AIDS, Hepatitis and Sexual Health

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HIV/AIDS

HIV stands for Human Immunodeficiency Virus, and it is the virus which can lead to AIDS - Acquired Immune Deficiency Syndrome. It is important to understand the difference between these two terms. If a person is "HIV positive" (sometimes written as HIV+) it means that the presence of the virus has been detected in a blood test. It does not mean that they are ill, have AIDS or will ever have AIDS. If a person has AIDS it means that the HIV virus, over a period of years, has weakened their immune system and allowed a range (or syndrome) of infections to make them ill.

Transmission

The HIV virus is present in infectious quantities in the blood, semen and vaginal fluid of an infected person and must pass from an infected person into the bloodstream of another person for transmission to occur. Breast milk also carries the virus and so could infect babies breast feeding from infected mothers. It is NOT transmitted by contact with other body fluids such as saliva, sweat, urine, tears, vomit or faeces (shit), nor by insect bites. The virus is very fragile upon contact with the air is not viable for the purpose of transmission. This is why the commonest way of transmitting HIV is during sexual intercourse (either vaginal or anal) with an infected person, when the virus passes to the non infected partner without coming out the body and in contact with the air. So it is NOT transmissible by kissing, touching or normal contact from living or working with someone with the virus.

There is a risk of infection by sharing needles or syringes during injecting drug use, when the virus may survive a short time in the airtight syringe or barrel of the needle. Other viruses such as hepatitis B and C are much more easily transmitted by sharing injecting equipment. See the sections on this site relating to these viruses.

Mother to baby transmission can happen but is now quite rare, especially if the mother is on certain medications which reduce her viral load at the time of birth. It is potential contact by the baby with the mother's infected blood during the birth process which might be a risk, rather than while the baby is being carried in the womb.

As far as blood transfusions are concerned, in Australia the blood bank has been screening supplies since May 1985. If needing a transfusion oversees, you should check the screening procedures in that country. Donating blood in Australia is perfectly safe, as fresh equipment is always used for each new donor.

Prevention

Safe sex practises, where blood, semen or vaginal fluid cannot be exchanged, will prevent transmission of HIV (and many other STIs).

Oral sex is a very low risk activity for HIV. Oral sex with a condom over the penis or a dental dam over the vagina, might also be considered.

Not sharing injecting equipment when using drugs is also important (see list of needle exchanges at the Vivaids website ).

HIV positive mums should not breast feed.

People handling blood in a hospital situation, or when there is a blood spill, should observe standard precautions.

Testing

If you think you have been at risk of contracting HIV you might want to consider an HIV test. The Melbourne Sexual Health Centre is an excellent place for HIV testing. Staff there have high levels of expertise as well as an understanding of how potentially stressful the situation might be for you. They also guarantee confidentiality.

The test for HIV is done by taking a sample of blood and running tests to identify whether there are antibodies to the virus present. These antibodies are your immune system's response to the presence of the virus, and it may take up to 12 weeks from the time of risk for your body to produce them. Therefore a test taken less than 12 weeks from the date of risk may not be completely accurate. This 12 week period is often called the "window period". So, if you have been at risk, you should wait these 12 weeks before testing. This can be a very stressful time, and during the wait, you should ensure you do nothing to put anyone else at risk. So safe sex practices are important at this time.

Once the test has been done, you will have to wait about 10 days for the result to come back. In Victoria, it is the law that everyone undergoing an HIV test must be offered appropriate pre and post test counselling to ensure they are best looked after. It must be done by a specifically qualified person. It is essential you attend in person when given your HIV test result. It should never be given over the phone, for confidentiality reasons as well as to ensure you fully understand what your result means and its implications.

Symptoms

Most people will experience no symptoms around the time they become infected with HIV. When symptoms do occur, they are often common to a number of other illnesses like flu. If you are experiencing on going symptoms of illness of any kind you should consult a doctor. As far as considering whether you might have contracted HIV, it is more important to look at any risk factors you may have see "Transmission" rather than looking at your symptoms. If you haven't been at risk you cannot have HIV no matter what your symptoms.

If untreated, a person with HIV might experience a range of symptoms some years after infection, which indicate that the immune system is being depleted. These may be relatively minor at first but get increasingly serious - even life threatening - as the immune system further deteriorates. Fortunately, there are now medication regimes which for many people are successfully arresting the progress of the virus and protecting them from many of these opportunistic infections which might make them sick.

Treatments

There are currently a variety of anti viral drug regimes which are proving quite successful for many people in reducing their viral load to levels which mean they are much less likely to become ill. People with HIV should discuss with their doctor their suitability for such medication. "Combination therapy" (taking more than one antiviral drug against HIV) is more likely to successfully stop HIV from infecting new cells in your body, and less likely to allow the virus to become resistant to the drugs. Some of the drugs may cause side effects which should also be discussed fully with a doctor. Another good resource in Melbourne for people wanting to know more about HIV medications is the Treatments Officer of the Victorian AIDS Council.

Some complementary therapies might also be used, either on their own or along with mainstream medications, to boost the immune system or lessen side effects.

For more details of each anti viral medicine and treatment regimes, check the web site of the Access Information Centre which is part of the Alfred Hospital in Melbourne.

PEP

HIV Post-Exposure Prophylaxis(PEP) is a type of drug therapy for HIV that is designed to reduce (but not eliminate) the possibility of infection with HIV after a known exposure. PEP is primarily intended for the prevention of HIV in cases where there has been a KNOWN HIGH RISK of transmission.

It has been found that there may be a window of opportunity in the first few hours or days after exposure to HIV. During this time a course of medications may be able to prevent establishment of HIV in people who did not have HIV prior to exposure. For PEP to have the most effect you will need to access it within 72 hours. The earlier you access PEP the most effective it may be.

An assessment by a health care professional will occur to determine the likely level of risk of exposure to HIV and then a shared decision will be made to determine if PEP is appropriate for you. You will be involved in the decision around accessing PEP. This is not a simple drug treatment and needs to be taken for 28 days. These drugs have side effects that may include nausea, headache, rashes, loss of appetite.

Taking PEP will not guarantee that you will not contact HIV. PEP is certainly not the new answer to prevent the transmission of HIV. Still, the most effective means of preventing HIV being passed on are safe sex and blood and body fluid awareness.

If you are concerned you may have been placed at risk of HIV in the past 72 hours and want to discuss PEP please call the NPEP 24 hour Hotline on 1800 889 887 and speak to a nurse/counsellor.

Morgan Alexander Consulting Morgan Alexander Consulting