to feel unwell on a more regular basis. Later still, the body may fall prone to "opportunistic" infections like Kaposi's Sarcoma - a form of skin cancer - or even diseases like psittacosis, a disease normally associated with parrots. When someone has two or more of these illnesses AND they are HIV+, a diagnosis of AIDS is made if they have a T4 count less than 250 and a viral load of 80,000 or more.
In summary HIV is the virus which might lead to an AIDS diagnosis is many years time.
HIV is not a strong virus, nor can it survive on its own in small numbers. This means that HIV can only be transmitted in certain body fluids. HIV can be transmitted in blood, semen, vaginal fluid and breast milk. There are NO OTHER FLUIDS capable of transmitting HIV. Sweat, urine, tears, mucous, faeces and vomit for example, only have tiny "non-viable" amounts of virus and are ZERO risk for HIV unless contaminated with one of the other "transmittable" fluids. (It is important to note however that other virus - like Hepatitis B are easily transmitted in urine, faeces and saliva. You could share a cup with 10,000 people living with HIV quite safely, you may however catch a cold or hepatitis B from sharing a cup with anyone). Pre-cum - or Cowpers fluid often contains semen and should be treated as you would semen.
With the exception of breast milk which only affects babies, the other "risky" fluids - blood, semen and vaginal fluid - are only dangerous if they can get into the bloodstream. This may be through sharing a hypodermic needle - where "flushing" leaves blood in the syringe - or through unprotected sex. This depends on the kind of sex and what barriers - if any - are used against HIV. With oral sex for example, only a handful of HIV cases have been attributed to fellatio - sucking a penis. Cunnilingus - licking a vagina - is safer still with only about three recorded cases worldwide. Of course if you have a sore throat or mouth ulcers, it makes good sense to either use a condom or a "dental dam" - a square of latex ideal for cunnilingus, you can also use a condom, cut lengthways if you prefer. On a technical point, it is safer to swallow than to spit. The virus is killed very quickly in the stomach whereas spitting causes pressure build up in the mouth which, if ulcerated allows a theoretical risk of transmission.
Penetrative sex - intercourse - whether anal or vaginal is the manner in which most HIV is transmitted. Although transmission is more common from the active person to the passive person, the virus CAN and often DOES go from the passive to the active. If someone ejaculates - comes - inside you without a condom on, the semen is left inside you. While intercourse was taking place, the friction - even from a very gentle lover - can leave tiny abrasions inside the vagina or rectum. These abrasions may be so small they do not "bleed blood" but perhaps just ooze a little plasma - which you wouldn't see. If the semen then washes over these abrasions - and any pressure applied - like the penis still moving around, the virus may be "pushed" into the blood stream.
Transmission the other way around - from the passive partner to the active one is rarer. What happens, is that underneath the foreskin (if present), the glans has some very fine membranes which are not as resilient as they might be. It is possible that HIV+ vaginal fluid on the penis could - with the aid of friction - transmit enough virus through the membrane to infect the active partner. It is also possible though unlikely that the virus could enter through the lining of the urethra in the penis through the meatus (hole).
Although the contraceptive pill, coil, diaphragm etc are all reasonably effective methods of birth control, they are utterly useless for protecting against HIV - or any other sexually transmitted disease. What is needed is a condom - rubber - prophylactic - johnny - whatever you call it, it can be a superb barrier against HIV - and other things - if only you handle it properly.
Always check that the condom has not passed its sell-by date. A condom is made from natural latex - which eventually rots and weakens. Open the packet carefully - not with your teeth please and remove it carefully - particularly if you have sharp nails. Wait until the penis is fully erect and then squeeze the teat at the end to get the air out while starting to unroll it over you or your partner's penis. It IS possible to try and put a condom on the wrong way around. If you make the mistake, put the condom in the bin and use another - otherwise you will probably have pre-cum (Cowpers fluid) on the outside of the condom - as this contains semen, it's not a good start. Continue unrolling the condom down the shaft of the penis, apply plenty of water based lubricant if you are about to have anal sex. If you wish to be ultra safe, withdrawal before ejaculation makes things safer still but that is perhaps asking a little too much, instead just withdraw before the penis goes soft, holding onto the condom at the base. Tie a knot in the end and pop it in the bin.
Look after your condom, it will look after you.
Condoms are made of latex (except the femidom, female condom which we'll talk about later), latex is a natural product which hates oils and grease, so if you put your condom on and then coat it in petroleum jelly - Vaseline, hand cream or massage oil, guess what will happen? Yep, it will either rip, tear, fall to bits or, more worrying still - just turn porous enough to be useless as a barrier but still look "intact" when you have finished. Use a water based lubricant, KY jelly is excellent but there are other brands to choose from too. If you have no lubricant and plan a night of passion, rather than use an oil based lubricant, make some yourself :
Emergency Water based lubricant
Boil kettle, get small jar, add a teaspoon or two of cornflour to the jar.
When kettle boiled, add about half a wineglass full of water to the cornflour.
Stir like something possessed until you have a thick paste.
Add cold water until you have the consistency you want.
Wait for it to cool (!) and then apply liberally.
NOT ideal but much more condom friendly than anything oil based.
