Prevention

HIV and Aids

The human immunodeficiency virus (HIV) causes acquired immune deficiency syndrome (AIDS). ‘Acquired’ means not inherited. ‘Immune deficiency’ means a breakdown in the body’s immune system. ‘Syndrome’ refers to a range of diseases that may be associated with another disease.

In this case, diseases that take advantage of the body’s weakened immune system are used to define the onset of AIDS. In Australia, HIV is most commonly spread by sexual intercourse without a condom and through sharing needles, syringes and other injecting equipment.

Symptoms

Symptoms of HIV are common to a number of other illnesses. If you think you have been put at risk of getting HIV, or if you have any of the signs below (or a combination of them) for a month or longer, you should consult your doctor. Symptoms can include:

  • Flu-like symptoms
  • Extreme and constant tiredness
  • Fevers, chills and night sweats
  • Rapid weight loss for no known reason
  • Swollen lymph glands in the neck, underarm or groin area
  • White spots or unusual marks in the mouth
  • Skin marks or bumps, either raised or flat, usually painless and purplish
  • Continuous coughing or a dry cough
  • Diarrhoea
  • Decreased appetite.

How it is spread

Someone who has HIV may not have any symptoms, but they carry the virus and could pass it on through blood or body fluids. HIV can be spread in a number of ways, including:

  • Unprotected vaginal or anal sex with someone who has HIV
  • Sharing injecting equipment and needles with someone who has HIV
  • From a mother who has HIV to a child during pregnancy, birth or via breastfeeding
  • Unprotected oral sex with someone who has HIV (this is less common).

HIV can’t be spread by social contact
There is no evidence to suggest that HIV is spread by ordinary social or family contact such as hugging, shaking hands, sharing household items or through toilets seats, swimming pools or pets. HIV doesn’t live long outside of the body. It can be killed by ordinary household bleach, or soap and warm water.

Safe sex explained
Safe sex means sex where semen, vaginal secretions or blood are not exchanged between sexual partners. Some safe sexual activities include:

  • Mutual masturbation
  • Touching
  • Cuddling
  • Body-to-body rubbing
  • Erotic massage.

Condoms
Using condoms properly during intercourse (anal and vaginal) will greatly reduce the risk of spreading HIV. Condoms must be used correctly and with plenty of lubricant. Water-based lubricant should be used, as other types of lubricants will cause condoms to break. Female condoms are also available and should also be used with lubricants. Dams are thin pieces of latex placed over the anal or vulval area during oral sex and can also be used to help prevent the spread of infections.

Condoms for men can be bought from supermarkets, chemists and other outlets. Female condoms and dams are available through Family Planning Victoria and may be available from selected shops. Latex free condoms are also available from some outlets. Male condoms and lubricant are available free from the Melbourne Sexual Health Centre, along with female condoms and dams on request.

Safe sex can prevent infection
HIV can be spread by unprotected anal or vaginal sex with someone who has HIV. Safe sex is recommended if either partner has HIV or if either partner is unsure of whether they have HIV. Other sexually transmissible infections (STIs) such as herpes, chlamydia, syphilis and gonorrhoea can also be spread by unprotected sex. If either partner has an STI, or if either partner is unsure of whether they have an STI, safe sex is also recommended. HIV infection is more readily acquired or transmitted if either partner is infected with another STI.

HIV and oral sex
Unprotected oral sex is low risk for spreading HIV but using a condom or dam or avoiding ejaculation into the mouth is recommended when either partner has ulcers or bleeding gums, or has recently brushed or flossed their teeth. Condom and dam use may also prevent the spread of other STIs such as herpes, chlamydia, syphilis and gonorrhoea. These STIs may be spread more easily by unprotected oral sex.

HIV and deep kissing
Only very small amounts of HIV are found in the saliva of people who have HIV. For you to get HIV, a lot of saliva would need to get into your blood via ulcers or bleeding gums. Deep kissing is a low risk behaviour for spreading HIV.

HIV and blood products
Since May 1985, all blood donations in Australia have been tested for HIV. This means that blood transfusions in this country are now an extremely low risk for HIV. It is impossible to get HIV when donating blood in Australia, because needles, packs, swabs, finger-pricking lancets and so on are never re-used.

