HIV is an infection that can be, among other ways, transmitted during sex, and also by a variety of sexual practices. It is classified as a chronic infection because there is currently no cure. There are medications that reduce the amount of virus in the body and the course of the infection, and which prevent the person living with HIV from developing what we call AIDS. The treatment is usually called antiretroviral drugs, ARVs, antiretroviral treatment, or HAART which stands for Highly Active Antiretroviral Therapy.
The HIV virus attacks cells in the body’s immune system by weakening or shutting down the functions that regulate the body’s defense against different infections, and against tumor cells. The virus enters the cells and fuses with the existing gene pool.
The HIV infection develops slowly, and even if you have caught HIV you can still feel well for a long time before the virus’s effects on the immune system start to show. Even if the infection has not been detected, the virus can still be transmitted to others.
The amount of HIV virus in the blood varies from person to person and over time. The immune system may initially restrain the HIV virus, and the amount of virus is therefore kept at a relatively constant level. Since the virus attacks cells in the immune system, however, the system grows weaker over time. This leads to the person living with HIV becoming more sensitive to other infections. An untreated HIV infection means that the within around 5-12 years the immune defense will drop to such low levels that the body is unable to fight off infections as it usually would. This is what we call AIDS, and if no medicine is taken when the person reaches this phase, the body will be unable to cope and the person will eventually die. As we mentioned, however, there are antiretroviral drugs available in Sweden.
How is HIV passed on?
HIV is transmitted through bodily fluids such as blood, sperm and pre-cum, vaginal secretions and breast milk. Another route is between mother and fetus during pregnancy. The virus is primarily absorbed through the body’s mucous membranes, which are found in the mouth (throat), vagina, urethra, the anus and the eyes, for example. Transmission can also take place intravenously, i.e. the virus can be caught directly in the blood. The most common ways of transmitting HIV are:
- Unprotected vaginal and anal sex
- Through infected blood, for example through blood transfusions and transplants
- Through infected blood when sharing syringes and needles
- During pregnancy, childbirth and breastfeeding if the mother has HIV
In Sweden, the most common way of transmitting the virus is through unprotected anal and vaginal sex. HIV can be passed on through oral sex between mouth and penis, but this is not very common. As the HIV virus is found in sperm, it is often when sperm has been involved in oral sex that the virus is passed on. A small proportion of all reported cases in Sweden have been transmitted through oral sex. Generally speaking, HIV is a virus that is not transmitted particularly easily, but it’s impossible to be certain if or when it will be passed on. It is, however, difficult to talk about risk in percentages, as the risk of transmission depends on all kinds of different factors. For example, susceptibility to HIV increases considerably if you are carrying an untreated STI.
Remember that HIV cannot be passed on through undamaged skin. Contact such as fondling, cuddling and deep kissing are therefore not dangerous, provided no open wounds are involved. You can also use the same toilet, swim, have a sauna and sleep together (and we mean sleep!) without passing on HIV.
No one has caught HIV from a blood transfusion in Sweden since 1985, when all donated blood started being tested.
Condoms provide effective protection against transmitting HIV. A condom worn correctly during anal and vaginal sex means that all parties can enjoy the sex without worrying about catching or passing on HIV. During oral sex between penis and mouth, the risk of transmission can be reduced by avoiding getting sperm in your mouth. If you want to be even more safe, you are of course welcome to use a condom during oral sex too. The risk of catching HIV during oral sex between a vagina or an anus and a mouth is virtually non existent, provided no blood is involved. Read more about safer sex under the Better Sex tab.
There are two different tests available on the Swedish market at the moment (Jan 2013). One is a rapid test with either 20 minutes or 60 seconds result; the other is a conventional blood test. It can take up to three months for a test to show whether or not you have HIV. So if you think you may have caught HIV on a specific occasion, you have to wait three months before an HIV test can show with certainty whether or not the infection was passed on. If you are worried, you can go and get tested earlier even though the result may not be 100 % accurate.
A conventional HIV test is a blood test taken from the crook of the arm. The test results come in 7-10 days. You agree with the clinic how you want to be informed, but the clinics generally prefer telling you face to face.
With the rapid test, the blood sample is taken from the finger and you get a result within either one or 15-20 minutes. So you have to be prepared to get an answer when you go to the clinic to get tested. Remember that it can take up to three months before HIV can be detected even in a test with rapid result. So it’s only the waiting time between the sample and result that is speeded up, you don’t have to wait 7-10 days to get the results. Venhälsan, The Gay Mens Health Clinic in Stockholm, along with a couple of other clinics currently offers testing with quick results. Getting tested is an excellent opportunity to talk about safer sex and get answers to any questions you may have.
There is no cure for HIV. Unlike bacteria, which can multiply of their own accord, a virus enters the body’s cells and uses the host cell to multiply. It is therefore hard to combat the virus without damaging the host cell. It is the body’s immune system that fights and keeps viral infections in check. There is currently no vaccine against HIV.
Even though there is no cure for the HIV infection, the course of the illness can be slowed through treatment. The drugs reduce the level of virus in the blood by making it more difficult for it to reproduce. The more HIV virus in the blood, the faster the immune system is thought to weaken. Treatment therefore aims to reduce the amount of HIV virus in the blood. This is thought to slow the development of AIDS since lower virus levels mean the immune system is not weakened as quickly, and the reduced virus levels give the immune system a chance to recover to some extent. The doctor’s instructions must be carefully followed during treatment. Since the virus cannot be eliminated completely, treatment with antiretroviral drugs is lifelong.
Thanks to effective antiretroviral drugs, a person who starts treatment today can bring down their virus levels so much that they aren’t even measurable. When the virus levels are so low there is also less risk of HIV being transmitted to others, which can bring extra peace of mind for people in a relationship with someone who doesn’t have the virus. Do keep in mind that the viral load changes over time, just because the viral load was low at the last check up, it does not mean that is is low now. A regular infection like a cold or an untreated STI may increase your viral load.
Modern drugs can have a range of mild or more severe side effects. The risk of side effects increases the more drugs that are combined. Sometimes the side effects can be so severe that treatment has to be put on hold.