Introduction:
National HIV Testing Week was first observed on June 27th 1995 as National HIV Testing Day in order to encourage people to get tested for HIV, as well as to get care and treatment if they need it. It was launched by the National Association of People with AIDS. From Monday 7th to 13th February is National HIV Testing Week, where we encourage people to get tested- especially those from groups most affected by HIV: Gay and Bisexual men, Black African men and women. The theme this year is ‘Give HIV the Finger’, referring to the finger prick test that you can get in person or online, making it easier to get tested for HIV and get a result quickly. The collective aim is to work towards ending new cases of HIV by 2030 and this will only happen if people continue to be tested.
What is HIV?
HIV stands for Human Immunodeficiency Virus, which is an infection that attacks the body’s immune system, specifically the white blood cells called CD4 cells. AIDS stands for Acquired Immune Deficiency Syndrome, it is a collection of illnesses caused by a virus that people pick up that makes their immune system weaker. In the 80s and 90s most people with HIV were diagnosed with AIDS because that is the term they knew for what was happening. Many modern-day doctors do not use the term AIDS anymore, instead preferring to use the terms ‘late-stage’ or ‘advanced HIV’.
Symptoms of early HIV:
Up to 6 weeks after getting infected with HIV, many people will experience a short one-two week illness called seroconversion illness. Symptoms include: sore throat, fever and a rash all over the body, these are signs that the body is reacting to the presence of the virus and then produces antibodies. It can be severe enough to put someone in the hospital or so mild it could be mistaken for flu, it differs from person to person. Once this illness happens, an HIV test will detect the antibodies and give a positive result. IF you do have HIV, your bodily fluids: blood, semen and vaginal or anal secretions are highly infectious during these early weeks and months after transmission- meaning you could pass it on to other people. It is in this time frame, that if you test positive you are highly encouraged to start on effective treatment and then it can take up to 6 months for the viral load becomes undetectable. Viral load refers to the amount of HIV in the blood. A viral load test shows how much of the virus is in the body via measuring how many particles of HIV are in a blood sample, the results will then be shown as the number of copies of HIV per millilitre of blood- e.g 200 copies/ml.
Symptoms of later HIV-related illness:
HIV weakens the immune system, so it will make it vulnerable to signs of other illnesses. Symptoms include weight loss, night sweats, thrush in the mouth, increase in herpes or cold sore outbreaks, swollen glands in the groin, neck or armpit, long-lasting diarrhoea and tiredness. With a weakened immune system, people can also be left open to other serious infections such as TB, pneumonia and some cancers.
How is HIV transmitted?
If someone has HIV and has a detectable viral load, they can pass on HIV through bodily fluids, these include blood, semen, vaginal fluid, anal mucus and breast milk. You can also get HIV through vaginal/frontal and anal sex WITHOUT a condom, sharing drug injecting equipment, sharing sex toys, mother to child transmission during pregnancy and coming into contact with contaminated blood. It CANNOT be passed on by kissing, hugging, shaking hands, sharing space with someone, sharing a toilet, sharing household items such as cutlery or plates and any other general social contact
How long does HIV survive outside the body?
Outside the body HIV cannot survive very long, coming into contact with blood or semen that has been outside the body does not generally pose a risk for HIV transmission but it is best to be careful. The risk of passing HIV onto someone else if you have a detectable viral load and cut yourself is also very low, it is important to wash and then cover the wound though.
How HIV is passed on through semen and vaginal fluid:
These bodily fluids can contain HIV, therefore if a person has HIV and a detectable viral load then it can be passed onto someone if their semen or vaginal secretions get into the body of a sexual partner during vaginal or anal sex. If a person has a detectable viral load and their semen gets into the body of their sexual partner during sex, then HIV can get into the other person’s bloodstream and infect them. Pre-cum also contains HIV, so there is also a risk of infection even if a person pulls out before ejaculating. If a person with a vagina has a detectable viral load then HIV can be found in their vaginal secretions, if these secretions come into contact with a penis during sex then HIV could be transmitted as it can enter through the delicate skin of the penis or foreskin.
Condoms and HIV:
Using a condom correctly prevents contact with semen or vaginal secretions as well as blood, which then stops HIV from being passed on because the virus cannot pass through the latex of the condom. Condoms should be used with water-based lubricant, as oil-based lube weakens the latex and people with HIV on effective treatment and have an undetectable viral load cannot pass on HIV through any bodily fluids. Even if you do not have HIV and have sex without a condom, it is important to remember that other sexually transmitted infections (STIs) can be passed on.