Diagnosing HIV
Blood tests can detect HIV infection. If you think you may have been exposed to HIV, see your doctor, health centre or STI clinic. If HIV infection is found in a person’s blood, this person is said to be HIV positive.

There is a short period where a person may have been infected by HIV but the HIV antibodies can’t be detected. This may require a follow-up test. Testing should be voluntary and only carried out with informed consent, except in exceptional circumstances.

Information should be provided about what is involved in the test, and information and discussion should take place about what it means to get tested. All people who request an HIV test must receive pre-test and post-test counselling.

Diagnostic testing for HIV is available on the Medicare Benefits Schedule. This means your doctor can order this test free of charge.

Post-test counselling
Post-test counselling is important regardless of the outcome of the test. If the test is positive, post-test counselling can provide emotional support, further information about the disease and referral to the support services available. If the test is negative, post-test counselling can provide education about HIV and how a person can avoid getting HIV.

The progression from HIV to AIDS
Someone who has HIV may not have AIDS. HIV weakens the body’s immune system, leaving it open to various infections and cancers. For most people who have HIV, the progression to AIDS is fairly slow. It may take several years from HIV infection to the development of AIDS.

Without treatment, people who have HIV eventually become ill and can develop AIDS within five to 10 years. However, there are a small percentage of people who don’t show any deterioration in their health, even after 10 years. AIDS diagnosis may require a number of special laboratory tests to be performed.

HIV and AIDS treatments
Currently, there is no vaccine or cure for HIV or AIDS. However, drug treatments are available that work against HIV. For the majority of people, these drugs can postpone, and possibly prevent, HIV-related illnesses and delay moving on to AIDS.

These drugs aren’t easy to take because of the side effects and difficult courses of treatment. It should be noted that once someone begins drug treatments for HIV, they should continue to take them for life.

There are also treatments for many of the specific illnesses associated with HIV and AIDS. Complementary therapies are used by some people who have HIV to manage the side effects of drug treatment and improve health and wellbeing. New drugs and therapies are being trialled all the time.

HIV and viral loads
People living with HIV, who are taking antiviral medication may still have undetectable ‘viral loads’ of HIV at certain stages of their treatment. A viral load is the amount of virus in body fluids such as blood, semen or vaginal secretions.

Research suggests that when the viral load is undetectable in the blood, the risk of HIV transmission is reduced. However, it is still possible to transmit the virus. Safe sex is an important part of reducing the risk of HIV transmission and should always be practised, regardless of the ‘viral load’.

Things to remember

  • In Australia, HIV is most commonly spread by sexual intercourse without a condom and through sharing needles, syringes and other injecting equipment.
  • Someone who has HIV may not have any symptoms, but they carry the virus and could pass it on through blood or body fluids.
  • Drug treatments are available that can postpone, and possibly prevent, HIV-related illnesses developing.

HIV and women – safe sex

Safe sex is important to protect women from human immunodeficiency virus (HIV) and a range of other sexually transmissible infections. In Australia, HIV is most commonly spread through unprotected anal or vaginal intercourse with an infected person.

Relationships in which one partner is HIV positive and the other is not are called ‘serodiscordant’. Being in a serodiscordant couple can raise a number of issues, such as how to have sex safely. Finding out more about what is safe, talking to others with experience or talking with a counsellor may be helpful.

If you are HIV positive, you should talk with your doctor or local HIV/AIDS organisation for further information and advice.

How HIV is spread
HIV is spread (transmitted) through body fluids including blood, ejaculate (cum), pre-ejaculate (pre-cum), female genital fluids (both vaginal and cervical fluid) and breast milk. The way the virus gains entry to another person may be directly across the mucosa (the lining of the vagina or bowel) or into the bloodstream. HIV can also pass from mother to baby during pregnancy or birth, or via breast milk.

Transmission can occur from men to women and from women to men and between same sex partners.

Safe sex
Safe sex is sex where semen, vaginal secretions or blood are not exchanged between sexual partners. It is important to prevent the transfer of these body fluids, whether you or your partner is HIV positive.

