HIV is an infection that can be, among other ways, transmitted during sex.
It is classified as a chronic infection because there is currently no cure. There are medications that inhibit the replication of the virus, thereby reducing the amount of virus in the body and slowing down the course of the infection, which prevents the person living with HIV from developing what is called AIDS. The treatment is usually called antiretroviral drugs, ARVs, antiretroviral treatment, or HAART, which stands for Highly Active Antiretroviral Therapy. Beyond the health benefits for the individual living with HIV, this treatment has the added advantage that it protects sexual partners from the risk of infection. This is sometimes called Treatment as Prevention, emphasising the effect on onward transmission of HIV.
Without the treatment, the HIV virus attacks cells in the body’s immune system by weakening or shutting down the functions that regulate the body’s defence against different infections, and against certain tumour cells. The virus enters the cells and fuses with the existing genetic material, thereby turning the cell into HIV factories. The target cells for HIV are an integral part of the immune system, which is the main reason the infection in the long term leads to immune deficiency.
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. Some 30-50 % of people who contract HIV will show symptoms consistent with the flu 1-2 weeks after infection, such as fever, aching joints or muscles, swollen lymph nodes or skin rashes. Since these symptoms are easily confused with the flu and dissipate with time, they are often disregarded both by the individual and medical staff. As a result, many people living with HIV carry the infection for a long time, without even realising it.
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 within around 5-12 years the immune defence will drop to such low levels that the body is unable to fight off infections as it usually would. This is what is called 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 mother’s milk. Another route is between mother and foetus during pregnancy. The virus is primarily absorbed through the body’s mucous membranes, which are found in the mouth (throat), vagina, urethra, the rectum, and the skin around the glans of the penis. Transmission can also take place intravenously, that is, 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 HIV is transmitted is through unprotected anal and vaginal sex. HIV may be passed on through oral sex from penis to mouth, 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 cases in Sweden are reported to have been transmitted through oral sex. That being said, a growing number of HIV researchers question whether HIV really is transmitted via 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.
HIV cannot be passed on through undamaged skin. Therefore, contact such as fondling, cuddling, and deep kissing are not a risk, provided no open wounds are involved. You can also share glasses and cutlery, 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 sperm in the mouth. 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.
GETTING TESTED
There are two different types of tests available on the Swedish market. One is a rapid test with a range from 1-15 minutes before there is a result; the other is a conventional laboratory test. Typically, the rapid tests detect antibodies to HIV, whereas the laboratory tests detect antibodies, as well as virus antigen. There is a period of time that passes before our immune system creates antibodies, and therefore before the tests can detect them. This is often referred to as the window period. This period varies from person to person, but the guideline in Sweden is that the negative result in rapid tests is reliable 8 weeks after the most recent risk. For the laboratory tests, the guideline is 6 weeks. Positive results may be evident earlier, in both types of tests.
A conventional HIV test is a blood test taken from the crook of the arm. The test results normally come in 7 days. You agree with the clinic on how you want to be informed, but the clinics generally prefer to contact you only in case of a positive result, which means if you haven’t heard from them within a week, you don’t have HIV. If you feel uncomfortable with this, insist on having your test result face-to-face.
With the rapid test, the blood sample is taken from your finger and you get a result within either 1-15 minutes. So, you have to be prepared to get an answer when you go to the clinic to get tested. Venhälsan, The Gay Men’s 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.
TREATMENT
There is currently no cure for HIV. Nor is there any vaccine against HIV, but the course of the illness can be radically slowed through treatment. Since the virus cannot be eliminated completely, treatment with antiretroviral drugs is lifelong. Adherence to the treatment is essential and follow up with one’s doctor is also of vital importance to stay healthy.
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 no 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.
Modern drugs can have a range of mild or more severe side effects. Managing side effects is one important aspect of medical follow up.