Blood and HIV:
If a person’s blood with a detectable viral load comes into contact with a cut or broken skin, there is a risk that HIV can be transmitted through the skin and into the bloodstream. In a medical setting, HIV could also be transmitted by someone accidentally cutting themselves with a blade or needle that has been used to treat a person with HIV. Menstrual blood also carries a risk of transmission if it has a detectable viral load.
HIV testing:
You can get tested at a range of different places, such as:
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A sexual health clinic
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An HIV testing centre
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A GP/family doctor
All the above provide free testing, but at a private clinic you will have to pay, you can also order tests online. There are 2 types: a self-test where you take it yourself and see the results within a few minutes and a postal test where you take a sample yourself and send it off to a lab, who will contact you with the result. In Southampton/Hampshire here are places you can order tests: https://freetesting.hiv/, https://www.letstalkaboutit.nhs.uk/, The Terrence Higgins Trust also sells self-testing kits: https://test.tht.org.uk/?ref=tht.
PrEP:
PrEP is a tablet that contains tenofovir and emtricitabine, these are drugs commonly used to treat HIV. You can take PrEP before being exposed to HIV so that there’s enough drug inside you to block HIV if it ever gets into your body. In the US a second pill has been approved as PrEP as well- the drug Descovy, injectable and implant methods of PrEP are also being researched. PrEP vaginal rings will be available soon to get alongside PrEP tablets. PrEP is available free on NHS in England from sexual health clinics, in Scotland, PrEP is available through sexual health clinics: https://prep.scot/, in Wales PrEP is available through sexual health clinics: http://www.friskywales.org/wales-prep-project.html and clinics in Northern Ireland will be offering consultation and assessment appointments for a pilot trial: https://www.iwantprepnow.co.uk/prep-on-the-nhs/#ni.
PEP:
It is a combination of HIV drugs that can stop the virus from taking hold, but only when taken within 72 hours (3 days) after the event where you have been at risk of HIV transmission, ideally it should be taken within 24 hours. It is an emergency last resort and it is not guaranteed to work, an emergency situation may be if a condom fails during sex and bodily fluids got into your body. It does not protect you from other STIs. PEP is available on NHS for free if you meet the guidelines about the use, but the best place to get PEP is from a sexual health or HIV clinic. You may be asked about the person you had sex with, the chances that they had HIV, the type of sex you had (vaginal, anal or oral) and if your sexual partner has HIV, then what their viral load is. If your sexual partner has HIV and has an undetectable viral load, then you will not need PEP as the virus would not have been transmitted
How HIV treatment works:
It doesn’t cure HIV, but it does work to stop the virus from reproducing in your body and reduce the amount in your blood to undetectable levels so that you cannot pass on HIV. Treatment is sometimes called combination therapy, as people usually take three different anti-HIV drugs at the same time, sometimes combined into one tablet. It is also known as antiretroviral therapy (ART) or highly active antiretroviral- HAART.
Media about HIV:
It’s a Sin: a tv show written by Russel T Davies following a group of young people who live in London together during the 80s-90s.
120 BPM: a film based on the true story of French ACT UP AIDS activists.
How to Survive a Plague: A documentary about the early days of the AIDS epidemic and the raw reactions to it, as well as the drug/medical side of it. Based on the book by David France of the same name.
Common Threads: Stories from the Quilt: A documentary by filmmakers Rob Epstein and Jeffrey Friedman about the importance of the Names AIDS Memorial quilt. It is told from the perspective of those infected, as well as their parents and loved ones
The Lazarus Effect: A 30-minute documentary that describes the impact of free antiretroviral drug programs on HIV-infected people in Zambia.
And the Band Played on: Based on the book of the same name by journalist Randy Shilts, the film tells the story of HIV/AIDS from the discovery of the first cases in Africa in 1976 through the political, social and scientific events that marked the 1980s. It is slightly dated due to the weakness in the book itself.
Helpful Links:
https://www.hants.gov.uk/socialcareandhealth/getiton/sexuallytransmittedinfections/hivtesting
https://www.tht.org.uk/news/national-hiv-testing-week-returns-2022
https://www.hivpreventionengland.org.uk/campaigns/national-hiv-testing-week/
https://www.hivpreventionengland.org.uk/evidence-and-guidance/national-guidelines/