Be guided by your doctor or health worker, but safe sex suggestions include:

  • Kissing, cuddling, masturbation, mutual masturbation, massage and ejaculating or urinating on unbroken skin are considered safe activities.
  • Men should always wear a condom and use a water based lubricant when having vaginal or anal sex.
  • Women may prefer to wear a female condom that is inserted into the vagina.
  • Pre-ejaculate (pre-cum) of an HIV positive man may transmit the virus, so don’t rely on the withdrawal method.
  • Oral sex with either a man or woman is considered a ‘low risk’ activity for transmission of HIV. However, the risk increases when people have cuts or sores in their mouth or on their lips, or have recently brushed their teeth and gums or flossed their teeth. For extra safety, you may choose to use a condom during oral sex performed on a man, or a dental dam or similar protection (such as clear plastic cling wrap – but not the ‘microwave safe’ variety which has tiny holes in it) during oral sex performed on a woman.
  • Avoid penetration of the vagina or anus with finger or fist if there are abrasions on the hand or arm – to be sure, wear a latex glove and use lots of water based lubricant.
  • Don’t share penetrative sex toys such as dildos – consider having a separate collection for each partner, covering them with a new condom each time they are used or washing them thoroughly in warm soapy water between partners.
  • Lesbian serodiscordant couples should also follow these safer sex suggestions.

Negotiating safe sex
Practicing safe sex is important even if you don’t know whether your partner is HIV positive or not. It protects you from HIV as well as other sexually transmissible infections (STIs). HIV is more easily transmitted when a person has another STI.

Telling sexual partners you have HIV is a complex issue. Deciding when and how to tell will vary according to the relationship, the situation and the people involved.

If you are a person living with HIV, you do have a responsibility not to transmit the virus. In Victoria, it is an offence to knowingly or recklessly infect another person with an infectious disease. NSW has specific legislation that requires that people disclose their HIV status before having sex. Any person who recklessly endangers or inflicts harm on another person may be charged under criminal law in all states and territories.

Some tips to consider

  • Negotiating safe sex is not always easy. Here are a few tips that may help.
  • Have condoms handy if you think there is a possibility that you will be having sex.
  • Don’t assume that safe sex is the man’s responsibility. Women can carry condoms too.
  • Don’t assume that a man will feel confident about using condoms. Learn about how they are used correctly so you can help. This can be fun.
  • Make it your business to find out about condoms. Investigate colours and flavours.
  • Find out where you can get condoms without embarrassment.
  • Try to negotiate safe sex before you get into the ‘heat of the moment’. This is usually not the best time for debate and discussion.

Some things you could say
Think up some statements that you feel comfortable using, for example:

  • ‘Where’s the condom?’
  • ‘Let’s have safe sex to protect both of us.’
  • ‘I can roll the condom onto you with my mouth.’ Make sure you can.
  • ‘To make sure I don’t get pregnant, I like to use condoms.’

What to do if you are exposed to body fluids
If you are exposed to body fluids, you should wash the skin or area thoroughly with soap and water. Don’t use a douche in the vagina or rectum as this can irritate the area and increase the risk of HIV transmission. See your doctor for further information and advice.

Post-exposure prophylaxis (PEP) is a month-long course of medication for people who have been exposed to the HIV virus. To be most effective, it should be started within 72 hours of exposure. It is best to start as early as possible after exposure. These drugs can be toxic on the body with unpleasant side effects such as vomiting, nausea and lethargy. PEP is not an alternative to safe sex.

If you think you have been exposed to HIV or think you need help, call 1800 889 887. This is a 24-hour telephone service.

Clothes, bedding or other material can be washed in water and detergent or dry-cleaned.

Don’t share toothbrushes or razors
Everyday household contact doesn’t transmit the HIV virus, but the intimacy of a sexual relationship means that lovers tend to share personal items, which can be a risk. A serodiscordant couple should avoid sharing toothbrushes, razors or any other personal item (including injecting equipment) that could have come in contact with blood.