Ok, sooner or later you may come across a femidom, these strange devices look as though the designers had often heard about penises and vaginas but never actually seen them in action. The femidom is a little smaller than a bin liner and slightly less attractive. It does however have one enormous plus point - it is made of plastic instead of latex. As a result you can use other lubricants if you really must - and they should stay in one piece. They are also extremely strong and, while they are not designed for the purpose, SEEM to be good for very safe anal sex. They also rustle when you walk if you are wearing one.
Going back to blood for a moment, it should be pointed out that giving blood is 100% safe in all developed countries. The hypodermic needle used is a "one hit" device and the chance of you contracting HIV is ZERO. (So give blood please) If you are receiving blood in developed countries which use screening (UK /USA does), the risk of receiving a pint of contaminated blood is somewhere around the 1 in 2,000,000 per unit of blood received. This is because of the "window period" where you can have the virus but not yet have developed the antibodies - which is what the screening test looks for. On the basis that they don't give you blood for the fun of it, the tiny risk is acceptable - on the basis that you will probably expire if you don't have it.
Poppers - amyl nitrite, butyl nitrite and certain other "aromatics" should be used with caution - whether you are HIV+ or not. These aromatics, whilst fully accepting their "plus side", do appear to have a damaging effect on the immune system - albeit only short-term. What it means however is that if you DO put yourself at risk with unsafe sex, your body will be less able than usual to fight off any virus.
For people for are diagnosed as being HIV+, a decision has to be made as to when to start taking drug treatments. Some people work on the basis that they should wait until they need them - so the virus has not had time to get used to them, others maintain that the treatment is best started as soon as possible. Take advice from the person giving your test because certain drugs like AZT (Zidovudine) and Acyclovir are not particularly pleasant drugs and you may well need other drugs to counter the side effects. It is always worthwhile asking if there are any drug trials in progress and asking what the likely side effects are etc. Sometime it is possible to get the best drugs a few years before they are generally available through this method although "early release" is sometimes permitted under compassionate grounds and the drug is then made available under caution to anyone who wants it.
Of great importance to anyone diagnosed with HIV, is a good diet. A healthy diet for someone living with HIV may make a huge difference to how the next ten years are going to be spent. Vitamin C is exceedingly useful, certain vitamins however are best kept to a minimum. Detailed information on this topic will be made available to you if you go for counselling. It is slightly outside the scope of this page really but if you want some direct answers, drop me a few direct questions and I'll answer them as soon as I can.
Many people find the prospect of having a test daunting, there are serious implication if the test is negative as well as if the test is positive - even more so if a couple have the test together, sometimes one person is positive and their partner is negative. Before you have a test - in the UK at least, you will be offered free counselling to make sure you fully understand the implication of the test - and how it will change your lifestyle whatever the results may be.
Some people, having been given a positive result work on the basis that there is no longer any need for safer sex - they have the virus already. If your partner is also positive, this will mean that you are both likely to be cross-infecting each other with different strains of the virus each time you have unprotected sex. This seems to hasten the development of the virus and is definitely not to be recommended. If your partner(s) are HIV negative / or unknown, apart from the ethical issues involved in willingly spreading HIV, certain countries are now making it a custodial offence. (USA and UK included)
Never "test" yourself by giving blood. Some people give blood when they are unsure if they are HIV+ or not, apart from being irresponsible, the results - if you are positive - are unpleasant. Instead of a nice cosy chat with a counselor in some discreet building, you get an official from the health authority telephoning you or knocking on your door, telling you that you are HIV+ and not to give blood in future, what seemed like a very "discreet" way of testing yourself may result in flat mates / visiting friends knowing what has happened. Don't do it.
Doctors are bound by certain rules of confidentiality, however these rules are not inflexible and they are not as far reaching as some people suspect. A doctor can quite properly disclose your notes to a fellow doctor - a locum perhaps - a hospital and so on. If you wish to get tested, please consider going to a large general hospital and find the GU (genitro urinary) clinic and book yourself in - or phone an appointment through. You will be asked your name - you may give a false one, just make sure you remember it, likewise you will be asked for a date of birth. Without this, you will NOT be given your results when they come through - a week or so later.
You will always have to collect your results in person. This is to prevent anyone else from discovering your results and also to ensure that there is someone around to talk with you about the implications of the result. GU clinics operate far stricter confidentiality policies and also permit false names / Date Of Birth - in the UK at any rate.
There are "home" test kits available. Please don't use them. They can often give incorrect results - both false negative and false positive, they are also grossly overpriced. Do it properly, get it done professionally. Apart from anything else, you will have to have two tests anyway if the first test comes back as negative, this is due to the "window period".
The window period is the time taken from HIV infection to the body having produced a sufficient quantity of antibodies to show up on the test. This usually takes around three months, it can take longer. If you have not had sex / shared needles for several months before having your test, the first result will almost certainly be a true indication of your status, HIV+ or not. If however you enjoy sex on a regular basis then all the test will confirm is whether you were HIV+ three or more months ago. This is why people are asked to come back for a second and sometimes even a third test. If you pass the third test, then you were definitely HIV negative when you first tested, if you have only had safe sex since that time, you should be fine.
Well, that's it for the moment, I've tried to cover things in enough detail to get the important points over, any comments, critical or otherwise are welcome. If you would like a link to your site - HIV / STI / Drug use / ect, drop me a line and I'll sort something out.
Links & Other Information
National AIDS Helpline - 24 hours - (UK only) 0800 567 123
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