Long-term relationships
Practicing safe sex in long-term relationships is a challenge. The term ‘safe sex’ seems to conjure up thoughts of condoms and not much else. However, in all relationships, reducing the risk of HIV transmission is vital.

Open discussion and being honest with your partner about your feelings and fears will help communication in your relationship. Different fears and concerns may arise for the positive person in the relationship and the negative partner. Often these fears may need to be addressed by a professional counsellor.

It is helpful to remember these fears are occurring because the partner cares. Remember that many serodiscordant couples have lived in intimate relationships for many years without passing on the virus to their partner.

Try to have fun
Keeping the spontaneity in your relationship alive is probably the hardest part to work at. To help, you could:

  • Keep a condom handy in your pocket.
  • Make your sex life as intimate and loving as you possibly can. Remember that intimacy is not all about sex.
  • Don’t forget to have fun – for example, massage can be a wonderful avenue for both of you to explore.

Talking to other people living with HIV about these issues may be helpful. Straight Arrows and Positive Women are community support organisations that have peer support workers.

Where to get help

  • HIV, Hepatitis and STI Education and Resource Centre, Alfred Health Tel. (03) 9076 6993
  • PEP Information Line, Victorian NPEP Service Tel. 1800 889 887 (24 hours)
  • Your specialist HIV doctor
  • Victorian HIV/AIDS Service, Alfred Health Tel. (03) 9076 6076
  • Positive Women Tel. (03) 9076 6918
  • Straight Arrows (heterosexual men, women and children) Tel. (03) 9076 3792
  • People Living with HIV/AIDS Vic Tel. (03) 9865 6772
  • Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017 or TTY (for the hearing impaired) (03) 9347 8619
  • Family Planning Victoria Tel. 1800 013 952 or (03) 9257 0100
  • Well Women’s Clinic, Royal Women’s Hospital Tel. (03) 9344 2288 or (03) 9344 2183
  • Blood Borne Viruses/Sexually Transmissible Infections Program, Department of Health Victoria Tel. (03) 9096 0000

Things to remember

  • The HIV virus is spread through body fluids including blood, ejaculate (cum), pre-ejaculate (pre-cum), vaginal and cervical fluids, and breast milk.
  • It is important to prevent the transfer of the HIV virus, whether the woman or her partner is HIV positive.
  • Safe sex is still possible in relationships where one partner is HIV positive and the other is not.
  • Talk with your doctor, health worker or AIDS organisation about how you can practice safer sex.

HIV and gay men – safe sex

In Australia, the human immunodeficiency virus (HIV) is most commonly spread through unprotected anal or vaginal intercourse with an infected person. Gay HIV positive men with HIV negative partners can still enjoy physically intimate relationships if they follow safe sex practices.

It is important to remember that the virus is transmitted by bodily fluids – for men this includes, blood, ejaculate and pre-ejaculate – entering the bloodstream. Remember that the risk goes both ways – for example, it is commonly believed that only the partner who is penetrated (the ‘bottom’) is at risk, but the HIV virus can be transmitted to the partner who penetrates (the ‘top’) via small cuts and abrasions on his penis.

Unsafe sexual activities
Unsafe sexual activities include:

  • Unprotected anal sex, since the virus can enter the bloodstream through mucus membranes or small cuts or abrasions
  • Withdrawing before ejaculation, since pre-ejaculate fluid can contain the virus
  • Using pre-ejaculate as a lubricant prior to anal intercourse
  • Sucking ejaculate from the anus (felching)
  • Activities involving razors or shaving, as blood can be drawn from small nicks and cuts
  • Any sexual activity that draws blood.

Safe sexual activities
Sexual activities that are considered safe include:

  • Kissing
  • Cuddling
  • Stroking and massage
  • Masturbation
  • Mutual masturbation
  • Ejaculating on unbroken skin
  • Urinating on unbroken skin
  • Oral sex (with a condom or no ejaculate in the mouth)
  • Protected anal intercourse (using condoms).

Safer sex suggestions
Some suggestions for safer sex, including when to avoid some practices:

  • Anal sex – use condoms and plenty of water-based lubricant.
  • Oral sex – there are a small number of recorded cases of people getting HIV from performing oral sex and taking ejaculate into their mouth. In almost all of these cases, the person had herpes sores, wounds, cuts or infections in their mouth. It isn’t easy for HIV to enter the bloodstream through the mouth or throat when sucking. However, to be sure of being safe, the HIV positive partner shouldn’t ejaculate into their partner’s mouth. To further reduce the risk, a condom can be worn. The HIV negative partner should avoid performing oral sex if they have cuts or sores in their mouth, a throat infection, have recently undergone dental work or have just brushed or flossed their teeth.
  • Penetration of the anus with finger or fist – avoid if there are cuts or abrasions on the fingers, hand or arm. To be absolutely sure, wear a latex glove.
  • Licking and kissing the anus (oral–anal contact or ‘rimming’) – HIV can’t be transmitted via oral–anal contact, but other diseases can. These include hepatitis A and intestinal parasites and bacteria (for example, shigella). Use a barrier such as a dental dam or clear plastic wrap (but not the ‘microwave safe’ variety – it has tiny holes in it).
  • Urinating on skin – avoid this practice if there are cuts or abrasions on the skin. Don’t allow urine to come in contact with the eyes or mouth, in case there is blood in the urine.
  • Faeces – HIV can be transmitted if there is blood in the faeces. Don’t allow faeces to come in contact with the eyes, mouth or cuts on the skin. Other illnesses, such as hepatitis and intestinal parasites, can also be transmitted by faeces.
  • Sex toys – always put a condom on any sex toy (such as a dildo) before use. Wash all sex toys after use with warm water and soap. Consider having a separate collection of sex toys for each partner.

What you can do after unprotected sex
Sometimes, a couple may slip and have some form of unprotected sex. Suggestions include:

  • If the broken skin of the HIV negative partner comes in contact with the ejaculate, blood, urine or faeces of their HIV positive partner, wash well with warm water and soap.
  • Seek advice from your doctor. Post-exposure prophylaxis (PEP) is a month-long course of medications for people who have been exposed to the HIV virus. To be most effective, they should be commenced within 72 hours of exposure. It is best to take them as early as possible after exposure. These drugs can be toxic on the body with unpleasant side effects such as vomiting, nausea and lethargy. PEP is not an alternative to safe sex. If you think you have been exposed to HIV, or think you need help, visit www.getpep.info or call 1800 889 887. This is a 24-hour telephone service.
  • Talk about the factors that led to the unprotected sex and work out ways to avoid the same mistake in future.

HIV and your relationship
HIV can trigger various relationship problems including:

  • Fear – both partners could be fearful of the HIV positive partner developing AIDS or of the HIV negative partner contracting the virus.
  • Sexual problems – some people may feel bored and frustrated by the constraints of always practicing safe sex, which can cause tension within the relationship. Sometimes, treatments can also affect the HIV positive partner’s libido.
  • Insecurity – the person with HIV may feel insecure and worry that their partner may leave them because of their HIV status.

Where to get help

  • Your doctor
  • Victorian AIDS Council/Gay Men’s Health Centre Tel. (03) 9865 6700 or 1800 134 840
  • Blood Borne Viruses/Sexually Transmissible Infections Program, Department of Health Victoria Tel. (03) 9096 0000
  • Positive Living Centre Tel. (03) 9863 0444 or 1800 622 795
  • People Living with HIV/AIDS Vic Inc Tel. (03) 9865 6772
  • Melbourne Sexual Health Centre (03) 9341 6200 or 1800 032 017 or TTY 9347 8619
  • The Centre Clinic, Northcote Tel. (03) 9481 7155
  • The Centre Clinic, St Kilda Tel. (03) 9525 5866
  • Education & Resource Centre at The Alfred Tel. (03) 9276 6993

Things to remember

  • HIV positive men with HIV negative partners can still enjoy physically intimate relationships.
  • Sexual activities that are considered safe include kissing, cuddling, stroking, massage, masturbation, mutual masturbation, oral sex (with no ejaculate in the mouth) and anal sex with a condom using water-based lubricant.